Pyloric incompetence in chronic non-specific lung disease.

Of 19 patients with chronic non-specific lung disease, chosen without reference to dyspeptic symptoms, 17 (89%) exhibited duodenogastric reflux of barium indicating pyloric incompetence. In the one patient who proved to have a gastric ulcer the amount of reflux diminished when the ulcer healed. The degree of pyloric incompetence was not found to be related to the severity of arterial blood gas or pH disturbance or to the presence of right heart failure. All patients who exhibited reflux had evidence of obstructive airways disease and most were receiving bronchodilators.We believe that reflux of detergent bile into the stomach may explain the high incidence of dyspepsia and acute gastric ulceration in chronic non-specific lung disease.

The lungs in lymphangiomyomatosis and in tuberous sclerosis.

Two cases of pulmonary lymphangiomyomatosis (PL) are described and 33 other cases from the literature are reviewed. These are compared with one case of tuberous sclerosis with pulmonary involvement (PTS) and 32 other cases from the literature. There are no differences in lung function between these two conditions, both of which show airways obstruction associated with diffuse radiological lung changes. There are, however, both clinical and radiological differences and also differences in the distribution of the lesions and the histological location of the excessive smooth muscle; these indicate that PL and PTS are probably different entities and not polar forms of one condition. Finally, the strictly female incidence of PL suggests a sex-linked disorder, and it is postulated that this may be related to congenital pulmonary lymphangiectases.

Changes in permeability of the alveolar-capillary barrier in firefighters.

The effect on alveolar-capillary barrier permeability of chronic exposure to a smoke produced by the partial combusion of diesel oil, paraffin, and wood was examined. An index of permeability was determined from the rate of transfer from the lung into the blood of the hydrophilic, labelled chelate 99mTc diethylene triamine penta-acetate (MW 492 dalton). The results of this test were expressed as the half time clearance of the tracer from the lung into the blood (T1/2 LB). The study was carried out at the Royal Naval Firefighting School, HMS Excellent. Permeability index was measured on seven non-smoking naval firefighting instructors who had worked at the school for periods of longer than two and a half months. Tests of airway function and carbon monoxide transfer factor were performed on four of these seven instructors. The results of the permeability index showed a T1/2 LB of 26 min +/- 5 (SEM) which differed significantly from that of normal non-smokers. By contrast all other lung function tests had values within the predicted normal range.