CASE REPORT J. C., a 46-year-old white female, was seen in 1962, when she had signs and symptoms of chronic tracheobronchitis. A roentgenogram obtained by her referring physician revealed a small periph eral lesion in the right lung. She was admitted to the hospital for evaluation. Tomography was done; this revealed two lesions in the right lung and two lesions in the left lung (figure 1A and B). Bronchoscopy revealed moderate tracheobron chitis. Cytologic studies of the bronchial washings were negative for tumor cells. Skin tests and com plement-fixation tests were negative. Past history disclosed that the patient had had a total abdominal hysterectomy for leiomyomata uteri several years prior to admission. Physical examination was not remarkable. Following the clinical studies, the two nodules in the right lung were excised. These were both diagnosed as fibroleiomyomatous hamartomas. Because of the benign nature of these unusual tu mors, and their multiplicity on the right side, it was decided that the patient could be observed without having definite treatment for the left side. During the ensuing six months the patient de veloped rather severe symptoms of peptic esoph agitis, and roentgenograms revealed a hiatal hernia of moderate size with reflux. This was not controlled well by medical management, and it was decided that it should be surgically corrected. At the same time, the nagging problem of the re maining nodules in the left lung could be elimi nated. A diaphragmatic herniorrhaphy and ex cision of two nodules were performed. Both of these lesions were diagnosed as fibroleiomyo matous hamartomas. Postoperatively, the patient has continued to do well. There has been no evidence of other ham artomas in the two years following.
We studied the effects of sleep fragmentation on arousal and ventilatory responses to hyperoxic hypercapnia, isocapnic hypoxia, and chemical stimulation of the larynx during sleep in 5 dogs. Sleep fragmentation was induced by repeatedly arousing the dogs with acoustic stimuli throughout 2 to 3 consecutive nights. Responses to respiratory stimuli were then studied during a subsequent daytime sleep. Arterial O2 saturation was measured with an ear oximeter, and sleep stage was determined by electroencephalographic and behavioral criteria. Hypercapnic and hypoxic ventilatory responses were unimpaired by sleep fragmentation. In contrast, alveolar PCO2 levels at arousal increased after sleep fragmentation, from a mean +/- SEM of 52.2 +/- 1.4 mm Hg to 55.6 +/- 1.5 mm Hg (p < 0.05) during slow-wave sleep, and from 57.9 +/- 1.5 mm Hg to 61.3 +/- 2.2 mm Hg (p < 0.05) during rapid-eye movement sleep. Similarly, arterial O2 saturation at arousal decreased after sleep fragmentation from 80.1 +/- 1.0% to 70.2 +/- 2.7% (p < 0.05) during slow-wave sleep, and from 66.3 +/- 3.6% to < 55% (p < 0.05) during rapid-eye-movement sleep. Arousal responses to laryngeal stimulation were also impaired after sleep fragmentation. We conclude that arousal responses to respiratory stimuli are decreased by sleep fragmentation.
The provocative concentrations of inhaled methacholine that cause 6% (PC6) and 20% (PC20) falls in forced expiratory volume in one second (FEV1) were assessed in a population of 100 nonsmoking persons, equally distributed for sex, who ranged uniformly from 20 to 60 yr of age. These subjects had no respiratory symptoms, rhinitis, atopic history, or familial history of asthma. Single twofold dilutions of methacholine from 2 to 128 mg/ml were used; 81 and 34 subjects, respectively, showed PC6 and PC20 values less than 128 mg/ml. Eight subjects had PC20 values less than 16 mg/ml. In these subjects, the test had a good reproducibility (r = 0.92) when we repeated it, and serial measurements of peak expiratory flow rates did not suggest asthma. The fact that PC6 was related, although loosely, to baseline FEV, FEV/FVC, and forced expiratory flow during the middle half of the FVC (FEF) and that 4 of the 8 subjects with PC20 values less than 16 mg/ml had lower values of FEF might suggest that responsiveness to methacholine is partially linked with baseline airway caliber.
Each antibiotic has a characteristic penetration into respiratory secretions, influenced by serum concentration, protein binding, transport systems, and the presence of infection. Whereas previous studies have used only bronchial secretions and blood, in the present study, blood, bronchial secretions, and bronchoalveolar lavage (BAL) fluid were analyzed for tobramycin levels. In 10 studies in 9 patients, serum levels were significantly related to BAL fluid levels (r = 0.8, p less than 0.01) when both were expressed as a function of creatinine (mean BAL level +/- SD = 144 +/- 124 micrograms/mg creatinine; serum level, 293 +/- 216 micrograms/mg creatinine). The level of drug penetration in BAL fluid, expressed by the slope of the relationship between blood and fluid, was 0.5. The penetration of tobramycin into bronchial secretions ranged from 0 to 1.4 micrograms/ml, the ratio of secretions to serum being 0.2 (r = 0.68; p less than 0.05). It is concluded that the disposition of tobramycin in bronchial secretions and BAL fluid differ. Thus, sampling both fluids offers a more suitable method to study antibiotic pharmacokinetics in bronchi and alveoli.
We studied the airways response to inhaled isoproterenol in 182 healthy Caucasian children (98 girls and 84 boys). Significant (p < 0.003) mean percentage changes were observed for FEF75 (16 ± 2.8%), FEF25−75 (9 + 1.6%), FEF50 (5 ± 1.4%), FEV1 (1.3 ± 0.4%), and FRC (1.5 ± 0.5%).
Of 1,019 Chinese patients with radiologically active pulmonary tuberculosis but with sputum negative for acid-fast bacilli on 5 initial microscopic examinations who were studied for 5 yr, 364 (36%) had 1 or more initial sputum cultures positive for Mycobacterium tuberculosis. All 1,019 patients were randomly allocated to (1) selective chemotherapy (antituberculosis chemotherapy not being started until the disease had been confirmed to be active); or to (2) daily streptomycin, isoniazid, rifampin, and pyrazinamide for 2 months; or (3) for 3 months; or to (4) a standard 12-month control regimen. In the 364 patients with 1 or more of their initial sputum cultures positive, the short-course regimens were inadequate, being followed by relapse rates of 32 and 13%, respectively, during 60 months, compared with 5% in the control series. In the 655 patients with all their initial cultures negative, the corresponding relapse rates were 11, 7, and 2%. In the selective chemotherapy series, 57% of the patients had treatment started during the 60 months because their disease was confirmed to be active.
Rat alveolar macrophages were examined for the presence of subpopulations with different capacities for modulation of mitogen-induced lymphocyte proliferation and production of the monokine, Interleukin-1 (IL-1). Alveolar macrophages lavaged from normal rats were separated into 5 density fractions by centrifugation through a continuous gradient of isosmotic colloidal silica (Percoll). Measurement of cell size and endogenous peroxidase suggested that the cells fractionated by density represented alveolar macrophages at different levels of cell maturation. Alveolar macrophages from each of the density fractions were cultured with whole lymph node cells and the mitogens, concanavalin-A and phytohemagglutinin. Functional heterogeneity was demonstrated among the fractionated cells with respect to suppression of lymphocyte mitogenesis. Alveolar macrophages from intermediate density fractions suppressed mitogenesis in a dose-dependent manner, whereas alveolar macrophages from both the lowest and the highest density fractions had minimal effect on lymphocyte proliferation. When adherence-depleted lymph node cells were used in the mitogenesis assay, rat alveolar macrophages functioned poorly in support of lymphocyte proliferation, and no uniquely supportive alveolar macrophage subfractions were identified. Functional heterogeneity was also demonstrated for production of IL-1. Maximal IL-1 production was associated with the most dense alveolar macrophages, with progressively less IL-1 produced by lower density alveolar macrophage subfractions. The results confirm functional subpopulations of rat alveolar macrophages with respect to the suppression of lymphocyte mitogenesis and the production of Interleukin-1. Such functional subpopulations of alveolar macrophages may reflect the presence of cells at varying levels of cell maturation.
This is a report of a 45-yr-old male patient who developed central sleep apnea syndrome because of hypothyroidism. In response to L-thyroxine therapy, the patient became euthyroid, and the apneic phenomenon disappeared. Previous reports have suggested that hypothyroidism can produce obstructive sleep apnea from either narrowing of the upper airway secondary to deposition of mucopolysaccharides and protein extravasation into the tissues or from abnormalities in ventilatory control. The present patient did demonstrate evidence of profound dysfunction of his respiratory control center: before therapy, the patient manifested blunted ventilatory and occlusion pressure responses to hypoxia and normal responsiveness to hypercapnia; after therapy, hypoxic responsiveness was restored and the ventilatory response to hypercapnia doubled. Hypothyroidism should be included in the differential diagnosis of central sleep apnea.
During the period 1964 to 1970, 31 cases of tuberculosis in humans due to Mycobacterium bovis were reported in Ontario, representing 0.5 per cent of all bacteriologically proved cases. There were no cases in children. Most cases were the result of infection that occurred either in Ontario many years ago or in other countries. Seventy-five per cent of the patients were 40 or more years old, and 60 per cent were foreign-born, of whom at least 50 per cent were infected before arriving in Canada. Of the 31 patients, 13 had pulmonary disease and 18 had extrapulmonary disease, which in 12 involved the genitourinary tract. Probable instances of transmission from animals to man, man to animal, and man to man were observed. Because of the persistent reservoir of infection in the human population, cases of tuberculosis due to Mycobacterium bovis will continue to occur for many years to come, and for both epidemiologic and clinical reasons must be differentiated from cases due to Mycobacterium tuberculosis. Bovine t...
In earlier electron microscopic studies of mycobacteriophage (1), micrographs were obtained which suggested that a study of the intracellular development of phage might reveal information on the morphogenesis of virus particles. Phage D32 was selected because it is the largest of the four mycobacteriophages studied (head diameter, 80 mu and tail length, 220 mu) and has the longest latent period. The latent period is approximately one hundred minutes, the rise period lasts for twenty minutes, and lysis occurs one hundred and twenty minutes after adsorption of phage to bacteria (2).
A patient with alveolar cell carcinoma presented with severe arterial hypoxemia due to a massive right-left shunt within the tumor site. The hypoxemia was dramatically relieved first in the laboratory by balloon catheter occlusion of the right pulmonary artery and subsequently by right pneumonectomy.
