Superoxide anion release from blood monocytes and alveolar macrophages in patients with diffuse lung fibrosis.

Superoxide anion release (O2-) after stimulation with phorbol myristate acetate was measured in alveolar macrophages (AM) obtained by bronchoalveolar lavage and in blood monocytes from 47 patients with diffuse interstitial lung disease: idiopathic pulmonary fibrosis (N = 15), hypersensitivity pneumonitis (N = 7), pneumoconiosis (N = 6) and sarcoidosis (N = 19). Differential cell counts demonstrated a lymphocyte predominance in patients with hypersensitivity pneumonitis (HP) and sarcoidosis while the other groups had neutrophil predominance. No correlation between O2- activity in alveolar macrophages (AM) or blood monocytes (BM) compared to lung function (VC and diffusing capacity) could be demonstrated. Smoking pneumoconiotics had significantly decreased BM O2- release (1.25 +/- 0.25 (SEM) nmol/min/10(6) cells) and significantly increased AM/BM O2- ratios (2.04 +/- 0.26) compared to smokers with idiopathic pulmonary fibrosis (IPF) who had the following mean values: BM O2- release = 2.58 +/- 0.25 and AM/BM O2- ratio = 0.86 +/- 0.23. When matched for sex and smoking, a significantly increased AM/BM O2- ratio was seen among patients with HP (2.19 +/- 0.98) in comparison with patients who had sarcoidosis (0.40 +/- 0.18). Patients with either HP or pneumoconiosis had generally elevated AM O2- release and reduced BM O2- release. These results suggest that environmentally related interstitial lung disorders (HP and pneumoconiosis) may be associated with elevated AM O2- release relative to BM O2- release in comparison to non-environmentally related disorders (IPF or sarcoidosis).

[Iatrogenic pneumothorax treated with a small calibre pleural tube]. / Iatrogen pneumothorax behandlet med tyndt pleuradraen.

Fourty-three patients (28 males, 15 females, median age 50 years) with iatrogenic pneumothorax following invasive diagnostic procedures (percutaneous transthoracic fine needle aspiration biopsy 26, fiberoptic transbronchial biopsy 14, pleurocentesis 3), were treated with small calibre thoracic tube drainage. The tube consisted of a teflon catheter, 160 mm long, 2 mm in outer diameter which was inserted into the second intercostal space in the mid-clavicular line in local analgesia. Pneumothorax was evacuated by intermittent aspiration with a syringe in 16 patients. In the remaining 27 patients the catheter was connected to a one way flutter valve. Treatment was uncomplicated in all patients and successful in 41 (95%) patients, while two required a large calibre chest tube on account of persistent leakage. The median drainage time was 48 hours. Small calibre thoracic tube with a one way flutter valve is convenient for treatment of iatrogenic pneumothorax, being less traumatic and less expensive than conventional thoracic tube drainage.

Bacteria-induced histamine release from human bronchoalveolar cells and blood leukocytes.

Histamine release induced by Staphylococcus aureus was examined in cells obtained by bronchoalveolar lavage (BAL) in non-atopic individuals. Approximately half of the individuals responded with mediator release to the bacterium, and the release was found to be time- and concentration dependent. No difference was found between the patients who responded and those who did not respond in regard to age, sex, smoker/non-smoker, % recovery of BAL-fluid, total cell count, differential cell counts, histamine content per mast cell, or diagnoses. Also stimulation of the BAL-cells with the calcium-ionophore A23187 resulted in histamine release. S. aureus-induced histamine release from basophils was examined in leukocyte suspensions obtained from the same individuals, and in all experiments release was found. The dose-response curves were similar to those obtained with BAL cells. The bacteria-induced mediator release from superficially lying cells in the airways epithelium might be of importance for the precipitation or exacerbation of bronchial asthma in respiratory tract infections.

Role of small calibre chest tube drainage for iatrogenic pneumothorax.

A 2 mm Teflon catheter was used as a chest tube in 28 patients with iatrogenic pneumothorax. Frequent aspirations through the catheter were performed in 16 of the patients. In the remaining 12 patients the catheter was connected to a one way flutter valve. The treatment was successful in 27 of the 28 patients--one patient required a large calibre chest tube. The mean drainage time was 48 hours. The small catheter technique is superior to the use of a large intercostal drain as it is much less traumatic and troublesome. The small calibre chest tube with a one way valve is recommended as a safe and easy technique.

[Lung transplantation]. / Lungetransplantation.

Isolated lung transplantation or combined heart and lung transplantation provides a new therapeutic possibility for patients with certain benign terminal pulmonary diseases. This method of treatment makes great demands on not only the donors but also the recipients. Following operation, which is undertaken in selected centres, life-long clinical control with immune suppressive treatment is essential. The method of treatment is associated with a series of complications and long-term survival does not appear to be optimal yet. A series of Danish patients have received lung transplantation abroad and are now followed in Danish special departments in cooperation with their own general practitioners.

Staphylococcus aureus and influenza A virus stimulate human bronchoalveolar cells to release histamine and leukotrienes.

Mediator release was examined from superficially lying cells in the airway epithelium obtained by bronchoalveolar lavage (BAL) in 13 non-atopic individuals. The BAL-cells were incubated (20 min, 37 degrees C) with Staphylococcus (Staph.) aureus or with human influenza A virus Staph. aureus was found to release histamine from cells from 7 of the 13 individuals and influenza A virus in 3 of 5 persons. Furthermore, Staph, aureus stimulated the BAL-cells to release leukotriene B4 in 7 of 11 subjects, whereas no release was found by influenza A virus in 7 examined persons. When cells from 4 persons were stimulated with Staph. aureus no release of leukotriene C4 was found. The mediator release caused by bacteria and virus might be of importance for the exacerbation of bronchial asthma in upper respiratory tract infections, since histamine is assumed to increase the epithelial permeability with entrance of allergens and other insulting particles, and leukotriene B4 facilitates airway inflammation.

Pneumopericardium after pneumonectomy and lobectomy.

Pneumopericardium is a rare condition, most frequently reported in connection with prolonged artificial ventilation in infants with hyaline membrane disease. No reports of pneumopericardium after pulmonary surgery have been published. Two cases of pneumopericardium are reported, one of tension pneumopericardium after pneumonectomy and artificial ventilation and one that followed radical lobectomy and artificial ventilation. The radiographic findings included pneumopericardium and subcutaneous emphysema and the patient who had had a pneumonectomy had severe symptoms of cardiac tamponade. Prolonged artificial ventilation in patients after pulmonary surgery and in the presence of an intrathoracic air leak may be a hazard. The importance of prompt surgical intervention in cases of tension pneumopericardium is underlined; the treatment of choice is thoracotomy with pericardiotomy.

Thoracic injuries. A review of 93 cases.

A report is presented of 93 patients referred for specialist management of thoracic injuries in the 5-year period 1973-1978. Penetrating trauma to the thorax had been sustained by 18 patients and blunt trauma by 75. Falls and traffic accidents were the most common causes (32 and 35 cases). Rib fractures were the most frequent lesions, and 10 of these 67 patients had flail chest. Hemothorax and/or pneumothorax were found in four-fifths of the patients. The diaphragm was torn in five cases. Three had lesions of the heart and/or pericardium and one patient had a tracheal lesion. Closed pleural drainage was the most commonly used treatment. Thoracotomy was performed in 10 of the 93 patients. The mortality rate in the series (10%) agreed with findings from other, similar studies.

Yellow nail syndrome--the triad of yellow nails, lymphedema and pleural effusions. A review of the literature and a case report.

The yellow nail syndrome, combination of yellow discoloured nails, lymphedema and pleural effusions, is a rare clinical condition. A review of the literature, including 97 patients, is presented. Most patients developed yellow nail syndrome in early middle age, and the overall male:female ratio was 1.1.6. The etiology of the syndrome is obscure, while the pathogenesis seems to involve impaired lymphatic drainage. A patient, whose recurrent pleural effusions were effectively controlled by chemical pleurodesis, is also presented.

Transcarinal mediastinal needle biopsy compared with mediastinoscopy.

A total of 183 patients with abnormalities on the chest roentgenogram were examined by bronchoscopy in conjunction with transcarinal mediastinal needle biopsy and mediastinoscopy to investigate the agreement between these methods regarding possible metastases. In 37 of the 159 patients with malignant pulmonary lesions, needle biopsy demonstrated metastases in the subcarinal lymph nodes. Mediastinoscopy had the same percentage of positive findings in the subcarinal nodes, but there was only agreement between the two methods in 20 cases. Transcarinal mediastinal needle biopsy as a supplement to conventional bronchoscopy is applicable in the outpatient evaluation of patients with malignant bronchial lesions as a screening for further examination. The method does not carry complications of any kind. Positive biopsy results, combined with other clinical findings, can at times spare the patient a mediastinoscopy. On the other hand, an adequately indicated needle biopsy which yields negative findings should always be followed by mediastinoscopy. In the planning of treatment for patients with malignant lesions of the lungs, it is of decisive importance to evaluate the dissemination of the tumor to the mediastinal structures, primarily to the subcarinal and the contralateral lymph nodes.

Transcarinal mediastinal needle biopsy as a supplement to bronchoscopic evaluation of neoplastic lung diseases.

A screening method for detecting the dissemination of malignant tumours to the bifurcal lymph nodes is described. The procedure was performed in 300 patients. Malignancies were found in 255 cases, 216 of which were bronchogenic cancers. The transcarinal mediastinal needle biopsy (TMNB) was positive in 25% of all cases with malignant diseases, but in patients with anaplastic tumours a positive TMNB was found in 40%. No complications occurred, the method could be applied to out-patients, and if positive, mediastinoscopy could be avoided.