Approach to the patient with diffuse lung disease.

When evaluating diffuse lung infiltrates, the clinician should place special emphasis on the acuity of symptoms, nonpulmonary complaints and findings, environmental exposures, and risk factors for immunosuppressive diseases. Certain radiographic features, such as the distribution of opacities, hilar adenopathy, Kerley-B lines or pneumothorax, or pulmonary function tests demonstrating air flow limitation also narrow the differential diagnosis. One can direct the subsequent workup based on the narrowed differential diagnosis, the pace of disease, the activity of the ongoing inflammatory-immune process, and the age, overall medical condition, and wishes of the patient.

Lung clearance of 99mTc-DTPA aerosol in conscious sheep.

This study was initiated to determine the rate and characteristics of 99mTc-DTPA clearance from the whole lung in a group of 9 sheep. Submicronic aerosol droplets were delivered to unsedated sheep held in a sling-like frame. Best fits for clearance curves to single- and biexponentials were calculated.

Post-cesarean section cecal volvulus.

Cecal volvulus after cesarean section is rare. Symptoms include abdominal pain, nausea, vomiting, constipation, cystic abdominal mass, and high-pitched bowel sounds. Abdominal x-ray photography is often diagnostic, revealing a dilated cecum with a single fluid level and distended loops of small bowel.

Effect of dietary vitamin E level on the biochemical response of rat lung to ozone inhalation.

We examined the effects of dietary vitamin E level on rat lung response to ozone (O3) inhalation. In one study, we fed 1-month-old Sprague-Dawley (SD) rats a test diet containing 0 or 50 IU vitamin E/kg for 2 months, and then exposed one-half of the animals from each dietary group to 0.8 ppm (1,568 micrograms/m3) O3 intermittently (8 hours daily) and the other half to room air for 7 days.

Oxygen radicals and human disease.

Toxic oxygen free radicals have been implicated as important pathologic mediators in many clinical disorders. We discuss the chemistry of oxygen radical production and the roles of iron and of various antioxidants as well as the diseases that have received active attention in oxy-radical research. Particular attention is focused on cigarette smoke oxidants, ischemia-reperfusion-induced radical production, carcinogenesis, and aging.

Bronchial blood flow measured by video dilution technique in sheep.

Bronchial blood flow was studied with the video dilution technique (VDT) in seven sheep. All animals were anesthetized (thiamylal and halothane) and ventilated. A videodensitometer and a videotape replay of the fluoroscopic image of dye moving through the common bronchial artery were used to construct dye mass vs.

Arterial insufficiency in hemodialysis access procedures: reconstruction by an interposition polytetrafluoroethylene graft conduit.

The interposition polytetrafluoroethylene graft conduit has found many uses in the armamentarium of the surgeon who performs vascular access for hemodialysis: when resection of aneurysm or pseudoaneurysm is required, or when an extension loop is required, either to simply lengthen the amount of graft or to circumvent an infected segment after resection. Herein, we have presented yet another use for the interposition polytetrafluoroethylene graft conduit, based on physiologically sound principles and a now proved successful outcome, namely as a surgical alternative for the patient with a hemodynamically unstable hemodialysis fistula resulting in arterial insufficiency. Poiseuille's Law regarding flow of liquids through a tube supports the concept on which our interposition graft is based: v = pi X P X R4/8 X 1 X n where v is the volume escaping per second, P the difference of pressure at the ends of the tube, R its radius, l the length of the tube, and n the coefficient of viscosity.

Postirradiation malignant fibrous histiocytoma of the trachea.

A 77-yr-old woman presented with a malignant fibrous histiocytoma (MFH) of the trachea 11 yr after right subtotal thyroidectomy and delivery of 5,400 rads to the neck for infiltrating papillary thyroid carcinoma. The tumor developed in the irradiated area. Postirradiation MFH tends to occur in subcutaneous tissues, and is rare in lung parenchyma or airways.

Clearance of instilled surfactant lipid from the lungs of unanesthetized sheep: lipids are differentially transported by nonlymphatic pathways.

The routes used by the lung to dispose of instilled exogenous surfactant lipid components were examined with the sheep chronic lung lymph fistula preparation. Small vesicles of radiolabeled dipalmitoyl phosphatidylcholine (DPPC) either alone or with radiolabeled cholesterol (CHOL) were instilled intratracheally, and samples of lung lymph and plasma were collected at 60-minute intervals for 12 hours. At any time point, the total amounts of either labeled DPPC or CHOL that appeared in lung lymph were small fractions (less than 0.

Penicillamine associated pulmonary hemorrhage.

Penicillamine is the drug of choice in Wilson's disease and a therapeutic alternative in rheumatoid arthritis. Autoimmune complications associated with penicillamine include cases resembling systemic lupus erythematosus and Goodpasture's syndrome. We report a case of diffuse pulmonary hemorrhage associated with prolonged penicillamine use in a patient with Wilson's disease with evidence of circulating immune complexes and complement activation, but without serologic or morphologic evidence of systemic lupus erythematosus, Goodpasture's syndrome or renal disease.

Tropoelastin production and tropoelastin messenger RNA activity. Relationship to copper and elastin cross-linking in chick aorta.

The elastin content of the chick thoracic aorta increases 2--3-fold during the first 3 weeks post-hatching. The deposition of elastin requires the covalent cross-linking of tropoelastin by means of lysine-derived cross-links. This process is sensitive to dietary copper intake, since copper serves as cofactor for lysyl oxidase, the enzyme that catalyses the oxidative deamination of the lysine residues involved in cross-link formation.

Comparative in vitro antimicrobial activity of Chinese medicinal herbs.

Eighteen herbs used in the treatment of infectious diseases in traditional Chinese medicine were evaluated for in vitro activity against ten microbial pathogens. Lyophilized teas were tested by the agar dilution technique at 100-1600 micrograms/ml. Eleven of the preparations were active against at least one microorganism and six of these were active against at least three of the test isolates.

Deferoxamine injection does not affect bleomycin-induced lung fibrosis in rats.

Bleomycin is an antineoplastic agent that causes a dose-related lung fibrosis that limits its therapeutic effectiveness. It has been proposed that the cellular toxicity and antitumor effects of bleomycin occur by formation of O2-Fe(II)-bleomycin complexes that degrade DNA and release O2- and OH radicals that attack other cellular components. Twice daily injections of the iron chelator deferoxamine were utilized in an attempt to ameliorate bleomycin-induced lung fibrosis.

Pancreatic pleuropericardial effusions. Fistulous tracts demonstrated by computed tomography.

Demonstration of the fistulous tract linking pancreatic pseudocysts to the mediastinum and pleural cavity has diagnostic and therapeutic implications. In four cases, pseudocyst drainage through the esophageal and aortic diaphragmatic crus into the mediastinum and pleural cavity was delineated by computed tomography. In two cases, significant pericardial effusions were demonstrated.

The antimicrobial activity of cefpirome, a new cephalosporin.

The activity of the extended spectrum cephalosporin cefpirome (HR 810) was compared with that of other beta-lactams and gentamicin. A total of 524 clinical isolates and strains known to be resistant to certain agents were studied. Against the Enterobacteriaceae, Haemophilus influenzae and Neisseria spp.

Bronchodilatory properties of 2-decarboxy-2-hydroxymethyl prostaglandin E1.

We evaluated in a double-blind study the bronchodilatory properties of 2-decarboxy-2-hydroxymethyl prostaglandin E1 (PGE1-carbinol), described recently as a nonirritant bronchodilator in animals. Fifteen asthmatic patients received by inhalation single doses of 1, 10, and 30 micrograms PGE1-carbinol, 55 micrograms PGE2, and placebo (10% ethanol in normal saline, which was also used as diluent for the PGs). Such pulmonary function tests as forced expiratory volume in 1 second, forced vital capacity, and maximal expiratory flow were monitored during 2 hours following inhalation of each compound.

Measurement of bronchial blood flow in the sheep by video dilution technique.

Bronchial blood flow was determined in five adult anaesthetised sheep by the video dilution technique. This is a new fluoroscopic technique for measuring blood flow that requires only arterial catheterisation. Catheters were placed into the broncho-oesophageal artery and ascending aorta from the femoral arteries for contrast injections and subsequent videotape recording.

Changes in response to ascorbic acid administered orally to rat pups: lung collagen, elastin and protein synthesis.

Rat pups were supplemented orally with high doses of L-ascorbic acid (AA) or D-isoascorbic acid (IA) throughout suckling. The regulation of AA in the lung and its relationship to collagen and elastin deposition were examined. Based on known responses of smooth muscle cells and fibroblasts in culture to high concentrations of AA, it was hypothesized that a markedly elevated intake of AA should increase net collagen deposition, but decrease net elastin deposition in the neonatal rat lung.

In vitro activity of CGP 31523A, a broad-spectrum cephalosporin, in comparison with those of other agents.

The in vitro activity of CGP 31523A, a new aminothiazolyl cephalosporin, was compared with those of cefoxitin, cefuroxime, moxalactam, piperacillin, ciprofloxacin, and other beta-lactams, when appropriate, against 533 recent clinical isolates and known resistant strains of bacteria. The MICs of CGP 31523A required to inhibit 90% (MIC90S) of the members of the family Enterobacteriaceae, Neisseria gonorrhoeae, and Streptococcus pneumoniae were less than or equal to 0.25 micrograms/ml.

Antioxidant protection: a function of tracheobronchial and gastrointestinal mucus.

It is proposed that one of the functions of the mucus layers lining the respiratory tract and gastrointestinal system is the scavenging of highly reactive oxygen-derived species. This would provide antioxidant protection to the underlying mucosal epithelial cells.