Emphysema type in relation to silica dust exposure in South African gold miners.

The relationship between silica dust exposure in gold mines and the type of emphysema was studied in a group of 1,553 white gold miners who had undergone autopsy examination between 1974 and 1987. Of particular interest was the contrast between centriacinar and panacinar emphysema as they relate to silica exposure and the presence of silicosis. Subjects with significant emphysema, that is, with an emphysema score of 30% or more, were classified as having predominantly panacinar or predominantly centriacinar emphysema, and compared to those without emphysema (emphysema score less than or equal to 10%). Of those who had significant emphysema (greater than or equal to 30%), 24% had predominantly panacinar, 43% predominantly centriacinar, and 33% were classified as mixed. The odds ratios (OR) for the association between each emphysema type and dust exposure (one unit of the cumulative dust index) were found to be statistically significant and of equal magnitude [1.019, with a 95% confidence interval (CI) of 1.005 to 1.033 for panacinar and 1.019 with a 95% CI of 1.007 to 1.031 for centriacinar emphysema]. In 163 nonsmokers insignificant panacinar emphysema was more common than centriacinar emphysema. The results indicate that a miner with 20 yr in high-dust occupations has a 3.5 (1.7;6.6) times higher odds of having a significant degree of emphysema at autopsy than a miner not in a dusty occupation. This is likely to be true of smoking miners only because there were only four nonsmokers with an emphysema score between 30 and 40%.(ABSTRACT TRUNCATED AT 250 WORDS)

Pneumocystis carinii pneumonia in HIV-positive and HIV-negative patients. An epidemiological, clinical and histopathological study of 18 patients.

Pulmonary histopathological and clinical changes associated with Pneumocystis carinii pneumonia (PCP) were found to be less severe in 10 HIV-positive patients (group A) with acquired immunodeficiency syndrome (AIDS) than in 8 patients (group B) with other immune deficiencies. Lung biopsies from group A showed minimal thickening of the alveolar walls from oedema and slight mononuclear cell infiltration, while in group B alveolar wall thickening was more prominent with distinct mononuclear cell infiltration and evidence of diffuse alveolar damage and interstitial fibrosis. Infection with P. carinii cysts was heavy in 60%, moderate in 30% and mild in 10% in group A patients v. heavy in 0%, moderate in 14% and mild in 86% in group B patients. These findings appear to suggest that AIDS/PCP presents with a heavy parasite load but only minimal histopathological changes that are reversible and that atypical change as observed in PCP in other immune deficiencies are caused by previous or concomitant insults other than pneumocystosis. Milder propagation of P. carinii in HIV-negative patients may be because there is a lack of undamaged type I pneumocytes to which trophozoites probably need to be attached at a certain developmental stage.

Endobronchial appearance of tracheobronchial amyloidosis. A case report and suggested classification.

Tracheobronchial amyloidosis with the co-existence of submucosal plaques and tumour-like masses is reported. The subdivision of tracheobronchial amyloidosis into submucosal plaques and tumour-like masses is questioned since there appears to be no difference in their clinical presentation and pathological appearance. It is suggested that lower respiratory tract amyloidosis should be classified into tracheobronchial, nodular parenchymal and diffuse alveolar septal amyloidosis.

Transbronchial biopsy during mechanical ventilation.

The diagnostic yield and risks of transbronchial biopsy (TBB) during mechanical ventilation were assessed in 13 patients with progressive pulmonary infiltrates. TBB was of considerable diagnostic value in ten patients and useful in excluding potentially treatable infections in the remaining three patients. Complications included two pneumothoraces, pulmonary hemorrhage in one case, and supraventricular tachycardia in another. No fatalities were attributable to TBB. TBB proved to be a relatively safe procedure, with a high diagnostic yield in these critically ill patients.

Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) has become one of the most important of the opportunistic pulmonary infections of the 1980s. In view of the rapidly expanding population of immunosuppressed patients, many more cases of PCP may be expected in the future. The history, microbiology, pathogenesis, pathology, clinical and laboratory features, diagnosis, treatment, course and prognosis of this disease are reviewed.

Pneumocystis carinii pneumonia in Johannesburg.

Pneumocystis carinii pneumonia is today an opportunistic infection of major importance, occurring in immunosuppressed patients. Twelve cases of P. carinii pneumonia were seen by the Pulmonology Unit in Johannesburg between November 1984 and December 1985. The clinical presentation, laboratory and radiographic features, method of diagnosis, treatment, complications of therapy and outcome of these 12 cases are described.

Acute respiratory failure in active tuberculosis.

We describe 15 patients whose acute respiratory failure associated with pulmonary tuberculosis necessitated their ICU admission during a 42-month period. There was a 1.5% incidence of respiratory failure in hospitalized tuberculosis patients. Eleven of the 15 patients required ventilatory assistance for a mean 17.3 days. Five patients died in ICU (early mortality = 33%), and two others died within 3 months of discharge (total mortality = 47%). We began specific anti-tuberculous chemotherapy in these patients within 3 +/- 4 (SD) days after hospital admission. Pulmonary histology was available in five cases. Despite the clinical and radiologic features compatible with the adult respiratory distress syndrome in these patients, histology showed confluent tuberculous bronchopneumonia with no evidence of the syndrome.

Rhabdomyoma of the heart in a newborn infant. Diagnosis by echocardiography.

An intracavitary right ventricular tumour was identified echocardiographically before operation in an infant with a rhabdomyoma of the heart. Necropsy showed associated tuberous sclerosis.