Water-pipe smoking and pulmonary functions

Water-pipe smoking is a type of smoking habit, widely encountered in Turkey and Arabic and Middle East countries. However there is limited data about the effects of water-pipe smoking. The aim of this study is to investigate this habit with regard to the duration and amount of smoking and to analyse its characteristics and effects on pulmonary function by the correlation of the results with those of cigarette smokers and non-smokers. All cafes in Izmir city were visited For this purpose. A total of 397 males were studied in four groups: water-pipe smokers, water-pipe smokers who used to smoke cigarettes, active cigarette smokers and non-smokers. After recording a detailed history of smoking, pulmonary function tests on each person were performed. There were statistically significant differences between cigarette smokers and non-smokers within most of the parameters. The results of recent study have shown that the detrimental effects on pulmonary function of water-pipe smoking are not as great as cigarette smoking (FEV1, FEV1/FVC parameters were higher in water-pips smokers), especially on the parameters for small airways (FEF50, MMEF parameters were higher in water-pipe smokers) (P<0.05). It is difficult to explain the reasons exactly without estimating possible mechanisms in detail, but the most likely mechanisms ar ise from the smoking technique itself which involves a water filter and a long spout through which the smoke passes before reaching the lungs

technetium-99m DTPA inhalation scintigraphy

Objective: Although extensive work has been done on cigarette smoking and its effects on pulmonary function, there are limited number of studies on water-pipe smoking. The effects of water-pipe smoking on health are not widely investigated. The aim of this study was to determine the effects of water-pipe smoking on pulmonary permeability. Methods: Technetium-99m DTPA inhalation scintigraphy was performed on 14 water-pipe smoker volunteers (all men, mean age 53.7 +/- 9.8) and 11 passive smoker volunteers (1 woman, 10 men, mean age 43.8 +/- 12). Clearance half-time (T 1/2) was calculated by placing a monoexponential fit on the time activity curves. Penetration index (PI) of the radioaerosol was also calculated. Results: PI was 0.58 +/- 0.14 and 0.50 +/- 0.12 for water-pipe smokers (WPS) and passive smokers (PS) respectively. T 1/2 of peripheral lung was 57.3 +/- 12.7 and 64.6 +/- 13.2 min, central airways was 55.8 +/- 23.5 and 80.1 +/- 35.2 min for WPS and PS, respectively (p less than or equal to 0.05). FEV1/FVC% was 82.1 +/- 8.5 (%) and 87.7 +/- 6.5 (%) for WPS and PS, respectively (0.025 < p less than or equal to 0.05). Conclusions: We suggest that water-pipe smoking effects pulmonary epithelial permeability more than passive smoking. Increased central mucociliary clearance in water-pipe smoking may be due to preserved humidity of the airway tracts.C1 Dokuz Eylul Univ, Sch Med, Dept Nucl Med, TR-35340 Inciralti Izumir, Turkey.Pamukkale Univ, Dept Chest Dis, Fac Med, Denizli, Turkey.Dokuz Eylul Univ, Sch Med, Dept Chest Dis, Izmir, Turkey

Behcet's disease with pulmonary involvement, superior vena cava syndrome, chyloptysis and chylous ascites

Behcet's disease is a chronic multisystem vasculitis of unknown aetiology. This case report describes a patient who applied to the hospital because of dyspnoea, ascites, oedema of lower extremities and recurrent episodes of haemoptysis. For the last 12 yr, he had superior vena cava syndrome (SVCS) and cardiac and pulmonary involvement of Behcet's disease, and biochemical examination of ascite fluid yielded a chylous effusion containing triglyceride 421 mg dl(-1) and cholesterol 49 mg dl(-1). Chyloptysis was also detected by Sudan III stain. The patient died from cardiac tamponade in spite of cardiac fenestration. To the authors' knowledge, this is the first reported case of Behcet's disease with chylous ascites and chyloptysis in the English literature

Endobronchial metastases from extrathoracic malignancies

Endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are breast, renal and colorectal carcinomas. In this study, we aimed to evaluate the clinical, radiographic and bronchoscopic aspects of patients with EBM who were diagnosed between 1992 and 2002. Data about patients' clinical conditions, symptoms, radiographic and endoscopic findings, and histopathological examination results were investigated. EBM was defined as bronchoscopically visible lesions histopathologically identical to the primary tumor in patients with extrapulmonary malignancies. We found 15 cases with EBM. Primary tumors included breast (3), colorectal (3), and renal (2) carcinomas; Malignant Melanoma (2); synovial sarcoma (1), ampulla of Vater adenocarcinoma (1), pheochromocytoma (1), hypernephroma (1), and Hodgkin's Disease (1). The most common symptoms were dyspnea (80%), cough (66.6%) and hemoptysis (33.3%). Multiple (40%) or single (13.3%) pulmonary nodules, mediastinal or hilar lymphadenopathy (40%), and effusion (40%) were the most common radiographic findings. The mean interval from initial diagnosis to diagnosis of EBM was 32.8 months (range, 0-96 months) and median survival time was 18 months (range, 4-84). As a conclusion, various extrapulmonary tumors can metastasize to the bronchus. Symptoms and radiographic findings are similar with those in primary lung cancer. Therefore, EBM should be discriminated from primary lung cancer histopathologically. Although mean survival time is usually short, long-term survivors were reported. Consequently, treatment must be planned according to the histology of the primary tumor, evidence of metastasis to other sites and medical status of the patient

Tc-99m-HMPAO uptake by bronchoalveolar cells

Lung uptake of intravenously injected Tc-99m-HMPAO is observed in smokers and in lung toxicity due to various agents. We investigated the Tc-99m-HMPAO uptake of bronchoalveolar lavage (BAL) cells in the lungs after incubation in in vitro conditions (6 patients), intravenous injection (IV) (7 patients) and inhalation (INH) (6 patients) of Tc-99m-HMPAO in order to show whether BAL cells are also responsible for Tc-99m-HMPAO uptake in the lungs. Cell/supernatant (C/S) count ratio was 7.0 +/- 3.5, 29.3 +/- 40.8 and 8.4 +/- 4.5 for in vitro, IV and INH groups, respectively. C/S-in vitro showed a positive correlation with % alveolar macrophages (r = 0.943, p = 0.0048) and a negative correlation with % neutrophils (r = -0.945, p = 0.0045). Cells/whole BAL fluid ratio cot-related with the amount of daily cigarette consumption in INH group (r = 0.95, p = 0.0037). Tc-99m-HMPAO showed adherence to mucus after inhalation. Tc-99m-HMPAO diffuses into alveolar spaces after injection and is present in BAL fluid and BAL cells both after injection and inhalation. Glutathione concentration and oxido-reductive state of the epithelial lining fluid and BAL cells may influence the lung uptake of Tc-99m-HMPAO