Superoxide anion release from blood monocytes and alveolar macrophages in patients with diffuse lung fibrosis.

Superoxide anion release (O2-) after stimulation with phorbol myristate acetate was measured in alveolar macrophages (AM) obtained by bronchoalveolar lavage and in blood monocytes from 47 patients with diffuse interstitial lung disease: idiopathic pulmonary fibrosis (N = 15), hypersensitivity pneumonitis (N = 7), pneumoconiosis (N = 6) and sarcoidosis (N = 19). Differential cell counts demonstrated a lymphocyte predominance in patients with hypersensitivity pneumonitis (HP) and sarcoidosis while the other groups had neutrophil predominance. No correlation between O2- activity in alveolar macrophages (AM) or blood monocytes (BM) compared to lung function (VC and diffusing capacity) could be demonstrated. Smoking pneumoconiotics had significantly decreased BM O2- release (1.25 +/- 0.25 (SEM) nmol/min/10(6) cells) and significantly increased AM/BM O2- ratios (2.04 +/- 0.26) compared to smokers with idiopathic pulmonary fibrosis (IPF) who had the following mean values: BM O2- release = 2.58 +/- 0.25 and AM/BM O2- ratio = 0.86 +/- 0.23. When matched for sex and smoking, a significantly increased AM/BM O2- ratio was seen among patients with HP (2.19 +/- 0.98) in comparison with patients who had sarcoidosis (0.40 +/- 0.18). Patients with either HP or pneumoconiosis had generally elevated AM O2- release and reduced BM O2- release. These results suggest that environmentally related interstitial lung disorders (HP and pneumoconiosis) may be associated with elevated AM O2- release relative to BM O2- release in comparison to non-environmentally related disorders (IPF or sarcoidosis).

Cardiopulmonary function at rest and during exercise after resection for bronchial carcinoma.

BACKGROUND: Measurements of postoperative spirometric values after pneumonectomy and lobectomy vary considerably, and few researchers have studied the changes in exercise capacity during maximal work after lung resection. The purpose of this study was to describe the postoperative alterations in cardiopulmonary function. METHODS: Ninety-seven consecutive patients with lung malignancy were prospectively examined with maximal exercise test, spirometry, and arterial gas tensions. Fifty-seven patients were reinvestigated 6 months postoperatively. RESULTS: In patients having lobectomy, forced expiratory volume in 1 second decreased 8%, and exercise capacity, expressed by maximal oxygen uptake and maximal work rate, significantly decreased 13%. In patients having pneumonectomy forced expiratory volume in 1 second significantly decreased 23%, but the loss in lung volume was partly compensated as measured by exercise capacity, which decreased only 16%. Generally patients with the smallest preoperative forced vital capacity had the smallest postoperative deterioration expressed in percentages. We found a weak correlation between alterations in maximal oxygen uptake and lung function after resection. CONCLUSIONS: Lobectomy is associated with only minor deterioration of lung function and exercise capacity. Pneumonectomy causes a decrease in pulmonary volumes to about 75% of the preoperative values, partly compensated in better oxygen uptake, which postoperatively was about 85% of the preoperative values. Alteration in forced expiratory volume in 1 second is a poor predictor of change in exercise capacity after pulmonary resection.

Comparability of albuterol delivered by a piezoelectric device versus metered dose inhaler in patients with chronic obstructive airways disease.

In recent years, there has been increased interest in developing propellant-free inhalers for the treatment of patients with chronic obstructive airways disease. Various powder inhalators have been developed. A recent alternative to the dose-metered aerosols has been produced using the piezoelectric effect. This double-blind, double-dummy, randomized, dual-dose, four-period crossover study was designed to compare the effect of albuterol inhaled from the piezoelectric device (PED) and albuterol inhaled from the metered dose inhaler (MDI). The primary efficacy variables were forced expiratory volume in one second (FEV1) and area under the curve (AUC). Although we found a statistically significant device effect for the primary efficacy variables, the two treatments (PED [test] and MDI [reference]) are comparable. The only variable for which comparability was not found was time of onset. We found no dose differences. In conclusion, we found a similar effect of albuterol inhaled by a PED versus an MDI in patients with chronic obstructive airways disease.

[Pulse oximetry during fiberoptic bronchoscopy under local anesthesia]. / Pulsoximetri under fiberbronkoskopi i lokalanaestesi.

Pulse oximetry during fiberoptic bronchoscopy in local anaesthesia was performed in 81 patients (52 male, 29 female), median age 60 years (range 25-80); 18 had impaired lung function with FEV1 less than 50%. Premedication consisted of atropine, diazepam and midazolam. The arterial haemoglobin oxygenation (SaO2) was registered continuously. Supplementary oxygen in doses of 2 1/min was administered to 41 patients (group 1), while 40 patients were examined without oxygen (group 2). The two groups were comparable as regards sex, age and lung function. Mean values of SaO2 during bronchoscopy were higher in group 1 (median 96%) than in group 2 (92%) (p less than 0.001). Minimum values of SaO2 were similarly higher in group 1 (median 93%) than in group 2 (87%) (p less than 0.001). The percentage numbers of patients experiencing hypoxaemic episodes with SaO2 less than or equal to 90% and SaO2 less than or equal to 85% were 34% and 5% in group 1 compared to 80% and 35% in group 2, respectively (p less than 0.01). The decrease in SaO2 and the frequency of hypoxaemic episodes were highest in patients with impaired lung function. Supplementary oxygen in doses of 2-3 1/min and pulse oximetry are recommended as routine procedures during fiberoptic bronchoscopy in local anaesthesia.

[Medium chain acyl-CoA dehydrogenase (MCAD) deficiency: a life-threatening defect of fatty acid oxidation]. / Mellemkaedet acyl-CoA dehydrogenase (MCAD)-mangel: en livstruende fedtsyreoxidationsdefekt.

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is a potentially fatal metabolic disease, which is characterized by non-ketotic hypoglycemia and lethargy. The disease manifests itself by periodic attacks in connection with infections and periods of fasting, or suddenly as unexpected child death or "near miss". Characterization of a prevalent disease-causing mutation (G985) in the MCAD gene has increased the diagnostic possibilities, since 75% of all patients with MCAD deficiency are homozygous for the mutation. Analysis for this mutation in genomic DNA from a bloodspot on a PKU-card constitute today a certain and specific diagnosis for the disease in 75% of all cases. In the remaining 25% the mutation analysis is supplemented with urine metabolite studies by gas chromatography/mass spectrometry, and with measurements of enzyme activities in cultured skin fibroblasts. The disease is today considered more common than previously anticipated, since the incidence of patients with MCAD enzyme deficiency in Denmark is estimated to 1/27,000 newborns, or two new cases annually. The relationship between the enzyme defect (gene defect) and the clinical expression of the disease is a main subject for the clinical research in the disease at present, because less than 10% of all patients with the gene defect are diagnosed. This applies not only to Denmark but also to other countries.

A comparative study of the bronchodilatating effects of ipratropium and terbutalin inhaled with Monaghan IPPB-M 515 by 19 patients with chronic obstructive airways disease.

The effect of ipratropium (Atrovent) 0.125 mg x 4 daily was compared to terbutalin (Bricanyl) 5 mg x 4 daily, given to 19 patients with chronic obstructive airways disease (15 with chronic bronchitis, 10 bronchial asthma, 7 pulmonary emphysema) as inhalation therapy with Monaghan IPPB-M 515, during 2 treatment periods of 3 days. The investigation was carried out as a controlled, double-blind, cross-over comparison. The effect of treatment was evaluated by measurement of PEFR, symptom scores, including the side-effects and the use of rimiterol MDI for the treatment of acute attacks. The PEFR values were all higher than the initial values (P less than 0.001) during the period of treatment (08.00-20,30 hrs). The highest values were recorded at 16.30 hrs, these were PEFR + 31.7% for the Atrovent period and PEFR + 28.0% for the Bricanyl period. No statistically significant difference was observed in the PEFR, symptom scores, side-effects and the use of rimiterol during the Atrovent and Bricanyl treatment periods. The authors suggest that Atrovent is a wellsuited alternative bronchodilatator, particularly for patients with tremor, muscle cramp, and "inner restlessness" following treatment with a beta 2-stimulator.

Fenoterol inhalation powder and aerosol.

The effect of 0.2 mg of fenoterol inhalation powder and 0.2 mg fenoterol from a metered dose inhaler were compared in a double-dummy, cross-over investigation. Ten patients with chronic obstructive lung disease entered the study, which showed no statistically significant difference between the effect of these two forms of the drug on lung function and pulse rate for a period of up to 6 hours after the inhalation of fenoterol. The patients considered the inhalation of powder by means of a commercial inhaler, the Ingelheim inhaler, was simple.

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma.

The aim of this study was to evaluate which parameters of preoperative spirometry and cardiopulmonary exercise test are the best predictors of postoperative morbidity and mortality in patients with bronchogenic carcinoma. Ninety seven patients were prospectively and consecutively examined. All patients had preoperative maximal exercise test and dynamic spirometry. Postoperative complications and causes of death were registered. Logistic regression was used and models explaining the relationship between preoperative variables and postoperative complications and deaths were constructed. We found significant differences in preoperative maximal workload and carbon dioxide output between groups, with and without cardiopulmonary-related complications, but not in spirometry variables. Logistic regression showed maximal workload to be the only predictor of cardiopulmonary complications. Maximal oxygen uptake was predictive of cardiopulmonary deaths. Maximal oxygen uptake and forced expiratory volume were predictive of postoperative complications. A maximal oxygen uptake <50% predicted was associated with high risk of death from cardiopulmonary causes. Kaplan-Meier survival curves showed that maximal oxygen uptake was correlated to long-term survival, while spirometric variables were not. Exercise testing can be used in the preoperative evaluation of patients with nonmetastatic bronchogenic carcinoma. A combination of the results of variables from spirometry and exercise testing is proposed to be used as a preoperative criterion for operability.