European journal of respiratory diseases最新文献

In a recent study, Kawakami et al, suggested that mixed venous blood oxygenation (PvO2) is one of the most important prognostic factors in patients with chronic obstructive lung disease (COLD). The aim of the present study was to evaluate the predictive power of PvO2 in 99 of our own patients with COLD. Lung function and pulmonary hemodynamics were investigated in a stable period of the disease. Follow-up studies were done at least 3 years after initial work-up. Observation time was 5.4 +/- 1.6 years in patients who survived (S) and 2.8 +/- 2.3 years in patients who died (N-S). The two groups differed significantly in the following variables (mean +/- SD for survivors and non-survivors): VC 3.0 +/- 1.0 1 and 2.3 +/- 8.1 1, FEV1 1.6 +/- 0.9 1 and 0.9 +/- 0.4 1, PaO2 9.6 +/- 1.4 and 8.3 +/- 1.7 kPa, SaO2 94 +/- 3% and 90 +/- 6%, PaCO2 5.0 +/- 0.9 kPa and 5.9 +/- 1.1 kPa, mean pulmonary arterial pressure (PAP) 2.6 +/- 0.7 kPa = 19.5 +/- 5.6 mmHg and 3.9 +/- 1.7 kPa = 29.4 +/- 12.9 mmHg, and hematocrit (Ht) 47 +/- 5% and 51 +/- 7%. The following three variables did not differ significantly: cardiac index 3.8 +/- 1.8.1 and 3.3 +/- 1.6, PvO2 5.6 +/- 0.9 kPa and 5.3 +/- 0.9 kPa, and coefficient of oxygen delivery (COD) 5.69 +/- 2.28 and 5.29 +/- 2.35. The number of patients with signs of tissue hypoxia (PvO2 less than 4.66 kPa) was similar in both groups, 7 (S) and 9 (N-S).(ABSTRACT TRUNCATED AT 250 WORDS)

The ability to detect early lung disease with different combinations of lung function tests was assessed by discriminant analysis. A number of lung function tests were performed in 224 never-smokers, 232 smokers, 111 pneumoconiotic subjects and 137 asthmatic patients. The discriminatory capacities of different combinations of test variables are presented. For detecting lung damage induced by tobacco smoke, a combination of the transfer factor and the slope of the alveolar plateau (phase III) increased the sensitivity from 18% to 32% at a specificity of 95%, compared with phase III alone. Dynamic spirometry did not add to the discriminatory capacity. Patients with asthma could be separated from reference subjects by airway resistance, Phase III or a combination of variables in dynamic spirometry. Pneumoconiotic subjects were best identified by a combination of the transfer factor, volumic compliance and phase III. Closing capacity divided by total lung capacity (TLC) and FEV1/TLC further improved the discrimination between different subgroups.

In order to study factors associated with changes in radiographic appearance and lung function after pleural effusion, we investigated 178 consecutive patients with non-malignant pleural effusion. At the initial examination etiology, smoking habits, asbestos exposure, ESR, blood eosinophils, size of effusion and other X-ray lesions were registered. At a 3-year follow-up, chest radiographs and lung function values were obtained and the association with the initially registered factors was evaluated. At follow-up, 20% of the patients had developed major additional X-ray lesions and/or significantly reduced lung function. Prognostically unfavourable factors were idiopathic etiology as compared to infectious, medium and large-size effusions and initial radiographs showing converging pleural linear structures and/or rounded atelectasis as compared to no or minor radiographic lesions. Converging pleural linear structures and rounded atelectasis were seen almost exclusively in association with idiopathic effusions. The obvious differences noted between patients with idiopathic and infectious effusions suggest that these effusions represent separate clinical entities.

Endotoxin (30 mg/kg) or saline was given endotracheally to guinea-pigs in order to investigate surfactant function in respiratory failure. Six hours later, bronchoalveolar lavage was performed. The lavage was analyzed for protein, phospholipids and surface activity, and fractioned into the phospholipid-rich sediment and the phospholipid-poor supernatant. The latter fraction was analyzed for surfactant inhibitor activity. After endotoxin, PaO2 and static lung-thorax compliance decreased. The lavage from endotoxin-treated animals revealed a 180% increase in protein, a 52 67% decrease in surfactant phospholipids, and increased minimum surface tension, as compared to the controls. After endotoxin, the supernatant contained a 58% higher activity of surfactant inhibitor, and the sediment had slower surface adsorption than after saline. We propose that abnormal surfactant function is important in the pathogenesis of respiratory failure in high-permeability pulmonary edema.

Recombinant murine Gamma interferon (rIFN-gamma) causes powerful inhibition of M. tuberculosis by murine peritoneal macrophages. This inhibition is totally abrogated by glucocorticosteroid hormones. In contrast, glucocorticoids do not oppose the weak inhibition of M. tuberculosis by human macrophages which can be induced with human rIFN-gamma, nor do they reduce the effect in this system of 1,25-(OH)2 vitamin D3. However, glucocorticoid hormones do decrease the baseline inhibition of M. tuberculosis exerted by monocytes from some normal human donors without any preincubation in an activating stimulus. Thus there is a steroid-sensitive anti-mycobacterial mechanism in human macrophages, but IFN-gamma is not the lymphokine which induces it. We suggest that this mechanism may be important for protection and steroid-induced reactivation, and deserves further study. On the other hand, the IFN-gamma and vitamin D3 pathway may be more relevant to immunopathology.

The effects of purified human airway lysozyme and hen egg-white lysozyme on growth rate and viability of growing type I Streptococcus pneumoniae were studied. Exposure of bacteria to human and hen lysozyme at the same final concentration (100 micrograms/ml) for 1.5-4.5 h resulted in a marked reduction of the number of colony-forming units per ml compared to control cultures. After a 1.5-h exposure to human or hen lysozyme, the remaining percentage of colony forming units per ml was 54% and 69%, respectively. The onset of growth only appeared after a 3.5-h exposure period for human lysozyme whereas it began at 2.5 h for hen lysozyme. After 3.5 h and 4.5 h of exposure, the number of colony-forming units was significantly lower (p less than 0.05) in human lysozyme-treated bacteria cultures compared to control cultures. Parallel electron microscopic observations of Streptococcus pneumoniae cultures confirmed that the density of pneumococci was less in the presence of either human lysozyme or hen lysozyme in comparison to control cultures, and showed the presence of numerous long, ribbon-like material and cytoplasmic condensations liberated in the culture medium.

The function of alveolar macrophages (AM phi s) was studied in terms of the secretion of various chemotactic factors. Human AM phi s were obtained by BAL from healthy non-smokers and smokers. One of the chemotactic factors was LTB4, an arachidonic acid metabolite of the lipoxygenase pathway. The amount of LTB4 was determined in culture medium, in cell homogenate and in BAL-fluid. The total chemotactic activity for neutrophils was measured in culture medium and in BAL-fluid. AM phi s from smokers showed an impaired secretion of LTB4. The spontaneous secretion in vitro was inhibited by 90% (p less than 0.05) and the stimulated one was blocked by 84% (p less than 0.05). This impairment was not followed by a decrease in total chemotactic activity, indicating the existence of other chemotactic factors than LTB4. Preliminary characterization of the chemotactic activity by gel filtration demonstrated at least four different chemotactic factors. Budesonide inhibited both the release of LTB4 and the total chemotactic activity in medium from stimulated AM phi s.

The respiratory epithelium of large airways was studied in biopsy specimens obtained by bronchoscopy in seven patients with cystic fibrosis (CF). All but one of these patients were chronically colonised with Pseudomonas aeruginosa. Biopsy specimens were also obtained from the large airways of 10 control patients with or without signs of chronic bronchitis. All samples were studied by transmission electron microscopy. Morphometry was applied to assess the volume density of various cell types and intercellular spaces and for quantification of microvilli of ciliated cells. In CF patients, the average number of microvilli per ciliated cell was decreased by 17% compared to patients with chronic bronchitis and by 34% compared to patients with apparently normal bronchi (p less than 0.02, respectively), but otherwise no abnormalities were found. In particular, the volume density of goblet cells was not increased. Thus the ultrastructure of the airway epithelium may be nearly normal in CF, even in adult patients with chronic respiratory infection.