bluuebunny/crossref_metadata_2025 huggingface dataset:
Bullous degeneration of the left lower lobe in a heroin addict
Authors: Smeenk FW , Serlie J , van der Jagt EJ , Postmus PE
Published: November 2022

A 34 yr old heroin addict was referred because of chest pain caused by air-trapping in a bulla in the left lower lobe. There was a marked difference between the functional residual capacity measured by body-plethysmography and helium dilution. A slow wash-in and wash-out were demonstrated by ventilation scintigraphy with Xenon133. Bullous degeneration is a known complication of intravenous drug abuse. Usually these bullae are found in the upper lobes. Possible causative mechanisms are discussed.
A dental technician with pulmonary fibrosis: a case of chromium-cobalt alloy pneumoconiosis?
Authors: Sherson D , Maltbaek N , Heydorn K
Published: November 2022

A 45 yr old male developed pulmonary fibrosis after 29 yrs of employment as a dental technician. He subsequently developed adenocarcinoma of the lung. Diffuse interstitial fibrosis was seen using light microscopy. Neutron activation analysis of non-neoplastic lung tissue demonstrated high levels of chromium and cobalt suggesting the possibility of a chromium-cobalt alloy pneumoconiosis.
Solitary bronchial amyloid presenting with haemoptysis
Authors: Tariq SM , Morrison D , McConnochie K
Published: November 2022

Pulmonary amyloidosis can be classified into tracheobronchial diffuse alveolar-septal and nodular parenchymal forms. Tracheobronchial amyloidosis can be further subdivided into diffuse and focal varieties. The latter is rare. We report a patient with a focal intrabronchial deposit of amyloid who presented with haemoptysis. The haemoptysis ceased following bronchoscopic removal of this deposit.
Aetiology of pulmonary diseases in immunocompromised patients
Authors: Heurlin N , Brattstrom C , Lonnqvist B , Westman L , Lidman C , Andersson J
Published: November 2022

Fibreoptic bronchoscopy with bronchoalveolar lavage (BAL), transbronchial lung biopsy (TBB) and brushing was performed, in 134 episodes of pulmonary disease in 118 compromised patients. Sixty eight of the patients were infected with immunodeficiency virus type 1 (HIV-1), 18 were renal and pancreas transplant recipients, 7 were liver and 15 were bone marrow transplant recipients, and 10 patients were undergoing immunosuppressive and/or cytotoxic drug therapy. Pneumocystis carinii (PC) was the predominant pathogen in HIV-1 infected patients. It was considered to be the aetiological cause of pneumonia in 54/82 (66%) episodes of lung complications noted in these patients. Cytomegalovirus (CMV) was the most common micro-organism in transplant recipients. CMV pneumonia was diagnosed in 22/42 episodes of pulmonary disease in these patients. CMV was detected by bronchoscopy procedures at a relatively high frequency of 36/82 (44%) episodes in HIV-1 infected patients. However, after analysis of clinical information, cultures from leucocytes and autopsy findings, CMV seemed to be involved in the pathogenicity of pneumonia in only two out of the 36 patients. Bacterial aetiology, including mycobacterial agents, was unusual, but was the major cause of pulmonary infections in 6/10 episodes in patients undergoing extensive immunosuppressive and/or cytotoxic drug therapy. Bronchoscopy was helpful in establishing correct aetiology in 98/134 (73%) episodes of pulmonary disease. Growth of Candida albicans and bacteria should always be viewed sceptically because of the possibility of contamination from colonization in the upper respiratory tract.
Non-invasive management of fever and breathlessness in HIV positive patients
Authors: Leach RM , Davidson AC , O'Doherty MJ , Nayagam M , Tang A , Bateman NT
Published: November 2022

In a prospective study of 72 human immunodeficiency virus (HIV) positive patients presenting with fever and breathlessness, a non-invasive management protocol, incorporating a scanning technique using radioactively labelled diethylenetriamine penta acetate (DTPA) and sputum induction, was found to be highly sensitive and specific in the early detection of Pneumocystis carinii pneumonia (PCP). At presentation, the DTPA scan was abnormal in 34 of 36 cases of PCP, irrespective of smoking history, whilst the chest radiograph was diffusely abnormal in 21 cases. Sputum induction identified 7 of 14 patients with PCP in the first six months of its use and 7 of 10 patients over the last six months. The DTPA lung scan and induced sputum examination are non-invasive techniques which can be used to investigate out-patients. In combination they detected all cases of PCP at presentation, reduced the need for bronchoscopy, resulted in a low case fatality (5.4%) and reduced the need for admission.
Proteolytic inactivation of alpha 1-proteinase inhibitor in infected bronchial secretions from patients with cystic fibrosis
Authors: Suter S , Chevallier I
Published: November 2022

The chronic, progressively destructive bronchitis of patients with cystic fibrosis (CF) is characterized by an important imbalance between tissue destroying granulocyte proteases such as granulocyte elastase (GE) and its physiological inhibitors in bronchial secretions. Recent in vitro studies suggest, that proteases derived from bacteria or endogenous proteases may contribute to inactivation of physiological inhibitors of GE. Since only trypsin-unreactive alpha 1-proteinase inhibitor (alpha 1-PI) was detected in CF bronchial secretions, we attempted to identify the mechanism of inactivation of alpha 1-PI. We found a heat stable, serine protease-like enzymatic activity capable of degrading 125I-labelled alpha 1-PI extensively in 22 infected but not in one non-infected CF bronchial secretion. In infected secretions, only degraded alpha 1-PI, which did not migrate like oxidized alpha 1-PI in tandem-crossed immunoelectrophoresis, was detectable. We conclude, that free GE in excess as well as GE bound to bronchial mucosal inhibitor may partly account for the alpha 1-PI-cleaving activity, but that other yet unknown bacterial or host serine proteases also contribute to alpha 1-PI inactivation.
Acute effects of external negative pressure ventilation in chronic obstructive pulmonary disease compared with normal subjects
Authors: Cooper CB , Harris ND , Howard P
Published: November 2022

This study compares the acute physiological effects of external negative pressure ventilation (ENPV) in normal subjects and patients with chronic obstructive pulmonary disease (COPD). The equipment consisted of an airtight jacket (Pneumosuit) and vacuum pump. Minute ventilation (Ve) was recorded using a light-emitting turbine transducer. Oxygen uptake (VO2) and carbon dioxide output (VCO2) were calculated every 30 s. Measurements were made at rest and during ENPV with pressures of -20 cmH2O and -40 cmH2O. The ventilator rate was fixed at 16.min-1. In 10 normal subjects, Ve increased from 8.6 to 22.9 l.min-1 (p less than 0.01) accompanied by an increase in VCO2 from 0.25 to 0.39 l.min-1 (p less than 0.01). In 10 normocapnic COPD patients (arterial carbon dioxide tension (PaCO2) less than 6.0 kPa) Ve increased from 11.5 to 17.1 l.min-1 (p less than 0.01) whilst in 10 hypercapnic patients (PaCO2 greater than 6.0 kPa) Ve increased from 9.7 to 12.4 l.min-1 (p less than 0.01). A change in VCO2 was not detected in the COPD patients, and VO2 did not change in any group. Arterial blood samples were obtained in eight hypercapnic patients. Baseline mean physiological deadspace ventilation (VD) was calculated to be 4.9 l.min-1 (56% of Ve) whilst Ve was 8.8 l.min-1 in this subgroup. During ENPV, arterial oxygen tension (PaO2) increased from 6.8 to 8.2 kPa (p less than 0.01) whilst PaCO2 decreased from 6.8 to 5.8 kPa (p less than 0.01) suggesting that despite the large physiological deadspace, a significant increase in alveolar ventilation had occurred. In advanced COPD, thoracic compliance falls and limits the ventilatory response to ENPV.(ABSTRACT TRUNCATED AT 250 WORDS)
Immunology of interstitial lung diseases: cellular events taking place in the lung of sarcoidosis, hypersensitivity pneumonitis and HIV infection
Authors: Semenzato G
Published: November 2022

This paper summarizes our research and the results obtained on the topic of immunology of interstitial lung disorders. Areas of investigation mainly included sarcoidosis, hypersensitivity pneumonitis (HP), and more recently the pulmonary involvement in acquired immunodeficiency syndrome (AIDS). In sarcoidosis patients two major mechanisms account for the alveolitis, i.e. an in situ cellular proliferation and a cellular redistribution from the peripheral blood to the sites of disease activity, including the lung. These findings involve both lymphocytes (CD4 helper-related cells) and macrophages, and lead to the formation and provide maintenance of sarcoid granuloma. In patients with hypersensitivity pneumonitis the lung infiltrates are characterized by cells bearing suppressor/cytotoxic phenotype. The expansion of cells with these characteristics in the lung of these patients is likely to be related to a local immune response to the antigenic stimulus. In the lung of patients with AIDS we also found a discrete lymphocytic alveolitis bearing the CD8 cytotoxic-related phenotype. The role of cytotoxic events, related to the lymphocytes and macrophages, which are operative in the lung of AIDS patients, is being evaluated. The analysis of cells recovered from the lavage, mainly lymphocytes and macrophages, in terms of surface phenotype, functional in vitro evaluations and molecular analysis, has provided new insights into the pathogenesis of the above quoted interstitial lung disorders.
The ability of noninvasive methods to detect and quantify laryngeal obstruction
Authors: Hoijer U , Ejnell H , Bake B
Published: November 2022

The ability of the noninvasive methods forced oscillation technique (Rosc), spirometry and flow-volume curves to detect and quantify laryngeal obstruction, using assessment of orolaryngeal (upper) airway resistance (Rol) as reference, was compared in 55 patients with various laryngeal diseases. Statistical analysis was performed by means of sensitivity/specificity, simple regression, stepwise regression and stepwise logistic regression. The results showed that the ability to detect a laryngeal obstruction was acceptable and that Rosc-Insp, peak inspiratory flow (PIF) and forced inspiratory volume in one second (FIV1) seemed to be the best variables for detection of a laryngeal obstruction. None of the studied noninvasive methods appeared to be adequate for quantification of laryngeal obstruction.
Mesothelioma presenting with pneumothorax and interlobar tumour
Authors: Mannes GP , Gouw AS , Berendsen HH , Verhoeff AJ , Postmus PE
Published: November 2022

A patient presented with a pneumothorax, a parahilar mass and a pleural effusion on the left side. Histology proved that this was caused by a malignant mesothelioma, epithelial type. The pneumothorax persisted, even after chest drainage and pleurodesis with talc powder and tetracycline.
Methacholine responsiveness, respiratory symptoms and pulmonary function in aluminum potroom workers
Authors: Kongerud J , Soyseth V
Published: November 2022

The relationship between nonspecific bronchial reactivity and work-related asthmatic symptoms was examined in a cross-sectional study of 337 aluminium potroom workers by a shortened method of continuous methacholine nebulization. The provocative concentration producing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) was less than or equal to 8 mg.ml-1 (hyperresponsiveness) in 17 workers (5%), whilst minor responsiveness (8 mg.ml-1 less than PC20 less than 32 mg.ml-1) was present in 24 subjects (7%). The prevalence of work-related asthmatic symptoms was 9%. Female sex, ex-smoker and airflow limitation were significant predictors of methacholine responsiveness (p less than 0.05). In a multiple logistic regression analysis the odds ratios (OR) for work-related asthmatic symptoms was 10.8 (95% confidence interval: 2.9-40.6) for hyperresponsiveness and 4.4 (95% confidence interval: 1.2-16.4) for minor responsiveness. The sensitivity, specificity and predictivity of PC20 less than 32 mg.ml-1 for work-related asthmatic symptoms were 35, 92 and 35%, respectively, whilst the agreement, when adjusted for the by chance expectation, was 0.27 (95% confidence interval: 0.10-0.54). Although a significant association was found between bronchial reactivity and work-related asthmatic symptoms, the usefulness of the methacholine test as a tool for detection of work-related asthmatic symptoms appears to be of limited value due to its low sensitivity.
Influence of demographic and disease related factors on the degree of distress associated with symptoms and restrictions on daily living due to asthma in six countries
Authors: Quirk FH , Baveystock CM , Wilson R , Jones PW
Published: November 2022

To investigate the influence of demographic and physiological variables on the degree of distress associated with asthma, 124 patients were recruited from six countries. All patients responded to 76 items relating to symptoms and impacts of asthma on daily living by marking a 10 cm visual analogue scale (VAS) to indicate the degree of distress associated with any particular item. The influence of three factors, age, sex and forced expiratory volume in one second (FEV1), on these VAS scores was investigated. Differences between patients accounted for 13.4% of the total variance (sum of squares) in VAS scores. There were no significant effects of sex, age or FEV1 on VAS score (p greater than 0.05 in each case). The separate proportionate contribution of each of these three factors to the total variance in item scores ranged from 0.02% (FEV1) to 0.2% (sex). There were significant differences between the mean VAS scores from the six countries (p less than 0.01) but these differences contributed to only 3.6% of the total variance in the measured VAS scores. We conclude that demographic and disease related factors account for very little of the differences in the degree of distress that patients attach to the symptoms and effects of asthma. We suggest that it is possible to make meaningful comparisons between countries of the impact of asthma on patients' lives.
Contribution of in vitro culture methods for respiratory epithelial cells to the study of the physiology of the respiratory tract
Authors: Jorissen M , Van der Schueren B , Van den Berghe H , Cassiman JJ
Published: November 2022

Different techniques for culturing respiratory epithelial cells have been developed to overcome the limitations of studies on in vivo and on bioptic material. However, each culture technique has its limitations, specifically concerning the expression of differentiated properties. These methods and limitations are described and discussed. Special attention is given to recent developments, which may resolve some of the current problems.
Lymphangitis after tuberculin test
Authors: Bouros D , Niotis M , Blatsios V
Published: November 2022

After Mantoux testing with purified protein derivative (PPD) equivalent to 5 tuberculin units (TU), a 28 yr old man developed extensive erythema, induration and proximal lymphangitis. This is the only such case observed after Mantoux testing in approximately 500,000 subjects during 10 yrs in the Greek Army.
Dyspnoea after pneumonectomy
Authors: Smeenk FW , Twisk SP , Berreklouw E , Gooszen HC , Postmus PE
Published: November 2022

We report the case of a 61 yr old male, who developed a severe right-to-left shunt through a patent foramen ovale, in the absence of elevated right-sided heart pressures, two months after a left-sided pneumonectomy. This is considered to be a rare complication after pneumonectomy. However, taking into account the approximately 20% incidence of patent foramen ovale in the general population, we suggest that right-to-left shunting through an unsuspected foramen ovale or atrial septum defect should always be considered as a possible cause of otherwise unexplained hypoxaemia.
Two years treatment with almitrine bismesylate in patients with hypoxic chronic obstructive airways disease
Authors: Bardsley PA , Howard P , DeBacker W , Vermeire P , Mairesse M , Ledent C , Radermecker M , Bury T , Ansquer J
Published: November 2022

Eighty nine patients with hypoxic chronic obstructive airways disease (COAD) were enrolled into the 1 year Vectarion International Multicentre Study-VIMS in 4 centres, Sheffield (UK), and Antwerp, Liege and Namur (Belgium). At the end of the year the remainder were invited to continue taking placebo or almitrine bismesylate (100-200 mg daily) in the same double blind manner for a further 12 months. In the almitrine treated patients mean arterial oxygen tension (Pao2) at the end of the treatment period improved from 7.5 (0.5) kPa to 8.2 (1.3) kPa (p less than 0.01) and arterial carbon dioxide tension (Paco2) fell from 6.1 (0.8) kPa to 5.8 (0.9) kPa (p less than 0.01). Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and measurements of breathlessness were unchanged. In the placebo treated group changes in the above variables were not significant. Twenty nine patients withdrew from the almitrine group with seven deaths and six cases of peripheral neuropathy, and 22 patients withdrew from the placebo group with six deaths and two cases of peripheral neuropathy. Death rates between the groups were not significantly different. In conclusion, 2 yrs of almitrine treatment (100-200 mg daily) leads to a persistent slight improvement in PaO2 and PaCO2 but no benefit in survival was demonstrated. Patients in this study had a high incidence of drug related side-effects. Lower dose schedules should be investigated.
Independent risk factors for cumulative recurrence rate after first spontaneous pneumothorax
Authors: Lippert HL , Lund O , Blegvad S , Larsen HV
Published: November 2022

From 1975 until 1987, 122 patients without (Group I, mean age 34 yrs) and 20 with pre-existing lung disease (Group II, mean age 66 yrs) were treated for their first spontaneous pneumothorax. Mean follow-up was 5.2 yrs (max. 12.8 yrs). There were 32 chest X-ray verified recurrences, 72% occurring during the first 2 yrs. One, 5 and 10 yr cumulative recurrence freedoms +/- standard error in groups I and II combined were 85 +/- 3%, 75 +/- 4% and 69 +/- 5%, respectively. Using Cox regression analysis in groups I and II combined, pulmonary fibrosis, age greater than or equal to 60 yrs, and height/weight ratio were independent predictors of recurrence. Combinations of these risk factors identified four risk strata with 10 yr recurrence freedoms ranging from 83-0%. Independent predictors in group I alone were pulmonary fibrosis, age greater than or equal to 60 yrs, height/weight ratio, and nonsmoking, resulting in four risk strata with 10 yr recurrence freedoms ranging from 98-31%. Recurrences after first-time treated spontaneous pneumothorax showed a distinct time-related pattern and should accordingly be analysed as a time-related event. In both the total patient-population and in the group without pre-existing lung disease, independent predictors of recurrence were identified, which allowed the patients to be substratified into groups with widely different recurrence rates.
Changes in left ventricular ejection fraction during REM sleep and exercise in chronic obstructive pulmonary disease and sleep apnoea syndrome
Authors: Levy PA , Guilleminault C , Fagret D , Gaio JM , Romand P , Bonnet C , Pison CM , Wolf JE , Paramelle B
Published: November 2022

Nine patients, 4 with chronic obstructive pulmonary disease (COPD) and 5 with obstructive sleep apnoea syndrome (OSAS) were monitored during sleep, rest and exercise. Left ventricular ejection fraction (LVEF) was investigated using gated equilibrium 99mtechnetium ventricular scintigraphy during rapid eye movement (REM) sleep, during exercise, and during wakeful rest. Control wakeful rest periods used for comparison with a study state (either REM sleep or exercise) were always selected during the same circadian segment as that state. Myocardial stress thallium-201 scintigraphy was performed during, and 4 h after, exercise, and results were compared to a daytime rest period. Several patients had myocardial hypoperfusion despite a normal electrocardiographic (ECG) treadmill test. During REM sleep, all patients exhibited a significant change in LVEF (greater than 5%) compared to wakefulness. During exercise, 5 subjects increased their LVEF normally (greater than 5%) and 4 (1 COPD, 3 OSAS) decreased it. All patients had a similar change (increase or decrease) during REM and at maximal exercise. Our results suggest that REM sleep in COPD and in OSAS can produce a myocardial stress as great as that produced by exercise. We conclude that REM sleep, like exercise, is a state in which morbidity may become higher and that it may account for mortality in COPD and OSAS patients with compromised myocardial circulation.
Pollen deposition in intrathoracic airways
Authors: Driessen MN , Quanjer PH
Published: November 2022

The pathophysiological mechanisms of pollen-induced asthma have until now remained unclear, because pollen particles have generally been considered too large to penetrate into the lower respiratory tract. Such grains are therefore believed to be unable to induce an immunological response in the lower respiratory tract. There is evidence, however, that a small percentage of large particles (20-30 microns) may penetrate into the peripheral areas of the lung. It also appears that small airborne units of less than 5 microns with the same antigenic activity as pollen, may contribute to inhaled allergen burdens. Pollen asthma probably results from a gradual cumulative effect of deposition of small amounts of allergen in lower airways, and is hence poorly correlated with daily pollen counts.
Diagnostic tests of hyperventilation syndrome
Authors: Vansteenkiste J , Rochette F , Demedts M
Published: November 2022

In 90 patients referred to the pulmonary function laboratory for evaluation of hyperventilation syndrome (HVS) and in whom somatic causes of the complaints had been excluded, we investigated the degree of concordance between three widely applied diagnostic methods: 1) the standardized Nijmegen questionnaire on major daily complaints; 2) the reproduction of the same symptoms during the hyperventilation provocation test (HVPT); and 3) the responses of end-tidal CO2 fraction (FETCO2) during the HVPT. In 86% of the patients a concordance was found between Nijmegen questionnaire (i.e. score of 24/64 or more) and symptom reproduction during HVPT (i.e. recognition of at least 2 major daily complaints). Based on these combined data we made a definite diagnosis of HVS in 37 patients, of non-HVS in 40 patients, and we retained only a possible HVS in 13 patients. Each of the 16 complaints in the questionnaire contributed significantly to the distinction between HVS and non-HVS patients, and a striking similarity in rank order of daily complaints and reproduced symptoms was found. The responses in FETCO, during HVPT had little additional diagnostic value. A spontaneous fall of at least 0.25% FETCO2 during the 5 min adaptation period before the HVPT, was most reliably correlated with the aforementioned diagnostic criteria of HVS: specificity 83%, sensitivity 57%, and accuracy 70%. Neither the 3 min FETCO2 ratio nor the 5 min FETCO2 ratio during recovery after the HVPT showed a good correlation with the other diagnostic criteria. The response of FETCO2 during HVPT did especially not provide additional useful diagnostic information in the 13 patients with only possible HVS.
Intestinal calcium absorption and parathyroid hormone secretion in asthmatic patients on prolonged oral or inhaled steroid treatment
Authors: Luengo M , Picado C , Piera C , Guanabens N , Montserrat JM , Rivera J , Setoain J
Published: November 2022

A secondary hyperparathyroidism resulting from decreased intestinal calcium (Ca) absorption has been proposed as a contributory factor to glucocorticoid-induced osteoporosis. Inhaled steroids do not usually suppress adrenal gland function unless daily doses above 1,500 microgram are used. A recent study, however, has shown a reduced total body calcium in patients on regular beclomethasone treatment. In theory, osteopenia in these patients could be due to a direct effect of inhaled steroids on bone or due to an impaired intestinal calcium absorption. In this study, Ca absorption and parathyroid hormone (PTH) secretion were evaluated in three groups: 1) asthmatics on continuous oral and inhaled steroid treatment (11.3 +/- 4.4, range 5-33.5 mg.day-1 prednisone and 660 +/- 265, range 400-1,600 microgram.day-1 beclomethasone, respectively); 2) asthmatics on regular beclomethasone therapy (585 +/- 210, range 400-1,200 microgram.day-1); and 3) healthy subjects. The prevalence of vertebral fractures was evaluated by a spinal X-ray. No differences were found in either Ca absorption or PTH serum levels between asthmatics and healthy subjects (analysis of variance-ANOVA). Vertebral fractures were significantly more frequent in patients from group 1 (14 of 25) than in those from group 2 (2 or 25). We conclude that both prolonged oral steroid treatment and inhaled steroids, at doses lower than 1,600 microgram.day-1 do not cause Ca malabsorption, and that hyperparathyroidism does not contribute to osteoporosis in these patients.
Plasma levels and effects of salbutamol after inhaled or i.v. administration in stable asthma
Authors: Janson C
Published: November 2022

The response and plasma levels of inhaled (0.15 mg.kg-1) and intravenous salbutamol (5 micrograms.kg-1) were studied in 12 patients who had previously been included in a study of acute severe asthma and were now in a stable phase. The maximal value for change (delta) in plasma salbutamol compared with the pretreatment value was higher after i.v. than after inhalation treatment (59 vs 30 nmol.l-1) but the areas under the curve (AUC) during 90 mins after treatment were similar for the two administration routes. The inter-individual differences in peak plasma salbutamol and AUC for delta plasma salbutamol were much greater after inhalation than after i.v. infusion. Immediately after treatment there was a greater increase in pulse rate (mean +17 vs +6 beats.min) and lower serum potassium level (mean -0.3 mmol.l-1) after i.v. than after inhalation treatment. The increase in peak expiratory flow (PEF) measured 90 min after the start of treatment (85 vs 31 l.min-1) and as AUC was significantly higher after inhalation than after i.v. treatment. Six patients had received i.v. treatment in the acute asthma study: in these patients delta PEF immediately after i.v. treatment was significantly lower in the stable situation (+49 vs +115 l.min-1). There was also a significant difference in the effect on the pulse rate immediately after i.v. treatment, with a decrease in the acute asthma and an increase in the stable asthma situation (-5 vs +16 beats.min-1).
Human respiratory muscles: fibre morphology and capillary supply
Authors: Mizuno M
Published: November 2022

In man the diaphragm (DIA) and abdominal muscles comprise approximately 50% slow-twitch (ST) fibres, whereas a higher proportion (60%) is found in intercostal muscles and the scalenes. All respiratory muscles show an equal distribution of fast-twitch (FTa and b) fibres with the exception of the expiratory intercostal muscles which have few FTb fibres. The inspiratory muscles have a uniformly small fibre size, in contrast to the expiratory intercostal muscle fibres which are large. The fibre size of the inspiratory muscles is maintained with ageing, whereas that of the expiratory intercostal muscles appears to be reduced after the age of 50 yrs. Capillary supply is most abundant in the expiratory muscles followed by DIA and the inspiratory intercostal muscles. In patients with chronic obstructive pulmonary disease (COPD) it is unknown whether a reduction in fibre size of the thoracic respiratory muscles is caused by extreme use due to increased ventilatory work, or by disuse due to an increased involvement of the extrathoracic respiratory muscles. Histochemical characteristics suggest that, in normal humans, the load on the inspiratory muscles is relatively small during contractions, whereas the expiratory intercostal muscles are exposed to severe continuous activity with a heavy load.
Which apparatus for inhaled pentamidine? A comparison of pulmonary deposition via eight nebulisers
Authors: Thomas SH , O'Doherty MJ , Page CJ , Nunan TO , Bateman NT
Published: November 2022

Aerosolised pentamidine 300 mg in 5 or 6 ml solution was administered via 8 different nebuliser systems to 12 patients with acquired immunodeficiency syndrome. Using 99mTc human serum albumin as an indirect marker for pentamidine, pulmonary, extrapulmonary (gastric and oropharyngeal) and alveolar deposition of pentamidine were measured using a gamma camera. Side effects (visual analogue scales) and changes in lung function associated with each treatment were also quantified. Deposition was completed more rapidly with the ultrasonic than the jet nebulisers. Mean total pulmonary depositions (mg +/- SEM) were Respirgard II, 6.1 +/- 0.5; Centimist, 7.3 +/- 1.0, System 22 Mizer, 14.3 +/- 2.1; System 22 Mizer with particle separator; 4.5 +/- 0.4; System 22 Mizer with Optimist 2, 6.3 +/- 0.9; Fisoneb, 6.0 +/- 1.2; Pentasonic (Portasonic); 4.6 +/- 0.9; Samsonic, 2.9 +/- 0.4. Differences between the nebulisers for peripheral lung and alveolar deposition reflected this pattern. Side effects scores were largest with System 22 Mizer, Pentasonic (Portasonic), and Fisoneb, and these produced the greatest oropharyngeal and gastric deposition. The largest reductions in lung function were associated with System 22 Mizer. A 300 mg dose of pentamidine nebulised via Respirgard II is known to be effective prophylaxis for Pneumocystis carinii pneumonia when given once monthly. Our results show that equivalent pulmonary deposition can be produced by other nebulisers. System 22 Mizer gives over twice the deposition associated with Respirgard II, and used with a pentamidine dose of 150 mg is likely to produce an adequate lung dose for prophylaxis. This nebuliser, however, is associated with more marked side effects.
Association of increased mycobacterium growth inhibitory factor with antituberculous immunity
Authors: Chandrasekhar S , Perumal VK
Published: November 2022

Cell-mediated immune mechanisms (CMI) were studied in 51 patients of pulmonary tuberculosis to evaluate the role of mycobacterium growth inhibitory factor in prognosis of the infection, before and after the administration of anti-tubercular drugs. Twenty five Mantoux negative individuals who were subsequently bacille Calmette-Guerin (BCG) vaccinated and 25 Mantoux positive, non-tuberculous controls were included in the study. Their clinical assessment was compared with skin sensitivity (Mantoux); lymphocyte transformation (LT) after stimulation with phytohaemagglutinin (PHA) and purified protein derivative (PPD); macrophage migration inhibitory factor (MIF), mycobacteria growth inhibitory factor (Myco IF) and listerial growth inhibitory factor (List IF). The tests were carried out at the beginning of the treatment and at intervals of three months, extending to one year. In the case of Mantoux positive controls, tests were carried out only once. It was found that Mantoux reaction had no correlation with LT, MIF, Myco IF and List IF. Both MIF and Myco IF, were significantly elevated in improving patients, whereas increase in List IF was not significant. An important finding was that Myco IF was at a higher level in improving patients whereas in those not responding to chemotherapy it was low.
Effect of cyclic AMP on ciliary activity of human respiratory epithelium
Authors: Di Benedetto G , Manara-Shediac FS , Mehta A
Published: November 2022

In order to investigate the effect of cyclic adenosine monophosphate (cAMP) on ciliary beat frequency (CBF) in human respiratory epithelium, cells were brushed from the inferior nasal turbinates of three groups of ten subjects: awake adults (aged 20-34 yrs), anaesthetized children (2-15 yrs) and anaesthetized adults (19-61 yrs). Cells from the awake adults were also studied after storage for 24 h in tissue culture medium. CBF was measured in vitro with a photometric technique at room temperature (22.0 +/- 1.5 degrees C). Samples were mounted in a perfusion chamber and challenged with either control solutions, dibutyryl cAMP (10(-4) or 10(-3) M), or the cyclic nucleotide-dependent protein kinase inhibitor 1-(5-isoquinolinylsulphonyl)-2-methylpiperazine (H-7). Dibutyryl cAMP (10(-3) M) caused a significant increase in CBF in all groups studied: awake adults (+1.1 Hz; p less than 0.01), anaesthetized children (+1.2 Hz; p less than 0.01), anaesthetized adults (+1.2 Hz; p less than 0.01), stored cells (+1.1 Hz; p less than 0.01). This response was inhibited by preincubation with H-7 (10(-4) and 10(-3) M). It is concluded that cAMP is a regulator of ciliary activity in human respiratory epithelium.
Oral N-acetylcysteine reduces bleomycin-induced collagen deposition in the lungs of mice
Authors: Shahzeidi S , Sarnstrand B , Jeffery PK , McAnulty RJ , Laurent GJ
Published: November 2022

N-acetylcysteine (NAC) has been employed in the treatment of acute lung injury but its therapeutic value is as yet unproven. In the present study we examined the effect of both L- and D-forms of NAC as inhibitors of bleomycin-induced fibrosis in mice. We hypothesized that, because of the D-form is not metabolized, it may be more effective than the L-form in ameliorating lung injury and fibrosis. Both drugs were given daily in the drinking water at a dose of approximately 400 mg.kg-1 body weight commencing one week prior to a single intratracheal instillation of bleomycin at a dose of 6 mg.kg-1 body weight. Lung injury was assessed 35 days later by measuring total lung collagen content, lung wet weight and examination of tissues by light and electron microscopy. Total collagen content and lung wet weight of animals receiving bleomycin together with L-NAC were 2.90 +/- 0.03 mg and 0.23 +/- 0.01 g, respectively. The values for collagen content, but not wet weight, were significantly less (p less than 0.05) than those given for bleomycin alone (3.90 +/- 0.02 mg and 0.260 +/- 0.005 g, respectively), but greater than (p less than 0.05) controls (2.10 +/- 0.01 mg and 0.160 +/- 0.002 g, respectively). Values for collagen content and wet weight of animals given bleomycin together with D-NAC (3.10 +/- 0.02 mg and 0.21 +/- 0.01 mg, respectively) were both significantly greater than values for control animals but lower than animals given bleomycin alone.(ABSTRACT TRUNCATED AT 250 WORDS)
Three cases of idiopathic bronchiolitis obliterans with organizing pneumonia
Authors: Alegre-Martin J , Fernandez de Sevilla T , Garcia F , Falco V , Martinez-Vazquez JM
Published: November 2022

Three patients with bronchiolitis obliterans organizing pneumonia are described. Chest X-ray films showed peripheral densities and pulmonary function tests a restrictive pattern. In all three cases transbronchial biopsy was not useful for diagnosis and we point out the importance of an open lung biopsy in order to make the differential diagnosis with other infiltrative lung disease with a different prognosis and therapy.
Accuracy of diagnostic tools for the management of nosocomial respiratory infections in mechanically ventilated patients
Authors: Torres A
Published: November 2022

This article reviews the medical literature concerning available diagnostic tools for managing nosocomial respiratory infections in mechanically ventilated patients. The first part deals with the reliability of the clinical criteria used in diagnosing nosocomial pneumonia in such patients and the accuracy of simple markers of pneumonia such as elastin fibres stain and antibody-coated bacteria. The second part reviews the presently available non-invasive and invasive methods for diagnosing pulmonary infections acquired during mechanical ventilation. With regard to invasive methods, protected specimen brush and bronchoalveolar lavage are extensively discussed in view of the different results in the literature. At the present time, these two methods seem to be the most accurate techniques available. The fact that bronchoalveolar lavage may combine the cytological examination and the quantitative culture of the sample obtained is noted. The role of percutaneous lung needle aspiration is also mentioned. Finally, histological diagnosis of pneumonia and pulmonary postmortem biopsy cultures are reviewed as "gold-standard" reference methods for investigation in this field. Future directions for further clinical research are addressed.
Interstitial pneumonitis and pulmonary vasculitis in a patient taking an L-tryptophan preparation
Authors: Bogaerts Y , Van Renterghem D , Vanvuchelen J , Praet M , Michielssen P , Blaton V , Willemot JP
Published: November 2022

A case is presented of interstitial pneumonitis and pulmonary vasculitis ascribed to the ingestion of an L-tryptophan preparation. An unintended rechallenge supported the causal relationship. There was neither myalgia nor peripheral eosinophilia. Bronchoalveolar lavage fluid contained 12% eosinophils but few were present in the surgical lung biopsy specimen. Lung infiltrates receded after withdrawal of the drug and treatment with steroids. Dyspnoea and pulmonary hypertension persisted. Cyclophosphamide had no effect. Sclerodermiform skin lesions appeared as a late sequel. Chromatographic analysis of the L-tryptophan revealed no suspect impurities.
Thymoma: a clinicopathological comparative study of 25 cases
Authors: Offner F , Vallaeys J , Roels H , Van der Straeten M
Published: November 2022

We reviewed 25 patients with thymoma for clinical symptoms at presentation, X-ray findings and outcome. The tumours of all patients were classified using 3 different pathologic classification systems and each system was evaluated for its predictive power with respect to survival. The recent classification system by Muller-Hermelink allowed to distinguish thymomas with associated systemic syndromes from those without. However, no good prediction with respect to outcome could be made by any of the 3 systems.
Ventilatory function impairment and risk of cardiovascular death and of fatal or non-fatal myocardial infarction
Authors: Lange P , Nyboe J , Jensen G , Schnohr P , Appleyard M
Published: November 2022

The relationship of ventilatory function to cardiovascular events was studied in 12,511 men and women, enrolled in 1976-1978 in a prospective population study. Until the end of 1983, 388 subjects died because of a cardiovascular disease, 133 died within 30 days of developing myocardial infarction (fatal myocardial infarction), while 238 had a non-fatal myocardial infarction. Cox proportional hazards models were employed for the analysis. In the models including tobacco smoking, cholesterol level, blood pressure, diabetes mellitus and body-mass index as covariates, forced expiratory volume in one second in percentage of predicted (FEV1% pred), forced vital capacity in percentage of predicted (FVC% pred), and the ratio between FEV1 and FVC (FEV1/FVC) were significantly related to the risk of cardiovascular death, e.g. compared with subjects with FEV1% pred or FVC% pred greater than or equal to 80 the risk of death from cardiovascular disease among subjects with FEV1% pred or FVC% pred less than 60 was approximately twice as high. There was a nonsignificant trend towards an increased risk of fatal myocardial infarction with reduction of FVC% pred, but in general the regression models did not show consistent relationship between lung function impairment and risk of myocardial infarction. In the regression models, which only included age and sex as covariates, reduced FVC% pred and FEV1% pred were significantly related to both cardiovascular mortality and to fatal myocardial infarction, but not to the non-fatal infarction, whereas the FEV1/FVC ratio was not related to fatal or to non-fatal myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Sensitivity and specificity of the histamine challenge test for the diagnosis of asthma in an unselected sample of children and adolescents
Authors: Backer V , Groth S , Dirksen A , Bach-Mortensen N , Hansen KK , Laursen EM , Wendelboe D
Published: November 2022

The purpose of this investigation was to study factors of importance for the degree of bronchial responsiveness and, furthermore, to evaluate the sensitivity, specificity and predictive value of a bronchial challenge test with histamine for the diagnosis of asthma in 495 randomly selected children and adolescents, aged 7-16 yrs, from Copenhagen, Rigshospitalet. Detailed history about allergic symptoms, physical examination and bronchial histamine challenge tests were performed at the out-patient clinic. Asthma, atopic disease and height were found to be of great importance for the degree of bronchial responsiveness, whereas the age, sex and smoking habits were of no significance. The percentage of asthmatics with bronchial hyperresponsiveness, i.e. sensitivity to the test, increased towards 100% on inhaling increasing concentrations of histamine, but this was accompanied by a decrease in specificity and predictive values of positive test in regard to the diagnosis of asthma. However, lower concentrations of histamine may be preferable in order to distinguish between asthma and non-asthma in population samples, as inhalation of 2.4 mg.ml-1 and provocative concentration producing a 20% fall in forced expiratory volume in one second (FEV1) (PC20) provided an acceptable sensitivity (57%), specificity (98%), and predictive value of a positive test (60%). We conclude that as regards the diagnosis of asthma, a low predictive value confirms that the bronchial challenge test plays only a supplementary, but valuable, role in detecting the disease in population samples.
One year treatment with almitrine improves hypoxaemia but does not increase pulmonary artery pressure in COPD patients
Authors: Weitzenblum E , Schrijen F , Apprill M , Prefaut C , Yernault JC
Published: November 2022

Almitrine bismesylate, a chemoreceptor agonist, improves hypoxaemia in a high percentage of chronic obstructive pulmonary disease (COPD) patients and its long-term use may thus be of interest in these patients. The course of pulmonary haemodynamics during a one year treatment was investigated in severe COPD patients (forced expiratory volume in one second FEV1 = 1,040 +/- 80 SEM ml) with persistent hypoxaemia (initial arterial oxygen tension (PaO2) in the range 6.6-8.6 kPa (50-65 mmHg]. Patients were given either almitrine (A, n = 27), 100 mg.day-1, during two consecutive months per quarter followed by a one month wash-out period (intermittent "schedule"), or placebo (P, n = 18) with the same schedule. Eleven patients in group A and 8 in group P could not complete the one year study because of lack of compliance, worsening of respiratory insufficiency, or for other reasons. In the remaining patients, PaO2 significantly increased in group A (n = 16) from 7.6 +/- 0.1 to 8.3 +/- 0.2 kPa (56.9 +/- 1.0 to 62.7 +/- 1.7 mmHg) (p less than 0.001) but not in group P (n = 10) from 7.5 +/- 0.3 to 7.9 +/- 0.3 kPa (56.1 +/- 2.3 to 59.1 +/- 2.1 mmHg). PaCO2 did not significantly change in either group. Pulmonary artery mean pressure (PAP) was stable in both groups: from 26.8 +/- 2.1 to 25.4 +/- 1.9 mmHg in group A, and from 20.6 +/- 1.1 to 20.9 +/- 1.5 mmHg in group P.(ABSTRACT TRUNCATED AT 250 WORDS)
Non-invasive determination of alveolar pressure during mechanical ventilation
Authors: Nicolai T , Lanteri C , Freezer N , Sly PD
Published: November 2022

The development of inadvertent positive end-expiratory pressure (PEEPi) in ventilated infants is of clinical relevance and difficult to measure non-invasively. A method for estimating end-expiratory alveolar pressure by applying a multiple regression analysis to airway opening pressure, flow and volume recordings during mechanical ventilation was evaluated. In eight open-chested, paralysed and mechanically ventilated mongrel dogs, alveolar pressure was measured directly with "alveolar capsules". Alteration of ventilation patterns and addition of a resistive element were used in three dogs to induce different levels of PEEPi. End-expiratory alveolar pressure measured directly and determined from multilinear regression of airway opening pressure correlated well (mean error 0.06 +/- 0.53 (+/- SD) hPa, limits of agreement -1.16 to +1.04 hPa). The other five dogs received inhalation challenges, two with histamine, two with hypertonic saline and one with methacholine resulting in a mean increase of respiratory system resistance of 230% (range 141-489%) of the baseline values. The mean error in determining PEEPi was 0.54 +/- 0.37 hPa, the limits of agreement were -0.20 to 1.28 hPa. The method was then applied to seven mechanically-ventilated children (aged 2 months to 8 yrs, weight 4.9-23.5 kg) and the results were compared to the pressure at which inspiration began (equalling PEEPi). Seventy eight measurements were performed during open heart surgery, while compliance changed by between 3 and 186% of baseline values due to the surgical procedures. PEEPi estimated by multiple regression agreed well with the pressure at which inspiration began (mean difference 0.25 +/- 0.68 hPa, limits of agreement -1.12 to 1.62 hPa).(ABSTRACT TRUNCATED AT 250 WORDS)
Domiciliary oxygen--by liquid or concentrator? Working Group on Oxygen Therapy of IUATLD
Authors: Howard P , de Haller R
Published: November 2022

A few hypoxaemic and even less non-hypoxaemic patients with chronic obstructive pulmonary disease (COPD) benefit from portable oxygen. For these few, selected by double-blind tests against compressed air, liquid oxygen would seem more convenient and efficient. The extra cost of treating all hypoxaemic COPD patients with liquid oxygen by displacing the oxygen concentrator is not justified on the basis of current knowledge. The application of differing oxygen delivery systems to COPD patients requires more evaluation. The selection of patients for long-term oxygen therapy (LTOT) still presents major difficulties, which reflects on the numbers of patients likely to benefit from portable oxygen. No studies have yet shown the benefit of LTOT to chronic respiratory failure in other disorders such as lung fibrosis. As the pathophysiology is quite different, extension of the use of LTOT and portable oxygen to non-COPD patients must be treated with great caution.
Metabolism and aerobic capacity of skeletal muscle in chronic respiratory failure related to chronic obstructive pulmonary disease
Authors: Wuyam B , Payen JF , Levy P , Bensaidane H , Reutenauer H , Le Bas JF , Benabid AL
Published: November 2022

The calf muscle energy metabolism of 8 stable chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure (arterial oxygen tension (Pao2) 7.7 +/- 0.4 kPa or 58 +/- 3 mmHg) was studied, using 31-phosphorus magnetic resonance spectroscopy (31P MRS). MRS spectra were acquired at rest and during the course of 360 pedal movements at 20, 35 and 50% of the maximal voluntary contraction (MVC) and during recovery. Eight healthy age-matched subjects served as the control group. No significant differences between groups were observed in resting muscle, as regards intracellular pH, Pi/PCr ratio (Pi: inorganic phosphate; PCr: phosphocreatine) and the relative ATP expressed as the ratio beta ATP/PCr + Pi + PME (PME: phosphomonoester). Although effective power outputs were similar for both groups at each work level, COPD patients exhibited a higher Pi/PCr ratio than health controls (3.34 +/- 0.89 vs 0.49 +/- 0.05 at 50% MVC; p less than 0.01) and a lower pHi (6.65 +/- 0.11 vs 7.06 +/- 0.02 at 50% MVC; p less than 0.01). PCr resynthesis during recovery was slower in patients than in control subjects (t1/2 PCr 1.27 +/- 0.26 min vs 0.47 +/- 0.05 min; p less than 0.05). These results suggest impairment of aerobic capacity in a non-ventilatory working muscle, which may be due to hypoxaemia in patients with chronic respiratory failure.