Effect on dyspnoea and hypoxaemia of inhaled N(G)-nitro-L-arginine methyl ester in hepatopulmonary syndrome.

Hepatopulmonary syndrome--a complication of chronic liver disease-is characterised by hypoxaemia, which results from widespread intrapulmonary vascular dilatations. Amplified production of pulmonary nitric oxide is thought to be important in development of this disorder in patients with liver cirrhosis. Here, we report a 64-year-old man with hepatopulmonary syndrome associated with hepatitis-C-virus-related cirrhosis. We gave the patient nebulised N(G)-nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthesis, which enhanced oxygenation (arterial oxygen pressure increased from 6.98 to 9.45 kPa). After L-NAME, the distance the patient could walk in 6 min rose by 92 m. Administration of L-NAME by aerosol might offer a new approach to treatment of hepatopulmonary syndrome.

Postoperative bronchopleural fistula: endoscopic closure in 12 patients.

Twelve consecutive patients with postresectional bronchopleural fistula were treated with endoscopic application of tissue glue adhesive (methyl-2-cyanoacrylate). Eight patients had associated empyema. Endoscopic gluing was successfully accomplished in 10 cases (success rate of 83%). The two failures both had fistulas of 0.5 cm or larger. Bronchopleural fistulas developed in 8 patients early after the intervention (< 15 days): of the 4 patients without associated empyema, 3 had their fistula definitely closed after endoscopic treatment. Similarly, 3 of the 4 patients with early bronchopleural fistulas and empyema were cured after endoscopic closure of the fistula and appropriate management of the empyema. Four bronchopleural fistulas occurred late after the operation (> 15 days) and all had associated empyema. Successful endoscopic closure of the fistula was accomplished in all. Resolution of the empyema occurred in 1. We conclude that endoscopic application of tissue adhesive may be a valid therapeutic measure in selected patients with postresectional bronchopleural fistula. In late bronchopleural fistula with empyema, the closure of the fistula can be achieved, but empyema may persist and require additional surgical procedures.

Clinical utility of tissue polypeptide antigen determination in lung cancer management.

In view of the fact that pulmonary malignancies still represent an important cause of tumor death and that the high rate of unsuccessful treatment may be partly due to the late clinical presentation, efforts should be spent not only to develop new and effective treatments but also to improve early diagnosis and to identify prognostic factors and parameters useful for the monitoring of the treatment. Tumor markers, if used properly, can provide a useful support for the management of patients suffering from various malignancies, including lung cancer patients. The clinical significance of one of the most widely used tumor markers, Tissue Polypeptide Antigen (TPA), has been reviewed and showed this marker to be useful to the clinician for the management of patients with pulmonary malignancy, as a complementary tool for diagnosing and staging the tumor as well as for monitoring treatment response or relapse occurrence.

Disappearance curves of tumor markers after radical surgery.

CEA serum levels were sampled from 15 patients with lung carcinoma, 12 patients with colon carcinoma, and 5 patients with gastric carcinoma before and after radical excision of the malignancy. In addition, TPA serum levels were measured in 7 patients with lung carcinoma and CA 19.9 serum levels in 9 patients with colon carcinoma, before and after curative surgery. Irrespective of the primary malignancy, a CEA half-life of approximately 3 days was calculated. The normalization time was related to the preoperative level of the marker, being longer when the preoperative CEA level was > 20 ng/ml. The TPA half-life was slightly longer than 1 day, ranging from less than 1 day to more than 3 days, with a normalization time of about 20 days. The CA 19.9 half-life was slightly longer than 1 day with variations from less than 1 day to about 3 days. Many factors, especially associated inflammatory processes and hepatic clearance imbalances, may influence marker kinetics in the postoperative period. A correct evaluation of the clinical significance of tumor marker half-life after radical surgery will require a larger number of patients as well as careful and prolonged follow-up.

Effect of lung resection on pulmonary function. A comparative study in different surgical procedures.

The effect of lung surgery on respiratory function has been investigated in 40 patients considering separately the three main procedures (pneumonectomy, lobectomy and thoracotomy alone) to ascertain if the resected lung and the volume removal can influence this function in the immediate postoperative period. The patients were submitted to spirometry and arterial gas analysis preoperatively and during 9 days postoperation; the tests controlled were VC, FEV1, TV and RR. No significant difference has been noticed among various surgical procedures.

Bal T lymphocyte subsets are reduced in primary lung neoplasias.

Direct observation with an optic fibre bronchoscope facilitates the diagnosis, staging and treatment of both neoplastic and other lung diseases, and the varying diameters available enable IVth or even Vth-order bronchi to be examined. The technique can be employed for deep lung lavage or bronchoalveolar lavage (BAL) and for transbronchial biopsy. The BAL fluid, too, can be used to study lung cells and soluble components. In this study, 21 patients aged 32-79 (mean 55.5), namely 16 with lung cancer and with non-neoplastic lung diseases, were subjected to BAL to allow a study to be made of the BAL fluid cell composition. In the neoplastic group, CD3 lymphocytes were 41.3% compared with 63.2% in the peripheral blood. CD4 (24.6% vs 40.6%) and CD8 (16.6% vs 28.7%) displayed the same pattern. The CD4/CD8 ratio, on the other hand, was much the same in both groups: 1.7 vs 1.5. CD19 were higher in the BAL fluid (20.1%) than in the peripheral blood (4.8%). In the non-neoplastic group the differences between the BAL fluid and the peripheral blood are of the same sign, but less marked. In conclusion, the BAL fluid subset composition in primary lung neoplasia differs from that in the peripheral blood through a reduction of CD3, CD4 and CD8 and an increase in CD19 compared with the peripheral blood. These modifications are less evident in patients with non-neoplastic lung diseases.

Pulmonary function in the patients submitted to lung exeresis.

The effects of lung surgery on respiratory function were investigated in 80 patients; 17 patients were submitted to left pneumonectomy (LPN); 11 patients were submitted to right pneumonectomy (RPN); 7 patients underwent a left upper lobectomy (LUL); 16 patients a left lower lobectomy (LLL); 17 patients were submitted to right upper lobectomy (RUL); 12 patients underwent right lower lobectomy (RLL). All patients were submitted to spirometry and arterial blood gas analysis. The effects of lung surgery on respiratory function depends upon the extent of the resected tissue.

Pulmonary function in patients with pleural effusion of varying magnitude and fibrothorax.

Pulmonary function was studied in sixty patients with pleural effusion and seventy patients with fibrothorax. The patients with pleural effusion were divided into three groups according to the extent of the effusion. The patients were submitted to spirometry and arterial blood gas analysis. The effects of pleural effusion on pulmonary function is evaluated with regards to the size of effusion. Small-size pleural effusion little affects arterial oxygen tension. Pleural effusion and fibrothorax have a similar pattern of pulmonary function.

Effect of verapamil on pulmonary function changes induced by fluid overloading in normal subjects.

The acute effects of the intravenous administration of 10 mg verapamil on pulmonary function changes induced by rapid saline infusion were studied in six normal subjects. Rapid intravenous fluid overloading caused on increase of closing volume (from 6.55 +/- 1.74 to 9.53 +/- 1.77%, p less than 0.05). After verapamil, the closing volume did not increase after infusion in three subjects and the mean increase was not significant (7.08 +/- 1.82 to 8.43 +/- 1.86%). These results suggest that the rapid administration of intravenous verapamil blunts respiratory function abnormalities caused by overhydration interstitial lung oedema.

A freeze-fracture study of human bronchial epithelium in normal, bronchitic and asthmatic subjects.

Tight junctions (TJ) play a major role in maintaining the integrity of epithelia. Damage of conducting airway surface epithelium is commonly observed in asthma, and recent data suggest that epithelial cells modulate airway smooth muscle tone by the production of relaxant factor(s). To evaluate the ultrastructure of tight junctions (TJ) in human bronchial epithelium of normal and diseased lung, biopsy samples were obtained by fiberoptic bronchoscopy in three normal healthy subjects, four asthmatic patients with bronchial hyperreactivity to methacholine and one heavy smoker with chronic bronchitis. Specimens were examined by electron microscopy, using both thin sections and freeze-fracture techniques. In normal subjects two types of TJ were identified, based on 27 type I, 23 type II junctional areas. Epithelium from the patient with chronic bronchitis showed extensive mucous metaplasia and only junctions of the second type. Extensive epithelial damage was detected in asthmatic subjects, so that a few TJ could be found. Varying degrees of TJ abnormalities were observed and the possible role of such ultrastructural derangements was discussed.

[Benign metastasizing leiomyoma of the uterus. Case report]. / Leiomioma benigno metastatizzante dell'utero. Segnalazione di un caso.

We have reported a "benign metastasizing uterine leiomyoma" case in a 55-year-old woman still living with "benign" metastases (lung, skin, lymph nodes, bone and perhaps the brain) 14 years after the first uterine myomectomy.

[Medical complications in lung resections]. / Le complicanze mediche nelle resezioni polmonari.

The complications of pulmonary resections are discussed with reference to a group of 82 patients. Arrhythmias, infections of pleural space and post-operative atelectasis occur with major frequency. Pleuropulmonary infections are most serious events because they are associated with significant mortality.

[Blood chemical parameters in the monitoring of inoperable bronchogenic carcinoma]. / Parametri ematochimici nel monitoraggio del carcinoma broncogeno non operabile.

Serum variations of 3 standard lung cancer markers (ferritin, carcinoembryonic antigen, gastrointestinal cancer antigen) were assessed in 27 patients with inoperable lung cancer diagnosed histologically and confirmed by cytology and/or histology. The study reveals that ferritin is the most sensitive marker.

[Bronchial carcinoma in subjects under 40]. / Il carcinoma bronchiale nei soggetti di età inferiore a 40 anni.

We investigated a series of 30 patients younger than 40 years with histologically proven bronchogenic carcinoma. Most patients were symptomatic for a mean duration of 3 months before examination. The most common cell types were squamous carcinoma in 10 patients, oat cell carcinoma in 9 patients, and adenocarcinoma in 5 patients. The disease was categorized as Stage I in 3 patients, Stage II in 3, Stage III in 17, and Stage IV in 7. Ten patients underwent resection, whereas 3 patients were inoperable at surgery. The average length of survival for the nonoperated patients was 4.2 months (range 1 to 16 months). The mean survival for the surgically treated patients was 23.3 months (range 0 to 84 months). Extent of resection did not have any statistical significance in the survival rates which were mainly affected by staging of disease.

[Occupational asthma from the use of synthetic resins. Personal case histories and a review of the literature]. / L'asma professionale da impiego di resine sintetiche. Casistica personale e revisione della letteratura.

33 cases of occupational asthma in plastics workers encountered by Turin INAIL in 1971-85 are examined. Functional and immunological test data reveal the possibility of various asthmogenic mechanisms both immune and non-immune.

[Potential use of indenolol in hypertensive patients with chronic bronchial asthma]. / Possibilità di impiego dell'indenololo negli ipertesi affetti da asma bronchiale cronica.

The data are reported on a double blind clinical experiment using indenolol on a group of asthmatic hypertensives. The drug revealed a satisfactory anti-hypertensive action in the absence of any significantly bronchoconstrictive effect. The orciprenaline test performed at the end of the experiment showed that the drug does not reduce the availability of beta 2 bronchial receptors vis-à-vis the beta 2 stimulants.

[Efficacy of the simultaneous aerosol administration of fenoterol and 2(alpha-thenoylthio)propionylglycine]. / Efficacia della somministrazione aerosolica contemporanea del fenoterolo e della 2(alfa-tenoiltio)propionilglicina.

The aim of the present study was to investigate the effect of a new mucolytic drug 2-alpha-tenoiltium-propionylglycine (2-alpha-TPG) administered in spray form together with a selective beta 2 stimulant, fenoterol. A double blind test was conducted on 26 patients to whom 2-alpha-TPG-fenoterol and placebo-fenoterol were given in spray form in two daily doses for 15 days at 10 day intervals. The data suggest the existence of an additive effect between the mucolytic drug (2-alpha-TPG) and the beta 2 stimulant (fenoterol) that would justify the use of the combination in the treatment of such patients.

[Pathological and clinical aspects of bronchial carcinoid tumor. The authors' own case reports]. / Aspetti patologici e clinici del tumore carcinoide bronchiale. Casistica personale.

Data (radiological, endoscopic, histological, clinical and surgical) are presented on 21 subjects with pulmonary carcinoid tumour encountered in the Turin University Chest Surgery Centre in 1980-1985. All patients were subjected to fibrobronchoscopy which revealed the tumour in 18 cases (14 were given multiple biopsies and in 4 cases samples could not be taken due to the patient's intolerance of the endoscopic manoeuvre). No appreciable bleeding occurred after any biopsy. Surgery was performed on all 21 patients (2 pneumonectomies, 7 bilobectomies, 12 lobectomies). There was 85.71% correspondence between pre and post-operative histological diagnosis.

[Collageno-vascular diseases and interstitial pulmonary fibrosis. An analysis of diagnostic tests]. / Malattie collageno-vascolari e fibrosi interstiziale polmonare. Una analisi dei tests diagnostici.

Collagenovascular diseases, particularly rheumatoid arthritis, LES and scleroderma frequently involve the lung. A group of 15 patients with collagen vasculopathies was analysed with a view to identifying the most suitable invasive and noninvasive tests for the diagnosis of the interstitial fibrosis of the lung that often accompanies such disorders. Among the noninvasive tests only the respiratory function tests (especially DLCO) are adequately sensitive, while chest X-rays, gallium scintigraphy of the lung and ACE are relatively unreliable. Bronchoalveolar lavage is often altered (though the intensity varies considerably) and transbronchial biopsy appears to be the ideal diagnostic examination.