The effect of a new expectorant drug on mucus transport in chronic bronchitis.

The expectorant effect of two weeks treatment with cistinexine dihydrochloride (Rec 15/1884/2, Recordati S.p.A, Milano), on mucus transport rate (MTR) was evaluated in a double-blind study on 30 chronic bronchitis patients, 20 treated with active drug (group D), 10 with placebo (group P). After inhalation of nebulized 99mTc labelled human albumin minimicrospheres (HAMM), MTR was determined by external gamma-camera counting over the thorax. To control initial particle deposition a penetration index (PI) was determined as the ratio of activity between peripheral and hilar regions of equal size. Before treatment no differences were found between groups in spirometry, PI, and MTR. After treatment spirometry and PI remained unchanged in both groups. MTR expressed as the half time (T1/2) of the exponential fitting between 0 and 40 minutes showed an interesting behaviour, particularly in group D. Considering the group as a whole, T1/2 did not vary significantly (381 +/- 400 min. before, vs 224 +/- 132 min. after treatment, p = 0.090). However, a statistically significant reduction of the index (815 +/- 396 min. before vs. 258 +/- 120 min. after treatment, p < 0.01) occurred in the seven patients showing at baseline a T1/2 higher than 338 +/- 182 min. (the reference value observed in our laboratory for 8 asymptomatic non smoker subjects). Therefore, the beneficial effect of the drug is seen only in patients with a severe impairment of MTR.

Ventilation-perfusion heterogeneity and gas exchange variables in acute pulmonary embolism evaluated by two different computerized techniques.

The mechanisms by which the disturbances of gas exchange develop in human pulmonary embolism are unknown. We investigated whether the inequality of ventilation-perfusion ratio is associated with the abnormalities of pulmonary gas exchange as evaluated by two different computerized techniques. We measured the alveolar to arterial gradients of oxygen and carbon dioxide by means of a computer based system with a mass spectrometer and the ventilation-perfusion distributions by the multiple inert gas technique in 5 patients with acute pulmonary embolism. In these subjects there was a marked ventilation-perfusion inhomogeneity, as detected from inert gases and this finding was in agreement with the impairment of the alveolar to arterial gradients and of their derived indexes. Consideration on the responsible mechanisms for the disturbances of gas exchange are also reported. In conclusion these two computerized techniques provide a useful assessment of the ventilation-perfusion relationships in order to explain the disturbances of gas exchange in critically ill patients.

Fatal peripheral airway cystic disease in a young woman.

Diffuse cystic transformation of both lungs was rapidly fatal in a 33-year-old woman. This disorder, a rare congenital condition in infants, has apparently not been described in adulthood.