[HRCT findings of pulmonary Mycobacterium avium complex: a comparison with tuberculosis].

Computed tomographic (CT) findings of 70 patients with Mycobacterium avium complex (MAC) disease were analyzed by two chest radiologists and compared with those of 37 patients with Mycobacterium tuberculosis infection. Common CT findings in patients with MAC, included bronchiectasis (97%), small nodules (89%), parenchymal distortion (60%), bronchial wall thickening (56%), consolidation (50%) and cavity formation (49%) and small nodules (86%), bronchiectasis (70%), consolidation (57%) and bronchial wall thickening (51%) in patients with Mycobacterium tuberculosis. Bronchiectasis and parenchymal distortion were significant in patients with MAC compared with Mycobacterium tuberculosis patients. Bronchiectasis involving the RUL, RML, lingula and LLL and small nodules involving the RML were often seen in patients with MAC. Both bronchiectasis and small nodules were commonly observed in multiple lobes in both types of patients. Cavities in MAC infection tended to be thin and smooth walled, and less commonly associated with consolidation. We conclude that CT findings of MAC infection were characterized by widely distributed bronchiectasis and small nodules and/or cavities with thin, smooth walls. These CT findings are one of the keys in differentiating MAC from Mycobacterium tuberculosis.

Three cases of primary lung cancer undetected by an annual checkup.

An annual check by chest roentgenogram is very important for the early detection of lung cancer. We present three cases of primary lung cancer which were not detected by the double check system or previous examination. The three patients visited our hospital for evaluation of an ill-defined opacity in the upper lobe of the lung. In the three cases, no abnormality had been reported in the previous year's annual chest X-ray, and we concurred in the decisions. The correct diagnoses of the three cases were well or poorly differentiated adenocarcinoma, and were still amenable for surgical therapy. A poorly defined tumor in this region is very difficult to detect because of superimposed opacities of other anatomical structures. When a questionable shadow in this region is found but without the typical radiological features of lung cancer, it is important to search for indirect indications of adenocarcinoma. These may include fibrotic changes and absence of inflammation. In our cases, the increased number of normal-size bronchi penetrating the ill-defined tumor, seem to have diagnostic significance.

Effect of chronic furosemide administration on acid-base balance in patients with chronic hypercapnic respiratory failure.

We quantitatively analyzed the effect of long-term administration of oral furosemide on the PaCO2 - H+ relationship in patients with chronic hypercapnic respiratory failure. In this study we measured arterial blood gases of eighteen outpatients (mean duration of visits, 7.6 years; mean rise of PaCO2, 15.4 mmHg). We obtained linear regression lines for PaCO2 - H+, and determined their Y-axis intercepts and slopes. The results indicated that an increase in the administered dose of furosemide decreased linearly the Y-axis intercept of the regression line [(Y-intercept) = - 6.9(dose of furosemide) + 30.9, r = 0.81], and increased linearly the slope of the regression line [(slope) = 0.094(dose of furosemide) + 0.22, r = 0.74]. Thus, the regression line of the PaCO2 - H+ relationship moved downward and became steeper at higher doses of furosemide. The regression lines for each dose of furosemide crossed at a PaCO2 of 75 mmHg. We concluded that there is a mutual interaction between the renal and respiratory mechanisms for acid-base balance in chronic hypercapnia and the effect of furosemide on the PaCO2 - H+ relationship is negligible in severe hypercapnia.

Diaphragmatic electrical activity during controlled and assisted mechanical ventilation in conscious human subjects.

Breathing during mechanical ventilation was analyzed in 8 conscious healthy volunteers by application of intermittent positive pressure ventilation through a mouthpiece. In controlled mechanical ventilation (CMV), the respiratory rate and tidal volume were fixed at 110 and 120% of the subject's corresponding spontaneous breathing parameters. The diaphragmatic electromyogram (EMGdi) decreased significantly but become synchronous with the rhythm of the CMV. In assisted mechanical ventilation (AMV), the EMGdi response developed prior to and during the inspiratory phase of AMV. Application of an unexpected mechanical breath elicited the EMGdi. As the triggering sensitivity was decreased, the EMGdi prior to and during a mechanical breath was augmented, however, its rate of rise was unaffected. Our results suggest that the EMGdi during mechanical ventilation in conscious subjects is initiated by the respiratory center, however, this activity is modulated strongly by input from the pulmonary afferents and from the cerebral cortex.

Acquired chronic pure red cell aplasia successfully treated with intravenous pulse methylprednisolone therapy.

A 65-year-old male patient developed acquired chronic pure red cell aplasia (PRCA) associated with hypergammaglobulinemia and positive Coombs' test during the treatment of eosinophilic pneumonia with prednisolone (PSL). His PRCA was treated with oral PSL at a dose of 60 mg/day for 3 weeks, but anemia further progressed. Immediately after high-dose intravenous pulse methylprednisolone therapy (1 g/day for 3 days) however, reticulocyte crisis occurred and his anemia rapidly improved. He has been in complete remission under a maintenance dose of PSL for more than 2 years. This patient indicates that high-dose intravenous methylprednisolone therapy is one of the useful treatments, not only for constitutional PRCA, but also for acquired chronic PRCA.

T2 of endotoxin lung injury with and without methylprednisolone treatment.

NMR relaxation times (T1 and T2) and the water content (WC) of in vitro rat lungs were measured during the course of endotoxin lung injury in rats. Measurements of normal lungs, untreated endotoxin-injured lungs, and endotoxin-injured lungs treated with methylprednisolone (MPSL) were compared. The untreated endotoxin lungs showed prolongation of the fast and slow T2 components (T2f and T2s), but no significant changes in T1 or water content. Also, there was no correlation between 1/WC and relaxation rates or between T1 and T2. MPSL treatment prevented T2f and T2s prolongation; however, the duration of MPSL effectiveness was limited. Animals which were treated with MPSL more than 7 h prior to measurements showed T2 prolongation. This study indicates that NMR relaxation times, particularly T2, can be useful in evaluating lung injuries and their treatments.

[Control mechanism of the respiratory muscle during forced expiration].

Control mechanism of the respiratory muscle during forced expiration was analyzed. Respiratory flow. EMG of the intercostal muscle (IC), external oblique (EO) and internal oblique (IO) abdominal muscle were analyzed in eleven healthy volunteers. The pattern of EMG activity during forced expiration could be classified according to its shape i.e., taper- or hill-shaped. The taper shape was found in 7 of 9 subjects for IC and in 8 of 11 subjects for EO. The hill shape was found in 4 of 6 subjects for 10. Twelve consecutive trials without intervals did not alter the pattern of flow-volume curve, activity of respiratory muscle and frequency component (i.e., H/L ratio). When the expiratory circuit was obstructed for a short interval during forced expiration, the rise in pleural pressure was slight but that in oral pressure was large, and the activity of respiratory muscle decreased for a short period. The latencies from the onset of expiratory circuit obstruction to the reduction in EMG activity were 61.5-100 msec. In IC, 61.5-106.5 msec in EO. and 58.0-92.3 msec in 10. These values did not differ significantly any given subject. Airway anesthesia with xylocaine did not alter latency. In conclusion, the pattern of respiratory muscle activity for forced expiration is predetermined and is specific for each muscle. Negative feedback from receptors in airway or in respiratory muscle was strongly suggested. Repetitive trials up to twenty times did not cause respiratory muscle fatigue.

Recurrent lupus pneumonitis with pulmonary hemorrhage in systemic lupus erythematosus associated with chronic thyroiditis and antithyroid hormone autoantibodies.

We describe a SLE patient with repeated lupus pneumonitis and pulmonary hemorrhage. The hemorrhagic episodes were considered to be related to thrombocytopenia and lupus pneumonitis, which have responded well to treatment with moderate doses of steroids and immunosuppressant. She was also found to be suffering from chronic thyroiditis (hypothyroidism) and was positive for anti-thyroid hormone antibodies, which have not been reported before in the SLE patients with thyroid diseases.