Mantoux testing of 7th graders in Tel Aviv, Israel.

As part of a countrywide program of tuberculin testing of 7th graders, 10,133 children were examined in the Tel Aviv area over the 3-year period, Septemer 1991-June 1994. Of these, 655 were from families recently arrived from the former Soviet Union (I), and 9478 from long-time resident families of Israel (L). Of the I group 537 had received BCG at least once (82.0%), of the L group 5306 (56.0%). In the nonvaccinated I group 33.9% had reactions of 10 mm or more (clinically significant) while the rate was 6.1% in the L group, a statistically highly significant difference. In the vaccinated I group the rate of clinically significant reactions was 49.3% as compared to 10.3% in the L group, also statistically a highly significant difference. In general, the clinically significant reactions were more commonly found in the I group as opposed to the L group. Both BCG vaccination and prior place of residence appear to be statistically significant independent variables. No cases of tuberculosis occurred among the entire population tested. These data provide a base for surveillance of tuberculosis risk in Tel Aviv specifically and Israel in general.

The occurrence, recrudescence, and worsening of asthma in a population of young adults: impact of varying types of occupation.

OBJECTIVE: To describe the rates of exacerbation of existing asthma and incidence of new disease in Israeli men during military service. DESIGN: All 17-year-old Israeli nationals are obliged by law to appear at the Israel Defense Forces (IDF) recruiting office for medical examination. The medical history of army recruits was noted during the 30-month period after their induction into the IDF, and medical examinations were performed by pulmonary specialists in all suspected cases of asthma. The duty status of the soldiers in combat units (CUs), maintenance units (MUs), and clerical tasks was related to their asthma status. RESULTS: Of a total of 59,058 recruits, 1.0% developed asthma during the 30 months of this study; of those in CUs, 1.2% developed asthma; of those in MUs, 0.8% developed asthma; and of those performing clerical tasks, 0.6% developed asthma. The relative risk for developing or worsening of asthma was related to both the preexisting asthma status of the recruit and the environment in which he carried out his military service. The annual incidence of occupational-related asthma in MUs was found to be 800/million: five to six times the rates reported elsewhere. CONCLUSIONS: Service in CUs was associated with an increased frequency of exacerbation of asthma among recruits with previous disease and with the appearance of disease de novo. "Normal" conscripts with a history of childhood asthma are at a higher risk of developing overt asthma when compared to subjects with no such history. We found a 25% relative excess of incident cases of asthma in soldiers posted in MUs compared to those performing clerical tasks [(0.8 to 0.6%)/0.8%]. This difference is probably attributed to the difference in occupational hazards in these categories. Further studies are needed to determine if this represents the elicitation of underlying preexisting airway lability by new work demands or other environmental conditions, or if this represents a new development of airway lability because of specific immune or nonimmune factors.

An algorithm for pulmonary screening of military pilots in Israel.

BACKGROUND: Medical screening is used routinely to qualify and classify candidates for pilot training. The respiratory system assumes even greater importance owing to the increased stress of flying high-performance aircraft in a hostile environment characterized by high altitude, varying acceleration ("G" forces), and the possibility of rapid decompression. Any respiratory dysfunction may threaten the pilot's health, flight safety, and completion of the mission. Only those candidates with the highest psychophysical score are accepted to undergo special aeromedical screening. Physical suitability is an important factor in the selection and classification of candidates for flight training programs, and pulmonary function testing is central within this screening protocol. METHODS: We developed a respiratory algorithm for this unique screening process. The algorithm represents a practical and efficient approach for large-scale screening of healthy candidates for flight training. The algorithm deals with the major pulmonary health problems encountered in a previously screened healthy population aged 17 to 25 years. If by anamnesis, physical examination results, or baseline spirometry findings there is reason to suspect a respiratory problem that could emerge to endanger the pilot's life, a specially designed evaluation is performed according to the algorithm. We explain, step by step, the basis for each suggested test in order to reach a decision (operational specifications). The pulmonary function studies we recommend are reasonably priced and can be easily and reliably performed by regular medical staff technicians. The major justification for performing pulmonary function studies in a healthy population that has already gone through a preliminary medical screening and has been found fit is to identify occult or latent abnormalities. These abnormalities may have no or minimal clinical expression under ordinary circumstances but, under the stress of flight during the ensuing 5 to 10 years, may produce serious limitation in function. RESULTS: Two cases, seen in the Air Force Medical Center, are presented to illustrate how the algorithm is implemented. The algorithm has been in use for more than 5 years, and has been applied to the screening of several thousand candidates. Follow-up of the accepted candidates has not revealed any significant defects in the decision-making process. CONCLUSION: Use of the algorithm is highly cost-effective since it allows for nonspecialist physicians to carry out pulmonary screening and involves the pulmonary specialist only infrequently, ie, when a particularly complicated and/or borderline case is encountered. It is our contention that a similar algorithm would be useful in many other settings where large-scale screening is required.

Prevalence of histoplasmin sensitivity in healthy adults and tuberculosis patients in southwest China.

Two hundred and seventy-one healthy students and workers and 28 hospitalized tuberculosis patients living in Sichuan Province (southwest People's Republic of China; PRC) were tested with histolyn and tuberculin. The age of the tested subjects ranged from 17 to 22 years among the students, 17 to 38, among the workers and 17 to their 70s among the patients. Thirty-eight students (24%), 21 workers (18%) and 8 patients (29%) reacted positively to histolyn, none of the differences being statistically significant. Positive reactions were significantly more frequent among students from the south of Sichuan Province (35%) than from the north (6%). The rates of positive reaction to tuberculin in the students (25%) and in the workers (27%) indicates that tuberculous infection continues to be a significant problem in southwestern PRC. The significant rate of histolyn reaction among the tuberculosis patients raises the possibility of either infection with both Histoplasma capsulatum and Mycobacterium tuberculosis, or a missed diagnosis of chronic pulmonary histoplasmosis.

Human in vitro nasal and tracheal ciliary beat frequencies: comparison of sampling sites, combined effect of medication, and demographic relationships.

In vitro nasal and tracheal ciliary beat frequencies (CBFs) were measured photometrically in brush samples of 15 patients undergoing bronchoscopy. Tracheal and nasal CBF values in these patients were found to be significantly correlated (r = .74, p less than .01), and the latter did not differ significantly from the nasal CBF of 80 subjects serving as controls. Premedication with morphine and atropine and local anesthesia with lidocaine hydrochloride significantly decreased the CBF. Among the control subjects, a significantly higher CBF (13.6 +/- 1.5 Hz) was found in the young age group (10 to 19 years) as compared to other groups (12.2 +/- 1.7 Hz). Gender and ethnic origin did not influence CBF in any age group. These data support the possible use of the in vitro study of nasal epithelium to reflect the CBF in the lower respiratory tract.

Mucociliary clearance from central airways in patients with excessive sputum production with and without primary ciliary dyskinesia.

Studies of mucociliary clearance were made on 17 patients with bronchiectasis and excessive sputum production. Tracheal mucus velocity was measured. Five patients with primary ciliary dysfunction and 12 who had no clinical evidence of this defect were studied. The mean (+/- SD) tracheal mucus velocity of the five patients with proved or presumptive primary ciliary dysfunction was 2.9 +/- 0.2 mm per minute and for the 12 patients without ciliary dysfunction, 7.9 +/- 1.4 mm per minute. (The previously determined rate for normals was 4.7 +/- 1.3 mm per minute.) In four of five patients with ciliary dysfunction, CBF was below 7.5 Hz while in the one patient of the 12 without ciliary dysfunction CBF was at the lower limit of normal values. Thus, mucociliary clearance responds to load, depends partly on CBF, and has a built-in control system and the means for compensating for ciliary dysfunction.

Skin sensitivity to histolyn, spherulin, and PPD in the People's Republic of China.

One hundred one subjects living in northwest Hunan Province, People's Republic of China (PRC) were tested with histolyn, (Berkeley Biological Laboratories), spherulin (Berkeley Biological Laboratories), and tubersol (PPD 5 tuberculin units, Connaught Laboratories). Age of the tested subjects ranged from 16 to 58 years; 93 subjects were 22 years old or younger. Nine subjects reacted to histolyn with 5.0 mm or more induration, two subjects reacted to spherulin, and 34 subjects reacted to tubersol. One of the spherulin reactors also reacted to both histolyn and tubersol. The feasibility and advisability of doing a large-scale survey throughout the PRC seem clearly supported by this pilot project.

Brain dysfunction in primary ciliary dyskinesia?

To identify possible altered flow of cerebrospinal fluid due to defective ependymal ciliary motion, 8 subjects, including 6 with Kartagener's syndrome (KS), 1 with primary ciliary dyskinesia (PCD) and 1 with situs inversus were studied by computerized tomography (CT) examination of the brain and paranasal sinuses and had their nasal cilia studied by in vitro ciliary beat frequency (CBF) analysis. Five of the 6 patients with KS and the one with PCD had abnormal CBF (slowed or absent), while the CBF of 1 KS patient and the subject with situs inversus was normal. CT evaluation of the brains of all subjects was normal. Sinus examinations of the 7 patients with KS and PCD revealed mucosal thickening. We conclude that slowed or absent ciliary activity as measured in vitro is not associated with brain abnormalities as demonstrated by CT examination.

Clinical features of sarcoidosis in elderly patients.

We reviewed 17 cases of biopsy-proven sarcoidosis occurring in patients who were 65 years of age or older at the time of diagnosis in order to determine the clinical features of sarcoidosis in this group of elderly patients. A female preponderance (76%) was noted, as well as significant respiratory and cutaneous symptoms. There were no characteristic diagnostic features of sarcoidosis in this group; therefore, we suggest that tissue biopsy is needed to exclude pulmonary diseases such as neoplasm or tuberculosis. Most elderly patients having sarcoidosis remained clinically stable during the period of follow-up and did not require therapy for sarcoidosis. We propose that sarcoidosis should be considered in the differential diagnosis of elderly patients presenting with pulmonary or multisystem disease.