Eight years of unexplained headaches (why did the diagnosis take so long?)

Clinical Laboratory Science, Fall 2001 by Gade, Wayne

10. Buist AS, Burrows B, Eriksson S, and others. The natural history of air-flow obstruction in PiZ emphysema. Am Rev Resp Dis 1983; 127(suppl):s43-s5O. 11. Piitulainen E, Tornling G, Eriksson S. Environmental correlates of impaired lung function in non-smokers with severe ct I -antitrypsin deficiency (Pizz) Thorax 1998;53:939-43.

12. Brandy ML, Paul LD, Miller BH, and others. Clinical features and history of the destructive lung disease associated with al-antitrypsin deficiency of adult with pulmonary symptoms. Am Rev Respir Dis 1988;138:327-36.

13. Afdhal NH, Keaveny AP, Cohen SB, and others. Urinary assays for desmosine and hydroxylysylpyridinoline in the detection of cirrhosis. J Hepatol 1997;27(6):993-1003.

14. Bode DC, Pagani ED, Cumiskey WR, and others. Comparison of urinary desmosine excretion in patients with chronic obstructive pulmonary disease or cystic fibrosis. Pulm Pharmacol Ther 2000;13(4):175-80.

15. Sveger T. Liver disease in alpha,-antitrypsin deficiency detected by screening 200,000 infants. N Engl J Med 1976;294:1316-21.

16. Silverman EK, Miletich JP, Pierce JA, and others. alpha1-antitrysin deficiency. High prevalence in the St Louis area determined by direct population screening. Am Rev Resp Dis 1989;140:961-6.

17. Yu M-H, Lee K-N, Kim J. The Z type variant of human al-antitrypsin causes a protein folding defect. Nature Struct Biol 1995;2:363-7.

18. Carrell RW, Lomas DA, Sidhar S, Foreman R. al-Antitrypsin deficiency, a conformational disease. Chest 1996;110 suppl:s243-7.

19. Sveger T. al-antitrypsin deficiency in early chilhood. Pediatric 1978;62:22-5.

20. Sveger T, Eriksson S. The liver adolescents with ocl-antitrypsin deficiency. Hepatology 1995;22:514-7.

21. Talamo RC, Langley CE, Reed CE, Sohei M. alpha1-antitrypsin Deficiency: A Variant with No Detectable al-antitrypsin. Science 1973;181:70-1.

22. Larsson C. Natural history and life expectancy in severe al-antitrypsin deficiency PiZ. Acta Med Scad 1978;204:345-51.

23. Ofulue AF, Ko M. Effects of depletion of neutrophils or macrophages on development of cigarette smoke-induced emphysema. Am J Physiol 1999;277(1):L95-105.

24. Ofulue AF, Ko M, Abboud RT. Time course of neutrophil and macrophage elastinolytic activities in cigarette smoke-induced emphysema. Am J Physiol 1998;275(6):Ll 134-44.

25. Zay K, Loo S, Xie C, and others. Role of neutrophils and alphal-antitrypsin in coal- and silica-induced connective tissue breakdown. Am J Physiol 1999;276(2-1):1,269-79.

26. Harmening Denise M. Clinical hematology and fundamentals of hemostasis, 3rd ed. Philadelphia PA: FA Davis 1997.

Wayne Gade PhD MT is Director of Medical Technology Program, University of Wyoming, Laramie WY.

Address for correspondence: Wayne Gade PhD MT Director ofMedical Technology Program, University of Wyoming, PO Box 3837, Laramie WY82071-6751

The peer-reviewed Clinical Practice section seeks to publish case studies, reports, and articles that are immediately useful, of practical nature, or demonstrate improvement in the quality of laboratory care. Direct all inquiries to Bernadette Rodak MS CLS(NCA), CLS Clinical Practice Editor, Clinical Laboratory Science Program, Indiana University Fesler 409, 1120 South Avenue, Indianapolis, IN 46202-- 5113.; or send e-mail to brodak@iupui. edu