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      The Role of Induced Sputum in Amiodarone-Associated Interstitial Lung Diseases

      a , b , b , c


      S. Karger AG

      Induced sputum, Amiodarone

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          Amiodarone, a highly effective medication for suppressing cardiac rhythm disturbances, may cause pulmonary injury, such as chronic interstitial lung diseases, in 5–15% of the patients who take it. We applied induced sputum (IS), a non-invasive technique, for diagnosing amiodarone-induced pulmonary toxicity. Four patients with interstitial lung disease who were treated by amiodarone for ischemic heart diseases were evaluated by a conventional clinical workup. All four patients showed marked interstitial pattern on computerized tomography and decreased diffusion capacity (DLCO-SB 51–76%). IS showed lymphocytosis, a high CD4 or CD8 count, eosinophilia and amiodarone in 3 of 4 patients. IS may be a useful tool for assessing amiodarone toxicity in patients with ischemic heart diseases and concomitant pulmonary side effects.

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          Most cited references 16

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          Use of induced sputum cell counts to investigate airway inflammation in asthma.

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            The evaluation of a cell dispersion method of sputum examination.

            In recent studies, sputum smear cell counts were found to be reproducible and usefully applied to research in asthma and other airway conditions. However, cell definition on the smears is poor, and the procedure is tedious and has limited utility. The objective of this study is to improve the methods of sputum examination. The subjects used in this study were people with bronchitis or asthma from whom sputum could be obtained. By inverted microscopy, portions of fresh sputum were selected to exclude salivary contamination. These portions were exposed to different volumes of dithiothreitol for varied time intervals. We used the resulting cell suspensions to perform total cell counts and prepare cytospins for differential cell counts and immunohistochemical stains for GM-CSF, EG2, TNF alpha and IL-8. Cytospins were compared with smears for differential cell counts on the same sputum specimens. Excellent cell dispersion and definition in cytospins could be observed. The time required for differential cell counting on cytospins was reduced and cytospin counts were more reproducible than smears. Greater duration of treatment of sputum with dithiothreitol tended to increase total cell counts and significantly decreased EG2 staining but had no effect on differential cell counts or the cytokine cell components. Therefore the proposed method of sputum examination involving cell dispersion and use of cytospins overcomes a number of the disadvantages of the examination of smears.
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              Is amiodarone an underrecognized cause of acute respiratory failure in the ICU?

              Amiodarone is a commonly used anti-arrhythmic agent, with well-recognized chronic toxicity. Less well known is amiodarone's potential to cause acute lung damage, which can be severe or, occasionally, life-threatening. Lungs that have already been exposed to physical insults, such as the lungs of patients undergoing cardiac surgery, are particularly susceptible to acute pulmonary toxicity (APT). Unfortunately, cardiac surgery is one of the clinical scenarios in which amiodarone is most commonly used. After reviewing the data, and even in the context of difficulties and discrepancies in the existing literature, we contend that there is sufficient evidence of amiodarone's potentially serious side-effect profile in surgical ICU patients to advise continued caution in its use with this severely ill patient group. We suggest that amiodarone has a potentially important, though underrecognized, role in inducing an APT/ARDS in some patients, such as those undergoing cardiac surgery. We also provide a hypothesis to explain the mechanism by which amiodarone causes lung damage.

                Author and article information

                S. Karger AG
                November 2007
                07 November 2006
                : 108
                : 4
                : 223-227
                aThe Institute of Pulmonary and Allergic Diseases, bDepartment of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, cThe Department of Pulmonary Medicine, The Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
                96782 Cardiology 2007;108:223–227
                © 2007 S. Karger AG, Basel

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                Page count
                Figures: 1, Tables: 2, References: 26, Pages: 5
                Original Research


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