• Tuberculosis and Respiratory Diseases
• /
• v.39 no.4
• /
• pp.334-342
• /
• 1992

Background: The activated T lymphocyte by inhalaed mycobacterial antigen may evoke cell-mediated immunity in patients with active pulmonary tuberculosis. These activated lymphocyte may influence the response of tuberculin-purified protein derivative (PPD) in skin test. But occasionally, anergy to PPD appear in patients with pulmonary tuberculosis in spite of active stage. Thus we evaluated the effect of change of subtypes of lymphocyte in bronchoalveolar lavage fluid (BAL) and peripheral blood on anergy to PPD in patients with active pulmonary tuberculosis. Method: We performed tuberculin skin test and flow-cytometry analysis of lymphocytes obtained from BAL fluid and peripheral blood in 11 healthy normal volunteers and 20 patients with active pulmonary tuberculosis. Results: 1) The composition of lymphocyte significantly increased in patients with active pulmonary tuberculosis when compared with that in healthy control ($25.2{\pm}4.8$ vs $6.5{\pm}1.3%$, p<0.01), but composition of monocyte significantly decreased ($69.6{\pm}5.7$ vs $89.2{\pm}1.4%$, p<0.05) in analysis of BAL fluid. 2) There were no differences in compositions of cells in BAL fluid between responders and no-responders to PPD. 3) The compositions of CD3 (+), CD4 (+), CD3 (+) IL-2R (+), CD3 (+) HLA-DR (+) significantly increased in BAL fluid when compared with those in peripheral blood in patients with active pulmonary tuberculosis. But the composition of CDS (+), CD4/CDS were not different between BAL fluid and peripheral blood. 4) There were no correlations between response to PPD and compositions of cells and lymphocyte subtypes in BAL fluid and peripheral blood in all patients with tuberculosis, responders, and no-responders, respectively. Conclusion: From these results, we suggest no direct relationship between compositions of inflammatory cells in bronchoalveolar lavage fluid and we could not rule out the possibility of compartmentalization of activated lymphocyte involving in anergy to PPD in skin test in patients with active pulmonary tuberculosis.

• Annals of Geriatric Medicine and Research
• /
• v.22 no.4
• /
• pp.200-203
• /
• 2018

Strongyloides stercoralis is an intestinal nematode that occurs sporadically in temperate areas like Korea. People who are in the immunosuppressed state, over the age of 65 or under the corticosteroid therapy are at risk for developing Strongyloides hyperinfection syndrome. Acute respiratory distress syndrome (ARDS) with alveolar hemorrhage is a rare presentation of Strongyloides hyperinfection. A 78-year-old man had been irregularly injected corticosteroid on his knees, but did not have any immunosuppressive disease. He was initially diagnosed with ARDS and septic shock. Bronchoalveolar lavage (BAL) fluid was bloody and its cytology revealed helminthic larvae identified as S. stercoralis. Results of Cytomegalovirus polymerase chain reaction (PCR), Pneumocystis jirovecii PCR, and Aspergillus antigen testing of the BAL fluid were positive. The clinical progress quickly deteriorated with multiple organ failure, shock and arrhythmia, so he finally died. This is a rare case of ARDS in an older patient without any known immunosuppressive conditions, with alveolar hemorrhage and S. stercoralis being found via BAL.

• Environmental Analysis Health and Toxicology
• /
• v.28
• /
• pp.14.1-14.9
• /
• 2013

Objectives This study was conducted to determine whether nano-sized carbon black exposure results in greater damage in high fat diet-induced overweight rats than normal weight ones and to identify the possible causes of any differences. Methods Two groups of Sprague-Dawley rats allocated by body weight (normal and overweight) were exposed to aerosolized nano-sized carbon black for 6 hours a day, 5 days per week over a 4-week period. Differential cell counts, lactate dehydrogenase (LDH) activities and albumin concentrations were measured in bronchoalveolar lavage (BAL) fluid, and histopathological findings in the lungs were evaluated. Tumor necrosis factor-alpha (TNF-${\alpha}$) and interleukin (IL)-6 were measured in BAL fluid and supernatants of lipopolysaccharide(LPS)-stimulated lymphocyte culture. Results Rats exposed to high concentrations of nano-sized carbon black showed significantly increased (p <0.05) polymorphonuclear leukocyte number and LDH activity in the BAL fluid from both overweight and normal rats. Mild histopathological changes were observed in normal rats irrespective of carbon black concentrations. However, severe histological scores were found in overweight rats ($1.75{\pm}0.46$, $2.25{\pm}0.46$, and $2.88{\pm}0.35$ after low, medium, and high concentration exposures). Proinflammatory cytokine levels of TNF-${\alpha}$ and IL-6 were significantly higher in the supernatant of LPS-stimulated lymphocytes of overweight rats, whereas there was no significant difference in the BAL fluid between normal and overweight rats. Conclusions Inflammation and damage to lungs exposed to nano-sized carbon black was more severe in high fat diet-induced overweight rats compared to normal rats.

• Asian Pacific Journal of Cancer Prevention
• /
• v.16 no.1
• /
• pp.201-204
• /
• 2015

Background: This study was designed to determine the accuracy of bronchoalveolar lavage fluid cytology (BAL) using histopathologic examination of transbronchial biopsy specimens as the gold standard in diagnosis of lung carcinoma at our center. Materials and Methods: A retrospective study was conducted to investigate a total of 388 patients who were suspected of having lung cancer and had undergone fiberoptic bronchoscopy in Shahid Sadoughi hospital from 2006 to 2011. Lung masses were proven to be malignant by histology. Results: Transbronchial lung biopsy (TBLB) identified malignancy in 183 of the 388 cases, including 48 cases (26.2%) with adenocarcinoma, 4(2.1%) with bronchioloalveolar carcinoma, 47(25.6%)with squamous cell carcinoma, 34(18.5%) with well-diffentiated neuroendocrine carcinoma, 35(19.1%) with small cell carcinoma, 14 (7.6%) with non-small cell carcinoma, and 1 (0.54%) with large cell carcinoma. A total of 205 cases were correctly classified as negative. BAL was also performed in 388 patients; 86/103 cases were consistent with the final diagnosis of lung cancer and 188/285 cases were correctly classified as negative. The sensitivity of BAL was 46.9%(CI:41.9%, 51.8%)) and its specificity was 91.6%(CI:88.8%, 94.3%). BAL had a positive predictive value (PPV) of 83.4%(CI:79.7%, 87.1%) and a negative predictive value (NPV) of 65.8%(CI:61%, 70.5%). The overall accuracy of BAL was 70.5% and the exact concordance was 39%. Conclusions: Our findings suggest that BAL cytology is not sensitive but is a specific test for diagnosis of lung carcinoma. If transbronchial lung biopsy is combined with bronchoalveolar lavage, the positive diagnostic rate will be further elevated.

• Tuberculosis and Respiratory Diseases
• /
• v.38 no.1
• /
• pp.16-24
• /
• 1991

Adenosine deaminase (ADA) is an enzyme which is essential for the differentiation of lymphoid cells, especially T-cells and ADA plays a role in the maturation of monocyte to macrophage. Therefore ADA levels are related to stimulation of cellular immunity. We have investigated the measurement of ADA activity in bronchoalveolar lavage fluid of the patients with active and inactive pulmonary tuberculosis and control group. The results obtained are as follows: 1) The ADA activity and corrected ADA activity from the BAL fluid in active tuberculosis group (Total Lavage ADA; $18.4{\pm}22.5\;mU$, Total Lavage ADA/Albumin; $2.45{\pm}1.61\;mU/mg$) were increased when compared with those in inactive tuberculosis (TL-ADA; $5.8{\pm}2.5\;mU$, TL-ADA/Alb; $1.83{\pm}O.53\;mU/mg$) and control (TL-ADA; $6.6{\pm}4.3\;mU$, TL-ADA/Alb; $1.62{\pm}0.60\;mU/mg$) groups. 2) The ADA activity and lavage ADA/serum ADA activity ratio in BAL fluid from the lesion site (TL-ADA; $42.9{\pm}42.3\;mU$, L-ADA/S-ADA; $0.53{\pm}0.32$) were increased when compared with those from the non-lesion site (TL-ADA; $12.5{\pm}11.2\;mU$, L-ADA/S-ADA; $0.29{\pm}0.12$)and normal side (TL-ADA; $12.7{\pm}11.0\;mU$, L-ADA/S-ADA; $0.34{\pm}0.27$) in active tuberculosis group. 3) The ADA activity in BAL fluid from far advanced group (TL-ADA; $62.5{\pm}30.3\;mU$) was increased when compared with those from the mild group (TL-ADA; $10.5{\pm}7.5\;mU$) and moderate advanced group (TL-ADA; $13.2{\pm}11.7\;mU$) in active tuberculosis. 4) The albumin level from the BAL fluid was correlated with the ADA activity (R=0.89). 5) The ADA activity recovered from the BAL fluid was correlated with the recovered lymphocyte percentage (R=0.60). In conclusion, the ADA activity from the BAL fluid in active tuberculosis group was increased when compared with that in inactive tuberculosis and control groups, especially from the lesion site. To evaluated the specificity of ADA determination for diagnosis of active tuberculosis, BAL must be done at lesion site of the diseased lung and the proper correcting material other than albumin must be chosen to correct the dilution factor of lavage fluid.

• Tuberculosis and Respiratory Diseases
• /
• v.41 no.6
• /
• pp.604-615
• /
• 1994

Background: Analysis of cells in bronchoalveolar lavage(BAL) fluid had been used to predict the histologic changes of the bronchioles and alveoli in patients with interstitial lung diseases(ILD). Definitive diagnosis can be a1so made in some cases of ILD, such as histiocytosis. However, there are a few data of the cellular components in BAL fluid in normal Korean individuals and in patients with ILD. In order to evaluate the role of the cellular analysis of BAL fluid in prediction of alveolitis and differential diagnosis among ILDs, we compared the cellular components in BAL fluid from 50 normal individuals and 86 ILD patients. Method: BAL was performed by instillation and retrievement of normal saline with fiberoptic bronchoscopy. The cell number was counted by Hemocytometer. Differential count was done up to 500 cells on slides prepared by Diff-Quik stain and non-specific esterase stain. We compared the recovery rate(RR), cell numbers(CN), and percentages of each cellular components(CP). Results: The results were as follows: 1) There was no difference in RR, CN and CP between the normal smoker group and normal non-smoker group. 2) Total cell numbers recoverd in BAL fluid increased in collagen vascular diseases(CVD), hypersensitivity pneumonitis(HP), idiopathic pulmonary fibrosis(IPF), and miliary tuberculosis(Mil TBC) groups. 3) The percentage of lymphocytes increased in HP, IPF and Mil TBC groups. Macrophage percentages increased in HP, IPF, and Mil TBC groups. Neutrophil percentages were increased in CVD, HP, IPF and Mil TBC groups. Eosinophil percentages were increased in HP, IPF and Mil TBC groups. The numbers of each cells showed same findings as the percentages did. Conclusion: The analysis of cellular components of BAL fluid can predict the presence of alveolitis in many cases of ILDs. However, It was not helpful in differential diagnosis among ILDs.

• Tuberculosis and Respiratory Diseases
• /
• v.47 no.3
• /
• pp.321-330
• /
• 1999

Background : Early diagnosis and proper antibiotic treatment are very important in the management of ventilator-associated pneumonia (VAP) because of its high mortality. Bronchoscopy with a protected specimen brush (PSB) has been considered the standard method to isolate the causative organisms of VAP. However, this method burdens consumer economically to purchase a PSB. Another useful method for the diagnosis of VAP is quantitative cultures of aspirated specimens through bronchoscopic bronchoalveolar lavage (BAL), for which the infusion of more than 120 m1 of saline has been recommended for adequate sampling of a pulmonary segment. However, occasionally it leads to deterioration of the patient's condition. We studied the diagnostic efficacy of minibronchoalveolar lavage (miniBAL), which retrieves only 25 ml of BAL fluid, in the isolation of causative organisms of VAP. Methods: We included 38 consecutive patients (41 cases) suspected of having VAP on the basis of clinical evidence, who had received antibiotics before the bronchoscopy. The two diagnostic techniques of PSB and miniBAL, which were performed one after another at the same pulmonary segment, 'were compared prospectively. The cut-off values for quantitative cultures to define causative bacteria of VAP were more than $10^3$ colony-forming units (cfu)/ml for PSB and more than $10^4$ cfu/ml for BAL. Results: The amount of instilled normal saline required to retrieve 25 ml of BAL fluid was $93{\pm}32 ml$ (mean${\pm}$SD). The detection rate of causative agents was 46.3% (19/41) with PSB and 43.9% (18/41) with miniBAL. The concordance rate of PSB and miniBAL in the bacterial culture was 85.4% (35/41). Although arterial blood oxygen saturation dropped significantly (p<0.05) during ($92{\pm}10%$) and 10 min after ($95{\pm}3%$) miniBAL compared with the baseline ($97{\pm}3%$), all except 3 cases were within normal ranges. The significantly elevated heart rate during ($l25{\pm}24$/min, p<0.05) miniBAL compared with the baseline ($1l1{\pm}22$/min) recovered again in 10 min after ($111{\pm}26$/min) miniBAL. Transient hypotension was developed during the procedure in two cases. The procedure was stopped in one case due to atrial flutter. Conclusion: MiniBAL is a safe and effective technique to detect the causative organisms of VAP.

• Tuberculosis and Respiratory Diseases
• /
• v.46 no.1
• /
• pp.44-52
• /
• 1999

Background : Airway infiltration by inflammatory cells, particularly of eosinophils, is one of the characteristic features of asthma. Several mechanisms for the recruitment of eosinophil is focused on the CD4+ T lymphocyte for the preferential production of Th2-c1erived cytokines. Interleukin-10(IL-10) is identified cytokine with potent antiinflammatory activity. This molecule has been shown to inhibit the release of cytokine from inflammatory cells including Th2 cell, and also to inhibit eosinophil survival. We therefore attempted to determine whether decreased synthesis of IL-10 in the lung of bronchial asthma may contribute to inflammation that is characteristics of this dease. Method: Subjects were patients with bronchial asthma(n=23) and normal controls(n=11). IL-10 produced from peripheral mononuclear cell(PBMC) and in bronchoalveolar lavage(BAL) fluid was measured by ELISA method. Degree of bronchial inflammation was assessed by total cell counts and eosinophil percents in BAL fluid, eosinophil infiltration on bronchial biopsy tissue and $PC_{20}$ for methacholine. Results: The IL-10 level produced by PBMC and in BAL fluid from patient with bronchial asthma were not different with normal controls(respectively, $901.6\pm220.4$ pg/ml, $810.9\pm290.8$ pg/ml for PBMC, $24.5\pm9.5$ pg/mL $30.5\pm13.5$ pg/ml for BAL fluid p>0.05). There were significant negative correlation between IL-10 in BAL fluid and eosinophil percents in BAL fluid or degree of eosinophil infiltration in bronchial biopsy (respectively r=-0.522, r=-0.4486 p<0.05). However there was no difference of IL-10 level according to $PC_{20}$ for methacholine. There were no correlation between IL-10 production by PBMC and peripheral blood eosinophil counts or serum eosinophilic cationic protein levels(respectively r=0.1146, r=0.0769 p>0.05). Conclusion: These observation suggest that IL-10 may participate but not acts the crucial role in regulation of the airway inflammation in bronchial asthma.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.18 no.6
• /
• pp.1694-1698
• /
• 2004

We hope to evaluate the effects of Sabaek-san for the bronchial asthma using assesment on the metrix metalloproteinase-9(MMP-9) after Sabaek-san was intravenously administered OVA-sensitized and -challenged mice. Seventy-two female mice, 8-10 weeks of age and free of murine specific pathogens, were used. Of the seventy-two mice, twenty-four mice were not sensitized and forty-eight mice were sensitized by intraperitoneal injection of OVA. Of the sensitized mice, twenty-four mice didn't administrate Sabaek-san and twenty-four administrated Sabaek-san. Mice were sensitized on days 1 and 14 by intraperitoneal injection of 20 fig OVA. On days 21, 22 and 23 after the initial sensitization, the mice were challenged for 30 minutes with an aerosol of 1% OVA in saline. Sabaek-san administered 200㎎/㎏ in the tail of the mouse, one time per day, for 7 days, beginning 14 days after first sensitization. Bronchoalveolar lavage was performed 72 hours after the last challenge, and total cell numbers in the BAL fluid were count. Also, level of MMP-9 in the BAL fluid were measured by Enzyme immunoassays and Western blot analysis. Enzyme immunoassay revealed that MMP-9 levels in the BAL fluids significantly increased 72 h after OVA inhalation compared with levels in the control group. After administration of the Sabaek-san, the levels of the MMP-9 in BAL fluids 72 h after OVA inhalation reduced dramatically. Western blot analysis revealed that MMP-9 levels increased in the all mice which were challenge with OVA without administered Sabaek-san compared the normal mouse. However, in the groups of the administered Sabaek-san, the MMP-9 level markedly decreased. Sabaek-san might be effect the treatment of the bronchial asthma as a inhibition of the MMP-9.

• Korean Journal of Veterinary Service
• /
• v.21 no.1
• /
• pp.41-56
• /
• 1998

These experiment was carried out to investigate the pulmonary lesions and the function of alveolar macrophages in rats exposed to cement dusts. 1. The number of total cells in bronchoalveolar lavage fluid(BAL) increased remarkably in 1st month. As time goes by, tend to less and less in numbers. 2. The number of neutrophil and lymphocytes obtaining from the total cell of BAL increased remarkably in first month, but as time goes by, they tended to grow less and less in number. Macrophages decreased gradually after being temporarily augmentation. 3. Histipathologically, the thickening of alveolar walls, alveolar interstitial, and infiltrated macrophages containing cement dusts.