bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuron-specific enolase in the diagnosis of small-cell lung cancer with pleural effusion: a negative report
Authors: Pettersson T , Klockars M , Froseth B
Published: November 2022

We measured the concentration of neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) in the serum and pleural fluid of 53 patients with pleural effusions, including seven patients with small-cell lung cancer (SCLC). High levels (above 12.5 micrograms.l-1) of NSE in pleural fluid were observed in five patients with SCLC (sensitivity 71%). However, pleural fluid NSE levels were also increased in five patients with other types of cancer and in four patients with non-malignant inflammatory diseases (specificity 80%). We conclude that although SCLC with pleural effusion can be associated with elevated pleural fluid NSE activity, this increase in enzyme levels is not specific for malignancy.
Serum immunoglobulins and immunoglobulin G subclasses in cystic fibrosis related to the clinical state of the patient
Authors: Hodson ME , Morris L , Batten JC
Published: November 2022

Levels of serum immunoglobulins and immunoglobulin G subclasses were measured in 32 cystic fibrosis (CF) patients, 30 asthmatics and 27 controls. When compared with the asthmatic patients and controls, the CF patients had raised levels of all IgG subclasses as well as total IgG, IgM and IgA, but there was not a statistically significant increase in IgE. The levels of immunoglobulins in the CF patients were examined in relation to the clinical features of the disease. Raised levels of IgG4 were related to levels of IgE, but these raised levels of IgG4 appeared to be part of a general increase in total IgG and not an isolated feature. There was a significant correlation between the total IgG level and its subclasses, IgG1, IgG2, IgG3, IgG4 and IgA. IgG1 was significantly correlated with IgG2 and IgG4; IgG2 with IgG4; and IgG4 with IgE. Total IgG was the immunoglobulin most closely correlated with poor lung function. Serum IgA was higher in patients with positive immediate skin prick reactions to pollens (p less than 0.005) and death within two years of the study was related to high levels of total IgG (p less than 0.01), IgG3 (p less than 0.001), IgA (p less than 0.001), and IgE (p less than 0.005).
Respiratory resistance and intrinsic positive end-expiratory pressure (PEEPi) in patients with the adult respiratory distress syndrome (ARDS)
Authors: Broseghini C , Brandolese R , Poggi R , Bernasconi M , Manzin E , Rossi A
Published: November 2022

Fourteen consecutive ARDS patients were examined within 24 h from the onset of mechanical ventilation to determine respiratory resistance (Rrs) and compliance (Cstrs), and to assess the influence of "intrinsic" positive end-expiratory pressure (PEEPi) on the measurement of Cstrs. Flow, pressure, and changes in lung volume were measured with the transducers of the Servo 900C Siemens ventilator. Airway occlusion was performed with the end-inspiratory and end-expiratory buttons of the ventilator. We found PEEPi (3.0 +/- 2.6 cm H2O) in ten of the fourteen patients. Without the correction for PEEPi, Cstrs was underestimated by 13.9 +/- 10% on average in the group as a whole (fourteen patients), and by 19.5 +/- 5.9% in the ten ARDS patients with PEEPi. Maximum and minimum respiratory resistance (Rrsmax and Rrsmin), and frequency-dependence of Rrs were also measured. On average, there was a marked frequency-dependence of resistance, as manifested by the difference between Rrsmax and Rrsmin, with an increase of both Rrsmin (7.7 +/- 4.2 cm H2O.l-1.s) and Rrsmax (14.3 +/- 5.0 cm H2O.l-1.s). The added resistance of the endotracheal tubes and ventilator tubings was flow dependent, and averaged 13.2 +/- 2.9 cm H2O.l-1.s.(ABSTRACT TRUNCATED AT 250 WORDS)
Type II alveolar epithelial cell in vitro culture in aerobiosis
Authors: Aerts C , Voisin C , Wallaert B
Published: November 2022

A method of Type II alveolar epithelial cell culture in aerobiosis has been developed. Isolation of Type II cells was performed by digesting guinea-pig lung tissue with crude trypsin and elastase and using discontinuous Percoll density gradients. The Type II cells, as identified by light and electron microscopy, were cultured in aerobiosis for up to six days, in direct contact with the atmosphere in conditions mimicking those present in the lower respiratory tract. Significant activities of cellular superoxide dismutase (SOD), manganese dependent superoxide dismutase (Mn-SOD), catalase and glutathione peroxidase (GSH-Px) were found at the time of isolation. In contrast, cell glutathione content varied widely from one experiment to another. Changes of antioxidant enzymes were evaluated during cell culture in aerobiosis. SOD, Mn-SOD and catalase were significantly decreased after three days but were not significantly different between a three day and six day culture. Antioxidant changes did not influence the cell culture. In marked contrast, decrease in cell glutathione was associated with rapid cell death, whereas good cell survival was obtained at high levels of cell glutathione. Cell culture in aerobiosis will permit a precise evaluation of the effects of gases, particularly oxidant gases, on a primary culture of Type II alveolar epithelial cells.
Conventional physiotherapy and forced expiration manoeuvres have similar effects on tracheobronchial clearance
Authors: van Hengstum M , Festen J , Beurskens C , Hankel M , Beekman F , Corstens F
Published: November 2022

This study compared the effect of two forms of chest physiotherapy. In the "conventional" form of physiotherapy, postural drainage was combined with percussion and directed coughing. The other, relatively new form of physiotherapy, was the forced expiration technique, i.e. huffing combined with postural drainage, breathing exercises and, if necessary, coughing. Eight patients (six with cystic fibrosis, two with agammaglobulinaemia) took part in the study. No difference was found in tracheobronchial clearance, regional lung clearance, sputum production or lung function between the two forms of treatment. The forced expiration technique can be performed without an assistant. Therefore, it is concluded that in general the forced expiration technique is preferable.
Active sensitization of guinea-pig airways in vivo enhances in vivo and in vitro responsiveness
Authors: Featherstone RL , Hutson PA , Holgate ST , Church MK
Published: November 2022

A plethysmographic method was employed to assess the airway resistance of conscious, free-breathing guinea-pigs. Using this method animals sensitized by inhalation of ovalbumin and appropriate controls were assessed for their responsiveness to histamine and methacholine in vivo. The cough frequency on exposure to citric acid mist in the two groups was also assessed. Tracheal spirals from these animals were subsequently tested for their responsiveness to histamine, methacholine and prostaglandin D2 in vitro. Sensitization increased responsiveness to histamine, methacholine and citric acid in vivo but only histamine responses were affected in vitro. These changes were accompanied by a significant eosinophilia in the airways as assessed by bronchoalveolar lavage. We conclude that sensitization of the airways to ovalbumin results in responsiveness changes in bronchial smooth muscle accompanied by signs of airway inflammation.
Empyema caused by Kingella denitrificans and Peptostreptococcus spp. in a patient with bronchogenic carcinoma
Authors: Molina R , Baro T , Torne J , Miralles R , Gutierrez J , Solsona JF , Alia C
Published: November 2022

Empyema caused by Kingella denitrificans and Peptostreptococcus spp. was diagnosed in a patient with bronchogenic carcinoma. This appears to be the third report providing evidence of a pathogenic role for K. denitrificans, and the first concerning infection in the pleural space and in a patient with underlying immunosuppressive disease. K. denitrificans should be added to the list of fastidious gram-negative bacteria associated with opportunistic infections in the compromised host.
Smoking and effect of chemotherapy in small cell lung cancer
Authors: Bergman B , Sorenson S
Published: November 2022

The relationship between smoking habits and outcome of treatment was studied in 154 patients with small cell lung cancer (SCLC) who received combination chemotherapy. Thirty-two patients had stopped smoking at least 6 months before the initiation of treatment or had never smoked (NS), 51 patients stopped smoking less than 6 months prior to the start of treatment (SS) and 71 patients continued to smoke during the treatment period (CS). Life table analysis of overall survival showed no significant heterogeneity among the groups (p greater than 0.7). Chi-square test for trend in survival yielded 0.23 (p greater than 0.6) with the longest survival in SS and CS patients, and the shortest survival in NS patients. Corresponding analysis of time to progression showed similar results, with a non-significant heterogeneity (p greater than 0.5) and trend (p greater than 0.4) among the three groups, with the CS patients doing best. In the whole series the disease-free two-year survival rate was higher in the CS patients than in the SS and NS patients (p = 0.04). The results do not imply that continued smoking during chemotherapy in SCLC has unfavourable effects on the outcome of treatment.
Control of the larynx in patients with obstructive and restrictive pulmonary impairment
Authors: Yanai M , Sekizawa K , Sasaki H , Takishima T
Published: November 2022

To study changes in glottic movements associated with pulmonary functional abnormalities, we measured changes in glottic resistance (Rgl) during quiet tidal breathing in normal subjects (N), patients with chronic obstructive pulmonary disease (COPD) and patients with idiopathic pulmonary fibrosis (IPF). Changes in Rgl were measured with a non-invasive method using low frequency sound. Changes in Rgl were tightly coupled to changes in tidal volume and were reproducible in all subjects. Rgl was higher during expiration than during inspiration in N and COPD. COPD showed greater changes in Rgl between inspiration and expiration than did N. However, Rgl did not differ between inspiration and expiration in three of six IPF, and was lower during expiration than during inspiration in two of six IPF. We suggest that glottic movements during quiet tidal breathing change in association with the functional abnormalities of pulmonary diseases.
Recording pressure at the distal end of the endotracheal tube to measure respiratory impedance
Authors: Navajas D , Farre R , Rotger M , Canet J
Published: November 2022

To minimize the flow-dependent effects caused by an endotracheal tube during impedance measurements, we recorded pressure inside the tube at its distal end. We used a commercial endotracheal tube with a lumen built into its wall with the opening located near the outlet of the tube. We characterized the effect of the tube by means of an effective transfer function (H). We measured H from 0.25-32 Hz on a mechanical analogue by using pseudorandom excitation with different peak-to-peak flow amplitudes (Vpp). For an 8 mm internal diameter (ID) endotracheal tube the modulus of H measured with Vpp 0.2 l.s-1 was 1.00 at 0.25 Hz and increased with the frequency to 1.40 at 32 Hz. The phase factor was close to zero (less than 5 degrees) over the whole frequency band. The modulus of H changed less than 5% and the phase factor less than 3 degrees when Vpp was increased from 0.2 to 0.8 l.s-1. We evaluated the method on five mechanical analogues with increased resistance or elastance and with a different tracheal area. The mean normalized distance in the complex plane over the whole frequency band (dz) between the analogue impedance and the estimated value from intubation was always less than 5%. Finally, the method was tested on an active analogue which superimposed a high-amplitude (up to 1.4 l.s-1 peak-to-peak) low-frequency (0.25 or 0.33 Hz) sinusoidal flow onto excitation: dz was always less than 4.3%.
Endobronchial versus intravenous application of the vasopressin derivative glypressin during diagnostic bronchoscopy
Authors: Breuer HW , Charchut S , Worth H , Trampisch HJ , Glanzer K
Published: November 2022

Glypressin is a vasopressin derivative which is used in the present study to stop pulmonary bleeding. The effects of endobronchially versus intravenously applied glypressin were examined during diagnostic fibreoptic bronchoscopy in 27 patients. Transcutaneously measured blood gases and haemodynamics were analysed after 1 mg glypressin was given. The glypressin plasma level was 251 fold higher after the intravenous than after the endobronchial administration. After endobronchial application no significant changes were observed for blood pressure, heart rate or blood gases. Following the intravenous glypressin application there was a significant increase in diastolic blood pressure. The bronchial mucosa pallor appeared earlier after topical than after systemic glypressin application. The haemostyptic effect was similar for both routes of application.
Q fever pneumonia: a review of 164 community-acquired cases in the Basque country
Authors: Sobradillo V , Ansola P , Baranda F , Corral C
Published: November 2022

One hundred and sixty four cases of Q fever pneumonia are reviewed. Coxiella burnetti is responsible for 18.8% of pneumonias acquired in the community in our region with an extremely high seasonal variation. 91% of the cases occur between January and June. 88.5% of the patients are less than 40 yrs of age and 77% are male. The most common clinical symptoms are high fever, cough, cephalalgia and myalgias. 46.5% of the patients have no respiratory symptoms although 34% of the cases report pleural pain. The radiological signs are nonspecific. With regard to laboratory data, it is often observed that the white blood cell count (WBC) is normal and the liver enzymes are abnormal (45%). Treatment with doxycycline reduces the fever more quickly than erythromycin.
Respiratory aspects of Shwachman's syndrome in adults
Authors: Wiggins J , Geddes DM
Published: November 2022

Shwachman's Syndrome is a rare disorder which causes considerable morbidity in childhood and can be confused with cystic fibrosis. Six patients (4 males; mean age 27 yrs) are described in order to illustrate the clinical picture of the syndrome in adults. Recognized features persisting in later life include pancreatic insufficiency and bone marrow dysfunction (all patients), short stature (5/6), advanced dental caries (4/6), and impaired glucose tolerance (2/6). Chest radiograph was normal in all patients whilst lung function tests showed mild restriction in three and obstruction in two. All patients were cyclically neutropenic (nadir count 2.1 x 10(9).l-1). Four of the six patients were thrombocytopenic and three had persistent immunoglobulin deficiencies. Neutrophil chemotaxis was abnormal in four patients and the nitro blue tetrazolium test was abnormal in a fifth. Two patients suffered from recurrent respiratory infections, one of whom died from bone marrow aplasia. Although Shwachman's Syndrome may be less troublesome in adults than in children, many of the abnormalities persist into adult life and may continue to cause diagnostic difficulty.
Treatment compliance and self-medication in asthma in France
Authors: Pretet S , Perdrizet S , Poisson N , Pujet JC , Marsac J
Published: November 2022

A study was carried out among asthmatic patients in order to determine their compliance to treatment and self-medication. Data collection used a self-administered postal questionnaire as tested in a previous study. The population under study included 450 asthmatic patients; 370 answered; their mean age was 47 +/- 16 yrs and 44% were men. An aerosol was the preferred route of administration (41%). Eighty two percent of the patients tended to reduce the doses following improvement; 80% claimed to know treatment for attacks; 90% had already been using an inhaler, although only 62% had been shown how to use one. Forty eight percent had already bought drugs without prescription, especially patients within the 25-34 yrs age group. This study is consistent with similar surveys performed in other populations. Improved quality of information about treatments and how to use drugs is higher in patients with chronic forms of asthma involving unpredictable acute attacks.
Effects of long-term treatment with inhaled cromoglycate and budesonide on bronchial hyperresponsiveness in patients with allergic asthma
Authors: Molema J , van Herwaarden CL , Folgering HT
Published: November 2022

Twenty two allergic patients with bronchial asthma completed this study. Effects of long-term treatment with inhaled cromoglycate 4 x 2 mg.day-1 were compared to the effects of inhaled budesonide 4 x 0.1 mg.day-1 on symptoms, additional beta 2-agonist use, lung function and bronchial hyperresponsiveness measured by the provocation concentration of histamine producing a 20% fall in forced expiratory volume in one second (FEV1) (PC20 histamine) and exercise-induced fall in FEV1. The study was carried out in a double-blind way with a randomized crossover design using a double-dummy technique. After a single-blind placebo period, the two active treatment periods of 6 weeks were separated by a single-blind placebo period. Symptom score and beta 2-agonist use decreased during both active treatment periods, which showed no mutual differences. Morning and evening peak expiratory flow rates were significantly higher during treatment with budesonide versus placebo (p less than 0.01 and p less than 0.001), and also versus cromoglycate (p less than 0.02 and p less than 0.05). FEV1 showed improvement after a 6 week treatment with budesonide versus placebo (p less than 0.05), although there was no significant difference between the two active treatments. PC20 histamine did not change during treatment with cromoglycate. Budesonide showed a significant increase in PC20 histamine versus placebo (p less than 0.05) and was marginally significantly better than cromoglycate (p = 0.05). Exercise-induced fall in FEV1 was not changed by cromoglycate, but improved significantly during budesonide in comparison with placebo (p less than 0.01) and also with cromoglycate (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Sympathomimetics in acute severe asthma: inhaled or parenteral, nebulizer or spacer?
Authors: Noseda A , Yernault JC
Published: November 2022

It is accepted today that all patients with acute asthma should be treated with a sympathomimetic, irrespective of previous therapy. This short review addresses the question of the optimal mode of administration of these drugs in acute severe asthma. Inhaled sympathomimetics are as effective as subcutaneous adrenaline, or intravenous salbutamol or terbutaline, and, as they produce fewer side-effects, are recommended as the best mode of administration. However, self-medication with a ready to use subcutaneous preparation may be indicated in those patients prone to very abrupt attacks. The conventional mode of inhalation therapy in acute asthma is nebulization, but equally effective bronchodilatation may be obtained with metered-dose inhalers combined with valved spacers. Tachypnoeic patients unable to perform a conventional inhalation manoeuvre can use one-way valve inhalation devices with repeated tidal breaths. Finally, sequential or even continuous inhalation techniques have recently been advocated, particularly in patients with impending respiratory failure.
Pretreatment with an inhaled alpha 1-adrenergic agonist, methoxamine, reduces exercise-induced asthma
Authors: Dinh Xuan AT , Chaussain M , Regnard J , Lockhart A
Published: November 2022

In order to assess the role of the bronchial circulation in the pathogenesis of exercise-induced asthma (EIA), we conducted a double-blind, randomized study of the effects of pretreatment with an inhaled alpha 1-adrenergic agonist, methoxamine (Mx), in nine asthmatic teenagers with known EIA. Exercise consisted of 5 min cycle ergometry at a submaximal, constant work-load, while the subjects breathed dry air at ambient temperature. Forced expiratory volume in one second (FEV1) was measured at baseline, 15 min after pretreatment of either Mx or saline, and serially after exercise. Mx significantly reduced the exercise-induced fall of FEV1 without modifying baseline FEV1 in five of the eight subjects, had little or no effect in three and caused an acute asthmatic attack in the remaining subject. Mx has potent constrictor effects on both bronchial and vascular smooth muscles through stimulation of postjunctional alpha 1-adrenoceptors. Therefore, the protective effect of Mx on EIA may be attributed to vasoconstriction of tracheobronchial vessels opposing the hyperaemia and mucosal airway oedema that may cause, at least in part, the exercise-induced acute bronchial obstruction in EIA. Alternatively, Mx stimulates mucus, water and electrolyte secretion by airway epithelium and may, therefore, oppose the dehydration of airway surface that could be a causative factor of EIA.
Amelioration of human neutrophil elastase-induced emphysema in hamsters by pretreatment with an oligopeptide chloromethyl ketone
Authors: Lucey EC , Stone PJ , Powers JC , Snider GL
Published: November 2022

Human neutrophils are a likely source of elastase in the pathogenesis of human pulmonary emphysema. A study was undertaken to determine whether emphysema, induced in hamsters by intratracheal treatment with human neutrophil elastase (HNE), could be ameliorated by intratracheal instillation of succinyl-alanyl-alanyl-prolyl-valine-chloromethyl ketone (CMK). One mg of CMK was given to hamsters 1 h before 300 or 360 micrograms HNE or 1 h or 4 h after 360 micrograms HNE. The animals were studied eight weeks after treatment. The CMK given 4 h after HNE did not ameliorate the emphysema. The CMK given 1 h before HNE, ameliorated the development of emphysema but not bronchial secretory cell metaplasia. A molar ratio of instilled CMK to HNE of 128 was required for 50% in vivo effectiveness in ameliorating emphysema. Clearance studies indicated that 6.9% of the instilled CMK could be lavaged from the lungs 1 h after instillation. Therefore, an 8.9 to 1 molar ratio of lavageable CMK to HNE, at the time of HNE instillation, resulted in 50% protection. Using an in vitro assay with 3H-elastin as substrate, a 3 to 1 molar ratio of CMK to HNE was required to inhibit 50% of the elastolytic activity; 14% of the activity remained with an 18 to 1 molar ratio of CMK to HNE. Study of the in vivo effectiveness of anti-elastases, given as pretreatment in ameliorating HNE-induced emphysema and secretory cell metaplasia, is a reasonable bioassay, which may be used as a step in evaluating such agents for possible use in the prevention of human disease.
The molecular genetics of human lung cancer
Authors: Slebos RJ , Rodenhuis S
Published: November 2022

With the development of molecular biological techniques the search for genetic alterations in cancer cells has resulted in the beginning of a molecular description of cellular transformation. Most of these genetic changes occur in genes which have a role in the control of cellular growth and development, the proto oncogenes. In the last decade, it has become clear that the myc and ras oncogene families are important in the carcinogenesis of human lung cancers. The myc oncogenes are usually found to be altered in small cell lung cancer (SCLC), and these alterations appear to correlate with rapid growth and progression. Mutations in the Kras gene are specific for adenocarcinoma, a subclass of non small cell lung cancer (NSCLC). Kras gene mutations are closely associated with tobacco smoking, since all were found in adenocarcinomas from patients with a history of smoking. The erbB oncogene, which encodes the epidermal growth factor receptor, is often highly expressed in epidermoid carcinomas. The roles for other oncogenes, such as raf or myb, as well as those of "suppressor" genes remain to be investigated, but may be of paramount importance. The study of alterations in proto oncogenes may aid in the (sub)classification and diagnosis of lung cancer, and may yield useful prognostic information in the near future.
Breathing 30 per cent oxygen attenuates bronchial responsiveness to methacholine in asthmatic patients
Authors: Inoue H , Inoue C , Okayama M , Sekizawa K , Hida W , Takishima T
Published: November 2022

The effect of breathing 30% oxygen on bronchial responsiveness to inhaled methacholine was studied in 30 asthmatic patients using a direct graphical recording method. An aerosol of methacholine solution was inhaled during tidal breathing by measuring respiratory resistance (Rrs) continuously, and dose-response curves were obtained on two separate days during air and 30% oxygen inhalation. Oxygen inhalations for 20 min caused no change in baseline Rrs. The threshold dose of methacholine, the dose which increased Rrs from the baseline value while breathing 30% oxygen, increased significantly compared with that while breathing air (p less than 0.01). No significant difference was found between the mean values of the slopes of the dose-response curves of the two groups. End-expiratory oxygen concentration (FETO2) during air breathing decreased significantly from 13.7% to 12.0% at the point where methacholine dosage reached threshold. This study suggests that hyperoxia attenuates the bronchial responsiveness to methacholine in asthmatic patients.
Pulmonary densities during anaesthesia. An experimental study on lung morphology and gas exchange
Authors: Hedenstierna G , Lundquist H , Lundh B , Tokics L , Strandberg A , Brismar B , Frostell C
Published: November 2022

The nature of dense areas in dependent lung regions regularly seen in anaesthetized humans was examined in a sheep model. During anaesthesia with muscle paralysis and mechanical ventilation dense areas in dependent lung regions could be seen by means of computerized tomography (CT). They had the same location and the same attenuation as in anaesthetized humans. Gas exchange impairment tended to increase in proportion to the size of the dense area on the CT scan. Microscopy showed that the densities in the sheep were atelectatic lung regions, with no or little interstitial oedema and only minor vascular congestion. The atelectatic lung tissue was sharply demarcated and the lung tissue in the immediate vicinity was well aerated, or even hyperinflated. Gravimetry showed the same amount of extravascular fluid and blood per unit lung weight in the atelectatic lung and in the aerated lung region. It is concluded that the densities appearing in dependent lung regions during anaesthesia are caused by atelectasis.
Time constant histograms from the forced expired volume signal: a clinical evaluation
Authors: Revelly JP , Feihl F , Liebling T , Perret C
Published: November 2022

We evaluated a multicompartment analysis of forced expiration, based on modelling the lung as a set of twenty parallel compartments emptying exponentially with time constants ranging from 0.1-10 s; the forced expired volume signal was represented by a histogram showing the fraction of forced vital capacity as a function of compartmental time constants. We applied this technique to 80 healthy and 12 asthmatic subjects. The histograms computed from three consecutive forced expirations were poorly reproducible in 18 of the 80 healthy and 2 of the 12 asthmatic subjects. In the asthmatics, the time constant histograms conveyed no additional information on bronchial obstruction, beyond that already present in standard spirometric indices. A simulation study showed a high sensitivity of the histograms to the truncation of the terminal part of forced expiration. We conclude that the usefulness of the time constant histogram technique appears doubtful.
Maxillo-mandibular surgery for obstructive sleep apnoea
Authors: Guilleminault C , Quera-Salva MA , Powell NB , Riley RW
Published: November 2022

Many therapeutic approaches, including mandibular surgery, have been proposed for the treatment of obstructive sleep apnoea syndrome. In the largest study of its type yet reported, 54 patients (population A) underwent mandibular surgery: 36 had palato-pharyngoplasty and inferior sagittal osteotomy of the mandible with hyoid myotomy and resuspension, and 18 (population B) had maxillo-mandibular hyoid advancement, a procedure consisting of palato-pharyngoplasty, inferior sagittal osteotomy of the mandible with hyoid myotomy and, several months later, a maxillo-mandibular osteotomy. Criteria for procedure selection and for evaluation of results were pre-set, and clinical and polygraphic follow-up occurred 6-8 months after final surgery. In population A, 32 of the 36 patients had improved; but only 20 were evaluated as "satisfactory". In contrast, all of the population B patients were judged satisfactory. Four of the population B patients received nasal continuous positive airway pressure (CPAP) before any surgery, and both approaches gave similar good polygraphic results. The degree of skeletal cranio-facial deficiencies, particularly retrognathia, is crucial for procedure selection. We describe potential procedural risks and problems.
Neisseria sicca pneumonia and bronchiectasis
Authors: Gris P , Vincke G , Delmez JP , Dierckx JP
Published: November 2022

Neisseria sicca, although considered a harmless saprophyte, has been recognised as an etiologic agent in three cases of pneumonitis, and rare cases of endocarditis, meningitis, and osteomyelitis, particularly in immunocompromised hosts. We report the case of a 76-year-old man with a community-acquired pneumonia, in whom both sputum samples and bronchial secretions obtained with bronchoscopic protected catheter brush grew pure culture of N. sicca with abundant polymorphonuclear neutrophils. Dramatic clinical improvement only occurred after initiation of an appropriate antibiotherapy according to susceptibility spectrum of the isolated N. sicca. Bronchiectasis underlying lesions were disclosed by computed tomography. N. sicca should be added to the list of commensal organisms able to cause pulmonary infection. Moreover, the association of N. sicca and bronchiectasis has never been published.
Diagnostic labels applied to model case histories of chronic airflow obstruction. Responses to a questionnaire in 11 North American and Western European countries
Authors: Pride NB , Vermeire P , Allegra L
Published: November 2022

In Canada, USA and 9 Western European Countries, 121 respiratory physicians responded to an English language questionnaire asking them to state how they would investigate, treat and label four model patients, chosen to represent well-recognized patterns of clinical features of chronic airflow obstruction. Selection of further investigations appeared to be determined more by the probable diagnostic label than by the need to define selected characteristics in the whole range of such patients. Differences in recommended treatment between countries were less than others have reported for the treatment of asthma. Analysis of the diagnostic labels showed: the classic terms asthma, chronic bronchitis, emphysema still predominated in clinical practice and were considered to be better defined entities than any of the many terms introduced to describe chronic airflow obstruction in the last 30 yrs; the term chronic bronchitis was a source of confusion unless qualified to indicate presence or absence of obstruction; the use of combination terms such as chronic asthmatic bronchitis and chronic obstructive bronchitis showed large differences between countries; there were few differences related to national language. The implications of these findings are discussed.
Examination of 41 cases of laryngeal tuberculosis observed between 1975-1985
Authors: Galietti F , Giorgis GE , Gandolfi G , Astesiano A , Miravalle C , Ardizzi A , Favata G , Miscioscia D
Published: November 2022

Forty one cases of laryngeal tuberculosis, accounting for 0.8% of all cases of tuberculosis observed in 1975-1985, are evaluated. The mean age was 53 yrs, the male/female ratio 9:1. In all cases current or earlier pulmonary tuberculosis was noted. The laryngeal sites affected were, in order of frequency: true vocal cords, epiglottis, false cords and laryngeal ventricles, arytenoid and interarytenoid area, subglottic area. The patients were usually treated with isoniazid, rifampicin, ethambutol for 6-12 months. Two cases required excision of laryngeal lesions. The results of chemotherapy were good.
A comparison of three measures of the response to inhaled methacholine
Authors: Knox AJ , Coleman HE , Britton  , Tattersfield AE
Published: November 2022

In studies of asthma prevalence bronchial responsiveness has usually been measured as the provocative dose of bronchoconstrictor causing a 20% fall in FEV1 (PD20FEV1). This is relatively insensitive and only 10-20% of subjects in a general population sample will show such a response. Attempts to increase sensitivity, such as the use of the provocative dose causing a 10% fall in FEV1 (PD10FEV1), have not demonstrated any overall advantage, due to poorer repeatability. It has been suggested that measurement of bronchial reactivity using flow at low lung volumes measured from a partial flow volume curve is a more sensitive index of bronchoconstriction than PD20FEV1. If equally repeatable, it would have advantages in epidemiological practice. In 20 subjects with asthma, we compared the sensitivity and repeatability of PD10FEV1, PD20FEV1, and the provocative dose causing a 40% fall in flow at 30% of vital capacity (PD40V30P) following methacholine challenge. PD40V30P was more sensitive than both PD20FEV1 and PD10FEV1 by 1.48 and 0.35 doubling doses (DD) of methacholine, respectively. PD20FEV1 and PD40V30P showed equal repeatability, the 95% range for a single estimate of both being 2.02 DD. PD10FEV1 was less repeatable, with a 95% range of 2.35 DD. Values for the intraclass correlation co-efficient, which measures the ability of a test to discriminate between subjects, were 0.63, 0.79 and 0.69 for PD10FEV1, PD20FEV1, and PD40V30P, respectively. The increased sensitivity and comparable repeatability of measurement of bronchial reactivity for PD40V30P suggest that this method may be useful for studies of asthma prevalence.
Combined measurements of neuron specific enolase and bombesin/gastrin releasing peptide in lung cancer
Authors: Scagliotti GV , Piani M , Gatti E , Gozzelino F , Albera C , Pozzi E
Published: November 2022

Pretreatment serum neuron specific enolase (NSE) and plasma bombesin/gastrin releasing peptide (BN/GRP) were measured in 92 lung cancer patients and 17 controls. The mean level of NSE (p less than 0.001) and BN/GRP (p less than 0.05) was significantly raised in patients with small cell lung cancer (SCLC, n = 62) compared to non-SCLC (n = 30) and controls. The mean concentration of NSE in extensive SCLC was significantly greater (p less than 0.005) than in limited stage but with a substantial overlap of values. Forty-seven out of 62 SCLC patients had at least one of the two markers raised (sensitivity 76%, specificity 83%), 44 had raised NSE (sensitivity 71%, specificity 89%) but only 24 had BN/GRP raised (sensitivity 42%, specificity 91%). At restaging, 16 of 19 patients with SCLC responsive to chemotherapy showed a significant fall of NSE; on the other hand, BN/GRP fell significantly in only 3 patients, remaining unchanged in the majority of responding patients. In conclusion, the combined determination of NSE and BN/GRP in SCLC, at diagnosis and during the follow-up, was not found to be superior to NSE determination alone.
Breath alkanes as an index of lipid peroxidation
Authors: Van Gossum A , Decuyper J
Published: November 2022

Formation of free radicals and lipid peroxidation are mechanisms that are involved in many conditions including cellular damage. In a human body, there are many antioxidant systems likely to limit the production of free radicals and to reduce their deleterious effect. The peroxidation of polyunsaturated fatty acids, such as linoleic acid and linolenic acid which are cell membrane components, induces the formation of volatile alkanes that are excreted in the breath. The determination of breath alkanes (pentane and ethane) is considered to be a valuable and elegant method to assess lipid peroxidation. The method for collecting a breath sample and the chromatographic analysis of the collected gas require a strict methodology. Moreover, we must take into consideration some factors, such as the hepatic function, which may influence the pentane metabolism itself. We critically describe the results of breath alkane determination obtained in humans in different clinical conditions.
Depression of polymorphonuclear chemotaxis and T-lymphocyte proliferation following histamine inhalation in man
Authors: Bury TB , Radermecker MF
Published: November 2022

Histamine, in vitro, via H2-receptor activation, exerts an inhibitory effect on polymorphonuclear (PMN) chemotaxis and T-lymphocyte proliferation. The aim of this study was to verify these histamine inhibitory effects in man. Healthy and asymptomatic asthmatic volunteers inhaled a histamine (0.1%), methacholine (0.1%) or saline aerosol for 3 min. Asthmatics were selected on the basis of low bronchial sensitivity to pharmacological agents. Blood was taken before and at different times following aerosol challenge. PMN chemotaxis was studied in vitro by the Boyden assay. T-lymphocyte proliferation was measured by counting H3-thymidine incorporation in cultured mononuclear cells. Plasma histamine was measured by a specific and sensitive radioimmunoassay. Inhalation of histamine or methacholine caused a 22-43% decrease in forced expiratory volume in one second (FEV1) in asthmatics only. In both groups, there was a transient increase of plasma histamine immediately following histamine inhalation, and 2 and 4 h later, a significant decrease of PMN chemotaxis and T-lymphocyte proliferation. Inhalation of methacholine or saline had no effect on leukocytes. Oral administration of an H2-receptor antagonist, cimetidine, before histamine inhalation, prevented the decrease of PMN chemotaxis and T-lymphocyte proliferation, whereas astemizole, an H1-antagonist, had no effect. In conclusion, histamine, at a dose commonly used for bronchial provocation tests, causes, in man, 2 and 4 h after inhalation, a depression of PMN chemotaxis (tested in vitro) and T-lymphocyte proliferation through activation of H2-receptors.
Osmolality changes in nebulizer solutions
Authors: Schoni MH , Kraemer R
Published: November 2022

Paradoxical effects (bronchoconstriction instead of bronchodilatation) have been reported after inhalation of beta2-mimetics in asthmatic children, and it has been suggested that this was due to osmolality and pH changes of the nebulizer solution. We tested commercially available nebulizer solutions and found osmolality changes after 5, 10 and 15 min of nebulization. Osmolality was measured in the nebulizer chamber and the airsteam of two types of jet nebulizers. When normal saline was nebulized chamber, from 282 +/- 7 mmol.kg-1 to 432 +/- 18 mmol.kg-1 resulted. Salbutamol ready made solution, and terbutaline respules were isotonic, whereas fenoterol, disodium cromogylcate (DSCG), beclomethasone dipropionate (BDP) and salbutamol (respirator solution 0.5%) were hypotonic (60-100 mmol.kg-1). When a mixture of sodium chloride (NaCl) and the drug solution (salbutamol, terbutaline, fenoterol) was nebulized for 10-15 min, the osmolality in the nebulizer cup increased to 420-500 mmol.kg-1. However, mixtures of the same beta 2-agonists with DSCG or with BDP remained hypo-osmolar. The same osmolality changes were present in the airstream. This study shows that after 10-15 min of nebulization osmotic changes occur in the nebulizer cup and airstream and that these changes differ according to the drug mixtures and the amount of the solution in the nebulizer chamber.
Tracheal mucus clearance in high-frequency oscillation: effect of peak flow rate bias
Authors: King M , Zidulka A , Phillips DM , Wight D , Gross D , Chang HK
Published: November 2022

We have reported previously that high-frequency oscillation of the chest wall (HFO/CW) enhances the tracheal mucus clearance rate (TMCR) in dogs. This enhancement of TMCR may be due in part to the expiratory bias in peak flow rate (VE/VI greater than 1) that occurs during HFO/CW. We examined this factor in 8 anaesthetized, spontaneously breathing dogs by comparing TMCR during the following manoeuvers: 1) HFO/CW, applied by means of a thoracic cuff; 2) symmetric high-frequency oscillation via the airway opening (HFO/AO), applied by means of a piston pump driven by sinusoidal signal; 3) HFO/AO with an expiratory bias in peak flow, and 4) HFO/AO with an inspiratory bias in peak flow. All manoeuvers were of 5 min duration and were performed at 13 Hz and an oscillatory tidal volume of 1.5 ml.kg-1. In the latter two manoeuvers, the piston pump was driven by a nonsinusoidal signal such that peak VE/VI was greater than and less than unity, respectively. A high-impedance, cross-current flow of warmed, humidified air was provided at the tracheal tube. The order of manoeuvers 2, 3 and 4 was randomized, while manoeuver 1 was repeated at the end. TMCR was determined by direct bronchoscopic visualization of charcoal particle transport. Each HFO manoeuver was bracketed by a control period of spontaneous breathing. We found that TMCR during HFO/CW was 2.4 x control (p less than 0.001), in line with previous results.(ABSTRACT TRUNCATED AT 250 WORDS)
The bronchodilator response from increasing doses of terbutaline inhaled from a multi-dose powder inhaler (Turbuhaler)
Authors: Persson G , Wiren JE
Published: November 2022

Twelve adult asthmatics inhaled single doses of 0.5, 2.0 or 4.0 mg of terbutaline, respectively, via Turbuhaler, on three separate days. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and pulse rate were measured 15, 30, 45 and 60 min after inhalation from the inhaler and then hourly up to 8 h. The results showed that a more rapid onset of action, a greater maximal response and a longer duration of action can be achieved by exceeding the standard dose of terbutaline of 0.5 mg. The incidence of adverse effects was very low even at the highest dose, 4 mg. This study emphasizes the need for individual dosing of inhaled bronchodilators.
"Intrinsic" positive end-expiratory pressure in stable patients with chronic obstructive pulmonary disease
Authors: Dal Vecchio L , Polese G , Poggi R , Rossi A
Published: November 2022

We have assessed "intrinsic" positive end-expiratory pressure (PEEPi), during quiet breathing in 18 patients with chronic obstructive pulmonary disease (COPD) in stable condition. Ventilatory flow, lung volume, oesophageal (Poes), gastric (Pga), and transdiaphragmatic pressure (Pdi) were measured. PEEPi was measured as the pressure difference (delta Poes) between the onset of the inspiratory effort, indicated by the start of the Pdi swing, and the point corresponding to zero flow. PEEPi was present in all of the 18 COPD patients, and averaged 2.4 +/- 1.6 cmH2O. The maximum transdiaphragmatic pressure (Pdi,max) was also measured and averaged 81.5 +/- 17.4 cmH2O. Following a randomized sequence, ten patients then inhaled an adrenergic agonist (fenoterol 1.6 mg), and eight patients the corresponding placebo. Fenoterol, but not placebo, caused a significant increase in forced expiratory volume in one second (FEV1) (+34%, on average), associated with a significant decrease in PEEPi (-63%, on average) and a significant improvement in Pdi,max (+19%, on average). We conclude that: 1) intrinsic PEEP can be present in stable COPD patients due to increased airflow resistance; 2) fenoterol improved diaphragmatic strength (Pdi,max) in our COPD patients, possibly due to a decrease in lung volume.
Bronchial stump recurrence after surgery for bronchial carcinoma
Authors: Verleden G , Deneffe G , Demedts M
Published: November 2022

In 10 out of 295 patients (3.4%), followed-up after radical resection for non-small cell bronchial carcinoma in the period from 1980 until 1986, bronchial stump recurrence developed. A good relationship was found between relapse time (4-52 months) and distance between the primary tumour and bronchial resection line (1-7 cm) (i.e. 5-8 months.cm-1) in 8 of the patients (p less than 0.01). The mean survival time after detection of the recurrence was 10 months (range 1-15 months), and was not clearly influenced by the therapy applied (resurgery, chemotherapy, radiation), nor by the TNM stage of the bronchial stump recurrence.
Pleural effusions in an overlap syndrome of idiopathic hypereosinophilic syndrome and erythema elevatum diutinum
Authors: Cordier JF , Faure M , Hermier C , Brune J
Published: November 2022

We report a patient with idiopathic hypereosinophilic syndrome presenting with bilateral eosinophilic pleural effusions. He also had erythema elevatum diutinum, a rare skin disease of the vasculitic type. No cardiomyopathy was present. Pleural effusions, skin lesions, and blood eosinophilia disappeared with prolonged corticosteroid treatment.
Airways response of asthmatics after a 30 min exposure, at resting ventilation, to 0.25 ppm NO2 or 0.5 ppm SO2
Authors: Jorres R , Magnussen H
Published: November 2022

We compared the effect of inhaled NO2 and SO2 on airway tone and airway responsiveness in 14 nonsmoking mild asthmatics (mean +/- SD age 34 +/- 14 yrs; mean +/- SD baseline forced expiratory volume in one second (FEV1), 86 +/- 17% pred). On 3 separate days, 30 min tidal breathing (average minute ventilation 10.6 l.min-1) of either filtered air, 0.25 ppm NO2, or 0.5 ppm SO2 was followed by an isocapnic hyperventilation test with 0.75 ppm SO2. To determine the provocative ventilation necessary to increase specific airway resistance (sRaw) by 100% (PV100sRaw) ventilation was increased in steps of 15 l.min-1, each step lasting 3 min. Resting ventilation of filtered air, NO2, or SO2 was followed by a slight but significant overall decrease of sRaw from 8.8 to 7.7 cmH20.s-1, with no differences between the study days. Mean +/- SEM PV100sRaw(SO2) was 46.5 +/- 5.1, 37.7 +/- 3.5 and 45.4 +/- 4.2 l.min-1 after tidal breathing of filtered air, NO2, and SO2, respectively. PV100sRaw(SO2) was significantly lower after NO2 as compared to filtered air or SO2 (p less than 0.01). There was a significant correlation (rs = 0.86) between the individual shift of PV100sRaw(SO2) after NO2 and the shift after SO2 as compared to filtered air. From these individual comparisons we suggest that in asthmatics short-term exposure to NO2 at rest enhances airway responsiveness to hyperventilation of SO2 without altering airway tone, whereas short-term exposure with low concentrations of SO2 does not.
Bronchoalveolar mastocytosis and lymphocytosis after nitrogen dioxide exposure in man: a time-kinetic study
Authors: Sandstrom T , Andersson MC , Kolmodin-Hedman B , Stjernberg N , Angstrom T
Published: November 2022

The combination of environmental chamber exposure and bronchoalveolar lavage (BAL) was used to study the time-course of the cell response in the human lung to nitrogen dioxide (NO2). Healthy subjects were exposed for 20 min to 7 mg NO2.m-3 (4 ppm), a concentration which occurs indoors in industries and is below the peak exposure limit for work places in most countries, 10 mg.m-3 (5.5 ppm). BAL was performed in all subjects several weeks before exposure and 4, 8, 24 and 72 h after exposure, in eight subjects at each time. Mastocytosis and lymphocytosis were found in BAL fluid 4-24 h after exposure, with normalization after 72 h. A mild increase in lysozyme positive macrophages was found 24-72 h after exposure. The time-course of the human pulmonary cell response to NO2, demonstrated in BAL fluid, represents a new and previously not reported finding after exposure to this common air pollutant. Our findings are diverging from results obtained in animal studies, using approximately the same NO2 concentrations, indicating that the results from the animal studies may not be transferable to man.