bluuebunny/crossref_metadata_2025 huggingface dataset:
Ventilatory effects of nasal continuous positive airway pressure
Authors: Kesten S , Rebuck AS
Published: December 2022

Nasal continuous positive airway pressure (nCPAP) improved arterial oxygenation in patients with sleep apnoea as well as those with acute pulmonary processes such as Pneumocystis carinii pneumonia. Despite an expanding pool of clinical information, little if any attempt seems to have been made to see whether nCPAP alters ventilatory patterns. The effect of nCPAP was assessed by respiratory inductance plethysmography in 14 healthy males. nCPAP reduced respiratory rate (14.3 +/- 1.47 to 9.7 +/- 1.98, p less than 0.0001) but increased tidal volume (0.483 +/- 0.090 to 0.602 +/- 0.140 l, p = 0.01). Accordingly, minute ventilation decreased (6.91 +/- 1.20 to 5.64 +/- 0.93 l.min-1, p = 0.0002). Duty cycle (TI/TTOT) decreased from 0.43 +/- 0.04 to 0.35 +/- 0.05 s during nCPAP (p less than 0.0001). Mean inspiratory time and mean expiratory time increased with nCPAP (1.79 +/- 0.19 to 2.20 +/- 0.41 and 2.44 +/- 0.38 to 4.27 +/- 1.07 s, respectively, p less than 0.02), but there were no significant changes in mean inspiratory flow rate or partitioning of rib cage and abdominal/diaphragmatic contributions to tidal volume. We conclude that nCPAP effects ventilatory pattern in a manner similar to that described for expiratory threshold loading; that is, by decreasing respiratory frequency and minute ventilation. nCPAP does not appear to stimulate healthy subjects to increase their level of ventilation.
The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome
Authors: Davies RJ , Stradling
Published: December 2022

We have studied the predictive importance of neck circumference, obesity, and several radiographic pharyngeal dimensions for obstructive sleep apnoea (OSA), in 66 patients. OSA was quantified as the mean hourly number of greater than 4% dips in arterial oxygen saturation during sleep. Neck circumference (correlation coefficient (r) = 0.63, 95% confidence interval (C.I.) 0.46-0.76), obesity index (r = 0.54, 95% C.I. 0.39-0.69), hyoid position (r = 0.40, 95% C.I. 0.17-0.59), soft palate length (r = 0.31, 95% C.I. 0.08-0.51), and hard palate-to-spine angle (r = 0.29, 95% C.I. 0.04-0.49), correlated significantly with saturation dips in single regression analysis. In stepwise multiple linear regression analysis (saturation dip rate as the dependent variable), only neck size and retroglossal space were significant independent correlates (total r2 = 0.42, 95% C.I. 0.22-0.61, p less than 0.0001). We conclude that the relationships between general obesity, hyoid position, soft palate length, and OSA are probably secondary to variation in neck circumference.
Comparison of bronchial and per oral provocation with aspirin in aspirin-sensitive asthmatics
Authors: Dahlen B , Zetterstrom O
Published: December 2022

Oral challenge with acetylsalicylic acid was compared with inhalation of Lysine acetylsalicylic acid (L-ASA) as a means to diagnose aspirin-idiosyncrasy in the airways. On the basis of history and/or clinical findings (asthma, rhinorrhea, nasal polyposis) 22 consecutive patients were challenged by both routes. Ten of these developed significant bronchoconstriction (greater than or equal to 20% drop in forced expiratory volume in one second (FEV1)) during either challenge, with the same absolute sensitivity for both tests (9/10). During the bronchial provocations, the reactions developed more promptly (20 min vs 1 h after provocation dose) and were limited to the airways. In contrast, the reactions evoked by the oral provocations were often more pronounced, longer lasting and occurrence of generalized symptoms was more common. Accordingly, the oral tests required more extensive drug treatment for reversal, whereas the bronchial provocations always were reversed by inhalation of bronchodilators. The bronchial method thus resulted in considerably shorter test sessions (4 h vs 8 h). The specificity of the bronchial test was indicated by the observation that a control group of 19 asthmatics with comparable severity of disease failed to bronchoconstrict in response to L-ASA. In conclusion, we have found the bronchial provocation method to be easy to interpret and to control, even in severely asthmatic patients. Consequently, bronchial provocation with L-ASA appears particularly useful in the out-patient office or for research on airway responses to ASA in ASA-sensitive asthmatics.
Evidence for the roles of histamine and prostaglandins as mediators in exercise-induced asthma: the inhibitory effect of terfenadine and flurbiprofen alone and in combination
Authors: Finnerty JP , Holgate ST
Published: December 2022

We investigated the effects of terfenadine, a histamine H1-receptor antagonist, and flurbiprofen, a cyclooxygenase inhibitor, on exercise-induced bronchoconstriction to assess the contribution of the mast cell products histamine and prostaglandins. Eight asthmatics were studied on 4 occasions with treadmill exercise tests. Terfenadine or placebo was administered 3 h prior to exercise, and flurbiprofen or placebo was administered 2 h prior to exercise, in a double-blind randomized trial. Airway calibre was determined by measurement of the forced expiratory volume in one second (FEV1) immediately prior to exercise challenge, and over 30 min post-exercise. Following placebo, the mean maximum percentage fall in FEV1 was 39%. This fell to 25% after terfenadine (p less than 0.05), 27% after flurbiprofen (p less than 0.05), and 30% after the active combination (NS). Analysis of the areas under curves of percentage falls in FEV1 over 30 min showed significant inhibition on all 3 active drug days (p less than 0.05). We conclude that histamine release and prostaglandin generation contribute to exercise-induced bronchoconstriction, although the interaction between these mediators appears complex.
Increased bronchial responsiveness in primary and secondary Sjogren's syndrome
Authors: Potena A , La Corte R , Fabbri LM , Papi A , Trotta F , Ciaccia A
Published: December 2022

We examined one group of 33 patients with primary Sjogren's syndrome, one group of 17 patients with secondary Sjogren's syndrome, i.e. associated with other connective tissue diseases, and one group of 14 patients with connective tissue diseases but without Sjogren's syndrome. In each patient we obtained chest radiographs and measured lung volumes, carbon monoxide diffusing capacity and airway responsiveness to methacholine. We observed no difference in chest radiograph abnormalities, in lung volumes and in carbon monoxide diffusing capacity among the three groups. However, we found a slight but significant increase of bronchial responsiveness in patients with primary and secondary Sjogren's syndrome compared with patients with connective tissue disorders but without Sjogren's syndrome. Thus PD20FEV1 methacholine was 1.07 mg (1.2) (geometric mean and GSEM) in primary Sjogren's syndrome, 0.91 mg (1.4) in secondary Sjogren's syndrome (NS), and 2.24 mg (1.09) in patients with connective tissue diseases but without Sjogren's syndrome (t = 2.59 and t = 2.8, both p less than 0.05, vs primary and secondary Sjogren's syndrome, respectively). These results show that some patients with Sjogren's syndrome have mild bronchial hyperresponsiveness, which may be related to the specific airway abnormalities of this disease.
Products of neutrophils and eosinophils increase the responsiveness of human isolated bronchial tissue
Authors: Hallahan AR , Armour CL , Black JL
Published: December 2022

This study examines the possibility that products of neutrophils and eosinophils could increase the responsiveness of human isolated bronchial tissue. Neutrophils and eosinophils were isolated from the peripheral blood of healthy volunteers. The cells were incubated with 1 microM calcium ionophore A23187 for 10-15 min then centrifuged, the supernatant collected and stored at -70 degrees C. Human bronchial rings (2-3 mm diameter, 3-4 mm long) were prepared from specimens resected at thoracotomy. The tissues were suspended in organ baths under a 1 g load and changes in tension measured isometrically. Stable contractions to bolus doses of histamine (0.1-10 microM) or to electrical field stimulation (40-100 V, 4-16 Hz, 1 ms for 20 s) were established. Supernatant from 106 neutrophils or 105 eosinophils was then added and tissue responsiveness reassessed. Neutrophil supernatant increased tissue responsiveness to histamine and electrical field stimulation by 54 +/- 17% (n = 5, p less than 0.05) and 18 +/- 7% (n = 6, p less than 0.05), respectively. Eosinophil supernatant increased the histamine response by 60 +/- 23% (n = 8, p less than 0.05) while tissue responsiveness to electrical field stimulation was unchanged (n = 3). Thus, as neutrophils and eosinophils can change the responsiveness of human bronchus in vitro it is possible that they do this in vivo and may not simply be temporally related to the development of bronchial hyperresponsiveness.
Prostaglandin E1 enhances the histamine induced stimulation of the mucociliary activity in the rabbit maxillary sinus
Authors: Dolata J
Published: December 2022

Inflammatory mediators are released in the airways during both inflammatory and allergic reactions, and many of these mediators affect mucociliary activity. To discover whether mucociliary activity is changed by a combination of mediators, the interaction between prostaglandins and histamine or methacholine was studied in vivo in the rabbit maxillary sinus. We used a photoelectric technique and recorded frequency changes induced by tested substances. Prostaglandins E1 and F2 alpha (PGE1 and PGF2 alpha) were given as ia. infusions followed by bolus injections of histamine or methacholine. Infusion with PGE1 (0.1 microgram.kg-1) enhanced the stimulating effect of a subsequent injection of histamine (10 micrograms.kg-1), maximum stimulation being 33 +/- 6% compared to 14 +/- 4% after histamine alone (p = 0.02). When the histamine injection was given 20 min after PGE1 no enhancement was observed. PGE1 did not enhance the stimulating effect of methacholine. In contrast to PGE1, PGF2 alpha failed to enhance the effect of histamine. It is proposed that a role of PGE1 is to modify the mucociliary response to other mediators released during inflammatory and allergic reactions.
The respiratory response to CO2 and O2 in patients with coma due to voluntary intoxication with barbiturates and carbamates
Authors: Launois S , Fleury B , Similowski T , Aubier M , Murciano D , Housset B , Pariente R , Derenne JP
Published: December 2022

We have investigated the respiratory response to CO2 and to O2 in comatose subjects self intoxicated with barbiturates and carbamates. The chemical drive of 12 such patients with coma was compared with that of comparable normal subjects. The ventilatory response to CO2 was depressed but the P0.1 response was of the same order of magnitude as in normals. O2 had little effect on the ventilatory parameters and occlusion pressure. There was no difference between the two groups of patients, indicating that the respiratory changes observed were more dependent on the intensity of the intoxication than on the nature of the drugs. In addition, mechanical factors seem mainly responsible for the depressed ventilatory response to CO2.
The transition between apnoea and spontaneous ventilation in patients with coma due to voluntary intoxication with barbiturates and carbamates
Authors: Launois S , Similowski T , Fleury B , Aubier M , Murciano D , Housset B , Pariente R , Derenne JP
Published: December 2022

We have investigated the transition from apnoea to spontaneous breathing in five comatose patients self intoxicated with barbiturates and carbamates. All patients were apnoeic on admission, and were studied throughout the course of recovery. The transition between the first respiratory movements and a stable and nearly normal ventilation (stable respiratory activity) ranged from 15 to 105 min, a very short time compared to the duration of the apnoeic state that lasted 6 to 72 h from admission. Minute ventilation and occlusion pressure during the first respiratory movements were 6.3 +/- 2.7 l.min-1 and 1.35 +/- 0.45 kPa, respectively. These values increased by roughly 50 and 100% by the time stable respiratory activity was achieved. The increase in minute ventilation was entirely due to an increased inspiratory flow, in relation to a proportionate increase in occlusion pressure, and without significant changes in the respiratory times or in the effective elastance. We conclude that the transition between apnoea and stable respiratory activity is characterized by its rapidity, by the fact that respiratory times are fixed throughout the recovery process, and by the fact that effective elastance is high.
Comparison of terbutaline via the Nebuhaler and salbutamol via the Volumatic: theory and practice
Authors: Chapman BJ , Crompton GK
Published: December 2022

The bronchodilating efficacy of terbutaline (250 micrograms.puff) inhaled via the Nebuhaler and salbutamol (100 micrograms.puff) inhaled via the Volumatic has been studied in 30 patients with reversible obstructive airways disease in a randomized crossover study. The salbutamol/Volumatic combination produced significantly greater bronchodilatation than terbutaline/Nebuhaler (one puff, p less than 0.001; eight puffs, p less than 0.01). The findings are discussed with particular reference to the theories of spacer action.
The cyclooxygenase theory of aspirin-induced asthma
Authors: Szczeklik A
Published: December 2022

Aspirin-induced asthma is a distinct clinical syndrome which affects about 10% of adult asthmatics. In these patients aspirin and several other analgesics precipitate asthmatic attacks. The idea that the attacks might result from the specific inhibition of a single enzyme, namely cyclooxygenase, has gained both experimental and clinical support. It stimulated a number of hypotheses on the mechanism of bronchoconstriction. All these hypotheses, here discussed, operate within the framework of the cyclooxygenase theory. Their major assumption is that inhibition of cyclooxygenase triggers specific biochemical reactions which lead to open asthma attacks.
The use of protriptyline for respiratory failure in patients with chronic airflow limitation
Authors: Carroll N , Parker RA , Branthwaite MA
Published: December 2022

Treatment of nocturnal hypoventilation in patients with restrictive chest wall disease and respiratory failure, results in improved daytime arterial blood gas tensions, increase in functional ability and longer survival. Success has been achieved with the use of protriptyline which reduces the duration of rapid eye movement (REM) sleep during which nocturnal hypoventilation occurs. Eighteen patients with severe chronic airflow limitation (CAL), took part in a randomized, double-blind, crossover trial of protriptyline and placebo. Seventeen patients completed the study. The use of protriptyline was associated with a fall in the median percentage of total sleep time spent in REM from 16 to 8.8% (p less than 0.01). This was associated with a reduction in the median daytime arterial carbon dioxide tension from 6.4 kPa (range 5.2-8.5 kPa) to 5.8 kPa (range 5.0-8.1 kPa) (p less than 0.01); increased respiratory muscle strength (p less than 0.05), and increased six minute walking distance from a median of 258 m (range 58.5-585 m) to 275 m (range 171-598 m) (p less than 0.02). We found pharmacological treatment of REM-related nocturnal hypoventilation in patients with CAL to be effective, but anticholinergic side-effects, particularly in older male patients, might preclude long-term treatment.
Short-term smoking reduction is associated with reduction in measures of lower respiratory tract inflammation in heavy smokers
Authors: Rennard SI , Daughton D , Fujita J , Oehlerking MB , Dobson  , Stahl MG , Robbins RA , Thompson AB
Published: December 2022

The beneficial effect of short-term smoking reduction in reducing lower respiratory tract inflammation was assessed in 15 healthy heavy smokers. All underwent fibreoptic bronchoscopy and bronchoalveolar lavage and were then treated with at least 20 mg of nicotine gum daily. Self-reported cigarette consumption decreased from 50.7 +/- 2.3 to 18.8 +/- 1.5 (p less than 0.001) cigarettes daily, and expired CO decreased from 48.5 +/- 2.5 to 27.3 +/- 2.5 ppm (p less than 0.001). After two months, repeat bronchoscopy and bronchoalveolar lavage revealed that bronchial inflammation, as assessed by direct inspection, neutrophilia of bronchial lavage fluid, and the number of alveolar macrophages, the number of alveolar neutrophils and the concentration of neutrophil elastase alpha 1-antiprotease complex in alveolar lavage fluid, had improved significantly. The present study suggests that smoking reduction may be associated with an improvement in lower respiratory tract inflammation in heavy smokers and may, if persistent, be an alternative for smokers who cannot, or do not wish, to quit.
Circulating immune complexes in sarcoidosis, a clinical role for the Raji assay?
Authors: Rooney DP , Finch MB , Elborn JS , Stanford CF
Published: December 2022

Many immunological abnormalities, including circulating immune complexes (CICs), have been described in patients with sarcoidosis. The relationship of these abnormalities to clinical states is uncertain. In 31 proven cases of sarcoidosis we used the Raji assay in the investigation of the relationship between disease activity and the presence of CICs. Circulating immune complexes (greater than 49 micrograms.ml-1) were found in 11 of 14 patients with evidence of recent significant disease deterioration, whereas only one of 17 patients with chronic stable sarcoidosis demonstrated CICs (p less than 0.001). At follow-up, it was found that eight of the 11 cases with active disease and detectable CICs had resolved clinically. Resolution was accompanied by normalization of CICs in seven and persistence in one. The remaining three patients did not improve clinically and continued to demonstrate CICs. Measurements of complement levels did not demonstrate any significant difference between the two groups of patients. It is concluded that elevated levels of CICs, as detected by the Raji assay, are commonly found in association with significantly deteriorating sarcoidosis, often normalize following disease improvement and, consequently, may have a useful clinical role as a marker of activity.
Accumulation of hyaluronan in bronchoalveolar lavage fluid is independent of iron-, complement- and granulocyte-depletion in bleomycin-induced alveolitis in the rat
Authors: Nettelbladt O , Lundberg K , Tengblad A , Hallgren R
Published: December 2022

Previous studies on bleomycin-induced alveolitis in rats have demonstrated a transient histological accumulation of hyaluronan (hyaluronate or hyaluronic acid) in the alveolar interstitium, corresponding to increases in hyaluronan (HA) levels in bronchoalveolar lavage (BAL) fluid and lung tissue extracts. The accumulation of HA was related to the influx of inflammatory cells, especially polymorphonucleated cells (PMNs) in BAL fluid and the increase in lung water. In this study we have investigated the influence of iron, complement and PMN dependent mechanisms on the early connective response of the lung in the bleomycin rat model. Iron depletion had no effect on HA or the cellular composition of lavage fluid recovered on day 4 post bleomycin. Treatment of bleomycin-injured rats with cobra venom factor (CVF), totally neutralized complement haemolytic activity but had no effect on lavage HA or the cell invasion in BAL. Treatment with anti-neutrophil serum (ANS), reduced blood and lavage PMN by 70-80%, but had no influence on HA levels in BAL. These results suggest that regulatory mechanisms other than those dependent on iron, complement activation or PMN recruitment are responsible for HA accumulation in this fibrosing alveolitis animal model.
Bleomycin primes monocytes-macrophages for superoxide production
Authors: Slosman DO , Costabella PM , Roth M , Werlen G , Polla BS
Published: December 2022

Bleomycin (BLM) induces lung inflammation and subsequent fibrosis in humans and animal models. We hypothesized that monocytes-macrophages represent target cells for BLM toxicity and participate in the initial stages of pulmonary inflammation. We developed an animal model of early lung lesions using systemic administration of BLM (2 U.100 g-1 body weight over 5 days) (BLM-rats). We observed a significant decrease in body weight and in serum angiotensin converting enzyme activity in BLM-rats as compared to matched controls rats, but no evidence of fibrosis was seen in optic microscopy of the lungs from BLM-rats. In contrast, electron microscopy revealed accumulation of intracapillary polymorphonuclear leucocytes and unusual presence of eosinophils. We then investigated the in vivo effects of BLM on the respiratory burst of monocytes-macrophages. As compared to control rats, production of superoxide (O2-) by alveolar macrophages from BLM-rats was increased upon stimulation with either phorbol myristate acetate (21.04 +/- 2.78 versus 11.45 +/- 2.26 nmol.10(6) cells.20 min-1, p less than 0.05) or opsonized zymosan (9.35 +/- 0.87 versus 7.03 +/- 0.66 nmol.10(6) cells.20 min-1, p less than 0.05). We also found in BLM-rats an increased number of circulating monocytes and an increased production of O2- by these cells. Monocytes-macrophages may represent a target cell in the early events of BLM toxicity in vivo and the increased production of O2- by these cells participates in tissue injury in pulmonary fibrosis.
First-time treatment with steroids in bronchial asthma: comparison of the effects of inhaled beclomethasone and of oral prednisone on airway function, bronchial reactivity and hypothalamic-pituitary-adrenal axis
Authors: Wilmsmeyer W , Ukena D , Wagner TO , Sybrecht GW
Published: December 2022

In a double-blind cross-over study of 12 asthmatic patients the effects of 1,000 micrograms.day-1 beclomethasone dipropionate (BDP) on airway function, bronchial reactivity and hypothalamic-pituitary-adrenal (HPA) axis have been compared to those of 15 mg.day-1 oral prednisone (PRD). None of the patients had ever received corticosteroids before. Fourteen days treatment with either of both steroids improved airway function, both subjectively and objectively. Both steroids slightly reduced the responsiveness to histamine. PRD suppressed the corticotrophin-releasing factor (CRF) stimulated cortisol release more than BDP did, whereas there was no significant change in adrenocorticotrophic hormone (ACTH) release. The results indicate that short-term treatment with 1,000 micrograms.day-1 BDP reduces bronchial hyperreactivity (BHR) in asthmatic patients, whilst having subtle effects on HPA axis.
The relationship between bronchial immunopathology and hyperresponsiveness in asthma
Authors: Poulter LW , Power C , Burke C
Published: December 2022

Physiological and Immunopathological parameters were investigated in 15 patients with diagnosed asthma, and 6 non-asthmatics presenting with other chest symptoms. The 15 symptom-free asthmatics expressed bronchohyperresponsiveness with a mean provocative dose producing a 20% fall in forced expiratory volume in one second (PD20FEV1) of 1 mg histamine. None of the non-asthmatics responded to 16 mg histamine. Twenty four hours later bronchoscopy was performed and endobronchial biopsies were obtained. Histological staining of frozen biopsy sections revealed a mononuclear cell infiltrate in all 15 asthmatics, while only 1 of the 6 non-asthmatics showed mild inflammation. Monoclonal antibodies were used to identify subsets of lymphocytes, activation markers, macrophages, and HLA-DR expression within the peribronchial infiltrates. In all samples, activated T-cells and macrophages were identified and HLA-DR expression was found to be raised, but the CD4: CD8 ratio was highly variable. No clear relationship was found between cellular distribution and measured lung function parameters. A highly significant correlation was found between the level of HLA-DR expression on the infiltrating cells (quantified microdensitometrically) and bronchial hyperresponsiveness. These results show for the first time that a chronic T-cell-mediated immune response is present in the bronchial tissue of asymptomatic asthmatics, and that the HLA-DR expression promoted correlates with the hyperresponsive status. These data promote the hypothesis that a T-cell-mediated response contributes to a predisposition to bronchial hyperresponsiveness in asthmatics.
The role of PEEP in patients with chronic obstructive pulmonary disease during assisted ventilation
Authors: Rossi A , Brandolese R , Milic-Emili J , Gottfried SB
Published: December 2022

In patients with acute respiratory failure (ARF) due to acute exacerbation of chronic obstructive pulmonary disease (COPD), the intrinsic positive end-expiratory pressure (PEEPi) can significantly increase workload for ventilation. It has been suggested that, in the presence of expiratory flow limitation, application of low levels of PEEP by the ventilator can be used to reduce PEEPi and therefore the magnitude of the inspiratory effort during assisted mechanical ventilation (or pressure support) and weaning. Clearly, pulmonary hyperinflation should not be further enhanced in order not to counteract the beneficial effect of removing PEEPi by decreasing respiratory muscle length and force. This use of PEEP in COPD patients is supported not only by theory, but also by recent experimental work, although sufficient clinical information is not yet available to provide a guideline for titration of the PEEP level. Therefore, application of PEEP in COPD patients requires close monitoring of the end-expiratory lung volume. This can be accomplished, among other noninvasive ways (e.g. the inductive plethysmography), by inspection of flow/volume curves during application of increasing levels of PEEP. The shape of the expiratory limb of the flow/volume curve can also suggest the presence of dynamic hyperinflation and expiratory flow limitation.
Investigations of an automatic screening device (MESAM) for obstructive sleep apnoea
Authors: Stoohs R , Guilleminault C
Published: December 2022

A digital recording device developed to monitor heart rate (HR) and breathing sounds (snoring), and used to screen subjects for obstructive sleep apnoea syndrome (OSAS), was investigated. This device is called the MESAM and is currently commercially available in some western European countries. The computer-based automatic scoring systems provided with the equipment and a hand-scoring technique developed at Stanford and requiring 10-15 min to perform, were used. Polysomnography and MESAM recordings were performed simultaneously on two groups of 25 sleep disorder patients (each with respiratory disturbance index greater than or less than 10). Patients were randomly monitored and records were analysed by two teams blind to the initial clinical impression, to the events which occurred during the recordings, and to each other's findings. Specificity and sensitivity were calculated for each of the MESAM scoring techniques considered, with polysomnography being selected as the recording standard, With "automatic HR scoring" specificity was 12%, sensitivity 92%; with "automatic breathing sounds (snoring)" scoring, specificity was 8% and sensitivity 96%; with "hand-scoring" specificity was 72% and sensitivity 92%. If the three scoring techniques were combined, all patients with a respiratory disturbance index (RD) greater than 10 were recognized as having OSAS.
Oral treatment with itraconazole of aspergilloma in cavitary lung cancer
Authors: Impens N , De Greve J , De Beule K , Meysman M , De Beuckelaere S , Schandevyl W
Published: December 2022

We report a case of aspergilloma in a necrotic small cell lung cancer, where poor pulmonary function and performance status of the patient precluded surgical treatment. High dose Itraconazole, a new oral anti-mycotic drug, was given for 13 months. During this treatment there was a decrease of the fungus ball size and no haemoptysis. Moreover control of the aspergilloma allowed chemotherapeutic treatment of the underlying bronchocarcinoma.
Haemophilus influenzae lobar pneumonia in the father of a child with epiglottitis
Authors: Manji H , Reeve P
Published: December 2022

We present a case of Haemophilus influenzae lobar pneumonia in the father of a child admitted with acute epiglottitis caused by the same organism. The suggestion that adult, as well as child, contacts for Haemophilus influenzae epiglottitis should be prophylactically treated is discussed.
Actual usage of medical facilities by asthmatics in two French rural settings: a preliminary study
Authors: Taytard A , Tessier JF , Gervais M , Gachie JP , Douet C , Kombou L , Vergeret J , Freour P
Published: December 2022

Until recently the medical management of asthmatic patients with respect to their socio-cultural environment had only been superficially studied. Four hundred and fifty eight adult asthmatics were identified through a two-stage questionnaire in two rural districts of south west France. The study has mainly demonstrated: 1) the large number of subjects experiencing more than one attack per week (33% in Gironde, 40% in Lot et Garonne); 2) the large number of subjects feeling disabled in their occupational and day-to-day life (52% in Gironde, 54% in Lot et Garonne); 3) the absence of a relationship between the severity of the disease and the use of medical facilities in the community. Despite the frequency of the attacks and the perceived disability, 27% of the patients felt that their asthma did not require any treatment and up to 60% did not seek medical help even during an attack; 4) the role of population density, type of dwelling and social status in the management of asthma. We conclude that under-treatment is widespread in these two rural settings and is closely related with the association of at least two of these three characteristics: 1) living in a low population density area; 2) living in an isolated dwelling; and 3) being a farm owner.
Clinical assessment after a life-threatening attack of asthma; the role of bronchial hyperreactivity
Authors: Pouw EM , Koeter GH , de Monchy JG , Homan AJ , Sluiter HJ
Published: December 2022

Between 1973 and 1986, 19 patients were treated on 21 occasions for life-threatening attacks of asthma. Twelve times mechanical ventilation was needed. None of the patients died. Most of the patients had been recognized as severely asthmatic before the life-threatening attack. Thirteen out of the 19 patients had previously been admitted with a severe asthmatic attack. All patients, except one, were already using maintenance treatment, and 17 had previously been referred to a pulmonologist. During follow-up the bronchial obstruction was, in most cases, fully reversible while using a rather extensive maintenance treatment (maximum forced expiratory volume in one second (FEV1), 69-138% of predicted). Recently, 17 of the 19 patients were reinvestigated, while in stable phase. The patients who had been mechanically ventilated were significantly more sensitive to inhaled histamine than the patients who had not been mechanically ventilated. This was not explained by any difference in basal FEV1 % pred or dosage of corticosteroids. A very low provocation concentration of histamine producing a 20% fall in FEV1 (PC20) may indicate the risk of a severe, life-threatening attack of asthma.
The effect of smoking and occupation on changes in respiratory symptoms in middle-aged Danish men
Authors: Vestbo J , Knudsen KM , Rasmussen FV
Published: December 2022

A group of 1404 middle-aged men from Aalborg who were examined in 1974 with interview and lung function tests were re-examined in 1985 using a postal questionnaire. Of the 1404 men, 1045 could be classified into well-defined occupational categories using information up to 1974. Of these men, 791 were alive at the time of the questionnaire survey. Questions on lung symptoms, occupation and smoking habits since the 1974 study were included in the follow-up survey; the response rate was 88%. Age and main occupation until 1974 were significantly related to the development of severe breathlessness from 1974 to 1985. After controlling for age, both cement workers and blue collar workers were considerably more likely to develop severe breathlessness than white collar workers: odds ratios (ORs) 2.51 (95% confidence interval 1.04-6.7) and 2.35 (1.02-5.42), respectively. Although weakened, these relationships remained after further controlling for forced expiratory volume in one second (FEV1) in 1974. Present smoking habit was an important determinant for the presence of cough, both in men with and without cough in 1974, yielding ORs of approximately 3 when comparing with lifetime nonsmokers. Cement workers tended to have cough in 1985 more frequently than white collar workers, OR = 2.09 (0.89-4.89) for men without cough in 1974 and OR = 2.60 (1.04-6.51) for men with cough in 1974.
The influence of cyclooxygenase inhibition on the loss of bronchoconstrictor response to repeated bradykinin challenge in asthma
Authors: Polosa R , Lai CK , Robinson C , Holgate ST
Published: December 2022

Bradykinin is a naturally occurring nonapeptide which may contribute to the pathogenesis of bronchial asthma. When inhaled by asthmatic subjects it is a potent bronchoconstrictor, but with repeated challenge airways responsiveness to the peptide decreases markedly. In vitro studies suggest that loss of bradykinin responsiveness may be due to the secondary generation of relaxant prostanoids. We have used the potent cyclooxygenase inhibitor flurbiprofen to investigate the potential role of prostanoid generation in bradykinin tachyphylaxis in eight asthmatic patients. The effects of oral flurbiprofen (150 mg) and matched placebo were observed on two consecutive dose response studies with inhaled bradykinin and histamine in a double-blind, randomized study. Venous blood was taken to measure the serum concentration of thromboxane B2 (TxB2) as a check on the extent of cyclooxygenase blockade achieved by flurbiprofen. Following recovery from the first challenge with bradykinin, the asthmatic airways showed a reduced response to a second challenge with this nonapeptide, the provocative concentration producing a 20% fall from baseline (PC20) increasing from 0.07 to 0.42 mg.ml-1 (p less than 0.01). The airway response to inhaled histamine after the second bradykinin challenge was not significantly changed. In the presence of demonstrable cyclooxygenase inhibition, flurbiprofen failed to prevent the development of reduced responsiveness to bradykinin observed on the second challenge, the PC20 increasing from 0.10 to 0.48 mg.ml-1 (p less than 0.01). This study demonstrates that repeated exposure to inhaled bradykinin results in loss of the bronchoconstrictor response which appears specific for this agonist and not secondary to the increased generation of protective prostanoids.
Nasal potential difference: a clinical diagnostic test for cystic fibrosis
Authors: Alton EW , Currie D , Logan-Sinclair R , Warner JO , Hodson ME , Geddes DM
Published: December 2022

Patients with cystic fibrosis (CF) demonstrate a markedly more negative potential difference (PD) across respiratory epithelia than normal or "diseased" controls. A technique is described for the measurement of nasal PD in both children and adults. 145 non-CF subjects showed a mean PD of -19.0 mV (range -2 to -36) in comparison to 60 patients with cystic fibrosis with mean of -46.0 mV (range -32 to -77). Amongst the latter group those with more severe disease had a more negative PD. Measurement of nasal PD is easily learnt and rapidly performed and may provide an additional means of diagnosis for CF.
Atypical ossification in bronchial carcinoid
Authors: Vanmaele L , Noppen M , Frecourt N , Impens N , Welch B , Schandevijl W
Published: December 2022

A patient is described with bronchial carcinoid and ossification in the surrounding bronchial wall. The osseous metaplasia was the only histologic abnormality discovered in bronchial biopsy specimens taken pre-operatively. We propose that underlying bronchial carcinoid tumour should be considered in isolated bronchial or bronchopulmonary ossification.
Amyloid tumour resected by laser therapy
Authors: Russchen GH , Wouters B , Meinesz AF , Janssen S , Postmus PE
Published: December 2022

We report a patient presenting with dyspnoea, cough and fever with a middle lobe atelectasis. Amyloid deposits in the bronchial wall caused almost complete obstruction of the middle lobe bronchus. The patient was treated with neodymium yttrium aluminium garnet (NdYAG) laser photoresection resulting in complete clearance of the middle lobe bronchus. Laser therapy has to be considered as first-line therapy for patients with endobronchial amyloidosis.
The effect of aminophylline on function and intracellular pH of the rat diaphragm
Authors: Shee CD , Wright AM , Cameron IR
Published: December 2022

We studied the effect of aminophylline on twitch tension (TT) and intracellular pH (pHi) in isolated rat diaphragm strips that were fatigued, hypercapnic, or hypoxic. Superfused muscles were directly stimulated at 0.5 Hz. The pHi was measured from distribution volumes of dimethyl-oxazolidinedione. Fatigue was induced by intermittent tetanic stimulation. Hypercapnia and hypoxia were produced by altering superfusate carbon dioxide tension (PCO2) or oxygen tension (PO2). Aminophylline (1.0 mmol.l-1) reversed the twitch decay seen during fatigue or hypercapnic acidosis, and caused partial recovery of twitch depression during hypoxia. Muscle fatigue was not due to an intracellular acidosis. Both hypercapnia and hypoxia lowered pHi. Aminophylline did not alter pHi in unstimulated muscles, but caused a significant fall in pHi in stimulated muscles that were fatigued or hypoxic. High dose aminophylline improved twitch tension in diaphragm strips that were fatigued, acidotic, or hypoxic. Twitch potentiation was not due to an intracellular alkalosis. Aminophylline lowered pHi in stimulated muscle, and thus, theoretically, could sometimes be harmful in the treatment of muscle fatigue.
Generation of oxygen free radicals from blood eosinophils from asthma patients after stimulation with PAF or phorbol ester
Authors: Chanez P , Dent G , Yukawa T , Barnes PJ , Chung KF
Published: December 2022

Eosinophils (EOS) may play an important role in the pathophysiology of bronchial asthma because they can release oxygen free radicals and several basic proteins which are cytotoxic to bronchial epithelium. We have studied the response of EOS isolated from the blood of atopic subjects with symptoms of asthma (AS, n = 7) or rhinitis (AR, n = 4) or without symptoms (AA, n = 5) and of subjects with the hypereosinophilic syndrome (HES, n = 5). EOS were separated using metrizamide density gradients and activated in vitro with platelet-activating factor (PAF, 100 nM) or phorbol 12-myristate-13-acetate (PMA, 100 nM). Oxygen free radical generation was assessed by a lucigenin-enhanced chemiluminescence (CL) assay. EOS purity was 83 +/- 1.7% (mean +/- SEM) with greater than 95% viability. Background CL responses of EOS from HES were significantly higher than those from AA (p less than 0.01) and AR (p less than 0.05). Normodense EOS from AS (PAF-induced CL = 90 +/- 27 mV) were more responsive to PAF than were those from AR (17 +/- 13 mV, p less than 0.01) and from AA (23 +/- 14 mV, p less than 0.01). Similar results were obtained with PMA. Hypodense EOS from HES subjects were as responsive as normodense EOS from AS to PMA and PFA. Thus, EOS from AS have an enhanced potential for activation, particularly by PAF; this may represent an important mechanism for the perpetuation of the inflammatory response in asthma, since EOS can also release PAF.
Effects of anaerobiosis upon morphology and energy metabolism of alveolar macrophages cultured in gas phase
Authors: Cazin M , Paluszezak D , Bianchi A , Cazin JC , Aerts C , Voisin C
Published: December 2022

Metabolic and morphological effects of anoxia were studied in alveolar macrophages obtained by lung lavage from guinea-pigs by means of an original method of cell culture allowing direct contact with air without interposition of liquid medium. After selection by glass adherence, alveolar cells were layered on a porous membrane applied to the surface of a reservoir filled with nutrient medium. Alveolar macrophages were then cultured in gas phase under either aerobic or anaerobic conditions for 24, 48 and 72 h. Cellular adenosine triphosphate (ATP) content, an indicator of cell vitality, significantly decreased by 68 and 88% after 48 and 72 h of exposure to anaerobic environment, respectively. Significant increases in lactate production (68% at 24 h) and in glucose uptake (125% at 24 h), evidence of marked glycolytic activity, occurred before these falls in intracellular ATP and parallel decreases in culture medium pyruvate level (76 and 85% at 48 and 72 h, respectively). The shift of energy metabolism resulted in cell death after 72 h, as noted by morphological degeneration and decreased cellular ATP content. Twenty-four hour re-exposure to normoxic atmosphere showed that recovery was possible when duration of anaerobiosis did not exceed 48 h. This reversibility in anoxic cell injury has been related to plasma membrane integrity. The results of these studies indicate that alveolar macrophage resistance to anaerobiosis is limited as ATP content falls and morphological degeneration occurs after 48 h. This novel approach of anaerobic effects at the cell level should be adaptable to investigations of activity and, in particular, the mechanisms of metabolic activity of antianoxic drugs.
Peak inspiratory flow and inspiratory vital capacity of patients with asthma measured with and without a new dry-powder inhaler device (Turbuhaler)
Authors: Engel T , Heinig JH , Madsen F , Nikander K
Published: December 2022

In 101 asthmatic adults with varying degrees of bronchial obstruction, lung function tests including peak inspiratory flow (PIF), inspiratory vital capacity (IVC), peak expiratory flow (PEF), forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) measurements were made. Significant correlations between inspiratory and expiratory volumes were found. In most patients, PIF was less reduced than the expiratory parameters of pulmonary function. When inhalation was performed through the new multi-dose, dry-powder inhalation device, Turbuhaler (PIF-TBH), it was significantly lower than PIF measured without Turbuhaler. In previous studies, PIF-TBH of 30 l.min-1 or more has proven sufficient to produce a therapeutic dose of terbutaline, and to produce significant bronchodilatation. Of 101 asthmatics in the present study, only four had PIF-TBH of less than 30 l.min-1. Although no parameters of spirometry could accurately predict PIF-TBH, there was a tendency for patients with severely impaired ventilatory capacity to produce lower PIF-TBH than patients with normal or near-normal ventilatory capacity. If patients with severely impaired ventilatory capacity are to receive inhalation therapy through Turbuhaler, either PIF or PIF-TBH should be measured, or the effect should be carefully monitored.
CO transfer capacity as a determining factor of survival for severe hypoxaemic COPD patients under long-term oxygen therapy
Authors: Dubois P , Machiels J , Smeets F , Delwiche JP , Lulling J
Published: December 2022

The transfer capacity for carbon monoxide is a commonly used method in clinical practice but is rarely considered as a prognostic factor for patients under long term oxygen therapy (LTOT). LTOT was applied to 217 stable, severely hypoxaemic (arterial oxygen tension (PaO2 less than 7.3 kPa or 55 mmHg) chronic obstructive pulmonary disease (COPD) patients, according to the usual recommendations. The average survival rate of this series is rather poor: 46% at 24 months. There is nevertheless an important difference between patients with a normal transfer coefficient and those with a decreased one (79% survival at 2 yrs as compared to 37%). On the other hand, the degree of airflow limitation has no prognostic value in the present series of very disabled patients. We can conclude that hypoxaemic COPD patients with a severely decreased transfer coefficient have a poor prognosis, even under LTOT, compared to patients with an equivalent impairment of airflow limitation and hypoxaemia but with a normal CO transfer factor/alveolar ventilation ratio (TLCO/VA).
Biochemistry and turnover of lung interstitium
Authors: Davidson JM
Published: December 2022

The lung contains a host of extracellular matrix components that comprise the supporting and adhesive elements of conducting airways, alveoli and the vascular tree. While none of these components is unique to the lung, their peculiar distribution determines the architecture and function of this gas exchange organ. Cells and tissues of the lung interact with the matrix through a variety of surface receptors, especially the integrins and adhesive molecules, some of which may play important roles in lung injury and repair. Collagen type I is the predominant determinant of tensile strength, but as many as 11 other genetic types of collagen with specialized adhesive and connecting functions can be found in various lung structures, including cartilage and basement membranes. Excessive matrix accumulation in the lung is the result of a complex set of influences on gene regulation, part of which may be due to the presence of inflammatory cytokines that directly stimulate matrix synthesis. However, degradation and turnover of the matrix are also critical processes influenced by many of the same mediators. Collagenase and gelatinase (type IV collagenase) are tightly-regulated metalloenzymes that, together with a set of specific inhibitors of metalloproteinases, determine the net abundance and distribution of collagen. Elastases of several biochemical types are also under tight regulation by proteinase inhibitors. Elastin is essential to lung function at the level of alveolar wall resiliency and patency, and loss of elastin in emphysema appears to be due to uncontrolled degradation of the embryologically-established pattern of elastic fibres accompanied by nonfunctional replacement as a response to injury. Injury to the vascular endothelium of the lung, as well as other physiological insults that elevate pulmonary blood pressure, can lead to the excessive accumulation of collagen and elastin in the conductance and resistance arteries of the pulmonary circulation. Mechanical stress and endothelial injury may mediate the medial hypertrophy of these vessels. Extracellular matrix components are critically involved in every stage of lung biology: development, normal function and acute and chronic disease states. To date, only glucocorticoids, cross-linking inhibitors, and protease inhibitors have been used in a general attempt to suppress either excessive matrix accumulation or loss. More detailed understanding of the regulation and specific interactions of matrix components is central to the analysis of disease states and the development of appropriate therapeutic strategies.
Pulmonary sequestration with congenital broncho-oesophageal fistula
Authors: Evers WB , Vissers R , van Noord JA
Published: December 2022

Complaints of older patients due to a congenital broncho-pulmonary foregut malformation are rare. A 53 yr old woman presented with this condition. The diagnosis was made by means of oesophagography, which showed a broncho-oesophageal fistula. Using the supplying vessel, identified by angiography, as a guideline, an operation was carried out to correct the anomaly.
Transient solitary pulmonary nodule caused by Dirofilaria immitis
Authors: Cordero M , Munoz MR , Muro A , Simon F
Published: December 2022

The second described case of solitary transient lung nodule caused by Dirofilaria immitis is reported. Diagnostic thoracotomy can be avoided with the use of enzyme-linked immunosorbent assay (ELISA), and hence a conservative serological follow-up is warranted in endemic areas.