Ozone-induced changes in the chloroplast structure of conifer needles, and their use in ozone diagnostics.

Ozone induces characteristic symptoms in the chloroplasts of the needles of several coniferous species. Chloroplasts are (1) reduced in size and (2) the stroma is electron dense. Moreover, (3) these chloroplast alterations are more pronounced in the outer mesophyll cell layers and in the upper side of the needle compared to the inner layers and lower side. The syndrome, including the three symptoms (1)-(3), is found in the green needles of Scots pine and Norway spruce not only in the experimental fumigations, but also in mature trees in the field, and has potential for diagnosis of ozone stress. For sound ozone diagnostics all three symptoms must be present in the samples studied. The symptoms in relation to needle anatomy and physiology is discussed, and recommendations for sampling and analysis are given.

Studies of cytokine levels in bronchoalveolar fluid lavage from patients with interstitial lung diseases.

Cytokine levels in bronchoalveolar lavage fluid from patients with eosinophilic pneumonia (n = 7), allergic alveolitis (n = 11), (cryptogenic) fibrosing alveolitis (n = 8), sarcoidosis (n = 10) were determined, as well as levels in control samples from healthy non-smoking volunteers (n = 11). Fibronectin levels were increased in all the patient categories, the highest absolute levels of fibronectin (100-fold increase) being found in eosinophilic pneumonia and allergic alveolitis. TGF-beta (transforming growth factor-beta) was significantly elevated in allergic alveolitis only. There was a significant difference between allergic alveolitis on the one hand and both sarcoidosis and fibrosing alveolitis on the other. Tumour necrosis factor-alpha (TNF-alpha) was significantly increased in eosinophilic pneumonia and allergic alveolitis; allergic alveolitis and fibrosing alveolitis differed significantly in this respect. Platelet-derived growth factor-BB (PDGF-BB) levels were significantly elevated in allergic alveolitis and fibrosing alveolitis. It was found that the level of PDGF-BB was significantly decreased in the case of sarcoidosis, with no overlapping with allergic alveolitis or fibrosing alveolitis. Interferon-gamma (IFN-gamma) was decreased in all patient categories. A significant difference in extent of the decrease was found between allergic alveolitis and sarcoidosis. The interstitial lung diseases thus differed in the pattern of cytokines expressed, indicating that these cytokines could well be a part of the pathogenic process, and also that the measurement of cytokine levels could be diagnostically useful.

Hard metal alveolitis accompanied by rheumatoid arthritis.

Hard metal lung diseases (HML) are rare, and complex to diagnose. We describe the case of a patient with allergic alveolitis accompanied by rheumatoid arthritis. A sharpener of hard metal by trade, our patient was a 45-year-old, nonsmoking Caucasian female who experienced symptoms of cough and phlegm, and dyspnea on exertion. Preliminary lung findings were inspiratory rales in both basal areas, decreased diffusion capacity and a radiological picture resembling sarcoidosis. A high-resolution computed tomography scan indicated patchy alveolitis as well. An open lung biopsy revealed non-necrotizing granulomas consisting of epitheloid cells and surrounded by lymphocytes, plasma cells and a few eosinophils. These cells also occupied the thickened alveolar interstitium. Macrophages in the alveolar spaces, some of them multinuclear, contained dust particles. Hard metal alveolitis is clinically well known and, in this patient, has been described histologically. After the patient had quit working with hard metal and following corticosteroid therapy, pulmonary symptoms and signs were relieved. During this recovery period, however, she contracted rheumatoid arthritis.

Exposure to chlorinated acetic acids: Responses of peroxidase and glutathione S-transferase activity in pine needles.

During long-term exposure of pine (Pinus sylvestris L.) seedlings to trichloro- and monochloroacetic acids via root uptake or acid mist treatments, both substances were removed from the plant tissues by metabolic activity. None of the treated plants exhibited visible stress symptoms at the concentrations used. In addition, the exposure to both substances led to dramatic changes in the activity of xenobiotic detoxification enzymes (peroxidase and gluthatione S-transferase) in the needles of the plants.

Alveolar lavage fluid (ALF) of normal volunteer subjects: cytologic, immunocytochemical, and biochemical reference values.

OBJECTIVE: Pooled bronchoalveolar lavage fluid (BALF), the return of lavage, contains both bronchial and alveolar material which differ from each other. Artifacts may be created by filtering, centrifuging and washing cells before cytopreparation. This study presents reference values of healthy volunteers for the alveolar sample, ALF, cytopreparation being performed without filtration or centrifugation. METHODS: Eighteen healthy, non-smoking volunteers underwent a standard bronchoalveolar lavage using 10 aliquots of 20 ml of saline. Excluding the return of the first and second aliquots, the rest were pooled and examined cytologically, immunocytochemically and biochemically. The mean, standard deviation, and 95% confidence limits were calculated for the following variables: amount of return, estimated content of epithelial lining fluid (ELF), total and differential cell counts on filter and cytocentrifuge (CCF) preparations, computed cell counts per unit volume of ALF, distribution of lymphocyte subgroups CD3+CD2, CD4, CD8, CD19, CD25 and CD57, and the ratio of CD4 to CD8, the amounts of lymphocytes in the same subgroups per volume of ALF, and the concentrations of total protein, albumin, immunoglobulins A, G and M, hyaluronic acid, eosinophilic cationic protein (ECP), procollagen III aminoterminal propeptide (PCP) and beta 2-microglobulin in ALF and in ELF, as well as the ratios of the concentrations of the solutes in ALF to the same in serum. RESULTS: The 95% confidence limits of means for the most important variables were as follows: estimated ELF content 0.42-0.74%; total cells in ALF 76.6-143.0 x 10(6) l-1; distribution of inflammatory cells on filter and CCF slides: macrophages 74.9-83.6 and 81.4-90.1%, lymphocytes 13.1-22.5 and 8.1-16.4%, and neutrophils 1.0-4.1 and 0.7-2.7%, respectively; distribution of lymphocyte subsets: CD3+CD2 85.6-90.6%, CD4 44.3-53.1%, CD8 26.9-35.8%; concentration of solutes in ALF: total protein 44.8-61.3 mg l-1, albumin 15.4-22.2 mg l-1, IgA 1.8-3.4 mg l-1, IgG 3.1-6.1 mg l-1, IgM 0.05-0.26 mg l-1, hyaluronic acid 8.8-11.1 micrograms l-1, ECP 0.19-0.77 micrograms l-1, PCP 0.005-0.58 micrograms l-1, beta 2-microglobulin 62.2-81.5 micrograms l-1. CONCLUSIONS: Our results show that excluding the bronchial sample from ALF of volunteer subjects and omitting filtering and washing before cytopreparation produces cytologic, immunocytochemical and biochemical reference values with reasonable 95% confidence limits to be used in clinical settings.

Rheumatoid arthritis as a cause of cardiac compression. Favourable long-term outcome of pericardiectomy.

In order to clarify the significance of rheumatoid arthritis (RA) as a cause of cardiac compression, we scrutinized pericardiectomy files of 47 patients over a ten-year period at two university hospitals in Finland. Five patients with RA were found. All the patients with RA were men with seropositive disease and subcutaneous rheumatoid nodules. Two of the patients had pulmonary fibrosis, one had cutaneous vasculitis and three had had rheumatoid pleurisy. There was a mean delay of 10 months from the first cardiac symptom to the diagnosis of cardiac compression, the most common misdiagnosis being primarily a liver disease. On the basis of clinical and operative data, four out of the five patients had constrictive pericarditis and one had an effusive-constrictive form of the disease. The histopathological findings in all cases were consistent with chronic fibrosing pericarditis. A follow-up of seven to seventeen years of four patients has not revealed any signs of recurrent pericardial disease. Our results demonstrate that RA is an important aetiological factor for cardiac compression. The long-term outcome of this manifestation seems to be good after pericardiectomy.

High concentrations of eosinophil cationic protein and eosinophil protein X in eosinophilic pleural effusions.

To analyze the association of the eosinophil granulocyte with pleural effusions, we measured the concentrations of two eosinophil proteins, eosinophil cationic protein (ECP) and eosinophil protein X (EPX), in pleural fluid and serum of 92 patients with pleural effusions of various causes. We observed significantly higher ECP and EPX concentrations in eosinophilic than in noneosinophilic pleural effusions (p < 0.001 and p < 0.05, respectively) and a positive correlation between the concentrations of both eosinophil proteins in pleural fluid and the total number of eosinophils in pleural fluid (ECP: r = 0.66, p < 0.0001; and EPX: r = 0.62, p < 0.0001). There was a positive correlation between the concentrations of ECP in pleural fluid and serum (r = 0.74, p < 0.0001) and between the concentrations of EPX in pleural fluid and serum (r = 0.41, p < 0.001). High ECP and EPX concentrations in pleural fluid indicated nonspecific etiology and not tuberculosis as the cause of the effusion. Our results suggest that eosinophils in pleural effusions release eosinophil proteins and probably actively participate in the local inflammatory reaction.

Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study, 1984-1988.

The occurrence of giant cell arteritis (GCA) (considering temporal arteritis and polymyalgia rheumatica as its manifestations) was investigated in Western Nyland, Finland. Between 1984 and 1988 54 patients were diagnosed in a population of about 44,500. Fourteen patients (26%) had biopsy proven arteritis at the initial evaluation, and 2 patients became biopsy positive during followup. The retrospectively determined annual incidence of GCA in a 44 month period was 22.5/10(5) in the whole population, and 69.8/10(5) in residents aged 50 years or older. The corresponding figures of a prospective 16 month study were 30.4/10(5) and 94.4/10(5). The incidence rates of the prospective study are higher than those reported in comparable studies. Polymyalgia rheumatica, occurring alone or combined with cranial symptoms, was the most frequent manifestation of GCA, being present in 87% of patients.

Open lung biopsy of patients with rheumatoid arthritis.

In order to shed light on the histological changes occurring in the lungs of patients with rheumatoid arthritis (RA), we scrutinized an open lung biopsy file of 199 patients and selected the patients with RA. The histopathological patterns observed were: pulmonary rheumatoid nodules (4 cases, including one with rheumatoid pneumoconiosis); usual interstitial pneumonia (UIP) (2 cases); desquamative interstitial pneumonia (2 cases); bronchiolitis obliterans with patchy organizing pneumonia (2 cases); follicular bronchiolitis (1 case); organizing pneumonia always associated with bronchiolitis (3 cases); granulomatous reaction (3 cases); obliterating vasculitis (3 cases); granulomatous vasculitis (1 case); lymphoid hyperplasia (2 cases); and localized pulmonary fibrosis (1 case). The clinical data and laboratory findings for the histopathological groups overlapped and did not properly predict the anatomical picture. Both patients with UIP died of lung disease. Otherwise the prognosis in the series was good.

Long-term exposure of Norway spruce, Picea abies (L.) Karst., to ozone in open top chambers: II. Effects on the ultrastructure of needles.

One clone of spruce, Picea abies (L.) Karst., was exposed to different concentrations of ozone in open-top chambers for three seasons. The treatments were filtered air (CF), non-filtered air (NF) and non-filtered air + ozone (NF+). Changes in ultrastructure occurring in the 1985 flush of needles were followed for three years. Ultrastructural changes due to ozone first occurred in the chloroplasts. A decrease in length of the chloroplasts, an increase of the density of the stroma, an accumulation of ribosome-like granules and a decrease in the size of starch grains, were observed. The second organelle to be affected was the microbody and the last the mitochondria. At this later stage the cytoplasm had also disintegrated. Structural changes always appeared first in the outer cell layer facing the sky. The changes then gradually advanced in the tissue towards the lower part of the needle. In the NF+ treatment changes were observed at the first sampling event in November, 1 month after the end of the first exposure period. At this time the needles were about 6 months old. In the NF treatment the same changes appeared when the needles were about 14 months old. No changes were observed in the CF treatment. Changes of the same type as those observed in the mesophyll tissue were also seen in stomatal and endodermal cells. In albuminous cells a general breakdown of the organelles was observed.

High concentrations of chromium in lung tissue from lung cancer patients.

The pulmonary chromium content was determined by plasma atomic emission spectrometer (DCP-AES) from 53 lung cancer and 43 control patients, and compared with smoking habits, severity of emphysema and occupational history. The chromium content from the lung cancer patients was higher than that from the smoking (P less than 0.025) or nonsmoking control patients (6.4 +/- 4.3, 4.0 +/- 4.0, and 2.2 +/- 0.6 microgram/g dry weight, respectively). A positive correlation between the pulmonary chromium and smoking time (P less than 0.025) and the severity of emphysema (P less than 0.001) was found in the control but not in the cancer patients. The difference in the pulmonary chromium content was greatest between those lung cancer and control patients who were light smokers or had mild emphysema. This group of lung cancer patients included subjects with occupational exposure to chromium. The possibility of occupational cancer should be considered especially with light smokers. The grade of emphysema and metals such as chromium accumulating from tobacco could serve as objective indicators of smoking.

Smoking and the pulmonary mineral particle burden.

The total pulmonary mineral particle burden and types of environmental particles were assessed in relation to smoking in 11 unselected autopsy lungs from adult male smokers and paired male non-smokers matched by age and lung. The lungs were fixed intrabronchially with formalin-polyethylene glycol-alcohol solution at a standard pressure and air-dried. A sample of 1-2 cm3 was taken from the posterior or apicoposterior segment of the right/left upper lobe and plasma ashed at low temperature. The mineral particles were identified by scanning transmission electron microscopy (STEM), electron microprobe analysis and electron diffraction. The number, mass and volume were calculated from the STEM image. The smokers' lung tissue had a lower number (54 +/- 15 X 10(6), mass (5.1 +/- 3.2 micrograms), volume (183 +/- 122 X 10(-5) mm3) and surface area (104 +/- 44 mm2/cm3 of lung tissue) of particles than the non-smokers' lung tissue (68 +/- 42 X 10(6), 12.6 +/- 13.4 micrograms, 468 +/- 501 X 10(-5) mm3 and 191 +/- 167 mm2/cm3 of lung tissue, respectively). All mineral types except talc were more numerous in the non-smokers' than in the smokers' lung tissue. The mineral particles were typical of the Finnish bedrock: quartz 15 +/- 7%, plagioclase 8 +/- 4%, microcline 13 +/- 5%, micas 22 +/- 10%, talc 4 +/- 4% and kaolinite 10 +/- 5%. Fibres were observed in only 2 cases, amounting to 1% in each. The lower mineral particle content of the smokers' lungs probably reflects more active clearance mechanisms caused by cigarette smoke.

Benign lymphocytic angiitis and granulomatosis.

A 37 year old woman underwent a lobectomy for a lesion with a tumour like appearance on the chest radiograph. This was shown microscopically to be benign lymphocytic angiitis and granulomatosis, a rare condition that responds well to cytotoxic drugs and has a good prognosis.

Electrocardiographic criteria for the diagnosis of right ventricular hypertrophy verified at autopsy.

Four commonly used sets of electrocardiographic (ECG) criteria for diagnosing right ventricular hypertrophy (RVH) were tested for sensitivity and specificity in 12 men with isolated RVH, 15 with combined right and left ventricular hypertrophy and 24 with normal ventricular weights. The cardiac ventricles were weighed separately at autopsy and the left-to-right ratio was calculated. All the patients showing isolated RVH, with a left-to-right ratio of two or less, had died of respiratory causes. Three sets of ECG criteria showed a specificity of 100 percent, but sensitivities only from 26 to 44 percent. One set was more sensitive (74 percent) but much less specific than the others (79 percent). A new combination of ECG criteria attained a 63 percent sensitivity and a 96 percent specificity.

Bronchial stenosis after aspiration of an iron tablet.

Stenosis of the right intermediate bronchus was found in a 60-year-old woman four months after aspiration of an iron tablet. Right middle and lower lobe lobectomies were performed. By light microscopy, small amounts of foreign, iron-positive material surrounded by giant cells, large collections of hemosiderin containing macrophages, and severe fibrosis with only minimal inflammation were observed in the bronchial wall. Early diagnosis and management are stressed in order to avoid the stenosing process which is also possible after aspiration of some tablets.

Bronchiolo-alveolitis with pulmonary basal lamina injury in a rheumatoid patient during gold treatment.

A 47-year-old housewife presented with nonproductive cough, progressive breathlessness and intermittent fever during gold treatment, originally prescribed for seropositive polyarthritis, which later fulfilled the criteria for systemic lupus erythematosus (SLE). An open lung biopsy showed abundant interstitial edema with mononuclear inflammatory cells and some eosinophils, and slight bronchiolitis. The picture was nonspecific but suggestive of hypersensitivity pneumonitis. Electron microscopy revealed splitting and local disappearance of the basal laminae of the alveolar capillaries, venules and alveolar epithelium. This injury was confirmed by immunohistochemical staining for type IV collagen and laminin, the major components of basal laminae. In most macrophages there was lysosomal electron dense granular material, i.e. aurosomes, which gave the spectrum of gold in electron microprobe analysis. After the gold treatment was stopped the pulmonary symptoms gradually decreased during several months and no permanent lung disease remained. Whereas the pulmonary manifestation could have been due to her underlying disease we discuss in this study the possibility of its being gold induced.