[Fire-eater's lung. Two cases and review of the literature]. / Feuerspuckerlunge. Zwei Kasuistiken und Literaturübersicht.

HISTORY AND ADMISSION FINDINGS: Two men were hospitalized (three years apart) after aspirating petroleum on their fist attempt at "fire-eating". Pt.1 (aged 25 years) complained of chest pain, dyspnea and dizziness. The other (Pt. 2; aged 29 years) had a hemoptysis. Pt. 1 had a normal body temperature, but the breath sounds were decreased over the left base. The breath sounds in Pt. 2 were normal, but he had a fever of 38.8 degrees C. Routine physical examination was unremarkable. INVESTIGATIONS: Laboratory tests in both patients revealed increased inflammatory parameters. Chest radiographs showed that Pt. 1 had a left basal alveolar infiltrate, while Pt. 2 had an infiltrate in the right middle and upper lobe, which on computed tomography after a few days showed signs of cavitation in the left infrahilar region and the middle lobe, respectively. Pneumococci were found in the sputum of Pt. 2. TREATMENT AND COURSE: Both patients were given antibiotics, Pt. 1 also had salbutamol inhalation treatment. The patients were discharged symptom-free after 8 and 10 days, respectively. A follow-up chest radiograph four weeks later in Pt. 1 merely showed streaky-fibrotic residues. CONCLUSION: These two case reports and detailed literature search indicate that immediate administration of antibiotics is important, while routine steroid treatment is not necessary.

Effects of nifedipine and moxonidine on cardiac structure in spontaneously hypertensive rats (SHR)--stereological studies on myocytes, capillaries, arteries, and cardiac interstitium.

Light and electron microscopic stereological studies were performed on the myocardium of spontaneously hypertensive rats (SHR) before and after treatment with nifedipine (27 mg/kg b.w./day) and the sympatholytic agent moxonidine (8 mg/kg b.w./day). The treated groups were compared with nontreated SHR and normotensive WKY (n = 10 in each group). When the therapy was started in 6-month old male SHR, blood pressure was increased and left ventricular hypertrophy had developed. On the other hand, pathologic changes of myocardial structure were not observed. After 3 months, the nontreated hypertensive rats showed cardiac fibrosis (volume density of fibrosis + 45%), activation and proliferation of interstitial cells (volume density of nonvascular interstitium + 240%), media hypertrophy of small arteries (total volume of arterial media in the left ventricle + 180%), reduced capillarization (length density of capillaries--11%), as well as focal degeneration of myocytes at the ultrastructural level. Both treatments showed similar effects on blood pressure, degree of hypertrophy, and cardiac structure. Blood pressure as well as degree of hypertrophy were significantly reduced (relative left ventricular weights: --25% and --16%). As far as myocardial fibrosis, capillarization, and regressive changes of myocytes are concerned a complete normalization was observed. Microarteriopathy and activation of nonvascular interstitial cells (first step in development of interstitial myocardial fibrosis) were significantly suppressed by therapy (total media volume --40%, volume density of nonvascular interstitium --38%), but the normal level of the normotensive control could not be maintained (+ 70%, + 111% vs WKY). This may be due to the slightly elevated systolic blood pressure despite therapy (+ 25%, vs WKY) or to hormonal factors in SHR which are independent of blood pressure. Since nifedipine and moxonidine are pharmacologically different drugs with different effects on sympathetic activity, one may cautiously conclude that increase in blood pressure itself is an important determinant of arterial, interstitial as well as myocellular alterations which are related to the pathogenesis of hypertensive heart muscle disease.