bluuebunny/crossref_metadata_2025 huggingface dataset:
Pleural exudate in a tropical hospital
Authors: Sinzobahamvya N , Bhakta HP
Published: November 2022

In one hundred consecutive patients with non-purulent pleural exudates without apparent cause, the final diagnosis was tuberculosis in 58, malignancy in 20, pyogenic infection in four, cardiomyopathy in two, pulmonary infarction in one. The aetiology remained unknown in 15. The technique of "semi-open" pleural biopsy was performed under local anaesthesia. It accurately detected 70% of cancer and 69% of tuberculosis cases with a 9% complication rate and no mortality. Tuberculosis was seen at all ages but mainly between 20 and 39 yrs, where it represented 75% of cases. In this age group, malignancy was relatively rare: 10% of cases. In our environment of limited facilities, early chemotherapy trial for tuberculosis is justified for unknown pleural exudates in patients below the age of 40 yrs.
Inhaled corticosteroids can modulate the immunopathogenesis of pulmonary sarcoidosis
Authors: Spiteri MA , Newman SP , Clarke SW , Poulter LW
Published: November 2022

We investigated the effect of inhaled corticosteroids on the phenotypes and functional capacity of macrophages obtained by bronchoalveolar lavage from patients with pulmonary sarcoidosis. The results were correlated with clinical status and therapeutic efficacy. Ten symptomatic sarcoid patients (previously untreated) with radiological parenchymal shadowing and abnormal pulmonary function received inhaled budesonide, 800 micrograms m twice daily via a Nebuhaler for 16 weeks. A placebo group included ten healthy volunteers and five sarcoid patients with similar features to the treated group. Drug distribution studies showed that 10% of the inhaled drug was deposited in the alveolar region. All ten treated sarcoid patients had symptomatic relief with no adverse effects. Three of these ten patients had significant resolution of their radiological shadowing. No significant difference in pulmonary function was observed. At the cellular level, a significant decrease in lavage lymphocytosis was seen after 16 weeks, during which time there was a concomitant change in the phenotype and functional characteristics of the alveolar macrophage population. No similar changes were observed in the placebo group. Our results suggest that inhaled budesonide can modulate the aberrant immunological reactions existent in the lung in pulmonary sarcoidosis, and produce concomitant symptomatic relief with no side effects. It is postulated that this effect may occur through action on the local alveolar macrophage population.
N-acetylcysteine in cystic fibrosis and Pseudomonas aeruginosa infection: clinical score, spirometry and ciliary motility
Authors: Stafanger G , Koch C
Published: November 2022

The effect of peroral N-acetylcysteine (NAC) in patients with cystic fibrosis (CF) and chronic pulmonary Pseudomonas aeruginosa infection was studied in 52 patients in a double-blind, placebo-controlled, cross-over trial of two, 3 month durations. Active treatment consisted of NAC, 200 mg x 3 daily (patients weighing less than 30 kg) or 400 mg x 2 daily (greater than 30 kg). The effect was evaluated by a subjective clinical score, weight, sputum bacteriology, blood leucocyte count, sedimentation rate, titres of specific antimicrobial antibodies, lung function parameters and measurement of nasal ciliary function in vitro. 31 patients completed the study. No significant differences in lung function or subjective clinical scores were seen between NAC and placebo for the study group as a whole. Patients with peak expiratory flow rate (PEFR) below 70% of predicted normal values showed a satisfactory significant increase in PEFR, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) during NAC treatment. No effect of NAC on ciliary activity was observed.
Deposition and clinical efficacy of terbutaline sulphate from Turbuhaler, a new multi-dose powder inhaler
Authors: Newman SP , Moren F , Trofast E , Talaee N , Clarke SW
Published: November 2022

A radioaerosol technique has been developed in order to assess deposition patterns from a new metered dose powder inhaler (Turbuhaler, Astra Pharmaceuticals). The radionuclide Tc99m dissolved in chloroform was added to a spheronised formulation of micronised terbutaline sulphate and the chloroform was allowed to evaporate. Turbuhaler subsequently delivered 0.5 mg of treated drug per metered dose. In vitro tests with a multistage liquid impinger showed that the fractionation of the drug dose between different particle size bands was similar to the fractionation of radioactivity. In a group of ten asthmatic patients, a mean 14.2% (SEM 2.1) of the drug dose was deposited in the lungs, with 71.6% (3.0) of the dose in the oropharynx. Of the remainder, 13.7% (2.1) was deposited on the mouthpiece, and 0.5% (0.2) recovered from exhaled air. The radiolabel was present in both central and peripheral zones of the lungs. All patients bronchodilated; forced expiratory volume in one second (FEV1) increased from 1.40 (0.24) l to 1.77 (0.24) l (p less than 0.01) 20 min after inhalation. These results suggest that both the distribution of drug and the clinical effect of terbutaline sulphate delivered from Turbuhaler are similar to those from a pressurised metered dose inhaler (MDI).
Occupational asthma caused by exposure to ash wood dust (Fraxinus americana)
Authors: Malo JL , Cartier A
Published: November 2022

A 63 year old man reported rhinitis and asthma, which occurred only at work where he was exposed to ash wood dust. Monitoring of peak expiratory flow rates (PEFR) and bronchial responsiveness to histamine when off work and at work showed increased variation of PEFR at work but no significant changes in nonspecific bronchial responsiveness assessed by the provocation concentration producing a 20% fall in FEV1 (PC20). Specific inhalation challenges were carried out in a special challenge room with ash wood dust. During the exposure for only 3 minutes, the mean concentration of particles was 3 mg-m3 and about 50% of particles had a diameter less than 10 mu. An immediate bronchospastic reaction was documented. Antibodies to a human serum albumin (HSA) ash wood conjugate were not significantly increased.
Effects of childhood and adolescence-adulthood respiratory infections in a general population
Authors: Paoletti P , Prediletto R , Carrozzi L , Viegi G , Di Pede F , Carmignani G , Mammini U , Giuntini C , Lebowitz MD
Published: November 2022

The role of childhood respiratory infections before 12 yrs of age (CRI) and during adolescence-adulthood (ARI) was studied in a general population sample (n = 3,289), living in an unpolluted area of Northern Italy. The presence of respiratory symptoms and diseases, as well as risk factors for obstructive airways disease (OAD), was assessed by a standardized questionnaire. Forced vital capacity and derived expiratory flows, and single-breath diffusing capacity were measured using computerized instrumentation. There were 1,185 (36.2%) subjects who reported pertussis (PT), 374 (11.4%) recurrent chest colds, pneumonia and croup, singly or in combination, with or without pertussis (CRI), and 1,718 (52.4%) reported no respiratory infections in childhood (NOCRI). Prevalence rates of respiratory symptoms and diseases were significantly higher in subjects of the CRI group in all ages, and in older smokers. Wheeze and attacks of shortness of breath with wheeze were significantly higher in younger nonsmoking subjects with a history of CRI. Respiratory symptoms and diseases were not more prevalent in subjects of the PT group. Prevalence rates of respiratory symptoms and diseases were significantly higher in subjects with a history of ARI, both in smokers and nonsmokers. Lung function parameters adjusted for sex, age and smoking were significantly lower in CRI subjects; PT subjects showed lower values than NOCRI subjects. A significantly higher prevalence rate of ARI was present in subjects who reported CRI, both in smokers and nonsmokers. Subjects with both CRI and ARI showed the highest prevalence of respiratory symptoms and diseases. In addition, they had the lowest lung function values regardless of smoking habit.
Diagnostic value of reversibility of chronic airway obstruction to separate asthma from chronic bronchitis: a statistical approach
Authors: Meslier N , Racineux JL , Six P , Lockhart A
Published: November 2022

Our aim was to assess the usefulness of tests of reversibility of airways obstruction (AO) in the differential diagnosis of asthma (A) and chronic bronchitis (CB). We selected on strict clinical criteria 20 CB and 32 A patients with stable AO and measured maximal forced expiratory flows before and after increasing doses of inhaled salbutamol. The highest sensitivity (Se), specificity (Sp) and likelihood ratio (L) were obtained when the improvement in forced expiratory volume in one second (FEV1) was expressed as a percentage of predicted FEV1. Se, Sp and L were 0.97, 0.95 and 19.3 (highest possible L: 20) for an increase of 10% of predicted FEV1 on 0.2 mg of salbutamol, and 1.0, 1.0 and 20, respectively, for an increase of 15% on 1 mg of salbutamol. Conversely, L was only 2.8 when the widely used increase in FEV1 of 20% over baseline was tested. In a second group of 42 unselected patients, who were referred to the laboratory for routine lung function testing with a presenting diagnosis of A or CB, L was only 5.5 when the 10% increase in predicted FEV1 was used and even lower for the classical 20% increase over baseline FEV1. We submit that routine tests of reversibility of AO have little diagnostic usefulness in unselected patients with AO and that the commonly used criteria of 15 or 20% increase in FEV1 over baseline are of no value in separating A from CB.
Lactobacillus pneumonia in a patient with oesophageal carcinoma
Authors: Querol JM , Manresa F , Izquierdo J , Cisnal M
Published: November 2022

We report a case of necrotizing pneumonia caused by Lactobacillus secondary to a tracheo-oesophageal fistula created by an oesophageal carcinoma. We emphasize the presence of resistance of Lactobacillus to clindamycin and cotrimoxazole, previously reported to be effective.
The relation between snoring and smoking, body mass index, age, alcohol consumption and respiratory symptoms
Authors: Kauffmann F , Annesi I , Neukirch F , Oryszczyn MP , Alperovitch A
Published: November 2022

Potential risk factors for snoring were studied in a population of 457 middle-aged men. Eversnoring was reported by 60% of the men and snoring with an age of onset before or equal to 20 years by 13%. Eversnoring was significantly related to older age, higher body mass index and smoking habits. Alcohol consumption, estimated by questionnaire and gamma-glutamyl transpeptidase was unrelated to a history of snoring. Logistic regression showed that snoring was independently associated with age, body mass index and smoking habits. An exposure-effect relationship clearly appeared between tobacco consumption and snoring. After adjustment for smoking habits, none of the upper or lower respiratory symptoms was significantly related to snoring.
Bronchial responsiveness to inhaled methacholine in epidemiological studies: comparison of different indices
Authors: Bruschi C , Cerveri I , Zoia MC , Maccarini L , Grassi M , Rampulla C
Published: November 2022

We evaluated the sensitivity and specificity of different indices drawn from the forced expiratory curve in order to detect the best one for evaluating bronchial reactivity in the general population, and particularly, for distinguishing between normal and asthmatic subjects. 654 subjects, between 15 and 64 years of age, who were representative for age and sex of the general population of a small Lombardy town (Italy), were studied. Of the total sample, 448 subjects were clinically normal and asymptomatic, 87 were symptomatic or with acute upper respiratory disease within 30 days before the challenge with methacholine, 43 with allergic rhinitis, 26 asthmatics and 50 chronic bronchitics. All the subjects who had a baseline FEV1 greater than 85% predicted underwent methacholine challenge. Provocative LnDoses of a 6, 10, 15% fall in FEV1 (LnPD6, LnPD10, LnPD15) and provocative LnDose causing FEV1 to fall more than 2 SD below the mean of 5 FEV1 measurements following buffer inhalation (LnTD) were evaluated. Furthermore we calculated the "Dose-Response slope" (SL) proposed by O'Connor. The cut-off value of each index to define a responder was calculated by discriminant analysis of the response to the challenge in normal and in the asthmatic group. Sensitivity, specificity and predictive value of LnPD6, LnTD and SL were 79, 74, 14%; 71, 74, 13% and 46, 97, 48% respectively. LnPD10 had the best sensitivity (83%) with a high specificity (83%), but, as compared to LnPD15, whose sensitivity was 79% and specificity 89%, a lower predictive value (21% vs 27%).(ABSTRACT TRUNCATED AT 250 WORDS)
Breath-actuated inhalers: comparison of terbutaline Turbohaler with salbutamol Rotahaler
Authors: Anani A , Higgins AJ , Crompton GK
Published: November 2022

Two breath-actuated inhalers, the Turbohaler and the Rotahaler, were compared in 24 patients with chronic asthma using an open, cross-over study design. Patients were treated with terbutaline (500 micrograms) and salbutamol (400 micrograms) four times daily, each trial period lasting three weeks. Mean morning peak expiratory flow (PEF) values were higher during Turbohaler treatment, but were similar 15 min after inhaler use. The Turbohaler was found to be easier to use than the Rotahaler.
Room temperature influences output from the Wright jet nebulizer
Authors: Kongerud J , Soyseth V , Johansen B
Published: November 2022

Standardization of the solute output from the Wright nebulizer is necessary in nonspecific bronchial challenge to obtain reproducible results. Airflow and driving pressure are known determinants of the output. In an epidemiological study, in which day-to-day variations in room temperature occurred, we found the reproducibility of the output from a Wright nebulizer to be outside the range of acceptance. We have, therefore, examined to what extent ambient temperature and humidity might influence the output from three Wright nebulizers. The solute output was linearly correlated not only to flow (r = 0.98) and driving pressure (r = 0.90) but also to room temperature (r = 0.96). The mean output increased approximately 23% when room temperature was increased from 19 to 24 degrees C. This is equivalent to an increase in airflow of more than one litre. Ambient humidity did not influence the nebulizer output. When temperature was included in the calibration procedure, the coefficient of variation of the output decreased from 5 to 2%. This emphasizes the need for calibration of the Wright nebulizer with regard to ambient temperature as well as to airflow and pressure, especially in epidemiological field studies in which large variations of temperature are likely to occur.
Agenesis of the lung
Authors: Kaya IS , Dilmen U
Published: November 2022

Agenesis of the lung is extremely rare. Developmental defects of the lung are usually associated with other congenital malformations. Half of all reported patients die either at birth or within the first 5 yrs of life. We report a case of right lung agenesis with absence of the left kidney, and fusion anomaly between ribs 4 and 5 on the left hemithorax.
Respiratory symptoms and FEV1 as predictors of hospitalization and medication in the following 12 years due to respiratory disease
Authors: Vestbo J , Rasmussen FV
Published: November 2022

The predictive value of cough, mucus hypersecretion, breathlessness, chronic bronchitis and forced expiratory volume in one second (FEV1) for hospitalization and medication were examined in a random population sample of 876 men, 46-69 yrs of age. All of the men were examined in 1974 with interview and lung function tests. Information on hospitalization in the period 1977-1986 was obtained from the Danish National Patient Register, and information on drug usage was obtained from 567 men in a questionnaire survey ultimo 1985. FEV1 was a strong predictor of both hospitalization and medication. Respiratory symptoms were good predictors of hospitalization due to either respiratory disease in general (odds ratios 2.56-3.29), or chronic obstructive pulmonary disease (COPD), (odds ratios 4.16-5.75). They contained predictive values in addition to that provided by FEV1. Respiratory symptoms were good predictors of medication for airway obstruction, relative risks 3.56-4.70, and/or airway disease in general, relative risks 2.67-4.69. After controlling for FEV1, cough was still significantly associated with treatment for airway disease in general and both cough, mucus hypersecretion and chronic bronchitis were significantly associated with treatment for airway obstruction. We conclude that apart from FEV1, respiratory symptoms are independent predictors of hospitalization and medication due to respiratory disease.
Colo-pleural fistula
Authors: Olesen LL , Pedersen JT
Published: November 2022

A case of non-traumatic colo-pleural fistula is recorded for the first time as the cause of a long-standing pleural empyema. The patient was treated with drainage, antibiotics and parenteral nutrition. The fistula was the result of a diverticulitis coli and/or a pancreatitis.
Energy expenditure and rib cage-abdominal motion in chronic obstructive pulmonary disease
Authors: Fitting JW , Frascarolo P , Jequier E , Leuenberger P
Published: November 2022

The resting energy expenditure (REE) was measured by indirect calorimetry in 10 patients with chronic obstructive pulmonary disease (COPD) in stable clinical state and in 10 normal subjects. In order to avoid artefactually increased values, REE was obtained from prolonged measurements in steady state using a ventilated hood, without facial apparatus. The REE of COPD patients was significantly increased to 117% of predicted basal metabolic rate and to 125% of the control group values. Rib cage and abdominal movements were measured in COPD patients by inductance plethysmography and expressed with three indices: rib cage contribution to tidal volume (RC/VT), variability in compartmental contribution to tidal volume (SD RC/VT), and maximal compartmental amplitude/tidal volume ratio (MCA/VT). No correlation was found between REE and any of the indices of rib cage and abdominal motion. We conclude that the REE is increased in patients with COPD in stable clinical state, but is not related to the degree of abnormal rib cage-abdominal motion.
Attempts at measuring pulmonary arterial pressure by means of Doppler echocardiography in patients with chronic lung disease
Authors: Torbicki A , Skwarski K , Hawrylkiewicz I , Pasierski T , Miskiewicz Z , Zielinski J
Published: November 2022

In 72 patients with severe chronic pulmonary or pulmonary vascular disease pulmonary arterial pressure was measured by means of right heart catheterization. Forty three patients had pulmonary hypertension, (32 +/- 11 mmHg) and 27 patients had normal pressure (14 +/- 3 mmHg). These patients were examined with continuous wave (CW) and pulsed wave (PW) Doppler echocardiography. The retrograde systolic tricuspid valve pressure gradient assessed with CW Doppler correlated with systolic pulmonary pressure (r = 0.92, p less than 0.001, SEE 7.7 mmHg) but was measurable in only 17 of the 70 patients. The flow velocity pattern in the right ventricular outflow tract could be recorded in 68 of the 70 patients. Acceleration time (AcT) from systolic flow onset to peak velocity correlated with mean pulmonary artery pressure (r = 0.72, p less than 0.001, SEE 8.3 mmHg). An AcT less than 90 msec had an 84% positive predictive value for pulmonary hypertension. Right ventricular isovolumic relaxation time could be measured in 59 of the 70 patients and correlated with systolic pulmonary artery pressure (r = 0.69, p less than 0.001, SEE 12.4 mmHg). No single Doppler method is at the same time easily applicable and accurate in prediction of pulmonary arterial pressure in patients with chronic lung diseases.
Cerebral air embolism after transthoracic aspiration with a 0.6 mm (23 gauge) needle
Authors: Omenaas E , Moerkve O , Thomassen L , Daehlin L , Larsen J , Eidsvik S , Gulsvik A
Published: November 2022

A 54 yr old man experienced weakness in his legs, ataxia and subsequent urinary retention after a percutaneous fine-needle aspiration of a tumor in the right lower lobe. Clinical neurological examination and electroencephalography revealed signs of a brain stem lesion, probably due to an air embolism to the basilar artery. The symptoms and signs gradually disappeared prior to, as well as after, hyperbaric oxygen treatment. We believe this to be the first case of air embolism after transthoracic puncture with a 23 gauge needle to be reported in medical literature.
Goodpasture's syndrome with normal renal function
Authors: Carre P , Lloveras JJ , Didier A , Gorguet B , Orfila C , Durand D , Leophonte P
Published: November 2022

Two cases of Goodpasture's syndrome with severe pulmonary haemorrhage and normal renal function are described. In spite of minor (patient 2) or even no (patient 1) biological or light microscopic signs of glomerulonephritis, immunofluorescence of immunoglobulin G (IgG) was strongly positive in a linear fashion along the glomerular basement membranes in both patients. We suggest that renal biopsy in patients with apparently idiopathic pulmonary haemorrhage may lead to an early diagnosis of Goodpasture's syndrome. It is not possible in this disease to recognize on presentation those patients who will remit spontaneously and those who will undergo severe disease. The deadly evolution for patient 1 and some cases in the literature lend support to the notion that cytostatics and plasma exchange must be added to corticosteroids, even if pulmonary haemorrhage is not active and renal function is normal at the time.
Procoagulant (thromboplastin) activity in human bronchoalveolar lavage fluids is derived from alveolar macrophages
Authors: Lyberg T , Nakstad B , Hetland O , Boye NP
Published: November 2022

Fibrin deposition in the alveolar space and the lung interstitium is a prominent feature of many types of inflammatory pulmonary diseases. Cells of the monocyte/macrophage line are the primary cells supplying procoagulant activity in inflammatory lesions. In the present study we found that both lung alveolar macrophages (LAM) and bronchoalveolar lavage fluids (BALF) from humans contained procoagulant activities. The procoagulant in BALF was associated with membrane vesicles which sedimented at 100,000 g for 1 h. By electron microscopy the BALF ultrasediment was seen to consist almost exclusively of membrane material and this was confirmed by monitoring the content of different marker enzymes for specific subcellular structures. Using macrophage membrane markers, at least part of the BALF-ultrasediment was shown to be derived from LAM. On the basis of phospholipase C sensitivity, antibody neutralization and the site of action of the procoagulant in the sequential activation of coagulation factors, both the LAM-associated and the BALF-associated procoagulant activity was identified as thromboplastin (tissue factor) or thromboplastin-factor VII complexes. This suggests that alveolar macrophages and the LAM-derived thromboplastin-containing microvesicles may contribute to intraalveolar and interstitial fibrin deposition in vivo and probably also have consequences for the development of pulmonary fibrosis.
Skeletal muscle metabolites and fibre types in patients with advanced chronic obstructive pulmonary disease (COPD), with and without chronic respiratory failure
Authors: Jakobsson P , Jorfeldt L , Brundin A
Published: November 2022

Eighteen patients with advanced COPD, 8 with chronic respiratory failure (RF) and 10 without (nonRF, NRF) were investigated using spirometry, arterial blood gas analysis and biopsies taken from the quadriceps femorls muscle. The biopsies were analysed for ATP, creatine phosphate (CrP), creatine (Cr), lactate and glycogen content. Muscle fibre composition was also studied. Low concentrations of ATP, glycogen and CrP were found in the RF patients. Significant correlations were found between muscle metabolites and arterial blood gas values with the strongest correlation between muscle glycogen and arterial PO2 (r = 0.70; p less than 0.001). A very low percentage of "oxidative" type I muscle fibres was found in both groups. Possible mechanisms causing depletion of muscle metabolites are discussed.
Familial spontaneous pneumothorax
Authors: Lenler-Petersen P , Grunnet N , Jespersen TW , Jaeger P
Published: November 2022

In a three generation family with 27 members we examined a relationship could be found between spontaneous pneumothorax and HLA-haplotypes, alpha 1-antitrypsin phenotypes or concentration or lung volumes and ventilatory capacity. Eight individuals in the family suffered from spontaneous pneumothorax. No relationship with the investigated markers could be found in this informative family. All patients showed normal lung volumes and ventilatory capacity after recovery.
Intravascular bronchioloalveolar tumour
Authors: De-Luca S , Sanguinetti CM , Bearzi I , Murer B
Published: November 2022

A case of intravascular bronchioloalveolar tumour (IVBAT) presenting in a 49 yr old asymptomatic man is reported. IVBAT was diagnosed by open lung biopsy. The disease had a presumable duration of ten years and showed a low tendency to progress. The endothelial origin of the tumour was immunohistochemically proven.
Characteristics of patients with soybean dust-induced acute severe asthma requiring mechanical ventilation
Authors: Ferrer A , Torres A , Roca J , Sunyer J , Anto JM , Rodriguez-Roisin R
Published: November 2022

Patients presenting with acute severe asthma during the Barcelona's outbreaks caused by soybean dust inhalation from August, 1981, through September, 1987, characteristically showed an abrupt severe onset of each attack followed by a rapid relief of symptoms after treatment. To throw further light on clinical findings, pathophysiology and outcome in the most life-threatening episodes, we reviewed records of acute severe asthma patients treated by mechanical ventilation in one of the four main hospitals of the city. Twelve such patients (15 episodes) were compared to 24 non-epidemic asthmatic patients (25 episodes) also treated by mechanical ventilation in the same institution during the same period of time. There was a male predominance during outbreaks (p less than 0.03) and epidemic patients were ventilated fewer hours (12 +/- 8 h) (mean +/- SD), admitted fewer days to intensive care (1.6 +/- 0.7 days), and hospitalized fewer days (7.1 +/- 4.4 days) than non-epidemic patients (65 +/- 84 h, 4.6 +/- 3.8 days (p less than 0.001, each), and 16.0 +/- 13.2 days (p less than 0.004), respectively). These differences together with both the fulminant presentation of the episodes of epidemic asthma and the point-source origin of the asthma outbreaks previously shown are consistent with the unusual nature of the aetiologic agent, soybean dust.
Respiratory muscle insufficiency in acute respiratory failure of subjects with severe COPD: treatment with intermittent negative pressure ventilation
Authors: Corrado A , Bruscoli G , De Paola E , Ciardi-Dupre' GF , Baccini A , Taddei M
Published: November 2022

Nine subjects with severe chronic obstructive pulmonary disease (COPD) in acute respiratory failure (ARF) and with marked weakness of the respiratory muscles (Group A) underwent intermittent negative pressure ventilation by means of an iron lung (8 h daily for 7 days). Seven subjects with COPD in stabilized chronic respiratory failure (Group B) were studied as controls and submitted to the same medical therapy without ventilator treatment. Functional respiratory tests were performed before and after 7 days of treatment. After ventilatory treatment, Group A showed an increase of maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), vital capacity (VC), arterial oxygen tension (PaO2), pH and a decrease of residual volume (RV), total lung capacity of (TLC) and arterial carbon dioxide tension (PaCO2) (all statistically significant). No improvement was ascertained in the functional parameters of Group B. The expiratory muscles seem to play a determining role in ARF. We conclude that the iron lung is a useful therapeutic defence in removing muscular fatigue and in restoring a good level of respiratory compensation of ARF in severe COPD.
Inhibition of adenosine 5'-monophosphate- and methacholine-induced bronchoconstriction in asthma by inhaled frusemide
Authors: Polosa R , Lau LC , Holgate ST
Published: November 2022

Recent studies have shown that inhaled frusemide exerts a protective effect against various bronchoconstrictor stimuli in asthma including exercise, fog and allergen. Since mast cell activation seems to be a component of bronchoconstriction by these stimuli it is possible that inhibition of mediator release accounts for some or all of the inhibitory effects of frusemide in asthma. Since inhaled adenosine 5'-monophosphate (AMP) is another stimulus that produces bronchoconstriction by augmenting mast cell mediator release, we have investigated the ability of this drug to antagonise the airway effects of inhaled AMP and methacholine in a randomized, placebo-controlled, double-blind study of 12 asthmatic subjects. Inhaled frusemide (approximately 28 mg) administered 5 min prior to challenge increased the provocation concentration of inhaled AMP and methacholine required to reduce forced expiratory volume in one second (FEV) by 20% from baseline from 30 to 96 mg.ml-1 (p less than 0.01) and from 1.1 to 1.8 mg.ml-1 (p less than 0.01), respectively. The protection that frusemide afforded against AMP was significantly greater than that against methacholine (p less than 0.05). These data suggest that inhaled frusemide may serve as a functional antagonist against a smooth muscle spasmogen, such as methacholine, possibly by augmenting prostanoid generation. Its more potent activity against AMP and other bronchoconstrictor stimuli, that are considered to involve mast cell mediators, suggests an additional action on mast cell functions possibly at the level of the Ca++/Mg(++)-ATPase.
Ludwig's angina and mediastinitis due to Streptococcus milleri: usefulness of computed tomography
Authors: van der Brempt X , Derue G , Severin F , Colin L , Gilbeau JP , Heller F
Published: November 2022

Despite intensive use of antibiotics, Ludwig's angina remains a potentially lethal infection because of the risk of upper airway obstruction and spread into the mediastinum. We present two patients who survived mediastinitis complicating Ludwig's angina due to Streptococcus milleri. Computed tomography performed early in the course of the disease detected pus collections and directed appropriate drainage procedures.
Endoscopic resection of an endobronchial hypernephroma metastasis using a polypectomy snare
Authors: Themelin D , Duchatelet P , Boudaka W , Lamy V
Published: November 2022

A 69 yr old male patient developed an acute respiratory distress. The emergency bronchoscopic examination showed a polypoid tumour obstructing the left main bronchus. A snare used for colorectal polypectomy was introduced through the bronchofibrescope to remove the tumour. The patient then dramatically improved. No side effects were observed. Histopathological examination showed metastasis from a hypernephroma. This simple technique is useful for bronchial deobstruction, when the tumour is accessible with a snare.
Bronchial response to nebulized antibiotics in children with cystic fibrosis
Authors: Chua HL , Collis GG , Le Souef PN
Published: November 2022

Nebulized antibiotics are being used increasingly in children with cystic fibrosis. We assessed the effect of nebulized antibiotic solutions of varying tonicity on lung function in 12 children aged 5-15 yrs with cystic fibrosis. Baseline forced expiratory volume in one second and (FEV1) was measured, followed by a single nebulization of normal saline (272 mosmol.kg-1), tobramycin (248 mosmol.kg-1), or ticarcillin (3,080 mosmol.kg-1). All children received each of these, administered randomly, one per day. FEV1 was remeasured 5, 15 and 30 min after completion of the nebulization. Ticarcillin (mean fall 10.7% (SD 8.9)) caused a larger fall in FEV1 than normal saline (4.8% (4.3), p less than 0.05). The fall in FEV1 for ticarcillin was greater than for tobramycin (1.2% (2.0), p less than 0.05). Normal saline did not result in a significantly larger fall in FEV1 than tobramycin (p greater than 0.05). Bronchoconstriction to ticarcillin persisted at 30 min. We conclude that nebulized antibiotics can affect lung function in children with cystic fibrosis if the solutions are hypertonic.
Long-term effects of budesonide on airway responsiveness and clinical asthma severity in inhaled steroid-dependent asthmatics
Authors: Juniper EF , Kline PA , Vanzieleghem MA , Ramsdale EH , O'Byrne PM , Hargreave FE
Published: November 2022

Budesonide 400 micrograms daily, in nonsteroid-dependent asthma, can produce improvements in airway responsiveness and clinical asthma severity, with some patients returning to normal responsiveness and becoming asymptomatic. This study examined whether similar improvements occur when asthmatics, who are dependent upon inhaled steroids, take either a regular maintenance dose of inhaled steroid or twice that amount for a year. Thirty two asthmatics were each stabilized on the minimum amount of inhaled steroid that would keep symptoms non-troublesome. In a double-blind, randomized manner, half were assigned to remain on a maintenance dose (MD) and the rest received twice that dose (MDx2) for one year. Before and monthly throughout the study, airway responsiveness to methacholine was measured and clinical asthma severity assessed by questionnaire, inhaled bronchodilator use and number of asthma exacerbations. There was a significant improvement in airway responsiveness and clinical asthma severity in both treatment groups. Those on MDx2 showed the greatest improvement but the difference between the two groups did not reach significance. This study provides strong evidence that prolonged use of inhaled steroids is associated with improvement in airway responsiveness and clinical asthma severity in inhaled steroid-dependent asthma with a suggestion that the improvements are dose related.
Lavage versus serum measurements of lysozyme, angiotensin converting enzyme and other inflammatory markers in pulmonary sarcoidosis
Authors: Prior C , Barbee RA , Evans PM , Townsend PJ , Primett ZS , Fyhrquist F , Gronhagen-Riska C , Haslam PL
Published: November 2022

The aim of this study was to explore whether amounts of angiotensin converting enzyme (ACE) and lysozyme produced within the lungs correlate more closely than serum levels of these enzymes, or other inflammatory markers, with chest radiographic profusion scores, lung function and therapy response in patients with pulmonary sarcoidosis. We have studied 25 patients, and levels in bronchoalveolar lavage (BAL) were used to determine "local" enzyme production by reference to serum and lavage albumin. Before treatment, serum lysozyme levels were elevated in more patients (80%) than serum ACE levels (40%). They also gave the best overall correlation with clinical measurements prior to treatment and falls in serum lysozyme closely parallelled improvement in lung function (transfer factor for carbon monoxide (DLCO)) on therapy. The only other markers showing significant correlations with disease severity were lavage neutrophil counts per ml and "local" ACE measurements prior to treatment. The value of pre-treatment levels of the different inflammatory markers in predicting response to corticosteroid therapy was explored and the only significant finding was that BAL lymphocyte percentages and numbers.ml-1 were initially higher in patients with lower post-treatment chest X-ray scores (p less than 0.01 and p less than 0.05, respectively). We conclude that serum lysozyme levels appear to be a more useful marker of overall disease activity in sarcoidosis than measurements of other inflammatory markers. However, BAL lymphocyte counts were the best predictive marker of radiographic response to corticosteroids.
Precipitins in bird breeder's disease: how useful are they?
Authors: Reynaud C , Slosman DO , Polla BS
Published: November 2022

Precipitating antibodies to avian antigens play a controversial role in the diagnosis of bird breeder's disease (BBD). In order to establish the sensitivity, specificity and accuracy of precipitins in our laboratory, we conducted a prospective study including 128 sera received in 1988 for determination, by immunoelectrophoresis, of avian precipitins. Accurate information was obtained for 90 patients; definitive clinical diagnosis was given by the patient's own physician. We found a high sensitivity (86%), specificity (93%) and accuracy (92%) of avian precipitins in the diagnosis of BBD. Bayes' theorem was applied to determine the predictive value of the test with varying disease prevalence, and established that precipitins were particularly valuable for low or medium a priori probability. Using the receiver operating characteristic (ROC) curve we evaluated the effects of varying the positivity threshold of precipitins. The threshold used in this study appeared to offer the best compromise between sensitivity and specificity. These results suggest that the diagnostic value of avian precipitins in the work-up of BBD should be reconsidered, also because they represent a simple, cheap and non-invasive diagnostic test.
Shape change of the occlusion-pressure wave during exercise
Authors: Loiseau A , Loiseau P , Dubreuil C , Pujet JC
Published: November 2022

In conscious subjects, the occlusion pressure measured in the initial part of the inspiration (up to 200 ms) appears to be a valid index of output of the respiratory centres. To interpret any relative change in occlusion pressure, the shape of the occlusion-pressure wave must remain absolutely constant. The purpose of this study was to test the hypothesis that the shape of occlusion-pressure wave does not change during exercise. However, we found that the shape changed significantly during cycle incremental-load exercise in five healthy subjects and in 12 of 17 patients with chronic obstructive pulmonary disease. The major change appeared during the second half of the exercise and mainly during the last workloads. This study shows that it is necessary to take into consideration this form change to interpret any relative change in mechanical transforms of the inspiratory neural output such as pressure at 0.1 s (P0.1) and mean inspiratory flow (VT/TI) or their ratio. This finding confirms, in direct fashion, the expected form change from previous data in which P0.1 is thought to measure the rate of change in chest wall muscle pressure (Pmus) over a segment somewhat removed from the onset of neural inspiration.
Respiratory input and transfer mechanical impedances in patients with chronic obstructive pulmonary disease
Authors: Ying Y , Peslin R , Duvivier C , Gallina C , Felicio da Silva J
Published: November 2022

Total respiratory input (Zin) and transfer (Ztr) mechanical impedances were measured from 4-30 Hz in 9 patients with severe chronic obstructive pulmonary disease (COPD) and in 12 healthy subjects. Zin was obtained by applying a pressure input around the head to minimize transmural pressure across extrathoracic airway walls, and Ztr was obtained with a pressure input at the chest. In agreement with previous studies total respiratory compliance and inertance were decreased in patients, while effective input resistance was increased and exhibited a negative frequency dependence. Effective transfer resistance (Re(Ztr)) was also increased at all frequencies, and, in some patients, the Re(Ztr)-frequency curve was sigmoid in shape, which was never seen in normals. When Ztr was analysed with a six-coefficient monoalveolar model featuring tissue properties, alveolar gas compliance, and airways properties, the model fitted the data less closely in patients than in normals and, in the former, provided unrealistic coefficients. Such was also the case with a bialveolar model. A better fit with more realistic values for the coefficients was obtained in selected patients with a model where central and peripheral (Rp) airway resistance were separated by a shunt representing airway wall compliance (Cb): Cb was found to range from 0.029-0.062 l.kPa-1 and Rp represented 44-81% of total airway resistance.
Are we recording peak flows properly in young children?
Authors: Greenough A , Everett L , Price JF
Published: November 2022

Peak flow rate is used in young children to assess bronchodilator response and monitor asthma status at home. Frequently the best of only three peak flow manoeuvres is reported. The aim of this study was to assess if this was sufficient to give the maximum peak flow rate and to determine the reproducibility of the measurement. Thirty nine children aged between three and ten years were recruited. Peak expiratory flow rate (PEFR) was measured six times in each child at two minute intervals. Less than half (13 of 39) of the children made their maximum blow in the first three manoeuvres. The maximum peak flow from the second set of three blows was a median of 7% greater than that from the first three blows. The coefficient of variation of the measurement was 8.8% suggesting a change in PEFR greater than 17.6% is necessary to demonstrate a response to bronchodilator. We conclude three peak flow manoeuvres are insufficient in the majority of young children to demonstrate the maximum peak flow.
Effect of heart-lung transplantation on airway potential difference in patients with and without cystic fibrosis
Authors: Alton EW , Khagani A , Taylor RF , Logan-Sinclair R , Yacoub M , Geddes DM
Published: November 2022

Measurement of the potential difference (PD) across the airways provides an indication of the viability and integrity of the lining epithelium. PD was recorded from the lower airways in "diseased controls" and in patients following heart-lung transplantation. Diseased controls showed a high PD centrally which fell (became less negative) peripherally (trachea -15.8 mV (SEM 1.0), lobar bronchi -12.6 mV (1.2), segmental bronchi -9.8 mV (1.2]. Following heart-lung transplantation (HLT) the profile of PD with airway size was altered in comparison to non-transplanted patients with reduced values in the large airways. Host tracheal values above the anastomosis were similarly reduced. Two episodes of rejection were associated with a lower mean airway PD; no significant changes were found with infection. In patients with cystic fibrosis (CF), values in the donor lung did not differ from those in non-CF transplanted patients up to one year following transplantation, although nasal PD in the host remained elevated. HLT selectively alters the PD profile only of larger airways, which may relate to the interruption of the bronchial arterial supply to these sites.
Effects of sodium-nitroprusside and urapidil on gas exchange and ventilation-perfusion relationships in patients with congestive heart failure
Authors: Adnot S , Radermacher P , Andrivet P , Dubois-Rande JL , Dupeyrat A , Lemaire F
Published: November 2022

Vasodilators usually decrease arterial PO2 in patients with congestive heart failure (CHF) because of alteration in ventilation-perfusion (Va/Q) relationships. The effects of sodium nitroprusside (SNP) and urapidil (U), a new selective alpha 1-receptor antagonist, were investigated in seven patients with CHF. The distribution of ventilation and perfusion was examined using the multiple gas elimination technique. The haemodynamic responses to SNP and U were similar, cardiac index increasing by 25% with SNP and by 31% with U. Despite a similar increase of mixed venous oxygen tension, the arterial PO2 decreased from 11.3 +/- 0.8 to 9.6 +/- 0.6 kPa (p less than 0.01) with SNP but remained unchanged (11.0 +/- 0.9 vs 11.4 +/- 0.8 kPa, NS) with U. SNP and U both increased perfusion to lung units with Va/Q ratios of 0.1 or less with no change in shunt fraction. The fractional perfusion to total low Va/Q ratios (low Va/Q + shunt) was higher with SNP than with U (14.1 +/- 2.6 vs 9.5 +/- 2.3%, p less than 0.01). The results suggest that gas exchange and Va/Q relationships are altered less with U than with SNP in patients with CHF.
Accuracy and precision of fourteen pulse oximeters
Authors: Hannhart B , Haberer JP , Saunier C , Laxenaire MC
Published: November 2022

Two sets of seven pulse oximeters (Criticare CSI-502; Nellcor-N200; Datex-Satlite; Physio-Control-Lifestat 1600; Critikon-Oxyshuttle; Ohmeda-Biox 3700; Ohmeda-Biox 3740; Radiometer-Oxi; Spectramed-Pulsat; Kontron-7840; Biochem-Ox2000; Invivo-4500; Engstrom-EOS; Novametrix-505) were studied in two groups of eight healthy subjects, aged 26-50 yrs. The transcutaneous oxygen saturation (SpO2) was compared with arterial oxygen saturation (SaO2) measured in simultaneously with drawn blood samples (OSM2 Radiometer) at four 20 min steady-state levels of inspired oxygen fraction (FIO2) (0.21, 0.10, 0.08 and 0.07; SaO2 99-55%) in a conditioned chamber. Both the error in accuracy (mean SpO2-SaO2 difference), and the error in precision (SD of the differences) remained less than 3% for the two highest FIO2 levels (SaO2 greater than 83%) but, during deeper hypoxia, they were increased to 8% and 5%, respectively. An instrumental systematic bias affected accuracy in particular. We concluded that a good agreement between SpO2 and SaO2, as reflected by the Bartko's intraclass coefficient, was observed in nine instruments.
Histiocytic medullary reticulosis occurring with small cell lung carcinoma
Authors: de Cremoux H , Monnet I , Fleury J , Chleq C
Published: November 2022

Haematophagocytic activity is a salient feature of malignant histiocytic medullary reticulosis. This potency has also been observed as an aberrant property of non-histiocytic malignant cells or as a benign histiocytic process in response to infections or malignancies. We report the case of a patient who presented simultaneously with a limited stage small cell lung carcinoma and a fatal reactive form of histiocytosis. We conclude that such a haematophagocytic syndrome may occur in the setting of small cell lung carcinoma s previously described in other malignancies.
Bricanyl Turbuhaler in the treatment of asthma: a six week multi-centre study carried out in Sweden, the United Kingdom, Denmark, Norway and Finland
Authors: Osterman K , Stahl E , Kallen A
Published: November 2022

Two hundred and fifty eight adult patients with bronchial asthma participated in an open, parallel group study of 8 wks duration. During a 2 wk run-in period the beta 2-agonist terbutaline (0.5 mg q.i.d) was delivered via a pressurized freon aerosol, Bricanyl metered dose inhaler (MDI). During the following 6 wks, one third of the patients continued with MDI and two thirds with the same dose of terbutaline in the form of dry powder, Bricanyl Turbuhaler. There were no statistically significant differences in the increases in peak expiratory flow rate (PEFR) after inhalation between the two treatment groups. The asthma symptom scores decreased in the Turbuhaler group during the study but remained the same in the MDI group. No difference in use of extra trial medication during the day was found. During the night, the difference was statistically significant in favour of Turbuhaler (p less than 0.05). Turbuhaler was well accepted and easy to use. As compared with the MDI used during run-in, 50% of the patients in the Turbuhaler group preferred to use Turbuhaler and 26% MDI, whilst 24% had no preference. In conclusion, Turbuhaler was at least as effective as MDI during the whole Turbuhaler life-span (6 wks).