Response to treatment with an analog of the luteinizing-hormone-releasing hormone in a patient with pulmonary lymphangioleiomyomatosis.

Pulmonary lymphangioleiomyomatosis is a chronic devastating disorder afflicting women of childbearing age, characterized by proliferation of atypical smooth muscle in the lung. Attempts to treat this disease have shown that a number of hormonal manipulations may be helpful but that surgical oophorectomy alone or associated with administration of progesterone is the most effective treatment. This report describes the response to treatment with an analog of luteinizing-hormone-releasing hormone, goserelin, which is able to induce a marked suppression of the secretion of ovarian sex steroid and demonstrates with pulmonary function studies, arterial blood gas determinations, and bronchoalveolar lavage parameters that this patient's disease was responsive to this agent.

Human ciliated bronchial epithelial cells: expression of the HLA-DR antigens and of the HLA-DR alpha gene, modulation of the HLA-DR antigens by gamma-interferon and antigen-presenting function in the mixed leukocyte reaction.

HLA-DR class II molecules are expressed by a variety of nonlymphoid cells, including the respiratory epithelium. However, it is not known if ciliated bronchial epithelial cells express the HLA-DR genes, if the expression of class II molecules on their surface can be modulated by immune mediators and, finally, if these cells, like other HLA-DR-positive epithelial cells, have the potential to serve as antigen-presenting cells. To answer these questions, we collected ciliated bronchial epithelial cells by brushing and by suction during fiberoptic bronchoscopy and by scraping surgically resected bronchi.

Characteristics and clinical significance of the lymphocytic alveolitis in interstitial lung disorders.

Although the mechanisms responsible for lung damage and respiratory function deterioration for each type of alveolitis are not entirely known, with the opportunity to study the cells present in the lower respiratory tract, their functions and the mediators released in different conditions, we will be able to better understand the link between the inflammatory process, the acute tissue damage, the progression of the disease and the pulmonary scarring. This knowledge will be helpful in a better management of patients with interstitial lung diseases modulated by immunologic mechanisms.

Human peripheral blood and pleural fluid eosinophils can be induced by immune complexes to release IgG immune complexes and aggregated IgE.

The ability of IgG and IgE immune complexes and of phorbol myristate acetate (PMA), a soluble membrane activator, to stimulate hydrogen peroxide (H2O2) release and to induce oxygen radical-mediated cytotoxic activity by human peripheral blood (PBL) eosinophils and by PBL neutrophils was evaluated in normal volunteers and patients with hypereosinophilic malignant pleural effusions due to lung cancer. PMA stimulated a significant respiratory burst. Similar results were obtained with IgG IC stimulation, although the levels of H2O2 were lower.

Bronchoalveolar lavage during fiberoptic bronchoscopy: what has it brought to pulmonary medicine?

In the last 13 years, bronchoalveolar lavage has been widely used to study the mechanisms involved in the defense of the lower respiratory tract and in the pathogenesis of a variety of lung disorders. This technique, which is a relatively safe and simple extension of fiberoptic bronchoscopy, has been proved to be a powerful investigative tool with enormous potential since it has enhanced our knowledge on a variety of disorders, including interstitial lung diseases, lung destruction associated to cigarette smoking and, recently, bronchial asthma. In addition, bronchoalveolar lavage has also been utilized as an interesting test to help in the diagnostic procedures and in the management of patients with a variety of pulmonary diseases.

Changes in pulmonary surfactant composition following MACC chemotherapy for lung carcinoma.

Many antineoplastic drugs can derange lung structures, cause necrosis of type I pneumocytes, abnormal proliferation of type II alveolar epithelial cells, and, occasionally, accumulation of inflammatory and immune effector cells. Since type II cells secrete lung surfactant, treatment may alter surfactant composition. In 8 patients with nonresectable lung cancer, we performed bronchoalveolar lavage before and after MACC polychemotherapy (methotrexate, doxorubicin HCl, cyclophosphamide and lomustine).

Symptomatic treatment of recurrent malignant pleural effusions with intrapleurally administered Corynebacterium parvum. Clinical response is not associated with evidence of enhancement of local cellular-mediated immunity.

Intrapleural injection of Corynebacterium parvum (CBP) has been recently proposed as a useful symptomatic treatment of recurrent malignant effusions. Although the result is often a fibrotic thickening of the pleura, CBP is thought to stimulate the effector cells present in the effusion and, possibly, to activate the antitumor cytotoxic activity of the pleural fluid mononuclear cells. To test this hypothesis, we studied 7 patients with recurrent malignant pleural effusions caused by lung cancer and evaluated the cellular composition, the proportions of lymphocyte subpopulations, and the cytotoxic activity of mononuclear cells in the pleural fluid before and 7 days after injection of CBP in the pleural space.

Helper T-lymphocytes in pulmonary sarcoidosis. Functional analysis of a lung T-cell subpopulation in patients with active disease.

Pulmonary sarcoidosis is a disease characterized by increased numbers of T-lymphocytes in the alveolar structures, which through the production of lymphokines modulate granuloma formation and polyclonally activate B cells to secrete immunoglobulins. The T-lymphocyte alveolitis is associated with a different expansion of various T-cell subpopulations identified by different monoclonal antibodies. Patients with active disease have increased numbers of helper T cells in the lungs, recognized by the OKT4 monoclonal antibody and decreased numbers of suppressor OKT8-positive lung T cells, whereas patients with inactive disease have increased numbers of OKT8-positive T cells and decreased numbers of OKT4-positive T cells in the lungs.

Different expansions of T lymphocyte subpopulations in the lung and corticosteroid-induced changes in patients with active pulmonary sarcoidosis.

Pulmonary sarcoidosis is a disease characterized by increased numbers of T lymphocytes within the alveolar structures and the consequent spontaneous release of a variety of mediators relevant to the pathogenesis of this disorder. This phenomenon is associated with a different expansion of the T cell subpopulations present in the lung. Using monoclonal antibodies specific for T cell subsets with helper functions, we have evaluated the different T lymphocyte subpopulations present in patients with active and inactive pulmonary sarcoidosis.

Alveolar macrophage stimulation of T-cell proliferation in autologous mixed lymphocyte reactions. Role of HLA-DR antigens.

Alveolar macrophages act as accessory cells in lymphocyte response to mitogens or alloantigens. Because the autologous mixed lymphocyte reaction (MLR), in which HLA-DR-positive non-T cells stimulate the proliferation of autologous T lymphocytes, represents a good model to study macrophage-T cell interaction, we examined and compared the ability of human alveolar macrophages and peripheral blood-derived monocytes to induce T-cell proliferation in autologous MLR. Maximal T lymphocyte proliferation was observed in both alveolar-macrophage- and blood-monocyte-stimulated autologous MLR at a T cell to alveolar macrophage or blood monocyte ratio of 4:1, but the ability to stimulate T-cell proliferation was lower for alveolar macrophages than for blood monocytes (p less than 0.

Acute myelomonocytic leukemia. Demonstration of pulmonary involvement by bronchoalveolar lavage.

Massive pulmonary infiltration by leukemic cells resulting in respiratory symptoms is a rare complication of acute leukemia. We report the findings in a patient with acute myelomonocytic leukemia presenting with acute onset of fever, dyspnea, and nonproductive cough, in whom the diagnosis of pulmonary invasion by leukemic cells was made by cytochemical analysis of bronchoalveolar cells recovered by lavage.

Lung inflammation in sarcoidosis: analysis of immunoglobulin levels in bronchoalveolar lavage fluid in active and inactive disease.

Cellular and biochemical analyses of bronchoalveolar lavage (BAL) were performed in 8 normal subjects and in 18 patients with pulmonary sarcoidosis. The patients were divided into two groups, according to the intensity of the alveolitis as assessed by lung T-lymphocyte percentage and by 67Ga lung scan. High-intensity alveolitis (HIA) patients had an increased ratio of OKT4-positive: OKT8-positive T cells in their lungs, but not in their blood, compared to low-intensity alveolitis (LIA) patients and to controls.

Low-dose cisplatin and etoposide in advanced non-small cell lung carcinoma.

Twenty-seven consecutive patients with locally advanced or metastatic non-small cell lung carcinoma were treated with low-dose cisplatin and etoposide. Out of 25 evaluable patients, 8% had a partial response, 56% had stable disease and 36% had disease progression. The overall median survival was 4 months.

Pulmonary sarcoidosis: excess of helper T lymphocytes and T cell subset imbalance at sites of disease activity.

Different lymphocyte subpopulations have been evaluated in bronchoalveolar fluid and blood obtained from six patients with active and six with inactive pulmonary sarcoidosis and from six normal subjects by means of two recently described monoclonal antibodies, 5/9 and MLR4. The percentages of OKT4 positive (helper) and OKT8 positive (suppressor) T cells were also determined. Patients with active sarcoidosis had significantly higher proportions of 5/9 positive T cells in the bronchoalveolar fluid than patients with inactive disease (p less than 0.

Intrapleural Corynebacterium parvum for malignant pleural effusions.

A pilot study of topical (intrapleural) treatment with Corynebacterium parvum was carried out in 10 patients with malignant pleural effusions complicating primary or secondary neoplasms and necessitating frequent thoracocentesis for symptomatic relief. The method was aspiration of all intrapleural fluid except a small portion left for dilution, and then injection of 7 mg of a preparation of Corynebacterium parvum suspended in 20 ml of normal saline solution. The treatment was repeated in each case as clinical conditions called for further thoracocentesis.