ISSN:0025-7931    

DOI:10.1159/000196469

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

To understand the significance of measured extravascular thermal volume of the lung (ETVL) in chronic pulmonary diseases, we measured ETVL using the double-indicator dilution technique in 17 emphysematous patients and 15 patients with pulmonary fibrosis. The level of ETVL in emphysema is significantly correlated with parameters reflecting the severity of the disease, including FEV1.0% (r = 0.54, p < 0.05), DLCO/VA (r = 0.54, p < 0.05), PaO2 (r = 0.61, p < 0.01), and mean pulmonary artery pressure (r = -0.61, p < 0.01). In pulmonary fibrosis, a significant inverse correlation was found between ETVL and PaO2 (r = -0.64, p < 0.02), DLCO/VA (r = -0.58, p < 0.05), and %VC (r = -0.61 p < 0.02). The mean level of ETVL in both groups of patients was lower than previously reported normal values. These results suggest that ETVL may reflect the decrease in pulmonary vasculature in emphysematous patients, while it may signify a decrease of pulmonary vasculature and increased volume of pulmonary interstitial tissue surrounding the pulmonary vasculature in pulmonary fibrosis. We conclude that ETVL may represent a good estimate of the condition of the pulmonary vasculature and interstitial tissue volume in patients with chronic pulmonary diseases.

ISSN:0025-7931    

DOI:10.1159/000196470

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The purpose of the current study was to determine the effect of low-dose Escherichia coli lipopolysaccharide (LPS) on pulmonary vascular permeability when administered after hemorrhagic shock (40% of baseline cardiac output) followed by resuscitation. Animals were monitored for 3-4 h after LPS infusion. Thirty minutes prior to termination of the experiment, 3 mCi of 125I-human serum albumin was injected intravenously to calculate a permeability index from the left lung lavage and plasma 125 0.05). Similarly, there was no difference in the wet-to-dry ratios between the three groups. The shock + LPS group required more intravenous fluids to maintain mean arterial blood pressure at control values than the LPS-only group (p < 0.003). We conclude that hemorrhagic shock and resuscitation do not lead to an acute increased permeability of the lung when it is subsequently challenged by a low dose of bacterial

ISSN:0025-7931    

DOI:10.1159/000196471

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Fibronectin (FN) is a glycoprotein present in the epithelial surface of airways and in the interstitial parenchyma of the lung. The aim of this study was to quantify the amount of FN in human lung parenchyma, and to investigate possible differences between smokers and non-smokers, both in lung parenchyma and in bronchoalveolar lavage (BAL) fluid. BAL fluid was recovered in 21 individuals. Quantification of FN in BAL was done by a non-competitive ELISA. Twenty-six lung parenchyma samples were also obtained from lung resections. FN was extracted with urea and heparin. Quantification of FN in lung parenchyma was determined by a competitive ELISA. The mean ± SD FN content in BAL fluid from smokers was 1.59 ± 1.65 μg/mg total protein and 0.53 ± 0.26 in non-smokers (p < 0.05). However, the amount of FN/ml BAL fluid was not statistically different between smokers (0.15 ± 0.13 μg/ml) and non-smokers (0.106 ± 0.07). The mean extractable FN in human lung tissue was 38.6 μg/g wet weight (31.7-45.5, 95% mean confidence interval) with no statistical difference between smokers and non-smokers. We conclude that in smokers, FN accounts for a higher proportion of the total protein in BAL fluid, and that there were no differences in FN content in lung parenchyma between smokers and non-

ISSN:0025-7931    

DOI:10.1159/000196472

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Pulmonary alveolar proteinosis (PAP) is a rare disease in which alveoli are filled with lipoproteinaceous materials. We measured carcinoembryonic antigen (CEA) concentrations in bronchoalveolar lavage (BAL) fluids and sera from patients with PAP and from healthy volunteers (HV). Significantly increased CEA values were found in BAL fluids and sera from patients with PAP compared with those from HV. BAL fluid CEA values significantly correlated to serum CEA values in patients with PAP. Serum CEA values significantly correlated to serum lactate dehydrogenase activity and alveolar-arterial PO2 difference values in patients with PAP. Successive measurements of serum CEA showed that serum CEA values reflect the disease activity of PAP. The determination of serum CEA is useful for evaluating disease severity of PAP.

ISSN:0025-7931    

DOI:10.1159/000196473

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The interaction of vagal neuronal and pharmacological mediator mechanisms on the airway-constrictory responses obtained from challenges with aerosolized methacholine (MCH) before and after bilateral vagotomy and in combination with electrical stimulation of the peripheral ends of the cut vagal nerves was investigated in anesthetized Ascaris allergen skin-sensitive sheep. Inhalation of aerosols of 2 and 5% MCH for 2 min in a control group of 10 sheep resulted in airway muscle constriction indicated by an increase in dynamic elastance (Edyn) (+70 and +256% of the basic value) or inspiratory airway resistance (RI) (+45 and +155%) and was associated with a significant rise in plasma histamine concentration (HiP1) from 0.2 ± 0.2 to 0.9 ± 1.1 and 1.5 ± 1.2ng/ml, respectively. Respiratory and cardiovascular responses to MCH were reproducible after 90 min of recovery. A second group of another 6 intact sheep showed similar alterations of respiratory mechanical parameters and HiP1 after MCH challenges. After bilateral vagotomy, Edyn and RI increased after 2 and 5% MCH inhalation only by 15-30% of the control responses with intact vagi. The diminished airway constriction was associated with similar changes in HiPl as observed with intact vagi. Inspite of severe cardiovascular responses, the most effective electrical stimulation of the peripheral ends of the vagal nerves resulted in an increase in Edyn or RI by only 40-50% of the basic value. In a tracheal segment beneath the cuff of the endotracheal tube isometric pressure effectively increased by almost 500% of the basic value. Vagus nerve stimulation was found without detectable changes in HiPl. Stimulation of the central ends of the vagal nerves did not induce airway constriction or alterations in HiPl. The combination of electrical vagus nerve stimulation and MCH inhalation resulted in a more than additive increase in Edyn and RI, but the airway responses did not reach the same level of obstruction after challenge with 5% MCH as observed with intact vagi. Electrical stimulation of the efferent vagi failed to simulate spontaneous vagal nerve activity at higher levels of airway muscle responses. The results demonstrate that vagal neuronal mechanisms interact with local mediator liberation in acute airway obstruction. Airway challenge tests using cholinergic substances liberate histamine from inflammatory cells in the lungs of Ascaris skin-sensitive she

ISSN:0025-7931    

DOI:10.1159/000196474

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

We studied 177 patients with pneumonia admitted to an internal medicine department over a period of 3 years to determine the incidence of two emerging pathogens, Legionellapneumophilaand Mycoplasma pneumoniae. Clinical, radiological and laboratory tests were performed and included blood cultures, serology, gram staining and sputum cultures. L.pneumophila was the agent involved in 9 patients (5.1%) and M. pneumoniae in 12 (6.8%). These prevalences were about in the middle of the range of previously published figures. Legionella pneumonia is a rare illness, which even in the absence of suggestive clinical signs must be considered because of its possibly serious course and to allow appropriate therapeutic decisions to be made.

ISSN:0025-7931    

DOI:10.1159/000196475

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Studies investigating the epidemiology of tuberculosis in Greece are lacking. Tuberculosis (TB) continues to be a public health problem and its dimensions are not clearly defined. The aim of this study was to estimate the incidence of pulmonary and pleural TB in each of the three branches of military personnel serving in the Greek armed forces, during the period 1965-1993. All military personnel with confirmed pulmonary or pleural TB during the period 1965-1993 were studied retrospectively. The age of the patients ranged from 18-45 years. A significant number of TB patients were detected by the regular chest radiography screening using mass miniature radiography during enrolment. The diagnosis of TB was made both by clinical and paraclinical examinations, such as history, symptoms, physical examination, tuberculin skin reactivity, chest X-ray and/or computed tomography of the thorax, bronchoscopy, microbiological examination of specimens (sputum, washings, bronchoalveolar lavage) as well as histological and bacteriological examination of the biopsies. We found that during the period studied, 4,628 patients were hospitalised for TB, 3,588 for pulmonary TB, and 1,040 for TB pleuritis (3,781 in the army, 445 in the navy and 402 in the air force). In 1965, the incidence (per 100,000) of TB (pulmonary and pleural) in the army was 60, in the navy 50, and in the air force 30. This incidence increased gradually from 1965 to 1980, followed by a decrease, since BCG vaccination became obligatory in 1980; values in 1993 were 18 in the army, 25 in the navy, and 15 in the air force. These figures are significantly higher than those reported for the civilian population, probably due to underreporting in the latter. Our results suggest that the incidence of TB in the Greek armed forces, although still high, is declining steadily. Strengthening of the anti-TB campaign is indicated.

ISSN:0025-7931    

DOI:10.1159/000196476

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

Bronchoscopy obtaining bronchoalveolar lavage (BAL) fluid and bronchial secretions (BS) and/or high-resolution computed tomography (CT) of the lungs were performed in 33 patients with pulmonary aspergillosis from 1987 to 1992. The sensitivity of BAL fluid or BS for detecting histologically proven fungal disease was 33 and 50%, respectively, whereas positive serologies were only documented in 8% of the cases. CT scans contributed to the early diagnosis of opportunistic fungal pneumonia: characteristic CT signs were found in 16 of 19 episodes. The more frequent use of bronchoscopy and CT scans between 1990 and 1992 compared to 1987-1989 for the differential diagnosis of new pulmonary infiltrates resulted in earlier appropriate treatment. The average introduction of intravenous (i.v.) antifungal therapy after the onset of pneumonia was shifted from 12 to 7 days (p < 0.05). The timely implementation of i.v. antimycotic therapy had a significant impact on survival. Initiation of antifungal treatment later than 10 days after the onset of pneumonia resulted in a mortality of 90%, as opposed to 41% with an earlier start of antimycotics (p < 0.01). The earlier use of appropriate antifungal therapy in the second treatment period improved survival from 33 to 50% (NS). Bronchoscopy and high-resolution CT scans are mutually complementary diagnostic tools and should be performed as early as possible in the course of pneumonia for patients at high risk for aspergillosis.

ISSN:0025-7931    

DOI:10.1159/000196477

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The relationship between the degree of nocturnal oxygen desaturation (NOD) and pulmonary hemodynamics, pulmonary function tests, and resting awake blood gases was evaluated in patients with chronic pulmonary diseases (CPD). The severity of NOD correlated with the degree of impairment of pulmonary hemodynamics, but not with pulmonary function tests or resting awake blood gases. NOD was markedly alleviated by oxygen inhalation in CPD patients who did not develop sleep apnea.

ISSN:0025-7931    

DOI:10.1159/000196478

出版商:S. Karger AG    

年代:1995

数据来源: Karger