Acknowledgements

This work was carried out during the years 1990-1999 at the former Päivärinne Hospital, at the Department of Medical Biochemistry, University of Oulu and at the Departments of Internal Medicine and Pathology, Oulu University Hospital.

I owe my deepest gratitude to my supervisor Professor in Pulmonary Medicine Vuokko Kinnula, M.D, Ph.D. Without her continuous optimism concerning this work, enthusiasm, encouragement and support this study would hardly have been completed. I also express my warmest gratitude to my other supervisor Docent Lasse Ryhänen, M.D., Ph.D., who suggested this topic to me. His guidance into the world of collagen metabolism and supervision in laboratory analysis have been essential during this work.

I am deeply grateful to Professor Antero Kesäniemi, M.D., Ph.D., Head of the ­Department of Internal Medicine, Professor Kari Kivirikko, M.D., Ph.D., and Professor Taina Pihlajaniemi, M.D.,Ph.D., Heads of Department of the Medical Biocemistry for making it possible to carry out this work in their departments.

I want to express my gratitude to the revisors of the manuscript Docent Pekka Klemi, M.D., Ph.D., and Docent Onni Niemelä, M.D., Ph.D.

I also owe a great debt of gratitude to Docent Paavo Pääkkö, M.D., Ph.D., for introducing me to the interesting world of pulmonary pathology. He and Riitta Kaarteenaho-Wiik, M.D., co-operated especially with the immunohistological approach, which I ­greatly appreciate. I am deeply grateful to Professor Juha Risteli M.D., Ph.D., for his support during the development of the analysis and measurement of the procollagen markers and the histochemical study. Docent Seppo Lähde, M.D., Ph.D., deserves my deepest ­gratitude for his fundamental assistance in the radiological diagnostics. My special thanks are due to Essi Lakari, M.D., for collaborating with the patient information and later with the development of the immunohistochemical methodology.

I want to express my deepest gratitude to all my colleagues in the Department of ­Pulmonary Medicine of the former Päivärinne Hospital for introducing me to the fascinating world of pulmonary medicine, especially Eeva-Maija Ruotsalainen, M.D., and Docent Timo Keistinen M.D., Ph.D., who also performed most of the bronchoscopies and bronchoalveolar lavages for this study. I also want to thank all the patients who participated this study.

I owe my deepest gratitude to the staff of the Bronchoscopy Unit and Laboratory in the former Päivärinne Hospital. Without your practical attendance, this study would never have succeeded. I want to thank Ms. Riitta Jokela and Ms. Jaana Träskelin for their technical assistance during the analysis of serum and BALF specimens and Mr. Manu Tuovinen, Mr. Hannu Wäänänen and Ms. Liisa Kaarela for their expert help during the immunohistochemical study.

I owe my deepest gratitude to my own staff in the Department of Pulmonary Medicine in Vaasa Central Hospital for their patience and flexibility because of my periods of absence from daily work, particularly Harri Lemettinen, M.D., who has mainly been my substitute during these periods. I want to express my gratitude to my dear friend Väinö Louekari M.A., for his friendship during all these years and for the valuable –and sometimes long- discussions to remind that there is also life outside pulmonary medicine.

Finally, I wish to thank my dearest ones, my beloved wife Merja and our dear son Ville-Matias and precious daughter Marjukka for their love, support, patience and understanding during these years.

This work was supported by grants from Finnish Anti-Tuberculous Association Foundation, Technology Development Centre, Finland (TEKES), Suomen Astra and Doctoral Society of Vaasa.

Vaasa, August 1999                                                                      Lauri Lammi