Three cases of pulmonary sarcoidosis associated with aspergilloma.

Three cases of parenchymal sarcoidosis with aspergilloma are described. Emphysematous bullae due to the basic disease were thought to predispose to aspergillomas. The roles possibly played by disturbances in cell-mediated immunity, associated with sarcoidosis, and by corticosteroid therapy are discussed. Antimycotics were effective in this difficult combination of diseases. Although the aspergillomas were not completely cured, a decrease in the amount of sputum and in the frequency of haemoptysis was noted for long periods. These drugs may also be useful as protective medication against invasive aspergillosis during corticosteroid therapy in patients with aspergilloma.

Asthma, allergy and bronchial hyper-reactivity to histamine in patients with bronchiectasis.

An allergy examination was made on forty-eight consecutive bronchiectasis patients, with a mean age of 37 years. Eleven had confirmed asthma and another nine, making twenty in all (42%), had distinct allergic diathesis. Allergy to a specific allergen was established in five cases. 50% of the patients in the total series had bronchial histamine hyper-reactivity, eleven without asthma or distinct allergic diathesis. The results corroborate views previously reported of the role of asthmatic symptoms and allergic diathesis as aetiological factors of bronchiectasis.

Deficiency of alpha1-antitrypsin and bronchiectasis.

60 consecutive patients with bronchiectasis were screened for alpha1-antitrypsin deficiency. Six cases (10%) with genotype PiMZ (alpha1-antitrypsin less than 66% of normal) were found. This frequency (10%) was statistically significantly (p less than 0.005) higher than the frequency of PiMZ (2.7%) in the control group. In two patients the bronchiectasis was cystic. It is suggested that the deficiency states of alpha1-antitrypsin promoting the proteolysis can participate in the genesis of bronchiectasis.

The effect of bronchography on pulmonary ventilation.

Using a gamma camera and the Xenon-133 washout method the reduction in lung function during unilateral bronchography was assessed in eleven patients. A considerable reduction in the washout rate was observed in the lung examined with bronchography both absolutely and compared with the opposite lung. Some improvement occurred after coughing out the contrast medium. It is concluded that the ventilatory function of the lungs is considerably impaired during bronchography and this should be borne in mind when referring patients with reduced lung function for this examination.

Acquired eventration of the diaphragm--results of surgery.

Results of surgical repair of acquired diaphragmatic eventration are reported. The series consists of nine adult patients studied pre- and postoperatively with clinical, radiological and lung function investigations. The repair was performed in all cases by a thoracic approach and plication of the diaphragm. The operative procedure was well tolerated in all cases. On follow-up seven patients were found to be improved and in two transient or no improvement occurred. Subjectively, gastrointestinal symptoms were alleviated most often by the operation. Radiological studies showed that although the immediate postoperative position of the diaphragm was very good in all cases, the diaphragm began to stretch and elevate gradually during the first year. In one case rupture of the repaired diaphragm developed 2 years after plication. Reoperation was performed with success. In one case the anatomical end result was no better than before the repair, in the others it was partially or completely improved. Plate atelectasis was observed no longer after the operation. Preoperative lung function studies showed a slight to moderate restrictive defect in 8 cases and a marked one in one case. 37% of the total lung perfusion was distributed to the affected side. On the average no significant changes could be found between the pre- and postoperative values.

Serum immunoglobulin A in chronic bronchial inflammation.

Serum IgA was determined by the single radial immunodiffusion method in specimens collected during 1 year from 178 patients suffering from chronic bronchitis syndrome. The IgA level was permanently, significantly higher in the group of patients than in the group of healthy controls. The difference between the patients and controls increased until middle age. This phenomenon was parallel with an aggrevation of the average functional severity of the pulmonary disease. Despite the continued aggravation, the difference lessened after the age of 49. Three cases of severe quantitative IgA abnormality were detected among the patients: one case of IgA myeloma and two cases of almost total IgA deficiency. One of the latter also showed IgE deficiency.

Pulmonary circulation in alpha1-antitrypsin deficiency investigated by cinedensigraphy.

The series consisted of eight cases of severe serum alpha1-antitrypsin deficiency (Piz homozygosity) and eight lung patients with a heterozygous level of the compound. The regional blood pulsation pattern in the lungs in the recumbent position was compared with the pattern in a group of normal controls using a cinedensigraphic device specially constructed for lung circulation studies. In the homozygous group, pulsation in the lower part of the lungs was significantly weakened to the benefit of the apical part. Individual variations occurred. The disturbance observed was not altered with oxygen breathing. This phenomenon is analogous to the redistribution of the blood flow demonstrated by scintigraphic methods. The heterozygous group did not differ significantly from the normal controls with regard to regional pulsation pattern.