On the function of cilia in the female reproductive tract.

A recently discovered syndrome is characterized by congenital immotility of the cilia. It consists of chronic infections in the respiratory system, male infertility, and, in about one-half of the cases, situs inversus. The syndrome thus includes Kartagener's syndrome. The syndrome provides a unique opportunity to gain insight into the role of the cilia in the human body. Five women evidently suffering from this syndrome were examined. They had no gynecologic disorders. Three of the five women had tried to become pregnant and two have suceeded. A review of the literature indicates that men with Kartagener's syndrome are usually infertile, whereas the women are not. This fact and the data presented herein constitute strong evidence that ciliary motility is not essential for female fertility. More conclusive proof could be obtained if any of the affected women would consent to ultrastructural investigation of the oviductal cilia.

PIP: A recently discovered syndrome is characterized by congenital immotility of the cilia. It consists of chronic infections in the respiratory system, male infertility, and in about 1/2 of the cases, situs inversus. The syndrome thus includes Kartagener's syndrome. The syndrome provides a unique opportunity to gain insight into the role of the cilia in the human body. 5 women evidently suffering from this syndrome were examined. They had no gynecologic disorders. 3 of the 5 women have tried to become pregnant and 2 have succeeded. A review of the literature indicates that men with Kartagener's syndrome are usually infertile, whereas the women are not. This fact and the data presented therein constitute strong evidence that ciliary motility is not essential for female fertility. More conclusive proof could be obtained if any of the affected women would consent to ultrasturctural investigation of the oviductal cilia.

Otologic manifestations of the immotile-cilia syndrome.

The immotile-cilia syndrome is caused by a hereditary, inborn, ultrastructural defect of the cilia, rendering them immotile or poorly motile and thereby abolishing mucociliary clearance. Five cases are presented and the otologic manifestations are described in some detail. The syndrome should be suspected in children who have a persistent secretory otitis media with recurring bouts of acute otitis media, and a perpetual cough with repeated episodes of bronchitis. A lobar atelectasis is a frequent finding. Half the cases also have situs inversus. The immotile-cilia syndrome is of special interest to the otologist, as it seems to throw some light on the pathogenesis of secretory otitis media.

Prevalence of contact dermatitis among dental personnel in a Swedish rural county.

The use of acrylate-based polymers in dental care in Sweden has increased dramatically in recent years. Acrylate monomers are sensitizers and can cause contact dermatitis. Allergy to latex, e.g. in rubber gloves, is also an increasing problem in health care and especially in dental care. The aim was to estimate the prevalences of work related allergies in dental personnel in a Swedish county with almost 700 dentists, dental nurses and dental hygienists. A questionnaire was distributed to all dental care units in the county and 98% of the population completed it. Specific allergy was verified with standard patch and prick testing. Work related allergy symptoms were reported by 189 subjects, 28%. The prevalences of acrylate eczema and latex allergy were 3,0% and 3,7% respectively. The prevalence of all work related skin allergy was estimated to 8%. The estimated prevalence of acrylate allergy was close to those of a few other published reports. However, the prevalence of hypersensitivity to latex rubber was lower than those reported from other studies. It is concluded that almost one dental care worker out of ten has a risk of contact dermatitis, unless measures to reduce hazardous exposure have been taken.

[Use of a labeled aerosol in the evaluation of the role of mucociliary transport and coughing in tracheobronchial clearance]. / Utilisation d'un aérosol marqué dans l'évaluation du role du transport mucociliaire et de la toux dans la clairance trachéobronchique.

The mucociliary transport system has been found to be an important defense mechanism of the airways. The system is severely damaged in certain acute infections. In chronic bronchitis mucociliary transport is most severely impaired and this impairment is probably directly involved in the pathogenesis of the chronic airways obstruction that may complicate the disease. In hypersecretory states much of the clearance is performed by coughing. Only productive cough is effective in clearing the airways from small particles.

Postural mechanisms in asthma: importance for nocturnal symptoms.

The supine position impairs ventilatory function in patients with ongoing asthma. The response is dual: an immediate decrease on lying down, present in healthy persons as well, and a progressive decrease specific for asthmatics. The changes are counteracted by bronchodilators, but are not linked to a decreased plasma adrenaline level when supine. The progressive decrease is tentatively explained by an increased vagal tone induced by the resting body position, and is likely to be a key factor in nocturnal asthma.

Impairment of ventilatory function by supine posture in asthma.

Forced expiratory volumes were recorded in the upright position in 10 asthmatics before and after lying supine. On consecutive days were investigated, in random order, the effect of being supine for 0.5 h, 2 h, 4 h, and of being upright as a control experiment. Peak expiratory flow (PEF) was similarly recorded in the upright position, and, in addition, at every 0.5 h in the supine position. PEF decreased progressively in the supine position, but not in the control experiment. The decrease averaged 24% when supine for 4 h. After return to the upright position, it increased rapidly but incompletely. Forced expiratory volumes tended to decrease after being supine. Thus, the supine position may induce airflow obstruction in asthmatics, and posture may be a major factor behind nocturnal asthma. This protocol may be used as a bronchial challenge test in order to study possible influences on posture-induced obstruction in asthma.

Posture-induced airflow limitation in asthma: relationship to plasma catecholamines and an inhaled anticholinergic agent.

Postural influence on ventilatory function was investigated in thirteen asthmatic subjects on three consecutive days starting at 10.00 am. Lung function was measured in the seated position before and after four hours lying supine. Peak expiratory flow (PEF) was measured every 0.5 h in the supine position. Blood samples for determination of plasma catecholamines were collected before, during and after lying supine. After the initial lung function testing, placebo or ipratropium bromide (0.125 mg) was inhaled. On the third day the whole trial was performed seated, without any drug, as a control experiment. On the placebo day lying supine induced an initial, rapid fall of PEF followed by a progressive decrease during the four hours. The progressive decrease in PEF was apparently caused by bronchoconstriction. Ipratropium bromide prevented this posture-induced bronchoconstriction. On the day seated there was also a tendency towards a decline of PEF though less pronounced than in the supine position on the placebo day. No significant alterations in plasma levels of catecholamines were observed. We conclude that the supine posture is a stimulus to bronchoconstriction in asthma, likely to be involved in nocturnal wheezing. Postural bronchoconstriction is not explained by lowered plasma levels of adrenaline, as has been suggested for nocturnal asthma. The results raise the question of whether cholinergic mechanisms are involved.

Tracheobronchial clearance in patients with emphysema associated with alpha1-antitrypsin deficiency.

Tracheobronchial clearance was studied in five patients who had emphysema associated with deficiency of serum alpha1-antitrypsin but no history of chronic bronchitis. After the patients had inhaled an aerosol of 6 micrometer teflon particles tagged with 99mTc, the radioactivity in the lungs was followed externally during 2 h. Clearance in the emphysematous patients was normal or even rapid as compared with clearance in healthy subjects, and was significantly more rapid than clearance in patients with a history of chronic bronchitis. The results indicate that emphysema can develop in patients with alpha1-antitrypsin deficiency without their having an impairment of mucociliary transport.

Working capacity and cardiopulmonary function after extensive lung resections.

Twelve patients were investigated 7-168 months after pneumonectomy. Two of them had also undergone resection of a segment of the remaining lung. The follow-up included studies of working capacity, static and dynamic lung volumes, alveolar gas exchange, diffusing capacity, blood gases and central haemodynamics with right heart catheterization. The working capacity was markedly reduced, limited by dyspnoea in 10/12 patients. The dyspnoea was related to reduced static and dynamic lung volumes (50% of normal). The diffusing capacity of the remaining lung was half of that predicted for two lungs from total haemoglobin and age and the transfer capacity of the lungs for oxygen was loaded to its maximum even at submaximal loads, resulting in a decrease in arterial oxygen tension and saturation and an increase in the alveolo-arterial oxygen tension difference. The central circulation was hypokinetic at submaximal loads and the stroke volume was small. The reduction in working capacity was caused by a number of coacting factors, inactivity, reduced lung function and small stroke volume. It was not possible from the present investigation to single out any of these factors as the main cause of dyspnoea during exercise and thereby the reduced working capacity.

Ultrastructural, cellular, and clinical features of the immotile-cilia syndrome.

The immotile-cilia syndrome is an autosomal recessive disease of the microtubules of ciliated cells and spermatozoa, and possibly also of neutrophil leukocytes; it affects approximately 1 in 20,000 people. A variety of aberrations in the axonemal microtubular apparatus has been observed. The most common is deficiency of dynein-arms, which leads to immotility or erratic movement of spermatozoa and respiratory tract cilia. The result is male sterility, and chronic or recurrent respiratory tract infections and bronchiectasis due to absence of mucociliary clearance. In addition, 50% of the persons have situs inversus and hence Kartagener's syndrome.

The immotile-cilia syndrome compared to other obstructive lung diseases: a clue to their pathogenesis.

Twentyfour adults, aged 19-47 years, with congenitally nonfunctioning cilia were investigated by clinical examination, radiography, spirometry, and in most cases by tracheobronchial clearance measurements and ultrastructural examination of respiratory tract cilia and/or sperm tails. They all suffered from chronic bronchitis, rhinitis and sinusitis, and most of them had bronchiectasis and a history of otitis. Most had spirometrically overt obstructive lung disease and four radiological signs of emphysema. Clinical profile, lung function and mucociliary clearance data were compared to corresponding data from samples of patients with other obstructive lung diseases. These comparisons indicate that a long-standing impairment of mucociliary clearance is of pathogenetic importance in common chronic obstructive lung disease associated with chronic bronchitis, but not in emphysema associated with severe alpha 1-antitrypsin deficiency without chronic bronchitis, and not in asthma. In cystic fibrosis and in hypogammaglobulinemia an impaired clearance is not of primary pathogenetic significance but may contribute to the development of obstructive lung disease.