Therapeutic lung lavages in children and adults

BACKGROUND: Pulmonary alveolar proteinosis (PAP) is a rare disease, characterized by excessive intra-alveolar accumulation of surfactant lipids and proteins. Therapeutic whole lung lavages are currently the principle therapeutic option in adults. Not much is known on the kinetics of the wash out process, especially in children. METHODS: In 4 pediatric and 6 adult PAP patients 45 therapeutic half lung lavages were investigated retrospectively. Total protein, protein concentration and, in one child with a surfactant protein C mutation, aberrant pro-SP-C protein, were determined during wash out. RESULTS: The removal of protein from the lungs followed an exponential decline and averaged for adult patients 2 – 20 g and <0.5 to 6 g for pediatric patients. The average protein concentration of consecutive portions was the same in all patient groups, however was elevated in pediatric patients when expressed per body weight. The amount of an aberrant pro-SP-C protein, which was present in one patient with a SP-C mutation, constantly decreased with ongoing lavage. Measuring the optical density of the lavage fluid obtained allowed to monitor the wash out process during the lavages at the bedside and to determine the termination of the lavage procedure at normal protein concentration. CONCLUSION: Following therapeutic half lung lavages by biochemical variables may help to estimate the degree of alveolar filling with proteinaceous material and to improve the efficiency of the wash out, especially in children

Factors associated with breast screening attendance: A controlled comparison between attenders and non-attenders in Scotland.

The present study aimed to compare a sample of screening mammography attenders with a sample of non-attenders, in terms of knowledge about breast cancer and mammography, health beliefs and personality variables, and identify factors associated with attendance. The sample consisted of 58 women; 29 had attended the National Breast Screening Programme and 29 had declined an invitation to attend. Assessment was made by use of anonymous questionnaire. Significant differences were found between the two groups in use of focusing and venting on emotions as a health-related coping style, knowledge about breast cancer and knowledge about mammography. The most powerful predictor of attendance was knowledge about mammography. Results are discussed predominantly in relation to provision of emotional-related and fact-related information