[Bronchiolo-alveolar pulmonary carcinoma]. / Carcinoma pulmonar bronquíolo-alveolar.

The authors present a clinical case of a patient with a bronchiolo alveolar lung carcinoma with an unusual form of presentation: secretory pattern with large amounts of bronchial secretion--1000 cc per day--. At the same time, a theoretical approach of lung adenocarcinoma is made, in particular the bronchiolo alveolar carcinoma, in which it concerns clinical, radiological, diagnosis, prognosis and therapeutical aspects.

[Extrapulmonary tuberculosis]. / Tuberculose extrapulmonar.

Although the respiratory tract is the major site for tuberculous lesions, all organs can be affected. The authors review the clinical files of 25 patients admitted to our Department with lung and/or pleural tuberculous disease, confirmed by bacteriology or histopathology, who simultaneously suffered from tuberculosis in other organs. We included 20 men and 5 women, aged from 10 to 74 years (mean: 37.12 years); 6 patients had pleural tuberculosis, 19 had pulmonary tuberculosis, 4 of them having miliary tuberculosis. Lymph node tuberculosis was diagnosed in 14 patients, tuberculosis of the bones in 4, laryngeal tuberculosis in 3 patients, tuberculous pericarditis in 2 patients, epididymitis in 1 and intestinal in another patient. Several clinical aspects are discussed, namely diagnostic procedures, M. tuberculosis identification in inflammatory exudates in 6 patients, in urine in 1, and in histopathology in 9 patients; in the 9 remaining patients extrapulmonary tuberculosis was accepted considering clinical and radiological findings in patients with respiratory tract tuberculosis. We concluded that tuberculosis may still assume severe clinical forms and that patients with tuberculosis should be globally evaluated.

[Pulmonary lymphangioleiomyomatosis]. / Linfangioleiomiomatose pulmonar.

The authors present a clinical case of Lymphangioleiomyomatosis of the lung. They analyse the clinical, radiological and functional features and comment on the evolution and therapeutic approach of this rare disorder. To the authors, lung involvement as well as therapeutic decision are important features that affect the prognosis.

Humoral and cellular immunity in extrinsic pulmonary granulomatoses.

In the present study the AA. analyse the immunological behaviour of patients taken from a group of 309 cases of Extrinsic Pulmonary Granulomatoses (E.P.G.). Humoral immunological changes were studied by assessing serum immunoglobulins, various complement fractions and, when possible, circulating precipitating antibodies. Immunoglobulins A and G values were significantly higher than control values. On the contrary there was no significant difference between IgM values, in patients and controls. The complement fractions (C3c, C4 and C3 activator) showed values within normal limits. Specific circulating antibodies were detected both in bird fanciers and in cork workers. Cellular immunity was evaluated by comparing the results of various tests. Eighty percent of all cases of E.P.G. had negative tuberculin tests, while eighty percent of the general population, in Portugal, has positive tuberculin tests. The Kveim-Siltzbach test was positive in one of 19 cases of E.P.G., and this was considered a false positive result. In vitro lymphocyte blastic transformation in presence of pigeon antigen showed a significant increase in pigeon breeders as compared with controls. The migration of leucocytes from affected and non-affected corkworkers, affected and non-affected pigeon fanciers and controls, in the presence of the specific antigens, showed significant results. Finally, similarities and differences in immunological behaviour of these patients are discussed.

Influence of immersion to the neck in water on airway closure and distribution of perfusion in man.

We measured closing volume (CV), expiratory reserve volume (ERV) regional distribution of lung volume (Vr) and perfusion in 7 normal subjects in air and during immersion to the neck in water. In four subjects immersion resulted in a CV greater than ERV and the normal perfusion distribution became inverted. In the other subjects, ERV remained larger than CV and perfusion distribution during immersion was uniform, not inverted. In 5 subjects closing volume increased and in 3 of them, the ratio of apical/basal Vr increased significantly during immersion. One subject had nomeasurable CV and in the other it was not measured. The data suggest: (1) that when CV is greater than ERV during immersion there is an inversion of the normal perfusion distribution, caused by hypoxia and/or an increase in mean alveolar pressure in the alveoli beyond the closed airways, and (2) that an increase in pleural pressure gradient during immersion may contribute to the increase in C.V.

Our experience with acetylsalicylic acid hypersensitivity.

Results of a study carried out in 21 patients with acetylsalicylic acid (Aspirin), hypersensitivity, 17 females and 4 males, aged 16 to 69 years (mean 45.7) are presented. Some patients suffered from several types of allergic symptoms - 11 from Asthma, 3 Rhinitis, 3 Quinke edema, 5 Urticaria and 2 Anaphylactic Shock. Concomitant drug allergies, route of administration and composition of the ingested drug, familiar complaints of drug allergy, nasopharyngeal examination and lung function by spirometry and Acetylcholine tests were evaluated. Blood, sputum and nasal mucous eosinophil count, as well as secretory IgA and its secretory piece identification in saliva and nasal mucous, serotonin and histaminopexic power of serum and immunoelectrophoresis of serum proteins were performed in all patients. Human basophil degranulation test to Aspirin were evaluated in 12 patients. Skin prick tests with one standard range of 21 common allergens were done in all patients and intradermal skin tests with 1 lysine acetyl-salicylate (1/100 and 1/1000) were performed in all patients as well as in a selected control group of 12 healthy subjects.

Alfa-one antitrypsin phenotypes and inhalatory pulmonary pathology.

One hundred and twenty nine workers in the cork industry, 69 rural workers, 66 carpet makers, 58 workers in a granite quarry and 51 workers in a rice husking factory were studied from an epidemiologic point of view. All were submitted to a standard questionnaire planned to detect respiratory disease due to inhalatory causes. They were submitted to a clinical examination, summary ventilatory function tests, a 70 mm microradiograph, and blood was taken to determine alfa-one antitrypsin and its phenotypes and, in the cork industry workers and rice husking workers, the level of IgA, IgG and IgM. The results are presented and an attempt is made to correlate the various parameters among themselves, and namely alfa-one AT phenotypes with the existence of respiratory pathology. Finally the results are discussed.

Results of a clinical trial with a Dermatophagoides pteronyssinus tyrosine adsorbed vaccine.

Twenty-eight patients were included in a double-blind placebo-controlled study of a vaccine containing tyrosine-adsorbed Dermatophagoides pteronyssinus antigen (Migen(R)). The aim of the trial was to show the efficacy and safety of Migen as a 6-injection course, with or without a follow-up course of 6 maintenance doses, for the treatment of bronchial asthma. The patients selected had suffered from perennial asthma for at least 2 years and gave a strong skin reaction to house dust mite. The subjects in the study were divided into two groups: one of twelve patients receiving only a standard course of six graded injections at weekly intervals and the other of sixteen patients receiving the same course followed by a maintenance course comprising six injections of the highest strength (400 N.U.). Approximately half the patients in each of these groups were on placebo. Assessment was based on the patient's and doctor's impression of the response to the treatment using a daily symptom record card and clinical observation of the patient at regular intervals. The overall assessment was graded in accordance with the following four point scale: very good, good, same and worse. Results showed that the pa tients receiving Migen as a 6-injection course responded better than patients receiving placebo; moreover, patients who received 6 maintenance injections of Migen gave a very good or good response compared to those who were submitted to 12 injections of placebo and also compared to those receiving the standard course. Particular notice was taken of the side effects of the vaccine. Migen proved to be a good and and safe method of treating bronchial asthma due to house dust mite (D. pteronyssinus).