摘要:

We evaluated right ventricular (RV) diastolic performance in 12 healthy subjects (control), 25 patients with chronic pulmonary diseases (CPD) and 6 patients with chronic pulmonary thromboembolism (PTE). Flow velocity patterns were determined by the pulsed Doppler technique. The values determined included acceleration time (AT), deceleration time (DT), and the ratio of the atrial contraction wave (A) to the rapid filling wave (R) (A/R ratio) from flow velocity patterns in the RV inflow tract. DT was significantly prolonged in the CPD and PTE groups compared with the control group, indicating dysfunction during the early (middle) filling period. The prolongation was marked in those patients with pulmonary hypertension. The A/R ratio was significantly higher in the CPD and PTE groups than in the control group, indicating a decrease in RV compliance. The A/R ratio increased slightly with the increase in the end-diastolic volume index. These results suggested that the pressure overload plays an important role in RV diastolic dysfunction in patients with pulmonary disease, and that preload contributes to the dysfunction.

ISSN:0025-7931    

DOI:10.1159/000196455

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We attempted to develop a pulmonary hypertension model in dogs by gelatin sponge embolization. We then monitored right-ventricular pressure overload by echocardiography. Gelatin sponges (Spongel®, Yamanouchi, Tokyo) were homogenized and mixed in normal saline (0.6 mg/ml). The mixture was administered via the jugular vein to general pulmonary emboli. Repeated administration of the sponges increased the mean pulmonary arterial pressure and caused right ventricular pressure overload. The degree of pulmonary hypertension was proportional to the volume of gelatin sponge injected. Echocardiography, performed both before and after embolization, proved useful assessing for the degree of right-ventricular pressure overload

ISSN:0025-7931    

DOI:10.1159/000196456

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We prospectively followed 68 patients diagnosed as idiopathic interstitial pneumonia (IIP) over a period of 1-11 years. Thirteen patients (19%) subsequently developed systemic manifestations of collagen vascular diseases (CVD) and were diagnosed as having had interstitial pneumonia as the sole presentation of CVD (CVD-IP). Compared with the 55 IIP patients, the 13 CVD-IP patients were relatively younger, predominantly female, and had a lower incidence of dust inhalation in their history. They also had a higher erythrocyte sedimentation rate, higher incidence of the x-ray finding of discoid atelectasis in the lower lung fields, and a better prognosis than the IIP patients. However, these features did not clearly distinguish the two groups. We conclude that the patients clinically and/or histologically defined as suffering from IIP cannot be distinguished from CVD-IP patients before systemic signs of CVD appear in the latter group.

ISSN:0025-7931    

DOI:10.1159/000196457

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A modified radioimmunoassay (RIA) for desmosine in the urine was investigated as a tool for the rapid estimation of lung elastin catabolism. Cystic fibrosis (CF) and oxygen toxicity were chosen as conditions that might show altered elastin destruction. Using an antibody bound to magnetic particles the RIA was adapted to handle large numbers of samples requiring only 50 μl or urine. The experiments show that it was not necessary to hydrolyze or extract the urine prior to assay and that collecting spot urines and normalizing the data to urine creatinine gives the same interpretation of the data as total desmosine in a 24-hour collection. Urine desmosine levels were elevated in 10 of 16 patients with CF; however, daily fluctuations were considerable in some subjects, varying as much as 5-fold and underlining the importance of assaying several consecutive days of urine in acute disorders for an accurate estimate of desmosine excretion. The RIA for desmosine is a rapid and sensitive assay that requires no sample preparation and could be applied to clinical situations that require large numbers of samples

ISSN:0025-7931    

DOI:10.1159/000196458

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Three different assays for fïbrin/fibrinogen degradation products (FDP) were evaluated in patients with suspected pulmonary embolism (PE) as rapid screening tests with the aim of evaluating whether they could be used either as a substitute of ventilation/perfusion lung scanning or to supplement scintigraphy in patients in whom the scan was inconclusive (low or intermediate probability). D-Dimer by enzyme-linked immunosorbent assay (ELISA) and latex and total FDP by ELISA were measured prospectively in 85 consecutive patients with suspected PE. With a cutoff of 500 ng/ml, D-dimer by ELISA presented a 96% sensitivity and a 42% specificity, with positive and negative predictive values of 49 and 96%, respectively. D-Dimer by latex, also with a cutoff of 500 ng/ml showed a 93% sensitivity and 29% specificity, with positive and negative predictive values of 43 and 89%. For total FDP, with a cutoff of 900 ng/ml, the sensitivity and specificity were 96 and 26% respectively, with positive and negative predictive values of 42 and 93%. A normal assay may have reduced the necessity of a ventilation/perfusion only in 28% patients with D-dimer ELISA, 21% with D-dimer latex and 17% with total FDP ELISA and with a possible error of 4, 11 and 7%, respectively. Conclusions: (1) a D-dimer by ELISA < 500 ng/ml or total FDP by ELISA < 900 ng/ml excludes the diagnosis of PE, and no more studies are needed; (2) a D 900 ng/ml does not exclude other diagnostic procedures, and (3) more extensive studies are needed to clarify the utility of D-dimer by latex

ISSN:0025-7931    

DOI:10.1159/000196459

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The cough reflex, a vagus-mediated respiratory protective reflex, was investigated in diabetics and healthy controls by establishing a cough reflex threshold to increasing concentrations of citric acid aerosol. Diabetics with autonomic neuropathy (n = 20), whether overtly symptomatic (n = 5) or evident only on certain non-invasive cardiovascular autonomic function tests, were found to have significantly (p < 0.05 by 0χ2 100%, median value 50%) in contrast to either the non-neuropathic diabetics (n = 20) or normal controls (n = 20; range 1-10%, median value 2%). This difference suggests vagal (parasympathetic) denervation of the respiratory tract, with possible serious consequences, hitherto little appreciated

ISSN:0025-7931    

DOI:10.1159/000196460

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The long-term low-dose administration of erythromycin is effective in treating chronic inflammatory diseases of the lower respiratory tract. The aim of this study was to clarify the mechanism for this therapeutic effect of erythromycin. We measured its effect on the production of superoxide anion (O2-) by polymorphonuclear leukocytes (PMN) that was induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) or by phorbol myristate acetate (PMA). 25 μM erythromycin inhibited fMLP-induced O2- production by about 50%, but not PMA-induced O2- production. Moreover, this inhibition was overcome by adding an inhibitor of cyclic AMP-dependent protein kinase (PKA), H-89. The fMLP-induced O2- production was also inhibited by isoproterenol, a β-adrenergic agonist, and by dibutyryl cyclic AMP, a cell membrane permeating analogue of cyclic AMP. The inhibition was also overcome by the addition of H-89. Therefore, the effect of erythromycin seemed to be, in part, mediated through the activation of PKA. The inhibition by erythromycin of O2- generation by PMN may contribute to the beneficial effect of this drug in treating chronic respiratory disease

ISSN:0025-7931    

DOI:10.1159/000196461

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

To clarify the mechanism for Cl- transport in swine tracheal submucosal gland cells, we measured chloride (Cl-) flux by means of a Cl--sensitive fluorophore, 6-methoxy-N-(3-sulfopropyl)quinolinium (SPQ). An abrupt change of Cl--free bath to a Cl--containing (114 mM) solution induced the Cl- influx into the cells at a rate of 0.52 mM/s (p < 0.05). Removal of sodium (Na+) and the addition of 0.5 mM furosemide significantly reduced the rate of gradient-induced Cl- influx to 0.21 (p < 0.05) and 0.19 mM/s (p < 0.05), respectively. In gland tissue treated with 0.1 mM ouabain, the removal of external potassium (K+) in the presence of 5 mM barium significantly reduced the rate of Cl- influx to 0.21 mM/s (p < 0.05). An abrupt change from a Cl--containing bath to a Cl--free solution induced the Cl- efflux from the cells at a rate of 0.10 mM/s (p < 0.05). Acetylcholine increased the rate of gradient-induced Cl- efflux in a dose-dependent manner to 0.78 mM/s at 10-6M This effect of acetylcholine was significantly diminished by diphenylamine-2-carboxylic acid (DPC, 10-9M), a Cl- channel blocker (p < 0.05). Isoproterenol (10-5 M) had no effect on the Cl- efflux. These findings indicate that a Na-K-Cl co-transporter plays a major role in Cl- entry, and that Cl- efflux was activated by cholinergic receptor stimulation, but not by β-adrenergic stimulation, via a DPC-inhibitable Cl- channel

ISSN:0025-7931    

DOI:10.1159/000196462

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The probability of an AIDS patient being infected with tuberculosis (TB) has been studied in different populations and found to be increased by as much as 500 times, but the reverse, i.e. the probability of a patient with TB being infected with HIV, has not been studied. The aim of this study was to investigate the hypothesis of greater HIV seropositivity and altered immune status, as indicated by CD4+ T-lymphocyte counts, in TB patients. We prospectively studied 162 males, aged 18-30 years, hospitalized for active, proven TB. Serum for HIV antibodies was tested twice by ELISA and confirmed by the Western blot technique. The control group consisted of 145,000 blood donor volunteers serving in the army, aged 18-30 years. The number of CD4+ T lymphocytes was also measured in the patients and the control group. We found that the rate of HIV seropositivity in TB patients was 2.4% (4 of 162), while it was 0.214% in the control group (p < 0.0001). Using the Bayes’ theorem we found that the probability of a TB patient being infected with HIV was 9.1%, approximately 150 times higher than the expected rate in the matched control group (p < 0.0001). The number of CD4+ T lymphocytes was significantly lower in pulmonary and extrapulmonary TB patients than in the control group, taking into account the HIV status (p < 0.001). Our results suggest that there is a 150 times greater probability of a TB patient being infected with HIV. CD4+ T lymphocytes are significantly lower in all groups of TB patient

ISSN:0025-7931    

DOI:10.1159/000196463

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

A rare case of ankylosing spondylitis with interstitial pulmonary disease of the upper lung field, at an early stage in the disease, is described. The patient, a 35-year-old asymptomatic woman, was admitted to the hospital due to an abnormal chest radiograph that was found during preoperative evaluation for a toxic adenoma of the thyroid gland. Her mother and sister were also found to suffer from ankylosing spondylitis but without lung involvement. History, physical and laboratory examination as well as open lung biopsy excluded other causes of an interstitial pulmonary disease. The diagnosis of ankylosing spondylitis was based on clinical, radiographic, positive human leukocyte antigen (HLA-B27) and histologic findings.

ISSN:0025-7931    

DOI:10.1159/000196464

出版商:S. Karger AG    

年代:1995

数据来源: Karger