Publications

OBJECTIVE

The likelihood of interstitial lung disease being detected on high-resolution CT scans and having functional significance is often related to the severity of the disease. The extent and severity of the abnormalities seen on high-resolution CT are usually assessed subjectively. This study was undertaken to investigate whether a subjective semiquantitative scoring method or a method using a cumulation of the different high-resolution CT features of asbestosis were comparable in suggesting asbestosis in a group of patients with histopathologic confirmation of disease. A secondary objective was to compare the results of these two high-resolution CT methods with chest radiographs in the same population.

MATERIALS AND METHODS

This study group consisted of 24 patients and six lungs obtained at autopsy. Histopathologic asbestosis was present in 25 of the 30 patients or lungs. The patients or lungs were imaged using selected high-resolution CT scans. The high-resolution CT scans were assessed in two ways. One used a subjective semiquantitative extent and severity score consisting of four levels of severity, while the other was a cumulative score adding the different types of high-resolution abnormalities in asbestosis. The commonest high-resolution CT abnormalities in the cases with confirmed asbestosis were interstitial lines (84%), parenchymal bands (76%), and architectural distortion of secondary pulmonary lobules (56%). Subpleural lines and honeycombing were less frequent. The histopathologic severity of asbestosis was independently graded on a four-point scale. Chest radiographs, when available, were classified according to the International Labor Organization (ILO) classification of pneumoconioses.

RESULTS

With the subjective semiquantitative high-resolution CT severity score, asbestosis was suggested in 16 (64%) instances, all with disease. With the cumulative method, any one type of abnormality was present in 88% of cases with asbestosis, two types in 78%, and three in 56%. However, to include only cases with asbestosis, three different abnormalities had to be present. The high-resolution CT scans were normal or near normal in five instances of asbestosis. Chest radiographs using the ILO classification predicted asbestosis with a lesser frequency than high-resolution CT in this selected population.

CONCLUSION

We conclude that a subjective semiquantitative grading system of the extent and severity of asbestosis and a method using a cumulative addition of the different findings in asbestosis give similar results in suggesting the presence of disease. Thus, for the high-resolution CT detection of asbestosis, a combination of the cumulative number of different findings and an assessment of the extent and severity of the abnormalities could be complimentary. We also conclude that asbestosis can be present histopathologically with a normal or near normal high-resolution CT scan.

We analyzed CK and CK-MB levels over 24 h in 15 male subjects admitted for alcohol detoxification following recent heavy ingestion. None had clinical or electrocardiographic evidence of myocardial ischemia or infarction. The mean 0-hour serum alcohol level +/- SD was 342 +/- 101 mg/dl. CK levels were measured by Kodak Ektachem and Abbott IMx assays, and CK-MB levels were determined by these assays and the Hybritech isoenzyme test. In 36% of the patients elevated 0-hour CK levels by the IMx and Ektachem assays were observed. The CK levels measured every 8 h decreased so that by 24 h CK was elevated in 1 patient by the Ektachem assay and in 2 by the IMx assay. Only 1 patient (7%) had an elevated 0-hour CK-MB value by two of the three assays, and it is unclear whether the source was cardiac or extracardiac. We conclude that: (1) elevated CK levels are common in heavy alcohol use patients without evidence of myocardial ischemia; (2) CK values over the first 24 h are decremental, not rising and falling as is typical of myocardial infarction and (3) current isoenzyme immunoassays eliminate a cardiac cause for elevated CK in most of these patients. These findings may assist in the evaluation of alcoholic patients with chest pain.

Interleukin 12 (IL-12) is a powerful stimulus for the growth of activated T and natural killer cells, their generation of interferon gamma (IFN-gamma), and the differentiation of T helper type 1 (Th1) effector cells from naive precursors in vitro. These activities are consistent with the capacity of exogenous IL-12 to heal otherwise susceptible BALB/c mice infected with the intramacrophage parasite Leishmania major. Using this characterized model of CD4 cell subset differentiation, we examined the immunologic effects of IL-12 administered either at the time of infection, when naive T cells are primed, or after 14 days of infection, by which time CD4+ subset differentiation has occurred. Given with the inoculation of parasites, IL-12 induced IFN-gamma and IL-10 and markedly suppressed IL-4. Effects on IL-10 and IL-4 were comparable in mice with homozygous disruption of the IFN-gamma gene (IFN-gamma 0/0), and suppression of IL-4 was unchanged by administration of neutralizing anti-IL-10 antibody. Induction of IFN-gamma and IL-10 mRNA by IL-12 also occurred in infected SCID mice. Given after day 14 of infection, however, IL-12 not only induced IFN-gamma and IL-10 but also induced IL-4 in normal and IFN-gamma 0/0 mice. These data demonstrate direct effects of IL-12 independent of IFN-gamma, IL-10, and IL-4 and demonstrate that the ineffectiveness of IL-12 administered following infection with L. major correlates with resistance of differentiated Th2 cells to the IL-4-suppressing activity of IL-12.