RESUMO
A 60-year-old white man with chronic bronchitis was noted to develop acute respiratory failure and metabolic acidosis four days after being started on methazolamide (Neptazane) for an ophthalmologic problem. The patient was intubated with ventilator support and improved after his metabolic acidosis resolved. Caution is emphasized in the use of carbonic anhydrase inhibitors in patients with obstructive airway disease.
Assuntos
Metazolamida/efeitos adversos , Insuficiência Respiratória/induzido quimicamente , Tiadiazóis/efeitos adversos , Acidose Respiratória/induzido quimicamente , Bronquite/tratamento farmacológico , Doença Crônica , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The occurrence of emphysema in people deficient in alpha1-antitrypsin and the production of emphysema in experimental animals with elastolytic enzymes suggest proteolysis as a mechanism for the development of emphysema. To investigate the possible role of pulmonary alveolar macrophages in the pathogenesis of emphysema, we measured elastase, acid protease, and elastase-like esterase activities in macrophages from patients with chronic obstructive lung disease and attempted to correlate the level of enzyme activity with the severity of pulmonary function abnormality measured in these patients. Compared to values for cigarette smokers with normal pulmonary function, these macrophage enzyme activities were not increased in patients with chronic obstructive lung disease, and there was no correlation of high elastase activity with more severe degrees of pulmonary function abnormality. These findings lead us to believe that the absolute level of proteolytic enzymes in pulmonary alveolar macrophages is not in itself a determinant of emphysema.
Assuntos
Pneumopatias Obstrutivas/enzimologia , Macrófagos/enzimologia , Peptídeo Hidrolases/metabolismo , Alvéolos Pulmonares/enzimologia , Adulto , Idoso , Carcinoma Broncogênico/enzimologia , Esterases/metabolismo , Feminino , Humanos , Neoplasias Pulmonares/enzimologia , Masculino , Pessoa de Meia-Idade , Elastase Pancreática/metabolismo , Enfisema Pulmonar/enzimologia , Fumar/fisiopatologiaRESUMO
Three cases of pneumonia caused by Neisseria meningitidis group Y are reported. From the results of these cases, the following conclusions were made. N. meningitidis probably can cause serious infection without preceding blood stream invasion. Primary meningococcal pneumonia is not rare; it has no distinctive clinical presentation; and it may not be recognized by routine expectorated sputum cultures. In addition, it may be associated with recent influenzal and adenoviral infections. Lastly, meningococci of the serogroup Y are capable of causing serious disease. Antimicrobial susceptibility studies showed that all three group Y isolates were sensitive to sulfadiazine and rifampin as well as to penicillin, ampicillin, erythromycin, and chloramphenicol.