bluuebunny/crossref_metadata_2025 huggingface dataset:
Metastatic prostatic adenocarcinoma-diagnosed by bronchoalveolar lavage and tumour marker determination
Authors: Verstraeten A , Sault MC , Wallaert B , Lemonnier P , Gosselin B , Tonnel AB
Published: November 2022

We report a patient who presented with a diffuse interstitial lung disease in whom clinical and radiologic investigation led to the suspicion of lymphangitis carcinomatosa. Bronchoalveolar lavage (BAL) was performed and revealed the presence of prostatic specific antigen (PSA) positive cells. A prostatic needle aspiration confirmed the diagnosis of adenocarcinoma. This case demonstrates the value of tumour marker determination in BAL.
Tracheobronchomegaly--the Mounier-Kuhn syndrome: report of two cases and review of the literature
Authors: Van Schoor J , Joos G , Pauwels R
Published: November 2022

Tracheobronchomegaly (TBM) is a rare disorder of uncertain aetiology, characterized by marked dilatation of the trachea and main bronchi, bronchiectasis and recurrent lower respiratory tract infections. Two patients with TBM are presented. In one case, a marked decrease of elastic and smooth muscle tissue was present in the bronchial biopsy specimens, obtained by rigid bronchoscopy. The airways of the second patient were visualized using computed tomography. The dimensions of the airways of our patients are compared with the normal values supplied in the literature.
Increased narrowing of bronchial segments from immature pigs
Authors: Mitchell HW , McFawn PK , Sparrow MP
Published: November 2022

Bronchial narrowing was investigated to determine whether changes in smooth muscle force, described previously in different aged pigs, are associated with differences in airway narrowing. The sensitivity of bronchial segments from suckling and young pigs was compared by perfusion through the lumen with a Krebs solution at a pressure of 5 cmH2O, measuring the reduction in flow in response to carbachol and histamine. Segments of the same internal diameter (i.d. approx. 2.5 mm) from each age were used by selecting proximal segments from suckling and distal segments from young pigs. The sensitivity to carbachol or histamine was the same in smooth muscle strips from proximal and distal bronchi in each age. Furthermore, segments from either age had a similar pressure-volume relationship between -10 and 30 cmH2O. However, concentration-flow curves showed that the airways from sucklings were five times more sensitive than airways from young animals to carbachol (p less than 0.01) and, less consistently, to histamine (p greater than 0.05), when flow was reduced by 50% of maximum. Flow was abolished by maximum concentrations of carbachol at both ages whereas histamine stopped flow in the young segments and reduced it by 80% in the suckling age group. Data indicate a greater sensitivity of bronchial narrowing to carbachol in the intact airway--this is consistent with a greater force production in suckling pig airway smooth muscle. These findings support a postnatal development of airway function, as suggested from clinical observations and provocation studies in humans.
Respiratory variation of the ballistocardiogram during increased respiratory load and voluntary central apnoea
Authors: Polo O , Tafti M , Hamalainen M , Vaahtoranta K , Alihanka J
Published: November 2022

Heavy snoring is associated with increased respiratory variation of the ballistocardiogram (BCG). The cause for this association is not known. Although the BCG is a sensitive method to measure myocardial performance, the validity of the signal as a marker of snoring-related haemodynamic changes has not been tested. The aim of this study was to investigate whether ballistocardiographic respiratory variation (BRV) correlates with intrathoracic pressure variation (IPV). The BRV and the IPV were measured in five healthy, normal-weight, awake adults during normal breathing, during breath-holding with constant intrathoracic pressure, and during breathing against increased respiratory resistance (high IPV). The BCG was recorded with the static charge-sensitive bed (SCSB) and the intrathoracic pressure with an oesophageal balloon. The mean BRV was significantly lower during central apnoea than during free breathing (8.2 versus 29.4% p less than 0.0001). When breathing against increased respiratory load, the BRV increased in a linear manner as function of the IPV (r = 0.68, p less than 0.01). There was significant interindividual variation in the response. We conclude that changes in the BRV reflect changes in the IPV. Further studies are needed to evaluate whether the BCG could be used as a noninvasive alternative to the oesophageal balloon in monitoring changes of respiratory resistance during heavy snoring.
Nocturnal oxygen saturation in advanced chronic obstructive pulmonary disease after a moderate dose of ethanol
Authors: Brander PE , Kuitunen T , Salmi T , Partinen M
Published: November 2022

The effect of a moderate oral dose of ethanol/(0.5 g.kg-1 body weight) on nocturnal arterial oxygen saturation (SaO2) was evaluated in nine male patients with advanced chronic obstructive pulmonary disease (COPD), (median forced expiratory volume in one second (FEV1) 0.9 l, arterial oxygen tension (PaO2) 9.3 kPa, arterial carbon dioxide tension (PaCO2) 5.3 kPa). During the four study nights (two after alcohol and two after placebo intake), the patients were monitored by whole-night computerized recordings of SaO2 (Biox-oximeter), airflow (thermistors) and respiratory as well as body movements (static charge sensitive bed). After alcohol intake, the mean blood ethanol concentration (SEM) in the evening was 42(2.3) mg.100 ml-1. Alcohol intake was associated with a marginal deterioration of nocturnal oxygenation; the mean (SEM) nocturnal SaO2 was 88.4(2.0) % after alcohol ingestion and 89.1(1.6) % after placebo ingestion, respectively. Only during the first 2 h in bed was there a statistically significant difference in SaO2 in favour of placebo (p less than 0.05). It is concluded that moderate alcohol intake in the evening, corresponding to "social" drinking, did not substantially aggravate nocturnal oxygenation in our patients with advanced COPD and mild to moderate daytime hypoxaemia.
Fibrosing alveolitis in an infant
Authors: Riedler J , Golser A , Huttegger I
Published: November 2022

A three month old female infant presented with unproductive cough, diffuse bilateral fine crackles, tachypnoea and failure to thrive despite a four month therapy with beta 2-agonists and antibiotics. A chest radiograph showing bilateral periphilar infiltrates and a patchy infiltrate in the right upper lobe and lingula did not explain the physical examination with diffuse bilateral fine crackles. As the condition did not improve and arterial oxygen tension (PaO2) and oxygen saturation decreased during the following two months, an open lung biopsy was performed. The surgeon described the lungs as rubbery in consistency and histological findings showed patchy mild interstitial fibrosis and thickened alveolar septa. A therapy with prednisone daily was started and given over a period of four months, but did not show sufficient improvement. Only after addition of azathioprine was clinical improvement and normalization of blood gases noted.
Superoxide anion release induced by platelet-activating factor is increased in human alveolar macrophages from smokers
Authors: Schaberg T , Haller H , Rau M , Kaiser D , Fassbender M , Lode H
Published: November 2022

This study was designed to investigate the effects of the platelet-activating factor (PAF) on the superoxide anion production (O2.) of human alveolar macrophages (AM) from nonsmoking (n = 18) and smoking (n = 30) subjects. Freshly isolated cells were stimulated with (PAF) or with a phorbol ester (phorbol 12-myristate 13 acetate (PMA)). Stimulation with PAF led to a dose-dependent increase of O2. production by AM in both groups. The median effective dose (EC50) for PAF action on O2. production of smoker AM was 0.5 x 10(-8) M, compared to nonsmoker AM with an EC50 of 1.0 x 10(-7) M. This effect of PAF was blockable by the PAF-antagonist WEB 2086 in a dose-dependent manner. Comparison of the relative increase of O2. production after PAF-stimulation showed that smoker cells were significantly more sensitive to PAF than nonsmoker cells (p less than 0.01). In contrast to the findings with PAF, the relative increase of O2. production after PMA-stimulation showed no differences between smoker and nonsmoker AM. Our data suggest that AM from smoking subjects are more sensitive to PAF than AM from nonsmokers.
Alveolar macrophages that suppress T-cell responses may be crucial to the pathogenetic outcome of pulmonary sarcoidosis
Authors: Spiteri MA , Clarke SW , Poulter LW
Published: November 2022

The alveolar macrophage (AM) population is widely recognized to be heterogeneous; distinct subpopulations can be identified by the use of macrophage-specific monoclonal antibody (MoAb) probes. We have isolated a macrophage subset that appears to react with both MoAbs that have previously discriminated between dendritic cells and classic macrophages. In the bronchoalveolar lavage (BAL) of patients with active sarcoidosis the proportion of this specific AM subpopulation increases dramatically (30.4 +/- 4.01% compared to 6.14 +/- 1.56% in normal BAL). This AM subset not only increases in direct proportion to the lavage lymphocytosis, but also exhibits sarcoid-related differences in surface receptor expression, physiology and induction of T-cell responses. An increased number of these AM expressed a separate antigen RFD9 (which identified epithelioid cells), and had raised fibronectin content, increased phagocytosis, and high lysosomal enzyme activity. Of functional significance, we found that while in normal volunteers this specific AM subset was capable of down-regulating by as much as 40% the induction of T-cell responses set up by other stimulator macrophages, in sarcoid patients this suppressor activity was enhanced, such that T-cell responses were completely abolished. In some studies this action was masked by the reduced enhancing capacity of sarcoid inducer AM. We postulate that the presence of an increased proportion of these suppressor AM (together with their sarcoid-specific features) in active sarcoidosis is of crucial significance in determining the fate of granulomata in the lungs of these patients.
Continuous longitudinal regression equations for pulmonary function measures
Authors: Sherrill DL , Lebowitz MD , Knudson RJ , Burrows B
Published: November 2022

The data from a longitudinal population study in Tucson, Arizona, were used to describe the development and decline of maximal expiratory flow-volume (MEFV) measures with age. On the basis of their answers to self-administered questionnaires, in 9 of the first 10 surveys (1972-1988) and having performed at least one MEFV test, 930 nonsmoking healthy subjects were selected, providing 3,848 individual observations. The data were analysed using statistical methods that yield continuous piecewise linear regression equations and allow subjects to have repeated measures which are unequally spaced and at different times for different subjects. In addition, the age intervals for the piecewise linear line segments are estimated for each of the MEFV indices, as part of the modelling procedure. The resulting predicted values are compared between sexes and to previously published cross-sectional results from the same population. All MEFV measures in healthy subjects have an early increase in the rate of development corresponding to the onset of the adolescent growth spurt. This rapid growth period is followed by a plateau phase which lasts around 10 yrs for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) in males, in which growth continues, but at a much lower rate. The plateau phase, is followed by a constant rate of decline which lasts throughout adulthood. In contrast, flow measures did not have a detectable plateau period, but did have points of increased rates of decline much later in life.
Standardization of single-breath transfer factor (TLCO); derivation of breathholding time
Authors: Chinn DJ , Harkawat R , Cotes JE
Published: November 2022

Breathholding time is usually defined using the procedure of Ogilvie et al. or of Jones and Meade; these procedures depend on knowing when inspiration begins and, for the latter, when it ends. Some alternative procedures do not require this information. With a view to standardizing the measurement, transfer factor of the lungs for carbon monoxide (TLCO) was measured in 18 adults with labile airflow obstruction, who were assessed before and after inhalation of salbutamol. The inflection points defining the start and end of inspiration were defined visually (method 1), and by extrapolation of the linear part of the inspiratory limb of the single-breath trace (method 2). The spirograms met recognized standards of quality and were rated by experienced observers. Compared with method 1 the TLCO and related indices by method 2 were lower using the procedure of Jones and Meade and higher using the procedure of Ogilvie et al. in each case by, on average, 1.0%. The within- and between-day variabilities were independent of the method used. Thus, the extrapolation and visual methods yielded interchangeable results when applied by experienced operators. However, extrapolation may be easier for inexperienced operators.
Alpha 1-antitrypsin alleles in patients with pulmonary emphysema, detected by DNA amplification (PCR) and oligonucleotide probes
Authors: Bruun-Petersen K , Bruun-Petersen G , Dahl R , Larsen B , Kolvraa S , Koch J , Bolund L , Gregersen N
Published: November 2022

Alpha 1-antitrypsin (AAT) deficiency is a serious predisposing factor for the development of pulmonary emphysema. Twelve representative Danish families were studied. AAT typing was performed as a comparative study between the traditional protein typing by isoelectrical focusing and the deoxyribonucleic acid (DNA) technique of enzymatic amplification and subsequent typing with radioactively labelled oligonucleotide probes. On the basis of clinical and radiological signs of pulmonary emphysema, 25 patients were selected. AAT typing was performed by use of the two techniques in combination, in search for new point-mutations among the patients. Results obtained with the two techniques were discordant in one patient, suggesting an unknown variant. The unexpectedly high PiZ frequency of 0.22 found in the study group is discussed.
Secretory leucocyte proteinase inhibitor: inhibition of fibronectin degradation by neutrophil elastase
Authors: Gervaix A , Thompson R , Bieth JG , Nick HP , Suter S
Published: November 2022

Degradation of surface-bound fibronectin of the upper respiratory tract by human leucocyte elastase (HLE) was shown to favour colonization of these mucosal surfaces by Gram-negative bacteria. We investigated the degradation of fibronectin by purified HLE and by enzymes released from stimulated human polymorphonuclear leucocytes (PMNs), in the presence of recombinant secretory leucocyte proteinase inhibitor (rSLPI) and alpha 1-proteinase inhibitor (alpha 1-PI), the two main inhibitors of HLE within the airways. Our results show that HLE degraded fibronectin at concentrations as low as 0.2 nM. To inhibit the degradation of fibronectin by pure HLE in an experimental system in which the enzyme was premixed with inhibitor, a twofold molar excess of rSLPI and an equimolar concentration of alpha 1-PI were required. On the other hand, a fivefold molar excess of rSLPI was necessary to inhibit degradation of fibronectin by enzymes released from stimulated neutrophils. In order to estimate the role of oxidants generated by stimulated PMNs in the activation of the inhibitory capacity of rSLPI by stimulated PMNs, we preincubated PMNs with antioxidants such as superoxide dismutase, methionine, catalase or Na-azide prior to stimulation of the cells. Under these conditions, a threefold molar excess of rSLPI over released HLE was required to inhibit the degradation of fibronectin, raising the possibility that either exogenous or endogenous antioxidants in the lung could be important in improving the efficacy of this therapeutic antiprotease. We conclude that a molar excess of rSLPI to HLE is always necessary to inhibit fibronectin degradation by HLE, and that addition of antioxidants partly prevents the inactivation of rSLPI by oxidants released from stimulated PMNs.
Pneumocystis carinii pneumonia in HIV-infected patients: diagnostic yield of induced sputum and immunofluorescent stain with monoclonal antibodies
Authors: Fortun J , Navas E , Marti-Belda P , Montilla P , Hermida JM , Perez-Elias MJ , Buzon L , Guerrero A
Published: November 2022

The purpose of this study was to evaluate the diagnostic yield of induced sputum (IS), assessing the reliability of indirect immunofluorescent stain with monoclonal antibodies (IFMoAb) and methenamine silver (Met-Ag) and analysing factors likely to influence the sensitivity of these techniques. An analysis was prospectively carried out on IS specimens collected from 61 human immunodeficiency virus (HIV)-infected patients during 69 episodes of suspected Pneumocystis carinii pneumonia. Ultrasonic nebulizers with hypertonic 2% saline were used. IFMoAb to P. carinii and Met-Ag were performed after cytocentrifugation of the specimen. Results were compared with those of bronchoalveolar lavage (BAL) with/without transbronchial biopsy (TBB), performed not more than seven days after induction of sputum. P. carinii pneumonia was confirmed in 32 episodes, of which IS was diagnostic in 23. The sensitivity of the staining procedures was 69% for IFMoAb, and 28% for Met-Ag. The three episodes of P. carinii pneumonia in patients on oral chemoprophylaxis yielded negative IS results; in contrast, IS was negative in only 6 of the 29 cases not receiving chemoprophylaxis. IS is a non-aggressive procedure that diagnosed P. carinii pneumonia in 72% of our cases. The yield increased significantly when IFMoAb was used in patients not receiving oral chemoprophylaxis.
Urinary leukotriene E4 in bronchial asthma
Authors: Smith CM , Hawksworth RJ , Thien FC , Christie PE , Lee TH
Published: November 2022

Leukotriene E4 (LTE4) is excreted into the urine in a relatively constant proportion of 4-7% when either leukotriene C4 (LTC4) or LTE4 is intravenously infused, regardless of the magnitude of the infused dose. Measurement of LTE4 in urine is, therefore, a convenient and non-invasive method for assessing changes in the rate of total body sulphidopeptide leukotriene production. We assayed urinary LTE4 in 17 normal subjects, 31 subjects with asthma without aspirin sensitivity, and 10 aspirin-sensitive subjects. The relationship between urinary LTE4 and nonspecific bronchial hyperresponsiveness, as assessed by the provocative dose producing a 20% fall in forced expiratory volume in one second (PD20) to inhaled histamine, was examined in 19 non-aspirin-sensitive asthmatic subjects. The urinary LTE4 values were log-normally distributed. Urinary LTE4 was detected in 28 of the 31 non-aspirin-sensitive asthmatic subjects, and the geometric mean (95% confidence interval (CI) of 43 (32-57) pg.mg-1 creatinine was no different to that of 34 (25-48) pg.mg-1 creatinine measured in the normal subjects. The geometric mean of 101 (55-186) pg.mg-1 creatinine measured in the aspirin-sensitive asthmatics was significantly higher than that measured in the normal subjects (p less than 0.005) and in the asthmatic subjects who were non-aspirin-sensitive (p less than 0.002), but there was considerable overlap between the three groups. There was no relationship between urinary LTE4 and PD20, or between urinary LTE4 and baseline forced expiratory volume in one second (FEV1) (% predicted). Thus, measurement of LTE4 in a single sample of urine will not predict the extent of bronchial hyperresponsiveness or degree of airflow obstruction.
No influence of airway heat flux on airflow-induced bronchospasm
Authors: Fuller SD , Freed AN
Published: November 2022

We used a canine model of airway reactivity to examine the role of airway heat flux in the response to dry air challenge. Airflow-induced bronchospasm (AIB) was assessed by measuring collateral system resistance (Rcs) with a wedged bronchoscope technique in anaesthetized mechanically ventilated dogs. We manipulate post-challenge airway heat flux by exposing peripheral airways to cool dry air (23.9 +/- 0.3 degrees C, 0.8 +/- 0.2 mgH2O.l-1), cool humid air (24.2 +/- 0.2 degrees C, 21.5 +/- 0.3 mgH2O.l-1), or warm humid air (35.3 +/- 0.4 degrees C, 40.6 +/- 0.3 mgH2O.l-1) during the recovery period (n = 14) following a high flow challenge (1,500 ml.min-1 for 2 min) with cool dry air. In a second series of experiments (n = 6), we attempted to further exaggerate airway heat flux during challenge by exposing peripheral airways to warm humid air during both baseline and recovery periods. In comparison to control (i.e. treatment with cool dry air before and after challenge), treatment with warm humid air during recovery period produced a small but significant attenuation (p less than 0.01) in Rcs. Cool humid air during recovery had no affect on Rcs following challenge. Warm humid air during both baseline and recovery tended to attenuate Rcs after challenge (p less than 0.05). We conclude that airway heat flux in itself has no significant physiological affect on AIB in the canine lung periphery.
Fractional processing of sequential bronchoalveolar lavage fluid from intubated babies
Authors: Grigg J , Arnon S , Silverman M
Published: November 2022

Two groups of intubated newborn babies were studied to determine the clinical effects of interrupted bronchoalveolar lavage (BAL) by suction catheter (S-BAL) and the similarities to adult fibreoptic BAL of fractional processing of sequential lavage fluid (BALF). Both groups were lavaged by two aliquots of 1 ml.kg-1, instilled via a blindly placed suction catheter, wedged on two separate insertions through the right main bronchus. In 14 infants, (sequential lavage group), BALF aliquots were analysed separately. There were no differences in the volumes recovered or total cell counts between the first and second BALF aliquots. Where cell morphology was visible (n = 11), the percentage of macrophages, but not the absolute number, increased in the second BALF aliquot (p less than 0.01). BALF urea and epithelial lining fluid volume estimated by urea dilution were similar between the two aliquots (n = 8). In a separate group (blood gas group), vital signs were recorded in 10 infants undergoing S-BAL. At 1 min after lavage there was a rise in mean arterial blood pressure (39 vs 49.5 mmHg, p less than 0.05) and a fall in transcutaneous oxygenation (10.6 vs 7.5 kPa, p less than 0.05). Recovery was present at 3 min post-S-BAL, but mean blood pressure remained elevated (39 vs 45 mmHg, p less than 0.05) and transcutaneous oxygen continued to be lower when compared to baseline values (10.6 vs 9.2 kPa, p less than 0.05). S-BAL of intubated infants appears to sample both the proximal and distal airways and results in changes in vital signs similar to routine non-selective endotracheal suctioning.
Hypoxaemia and liver cirrhosis: a new argument in favour of a "diffusion-perfusion defect"
Authors: Thorens JB , Junod AF
Published: November 2022

Liver cirrhosis is sometimes associated with very severe hypoxaemia, which is thought to be the result of intrapulmonary vascular dilatations (IPVDs). These vascular abnormalities, although close to the gas exchange units, are so dilated that diffusion of oxygen molecules to their centre is impaired, causing an increase in alveolar-arterial oxygen tension difference (P(A-a)O2). On the other hand, administration of 100% oxygen provides enough driving pressure to overcome this relative diffusion defect and rules out a true intrapulmonary shunt. We report a case in which, in spite of a normal increase in arterial oxygen tension (PaO2) under 100% oxygen, exercising results in a marked impairment of oxygen exchange and a large intrapulmonary shunt. This is probably due to the increased cardiac output and preferential blood flow through these low resistance IPVDs.
Smoking-induced changes in epithelial lining fluid volume, cell density and protein
Authors: Burke WM , Roberts CM , Bryant DH , Cairns D , Yeates M , Morgan GW , Martin BJ , Blake H , Penny R , Zaunders JJ , et al.
Published: November 2022

Bronchoalveolar lavage has proved a useful research technique for recovering cellular and molecular contents of the lower respiratory tract. Because the recovered fluid is variably diluted, an accurate estimation of molecular and cellular concentrations can only be made if the epithelial lining fluid volume recovered is also known. It has been suggested that smoking may alter epithelial lining fluid volume by reducing clearance or by stimulating production and, thus, affect the interpretation of bronchoalveolar lavage studies. In this study, urea was used as an endogenous marker of epithelial lining fluid volume in a comparison of 26 smokers and 31 nonsmokers. The mean epithelial lining fluid volume recovered from smokers was significantly greater than that of nonsmokers (2.4 +/- 1.40 ml vs 1.2 +/- 0.75 ml, p less than 0.005). The total cellular concentration in the bronchoalveolar lavage fluid in smokers was also greater (94.2 +/- 46 x 10(6) vs 33.9 +/- 21.5 x 10(6) cells per 300 ml lavage), even when corrected for bronchoalveolar lavage volume recovered (63.1 +/- 32.5 x 10(6) vs 24.9 +/- 13.3 x 10(6) cells per 100 ml recovered lavage fluid). This was true for macrophage, lymphocyte and neutrophil cell numbers. However, when corrected for the apparent epithelial lining fluid volume, only the macrophage count remained significantly higher in the smokers compared with nonsmokers (30.66 +/- 20.7 x 10(6) vs 18.21 +/- 8.6 x 10(6) macrophages.ml-1 ELF). In addition, concentrations of albumin and immunoglobulin M (IgM) were significantly lower in smokers after correction for epithelial lining fluid volume. These results highlight smoking as a confounding factor in the interpretation of bronchoalveolar lavage data.(ABSTRACT TRUNCATED AT 250 WORDS)
A twelve month comparison of salmeterol with salbutamol in asthmatic patients. European Study Group
Authors: Britton MG , Earnshaw JS , Palmer JB
Published: November 2022

The efficacy and tolerability of salmeterol, 50 micrograms b.i.d. was compared for three months with salbutamol, 200 micrograms q.i.d., administered from metered-dose inhaler. For the following nine months, safety and clinic lung function was monitored on salmeterol, 50 micrograms b.i.d., compared with salbutamol, 200 micrograms b.i.d. This comparison was made in a multicentre, double-blind, parallel-group study of 667 moderate asthmatics, who had a forced expiratory volume in one second (FEV1) or peak expiratory flow rate (PEFR) > 50% predicted, a 15% reversibility to inhaled salbutamol and who were experiencing symptoms. Throughout the first three month treatment period, both morning and evening PEFR were significantly higher on treatment with salmeterol than salbutamol (mean differences between the treatments 30 l.min-1 for morning, p < 0.001, and 11 l.min-1 for evening, p < 0.01). In addition, the diurnal variation in PEFR, nocturnal and daytime symptoms and use of additional salbutamol were significantly lower in the salmeterol treated group. This improvement was also apparent in the separate subpopulations of patients taking no concurrent glucocorticosteroid or concurrent inhaled and/or oral glucocorticosteroids. Both treatments were well-tolerated throughout the 12 months of treatment. There was a lower incidence of asthma and related events during salmeterol treatment compared to salbutamol treatment subgroups. The results of the study clearly demonstrate that salmeterol, 50 micrograms b.i.d., is well-tolerated and more effective than salbutamol, 200 micrograms q.i.d., in the treatment of moderate asthma.
Relationship of the type of tobacco and inhalation pattern to pulmonary and total mortality
Authors: Lange P , Nyboe J , Appleyard M , Jensen G , Schnohr P
Published: November 2022

Data from The Copenhagen City Heart Study, a prospective population study, were analysed to investigate the influence of the type of tobacco and inhalation on pulmonary and total mortality. The study sample comprised 6,511 men and 7,703 women, selected randomly after age-stratification from the general population. There were 2,986 plain cigarette smokers, 3,222 filter cigarette smokers, 1,578 smokers of cheroots/cigars, 433 male pipe smokers and 773 subjects smoking more than one type of tobacco. From 1976 until the end of 1989, 2,765 subjects died. Lung cancer was considered as main death cause in 268. Chronic obstructive pulmonary disease (COPD) was considered as the main cause in 94 cases and main or contributory cause of death in 195 cases (COPD related mortality). Current smokers had a higher risk of total mortality compared to lifetime nonsmokers: the relative risks (RR) ranged between 1.2 for male pipe smokers and 2.4 for female plain cigarette smokers. With regard to lung cancer mortality, the RR ranged between 4.1 for male pipe smokers and 7.9 for female plain cigarette smokers. Even higher RR values were estimated for COPD related mortality. In both sexes, the RR for the investigated end-points were lower in cheroot/cigar smokers and in pipe smokers than in cigarette smokers, but these differences were markedly diminished after an adjustment for the inhalation habit. The present study substantiates the view that tobacco smoking increases pulmonary and total mortality. The small differences between the various types of tobacco are probably caused by different inhalation patterns.
Breath-actuated inhalers in chronic asthma: comparison of Diskhaler and Turbohaler for delivery of beta-agonists
Authors: Brown PH , Lenney J , Armstrong S , Ning AC , Crompton GK
Published: November 2022

An open, randomized, cross-over study was performed to compare the efficacy and acceptability of two breath-actuated inhalers, the Turbohaler (T) and Diskhaler (D), for delivery of beta-agonists. Thirty six adults with chronic asthma requiring beta-agonists four times daily were treated with terbutaline 500 micrograms via T and salbutamol 400 micrograms via D four times daily, each period lasting four weeks. Additional bronchodilator via pressurized aerosol was permitted as required. Peak expiratory flow (PEF) was recorded in the morning (before and after beta-agonist) and in the evening. The mean morning PEF was higher during the first two weeks using T (295 l.min-1) than whilst using D (281 l.min-1, p < 0.01), but this difference did not persist during the second two weeks and there were no differences in post-bronchodilator PEF or rescue beta-agonist use. After four weeks, > 90% of patients used both inhaler devices efficiently and they were equally acceptable in terms of ease of use and convenience to carry. The Diskhaler and Turbohaler achieve similar clinical efficacy for delivery of beta-agonists.
Nosocomial pneumonia in critically ill comatose patients: need for a differential therapeutic approach
Authors: Rello J , Ausina V , Ricart M , Puzo C , Net A , Prats G
Published: November 2022

The purpose of this prospective clinical study was to determine the incidence, bacteriology and outcome of lower respiratory tract infections developed among 208 consecutive, critically ill comatose patients, hospitalized in a university hospital, medical-surgical intensive care unit, over a three year period. Nosocomial pneumonia developed in 53 (25%) patients after a mean of 8.1 days (range 3-31 days). Furthermore, there were five superinfections, raising the mean incidence to 28%. One patient developed secondary bacteraemia, and another two had septic shock. Fifteen (28%) patients from the pneumonia group died, and six of these deaths were considered to be directly related to nosocomial pneumonia. Identification of the causative agent, using the protected specimen brush technique, was possible in 42 episodes; in 10 (24%) of these cases more than one microorganism was isolated. Gram-positive cocci represented 53% of isolates, and Staphylococcus aureus accounted for 78% of all Gram-positive cocci, being the most frequent microorganism in this population. In conclusion, nosocomial pneumonia is a common complication of critically ill comatose patients. Its characteristic aetiological spectrum in this population should affect antibiotic prescription. Consequently, we suggest including antimicrobial drugs which are active against S. aureus in the empirical regimen until aetiological diagnosis is established.
Pulmonary alveolar microlithiasis and lymphocytic interstitial pneumonitis in a ten year old girl
Authors: Ratjen FA , Schoenfeld B , Wiesemann HG
Published: November 2022

Pulmonary alveolar microlithiasis (PAM) is a rare lung disease, characterized by progressive formation of intra-alveolar calculi in response to an unknown stimulus. We report an unusual presentation of PAM in a 10 year old girl with clinically significant interstitial lung disease and histological evidence of both PAM and lymphocytic interstitial pneumonitis. A rapid improvement of pulmonary function and exercise tolerance was seen in response to glucosteroid therapy.
Systemic to pulmonary vascular malformation
Authors: Pouwels HM , Janevski BK , Penn OC , Sie HT , ten Velde GP
Published: November 2022

A case is reported of life-threatening haemoptysis as a result of an anomalous communication between a bronchial artery and pulmonary vein, demonstrated by angiography. The patient recovered following bilobectomy of the right lower and middle lobes. When a systemic artery is involved in an arteriovenous malformation of the lung, haemodynamics are different compared with those present in malformations fed by the pulmonary artery. This implicates other clinical features, options for surgical intervention and prognosis. In reviewing the literature, a relationship with Rendu-Osler-Weber disease is absent in these specific malformations.
Inhaled loop diuretics as potential new anti-asthmatic drugs
Authors: Bianco S , Pieroni MG , Refini RM , Robuschi M , Vaghi A , Sestini P
Published: November 2022

The observation that changes in bronchial osmolarity can induce bronchoconstriction in asthma inspired the experimental studies which, unexpectedly, revealed that frusemide is an effective bronchoprotective agent against a variety of osmotic and non osmotic stimuli. Although the mechanism of this protective effect is not fully understood, studies in vivo and in vitro suggest that frusemide may inhibit the activation of different cell types induced by bronchoconstrictor stimuli. Other loop diuretics also exert bronchoprotective activity, but frusemide appears to be the more effective bronchoprotective agent of this family, regardless of their diuretic potency and lipid solubility. Despite the relatively large amount of experimental evidence, there is currently little information on the clinical effectiveness of frusemide in asthma and a long-term controlled study is currently in progress. The observations that treatment with a combination of inhaled acetylsalicylate and frusemide results in a markedly increased bronchoprotective effect compared to either drug alone, opens a new perspective in the possible clinical use of these drugs. Preliminary studies suggest that the association of these drugs is well tolerated and may result in a remarkable steroid sparing effect in patients with steroid dependent asthma, for whom a convenient alternative to long-term steroid therapy is not currently available.
Localization of the cystic fibrosis transmembrane conductance regulator in airway secretory glands
Authors: Jacquot J , Puchelle E , Hinnrasky J , Fuchey C , Bettinger C , Spilmont C , Bonnet N , Dieterle A , Dreyer D , Pavirani A , et al.
Published: November 2022

Cystic fibrosis (CF) is caused by mutations in the gene coding for the CF transmembrane conductance regulator (CFTR). From human normal tracheal submucosal gland cells in culture, we identified endogenous CFTR as a 170 kDa protein, consistent with that of fully glycosylated, mature CFTR molecule. This observation led to the hypothesis that airway secretory glands could be an important site for the CFTR expression. Using anti-human CFTR polyclonal and monoclonal antibodies, we examined the cellular and subcellular localization of the CFTR protein in airway submucosal glands from human and bovine tracheal tissues as well as in tracheal gland cell cultures. In human tracheal tissue, CFTR immunolabelling was present along both the apical and basolateral plasma membranes of glandular mucous cells. In contrast, CFTR was associated with the secretory granules of glandular serous cells. Using immunogold electron microscopy, we demonstrated that CFTR protein was more specifically associated with the membrane of serous cell secretory granules. In bovine tracheal tissue CFTR labelling was also identified in the secretory granules of glandular serous cells. In contrast, when bovine and human tracheal gland cells were cultured, no mature secretory granules were present, but a predominantly intracytoplasmic distribution of CFTR was observed. Our data thus suggest that in airway tissues, CFTR could be involved in intracellular processes of the mucus exocytosis in submucosal secretory glands.
Bronchial responsiveness to inhaled propranolol in asthmatic children and adults
Authors: Foresi A , Chetta A , Pelucchi A , Mastropasqua B , Moretti D , Olivieri D
Published: November 2022

Inhaled propranolol (P) was administered to a population which included asthmatic children (30 subjects) and adults (43 subjects): 1) to investigate the determinants of induced bronchial response; 2) to examine the relationship with treatment requirements; 3) to determine the relationship with responsiveness to methacholine (M) and ultrasonically nebulized distilled water (UNDW) (50 subjects); and 4) to establish the short-term repeatability of bronchial response to propranolol compared with methacholine (22 subjects). Bronchial response to propranolol and methacholine was expressed as the cumulative provocative dose (PD20 in mumol) and responsiveness to UNDW as the provocative output (PO20 in ml.min-1) producing a 20% fall in forced expiratory volume in one second (FEV1). Response to propranolol was significantly related to the degree of responsiveness to methacholine, but not to age, gender, presence of atopy, age at asthma onset, or baseline FEV1. PD20P was measurable in all but three subjects. A significant difference in mean PD20M but not in PD20P was found between subjects requiring more anti-asthmatic treatments compared to those without therapy. The difference between geometric mean PD20P and geometric mean PD20M was 14.1. PO20UNDW was measurable in only 21 out of 50 subjects. Both PD20P and PD20M were significantly lower in responders to UNDW than in nonresponders. Reproducibility of PD20P was comparable to that of PD20M (coefficients of repeatability: 1.17 and 1.09). We conclude that bronchial responsiveness to propranolol is safely measurable in most children and adults with asthma. Repeatability of bronchial response to propranolol is comparable to that of methacholine. Moreover, responsiveness to propranolol is not a predictor of treatment requirement.(ABSTRACT TRUNCATED AT 250 WORDS)
Force-frequency relationships of in vivo human and in vitro rat diaphragm using paired stimuli
Authors: Yan S , Gauthier AP , Similowski T , Faltus R , Macklem PT , Bellemare F
Published: November 2022

Supramaximal stimuli, with time intervals of 100 ms (10 Hz) to 10 ms (100 Hz), were delivered in pairs to the phrenic nerves, bilaterally, in five seated normal subjects, while transdiaphragmatic pressure swings (Pdi,s) were recorded at relaxed end-expiratory lung volume with airways closed. In fresh diaphragms, Pdi,s increased between 10-20 Hz and reached a plateau between 20-30 Hz. Diaphragmatic fatigue decreased Pdi,s at all frequencies. Pdi,s was assumed to be the sum of two successive responses (T1+T2), T1 being constant at any frequency and equal to a single twitch, T2 being obtained by subtraction. We found that T2 amplitude, which was significantly reduced after fatigue, was fully returned to normal after 15 min rest at high, not at low, stimulation frequencies. The ratio of T2 at 10 Hz over 100 Hz (T2(10/100)) thus decreased from 1.33 +/- 0.05 before fatigue to 0.97 +/- 0.12 after fatigue, and to 0.81 +/- 0.06 after 15 min rest. Similar results were obtained in isolated rat diaphragmatic strips stimulated and fatigued in vitro, from which we found a highly linear relationship (r = 0.94, p < 0.001) between the ratio of T2(10/100) and that of tetanic force at 10 Hz over 100 Hz (P10/100). We conclude that phrenic nerve paired twitches provide similar information when obtained from phrenic tetanic stimulation in terms of diaphragmatic contractility, and the decrease in T2(10/100) ratio indicates diaphragm low frequency fatigue.
Effect of pleural effusion on respiratory mechanics, and the influence of deep inflation, in dogs
Authors: Dechman G , Sato J , Bates JH
Published: November 2022

We wished to study how pleural effusion affects dynamic mechanics of the lung and the chest wall. We also determined if these changes could be reversed by deep lung inflations. Pleural effusion was produced by saline infusion into the pleural space. During the infusion and over the following 2 hours, dynamic elastance and resistance of the lungs, the chest wall and the whole respiratory system were recorded. Dynamic elastance and resistance of the lung increased significantly during fluid loading and were partially, and only transiently, reversed by deep inflations. Dynamic elastance and resistance of the chest wall were little affected by these procedures. Thus, pleural effusion can have significant effects on dynamic elastance and resistance of the respiratory system (ERS, RRS). The transient nature of the change in lung parameters after deep inflation suggests that therapies based on periodic lung inflations may be of little benefit to patients with this condition.
Membrane diffusion of the lungs in patients with chronic renal failure
Authors: Moinard J , Guenard H
Published: November 2022

Patients with chronic renal failure (CRF) and haemodialysis treatment usually have a reduced CO transfer factor. The aim of this study was to evaluate the effects of alveolar wall fibrosis and of anaemia on gas diffusion in the lungs. The NO and CO transfer factors of the lung (TLNO and TLCO) were measured, simultaneously, in 15 patients haemodialysed three times a week for 1-10 yrs. Assuming that NO is highly reactive with blood, Tlno is thus directly proportional to the membrane diffusion factor (DmCO). The lung capillary blood volume (Vc) was derived from the set of the two transfer equations. Transfer factors were measured between haemodialysis sessions. All patients but one were anaemic, with haemoglobin concentrations ranging 61-151 g.l-1. All had decreased Vc, and a decreased DmCO was observed in 14 patients. However, after correction for the anaemia, Vc values were normal with the exception of three patients. The percentage decrease in DmCO with respect to normal was correlated with the time elapsed since the first haemodialysis. These results support the idea of a progressive development of haemodialysis-induced chronic lung disease, that may be related to a mechanism of complement activation by a bio-incompatible membrane (Cuprophane). Accordingly, patients with compromised cardiopulmonary functions should be dialysed with a bio-compatible membrane.
Treatment of hydatid disease in childhood with mebendazole
Authors: Gocmen A , Toppare MF , Kiper N
Published: November 2022

The general characteristics of 56 childhood cases of cystic hydatid disease were analysed and the results of mebendazole therapy versus surgery were verified. Pulmonary radiograms and ultrasonography were used in the diagnosis. The cysts were localized primarily to the lungs. Twenty seven patients were surgically-treated, with eight having recurrence after a mean period of 3.6 yrs. Thirty patients received regular mebendazole treatment, in a dose of 50 mg.kg-1 with a mean duration of treatment of 11.7 months. Twenty one patients were cured and discontinued the therapy. Nine still use the drug, seven of whom have had dramatic improvement, while the other two have minimal radiographic changes but subjective improvement in general condition. The lung cysts vanished leaving minimal scars, whilst the liver cysts turned into inactive forms. The surgically-treated and drug-treated groups were similar in age, duration and severity of the disease. The recurrence rate of drug-treated children (1 out of 20) was lower than that of the surgically-treated children (8 out of 27); however, this was not statistically significant.
Reliability of a monitoring system for respiratory emergency room admissions
Authors: Martinez F , Sunyer J , Anto JM
Published: November 2022

A respiratory emergency room admissions monitoring system (RERAMS) was set up in Barcelona between 1985-1989, in order to investigate asthma epidemics in the city. Information on emergency room admissions for asthma and chronic obstructive pulmonary disease (COPD) was recorded daily from the four main hospitals of the city. The present study aims at assessing the reliability and coverage of this monitoring system. Identification of asthma and COPD emergencies was repeated by a reference observer, following the same protocol to extract data as that used by the register. To assess the coverage of the monitoring system, information was collected over 28 randomly selected days, from the emergency room clinical records for the seven additional hospitals in the city with five or more daily emergencies. Identification of asthma emergencies was highly reliable (kappa value, kappa = 0.81) as was the discrimination between asthma and COPD diagnoses (kappa = 0.91). Reliability for emergencies classified as COPD was lower, but still good (kappa = 0.65). The monitoring system covered 76 and 78% of all Barcelona asthma and COPD emergency room admissions, respectively. Emergency room admissions from our monitoring system did not differ in terms of social and demographic characteristics from emergencies recorded at the other hospitals. We conclude that the monitoring system for the Barcelona respiratory emergency room admissions was highly reliable, which suggests that, when adequately collected, information from clinical records of respiratory emergencies could be used for environmental epidemiological purposes.
Longitudinal methods for describing the relationship between pulmonary function, respiratory symptoms and smoking in elderly subjects: the Tucson Study
Authors: Sherrill DL , Lebowitz MD , Knudson RJ , Burrows B
Published: November 2022

In this study recently developed longitudinal techniques are used to examine the relationship between respiratory symptoms, smoking and pulmonary function measures in elderly subjects. The subjects were participants in the Tucson Epidemiological Study of Airways Obstructive Disease, aged > or = 55 yrs at the first survey 1972-1973, who had received pulmonary function testing and completed questionnaires in at least one of the six selected surveys. There were 633 males and 891 females, with up to 14 yrs follow-up included in the analysis. Based on their questionnaire responses, subjects were classified according to their respiratory symptoms and smoking habits at each survey. The pulmonary function testing included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and their ratio (FEV1/FVC). The pulmonary function data were analysed gender specific, with and without stratifying on vital status. The results indicate that respiratory symptoms are generally associated with lower levels of lung function, and that the impairment associated with chronic cough was observed predominantly in male subjects. The negative association of smoking was apparent in most measures, but was largest and most progressive in the FEV1/FVC ratios. Ex-smokers, in all cases, had better lung function values than current smokers, but their mean curves were always significantly below the values of nonsmokers.