Prognosis in cystic fibrosis

Prognosis for patients with cystic fibrosis has improved dramatically over the past three decades. In the United States, median survival age is now 28.9 years. Although genotype predicts exocrine pancreatic function, it does not correlate with pulmonary status or overall clinical outcome. However, there are a number of parameters, such as exocrine pancreatic sufficiency, male gender, absence of colonization with mucoid Pseudomonas aeruginosa, presentation with predominantly gastrointestinal symptoms, balanced family functioning and coping, and compliance with treatment regimens, that predict a more favorable outcome. The impact of early diagnosis and treatment is still controversial. Although nonblinded studies indicate decreased morbidity in the first 2 to 4 years of life among patients diagnosed by newborn screening, no data support long-term benefit in terms of pulmonary function or survival. With increased longevity, there is now evidence of a small but significantly increased risk of gastrointestinal tract cancer among patients with cystic fibrosis.     

Lung transplantation in cystic fibrosis

PURPOSE: To assess the non-cutaneous involvement in primary B-cell non-Hodgkin's lymphoma (NHL) of the skin. PATIENTS AND METHODS: Data from 45 patients with B-cell NHL of the skin were retrospectively analysed. The patients were diagnosed on histologic and immunocytochemical grounds between June 1977 and July 1993, and 14 cases were selected for their exclusively cutaneous initial involvement. Initial treatment, response to therapy, disease-free survival characteristics of relapse and therapeutic sequence were evaluated in every case. RESULTS: Cutaneous involvement presented as nodules or patches, on a single location, in 12 cases, or disseminated, in 2 others. No prognostic factor could be identified, and complete remission was attained in all cases. Cutaneous relapse was seen in 7 patients after 4 to 108 months since diagnosis. Extracutaneous dissemination was not seen in any case, and 13 patients are alive and disease-free. A 90 year-old woman died of toxic complications. CONCLUSIONS: The clinical facts reported here confirm the not too aggressive behaviour of certain B-cell cutaneous NHL, probably related with their origin on the skin itself.     

Systemic amyloidosis in cystic fibrosis

We report two siblings with cystic fibrosis and systemic amyloidosis. The major clinical problem in both cases was recurrent respiratory infection with pulmonary fibrosis and bronchiectasis prior to death at ages 20 and 22 years. Findings from postmortem examinations disclosed diffuse amyloidosis. In addition, amyloid infiltration developed in both patients, with enlargement of the thyroid gland, and one required thyroidectomy. An autopsy review of 17 additional cases of cystic fibrosis failed to disclose any other instances of systemic amyloidosis.     

Polyamine metabolism in cystic fibrosis

Increased blood levels of spermidine and an increased spermidine/spermine ratio is documented in 31 patients with cystic fibrosis (CF). Some 29 percent of CF patients overlap with the control group. An abnormality of urinary free polyamines or their metabolic derivatives related to electrolyte transport, serum ciliostatic factors, and the autonomic nervous system are elaborated upon.     

Pregnancy in patients with cystic fibrosis

With increasing life span of patients with CF, more women with CF are becoming pregnant and others are seeking information about the risks involved during pregnancy and delivery. A striking limitation of the available information is the lack of large prospective studies of pregnant patients with CF matched for age and disease severity compared with their non-pregnant cohorts. A study investigating the effect of pregnancy on morbidity and mortality is being completed by the Cystic Fibrosis Foundation. We recommend that all women with CF be offered contraceptive measures and counseling on the maternal and fetal risks of pregnancy, including the genetic risks for the child. The issue of who will raise the child in the event of subsequent morbidity or maternal mortality should ideally be prospectively discussed.     

L-fucose metabolism in cystic fibrosis fibroblasts

The capacity of skin fibroblasts from cystic fibrosis (CF) and non-CF individuals to incorporate exogenous L-fucose into various metabolic pools was compared. Incorporation into intracellular acid-soluble pools and extracellular glycopeptides was measured by a dual-label co-chromatographic technique, whereas total macromolecular incorporation was measured by a single-label procedure. Although CF and normal fibroblasts incorporate exogenous fucose into intracellular acid-soluble and high molecular weight compounds in a similar manner, CF cells appear to be characterized by an increased incorporation of label into low molecular weight extracellular glycopeptides.     

Gender gap in cystic fibrosis mortality

The authors conducted the largest study to date of survival in cystic fibrosis. The study cohort consisted of all patients with cystic fibrosis seen at Cystic Fibrosis Foundation-accredited care centers in the United States between 1988 and 1992 (n = 21,047), or approximately 85% of all US patients diagnosed with cystic fibrosis. Cox proportional hazards regression analysis was used to compare the age-specific mortality rates of males and females and to identify risk factors serving as potential explanatory variables for the gender-related difference in survival. Among the subjects 1-20 years of age, females were 60% more likely to die than males (relative risk = 1.6, 95% confidence interval 1.4-1.8). Outside this age range, male and female survival rates were not significantly different. The median survival for females was 25.3 years and for males was 28.4 years. Nutritional status, pulmonary function, and airway microbiology at a given age were strong predictors of mortality at subsequent ages. Nonetheless, differences between the genders in these parameters, as well as pancreatic insufficiency, age at diagnosis, mode of presentation, and race, could not account for the poorer survival among females. Even after adjustment for all these potential risk factors, females in the age range 1-20 years remained at greater risk for death (relative risk = 1.6, 95% confidence interval 1.2-2.1). The authors concluded that in 1- to 20-year-old individuals with cystic fibrosis, survival in females was poorer than in males. This "gender gap" was not explained by a wide variety of potential risk factors.     

Osteoporosis in patients with cystic fibrosis

Decreased bone density and increased risk of fractures are seen in patients with cystic fibrosis. Suboptimal vitamin D levels, nutrition problems, hypogonadism, inactivity, corticosteroid use, and cytokines may contribute to the low bone mass seen in these patients. Treatment recommendations must be individualized and may include nutrition, vitamin D, estrogen or testosterone, and exercise. In high-risk patients calcitonin or growth hormone could be considered.     

Early pulmonary disease in cystic fibrosis

Pulmonary bronchogenic cysts with tracheobronchial communication may occasionally mimic tension pneumothorax leading to unnecessary thoracostomy. We describe such a case to emphasize that cautious identification of the direction of displacement of the collapsed lung tissue on chest radiograph or computed tomography (CT) may help in differentiating these two diseases. Tension pneumothorax should lead to centripetal compression of the ipsilateral lung toward the hilum while giant bronchogenic cysts result in centrifugal displacement of the adjacent lung away from the hilum.     

The Irish cystic fibrosis database

We have found records of 1014 Irish cystic fibrosis patients alive by December 1994, belonging to 883 families. Prevalence in the population is 1/3475 and incidence at birth 1/1461, with a gene frequency of 2.6%. Twenty percent of the patients are aged over 20 years, but at present survival rate falls rapidly after that age. We have identified 85% of the mutations on the CFTR gene in a sample of 29% of the families (506 CF chromosomes). Mutation delta F508 is found in 72% of Irish CF chromosomes, G551D in 6.9%, and R117H in 2%. These are the highest frequencies reported for the latter two mutations world wide. Another seven mutations are found in an additional 4% of CF families. We present new microsatellite haplotype data that could be useful for genetic counselling of CF families bearing some of the 15% of CF mutations still unidentified, and comment on possible uses of our database.     

Lung transplantation for cystic fibrosis

This reprint of an article that first appeared in Nucleonics in 1966 provides a unique perspective of the introduction of the cyclotron into clinical medicine and medical research. The cyclotron offers a potentially powerful tool to biomedical centers. With this accelerator one can produce a variety of short-lived nuclides that are unavailable from other sources.     

Animal studies of cystic fibrosis

Cystic fibrosis is the most common life-threatening autosomal recessive genetic disorder in Caucasian populations. It is a disease primarily of epithelial tissues, including the airway, pancreatic duct, intestine, genital tract and sweat glands. The affected gene was cloned and characterized in 1989. In the absence of an identified natural animal model of the disease, a major effort has been made to develop transgenic cystic fibrosis mice, by disrupting the gene in these laboratory animals. Such mice show many, but not all, of the symptoms of cystic fibrosis. In this article, the major past and present contributions of other animal systems to our understanding of cystic fibrosis are examined and their potential for future studies of this disease are discussed. It is intended to give the reader a broad overview of the field, exploring the usefulness of animal studies, rather than dealing more fully with specific aspects of cystic fibrosis.     

Neonatal screening for cystic fibrosis

Cerebral atrophy often coexists with other brain disorders and by itself may alter the pattern of cerebral perfusion. If unrecognized, it may confound diagnoses based on brain single-photon emission tomography (SPET). In this retrospective study, we describe and evaluate criteria for the diagnosis of cerebral atrophy on technetium-99m hexamethylpropylene amine oxime brain SPET studies. The SPET scans of 11 patients with cerebral atrophy and ten controls were evaluated for the presence of a prominent interhemispheric fissure, presence of prominent cerebral sulci, separation of thalamic nuclei, and pronounced separation of caudate nuclei. The SPET studies were interpreted by two independent observers blind to the findings of magnetic resonance imaging, which provided the final diagnosis of cerebral atrophy. The combination of the four scintigraphic signs was accurate in the diagnosis of cerebral atrophy in 95% of the cases and had a sensitivity of 91% and a specificity of 100%.     

Atypical case of cystic fibrosis

A patient of cystic fibrosis is hereby reported. He had no family history and presented with chest symptoms, only. There was no evidence of hepatic or pancreatic involvement. To our knowledge this represents the first case of its kind from this part of country.     

New therapies for cystic fibrosis

In the decade since the gene responsible for cystic fibrosis (CF) was identified, our understanding of the pathophysiology of CF pulmonary disease has significantly improved. The current model for CF lung disease suggests several levels at which clinical interventions may be made in an attempt to alter the natural course of disease progression. The first part of this review highlights some of the progress made in novel forms of therapy directed at earlier portions of the pathophysiologic cascade such as gene therapy, protein therapy, and ion-transport regulatory therapy. New developments in well-established modes of therapy such as mucolytic therapy, airway clearance therapy, and antibiotic therapy are discussed next. The review concludes with a look at the use of two forms of therapy that have been adapted to CF care, anti-inflammatory therapy and lung transplantation.