Showing papers in "Thorax in 1977"

Effect of lung function and mode of inhalation on penetration of aerosol into the human lung.

Abstract: The method using radioactive tracer particles has been applied to study the effect of the mode of inhalation of aerosols on the depth of deposition in the lungs of 50 patients with airways obstruction. The findings show that the penetration of particles is directly related to: (1) volume inspired per breath (VI); (2) forced expiratory volume in one second (FEV1); and inversely related to (3) flow rate during inhalation (V). In mathematical terms, alveolar deposition (%) = 40-3 (VI)+10-98 (FEV1)--0-75 (V)+40-4; for this regression F = 4-41 and P less than 0-01.

Physical rehabilitation for the chronic bronchitic: results of a controlled trial of exercises in the home.

Abstract: Twenty-four men with chronic bronchitis participated in a controlled trial of a physical training scheme. The training involved progressive stair-climbing exercises carried out over a three-month period unsupervised at home. The twelve men in the exercise group benefited significantly in terms of general well-being and reduced breathlessness. Their exercise tolerance increased significantly as judged by increased walking speed in a simple 12-minute walking test and by a greater work load tolerated in a progressive work load test on a bicycle ergometer. The mean stride length during the walking test increased significantly with training. No significant changes occurred in body weight, ventilatory function tests or heart rate on exercise. There were no important changes in the control group. It is not clear whether the improvements noted were due to physiological changes such as improved neuromuscular coordination producing a more efficient walking pattern or to predominantly psychological factors such as increased tolerance of dyspnoea. The study demonstrates that a simple training scheme which can be administered from a hospital clinic or family doctor's surgery is safe, feasible, and of benefit to the chronic bronchitic.

Extrinsic allergic alveolitis: a disease commoner in non-smokers.

Abstract: The smoking habits of 18 patients with extrinsic allergic alveolitis, 22 with cryptogenic fibrosing alveolitis, and 75 patients with sarcoidosis were compared with the smoking habits of the normal population of the Prairie Region for 1973. The patients were diagnosed at the same two hospitals over the four-year period November 1971--75 and were of comparable age. Non-smoking was significantly associated with allergic alveolitis in men and the three cases in women were all non-smokers. For the other two diseases, smoking habits were similar to those of the local population.

Protective effect of drugs on histamine-induced asthma.

Abstract: Controlled standardised histamine inhalation tests were carried out in 21 asthmatics to determine the degree of non-specific bronchial hyperreactivity with and without prior treatment with several anti-asthmatic drugs. A significant protective effect was produced by inhaled salbutamol, 200 microgram, ingested salbutamol, 4 mg, inhaled Sch1000, 40 microgram inhaled atropine sulphate, 290 microgram, and ingested choline theophylinate (200 or 400 mg) producing serum theophylline levels over 10 mg/l. Inhaled salbutamol was consistently the most effective and was significantly better than the other drugs. The protective effect between the other four was not significantly different. Drug side-effects occurred only with the ingested drugs. No significant protection was detected after ingested choline theophyllinate producing serum theophylline levels of less than 10 mg/l, inhaled sodium cromoglycate, 20 mg given once or six-hourly for one week, or ingested ascorbic acid, 1 gram.

Relationship between occupations and asbestosfibre content of the lungs in patients with pleural mesothelioma, lung cancer, and other diseases

Abstract: Whitwell, F., Scott, Jean, and Grimshaw, Myra (1977). Thorax , 32, 377-386. Relationship between occupations and asbestos-fibre content of the lungs in patients with pleural mesothelioma, lung cancer, and other diseases. The light-visible asbestos-fibre content of 300 lung specimens has been measured using a potash-digestion and phase-contrast microscopy technique, and the results have been correlated with the occupations of the patients. Among 100 pleural mesothelioma specimens were 88 where the patients had been exposed to asbestos, and in 73 of these (83%) the lung tissue contained over 100 000 asbestos fibres per gram of dried lung, and only one specimen showed less than 20 000 fibres per gram. When asbestosis was present, the lungs nearly always showed over 3 million fibres per gram. In 100 control lungs (those without industrial disease or lung cancer) there were less than 20 000 fibres per gram of dried lung in 71% of specimens. Lungs from 100 patients with lung cancer but no industrial disease contained less than 20 000 fibres per gram of dried lung in 80% of cases. Patients with parietal pleural plaques nearly all had over 20 000 fibres per gram in their lungs. The number of asbestos fibres found in the lungs was closely related to the occupations of the patients but not to their home environment. Patients who had lived near likely sources of atmospheric asbestos pollution did not have higher asbestos fibre counts than the rest of the patients. It is concluded that there is a definite dose relationship between asbestos exposure and mesothelioma formation but that9 `sub-asbestosis9 levels of asbestos exposure do not contribute to the formation of lung cancer in those not subjected to industrial asbestos exposure.

Revival of the Senning operation in the treatment of transposition of the great arteries. Preliminary report on recent experience.

Abstract: This preliminary report presents recent experience with the Senning operation for transposition of the great arteries Reasons are given why the traditional Mustard procedure was abandoned in favour of the Senning operation Technical details are presented and the advantages and disadvantages of the procedure are discussed

Cerebral protection during open-heart surgery.

Abstract: To reduce the incidence of cerebral damage after open-heart surgery measures were undertaken based on physiological principles and consideration of the possible injury caused by microemboli. Intellectual function was measured by psychometric tests before and after operation. The results were compared with those of an earlier series. There was a striking reduction in the incidence of neurolocial complications. There was also a considerable reduction in the degree of impairment of intellectual function previously shown to develop after open-heart surgery. However, there are still signs that cardiopulmonary bypass brings about subclinical cerebral injuriies. The measures taken and their rationale are discussed. Psychometric testing is a useful method for evaluating the quality of cardiopulmonary bypass as it allows a quantitative assessment of postoperative cerebral function.

Thoracoscopy in the diagnosis of pleural effusion.

Abstract: The technique, indications, and complications of diagnostic thoracoscopy are described. Two hundred and eight explorations have been performed in our service in the last seven years. From 137 pleural malignancies we have obtained an unequivocal positive biopsy in 129 (94%) with a minimum number of complications and no mortality. From our experience we conclude that thoracoscopy, when porperly performed, is diagnostic in most pleural conditions.

Ultrastructural immunocytochemical localisation of lysozyme in human bronchial glands.

Abstract: An immunocytochemical unlabelled antibody method using rabbit antihuman lysozyme, antirabbit immunoglobulin, and soluble rabbit antihorseradish peroxidase/horseradish peroxidase complexes was used to study the fine structural distribution of lysozyme in human bronchial glands. None was identified in mucous cells but there was heavy staining of the serous cell granules. The serous cell granules were not stained uniformly, suggesting the presence of other secretory products but lysozyme secretion appears to be a major function of these cells. The pathological implications of this are discussed.

Oesophageal trauma: incidence, diagnosis, and management.

Abstract: The clinical manifestations, diagnosis, and surgical treatment of 110 cases of oesophageal trauma, admitted under the care of one surgical team between 1949 and 1973, are reviewed. The importance of early diagnosis and an aggressive surgical approach in the management of a potentially lethal situation are stressed. In our opinion, spontaneous rupture of the oesophagus, instrumental perforation, open and closed traumatic lesions, and postoperative anastomotic leaks are, as far as diagnosis and management are concerned, different aspects of the same desperate surgical problem. Oesophageal trauma is accompanied by a high morbidity and mortality rate if diagnosis and treatment are delayed. Perforations of the cervical oesophagus may be treated conservatively. Intrathoracic perforations demand an aggressive surgical appraoch; only exteriorisation followed by reconstruction at a later date offers a reasonable chance to save the life of the patient and ultimately restore continuity.

Asthma deaths in children--a continuing problem.

Abstract: The clinical and pathological features of five children who died of asthma over a recent 12-month period are reported. All had severe, chronic asthma requiring maintenance corticosteroid therapy. Three had been receiving beclomethasone dipropionate by inhalation and these had acute inflammation of the tracheobronchial tree at necropsy. Adrenal atrophy was found in all four cases examined histologically, despite normal short tetracosactrin tests in three of these shortly before they died. The need for high-dose corticosteroid by mouth for exacerbations of asthma in those weaned from oral steroids is emphasized by these deaths. The introduction of beclomethasone dipropionate by inhalation has led to an increase in the number of children in this high-risk group.

Quantitative structural study of pulmonary circulation in the newborn with aortic atresia, stenosis, or coarctation.

Abstract: Study of the structural features of the pulmonary circulation in various types of congenital heart disease makes it possible to correlate function and structure in the fetal and newborn lung. We applied quantitative morphometric techniques to the injected and inflated lungs of newborn infants who had died with obstruction to left ventricular outflow from aortic atresia, stenosis, or coarctation. The structure and development of the pulmonary circulation was judged by the number of arteries and veins and their size and wall structure, with particular attention to vessels within the respiratory unit. The study established for the first time that the structure of the pulmonary circulation is modified by the antenatal abnormalities in blood flow that occur through the heart and great vessels in the presence of congenital heart disease. Fetal multiplication of intra-acinar arteries in aortic atresia and stenosis is increased as also is the muscularity of both pre- and intra-acinar arteries and veins, muscle extending into smaller and more peripheral vessels than is normal at birth. When the pulmonary circulation is normal before birth but arterial pressure and flow are abnormally increased at birth, as in coarctation with patent ductus and ventricular septal defect, an increase in arterial diameter and muscularity is apparent within the first week of life.

Intracavity suction and drainage in the treatment of emphysematous bullae.

Abstract: Patients with large intrapulmonary emphysematous bullae present a considerable therapeutic problem, particularly if their respiratory reserve is low, because of the risks of open operation. The method of draining intrapulmonary cavities, pioneered by Monaldi for the treatment of tuberculosis, is here described as applied to emphysematous bullae. Thirty-one patients were treated by intracavity suction and drainage. There were two operative deaths (6.5%). Apart from infection, no other significant postoperative complications ensued. Radiographic improvement occurred in all patients but one (96.7%). Where forced expiratory volume in one second and vital capacity were measured improvement was obtained in five out of six patients. Symptomatic improvement, which generally corresponded well to improvement in respiratory function tests, occurred in 28 patients (90.3%), all but one of whom survived.

Intrasubject variability of maximal expiratory flow volume curve.

Abstract: Analysis of airflow in the terminal portion of the maximal expiratory flow volume curve has been suggested as a useful test for the early diagnosis of chronic airways obstruction. Whether such an analysis can identify early disease, and whether any subsequent action can prevent the progress of chronic airways obstruction, is unknown and will require prospective studies. As a precursor of such a study we have tried to establish the intrasubject variability of those tests of forced expiration which may be used for screening. We therefore measured expiratory flow volume curves of five healthy males and five healthy females aged 20-30 years as this is an age-group in which early detection of airways obstruction may be of value. Flow volume curves were obtained on the same day of the week for six weeks, and on three separate days during this period we carried out three flow volume curves every hour from 9 am to 6 pm. The data were subjected to analysis of variance to determine the variability of each measurement. Data were collected from forced expired volume in one second (FEV1) forced vital capacity (FVC), maximum expiratory flow rates at 50% and 75% of expired vital capacity, and forced expiratory time (FET). The results showed no consistent pattern of diurnal variation over the working day. The variation in any subject for FEV1 and FVC over the study period was considerably less than variations detected in the maximal expiratory flow rates at 50% and 75% of the expired vital capacity and FET. Our results suggest that the intrasubject variation found in flow rates of the terminal portion of the maximal expiratory flow volume curve and forced expiratory time may limit the usefulness of these tests in detecting early airways obstruction. FEV1 and FVC are more reproducible tests and are therefore particularly suited for cross-sectional screening. The more sensitive maximal expiratory flow volume curve may, however, be more useful for long-term studies in individuals when the onset of disease is sought, or for short-term challenge studies requiring the most sensitive index of change in airway characteristics.

Studies in chronic allergic bronchopulmonary aspergillosis. 3. Immunological findings.

Abstract: Precipitin tests by two different methods, double-diffusion (DD) and counterimmunoelectrophoresis (CIE), and measurements of total and specific IgE against Aspergillus fumigatus were made in 50 patients with chronic allergic bronchopulmonary aspergillosis and in three control groups--atopics with a positive immediate prick test to A. fumigatus but no evidence of allergic aspergillosis, atopics with a negative prick test to A. fumigatus, and non-atopics. Precipitins were found in 84% and 78% of the patients with aspergillosis by the DD and CIE methods respectively. Precipitins were also found in 6 out of 27 (22%) patients with a positive prick test to A. fumigatus but no evidence of aspergillosis and in 1 of 24 patients with a negative prick test to A. fumigatus. The means of specific and total IgE values were significantly higher in the group of patients with aspergillosis than in the three other groups of patients. The increase in specific but not total IgE showed a statistically significant correlation with positive precipitin tests in the patients with aspergillosis. Total IgE but not specific IgE values were significantly higher (0-02 less than P less than 0-05) in patients who had had a transient radiographic shadow in the previous three months. Positive precipitin tests were also significantly correlated with the number of transient shadows in the past and with the interval of time since the last transient shadow.

Intravenous or inhaled salbutamol in severe acute asthma

Abstract: Ten patients with life-threatening attacks of asthma (status asthmatiucus') were treated with salbutamol inhaled by intermittent positive pressure breathing, and their response in terms of rise in peak flow rate was measured. They were then given intravenous salbutamol and any further increment in peak flow was measured. Hydrocortisone treatment was started simultaneously and the responses to salbutamol were re-measured on each of the next three days. Only two patients initially responded to the aerosol, whereas all save one responded to the intravenous drug. The two who responded initially to the aerosol were the two who were able to produce sputum at the time of admission. All patients subsequently responded to the aerosol, and the onset of this response correlated closely with the beginning of sputum production. Sympathominetics should be given parenterally to patients in severe asthma if the response to inhaled drug is reduced or absent.

Quantitative structural study of pulmonary circulation in the newborn with pulmonary atresia.

Abstract: The lungs of eight newborn infants who had died from pulmonary atresia were studied by quantitative morphometric techniques. It was established for the first time that the abnormal pattern of blood flow through the heart and great vessels in a fetus with pulmonary atresia is associated with impaired lung development as shown by arteries that are too few, too small, and with an abnormally thin muscle coat, although the distribution of muscle along the arterial pathway is normal. Differences between the cases in the degree of impairment of lung development could be detected and related to the degree of reduction in pressure and flow before birth in the individual case. Although blood flow through the pulmonary circulation is small before birth lung development seems sensitive to any further reduction.

Studies in chronic allergic bronchopulmonary aspergillosis. 1. Clinical and physiological findings.

Abstract: This report outlines the clinical and physiological features in 50 asthmatic patients with chronic allergic bronchopulmonary aspergillosis in whom the diagnosis was made from 2 to 25 years ago (mean duration 10-9 years). From a questionnaire and analysis of the peak expiratory flow rate measurements it was found that they were worse in the winter months, corresponding to the maximal concentrations of Aspergillus fumigatus in the atmosphere. Nineteen patients reported daily sputum production of up to an eggcupful or more, and 24 had noticed sputum 'plugs' in the previous year. Reduction of vital capacity (VC) was found in 20 patients, of forced expiratory volume in one second (FEV1) in 38 patients, and of maximal expiratory flow at 50% VC breathing air (V50air) in 47 patients. Nine patients had significantly reduced gas transfer factor (DLCO). Significant improvement (more than 15%) in FEV1 after inhaled bronchodilator was shown by only 17 patients. There were statistically significant correlations between the degree of reduction in the physiological measurements of VC, FEV1, and V50air with the age of the patient at the time of the study and the later in life the diagnosis of aspergillosis was made, whereas the reduction in DLCO was also significantly related to the duration of aspergillosis. Prospective studies are needed for a proper assessment of any protective effect of treatment on the pathophysiological changes due to the disease over many years.

Lung involvement in Hodgkin's disease.

Abstract: Lung involvement occurred in 43% of 284 patients with Hodgkin's disease in Nottingham during 1960-75. It was commoner than pleural, hilar or mediastinal node involvement, although over three-quarters of patients with any other thoracic manifestation subsequently developed pulmonary involvement. The patients with pulmonary involvement contained significantly fewer with the histological feature of lymphocyte predominance. The commonest radiographic type, peribronchial infiltration, tended to occur early in the course of the disease while less common types, homogeneous or pneumonic infiltrates and nodules, occurred later. Modern chemotherapy was very effective in the treatment of pulmonary Hodgkin's disease. Since two-thirds of the patients who developed lung involvement already had stage IIIB or IV disease, the early use of chemotherapy should reduce the incidence of this common complication.

Cuirass respirator treatment of chronic respiratory failure in scoliotic patients.

Abstract: The results are reported of domiciliary cuirass respirator treatment, using tailor-made shells, in four patients with severe thoracic scoliosis. Three of the patients had suffered from poliomyelitis. All complained of increasing dyspnoea on exertion, ultimately interfering with almost every activity of daily life; three patients had severe acute respiratory failure necessitating urgent admission to the Respiratory Care Unit. Right heart failure was present in two. Two patients required mechanical treatment via an endotracheal tube. All the patients were discharged home with a cuirass respirator. Standard type shells were used initially with low efficiency due to the poor fit of the cuirass shell to the deformed thoracic cage. Tailor-made shells were constructed from polyester reinforced with glass fibre, modelled on plaster casts of the thoracic cage. Subjectively the patients improved greatly and were able to resume and increase many activities. One patient committed suicide for reasons unconnected with treatment but the other three patients have been doing well from the time the cuirass respirator treatment was started, respectively, 3, 6, and 10 years ago. This treatment seems particularly effective in younger patients with severe paralytic scoliosis and cardiorespiratory failure, although the possibility of using it in older patients suffering from scoliosis of other aetiology should certainly be explored.

Nocturnal asthma and urinary adrenaline and noradrenaline excretion

Abstract: Soutar, C. A., Carruthers, M., and Pickering, C. A. C. (1977). Thorax , 32 , 677-683. Nocturnal asthma and urinary adrenaline and noradrenaline excretion. Urinary adrenaline and noradrenaline excretion, heart rate, and peak expiratory flow rate have been measured every two hours for 24 hours in seven asthmatic patients suffering from nocturnal or early morning exacerbations of dyspnoea. The excretions of these catecholamines were normal or slightly raised, this being consistent with a normal response to asthma or the conditions of the test. The expected physiological fall in catecholamine excretion occurred at night. In every patient the peak expiratory flow rate fell to its lowest values during the period of lowest catecholamine excretion, and the mean two-hourly peak expiratory flow rate for all seven patients was significantly related to the sum of the mean adrenaline and noradrenaline excretion in each preceding two-hour period (p Individually, in three patients the relationship between peak expiratory flow rate and adrenaline and noradrenaline excretion during the evening and night was so close as to be consistent with the hypothesis that changes in sympathetic tone mediated the changes in asthma. In a further three patients the relationship was present but less clear, and in one the changes in peak flow rate and catecholamine excretion were dissociated. Studies of mean heart rate and sinus arrhythmia gap suggested that an increase in vagal tone at night might have mediated the early morning asthma in the patient in whom changes in catecholamine excretion were dissociated from change in peak flow rate. These findings would be consistent with the view that the physiological reduction in sympathetic tone at night mediates the nocturnal and early morning exacerbation of dyspnoea in some asthmatics, although other mechanisms such as alterations in vagal tone must be important in others. Confirmation of a causal relationship requires further study.

Ultrastructural examination of broncho-alveolar lavage for diagnosis of pulmonary histiocytosis X: Preliminary report on 4 cases.

Abstract: Fibreoptic broncho-alveolar lavage was used in four patients; the diagnosis of histiocytosis X had been established by lung biopsy in three and was suggested on clinical grounds in the remaining patient. Characteristic cells with an ultrastructural cytoplasmic marker (X body) were found in the washes of all four patients. In the patient without biopsy confirmation, the findings in the broncho-aleolar washes supplied the corroborating evidence for the diagnosis. From this preliminary study the technique seems able to provide a diagnosis in pulmonary histiocytosis X without the need for an open lung biopsy.

A case of pulmonary veno-occlusive disease respondong to treatment with azathioprine.

Abstract: Histological features of a lung biopsy specimen from a 46-year-old woman showed all the characteristics described in veno-occlusive disease. The clinical features, however, were distinctive in that in addition to the lung involvement there was alopecia, digital vasculitic ulcers, Raynaud's phenomenon, polyarthritis, and muscle weakness. Treatment with azathioprine resulted in a progressive improvement in her condition. It is suggested that pulmonary small vein occlusion may occur as a pattern of tissue response in more than one situation and that is sometimes more amenable to therapy than has been previously reported.

Interaction between isoprenaline and aminophylline in asthma

Abstract: Campbell, I. A., Middleton, W. G., McHardy, G. J. R., Shotter, Margaret V., McKenzie, R., and Kay, A. B. (1977).Thorax, 32, 424-428. Interaction between isoprenaline and aminophylline in asthma. Using a factorially designed study, 38 patients with bronchial asthma received a single dose of either isoprenaline by inhalation (9), aminophylline intravenously (10), isoprenaline and aminophylline (11), or placebo (8). The maximum expiratory flow (V max), the maximum expiratory flow at 50% of vital capacity (V max50), and the concentrations of plasma cyclic AMP were measured at time intervals up to two hours. The combination of isoprenaline and aminophylline acted synergistically in terms of the percent increase in V max50. However, this was statistically significant only at 20 minutes. Plasma cyclic AMP concentration rose with a similar time course of response to the changes in small airways. The elevations in plasma cyclic AMP observed with the drug combination were higher than those for the individual drugs at 10, 20, 30, and 60 minutes but these differences were not statistically significant. These observations support the concept that changes in bronchial smooth muscle tone are mediated by concentrations of cyclic nucleotides and that combinations of isoprenaline and aminophylline, rather than the administration of each drug separately, may have therapeutic advantages in the treatment of bronchial asthma.

Diagnostic fibreoptic bronchoscopy in the immunocompromised host with pulmonary infiltrates.

Abstract: Nineteen immunocompromised patients with pulmonary infiltrates underwent diagnostic fibreoptic bronchoscopy with transbronchial forceps and brush biopsy. A specific diagnosis was obtained in 21/25 procedures (10/11 focal lesions and 11/14 diffuse legions). The most common diagnosis was infection, and organisms isolated included bacteria, fungi, Pneumocystis carinii, and herpes simplex. A pneumothroax requiring tube drainage occurred in two cases and mild lung parenchymal bleeding was noted in two others. It is concluded that fibreoptic bronchoscopy with forceps and brush biopsy can be performed safely with an excellent diagnostic yield in immunocompromised hosts with lung lesions. Supplemental oxygen should be administered during fibreoptic procedures in these patients and platelet transfusions should be given when thrombocytopenia is present.

Lung function of healthy boys and girls in Jamaica in relation to ethnic composition, test exercise performance, and habitual physical activity

Abstract: Miller, G. J., Saunders, M. J., Gilson, R. J. C., and Ashcroft, M. T. (1977). Thorax , 32 , 486-496. Lung function of healthy boys and girls in Jamaica in relation to ethnic composition, test exercise performance, and habitual physical activity. The relationships of forced expiratory volume and forced vital capacity on height, age, sex, area of residence, and ethnic composition were assessed in 622 children in Jamaica. Rural children in hill-farming communities were judged to have a higher habitual physical activity than urban children. Allowing for differences in body size, forced vital capacity averaged 3% greater in rural children than in urban children, 7% less in girls than in boys, and 16% greater in children of European origin than in children of African descent. Lung volumes, indices of gas transfer, and submaximal-exercise responses were measured in a subgroup of 108 children of African descent believed to be of common genetic stock. Total lung capacity and vital capacity averaged respectively 6% greater and 7% greater in rural than in urban children of equal height but residual volume and transfer factor did not differ significantly between localities. Rural children had a lower average cardiac frequency during test exercise than did urban children. Sex differences and locality differences in vital capacity and total lung capacity disappeared when allowance was made for standardised exercise cardiac frequency. At standard body size and age transfer factor increased with decreasing cardiac frequency for standard work. The results suggest an harmonious development of the cardiac and respiratory components of the oxygen transport system, consonant with the demand for muscular work. Increased habitual physical activity and improved exercise performance appear to be associated with increases in vital capacity, total lung capacity, and transfer factor.

Quantitative characteristics of the Feyrter (APUD) cells of the neonatal rabbit lung in normoxia and chronic hypoxia.

Abstract: Our studies show that the apparent number of Feyrter cells in the lung declines during the neonatal period in normoxic rabbits, and that in hypoxic animals a uniformly and significantly lower number of cells occurs as compared with the normoxic rabbits. There is some indication of degranulation of cells in the hypoxic groups. It is suggested that environmental and/or physiological factors associated with the start of extrauterine life, or lung development, may affect the apparent number and probable level of activity of these cells. These changes seem to be enhanced by hypoxia. Mast cells are scarce, and Feyrter cells are relatively more numerous along the airways. These cell types could possibly represent storage sites for 5-hydroxytryptamine, as suggested also by other investigators. Intraepithelial nerve fibres in bronchi and bronchioles were found but they were not limited to innervations of Feyrter cells or related cell bodies.

Penumopericardium and tension pneumopericardium after closed-chest injury

Abstract: Three recent cases of pneumopericardium after closed-chest injury are described. The mechanism of pericardial inflation suspected in each was pleuropericardial laceration in the presence of an intrathoracic air leak. Deflation of the pericardium was achieved by underwater seal drainage of the right pleural cavity in the first patient, during thoracotomy for repair of tracheobronchial rupture in the second, and by subxiphoid pericardiotomy in the last. Haemodynamic changes after escape of air from the periion pneumopericardium and air tamponade.

Familial pulmonary veno-occlusive disease: a case report.

Abstract: A case of pulmonary veno-occlusive disease in a male infant who died at the age of 3 months is presented. Both intra- and extrapulmonary veins were involved. Two years earlier a brother had died of the same disease at the age of 8 weeks, but, in that case, the disease was restricted to the intrapulmonary veins. It is suggested that the disease may have been caused by a viral infection, the mother acting as a carrier. The simultaneous occurrence of intra- and extraparenchymal pulmonary vein occlusion indicates that some instances of isolated extraparenchymal pulmonary vein atresia or obstruction may also have been examples of pulmonary veno-occlusive disease.

Chylothorax: diagnosis by lipoprotein electrophoresis of serum and pleural fluid.

Abstract: This report describes a 31-year-old woman who underwent a technically difficult left pneumonectomy for tuberculosis and developed thereafter a large left pleural effusion which was milky in colour. A traumatic chylothorax was suspected, and the diagnosis was confirmed by simultaneous fasting pleural and serum lipid studies and lipoprotein electrophoresis. The latter study was especially helpful in confirming the chylous nature of the fluid in that it revealed a marked chylomicron band at the origin; this was not present in the patient's serum nor in the pleural fluid of five patients with other disease states studied as controls.