In April 1992 an outbreak of severe respiratory illness occurred among aerographic textile workers in the area of Alcoi, Autonomous Community of Valencia, Spain. An epidemiological study linked this outbreak to the use of a reformulated aerosolized product, Acramin-FWN. We analyzed clinical, laboratory, and pathological data of the first 14 patients with confirmed organizing pneumonia (OP) secondary to this newly recognized occupational toxicant. The mean age of the patients was 30 yrs. The most common clinical findings were cough (86%), epistaxis (71%), dyspnoea (64%), oppressive chest pain (57%), and crackles (50%). A restrictive functional pattern was evident in 64%. Radiographic findings consisted predominantly of patchy infiltrates in 65% and a micronodular pattern in 35%. Treatment with corticosteroids did not prevent initial progression in 11 of the 14 patients and development of irreversible respiratory failure in five patients. At necropsy, besides features of OP, interstitial fibrosis and diffuse alveolar damage were evident. A low total lung capacity, the presence of crackles at admission, and increases in the alveolar-arterial oxygen difference were predictive of death. The organizing pneumonia caused by the inhalation of Acramin-FWN is characterized by a tendency to evolve into progressive interstitial fibrosis despite the use of corticosteroids. The illness is restricted to the respiratory system and once respiratory failure has developed the prognosis is poor.
Background: Although organizing pneumonia (OP) is a common pathological finding, studies including a substantial number of patients with idiopathic forms from a unique center and a long follow-up are rare. Objectives: To determine patients with cryptogenic forms of organizing pneumonia (COP), in order to characterize their clinical course, to identify predictive factors for relapse and to assess their effect on outcome. Methods: For a 19-year period, all histopathological reports from a community teaching hospital were reviewed, and OP was found in 210 lung specimens belonging to 197 patients. Results: Thirty-three (17%) patients presented cryptogenic forms and 32 of them (97%) responded to steroid therapy. At follow-up, 14 patients presented no relapses (no-relapse group, NR) and 18 (56%) presented relapses (relapsing group, RG) that resolved with ulterior treatment. Multifocal opacities on chest X-ray (RG 83% vs. NR 36%, p = 0.02) appeared to be a predictor for relapse. Patients with relapses showed a shorter time span to chest X-ray normalization (RG 8 ± 8 weeks vs. NR 13 ± 9 weeks, p = 0.09) that became significant in patients with 3 or more relapses (multiple-relapse group, MR, 4 ± 2 weeks vs. NR 13 ± 9 weeks, p < 0.04). Although the initial prednisone dose was similar in patients with relapsing forms, its maintenance was shorter than in patients without relapses, showing a trend to significance (RG 4 ± 3 weeks, NR 7 ± 6 weeks, p = 0.09). Lower levels of lactate dehydrogenase and γ-glutamyltransferase, although always within the normal range, were found in patients with relapsing forms. Conclusion: COP is a specific but infrequent form of OP with a good response to steroid therapy. Relapses are frequent and typical characteristics of COP which resolved with ulterior treatment. Multifocal opacities on chest X-ray and a shorter maintenance of the initial steroid dose may increase the risk of relapse.
Intraspecific diversity can be strongly impacted by the dynamics of reproductive isolation during secondary contacts. The high levels of hybridisation and introgression between Atlantic and Mediterranean lineages in contemporary populations of brown trout in the Northern part of the French Alps are a good case in point. After a long period of allopatry, which one assumes has facilitated their divergent phenotypic and genetic evolution, man has removed a geographical reproductive barrier via stocking the Atlantic lineage in the Mediterranean area, thereby potentially enabling gene flow between native and non native populations. We investigate how much a prezygotic reproductive behaviour, that is female preference for male phenotype, can influence hybridisation in natural environments, using subaquatic video recording of reproduction. Our statistical model indicates that female preference appears to be largely heterogamous: females tend to select dissimilar males with respect to their own phenotype; thus, rather than acting as a barrier to gene flow, female preference is favouring gene flow between lineages that have been artificially placed in sympatry. This finding based on observational data is in agreement with previously reported genetic data, high levels of hybridisation between the lineages. We suggest that a knowledge of reproductive behaviour in natural environments is an essential tool for biodiversity managers to assess the potential risks associated with the introduction into recipient populations of non‐native lineage fish at the intraspecific level.
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