Scandinavian journal of respiratory diseases最新文献

An intravenous injection of 100 microgram salbutamol sulphate was administered to a group of atopic asthmatics and a group of atopic control subjects without asthma. There was no difference in the metabolic and cardiovascular reponses of the two groups.

All cases of pleural plaques discovered at mass X-ray screening in Uppsala County during 1970-1976 were collected. Case histories, including the history of exposure to asbestos and smoking habits, were taken. A total of 508 cases, 492 males and 16 females, were found. Eighty per cent were smokers, which was more than expected, and 80% confirmed exposure to asbestos. The frequency of pleural plaques was found to increase steadily with the years parallel to the increase in the use of asbestos which had started 30 years earlier. The pleural plaques showed gradual development and many finally calcified.

A 25 year-old man, known to suffer from Ehlers-Danlos syndrome, developed a left-sided pneumothorax. At thoracotomy, pulmonary blebs and bullae were found at the apex of the lung. Bullectomy with removal of adjacent lung tissue was performed. The histological and ultrastructural findings in the lung tissue must be regarded as non-specific. These findings do not reflect a direct cause-and-effect relationship, even in the presence of the inheritable connective tissue disorder.

Terbutaline, a selective beta2-adrenergic receptor stimulator was given to 10 patients with chronic bronchitis. The effects of the drug were tested by measurements of forced expiratory volume in 1 sec (FEV1), peak expiratory flow rate (PEFR), heart rate, blood pressure and blood gas analysis. The measurements were performed before and 1, 2, 4, 5, and 6 h after oral administration of placebo, 2.5 mg, or 5.0 mg terbutaline. Terbutaline caused a significant dose-related increase in FEV1 and PEFR as compared with placebo. The maximal effects were found at the 4-h measurement and were still present at the measurements performed at 6 h. Heart rate, blood pressure and arterial oxygen tension (PaO2) were not significantly affected. Four patients experienced side effects as tremor and/or heart palpitations. It is concluded that orally administered terbutaline may be an important therapeutical agent in the treatment of chronic bronchitis.

In 218 men, who had minimal occupational exposure to dusts, fumes, temperature variability, or physical exercise, the relation between housing conditions throughout life and lung function was analysed. The number of years spend in dwellings without central heating was significantly inversely associated with the level of FEV1 and MMEF, and significantly directly associated with closing capacity in per cent of TLC, CC%. Significant dose-response relationships between smoking habits and FEV1, MMEF, CC% and slope of the alveolar plateau (phase III) were found, whereas closing volume, CV%, was only correlated to age. The association between dwelling conditions and ventilatory capacity was independent of smoking habits. Tobacco smoking, however, moderated the association in as much as it was strengthened after standardisation for tobacco consumption. These data support the hypothesis that poor dwelling conditions during childhood and adolescence are associated with development of peripheral airways disease and expiratory airflow obstruction at middle age, and that comparisons of lung function between different occupational categories are incomplete and may be misleading if lifelong housing conditions or other factors reflecting socio-economic status are not taken into consideration.

Three groups of patients (total 48) with acute exacerbations of chronic bronchitis were treated orally for 10 days, in a double-blind clinical trial, with bacampicillin (an ampicillin ester) 1600 mg twice daily, 800 mg three times daily and oral ampicillin 1000 mg three times daily. Most exacerbations were caused by Haemophilus influenzae or Streptococcus pneumoniae. Clinical and bacteriological results were significantly more favourable in the two bacampicillin-treated groups. Both drugs were generally well tolerated. Serum and sputum ampicillin assays after the first dose showed higher and earlier peak levels after bacampicillin. Only after bacampicillin did the sputum levels regularly exceed the ampicillin M.I.C. for the Haemophilus influenzae strains. After the 1600 mg and 800 mg dose these levels averaged 0.85 and 0.41 mg/l respectively. One third of the Haemophilus influenzae strains studied required more than 0.25 mg/l ampicillin for inhibition of growth. Bacampicillin 1600 mg twice daily appears to be an effective and safe treatment for most episodes of acute exacerbations of chronic bronchitis.

Transbronchial lung biopsy (TBB) was performed during fiberoptic bronchoscopy under fluoroscopic guidance in 133 patients with diffuse or peripherally localized lung diseases without endobronchial lesions. Histological diagnosis consistent with the clinical course and roentgenographic appearance was obtained in 96 patients (72%). In four cases specimens were inadequate for histological evaluation (3%). In 33 cases a diagnosis was not possible even though the specimens were adequate for histological examination. The low complication rate in this series seems due to the selection of patients and the technique used.

Fibrinogen, fibrin(ogen) degradation products (FDP) and fibrinopeptide A (FPA) were analysed in pleural fluids from 20 consecutive patients with major effusions of various aetiology. FPA is a short-lived polypeptide which is split off from fibrinogen, whereafter fibrin is formed. FDP are formed through lysis of fibrin or fibrinogen. In 18 patients no fibrinogen could be detected in pleural fluid, whereas two (both having malignant tumours) had detectable but low concentrations. High FPA concentrations, interpreted as reflecting very recent fibrin formation, were found in all pleural fluids except for one case of empyema and one transudate. Plasma concentrations were low in most cases. The same pattern was found with regard to FDP, i.e. exudates showed high concentrations, whereas plasma concentrations were low. The only patient with a transudate showed absence of fibrinogen and low concentrations of FDP and FPA. We interpret our findings as indicative of a high rate of fibrin formation and degradation in pleural exudates and have not found any differences between various types of pleural exudates. Consequently, the findings may illustrate the close association between the coagulation system and inflammatory reactions which may be common to most pleural diseases.

Serum angiotensin-converting enzyme (ACE) activity and lysozyme (LZM) concentration in 22 silicosis and 18 asbestosis patients were studied. These patients were compared with 57 untreated and 36 treated sarcoidosis patients. In all groups significantly raised ACE and LZM mean values were noted. Untreated sarcoidosis patients had the highest values. Raised ACE activity in silicosis and asbestosis has not been reported before, and weakens the differential diagnostic value of this enzyme determination for sarcoidosis. The similar patterns of increased ACE and LZM mean values in all three diseases suggest that these enzymes have a common source.

The radiological appearances and the progress of the pulmonary manifestations of serologically-proven acute Mycoplasma pneumoniae infection were studied in 29 patients. The radiological changes seen at and after admission were not helpful in establishing an aetiological diagnosis except in three patients, in whom a "classical" pattern of mycoplasma pneumonia, based on the radiological appearnaces at different histopathological stages of the disease, could be recognised retrospectively. The patterns seen were varied and generally non-specific, and were not related to the age of the patient or to the duration of disease prior to admission. Specific anti-mycoplasma therapy may have prevented the progress of the disease after admission, although five of six patients in whom radiological deterioration occurred after admission were receiving such treatment.