bluuebunny/crossref_metadata_2025 huggingface dataset:
Thrombolytic treatment of pulmonary embolism with APSAC
Authors: Vander Sande J , Bossaert L , Brochier M , Charbonnier B , Serradigmini A , Elias A , Pintens H , Lauwers MC
Published: November 2022

BRL 26921 (Eminase registered trade mark in Belgium, Germany and The Netherlands) is the p-anisoyl derivative of the primary (human) lys plasminogen-streptokinase activator complex (APSAC). The acyl-enzyme has the theoretical advantage of causing fibrinolysis in situ in the presence of fibrin clotbound plasminogen. It was administered to 34 patients with severe pulmonary embolism (PE) in an open multicentre study. PE was suspected on clinical, blood gas, ECG, and radiographic data. Pulmonary angiograms performed pre- and post-treatment confirmed the diagnosis and were assessed using the Miller Index (MI). Fibrinogen, plasminogen, alpha-2-antiplasmin, fibrinogen degradation products (FDP), activated partial thromboplastin time (APTT), partial thromboplastin time (PTT) were closely monitored before and after each administration of APSAC. Median angiographic improvement was 50% (range 0-94%). The following adverse events were reported: bleeding at puncture sites (n = 12), haematuria (n = 1), epistaxis (n = 3), fever (n = 2). A blood transfusion was given in one patient with an inguinal haematoma. Systemic fibrinogenolysis occurred in 20/28 patients.
Upper airways resistance and snoring in anaesthetized dogs
Authors: Widdicombe JG , Davies A
Published: November 2022

We have measured upper airways resistance from the trachea and from the pharynx to the atmosphere, EMG of genioglossus muscle, and the sound of snoring, in anaesthetized greyhounds breathing spontaneously through the upper airways. Using extra-corporeally produced continuous flow we determined flow/pressure curves for the upper airways in an expiratory direction and analysed them in terms of resistances from the trachea and from the pharynx. Resistances and other variables were determined with the nose open and the nostrils blocked. About one-third of the dogs snored spontaneously and most of the remainder did so when the nose was blocked. During snoring with nasal blockage the upper airways resistance increased considerably, and the sound of snoring and genioglossus EMG were also enhanced. The results show that the anaesthetized greyhound is a suitable model for studying snoring with simultaneous measurements of upper airways resistance and the activity of pharyngeal dilator muscles.
Fibreoptic bronchoscopy in smear-negative pulmonary tuberculosis
Authors: Chawla R , Pant K , Jaggi OP , Chandrashekhar S , Thukral SS
Published: November 2022

Fifty smear-negative pulmonary tuberculosis patients underwent fibreoptic bronchoscopy. Bronchial aspirate smears of twelve patients and post-bronchoscopic sputum smears of fourteen patients were positive for acid-fast bacilli (AFB). Bronchial biopsy provided the diagnosis in 9 out of 30 patients. Brush smears were positive in 28 patients, being the only positive sample in ten cases. A high yield from brush smears was obtained due to their preparation from caseous material wherever visible in the bronchi. With these results a rapid diagnosis was established in 36 of the 50 patients. When culture results were available, a definite diagnosis of tuberculosis was made in 45 of the patients. The yield from brush smears was found to be significantly better when compared to bronchial aspirate smears (p less than 0.01) and post-bronchoscopic sputum smears (p less than 0.01).
Oral N-acetylcysteine reduces selected humoral markers of inflammatory cell activity in BAL fluid from healthy smokers: correlation to effects on cellular variables
Authors: Eklund A , Eriksson O , Hakansson L , Larsson K , Ohlsson K , Venge P , Bergstrand H , Bjornson A , Brattsand R , Glennow C , et al.
Published: November 2022

Bronchoalveolar lavage (BAL) was performed on eleven healthy smokers before and after eight weeks of oral treatment with N-acetylcysteine (NAC) 200 mg t.i.d. The concentrations of selected eosinophil and neutrophil granule constituents and of selected proteases and protease inhibitors, albumin and endotoxin were determined in the recovered BAL fluid and in plasma or serum samples. In addition, in vitro chemotactic activities for neutrophils and eosinophils were assessed in the BAL fluid. Significant reductions in BAL fluid content of lactoferrin (LF), eosinophil cationic protein (ECP), antichymotrypsin (ACT) and chemotactic activity for neutrophils were recorded after NAC treatment. The levels of other examined markers tended to be reduced or were not affected. In serum/plasma, the concentrations of myeloperoxidase (MPO) and elastase were reduced after NAC treatment whereas concentrations of other constituents examined were unaltered. These data, together with previously reported findings, suggest that oral NAC may influence the activity of "inflammatory" cells in the bronchoalveolar space of smokers.
Influence of airway calibre on the intrapulmonary dose and distribution of inhaled aerosol in normal and asthmatic subjects
Authors: Chung KF , Jeyasingh K , Snashall PD
Published: November 2022

We investigated the relationship between airway calibre and the dose and distribution of inhaled aerosol in ten normal and six asthmatic subjects. Subjects inhaled saline aerosol containing 99mTcO4 delivered from a nebulizer connected to a dosimeter, and the lung fields were scanned with a gamma-camera. Right lung dose (RLD) was calculated as percentage of total dose. Intrapulmonary distribution was measured as penetration index (PI) (peripheral zone counts/central zone counts). Asthmatics had a significantly lower PI than normal subjects and there was a linear relationship between PI and baseline specific airway conductance (sGaw, p less than 0.001), and forced expiratory volume in one second (FEV1, p less than 0.05). After bronchodilatation with salbutamol (delta sGaw 101 +/- 31%, mean +/- SEM), PI increased from 0.73 +/- 0.11 to 1.09 +/- 0.15 (p less than 0.05); after bronchoconstriction with methacholine (delta sGaw 62.6 +/- 2.9%), PI decreased from 1.42 +/- 0.24 to 1.06 +/- 0.22 (p less than 0.05). Changes of PI were correlated with changes in sGaw and FEV1 (n = 20, p less than 0.001) but changes of RLD and changes in airway calibre were not. The distribution of inhaled aerosol, but not the dose, is largely dependent on airway calibre. The differences in PI between normal and asthmatic subjects may at best be explained by the differences in central airway calibre.
A conservation device for oxygen therapy in COPD
Authors: Evans TW , Waterhouse JC , Suggett AJ , Howard P
Published: November 2022

Patients with hypoxaemia secondary to chronic obstructive pulmonary disease (COPD) are frequently prescribed oxygen therapy for short- and long-term domiciliary use. Oxygen administered via nasal cannulae incorporating a small collapsible reservoir ("Oxymizer", Chad Therapeutics Inc., CA, USA) improves transcutaneous oxygen tensions in the short-term when compared to standard nasal cannulae. The effects of this device on arterial oxygen (PaO2) and carbon dioxide (PaCO2) tensions was assessed over 60 min in twelve patients with severe hypoxaemia (6.2 +/- 0.9 kPa, mean +/- SD) and hypercapnia (7.5 +/- 1.2 kPa). Following baseline measurements, oxygen was administered using standard nasal cannulae, and further measurements were made at 15 min intervals for at least 45 min. Patients were then changed to the "Oxymizer" and measurements continued at 15 min intervals for a further 60 min. Mean PaO2 increased by 1.1 +/- 0.78 kPa (p less than 0.001), using the "Oxymizer", but PaO2 was significantly greater after 15 min on the device than after 60 min (p less than 0.05). There was no change in PaCO2 (p greater than 0.05). The "Oxymizer" increases PaO2 compared with standard cannulae, but the effect may not be sustained.
Features in hospitalized patients with symptom-detected or radiologically-detected pulmonary tuberculosis
Authors: Herer B , Kuaban C , Papillon F , Durieux P , Chretien J , Huchon G
Published: November 2022

To compare features of tuberculosis detected either clinically or radiologically, we studied 498 patients hospitalized for tuberculosis. Tuberculosis was less frequently radiologically-detected in patients over 65 yrs old (p less than 0.01) and in directorial staff and inactive subjects (p less than 0.0001). Pleural effusion and radiological cavities were more frequent in the symptom-detected group, but half of the radiologically-detected patients had clinical symptoms which could have led to the diagnosis of tuberculosis, especially in alcoholics and office workers. Finally, 26% of the radiologically-detected patients had positive direct tuberculosis smears and should be considered contagious.
A simultaneous single breath measurement of pulmonary diffusing capacity with nitric oxide and carbon monoxide
Authors: Borland CD , Higenbottam TW
Published: November 2022

Pulmonary diffusing capacity (DL) for carbon monoxide (CO) and nitric oxide (NO) were simultaneously measured in man using the single breath method, by adding 4O ppm of NO to the inspired gas and analysing the expirate for NO by a chemiluminescent method. The mean ratio of DLNO to DLCO in thirteen subjects was 4.3 (SD 0.3), mean DLNO = 49 mmol.min-1.kPa-1 (SD 10) and mean DLCO = 11 mmol.min-1.kPa-1 (SD 2). An increase in alveolar oxygen concentration from a mean of 18 to 68% in five subjects was associated with a 54% fall in DLCO but no change in DLNO. A reduction of lung volume from total lung capacity (TLC) (mean of 7 l) to a mean volume of 3.9 l in five subjects caused a fall in both DLNO (by 34%) and DLCO (by 8%). With 175 watts cycle exercise in three subjects the DLCO rose by 45% and DLNO by 25%. Since NO reacts much faster with haemoglobin than CO, DLNO should be influenced much less by reaction with haemoglobin, and perhaps represents a better index for the diffusing capacity of the alveolar-capillary membrane (Dm) than DLCO.
Effects of rebreathing conditions and body size on normal human lung tissue volume
Authors: Polianski JM , Vivet PD , Chinet TC , Labrune SI , Henzel DG , Huchon GJ
Published: November 2022

To evaluate the consequences of breathing pattern variations inherent to lung disease on the rebreathing measurement of lung tissue volume (Vt), we carried out a study of ten normal human subjects in whom we assessed the effects of changes in rebreathing volume (Vreb), additional deadspace volume (AVD), respiratory rate (RR), and body height. Vt and alveolar volume (VA) were determined from the end-tidal concentrations of acetylene and helium. We performed Vt measurements using different combinations of Vreb (20, 30 and 50% of predicted vital capacity), of AVD (0, 100, and 200 ml) and of RR (10, 25, and 40 br.min-1). Only slow RR (10 br.min-1) resulted in a higher Vt (p less than 0.001). An increase in Vreb induced an increase in VA but not in Vt. VA and Vt were positively correlated with the height of the subjects. We conclude that, in normal subjects, Vt increases: 1) with the height of subjects; and 2) when the respiratory rate is low. Interpretation of Vt results must take into account these two variables.
Comparison of the constant flow and occlusion methods for assessment of bronchoconstriction in guinea-pigs
Authors: Lorino AM , Benichou M , Kochi T , Lorino H , Milic-Emili J , Harf A
Published: November 2022

Assessments of total respiratory compliance (C) and conductance (G) with the constant inspiratory flow and the occlusion methods were compared in the basal state and during histamine or serotonin induced bronchoconstriction in 22 normal, anaesthetized, paralysed, mechanically ventilated guinea-pigs. In the basal state, no significant difference was found between the C and G values measured by both methods. During drug-induced bronchoconstriction, small but significant differences were observed between the respiratory parameters measured by the two methods, and expressed as the percentage ratio (R) to the corresponding basal values (respectively RCCF and RCOC, and RGCF and RGOC). This discrepancy, which was independent of the drug and of the dose, was probably attributable to a modification of the visco elastic properties of the lung due to either the mechanical ventilation or the infused drug. Nevertheless, this study demonstrates that both methods can be considered as equivalent for bronchoconstriction assessment because very strong correlations were found between RCCF and RCOC (r = 0.96, p less than 0.001) and between RGCF and RGOC (r = 0.97, p less than 0.001), and because the slopes of the linear relationships were not significantly different from unity in both cases.
Attempts at estimating mixed venous carbon dioxide tension by the single-breath method
Authors: Ohta H , Takatani O , Matsuoka T
Published: November 2022

The single-breath method was originally proposed by Kim et al. [1] for estimating the blood carbon dioxide tension and cardiac output. Its reliability has not been proven. The present study was undertaken, using dogs, to compare the mixed venous carbon dioxide tension (PVCO2) calculated by the single-breath method with the PVCO2 measured in mixed venous blood, and to evaluate the influence of variations in the exhalation duration and the volume of expired air usually discarded from computations as the deadspace. Among the exhalation durations of 15, 30 and 45 s tested, the 15 s duration was found to be too short to obtain an analyzable O2-CO2 curve, but at either 30 or 45 s, the calculated values of PVCO2 were comparable to the measured PVCO2. A significant agreement between calculated and measured PVCO2 was obtained when the expired gas with PCO2 less than 22 Torr was considered as deadspace gas.
Pneumonia due to Legionella pneumophila and pneumococcal pneumonia: similarities and differences on presentation
Authors: Granados A , Podzamczer D , Gudiol F , Manresa F
Published: November 2022

We compared clinical, radiological and laboratory data from 32 cases of community-acquired pneumonia due to Legionella pneumophila, with 37 cases of pneumococcal pneumonia (PP). This study revealed few clinical differences between the two types of pneumonia: in our experience Legionnaire's disease presents like a "typical" bacterial pneumonia. Given the difficulty of making a diagnosis on clinical data alone, we propose early aetiological diagnostic measures and recommend that the choice of initial treatment be based not only on the features at the time of presentation, but also on a consideration of the epidemiology of different types of pneumonia in a given area.
Magnetopneumography: a general review
Authors: Le Gros V , Lemaigre D , Suon C , Pozzi JP , Liot F
Published: November 2022

Magnetopneumography is the study of the remanent magnetism of foreign intrathoracic ferromagnetic particles after magnetization by an external magnetic field. Given knowledge of the magnetic characteristics of the inhaled particles, this highly sensitive and non-invasive technique allows the measurement of lung dust loads. Many groups of workers have been examined in this way, e.g. welders, coalminers, asbestos, foundry and steel workers. Magnetopneumography also allows analysis of the distribution of aerocontaminants in the different anatomical structures and, when repeated, the study of clearance speeds and migration from site to site of such particles. Emphasis has been laid on the importance of study of the fading of the remanent magnetic signal as time elapses. This short-term phenomenon, called relaxation, seems highly significant for the study of the dynamic properties of the immediate environment of extra pulmonary particles and especially for the study of macrophage activity.
Incidence and clinical features of community-acquired legionellosis in hospitalized patients
Authors: Ruf B , Schurmann D , Horbach I , Fehrenbach FJ , Pohle HD
Published: November 2022

In a two-year prospective study of patients hospitalized because of community-acquired pneumonia, the incidence of legionellosis was found to be 3.8% (17/442 cases). After S. pneumoniae, M. pneumoniae and influenzae viruses, legionellae were the fourth most frequently identified pneumonia agents. We evaluated the clinical data from 41 cases with legionellosis, 17 diagnosed in this prospective study and 24 prior to the study. The age range of all patients (22 women, 19 men) was 24-78 yrs (median 61.3 yrs), 14 of 41 cases (34.1%) had extrapulmonary organ involvement. Twelve patients (29.3%) died. The fatality rate was 4.5% (1/22 cases) in patients treated with erythromycin, and 57.9% (11/19 cases) in patients treated with other antibiotics. Antibiotics effective in legionellosis should be added to the routine therapy of community-acquired pneumonia when this aetiology can not be excluded.
Bronchial hyperresponsiveness: the need for a distinction between hypersensitivity and excessive airway narrowing
Authors: Sterk PJ , Bel EH
Published: November 2022

Bronchial hyperresponsiveness is currently defined as an increase in sensitivity to a wide variety of airway narrowing stimuli. Most patients with asthma and chronic obstructive pulmonary disease (COPD) exhibit such an enhanced sensitivity. In asthma, in particular, this hypersensitivity is accompanied by excessive degrees of airway narrowing. This raises the question as to whether measures of sensitivity, e.g. the provocative concentration or dose producing 20% fall in FEV1 (PC20 or PD20), comprise all the relevant information in bronchial hyperresponsiveness. In adjunct to model studies, there is experimental evidence in man that the potential mechanisms of bronchial hyperresponsiveness can be divided into those causing hypersensitivity and those responsible for the increase in the maximal attainable degree of airway narrowing. The recognition and distinction of these components of hyperresponsiveness have clinical implications in the diagnosis and therapy of asthma and COPD. Bronchial hyperresponsiveness is a composite functional disorder, which requires treatment of each of its components.
Exercise tolerance in chronic obstructive pulmonary disease: importance of active and passive components of the ventilatory system
Authors: Loiseau A , Dubreuil C , Loiseau P , Pujet JC , Georges R , Saumon G
Published: November 2022

We investigated which components of ventilatory function are related to exercise tolerance in chronic obstructive pulmonary disease (COPD) patients. Physical characteristics, usual lung function, timing and neuromuscular components of ventilation were measured in 113 outpatients in whom FEV1/VC was less than 75% of the predicted value and exercise was limited by breathlessness. These variables were used to predict the maximum work load during progressive bicycle exercise. The prediction was obtained using a stepwise procedure in men and women separately. Among the variables selected, age, body weight, FEV1/VC, PImax, and P0.1/VT/TI accounted for 79% of the variability in maximum performance in men. The predictive model was statistically verified and was stable. The mean prediction error was 12 Watts. Among these variables, P0.1/VT/TI, PImax, and FEV1/VC were the main determinants of maximum work load (MWL). These results show that exercise limitation in COPD is related to impairment of both the active (inspiratory muscles) and passive (respiratory impedance) components of the ventilatory system. The same conclusions concerning passive components are proposed for women, despite a smaller population which prevented verification of the prediction.
Development of persistent late onset asthma following treatment with captopril
Authors: Lipworth BJ , McMurray JJ , Clark RA , Struthers AD
Published: November 2022

We describe the first case of de novo asthma following treatment with the angiotensin converting enzyme (ACE) inhibitor captopril. Despite drug withdrawal there was evidence of persistent airways obstruction and bronchial hyperreactivity. This suggests the possibility that ACE inhibitors may uncover an asthmatic tendency in patients with pre-existing bronchial hyperreactivity.
Optimal inhalation technique with terbutaline Turbuhaler
Authors: Hansen OR , Pedersen S
Published: November 2022

The bronchodilator response after four different modes of inhalation of 0.25 mg terbutaline from a Turbuhaler was assessed, in a double-blind cross-over study, of 14 asthmatic children aged 8-14 yrs (mean 11.6 yrs). The children inhaled as fast as possible (mean peak inspiratory flow rate = 53 l.min-1), because fast inhalations have been found to be more efficient than slow inhalations when the Turbuhaler is used. Tilting the head back during inhalation and a breath-holding pause of 10 s after the inhalation had no significant effect upon bronchodilation. Furthermore, the response was the same whether the children inhaled from residual volume (RV) or functional residual capacity (FRC). These results suggest that this new inhaler can be used with a very simple inhalation technique without any loss of effect. A simple inhalation technique is likely to facilitate teaching and improve compliance.
Lung mechanics and their relationship to lung volumes in pulmonary sarcoidosis
Authors: Bradvik I , Wollmer P , Simonsson B , Albrechtsson U , Lyttkens K , Jonson B
Published: November 2022

Pulmonary sarcoidosis was studied with respect to lung mechanical properties and to the influence of these on lung volumes. Sixty-six patients, with histological support for the diagnosis of sarcoidosis, and radiological signs of pulmonary involvement, i.e., stage II or III, were studied. The static pressure/volume (P/V) curves showed that the static elastic recoil pressure (PelL) tended to be increased at a given percentage of predicted total lung capacity (TLC). Reduction of static lung compliance (CstL) was a typical finding. At maximal inspiration PelL was abnormally low in 20 subjects, including in the main those with recent onset of the disease and older patients. The possibility of a greater inflammatory activity at the site of mechanical receptors in the lungs and airways of these patients is proposed. Pulmonary resistance, measured at a given PelL, was usually increased signifying bronchial involvement. TLC, residual volume (RV) and functional residual capacity (FRC) were lower in current smokers and ex-smokers than in lifelong nonsmokers. This may be due to synergistic effects of the inflammatory processes caused by smoking and sarcoidosis. A reduced vital capacity (VC) mainly reflected a low CstL but also obstruction with increased RV. Forced expiratory volume in one second (FEV1) reflected lung stiffness and obstruction equally. Lung mechanics revealed functional abnormalities which were not obvious from the standard tests, particularly in patients with respiratory symptoms.
Influence of the duration of inhalation of cold dry air on the resulting bronchoconstriction in asthmatic subjects
Authors: Caire N , Cartier A , Ghezzo H , Malo JL
Published: November 2022

Hyperventilation of cold dry air causes bronchoconstriction in asthmatic subjects and has been proposed as a test for assessing bronchial hyperresponsiveness. The influence of the duration of inhalation of unconditioned cold air has not been studied. We have investigated the question in 12 asthmatic subjects in a clinically stable state. Each subject underwent three inhalation tests at a maximum interval of two weeks. On each day, the duration of inhalation was different, being randomly 2, 3 or 4 min depending on the subject. Doubling doses of cold air produced by a freon conditioner were administered, increasing ventilation from 7.5 to 15, 30, 60 l.min-1 and maximum voluntary ventilation (MVV). Forced expiratory volume in one second (FEV1) was assessed after each period of cold air inhalation. The test was stopped when the FEV1 had decreased by 20% or more, or when MVV had been achieved. The dose of cold air expressed as the level of ventilation causing a 20% change in FEV1 (PD20) was interpolated from individual dose-response curves. Dose-response curves shifted to the left when the duration of ventilation was increased. PD20 was significantly lower after 3 min of ventilation than after 2 min (mean +/- SD PD20 of 41.7 +/- 1.4 l.min-1 compared with 53.3 +/- 1.2 l.min-1; p = 0.002). There was a further fall in PD20 after 4 min of ventilation (PD20 = 36.1 +/- 1.5 l.min-1) but the difference compared with the values obtained after 3 min was not significant (p = 0.09), thus suggesting a plateau.(ABSTRACT TRUNCATED AT 250 WORDS)
Improvement of oxygen delivery in severe hypoxaemia by a reservoir cannula
Authors: Collard P , Wautelet F , Delwiche JP , Prignot J , Dubois P
Published: November 2022

In 36 severely hypoxaemic patients (arterial oxygen tension (PaO2) less than 7.3 kPa or 55 mmHg), candidates for long-term oxygen therapy, we compared the effectiveness of three oxygen-delivery systems, the standard nasal prongs, a so-called oxygen-conserving reservoir device ("Oxymizer Pendant") and the reference pharyngeal catheter, at a preset flow rate of 2 l.min-1. After 30 min, the conserving device (OX) was at least as efficient as the pharyngeal catheter (PC) and did significantly better than the nasal prongs (NP), the mean increments in PaO2 and arterial oxygen saturation (SaO2) being, respectively, 1.1 kPa (8.1 mmHg) and 1.3% higher with OX than with NP. Twenty patients did not reach the target level of 8.6 kPa (65 mmHg) PaO2 with the nasal prongs, but the reservoir cannula allowed nine of these "refractory" patients to hit this therapeutic goal, a result indicating a clear trend towards improved immediate oxygen response. Although initially designed to spare gas, we suggest that a reservoir cannula could serve another purpose, namely to optimize oxygenation in patients treated by an oxygen concentrator. Indeed, since the oxygen flow rate cannot be reliably increased over 3 l.min-1 with the available oxygen concentrators, the reservoir device could be more effective in some selected patients whose hypoxaemia cannot be adequately corrected by standard nasal prongs.
The acute effect of cigarette smoking on the neutrophil elastase inhibitory capacity of peripheral lung lavage from asymptomatic volunteers
Authors: Tetley TD , Smith SF , Winning AJ , Foxall JM , Cooke NT , Burton GH , Harris E , Guz A
Published: November 2022

Cigarette smoke-induced emphysema is thought to involve reduction of antielastolytic capacity, resulting in elevated elastase activity and lung tissue damage. Peripheral lavage collected from ten asymptomatic subjects immediately before and 20 min after smoking two high tar cigarettes was analysed for neutrophil elastase (NE) inhibitory capacity (IC), alpha 1-proteinase inhibitor (PI) function, elastolytic activity and immunoreactive levels of PI and bronchial inhibitor (BI). The only change found was a small fall in mol immunoreactive PI/mol albumin after smoking (approximately 17%, p less than 0.05) which did not affect NEIC, since PI contributed less than 50% of the NEIC. There was often more NEIC than mol BI + functional PI, suggesting the presence of other NE inhibitors. Thoracic computerized tomography scans of eight of these subjects highlighted two with emphysematous regions of lung; lavage from these two subjects contained either undetectable BI or inactive BI and this suggests a protective role for BI in emphysema.
FEV1 decline in asymptomatic young adults: relationships with some tests of small airways function
Authors: Marazzini L , Cavigioli G , Mastropasqua B , Pelucchi A
Published: November 2022

The aim of this study is to determine whether some tests proposed as diagnostic of small airways obstruction (SAO) are useful in identifying the subjects at risk of developing chronic airflow limitation. Eighty five healthy male workers (46 nonsmokers and 39 smokers, aged 21-41 yrs), living in the same area and not exposed to occupational pollutants were re-examined after an interval of 6 yrs. At the first survey 39 had functional evidence of SAO as determined by the presence of one of: maximal mid-expiratory flow (MMEF) less than 65% of predicted value (pred); maximal expiratory flow when 25% forced vital capacity remains to be expired (Vmax25) less than 60% pred; closing capacity (CC) greater than 130% pred; 46 had all functional values in the normal range. We considered four subgroups: smokers and nonsmokers with and without SAO. The rate of decline in FEV1, the decline in %delta FEV1 and delta FEV1.height-3, have been evaluated and compared in the subgroups. Initial values of specific tests (MMEF, Vmax25, CC and slope of phase III) have been examined for a possible relationship with decline of FEV1. Statistical analysis of our data showed that only CC was related to FEV1 decline. However, there were no significant differences in FEV1 decline among the subgroups. We conclude that in young adult subjects functional characteristics of SAO have no predictive value for development of chronic airways obstruction.
Comparison between theophylline and an adenosine non-blocking xanthine in acute asthma
Authors: Vilsvik JS , Persson CG , Amundsen T , Brenna E , Naustdal T , Syvertsen U , Storstein L , Kallen AG , Eriksson G , Holte S
Published: November 2022

Enprofylline, a drug without adenosine antagonism and theophylline, a potent adenosine antagonist, were compared, double-blind, randomized, in acute asthma (n = 33). The drugs were given intravenously as loading over 10 min followed by maintenance infusion for 24 h. Mean final plasma levels were very high with enprofylline (14 mg.l), and larger than calculated with theophylline (16 mg.l). Seven patients had maximum levels of enprofylline ranging between 16 and 42 mg.l. Extreme plasma levels of enprofylline were not associated with any theophylline-like central nervous system excitatory effects related to seizure-inducing ability. Some irregularities in the heart rhythm did not raise clinical problems and no significant difference between enprofylline and theophylline was recorded. At 1 h patients on enprofylline (mean plasma level: 5.7 mg.l) and theophylline (12.2 mg.l) had improved their peak expiratory flow rates by 31% and 15% (p less than 0.05), respectively. The improvement in lung function after 24 hours did not differ between treatments suggesting that the high levels of enprofylline were supramaximal for its anti-asthma effects in this situation. In conclusion, with enprofylline it is demonstrated that an adenosine non-blocking xanthine derivative may lack CNS-excitatory effects, but be more potent than theophylline in the treatment of acute asthma.
The use of a vasodilator, felodipine, as an adjuvant to long-term oxygen treatment in COLD patients
Authors: Bratel T , Hedenstierna G , Nyquist O , Ripe E
Published: November 2022

Eight patients with chronic obstructive lung disease (COLD) and pulmonary hypertension were given an infusion of a calcium antagonist, felodipine, during ongoing, long-term oxygen treatment (LTOT). The effects on central haemodynamics and ventilation-perfusion matching were studied. At rest pulmonary and systemic vascular resistances (PVR and SVR) were reduced by 18% (NS) and 26% (p less than 0.05), respectively. Cardiac output increased by 23%. There was a tendency to increased perfusion of low alveolar ventilation-perfusion ratio (VA/Q) areas (VA/Q less than 0.1) and to increased shunt compared to pretreatment values. Arterial oxygen tension (PaO2) fell by 0.7 kPa (p less than 0.001) but total oxygen transport increased by 23% (p less than 0.001). After treatment with oral felodipine (7.5-15 mg.day-1) for a mean time of 14 wks, PVR and SVR were reduced by 16% (p less than 0.05) and 7% (NS), respectively, as compared to pretreatment values at rest. Cardiac output rose by 13%. The VA/Q ratios and the PaO2 returned towards pretreatment values. The total oxygen transport increased by 11% (p less than 0.05) at rest and increased by 19% (p less than 0.05) during exercise as compared to the pretreatment value. The positive effect on central haemodynamics indicates that felodipine may be a valuable adjunct to ongoing LTOT.
Chrysotile asbestos exposures can produce an alveolitis with limited fibrosing activity in a subset of high fibre retainer sheep
Authors: Begin R , Cantin A , Sebastien P
Published: November 2022

Inhalation of fibrogenic mineral dust may enhance fibronectin (Fn) production by alveolar macrophages and increase fibroblast growth activity (FGA) in lung lavage fluid. To investigate the relationship of these changes to fibre retention and the development of asbestosis, we exposed 15 sheep to 100 mg Canadian chrysotile fibres in 100 ml saline, and ten sheep to 100 ml saline only, at ten day intervals. The animals were studied at 3 month intervals. At month 18, ten sheep had abnormal chest radiograph (category greater than or equal to 1) (group B) and five had normal radiograph (category 0) (group A). Pulmonary function data indicated restrictive patterns of abnormalities in both groups, more severe in group B. Sheep in group A had bronchoalveolar lavage (BAL) cellularity and biochemistry comparable to controls; sheep in group B had significant increases in total BAL cells (x2), macrophages (x2), neutrophils (x4) and eosinophils (x3), increased BAL lactate dehydrogenase and Fn, but FGA and procollagen 3 comparable to controls. Fibre retention was significantly increased in all exposed sheep and 2.5 x higher in group B vs group A despite similar exposures (70 intratracheal, 100 mg chrysotile infusions). Enhanced fibre retention in group B preceded the appearance of disease. This study confirms our earlier observation linking individual susceptibility to development of alveolitis to individual dust burden and provides evidence that the excess of fibre retention can be observed before detectable disease. In addition, we report a chrysotile-induced early alveolitis with incompletely expressed fibrosing activity at the time of initial radiographic detection. The intensity of the alveolitis is related to the degree of fibre retention.
Lung growth of pre-adolescent children
Authors: Smeets M , Brunekreef B , Dijkstra L , Houthuijs D
Published: November 2022

Lung growth was studied in 420 Dutch children aged 6-11 yrs. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) and maximal mid-expiratory flow (MMEF) were measured four times over a 2.5 yr period with a rolling-seal spirometer. In boys, pulmonary function increased with approximately the same velocity at all ages studied. In girls, however, the growth velocities of FVC and FEV1 increased markedly at age 10 yrs, and growth velocities of PEF and MMEF had increased already at age 9 yrs. The minimum pulmonary function growth velocity could not be determined from the available data in boys. In girls, the minimum pulmonary function growth velocities preceded the minimum height growth velocity at the onset of the pubertal growth spurt. All lung function growth rates were significantly associated with the growth rate of height. In girls, the growth rate of FVC was also associated with the weight growth rate. There was also some association between the growth rates of PEF and MMEF and age. In boys, there was a negative association between age and the growth rates of FVC and FEV1, after adjustment for the growth rate of height.
Acquired factor V deficiency in a patient with pulmonary tuberculosis
Authors: Aliaga JL , de Gracia J , Vidal R , Pico M , Flores P , Sampol G
Published: November 2022

A 29 yr old man with pulmonary tuberculosis and concomitant acquired plasma coagulation factor V deficiency is reported. The case is discussed together with three previously described cases. The bleeding tendency in a patient with pulmonary tuberculosis may be caused by a coagulation factor antibody and may be corrected by chemotherapy, as in the case described. Special therapeutic approaches are required in some cases.
Revaccination with BCG: its effects on skin tests in Kuwaiti senior school children
Authors: Shaaban MA , Abdul Ati M , Bahr GM , Standford JL , Lockwood DN , McManus IC
Published: November 2022

Following a policy of BCG vaccination adopted in Kuwait more than 20 yrs ago, children receive their first vaccination just before starting school. Those who have a response of less than 10 mm induration to 2 tu of RT23 PPD, when they are 13 yrs old, are revaccinated. The effects of this revaccination on skin test positivity in a group of 18 yr old senior school children have been investigated. In a random study group 23% were found to have received BCG a second time. Revaccination resulted in a significant increase in positivity to tuberculin, and to the other 6 reagents tested, that was much more than would have been expected due to the passage of time alone in low responders. Scars of the second BCG vaccination were larger than those after the first vaccination, and showed a sex difference, with scars being significantly larger in boys than in girls. Boys also tended to show the largest responses to skin tests, with the notable exception of tuberculin to which girls showed the largest response. In most cases responses to skin tests were larger after revaccination than after a single vaccination. Based on this study, it is impossible to be sure that revaccination improved protective immunity, but the increase in tuberculin responsiveness, and recognition of environmental mycobacterial species may be indirect evidence supporting this conclusion.
Primary intrapulmonary benign schwannoma. A case with ultrastructural and immunohistochemical confirmation
Authors: Bosch X , Ramirez J , Font J , Bombi JA , Ferrer J , Vendrell J , Ingelmo M
Published: November 2022

Neurogenic pulmonary tumours are rare. Neurofibromas are the most common variety and tend to occur in patients with generalized neurofibromatosis, whereas schwannomas arise sporadically in patients who have no evidence of this disorder. A case of solitary benign schwannoma arising in a segmental bronchus is presented, and the published cases reviewed. Microscopically, the tumour had a spindle-shaped cell proliferation with palisade formation in several fields and low cellularity in other areas. The diagnosis was supported by positive immunostaining for S-100 protein and by ultrastructural examination which showed elongated cells surrounded by well-preserved basal lamina and numerous cytoplasmic processes also possessing a basal lamina.
Ofloxacin in miliary tuberculosis
Authors: Alegre J , Fernandez de Sevilla T , Falco V , Martinez Vazquez JM
Published: November 2022

We report one case of severe miliary tuberculosis with liver failure and respiratory insufficiency in a twenty-seven year old patient. We emphasize the presence of hepatic, occular and vestibular toxicities secondary to the treatment and the usefulness of ofloxacin with cycloserine given for nine months.
Aminophylline enhances ventilation in phrenicotomized rats
Authors: Nachazel J , Palecek F
Published: November 2022

The aim was to test the effects of aminophylline (AP) on breathing of phrenicotomized rats. Fifty seven male rats of the Wistar strain were anaesthetized with 1.3 g.kg-1 urethane i.p. They were phrenicotomized, divided into 6 groups and given 5, 10, 20, 40 and 80 mg.kg-1 AP i.v. or a corresponding volume of saline. Ventilation, tracheal occlusion pressure and arterial blood gases were measured. In all animals phrenicotomy resulted in hypoventilation with corresponding hypoxaemia (from control 11.9 +/- 1.0 to 10.4 +/- 0.8 kPa) and hypercapnia (from control 4.6 +/- 0.5 to 5.5 +/- 0.6 kPa). In the control group (with saline) 4 h later the PaO2 was 8.6 +/- 1.1 kPa and PaCO2 7.2 +/- 0.6 kPa. After AP 1 h after phrenicotomy the minute ventilation increased in a dose-dependent manner by 1-66%. 4 h after phrenicotomy the minute ventilation of rats with 20 and 40 mg.kg-1 of AP was significantly higher than that of the control group. AP prevented hypoventilation when injected into phrenicotomized rats. The results give no unequivocal basis from which to decide the proportion of central and peripheral effects of AP.
CO transfer factor on exercise: age and sex differences
Authors: Kendrick AH , Laszlo G
Published: November 2022

The effects of age and sex on the single-breath transfer factor (TLCO) estimated during exercise have been investigated in 80 normal subjects (40 men) divided equally into four groups: 1) 20-29 yrs; 2) 30-39 yrs; 3) 40-49 yrs and 4) 50-59 yrs. Oxygen consumption (VO2), cardiac frequency (fc), TLCO and transfer coefficient (KCO) were estimated at rest and at 25 W increments up to 100 W in women and 150 W in men. Quadratic regression equations were obtained for the relationships of TLCO and KCO to VO2, fc and workload (WL). TLCO and KCO at any WL, VO2 or fc were greatest in group 1 and least in group 4. The rate of decline of TLCO and KCO in men and women at l.min-1 VO2 was 0.063 and 0.031 mmol.min-1.kPa-1.yr-1 and 0.006 and 0.007 mmol.min-1.kPa-1.l-1.yr-1, respectively. Within each sex the curvilinearity of the relationships was similar regardless of age. At any WL, TLCO was greater in men than in women, whilst KCO was greater in women than in men. Sex differences were not abolished by correcting TLCO and KCO for anthropometric indices. We conclude that age and sex have significant effects on TLCO and KCO on exercise.
Platelet-activating factor in bronchoalveolar lavage fluid from asthmatic subjects
Authors: Stenton SC , Court EN , Kingston WP , Goadby P , Kelly CA , Duddridge M , Ward C , Hendrick DJ , Walters EH
Published: November 2022

Bronchoalveolar lavage (BAL) was performed on 28 asthma patients, 7 patients with emphysema and 11 control subjects. Total and differential cell counts were performed and cellular metabolic activity was assessed using luminol and lucigenin amplified chemiluminescence. BAL supernatants were assayed for platelet-activating factor (PAF) and lyso-PAF using a sensitive guinea-pig bioassay. Eight of the asthma patients but none of the emphysema patients or control subjects had PAF in their BAL fluid. Lyso-PAF was measurable in BAL fluid in most subjects and no differences were detected between groups. Among the asthma patients, the presence of PAF in BAL supernatant was significantly associated with a combination of low neutrophil and high lymphocyte counts (p less than 0.05) and with macrophage metabolic activity as assessed by lucigenin chemiluminescence (p less than 0.05).
Clinical relevance of ventilation-perfusion inequality determined by inert gas elimination
Authors: Rodriguez-Roisin R , Wagner PD
Published: November 2022

The first part of this review deals with the basic mechanisms and factors determining hypoxaemia and hypercapnia and the different approaches used in clinical practice and in clinical research to assess the presence of ventilation-perfusion mismatching, shunt and diffusion limitation for oxygen, and more specifically the multiple inert gas elimination technique (MIGET), in pulmonary medicine. The second part reviews three different respiratory disorders where the complex interplay between intrapulmonary and extrapulmonary factors regulating oxygen are essentially interpreted through the results afforded by the MIGET over the last decade. The gas exchange response to bronchodilators in bronchial asthma, an airway disease, and then the major determinants governing abnormal gas exchange in acute pulmonary embolism, a pulmonary vascular disorder, and during haemodialysis, a respiratory entity of extrapulmonary origin, are successively explored in the light of the inert gas method.
The effect of hyperinflation on respiratory muscle work in acute induced asthma
Authors: Wheatley  , West S , Cala SJ , Engel LA
Published: November 2022

To examine the relationship between end-expiratory lung volume and respiratory muscle work during acute bronchoconstriction, we measured the work of breathing in nine asthmatic subjects, in whom bronchoconstriction was induced with histamine aerosol. When the forced expiratory volume in one second (FEV1) fell below 60% of the control value, work was measured at the spontaneously hyperinflated lung volume (VLS), at a volume equivalent to the control functional residual capacity (FRC) and at a volume 30% of vital capacity (VC) above the control FRC. Hyperinflation to VLS caused a 39% decrease in the total positive work per breath from 2.8 +/- 0.4 to 1.7 +/- 0.1 J, entirely due to a decrease in expiratory work per breath from 1.6 +/- 0.4 to 0.10 +/- 0.05 J. Inspiratory work did not change at any lung volume, because the increase in inspiratory elastic work due to hyperinflation was offset by the decrease in flow resistive work. Breathing above VLS did not alter the total positive muscle work, but did increase the negative work of the inspiratory muscles from 0.4 +/- 0.1 to 0.8 +/- 0.1 J.breath. We conclude that during induced asthma spontaneous hyperinflation minimizes the total respiratory muscle work and may constitute a mechanism for minimizing energy expenditure.
Influence of age and duration of follow-up on lung function after combined chemotherapy for Hodgkin's disease
Authors: Jensen BV , Carlsen NL , Nissen NI
Published: November 2022

Pulmonary function was studied in 48 patients 4-13 yrs after treatment for Hodgkin's disease with mantle-field irradiation followed by standard mechlorethamine, Oncovin, procarbazine and prednisone (MOPP) chemotherapy. The patients were found to have a restrictive lung disease suggestive of pulmonary fibrosis. Low age at therapy (less than or equal to 30 yrs, median 24 yrs) was associated with a significantly more pronounced restrictive lung function impairment than older age (greater than 30 yrs, median 40 yrs) suggesting a higher susceptibility to the pulmonary side-effects of therapy. In addition younger smokers had a significantly greater reduction in diffusion capacity and forced expiratory volume in one second than older smokers, suggesting a higher susceptibility to the additional adverse effect of smoking. With longer follow-up nonsmokers had an increase in static lung volumes. It is suggested that this may be the result of more frequent pulmonary infections in such patients as compared with the general population. However, the duration of follow-up was not associated with changes in other indices of lung function.
Output characteristics of DeVilbiss No. 40 hand-held jet nebulizers
Authors: Chan KN , Clay MM , Silverman M
Published: November 2022

DeVilbiss No. 40 hand-held nebulizers are widely used for quantifying airway responsiveness in large populations using pharmacological agents. We examined the aerosol characteristics of five nebulizers. Within each device, the aerosol output and droplet size were reasonably stable over a wide range of bulb pressures, although there were considerable differences in output characteristics between nebulizers. The droplet size was very large compared to conventional aerosol delivery systems, with a mass median diameter greater than 10 microns for three of the five devices. Between 28-50% of the output was in particles sufficiently small for airway deposition (less than 6.2 microns). A more vigorous compression of the bulb caused a small increase output and a reduction in droplet size, resulting in a much bigger variation in the output of the respirable aerosol (less than 6.2 microns) with changes in bulb pressure. The loss due to evaporation was about 3.5%, causing a similar rise in the osmolality of the nebulizer solution. In view of the variable nebulizer output and the marked between-operator variation in bulb pressure, the characteristics of individual DeVilbiss No. 40 nebulizers should be evaluated by individual operators before use in clinical practice or research.
Expiratory flushing of airways: a method to reduce deadspace ventilation
Authors: Jonson B , Similowski T , Levy P , Viires N , Pariente R
Published: November 2022

A jet of fresh gas entering the trachea during the last part of expiration, expiratory flushing of airways (EFA), may during mechanical ventilation bring the fresh gas interface into the trachea to reduce deadspace. EFA, delivered in a variety of modes, was tested in healthy dogs. EFA allowed tidal volume, peak and mean airway pressure to be reduced by about 25%. EFA was administered in the form of pulses with frequencies 2-8 Hz, and as a continuous flow. The mode was of little importance. EFA was found to be efficient and should be clinically tested.