Distribution of immunocompetent cells in the bronchial wall of clinically healthy subjects showing bronchial hyperresponsiveness.

BACKGROUND--Nearly all asthmatic subjects show bronchial hyperresponsiveness, in that the provocative concentration of histamine reducing forced expiratory volume in one second (FEV1) by 20% (PC20FEV1) is < or = 8 mg/ml histamine, and have underlying chronic inflammation of the bronchial wall mediated by T cells. The possible cause and effect relationship between these phenomena remains an enigma. As a proportion of clinically healthy subjects show bronchial hyperresponsiveness, this study was undertaken to determine whether they also show evidence of bronchial inflammation. METHODS--Bronchial biopsy specimens were obtained from 27 clinically healthy subjects with no history of lung disease. Samples were taken perioperatively before elective knee arthroscopy for sports injuries. Specimens were frozen and cryostat sections analysed immunocytochemically with monoclonal antibodies to identify the presence of T lymphocytes, antigen presenting cells, and the expression of HLA-DR. Double immunofluorescence studies were performed with monoclonal antibodies RFD1 and RFD7 to show the relative proportions of RFD1+ RFD7- antigen presenting cells, RFD1- RFD7+ mature phagocytes, and RFD1+ RFD7+ suppressor macrophages. Histological stains were performed to show the presence of eosinophils and mast cells. Three to four weeks after bronchoscopy spirometry was performed on these subjects to record FEV1, forced vital capacity (FVC), FEV1/FVC, and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75). Bronchial hyperreactivity was recorded by determining PC20FEV1 to histamine. RESULTS--Nine of the 27 subjects showed bronchial hyperresponsiveness as defined by a PC20FEV1 of < or = 8 mg/ml histamine. Segregated subjects with and without bronchial hyperresponsiveness showed no difference in spirometric results. Immunohistological analysis showed no evidence of inflammation in either group. Numbers of T cells, eosinophils, and mast cells were the same in both groups as was the expression of HLA-DR antigen. No neutrophils were observed in any tissues. Interestingly, reduced numbers of macrophages with the phenotype of antigen presenting cells (monoclonal antibodies RFD1+ RFD7-) were recorded in the subjects with bronchial hyperresponsiveness, who also had a significant increase in the proportion of RFD1+ RFD7+ suppressor macrophages. CONCLUSIONS--Up to 30% of selected clinically healthy subjects may have a PC20FEV1 of < or = 8 mg/ml histamine. This physiological trait can exist in the absence of bronchial inflammation. This suggests that bronchial hyperresponsiveness as currently defined is not dependent on immunopathological changes in the bronchial wall and does not necessarily promote even subclinical inflammation.     

Unreliable residual volume measurement after increased water load diuresis

BACKGROUND: The aim of the present study was to examine whether increased water load intake prior to ultrasound examination of the lower urinary tract, affects the measurement of postvoid residual urine volume. PATIENTS AND METHODS: Ninety four male patients with postvoid residual volumes after increased water load diuresis of more than 100 mL (PVR1) were included in the present study. All patients underwent a second PVR measurement by an urologist with a portable transabdominal bladder ultrasound scan without having received an increased water load (PVR2). A comparison of the measurements was performed and the PVR values were also correlated with other parameters, such as age, International Prostate Symptom Score, prostate volume and serum prostate-specific antigen (PSA) values. RESULTS: Postvoid residual urine volume after increased water load diuresis (PVR1) differed from that recorded after normal bladder filling and voiding at first desire (PVR2), with the former being larger than the later in every patient (P < 0.001). The PVR values, PVR1 and PVR2, were independent to patient age, symptom score prostate volume and PSA value. CONCLUSIONS: Measurement of postvoid residual volume in a relaxed patient, who voids at first desire, represents everyday life and should be the correct method of testing.     

Normal bronchial healing without bronchial wrapping in canine lung transplantation.

The deleterious effect of steroids on bronchial healing in lung transplantation has led to the development of techniques to protect the anastomosis and to the exclusion of steroid-dependent patients from transplantation. The effect of steroids on bronchial healing was tested in a canine single-lung allotransplantation model. Twenty size-matched mongrel dogs (20 to 30 kg) underwent left lung transplantation without anastomotic wrap or direct revascularization. Postoperatively, all received daily doses of cyclosporine (15 mg/kg) and azathioprine (1 mg/kg) and were subdivided into three steroid dosage groups. Group A (n = 10) animals received 1.5 mg/kg of prednisone per day whereas groups B (n = 5) and C (n = 5) received 5.0 mg/kg of prednisone per day for 28 postoperative days. In addition, group C received prednisone (5.0 mg.kg-1.day-1) for 1 month preoperatively. In group A, 8 of 10 dogs survived 28 days without evidence of respiratory compromise, with anastomotic bursting pressure greater than 510 mm Hg. In group B, all 5 dogs survived to 28 days without evidence of respiratory compromise and with intact bronchial anastomoses (bursting pressures greater than 510 mm Hg). In group C, 3 of 5 animals survived to 28 days with intact anastomoses. Histological examination demonstrated normal bronchial healing in all anastomoses. These data suggest that preoperative steroid dependence should not be a contraindication to lung transplantation and that bronchial anastomotic wrapping with vascular tissue may not be essential.     

Lung function and bronchial reactivity in farmers.

The purpose of this study was to evaluate the prevalence and type of lung function disorders in Danish farmers. Three samples of farmers were drawn from a group of unselected farmers who had participated in an epidemiological study. Group I (47 persons) was a sample of the 8% of all farmers who had reported that they had asthma; group II (63 persons) was a sample of the 28% of farmers who had had wheezing, shortness of breath, or cough without phlegm; and group III (34 persons) a sample of the farmers (64% of the total) who had no asthma and no respiratory symptoms. The farmers with symptoms (groups I and II) had low mean levels of FEV1 and high values for residual volume, whereas the symptomless farmers had normal lung function and no airways obstruction. The proportion of farmers with an FEV1 below the 95% confidence limit for predicted values was 43% in group I and 23% in group II; there were none in group III. Bronchial hyperreactivity to histamine occurred in 96% of asthmatic farmers, 67% of farmers with wheezing or shortness of breath, and 59% of symptomless farmers. A low level of FEV1 was associated with the number of years in pig farming and bronchial hyperreactivity in group II but not group I or III. Most of the bronchial hyperreactivity was explained in the multiple regression analysis by a low FEV1, though this was significant only for farmers in group II. Thus farmers who reported asthma, wheezing, shortness of breath, or a dry cough in general had airways obstruction with an increased residual volume, whereas symptomless farmers had normal lung function. Severe bronchial hyperreactivity was mostly explained by a diagnosis of asthma and poor lung function, though some farmers with normal lung function and no respiratory symptoms had increased bronchial reactivity.     

Lung deposition patterns of directly labelled salbutamol in normal subjects and in patients with reversible airflow obstruction.

BACKGROUND--Earlier studies of aerosol deposition in the lungs have relied on indirect labelling of Teflon spheres of a similar size distribution to the drug in question and have assumed similar aerodynamic properties. Using a modification of a new technique for directly labelling salbutamol, the deposition of salbutamol within the lungs of normal subjects and patients with asthma has been studied with the use of a metered dose inhaler (MDI) alone, an MDI with a spacer device, and a dry powder inhaler (DPI). METHOD--Salbutamol was directly labelled with technetium-99m and placed in an MDI or DPI. Ten normal subjects and 19 patients with asthma inhaled 200 micrograms of salbutamol by means of the MDI alone, the MDI with a spacer device attached, and by DPI on separate days. Deposition was assessed by a dual headed gamma camera after inhalation of the drug. RESULTS--The total mean (SD) percentage deposition of the drug in the normal subjects was 21.6% (8.9%) with the MDI alone, 20.9% (7.8%) with the MDI with spacer, and 12.4% (3.5%) with the DPI. For the patients, the mean percentage deposition was 18.2% (7.8%) with the MDI alone, 19.0% (8.9%) with the MDI and spacer, and 11.4% (5.0%) with the DPI. Bronchodilatation achieved by the patients was similar with all three techniques. Mean peripheral lung deposition was significantly greater with a spacer device than when the MDI was used alone in both normal subjects (49.4% (6.1%) v 44.1% (9.9%)) and patients (38.6% (11.1%) v 30.4% (9.4%)). CONCLUSIONS--The deposition of directly labelled salbutamol from an MDI is greater than previously estimated by indirect labelling techniques. The deposition of labelled salbutamol from a DPI, however, is little different from that measured by indirect techniques.     

残余尿在前列腺增生症所致膀胱出口梗阻中的临床意义

作者应用压力－流率测定法确定前列腺增生症（ＢＰＨ）患者有无膀胱出口梗阻（ＢＯＯ），并经导管法测定其残余尿，分析５１例有或无膀胱出口梗阻的前列腺增生症患者的残余尿状况。ＢＯＯ组和无ＢＯＯ组分别为３１例和２０例；残余尿分别为３２．８±３５．９ｍｌ和２５．２±２２．７ｍｌ，范围分别为６～２１０ｍｌ和３～８８ｍｌ。两组间残余尿量无显著性差异（Ｐ＞０．０５）；其余指标均存在显著性差异（Ｐ＜０．０１）。作者认为以残余尿作为选择ＢＰＨ患者手术的重要指标并不可靠，ＢＯＯ不是产生残余尿的唯一原因。ＢＯＯ患者可无明显残余尿，无明显残余尿的ＢＰＨ患者不能除外ＢＯＯ。     

Lung mechanics after cardiac valve replacement.

Fourteen patients undergoing single aortic or mitral valve replacement had measurements made of lung volumes, static pressure-volume (P-V) relationships, and conductance-pressure relationships during deflation before operation and again between one and two years later. At follow-up, total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), and static tidal compliance (slope of static P-V deflation line for one litre above FRC) had increased significantly, in association with a decrease in heart size. There was a change in the shape and position of some P-V curves both in the aortic and mitral patients. In the patients with aortic disease P-V deflation curves shifted to the left after operation. In the patients with mitral disease the P-V deflation curves before operation crossed those measured after operation, so that at high lung volumes recoil became less after operation, but at low lung volumes recoil increased. Conductance had increased at high lung volumes. The data suggest that in longstanding pulmonary congestion, airways are more rigid making them less distensible at high and less compressible at low transpulmonary pressures than after operation when congestion has been at least partly relieved.     

剩余分数在膀胱出口梗阻中应用的评价

目的 评价剩余分数在膀胱出口梗阻中的应用。方法 应用B型超声波检测仪及尿流参数自动检测仪对60名患有良性前列腺增生症的门诊患者(尿潴留及神经原性膀胱患者除外)进行排尿前尿量、剩余尿量及最大尿流率测定。分别用剩余分数、剩余尿量与最大尿流率作直线相关分析。结果剩余分数与最大尿流率呈负相关,且相关系数具有极显著意义(r=-0.3425,P<0.01),剩余尿量与最大尿流率也呈负相关,其相关系数具有显著意义(r=-0.2587,p<0.05)。结论 剩余分数值越大,膀胱出口梗阻愈严重,膀胱排尿功能愈差。剩余分数较剩余尿量更能准确地反映膀胱出口梗阻情况。     

Respiratory obstruction in the newborn associated with increased volume and opacification of the hemithorax

Respiratory obstruction in the newborn can be associated with retained fetal pulmonary fluid if the obstruction was present in utero. The chest roentgenogram demonstrates increased volume and radiopacity of the affected lung. Two patients in respiratory distress with these roentgenographic manifestations are presented. The diagnostic approach to this problem is discussed.     

Expandable metal stents for non-malignant bronchial obstruction.

An expandable metal stent was inserted to relieve bronchial obstruction following lobectomy for localised squamous carcinoma which had not been relieved by bronchoplasty with a Goretex flap. This resulted in substantial improvement in lung function and exercise tolerance for nine months, following which severe inflammation around the stents required residual pneumonectomy.     

Retained intrapulmonary bullet presenting with bronchial obstruction.

A patient is presented who demonstrated migration of a retained intrapulmonary bullet 7 years after injury. This resulted in bronchial occlusion and post-obstructive lung infection without apparent hemoptysis. Lobectomy is considered the operative procedure of choice for this condition.     

残余尿在前列腺增生所致膀胱出口梗阻中的临床意义

作应用压力－流率测定法确定前列腺增生症（ＢＰＨ）患有无膀胱出口梗阻（ＢＯＯ），并经导管法测定其残余尿，分析５１例有或无膀胱出口梗阻的前列腺增生症患的残余尿状况。ＢＯＯ组和无ＢＯＯ组分别为３１例和２０例，残余尿分别为３２．８±３５．９ｍｌ和２５．２±２２．７ｍｌ，范围分别为６～２１０ｍｌ和３～８８ｍｌ，两缚间残余尿量无显性差异（Ｐ〉０．０５）；其余指标均存在显性差异（Ｐ〈０．０１）。作认     

Respiratory mechanics in airways obstruction associated with inspiratory dyspnoea.

Inspiratory muscle strength and the flow and elastic pressure opposing inspiration were measured in seven patients with severe airways obstruction who found inspiration difficult at rest. A comparison was made of measurements obtained from seven normal subjects and five patients with airways obstruction not experiencing inspiratory dyspnoea at rest. Measurements were also obtained when inspiratory dyspnoea was induced in the normal subjects by adding an inspiratory resistance or by voluntarily increasing lung volume. Compared with the controls the inspiratory muscle strength of the patients was reduced but was not significantly less than that of the patients without inspiratory dyspnoea. The pressure required to produce inspiratory flow was significantly greater when inspiratory dyspnoea was present (P = 0-01). However, there was considerable overlap in the pressures of those with and without inspiratory dyspnoea. A better relationship was obtained when muscle strength was considered. The ratio of inspiratory muscle strength to the pressure required to produce flow was 0-24 +/- 0-07 (mean +/- SD) in patient with inspiratory dyspnoea, 0-10 +/- 0-03 in patients without inspiratory dyspnoea, and 0-033 +/- 0-019 in normal subjects. There was no overlap between the two patient groups. The ratios of the normal subjects were increased when inspiratory dyspnoea was induced and, with the exception of two cases, were all above those obtained when inspiratory dyspnoea was absent. Inspiratory dyspnoea was experienced with lower ratios in the normals than in the patients with airways obstruction.     

Renal arteriolar obstruction without hypertension.

Selective partial occlusion of the intrarenal arteriolar bed with microspheres in rats resulted in contracted kidneys simulating those of benign nephrosclerosis in man. There was no elevation of blood pressure, renal vein plasma measured by radioimmunoassay, or juxtaglomerular indices of affected kidneys. It is unlikely that arteriolar lesions are pathogenetically related to the development of hypertension.     

Lung allografts with and without omentopexy in canines--bronchofiberscopic and histologic observation of bronchial anastomosis healing

An endoscopic evaluation of the effects of omental wrapping around the bronchial anastomosis of lung allografts in an early post-transplant phase, was performed in 13 mongrel dogs. Disruption or marked stenosis of the anastomotic portion was bronchofiberscopically observed more frequently in dogs without omental wrapping than in dogs with omental wrapping and the above findings were later confirmed histologically by light microscopic observation.     

Effects of hypothyroidism on bronchial reactivity in non-asthmatic subjects.

The effect of hypothyroidism on non-specific bronchial reactivity was studied in 11 patients without pulmonary disease (mean age 40 (SD 13) years) who had had a total thyroidectomy and radioiodine treatment for thyroid cancer 41 (36) months before the study. All patients when mildly hyperthyroid while having long term thyroxine replacement treatment and once when hypothyroid two weeks after stopping triiodothyronine for the purpose of screening for metastases. Bronchial reactivity was assessed by measuring specific airways conductance (sGaw) after increasing doses of inhaled carbachol (45-1260 micrograms). The dose producing a 35% decrease in sGaw (PD35) was determined from the cumulative log dose-response curve by linear regression analysis. Mean baseline sGaw values were similar when the patients were hypothyroid and when they were hyperthyroid (1.35 (0.36) and 1.41 (0.56) s-1 kPa-1). The interstudy coefficients of variation of baseline sGaw were higher in the thyroid patients than in a euthyroid control group (14% versus 8%). Geometric mean PD35 was lower when the patients were hypothyroid (97 micrograms) than when they were mildly hyperthyroid (192 micrograms). It is concluded that acute hypothyroidism increases non-specific bronchial reactivity in nonasthmatic subjects.     

Circadian change in bronchial responsiveness and airflow obstruction in asthmatic children.

To throw light on the question of whether the increase in bronchial responsiveness seen during the night is due to increased airflow obstruction, nine asthmatic children with increased airflow obstruction at night (group 1) were compared with nine without (group 2). The mean fall in forced expiratory volume in one second (FEV1) between 16.00 and 04.00 hours was 21.9% in group 1 and 2.3% in group 2. Selection of patients was based on the amplitude of change in peak expiratory flow (PEF) measured every four hours for three consecutive days at home. The study was performed in hospital on four consecutive days. Medication was withheld for three days before and during the measurements at home and in hospital. On the first day in hospital (day 4) FEV1 was measured every four hours for 24 hours. On day 6 inhaled histamine provocation tests were performed at the same times as the FEV1 measurements on day 4. Both groups showed a nocturnal fall in the provocative dose of histamine causing a 20% fall in FEV1 (PC20). The mean change in histamine PC20 from 16.00 to 04.00 hours was 1.1 doubling doses of histamine in group 1 and 1.5 doubling doses in group 2. The results indicate that the increase in nocturnal bronchial responsiveness that occurs at night is not due to an increase in airflow obstruction.