Bronchial glomus tumor mimicking a COPD exacerbation

We report the case of a glomus tumor originating in the left main bronchus diagnosed in a 79 year old Caucasian man. A glomus tumor is an extremely rare neoplasm in the bronchi with nonspecific clinical features. Bronchoscopy allows the diagnosis through biopsy and subsequent histopathological examination of the tissue and in selected cases may represent a valid alternative to surgery permitting a radical tumor excision.

Near-fatal asthma phenotype in the ENFUMOSA Cohort

BACKGROUND

Near-fatal asthma (NFA) is characterized by severe asthma attacks usually requiring intensive care unit admission. This phenotype of asthma has been studied mainly in acute conditions.

METHODS

The aim of our study was to compare the clinical, functional and inflammatory characteristics of NFA patients with mild to severe asthmatics in stable conditions. We recruited 155 asthmatic patients from five centres of the European Network for Understanding Mechanisms of Severe Asthma: 67 patients with mild-to-moderate asthma controlled by low/medium doses of inhaled corticosteroids; 64 with severe asthma that, despite treatment with high doses of inhaled corticosteroids, long-acting beta2-agonists and for 1/3 also with regular oral corticosteroids, had at least one asthma exacerbation in the previous year; 24 with an NFA episode in the previous 5 years in the absence of inclusion criteria for the previous groups. All the patients were examined in stable conditions.

RESULTS

NFA patients were taking less corticosteroids and were less compliant to prescribed asthma medications than the other two groups of patients. Lung function, blood gases, atopic status, sputum and blood inflammatory cell count of NFA patients were similar to mild-to-moderate, but not severe, asthmatic patients.

CONCLUSIONS

In stable conditions patients with an NFA attack in the previous 5 years cannot be distinguished from patients with mild-to-moderate asthma, while they are different from severe asthmatics both in terms of lung function and of airway inflammation. The risk factor that characterizes this group of patients is reduced usage of prophylactic corticosteroids.

Ectopic thymoma simulating a pericardial cyst

We present a case of a 53 year old man with a thymoma near the pericardium, a rare ectopic localisation of thymoma. A round radiodensity found at the right cardiophrenic angle was initially suspected at the echocardiography to be a pericardial cyst. The diagnosis of thymoma was made only after histopathological examination of the surgically re-sected lesion.

COPD increases the risk of squamous histological subtype in smokers who develop non-small cell lung carcinoma

BACKGROUND

Squamous cell carcinoma has a stronger association with tobacco smoking than other non-small cell lung cancers (NSCLC). A study was undertaken to determine whether chronic obstructive pulmonary disease (COPD) is a risk factor for the squamous cell carcinoma histological subtype in smokers with surgically resectable NSCLC.

METHODS

Using a case-control design, subjects with a surgically confirmed diagnosis of squamous cell carcinoma were enrolled from smokers undergoing lung resection for NSCLC in the District Hospital of Ferrara, Italy. Control subjects were smokers who underwent lung resection for NSCLC in the same hospital and had a surgically confirmed diagnosis of NSCLC of any histological type other than squamous cell.

RESULTS

Eighty six cases and 54 controls (mainly adenocarcinoma, n = 50) were enrolled. The presence of COPD was found to increase the risk for the squamous cell histological subtype by more than four times. Conversely, the presence of chronic bronchitis was found to decrease the risk for this histological subtype by more than four times. Among patients with chronic bronchitis (n = 77), those with COPD had a 3.5 times higher risk of having the squamous cell histological subtype.

CONCLUSIONS

These data suggest that, among smokers with surgically resectable NSCLC, COPD is a risk factor for the squamous cell histological subtype and chronic bronchitis, particularly when not associated with COPD, is a risk factor for the adenocarcinoma histological subtype.

Pulmonary blastoma: case report in an adult

We present a case of biphasic pulmonary blastoma, a rare primary malignant lung neoplasm, in a 48 year old man. Despite its resection followed by postoperative chemotherapy, the neoplasm recurred and the patient survived only 41 months after the diagnosis.

An unusual case of congenital short trachea with very long bronchi mimicking bronchial asthma

Case reports of a short trachea with early branching of the main bronchi are uncommon. The case is presented of a 64 year old woman with upper airway obstruction due to this anatomical abnormality which caused breathlessness and wheezing that was misdiagnosed (and treated) as bronchial asthma for many years.

[Hemoptysis in a patient with post-obstructive pneumonia due to a broncholith]

A case of a 51-year-old man admitted to the hospital for hemoptysis after a three-week history of fever and cough is presented. The chest x-ray film revealed consolidation in the left upper lobe. Because microbiologic studies of the bronchial lavage showed the grew of Pseudomonas aeruginosa, the patient was treated with piperacilline and pefloxacin. Haemoptysis and abnormal temperature was persistent for several days. Revaluation of the chest x-ray permitted to discover a little calcified nodule of 1 mm diameter. CT scan of the thorax confirmed the consolidation of the left upper lobe and the little calcification. A second fiberoptic bronchoscopy was performed in 10th day, using a bronchoscope with a smaller diameter; it was possible to observe the occlusion of the subsegment bronchus LB 1&2 due to a mobile protruding mass. The mass was gentle removed by the use of alligator bioptic forceps; it presented as a grey, hard, 2 mm diameter body with irregular surface like a "floating mine". On microscopical examination of the mass, aspergillus hyphae appeared as broad septate filaments. Culture of the samples were negative. Haemoptysis and fever stopped after FOB. Chest x-ray in 19th day was negative: consolidation and calcification were absent.

Antioxidant activity of carbocysteine lysine salt monohydrate

BACKGROUND

Reactive oxygen radicals are involved in many respiratory diseases, including chronic obstructive pulmonary disease (COPD). Carbocysteine lysine salt monohydrate (CLS) is a mucoactive drug effective in the treatment of bronchopulmonary diseases characterized by mucus alterations, including COPD. In the present study, the antioxidant activity of CLS was studied in vitro in three different oxygen radical producing systems, i.e. bronchoalveolar lavages (BAL) from patients affected by COPD, ultrasound treated human serum and cultured human lung endothelial cells challenged with elastase.

METHODS

BAL, exposed or not to different concentrations of CLS (1.5-30 mM), was assayed for free radical content by fluorometric analysis of DNA unwinding (FADU) or by cytochrome c reduction kinetics. Human serum was treated with ultrasound in the presence or absence of CLS (1.5, 2.5 mM) or N-acetyl cysteine (NAC; 4, 5 mM) and assayed for free radical content by FADU. Human endothelial cells cultured in vitro from pulmonary artery were incubated with elastase (0.3 IU/mL), in the presence or absence of glutathione (GSH; 0.65 mM) or CLS (0.16 mM). The supernatant was tested for cytochrome c reduction kinetics whereas cell homogenates were assessed for xanthine oxidase (XO) content by SDS-PAGE.

RESULTS

Results showed that CLS is more effective as an in vitro scavenger in comparison to GSH and NAC. CLS reduced the damage of DNA from healthy donors exposed to COPD-BAL and was able to quench clastogenic activity induced in human serum by exposure to ultrasound at concentrations as low as 2.5 mM. NAC protect DNA from radical damage, starting from 5 mM. In human lung endothelial cells cultured in presence of elastase, CLS (0.16 mM) decreased xanthine oxidase activity.

CONCLUSIONS

These results suggest that CLS could act by interfering with the conversion of xanthine dehydrogenase into superoxide-producing xanthine oxidase. The antioxidant activity of CLS could contribute to its therapeutic activity by reducing radical damage to different lung structures.

Congenital diaphragmatic hernia in an adult simulating a pleural liposarcoma

We report the case of a 32-year-old man with the onset of exercise-related dyspnea, chest pain and chest radiography simulating a pleural effusion. The computed tomography of the chest showed signs suggesting pleural liposarcoma. Because of these findings, a videothoracoscopy was performed which surprisingly showed the presence in the left pleural space of intrapleural omentum and spleen. This report underlines that the clinical manifestations of Bochdalek hernia in adults are variegate and in most cases preoperative diagnosis is not possible.

Detection of xanthine oxidase activity products by EPR and HPLC in bronchoalveolar lavage fluid from patients with chronic obstructive pulmonary disease

Xanthine oxidase (xanthine: oxygen oxidoreductase, EC 1.1.3.22), a molybdenum-containing hydroxylase that produces superoxide and uric acid from purine substrates and molecular oxygen, is involved in the oxidative stress underlying several human pathologies including lung diseases. An enzymatic activity similar to xanthine oxidase was previously reported in bronchoalveolar lavage fluid of patients with chronic obstructive pulmonary disease (COPD-BAL), by fluorometric analysis of DNA unwinding and cytochrome c reduction kinetics. Here we report the detection of xanthine oxidase activity products by electron paramagnetic resonance (EPR) in presence of the spin-trap 5,5-dimethyl-1-pyrroline N-oxide (DMPO) and reversed-phase high-performance liquid chromatography (RP-HPLC) in COPD-BAL (n = 14, average age of patients 65 years, range 38-81) and BAL from healthy nonsmoker controls (n = 6, average age 64 years, range 44-73). Superoxide DMPO adducts were detected in COPD-BAL and in an in vitro system containing xanthine and xanthine oxidase (XA/XO), but not in BAL controls and when superoxide dismutase (SOD, 1000 I.U./ml) was added to COPD-BAL. The HPLC analyses after addition of xanthine showed production of uric acid in COPD-BAL and in the XA/XO system but not in BAL controls. These results support the involvement of xanthine oxidase in the mechanisms of superoxide production by BAL supernatant, which increases oxidative stress in chronic obstructive pulmonary disease.

In chyloptysis, SP-A affects the clearance of serum lipoproteins entering the airways

Serum lipoproteins may enter the airways and appear in sputum (chyloptysis) when the lymphatic circulation is impaired by inflammation, neoplasia, or an abnormal proliferation of smooth muscle cells. While analyzing the bronchoalveolar lavage fluid of a patient with chyloptysis, we noticed that surfactant could not be separated from contaminating serum lipoproteins and speculated that lipoproteins might interact with surfactant components. To clarify this point we immobilized surfactant protein (SP) A on microtiter wells and incubated it with 125I-labeled very low density lipoproteins (VLDLs), low-density lipoproteins, and high-density lipoproteins. We found that SP-A binds lipoproteins. Studying in greater detail the interaction of SP-A with VLDLs, we found that the binding is time and concentration dependent; is inhibited by unlabeled lipoproteins, phospholipids, and antibodies to SP-A; is increased by Ca2+; and is unaffected by methyl alpha-D-mannopyranoside. Whole surfactant is a potent inhibitor of binding. Furthermore, we found that SP-A increases the degradation of VLDLs by alveolar macrophages and favors the association of VLDLs with alveolar surfactant. We conclude that SP-A influences the disposal of serum lipoproteins entering the airways and speculate that binding to alveolar surfactant might represent an important step in the interaction between exogenous substances and the lung.

Xanthine oxidase activity in bronchoalveolar lavage fluid from patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a serious respiratory pathology characterized by irreversible limitation of expiratory flow and includes chronic obstructive bronchitis, chronic airflow limitation, and emphysema. To determine whether xanthine oxidase activity increased in the airspaces of COPD patients, we examined bronchoalveolar lavage fluid (BAL) from COPD patients recruited during a 2-year clinical study. Filtered BAL supernatant from COPD patients and healthy nonsmoking controls was examined by fluorometric analysis of DNA unwinding (FADU) and spectrophotometric assays (cytochrome c reduction kinetics and uric acid kinetics). Compared to controls, filtered BAL supernatant of subjects with COPD exhibited a detectable clastogenic activity probably related to superoxide production. The method of BAL preparation as an acellular system strongly suggests that superoxide production may be due to xanthine oxidase activity.

[Pyrrolidone and piperidone derivatives with antihistaminic and antianaphylactic activities. Synthesis and pharmacological study]

The preparation of several derivatives to oxatomide (A), with the benzimidazolinone moiety replaced by another heterocyclic residue is described. In some cases changes to the basic chain of (A) were also considered. All the new compounds were evaluated as antihistaminics (H1) and antianaphylactics. The derivatives where the heterocyclic moiety was an unsubstituted or phenylsubstituted 2-pyrrolidone or 2-piperidone residue showed antihistaminic and antianaphylactic activities similar to those of oxatomide while modification of the basic side chain with elimination of the benzhydryl group, gave a complete loss of activity. The pharmacological screening was completed by the evaluation of the barbiturate induced sleep prolongation and of acute toxicity.

[Methionine derivatives with liver protecting activity]

Some methionine derivatives with the amine group acylated with an aliphatic group bearing a free, esterified or etherified thiol group in the omega position were prepared and tested for protection against CCl4, paracetamol, ethyl alcohol and ethionine intoxication. Acid (XIV) (MG 28013) (Table I) and some of its alkyl derivatives (XVIII) (MG 28228) and (XIX) (MG 28226) proved to have significant activity in these tests. A more in-depth study on MG 28226 however indicated a slight intolerance when subacute toxicity was examined (90 gg).

[New derivatives of clofibrate and probucol. Preliminary study of their hypolipemic activity]

The preparation is reported of compounds with a free or esterified hydroxyisobutyric acid grouping characteristic of clofibrate, on various supporting molecules related to clofibrate itself or to probucol. Some compounds showed clear hypolipemic activity and for one compound (MG 6893) the effect was not accompanied by hepatomegalia.

[N-acylated derivatives of cyclohexylaniline with potential antiallergic and analgesic-antiinflammatory activity]

Some N-acylated derivatives of cyclohexylaniline were prepared. These can be considered as derived from oxarbazol (A), a carbazolic structure with antiallergic activity, by breaking the bond between carbon atom 4a and 4b. In the new molecule the following groups were introduced: benzoic acid, salicylic acid, acetylsalicylic acid and tetrazol. The synthesized compounds were studied for analgesic, antiedema and antiallergic activity. Some showed analgesic action (phenylquinone) comparable with that of naproxen. Antiinflammatory activity was slight and antiallergic activity nonexistent.

[Derivatives of 4-phenylcyclohexylethylamine with antidepressive activity]

Several new derivatives of trans-1-(4-phenylcyclohexyl)-ethylamine (M.G. 6669) have been synthesized with various substituents at the alpha-carbon and/or at the amine nitrogen atom. All compounds were evaluated for a potential antidepressant activity taking M.G. 6669 as reference. They turned out to be less active than the reference substance. Pharmacological evaluation of M.G. 6669 itself was broadened during this work. The good antidepressant properties of this compound were confirmed, accompanied however by some toxic phenomena.

[Heterocyclic compounds containing the residue of a 4-aminophenylalkanoic acid with potential anti-inflammatory activity. IV. Derivatives of 2-phenyl-2H-indazole]

Numerous derivatives of 2-phenyl-2H-indazole were prepared. The compounds were of general formula I: where R is an acid, neutral or basic radical and R1, R2, R3 represent various functional groups, hydrogen atom or chlorine. The compounds were examined for analgesic-antiinflammatory properties and in some cases as inhibitors of platelets aggregation. Among the compounds where R is an alkanoic acid residue, the only compound showing interesting activity was M.G. 18755 [R = CH(CH3) COOH; R1, R2, R3 = H] and its lysine salt (M.G. 18334), which in various tests showed activity greater than that of ibuprofen. The homologous butyric derivative (M.G. 18860) showed a good anti-aggregatin activity.

[Heterocyclic compounds containing a 4-aminophenylalkanoic acid group with potential antiinflammatory activity. II. 2-Substituted morpholine derivatives]

Derivatives of 4-aminophenylalkanoic acids where the amino groups is part of a 3-morpholinone or a 2-morpholine ring, substituted in position 2 with a methyl, phenyl, 2-thienyl or (2-cyclohexyl)phenoxymethyl residue are described. Pharmacological evaluation aimed at evidencing analgesic and anti-inflammatory activity gave no noteworthy results.

[2-(2-Thienyl)morpholines with CNS activity]

The synthesis and pharmacological investigation of 2-(2-thienyl)morpholine and some of its derivatives substituted on the nitrogen are described. The non-substituted compound showed interesting antidepressive properties with a pharmacological profile similar to that of imipramine.

[Cyclohexylphenoxymorpholines with antidepressive activity]

A report is given of the synthesis and pharmacological investigation of some cyclohexylphenoxymethylmorpholines of general formula: Formula: (see text). The compound in which R = H and bearing the cyclohexyl group at the ortho position showed a pharmacological profile typical of drugs with antidepressant activity and was studied in detail in comparison with viloxazine and imipramine.

[Synthesis and pharmacological study of orciprenaline and salbutamol derivatives]

The effect of replacing the basic aliphatic residue of orciprenaline [(A); R = isopropylamino] and salbutamol [(B); R = tert.butylamino] with: a) a heterocyclic amine; b) a basic residue containing a phenylcyclohexane radical had been studied. The synthesis of the compounds is outlined. They were tested in vitro for relaxation of histamine-induced spasm of tracheal chains and on the isolated Langendorff heart, and in vivo according to the Konzett and Rössler technique and for their action on the cardiovascular system. In all tests the new derivataives were less active than the reference substances; the only exception was (A) where R = 4-phenylpiperidine (M.G. 6604), which was almost as active as orciprenaline in the Konzett and Rössler test, had one third of its activity on isolated trachea and showed absolutely no influence on heart rate in vitro or in vivo. Its effect was not inhibited by beta-blocking agents; it therefore showed an antihistaminic profile.

[A new cyclohexylphenyl and cyclohexylphenylamine. Synthesis and pharmacological activity]

Derivatives of some primary amines and their N-benzyl derivatives containing a 4-cyclohexylphenyl or a 4-phenylcyclohexyl group were prepared. Pharmacological study showed clear analgesic activity in the phenylquinone test which was more accentuated for the 4-phenylcyclohexyl derivatives. All the compounds proved devoid of sympathomimetic activity on the cardiovascular system and without anorexic effect. Some of the compounds showed some antireserpine activity.

[Preparation and pharmacological activity of N6, 02-dipivaloyl-cyclic AMP]

The synthesis of N6,O2'-dipivaloyl-cyclic AMP is described with some pharmacological tests made in comparison with the dibutyryl homolog. The two compounds proved equally active in increasing glycemia in the rabbit whereas the dipivaloyl derivative is less effective in counteracting contractions induced by imidazole in the isolated guinea-pig trachea.

[Lidoflazine derivatives with cycloaliphatic residues of coronary dilator activity]

The preparation of some derivatives of lidoflazine bearing a phenylcyclohexane residue in place of the m.xylene is described. Study of the coronary dilating activity on the isolated heart showed that this activity is markedly increased by the modification. Acute toxicity in rats is also strongly increased.

Basic ethers of cyclohexylphenols with beta-blocking activity: synthesis and pharmacological study of exaprolol

The paper describes the preparation and study of the pharmacological properties of a series of derivatives with the general formula. (see article) where R is a cyclohexyl or cyclohexenyl radical and R1 is a hydrogen, methyl or cyclohexyl. The compounds with a single cycloaliphatic radical ortho to the basic chain, and in particular the one with a cyclohexyl (exaprolol), were found to be particularly active in blocking the beta-adrenergic receptors, as antiarrhythmics and local anesthetics, while the introduction of a second radical or the shift of the cycloaliphatic radical to meta or para position caused the said pharmacological activities to disappear almost entirely, with the exception of the local anesthetic action.

[Synthesis and antibacterial activity in vitro of some penicillins containing the phenylcyclohexanie residue]

Some penicillins with structures similar to that of ampicillin and cyclacillin bearing the phenylcyclohexane grouping were prepared. In vitro tests of antibacterial activity showed that the introduction of this residue led to reduced activity in comparison with that of the parent compound.

[New esters of prednisolone and triamcinolone acetonide and their anti-inflammatory activity]

Seventeen acids with diphenylyl and cyclohexylphenyl groups were esterified with the hydroxyl group at position 21 of prednisolone and triamcinolone acetonide. Some of these esters showed marked activity against carrageenin edema and Selye spots in the rat, especially on local application.

[Isoxazolylpenicillins with cycloaliphatic substituents in the isoxazole ring]

Some derivatives of oxacillin were prepared containing in place of the phenyl group a cyclohexyl, cyclohexylphenyl, phenylcyclohexyl or diphenylyl moiety. In the same compounds a methylene bridge between the carboxy group and the heterocyclic ring was inserted. The results of in vitro evaluation of antibacterial activity are given.