Showing papers in "The American review of respiratory disease in 1979"

Incidence of spontaneous pneumothorax in Olmsted County, Minnesota: 1950 to 1974.

Abstract: Between 1950 and 1974, 318 cases of initial pneumothorax were diagnosed among the residents of Olmsted County, Minn. Seventy-five cases were due to trauma, and 102 were iatrogenic. One hundred forty-one cases were spontaneous in onset, of which 77 were primary and 64 secondary to a specific underlying pulmonary disease. The age-adjusted incidence of primary spontaneous pneumothorax was 7.4/100,000/yr for males and 1.2/100,000/yr for females. For secondary spontaneous pneumothorax, the incidence was 6.3 and 2.0/100,000/yr for males and females, respectively. The ratio of male-to-female incidence was 6.2:1 for primary and 3.2:1 for secondary spontaneous pneumothorax. The differences between the incidence rates for primary and secondary pneumothorax by sex or in total were not significantly different.

Ventilation-perfusion distributions in the adult respiratory distress syndrome.

Abstract: The distribution of ventilation-perfusion ratios, as determined by the multiple inert gas elimination technique, was measured in 16 patients with the adult respiratory distress syndrome. In each case, the distribution of ventilation-perfusion ratios was bimodal. The upper mode consisted of units with normal ventilation-perfusion ratios that received a mean of 52 % of the cardiac output. The lower mode, which received the remainder of the cardiac output, consisted of either pure shunt or shunt plus a small number of units with very low ventilation-perfusion ratios (< 0.01). The measured arterial Po2 and that predicted from the distributions of ventilation-perfusion ratios were very closely correlated (r = 0.93), indicating that the hypoxemia was completely explained by the measured ventilation-perfusion inequality. In 12 patients, the effect of positive end-expiratory pressure on the distribution of ventilation-perfusion ratios was also determined. The addition of positive end-expiratory pressure uniformly...

Predictors of mortality in chronic obstructive pulmonary disease. A 15-year follow-up study.

Abstract: The relative usefulness of various initial findings in predicting survival is reported for 200 patients with chronic obstructive pulmonary disease who have been followed for approximately 15 years. After 5 years of follow-up, subjects 62 or more years of age showed a poorer survival rate than younger subjects. After controlling for age, the per cent predicted forced expiratory volume in 1 sec after administration of bronchodilator was the best indicator of prognosis. In subjects less than 65 years of age, the presence or absence of cor pulmonale further improved the prediction of subsequent mortality. Regardless of initial findings, however, there was wide individual variability in prognosis, and factors relating to this variability remain obscure. No difference in survival rate was noted between the 178 male patients who were enrolled in Chicago 15 years ago and the 100 similarly impaired men enrolled in Tucson approximately 7 years ago.

Determinants of allergen-induced asthma: dose of allergen, circulating IgE antibody concentration, and bronchial responsiveness to inhaled histamine.

Abstract: The relationships among bronchial responsiveness to allergen, bronchial responsiveness to histamine, and cutaneous sensitivity to allergen were examined in 25 asthmatic subjects. Bronchial responsiveness to allergen was determined by inhalation tests with 2-fold increasing doses of allergen extract, and was expressed as the provocative concentration producing an early asthmatic response with a 20 % decrease in the forced expiratory volume in one second (allergen PC20). Bronchial responsiveness to histamine was determined in a similar way and was expressed as histamine PC20. Cutaneous sensitivity to allergen was determined by duplicate prick skin tests with doubling concentrations of the same allergen extract used for inhalation, and was expressed as the concentration producing a mean wheal diameter of 2 mm. There was a poor correlation between histamine PC20 and cutaneous sensitivity to allergen (r = −0.03, p > 0.1). There was a good correlation between allergen PC20 and histamine PC20 (r = 0.52, p > 0.02...

Basal lamina of alveolar epithelium and capillaries: quantitative changes with aging and in diabetes mellitus.

Abstract: Epithelial and capillary basal laminae (BL) of alveoli are significantly thicker in diabetics than they are in age-matched control subjects The degree of thickening does not correlate significantly with patient age or with known duration of diabetes The thickness of both types of BL in the lungs correlates significantly with thickness of BL in renal tubules and muscle capillaries However, in muscle capillaries and in renal tubules, the BL deposits are 5 to 10 times greater than they are in the lungs The effects of BL changes on pulmonary function remain to be explored

Adenocarcinoma of the lung: recent results from the Veterans Administration Lung Group.

Abstract: Adenocarcinoma has become the most common type of cancer of the lung. Its distinct natural history necessitates separation from the other cell types. Results from recent Veterans Administration Lung Group studies show that local-regional failure occurred in 59 % of patients after irradiation for adenocarcinoma limited to the thorax. Data from 300 consecutive autopsies reveal that death was caused by intrathoracic complications of the tumor in 38 %, and by metastases in 57 % of patients. Adenocarcinoma has an intermediate risk of local and distant failure when compared to squamous and small-cell carcinoma. However, brain metastases are most frequent with adenocarcinoma. Preliminary results suggest that prophylactic brain irradiation decreases the frequency of brain metastases. Patients with adenocarcinoma are more likely than those with other cell types to have metastases only in the brain. Prophylactic brain irradiation may make the greatest contribution to improved survival in patients with adenocarcinom...

Ultrasonographic evaluation of ventilatory effect on inferior vena caval configuration.

Abstract: Ventilatory effect on inferior vena caval configuration was studied by ultrasonography in 14 subjects, including 5 with chronic obstructive pulmonary disease, 3 with cardiac tamponade due to carcinomatous pericardial effusion, one with tuberculous constrictive pericarditis, and 5 normal subjects. The inferior vena caval lumen decreased in the early inspiratory phase, reached a minimum at the end of inspiration, distended again during expiration, and closed transiently 2 to 3 cm below the diaphragm during maximal inspiration. These ventilatory changes of the inferior vena cava reversed with increase in intrathoracic pressure during the Valsalva maneuver and positive-pressure ventilation. When the central venous pressure was increased, as in cardiac tamponade, the inferior vena cava was fully distended through the entire phase of inspiration and expiration. Collapsibility of the inferior vena cava was inversely proportional to central venous pressure when the pressure was less than 10 cm H2O, but not when the pressure was greater than approximately 10 cm H2O. Our results suggest that the study of inferior vena caval configuration with ultrasonogrphy is a valuable noninvasive clinical aid for estimating central venous pressure and for analyzing inferior vena caval hemodynamics in various clinical conditions.

Pulmonary hypertension complicating portal hypertension.

Abstract: We report 9 patients with pulmonary hypertension complicating portal hypertension. The cause of portal hypertension was cirrhosis in 7 patients, nodular regenerative hyperplasia of the liver in 1, and portal vein obstruction in 1. Six patients had been treated by portal-systemic shunting before the clinical onset of pulmonary hypertension. The interval between the first manifestation of portal hypertension and the recognition of pulmonary hypertension ranged from 2 to 15 years. Histologic examination in 1 of these patients revealed medial hypertrophy, concentric intimal proliferation, and plexiform lesions affecting the small pulmonary arteries. Pulmonary hypertension might result from the effect of a vasoconstrictive agent on the small pulmonary arteries or of a substance toxic to the walls of these vessels that is produced in the splanchnic territory, destroyed by the liver in normal subjects, and reaches the pulmonary arteries through portal-systemic shunts in these patients.

Effects of sulfur oxides and respirable particles on human health. Methodology and demography of populations in study.

Abstract: As part of a study of health effects of sulfur dioxide and particulate matter, we have established a cohort of adults 25 to 74 yr of age in 6 communities who will be followed prospectively. At the conclusion of our first cycle of measuring the health of adults in 6 sites we found that, although we used different sampling frames, our samples were close to the distribution shown in the U.S. Census for age, sex, and occupation, with the possible exception of one city. Analysis of the cross-sectional data indicated that for both age- and height-adjusted values for forced expiratory volume in 1 s and for selected rates of various respiratory symptoms standardized for age, differences among smoking groups were apparent. Differences in these parameters between sites suggest trends that were associated with levels of pollution. Further analyses of the prospective data currently being collected will be required before definitive statements can be made about the effect of specific levels of exposure.

Correlation between the function and structure of the lung in smokers.

Abstract: To study the relationship between morphologic changes and alteration of lung function, the excised lobes of 21 smokers and one nonsmoker who required lobectomy for small peripheral tumors were inflated and fixed in formalin, and measurements of bronchiolar narrowing and degree of emphysema were made. All patients had comprehensive pulmonary function tests (including diffusing characteristics, the single-breath N2 test, measurements of elastic recoil, and flow-volume measurements with air and helium) performed before lobectomy. Eight of the lobes excised from the smokers had emphysema of grade 15 or more, the greatest being grade 50. Lobes from 11 patients had evidence of airway narrowing. There were 6 lobes with both emphysema and airway narrowing. Pulmonary function was abnormal in some aspect in all lobes except that from the nonsmoker. Whereas the tests of diffusing capacity, particularly the fractional uptake of CO, correlated with the degree of emphysema, the tests of elastic recoil were not predictive of this early degree of emphysema. The degree of small-airway narrowing correlated with maximal mid-expiratory flow rate and the single-breath N2 test. The maximal flow/static recoil pressure curves were the most sensitive indicators of airway abnormality in the patients with emphysema.

Pulmonary injuries associated with acute sulfur dioxide inhalation.

Abstract: This report describes an industrial accident in which 5 previously healthy persons were acutely exposed to very high concentrations of sulfur dioxide. Of these 5 subjects, the 2 with the highest exposure died immediately; histologic examination of the lungs revealed extensive sloughing of the mucosa of large and small airways along with hemorrhagic alveolar edema. The 3 survivors were evaluated with pulmonary function tests performed at regular intervals. One subject subsequently developed symptomatic severe airway obstruction unresponsive to bronchodilators; another subject developed asymptomatic mild obstructive and restrictive disease, and the third subject continued to be asymptomatic with normal pulmonary function tests. This report serves to document the histologic features of fatal exposure to sulfur dioxide and stresses the need to follow parameters of pulmonary function in the nonfatal cases.

Viral and bacterial infections in adults with chronic asthma.

Abstract: To determine the frequency of viral, mycoplasmal, and bacterial infections in adult asthmatic patients, 19 patients were examined for the presence of these organisms during wheezing exacerbations a...

Prognosis in severe chronic obstructive pulmonary-disease

Abstract: A long-term prognostic study of 129 patients with severe chronic obstructive pulmonary disease (initial value for forced expiratory volume in 1 sec [FEV1 ≤1,000 ml) is reported. Data from the patients (72 per patient) were obtained in a clinically stable phase during the first hospital admission and subsequent regular outpatient visits; the data were processed using multiple regression and discriminant analysis. Five- and 10-year cumulative survival rates were 69 and 40 per cent, respectively. Prediction of survival rate was determined mainly by the rate of decrease in initial FEVj per year and the degree of increase of initial FEV1 after administration of thiazinamium, a bronchodilator. Initial FEV1values per se contributed to prediction only when they were less than 450 ml. Study of the data from the individual patients showed the presence of different types of decrease in FEV1 linear, exponential, combined linear-exponential, and phasic. FEV1 sometimes remained unchanged for several years or even showe...

Function of the isolated paced diaphragm and the cervical accessory muscles in C1 quadriplegics.

Abstract: Function studies of the electrically paced diaphragm and of the sternomastoid and trapezius muscles acting alone were carried out in 3 young C1 quadriplegic men. Phrenic pacing offers the unique advantages of allowing one to examine the function of the diaphragm acting alone, keeping the degree of phrenic activation constant while examining its mechanical responses to other variables. Changes in anteroposterior and lateral diameters of both rib cage and abdomen were measured with magnetometers; changes in pressure and volume were recorded together with thoracoabdominal motion as indices of inspiratory muscle effectiveness as lung volume and body position were changed. Isolated paced diaphragmatic contraction caused both abdominal diameters and the lateral diameter of the lower rib cage to increase. The anteroposterior and lateral diameters of the upper rib cage, however, decreased. Isolated contraction of the trapezii and sternocleidomastoids caused decreases in all diameters except for the anteroposterio...

Alpha,-antitrypsin and leukocyte elastase in infected and noninfected sputum.

Abstract: Leukocyte elastase and alpha 1-antitrypsin have been implicated in the pathogenesis of pulmonary emphysema The relationship between these proteins has been studied in sputum both qualitatively and quantitatively in bronchitic patients with and without chest infections Leukocyte elastase was found in 75% of the noninfected samples but was enzymatically inactive, suggesting complete inhibition During infection, leukocyte elastase and alpha 1-antitrypsin concentrations increased, although the enzyme was only partially inactivated The proportion of alpha 1-antitrypsin present as "complex" was smaller in the presence of infection, suggesting damage of the protein by excess enzyme

Farmer's lung disease: long-term clinical and physiologic outcome.

Abstract: To determine the long-term effects of farmer's lung disease and the factors influencing the outcome, 141 patients with farmer's lung disease were evaluated. At the time of the last follow-up, 29 pa...

The management of allergic bronchopulmonary aspergillosis.

Abstract: Twenty-five patients with allergic bronchopulmonary aspergillosis (ABPA) were observed for periods of 12 months to 10 years (average duration, 2.6 years) after initial therapy with prednisone, whic...

The number and distribution of mast cells in monkey lungs.

Abstract: We estimated the number of mast cells in monkey lungs by both quantitative histologic examination and measurement of total lung histamine, and showed that monkey lungs contain between 107 and 108 mast cells, with approximately 83 per cent of these being located in conducting airways, and 17 per cent in the parenchyma. The number of mast cells found in each airway generation increased from approximately 60,000 in the trachea to 8 million in the terminal bronchioles. In airways from different generations the number of mast cells superficial to the basement membrane in the epithelium and lumen (EMC) was compared to the number of mast cells found in the submucosa between basement membrane and cartilage and to the number of those found outside the cartilage. The number of EMC varied between animals and ranged from 0–0.4 per cent of the total number of mast cells in the trachea, to 0–27 per cent of the total in the terminal bronchioles. On the average, EMC accounted for 12 per cent of the total number of mast c...

Ventilatory control in patients with hypoxemia due to obstructive lung disease.

Abstract: In 20 patients with chronic hypoxemia due to chronic obstructive pulmonary disease, we measured responses to CO2 and hypoxia in terms of ventilation and P0.1, the pressure generated by the respiratory muscles during the first 0.1 s of inspiratory effort against a closed airway at functional residual capacity. These responses were compared to those of a control group of 17 patients with similar ventilatory abnormality but without hypoxemia. Hypoxemic patients demonstrated significantly less response to hypoxia than did control subjects in terms of both ventilation and P0.1 The decreased hypoxic response might be analogous to that reported in high altitude dwellers and patients with cyanotic congenital heart disease. Ventilatory responses to CO2 were depressed in hypoxemic patients, but P0.1 responses were not significantly decreased. While breathing at rest with arterial O2 saturation of 95 per cent, hypoxemic patients demonstrated the same minute ventilation as control subjects, but tidal volume was smaller, inspiratory duration was shorter, and breathing frequency was slightly higher. This breathing pattern appeared to be independent of whether or not these patients retained CO2.

The value of Pneumocystis carinii antibody and antigen detection for diagnosis of Pneumocystis carinii pneumonia after marrow transplantation.

Abstract: Thirty-three marrow transplant patients with Pneumocystis carinii pneumonia were studied to determine the usefulness of antibody and antigen detection in the diagnosis of pneumocystis infection. Antibody against P. carinii was present in one half of all patients tested, and changes in antibody titer were not helpful diagnostically. P. carinii antigen was detected by counterimmunoelectrophoresis in the serum of 22 of 28 patients tested. Fifteen of 28 patients had antigen detected before or within 72 h after diagnosis. However, antigen was also present in 35 of 52 marrow transplant patients with viral or idiopathic pneumonia, in 11 of 25 transplant patients with no pneumonia, and in 22 of 28 other patients with pulmonary infiltrates. Only 1 of 50 normal marrow donors had detectable antigenemia. Detection of this antigen does not appear to establish the diagnosis of P. carinii pneumonia in the absence of other clinical or histologic data. The data may suggest that subclinical infection with this agent is more common than was previously recognized.

Influence of dose and fiber type on respiratory malignancy risk in asbestos cement manufacturing.

Abstract: This investigation provides information concerning the risk of respiratory malignancy in relation to duration, degree, and fiber type of exposure to asbestos in a manufacturing cohort of 5,645 with long-term follow-up. Excess mortality for this cause was found in groups with moderate and high cumulative exposure (standard mortality ratios of 290 and 226). Analysis of the influence of components of total exposure dose (duration, average concentration) revealed no detectable excess risk in persons employed for less than 2 years or with low-degree average exposure. Exposure to corcidolite (blue) fiber in addition to the predominantly used chrysotile in pipe making appeared to be associated with higher risk than was exposure to chrysotile alone.

Acute pulmonary injury in rats by nitrofurantoin and modification by vitamin E, dietary fat, and oxygen.

Abstract: The subcutaneous administration of nitrofurantoin to rats caused severe pulmonary damage, characterized by edema, congestion, and hemorrhage. The acute lethality of the drug was greater in rats fed vitamin E-deficient diets high in polyunsaturated fats as compared to rats fed the NIH open-formula diet. The survival times of vitamin E-deficient rats were increased if such animals were fed diets supplemented with vitamin E and/or diets containing saturated fat (lard) for 3 weeks before administration of nitrofurantoin. The toxicity of nitrofurantoin was enhanced in both the rats deficient in vitamin E and in those given vitamin E supplements and exposed to O2-enriched atmospheres. These results, in conjunction with previous metabolic studies in vitro showing redox cycling and O2 activation in rat lung microsomes in the presence of nitrofurantoin, illustrate certain similarities with the lung-toxic herbicide, paraquat, and raise the question of whether the 2 agents may be capable of damaging lungs by a common mechanism.

Pneumothorax and other forms of pulmonary air leak in newborns.

Abstract: A retrospective review was performed of the records of 222 infants to survey the entire spectrum of pulmonary air leak (used to indicate alveolar rupture, because for many sick infants with lung ru...

Accuracy sensitivity to carboxyhemoglobin, and speed of response of the Hewlett-Packard 47201A ear oximeter.

Abstract: We have shown that the Hewlett-Packard 47201A ear oximeter measures arterial O2 saturation with-in 95 per cent confidence limits of ± 4 per cent when arterial blood saturation is more than 65 per c...