We report two patients with bilateral apical pleural fibrosis which may be a form of benign asbestos-related pleurisy, one of these being steroid responsive. The pulmonary function defect of reduced lung volumes with raised gas transfer coefficient is characteristic and is best described as 'constrictive'.
Identical male twins born in 1959 have developed chronic beryllium disease. Twin 1 was exposed to beryllium for more than 3 years. The diagnosis was first suspected at the time of his post-employment chest radiograph. Twin 2 was exposed for 21 months and ceased employment at the same time as his brother. His post-employment examination was normal. Thirty months later he developed an unusual skin rash which biopsy showed to be granulomatous. Further investigations proved the diagnosis. Both men have reduced tear secretion measured with Schirmer's test, a feature not previously reported in this condition. Bronchoalveolar lavage and laser microprobe mass spectrometry (LAMMS) were used as aids to the diagnosis. Sarcoidosis has been reported in identical twins, suggesting genetic susceptibility, which may also be of importance in chronic beryllium disease.
Apical pulmonary fibrosis has been established as a non-articular complication of ankylosing spondylitis. Although psoriasis is frequently associated with arthropathy and spondylitis, there is only one previous report of apical fibrosis occurring in a patient with psoriasis. We report two patients with psoriasis complicated by apical pulmonary disease in whom extensive investigations were negative.
We report two subjects without previous evidence of asthma in whom wheeze, breathlessness and bronchial hyperresponsiveness occurred following an acute smoke inhalation injury.
Seventy-three patients with superficial lymph node tuberculosis, who received either 9 months' or 18 months' treatment with rifampicin and isoniazid, supplemented by ethambutol for the first 8 weeks, were followed up for 5 years. No clinical nor microbiological relapse was recorded. The cosmetic results were good in both groups. Initial surgery or aspiration conferred no advantage or disadvantage. The 9-month regimen can therefore be recommended as effective therapy for superficial lymph node tuberculosis.
Chest physiotherapy should now be updated with attention to three important features: first, its use should be limited to those patients with actual or potential sputum production and its central aim should be to increase expectoration. Second, it should incorporate the forced expiration technique with postural drainage and omit traditional elements such as percussion and vibration. Third, the additional use of inhaled adrenergic agents and possibly oral high frequency oscillation may increase sputum clearance further.
BAL and blood mononuclear cells and their reactivity to Kveim antigen, tuberculin and concanavalin A (Con A) were studied in nine patients with different clinical stages of sarcoidosis. After separation by plastic adherence, non-adherent cells (mainly lymphocytes) were admixed with 10% autologous adherent cells (monocytes/macrophages). After 3 and 6 days' culture with Kveim antigen (1, 10, 100 μg/ml), PPD tuberculin (2.5 μg/ml) and Con A (10, 20, 40 μg/ml) stimulation was measured as incorporation of 14C-thymidine into DNA.
Except for occasional reactions the study did not show any unitary significant increase in lymphocyte response to the different concentrations of Kveim antigen in either BAL or blood. For Con A there was a weaker response by BAL-mononuclear cells with no difference between 3 and 6 days, compared with blood where there was an early peak. The lymphocyte reaction to PPD was weak with no difference between blood and BAL.
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