Association of complete blood count parameters with the risk of incident pulmonary heart disease in pneumoconiosis: a retrospective cohort study.

BACKGROUND: Pneumoconiosis mostly combines pulmonary and cardiovascular diseases, among which pulmonary heart disease (PHD) is of major concern due to its significant impact on the survival of pneumoconiosis patients. White cell count (WCC), red cell distribution width (RDW) and platelet parameters are thought to affect inflammatory responses and may be predictors of various cardiovascular diseases. However, very few studies have focused on PHD. OBJECTIVES: To examine the relationship between baseline complete blood count parameters (WCC, RDW, platelet parameters) and the risk of incident PHD in pneumoconiosis patients. DESIGN: A retrospective cohort study. SETTING: This was a single-centre, retrospective cohort study that used data from an Occupational Disease Hospital, Chengdu, Sichuan. PARTICIPANTS: A total of 946 pneumoconiosis patients from January 2012 to November 2021 were included in the study. Female patients and patients who had PHD, coronary heart disease, hypertensive heart disease, cardiomyopathy, heart failure, oncological disease, multiple organ dysfunction, AIDS at baseline and follow-up time of less than 6 months were also excluded. OUTCOME MEASURES: We identified PHD according to the patient's discharge diagnosis. We constructed Cox proportional hazard regression models to assess the HR of incident PHD in pneumoconiosis, as well as 95% CIs. RESULTS: In the multiple Cox proportional hazard regression analysis, platelet count (PLT) and plateletcrit (PCT) above the median at baseline were associated with an increased risk of PHD in pneumoconiosis with adjusted HR of 1.52 (95% CI 1.09 to 2.12) and 1.42 (95% CI 1.02 to 1.99), respectively. CONCLUSION: Higher baseline PLT and PCT are associated with a higher risk of PHD in pneumoconiosis.

The role of the serum IL-33/sST2 axis and inflammatory cytokines in chronic obstructive pulmonary disease.

The IL-33/sST2 axis is associated with inflammation and cardiac stress. This study examined the roles of serum IL-33/sST2 and other inflammatory cytokines in chronic obstructive pulmonary disease (COPD) patients, with or without chronic cor pulmonale (CCP). The levels of serum IL-33 and sST2 in 36 COPD patients without CCP, 42 cases with CCP, and 37 healthy controls (HCs) were analyzed by enzyme-linked immunosorbent assay. The concentrations of serum TNF-α, IL-1ß, IL-6, IL-8, IL-10, and IL-12 were analyzed by cytometric bead array. The pulmonary function was also determined. The levels of IL-33 in COPD patients were lower than in patients with CCP during the acute episode stage and HCs, and increased as patients transitioned into the stable phase, especially in patients whose modified medical research council scale values decreased. IL-33 levels were correlated positively with FEV1%pre, FVC%pre, FEF50%pre, and MMEF75/25%pre, while they correlated negatively with center airway resistance. There were no differences in the levels of sST2 among these groups. The concentrations of IL-6 and IL-10 in COPD patients during acute episodes were significantly higher, and decreased during stable phases. IL-33 may be considered an important factor in the pathogenesis of COPD, and decreased IL-33 levels may be an indicator of the pulmonary function decline of COPD patients.

Elevated C-reactive protein, depression, somatic diseases, and all-cause mortality: a mendelian randomization study.

BACKGROUND: Elevated levels of plasma C-reactive protein (CRP) have been associated with many diseases including depression, but it remains unclear whether this association is causal. We tested the hypothesis that CRP is causally associated with depression, and compared these results to those for cancer, ischemic heart disease, chronic obstructive pulmonary disease, and all-cause mortality. METHODS: We performed prospective and instrumental variable analyses using plasma CRP levels and four CRP genotypes on 78,809 randomly selected 20- to 100-year-old men and women from the Danish general population. End points included hospitalization or death with depression and somatic diseases, prescription antidepressant medication use, and all-cause mortality. RESULTS: A doubling in plasma CRP yielded an observed odds ratio (OR) of 1.28 (95% confidence interval [CI]: 1.23-1.33) for hospitalization or death with depression, whereas for genetically elevated CRP, the causal OR was .79 (95% CI: .51-1.22; observed vs. causal estimate, p = .03). For prescription antidepressant medication use, corresponding ORs were 1.12 (1.11-1.15) and .98 (.83-1.15; p = .08). These results were similar to those for risk of cancer (p = .002), ischemic heart disease (p = 4 × 10(-99)), chronic obstructive pulmonary disease (p = 6 × 10(-86)), and all-cause mortality (p = .001) examined in the same individuals. CONCLUSIONS: Elevated CRP was associated with increased risk of depression in individuals in the general population, but genetically elevated CRP was not. This indicates that CRP per se is not a causal risk factor for depression.

Soluble receptor for advanced glycation end products in COPD: relationship with emphysema and chronic cor pulmonale: a case-control study.

BACKGROUND: The receptor for advanced glycation end products (RAGE) is a multiligand signal transduction receptor that can initiate and perpetuate inflammation. Its soluble isoform (sRAGE) acts as a decoy receptor for RAGE ligands, and is thought to afford protection against inflammation. With the present study, we aimed at determining whether circulating sRAGE is correlated with emphysema and chronic cor pulmonale in chronic obstructive pulmonary disease (COPD). METHODS: In 200 COPD patients and 201 age- and sex-matched controls, we measured lung function by spirometry, and sRAGE by ELISA method. We also measured the plasma levels of two RAGE ligands, N-epsilon-carboxymethyl lysine and S100A12, by ELISA method. In the COPD patients, we assessed the prevalence and severity of emphysema by computed tomography (CT), and the prevalence of chronic cor pulmonale by echocardiography. Multiple quantile regression was used to assess the effects of emphysema, chronic cor pulmonale, smoking history, and comorbid conditions on the three quartiles of sRAGE. RESULTS: sRAGE was significantly lower (p = 0.007) in COPD patients (median 652 pg/mL, interquartile range 484 to 1076 pg/mL) than in controls (median 869 pg/mL, interquartile range 601 to 1240 pg/mL), and was correlated with the severity of emphysema (p < 0.001), the lower the level of sRAGE the greater the degree of emphysema on CT. The relationship remained statistically significant after adjusting for smoking history and comorbid conditions. In addition, sRAGE was significantly lower in COPD patients with chronic cor pulmonale than in those without (p = 0.002). Such difference remained statistically significant after adjusting for smoking history, comorbidities, and emphysema severity. There was no significant difference in the plasma levels of the two RAGE ligands between cases and controls. CONCLUSIONS: sRAGE is significantly lower in patients with COPD than in age- and sex-matched individuals without airflow obstruction. Emphysema and chronic cor pulmonale are independent predictors of reduced sRAGE in COPD.

[Serum adiponectin level in patients of chronic pulmonary heart disease with cardiac failure].

OBJECTIVE: To investigate the changes of the concentration of serum adiponectin in patients of chronic pulmonary heart disease (CPHD) with cardiac failure. METHODS: Thirty-eight CPHD patients with cardiac failure underwent conventional treatment, and were divided into 2 subgroups: remission subgroup (n = 32) and non-remission subgroup (n = 6) according to the therapeutic effects 2 weeks later. Peripheral blood samples were collected from these 38 CPHD patients (CPHD group), including the remission subgroup and non-remission subgroup, and 30 healthy persons (as normal control group). Enzyme linked immunosorbent assay (ELISA) was used to detect the serum levels of adiponectin, interleukin (IL)-6, and tumor necrosis factor (TNF)-alpha before and 2 weeks after treatment. RESULTS: The serum adiponectin of the CPHD group was (9.5 +/- 7.1) ng/L in general, significantly lower than that of the normal control group [(21.5 +/- 9.0) ng/L, P < 0.01]. The serum adiponectin of the remission group was (17.0 +/- 6.3) ng/L, significantly higher than that of the non-remission group [(8.1 +/- 4.8) ng/L, P < 0.01], but still significantly lower than that of the normal control group (P < 0.05). The IL-6 and TNF-alpha levels of the CPHD group were (50.0 +/- 17.6) and (53.8 +/- 16.2) ng/L respectively, both significantly higher than those of normal control group [(24.4 +/- 9.1) and (28.4 +/- 11.4) ng/L respectively, both P < 0.01]. The IL-6 and TNF-alpha levels of the remission group were (29.0 +/- 12.1) ng/L and (32.3 +/- 13.5) ng/L respectively, both significantly lower than those of the non-remission group [(56.0 +/- 16.0) and (59.3 +/- 19.1) ng/L respectively, both P < 0.01], but not significantly different from those of the normal control group. There were no significant differences in the adiponectin, IL-6, and TNF-alpha levels between the non-remission group and the CPHD group. CONCLUSIONS: Adiponectin is involved in the pathophysiological process of heart failure in the CPHD patients. It may be a useful index to guide treatment and judge prognosis by dynamically determining the serum adiponectin.

Pulmonary tumor embolism: a rare cause of acute right heart failure with elevated D-dimers.

We report the case of a 49-year-old woman with a prior history of breast cancer who presented with a subacute course of progressive dyspnoea, culminating in cardiovascular collapse from acute right heart failure. D-dimer serum level was elevated. While a computed tomography of the chest was negative for pulmonary embolism, the autopsy study revealed multiple carcinomatous emboli in distal pulmonary arteries, veins, and lymphatics. Pulmonary tumor embolism may be more frequent than previously thought, and could be mistaken for pulmonary thrombo-embolism.

Effects of trimetazidine on lipid peroxidation, antioxidant enzyme activities and plasma brain natriuretic peptide levels in patients with chronic cor pulmonale.

An oxidant/antioxidant imbalance in favour of oxidants appears to occur in chronic cor pulmonale (CCP). Oxidative stress could also be a critical event in the pathogenesis of this condition. Trimetazidine (TMZ) has antioxidant properties and may affect the utilization of oxygen radicals. We investigated the effect of TMZ (20 mg three times daily, orally) on activities of erythrocyte malondialdehyde (MDA) and catalase (eCAT), erythrocyte and plasma glutathione peroxidase (GSH-Px) and plasma superoxide dismutase (pSOD) in CCP patients. We also assessed changes in plasma levels of brain natriuretic peptide (BNP) with TMZ therapy. Sixty CCP patients with significantly higher MDA and markedly lower pSOD, eCAT and GSH-Px (erythrocyte) activities than 24 healthy controls were randomly allocated to receive routine treatment or routine treatment plus TMZ. After 3 months' therapy, greater pSOD, eCAT and GSH-Px (erythrocyte and plasma) activities and lower MDA activity were found with TMZ treatment compared with routine treatment. Plasma BNP levels were significantly lower in TMZ-treated patients and higher in the routine treatment group than in the control group. TMZ improved antioxidant levels, decreased oxidative stress and decreased plasma BNP levels in CCP patients.

The significance of elevated brain natriuretic peptide levels in chronic obstructive pulmonary disease.

We investigated the clinical significance of brain natriuretic peptide (BNP), a cardiac hormone, in chronic obstructive pulmonary disease (COPD). Subjects were 38 patients with stable COPD, of whom 20 had cor pulmonale (CP), and 22 were healthy individuals. Plasma BNP levels were measured and pulmonary arterial pressure (PAP) was estimated by echocardiography. Arterial blood gas analysis, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also recorded. BNP levels of patients with COPD were higher than those of controls (48.2 +/- 37.5 and 9.3 +/- 3.0 pg/ml). Patients with CP had a higher mean BNP level with respect to those without CP (73.9 +/- 35.8 and 21.0 +/- 10.2 pg/ml, respectively). BNP levels correlated with PAP (r = 0.68), partial arterial oxygen pressure (r = -0.70), FEV1 (r = -0.65) and FVC (r = -0.52). We have concluded that BNP determination has a role in the diagnosis of CP in patients with COPD.

[Study on the clinical significance of plasma adrenomedullin and brain natriuretic polypeptide in the patients with chronic cor pulmonale on highland].

OBJECTIVE: To study the clinical significance of plasma adrenomedullin (ADM) and brain natriuretic polypeptide (BNP) in the patients with chronic cor pulmonale on highland (HACCP). METHODS: The levels of ADM and BNP in plasma of 44 patients with HACCP in the acute and in the remission stages were determined with radioimmunoassay. Their correlations with partial pressure of oxygen in arterial blood (PaO(2)), endothelin-1 (ET-1), and the ratio of right ventricular pre-ejection time to the pulmonary flow acceleration time (RVPEP/AT), which reflected the degree of pulmonary hypertension, were investigated. Twenty healthy subjects served as a normal control group. RESULTS: The levels of ADM [(38.8+/-7.2)ng/L and (26.2+/-5.3)ng/L] and BNP [(81.4+/-13.8)ng/L and (58.9+/-9.3)ng/L] in the acute and remission stages of cor pulmonale groups were both significantly higher than those in the normal control group [(15.0+/-3.2)ng/L, (38.6+/-3.4)ng/L, respectively, all P<0.01]. The levels of ADM and BNP in acute stage were both significantly higher than those in remission stage (both P<0.01). In the acute and in the remission stages, the levels of ADM in plasma were negatively correlated with PaO(2) (r(a)=-0.826, P<0.01; r(r)=-0.783, P<0.01), positively correlated with ET-1 (r(a)=0.755, P<0.01; r(r)=0.668, P<0.01) and RVPEP/AT ratio (r(a)=0.788, P<0.01; r(r)=0.734, P<0.01). In the acute and in the remission stages, the levels of BNP in plasma were negatively correlated with PaO(2) (r(a)=-0.787, P<0.01; r(r)=-0.554, P<0.01), positively correlated with ET-1 (r(a)=0.725, P<0.01; r(r)=0.679, P<0.01) and RVPEP/AT ratio (r(a)=0.771, P<0.01; r(r)=0.722, P<0.01). CONCLUSION: The study suggests that ADM and BNP are involved in the pathophysiological process of HACCP in the patients and may play a compensatory role in the disease.

[Hemodynamics, blood gas composition and viscosity in patients with chronic obstructive bronchitis complicated by chronic cor pulmonale]. / Sostoianie gemodinamiki, gazovogo sostava i viazkosti krovi u bol'nykh khronicheskim obstruktivnym bronkhitom, oslozhnennym khronicheskim legochnym serdtsem.

Hemodynamics, external respiratory function (ERF), blood gas composition and viscosity were studied in 120 patients with chronic obstructive bronchitis at different developmental stage of cor pulmonale. In pulmonary hypertension, there were moderate ERF disorders that became more marked in the compensatory and particularly decompensatory cor pulmonale. As bronchial patency deteriorated, the index of right ventricular performance increased from 0.76+0.081 to 1.23+0.022 in the examinees. Examination of blood gas composition revealed insignificant hypoxemia in pulmonary hypertension and compensatory cor pulmonale, which progressed with decompensation of chronic cor pulmonale (CCP). As bronchial obstruction progressed, there were increases in systolic, diastolic, and mean pressure in the pulmonary artery. The viscosity of blood and plasma and the indices of red blood cell aggregation and deformability were in the normal range in pulmonary hypertension and compensatory CCP. In CCP decompensation, the viscosity of blood and plasma and the index of red blood cell aggregation were increased and the index of red blood cell deformability was decreased.

[Changes of plasma adrenomedullin level during the process from chronic bronchitis to chronic cor-pulmonale].

OBJECTIVE: To investigate the relationship between the plasma adrenomedullin (ADM) levels and the extent of chronic cor-pulmonale and its underlying diseases, and explore the role of ADM in these diseases. METHODS: Totally 26 patients with chronic bronchitis, chronic bronchitis accompanied with obstructive pneumonectasia or chronic cor-pulmonale were included respectively as clinical test group T1, T2 and T3; 26 normal people and 14 patients with pneumonia were chosen as control groups (group C1 and C2). Plasma concentration of ADM in every selected individual had been measured with specific radioimmunoassay. RESULTS: Levels of plasma ADM in T3 were significantly higher than those in T2, and T2 than T1, C1 and C2 (P < 0.05), but there were no obvious difference between T1 and C1, between T1 and C2 (P > 0.05). CONCLUSIONS: Plasma ADM levels can reflect the severity of the above series of diseases.

Effect of disease states on theophylline serum concentrations: are we still vigilant?

The use of theophylline has decreased over the past decade because of concerns over the risks of serious adverse effects as well as availability of more effective, safer drugs. Because of this decline in use, some clinicians may not be alert to the marked effect of some disease states on theophylline serum concentrations. The purpose of this review is to heighten awareness of the effect of decompensated heart failure, cor pulmonale, hepatic dysfunction, thyroid disease, and febrile illness on theophylline serum concentrations. Because many patients receive some benefit from this drug, safe use by clinicians requires closer monitoring of serum concentrations in patients with factors that alter theophylline clearance, including several disease states.

[A study on the changes of blood levels of type III procollagen and type IV collagen in relation to artery blood gas and lung function in patients with cor pulmonale].

This study was conducted to explore the changes of PC III (type III procollagen) and C IV (type IV collagen) in the serum in patients with chronic pulmonary heart diseases. The blood levels of PC III and C IV in 25 patients with chronic pulmonary heart diseases and 20 normal subjects were measured by radioimmunoassay and were analysed in relation with the artery blood gas and pulmonary function parameters. The results revealed that the blood levels of PC III and C IV in the patients were significantly higher than those in normal subjects, and were negatively correlated with PaO2, FEV1%, MBC and MMEF (P < 0.05, P < 0.01). The results suggest that the blood levels of PC III and C IV of patients with chronic pulmonary heart diseases are significantly increased and significantly correlated with pulmonary function damage and hypoxia.

Distinctive features and long-term survival of reversible and chronic hypercapnic patients with COPD.

Hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD) is an indicator of poor prognosis compared to that for normocapnic patients. On the other hand, there exist particular patients who are hypercapnic during an acute exacerbation of COPD but revert to normocapnia after adequate therapy. The aims of this study were: 1) to document the admission characteristics of such patients in terms of clinical and laboratory findings; and 2) to analyse the long-term course and survival of chronic and reversible hypercapnic and normocapnic patients. Fifty-six consecutive patients, admitted with an acute exacerbation of COPD, were enrolled and divided into three groups according to arterial carbon dioxide tension (Pa,CO2) at first admission: 22 chronic hypercapnic (group 1), 15 reversible hypercapnic (group 2) and 19 normocapnic (group 3) patients. Age, sex, smoking history, white blood cell count, serum sodium, potassium, urea and albumin levels and pulmonary function tests at first admission were similar in the three groups. The haematocrit level was significantly higher in group 1 compared with the other groups. Groups 1 and 2 had lower pH, arterial oxygen tension (Pa,O2) and arterial oxygen saturation (Sa,O2) and a higher Pa,CO2 than group 3. The Pa,CO2 was also higher in group 1 than in group 2. The presence of cor pulmonale was significantly higher in group 1 compared with groups 2 and 3 (81.8 versus 60 and 10.5%, respectively). During the follow-up period, a significant increase was observed in airway obstruction associated with progressive hypercapnia and hypoxaemia in chronic hypercapnic patients, and 12 of 15 (80%) reversible hypercapnic patients progressed to a chronic hypercapnic status. The survival analyses after 10 yrs of follow-up revealed comparable survival durations in chronic and reversible hypercapnic patients (median of 8.86 versus 9.52 yrs, p > 0.05). In conclusion, despite careful monitoring of particular characteristics in chronic and reversible hypercapnic patients at the time of admission, no long-term predictivity of these features for either the course of the disease or survival could be found.

Elevated plasma brain natriuretic peptide levels in chronic respiratory failure with cor pulmonale.

Elevated plasma brain natriuretic peptide (BNP) levels have been described in patients with congestive heart failure and acute myocardial infarction. We measured plasma BNP levels in patients with chronic respiratory failure to evaluate the correlation between plasma BNP levels and pulmonary haemodynamics. Plasma BNP levels were measured in 28 patients with chronic respiratory failure accompanied by three underlying diseases [14 with chronic obstructive pulmonary disease (COPD), seven with sequelae of pulmonary tuberculosis (sequelae Tbc) and seven with diffuse panbronchiolitis (DPB)] by immunoradiometric assay methods (IRMA). Twenty-one of 28 patients had already received oxygen supplementation and 16 of 21 patients were treated as outpatients with home oxygen therapy. Plasma BNP levels were significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (81.5 +/- 13.1 pg ml-1) compared to patients without cor pulmonale (13.3 +/- 2.7 pg ml-1, P < 0.001). As controls, plasma BNP levels in 10 patients with primary lung cancer were studied, and the results (3.5 +/- 1.0 pg ml-1) were not significantly different from those of patients with chronic respiratory failure without cor pulmonale. Plasma BNP levels in 12 healthy subjects were also studied, and the results (7.2 +/- 1.0 pg ml-1) were not significantly different from those of the control subjects. Plasma BNP levels showed a weak linear correlation with systolic pulmonary arterial blood pressure, estimated by Doppler echocardiography (r = 0.43; P = 0.068), but there was no significant correlation between BNP levels and the degree of hypoxaemia (r = 0.30; P = 0.138). Plasma atrial natriuretic peptide (ANP) levels in patients with chronic respiratory failure were also measured using the same samples. Plasma ANP levels were also significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (80.8 +/- 12.1 pg ml-1) compared to patients without cor pulmonale (26.1 +/- 4.4 pg ml-1, P = 0.003). A significant correlation was found between plasma BNP and ANP levels (r = 0.68; P < 0.001). Our results suggest that the plasma BNP or ANP level may be a useful indicator for detecting the presence of cor pulmonale in patients with chronic respiratory failure.

Bronchoalveolar and systemic cytokine profiles in patients with ARDS, severe pneumonia and cardiogenic pulmonary oedema.

The aim of this study was to investigate whether bronchoalveolar lavage (BAL) and serum levels of proinflammatory cytokines discriminate between different entities of patients with acute respiratory failure. BAL and circulating concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-alpha) were measured in 74 mechanically-ventilated patients and 17 healthy controls. Patients were classified as cardiogenic pulmonary oedema (CPO), acute respiratory distress syndrome (ARDS), primary severe pneumonia (PN) and a combined group (PN+ARDS). In all patients with ARDS and/or PN, markedly elevated BAL levels of IL-6 and IL-8 were detected, which were significantly greater than levels in CPO and healthy controls. Absolute quantities and time-course of these cytokines did not differentiate between the absence and presence of lung infection, or different categories of PN. Similarly, circulating IL-6 levels were comparably elevated in patients with ARDS and/or PN, whereas circulating IL-8 concentrations were inconsistently increased. TNF-alpha was rarely detected in BAL samples, but increased serum concentrations were measured in ARDS and/or PN patients. Bronchoalveolar lavage levels of interleukin-6 and interleukin-8, but not tumour necrosis factor-alpha, and serum concentrations of interleukin-6 are consistently elevated in acute respiratory distress syndrome and/or severe pneumonia, discriminating these entities from cardiogenic pulmonary oedema. Alveolar and systemic cytokine profiles do not differentiate between acute respiratory distress syndrome in the absence of lung infection and states of severe primary or secondary pneumonia, which evidently present with comparable local and systemic inflammatory sequelae.

[The effect of high blood viscosity, caused by secondary polycythemia, on pulmonary circulation and gas exchange in patients with chronic cor pulmonale]. / Secunder polycythaemia okozta hyperviscositas hatása a kisvérköri haemodinamikára és gázcserére idült cor pulmonales betegeknél.

Blood viscosity, pressure of pulmonary artery, pulmonary functions, arterial and mixed venous oxygen content, cardiac output, oxygen transport capacity, oxygen consumption, ejection fraction have been examined at 25 patients with or without hypoxic cor pulmonale with or without secondary polycythaemia. Although secondary polycythaemia occurs in patients with hypoxic cor pulmonale as a compensatory process to increase the oxygen carrying capacity of the blood theoretically but as our findings: 1. The rise of haematocrit causes rise in blood viscosity significantly. 2. Polycythaemia secondary over 0.50 l/l of haematocrit contributes the rise of pressure in pulmonary artery. 3. The systemic oxygen carrying capacity is increasing with the rise of haematocrit up to 0.45 l/l but decreasing over 0.50 l/l. 4. Oxygen consumption is decreasing parallel with the rise of haematocrit. 5. Pulmonary functions, cardiac output do not change by the rise of haematocrit.

[Development of chronic cor pulmonale in restrictive and obstructive pulmonary dysfunctions]. / Razvitie khronicheskogo lëgochnogo serdtsa pri restriktivnom i obstruktivnom tipakh narusheniia funktsii lëgkikh.

A total of 2840 patients with pulmonary tuberculosis and bronchial asthma were studied. Antigens are shown to induce a systemic vascular response with elevated systolic pressure in the pulmonary artery, peripheral venous spasms. There is activation of the sympathoadrenal system and desensitization of beta-adrenoreceptors with lower levels of cyclic adenosine monophosphate (CAMP). There is a direct correlation between the CAMP levels and the cardiac output, between those and the pulmonary systolic pressure (PSP). This determines hyperkinetic hemodynamics in tuberculosis with the volume- and pressure-loaded heart. Paresis of pulmonary circulation, as well as hypokinetic hemodynamics occur as a result of an allergic immunological reaction in severe fibrocavernous processes in the area of tuberculosis. There is a direct correlation between the circulating immune complexes and CAMP. In bronchial asthma microcirculation is impaired due to antigenic exposures and elevated intrathoracic pressure. Pulmonary capillary reduction in restrictive processes results in higher levels of CAMP and right-to-left shunt, leading to hypoxemia. In obstructive pulmonary diseases, hypoxemia is caused by hypoventilation and impaired ventilation-perfusion ratios.

[Observations on serum digoxin-like immunoreactive substances in patients with cor-pulmonale].

The level of endogenous digoxin-like immunoreactive substances (DLIS) was determined with RIA in 27 patients with cor-pulmonale and 10 normal subjects as controls. The results showed that the concentration of serum DLIS was 0.51 +/- 0.18 ng/ml in the controls, 0.82 +/- 0.24 (P < 0.05), 1.45 +/- 0.51 (P < 0.001), and 2.31 +/- 1.22 ng/ml (P < 0.001) in the patients groups with cardiac function grade II (9 cases), III (10 cases) and IV (8 cases) respectively. It has been reported that both endo- and exogenous digoxin-like substances have the same function. Cor-pulmonale patients with heart failure who are treated with digoxin tend to have toxic reactions. We consider the increase in serum endogenous DLIS as the cause. It is suggested that the dosage of digoxin, if it must be used, should be individualized and the serum level monitored if possible, so as to achieve best therapeutic effects with smaller doses.