bluuebunny/crossref_metadata_2025 huggingface dataset:
Is the carbon monoxide transfer factor diminished in the presence of diabetic retinopathy in patients with insulin-dependent diabetes mellitus?
Authors: Britton J
Published: November 2022

Impaired carbon monoxide gas transfer has been demonstrated in patients with insulin-dependent diabetes mellitus (IDDM), but no relationship has been documented between impairment of gas transfer and the presence of other clinical evidence of diabetic microangiopathy. This study set out to determine whether carbon monoxide gas transfer was related to the presence of microangiopathy by measuring the carbon monoxide transfer coefficient (KCO) in twenty patients with IDDM complicated by retinopathy, and in twenty patients without retinopathy. The patients were reasonably matched for age (mean 47 yrs in the retinopathy group, 41 yrs in the non-retinopathy group) but those with retinopathy had a longer mean duration of diabetes (23 yrs vs 13 yrs). Carbon monoxide transfer coefficient was normal in both groups, with no significant difference between them. Values for forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were lower than predicted in the retinopathy group (92 (SEM 3.6%) and 91 (SEM 4.0%) respectively, p less than 0.05) but were not significantly different from those in the non-retinopathy group. This study demonstrates normal lung function in IDDM, with no relationship between impairment of gas transfer and the presence of microangiopathy elsewhere.
Effects of oral steroids on immunoglobulins in bronchoalveolar lavage fluid in active sarcoidosis
Authors: Spatafora M , Mirabella A , Rossi GA , Bonanno A , Riccobono L , Merendino A , Bellia V , Bonsignore G
Published: November 2022

Immunoglobulin (Ig) levels increase in the lower respiratory tract of patients with pulmonary sarcoidosis. We evaluated the effects of prednisone therapy upon Ig concentrations in bronchoalveolar lavage (BAL) fluid of ten patients with active disease (greater than 30% T-lymphocytes in BAL and positive 67Gallium (67Ga) lung scan). Therapy significantly lowered T-lymphocyte percentages in BAL and 67Ga lung scan indices and was followed by a slight improvement of the studied functional parameters. Biochemical analysis of BAL showed a significant decrease of both IgG/albumin (baseline 1.24 +/- 0.21; after therapy 0.40 +/- 0.12) and IgA/albumin (baseline 0.55 +/- 0.07; after therapy 0.14 +/- 0.03) ratios in all patients. Conversely, comparisons of IgM/albumin ratios did not show any change over the study period (baseline 0.05 +/- 0.01; after therapy 0.06 +/- 0.03). Thus oral steroid treatment suppresses the alveolitis of pulmonary sarcoidosis, as shown not only by the reduction of lung T-cells and 67Ga lung uptake, but also by the decreased Ig levels in the alveolar spaces.
Approaches to the diagnosis of viral pneumonias in the immunocompromised host: the importance of assaying cytopathogenic viral effects in bronchoalveolar lavage cells
Authors: Chanez P , Aubas P , Segondy M , Barneon G , Cluzel M , Maria Y , Mandin J , Michel FB , Godard P
Published: November 2022

Pneumonopathic conditions in the immunocompromised host (IH) are frequent and often serious. Rapid diagnosis is essential and is made possible by bronchoalveolar lavage (BAL). Sixty-two pneumonopathic episodes in 53 immunocompromised patients were examined by BAL, for viral cytopathogenic effects (CPE) in isolated cells, with appropriate viral culture techniques. Viral culture was positive in seventeen of the eighteen episodes in renal allograft recipients and AIDS patients as against eight of the fourty-four episodes in other causes of IH (p less than 0.001). CPE was found thirteen times; in seven cases it was characteristic of cytomegalovirus. Positive viral culture and CPE were shown simultaneously during thirteen episodes in eleven patients. Ten patients died (autopsies performed in three cases confirmed viral presence). Positive viral culture with absence of CPE was observed in twelve cases. There were only four fatalities in this group (the autopsies performed in three cases did not establish the presence of a virus in the pulmonary parenchyma). The percentage of lymphocytes was high in both groups of patients (18.6 +/- 2.8%). CPE is a simple and rapid examination for the diagnosis of viral pneumonopathology in the IH. Prognosis at present is gloomy; more complex examinations such as viral cultures and/or identification of the virus by immunofluorescence will be indicated only when effective antiviral agents become available.
Sarcoidosis and acquired type II-b hyperlipoproteinaemia
Authors: Umeki S , Niki Y , Soejima R
Published: November 2022

In four of eleven patients with histologically-proven sarcoidosis (stage II or III), type II-b hyperlipoproteinaemia (HLP) with increased levels of total cholesterol, triglycerides and low density lipoprotein, and a decreased level of high density lipoprotein was observed. These results suggest that type II-b HLP may be associated with sarcoidosis with systemic sarcoid infiltration (stage II or III).
Measuring health status in chronic airflow limitation
Authors: Guyatt G
Published: November 2022

A health status instrument for use in clinical trials must be valid (measuring what it is supposed to measure) and responsive (able to detect clinically important change). Approaches to measuring health status in clinical trials include using a battery of instruments, a general instrument which provides a profile of the patient's health, an instrument that generates a health utility, or an instrument that focuses on the problems associated with a particular disease. Disease-specific instruments have been used in clinical trials in chronic airflow limitation (CAL). The Oxygen Cost Diagram is simple and easy to administer, but responsiveness and validity are unproven. The Transition Dyspnoea Index is valid and responsive, but is difficult to use in trials in which multiple measurements are desired. The Chronic Respiratory Disease Questionnaire has proved valid and responsive in controlled trials in CAL patients. Health status measures should be included in all clinical trials in CAL.
Tuberculous pseudo-aneurysm of the descending thoracic aorta
Authors: Sandron D , Patra P , Lelann P , Bouillard J , Pioche D
Published: November 2022

A tuberculous pseudo-aneurysm of the thoracic descending aorta was found in a 57 year-old female with haemoptysis three months after successful chemotherapy for a miliary tuberculosis. After aortic angiography, the aneurysm was resected and the aorta was repaired with a Dacron prosthetic graft. The patient is doing well one year after the operation.
Determinants of respiratory disturbance and oxygen saturation drop indices in obstructive sleep apnoea syndrome
Authors: Quera-Salva MA , Guilleminault C , Partinen M , Jamieson A
Published: November 2022

Although chronic sleep fragmentation and oxygen saturation (Sao2) drops alone do not induce obstructive sleep apnoea (OSA), both are part of the feedback loop leading to obstructive sleep apnoea syndrome (OSAS). To determine factors in respiratory disturbance and Sao2 drops, we used polysomnographic and cephalometric data from 120 OSAS patients to construct a model which we then applied prospectively to 25 new OSAS patients, calculating the correlation between observed and predicted values. We found body mass index and the amount of stage 1 non-rapid eye movement sleep to be significant variables when considering both the respiratory disturbance index (RDI) and Sao2 drops. Posterior airway space was also a significant variable for RDI. Forced expiratory volume in one second, expressed as the percentage of forced vital capacity (FEV1/FVC), was significant when considering Sao2 drops. Upper airway abnormalities were also significant variables in the models and must be considered when treating OSAS patients.
Lung function in patients with tracheobronchopathia osteochondroplastica
Authors: Tukiainen H , Torkko M , Terho EO
Published: November 2022

We have analysed the ventilatory function of seven patients with tracheobronchopathia osteochondroplastica. One patient showed reversible airflow obstruction meeting the criteria of bronchial asthma. Another two patients yielded reduced percentage forced expiratory volume (FEV%) and features of small airways obstruction. The patients' previous spirometric measurements also made the rough estimation of longitudinal changes in lung function possible during a follow-up period of 1-8 yrs (mean 4.2 yrs). Although most patients had suffered severe chest infections, no deterioration in spirometric parameters was found during the follow-up. These findings suggest that tracheobronchopathia osteochondroplastica usually has a benign course.
Gastro-oesophageal reflux and nocturnal asthma
Authors: Ekstrom T , Tibbling L
Published: November 2022

Gastro-oesophageal (GO) reflux is believed to be a possible cause of nocturnal asthma. The aim of this study was to see if there is any correlation between the incidence of GO-reflux at night and nocturnal asthma. Thirty-seven adult patients with a history of nocturnal asthma for more than one hundred days a year and of reflux disease were evaluated using 24 h pH-monitoring of the oesophagus and measurement of peak expiratory flow (PEF) rate every hour when awake. Half of the patients suffered from severe GO-reflux at night, whilst the other half had no nocturnal reflux. Respiratory symptoms and inhalation of beta-2 agonists were recorded during the night and PEF was recorded when the patients awoke in the morning. A significant correlation was found between reflux at night and the degree of bronchial obstruction in the early morning, but not between night-time reflux and nocturnal respiratory symptoms. It would appear that GO-reflux in most asthmatics is neither a strong nor immediate trigger factor in nocturnal asthma, although it does seem to influence bronchial obstruction during the night as was demonstrated by a low morning-PEF value.
Superior vena caval syndrome due to substernal goitre
Authors: Wesseling GJ , van den Berg BW , Kortlandt JG , Greve LH , Ten Velde GP
Published: November 2022

Superior vena caval syndrome is usually due to malignant disease, however, benign cases do occur. Two patients with superior vena caval syndrome due to substernal goitre are reported, and the use of phleboscintigraphy and/or vena caval phlebography are advocated. A review of potentially helpful diagnostic procedures is given.
Elastase activity of bronchoalveolar cells in advanced pulmonary sarcoidosis
Authors: Mordelet-Dambrine M , Lafuma C , Stanislas-Leguern G , Robert L , Chretien J , Hornebeck W
Published: November 2022

Elastase activities were investigated in bronchoalveolar lavage (BAL) cells from healthy controls (C, n = 8) and patients with untreated mediastinopulmonary sarcoidosis at different stages: I (n = 5), II (n = 7), IIIA (n = 3), IIIB (n = 4). Elastase activities (EA and ELA) were measured against a synthetic substrate, succinyl-trialanine-paranitroanilide (SLAPN) and radiolabelled ligamentum nuchae 3H insoluble elastin (specific radioactivity 3.7 MBq.mg-1). A significant increase of ELA of BAL cells was observed in patients (S III), in particular those exhibiting fibrotic roentgenographic patterns and a higher number of polymorphonuclear cells. On the contrary, EA of BAL cells showed no variation between different stages of sarcoidosis. ELA was never detected in the macrophage culture medium and appeared to be mainly associated with non-adherent macrophages, whereas EA appeared to be preferentially associated with adherent macrophages. The inhibitory profiles of ELA and EA were investigated using general proteinase inhibitors and also compounds interacting specifically with leucocyte elastase. ELA was mainly due to a serine protease, which has a sensitivity to inhibitors similar to leucocyte elastase and is increased in advanced stages of sarcoidosis. EA appears to be only slightly modified, if at all, in sarcoidosis and is probably related to the action of both a serine protease and a metalloenzyme. Thus, only ELA yields diagnostic information concerning stage III of sarcoidosis associated with a fibrotic or bullous roentgenographic pattern.
Malnutrition and peak expiratory flow rate
Authors: Primhak R , Coates FS
Published: November 2022

In order to assess the effects of malnutrition on the growth of lung function, 376 Indian schoolchildren aged 6-12 yrs were studied. Peak expiratory flow rate (PEFR) was measured with a Wright peak flow meter, and nutritional status assessed by calculation of the percentage predicted height for age (HFA) and weight for height (WFH) using Harvard standards. After standardizing for height and sex, the PEFR of 30 wasted children (WFH below 80%) was significantly reduced (p less than 0.01), but that of 135 stunted children (HFA below 90%) was higher than average (p less than 0.05). It is concluded that current malnutrition has a negative effect on PEFR, possibly due to impaired muscle function, but that past or chronic malnutrition affects growth of lung function less than it affects somatic growth.
The role of lymphatics in removing pleural liquid in discrete hydrothorax
Authors: Nakamura T , Tanaka Y , Fukabori T , Iwasaki Y , Nakagawa M , Kira S
Published: November 2022

The thoracic duct and right lymphatic duct of the dogs in the experimental group were ligated at the neck. Saline labelled with Evans blue was injected (10 ml.kg-1) into the pleural cavity. The colloid osmotic pressure of the saline was adjusted to be exactly equal to that of normal pleural liquid. The change in the volume of the liquid and the decrease of the marker were studied for 3 h. The dynamics of the pleural liquid were investigated. In the control group, the volume of the pleural liquid decreased at the rate of 1.31 ml.h-1.kg-1 body weight and 87% of it left via the lymphatics. With the ligation of the bilateral lymphatic ducts, the lymphatic removal rate decreased to about one tenth. This result shows that the hydrothorax leaves the pleural cavity mainly via the lymphatics.
Comparison of two different mouthpieces for the measurement of Pimax and Pemax in normal and weak subjects
Authors: Koulouris N , Mulvey DA , Laroche CM , Green M , Moxham J
Published: November 2022

We investigated the effect of mouthpiece design on maximum static expiratory (PEmax) and inspiratory (PImax) mouth pressures. We measured PEmax from total lung capacity (TLC) and PImax from residual volume (RV) in 21 healthy volunteers, and in 40 patients referred for respiratory muscle testing. We compared two different mouthpieces, a semi-rigid plastic flanged type fitting inside the lips, and a 4 cm diameter rubber tube held against the lips. The tube mouthpiece gave significantly higher values for PEmax (p less than 0.02) in all subjects. PImax was also significantly higher (p less than 0.005) with the tube mouthpiece in subjects who recorded normal pressures. We conclude that maximum pressures are obtained in all normal subjects with the rubber tube mouthpiece, and that differences in quoted normal ranges of maximum static respiratory pressures reflect in part the design of the mouthpiece and the way in which it was used.
Spontaneous increase and decrease of thoracic lymphadenopathy and SACE in sarcoidosis
Authors: Lhote F , Valeyre D , Clerici C , Amouroux J , Battesti JP
Published: November 2022

A case of sarcoidosis with iterative spontaneous increase and decrease of thoracic lymphadenopathy is described. No condition such as infectious disease, particular environmental exposure or medication could explain this unusual course of thoracic sarcoidosis.
Beneficial effect of omeprazole in a patient with severe bronchial asthma and gastro-oesophageal reflux
Authors: Depla AC , Bartelsman JF , Roos CM , Tytgat GN , Jansen HM
Published: November 2022

A 25-yr-old man suffered from severe nocturnal asthma, which was shown to be provoked by pathological gastro-oesophageal reflux. A dramatic, immediate improvement of his pulmonary condition was achieved by treatment with omeprazole after failure of other therapeutic measures, including high doses of ranitidine.
An unusual cause of subcutaneous emphysema, pneumomediastinum and pneumoperitoneum
Authors: Boersma WG , Teengs JP , Postmus PE , Aalders JC , Sluiter HJ
Published: November 2022

A 62 year old female with subcutaneous emphysema, pneumomediastinum and pneumoperitoneum, was observed. Pneumothorax, however, was not present. Laparotomy revealed a large infiltrate in the left lower abdomen, which had penetrated the anterior abdominal wall. Microscopically, a recurrence of previously diagnosed vulval carcinoma was demonstrated. Despite intensive treatment the patient died two months later.
Lethal extrapulmonary mycobacteriosis
Authors: Kos S , Dura J , Jirasek J
Published: November 2022

A 60 yr old previously healthy man was treated for gradually elevating fever and rash followed by leucopenia and mycosis of the gastrointestinal tract; he died within 6 weeks of the first symptoms appearing. Histologic examination revealed disseminated tuberculosis of paratracheal lymph nodes, liver, spleen and bone marrow with the presence of acid fast bacilli by smear examination. Multiple colonies of the same strain of Mycobacterium kansasii were isolated by bacteriological examination of lymph node and spleen tissue. Neither macroscopical nor histological examination showed any evidence of lung tuberculosis. The final diagnosis of the described acute disease and rapid death was stated as generalized extrapulmonary mycobacteriosis, which is a rare observation.
Pathogenesis of secondary hypertrophic osteoarthropathy: a hypothesis
Authors: Doyle L
Published: November 2022

Wide ranges both in the location and the pathological state of the primary disease associated with hypertrophic osteoarthropathy (HO) have been noted. The combined distribution of the glossopharyngeal and vagus nerves appears to coincide with the range of locations of the primary disease associated with HO. These two nerves are believed to contribute to the innervation of the blood vessels in this same area. This hypothesis states that: i) some of this innervation is part of a blood volume control system; and ii) by an inappropriate stimulation of this system, as a result of blood-flow in an anomalous vascular rearrangement lying close to the primary disease associated with HO, a cerebral salt centre is stimulated to retain extra-cellular sodium. A secondary atrial natriuretic peptide over-secretion ensues and a "near steady-state" is established, with the presence of excess fluid and dilated vessels in all four limbs. Thus, the pathogenesis of HO and the distribution of an extra-renal volume control system are reciprocal facets of the same question.
Histiocytosis X characterized by marked elevation of serum alkaline phosphatase and rapid destructive changes in the lung parenchyma
Authors: Hansen PB
Published: November 2022

A 23 yr old man was admitted suspected of having a liver disease because of marked elevation of the serum alkaline phosphatase. A biopsy of the liver was without cholestasis. A skin biopsy of a papule was compatible with eosinophilic granuloma. Over a few months the patient developed severe restrictive lung disease. The elevation of the serum alkaline phosphatase was probably due to diffuse bone affection.
Increased generation of the arachidonic metabolites LTB4 and 5-HETE by human alveolar macrophages in patients with asthma: effect in vitro of nedocromil sodium
Authors: Damon M , Chavis C , Daures JP , Crastes de Paulet A , Michel FB , Godard P
Published: November 2022

Alveolar macrophages (AM) are the principal resident phagocytes in the human lung, and play a major role in local defence against environmental agents. It is now known that during asthma these cells take part in the amplification of the inflammatory mechanism. It has been demonstrated in vitro that they can be activated to generate leukotriene B4 (LTB4) and 5-hydroxyeicosatetraenoic acid (5-HETE), mediators with potent pharmacological properties. These two arachidonic metabolites were identified and quantified by reversed phase high performance liquid chromatography (HPLC) performed in cell suspensions, and in cell free supernatants. AM from asthmatics, after stimulation by the calcium ionophore A23187 or opsonized zymosan, released significantly (p less than 0.05) more LTB4 than those from healthy subjects. The increase in LTB4 release could be evidence for in vivo activation. On the other hand, the levels of 5-HETE in the AM from asthmatics were significantly (p less than 0.03) higher than those in cells from healthy subjects. This intracellular increase could be correlated with a greater migratory ability of these inflammatory macrophages, as observed for eosinophils. The clinical efficacy of nedocromil sodium may be partly related to the decreases in LTB4 releasability and intracellular 5-HETE levels observed only in AM from asthmatic patients.
Effect of nedocromil sodium and sodium cromoglycate against bronchoconstriction induced by inhaled adenosine 5'-monophosphate
Authors: Phillips GD , Scott VL , Richards R , Holgate ST
Published: November 2022

In this randomized, double-blind, placebo controlled study, the effect of prior inhalation of nebulized sodium cromoglycate (SCG) (7.3 +/- 0.6 mg) and nedocromil sodium (NED) (7.5 +/- 0.6 mg) was observed on adenosine 5'-monophosphate (AMP)-induced bronchoconstriction in 11 non-atopic asthmatic subjects. The geometric mean provocation doses of methacholine and AMP required to produce a 20% decrease in forced expiratory volume in one second (FEV1) (PD20FEV1) were 0.6 (0.1-18.8) and 5.1 (0.8-130.7) mumole respectively. The repeatability of the AMP challenge procedure for PD20FEV1 was within one doubling dose difference. SCG and NED, administered 30 min prior to bronchoprovocation with AMP, displaced the AMP dose-response curve to the right by 9.6 (1.5-41.6) (p less than 0.01) and 22.2 (3.7-89.1) (p less than 0.01)-fold, respectively, the difference between the two drugs being significant (p less than 0.05). There was a significant correlation (r = 0.7, p = 0.02) between the log dose ratios for PD20FEV1 for SCG and NED. We conclude that both SCG and NED protect against AMP-induced bronchoconstriction, NED being at least 2.3 (0.7-11.5)-fold more potent than SCG, and that they achieve this effect by a similar mechanism(s).
Effects of vitamin C on airway responsiveness to inhaled histamine in heavy smokers
Authors: Bucca C , Rolla G , Caria E , Arossa W , Bugiani M
Published: November 2022

Histamine bronchial threshold, the provocation concentration of histamine causing a 25% fall in maximal expiratory flow at 50% of forced vital capacity from the control value (PC25MEF50), was measured in seven heavy smokers and in seven sex- and age-matched nonsmokers before and one hour after ingestion, double-blind, of vitamin C (2 g) or placebo. Smokers had significantly lower baseline values of serum ascorbate, maximal expiratory flow at 50% of forced vital capacity (MEF50) and PC25MEF50: the latter was negatively related to serum ascorbate (r = -0.85; p less than 0.001). Acute treatment with vitamin C produced a significant decrease in PC25MEF50 in smokers (95% confidence limit (CL) from 4.87-3.36 to 2.91-2.01 mg.ml-1; p = 0.017), whilst it had no effect in nonsmokers. A preliminary open study on the effect of prolonged administration of vitamin C (1 g daily) was performed in smokers. One week of treatment produced a further significant decrease in PC25MEF50 (p less than 0.0001). Our results suggest that in heavy smokers histamine bronchial responsiveness may be attenuated by chronic ascorbate deficiency. In these circumstances, acute and short-term treatment with vitamin C may increase the bronchoconstrictive response to inhaled histamine.
Effect of N-acetylcysteine on gas exchange after methacholine challenge and isoprenaline inhalation in the dog
Authors: Ueno O , Lee LN , Wagner PD
Published: November 2022

N-acetylcysteine (NAC) has antioxidant and possibly mucolytic properties. To determine whether NAC could be of benefit in acute bronchoconstriction induced by methacholine, 12 of 24 anaesthetized dogs (group 1) received NAC i.v. (loading dose 150 mg.kg-1, then 20 mg.kg-1.hr-1). The other 12 (group 2) received diluent. Nebulized methacholine (1%) was then inhaled until arterial oxygen tension (PaO2) fell to a mean of 5.5 kPa, after which isoprenaline 0.5% was inhaled in six dogs of each group to reverse bronchoconstriction. Over the next 3 h we measured total lung resistance, functional residual capacity (FRC), haemodynamic variables, and pulmonary gas exchange for respiratory and inert gases. After methacholine challenge, lung resistance increased and then fell similarly for both groups, but PaO2 was higher in the NAC group (by 0.6-1.9 kPa) throughout the observation period. The ventilation-perfusion distribution measured by inert gas elimination also showed less abnormality in the NAC treated dogs over this time. Mucus was visible during post-mortem in the large airways in about half of the dogs in both groups, with no significant differences between them. These results show that NAC produces a measurable improvement in gas exchange following methacholine challenge (both with and without subsequent isoprenaline therapy) by mechanisms that remain to be determined.
Cough induced by enalapril but not by captopril
Authors: Puolijoki H , Nieminen M , Moilanen E , Siitonen L , Lahdensuo A , Reinikainen P , Vapaatalo H
Published: November 2022

We report a 68 yr old woman with hypertension who developed a dry cough on enalapril but not on captopril therapy. Pulmonary function tests, methacholine inhalation challenges, total blood eosinophil counts, and changes in plasma concentrations of prostaglandin E2 and thromboxane B2 did not explain the difference in the adverse reaction between these two angiotensin converting enzyme inhibitors.
Comparison of inhaled budesonide with oral prednisolone at two dose-levels commonly used for the treatment of moderate asthma
Authors: Namsirikul P , Chaisupamongkollarp S , Chantadisai N , Bamberg P
Published: November 2022

The purpose of the study was to compare the anti-asthmatic efficacy of two doses of inhaled budesonide with two doses of oral prednisolone commonly used in clinical practice. The patients studied had not been taking regular inhaled glucocorticosteroids and so there was minimal interference from previous medication. The study was conducted as two double-blind crossovers with a washout period between them - firstly, comparing 400 micrograms budesonide with 5 mg prednisolone per day and secondly, 800 micrograms budesonide with 10 mg prednisolone per day. Lung function and symptoms were improved significantly from run-in by all treatments and improvement on both drugs was dose-dependent. When low-dose treatments were compared, mean morning peak expiratory flow rate was higher during budesonide treatment and, as a result, diurnal variation was significantly less than that during prednisolone treatment. At the higher doses, differences between the drugs were not observed, but this may have been due to the fact that a "ceiling effect" had been reached.
Effects of maximal breath holding on maximal expiratory flows
Authors: Mialon P , Barthelemy L , Sebert P
Published: November 2022

Effects of breath holdings (BH) on bronchomotor tone, maintained until their breaking points, have been studied using maximal expiratory flow volume curves (MEFVC). BHs have been performed either at high lung volume (total lung capacity, EIBH) or at low lung volume (residual volume +250 ml, EEBH), an inspiratory manoeuvre immediately preceding the MEFVC. The results show that: (1) EIBH induces a significant increase of expiratory flow at 25% of FVC; (2) EEBH induces a significant and constant decrease of expiratory flows at 50% and 25% of FVC. The same modifications were recorded after inhalation of 400 micrograms of Fenoterol or 80 micrograms of Ipratropium bromide. The observed results are suggestive of mechanical effects of BH on expiratory flows. After EIBH airway hysteresis dominates over lung hysteresis, with opposite effects after EEBH.
Lung volume-related changes in the pharyngeal area of obese females with and without obstructive sleep apnoea
Authors: Rubinstein I , Hoffstein V , Bradley TD
Published: November 2022

The majority of male patients with obstructive sleep apnoea (OSA) have an abnormal pharyngeal structure and function, with episodic complete airway occlusion during sleep. Since OSA is less common in females than in males, it is possible that other abnormalities are active in female patients with OSA. Consequently, we measured pharyngeal area and its lung volume-related changes (LVRC) from functional residual capacity (FRC) to residual volume (RV) in overweight females, 14 with OSA and 14 without OSA. Pharyngeal areas were measured using the acoustic reflection technique. While there were no significant differences in pharyngeal area between the OSA and control groups at either FRC (mean +/- SD, 3.49 +/- 0.46 cm2 vs 3.08 +/- 0.63 cm2) or RV (2.86 +/- 0.47 cm2 vs 2.67 +/- 0.49 cm2), the reduction in pharyngeal area between FRC and RV was significantly greater in the OSA group (0.63 +/- 0.23 cm2 vs 0.33 +/- 0.32 cm2, p less than 0.05). Furthermore, although the expiratory reserve volume (ERV) was not significantly different between the two groups (0.4 +/- 0.2 l vs 0.4 +/- 0.3 l), LVRC, defined as the reduction in pharyngeal area normalized by ERV, was significantly higher in the females with OSA than in the non-apnoeic controls (2.68 +/- 2.24 cm2.l-1 vs 1.17 +/- 1.23 cm2.l-1, p less than 0.02). We conclude that females with OSA have abnormal pharyngeal mechanics similar to males with OSA.
Spirometric reference values in Senegalese black adults
Authors: Dufetel P , Pigearias B , Lonsdorfer J , Derossi G , Diaine C , Faltot PJ
Published: November 2022

Spirometric volumes and expiratory flows were measured among 448 Senegalese males and females of 25-80 yrs of age. The values obtained are similar to those reported for black Africans and black Americans in the literature. Volumes are 15-25% lower in males and 23% lower in females than in Caucasians. Forced expiratory flow between 25-75% of vital capacity (VC), (FEF25-75) is 5-18% lower in males and 19% lower in females. FEF25-75/VC ratio is higher in blacks than in Whites, but the forced expiratory volume in one second FEV1/VC ratio is similar in black and white subjects. However, we cannot use proportional factors to determine spirometric black standards from white reference values, so, equations of regression and nomograms with age and height are proposed for black Africans.
Lung function in allogeneic bone marrow transplantation recipients
Authors: Rodriguez-Roisin R , Roca J , Granena A , Agusti AG , Marin P , Rozman C
Published: November 2022

In order to investigate the incidence of pulmonary function complications following bone marrow transplantation (BMT), 17 patients with leukaemia and 8 with aplastic anaemia were sequentially assessed over a one year period. Before BMT, all the patients were free of respiratory symptoms and had both normal chest X-ray and routine lung function tests. However, 5 patients disclosed airway hyperreactivity. Aplastic anaemia patients had significantly lower haemoglobin-adjusted diffusing capacity for carbon monoxide (DLCO) than those with leukaemia, a finding significantly related to the lower haemoglobin values shown in the former individuals. Following BMT there were transient mild to moderate reductions in DLCO and static lung volumes; moreover, patients with leukaemia had lower DLCO than those with aplastic anaemia. Fourteen of the 25 patients had ventilatory defects, including 10 individuals with bronchial hyperresponsiveness. Post-BMT lung function changes were transiently accompanied by mild to moderate symptoms of respiratory disease in most of the patients.
Immediate and late asthmatic responses induced by exercise in patients with reversible airflow limitation
Authors: Speelberg B , van den Berg NJ , Oosthoek CH , Verhoeff NP , van den Brink WT
Published: November 2022

The existence and prevalence of late asthmatic responses to exercise in patients is uncertain. We investigated whether the late falls of peak expiratory flow rate (PEFR) after exercise challenge were still significant after comparison with the corresponding clocktime PEFR on a control day. We examined 86 patients with reversible airflow limitation, 79 with asthma and 7 with chronic obstructive pulmonary disease (COPD), all under regular treatment with bronchodilators and/or anti-inflammatory agents. Patients were randomized for a control day and an exercise day and PEFR was recorded hourly. On the exercise day, each patient underwent an 8 minute bicycle ride at 90% of predicted heart-rate. An early and a late asthmatic response to exercise were considered to occur when PEFR decreased by 10% or more on the exercise day compared to the corresponding clocktime PEFR on the control day. Thirty-three patients (38%) had a 10% or greater fall of PEFR at 4 to 13 hours after exercise when PEFR was compared with the corresponding clocktime on a control day. Seven (8%) had an isolated late asthmatic response, and 26 (30%) had a dual asthmatic response. We conclude that true late asthmatic responses develop after exercise in a significant number of patients with well controlled reversible airflow limitation.
Cell-mediated immunity in pigeon breeders' lung: the effect of removal from antigen exposure
Authors: Johnson MA , Nemeth A , Condez A , Clarke SW , Poulter LW
Published: November 2022

Eighteen precipitin-positive pigeon breeders, thirteen symptomatic (SPB), with extrinsic allergic alveolitis (EAA), and five asymptomatic (APB), without lung disease, underwent bronchoalveolar lavage (BAL). Cytospins were prepared on which differential cell counts were performed. Immunocytological methods, using monoclonal antibodies, were performed to identify lymphocyte and macrophage subsets. Marked abnormalities in cell populations were observed in both groups but with no suggestion of differences between the groups. All subjects had a lymphocytosis in BAL (SPB 45%; APB 29%). These lymphocytes were almost exclusively T-cells. The cluster designation CD4/CD8 ratio was decreased (SPB 0.86; APB 1.13) and a significantly higher proportion of these cells than normal expressed UCHL1 (an antigen associated with the common leucocyte antigen complex) indicating immune commitment. In the macrophage population increased proportions of cells expressing antigens associated with interdigitating cells (RFD1+) and mature macrophages (RFD7+) were also abnormal. When six SPB patients were relavaged after isolation from pigeons for three weeks, there was a significant reduction in the lymphocytosis and in the proportion of UCHL1+ lymphocytes. This was accompanied by reductions in the percentage of macrophages expressing RFD1 and UCHL1. We suggest that EAA in pigeon breeders is associated with a cell-mediated immune response which is down-regulated by isolating patients from exposure to pigeon derived antigens.
Why are hospital admissions of children with acute asthma increasing?
Authors: Mitchell EA , Dawson KP
Published: November 2022

The hospital admission rate for asthma has increased in many countries. Particularly prominent has been the increase for children, especially male children under five yrs. The increased admission rate refers to increased number of individuals and to increased frequency per individual. The moderate increase in asthma prevalence does not account for the large increase in admissions. Various other factors are discussed here, such as changes in admission criteria, medical management, and/or clinical expression of the disease.
Adaptation to intermittent positive pressure ventilation applied through the nose during day and night
Authors: Rodenstein DO , Stanescu DC , Delguste P , Liistro G , Aubert-Tulkens G
Published: November 2022

A 49 yr old poliomyelitic patient had been under cuirass-type nocturnal negative pressure ventilation for more than 20 yrs. He had a severe restrictive ventilatory impairment, and normal awake blood gases at rest and during light exercise. He was offered a trial of intermittent positive pressure ventilation applied through the nose (nIPPV). Two daytime studies and one night study were carried out under nIPPV, and one night study was performed under negative pressure ventilation. Tidal volume, respiratory frequency (Respitrace), blood gases and electromyogram (EMG) of the diaphragm (DEMG, oesophageal electrode) and/or sternocleidomastoid (ScEMG, surface electrodes) were measured. During daytime studies under nIPPV, the DEMG (and/or the ScEMG) did not decrease by more than 25% (p less than 0.005). However, when the patient was encouraged to relax, the DEMG decreased by 62% (p less than 0.001). Tidal volume and ventilation significantly increased during daytime nIPPV (p less than 0.025), whereas blood gases were kept at physiological levels. At night, the ScEMG was present and prominent until sleep onset. Thereafter it disappeared and remained silent, including periods of wakefulness during sleep time, until final awakening in the morning. This was true for both negative pressure ventilation and nIPPV. Snoring was present throughout sleep under negative pressure ventilation but not under nIPPV. We conclude that the behavioural response of the subject may determine the electrical activity of respiratory muscles during assisted ventilation.
Endobronchial hamartoma removed by rigid bronchoscope
Authors: Sahin AA , Aydiner A , Kalyoncu F , Tokgozoglu L , Baris YI
Published: November 2022

An endobronchial hamartoma of the right lower lobe was discovered in a 60 yr old female patient. She had been diagnosed and treated for chronic intractable bronchial asthma for more than 10 yrs. The endobronchial hamartoma was successfully removed with a rigid bronchoscope.
Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls
Authors: Horner RL , Mohiaddin RH , Lowell DG , Shea SA , Burman ED , Longmore DB , Guz A
Published: November 2022

It has been suggested that deposition of fat in the soft tissues surrounding the upper airway may be an important factor in the pathogenesis of obstructive sleep apnoea (OSA) in obese subjects. We have used magnetic resonance imaging to determine the site(s) and size(s) of fat deposits around the upper airway in six obese patients with OSA (116-153% of ideal body weight) and five weight-matched controls without OSA (107-152% of ideal body weight). In all subjects, large deposits of fat were present postero-lateral to the oropharyngeal airspace at the level of the soft palate. Significantly more fat was present in these regions in the patients with OSA (p = 0.03). Fat deposits in the soft palate were observed in 4 of the 6 patients with OSA but none of the controls. Fatty streaks were observed in the tongue in 2 of the 5 controls and 3 of the 6 patients with OSA. Fat deposits were observed anterior to the laryngopharyngeal airspace, in submental regions, in all obese subjects. This study shows that more fat is present in those areas surrounding the collapsable segment of the pharynx in patients with OSA, compared to equally obese control subjects without OSA.
A 10 year follow-up of semi-annual screening for early detection of lung cancer in the Erfurt County, GDR
Authors: Wilde J
Published: November 2022

A prospective and controlled study for early detection of lung cancer in the county of Erfurt with a follow-up of 10 years is presented. A collective of 41,532 males born between 1907 and 1932 was screened by chest fluorography at 6 month intervals and compared with a control group consisting of 102,348 males of the same age, who were screened at intervals of about 18 months. No significant reduction of overall mortality and of lung cancer mortality was achieved. Semi-annual screening brought about a higher detection rate (9%/6.5%), an increase in the resection rate (28%/19%) and higher 5 and 10 year survival rates (52%; 27%/39%; 19%) of resected patients than screening in 18 month intervals. Among those patients who refused resection or were surgically untreatable, the difference in survival rates between the two investigation groups lasted only up to the 12 months barrier. This is regarded as the effect of the lead-time bias. Fluorographic screening is effective only in patients with peripheral cancers. Patients resected for central lung cancers did not show differences in the survival rates. In both investigation groups considered together surgical therapy was possible mainly in those patients who had been detected by screening (resection rate: 48%; 5 yr survival rate: 26.9%). The resection rate of all the others amounted to 9%, the 5 yr survival rate to 1.4%. Therefore we consider fluorography to time as the only chance for lung cancer control of high risk groups in spite of the absence of reduction of lung cancer mortality.
Terbutaline as powder inhalation from Bricanyl Turbuhaler compared to terbutaline as nebulizer solution in severe chronic airways obstruction
Authors: Hansen NC
Published: November 2022

Twenty two adults with severe chronic airways obstruction--FEV1 from 14 to 57% of predicted--participated on two consecutive days in an open cross over comparison of inhalation of 2 mg terbutaline powder by Bricanyl Turbuhaler and 5 mg terbutaline by a conventional jet nebulizer (Pari Inhalierboy). All participants were domiciliary users of nebulized terbutaline previous to inclusion in this study. The mean (SD) maximal increase in FEV1 within the 60 minutes following inhalation by Turbuhaler and by Pari Inhalierboy was 27% (15%) and 28% (15%). The mean (SD) maximal increase in FVC was 30% (20%) and 29% (16%). The differences were not statistically significant. All participants were able to produce inspiratory flows high enough to use the Turbuhaler. The study suggests that it will be possible to replace the use of nebulizers with powder inhalations, as far as the bronchodilating effects are concerned.
Relationship between immunoglobulin levels, tuberculin hypersensitivity and radiological extent of disease in Greek patients with pulmonary tuberculosis
Authors: Michaelides S , Grange JM
Published: November 2022

Greek patients with pulmonary tuberculosis, who were studied before receiving any form of treatment, tended to have elevated immunoglobulin (Ig) levels in the IgG and IgA, but not the IgM, classes. This is in agreement with the findings of the majority of studies on immunoglobulin levels in other countries. The levels of IgA were particularly associated with the extent of disease and were significantly higher in smear-positive than in smear-negative patients. There was no significant relationship between the intensity of tuberculin sensitivity and immunoglobulin levels except for a weak tendency for patients with high IgA levels to have small skin reactions to tuberculin.
Lung function in adolescents after uncomplicated whooping cough in childhood
Authors: Teculescu DB , Aubry C , Pham QT , Locuty J , Deschamps JP , Manciaux M
Published: November 2022

Ventilatory function (forced vital capacity, forced expiratory volume in one second, forced expiratory flows), static lung volumes, phase III slope and closing volume (single-breath nitrogen washout test) were measured in 499 children and adolescents aged 10-16 yrs from a general population sample in North-East France. A history of whooping cough was given by 44 children (22 of each sex); their results were compared to those of the 455 children (215 girls) with a negative history. The only difference between the two groups was a minimal increase in the residual volume/total lung capacity ratio in cases (19.2 +/- 3.1 vs 18.0 +/- 2.9%). We conclude that uncomplicated whooping cough in early childhood did not lead to significant pulmonary function abnormality in this population of children born after 1967.
The changes in airways structure associated with reduced forced expiratory volume in one second
Authors: Matsuba K , Wright JL , Wiggs BR , Pare PD , Hogg JC
Published: November 2022

We compared the structure of the membranous and respiratory bronchioles of resected lungs from 111 patients with a normal predicted forced expiratory volume in one second (FEV1) to the structure of these airways from 45 patients with an FEV1 reduced below the 95% confidence limits for height and age. Membranous and respiratory bronchioles of less than 2 mm in internal diameter were counted and their diameter and wall thickness were measured. The data show that there were more membranous bronchioles of internal diameter less than 0.4 mm in patients with reduced FEV1. The wall thickness of respiratory bronchioles was increased in the obstructed group and there was also an increase in the ratio of wall thickness to lumen diameter in these airways. The walls of membranous bronchioles were not increased in thickness but there was an increase in the ratio of wall thickness to lumen diameter. Although the data is consistent with the hypothesis that airways obstruction in patients with chronic obstructive pulmonary disease is due to thickening of the airway wall and narrowing of the airway lumen, we cannot rule out distortion of the membranous bronchioles by loss of elastic recoil.
Oral terbutaline alone and in combination with theophylline: dose, plasma concentration, and effect in long-term treatment of bronchial asthma
Authors: Stalenheim G , Lindstrom B , Lonnerholm G
Published: November 2022

Oral terbutaline, in gradually increasing doses from 2.5 to 10 mg three times daily (t.i.d.) was administered to 12 patients with chronic bronchial asthma. There was a linear relationship between dose and steady-state plasma concentrations in individual patients, but the plasma levels varied fourfold between patients taking similar doses. The need for other medication tended to decrease, and the symptom score, peak expiratory flow rate (PEFR) and forced expiratory volume in one second (FEV1) improved significantly during the treatment, with a roughly linear dose-effect relationship for the doses 2.5, 5 and 7.5 mg t.i.d. An increase in the dose from 7.5 to 10 mg did not improve PEFR and FEV1 any further. Side-effects were generally few and mild. Oral theophylline 200 mg t.i.d. added to terbutaline 10 mg t.i.d. brought about a further improvement in pulmonary function without adding any troublesome side-effects. Our data indicate that there is little to gain by prescribing terbutaline doses higher than 7.5 mg t.i.d. Instead, theophylline might be added, since this combination seems to have a favourable therapeutic index.
Four and six parameter models of forced random noise respiratory impedance in normals
Authors: Lorino H , Mariette C , Lorino AM , Harf A
Published: November 2022

Total respiratory impedance has been measured between 3-42 Hz by the forced random noise technique, in 15 subjects breathing either air or a helium oxygen mixture in three experimental conditions: at basal state, and then with a resistor or a tube added at the mouth. Impedance is modelled, either by a 4-parameter model (M4), derived from the series model (resistance, inertance, compliance) by making resistance a linear function of frequency; or by a 6-parameter model (M6) including a central compartment (airway resistance and gas inertance), and a tissue compartment (resistance, inertance and compliance in series) placed in parallel with alveolar gas compliance. The additive resistance is perfectly evaluated by both models, whereas the additive inertance is not accurately estimated by the model M6, the fitting of which combines the real and imaginary parts of impedance. Resistance extrapolated at zero frequency on the one hand, inertance of M4 and central inertance of M6 of the other, are highly correlated. However, changes in some parameters of both models according to the experimental conditions are difficult to explain on physiological grounds. We conclude that the model M6 cannot be easily and accurately identified over such a limited frequency range, at least in normals, while the model M4 yields a simplified description of impedance which may be sufficient for diagnostic purposes.