European journal of respiratory diseases最新文献

The proteolytic activities of human tumor cell lines deriving from bronchial squamous cell carcinoma, a lung metastasis of an embryonal rhabdomyosarcoma and a pleural mesothelioma were measured by use of chromogenic substrates. N-acetyl-alanine aminopeptidase activity, plasminogen activator activity, H-D-Ile-Pro-Arg-p-NA splitting activity as well as plasmin-like activity, cathepsin G-like activity and plasma-kallikrein-like activity were found in cell lysates. The enzymatic activity of N-acetyl-alanine aminopeptidase, plasminogen activator and H-D-Ile-Pro-Arg-p-NA splitting activity changed during culturing. Plasminogen activator and H-D-Ile-Pro-Arg-p-NA splitting activity decreased to very low values, whereas N-acetyl-alanine aminopeptidase activity leveled at 1 x 10(-5) mU/cell. Unlike other proteolytic activities, plasminogen activator was released into the medium. Plasminogen activator activity could be measured in culture medium which contained no fetal calf serum.

Many antineoplastic drugs can derange lung structures, cause necrosis of type I pneumocytes, abnormal proliferation of type II alveolar epithelial cells, and, occasionally, accumulation of inflammatory and immune effector cells. Since type II cells secrete lung surfactant, treatment may alter surfactant composition. In 8 patients with nonresectable lung cancer, we performed bronchoalveolar lavage before and after MACC polychemotherapy (methotrexate, doxorubicin HCl, cyclophosphamide and lomustine). Before treatment, cellular composition and the phospholipid and fatty acid constituents of lavage surfactant were similar to those found in control subjects. After MACC polychemotherapy there was, in all patients, a mild decrease in the number of immune effector cells, without changes in the relative proportion of cell types. In addition, MACC therapy resulted in a significant decrease of phosphatidylcholine levels, and increased levels of phosphatidylglycerol, whereas the levels of palmitic lavage surfactant were decreased. These MACC treatment abnormalities of the phospholipid and fatty acid composition of lung surfactant may reflect preclinical pulmonary toxicity. The decrease in the numbers of bronchoalveolar cells suggests that the changes in surfactant composition may be chemically induced rather than immune mediated.

Reports of raised serum calcium in the presence of tuberculosis have tended to be from centres where sunlight is plentiful. U.K.-based data have suggested that normocalcaemia prevails. In a prospective study of 15 African patients with pulmonary tuberculosis, resident in East Africa, corrected serum calcium was significantly lower in a control healthy group (2.59 mmol/l +/- 0.08 and 2.49 +/- 0.06 mmol/l respectively: P less than 0.001). Serum 25-hydroxy vitamin D was significantly lower in the patient group (median, 15.9 ng/ml, range 6.7-35.7) compared with the control group (median 26.2 ng/ml, range 10.5-45.9, P less than 0.05). No significant difference was found between patients and controls for 1,25-dihydroxy vitamin D or parathyroid hormone. No correlation was found between serum calcium and 1,25 (OH)2 D3. Serum albumin showed a negative correlation with radiographic extent of disease and with extent of cavitation. Where sunlight is plentiful, relatively high serum 25-hydroxy Vitamin D may give rise to raised serum calcium in the presence of tuberculosis.

Despite previous findings to the contrary in uncontrolled studies, we have found in a randomized trial that rifampicin does not suppress the tuberculin reaction in patients with tuberculosis.

To evaluate the clinical significance of tumor Ga-67 uptake, we studied 89 consecutive patients with a potentially resectable non-small cell lung cancer (NSCLC) by performing a whole body Ga-67 scan. For each scintigraphy, an overall Ga-67 accumulation index (T-N) and a volume independent index (T/Nr) were calculated. Both parameters were related to disease extent, response to subsequent treatment and host survival. With the exception of the significant correlations of T-N to both stage of disease and survival-the higher the T-N, the more advanced the disease and the worse the prognosis-no other relationship was found. Based on these findings, we conclude that, in NSCLC at least, gallium uptake is mainly dependent on tumor size and, therefore, of limited practical value.

Human blood monocytes were incubated for different periods of time with lung surfactant (phospholipid concentration 1-2.5 mg/ml). After short-term (30 min) incubation, there was an increase in the nitroblue tetrazolium (NBT) reduction of the monocytes both at rest and during stimulation with E. coli bacteria, and enhanced ingestion of fluorescein-labelled yeast particles. Electron microscopic examination of the same monocytes showed an active cell surface with numerous protrusions. Long-term (24 h) incubation with surfactant resulted in a reduced ability of the cells to adhere to plastic dishes. Although the NBT-reduction of resting monocytes was increased after long-term incubation with surfactant, the additional enhancement of NBT-reduction after stimulation with bacteria was decreased. These cells were rounded, usually devoid of surface structures, their nuclei were condensed, and their cytoplasm filled with surfactant material. Thus, monocytes are initially activated in the presence of surfactant, but if the cells become overfed with surfactant lipids their functional capacity decreases.

Data from 303 patients with 389 admissions for spontaneous pneumothorax from 1970 to 1980 at Ullevaal Hospital, Oslo, Norway, were reviewed. Spontaneous pneumothorax carried a significantly higher complication and mortality rate in patients suffering chronic obstructive pulmonary disease (COPD). Their higher median age compared to non-COPD patients contributed to this, but did not account for the increased mortality. The risk of developing wound infection and/or pneumonia was significantly higher after 7 days of chest tube treatment in both patient groups, independent of age. There was no association between recurrence rate and COPD/non-COPD, age or duration of chest tube treatment (1-7 days, 8 days or more). Complications were not more frequent after thoracotomies performed in COPD patients. Therefore operative treatment for both primary and COPD-related spontaneous pneumothorax should be considered if tube treatment is not successful after 1 week and there are no contraindications.

The syndrome of inappropriate anti-diuretic hormone secretion (SIADH) is a feature of approximately 7% of cases of small cell lung cancer (SCLC). The elaboration of peptide hormones by this tumour is well recognised and cerebral oedema resulting from inappropriate ADH secretion may be a life-threatening complication of this illness, requiring prompt intervention. We report a patient with SCLC who presented with SIADH which worsened abruptly each time he was treated with trifluoperazine for a co-existing psychosis.

Fourteen asthmatics volunteered to stop smoking. Seven managed to stop for only 24 h and seven for 1 week. There was a significant increase in peak flow and specific airways conductance as early as the first 24 h of abstention, while after 7 days of abstention there was a further increase in peak flow and specific airways conductance and a reduction in bronchial responsiveness to histamine. Two subjects felt that their symptoms were worse while abstaining and one of these showed an increase in bronchial responsiveness. After abstention for 1 week, four of the seven subjects recorded an improvement in symptoms. Asthmatics who smoke should be encouraged to stop. Despite an improvement in symptoms and objective measurements, asthmatics may find it difficult to stop smoking and will need considerable help and encouragement if they are to succeed.