摘要:

Lymphocyte subpopulations analysis by an 11-monoclonal antibody (MoAb) panel was carried out in pleural fluid and in peripheral blood in 30 patients affected by newly diagnosed, untreated pleural effusion of different etiology determinated with bacteriological, cytological or histological criteria. Lymphocytes were the predominant cell type, in pleural fluid, in neoplastic pleural effusions as well as in congestive heart failure pleural effusions and, especially, in tuberculous pleural effusions. Lymphocyte analysis in pleural fluid and in peripheral blood suggests the involvement of different mechanisms for the lymphocyte accumulation in the pleural space according to different etiologies. Tuberculous pleural effusions showed an evident CD4+ and TEC T5.9+ lymphocyte accumulation from peripheral blood. In these patients, cutaneous skin test response to purified protein derivative was strongly related to this situation. In neoplastic pleural effusions there was a lower percentage of CD4+ lymphocytes, reflecting circulating lymphocyte pool; however, in neoplastic pleural effusions, various lymphocyte patterns may be sometimes observed depending on different histologies. Passive lymphocyte accumulation seems to be the most important mechanism in congestive-heart-failure pleural effusions

ISSN:0025-7931    

DOI:10.1159/000195899

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

We have studied three different lavage procedures (100, 200 and 300 ml) in patients with pulmonary sarcoidosis (stage I). The effect of bronchoalveolar lavage (BAL) on cell yield, lavage fluid recovery, dwelling time, lavage-induced arterial oxygen desaturation and occurrence of side effects was analyzed. The patients did not differ significantly in prelavage lung function and blood gas parameters. The lowest BAL return was seen in the 300-ml lavage procedure (49.5%), while the medium yielded over 70%. The lowest cell yield was seen in the BAL 100 group (10.4 × 106); the highest in the BAL 300 (19.4 × 106), but the latter did not differ significantly from BAL 200 (18.4 × 106). Dwelling time of the fluid differed only slightly between the small and middle volume lavage (average 3.2 vs. 3.9 min p < 0.01), but was significantly lower from the average dwelling time in the BAL 300 group (9.8 min, p < 0.001). Arterial oxygen desaturation was lowest in the BAL 100 and most pronounced in the large-volume lavage. Side effects were seen in all but 1 patient undergoing BAL 300. Cough was the most often reported side effect (9 patients); fever was observed in 6 patients, dyspnea in 4 (all undergoing large-volume lavage). Considering our results we do not think that it is justifiable to increase the volume of instilled fluid above 200 ml, because this may lead to serious side effects without increasing benefits. Using lower than 200 ml volumes decrease diagnostic yield although the risk of developing side effects is much lo

ISSN:0025-7931    

DOI:10.1159/000195900

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Twenty-five patients with histologically proven small cell lung cancer who were in too poor physical condition to receive ‘aggressive’ chemotherapy were treated with vindesine and etoposide (VE). The median survival was 195 days, and there were 4 survivors of > 460 days. Eight patients died before the second pulse of chemotherapy, and these all had a Karnofsky score of less than or equal to 20 at diagnosis. Toxicity of the chemotherapy regimen was minimal, and the results suggest that VE chemotherapy may be suitable for the treatment of patients with small cell lung cancer who are unsuitable for more toxic chemothe

ISSN:0025-7931    

DOI:10.1159/000195901

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Sixteen patients with mitral valve disease, in whom bronchial hyperresponsiveness to methacholine had been detected shortly before mitral valve replacement (MVR), were reevaluated 35 ± 1.5 months after MVR. In 9/16 patients there was a significant (> 1.5 fold) increase in bronchial provocation dose of methacholine (PD20FEV1) after MVR. In the same patients there was a significant increase in vital capacity (from 69.6 ± 5 to 75.8 ± 5.2% of predicted, p < 0.01), a significant decrease in cardiothoracic ratio and in radiologic score for lung edema (from 64.3 ± 2.9 to 56 ± 2.1, p < 0.01 and from 38 ± 4.5 to 14.6 ± 2, p < 0.001, respectively). In all the patients the increase in PD20FEV1 was not related to any change in spirometric values but it was related to the decrease in cardiothoracic index (r = 0.72, p < O.Ol) and in radiologic score for lung edema (r = 0.61, p < 0.05) observed after cardio

ISSN:0025-7931    

DOI:10.1159/000195902

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The pulmonary and systemic circulatory response to repeated exercise has been studied in 24 patients with chronic lung disease, mainly chronic bronchitis. The exercise consisted of supine bicycling at a constant low load (from loadless pedalling to 30 W) for 10 min with a 20 min rest period between exercises. Cardiac output was similar during the first (E1)and the second (E2) exercise periods, as well as pulmonary vascular resistance. Systemic arterial pressure, however, was lower during E2 than during E1, and this difference was significantly correlated with lung function (VC % predicted, FEV1 and FEV1 % predicted) and blood gases at rest and during exercise. The patients with PaO2 below 65 mm Hg showed a larger increase in systemic arterial pressure during E1 and a smaller increase during E2 than the others. The larger increase might be due to a vasoconstrictor effect of hypoxemia and/or of the functional residual capacity increase observed in such patients with exercise. Whatever the mechanism involved, these results show that the systemic circulation is modified in patients with chronic lung disease. Results after some intervention have to be interpreted with caution if the protocol includes two exercise periods

ISSN:0025-7931    

DOI:10.1159/000195903

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

The influence of erdosteine (a mucomodulator endowed with mucolytic and antioxidant properties) on human mucociliary transport (MCT) was investigated in a double-blind placebo controlled study. Sixteen former smokers affected by chronic bronchitis, preselected for their mucociliary responsiveness to an inhaled β2-agonist, were divided into two groups (matched by number, sex, age and FEV1%) and orally treated with placebo or erdosteine (300 mg t.i.d.) for 8 days. Their MCT was assessed by the bronchofiberscopy technique just before starting the treatment and at the end of the treatment. The pretreatment mucus transport velocity in these patients was significantly decreased with respect to healthy subjects. The erdosteine treatment induced a significant improvement of MCT while placebo was inactive (mean % variation ± SE against their baseline values being +60.4 ± 18.4 and -3.0 ± 5.9, respectively). This peculiar activity of erdosteine on mucus transport may be of clinical usefulness in chronic bronchitic patients and it can be added to β2-agonists to restore the decrease

ISSN:0025-7931    

DOI:10.1159/000195904

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Pulmonary function has been studied extensively in patients with unilateral diaphragmatic paralysis (UDP), but there is scarce information regarding the respiratory function during sleep in this condition. We therefore studied pulmonary function in 12 patients with UDP when awake and when asleep. Diaphragmatic dysfunction was confirmed by the demonstration of low maximal transdiaphragmatic pressures in most of our patients; paradoxical gastric pressure swing was observed in 6 patients. There was a restrictive pattern in pulmonary function tests and resting arterial blood gases were rather well preserved (range SaO2 90–95%). Overnight sleep monitoring showed that the time spent in REM sleep and stage 3 and 4 sleep was reduced. The mean maximum decrease in SaO2 was 15.2 ± 6.2% and the time with an SaO2 drop of more than 5% of the awake SaO2 was 25.4 ± 22.8 min. None of our patients was in respiratory failure or had clinical evidence of cor pulmo-nale. We conclude that UDP leads to significant nocturnal hypoxemia but, in the absence of systemic lung disease, does not lead to chronic respiratory failure and cor pulmo

ISSN:0025-7931    

DOI:10.1159/000195905

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

To determine its predictive value, polysomnography was performed on 14 snorers with sleep apnea syndrome (SAS) before and 3 months after uvulopalatopharyngoplasty (UPPP). In the 8 patients considered as cured (less than 10 apneas per hour after UPPP), total apnea index (TAI) decreased from 29.7 ± 22.6 to 4.9 ± 3.5. Rapid eye movement sleep (REM) increased from 10.9 ± 3.6 to 14 ± 5.7% of the total sleep period (TSP). In the 6 uncured patients, TAI decreased from 59.7 ± 15.7 to 32 ± 15.7 and REM increased from 7.7 ± 5.6 to 15.8 ± 7.2% of TSP. Snoring and drowsiness decreased in both cured and uncured patients. A presurgical apnea index < 40 seems to be a reliable predictor of sucessful UPPP. The association of obstructive apnea with either central apnea or mixed apnea was not a factor of poor prognosis. Better sleeping could explain in part the clinical improvement in both cured and uncured patients, but postoperative polysomnography is needed to detect asymptom

ISSN:0025-7931    

DOI:10.1159/000195906

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

Since patients with chronic liver disease present with greatly varying theophylline disposal reductions, in cirrhotics the acute theophylline dose schedule must be guided by an index of liver function that predicts theophylline pharmacokinetics. We therefore studied 26 patients with severe chronic liver disease to ascertain the efficacy of the routinely used clinical and biochemical liver function tests in predicting theophylline pharmacokinetics. The prealbumin plasma level, recently proposed as a valuable index of liver function, was also considered. With respect to 10 controls, theophylline clearance was found to be significantly reduced (30 ± 2 vs. 75 ± 11 ml/kg/h, mean ± SD, p < 0.01). However, only 7 patients had a reduction great enough to require a reduced intravenous theophylline dose schedule. An analysis of clinical utility, made on the basis of ROC curves, showed that the albumin/globulin ratio was the most effective index for identifying patients requiring lower doses of theophylline. Prealbumin and albumin were also useful, whereas bilirubin, prothrombin time, pseudocholinesterase, the presence of ascites and Pugh-Child’s classification of the severity of liver disease were found to be wort

ISSN:0025-7931    

DOI:10.1159/000195907

出版商:S. Karger AG    

年代:1991

数据来源: Karger

摘要:

This report describes 2 cases of pulmonary aspergiUoma in whom the fungus balls were visualized on fiberoptic bronchoscopy.

ISSN:0025-7931    

DOI:10.1159/000195908

出版商:S. Karger AG    

年代:1991

数据来源: Karger