摘要:

Eight patients with mild extrinsic asthma participated in a double-blind randomized intraindividual cross-over study involving 6 weeks’ treatment with twice daily oral theophylline (2 × 1 capsules = 800 mg/day Cronasma 400®) and 6 weeks’ treatment with twice daily inhaled budesonide (2 × 2 puffs = 0.8 mg/day Pulmicort®) with nebuhaler administered in the morning and in the evening before eating. Lung function and carbachol provocation measured with the whole-body box method were performed at the beginning and after 6 weeks of treatment. Mucociliary clearance (MC) assessed with a scintillation camera and bronchoalveolar lavage (BAL) were both performed after 6 weeks of treatment. All patients documented daily peak flows in the morning and in the evening. Additional use of β2-agonists at night and during the day was not different for theophylline (0.10 ± 0.39 and 1.16 ± 2.87 puffs) and budesonide (0.11 ± 0.45 and 1.97 ± 3.02 puffs). MC (32 ± 15% under theophylline and 33 ± 14% after budesonide), carbachol provocation and lung function data at the end of both treatment periods were the same as well as BAL data. Two patients needed a reduction of the theophylline dose due to nausea. This study documents the equipotency of theophylline (mean blood level 11.9 ± 4.6 mg/l) and budesonide (2x2 puffs = 0.8 mg/day) in patients with mild-to-

ISSN:0025-7931    

DOI:10.1159/000196346

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Data on reference values of total respiratory resistance (Rint) in healthy people are limited. The aim of this study was to examine the relationship between Rint and gender, height, weight, age and smoking habits. The instrument used was the Jaeger Pneumoscope with a flow interruption device. The method is based on transient interruption of airflow at the mouth for a brief period during which alveolar pressure equilibrates with mouth pressure. Measurement of mouth pressure is used to estimate alveolar pressure prior to interruption. The ratio of this to the flow prior to interruption gives airway resistance. The Rint data were correlated with height, weight, age, gender and smoking habits in 172 healthy subjects. They had a normal lung function (VC, FEV1) and no signs of pulmonary disease. The important determining factor for the value of the Rint were height and age. The mean Rint of 172 subjects was 0.38 ± 0.17 kPa·1-1·s. The average within-subject variability of repeated measurements of Rint expressed as coefficient of variation was 14.4 ± 6.9%. Reference equation and normal values for Rint in a healthy population are related to height and age. The measurements were obtained with a commercially available interruption techni

ISSN:0025-7931    

DOI:10.1159/000196347

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Exercise-associated oxygen desaturation in severe chronic obstructive pulmonary disease (COPD) remains a topic of unknown prognostic and clinical relevance and of unknown therapeutic importance. Furthermore, exercise limitation in these patients is due to multifactorial interaction of respiratory, cardiac, circulatory and ‘peripheral’ mechanisms. For the evaluation of the role of the oxygen-dependent mechanisms of exercise limitation we studied 14 stable patients with severe COPD (FEV1 32% pred., FEV1/VC 41%, thoracic gas volume of 180% pred.) and mean Pa O264 mm Hg by a stage 1 cycle exercise test during breathing room air (FiO2 0.21) and hyperoxic (FiO2 0.35) air. The measurements were performed by an open system using a low dead space valve (55 ml) measuring real-time breath by breath oxygen consumption (VO2) via a differential oxygen sensor, expired carbon dioxide (VCO2), ventilation (VE), oxygen pulse and oxygen saturation in both conditions. With FiO2 0.21 the mean exercise limitation was restricted to 37 ( ± 14) W and the VO2 to 11.7 ( ± 2.4) ml/kg/min with peak oxygen desaturation of 86.4 ( ± 3.2). With FiO2 0.35 the patients achieved a significant increase of workload to 55 ( ± 12.4) W and of VO2to 14.9 ( ± 2.9) ml/kg/min. Despite the complete abolition of exercise desaturation by FIO2 0.35 the mean peak ventilation of 261/ min ( ± 5.1) vs. 27 1/min ( ± 4.1) remained unaltered and therefore the restriction of the ventilatory pump limited the exercise ability. The effects of FiO2 0.35 occurred in these patients at submaximum exercise and may be related to reduction of ventilatory cost of energy and delayed onset of metabolic acidosis. We conclude that oxygen treatment in borderline hypoxemic COPD patients who desaturate in exercise is of substantial benefit because oxygen may diminish the generally excessive ventilatory cost of energy at submaximu

ISSN:0025-7931    

DOI:10.1159/000196348

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Abnormalities in endothelin-1 (ET-1) pulmonary metabolism have been reported in patients with pulmonary hypertension, asthma and chronic obstructive pulmonary disease (COPD). In this study we have evaluated the 24-hour urinary excretion of ET-1 in COPD patients both during acute exacerbation and stable phase of the disease. ET-1 plasma and urinary levels were measured in 13 COPD patients on admission to the hospital for an acute exacerbation and at the recovery period. Ten healthy volunteers were also studied. Determination of plasma and 24-Hour urinary ET-1 levels were carried out with a radioimmunoassay test. Plasma ET-1 levels in COPD patients were similar during exacerbation and recovery and were not significantly different from those in the healthy subjects. 24-hour urinary excretion of ET-1 was increased in COPD patients during acute exacerbation; it decreased during recovery, but remained elevated when compared to normal subjects. A negative correlation was found between arterial oxygen pressure and ET-1 excretion; no correlation was found between plasma and urinary ET-1 values. In conclusion, COPD patients excrete higher amounts of ET-1 compared to healthy subjects. Urinary ET-1 values are further increased during acute exacerbation of the disease.

ISSN:0025-7931    

DOI:10.1159/000196349

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Myeloperoxidase (MPO) level and MPO scoring were estimated in Indian bidi smokers and compared with those in cigarette smokers and non-smokers. The values were higher in the neutrophils of 20 bidi smokers compared to 20 age-matched non-smokers (p < 0.001). However, they were similar to those in 20 cigarette smokers. No correlation of MPO activity was observed with blood carboxyhaemoglobin levels and smoking indices except in bidi smokers. Total leucocyte count and total neutrophil counts were also higher in bidi and cigarette smokers. This increased MPO activity in the neutrophils of bidi and cigarette smokers may contribute to the greater risk of obstructive pulmonary disease.

ISSN:0025-7931    

DOI:10.1159/000196350

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Wheeze detection has been proposed as an indicator of bronchial responsiveness during airway provocation challenge (APC) test. However, there is evidence that wheeze may be occasionally absent in subjects whose APC is positive by spirometry. We tested the hypothesis that, in this case, inspiratory breath sound intensity (BSI) over the chest is noticeably decreased. Six patients (3 asthmatics and 3 patients with atopic rhinitis) were selected, whose forced expiratory volume in 1 s (FEV1) fell by 20% or more at the end point of the challenge in the absence of concurrent wheezing. Lung sounds were recorded at the right posterior lung base and analysed by computer. Inspiratory BSI at the end point of the challenge was markedly decreased in all patients, a change almost completely reverted by the inhalation of 200 μg of salbutamol in all of them but one. These results support the view that BSI monitoring is potentially useful as an indicator of bronchoconstriction during bronchial provocation testing. However, further studies are necessary to confirm this hypothesis

ISSN:0025-7931    

DOI:10.1159/000196351

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Surgery represents the first-choice treatment to manage pulmonary metastases from colorectal cancer when the primary tumor has been controlled and there is no evidence of metastatic spreading to any other organ. In our experience on 13 patients, we obtained a survival at 5 years of 23%. The average number of metastases resected was 2.9. The increase of carcinoembryonic antigen was the first clinical sign in 10 cases (76.9%, higher or equal to 5 ng/ml) that led to its discovery. The surgical technique most frequently used was wedge resection and/or atypical segmentectomy. Intraoperative mortality was zero and morbidity low (15.3%).

ISSN:0025-7931    

DOI:10.1159/000196352

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

This study was set in a general, university hospital in the Canary Islands, with the objective to evaluate an enzyme-linked immunosorbent assay (ELISA) using A60 in the serodiagnosis of tuberculosis. IgG antibody to A60 was determined in 205 patients with active disease [149 culture-positive patients with pulmonary tuberculosis (positive sputum smear 94, negative sputum smear 55) and 56 patients with extrapulmonary tuberculosis], 20 patients with inactive disease, 22 patients with lepromatous leprosy, and 51 controls. The mean levels of anti-A60 antibodies were significanctly higher in patients with active disease as compared with controls or patients with inactive disease. Differences were also found between tuberculous patients with pulmonary and extrapulmonary disease. In patients with pulmonary disease, significant differences were detected between smear-positive and smear-negative patients. The overall sensitivity of the test (cutoff 240 ELISA units) was 52.2%. The highest sensitivity was found among smear-positive patients with pulmonary tuberculosis (67%) and the lowest among those with extrapulmonary tuberculosis (32.1%). We conclude that ELISA for the measurement of IgG antibody to Mycobacterium tuberculosis antigen A60 could be of interest, specially in smear-negative cases and extrapulmonary tuberculosis.

ISSN:0025-7931    

DOI:10.1159/000196353

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We describe a 25-year-old patient with severe bronchial asthma, which was difficult to treat with oral theophylline. Bamifylline, a xanthine derivative, clearly improved the clinical signs, symptoms and lung function. We critically review the literature on bamifylline.

ISSN:0025-7931    

DOI:10.1159/000196354

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

This is a report of a 28-year-old HIV+ man with extensive involvement of lungs, spinal roots and peripheral nerves by neurofibromatosis von Recklinghausen. Huge masses (neurofíbromas) ventral of the spine, which already infiltrated into the foramina intervertebralia, could be located by magnetic resonance imaging and high resolution computer tomography. Strikingly, most biopsies taken by bronchoscopy of the bronchial wall from various parts of the airways revealed extended infiltration by neurofíbromas in submucosal areas, but no malignant tissue components. In addition, HIV infection with low CD4/CD8 ratio (0.1) and low CD4+ cells (160/µl) was fou

ISSN:0025-7931    

DOI:10.1159/000196355

出版商:S. Karger AG    

年代:1994

数据来源: Karger