European journal of respiratory diseases最新文献

The peptide aldehyde Ro 31-3537, N alpha-(1-adamantanesulphonyl)-N epsilon-(4-carboxybenzoyl)-L-lysyl-L-alanyl-L- valinal, is a reversible competitive, hydrophilic, specific inhibitor of elastase. Its Ki against human leucocyte elastase is 6 x 10(-8) M. The effect of this compound has been studied on a model of emphysema in the hamster induced by multiple sequential intratracheal doses of human leucocyte elastase. Concomitant intratracheal dosing of 200 micrograms of inhibitor with the enzyme significantly reduces lung damage as measured by quasi-static lung compliance and by histological assessment of the emphysema.

The diagnostic value of the soluble antigen fluorescent antibody (SAFA) test in childhood tuberculosis was studied in 117 children in the age group 0-12 years; 79 cases belonged to the study group, 23 children were non-tuberculous controls and 15 were tuberculin-negative healthy controls. The SAFA test was positive in 35 of 44 children with only pulmonary tuberculous lesions (80%) and in 21 of 35 children with other types of tuberculosis (60%). In the 23 non-tuberculous and 15 healthy controls it was positive in 11 cases (48%) and 7 cases (47%), respectively. The sensitivity, specificity and predictivity of the test were found to be 71%, 53% and 72%, respectively. The diagnostic value of the SAFA test was thus found to be low in childhood tuberculosis, especially in disseminated disease and tuberculous meningitis.

Twenty-one patients with cystic fibrosis (CF), aged 1-18 years, with chronic lower respiratory tract infection caused by Pseudomonas aeruginosa, received 38 treatment courses of ceftazidime of 10-14 days duration. A favorable clinical response was observed in 28 of the 38 treatment courses. The minimal inhibitory concentration values of ceftazidime for the Pseudomonas isolates were concentrated around 0.5-1.0 mg/l, although a wide range of sensitivities was found (less than 0.03-32 mg/l). P. aeruginosa was eliminated after five treatment courses, but recurred after 1 month in four of these patients. The organism was permanently eradicated in one patient until his death 8 months later. Ceftazidime was well tolerated. The doses used in this study (50 mg/kg body weight i.v. twice daily) should probably be increased in order to achieve better microbiological response.

The pathogenesis of "shrinking pleuritis with atelectasis" or "rounded atelectasis" is discussed on the basis of 37 operated patients and on experiments on cadaver lungs. Peroperative dissections with microscopic examinations and the results of experiments with the cadaver lungs support the concept that the lesion is caused by an inflammatory reaction in the visceral layer of the pleura, caused by asbestos fibers. The inflammation occurs in stages, with deposition of connective tissue that shrinks and causes considerable atelectasis of the underlying pulmonary parenchyma. Compression of the lung due to fluid collecting in the pleural cavity involved was not noted.

Adrenaline may have beneficial effects in asthma in addition to a direct beta-adrenoceptor mediated bronchodilatation, such as alpha-receptor mediated reduction in microvascular leakage and oedema, and inhibition of bronchoconstrictor neural pathways. We have compared the bronchodilator effect of nebulised adrenaline (1 mg) with nebulised salbutamol (2.5 mg) in patients with acute severe asthma. Eighteen patients admitted with acute asthma (mean peak expiratory flow 22% predicted) were randomised to receive either adrenaline or salbutamol in a double-blind fashion and, after 15 min, were changed to the alternative nebulisation to determine if there was any additional bronchodilation. There were no differences between the increase in PEF after adrenaline (mean +/- SEM increase 99 +/- 20.5 L/min) or after salbutamol (119 +/- 22.7 L/min). Heart rate fell after each nebuliser and there was no difference between treatments. PaO2 rose after adrenaline (0.5 +/- 0.15 kPa), but fell after salbutamol (-0.2 +/- 0.11 kPa). These results suggest that nebulised adrenaline is as effective as a nebulised beta-agonist in acute asthma and is without significant side-effects. The theoretical advantages conferred by alpha-agonist activity do not produce any additional bronchodilation but may prevent any fall in PaO2 due to ventilation-perfusion mismatching.