The purpose of the study was to determine the role of lymphocyte subsets (Ly) and reactive oxygen metabolites RSM, concerning the activity of BAL cells, in the pathogenesis of lung involvement in 12 patients with systemic sclerosis (SS) and 4 with systemic lupus erythematodes (SLE) in comparison with 10 control subjects. The cellular activity was measured by means of cytofluorometry (CFM) and chemiluminescence (CL). In SS/SLEY CD3+, CD4+, CD4/CD8-ratio, CD25 + T-Ly and luminol-dependent CL are increased (p less than 0.05). Correlations exist between CD3+, CD4+, CD8+ and CD25 + T-Ly and both luminol-dependent CL and neutrophils (p less than 0.01). The results suggest, that increased secretion of RSM by BAL-cells may be caused by local release of lymphokines by these activated T-Ly. Therefore CFM and CL seem to be useful in addition to BAL cell differentiation in characterizing the BAL cell activity in the diagnostic of lung involvement in SS and SLE.
Since 1974 in a follow-up study 54 still exposed and 29 formerly exposed workers of a carbon black producing factory (Oranienburg, FRG) were asked anamnestically and investigated clinically including lung function tests and E.C.G. Evaluating our results we did not hardly find out any important pathological findings. Considering different periods of exposition there was no fundamental yearly decrease of the ventilation values of still exposed and formerly exposed workers in comparison to the normal population. An additional pulmonary care is not to be required beside the demanded occupational medical check-up.
The diagnosis of pulmonary emphysema and fibrosis is possible by measuring the inspiratory behaviour of phase angle PSI of oscillation method. In addition to the different lung compliance as the main reason an influence of the shifting intrathoracical blood volume as the result of the pressure change is discussed especially for the appearing secondary PSI-periodic. Because a direct experimental evidence is not present in this study it was attempted to describe qualitatively the blood volume shift. Thoracic electrical impedance plethysmography and methods of nuclear medicine were used as methodological base. Although impedance plethysmography appears theoretical suitable and there are references, that alterations being independent from the heart rhythm may be detected, the originally aim of the study was not reached by the used method. The registration of radioactive labeled blood over the thoracical region by means of methods of nuclear medicine was applied as an alternative method. In contrast to the theoretical concept of a suction effect of the decreasing pressure during inspiration a decrease of the impulse rate and an increase of the latter during expiration was found. The reason could be the isolated registration of changes in the alveolar vessels. Possible secondary oscillations, which could be in relation with findings of lung mechanics, were not observed.
With a view of the pathogenesis of chronic bronchopulmonary diseases the interrelations between infections and evolving defense system are of interest, they are perhaps detectable by means of diagnostic bronchoalveolar lavage. We carried out cytodifferentiation, investigated adenosine deaminase activities and interleukin 1 formation of macrophages, determined immunoglobulin concentrations (secretory IgA), lysozyme, alpha 2-macroglobulin, alpha 1-antitrypsin, albumin. Because the cytodifferentiation yields insight into topical inflammatory reactions, shows diagnostic useful informations in single cases and because it is simple to carry out we can recommend it for each bronchological examination. There were no results specific for any disease group for parameters mentioned above.
The authors describe a case originally assumed to be pneumonia. As a consequence of unsuccessful antibiotic treatment surgical intervention took place. Then histological examination revealed pulmonary lymphogranulomatosis. The authors draw the attention to the responsibility of the GP-s and hospital doctors to include pulmonary lymphogranulomatosis in the range of suspected diseases if the symptoms are similar to those of the analysed case.
Oscillatory measurement of resistance can get more practical relevance including the phase angle (PSI) and the volume dependence. Different findings during deep inspiration in patients with pulmonary emphysema (PSI unchanged) and with pulmonary fibrosis (PSI-Negativation) are known. To explain these findings transpulmonary pressure (Ptp) was measured parallel to PSI in 85 subjects. PSI-negativation was found in 31 of 43 patients with pulmonary fibrosis and in 10 of 19 healthy subjects. Patients with pulmonary emphysema have nearly constant or slight positive phase angles. Subjects with negativation of phase angle have significantly higher Ptp-levels at 100% TLC. This high pressure is reached by an in comparison to volume overproportional increase of pressure in the end part of the lung expansion curve. It is proposed to estimate the PSI-V-dependence in ranges from middle level of breathing to 75% of vital capacity VC and from 75% to 100% VC separately. By this modification the qualitative noninvasive assessment of lung compliance could be more efficient. Several findings indicate, that the observed secondary periodic of PSI are dependent from heart rhythm and therefore from intrathoracic blood volume.
Describing the structure of a chest clinic in a large city requirements for a high level on the field of medical assessing in patients with non-specific lung diseases are formulated. 1. It must be sure, that all patients suffering from lung diseases are referred to a pneumologist. 2. Opportunities for optimal diagnosis must be given (knowledge and experiences of physicians and nurses; medical equipments of a high technical standard). 3. A scientific-based treatment must be guaranteed. Under optimal conditions it is possible to shorten the duration of disablement and to avoid the hospitalization in some cases.
Reference values published by the Section Pathophysiology of Breathing in the Society for Pulmology and Tuberculosis of the GDR and reference values of European Community for Coal and Steel (EGKS) were compared on example of FVC and FEV1. It was found a relative well accordance of reference values of FVC and FEV1 in younger and middle-aged men of a height from 160-200 cm (between -5 to +15%). In women with a body height of 150 to 200 cm a well correlation for FVC and FEV1 is also given (-10 to +10%). Reference values are showing a more important difference with increasing age and independent of sex. There are problems concerning the reference values in male and female lower than 155 cm body height.
