Diagnosis of diffuse lung disease by cutting needle biopsy.

The results of 15 consecutive automated cutting needle (1.2 mm, n = 14; 2.0 mm, n = 1) biopsies of diffuse lung manifestations are presented. Sufficient material for histologic analysis was obtained in 13 of 15 specimens (87%) and a specific diagnosis was obtained in 11 of 14 patients (79%). The tissue specimen confirmed the clinically probable lung disease in 6 patients, gave a new, unsuspected, diagnosis in 2, and resolved a differential diagnostic problem in 3 patients. One pneumothorax after a 2.0-mm needle biopsy necessitated catheter drainage. We conclude that percutaneous lung biopsy with the automated biopsy device mounted with a 1.2-mm needle yields a histologic diagnosis with high accuracy in interstitial and alveolar lung changes, reducing the need for more invasive methods such as open lung biopsy.

Feasibility of cutaneous blood gas monitoring during exercise stress testing.

The feasibility of cutaneous blood gas monitoring in connection with exercise testing was evaluated in 113 consecutive patients. Arterial blood samples were taken immediately after exercise. Because of loosening of electrode tapes only 99 satisfactory registrations of O2 and 98 registrations of CO2 were obtained at the end of exercise testing. In this phase the correlations between transcutaneous and arterial O2 and CO2 values were r = 0.60, p less than 0.001 and r = 0.66, p less than 0.001, respectively. Nevertheless, the correspondence for clinical work remains poor. The shape of the whole transcutaneous O2-CO2 registration curve is diagnostically more rewarding than single transcutaneous O2 and CO2 values.

Sudden death after myocardial infarction and T-wave changes in connection with exercise testing.

Exercise testing-induced T-wave changes in lead CH6 were analysed after acute myocardial infarction. In 21 patients with subsequent sudden death the mean +/- SD T-wave amplitude at supine rest 5 minutes after exercise was -2.74 +/- 2.37, in 26 patients with non-sudden death -1.08 +/- 2.67, and in 23 patients who survived +0.44 +/- 2.26 mm. Differences between groups were statistically significant. Within the sudden death group and in patients who survived the T-wave was lower (p less than 0.05) after exercise than before exercise. In the non-sudden death group, however, the T wave depth was about the same before and after exercise. The pattern of T-wave changes in the sudden death group was similar to the primary, "vasoregulatory" T-wave changes in young men and, accordingly, enhanced sympathoadrenal activity could be involved.

Glucose tolerance and sudden death after myocardial infarction.

In connection with a rehabilitation study of myocardial infarction, glucose tolerance tests were performed at the end of the hospital stay in patients recovering from the infarction. At the same time serum cholesterol and triglyceride values were determined. The degree of intimal and medial calcification in the peripheral arteries was estimated on X-ray films. During a 6-year follow-up period 22 patients died suddenly (less than 1 hour) and 28 patients less suddenly. The results of these groups were compared with results of a random sample of 23 surviving patients. Mean 1 and 2-hour glucose values were lower in the sudden death group than in patients who survived (p values less than 0.03 and less than 0.02 respectively). Also the body weight was lower in the sudden death group (p less than 0.05). Differences in the other variables measured were not statistically significant. The mechanisms of the possible protective role of impaired glucose tolerance regarding sudden death are discussed.

Pulmonary apical fibrocystic disease. A serologic study.

Common aetiopathogenic factors were sought in 12 patients with progressive pulmonary apical fibrocystic changes, active human-type tuberculosis excluded. HLA-typing did not reveal any clear-cut trends; only the three patients with ankylosing spondylitis or Reiter's disease were HLA-B27 positive. Six patients had HLA-Cw3, which exceeds the prevalence in referents, antibodies, as well as other tissue antibodies, were mainly negative so that autoimmune aetiology is not likely. Similarly, antimicrobial antibodies were found occasionally, while low-titred influenza antibodies were positive in all patients. Serum proteins, immunoglobulins, rheumatoid factor and C-reactive protein were suggestive of chronic inflammation, as were low positive titres of smooth muscle antibodies in nine patients. In spite of the uniform clinical picture and course of the disease, no uniform aetiopathogenic factors were found, but possible unidentified slow- and low-grade viral or fungal infection is discussed.

PQ-time shortening during somatomotor activation as predictor of death after myocardial infarction.

The PQ-interval was measured while resting supine before exercise testing, in the erect position on the bicycle before starting exercise, and resting supine after exercise in 68 men 6--8 weeks after acute myocardial infarction. During a 6-year follow-up period the death was non-sudden (greater than 1 hour) in 25 of these patients. In this group the PQ-time was significantly shorter (p less than 0.001) during somatomotor activation on the bicycle before exercise than resting supine. The same directional change (p less than 0.01) was seen in the sudden death (less than 1 hour) group (N = 21), but not in the patients who survived. PQ-time at supine rest before exercise testing, however, was significantly shorter (p less than 0.02) in surviving patients than in the non-sudden death group. The possible mechanisms of these, and of previously reported changes in the R-wave amplitudes and QT-times, are discussed.

Low exercise R wave amplitude after myocardial infarction predicting subsequent non-sudden death.

R wave amplitude was measured before, during and after exercise test in 68 men 6--8 weeks after acute myocardial infarction. During 6-years follow-up 21 patients died suddenly (within one hour) and 25 non-suddenly. The highest mean R wave amplitude in lead CH5 during exercise test was lower in patients with subsequent non-sudden death (1.93 mV) than in patients with sudden death (2.70 mV) (p less than 0.01). Survivors (22) had the highest mean value (2.91 mV). R wave amplitude values in lead V5 at rest in the supine position before and after exercise did not differ significantly in these patient groups.

HLA-antigens and pulmonary upper lobe fibrocystic changes with and without ankylosing spondylitis. A report of seven cases.

Seven patients with remarkably similar progressing pulmonary apical fibrocystic disease are presented. Active tuberculosis was excluded, antituberculous chemotherapy had no effect on the pulmonary lesions. One of the patients had the typical clinical picture of Reiter's syndrome, the other that of ankylosing spondylitis. HLA-antigens were determined in all seven cases, only two patients, one with Reiter's syndrome and another with ankylosing spondylitis, had the HLA-B27 antigen.

Pulmonary infiltrates with eosinophilia and urinary symptoms during disodium cromoglycate treatment. A case report.

A 64-year-old asthmatic woman began to suffer from urinary irritation after 5 months' treatment with disodium cromoglycate. After 10 months she contracted, additionally, a dry, hacking cough and gradually increasing exercise-induced dyspnoea. Chest X-ray revealed scattered, micronodular infiltrations in both lungs, and her spirogram was clearly restrictive. Peripheral blood showed eosinophilia of 23.5%. Urine was clean. When DSCG was withdrawn, her urinary symptoms and cough disappeared overnight, and her dyspnoea improved within weeks, as did her chest X-ray. Inhalation provocation test with DSCG 2 months later resulted in an immediate asthmatic reaction followed by a possible delayed-type reaction 9 hours later. Disodium cromoglycate is regarded as the possible aetiologic agent.

Tuberculosis pleurisy due to Mycobacterium fortuitum in a patient with chronic granulocytic leukemia.

A case of tuberculous pleurisy due to Mycobacterium fortuitum in a 47-year-old woman with chronic granulocytic leukemia is described. The mycobacterial aetiology of the pleurisy was confirmed by pleural biopsy and by positive culture of M. fortuitum in pleural fluid. Antituberculosis chemotherapy with INH, RMP and EMB, combined initially with prednisolone, was successful in spite of total resistance of the strain to the drugs used. A short review of mycobacterioses and of recent literature on the topic, especially on M. fortuitum, is also presented.