Measurement of nasal potential difference in adult cystic fibrosis, Young's syndrome, and bronchiectasis.

Previous work confirmed the abnormal potential difference between the undersurface of the inferior nasal turbinate and a reference electrode in cystic fibrosis, but the technique is difficult and the results show overlap between the cystic fibrosis and the control populations. In the present study the potential difference from the floor of the nose has therefore been assessed in normal subjects, as well as in adult patients with cystic fibrosis, bronchiectasis and Young's syndrome. Voltages existing along the floor of the nasal cavity were recorded.

Distal intestinal obstruction syndrome in cystic fibrosis treated by oral intestinal lavage, and a case of recurrent obstruction despite normal pancreatic function.

An oral intestinal lavage solution has been successfully used in the treatment of six patients with chronic distal intestinal obstruction syndrome (previously referred to as meconium ileus equivalent) complicating cystic fibrosis and a further case of recurrent small bowel obstruction. The patient with recurrent obstruction is unusual in having no evidence of pancreatic maldigestion, which previously has been considered a prerequisite for the syndrome.

Upper respiratory tract viral infection and mucociliary clearance.

Twenty-six normal volunteers were exposed to rhinovirus or influenza B virus. Measurement of nasal mucociliary clearance, ciliary beat frequency, percent of epithelium ciliated, ciliary ultrastructure and nasal transmucosal potential difference were made before exposure, during viral incubation and at the time of expected overt infection. Ten volunteers failed to become infected, six were subclinically infected and nine were infected with symptoms.

Incidence of pulmonary nodules detected by computed tomography in patients with bronchial carcinoma.

Computed tomography (CT) is more sensitive in detecting pulmonary nodules than conventional chest radiography. The incidence of pulmonary nodules on thoracic CT scans, not visible on chest radiographs, in patients with small-cell carcinoma of the bronchus (SCCB) was 27%, and in patients with non-small-cell carcinoma (non-SCCB) the incidence was 28%. Some of these nodules may be malignant.

Morphological and secretory properties of bronchoalveolar lavage mast cells in respiratory diseases.

We have studied various functional and morphological characteristics of mast cells obtained in bronchoalveolar lavage from fifty-two patients with several lung diseases. The percentage of mast cells ranged from 0.04 to 0.

Social consequences of brain or liver relapse in small cell carcinoma of the bronchus.

The time spent in hospital when cerebral metastases occur as the first site of relapse in patients with small cell carcinoma of the lung (SCCL) has been analysed and compared to the consequences of relapse in the liver. In the course of a clinical trial with 370 patients, 50 patients relapsed initially in the brain and 20 in the liver. The 2 groups were comparable with respect to performance status at diagnosis and the amount of home support available.

An oxygen conserving nasal cannula.

Oxygen administration via a nasal cannula incorporating a small collapsible reservoir (Oxymizer, Chad Therapeutics Inc, California) was compared with delivery via a standard nasal cannula. Twelve patients with chronic, stable hypoxaemia (arterial oxygen tension less than 60 mm Hg (8.0 kPa)) were studied.

Effect of oral high frequency ventilation by jet or oscillator on minute ventilation in normal subjects.

Normal subjects were asked to breathe through an open ended tube while high frequency oscillations were superimposed on tidal breathing via a side arm, either an eight inch (20 cm) loudspeaker or a jet ventilator being used. Both systems were comfortable and well tolerated. Spontaneous minute ventilation fell by 19-46% at frequencies up to 33 Hz without a rise in transcutaneous PCO2.

Ventilatory saving by external chest wall compression or oral high-frequency oscillation in normal subjects and those with chronic airflow obstruction.

Oscillation of the air within the lungs at high frequency is associated with an increased clearance of CO2. Because of the high frequency and low volume of these oscillations, spontaneous breathing is unhindered and the technique has potential value as a supplement to ventilation. High-frequency oscillations were superimposed upon tidal breathing by using a loudspeaker attached to a mouthpiece (oral high-frequency oscillation, OHFO) or by external chest wall compression (ECWC).

Transepithelial potential difference in cystic fibrosis.

In cystic fibrosis the potential difference between interstitial fluid and the surface of respiratory and sweat duct epithelia is abnormally large. This study attempted to confirm this finding and investigate its value for a diagnostic test. With a subcutaneous reference electrode the mean potential difference of the inferior turbinate was -25 mv in 19 patients with cystic fibrosis, which was significantly greater than the difference of -13 mv in 22 normal subjects (p less than 0.

Increase in mucociliary clearance in normal man induced by oral high frequency oscillation.

Data on the effect on mucociliary clearance of oral high frequency oscillation is conflicting. By means of a technique to superimpose high frequency oscillation on tidal breathing, changes in mucociliary clearance during high frequency oscillation were studied in seven normal non-smokers by monitoring the clearance of inhaled radiolabelled aerosol from the lungs. After inhalation of 5 microns technetium 99m labelled particles under controlled conditions, whole lung clearance was monitored by scintillation counters half hourly for six hours with a final count at 24 hours, from which tracheobronchial deposition and clearance could be calculated.

High frequency ventilation.

What is high frequency ventilation? Is it useful or just another transatlantic fad? Apart from appearing to break all the rules of physiology, this technique has definite advantages over conventional ventilation in certain areas and great potential in others.

Prognostic significance of laboratory parameters measured at diagnosis in small cell carcinoma of the lung.

An analysis of prognostic factors in small cell lung cancer has been carried out using data from 371 patients treated with identical chemotherapy in the context of a large prospectively randomized clinical trial. Prognosis was shown to be strongly correlated with initial performance status, disease extent, and routine biochemical tests at the time of diagnosis. Plasma albumin, plasma sodium, alkaline phosphatase, and gamma-glutamyl transpeptidase were all predictive of survival.

Newly diagnosed cystic fibrosis in middle and later life.

Four patients with cystic fibrosis diagnosed in middle and later life are presented. All had chronic bronchopulmonary infection with a high sweat sodium concentration, and chest radiographic evidence of upper zone bronchiectasis. Two patients had pancreatic dysfunction.

Radiation-induced lung fibrosis after treatment of small cell carcinoma of the lung with very high-dose cyclophosphamide.

Twenty-five previously untreated patients with small cell carcinoma of the lung were treated with cyclophosphamide 160 to 200 mg/kg (with autologous bone marrow support) followed by radiotherapy (4000 cGy) to the primary site and mediastinum. No other treatment was given until relapse occurred. Nineteen patients were assessable at least 4 months after radiotherapy; of these, 15 (79%) developed radiologic evidence of fibrosis, which was symptomatic in 14 (74%).

High frequency oscillations improve nasal mucociliary transport.

The saccharin clearance time technique was used to determine the effect upon nasal mucociliary transport of sine wave oscillations. Nasal air was oscillated at 8 Hz, 14 Hz, and 20 Hz by a loudspeaker attached to a nasal mask. Mucociliary transport was significantly increased at all frequencies with an overall mean rise of 161%.

Self-administered home intravenous antibiotic therapy in bronchiectasis and adult cystic fibrosis.

10 patients (mean age 23.1, range 17.1-40.

Radiotherapy in small cell cancer of the lung treated with combination chemotherapy: a controlled trial.

Three hundred and seventy one patients with extensive or limited small cell cancer of the lung took part in a randomised trial to evaluate irradiation of the primary tumour in patients treated with combination chemotherapy. They were randomly allocated to treatment either with chemotherapy alone (198) or with both chemotherapy and radiotherapy (173). All 371 initially received 12 weeks of chemotherapy after which they were categorised according to response.

Extrinsic allergic bronchiolitis in a bird fancier.

A patient in whom a severe systemic illness was characterised by weight loss, arthralgia and breathlessness was exposed to her pet bird. This pragmatic approach reproduced the features of her illness. The changes that occurred in her pulmonary physiology and histology differed from those seen in extrinsic allergic alveolitis in many important respects.