bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and subclinical alveolitis in collagen vascular diseases: contribution of alpha 2-macroglobulin levels in BAL fluid
Authors: Martinot JB , Wallaert B , Hatron PY , Francis C , Voisin C , Sibille Y
Published: November 2022

The probability that patients with collagen vascular diseases (CVD) will develop fibrosis is unpredictable. Since changes in bronchoalveolar lavage (BAL) cell data can be observed in CVD patients without evidence of lung involvement, we investigated whether the study of soluble components in BAL could help to distinguish CVD patients with lung involvement (n = 15) from those without pulmonary disease (n = 37). Our results demonstrate that the alveolitis observed in patients with overt lung involvement is associated with an increase of BAL alpha 2-macroglobulin (alpha 2-MA). In contrast, the BAL alpha 2-MA levels were found to be normal in CVD patients without evidence of pulmonary disease as well as in CVD patients with overt lung involvement treated with steroids. This was observed even in the presence of high neutrophil or lymphocyte counts in BAL. In conclusion, when neutrophils or lymphocytes accumulate in the lungs of CVD patients without evidence of lung damage, in the majority of patients this cell accumulation is not associated with an increase of BAL soluble components.
Estimates of mean alveolar gas in patients with chronic airways obstruction
Authors: Giannella-Neto A , Paoletti P , Fornai E , Giuntini C
Published: November 2022

Alveolar to arterial differences (AaD) may be computed from representative alveolar gas pressures (PA). These are particularly difficult to obtain in patients with chronic airways obstruction (CAO) and severe inhomogeneity of the ventilation/perfusion (VA/Q) ratio. In 25 such patients, using a computerized mass spectrometer, representative values of alveolar gas were obtained: 1. as end-tidal concentrations (ET); 2. using the alveolar air equation with PACO2 derived from Bohr's equation (BE); 3. putting PACO2 = PACO2 into the alveolar air equation to compute ideal O2 alveolar pressure (ID); 4. applying Rahn's definition of "mean" alveolar gas (RD), i.e. taking within each jth breath, the alveolar pressures corresponding to the moment when the instantaneous gas exchange ratio R(t)j equals the overall exchange ratio for that breath Rj. During quiet breathing, the point where R(t)j equals Rj occurred at 71% of tidal volume (VT). Alveolar pressures by BE and RD resulted in similar values (115.5 +/- 6.9 and 115.5 +/- 6.6 mmHg for O2 and 30.3 +/- 5.7 and 30.8 +/- 5.7 mmHg for CO2, respectively), but they were significantly different from those by ET and ID (106.2 +/- 9.5 and 95.6 +/- 13.5 mmHg for O2 and 36.3 +/- 7.7 and 48.2 +/- 11.2 mmHg for CO2, respectively). These findings may be explained considering that PA(BE) and PA(RD) represent both high and low VA/Q units, whereas PA(ET) and PA(ID) represent mainly low VA/Q units. AaDCO2 by RD and BE appeared proportional to the severity of CAO as estimated from VT. Automated techniques make it possible to substitute end-tidal determinations with more accurate estimates either by measuring anatomical dead-space and using Bohr's equation or by applying Rahn's definition.
Pharmacological approach to smoking cessation
Authors: Prignot J
Published: November 2022

At present, the possibilities of pharmacological intervention in smoking cessation remain limited. Some products, like smoking deterrants, lobeline, amphetamine and sedatives, definitely seem to have been rejected. The efficiency of other drugs aiming to treat the withdrawal syndrome (e.g. clonidine) or to eradicate the smoking habit (e.g. mecamylamine) must still be confirmed in large controlled trials. The same is true of the "cigarette substitutes" which have appeared recently. The only effective substitute treatment currently available is nicotine, presented as nicotine gum; other modalities of administration of nicotine are in preparation. Even if it has not fulfilled all the expectations of its promoters and of the smokers who hoped for a panacea, nicotine gum, when administered to highly dependent smokers motivated to stop, with the appropriate technique, effects a moderate increase not only in the cessation rate but also in the long-term abstention rate, in so far as the necessary psychological support is provided, either by the physician in medical settings, or by other health professionals, in smoking-cessation clinics or in industrial and community settings. The addiction to psychoactive nicotine presents only one facet of the smoking process in chronic smokers. They must also be helped to face the behavioural components of their habits, so individualized counselling remains essential, in addition to the prescription of the gum, in order to achieve satisfactory rates of long-term smoking cessation.
Local increase of antiprotease and neutrophil elastase-alpha 1-proteinase inhibitor complexes in lung cancer
Authors: Marchandise FX , Mathieu B , Francis C , Sibille Y
Published: November 2022

Tumour progression is dependent on many factors including antiproteases and proteases released by tumour cells or host cells infiltrating the tumour. In the present study, we evaluated the antiprotease content, namely alpha 2-macroglobulin (A2M) and alpha 1-proteinase inhibitor (A1PI) and neutrophil (PMN) elastase complexed with A1PI, in limited and extended lung cancer patients compared to a nonsmoker and smoker control population. Data showed that A2M and A1PI were increased in the involved lung from limited cancer when compared to normals. In extended lung cancer, A2M content was also increased in the uninvolved side. The concentration of PMN elastase-A1PI complex was increased on both sides in lung cancer patients (10.2 ng.ml-1 in the uninvolved side, 8.2 ng.ml-1 in the involved side) when compared to nonsmokers (1.9 ng.ml-1, p less than 0.001) and smokers (3.8 ng.ml-1, p less than 0.005). This increase was not solely due to the smoking habit. We conclude that antiproteases and PMN elastase complexed with antiprotease are increased in lung cancer area. This increase could result in extracellular changes in lung cancer.
Bronchoscintigraphic visualization of the acute effect of tobacco exposure and terbutaline on mucociliary clearance in smokers
Authors: Mortensen J , Groth S , Lange P , Rossing N
Published: November 2022

The aim of this study was to examine the acute effect of tobacco smoke exposure and inhaled terbutaline on mucociliary clearance in 9 healthy smokers. It was based on a recently described method for scintigraphic visualization of the bronchi (bronchoscintigraphy). After an initial bronchoscintigram had been made by having the subjects inhale aerosolized 99mTc-albumin, they inhaled either terbutaline or placebo from a metered-dose inhaler. Subsequently, data acquisition for production of bronchoscintigrams was repeated at 10 min intervals for 120 min, and the mucociliary clearance was estimated from the movement of radioactivity in the series of bronchoscintigrams thus obtained. On two study days the subjects remained tobacco abstinent, while on two occasions they chain-smoked during the examination. Acute tobacco exposure resulted in an increased clearance rate in the lobar bronchi in 8 of the 9 smokers (p less than 0.03), while in the main bronchi and the trachea the effect was inconsistent. In all subjects terbutaline systematically increased the clearance rate in all visible bronchial structures compared to placebo (p less than 0.04). The combination of smoking and terbutaline caused a faster clearance rate in the lobar bronchi in most subjects than tobacco smoke or terbutaline alone. It is concluded that both acute tobacco exposure and terbutaline increase mucociliary clearance in healthy smokers.
Effect of protriptyline on ventilatory responses to hypercapnia and asphyxia in normal subjects
Authors: Simonds AK , Carroll N , Branthwaite MA , Saunders NA
Published: November 2022

A double-blind crossover study was undertaken to assess the effect of protriptyline on ventilatory responses in normal subjects. Seven subjects received in random order placebo, 10 mg and 20 mg protriptyline daily for 2 weeks. Measurements of hypercapnic ventilatory response (HCVR) and asphyxial hypoxic ventilatory response (HVR) were made before treatment, 6-8 h after the first dose, and after 2 weeks treatment. Mean HCVR and HVR following 10 mg and 20 mg protriptyline did not differ significantly from measurements on placebo, neither for the single dose study or after 2 weeks.
New methodology for specific inhalation challenges with occupational agents in powder form
Authors: Cloutier Y , Lagier F , Lemieux R , Blais MC , St-Arnaud C , Cartier A , Malo JL
Published: November 2022

Numerous agents in powder form (wood dust, flour, antibiotics, drugs, etc.) can cause occupational asthma. The diagnosis is generally confirmed by specific inhalation challenges in a special challenge room. There are several pitfalls to the procedure: 1) subjects may be exposed to high concentrations of particles; the concentrations of particles may be higher than the threshold limit value-short term exposure level (TLV-STEL), possibly resulting in severe or irritant reactions; 2) the exposure is erratic. To overcome these problems, a new device for aerosolization of powders has been developed. This apparatus consists of three parts: a particles generator, an aerosol delivery system connected to an orofacial mask, and monitors - a photometer and a cascade impactor. Information on the concentration and size distribution of inhaled particles can therefore be obtained. We performed specific inhalation challenges with this apparatus on 20 subjects suspected of having occupational asthma. The concentration of particles was generally below or close to the TLV-STEL and information was obtained on the proportion of particles with a diameter less than 10 mu. Falls in forced expiratory volume in one second (FEV1) were progressive with each increase in the duration of exposure. The five subjects who had negative reactions to exposure were asked to tip the relevant product from one tray to another in the traditional realistic way. All had negative responses. We conclude that this new procedure offers advantages over the traditional method as it gives information on the concentration and size distribution of inhaled particles and makes the drawing of a dose-response curve possible, both of which may improve the safety and accuracy of the test.
Unresolved pneumonia due to endobronchial lipoma and actinomycosis
Authors: Arber N , Breuer R , Berkman N , Okon E , Ben-Yehuda D
Published: November 2022

We report an unusual case of unresolved pneumonia in a 59 yr old woman due to endobronchial lipoma and actinomycosis, two rare diseases that have never been described before in the same person.
Total respiratory resistance and reactance in patients with diffuse interstitial lung disease
Authors: van Noord JA , Clement J , Cauberghs M , Mertens I , Van de Woestijne KP , Demedts M
Published: November 2022

In 54 patients with interstitial lung diseases and no signs of airway obstruction we measured lung volumes, maximal expiratory flows, diffusing capacity (DLCO), total respiratory resistance (Rrs) and reactance (Xrs) between 4 and 26 Hz by means of the forced oscillation technique. In all patients DLCO was less than 75% of the expected value. Patients were classified into two groups depending on total lung capacity (TLC): group A with TLC less than 80% of expected, and group B with TLC of 80% or more. Group A demonstrated a decrease of Xrs especially at low frequencies, with small, not significant changes in Rrs. In the patients in this group with the lowest values of TLC (less than 50%), we observed an increase of Rrs at low frequencies causing a negative frequency dependence of Rrs. In group B no distinct changes of Rrs and Xrs occurred. Canonical correlation analysis between routine lung function data and forced oscillation parameters, showed tight correlations between TLC in absolute value or VC in percent of the predicted value on the one hand and average level of Xrs and average slope of Xrs (and Rrs) vs frequency curves on the other hand. Measurements of lung mechanics in five additional patients and comparison with a model of the respiratory system suggest that the changes of Rrs and Xrs are not explained totally by the observed increase in lung tissue resistance and decrease in lung compliance. The observed changes in Rrs and Xrs are not specific for restrictive lung disorders; similar changes are met also in moderately advanced obstructive diseases.
Treatment of post pneumonectomy pleural empyema by open window thoracostomy
Authors: Postmus PE , Kerstjens JM , de Boer WJ , Homan van der Heide JN , Koeter GH
Published: November 2022

In 13 patients an open window thoracostomy (OWT) was performed for post pneumonectomy pleural empyema. The operation, and life with an OWT cavity, were tolerated well. Early closure of an OWT is not advisable because of a high chance of recurrence of the infection and, in lung cancer patients also the risk of tumour relapse within two years after tumour surgery.
LG 30435, a new potential antiasthmatic agent
Authors: Berti F , Daffonchio L , Magni F , Omini C , Rossoni G , Subissi A
Published: November 2022

LG 30435 is a new quarternary phenothiazine derivative with H1-antihistaminic and antimuscarinic properties. The ability of LG 30435 to prevent changes in respiratory mechanics, induced by different mediators and the immunological reaction, was monitored together with biological and radioimmunological determination of circulating thromboxane-A2 (TxA2) in anaesthetized guinea-pigs. LG 30435 dose-dependently reduces the bronchoconstriction and TxA2 generation caused by different stimuli such as histamine, acetylcholine, leukotriene C4 (LTC4) and PAF-acether. In addition i.v. and aerosol administration of LG 30435 causes a dose-dependent reduction of the increase in airway resistance and TxA2 generation induced by ovalbumin challenge in actively sensitized animals. LG 30435 infused at different concentrations through the isolated guinea-pig lungs inhibits the TxB2 generation caused by different anaphylactic mediators, but not by arachidonic acid. These data, which further substantiate the bronchodilator activity of LG 30435 against a variety of stimuli and demonstrate its protective properties on lung anaphylaxis, suggest that this compound has a potential therapeutic value in the treatment of asthma.
Technique of on-line analysis of diaphragmatic electromyogram activity in the newborn
Authors: Chambille B , Vardon G , Monrigal JP , Dehan M , Gaultier C
Published: November 2022

The present study provides an on-line analysis of diaphragmatic electromyographic activity (EMGdi) in newborns. EMGdi was recorded using surface electrodes. EMGdi signals were processed using a microcomputer (Apple IIe). The centroid frequency (Fc) and the high over low (H/L) frequencies ratio of the power spectrum were calculated. Furthermore the model frequency (Fo) was computed by an autoregressive model of the EMG signal. EMGdi analysis was performed in seven healthy spontaneously breathing preterm newborns. Fc ranged from 46-62 Hz. Fc was significantly lower than Fo in four of the seven preterm newborns. The coefficient of variation for Fc was significantly lower than for the H/L ratio (p less than 0.001). The coefficients of variation for Fo and Fc were not significantly different, but the percentage of rejected calculations for Fo was significantly higher than for Fc (p less than 0.01). Therefore, in healthy preterm newborns, Fc appears to be the best index of EMGdi analysis.
The origin of DNA associated with mucus glycoproteins in cystic fibrosis sputum
Authors: Lethem MI , James SL , Marriott C , Burke JF
Published: November 2022

The relative importance of host and bacteria-derived deoxyribonucleic acid (DNA) in the increased viscoelasticity of purulent sputum in cystic fibrosis (CF) and other airway diseases is unclear. We report the identification of the DNA associated with mucus glycoproteins purified from the purulent sputum of 9 patients with CF. Mucus glycoproteins were purified from CF sputum by gel exclusion chromatography and the co-purifying DNA isolated by phenol extraction. Electrophoresis indicated that the DNA preparations had a size of approximately 300 to greater than 50,000 bases. The origin of the DNA was determined by slot blotting and subsequent hybridization with 32P-labelled DNA probes specific for human DNA sequences and those from bacterial species commonly isolated from CF sputum. The results indicated that in all cases the DNA was almost entirely human in origin. This implies that it is the patient's own DNA which may contribute to the rheological abnormalities of CF sputum.
Respiratory changes with deep diving
Authors: Segadal K , Gulsvik A , Nicolaysen G
Published: November 2022

Deep diving refers to saturation diving to a depth of more than 180 m (1.9 MPa ambient pressure). In the 1990s diving to 400 m may be necessary on the Norwegian continental shelf. The safety margins are narrow and the respiratory system is subject to great strain at such depths. The respiratory resistance increases and the dynamic lung volumes are reduced as the pressure increases due to enhanced gas density. Helium is used together with oxygen as breathing gas and its lower density partly normalises the dynamic lung volumes. The respiratory system puts clear limitations on intensity and duration of physical work in deep diving. Systematic studies of lung mechanics, gas exchange and respiratory regulation in the different phases of deep dives are lacking. Detection of occupational respiratory disorder following diving are dependent on long-term follow-up.
Acute lung reaction due to zinc inhalation
Authors: Malo JL , Malo J , Cartier A , Dolovich J
Published: November 2022

A 27-yr-old man began work at a company that produces concrete pipes in April 1987. The pipes are linked with rings covered with zinc. In September 1987, he was transferred to a new job in the same plant where he had to heat zinc wires and shoot the heated zinc in powder form onto the iron rings. He had no past personal nor family atopic history. Two weeks after he began in his new job, he experienced an episode of chills with muscle aches and dyspnoea at the end of a working day. The fever persisted until the next day, at which time he saw a physician. A chest radiograph revealed diffuse interstitial shadows. He was off work for 10 days. His symptomatology disappeared and his chest radiograph cleared. He went back to work and experienced a similar episode. He remained away from work for one month, after which specific inhalation challenges were performed. On a control day, there were no significant changes in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), or buccal temperature. Two white blood counts (WBC) showed 8,400 and 8,500 white cells. He was exposed to his usual work environment for one hour on two consecutive days. On both occasions, there were significant falls in FEV1 (16% and 20%) and FVC (10% and 11%), occurring 4-6 h after exposure. Buccal temperature reached 38.1 and 38.7 degrees C on the two occasions, and WBC were 17,000 and 15,900 at the end of each day. Precipitins were negative and specific IgG antibodies could not be detected.(ABSTRACT TRUNCATED AT 250 WORDS)
Structural characterization of bronchial mucosal biopsies from healthy volunteers: a light and electron microscopical study
Authors: Soderberg M , Hellstrom S , Sandstrom T , Lundgren R , Bergh A
Published: November 2022

Bronchial mucosal biopsies were collected by flexible fibreoptic bronchoscopy (FFB) from normal healthy volunteers. The volunteers were not receiving any medication and had been free from respiratory infection for at least five weeks prior to the bronchoscopy. Biopsies with a minimum of 115 microns of undamaged perpendicularly sectioned epithelium were investigated by light and transmission electron microscopy. The height of the epithelium varied between 22-62.5 microns, with a median value of 41.5 microns. The volume density of the various epithelial cells in relation to the total epithelium was 61% for the ciliated and non-ciliated, non-secretory luminal cells, 6% for the goblet cells and 32% for the basal cells. The width of the lamina reticularis of the basement membrane ranged between 3-17.5 microns, with a median value of 8.5 microns. Blood vessels occupied 2.8% of the subepithelial tissue. Only a few inflammatory cells were seen in the connective tissue, volume density occupied by lymphocytes and polymorphonuclear granulocytes, 0.6% and 0.2% respectively. This study shows that structural damage is a common finding in biopsies collected by FFB. Mechanical damage of bronchial biopsies caused by the forceps should be considered before alterations in the epithelium are attributed to pulmonary disease.
Opportunistic agents in bronchoalveolar lavage in 99 HIV seropositive patients
Authors: Durand-Amat S , Zalcman G , Mazeron MC , Sarfati C , Beauvais B , Gerber F , Perol Y , Hirsch A
Published: November 2022

During a ten month period, 117 fibreoptic bronchoscopies and bronchoalveolar lavages (BAL) were performed in human immunodeficiency virus (HIV) infected patients suspected of having opportunistic pulmonary infections. The BAL were classified into 3 groups, according to clinical manifestations related to HIV infection at the time of fibreoptic bronchoscopy: pre-acquired immunodeficiency syndrome (AIDS) (n = 54), AIDS with Kaposi's sarcoma (n = 37), AIDS without Kaposi's sarcoma (n = 26). On chest X-ray, diffuse infiltrates were most common (54%), followed by normal X-rays (24%) and localized infiltrates (18%). Amongst the 117 BAL, 68 (58%) yielded at least one opportunistic agent. In 28 BAL performed for pulmonary signs or unexplained fever with normal chest X-rays, one or several opportunistic agents were isolated in 17 samples of BAL fluid. The most frequently identified opportunistic agents were Pneumocystis carinii (in 38% of BAL) and cytomegalovirus (35%); these were associated in 17% of BAL. There was no statistically significant difference in opportunistic agents among the 3 groups of BAL (pre-AIDS, AIDS with Kaposi's sarcoma, AIDS without Kaposi's sarcoma). In particular, cytomegalovirus was found in BAL with the same frequency in these 3 groups.
Expiratory timing in obstructive sleep apnoeas
Authors: Cibella F , Marrone O , Sanci S , Bellia V , Bonsignore G
Published: November 2022

Diaphragmatic electromyogram was recorded during NREM sleep in 4 patients affected by obstructive sleep apnoea (OSA) syndrome in order to evaluate the behaviour of expiratory time (TE) in the course of the obstructive apnoea-ventilation cycle. The two components of TE, i.e. time of post-inspiratory inspiratory activity (TPIIA) and time of expiratory phase 2 (TE2) were separately analysed. TPIIA showed a short duration, with only minor variations, within the apnoea, while its duration was more variable and longer in the interapnoeic periods: the longest TPIIA values were associated with the highest inspiratory volumes in the same breaths. This behaviour seemed regulated according to the need of a more or less effective expiratory flow braking, probably as a result of pulmonary stretch receptors discharge. Conversely TE2 showed a continuous gradual modulation, progressively increasing in the pre-apnoeic period, decreasing during the apnoea and increasing in the post-apnoeic period: these TE2 variations seemed related to oscillations in chemical drive. These data show that TE in the obstructive apnoea-ventilation cycle results from a different modulation in its two components and suggest that both mechanical and chemical influences play a role in its overall duration.
Effect of oral N-acetylcysteine (NAC) on volume and albumin content of respiratory tract fluid but not on epithelial secretory cell number in "smoking" rats
Authors: Robinson N , Brattsand R , Dahlback M
Published: November 2022

This study was designed to look at the effect of N-acetylcysteine (NAC) on epithelial secretory cells and the respiratory tract fluid volume and albumin content from the lower airways of "bronchitic" rats. Rats were exposed either to tobacco smoke (TS), TS and NAC, or NAC alone. TS caused a significant increase in epithelial secretory cell number which was not reduced by concomitant NAC administration; NAC alone had no effect on cell numbers. TS increased respiratory tract fluid volume and albumin content by a small but non-significant amount, whereas TS and NAC increased the volume and albumin content by a greater and significant amount; NAC alone was also shown to significantly increase both fluid volume and albumin content.
Accuracy and reproducibility of the Assess peak flow meter
Authors: van Schayck CP , Dompeling E , van Weel C , Folgering H , van den Hoogen HJ
Published: November 2022

The variability of peak flow measurements was studied in 24 patients with airway obstruction, using 12 Assess peak flow meters and a Fleisch pneumotachograph type 4 as a standard. The Assess peak flow meter gave systematic under-readings of 19-34% (low accuracy). The value scale of the Assess peak flow meter should be adjusted. As systematic under-readings do not influence the variability in peak flow measurements, variability was only caused by the random error of the instrument. The random error of the Assess peak flow meter was relatively low: about 4% of the measured peak flow value (high precision). The contribution of the Assess peak flow meter to the total variability of peak flow measurements showed a linear relationship (r = 0.53) with the value of the peak flow rate itself and varied from 9% (at 3 l.s-1) to 86% (at 10.8 l.s-1). Reading errors of the peak flow meter were responsible for about 1% of the total variability. The remaining variability is probably caused by the correctness of the peak flow performance and the motivation of the patient.
Unexplained severe pulmonary hypertension in two brothers
Authors: Puolijoki HJ , Niemela KO , Siitonen LO
Published: November 2022

Unexplained pulmonary hypertension of nearly simultaneous onset is reported in two brothers, aged 17 and 26 yrs. Echocardiography revealed right ventricular hypertrophy and dilatation, paradoxical septal motion and an enlarged main pulmonary artery. In the right catheterization highly elevated pulmonary arterial pressures (107/58 and 84/46 mmHg) were seen. Doppler echocardiography showed significant leakage of the pulmonary and tricuspid valves in the younger brother, who died suddenly three weeks later. An initial decline in pulmonary arterial systolic pressure was achieved in the older brother by drug therapy. Eight months later, however, the pressure had risen to the pretreatment level. Dyspnoea increased and the patient underwent heart-lung transplantation but subsequently died. In the family study a third brother, father and mother were healthy.
Circadian rhythms of specific airway conductance and bronchial reactivity to histamine: the effects of parasympathetic blockade
Authors: Dreher D , Koller EA
Published: November 2022

In ten healthy, nonsmoking, non-atopic, young volunteers, specific airway conductance and bronchial response to aerosolized histamine were measured plethysmographically at intervals of 4.8 h during two periods of 24 h, i.e. one day without, the other with, a parasympatholytic aerosol (0.20-0.24 mg ipratropium bromide) inhaled 1 h before each measurement, in order to determine the role of the parasympathetic innervation in the circadian rhythms of the airways. Specific airway conductance and bronchial reactivity showed clear circadian variations with corresponding peak times (16.11 and 04.41 h, respectively). Topical vagal blockade markedly increased specific conductance and resulted in a significant reduction of its rhythm amplitude, whereby the strong correlation between specific conductance and heart rate was significantly diminished. On the other hand, bronchial reactivity to histamine was lowered without flattening of its circadian rhythm. It is concluded that central parasympathetic outflow is an essential factor for the circadian rhythm of bronchial tone and, thus, for the increase in bronchial resistance at night.
A respiratory gas exchange simulator for routine calibration in metabolic studies
Authors: Huszczuk A , Whipp BJ , Wasserman K
Published: November 2022

We have developed a method for simulating respiratory gas exchange for on-line calibration of metabolic measurement systems. It utilizes a pump which intakes a mixture of atmospheric air and a known flow of precision-analysed calibration gas (21% CO2, 79% N2). It expels the resulting mixture with flow wave form and profiles of gas concentration which closely resemble those of normal expiration. Control of the calibration mixture's inflow allows the investigator to set any desired metabolic rate regardless of the minute ventilatory rate. This separation of metabolic from ventilatory rates provides a stringent test of the computational performance of the respiratory gas exchange measurement systems. The apparatus can reproduce any range of respiratory and metabolic performance (currently ranging from 0.2-5 l.min-1 O2 uptake and CO2 output) with accuracy +/- 2%.
Comparative effects of volume history on bronchoconstriction induced by hyperventilation and methacholine in asthmatic subjects
Authors: Malo JL , L'Archeveque J , Cartier A
Published: November 2022

The aim of this study was to find out if bronchodilatation following deep inspiration can be induced by the inhalation of a "natural" stimulus (hyperventilation of cold dry air), and if the effect is similar to that induced by methacholine. After baseline assessment of lung resistance (RL), 10 asthmatic subjects were asked to inhale cold dry air for 3 min. RL was monitored continuously for 3-4 min, at which time subjects were asked to take a fast deep inspiration. After recovery, the manoeuvre was repeated and RL was reassessed. The manoeuvre was then repeated a third time. After functional recovery, progressive doses of methacholine were inhaled until the increase in RL was comparable to that obtained after hyperventilation (56 +/- 16% and 65 +/- 24%, respectively, mean +/- SD, NS). The same deep inspiration manoeuvre was repeated three times with recovery as after hyperventilation of cold dry air. Maximum changes in RL were not significantly different after each of the three manoeuvres for either type of bronchoconstriction. The mean fall in RL was 14.2 +/- 9.9% after hyperventilation and 16.4 +/- 10.5% after methacholine. There was a satisfactory correlation (r = 0.80, p less than 0.01) between the bronchodilatation after deep inspiration for both types of stimuli. We conclude that the bronchodilator effect of deep inspiration is no different using either a pharmacological stimulus (methacholine) or a "natural" stimulus (hyperventilation of unconditioned air). These results show that assessing the response to hyperventilation with manoeuvres requiring deep inspiration, forced expiratory volume in one second (FEV1) may alter airway tone in a way similar to pharmacological stimuli.
The effect of almitrine on the steady-state ventilatory response to carbon dioxide at rest and during exercise in man
Authors: Cummin AR , Jacobi MS , Patil CP , Telford RJ , Morgan CN , Saunders KB
Published: November 2022

Almitrine has potential as a tool for testing the physiological role of the peripheral chemoreceptor. The effects of almitrine on CO2 chemosensitivity were studied at rest and during light exercise using a constant inflow technique that avoids the hyperoxia of rebreathing methods. The steady-state ventilatory response to CO2 was measured in two groups of six normal men before and 150 min after 100 mg oral almitrine bismesylate or placebo. One group was studied at rest, the other while pedalling at 50 W. The resting group showed a significant increase in CO2 response slope after almitrine when compared with placebo but there was no significant change in the response intercept. During exercise the individual results were very variable and after almitrine no significant change was seen in either the response slope or intercept. Control ventilation was not affected by almitrine in either group. Even in the absence of marked hyperoxia the effect of almitrine on CO2 sensitivity at rest in small. The lack of effect at 50 W is against any important role for the peripheral chemoreceptor during light exercise but other interpretations are possible.
Effect of smoking on the lipid composition of lung lining fluid and relationship between immunostimulatory lipids, inflammatory cells and foamy macrophages in extrinsic allergic alveolitis
Authors: Hughes DA , Haslam PL
Published: November 2022

Normal lung lining fluid suppresses lymphoproliferative responses. This effect is mediated by the major phospholipid components, but minor lipid components can stimulate lymphocyte proliferation. The aim of this study was to discover whether the changes in lung lipid composition reported in patients with extrinsic allergic alveolitis (EAA) might influence the levels of lymphocytes which occur in the lungs of these patients. Since cigarette smokers are less susceptible to EAA, we also investigated the effect of smoking on the lipid composition of lung lining fluid. Lung lining fluid was sampled by bronchoalveolar lavage (BAL) from 15 patients with EAA, and 9 non-smokers and 13 smokers without lung disease. The smoking controls had increases in phosphatidylethanolamine, sphingomyelin and phosphatidylglycerol, but lower levels of cholesterol and cholesterol:total phospholipid ratios compared with the nonsmoking controls. By contrast, the patients with EAA had increases in total phospholipid and sphingomyelin; there were no smoking related decreases in cholesterol; and several patients had levels of cholesterol and cholesterol:total phospholipid ratios above the upper limit for the controls. In the BAL fluids of the EAA patients, the levels.ml-1 of the immunostimulatory lipids sphingomyelin, phosphatidylethanolamine, cholesterol and cholesterol esters correlated with the number.ml-1 of lymphocytes, mast cells, neutrophils and "foamy" macrophages. Cholesterol levels (rs = 0.82) and lymphocyte counts (rs = 0.90) correlated most closely with "foamy" macrophages (p less than 0.001), suggesting that uptake of cholesterol by macrophages may enhance antigen-presenting function. These observations provide some support for the hypothesis that inflammatory reactions in the lungs might be influenced by the local lipid environment.
Pneumocystis carinii pneumonia and acquired immunodeficiency syndrome: an atypical presentation with lung cavitations
Authors: Praz JO , Lorenzi P , Chevrolet JC
Published: November 2022

The differential diagnosis of lung cavitations is very broad. We report a case of Pneumocystis carinii pneumonia (PCP) with lung cavitations on the chest X-ray in a patient with the acquired immunodeficiency syndrome (AIDS). We discuss the differential diagnosis of such an X-ray pattern and emphasize that multiple cavitations can be a roentgenographic presentation of PCP.
Erythrocytes prevent inactivation of alpha 1-antitrypsin by cigarette smoke
Authors: Mangione S , Kueppers F , Puglia C , Greenspon LW
Published: November 2022

Red blood cells (RBC) possess strong antioxidant activity. We tested whether this activity was sufficient to prevent the oxidative inactivation of alpha 1-antitrypsin (alpha 1-AT) by cigarette smoke. We found that RBC in physiological concentrations completely prevented the inactivation of alpha 1-AT. The major erythrocytic antioxidants, catalase, superoxide dismutase and glutathione were then selectively inhibited and the RBC retested. Only the inhibition of catalase significantly impaired the protective ability of added erythrocytes. We suggest that RBC antioxidants may be an important variable in determining the degree of protection of alpha 1-AT against oxidation.
Effect of human antileucoprotease on experimental emphysema
Authors: Rudolphus A , Kramps JA , Dijkman JH
Published: November 2022

Antileucoprotease (ALP), a potent inhibitor of human neutrophil elastase (HNE), may be a modulating factor in the pathogenesis of emphysema. Investigating the clearance of intratracheally-instilled ALP in hamsters, we observed a rapid clearance from the airway lumen within 60 min, whereafter the remaining 40% slowly decreased with a calculated half-life (T0.5) of 2.8 h. Lung tissue-associated ALP showed a peak at 40 min and slowly decreased (T0.5 approximately 3 h). In vivo efficacy of ALP on HNE-induced pulmonary lesions was studied by instillation of either 365 micrograms or 730 micrograms ALP, followed after 1 h by 420 micrograms HNE. Emphysema, haemorrhage and secretory cell metaplasia (SCM) were quantified 21 days after instillations. ALP was found to be able to inhibit emphysema and haemorrhage in a dose-related way, the decrease of haemorrhage being less pronounced. SCM was minimally affected. These results show that ALP inhibits efficiently the development of HNE-induced emphysema and, to a lesser extent, haemorrhage. We speculate that tissue-associated ALP might be responsible for this protection.
Disseminated lung cancer or extragonadal germ cell tumour?
Authors: Wouters E , Van Meerbeeck J , Dirix L , Janssen M , Van Marck E , Vermeire P , Van Oosterom A
Published: November 2022

Two patients are reported in whom an initial diagnosis of disseminated non small cell bronchogenic carcinoma was subsequently changed into a final diagnosis of extragonadal germ cell tumour. The clinical importance of the differential diagnosis between these two malignancies is highlighted and the management of extragonadal germ cell tumours is discussed.
Lung CT density correlates with measurements of airflow limitation and the diffusing capacity
Authors: Gould GA , Redpath AT , Ryan M , Warren PM , Best JJ , Flenley DC , MacNee W
Published: November 2022

We studied 80 subjects (63 M, 17 F; 23-82 yrs) and related lung computerized tomography (CT) density with age, height, spirometry, lung volumes, diffusing capacity and arterial blood gas tensions. These subjects demonstrated a wide range of physiological impairment (forced expiratory volume in one second (FEV1) 8-116% predicted; diffusing capacity (Kco) 15-139% predicted; arterial oxygen tension (Pao2) 38-91 mmHg). They ranged from normal subjects to patients with chronic respiratory failure. Lung density was derived from CT density histograms measured as both mean Emergency Medical Information (EMI) number (EMI scale: 0 = water, -500 = air, EMI number of normal lung tissue range approximately -200 to -450) and the lowest 5th percentile EMI number, the latter value being more likely to represent the density of lung parenchyma. Lung CT density correlated most strongly with airflow obstruction (EMI 5th percentile versus FEV1/forced vital capacity (FVC) % predicted, r = 0.73, p less than 0.001) and diffusing capacity (EMI 5th percentile versus Kco, r = 0.77, p less than 0.001). This suggests that reduction in lung density, which reflects loss of the surface area of the distal airspaces, is a major index of respiratory function in patients with smoking related chronic obstructive pulmonary disease (COPD). These data provide no indication of other factors such as small and large airways disease, and loss of elastic recoil, which may contribute to airflow limitation, or disruption of the pulmonary vascular bed which may also affect CT lung density.
Pericardial diverticulum with unusual symptomatology
Authors: Waterbolk TW , Henkens CA , Remmert DG , van der Jagt EJ , Postmus PE
Published: November 2022

A healthy 37 yr old female presented with recurrent right-sided chest pain which spontaneously disappeared. On a chest roentgenogram a lesion in the right cardiophrenic angle was found. Magnetic resonance imaging suggested a cystic structure. During thoracotomy a pericardial diverticulum was found. The pain was probably caused by intermittent volvulus of the diverticulum.
Occupational dust or gas exposure and prevalences of respiratory symptoms and asthma in a general population
Authors: Bakke P , Eide GE , Hanoa R , Gulsvik A
Published: November 2022

The relationship of occupational airborne, exposure to respiratory symptoms and asthma was examined using a self-administered questionnaire in a cross-sectional survey of a random sample (n = 4,992 subjects) of the general population aged 15-70 yrs of Hordaland county, Norway. The response rate was 90%. Twenty nine percent of the population had a history of occupational dust or gas exposure, 5% reported having been exposed to asbestos at work, and 4% reported quartz exposure. A history of occupational dust or gas exposure was associated with morning cough, chronic cough, phlegm when coughing, breathlessness on exercise, occasional wheezing and a physician's diagnosis of asthma after adjusting for sex, age, smoking habits and urban-rural area of residence. The adjusted relative odds ratios for the respiratory disorders in subjects exposed to dust or gas ranged from 1.6-1.9. The population attributable risk of occupational dust or gas exposure for the respiratory disorders ranged from 11-19%. The study indicates that respiratory disorders are independently associated with occupational airborne exposure in a Norwegian general population sample.
Protective effect and duration of action of formoterol aerosol on exercise-induced asthma
Authors: Patessio A , Podda A , Carone M , Trombetta N , Donner CF
Published: November 2022

The short-term protective effect on exercise-induced asthma (EIA) and the duration of action of formoterol, given by metered dose aerosol at a dose of 24 micrograms, were compared with salbutamol (200 micrograms) and placebo in twelve asthmatic EIA-positive patients in a double-blind, placebo-controlled, three period cross-over study. On each treatment day the patients were given one of the drugs or placebo and two exercise tests were performed at the second and at the eighth hour after dosing. Using a standard procedure, exercise was performed by treadmill in well-controlled environmental conditions. In the first test at 2 h a significant difference relative to placebo (p less than 0.001) at each incremental time after exercise (i.e. 5, 10, 15, 20, 30 min) was obtained with both formoterol and salbutamol, without any significant difference between formoterol and salbutamol. After the eighth hour test formoterol still protected against EIA in comparison to both salbutamol and placebo. The effect of salbutamol at this time was not different from placebo. No adverse effects were reported in any treatment group. Formoterol has a long duration of action in protecting against EIA that persisted for eight hours, removing the need to dose with beta 2-agonist before every exercise.
Inflammatory cell response in bronchoalveolar lavage fluid after nitrogen dioxide exposure of healthy subjects: a dose-response study
Authors: Sandstrom T , Stjernberg N , Eklund A , Ledin MC , Bjermer L , Kolmodin-Hedman B , Lindstrom K , Rosenhall L , Angstrom T
Published: November 2022

The combination of environmental chamber exposure and bronchoalveolar lavage (BAL) was used to study the effects of the common air pollutant nitrogen dioxide (NO2). Eighteen healthy nonsmokers were exposed to NO2 during 20 min in an exposure chamber during light bicycle ergometer work. All subjects were examined with BAL at least 3 wks before exposure, as a reference. The subjects were re-examined with BAL, in groups of eight, 24 h after exposure to 4, 7 and 10 mg NO2.m.3 (2.25, 4.0 and 5.5 ppm), respectively. An inflammatory cell response was found after exposure to all concentrations. An increase in the number of lymphocytes in BAL fluid was observed after 7 and 10 mg.m.3 (p less than 0.05 and 0.02, respectively). An increase in the number of mast cells, that appears to be dose-dependent, was found after exposure to all concentrations. The proportion of lysozyme positive alveolar macrophages was elevated after exposure to 7 mg.m.3. The inflammatory mediators fibronectin, hyaluronan, angiotensin converting enzyme (ACE) and beta 2-microglobulin were unchanged by exposure. Due to the findings of inflammatory cell changes far below the peak exposure limits for work places in industrialized countries, 9-18 mg.m.3, the safety of these limits is questioned. Studies are in progress in our laboratory using BAL to evaluate the effects of repeated NO2 exposure.
Scoliosis as cause of pulmonary atelectasis
Authors: ter Wee PM , Luth WJ , van der Schee AC , Stam J
Published: November 2022

We present a patients with persistent position-dependent productive cough and intermittent fever. He was first examined at 38 yrs of age. Chest X-ray showed a severe thoracic lordoscoliosis and an atelectasis of the right lower lobe. Bronchography revealed a total stenosis of the right lower lobe bronchus. Five years later had increased symptoms. Spirometry showed total lung capacity (TLC) 3.8 l (predicted value 6.7 l), forced vital capacity (FVC) 2.6 l (4.8 l) and forced expiratory volume in one second (FEV1) 1.7 l (3.9 l). Bronchoscopy demonstrated a smooth stenosis of the right lower lobe bronchus but the stenosis could be passed through with a brush. Computed tomographic scanning demonstrated compression of the right lower lobe bronchus and the atelectasis. After surgical removal of the right lower lobe, all symptoms disappeared. Histological examination of the right lower lobe revealed fibrosis and chronic inflammation.
Alveolar macrophages in idiopathic pulmonary fibrosis display a more monocyte-like immunophenotype and an increased release of free oxygen radicals
Authors: Kiemle-Kallee J , Kreipe H , Radzun HJ , Parwaresch MR , Auerswald U , Magnussen H , Barth J
Published: November 2022

Bronchoalveolar lavage (BAL) was performed in 13 patients with idiopathic pulmonary fibrosis (IPF) and in 10 control subjects. Free oxygen radical (FOR) production of alveolar macrophages (AM) and of blood monocytes was measured by luminol-dependent chemiluminescence (LDCL) without and after stimulation with zymosan A. We confirmed earlier studies that alveolar macrophages of IPF patients display a significantly elevated release of FOR under basic and under stimulated conditions. In contrast to alveolar macrophages, blood monocytes did not reveal altered LDCL in IPF. This indicates that the functional properties for augmented FOR release by IPF alveolar macrophages are acquired in the lungs and not in the peripheral circulation. To elucidate the possible mechanisms leading to the augmented LDCL response, immunophenotyping of alveolar macrophages was carried out. A panel of new monoclonal antibodies of the Ki-M-series, discriminating differentiation stages of monocyte/macrophage subpopulations, served for immunocytochemical staining. In IPF patients distribution of Ki-M2, Ki-M3, Ki-M6 and Ki-M8 positive AM demonstrated an increased proportion of alveolar macrophages expressing a more monocyte-like immunophenotype. Normally, monocytes as precursors of AM reveal a markedly stronger LDCL than alveolar macrophages themselves. Therefore, it seems likely that the increased LDCL of alveolar macrophages in IPF is due to the higher proportion of more immature monocyte-like cells in the alveoli of these patients.