Obstructive Ventilatory Disorder Research Articles

Bronchoalveolar lavage in allergic granulomatosis and angiitis

Pulmonary involvement occurs in approximatively half of patients with allergic granulomatosis and angiitis (AGA). We studied bronchoalveolar cells from six patients with histologically proven AGA and compared our results with those obtained from four patients with chronic eosinophilic pneumonia (CEP), nine nonsmoking patients with bronchial asthma and blood eosinophilia, and 10 healthy nonsmokers. Pulmonary infiltrates were present in 5 out of 6 AGA patients. None of these patients was receiving corticosteroids at the time of entry to the study. Pulmonary function tests were normal in two cases, and demonstrated on obstructive ventilatory disorder with hypoxaemia in four cases. Total cell yield did not differ between AGA patients (22.4 +/- 4.9 x 10(4) cells.ml-1), asthmatics (9.6 +/- 1.7 x 10(4) cells.ml-1) and controls (11.3 +/- 1.5 x 10(4) cells.ml-1), whereas it was dramatically increased in patients with CEP (186.4 +/- 26.3 x 10(4) cells.ml-1). All six AGA patients demonstrated an increased percentage of alveolar eosinophils (mean: 31.1 +/- 9.9%; range 6-66%). In two patients evaluation of alveolar eosinophil subpopulations showed a low percentage (27 and 36%) of hypodense cells, when compared to the high levels (> 80%) found in CEP. No significant correlation could be established between bronchoalveolar (BAL) results and clinical data, pulmonary function abnormalities, or biological results. Sequential evaluation of alveolitis in two AGA patients undergoing corticosteroid therapy demonstrated persistent alveolar eosinophilia, despite disappearance of clinical, radiological and biological abnormalities. Our data demonstrate that eosinophils are present in the alveolar spaces of patients with AGA.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulmonary function parameters, arterial blood gases and flow volume curves of dental technicians.

Dental technicians working in laboratories are exposed to different doses of various dusts. Disorders of pulmonary function may occur before radiographic changes are evident. If these pulmonary function disorders are found at an early stage, the risk may be reduced by early, adequate local ventilation and by appropriate individual protective methods. Unless adequate preventive measures are taken, pulmonary disorders will increase, finally leading to obstructive or restrictive ventilatory disorders, or progressive massive fibrosis. Results of pulmonary function tests provide objective criteria for prognosis, and are a measure of disease disability. In this situation, abnormal pulmonary function results should be considered as alarm signs.

Complications of Laser Surgery

It is only through meticulous attention to detail that complications in the use of lasers can be avoided. Lasers can be efficient, safe, and effective tools for the head and neck surgeon. However, it is imperative that the surgeon take all precautions so that the incidence of complications, uniquely attributable to laser energy, will be kept to a minimum. Inattention to detail may expose the patient to an unnecessary risk of complications.

Immunological Release of Histamine from Human Lung

The experiments reported in this work have been performed to measure the effects of acetylcholine and the anticholinergic agent ipratropium bromide on the antigen-induced release of histamine from sensitized human lung in vitro. Primarily, ipratropium bromide did not have any effect, even at higher concentrations. Acetylcholine at a concentration of 1 x 10(-7)M increased the antigen-induced release of histamine by approximately 41%. When the lung tissue was treated with ipratropium bromide before acetylcholine, the competitive inhibition of the cholinergic receptor almost completely abolished this acetylcholine-induced increase of histamine release. Therefore, in our opinion, anticholinergic agents are primarily useful in vagus-controlled chronic obstructive ventilatory disorders; they are of secondary importance in allergic bronchial asthma.

Long-term side effects in irradiated patients with Hodgkin's disease

135 out of 168 patients with Hodgkin's disease in complete remission who had received radiotherapy with tumor doses between 3000 and 5000 rad in the years 1948–1974 were investigated with regard to long-term side effects. The results obtained so far are as follows: 1. 1. Catamnestic results: Deteriorated general condition and reduced performance in 23% and 28%, spontaneous restriction of the daily routine in 45% and increase in susceptibility to infections (common cold) in 15% of the patients 2. 2. Hematological investigations, (a) Peripheral blood: No indication of severe anemia. Granulocytopenia with less than 3000 cells/mm 3 in 18.5%, lymphocytopenia with less than 2000 cells/mm 3 in 37%, no incidence of thrombocytopenia with less than 100,000 platelets/mm 3 or leukemia. (b) Sternal marrow cytology (locally irradiated): Aplasia in 76%, hypoplasia in 18%. No signs of leukemia. (c) Iliac crest cytology (not directly irradiated): Slight hypoplasia in 38%, severe hypoplasia in 8%, no signs of leukemia. 3. 3. Pulmonary investigations: Slight paramediastinal fibrosis in 44%, distinct in 36% and severe in 9%. Restrictive ventilation disorder in 84%, increase in residual volume in 61%, O 2-diffusion disorder in 18% and obstructive ventilation disorder in 7% of the patients. 4. 4. Cardiological investigations: Under stress pulmonary hypertension in 18%, right ventricular function disorder in 9%, left ventricular function disorder in 9%, cardiac insufficiency in 2%, restriction of the maximum ergometer cycling exercise capacity in 53% of the patients. 5. 5. Thyroid function investigations: Hypothyroidal or latent hypothyroidal thyroid insufficiency in 16.5%. 6. 6. Neurological symptomatology (excluding herpes zoster): Slight to moderately severe double-sided cross section symptomatology in 3 of 122 patients (2.5%), bilateral or unilateral plexus paresis in 4 of 122 patients (3.5%). 7. 7. Genito-urinary tract ( male) investigations: Infertility (azoospermia, asemia, akinesis) following infradiaphragmatic irradiation using the inverted Y-method in 70%, restricted fertility (oligo-, astheno-, teratospermia) in 26% of the cases (in spite of the constant usage of a testicular capsule). 8. 8. Dermatological investigations: According to the number of patients, teleangiectasis, induration of the irradiated fields, and medium to severe irradiation discomfort occured in 22, 15.6 and 8% respectively.

Prognostic evaluation of pulmonary circulatory disturbances in patients with chronic obstructive ventilatory disorders

山口大学三瀬内科で扱かつた慢性閉塞性換気障害をもち,諸検査成績のえられた65症例について最長10力年におよび臨床経過並びに予後を観察した結果,予後判断に必要な条件としての換気,肺機能異常の程度を評価するために行なつた機能的障害度区分の有用性を把握し,かつ肺動脈圧中間圧(PAm)を主とする肺循環動態を分析し,その障害の程度を前述の機能障害度区分と比較することは疾患の予後を判断する上に一層の信頼性を加うることを知つた.とくに肺高血圧の有無,その程度を肺動脈圧中間圧(PAm)でもつて4段階にわけて観察した結果, 1)慢性肺気腫,肺気腫を主病変とした肺結核,珪肺などの病群と気管支拡張症あるいは気管支喘息を主病変とし,ある程度の肺気腫を合併した症例,さらに肺気腫をともなわない気管支拡張症,気管支喘息,肺結核などの病変とでは病状の進展,重症度,予後にはかなりの相違があり,前者では機能的障害度と肺循環障害度はよく平行し,この両者からきわめて有意な評価が可能であつたが,後者では多彩な経過を示し,これらの推定方法では評価が難かしかつた. 2)前者において正常肺血圧,肺高血圧群とにわかちおのおのの検討を行ない, PAmのもつ意義が大であるとともに,とくにPAmと楔入圧(WP),肺血管抵抗(PVRI),右室拡張期終圧(RVd)との相互関係から,かなり正確に予後評価が可能であつた.

Airway resistance measurements in the internist's office. Routine determination in the diagnosis and care of breathless patients.

Certain limitations of conventional spirometry1 imply that sophisticated appraisal of the presence and degree of physiologic dysfunction in patients with obstructive ventilatory disorders should include definition of the important pressure-volume-flow determinants of lower airway resistance. Macklem and Mead2 have analyzed the complexities inherent in the use of pulmonary function tests dependent upon a forced expiratory maneuver as an index of airway dynamics. The usefulness of the whole-body, volume-displacement plethysmograph as a source of more critical estimates of airway resistance and airway responsiveness3-8 has been documented beyond cavil. Payne and associates8 further suggest that estimates of bronchodilator drug potency, based upon spirometric changes alone, may be misleading in terms of locus of action by reflecting summation of various organ responses rather than the airway only.