摘要:

The actual deposition pattern of micronized drugs from metered dose inhalers (MDI) is incompletely known because there are no methods available to label the drugs (β2-agonists) with γ-emitters. Indirect measurements of the distribution of the drug in man differed greatly due to the method used. Our method uses the better solubility of 99mTcO-4 in the β2-agonist-micronized drug in relation to the propellant with surfactant. The principle is to extract the 99mTcO-4 from the original water phase into the liquid phase of the propellant with ethyl methyl ketone. For labeling the micronized drug particles, the original MDI must be cooled to -60 °C and some labeled propellant (including surfactant) with high specific activity of 99mTcO-4 is added through an aperture in the bottom of the container. The aperture is sealed with a screw. After rewarming the MDI, more than 90% of the added 99mTcO-4 is dissolved in the β2-agonist-micronized drug in relation to its volume. This is proved by comparing the distribution of the radioactivity component with chemical analysis. The pattern of deposition of both MDIs -placebo and β2-agonist-micronized drug – was shown to be similar in healthy volunteers. With a labeled MDI a preliminary study with 2 different inhaling maneuvers was performed in 7 volunteers: inhaling from residual volume after a pause of 2 s the intrabronchial deposition was 18.7%, and inhaling at 50% of vital capacity maneuver the intrabronchial deposition was 33.0%. The data obtained with actual measurement of the inhaled drug from MDI suggest greater intrabronchial deposition than was assumed before in the lit

ISSN:0025-7931    

DOI:10.1159/000195399

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Inhaled adenosine causes bronchoconstriction in asthmatic patients. In 7 symptom-free asthmatics a study was performed to investigate the effect of sodium cromoglycate and nifedipine on adenosine-induced bronchoconstriction. All patients were challenged with increasing doses (from 0.03 to 2 mg) of nebulized adenosine to assess airway reactivity. The same procedure was repeated on different days at the same time each morning after administration of placebo and drugs in a randomized double-blind study. Airway response was measured as the forced expiratory volume in 1 s (FEV1). The PD20 value and the fall of FEV1 at the provocative dose were calculated. The PD20 data were modified in log values and the statistical analysis was performed by two-way analysis of variance. Mean decrease of FEV1 after adenosine challenge was 26.02 and 28.87% with placebo sodium cromoglycate and placebo nifedipine, respectively. Sodium cromoglycate and nifedipine gave a mean decrease of FEV1 of 6.44% (p < 0.05) and 22.22%, respectively. PD20 values (geometric mean) after adenosine inhalation were 0.72 and 0.74 mg for placebo sodium cromoglycate and placebo nifedipine and 0.86 mg for nifedipine. Sodium cromoglycate gave a significant protection against adenosine in all subjects and in no case did the maximum dose used (2 mg) result in a fall in FEV1 20%. Adenosine antagonism could be considered as a possible factor contributing to the pharmacologic efficacy of sodium cromoglycate in asthmatic patients. No protective effect was noticed with nifedipine. The results demonstrate that adenosine-induced bronchoconstriction is not related to calcium metabolism, even if the data provided do not completely exclude a possible action of adenosine on calcium channels.

ISSN:0025-7931    

DOI:10.1159/000195400

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

In 23 consecutive patients (mean age, 38.6 years) with systemic lupus erythematosus (SLE) and in 17 healthy subjects (mean age, 37.5 years) fatigue of respiratory (diaphragm, musculi intercostales externi) and leg muscles (musculus gastrocnemius) was determined comparatively by electromyography. Additionally, routine lung function parameters, including maximum inspiratory (PImax) and expiratory (PEmax) mouth pressures, were measured. The SLE patients showed lower values of vital capacity (VC), total lung capacity (TLC), thoracic gas volume (TGV), FEV1, PImax and PEmax than the healthy controls, while FEV1/VC, residual volume and specific airway conductance were not significantly different in either group. Lung compliance, corrected for TGV, was normal in the SLE group. Breathing through stenoses with increasing resistances resulted in fatigue of the diaphragm in 73 % of the SLE group and in 41 % of the control group. The corresponding values of the external intercostal muscles were 74% (SLE group) and 29% (control group). Electromyographic signs of respiratory and leg muscle fatigue occurred at lower loads in the SLE group than in the healthy subjects. The pattern of lung function data in patients with SLE was characteristic neither of lung restriction nor of airway obstruction. Respiratory muscle weakness can explain the decrease in TLC, VC, TGV, FEV1 PImax and PEmaχ

ISSN:0025-7931    

DOI:10.1159/000195401

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

On the basis of comprehensive clinicopathological evidence 6 patients presenting with unilateral left-sided hyperlucent lungs are evaluated for pathogenesis, function and postoperative (n = 5) course. The common denominator in all proves to be moderate to severe hypoperfusion and overinflation of the respective lungs. Pulmonary function is characterized by a combined restrictive-obstructive pattern. In 4 patients overinflation is due to a central check-valve mechanism (tumor: n = 3; central airways collapse: n = 1), whereas in 2 increased translucency results from some sort of peripheral obstruction (Swyer-James syndrome: n = 1; congenital cystic bronchiectasis: n = 1). We consider the origin of hypoperfusion to be alveolar distension and hypoxic precapillary vasoconstriction, both participating in diminished blood flow to the check-valve obstructed lung. In Swyer-James syndrome reduced vascularity is an additional feature.Preoperative and long-term postoperative lung function data of 5 pneumonectom-ized patients are compared. On the whole, FEV1 and IVC remain unchanged, whereas the obstructive profile (RV, RV/TLC, sRAW) improves. From these data it is concluded that the affected hyperlucent lung is ‘amputated’ even before operation – irrespective of the nature of tissue damage. On the other hand postoperative relief of airways obstruction is supposed to be due to both antiobstructive medication and the removal of a diseased

ISSN:0025-7931    

DOI:10.1159/000195402

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

Longitudinal light and electron microscopy investigations were previously carried out on Wistar rats to study the pathogenesis of pulmonary fibrosis due to asbestos. In the present study, the genesis of pulmonary carcinomas and pleural mesotheliomas have been investigated by light and electron microscopy on the same model after intrabronchial instillation of chrysotile B and benz(a)pyrene, as well as a combination of the two carcinogens. A single instillation of 1 mg chrysotile B with a fiber length between 0.05 and 0.2 μm in 0.1 ml tricaprylin by means of a polyvinyl catheter into the right lower lobe of the lung of 70 anesthetized 6-week-old Wistar rats caused pulmonary carcinomas or malignant pleural mesotheliomas in 18 animals (24%). The tumors occur at intervals between 12 and 31 months after the asbestos application. By electron microscopy, small asbestos fragments can be detected under the pleural mesothelium at the earliest 1 year after the intrabronchial application of chrysotile. A single combined instillation of 1 mg chrysotile and 0.5 mg benz(a)pyrene does not increase the tumor incidence. With simultaneous administration of these two substances, however, lung tumors arise very much earlier than in instillation of only one of the carcinogens. Thus, an ad-enocarcinoma was found in the lungs after 4.5 months, and a pleural mesothelioma was already found after 7.7 months. The intrabronchial instillation of benz(a)pyrene alone causes fewer lung tumors (tumor incidence 10%, interval between 13 and 33 months)

ISSN:0025-7931    

DOI:10.1159/000195403

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

A woman aged 17 years presented with symptoms of somnolence. A bilateral diaphragmatic paralysis and an Arnold-Chiari malformation were diagnosed. Lung function tests revealed a marked restrictive defect and a blunted ventilatory response to hypercapnia and hypoxia. A sleep study also showed central apneas, an irregular pattern of breathing and marked hypoventilation.

ISSN:0025-7931    

DOI:10.1159/000195404

出版商:S. Karger AG    

年代:1988

数据来源: Karger

摘要:

We describe 3 patients with simultaneous infection by Cryptococcus neoformans and Legionella pneumophila. Legionnaires’ disease (pneumonia) occurred shortly after onset of cryptococcal meningitis in a cardiac transplant patient receiving ciclosporin, a second patient with chronic lymphocytic leukemia and a third patient with Hodgkin’s disease and autoimmune hemolytic anemia. Defects in cell-mediated immunity have been identified in patients with hematologic malignancies and in those who have received organ transplants. Clinical and experimental data suggest that the primary host defense mechanism against cryptococcal and Legionella infection involves cell-mediated immunity. Thus, the simultaneous occurrence of cryptococcal and L. pneumophila infection in these 3 patients supports experimental studies which have demonstrated common host defense mechanisms against both pathog

ISSN:0025-7931    

DOI:10.1159/000195405

出版商:S. Karger AG    

年代:1988

数据来源: Karger