bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of albumin and urea as reference markers in bronchoalveolar lavage fluid from patients with interstitial lung disease
Authors: Jones KP , Edwards JH , Reynolds SP , Peters TJ , Davies BH
Published: November 2022

Lavage fluids were investigated for 67 subjects in 6 groups: 12 with active sarcoidosis, 8 with inactive sarcoidosis, 17 with pigeon breeder's disease, 10 asymptomatic pigeon breeders, 12 with idiopathic pulmonary fibrosis (IPF) and 8 normal subjects. Albumin and urea per ml of bronchoalveolar lavage fluid (BALF) were determined for each subject together with percentage return of fluid (BAL%). Novel assay systems were employed to measure urea and albumin and these were compared with existing analytical techniques. When compared with the control group, we found that urea per ml of BALF was not statistically different for all other groups, except those with pigeon breeder's disease who had significantly raised levels. For albumin, however, three groups had significantly higher levels than the controls, namely those with active sarcoidosis, pigeon breeder's disease and IPF. BAL% return showed no significant differences for any group when compared with the controls. We conclude that since albumin is significantly raised in most patients with interstitial lung disease it does not represent a suitable marker for the quantitation of reactive proteins in BALF. Urea shows much less variability between groups than does albumin, and hence in the absence of a proven alternative represents the most reliable estimate available of epithelial lining fluid dilution during the lavage procedure, providing dwell time is kept to a minimum.
Does non-specific bronchial responsiveness indicate the severity of asthma?
Authors: Josephs LK , Gregg I , Holgate ST
Published: November 2022

It is difficult to analyse the relationship between bronchial responsiveness and the severity of asthma since each alone is difficult to assess. Asthma is a heterogeneous condition with many patterns of expression, and clinical methods used to assess its severity have their limitations. Problems also arise in interpreting the results of bronchial provocation tests and methodological differences make comparisons between studies difficult. The findings of both cross-sectional and longitudinal studies have shown a general relationship between the degree of responsiveness and the severity of asthma, but within subjects the relationship is weaker. A greater understanding must await increased knowledge of the mechanisms underlying asthma and the contribution which hyperresponsiveness makes to each of these.
Viewpoint: untoward effects of beta-adrenoceptor agonists in asthma
Authors: Morley J , Sanjar S , Newth C
Published: November 2022

Beta-adrenoceptor agonists are potent and selective relaxants of airway smooth muscle. They produce symptomatic bronchodilatory effects and are the most widely used therapy in asthma. In patients with asthma, they usually effect a reduction of airway resistance, but there have been several reports of episodes of increased airway obstruction, arterial hypoxaemia and even death associated with such therapy. "Anomalous or paradoxical bronchospasm" are appropriate terminologies to describe this unexpected phenomenon. Five mechanisms have been proposed to account for anomalous responses to these substances: 1) reactive myogenic tone; 2) metabolic products with spasmogenic activity; 3) adrenoceptor tachyphylaxis; 4) increased inflammatory burden; and 5) induction of airway hyperreactivity. Following a review of the relative merits of each proposal, it is concluded that increased inflammatory burden and induction of airway hyperreactivity, alone or in combination, provide the most plausible explanation for paradoxical bronchospasm.
Phagocyte enzymes in bronchoalveolar lavage from patients with pulmonary sarcoidosis and collagen vascular disorders
Authors: Sibille Y , Martinot JB , Polomski LL , Wallaert B , Demusis M , Rankin JA , Voisin C , Gee JB
Published: November 2022

The balance between proteases and antiproteases in the lower respiratory tract is believed to play a role in the outcome of interstitial lung diseases. In this cross-sectional study, we measure several phagocyte derived enzymes, namely plasminogen activator, neutrophil elastase and an ill-defined protease active on the trialanine chromophore substrate succinyl-alanine3-nitroanilide (SLAPN) in bronchoalveolar lavage (BAL) fluid from 42 patients with pulmonary sarcoidosis and from 43 patients with collagen vascular disease (CVD), 22 without lung disease (group I) and 21 associated with parenchymal lung disease (group II). The results show: a) that sarcoidosis is associated with increased plasminogen activator activity and with the presence of enzymatic activity against SLAPN corresponding at least in part to a metalloprotease; b) that CVD in the absence of radiographic lung disease is associated with an increase of plasminogen activator activity and increased levels of alpha 1-antiprotease-neutrophil elastase complexes; c) that the majority of untreated CVD (group II) patients have detectable levels of neutrophil elastase activity. These data show that patients with pulmonary sarcoidosis and CVD have different enzymatic profiles in their lower respiratory tract as assessed by BAL. Thus, sarcoidosis (mostly lymphocytic) is associated with enhanced macrophage-derived proteolytic activity in BAL, while CVD patients both with and without lung disease have increased neutrophil counts and neutrophil elastase complexed to alpha 1-protease inhibitor and presumably inactive in BAL. Finally, only BAL from untreated CVD patients with interstitial lung disease contain neutrophil elastase activity. This latter activity could contribute to the lung lesions frequently observed in these disorders.
Class-specific antibodies during follow up of patients with farmer's lung
Authors: Ojanen T , Terho EO , Tukiainen H , Mantyjarvi RA
Published: November 2022

Sequential serum samples of 13 patients with acute farmer's lung (FL) taken during a follow-up of 18-36 months, were tested for antibodies of immunoglobulin G (IgG), IgA, IgM and IgE classes against Thermoactinomyces vulgaris and Micropolyspora faeni, and compared with contemporary lung function parameters. In the acute phase, antibodies of several Ig classes were present, those of IgG and IgA being most common. At the end of the follow-up, the mean values of all antibody titres were lower than in the acute phase, and antibodies were now mostly of one or two Ig classes only. The reduction in antibody levels was most often detectable in IgG and IgA antibodies against T. vulgaris. Antibody titres correlated inversely with tested lung function parameters, especially IgA antibodies with pulmonary diffusing capacity. Our results show that a follow-up of levels of class-specific antibodies, especially of IgG and IgA gives valuable information on causative microbes and on temporal changes of the exposure.
Acute bronchoconstriction is not a stimulus for sympatho-adrenal activation in asthmatic or healthy subjects
Authors: Larsson K , Hjemdahl P , Theodorsson E
Published: November 2022

Bronchoconstriction has been found to cause little sympathoadrenal activation in asthmatic patients. It has been questioned whether this is due to blunted sympatho-adrenal reactivity in asthmatics or if bronchoconstriction is a stimulus for sympatho-adrenal activation at all. We therefore compared sympatho-adrenal responses in eight asthmatic patients and 12 healthy subjects by measurements of plasma adrenaline and noradrenaline concentrations before, during and after methacholine-induced bronchoconstriction. Significant bronchoconstriction was obtained in eight of the healthy subjects and in all of the asthmatics. Considerably higher concentrations of methacholine were required to evoke bronchoconstriction in the healthy subjects but the relative magnitudes of bronchoconstriction were similar in the two groups: peak expiratory flow (PEF) decreased by approximately 24 and approximately 28% and specific airway conductance (sGaw) decreased by approximately 68 and approximately 70% in asthmatics and controls, respectively). Methacholine-induced bronchoconstriction did not alter plasma catecholamine levels significantly in either group. In addition, plasma concentrations of catecholamines and neuropeptide Y-like immunoreactivity (NPY-LI) were measured before and during bronchoconstriction induced by histamine or allergen in 8 and 5 asthmatic subjects, respectively. Plasma noradrenaline, adrenaline and NPY-LI remained unchanged up to 30 min after bronchoconstriction induced by histamine or allergen. We, therefore, conclude that bronchoconstriction is not a stimulus for sympatho-adrenal activation and that the lack of an adrenaline response to bronchoconstriction is not likely to be related to NPY release.
Determination of lung capillary blood volume and membrane diffusing capacity in patients with COLD using the NO-CO method
Authors: Moinard J , Guenard H
Published: November 2022

Lung capillary blood volume (Qc) and the membrane diffusing capacity (Dm) can both be determined from the combined measurement of nitric oxide (NO) and carbon monoxide (CO) transfers using the single-breath method. In ten healthy subjects, no differences was observed between the values of transfer factor of the lungs for carbon monoxide (TLCO) recovered after a 3 s or 9 s breath-holding time (tBH). The NO-CO method could thus be used with a short tBH and a low fraction of inspired nitric oxide (FINO) (8 ppm). However, in ten patients with chronic obstructive lung disease (COLD), the values of both transfer factor of the lungs for nitric oxide (TLNO) and TLCO were underestimated by around 20% at a short tBH (3 s). In COLD patients, the NO-CO method therefore requires a longer tBH and a higher inspired fraction of NO (30 ppm) than in healthy subjects. Similar values of Dm and Qc were obtained using the NO-CO method and the two-step conventional method, at two levels of the oxygenation. The former method gave less scatter. Furthermore, TLNO is independent of the fraction of inspired oxygen (FIO2) and directly proportional to carbon monoxide membrane diffusing capacity (DmCO).
Bronchial reactivity in patients with chronic renal failure undergoing haemodialysis
Authors: Ferrer A , Roca J , Rodriguez-Roisin R , Lopez-Pedret J , Revert L
Published: November 2022

We hypothesized that patients with chronic renal failure may present nonspecific bronchial hyperreactivity due to subclinical interstitial lung oedema. To assess lung function disturbances and methacholine (MTH) bronchial responsiveness in this condition, we studied 12 patients (9 men and 3 women; 41.8 +/- 13.3 yrs (SD] with chronic renal failure undergoing regular haemodialysis (HD). Before HD, mean results of conventional lung function tests were within the normal range: forced expiratory volume in one second (FEV1), 89 +/- 12.9% predicted; forced mid-expiratory flow (FEF25-75), 81 +/- 36.7% predicted; total lung capacity (TLC), 94 +/- 14.6% predicted, but 3 subjects presented mild reduction in lung volumes and 5 individuals showed mild obstructive ventilatory impairment. After HD, maximal expiratory flow rates increased significantly (FEV1, + 8.2 +/- 5.1% (p less than 0.005); FEF25-75, +26.2 +/- 25.9% (p less than 0.005]. Interestingly, these increases in FEV1 after HD correlated with body weight loss during HD (r = 0.74, p less than 0.01). In contrast, pre-HD bronchial reactivity was within the normal range (mean % change in FEV1 after MTH, -3.7 +/- 4.5%; range, +1- -14%) without significant changes in methacholine bronchial responsiveness after HD. We speculate that interstitial lung oedema may play a significant role in lung function impairment observed in patients with chronic renal failure. This study shows that nonspecific bronchial hyperreactivity is not present in clinically stable patients with this disorder.
The effect of bromhexine hydrochloride on the viscoelastic properties of mucus from the mini-pig
Authors: Martin GP , Loveday BE , Marriott C
Published: November 2022

Mucus was collected daily from open-ended pouches established surgically in three mini-pigs. After a five day control period bromhexine hydrochloride (BHCl) was administered to each pig at dose levels of 0.5, 1.0 and 2.0 mg.kg-1 twice daily for five days. Each study period was followed by a five day washout period, when mucus was collected but no drug given. The viscoelastic properties of each mucus sample were determined using creep compliance analysis. BHCl was shown to reduce the residual shear viscosity (p less than 0.05) and increase the instantaneous shear compliance at all dose levels (p less than 0.005), despite the large inherent intra- and inter-animal variation in the rheological properties of the daily samples. No change was found in the wet weight of the mucus samples throughout any of the study periods. This experimental model would appear to provide a valuable in vivo method of assessing the mucoregulatory potential of administered compounds.
Fibreoptic bronchoscopy in the management of lone pleural effusion: a negative study
Authors: Kelly P , Fallouh M , O'Brien A , Clancy L
Published: November 2022

In a retrospective review of 3,000 consecutive fibreoptic bronchoscopies, fifty were performed for investigation of lone pleural effusion. While 7 patients had bronchogenic carcinoma, in only one case was it visible endoscopically. In the absence of radiological or clinical features suggesting an endobronchial lesion, fibreoptic bronchoscopy is unlikely to aid in the diagnosis of lone pleural effusion.
High-dose corticosteroids during bleomycin-induced alveolitis in the rat do not suppress the accumulation of hyaluronan (hyaluronic acid) in lung tissue
Authors: Nettelbladt O , Tengblad A , Hallgren R
Published: November 2022

A single intratracheal injection of bleomycin in rats induced, 4 days later, a considerable accumulation of hyaluronan (hyaluronate, hyaluronic acid) in the lung tissue. This connective tissue reaction was quantified biochemically by analysing hyaluronan (HA) in bronchoalveolar lavage fluid (BAL) and lung tissue extracts. The molecular weight of the HA recovered during lavage was 0.2-0.3 X 10(6) daltons. The HA accumulation was related to an increase in lung water content and associated with an increased influx of eosinophils, neutrophils and lymphocytes into BAL fluid. High-dose corticosteroid treatment (prednisolone 15 mg.kg-1 bw per day) to bleomycin injured rats had no effect on the lung tissue content of HA, the recovery of HA during BAL or the molecular weight of HA accumulated in the alveolar space. Furthermore, steroids did not influence the increased lung water content, or the appearance of inflammatory cells in lavage fluid. These findings indicate that the early connective tissue response to the bleomycin lung injury is mediated by a mechanism which is unaffected by systemic high-dose corticosteroids.
Comparison of pulmonary and systemic effects of adenosine triphosphate in chronic obstructive pulmonary disease--ATP: a pulmonary controlled vasoregulator?
Authors: Gaba SJ , Prefaut C
Published: November 2022

During stepwise incremental intravenous adenosine triphosphate (ATP) infusion, systemic and pulmonary vascular effects were compared in 10 patients with stable chronic obstructive pulmonary disease (COPD). Pulmonary vasodilation was: 1) predominant and maximal as early as the lowest dose infusion (0.1 mumol.kg-1.min-1) with pulmonary arterial mean pressure (Ppa) (-16%; p less than 0.01) and pulmonary vascular resistance (PVR) decreases (-28%; p less than 0.005) and simultaneous increasing delta PVR/delta SVR ratio; 2) associated with worsening hypoxaemia (-14%; p less than 0.001), but also with increasing alveolar-arterial oxygen pressure difference (P(A-a)O2) and venous admixture (Qs/Qt) suggesting some inhibition of hypoxic pulmonary vasoconstriction. Systemic vasodilation was: 1) clearly dose-dependent, but only reached significant level at 0.2 mumol.kg-1.min-1 with systemic arterial mean pressure (Psa) (-12.5%; p less than 0.05) and systemic vascular resistance (SVR) decreases (-30%; p less than 0.01); 2) associated with arterial carbon dioxide tension (PaCO2) decrease (-12.5%; p less than 0.005) and recurring uncontrollable hyperpnoea, suggesting a ventilatory stimulatory effect of ATP in man. In patients with stable COPD, ATP infusion has dual acute haemodynamic effects depending on the dose-level. The predominant pulmonary vasodilating effect occurs as early as the lowest dose-levels without any further increase of pulmonary vasodilation. This contrasts with the dose-related systemic vasodilation effect. Such a dual haemodynamic effect is an indirect indication of in vivo lung metabolism of ATP.
Intralobar pulmonary sequestration presenting as a psoas abscess
Authors: Sinclair DG , Meredith-Brown M
Published: November 2022

Intralobar pulmonary sequestration is a relatively rare congenital anomaly. The commonest clinical presentation is with chronic cough, expectoration and recurrent attacks of pneumonia. An unusual presentation with a psoas abscess is reported.
Acetylcholine and adenosine diphosphate cause endothelium-dependent relaxation of isolated human pulmonary arteries
Authors: Dinh Xuan AT , Higenbottam TW , Clelland C , Pepke-Zaba J , Wells FC , Wallwork J
Published: November 2022

Endothelium-dependent vasorelaxation mediated by endothelium-derived relaxing factors (EDRF) has been extensively studied in animals but only limited studies in man are available. Demonstration of EDRF-mediated dilatation of human vessels is fundamental for understanding the mechanisms of vascular diseases in man. We have investigated endothelium-dependent relaxation of isolated human pulmonary arteries. Vascular segments, taken from uninvolved regions of resected lung from eight patients undergoing lobectomy for lung carcinoma, were cut into rings. In rings precontracted with phenylephrine, both acetylcholine (ACh) and adenosine diphosphate (ADP) induced dose-dependent relaxation in the presence of endothelium but not when the endothelium had been carefully removed. The rings without endothelium relaxed completely with sodium nitroprusside, a vasodilator agent acting directly on vascular smooth muscle. Pre-incubation with indomethacin, a cyclo-oxygenase inhibitor which blocks production of prostacyclin, did not alter the vasorelaxant responses to ACh and ADP, suggesting that one (or several) non-prostanoid EDRF(s) are responsible for the endothelium-dependent relaxation of isolated human pulmonary arteries.
Quantification of aspirated air volume reduces treatment time in pneumothorax
Authors: Engdahl O , Boe J
Published: November 2022

In 62 consecutive cases of pneumothorax, suction treatment was applied by a new method using a recently-developed vacuum pump (Pleupump) allowing the quantification of the volume of air through the chest drain. The previous 62 cases of pneumothorax treated with standard suction equipment were used as a control group. The new technique resulted in a statistically significant reduction in the mean suction treatment time from 8.1 to 4.8 days in patients with spontaneous pneumothorax. The mean total number of days in hospital was reduced from 10.0 to 6.5. This was accomplished without an increase in the number of complications or recurrences of the pneumothorax.
Paradoxical evolution of arterial blood gases during exercise in patients with chronic obstructive bronchitis
Authors: Frans A , Lampert E , Tuo N , Clerbaux T , Nullens W , Lonsdorfer J
Published: November 2022

In more than a thousand chronic obstructive lung disease (COLD) patients we have observed in six cases, that exercise-induced hypercapnia was accompanied by a concomitant improvement in arterial oxygen tension (PaO2) and a decrease in the alveolo-arterial O2. This behaviour was not due to technical errors. We explained the increase in PaO2 during exercise by three nonmutually exclusive mechanisms: 1) an increase in the respiratory quotient; 2) the exercise induced increase in alveolar ventilation, although inadequate to match the increase in CO2 production, would be redistributed to previously poorly ventilated regions of the lung, these regions therefore receiving enough oxygen to arterialize the blood flowing through the alveolar capillaries; 3) alternatively, perfusion would be redistributed in a more efficient way during exercise, so that even in the presence of hypoventilation, oxygenation would be improved.
Quality assessment and predictors of survival in long-term domiciliary oxygen therapy. The Swedish Society of Chest Medicine
Authors: Strom K , Boe J
Published: November 2022

On January 1, 1987, 560 patients (267 male) were registered as using long-term domiciliary oxygen therapy (LTO) in Sweden. The duration of LTO before this date varied between 10 days and 11 yrs. During a two-year follow-up 12 patients had their LTO withdrawn because they were no longer hypoxic. In 139 patients the arterial oxygen tension (PaO2) on breathing air was registered three times. In seventeen (12%) of these patients the PaO2 exceeded 7.5 kPa on all three control occasions. The two year actuarial survival in all patients was 57%. The two year actuarial survival was 77% in patients with kyphoscoliosis, 56% in patients with sequelae of tuberculosis, 54% in patients with chronic obstructive pulmonary disease (COPD) and 39% in patients with fibrosis. In COPD patients survival was predicted by age, sex, current smoking habits, arterial carbon dioxide tension (PacO2) when breathing oxygen and oral steroid medication. A poor Zubrod performance score was associated with a high mortality rate in all patient groups.
Psychological status of COPD patients on long term oxygen therapy
Authors: Borak J , Sliwinski P , Piasecki Z , Zielinski J
Published: November 2022

We evaluated the psychological status of chronic obstructive pulmonary disease patients with chronic respiratory failure, who were qualified for or on long-term oxygen therapy. Forty eight patients were examined. The patients' psychological status was assessed by means of the following methods: detailed clinical interview, the Taylor Manifest Anxiety Scale (MAS), Beck's Depression Inventory, and Tylka's Psychological Evaluation of Rehabilitation Efficiency Scale (SOPER). The study demonstrated that the great majority of patients presented a high degree of anxiety, depression and psychological tension, had low self-esteem and did not believe in the efficiency of therapy.
Radiographic chest assessment of lung injury following hemithorax irradiation for pleural mesothelioma
Authors: Maasilta P , Kivisaari L , Holsti LR , Tammilehto L , Mattson K
Published: November 2022

To characterize the nature, extent and time-course of radiation-induced lung injury, and to evaluate the usefulness of serial chest radiographs in this assessment, we studied 253 chest radiographs of 46 patients with pleural mesothelioma given hemithorax irradiation according to one of four different regimens: I 20 Gy; II 55 Gy; III hyperfractionation 70 Gy; IV hyperfractionation 35 Gy followed by local hypofractionation 36 Gy. Lung injury on the chest radiograph was graded from 0 (none) to V (maximal) based on the degree of loss of aerated lung tissue. Grade I changes were present 1-2 mths after radiotherapy in regimens II-IV. Grade V injury had developed in all but 3 out of 4 patients of the 20 Gy group by 6-12 months after irradiation. The extent and time-course of radiation-induced lung injury could be defined by serial chest radiographs alone. However, the documentation of tumour status and/or infections needed additional imaging or laboratory investigation, especially when grade IV-V lung injury was present. For research protocols evaluating radiation-induced lung injury serial chest X-rays are recommended at the following time-points: before treatment and 2, 6 and 12 mths after treatment, with additional computerized tomographic (CT) scans as required for differential diagnosis.
Respiratory muscle fatigue limiting physical exercise?
Authors: Fitting JW
Published: November 2022

Inspiratory muscle fatigue has been documented during loaded breathing or acute respiratory failure, but its role in exercise limitation is still undetermined. Electromyographic (EMG) signs of diaphragmatic fatigue develop in normal subjects hyperventilating above 70% of maximal voluntary ventilation (MVV), a ventilatory level commonly attained at peak exercise. EMG signs of diaphragmatic fatigue also occur during high power cycling exercise in normal subjects and chronic obstructive pulmonary disease (COPD) patients. However, a loss of respiratory muscle strength has rarely been documented following strenuous physical exercise with techniques independent of the subjects' collaboration. Prior inspiratory muscle fatigue decreases exercise tolerance in normal subjects but its effect is largely unknown in COPD patients. Respiratory muscle rest by negative pressure ventilation was reported to improve exercise tolerance in COPD, but this beneficial effect was not confirmed by controlled studies. The effect of inspiratory muscle training on exercise tolerance is still undefined by existing data, in part because of differences in methods and selection criteria between studies. Although respiratory muscle fatigue may occur during exercise, it is not clearly established whether interventions directed at respiratory muscles may improve exercise tolerance in COPD.
An attempt to evaluate lung aggression in monkey silicosis: hydrolases, peroxidase and antiproteases activities in serial bronchoalveolar lavages
Authors: Hannothiaux MH , Scharfman A , Wastiaux A , Cornu L , van Brussel E , Lafitte JJ , Sebastien P , Roussel P
Published: November 2022

Exposure to silica can induce fibrosis and/or emphysema. Various factors such as proteases, other hydrolases and oxidants may be involved in the destruction of lung parenchyma. On the other hand, antiproteases play an important role in the protection of lung parenchyma against the action of proteases. We have developed an animal model of silicosis in monkey Macacus cynomolgus and followed these factors by bronchoalveolar lavage (BAL). We have studied glycosidases activities, elastase-like activity, immunoreactive alpha 1-protease inhibitor (alpha 1PI), neutrophil elastase inhibitory capacity (NEIC) and myeloperoxidase. Bronchoalveolar cells in serial BAL were also studied. Six monkeys were exposed to quartz aerosols (100 mg.m-3) for 18 wks. They were followed until they developed X-ray changes, which occurred between 21-64 wks after the end of the dust exposure. Cellular "silicotic nodules" were observed in lung biopsies. A control animal underwent serial BAL. Changes were seen in the differential cell count. The release of superoxide anion by bronchoalveolar cells obtained during the experiment was increased. Separation on a gradient of Percoll showed the presence of young macrophages, which exhibited enhanced release of superoxide anion as compared to the totality of bronchoalveolar cells. The biochemical analysis of BAL fluids obtained during and after the period of dust exposure showed an increase in glycosidases, alpha 1PI and NEIC. Some free elastase-like activity was simultaneously detected in BAL fluids from exposed animals but not from the control. This elastase-like activity was very low compared to NEIC. The increase in enzymatic and antiprotease activities occurred at different points in time for each animal, suggesting large differences in individual responses to dust, but occurred before the chest X-ray abnormalities.
Flurbiprofen does not affect elastase-induced bronchial secretory cell metaplasia in hamsters
Authors: Nields HM , Snider GL , Christensen TG
Published: November 2022

The anti-inflammatory drug flurbiprofen speeds the repair of cigarette smoke-induced bronchial secretory cell metaplasia (SCM) in rats. We tested whether flurbiprofen would prevent or mitigate the development of elastase-induced bronchial SCM in hamsters. Twice daily injections of flurbiprofen (4 or 6 mg.kg-1.day-1) were begun immediately after intertracheal instillation of porcine pancreatic elastase (PPE) or its vehicle, saline. At 3 wks, the bronchi of these animals were compared to those of animals receiving PPE or saline. PPE-treated hamsters, with or without flurbiprofen, developed moderate to severe SCM. Control hamsters had normal airways. Flurbiprofen had no effect on the neutrophilic pulmonary infiltrate seen 2 h after PPE instillation. We conclude that the development of elastase-induced SCM in hamsters is not affected by a flurbiprofen regimen begun directly after elastase instillation. The pathogenesis of this lesion may involve factors which are insensitive to flurbiprofen or which trigger the lesion immediately upon exposure to the enzyme.
Inhalation of the propeller from a spinhaler
Authors: Polosa R , Finnerty JP
Published: November 2022

A 39 yr old man with a 5 yr history of asthma opened his spinhaler to inspect it. He sucked at the capsule to see if its contents were damp. The capsule and propeller came off the spindle, and he aspirated them. He attended a casualty department. The chest radiogram was normal. Over the next three months he developed dypnoea and pain in his chest. He also noticed a whistling noise from his chest, more marked when he lay on his right side. On renewed examination, expiration was prolonged over the right side of the chest, and an occasional whistling wheeze could be heard on that side. A renewed chest radiogram was normal. By means of rigid bronchoscopy, the spindle was removed from its lodged position in the right intermediary bronchus just beyond the orifice to the right upper lobe.
Relationships between lung function and physical characteristics in young adult black and white males and females
Authors: McDonnell WF , Seal E
Published: November 2022

The relationships of lung function to physical characteristics in young adults have not been adequately described for different gender-race groups in the United States. As part of a study of the effects of ozone exposure upon Black and White men and women, we measured lung volumes, expiratory flow rates, and airways resistance on a sample of 314 healthy 18-35 yr old nonsmokers. Regression analysis indicated that lung function was adequately described as a linear function of either height or sitting height in each of the four groups, and that while not always significant, gender and race differences in the height and sitting height coefficients were consistently present with those of males and Whites larger than those of females and Blacks, respectively. Lung volumes were frequently observed to be associated with body mass index as measured by Quetelet Index (weight.height.2). The best fitting gender-race specific multiple regression models including these terms and occasional age terms are presented. Two additional models are presented, one of which simultaneously adjusts for both gender and race, and the other of which adjusts for gender for a given race. Comparison of predicted values from our study to those of other studies suggests that the population samples from this study may be similar to those of other American populations reported upon by others.
Application of a new ventilator-multi-plethysmograph system for testing efficacy of surfactant replacement in newborn rabbits
Authors: Sun B , Kobayashi T , Cursted T , Grossmann G , Robertson B
Published: November 2022

We applied a new ventilator-multi-plethysmograph system to evaluate the effect of surfactant replacement in newborn rabbits under well controlled, nearly physiological conditions characterized by normal ECG and adequate PCO2 in right ventricular heart blood obtained at the end of the experiment. Up to 10 animals were ventilated in parallel with a pressure-constant common respirator system. Using a working pressure of 4.9 kPa (50 cmH2O), we could adjust the pressure delivered to each animal within the range of 0.49-4.4 kPa (5-45 cmH2O), by changing the length of an open high-resistance tube constituting the outflow limb of the connection between the common ventilator tube and the tracheal cannula. Immature newborn animals obtained after 27.5 days gestation and ventilated for 30 min with a tidal volume of 8-10 ml.kg-1 had a mean +/- SD lung-thorax compliance of 4.2 +/- 1.1 ml.kPa-1.kg-1 (0.41 +/- 0.11 ml.cmH2O-1.kg-1) and PCO2 of 8.5 +/- 1.9 kPa. In littermates treated at birth with a large dose of natural surfactant (Curosurf, 200 mg.kg-1, compliance increased to 6.0 +/- 1.0 ml.kPa-1.kg-1 (0.68 +/- 0.10 ml.cmH2O-1.kg-1) (p less than 0.01) and PCO2 decreased to 6.9 +/- 1.2 kPa (p less than 0.01). Near-term animals, obtained at 30 days gestation and ventilated under similar conditions had a compliance of 7.2 +/- 0.9 ml.kPa-1.kg-1 (0.71 +/- 0.09 ml.cmH2O-1.kg-1) and PCO2 of 6.4 (1.2) kPa. Administration of surfactant (same dose as above) to these mature animals at birth had no adverse effects.
Search for a retroviral cause for sarcoidosis: no evidence from peripheral blood studies
Authors: Lyons DJ , Sinclair A , Smith HG , Mitchell DN , Dalgleish AG
Published: November 2022

Twenty six patients with sarcoidosis of recent onset or with severe progressive disease were studied for evidence of retroviral infection. Peripheral blood mononuclear cells (PBMC) were cultured in vitro and stimulated with phytohaemagglutinin and interleukin-2. Induction of syncytia (SI) and production of reverse transcriptase (RT) were sought as indicators of possible retroviral infection. PBMC from two patients showed syncytia formation and in one of these two there was associated production of low levels of reverse transcriptase. The remaining patients showed neither RT nor SI activity. The predominantly negative results of this study indicate that sarcoidosis is unlikely to be of retroviral aetiology; however, cell populations from sites of active disease should be studied before drawing this conclusion.
Pain in scar as an early symptom of acquired thoracic lung hernia
Authors: Meek JC , Bollen E , Koudstaal J , Versteege C , Maesen FP
Published: November 2022

Hernia of the lung manifests itself as an elastic, usually replaceable, swelling in the chest wall, which changes in size during inspiration and expiration. It does not generally cause any symptoms. We describe the case history of a 49 yr old man with an acquired thoracic lung hernia, which had first presented three years previously as pain in an operation scar during coughing and lifting. Histopathology of the excised lung tissue showed abnormalities suggestive of previous episodes of strangulation.
Non-invasive mechanical ventilation for cystic fibrosis patients--a potential bridge to transplantation
Authors: Hodson ME , Madden BP , Steven MH , Tsang VT , Yacoub MH
Published: November 2022

The case histories of six cystic fibrosis patients awaiting heart-lung transplantation are reviewed. They all deteriorated with severe hypoxia and hypercapnia before donor organs became available. Nasal intermittent positive pressure ventilation was used in preference to conventional ventilation with excellent results in four patients. There were no episodes of hypotension or toxaemia and the patients were in a stable condition at the time of surgery and made an excellent post-operative recovery. The patients who were transplanted and the patient who died, for whom suitable donor organs did not become available, probably had a more comfortable time than they would have done if treated with conventional ventilation. This method of ventilation appears to be a useful bridge to transplantation when a patient suddenly deteriorates. It gives them a chance of survival for a few more days or even weeks during which time an urgent search for donor organs can be made. This is also a very cost effective method of ventilation and does not encroach on conventional Intensive Care Unit (ICU) facilities.
Lack of effect of 4 weeks of oral H1 antagonist on bronchial responsiveness
Authors: Ruffin RE , Latimer KM
Published: November 2022

Ten patients with stable chronic asthma completed a randomized double-blind placebo controlled crossover study examining the effect of 120mg terfenadine twice daily for 4 weeks on bronchial responsiveness. Bronchial responsiveness was measured by methacholine inhalation tests performed by the tidal breathing technique at 0, 2 and 4 weeks of active and placebo treatment periods separated by a one week washout period. There were no significant differences in mean baseline forced expired volume in 1 sec (FEV1) for placebo and terfenadine treatments (p greater than 0.05) and there were no differences between geometric mean provocative concentrations of methacholine to cause a 20% fall in FEV1 (PC20M) at 2 and 4 weeks of terfenadine (0.89 and 0.99 mg.ml.1) from placebo (0.94 and 0.84 mg.ml.1) (p greater than 0.05). Examination of individual PC20M values during terfenadine treatment showed that 5 patients had PC20M's outside their 95% confidence interval; 2 increased both 2 and 4 week values, 1 increased one value and 2 decreased one value each. It is concluded that terfenadine does not produce clinically significant changes in stable asthmatics.
The acoustic reflection technique for non-invasive assessment of upper airway area
Authors: Hoffstein V , Fredberg JJ
Published: November 2022

Non-invasive assessment of upper airway area by acoustic reflections has been developed in the last 12 yrs. The technique is based on the analysis of sound waves reflected from the airways. Measurement of the amplitudes of the reflections and their times of arrival at the sensing microphone permits construction of a plot of airway area vs distance from the microphone. We describe the theoretical foundations of the method and review the underlying assumptions. This is followed by a summary of the results of in vitro and in vivo validation studies, with particular attention to the reproducibility, accuracy and variability of the technique. The description of clinical and physiological applications of this technique includes detection of tracheal stenosis, demonstration of structural and functional abnormalities of the pharynx and glottis in patients with sleep apnoea, dichotomous response of the airway area to exercise, and airway vs parenchymal hysteresis. Finally, we comment on the future directions that might be investigated using this technique.
Spherocytosis and pulmonary hypertension coincidental occurrence or causal relationship?
Authors: Verresen D , De Backer W , Van Meerbeeck J , Neetens I , Van Marck E , Vermeire P
Published: November 2022

A report is given on a 59 yr old man with hereditary spherocytosis and progressive shortness of breath on exertion, due to severe pulmonary hypertension and cor pulmonale. An open lung biopsy was performed in order to exclude all known aetiologies of secondary pulmonary hypertension. Pathological examination revealed in situ thrombosis and asymmetric fibromuscular hyperplasia of small- and medium-sized pulmonary arteries. Both primary pulmonary hypertension and hereditary spherocytosis have a low incidence in the general population and their simultaneous occurrence has not been reported previously; the possibility that this was due to a causal relationship and not to coincidence cannot be ruled out, in view of some similarities with pulmonary hypertension complicating sickle cell anaemia.
Neuroendocrine cells in anthracosilicotic lungs
Authors: Gubbelmans HL , Maesen BL , Koudstaal J , Thunnissen FB
Published: November 2022

In normal human lungs, neuroendocrine (NE) cells can be found as solitary NE cells and in corpuscular aggregates, the neuroepithelial bodies. By means of a quantitative morphometric method, we compared the number and distribution of chromogranin-reactive NE cells in anthracosilicotic and control lungs. After death, 14 pairs of control and 12 pairs of anthracosilicotic lungs were sampled. The extents of anthracosilicosis and emphysema were described for the right lung. The left upper lobe was used for quantitative determination of the number and distribution of NE cells, visualized by immunohistochemical staining for chromogranin. In contrast to expectations, we found no statistical difference in the numbers of chromogranin-reactive NE cells per 10 cm of epithelium between control (11.0) and anthracosilicotic (2.4) lungs. In both groups, there was a much greater number of chromogranin-reactive cells in the more peripheral compared to the central airways. Most peripheral NE cells were arranged in neuroepithelial bodies, which were not found in the central airways.
What factors explain racial differences in lung volumes?
Authors: Donnelly PM , Yang TS , Peat JK , Woolcock AJ
Published: November 2022

In order to examine the physical characteristics that may determine racial differences in lung volumes, we studied healthy, nonsmoking Caucasian, Chinese and Indian males of similar ages (range 18-51 yrs). We measured spirometric function, flow volume curves, lung volumes, inspiratory and expiratory muscle pressures, alveolar distensibility and diffusing capacity, together with height, weight and fat free mass. Chest shape was measured using radiographs. The mean total lung capacity and vital capacity in the Caucasian group, expressed as percentage predicted, were 5 and 10% higher than in the Chinese group and 17 and 20% higher than in the Indian group. Chinese values for these measurements were 12 and 10% greater than Indian. We found that Caucasians had higher fat free masses, higher inspiratory and expiratory muscle pressures and wider chests than the other races. The Caucasians and Chinese had longer chests than the Indians. There was no difference in alveolar distensibility or in the diffusion coefficient between the groups. These findings suggest that Caucasians have larger lung volumes than Chinese and Indians because they have increased numbers of alveoli and physically larger chest cavities, and not because of greater alveolar distensibility. Chest dimensions, together with height and race explained 90% of the variation in forced vital capacity and 86% of the variation in total lung capacity. Height multiplied by fat free mass, a "physique factor", previously suggested as the best predictive factor for forced vital capacity in Caucasians, did not account for much of the variation in forced vital capacity between Caucasians and Indians, presumably because it takes no account of differences in chest dimensions.
Recurrent adult respiratory distress-like syndrome associated with propylthiouracil therapy
Authors: Chevrolet JC , Guelpa G , Schifferli JA
Published: November 2022

We report a patient who presented with an association between propylthiouracil treatment and recurrent episodes of an adult respiratory distress-like syndrome (ARDS). The bouts of ARDS were associated with a generalized reaction suggestive of systemic lupus erythematosus (SLE), responsive to corticosteroid therapy.
Bronchial asthma improved after removal of a phaeochromocytoma
Authors: Janssen JA , Tjiong HL
Published: November 2022

It is uncommon for bronchial asthma to be a symptom of phaeochromocytoma. We describe a patient with a phaeochromocytoma who presented with worsening of her asthma and persistent dyspnoea between attacks. She had markedly elevated levels of catecholamines. After surgical resection of the phaeochromocytoma there was a lasting improvement of the bronchial asthma. We hypothesize that worsening of bronchial asthma in phaeochromocytoma patients may be due to catecholamine-induced deterioration of asthma.
Pulmonary schistosomiasis resembling acute pulmonary tuberculosis
Authors: Schaberg T , Rahn W , Racz P , Lode H
Published: November 2022

Pulmonary involvement of schistosomiasis is usually characterized by a miliary mottling or diffuse nodular infiltrates. In most cases, pulmonary involvement is associated with an apparent clinical involvement of other organs. This report describes a 35 yr old patient who developed a cavity, a parenchymatous infiltrate and hilar adenopathy in association with pulmonary schistosomiasis. Schistosoma eggs were demonstrated in transbronchial biopsies from the lung. Pulmonary involvement of schistosomiasis is reviewed and atypical features are discussed, which may lead to diagnostic difficulties, particularly compared to tuberculosis.
Spontaneous haemopneumothorax: a rare clinical entity
Authors: Baas P , Stam J
Published: November 2022

A 39 yr old man presented with a spontaneous pneumothorax. On initial pleural drainage 120 ml of haemorrhagic fluid were collected. Twenty four hours, after re-expansion of the lung, shock developed and 1,200 ml of haemorrhagic fluid were spontaneously collected. The diagnosis haemopneumothorax was considered and at operation a bleeding vessel, which originated from the parietal pleura, was located and coagulated. The occurrence of an air fluid line at radiological examination, the development of a haemorrhagic pleural effusion and shock should alert the physician of this entity. This case stresses the importance of early recognition and surgical intervention because of the possible lethal evolution.
Pulmonary veno-occlusive disease: a case report and a review of therapeutic possibilities
Authors: De Vries TW , Weening JJ , Roorda RJ
Published: November 2022

We describe the observation of a 12 yr old girl who died of pulmonary veno-occlusive disease (PVOD). Diagnosis was based on histological examination of an open lung biopsy. The differential diagnosis, pathogenesis and possible therapies are discussed. Although medical therapy can sometimes give some temporary relief, lung transplantation might offer these patients a better chance of survival and a better quality of life.
Inhaled clemastine, an H1 antihistamine inhibits airway narrowing caused by aerosols of non-isotonic saline
Authors: Rodwell LT , Anderson SD , Seale JP
Published: November 2022

Asthmatic subjects were challenged with aerosols of hyper- and hypotonic saline 15 min (Group A) and 90 min (Group B) after inhaling clemastine. Measurements were made of forced expiratory volume in one second (FEV1) before and after medication and after challenge. When the FEV1 values (% predicted) were compared on the active and placebo days they were higher 15 min after clemastine (p less than 0.05) for both challenges and higher 90 min after clemastine inhalation (p less than 0.05) for the hypertonic challenge. The % fall in FEV1 was compared after the same concentration of saline aerosol had been given on both active and placebo days. In Group A the % fall in FEV1 on the clemastine day was reduced after challenge with hypertonic (p less than 0.02) and hypotonic (p less than 0.03) aerosol. In Group B there was a reduction in the % fall in FEV1 on the clemastine day only after hypertonic challenge (p less than 0.04). The protective effect afforded by clemastine was unrelated to change in baseline lung function. We conclude that histamine is an important mediator of the airway response to non-isotonic aerosols and suggest that the aerosol route of administration may be useful for delivering antihistamines.
Occupational asthma to spores of Pleurotus cornucopiae
Authors: Michils A , De Vuyst P , Nolard N , Servais G , Duchateau J , Yernault JC
Published: November 2022

We report the case of a young man who developed severe asthma a few months after starting work in a factory producing a single type of mushroom: Pleurotus cornucopiae (a basidiomycete). Immunological investigations, performed with material recovered from the filtering devices of the mushroom's bed, led to demonstration of specific IgE and IgG against spore extracts and to isolation of one discriminant antigen (molecular weight: 10.5 kd). Current data concerning the underestimated role of the basidiomycetes in allergic asthma are reviewed.