European journal of respiratory diseases最新文献

Responses of isolated human airways, obtained from a single asthmatic patient at thoracotomy, were compared to responses of airways from 10 non-asthmatic subjects in vitro. Asthmatic bronchiolar strips exhibited increased contractile responses to histamine, methacholine and leukotriene (LT) C4, and relaxed normally in response to 1-isoprenaline and forskolin. The non-adrenergic inhibitory response to field stimulation was low, but was not significantly different from control values. These results suggest that increased airway smooth muscle contractility may contribute to the asthmatic airways hyperresponsiveness in this patient.

Pleural fluid lactate (PFL) and blood lactate (BL) concentrations were simultaneously measured in samples from 46 patients with pleural effusion. PFL exceeded 6 mmol/l in all 15 patients with pyogenic bacterial pleurisy but in only 5 of the other 31 patients. We have found that a PFL-BL difference greater than or equal to 6 mmol/l has a sensitivity of 100% and a specificity of 93.8% in detecting pyogenic pleural effusions. Results are available within 1 h of sample collection, so that PFL-BL difference may become a useful aid in the early assessment of pleural effusions.

We have measured adenosine deaminase (ADA) in pleural effusions of 95 patients, using a method optimalised for rapid determination on a Hitachi 705 analyzer. High ADA activity was found in four of the five patients with tuberculous pleurisy, in four of the seven with empyema and in three of the seven patients with mesothelioma. One patient with very high serum ADA activity due to liver disease also had a high activity in the pleural effusion. Low activity was found in all patients with other neoplastic pleural effusions, parapneumonic pleural effusions, transudates, and in pleural effusions due to some other diseases. We conclude that in a country with a low tuberculosis incidence a high ADA activity in pleural effusion in neither sensitive nor specific enough to rely on the diagnosis of tuberculous pleurisy. Routine determination of ADA is not recommended; in selected cases, however, it may be useful.

The concentrations of theophylline, terbutaline and salbutamol in post-mortem blood samples from 68 patients (17-85 years old) with asthma or chronic obstructive lung disease, 54 of whom had died of asthma, were analysed. Information on recent prescriptions was obtained for 61 patients. There was agreement between prescription and drug analysis in the blood in 87% of the patients with regard to theophylline and in 92% for salbutamol and terbutaline combined. Theophylline levels were generally low; 30 patients had concentrations below 25 mumol/l and only three above 110 mumol/l (therapeutic interval 55-110 mumol/l). Both salbutamol and terbutaline were detected in most samples. Fourteen patients had blood concentrations above 200 nmol/l. No definite explanation for these high values could be found. The majority of patients who died from asthma had low drug levels and had not been prescribed corticosteroids.

The susceptibility of smokers to pneumonia caused by Haemophilus influenzae may result from impairment of phagocytic or bactericidal function of pulmonary alveolar macrophages (PAM). We compared ingestion and killing of non-typable H. influenzae and H. influenzae type B by alveolar macrophages from asymptomatic smokers and non-smokers. Three times as many cells were recovered from bronchoalveolar lavage of smokers. Non-typable H. influenzae (NTHI) were phagocytosed and killed readily by PAM from both groups of subjects, while H. influenzae type B were resistant to phagocytosis. No difference in uptake of bacteria was detected between PAM of smokers and non-smokers. PAM from smokers had a slightly greater bactericidal activity than PAM from non-smokers. These results suggest that other host factors, such as impaired tracheobronchial clearance or the presence of conditions that favor bacterial growth rather than damage to alveolar macrophages, are responsible for the susceptibility of smokers to Haemophilus infections.