Introduction: The purpose of this study was to classify the accessory fissures of the lung and to assess their frequency by using high-resolution CT. Methods and patients: HRCT scans of 115 patients were prospectively reviewed. 1 mm thin sections were obtained at 10 mm intervals with a scan time of 1.9 s. The fissure and its relationship to the segmental bronchovascular structures were then evaluated on transverse sections. Results: Forty-four accessory fissures were detected in 35 of 115 patients. The most common accessory fissure was the inferior accessory fissure (12%). The second most common accessory fissure was the left minor fissure (8%). The right superior accessory fissure (5%), the accessory fissure between the medial and lateral segments of the right middle lobe (5%), and the accessory fissure between the superior and inferior segments of the lingula (5%) were seen in equal frequencies. Also, intersegmental accessory fissures, namely the fissure between the anterobasal and laterobasal of both the right (1%) and the left (2%) lower lobes were detected. We found only one subsegmental accessory fissure. Discussion and conclusion: The inferior accessory fissure and the left minor fissure were the most common accessory fissures in our study.

Journal of the American Geriatrics SocietyVolume 6, Issue 1 p. 27-32 Article AN INTRODUCTION TO THE SUBJECT OF BRONCHIAL ASTHMA Nathan E. Silbert M.D., F.A.C.A., Nathan E. Silbert M.D., F.A.C.A. Lynn, MassachusettsAssociate Fellow, American College of Chest Physicians.Search for more papers by this author Nathan E. Silbert M.D., F.A.C.A., Nathan E. Silbert M.D., F.A.C.A. Lynn, MassachusettsAssociate Fellow, American College of Chest Physicians.Search for more papers by this author First published: January 1958 https://doi.org/10.1111/j.1532-5415.1958.tb00683.xCitations: 1 Senior Consultant, Department of Allergy, Lawrence Quigley Memorial Hospital and Soldiers' Home, Chelsea, Mass., and Associate Physician, Department of Medicine, Union Hospital, Lynn, Mass. Office address: 214 Ocean Street, Lynn, Mass. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume6, Issue1January 1958Pages 27-32 RelatedInformation

Trypsin, a proteolytic enzyme, can liquefy heavy sputum, as seen in the laboratory when lysis of thick exudates is necessary in order to carry out tests.' Methods of direct application of trypsin and of other enzymes to human subjects have been discussed and reported in the a Liquefaction of thickened secretions has been a consistent finding. Clinical experience with inhalation of trypsin prompted an investigation of parenteral administration. Trypsin by aerosol was effective, but irritating; patients responded with copious easy raising of sputum, but developed raspy sore throats. In a previous paper,4 I have reported the clinical results with trypsin in oil in a variety of patients with allergic chest disease, all of whom had long-standing bronchial conditions and allied pathology, including emphysema. These patients showed marked clinical improvement within two or three days after the commencement of treatment; the relief was temporary in some cases and prolonged in others. The schedule of dosage was roughly the same for all patients and consisted of daily injections intragluteally of 5 mg. of trypsin for one week, followed by three to five injections tapering off over the next week or two. In those patients who reverted in a few weeks to their original physical status, second and third courses were found almost as effective as the primary course. Side effects consisted of pain a t the site of injection and, in some casks, a fine maculopapular rash around the pelvic girdle. The rash cleared on withdrawing trypsin. It was possible, however, to complete a course of treatment after an interruption of a few days. One patient developed a sensitivity to the trypsin in oil on the second course, as shown by exacerbation of her asthma; she was the only patient who did not complete the course of therapy. Improvement consisted of thinning of the bronchial secretions within the first few days so that raising was facilitated; this was followed by a gradual diminution in the quantity of the expectorated material. Breathing was easier, usually by the second day, and it improved progressively in the succeeding days. Radiological examination before treatment indicated the degree of emphysema and of the exaggeration of bronchovascular markings. Follow-up examinations revealed changes in the bronchovascular markings, but none in the emphysema. Objective measurements were made in all patients in the series. It is the purpose of this paper to present and to discuss these findings and to present additional data acquired from patients receiving trypsin in a different form. The new preparation, the use of which has not been reported

Among the pathognomonic signs of bronchial asthma, chronic bronchitis and bronchiectasis is an accumulation of tenacious, inspissated mucus which becomes adherent to the tracheobronchial tree. This “gunk” may aggravate and create the edema of the bronchial mucosa, and contractions of the smooth muscle bundles with resulting bronchospasm, and even emphysema. The mucus, which becomes glairy and tenacious and which obstructs the bronchial lumen, produces a thickened basement membrane persisting in some patients for periods of many months to years, causing respiratory and social embarrassment. Many therapeutic agents and methods have been employed with varying degrees of success and efficiency1 but none has satisfactorily removed these accumulations. Enzymes have long been used in the laboratory to liquefy thick heavy sputum by direct lytic action. To investigate in vivo application, Limber et al2 administered an aerosol of the enzyme try#{231}sin to animals without untoward effect and therapy proceeded to clinical studies. Aerosolized solutions of trypsin were shown to be effective in loosening, thereby facililating the raising of thick mucus, particularly from the upper part of the tracheobronchial tree. In their work with tuberculous patients, they concluded that the liquefying action was due to lysis of the mucus and also to stimulation of the cells of the mucous membrane lining the respiratory tract. Unger and Unger3 reported that aerosolized trypsin was effective in clearing the upper part of the respiratory tract in bronchiectasis, acute atelectasis, and bronchial asthma with infection, but the results in chronic bronchial asthma and emphysema were not as favorable. Our personal experience with aerosol trypsin was similar, but it was found that inhalation therapy was not tolerated by several patients because of the irritation to the mucous membrane. The findings of Farber et al’ showed alteration of the epithelial cells of the trachea when trypsin solution was inhaled as an aerosol. Rationale