MONDAY, JUNE 14

O.l!il. The correlatioo 8Illlbsis _ted that there _ a st:/'(q correlatioo and Pa02 ( r=-ll.366. P
~ and ~..-..c..... ..-et tof the anatyM and ~ (II \'tie data T,,"- tno-ed that 1M ~ progtal'IW'IW had ." ~ ~ poeiINe inftuence WI get*aI on the q..,eity or Ide Of ~l& wt1?l etwoNr; atrflow IimMIon ,..,.,. . . . . . heQNYlignificMt~in1MphyM;8I~(IIthe~

Thty ~ ~

ltl . . aclMty

..... , ..~ and ~ S'MU'

r"... _" no ~ eAan9tl(l

tnelr

af1ectro",e

btfta¥IOt Thllwaa1M fwsI South NticM study I(l this fIIIldand the hndIngI con ........ ...cI'l ~. . ., Itvdon

CHEST I 103 I 3 I MARCH, 1993 I Supplement

1838

MONDAY, JUNE 14 (Chronic Obstructive Pulmonsry DISftIIIIII-COIItinued) A I'IV1Ol'YPII: JQOlU!IXZ SYS'IBl I'I::R SUPl'CR'l'II«: DIJ!lKlSTIC lE:ISIQI III -..l'UDGr. sp~. S!IlI"lQ6 AM> EXPf2UI!1C!S III OIUIIC CIISTRI.JC'I'IV PULJOWlY DISEASE. K. SIpilqlculoa. D. L~. D.

llougonis. G.Qmltziot:is.

A. TaUiras

l'U18:lnary Divisiat of Internal IIsdicine ~ ~ of Electrical !D,Ju-rinq. SChool of !D,Jineerinq. I'lltraa lbiversity. I'lltraa.

er-...

_ t _ _ in intaligBnt handlinq of data opala . . . ~ " " " in ItIdical dJa<)noais orimted clecisiat support ~ . In this ~

.. prototype kncwledy _ (KIl) sysu. has been _lq.ed. supporting reaJrSi... -.t:hccla of -tical e.t....tiat. to eauesl at ~ i c data (SI')

~ an:! expu1....- at ctlronic cb8tructive ~ d i _ (
tral.ninJ ~. ~ ~·s ~-.tatiat has been finacially ""RXXted. by ~ ~t1
al!tstiat an:!

on.

t...

'1UE projects.

~YCHOLoeICAL

IY ClPD

FEATURES

AND QUALITY OF LIFE

IN SUBJECTS AFFECTED

Aver•• C., Fr••••nita "_, "-s.ar! G_, "wo D.C., 81n1.1 ".P. -

Dep.r~-.n~ of Re.piratory ~hy.1o-p.tol09V Hospital ·A.Galateo· Leece (Italy)

The a1_ of this study 1. the quality of 11f. ~pir.tory

to verify the psychological attitude and 1n patients suff.r1n9 frOM chronic

1neufficiency.

T.k1n9 for 9r.nted th.t • bad qu.l1ty of lif. i . connected Nith the .y.pton o f . d.pr••sed . t . t . (los. of .ppet1te, qu.lity of . l. .p, . .xu.lity, psyc~tar .lOWin9 dONn, las. of en.r9Y, . . .r1nes., reduced interest for the .xt.rn.l MOrld, f . . l1n9. of . . If-deY.luat1on, r"uc" MOrkin9 .nd concentr_tion C.JN,city, coapl.ininvs of turninv aver type) we have t.ken •• ind.. of "nor. . l qu.lity of life" the l.ck of the.e .tt1tude. carr.l.tin9 t~ to the cl1nic.l Sy.ptOMS .nd/ar the p.tient'. function.l troubles .nd v.ri fy1n9 "". ....ch they c.n .ffect the psychologic.l fe.tur•• and haN ....ch the deter1ar.tion of the, qu.lity of 11f•• ~ar this re.son _ qu••t1onn.ire, t.ken fro- the ~I test ("inn.sat. ~ltipha.ic Per.on.lity Inventory), r •• trict" to the i t _ . rel.ted to the D ac.l. (d.pre.sion ac.l.). has a.n given to one hundred COPD p.tients Nhe h.d been ••••in.ted previou.ly frOM. clinic.l-function.l point of view. In the end, we have dr..." our results both on the 9round of the an_r. 91vttn by ttw IN,tients to the .in91. question. .nd on the 9round. of the tot.l scar. D (- d.pr. . .ion index) .nd rel.tin9 the pr.vious d.t. Nith the ttw cl1nic.l-function.l on. . . Fin.lly we h.ve COMJN,reted t . . . . d.t. with tho.. one. connect.d N1th non .elected popul.tion.

1848

CRYPTOGENIC EOSINOPHILIC PNEUMONIA, CLINICAL AND RADIOLOGICAL SPECTRUM. THE RESPONSE TO TREAnIENT S.A.Papir1s. M.Maniati. S.H.Constantopoul08 UniversIty of Ioannina, Department of Internal Medicine, Pulmonary Section. Ioannina GREECE Six patients. 2 men and 4 women were admitted to our Deport. .nt. during the last two years With "chronic" eosinophi 1 re pneumonia. In 5 of them. 1 IDeO and 4 women the clinical picture was that of a subacute ilness With fever « 38·C) night sweats. weight IOS8. melaisa and mild dyspnea. The 6th patient presented with severe breathlessness (like asthme attach) and cyanosis. Hie chest radiogram wos that of a mixed interstitial and acinar pattern with hyperinflation. Flow-volume curve was also that of a mixed pottern WIth prevalence of obstruction end the absolut number of blood eosInophile was higher than 15.000/mm'. In tha other patients. rad1010gic appearance was that of widespread alveolar disease with peripheral prevalence in 2 women and that of less extensive alveolar disease
IDIOPATHIC PULMONARY FIBROSIS IN GREECE M.Maniati, S.A.Papiris. S.H.Const8ntopoulos University of lo~nnina, Department of Internal Medicine. Pulmonary SectIon. I08nnIna GREECE In the last thrae years. we evaluated 22 pat1ents. 15 men ond 7 women with Idlopothic pulmonory fibrosis (IPF). All pat1ents had typical cl1nical presentation with non-productive cough. progreSSIve dyspnea fine crocles. fInger clubbIng and compatible lung biopsy. Rodiologic appearanc~ wos that of 8n extensive honeycomb pattern 1n all bUt two patient8 who hod earlier findings. They Wo~ confirmed by chest computed tomography (CT). In one pat1ent exten8ive mediastinal lymphadenopathy was present but he aleo had chronic lympocytic leuJc.emia. PneUJDCJme:diastinum and subcutaneous emphyseme occured In one patient. Pulmonary function tests were c~tible in 011 with severe re8tr~ctlon. low OLCO. Increased P{A-o)02 with further icrease during exerCIse in all patients. Eight patient8 accapted treatment (methylpredo1solone 5 and plus cyclopho8phamlde 3) while 14 d1d not accept it. Until today 13 patient8 had died (10 without tre8tment 8nd 3 tre8ted). 10 from reSpIratory failure. 1 from m¥ocardial infarctIon,! from suppu~a­ tive infectIon, 1 from scar cancer of the lung. Conclusion: IPF confirms r t ee Lf e t eo JO Gr·eek patIents. ~s an extre~ly severe disease. It was very difficult for us to conVlnce potienls to recelV~ trotment. Treatment stlll r eme rne i nedeque t e fQr t m e disease.

MONDAY, JUNE 14 cardiomyopathy, Arrhythmias, and Pacemakers Afternoon ASSYMETRrC HYPERTROPHY OF THE INTERVENTRICULAR SEPTUM TN COR PULMONALE Aristotle University of Thessaloniki.Depar~mentof Tnternal Medicine -G Papanikolaou· General Hospital Thesaaloniki. Macedonia,Greece. Anqoaachalelis.Nest.,MD FCCP.Ti~opoulo. Herr..,MD,Kazakou X" MD,Gavrielides A.,HO. The purpose of this study was t.o evaluate the presence of Asaymetric Septal Hypertrophy (ASH) in cor pulmonale. M-modeEchor.ardioqraphy was perfo~d in 35 selective coser.utive patients (pta) mean age 60 6tlO yeara.wi~h cor pulmonale. The following echo paraaeters were exaained: L.V.N.T.d. I.V.S.T.d and the raTio R-I.V.S.T.d/L.V.W.T d,while FEVl'.Pa02 and PaC02 of eachpatient were also calculated. The result.s showed: L.V.W.T.d-O.98 to.14 ~ ·.r V.S.T.d-l.22tO 18 em, FEV1',38 2S·14.Pa02,48.6 16.S mmHg and PaC02-47.9tS.7 .aRg. ASH (R>1.3) waa found in lS out of 3S pta (R-l.33,51.4'),in whom statistir.ally significant correlation was revealed between Rand FEV1' (r--O.S8,pO.OSl. We conclude that' 1. ASH ia found in 51.4' of pta with cor pUlmonale. 2. The presence of ASH could be predictive of left ven~ricular diastolic dysfunction, 3. ASH is correlated with certain indexes of respiratory function (FEV1,Pa02)' 4. ASH seems to be of great proqnostic value for the identification of the disease severity in cor pUlmonale.

MYOCARDIALS11FPNESSCHANGES ASSESS&D BY DIRECT MEASUREMENT OF MECHANICAL IMPEDANCE

.,.+

t

-.H.

·W',P. P., K. H. ScIleId fir llloru-, lim- uad Gc8IcIIiJ"'Iic

Klinik uad _

AJbcrt-~.

33,4400 _,aa..ay

MyoconlW _ _ OR _ ill Ian _Iliftias. Modulalioallll IIIOCbonicaI Iiauc pocpcnics cIoariaa lbc Ian cydc oad. . . . ioolnJpil: _ _ ...ve _ . - by IIlCISUrioIIIIOCbonicaI ......-- u .. iodoxlOr-..ilily. 4 houscswine (60-10 kg) of either .-hC:lUIOd wilh sodium pentobaIbilal. Access to lbc Ian was ol>loiDed lbrouab lbc 6ftIl iIIlen:oIlaI __ by IIIinimol in...i.., su'F'Y. A ~ excitor_ ~ was opptiod to lbc left _ pericanIioJ surface via • rocI-iJHube _ _ device. The ( _ IIld Fon:c s.r~

211 A II, PCB PicZllllronicI INC.• NY) was. - COltop of. vibrator (LiDa. Lcndoa. ux., ModelV 100. run by.!.iDa"'- PA 2'E) wbicbproduood. _ _ ompIiludc vilHalion. SipaJ sampIiDs cxlCDdod OW< . . . to _ _ qdco AI cad> _ . The ...... __ FFT-proccaed IIIiDs ~ . _ cilia .-Jysio softwan: l1IIl COl OR IBM PC. MechaaicaI ialpodoacc was deIlaodu lbc nIio ~ foRe oad acaIcnIion. lbae&lre to . . ~ _ . ClIoaFo ill myocanIioJ _ _ foRe - . : induced by 2 MAK HaIcchano IIld 6""'" x min Dapomiae, nlIj*ti..ty. CallJal -no _ ~ was conlrOIIcd by OR _ baIIooD by wbicb...-cInlpo _ II-. 20%. . . . HaIcchano -.:~.

_.llIpOblIioc

As - . lbc _ _ IIIlpIiludoIwried ... II-. 10% ill all ~. At CldJibil • muimoI . , - . At:conIio8IY,lbc impolIoDce. i.e., lbc ompIiludcdue to • . - oflbc cIlOc:ti..ty vibnlioa _ was cIolorIIIiaod AI 36Hz 1IlrcloIPout all _ _ Under COlllJOI CCDlIibons. systolic ialpodoacc wried by • _ of 2. IDolropic _ _ _

3,..'

inducedc:haIJFs in systolic_

=--

+7'% IIld -60%, n:opcdivdy. hal COlllJOI. Oiucolic:

- . : DOl sipIificanl.

-

u_

e-

Force s_

DiMIoIe

Acceleration s_

~

O.93t:O.1

1.9t:O.l

6.1 to.4

S.OtO.S

2." to.6

46102

6.HO.2

1.7:*:0-1

I.Ot 10

7.3to.7 '.ltO.6

.. 9tO.4

Impedance s_

DiMIoIe

O.IS to_02 0.)) to,07 0.21 to.04

O.lI tOO1

0.71 tOO4 1.6J:tOU

FFT AmpIitucIe AI 36 Hz <:!:SD) McchaaicaIImpedaocc is. - . . iodoxof...,.-J myocanIioJ _ _ - . . The _ can cuiliy be_...",. canIioc _ ud durioa """""'-'!>Y.

IMPAIRMENT OF LEFTVENTRICULAR DIASTOlIC FUNCTION INADULT PATIENTS WITH RlGHT~ OVERlOAD· Takeo NaIto. M.D., Hinlfuml Habu, ·M.D., Hl108hl lkawa, M.D., Yutaka Hirano, M.D.• Takeehl SuaJd, M.D., Kinjl .lhikawe, M.D., Hlloehl Shirolanl, M.D., Yuldo Naguaka, M.D.•FCCP..Nobuyo8hI KawaI, M.D, Ryo Katon, M.D. Kinkl UnIver8lly and 8eikaika1 HoIpIlaJ. Oaaka, Japan. ~ Itudiel 8how that IIIfI ventrlclIlar (LV) dlallOllc function Is impaired in pallenta with rtght ventrlclI"r CMIfload. ~r, which of volume overload or preuure overload wiN be 1tle causative factor I. not known. Twodimentional and pulled Doppler echocardlography were perfonned In 16 healthy controll and 74 patients with atrtel aeptal defect (ASD) or pulmonary vaacu"r d...... The patlents were divided Into 3 groupe: Group P(nc19) had preaaure gradient _ trIcuapld valve (PG) more than 35 mmHg wiIhout ASD, group VP(n-17) had aIao PG more than 35mmHg with ASD and group V(n-38) had PG .... than 35 mmHg. LV dilIlortion ICOI8 at end-syatoIe (OS) obtalMd br two-dlmenllonal ec:hocardlography caJculated u the ratio of the IaIgeat LV anterIor-poaterlor dlamelllr to the "rgest aepla....teraJ diameter which crolIMI • at right angIea. Left ~Iar filing parameters obtained br pulted Doppler ec:hocardIograp were 1llMIUt8d; peak flow velocity i1 early fIlllng(E), peak flow veIocIly i1 atrial contrectIon (A), time Intervalfrom onset of 2nd cardiac aound to E(PFl} and time Interval from onaet of 2nd cardiac -.ICI to orl88l 01 early flIlng(lRT). Reaults were u below:

PERIPARTAL CARDIOMYOPATHY ALI H. HANDJANl H. D. FACC FCCP SHAHRAH HANDJANl H.D. SHIRAZ HEDICAL SCI«lOL , IRAN Seventeen cases of peripa r tal ca.-diOllyopathy were collected between 1913198'5 at two university hospitals. Stu ree , Iran. Ages ranged between 17-4S years. It was noted that the 80st iaportant predisposinS factors were lauItiparity in 8 cases, twins in 2, hypertension in 4. and cesereen-aec r r oe in 2 cases. It was observed that 15/17 cases were of poor ecc Ic-eccncetc status. 15/17 cases were initially seen with congestive heart failure. Harked cardlO11esaly was found in 7/17 cases. ECG changes were non-specific 5T-T chenges in ecet. cases, arrhythaias. including VPC's • atrial fibrillation and atrial f l ut r er in 7/14 cases. The echocardiography perfonted in 10 cases revealed typical-pattern cardlO1lyopathy in 9 cases. The cardiac catheterization suggested .ultiple chaaber enlar8~nt with decreased ejection fraction and wall .-otion. Treat8e'nt with digoxin, diuretics. heparin and • in SOfIte patients, afterload reducinu. alents was initiated and continued during hospital1zat1on. The results were as follow: Four cases improved significantly and were dischersed. Five cases improved clinically while ECG and chest x-ray chanses reJDained abnorJIBI at patient's hospital di_issal. Four cases, in spite of the lledications, progressed toward 0: chronic and allaOst intractable type of congest he heart failure. Four patients expired. Patient record follow-up was up to four years after discherle.

Normal group P group VP group V 1.1%0.1 1.810.8'" 1.7±O.S-1.2tCI.1·55.ll:t11.5 37.4±13.2-·' 35.ll:t8.4·44.7±14.6A(cmIaec) 46.4±10.8 46.5%11.1 47.4±15.8 41.1±10.1 AlE O.8ll±O.24 1.35±O.as-·, 1.34:1:0.34-" 1.04:1:0.45 PFT(maec) 158.0±12.7 184.1±38.r· 179.9:t29.9" 173.6:t27.4·· !RT(JII88C) 70.0±14.2 93.5±23.r· 82.6:t28.4 73.5%24.4 ·pcO.OS, ··pcO.01, ·"pcO.OO1 vs Normal, Ip
os

E(c:mIaec)

E we. Inversely and PG poaltlvely nlIated to LV dlalOltion ICOI8 at endayatoIe (r. -o.47,pcO.01, r-o.72, pcO.01. reapectlvely). ConcJuaIon; LV dlutollc function _ Impalred i1 chronic rtght ventricular overloed. We found that eIeYated RV ayatollc preaaure which caused LV dIalortlon Is lI1e main caU8lltlve Iaclor to impair LV diastolic function.

CHEST I 103 I 3 I MARCH. 1993 I SuppIemenl

1855

MONDAY, JUNE 14 (CBrdlomyopathy, Arrhythmias, and Pacemakers-contlnued) DIFFERENT EXPRESSION OF Gia·PROTEINS IN RIGHT AND LEFT VENTRICLES ""OM CARDIOMYOPATHIC HUMAN HEARTS Katharina LariJCh. UIriIca MoncIe·. Wilhelm Schmitz·. HellO Sc:hoIz•• EtlancI Erdmann. Mad. Klinlk I. UnIvwaIty 01 MoJncllan. • PIlarmakoiogischea lnatitut Ham....g. •• Pharmak~ InaIltul Heidelberg. Germany

INCREASED INCIDENCE OF CANCERS IN PRIMARY DILATED CARDIOMYOPATHIES

MicIIaeI _ , Thoma. ESChenhagen·. hler

RN SACHS. B. CORSINI. P. OUPOUY.M. NAMAOE.J. O'ESTANQUE. O. TALVARO.J. LANFRANCHI 0epInmcn1 of Cardiology.HllpiraJ Avicenne. 12S rue de SraJingrod. 93009 BOBIGNY, FRANCE

Gierachlk··.

A dowrngulalion 01 B-adranoc.ptor. (BARI and

an increaJe 01

inhibitory guanine(LV> . . . or ~ neur-..cnna changes in heart lab.. The rKern obMrvatIon ltlet IIAIl downregulalion doe. not occur in tha ventricle. from patients with Isolated lailure of the right venlricle. (RV)ouggest that Iocel differenc•• might occur in tha failing heart. we IItUdied Gia and BAR in LV and RV from petientJ with pradomInent LV· I.ilure due 10 d~.led (DCMl or ischemic (ICMl cardiomyopathy .nd nonl.iling controls (NFl. IIuIll1I; Gill A6Il LV RV LV RV

. Auto-immunity and viruses lie thoughl 10 be in some instances responsible of the developpemml of primIry dilaledcanIiomyopedlies (CMD).

nucleolicIe binding proteins (GiG!

Cancershavebeen usociaICd wilh dennolO-polymyositis. which might shue III idenlicaI poIhopbysiology.

OCC\W

in left _

Ther.,ora.

In • retrospective study. we anaIyocd the incidence of cancers in patients with CMO. Sixty tllree mea .nd 20 w _ , 15 to 79 yean old, were invesdpted -.Inly ror lI.rt raUare, rro. 1978 to 1991 and ~1Ied .. CMD. The diaposis was mode on clinical examination. ECG. X ray radiography. echocardiopapby. hemodynamic SlUdy. coronary IIlgiograp/ly. and LV endomyocanIiaJ biopsy, in mcxe lhIIlllO'l> of the J*ients.

NF

1.6%0.1 (12)

2.7%0.2 (81

73.3%4.5 (15)

84.5%4.4 (111

Ten ..-cen h.ve been found (12-'). There were1 _ and 2 women. The sites of cancerswere u follow:

ICM

2.6%0.1 (19)

3.0%0.2 (13)

38.1 %2.7 (281

211.8%2.4 (20)

respiratoty tract : thyroid: blood: biJiary net :

DCM

3.6%0.2· (31)

2.9%0.2 (171

38.3%2.3· (32)

Tllere were : 65 -. beavy .Icol.... drinkers, 49 -. diabetics.

.moker., .nd 9.6-'

1 I 1 1

The an-.J IlIddenee of cancersis 0,ll6 -. in CMO u compared 10 CI,3O -. in the aeneraI popuI.tion reportrd in the national re8istryof cancersfrom 191810 1982.

We cond • • tat tile inddenee

TiU.:THIRTY-yItAR JAPAN

or cancen Is elevated

AUTOPSY

STATISTICS

or

It i. concluded thaI Gia i. differently r.gulated in LV .nd RV in patienlJ with predominllnl LV·I.ilure in which BAR downregulalion i. limil.r. This could be cIua to local diff.renc•• in myocardi.1 neuroendocrine change. or due to • general Iimitallon 01 the RV10 incre... ilS Gi.....xpr.lISion.

In CMD.

CARDIOMYOPATHIES

IN

1IIDIll.I1:

U.i... the Annu.l. of P.tholoaic.l Autop.y C.... in Japan coy.rina the 30-y.ar period of 1858-1887, c •••• of idiop.thic c.rdio~op.thi... includi... dilat.d(DCH). hyp.rtrophic(HeN) and uncl ••• ified(UCN) typ•• w.r• •elected for .t.ti.tic.l .n.ly.i•. RlSULT AND CONCLUSIONS: In a total of 748.355 .utop.y c .... r.a1ater.d durina the thirty succ in y••r •• 1,584 c ••e. of DCH. 488 c •••• of HeN and 714 c of UeN w.r. found. Th. incidence. were 0.11_, o.oe_ and 0.10_, re.pectiYely. The incid.nc•• of DCH and HeN .how.d an incre.aina t.nd.ncy from the l.tt.r h.lf of the 1870'., wh.r••• th.t of UCH d.cr. . . .d ar.du.lly. The annual incid.nc. of eN. fluctu.t.d ov.r .n int.rv.l of .eyer.l y.an which .Ull&•• t.d p.rticip.tion of inf.ction in the c.us. of de.th. Th. nllllber of HeN c ••e. • ccount.d for on. third to h.l f of th.t of DCN alllO.t .v.ry y••r. All. di.tribution p.tt.rn .how.d two peall. in the young and .iddl.-&led aroup. of DCH and HeN. liahty c.... of HeN(l 7 .Illl were complic.t.d with aalillDant n.opl .... , .nd the r.t. was .ianit1cantly hiah.r than th.t of DCH(5. 3". p
• OCM .._......._HCM

188S

1970

29.3%2.0· (211

• p<0.05 v•. NF: BAR in Imol 1251.CYP/mg prol.in, Glainpg tr.naclucin almg protein;

lUBlQII: The yearly abitt and current atatue of prevalence ot cardloayopatbl •• (CMa) 1n Japan were a ••••••d throuch a countrywid• •tudy of .utop.y c ••••.

1960

.

number of hearts is given in parenthe ....

Author(s): Y.Ni.hi. S.Kawal, R.Okad•. Rea.arch Laboratory tor Cardiovaacular Pathoiocy, Juntendo Univeraity School of N.dicin., Tokyo, J.pan

200

.

(year)

POlYMYOSITlS/lIE_TIJlYOSITIS AIID SIGIlIFlCAIIT PUlCARDIAI. DIS£AS£--REPORT OF FOUR CASES. A Adlakh., M.D••nd EC Rosenow, M.D., FCCI'. Mayo 6r.dUlte School of Medicine, Rochester, MIl. Pol,.,yosltls/oer-tc.yos It Is (PII/IJl) .re rare .utol.......ltlsyst. Infl_tory disorders of unknown etlolO9Y. Cardiac InyolY_t s _ to occur frequently, though. lesser percentage .re cllnlc.lly s)llptoaatlc. Slgnlflc.nt peric.rdl.l disease h.s been reported In less th.n fhe pat let. In the lIter.ture. Of the 350 pat lents of PII/III seen .t Mayo Clinic fr. 1972 to 1992, 60 (171) had s)lllptOllltlc c.rdl.c InyolY_nt. Of these 60, 4 (71) had assocl.ted slgnlflc.nt perlc.rdl.l disease. Their ages r8ll9ed fr. 52 to 73 ye.rs. Three were females and one w.s • male patient. Two H<:h h.d underlying IJl and PII. Dur.tlon of musculoskelet.l SJllPtoas ranged fr. 2 to 18 IIOnths prior to dl.gnosis of perlc.rdl.l lnyolY_t. One had constrlcthe pericarditis (requiring perlc.rdlactCJIY), two h.d perlc.rdhl tllllPoilade (need.d perlc.rdlocentesis), .nd one h.d lIIOder.te she cte...faren. tial effusIon. None h.d associated lung lnyolY_t. Elevated .uscle enQIICs with signs of .cthe 1IY0sltis (requiring tre.~t) were present In all except the one with constrict he pericarditis. Antlnucl••r ..tlbodles were IIIOderately poslthe In two patients (with nonul antl·cIs 1IllA). R.....• told factor, anti-scI 70, .ntl-Jo, extractable nucle.r .ntlgen .ntlbodles were neg.the 1••11. None h.d underlying malignancy. No recurrence of perlc.rdial disease has been noted In .11 these patients aftar • follow-up r.nglng frCJI 6 to 48 _ths. In s_ry, signIfIcant perlcardhl disease may cOllPlIc.te clinical course of PII/III, and physicians need to be aw.re of this association and thus .. Intaln • high Index of suspicion for Its diagnosis Illd e.rly ther.peutlc lnterYentlon •

MONDAY, JUNE 14 CMIlIIJiASl1Ult (1IIJRlIIIlIC) IfSI'OIISI!S III UII'IalY V.R. JmfI, K.D. NlIW.Nll & J.V. PAl - IHlIG\T. Di!!i8~ <:L Medicine, Nair Hospital, lIooobay, In:lia. Leo>rosy is .. i~rtant tropical disease in Ird1a. Aut.,.,..ic nerves MY be affected in the early sta~ of the disease, often with trwbl_ cardiovascular ~ . Thirty five DStients with .w.tibacillary le!"'OSy '" twenty utched controls ""rticipated in the stu:Iy. SIdn Slle8T8 f1'04l varloua aites were nraded as i to 6 by tOO roo of bacilli & the a1bjects with a bactertolo>1cal in:Iex >2 were stu:Il.ed. l.eoroll8t<1lS CBtients hail a hi')her bacterlol"31cal in:Iex than borderline ~tients. AI:. th;. ti_ of the stuly patients hod atleast Q'l2 of the following ~a.s: G1ddI.ness, ;xrlal adaa, .pal!?itatiQII, _ati~,C.I. disturbance. 1lltonCB1c fl.n:tlon t~ inclUded heart rate variation to valsalva ~r , heart r...ee re8lXlnSe' to stard1w., heart rate re8!X"'8e to deep breatillllll, blood fIi'iI!3\JI"e-TeS~ to stanl1.nl.n.x: sy...lIItil....uc & ""rasytr;>ath3cic l.>s1on & 141, ''Iad isolat3:l pr.raSY-:")8t:"'tic ill\lOlv_. T..,., JlClUI'O!'Ilthy ...s ........ in 87.51, of pati:>nts w1.t:) h;>routous leorosy '" 601 of ootients with borderline borosy. C1dd1~ss """ Dc ~ot o)'ll!lton Of autonoooic dysfunction. In 751, of controls & 20t of borosy l>8t1..'"I1ts, rorul aJtonooo1c function was obs~rv3d. In conclusion, cardiovascular dvsfl.n:tion is frequently ~ in leorosy, ~rticularly in tro l"!'rDBat<1lS' variety, oiI1cil ,)85 a ".,at~r SN~rity of infec,tion.

1.16 + 0.0&

1.14 + 0.04

Par8S}'ll!>llthetlc

1.2& + 0.16

1.05 + 0.08

*Par8S}'ll!>llthet:ic

1.11 + 0.06

0.96 + 0.04

*PansJ""llt.'>..->tlc

~~~to

-3.51 + 8.49

-5.60 +.8.57

S}'IIDSt:>etic

3.P: re51Xl1'Ule to sustained ,laIlderlp

28.75 + 2.94

20.66 + 3.30

*Sya""t:~ic

Valsalva ratio IIHrt r a t e _ •tr> stard1~ 30]15 Heart tat~~res,;>onse to deep bre8th1l'lf;

Infections in pa..:e••ker pat1eht•. Balbi M., Bertero G., Canonelo D., Sal-bar. C., Caponnatto S. cardic.lol/Y cnarr , Univenity ·)f cenca , Italy_ Infection of paceaaker'. POCKPt or intrav.nou. lead 16 the aost dangerous co.plication of cardiac pacinl/. Thi. event occur in 1 end aay M cl..... lhed .1\, primitive (~ont...a ination durlnv .url/ica1 operatlon) or seCOnddry (subsE.-quent to skin erosion). s•• t solution ·)f thltJ proble. 1s the paceaalter rt:'.oval and leada E'xtractlon; but oftE'ft p~rcutaneous withdrawal )f lhe lead 1s d1ff1cl41t or tiU~ ttt iaposslble. and .. url/ical a.lhodB (thoracotoay and cardlotoayl are .audatoc·(. In this pal*l we l-eport our .xper1allc~ in tu Iu field. Over t.he years 1981-1991 we perforaed 56S pa';~Dlah.t.Jl: iaplantdUons; dUl'iul/ follow lop w. ob...rv.d: yroup A) 19 ~kin erosions "oithout in faction (r.qull:...nr 'Ji11y pla"tic surl/.. ry). 4 of th•• (21') .vo1v.d to op.n i,)fecl1on, req\lil"iul/ leach. extracti",) (with dir.ct t'· ...c tl·Jn or countertraction in all ca.es), group B) 8 "k"u erosion. with local cont_in...Uou (requldn9 a new contro1at...al iaplant. wIth the old leada left in .itu). ~ of th.a (25') had septic. .ia. r.quirin9 the .~traction of o~d leads (in one case by cal"diotoay, in the other one by percutaneous "xtractiou of didodl/.d lead in ... renal v e in). fJroup C) 5 open infections llivolvinv l ....da. with or w1l.hout septiceaia (iu this caee.. we alway. try le.da .xtr...c t Lou) . We were able to .,xt. act tbe lead.. in 4/5 pt.; in the otb.. r OU8 ,,,, left ill ;J)..d';~ th-.:o lead f11f1.j cOWlected it with lht:" UttW controlateral geneL'ator by a I;ubcutanaous extenaion. ccuc Ius rcus . .... on'1 the 27 co!;t!s in which we try a cOJ1l.et"vettive approach (I/"onp 11 • B) there were 6 late epi.odes 01 illf"c I lou,; (22\): all ,·equir ..d new BUrl/led intervention•• with additl')lial costs aud discOJifort for the patients, our conclusions are t:.hdl. a more L-4di.~al dpproach 1~ Il.eded wheRever tb.re is t ne. suspicion of paceaaker and lead cont_ination; thl. approa"h con6ist of leads extraction (now, with counte.l:tral."t.i.ull aanoeuvreJi, we ach.J.ave this result.in aI.oat all cali.B) and new - 7'!. of all paceaaker iaplant.~Uon..

contl-olaterdl

i..~lallt.

--------------------------------------

ATRIAL NATRIUAET1C PEPTIDE ANDMAGNESIUM LEVB.S .. CHRONIC HEART FAILURE: PROGNOSTIC IMPORTANCE IN DEVELOPIIENT OF VENTRICULAR

jlRRHYntIIIA8. F.Ol GregorioMO. A. Uguori MO. N.OlIeso MO. LFurla Ph.D'. SA.CIafffl Ph.D', C. NIpoli MO, A.VarrIaIe MO. Olvislon at C8rdioIogy-<:CU. HospItal at Pellegrini, Naples lII1d 'Depar1menl at ExperimenlBl MedIcine, II UnMlrsity at Rome. Italy.

As cardiac peIfonn8nce declines in palienls with chronlc Mart failure (CHF), various 1I8UI0h0ml0I1B1 sysI8m8 are stimula1Bd In an all8mpt to mantaln cin:ulalllly homeoslasls. ThIs neurohormonalactivalIon becomes progessively more markedas lhe disease state advances lII1dmay acx:eUeral8 lhe deSerioration at left ventricular tuncIIon that occurs 0\'l!Itlime. P!evIous SlUdiIshaw ~ua1lId lhe relation ~ neurohormoneslII1d survIVal In CHF in man. These studies haw focused on lhe aclIY8lion at VlI8OCOlIlllrlctor sysl8ms. On olher hlIIld, olhers neuropeplides had a vasodIlalatory propertiellUdl as 8lriaJ natrlureIIc pepIIde (ANP) lII1dprosllIgIandIns (PGE. ancI prostIc)dn). MlIlJ'le8Un Is lhe lIlICClI1d mostabtnlart dvaIerC IonIn lhe body lII1d participates In lhe actiVation at vasopressin-eensi1Ive adenylate cyclase. H)pomagI_,ia Isaeeoclllecl will n:.- in bblCI pIeBn andellMllion In ~ V88CUar 188lslance. In cu pnMous ~ SlIdes we obIenIed lhellhe nllease at ANPbylhearla maybealllll8d ~ ~ ancI ~"'In I8Is. lhe IIl1pamlenl at~ ~ rangeCXlUld be i'MlMl1n lhe allenIlIonatANP secretoIy mechanlams. In this brlet study we haw evaluated lhe relation beIwe«I plasma AHP IeIIllls wtltlplasma magnesUn IeIIllls In CHF In tunlnI. 12 palIents __ in NYHA tundional class II and 10 In class III. ANP Ie\I9ls _e measured by a radIoInvruIoassy melhod. Dala. . 8lCpr8S88d. ~:t.SE.

nu.

NYHAI 1315:125

1.9;tD.3

2.5jD.2

33i2

NYHA. 185$'M'

1.5;tD.25' 1.6:tD.1S'

23J:3'

INCREASED THYROXINE (T4) TO TRIIODOTHYRONINE (T3) PERIPHERAL CONVERSION IN PATIENTS WITH IDIOPATHIC VENTRICULAR ARRHYTHMIAS ScrJio Berti. GiorJio Iervui, RilalloniDi, CatoIdo PIJmiaj. Stefano TIIId1i.ScipiollefllIIIiae, Giuseppe TriInni, Romano Diancbi, Andrea Biagini C.N.R. 0inicaI Pbysi%ly InSliMe , Piss Italy NucIcIr Medicine lllSlialle Uniwnity of Piss, llaly It is weIJ knowDdIIIlbyroid bormones Rplale die Illtl&bolism of§'pbenI tissueIlld diftaly iafl_ canIiac c:omnctiJity and excilability. Actually die R ' • baween Ibyraid bormones kinclics Illd cardiac disfunction OR DOl wen elucidated 10 11le perlphenl metabolism of Ibyraid hormones wu evaluated in II palienu(pis) wilb D«maIpIaSIIllIlic T4. n Illd 1'5H Ieve1s Illd with idiopaIbic: oomplex ventriculv urbytbmiu (1.owD dus > 4) (poup A) in compcisoD 10 U nwched normal subjects (8), 10 bypochyraid (C) IDd S byperlbyroidPIs (0) all withoul CIl'diac mbytbmias. AllPIS _ submitbld 10 • complete canIioIogicaI evaluation C
IIIlllIiIDriDl

Kjpetjc SJp4y: after 12SI_T41lld1311-n iv bolus injection. SeIlblldex G2S ~y wu used10 purify labeled n Illd T4.DisapptImICC curves of 12SI-T41lld 1311_n Illd Ibe appearance curve of ill vivo 12SI_T3 sener.ted from 12SI_T4 were c1ctermilled. MuI~taIl1la1YSis basedon • composed 6-pool model ~Juma. futlDd slowpools ~~Illd n) wu used10 compule kinetic parameltn. The I""' ~ Ibe maiD

t

I

::

3

1111111111

120 100 80

>- 8

~ ~

40 20

-

0+---r~~T'"~-r~~T'"~"":;

o

20 40 80 .0 T..13PERIPHERAl. OONVERSlON ""

100

Mean T4·n periphc:nI conversion wu in BJOUP A, D, C Illd 0 47"±19, 2B~, 46ti911ld 32.2..±8 respec1lvely (A vs B. CandO p< .001), wbile T4 daily production wu 71±26, 9B±IO, 16.3:1>4 and 47&±10 III (A VI D,C Illd 0 p< .OO\) III conclusion _ pIS witb Idiopatbic: lXlIlIpIex ven1ricuJar mbyuniu, show• poc:uIiar peripllenI thyroid melabolic beb.viour different from normals and thyreopatic subjects. 11 can be bypoceslzed Ibat Ibis abnorma1ity plays • tole in the palboaenesu of idiopdIic COGlplell veutricuIar mbytbmiu.

CHEST I 103 I 3 I MARCH, 1993 I Supplement

1878

MONDAY, JUNE 14 (Cllrdlomyopathy, An1Jythm/as, and PBcBmakers-contlnlHld) MAIlAGEl4ENT OF SINUS TACHYCARDIA WITH IMDIGEIlOUS HERBAL

SURFACE AVDtAGED P WAVE IN CORONARY IIEAIlT DISEASE

PREPAllATIOR

laJKERJI, P.K., PH.D. - Prof. & Head: Pf,UL, 11., 11.Sc. , PAL 11::, - Research Fellows, Psycho-diagnostic & Therapy Res ea rch Institute, Calcutta: 700 009.

HD

The

effectivity

of

a

herbal preparation ~ I lientat I (Hi.al aye Drug Co.l was studied in 33 cases of sinus tachycardia of 'unknoun orl~lnt. 018300818 ~as based on tachyc&rdla without any

'apparent stiaulua' paroxysas lasting froa \ to 3 hrs: ECC was nor.al and there was no heart disease ee carditis, thyrotoxicosis, infection etc. Pstients hsd beco.e reactively depressed, fsti::ued and phobic. Of the 33 study cases, 27 had snxiety-prone personality structure. Re.a1ning 6 were hypochondriac with definite body ha::e deluaions of deep-seated psychotic trend: these were not inducted 89 subjects of the pT'0,3ra••e. The foraer nroup(of 27) was divided into 3 subsroups of 9 cases in each, who received non-cardia-selective beta-blockers, '(lentat' and non-specific placebos re spect tvel y for 90 days. While B.P. was co.paratively stable in the sub-

3rouP who received plac.bos and beta-blockers reduced the du~ ration of palpitation, the frequency of the attacks was aark:>dly n.':ucedlF-test; p-O.Oll with 'l1cnt~t' than in the other two sub-groups. The results indicate that the Indian herbal dru~

tl~(!ntat'

•• y

be

quite effective 1n

the

lIana:.;elllcmt

of

ainus-tachycardia of anxiety-prone persons. The cospoe t c Lon of '(Ientat' and the possible .ode of action of its herbal ingredients are discussed in the paper.

DSII-III n, tto, Axis III of Aeerican Psychiatric Associstion was used in the study.

COMPARISON OF DETEIIMINIS11C LOGIC VERSUS ARTIFICIAL NEURAL NETWORKS INTHE DIAGNOSIS OF ATRIAL FlBRJUATJON Ten-F-.g Y-.g , BI1enDIMne • Peter W Macfarl8ne UnMnIty DepIr1mInl 01 M«Ik:aICanIology, GIMgowRoyaIInflrmaJy, GIMgow,ScodInd, U. K. 031 2ER

o....

ltililllc Iogit II cumnIIy ~ to rtP,oIIvn anIIyslsIn ~ ECG k.......IIltka' methodt dlMIoped In GIMgowRoyeIInfIrmaJy. 8ecauM artillciaI _ _ '*'-lcI . . not ruIe-bMed II'ld Qn be IIIlPIed In ., . , . where rules . . dIlfIcuIt to formllIIIe or . . ~ , !hili .. tbeomic:aIIy pertIcuIarIy subble for ~ to IIluII patlem r-.lIlIcn problems. The study was therefore dIIIgned to compIIN an artillciaI llIInI IlItWork(NN) venus determInIslIc Iogit for IIIJRIIng . . . ~ wIlh 8IItII JlNIlIlIbn bNlIIAPlIIl lIldIor IIIIltrlcular pnIIIIIIn ~ hom 8IItII ~ IIIIng the GIMgow Plogram. The GIMgow progrIIII b ECG ~ _ 3 leads SIlecDd hom the 12-lead ECG for...... IlIIIa, 01 e:-dIIc rtP,oIIvn. 11.- 3 leads. . choIen hom a study01 the . . . bella ~ hiM ' - ' caIcuIMm by the main Iogit. ~ on PR and RR k*MII reguIMIIjI. pNM>Ce or -...c. 01 cIIcrete P - . nUIIple P _ II'ld 10 on . . ~ In the pNM>Ce 01 AF, It IlIko1y lhII fIdIby _ IIIIIlI for the JlUIPC*S 01 rtP,oIIvn anaIj/IIs be cIetec:ted .. P WlM!S II'ld hmcc the concepls 01nUIIpIe P _ and PR J'lIlIUIarIty etc IlIII apply. 716 ECGI_ -.a.d for a traInklg Nt. 523 had AF and 193 had SR + (APlk lIldIor VP8II. 11.- ECGI, wIlh iIjljliOjA IIIIIt clasIlflcatIon, _ fed to a variety 01 NN c:cntalnng a dIffcNnt runber 01 qu -w.Ies II'ld ...nou. runbers 01 neurons In the hIdcIIn II!Im but .. wIIh a *ge output neuron. The training ~ was periormed through the bec:k-pOP.tIOil mechaniIm.After Ihaty NNI werecompletely tnnd, a III c:cntalnng 717~, wIlh 523 AF II'ld 194 SR + (APBs lIldIor VP8II. _ then 1lUdIed. The NN wIlh the bat periorrnance _ fo II'ld 92.3'lfI respedIuIly. In concIuIlon, the appIIcalIon 01 NN did lad to a 3.5% mprowmenl in the -.IlIvIIy 01 the dIagnosII 01AF compared to the . . 01 dellmnInIstIc Iogit, which each appoech had the _ high speclfIdly.

...-n

"'**!lIIt

188$

M. YlIJOIIi, G. l-.cci, M. GIonitIIto. F. M. Di PIIOIo. R. CkIfdo, ll. ~ G.lJacitIreIlo. Arr#ryIMIia COfIIr'OllhUt, La SIP- f.JnI-.Ity, &.e. Italy. Pa~ . . fIlriIIItioa (AF) iI . . . ~ 1MIIywItIydllllia IiIbd to cenInI . . . . . III onIer to idIIItifY pIIieID (pia) pnIIIIl to AF,IIWIIty

64MIIId 14F,~SD . . SIJ.7+9.7,..., wiIIl-r ~ iIMItiI*d by - - . . ECG, to - * iIto . . - r:I ~. (LAP), ....... r:I AF. A-.d P _ _ - - . .. tile ~ o-3OOHz (_ &end P, NFP), IIId IOO-3OOHz (&end P, W). PIDaII _ divided ill 2 puapa: . . , A, 41 pea . . . AF, ... . . , B, 30 pea willi AF, do' • « by .-danI ECOs ell' HaIIII' . . . . . Ita. COI8ol paap (C), 30 _ _ IlIbjecla _ ...... ~ of _ _ FP IIId NFP _ cIl6IIcI LAP. ReMIs I) _ FP iI IatIIer ill . . , B (135.6+17.1 _ w 121.7+11.2 1M ill paap A IIId w 116.1+9.0 1M .. paap C, ~.OOOI); 2) _ NFPcIInIimlila difIlnIIt ill tile tine FJlIIlI; 3) ~ r:lLAP i I _ evida ill.., B (13.3% w 11.7% .. paap A'" 3.3% .. . . , C, ~.OOI); 4) _ r:I FP iI a 's ".17 di&r.- . . . FJlIII' bat tile _ r:l1aIt20 _ .. ..tAP pea IIId _ _ IlIbjecla iI oipifI W!y di&r.- ........... r:I LAP (1.9+I.2uV'" 1.9+l.1aV w U+O.71aV~.OI). LAP _ to be • pclIIiIIIe r:lpeawilla am .... to AF. ~, • -.jar pool r:I pea iI to ClOIIIlna oar.."" . y dID. .... pis,

~ (CHD) IIId . . dIyda, ~ " -

"1IIe"

-=

1JIIk.,..

THE PREVENTIVE EFFECT OF ALLOPURINOL ON REPEIlFUSIOIl AlUlYTHMIAS AFTER TROMBOLITIC THERAPY IN MIYOCARDIAL INFARCTION ARSLAN, N., OZKAN, M., EROOL,

c,,

DEHt~,

D.

It has been proposed that the free radicals play an ilmportant role, in the development of reperfuaion arrythmiaa after trombolitic therapy in patienta with acute myocardial infarction. The most important ori~in of free radical a in the peatiachemic tiasue ia Xanthine oxidaae enzyme (XOE). In this stUdy, we have conducted a investigation on the preventive role of Allepurinol which is an XOB inhibitor. Upon the reperfusion arrythmias after post ischemic reperfuaion. 40 patients who applied to the hospital sufferin~ from cheat pain (within first 4 hours) were atudied. 33 of them were . .le and 1 fe. .le. Mean age. 46. Me used atreptokinase 1 500 000 1.u. as a thrombolitic agent. We infused thia a~ent within 45 minutea or in a ahorter ti.. , intravenously. we divid.d the patients into two ca~~ (A. Allopurinol ~roup. 20 patiects, B. Control ~roup. 20pat~1 Allopurinol 300 mg. daily waa 9iven to Group A, but not to Group B, durin~ the firat 10 days. Both ~roup have been investi~ated for ventricular ectopic beat (VEB), double-VEBa, mu1tifocal-VEBa, ventricular techicardia (VT) and ventricular fibrillation (VF) for 10 daya. Results are: Type of Arrytluaiaa

YEB Double VEB's Multiforal VEB's VT VF

Croup A n,20 ~ 19

13

4 3

Group B n:20

----rr3 5

P

<0,05

<0,001 <0,01 <0,01 <0,01

Aa a conclusion, we can aay, Allopurinol has lowered r.perfuaion arrythmiaa after thrombolitic therapy in miyocardia: infarcted patients, compared with the controls.

MONDAY, JUNE 14 Therapeutic Interventions In Critical Care Afternoon

EXOGENOUS PULMONARY Sl'RFACTANT NEBULIZATION (EPSN) IN ADULT PATIENTS

J.L. do Campo; A.To"","",lIo; O.Van:Ia; E.G.Denl'llOOll;G.Mcnga; A.Hager; T.De Paob. Hospita Prindo de Comunidad MlU'del Plata .Faculty of Biochemi.. ry. Unive ....ily of Bue"""

Alres.Argentina. Retents sludies showed good results with tbe use of pu!morlIIJy surfllCl"'" (PSI in the treatment of ""tienls with ARDS. The surfllClant lOlImini.. rotion dcserihed is the bronchilll insliiallon.The object of lhe present study is e.a1uate ibe EPSN a.sa po!"nebulizalion wllh lhe Pul""ing ,Bubble Surfactometer, The gammagr.ophics study was done with a Piken Dyna cammera 4 and tbe PS wa.s labeled wilh (9901 Tcj.Tbe popolation were I>lOlIulls .0IUlllee" on ..anding po!"erior and in 3 ""Iienls oblique .The anterior counts were used for lhe venex ".ba.",s lIIlaIysis. The re!lUlts

are expresed in percentageof 101611 counl!lio per area. Results: Antherior Yertex

Righllung 54.33'.. 3X'l 1>2'* 49.1>2'*

Left Lung

Upper Lung

lower lung

45.1>7'l 37'k 1>3'.. 5O.3X'k

Base Postenor RighI Oblique 49.1>3 'iI 50.37'* Left Oblique 51.93'it 4K.07'l The surface lension was nol modified after nebubzalion with nlues around 0 dynlcm2 after 10 minules of pulsalmg bubble surfaclomeler control of each sample. Condusi..,s : I tThe EPSN does nol change lhe surface acll.ily of the PS. 2)There was a good distnbulion in tbe Iwo IWlgs . wllhout sigmlflCant differences berwen upper and lower area, 3tThe upright posiuon mOuenced rbe difference count in vertex vs. ba.",s .4) Future clinical slud,es will demonslrale if tbe EPSN mIght replace tbe bronchial inslillation in lOlIult patienls.

EXOGENOUS PULMONARY SURFACTANT NEBULIZATION (EPSN) AFTER CAR· DlAC SURGERY (CSI WITH CARDIOPULMONARY BYPASS (CPBP). J.L.do Campo : E.G.Denranou : D.BigaUi ; M.Arera ; R.Battelbm ; R.Beeeno. ; A.llager ; T.De P-aob; J.IhJoliospilal Pnvado de Comunidad Mar del Plala.Facully of Pbannacy and Biochemistry. Universily of Buenos Aires.Argentina. The pulmonary surfac1anl defICit after CS wuh CPSI' has been previously descnbed ( Am.Rev. Respir.Dis.l41 :512.1990). The pulmonary changes afler CS wtlh CpBp are similar to ARDS in tbe initial slages.(abnonnal.a1ues of Pa 021 pA 02 tatio:rhe CXR show low lung volume, aleletas;"s and BAL has pulmonary surfac1anl deflCitl.( Am.Re v . Respir. Dis.141: 142.19901. Recent sludies showed good results with surfactanl mSlillalion 10 ARDS ""Iients .The object of Ihis sludy is 10e.a1""le tbe pullllOflllJ'Y fWIClionafter EPSN in the inmedially pus! Op of CS wilhCpBp. .Malerial and Melhods :R patients lage bb±6; IWO men) 4 cOlOlllU'y re.ascula.ri""ion and 4 .a1ve replacement . were treated with EPSN in the'inmediotly pee Op. allhe ICU.AII of lhem were under mechanical.enlllation.The surfllClanl u....d was p'g surfaclllfll INatswf) from Cbemotecnica Slntyal SAThe nebulize....were Raindrop Medicallon Nebulizer from Puritan Bennelt .The Pa 02IPA02 was controled m the inme,bally pus! Op. and two h.•. after EPSN.The ""Iients were di.ided into two ~roups Wlthoul conSIdering thell pre.ious record. One group received 10 m~~ of EPSN and the other 30 mg/kg.The Pa 021 pA 02 11I110prior and p<>" EPSN were compared using paired t lesl and two sample t tes! for Pa 021 pA 02 rauo improve.ment..The exclusion criteria was pulmmary capilaty pIe"sure,. IX mmHg. Re-.uh...

PO.nicnl' PO'"Op 10 mgt Kg P-J02/PA02

4

poe EPSN P-a02/PA02

posI Up P-J02/PA02

pos' EPSN P-a02/PA02

O.3~

0.40

0.45

0.72

O~K

0.1lO

0.52

O.b4 O.W

0.27

0..' .'

0.K3 0.55 0.1>1

poured t test (l"O.OOOl AVGlmpnlVc of P-a021PA02 O.07±O.\XlK Two sample I Ie'"

0.26 4 O..W paired I lest p=O.OOO3 AVG Improve of Pa02IPA02 ~J.02 0.25tO.033

Conclus,ons: I .In The IWO ~roups the P-J021PA02 Impro.ed afler the EPSN bu. the ma",itud of P-a021PA02 impro.emenl was higer in lhe group wilh 30 m~~. 3) Con"denn~ the CS with CpBP as a model of acule lun~ injUry simdar 10 ARDS fUlure randomIZed studies are Itedeed 10 define the ulility of EPSN in CS with CpBP and ARDS """enls .

CHEST I 103 1 3 1 MARCH. 1993 I Supplement

1895

MONDAY, JUNE 14 (Therapeutic Interventions In Crltlcsl Care-contlnued) Plotr.rA••I ......IBDUCBD ACO'1'8 LUBG IIIJURY AIID 'l'B8

PR~IVB

BFFECT OF AGBIft'S '!'BAT IIICRBASB cAIIP

I ...g B.u lID; oavid ....g ... ; Chien-Y.h Shen lID, FCCP; and Chi-Bu.i Chiang lID, FCCP.

PuI.oaery Division, ~i-llervice GeIl.r.l BOIlpital, ...tional oafen•• lledical cent.r, t'aipei, or.iw.n, R.O.C.

Polycation., .uch •• protaeine .ulf.te .nd polyly.ine h.v. been ieplicated in the cau.e of .cute lung injury. lie .tadied the v••culer effect of protaain. .ulf.te and th. protective effect of .gent. that incr e cl\llP in bol.ted r.t lung. perfu.ated with • cell-...d pl -free .olution. Protaein• •ulfate (3 eg) Dllrtedly incr_.ed pul80Dary .rt.ry pr_.ure (PAP) fr_ lS.6tO.S to 30.8tl.2 _ g (P< 0.01), ...d lung weight gain (LlIG) waa .1.0 incr...ed .ignificantly within 30 ain (P<0.001). Pr.tr_t8ent with dibutyryl .dano_ine 3', S'-eyclic 8ODophoaphate (OBcMP), aainopbylline .nd pentoxifylline prevented the incr.... in PAP ...d LlIG. orbe _ a n i•• of th. protective effect . .y involve ... incr. . . . in cAIIP, becauae OBcMP, aainophylline .nd pentoxipbylline which incre••e cAIIP by different eecbani_ .11 had .ieil.r effect.. Aa th.r. i. no blood in the perfua.te, the eechani•• of cAIIP on cellar ca.ponenta .ueb •• neutrophil., can be ruled out .pontaneou.ly. orbe .ndotheli.l cell. are eore litely be the target celb, beeaua. charge inter.ction i. believed to occur there. orbi. r ••ult will be very ieportant in th. .lucidation of the protective effect of cAlIP on acute lunq injury.

NlACIN INHIBITS ACUTE LUNG INJURY INDUCED BY' LIPOPOLYSACCHARIDE IN THE HAMSTER. At&ushi NAGAI M.D.• Eriko SAKAMOTO M.D•• Shuji VASUI M.D..

.Ta"ao TAllZAI" II. D.• Ki.io KONNO iI. D. fro. First Departaent of Medicine. Tok10 loaena' Medical Col ege, tSaiseikai Kurihashi Hospital

lipopohsaccharide (LPS) is .ideh used for aniaal aodels of adult

respiratory distress s s nd r oee . Ie adainistered 0.01 _. of LPS (Eacbericbia coli) per 100g body weh:ht transtracbealb into the lunes of ba.sters.

Hiacin

tzso

or SOO.g/ke bod} weichtl

ees

injected

intrap.riton.ally Z4 h before. 30 ain before and I h after the LPS ad.inistration. lPS treataent increased wet/dry lunc

weicht. albu.in

content and neutrophi I counts in bronchoaheolar lavale fluid. In h••sters treated .ith niacin.

wet/dry lung weicht. albu.in content and

intraalveolar cell counts were noraal. dinucleotide (NADI

in

Nicotina.ide adenine

lune tissue was significantly decreased in

h••sters treated wi th lPS alone. but was increased in hit.sters treated with LPS and niacin. Histopathological exaaination re\'ealed that the lungs of niacin-treated h••slers appeared noreal. in conlrllst to the lungs of lPS-

RAPID RKCOVBRY

or

DOZORUBICI.-IKDUCBD

CARDIAC

_ l U l l , RllI08l ABO ADBBIR I. llOLllTlD PlllFUalD

rAILOR& BY IIA~

JIDJl'!

Zhong T. Tan, M.D., Ph.D., Deborah Research Institute, Browns Mills, NJ OSOlS, USA Pur,po •• :

To

establish

cardiac failure.

new therapy

Me~hod.:

for

doxorubicin

induced

Isolated perfused working rat heart.

(30 _le lIistar rats, 2S0-300 g) were perfu.ed by Kreb.Henseilet buffer, with doxo[Ubicin (6 mq/L) for 30 mins, followed by the addition of maggesium chlorida (2 mM), ~ (1 mM) and ~ (1 mM) for IS mins . . . . .ult. are:

COlal/aipl Anl_/., CrIll'''.> rCPIllPiI S9.5t6.2 27.St3.1 36.7t4.S 2.S7tO.OS Dox 20.St2.2 9.ltl.2 l3.3t2.S 0.33tO.03 Dox+aib+Ad.D 19.5t2.l' S.6tl.9' 12.6t2.9' 0.29tO.03' Dox+N9 26.7t2.S* 10.3tl.4' 20.4t2.1* 0.65tO.04* Dol!+llp+lU!+Meg 46.0t2.S" l4.6t2.0* 23.lt2.7" l.l4tO.Oi" n-6, MeantSI. t-test. **: PsO.OOS; *: psO.OS, .: P>O.OS compared to Group Dox.

9rolIR

CoD~rol

Dox: Doxorubicin. Mg: Magnesium. Rib: &.U!2U. Aden: &aD..\.u. CO: Cardiac output, ml/min. ATP: Myocardial ATP, nM/1KJ dry lit. CP: Myocardial creatine phosphate, nM/mq dry lit. [CPJ/[Pi]: [CP]/[Inorganic phosphate]. CoDcl ...loD: doxorubicin decreasad myocardial function (CO), mitochondrial function ([CP]/[PiJ) and myocardial ATP. Ribo.e and

adenine

had

no

inotropic

effect

on

doxorubicin-induced

cardiac failure. MAgnesium had slight inotropic effect, while combined with ATP precursors (ribose + odenine), significantly enhanced the recovery of mitochondrial function, myocardial ATP and function.

THB DIIlBCT BFFECT OF KETAIIINE ON ISOLATBD NOIlBPINEPBIlINBPIlECONTRACTBD RABBIT PULIIONAIlY AIlTEIlIES T.S. IAe, II.D., FCCP, Y. Xla, II.D., X. Hou, II.D., Harbor-UCLA IIedIoeI Canter, TOrNDoe. CA It bas _ ~ded to .voId ~ , • ~ uaed Intra_ _tbatlc apnt, In pw-ry hypertualon ~ oflte hypot!latbl tadaDcy to 1DcNue pw-ry 9UCUIsr ThIa.tudy _ dasICl>ed to In...tIpta tba direct effect of ketesdDe on IeoIated rabbit puImoDarY U'teI'Iee wblch _re preooatracted with DOreplnephriDe (NE). Sbt N_ ZeaIsDd wtdta rabblta, weJcbInc 2-2.5 Ira, -.. uaed tor tba ezpert.snt. The rabbits _ _thetbed with sodfuII JlIIIltobsrbt1a1 (40 ac/q). A sapeDt of aID JlIl'-'7 artery juet prior to tba bIfInoeatiall _ - - S ~tely followla& reeplKtory ....... th!ou&h 1IId..~ . Precautlon _ _ to.vc4dcla8epoftbalnu-l.....r.oe. The ...... _ r.- f.- tba ooDDeCtlve tIsaue and out Into rInp ( _ wIda). The rInp of PA ...... ~reed In • 10 11II tissue bath oontalDlD&• OOIltlnuouely ozypDated tMIIna. W..-dude tbat ketudDe, • powerful bl'OllchocllJetor, fa aIeo • stroDC dilator for ~ arlen- and that Ia endotbaUwD 1Ddependent. l(.tomiM Indycede Reioxatiort 0fI N£ ( .ltnM )

resIe_.

Prec:ontrocted Pwlmonory

treated haasters which wen' infiltrated with jnfla_atory cells and had

Art~

interstitial edeaatous changes. Ie condudE" that niacin :>lrongly inhibits lPS·irlduced acute lung injury. proLabi): b:.'

prE"\'f'ntin~

the depletion of

NAP.

lleterenaes : I. AneetheetloJocy 1985, 62:287-293. 2. Crlt. CAre Mad. 1989, 17:780-785.

1908

....

"1

CU-C'MM}

U

t

)

I;~

MONDAY, JUNE 14 COMPAIlISON OF DIRECT EFFECTS OF DIAZOXIDE AND NITROPRUSSIDE ON ISOLATED RABBIT MYOCARDIUM T.S. Lee, 11.0., FCCP, Y. Xla, 11.0., X. Hou, 11.0.; ~ t or ADeathealo1ocY, Harbor-UCLA IIedlaU Center, To......ee , CA 9050lI DIazoxide (DZX) Is an effectlve and relatively ~t1DC parentereIIy admIDIatered artel"loJar cWatol' that Is uud to tl'eat hype1'teDalve _l'pDcIea. Whl1ell1tl'Opl'Usaide (NP), anothal' cI1l'ectvuocWatOl', hu been shown to eause no JllYOCIll'dIaldepl'MSlon. tha cI1l'ect eft'ect or DZX on IIIyOCIIl'dlel oontractlIity hu DOt been cba1'8ctel'laed. The study CClIIlpal'8d tha cI1l'ect IIIyOCIIl'dlel effects or thaae two vuocWatOl'S In rabbits. Seven de_ted IIIyOCIIl'dlel septa or N_ Zeeland rabbits _ ... uud. The ftl'at septal p8l'foratol' of tha Wt OOI'OIl8l'Y 8l'tel'y _ eannulated and pel'fueed with ozypneted ItI'eb-1linpl' bieal'bonate buff... eoIution (UB). Tbe septum _ suapended from a tenaion tl'aIladu""l' with adJuated ....t1DC tanaion or 3-5 PI and as-volt eIectrIeal stlllluJation _ liven at 1.5 Hs. Aftel' stabiIIaetion, pel'tuaion with NP and DZX....... liven e1te1'1latalyat 1 ml/Pl/1IIIn with OODoeDtl'Stiona dUuted In UB or 0.1. 1. 10, 100 and 200 -e/ml. Each doaap _liven fol' 10 IIIInwith ozypneted KRB liven In b e _ as tha contl'Ol. The peak deveIopecl tenaion (PDT) and maximal acceleration (dT/dt) _ ... -.U1'8d as' or oontl'o1~. Data ....... exp1'8SS8d as _ t SEll. Stat1atieaI anaIyaIa _ pel'fo1'm8d uaIncStudent's t-teat. A P veIue <0.05 _ conaideNd aipIfIoant. The ....uIts .... s ~ below:

- -- -- --

100 t-.n;g;,· "- 7S PDT

SO

2S

C 0.1

I

HVPERBARIC OXYGEN THERAPV IN PARENCHYMAL LIVER DISEASE Dr. N.Bhattacharya NO fCCP. Dr. P.J.Ku•• r NO. Dr. T.K.Sahnl NO DNN. INHS Asvln!. Colab•• BoebaY-400 00&, INDIA. Hyperbaric

Oxycen

institute

for

the

.oooplace chaaber chaaber was also

Therapy

lasl

(H80)

over

has

twenty

been

In

Years.

use

In our

InItIallY

sickness Is well known and over the years H80 has been used In

the .anace.ent of dIabetic &ancren8. lschaealc Ii.ba. chronic ost80.ye11115 and various non-heallnc ulcers. We have used In cerebral oedeaa of closed head injury and In carbon aonoxide poisoning. We trIed a.perleally H80 In a few cases of fuI.lnant hepatic failure and end steee liver disease and the ~Qsyl~~

~~iC

~~ry

~rafltYlng.

There is paucity of literature recardinc the use and efficacy of HSO In liver diseases. A control tr ial was therefore undertaken to ascertain the effect of H80 in parenchyaal liver disease. Sixty cases of viral hepatitis were selected (or this prospective study. Thirty cases were treated with H80 while reaaininc croup o( thirty patients received onlY conventional therapy (control). All patients were .ale and patients wi th ee r ua bilirubin over IO.c/dl were included in this study. AI.ost equal nu.ber o( cases with australia antlcen positive serua were included in both the croups. It was observed that the study croup with H50 therapy recovered faster. They had an earlier sense o( well-beine. eained appetite (aster and pruritus disappeared earlIer. They achieved faster noraal liver functions and also nee_tive australia antlcenaeala. They had overall shorter hoapital stay and convalescence. Adverse effects of HSO were unreaarkable.

10 100 200

DIAZOXIDE (,ug/ml)

Out' study ...vealed that DZX _ • aipIfIoant doae-1'8leted depl'8Uant effect on IIIyOCIIl'dlel oont....,UUty. CoIIIpal'ecI with NP "bich hu DO effect on tha 1D)'OCIIl'CIium. its use In petients with IIIyOCIIl'dlellnautftciency should be avolded.

REFEIlENCE I. Cbeet 98(2) :838. 1880

ASSESSMENT OF RESPIRATORY MECHANICS IN DOGS WITH IDSTAMINE-INDUCED LUNO INJURY

EHllOI.ISATION Of PULMONARY ARTERIOVENOUS MALFatMATiONS Tj. Hait,ietla , C.J.J. lIestenunn, T.Th.C. Overtooa St. Antonius Hospital, Ni_gein, lletherlands

Xi-Qlng Sun, :xu..-Yu Wu, Ll-Fan Zhang. Laboratory of Applled

A total of 14 patients (12 WOEn and 2 .n) with pul..nary arteriovenous .. lfonutions {PAYMl. thirteen of whoa had hereditary hellOrrhagic telangiectasia, were treated with coil eabolotherapy. The coaplaints were dyspnea in 8 patients, cyanosis in I patient, stroke in 2 patients. and .tastatic abcesses in 1 patient; 4 patients had no coaplaints. In these patients a total nuaber of 46 pAYMs .ere eabolized. which reduced the .an right to left shunt fraction f~ 1M to M. In 5 patients the shunt after eabolisation was ..re then 10%, which was caused by ..ltiple PAYMs too s..ll to eaboli se. The total nUBber of procedures was 19; there were ainor coaplications in 7 of these procedures. These coapllcations consisted of transient thoracic pain in 4 patients, fever in 1 patient, cardiac arythaia in I patient, and hyperventilation induced seizure in I patient. Recanalisation of an eabolized vessel was seen in 2 patients. 28 and 30 ..nths after the initial procedure. These recurrences were succesfully treated with a second eIIbolization. The .dian period of follow-up was 25 ..nths.

and Syetema Physiology. Fourth Military MecI1cal Unlvenlty.

Xi'an, China In the cou.... of bl'Onchial challenle.bl'Onchopulmonary reBPODIIe

• rnent requIre. pleural ~ zneaauroement. Rowevel', the meuurernent Is dlfncuIt to perform In anesthetbed paralyMd ventUated animala In ol'der to oIKaln _dy pulmonary JIlU1UIl8tera.

The aim of thla study.... to demonstrate that the pulmonary respoDlle to histamine can be correctly appreciated fl'Om the respiratory respoDlle. In ten aneathetlzed paraIy8ed mechanically ventllated dogs. pulmonary and respIratory ayatem compliancee(c.. and Crs) were measured totrether with pulmonary and .-plratory 8)l8tem condUctanc.(OL and Ora).

umnc

curve fittlnc method.

Pulmonary and respiratory mechanics were compared In

the baaaI etate' and at the end of a 30 min histamine lnfuelon(5 .. I . k,-a . min-a). The results showed that histamIne lnfuelon produced a

marked d _ In c... era. 0 ... Ora. PaO•• and a marked Increaaed In Paoo•• Q./Q.... HIcbly elcnlficant correlations were found between c.. and

era

on the one hand (r=O.95.

P< 0.001).

and

between OL and On on the other (1'=0.95, P
P!'Ovldee a

a

was In use while In 1980 8 aultlplace Co•• lls1oned. Use of H80 in deco.presslon

elmple and accurate

_ e n t of the pulmonary response.

CHEST I 103 I 3 I MARCH, 1993 I Supplement

1918

MONDAY, JUNE 14 (Therapeutic Interventions In Critlca' Care-contlnued) EFFECTS OF 8LOOO LOADING ON LEFTVEHnlCULAR DIASTOlIC FUNCTION

IN CHROMe UREMICS WITH ARTERlO-VENOUS FISTULA A LiguOri MD. F Di GregoriO MD. G Bruzzese MD. APiano MD. F Punzo MD. C Napoli MD. E 5antamato'PhD. SA CiaIre-PhD. V Boaa MD. P Sorice-M[) and A. VlImIIeMD DMsionsa l"~ I anl ~ , Ho!IpilIII a PeIe!JrI, NllpllIs. "Q:ll

a~ ~FacUly~~~aNllPeS'lnI""Q:ll d~Mecici'le. Schoola Mecicine. 1Il.JrMr3ily

a Rome. IIIlIy

Previous studies in anesthetized dosed-chest dogs have shown that blood loading activates mechanisms that mantain cardiac output (heart rate decrease, total systemic reSistance increase and end-systolic volume increase) (JACC 1992; 19 Suppl A:388A.) We previOusly have demonstrated that a diastolIC dysfunCllOn occurred m hemodlalyZed patients (HD) and that this phenOmenOn was earlier ,n hypertensive than normotensive HD Thus, In the present study we investigate whether temporary occlusion (1 minute) of arteria-venous fistula (cAVF) In normotensive HD produces effects on left ventncular diastolic tuncnon (LVDF) After AVF occlusion we studied patients with opan AVF (oAVF) 20 normotensive HD _e studied, aged 545±15 years, 13 males and 7 females, ASP 121 ± 10 mmHg. ADP80 ±8mmHg. HR 788± 10.1 bpm). Patients underwent to Chronic hemodialytic treatment. three times a week. from 94.6.± 48.1 months. All patients _e examined 24 hours after dialysiS by an M-mode and twa-dimenSional echo-doppIer. For assessment of LVDF measurements of mitral inflow velOCIties were made. the pulsed doppler sample volume being poSitiOned at the Ievef of the mitral anulus from an apiCal 4-chamber view. The peak velocities of early dtastollc filling (PEDFVICmJsec) and atrial diastolic filling (PADFVICmJsec) were thus obtained Cardiac output (Ihnin) was calculated from the aortic veIocity-time integral obtained with pulsed doppler. the aortiC dtameter measured from 2-D echo and heart rate.The results were expressed as mean± SE. ·p
-EEDBl

o 61±0 20

070±021·

•pEPBUPApFy 080±031 76±O27 o 78±0.25 0.90±025·

..fADEY

o

Cardiac OI4IJUt

A NEW, SAFE PENETRATION OF BODY CAVITIES OR SPACES FOR DIAGNOSIS AND THERAPY P. C1a111a, HoD•• FACS John DaTral11a, H.D_, FACS ~.Dn.th

D. Gran1ero. M.D.

Willi•• Marx, M.D., fACS St. Elizabeth Hospital, Utica, New York

13501

The .olld, laterally pointing corkscrew ha. had seyerat modifications for medical and surgical uses. However, we ha.e

deyeloped a hollow, corkscrew needle which takes ad.antaae of

the .afety features of the laterally directed point and the slow, controlled penetration. These characteristics ayoid po.sible injury to internat organs during entrance of the peritoneua, pleura, peric$rdiua or abnoraal cayities 1n diagnosis or therapy.

Entrance into the cayity i. i ••edistely signaled by the descent of the piston of the saline-filled syrinae which is under slight pressure (induction of pneuaoperitoneua), or withdrawal of air or fluid in a aaline-filled syr1nle, under slight negatiye pressure (pleura, pericardium, abnor.al space, etc.). Once within the space, no penetration of the point can occur unle•• there is clockwise rotation, due to the lateral pointing tip. In one _odification, after entrance of the corkscrew saaaent, the a.ooth shaft can be inserted with aD anti-clockwise rotation which guarantees that no penetration or trau_a can occur with any contact with a Yiacus. We de.onstrate with slides and/or Yideo and photographs the technique and results in animals and human beings •

37±08 4.5±0. 5·

Although blood loading in HD patients Increases PEDFV but not PADFV. Thus blood loading in man produces similar Changes in PEDFV that similar expenmental procedure In dogs. Cardlllc output increased Of 22% after oAVF. In addition. analysiS of values obtained after correction with fistula blood flow clearly demonstrated a close correlation with PEDFV increase (r=O.72).

CONCLUSIONS: Blood loading induces an increment 01 PEDFV but not ?ADF In hemodialyzed patients with arteria-venous fistula.

EFFECTS OF SHORT-TERM FELODlPINE THERAPY ON LEFT VEN7RICULAR DlASTOUC DYSFUNCTION IN MODERATE HYPERTENSIVE CHRONIC UREMIC PATIENTS A. LiguorI MD. F. Di GreaoriO MO. C. Napoli MD. P Sorice· MD. SA. Clafr,oPh.D, N. Di leao MO. R ColasanTi as and A.Varriale MD. DiviSions 01 Cardiology-eCU and ·Nephrology, Hospital of Pellegrini, Naples and °Dpt 01 Experimental'Medicina, II University of Rome. Italy. In our previous studies we have demonstrated that an early alteratiOn of left ventricular diastolIC function (LVDF) occurred in hypertenSive hernodialyZed (HD) patients. Feiodipine is a ' - dihydropyridine calcium antagonist higher vascular selective than n1fedlplne. Thus. the aim of this study was to investigate about LVDF in moderate hypertensive HD before and alter felodipine treatment Of four _ k (5-10 mgJday). 8 HD patients _re studied (6 males and 2 females. aged 58±12 years). HD patients underwent to chronic hemodialytic treatment. lhree times a week. from 74.5 ± 35.7 months. All patients were examined 24 hours after dialysis by an M·rnode and two-dimensional. echodoppler. P8tients did not receive other c.rdlOvascular drugs dunng the time 01 the study The left ventricular end-diastolic diameter (LVEDD) was measured from a left parasternal echo view. For assessment of LVDF measurements of mitral ,nnow veloCIties were made. the pulsed doppler sample volume being positioned at the level of the mitral anulus from an apical 4-cltamber view. The peak velocities of early diastolic filling (PEDFV) and atrial diastolic filling (PADFV) _e thus obtained. The protocol Study was approved by The Local Ethical Committee. The results were expressed as mean± SE·pc 0.01 vs Beforetreatment 8fdtxe-trMtmAnt Aftftr·UMtment lVEDD (mm) 515± 62 503± 4.9 Shortening Fraction (%) 40 9± 37 41.5± 73 PEDFV (em/sec) 612± 117 805± 109· PADFV(em /sec) 857± 154 578± 112· PEDFVIPADFV ratio O.h 029 14± 07· Mean Arterial Pressure (mmHg) 135 ± 15 105 ± 12· Heart Rate (bpm) 80.5± 15 81.5± 18 PEDFV decreased signdlcan~y In hypertenslve-HD but have higher values of PADFV than we previously reported for normotensive HD (p
1925

PROTOCOLFOR USE FOR THE PASSY-MUIR TRACHEOSTOMY AND VEN11LATOR SPEAKING VALVES MIa MII9O. M.S., CCC.sLP, Voidn,!, Inc., Newpon Bacb, CA. USA Therapy MIaaIement IDllOYII_. Wortlli"""". 011. USA R.C •• Pasy-Muir.Inc.• Irvl.... CA. USA

fI1...BlImI:x,

A lested protocolfor useof the P..sy-Muir tracheostomy and ventilator speakin,valves will be plUenled. These valves are the only one way speech valves willi a positive closure desian and fDA re,i_ for in-line venlilM« uSlle. Upper_ y paIeIICy .....sment and pulmonary compliance issues for successful ttansitionina and problem solvina to valve USlle will be addresoed. VentilM« weanlna .....-Jon .... tracheoltOmy decannulalion ..slstance i...... will be preseIIled. This proIDCOl has been reviewed with a series of patients with a variety of disabllilies In acule care. rehabllilalion. ionaterm care.and homecaresellin,s. include: spinalcord Injwy. traumalic brain lIVwY. pro,ressive neurologieal diseases. birth and developmental injuries in the pedlalrlc popuillion. post suraery patients with cardiac. and neuroloaleal complications. and chronicpulmonary dlsonle",. 011I presented will include oly,enalion results. patienl case studies and video fluoroscopic fondlnas. Prococol for appropriale candidale assessmeIWS will be provided. Rehabilitative cains in oxy,enation. swaUowina. secretion manIIement cXpectOraion, hy,iene and appelile improvemelll will be addressed. Rehabililllive pins with use for decannulalion will be preseIIled .. !hey relale fD physlololical. psychololieal and ..sessments methods. Restorllion of exhalation can allow confidence in airwaypatency for both physician and patient. Reorienlllionto upper airway uSlle for elpectOrllion. swallowina. airflow sensitivity. vocal cord stimulus. airwaypressures and speech canbe established for decannulalion intervention. VentilM« weanina auamelllllionwill be explained in IermJ of intervention for wort of brealhina traininl. reorientalion to upperairwayusase. functiona1expectoralion. productive ......... fatillle ievels. and speech. Compensations for ventilator .....e and palient transitionln& in volume. rile. PEEP requirements. alarmadjustments and airwaypllency arediscussed. Trouble shooling for successful usage will include ..sessment tools and spproprille monitoring techniques. The second ponion of this presenlation will be a discussion and listing of the transdiscipllnary tracheostomy and venlilatordependent team members and their idelllified roles. ThePassy-Muir tracheostomy and ventilllor spealtina valves canprovide medical professionals with a new method to transition and affect the quality of life for theever increasinl populanon of Iracheostomized and ventilator dependent palients.

MONDAY, JUNE 14 lJRtIl ASSlllPTHJj FRl»4 11£ EPIWlAl SPACE IN ANIMAl. IOlEL WITH ()(X;S Judit Hallay, Z. Galajda x• J. esongor xx, Irm Mikd, I. Furka xxx

2nd Dept. of Surgery and Central R",?"arch laboratory and Dept. of Experi".,ntal Surgery Oebrecen, I*Jngary EpickJral space 15 used for pain relief in everyday practice. Too aim of this

study was to determine the effect of other drugs than local anesthetics and morphine derivates albinistered to the epidural space. PlaSlll3 level. sane detectable general effects as well as histological changes at the si te of epidural canule were studied. I4e !libelled penicillin was albinistered epidurally to 6 animals whUe 6 l:25ieved the s ..... drug I.m. One experiment was repeated with the use of J labelled penicillin. Epidural aQainistration was resulted in a higher and earller peak in the drug plasma level.labelled penicillin has beo;n noticed in th€' rl~~'!la 9!ter epi~..:r~! \"'~ir!i~tr:!ti~ !cr :: !::":': ;:ep~~d. 8 ti".,s longer relaxation tilll8 was _sured by the n. tibialis anteeror stilllJlating technique giving a depolarizing muscle relaxant Succinylcholin epldurally. The COO1'arison has been _ to the i .v, albinistration. According to the histology no destructive changes have occured at the site of epidural drug albinistration.

Experiences of our animal study could be extendeclhopeful!y in our intensive care units to patients who are suffering from thoracical injuries and have epidural canule for pain rellef. Epidural albinistration of drugs ie. antibiotics seems to be an alternative and si""le method to achieve rapid but long lasting effect.

nosm AL

"-'u:KnADQN DOM apr1IAJOIY Alll8IOV1'SIQI

"IICl..,....,MI pswtwpg "ClnMelMyMd' " "

CJhsfM. . .

Soudt G1uIcqM ~SenicepI'O'ftdoI-..c:Y..-.a .mcc.IO. ~oIJ96JD) 187...,.-iIea. o--._~..oIhIdy period pre....... teIUIoCit¥ioa .a:eaapced ia ~ . m __ l rcapinIIory ~ (. . . ~ . . . ~ caraaid~)_ dac tClUiailIc4CMea (26" : 22

~ ia

CMeL C o I I l b i I l e d ~ ~ _ . . . . . . 909c-.(636 .

..,._.....->-

_ _ .51_1"·75·6<2$951001)·

pn:IICM"

Alt.2_ . . . ol,.,....,8mII& __ -.-octn-...-...sbytM~~~ (3ft0l.. _

cMi6ld . . . . lila _ -a die ~ .... tr-.porced 10 bcJIpQI arritlIl_ 3S ("12.K) __ ........ D pMiaI:I reqIired-.c:tauical )ood.oI_.--.,-. Dpooioou(<7....) __ - . . .

Of die 48 pedoaa. c-. wIrlero a __ c:orti6Id

--...

_(~l_"'a

T_

---_. ..

--- -

1'"DetabMi a.lIiDcadla~ud~oIt1M»e

e-

c..-

a

-...peol

8

• ••

""IUrwt

u_

................ AII.,.-

~UUIed.

)

("''''')

.(~)

'(~)

, (lIMO)

2(33"')

o

3

3 2 1

o

2 1 1

o

o

I

B

35

n..e ... eo~diIfcn:Dcc .....m.l"'b~p.IioDq"""b)''''''sutl .. ""'-_(110121 '""'""'0• ood copoIlIcol_ _ . (1301V la~""'sulfcriacpn-balpicalrapinlorfUl'Cll

_ _ _ r-. niadala prvwidlsa . . .. .

~...m.l

pn..y,..,......,

oId1o~_

foIowiDI

aRI2~poapwbo~

oltnlCl

~

01 pre-1Impital __

_ ~ _ ~

aD

airDoII

~ ~

1m*.

MASSIVE OR LIFE THREATENING HDlOPTYSIS.

FII Sha.ji pccr I . valli.r.. TR Tgdd fCCP ILl S0eb. University ot ottawa, ottawa civic Hospital, Ottawa.

rccp

Urgent surgical intervention in the tace ot active ongoing . .ssive heaoptysis carries a signit1cant operative risl<. The use ot endoscopic or angiographic _ans to teaporarlly control the _rgency and to perait elective therapeutic surgical intervention should decrease this risk signit1cantly. Froa Deceaber 1985 to January 1991, we have treated 22 patients with . .ssive (15) or lite threatening (7) heaoptyais.Causes tor heaoptysis were . .lignancy (7), bronchiectasis (5), artericvanoua aaltoraation (3), intectlon (2), .iscellaneous (3), and unknown (2). Two petients could not be resuscitated. In the other 20 patients, history, physical exaaination, plain chest x-ray and early bronchoscopy allowed lateralization ot the bleeding in 19 patients (95t), lobar localization in 15 (75t). Bleeding stopped spontaneously in 6 patients (30t) •Because ot ongoing heaoptysis, _lective airway exclusion was obtained in 13 patients (65t) which controlled the bleeding in all but 4. These latter plus 2 others (n-6) underwent angiographic eabolization, either as a pre-operative teaporizing . .asure (3) or as the detinitive treataent (3), which was considered successtul in 5.Twelve (60t) petients underwent surgery, 11 ot which survived. Eight patients were treated conservatively tor varous r . .sona, 7 ot which survived. OVerall survival was 82t. An algoritlm retlecting our investigational, resuscitative and surgical approach to lite threatening heaoptysis is rec-..ded as evidenced by our enhanced survival rate coapared to current statistics available in the literature.

CHEST I 103 I 3 I MARCH. 1993 I Supplement

1935

MONDAY, JUNE 14 (Therapeutic Interventions In Crlticsl CBre-continued) OlllUTYRYL CYCLIC ADEfIOSIN£ I«lNOPt;OSP;:;·.S': BUT NOT PEnTOXIFYLLlN£ PROTECTS AIR EfIBOLiSIl llIDUCEO ACUTe LUNG lilJU..Y Hen-, Lin ,iJ. FCCP; Kilng ilsu tI); llav';d Uang 115.

Pull1Ona,'y J1V;S;Oil, T::-Service General Hospi tal , llational Defense ,ied;cJJl Center, Taipei, Taiwan, R.O.C.

Air embolizadon ,.;

.~1I0~!J1 ..0

occur 1n a variety of situations, and

induces acute lun~ injury in 501..., conditions. Dibutyryl adenosine uonophosphese (OBcA14P). an analog of crJlP. passes

also

cyclic easily

through the cell h1ellil.>:-ane; pem.:oxifJlline (PTX), a methylxanthine derivative, Coil inhibit phosphodiesterase and increase in..:;·acellular concentration of cAMP; all have a pro~ect'jYe effect in some acute lung injury loodels. In order to evaluate olislol induced acute lung injury. we set up an

PTX and isolated

lung perfusion 1.lOdel 1n ..:he rat, and an induced experhtent.l acuce lung injury s int l ar co AROS b~' intravenous infusion of 0.4 1.11 of air over a 1.5 minute period I.hrough a roller PUIIp at a constant rate. Three groups {each group contains 6 rats} of experinoental rats were studied. In group 1~ ::'he conc.:o l lj,'ouj)~ only air was infused; g:-oup ~~ PTX l)'19/300~ booy l;.,'eighl. was given in,ravenously 10 ,.inu;;es before air infusion; group 3. One.lflP 4fJgl3llOgm body weight was given intravenously 10 minutes befol"c air ;nfusion. \Ie found that pUIW;1.l'i a r , er t s l "ressure was strikingly increased then declined ilolUediately a~,e;, air infusion in all groups. There was no significant differenct uh.. i l ~O I.rinutes. lung weight gain was 1.1ai"'1
AIllUOlIIlIIl'HIC IUNKlSIS 01' l'UUQl&ItI DB)LIIII (PS) III caITICAU.Y ILL PATIIlITS USIIlG A IllfAlHWIZCA'ftlII,'lBIl. Cuoloa II. Wna (1CCl') • .....i _ c. Jolb. ·Jor. . LlMea8teill. " ' l DllYit. ICU ~io a.>1ie. PIl~ » 1 _ DJy18i... Clilli....· -J.... iIil· s... lIu1;in- UnivePIIU;~ lfospi1;a1. a-.. Ai..... ar-rt.iDa. . A ...Habl. beclaidlt in - - . I the • riDa it with

_ _ ~or crU;ioall~

P1f•. s·• •dU~

_Uabl. at the .t111 ~ . ... di~ic val o~ the ~ ~ with oathe1ier (PABG) th18 kiJld o~ pati_1ie br _ clinical data eDd _ ....-l1ie o~ dlff._t ta.te. d~18o~

rn . 'liatieDte : ' .

_ t ~ . ~ ccaaecuth. II&ti_ with _ PS _ a d~ic ............. eDd a oa_tari_tiOll _ _ ... 1acl_. OOIdilwatioll _ _ br .U_r _ _ t i _ l P l ~ ~......... or _iDt~. PS _ 00Id~ in 11 patieDta aDd led oat ill 17. PA8G _ p e r r _ aX- ill all. br _ inJecti o~ OOIltreat throuIb _ cl1ata1 oa_tar orifioe. ODe U> .. lober arteries _ _ atladied _U. _ __ ter _ . . . . . . br _ ballOOll inflatiOll. Clinioal f_taree. _ l _ t a r s r lItUdl... (iDcllllliDa 1&1;i... taet.a). ~ data eDd ~ocPQhic f ~ recorded aDd. em that bee18. 81 dU~......t _ _~ 1 c iabl_ ..... d1tn_. _ib1l1Q. _ifict~. fal. _ i ti _ raw. ~&1_ _t i _ ra1ie. Yalid11;~ index. J of JaardeD eDd _11;i_ aDd _ t i _ .....u.cti_ Yal_ _... oaleul.ted for the 81 ...... labl•• 1;PJ'iDa U> _ _11' d~ic ~ . AD _ i a 1 i e _ U> ....l_ta _ cIiatI_ i c 1ieete i. U> d1t1ierm.- _ PI'Ob8bU11;~ o~ PS with _ 1ietIt _itive [P(D+/T+)] aDd _ . .t i _ [P(J1t./T-)] .... _ _li_tioll o~ the 8Qe. tbeo..... Blt_ _ 10 _t1ier . u - t i c _18 (tabl.) CIDb PABG ~ P(I)+/T:\ .... P(D+ID+) . . . .PASG 98.4. 5.8X P(D+/T-) raUle .i.Tachyoardla (> loo/mln) 76.1. 7.0. ular U> tIaoee ... HlIParooaculabillty 55.7X 1.8X _l1F~iIl . Positive venoue Doppler -hi4IJl llC'ObUtilitll'57.5. 24.7• • Abno...... l BeG 53.8. 18.5• 1 _ eoiJlt~. .Hyper~ibrino••neeia 55.2X 23.8X It _ .s--tra.Clinic.lly v.nous throehl 59.5. 33.8" .ST-T inf.rior BOG chana•• 51.2X 31.8X ted that PABG ill tIaie &l'OOIP of _ .Abno...... l luna 1I01nti...... 43.1. 0.8X .Pa02< 80 -.Ha(1'102=0.21) ·41.7" ti_ta 18 a _ 0.1n with a hi4IJlPScIiatI_ i c Yal it _ _11;i_ _ _ 88.'" aDd _ _ it _ _t i _ the _ O.S. PA8G _ l d he p a r l _ OIl patieD1ie U> _ _ PS _ _ _ _ritll' o~ _11' clinical OODd1tioD _ DOt &11_ p e r ~ ~ of e i _ r • eoillt~ or a ..........m;i_l _ i.......... perlo~.

~ic

~.

llC'ObUtU1t~

o~

probabUit~

~

CLINICIANPERFORMANCE IN THE DIAGNOSIS ANDTREATMENTOF FATAL PULMONARY EMBOLISM TimotIIy L Mor1IMIIIIer M.D....., H.1tJlI M.D.,FCCP Ma10 CllaIi: aIId F~ RodIoIler, MN

Pulrnonuy embolism (PE) is a dangerous COlIlCquence of venous thrombosis Illd accounlS for about 6.. of hospital deaths annually in North Ameria. In most studies of fatal PE. the conett antemortem diall"OIis is suspected· only about 30.. of the tUne. Several clinician perfonnance factors may contribute to the hilb rile of fatali,>, in PE: I) inadequate level of clinical suspicion. 2) in&jIPropriate use of testing. 3) madequate treaunent. Illd 4) infrequent use of llIOIlby1aJti.. We performed a 5 year retnlSpeCtive _iew of 186 cues at our instilUtion wheie the J*hololists listed pulmonary embolism u a cause of death. After study of autopSy Illd clinical data, 94 deaths were found to be diRCdy caused by pulrnonuy emboliJm. In tbeIe 94. clinical pceoetllaliolls were ofIen atypical For eurnpIe, chestpain.dyspnea, Illd l&Chypoea occumd u a tNd in <10'll> of pallents. Despite atypical ~..tiOllS, venousthromboembolic disease wasconsidered by the clinician in 45.. of cues (42 total; 15 DVT, 31 PE). A diaposis waspunued in 17(4O'll» of theoe patients. Adequate IeSlingoa:umld in 14, inadequate in 31lld no lelting in 2S(6O'll». Tau performed foUow: 14 VIQ IC&IlS were performed in 13 SUspeclS (6 hilb probability. 3 low pmbability. 5 intermedill\le); pulrnonuy angioJr&Pby in 8 patients (4 acute PE, I cbnKUc PE, 3 normal); impedaDce pJedlysmop1pby in 2 patients (lposi\ive. I nonnaI); duplex ultruoulld let Sltldies in 2 patients (2 positive). Of the 14 patienlS adequa.... y 1I:Sted. 12 n:ceived adequate ~y Illd I died at an';opaph}'. One of the patients with a negative pulmonary anpogram wu left untreated. Three patients were inadequa....y tesled; I left &pinst medical . .ice.Illd I was admined for comfort C&Je only. Of the 25 patients in whom the diagnosis wu _ pursued. 7 were anticoagulated for other reasons. I admined for comfort Cate onIy.1lld 4 had caIU\I'Ophic pcaentations which pReluded IeStina- Thus, of patients dying of PE in whom the diagnosis wu considered antemortem. 19(45") were adequately treated. 6(14") died too rapidly for lI:StingIlld _ t to occur. 1(2") had falJely reassuring teat resullS forestalling ueaunent. Illd 5(12") were not rested or lreated by patient leQuesL Only 11(26") died without benefit of ....ting or IreatIllent We conclude that improved clinician performance in use of diagnostic tests Illd treaanent may have only slight impact on decreasing deaths from pulrnonuy embolism. In 55% of all patienlS with fatal PE. the diagnosis wasneversuspected. Prophylaxis wu used in < 2Oil> of patients. Effons must be direcled at increasing the suspicion of PE and, _ imponandy. improving compliance with JIIOPhylactic practices in patienlS at rislt.

OCcupational and Drug-Induced Lung Disease Afternoon PULllOlWlY FIBROSIS INDUCED BY AIIIOO_: TWO CASE REPORT. A. Caa&Ulo, F. Chiuu.rulo·, R. Sabato, A. Al tier!. A. Cappablanca. F. MfUeo~ E. Grulecloni.

Departaent of' R.spiratory Dl...... - Un1verei ty of' Bar! - ltal,..

• Intensive Reapiratory

care -

Co1ltlcfto "'-pltal - Bart - ltal7.

The luna has been Increaa1na by recoa;nlaed _ a potential .1w" or adverse druc.;. rc..etlona. 'lb~l. 111 the . .t C~ pattern of' InjW"1' encounter-'

with drua-indueed pul.onary di......

A apecial _ntion UlOI\& dru& which are responsible or PulIMN1U"7 Fibl'Mt. n"cIa Aalodarone (All).
_are

EGA: pH 7.37

pe024O.7

p02 86

aet.0296.3lI

XR: COPD interati tial .arkinas CT hi&ht resolution: COPD, bulla enph,yseu, interstitial ..,.klnp VC It 3.4 (-191') LC I t 5.0 (-20l1) OLCO 60lI (-IS) Concluaions: Our olinical findinaa sugeat that it ia very illpOrtant a follow up of patients in _iodarone therapy by chest radioaraphy, DU'1ua1.l'l& C8paci ty and functional teata in order to prevent reapiratory faUure,. The posaibUity of rtndina~ in clinic, patients with initial -taae of fibroais by druas is rather rare. Infact theae patienta co-e to a heepi talization when di.ease is in an advanced staae and it i. cOllplicated by inf'.ction and re.piratory failure such as to flake often neee.aary the tranafert of the patients to an intensive respiratory care.

1148

Ab8trIIcls,

XVII World ~ on ~ oIlhe Cheet

MONDAY, JUNE 14 METABOLISM AND TOXICITY OF CERAMIC FIBERS IN HUMANS J.M.VERGNON" P. ~BASnEN'" O. BlANCHARD'" M. PERRIN COrnER..••• P. FOURNel" A. EMONOT"services de Pneumologie' et de·Cytologie.. ••• centre HospltaUer Universitaire de SAINT ETIENNE (France). -IRSST Qujbec (Canada). "'INERIS Vemeuil en Halatte (France).

CORRELATION BEMEN HIGH RESOlUTION COIf'UTED TOKlGRAPHY. CHEST RADIOGRAPHY. AND THE PULMONARY FUNCTION TEST IN ASBESTOS RELATED DISEASE. Si d~r 1..

In rats. a chronic inhalation o~ refractory ceramic fibers (RCF) induces a slight fibrosis. A progressive dissolution of RCF occurs during the clearance time. wtthout chemical transformation . The human metaboUsmand toxicity of RCF remains unknown. We have studied 10 current workers in a ReF plant and analyzed In each case chest X ray, pulmonary functional tests, GalHum scan and broncho-alveolar lavage (BAL) data. The 10 men (mean age : 44 years) were employed at primary production. eXclusively. for periods ranging from 10 to 21 years. Five patients were smokers. Six Pelients complained of Irritative cough. Only one had an abnormal chest X ray with reticulonodular aspect. Functional tests were normal in 6 cases. but found a moderate decrease In transfer! test (Kco) in 4 smoker patients 8880dated in 2 cases wtth an obstructive feature. Gallium scans were normal in each case. Fiber bronchoscopy found atrophic bronchitis in 7110 Pellents. In non smokers, BAL cell analysis did not reveal any alveolitis (71.6 cellstmm 3 , range17142; normal 116±16) but a slight increase in polymorphonuclear cells (2.5 cellstmm 3 , range 0-6.8; normal 0.7±O.3). In contrast, in smokers we found both an aJveolltls (n7 cellSlmm 3 , range 163-1400; normal 356±46) and an increase in polymolD/lOnuclear cell!i (13.3.cellstmm3 • range 0-28; normal 2.8 ± 0.5). Mineralogic studies of fibres were performed on BAL fluid with transmission mode electronic microscope fitted with an EDAX 9900 energy dispersive spectrometer. Nine patients were studied; 819 samples contained RCF of more than Slim of length (from 160 to 2500 IIml); no other type of fibers was found. The highest value of RCF concentration was found in the petient with abnormal chest X ray. There is a positive relationship between RCF concentration and cellularity in BAL. Fibers were present in 'native form' of alumino silicate or in "1ransformed form" : some looked like a cylindrical hollow tube made of cristalline iron granules without RCF com~nent~ detectable. Other iron-rich fibres correspond to fully coated fibres, mimicking In some cases asbestos bodies. In these coated fibres some of them were lying in a background of fine siliceous material. This fibe; transformation seems tobacco dependant and is highly predominant in non smokers. Contrasting with rats. this study shows that humans are able to metabolize RCF.throu!lh a ferruginous transformation. Toxicity of RCF in human lungs could be higher In smokers (high alveolltis) who exhibit a lower metabolism than non smokers.

In order to as ses s the practical utility of high reso lut i on comput~d tomography (HRCT) in th~ diagnosis of asbestos related disease. 25 patients with significant e sbes tos exposure (gr~at~r than 20 y~ars) w~r~ r~yiew~d.

BROIICHOALVEOLAR LAVAGE II BAIlLY DETECTION OP EXTRIlISIC TOnC ALVBOLITIS III JUCDL-IlIDUSTRY WORItBRS. V.V. Polyakov, A.G.Bullohiov, A.V. Zuravl1ov, G.P. Orlova and 1I.G. Jakovleva. lIat1oaaJ. I ... t1tute o~ Pulmonolosy, St. Petereburg, Russia We .tudied 47 worltere expowred to Dickel and its salts. I(ost pari o~ thea - 41 paUent (87'" - had bystory o~ e%powre and scantl Diokel expowre related a;yaptoas, 6 as;yaptoaaUc worken {13") had Demel ohest rad1ographa, sp1roaetrio test rewlt., lung volUM aDd di~~1ng oapao1~y ~or carbon mononde (Dz. CO). Thare was no di~~erenoe 1n Han values o~ age, number o~ y~ara 1n their occupaUon and SDlOlt1ng habit 1n compari.on with .;yaptoaauoJaUsntB. Bronchoalveolar lavage-(BAL) was used to as. . . . 100 ~olog1c and 1I1fl_tory evente in a1rway.. D1~~erenUal oounts of 400 oells were pe~o:nDad on ae.al&1Ul-Bo.1.D-sta1ned preparaUons. The upper 11a1 t of nomel ~or lavage .neutrophils (~ 4~), l;yaphocytes (" 14~) and _orophages (~ BOl') was dsteDl1ned ~roa the mean plue SEll o~ ae&8l1rell8nts made in 11 healthy volonteera. Blaetase and collr.=nase acUvity 1n BAL-~lu1d, phagocyte acUvity o~ monoc es and neutrophile 1n peripheral blood and alveolar macropages 1n BAL-~lu1d and DL CO were studied. There were aet two classic typee o~ alveoUUs: neutrophiUc (5 pat1ente) and l;yaphocyt1c (11 patients. The salient ~eatu­ res o~ pulmon&rY. reaponee to Dickel exposure were the following: - 1ncreass o~ neutrophils in BAL-nuid (about 36~ va O~ in heal thy volonteera); • - 1n~rease o~ elastase acUvity (J.S5-J.91 DlDol x mg/ain ve 2.1 - 0.09 as nonllal range (lIR) (P £ 0.05) and collagenase acUvHy in BAL-tlu1d {5.53-6.35 imp. x mg/lll1n vs 1.29 % 0.12 as 1IR (P £ 0.05), - decrease o~ DL CO (staty state tset) to 77.38 4.95J of predicted. Changea 1n sel'Ulll 1JIIIIlmoglobul1n levels, T-l;yaphocyte populaUon and phagocyte acUvity o~ monocytes and neutrophile 1n peripheral blood and AM 1n BAL-~lu1d were not epec1f1cal and cOlllllOn ~or nuaeroue lung diseases with pulmonary f1bros1s. We conclude that Dickel-industry workera have a high risk origin of extrinsic tonc alveoUUa and applicaUon of BALanalyaea can repreeent a great hint to early d1agnoe1a.

*

(Northwest~rn

Memorial Hospital. Chicago. IL 60611)

Each pat tent in the study had a ches t radiograph. HRCT and pulmonary function test (PH). The HRCT tnc luded sup ine and prone views of tbe chest , A total of 9 pat ients demonstrat~d findings consf stent with pulmonary fibrosis on the HRCT but in only 5 pat tent s

could any abnormal Hies be identified on the chest radiograph.

In no pat ient was the HRCT nonnal wh~n the chest radiograph sugg~st~d fibrosis. Of th~s~ g pati~nts with ~yid~nc~ of fibrosis on HRCT. only 4 d""",nstrat~d any PH abnonnal1ti~s. Of th~ 16 pattents with a nonnal HRCT. 7 demonstrat~d mild to mod~rat~ly-s~Yer~ restr tct tve abnonna1iti~s on PH. Th~ remaining g pat ients with normal scans also had normal PH's. Lastly HRCT demonstrat~d pleural p l eque in 13 of th~ 25 ce ses whil~ ches t radiography could only identify 6. on~ of which proved to be subpleural fat on th~ HRCT .. Our data sugg~sts that HRCT can demonstrat~ anatomic chang~s ~arli~r than the chest radiographs but the clinical significance of these early changes remains unclear.

ASBESTOS CONTENT OF BRONCHOALVEOLAR LAVAGE FLUID: A COMPARISONOF LIGHT AND SCANNING ELECTRON MICROSCOPIC ANALYSIS V.L. RonJl. M.D•• F.C.C.P•• P.G. Coin, Ph.D•• N.1l ...olnty .... ".0.. F.C.C.P... nd D.Y. Bell. Ph.D. D.partm.nt of P.theiOlY, Durllam V.t.r.na Admlnlstr.tlon .nd Duk. Unly.rslty Medloal cent..... Dum.m. NC USA. 21105 W. studied the ubestos eontent of bronohoalYeolar lavaca fluid (BALI') from nln. patl.nts with asbestosis, 11 asbestos-.xposed but without ubestosls 15 with idiopathic pulmonary fibrosis (l.P.F.), and nine non·exposed

volunte~rs. The

o.llul.r I.Yaca pall.t wu dlr.sted In IOcIlum hypoohlorit. .nd tIIter.d onto Nuol.po... tIIt.rs for asbestos body (AB) quantlflo.tlon by Ilmt mloroscopy (L") and .nalysls of numbers .nd types of coated (AB) .nd unooated fibers (Ul') by "".nnlnr .I.ctron mloroscopy (SE ..) and .n.rrY dlsperslY. x-r.y .naIysls (EDXA). TIIere wu • st.tlltleally slplflc&llt dlff ......... In the number of AS per mlllloo o.lIs eeecveeed or par ml BALI' .monr the asbestosis patl.nts (l32t218 AB/IO' c.11s .nd 19U5 ABlml BALI') and asbestos-expoled patl.nts (2SUOS ABIIOS 0.1Is .nd s.ien ABlml BALl') u eompared to the 1.1'.1'. patl.nt. (O.S1U.O ABIIOS 0.11. .nd 0.42tO.94 AB/ml BALI') .nd the non-exposed volunt••rs (0.aetO.8 ABIIOS c.lIs .nd 0.latO.2 AD/ml BALl') (p<0.05). TIl. AB cont.nt .xceeded I ABIlOa 0.11s In 8/9 (899lo) patl.nll with asbestosis u compared to 4/11 (249lo) asbestos-.xposed. 2/15 (l39lo) 1.1'.1'., and 1/9 (l19lo) nOD-exposed volunt...... Similarly, tb. AB oont.nt .xo.eded I ABlml BALI' In Sit (S19lo) patl.nll with asbestosis eI eompared to 3/11 (l89lo) ubestos-.xpoled. 1/15 (19lo) 1.1'.1'•••nd 0/9 (09lo) non-.xposed volunt...... Lerre .mounts of bl.ok, oarbon-eored P H _ t o s bodies .nd wood stoye dUit were reeovered from the lunp of one patient with I.P.F. and an unusual e:lCpC*lre

hls,ory. TIl. UF oont.nt u d.t.rmlned by SEM Wei similar for all 4 ll"Oupe. How.v.r. the types of fibers w.... substantially dlff ....nt. Comm.rclal .mphlboles (.moslt. or oroeldollt.) w.re Id.ntlfled In 5/1 (119lo) patl.nts with asbestosis u oompared to 3/15 (209lo) asbestos-.xposed. 1110 (l09lo) 1.1'.1'•••nd 1/8 (l29lo) non-

expoaed volunteers. Non-eommerelal amphiboles. chrylOtlle, and non-ubeatol mineral fibers were deteeted to a almUar extent In all .. IfOUPL Aabeatos bodl.. were detected by 82M In only 9 of 50 cues. However, 1 of theae had asbeltoala and the oth.r two w.r. asbestos-.xposed. N

Asbestosis

Asbestos-.xposed 1.1'.1'.

Non-exposed volunteers

9 11 15 9

AB/I06 gells

132t218 28tl06 0.61U.0 0.SStO.8

ABlml BALF 18.at35 3.1tll

0.4UO.94 0.IStO.2

UF/I06 c.lls 34IU20 211t23S 512t1390 20U190

UFlml BALF 89tl53 53t52 405t1310 31t3S

W. oonolud. th.t the flndlnp of more than I ABIIOS 0.1Is or I ABlml BALI' by LM

.nd of ubestos bodl.s or oomm.rclal .mphlbol. fibers by SEM .r. Indlo.tly. of

considerable exposu,.. to asbestos in the vast majority of cases.

CHEST I 103 I 3 I MARCH, 1993 I SuppIemenl

1958

MONDAY, JUNE 14 (OCcupational and Drug-Induced Lung Disesse-contlnuBd) IIOICIIOAlVlOUl LAV. nlm PIlGfIU II SUIACUTE EXTllIISIC AUOSlC AI. VlOLms ,.nUTS I£LATED TO TIl£ PlESt:1C£ • AlSt:ICE Of PLASIIA CELLS

Ill;

Harjoleln Drentl• ~; Sjoerd sc, lIagenu"z, Heleen van Yelzen-Slad , MSc; Paul G.H. Mulder, MSc; Jules M.M. van den Boschl, Ill, FCCP

~parr.ents of Pul.,nary Disease~, Pathology and r_nology, St •.4ntonius Hospital, Iti~in and ~parr.ent of Epidetliology and Biostatistics, Era_s Uni.t1rsity, Rottt1rd.., The ~therlands. Jntl'Gduc:tiOll Genera 11)' plaSll& cells (PC) are not found in bronchoa lveo lar lavage fluid (BAlF). _ver, extrinsic allergic alveolltls (EM) Is associated with Increased lyilPhocytes and often the presence of a few PC in BAlF. The ala of this study was to Investigate whether there Is a correlation between the presence of PC In BAlF, other cells and l_nogloOO1ln (lg) levels In BAlF of EM patients. 'atients Thirty-three non-s.,ldng EM patients. who had a BAl within two till seven days after the last exposure to the causative antigen were selected.

llethods

BAl was perforaed according to our hospital protocol. Cell differentiation, Identification of lyaphocyte subpopulatlons and proteins were ..de. Morphologically PC were Identified in a routine MGG-stalned slide. The Hann-lIhltney U test was used to Investigate whether there were statistically significant differences between the two EM-patient groups. Spearaan rani< correlation coefficients were est_lnated In order to test the relationship between the nuaber of PC and Ig levels. .eSlllts EM patients with PC In the BAlF (PC'·EM patients; n-2O) had a decreased nuaber of alveolar ..crophages, an Increased nuaber of lyaphocytes, a decreased CD4/CD8 ratio and Increased Ig levels as coapared with EM patients without PC In the BAlF (Pc"-EM patients; n-I3). Cone Ius iOll There is a correlation between the presence of PC in BAlF and other BAlF constituents, especially Igs. This strongly supports the concept of local production of Igs by PC within the lung after antigen exposure In susceptible Individuals.

NONALLERGIC INTERSTITIAL LUNG DISEASE CAUSm BY DRIED MILK R. Jlckel, R. SchOneich, S. Hummer Federal Institute for Occupational Health, N61dnentr. 40 - 42, D-J134 Berlin 'Special Hospital for Lun& Diseases and Tuberculosis, Karower Sit. II, D-J1IS Berlin

The ~ence of respiratory diseases was sludied in 76 unselecled workers expoocd to dried milk. The investiplion pnlIram contained clinical and immunoiOllical methods and exlellSive pulmonary function leS1S. There wen: palIJoIocicaI respiratory findings in 88,2" of the worb:rs. The pan of aIIcqic d i _ such as aIlerJic minitis, ISlhma or a1veo1itis only amounted to 2,6" of the subjects. In the other workers with pa1hoIOIlical disorders no antibodies to milk compounds were found in radioallergosolbent-leSt and in QOIl/ller immunoelectropbora. They abo hadn'l a IypicaI history of an aIlerJic disease. The )lRIdominant diagnoses of these subjects were chronic atrophic rhinitis and chronic obstructive bronchitis. A tltird of the expoocd worIrers slIowtd a hypoxemia durinc the exen:ile testinc. This hypoxemia wasn't explicable with a manifest lunc function disorder. The worb:rs only complained dyspnoe during exercise and dry cough. X-ray-chan&es were found only in one penon. On the supposition to find an interstitial lung disease in some of these worken a bronchoseopy with BAL has been performed. In some cases we found cytologically and macroscopically marks of inflammaJory disorders bUI not sufficienl evidence of an allergic disease such as antibodies or other immunopatholoaical markers in the BAL. The results point to the fllCl thai OCher pathomechanisms for these disorders might be diSClWCd. The dried milk contains enzymes and microorganisms. Among others 11K. subIiIIs is a component of normaI milk flora. Spores of Hac. subtilis can survive the c!ryinc process. We assumed that these disorders have been csuscd by enzymes and/or microorpnisms in the milk. It is possible thai these disorders are an exJlRSSion of a chronic variant of the orpnic dust toxic syndrome.

UNlBlUIA110N

OF

mIlNA

FOR

~y

CY'roJaNIlS (JL-IAJL4)ANDAC11NlNlIlBOMYaN-INJUIUlD!lAD I.J.JNOS. JH Willi., Jr- KZ Guo. D H".kcpm.. R AriaD. PubDOIW)'

uc IrviDe MecIIclII Caller, 0raIlge, CA. InlratracbeaI insdllalioo of bleomycin (ITB), wben cbarac:tcrizcd by broncboaIveoIar Jawce (BAl.), induca lID inflammatory procell witbin 24 boun, wbicb ~ into a reliable and frequenlly_pIoyed model oIlq fibroIia. Intcrleuldn-l (D..-I) is lID early, pro-infIammatory ~ and produclioIl of D..-l-like ae:tivityby alveolarmacropbageI hal been ideDtifieclat early at 6 boun folJowina: ITB inatiIIatiOlL However, precedinc upJO&lllatloft of mRNA expraaion for IL-1.8, tho primary e:rtraeeI1u1ar form of D..-I, hal DOl been dcsatbed in this moclel UkewiIe, mRNA aprcuion of anotber immunomoclulatory eytoIrlne IL-6, which may play lID important role in latepbale relpllllleS, hal not been cbaracterized in this model In the CI' rrent 5rlld\, we examiJl.ld mRNJ\ utrae:lcd from !u::2 ~ eaJ." in l!1e process. A1 two And six boun following rm, to determine if -;'p-reguJatioo of llk:ae eytOkine gena proceecla BAL evidence of inflammatory cell accumulation in tho airways. ME'IHODS: Ten unitsIKg bleomycin, carrier (saline), or air were instilled intratracbeally in Sprague-Dawley rats 2 and 6 boun prior to aacrifice. At aacrifice, lunllS were excised, tho airwayllavaged to determine c:ellularity, and remainina tissue minced and bomoaenized for RNA extraction. Nortbem bIolI 01 extracted RNA were hybridized with eDNA probes for IL-6, D..-IB, and yactin. RESULTS: BAL did not demonstrate leukocyte influx at eitber 2 or 6 boun following ITB. IlAi mRNA was not evident in controls or animals injured with ITB two boun before, bllt was evident six bOIlrs following ITB. D..-IB mRNA expression also vinuaIIy undetectable in controlJ, but was modeslly IIp-regulated two boun following ITB, and markedly IIp-regulated at six hours. Actin mRNA expressioo was evident in controls, but appeared modeslly IIp-regulated at both two and six bours. CONa.uSIONS: 'IbeIe data demOllStrate IIp-regulation of ~ imml1DOll1oc1u1atory cytokines well before recruitment of leulcocytes to tho airspaces, and thoreby place thom temporally in pllIition to mediate or modify ~ events. Tbe signif"tc:llIlce 01 increued actin mRNA in this model, normally utilized 81 a constitutively expressed reference gene, remains more speculative. MedicIDe,

1888

MONDAY, JUNE 14 LYMPHOCYTIC ALVEOLlTIS AFTEIl INTRATRACHEAL CHAlLENGE WITH

POTASSIUMDICHROMATE IN HAMSTERSPREVIOUSLYSENSrnzm TO 11US METAL SALT. H. DB RAIM! MD, IE. K. VI!IlIIBICI!N MD, M. DBMBDTS MD FCCP, B. NI!MI!IlY MD PHD. LwJg ToxiaHogy (~umoIogy and OccupaI;OIIll1 Mm;cine) DIId JPaIho1ogy. K. U.WIIeIl. KiJpfldJIfDlYOt!r JS , B-J(XX) UIlIleIl, &Ig;"",. semilizalioll to metals, includina chromates, is a frequent cause of COIIllICl dermatitis, a conditionclusicaJly considered to be a type IV a1qic n:action. The efTa:t of the pulmonary depositionof the sensitizin& mctaI in thus sensitized subjects is 1lOI1mown. We have asxssed whether hamsters dermally sensitized to potassium dichromate (X2Cr2o,) had sians of a pulmonary bypersensitivity n:action when liven K2Cr2o, inttalIllcheally. Male and female Syrian &oIden bamstcn were sensitized by the application on the shaved abdomen of 100 pi K2Cr2o, (O.S" in dimethylsulphoxide, DMSO), followed by occlusion for 4811. Seven days after the induction, sensitization was verified by measurin, the chan&e in ear thickness48h after the applicationof 40 1'1 KzCr2O, (0.2" in DMSO) on the left ear. Nine days after the induction of sensitization, the hamsters were challenged with a single inbalracheal (i.t.) instillation of KzCr2O,(0.1" in saline, 2 m1lk&l. Controlanimals r=ived velticles only. This &ave4 experimental JI'IlUPS: non sensitized - non chaJlen&cd (group I). IelISitized - non chalIen&cd (group 2), non sensitized - chalIen&cd (&roup 3), sensitized cha1Ien&cd (group 4). The followin&endpoints wete measured2, 4, 8, 16 and 2Sdays after the i.t, challen&e: wet and dry luna wci&ht, protein concentration and LDH activity in the brolIcho-alveoiar lavage (BAL) fluid, as well as the number and distribution of inOammalOry cells in BAL. Histological examination of the lungs wasperformed without knowlcdae of the animal's treatment. Two days after thC LL administration of K2CrzO" animals from groups 3 and 4 showed signs of toxicity: inaeascd wet and dry luna wci&ht;inaeascd protein concentration. LDHactivity and total cell count in the BAL fluid. At the later time points these changes were no longer swislicaIly signiflCaJlt. However, at all time points animals from &IOUJl 4 had sipificantly higher proportions of lymphocytes in their BAL [8 ± I" (2d), II ± S" (4d). 10 ± 4" (Sd), 3 ± 3" (I6d) and4 ± 2" (2Sd») than those from the other groups (means of 0" to a maximum of3" on day 4). Histology showed that only the animals hom &IOUJl 4 had peribronchiolar and ""me interstitial lymphocyte infiltration. We conclude that hamsters dermally sensitized to a Cr-salt exhibit a lymphocytic alveolar response followin& the Lt. administration of this salt and this effect appears to persist with time. thus suucsti", the occurrenceof a pulmonary hypersensitivity n:action.

IIIIIBITION OF PUUIlIlARY FIBROSIS BY RETlIIOID - IN VITRO AIItJ IN YIVO STOOIES ON PARAQUAT-INDUCED LUNG FIBROSIS IN RATS Tatsuo I ij i.... M. D.• Takesaburo Ogala. M. D. FCCP. Hisashi Horiguchi. M. D. and Hiroshi lana. M. D. Depart""nt of PalOOIOlY. Insti tute of Basic Medical Sciences. Tsukuba Universi ty. Tsukuba 305. Japan PulJlonary fibrosis is the final feature of lung injury that is ini t ia ted by exudation and de novo activation of eacropbages. The fibrosis is believed to be caused by proliferation of pull,onary interst i t ial cells which noraally exist in tbe a lveolar sept i of the lung. The interstitial cells of the lung noraally contain lipid granules that aay store retinoid. Ie perforsed the experieents using paraquat induced lung injury to deteraine the effects of retinoid on the pul-mary interstitial cells durin. the fibrosing process of the lung. • IIATERIALS AIItJ IETIlOOS I) In vitro study. Alvrolar ...crophagcs werc collecled by BAL froll the lungs of rats which had been treated wi th 40 q/kg of paraquat 7 days before. Frotl the cul tui e acdiue 01 the aacrophages. a condi tioned Ediu. was harvested for studies of _crophage-released cytokines which aay act on proliferation of the intersti tial cells. The condi tioned aediu. was added to the cui tun.' systes of pul.xl8ry intersti tial cells wi th or wi thout previous t reatsent of retinol (lO-e. 10-'. 10-' M). and thea cell nueber and BrdU uptake were ,"""sured. In addi t ion, the cytokines of the conditioned Ediua and their receptors of interstitial cells were exaeined by using antibodies aga ins t PDGF. IGF-1. bfGF and IL·1. and antibodies against their receptors. 2) In vivo study. Retinol (IO~ or 2x10' IU/kg per week) was injected in the peri toneal space of retinoid-free rats and lhen they were treated wi th paraquat (40 ag/kg). The ani ... ls were sacrificed 2. 5. 7. 10. 14 and 30 days after the injection of paraquat. The lungs were exaamed histologically. RESULTS In the in vi tro study. retinol inhibi led cell growlh of inlerstitial cells which sere induced by tbe conditioned aediua of alveolar I18croph8ges activated by ~ paraquat t reatsenrs. Ie confitw!
TIl: 1I:Iml11lAY1ll'l II" IIlUOm. PIIl.Ir.t: J~ IlRO:I'CInII.m:LIIl UV.a aILS MD ITS POtL\TIAI. lISt FIll TI£ DIAIi\:OSt II" U"G FIBROSIS

l!aofa Qia.SbUie Ua.SbaQIa ~ Iool: rin Ilopl.of aoo-tl_1 Reolth.SchooI of Ilc IIeolth,&eIJirl&Hedical l'nhenlll, &eWe 100083,P.1.00iDo ~ fihnlais Is tho spocific dIaD&e ... tho fi..1 oul.conle f... _ .--irolor)· ,Ii_ _ • Aloac "Ith tho· ..... 101_1 or bronchooheolar 1.,·_ (BAI.) techDl_, . .Irsia of B.lL rIaid (&lIE) coasliloeaU .s .Wlilian dIa&flO$llc _liS for fibroptlc 1-& dlse.ue:s hIVe been tot mort: .ntr r..ol'e Mllt>JltiOIi. '\ltJtU'¢h e_rllllanlal .... clialcel .1.lIdi"" bo,e re,.. led _ . cb.ntes of B.U """,,"lit_.ts in an_lor &*!pIe ~'ith flhtoplic JUDI dbea~.5lJ("lCjnc parueters for 1111&& fU,rosh .re slill ..1....1. tIli. 8tolI> •• oew paruoeter-b>cIr.,.,1 proline (II>P) i.B.1I. cell. bas bees ia"uLipted aDd COIIIL*red "itl. ~ oUter pa.~t.ers such as Ute c''ell ~l,oell -'lac..... tile - u of lolal proteia ,oerulopl....I..... tile aclhill of lactate M)-dI_"" (UII) in tile supen>ataDl or BAlI in botll .lIi_1 exp<·,-; u .... _Ie "ItIl silicosis. Ib·p in Boll. ""II. is c1elen,inecI by _,I> ..... P-diaot!l)'l..I~ldoh>cIe -=1...,p1O""'-,I" ... UIOd.11I .'('0',.;""".1&1 .llld> • ,...ls were Intnt.r'adleelb' _.inist.rat.ed ",ju. 50 I ( quarl.Z·(ur <.ICte IIORU,.And to e\1tlluate the sa.«ifidt) or u..,. ~Iected v-raa.elf.u fUI }un& fill1"usi".SQi'" lers line also ~t.el'inBed for Mils fOUl' bours atter 0.01\' HCL inLratnclM.lb achinbtrelioll. 1'be u~~'Ults ~ lIMat Ute IbP in 8AL 0:11$ of r.ls iutf'lltradle.8lb adD.inist.r .. t.ed '11th ~ _"lz dust f....... _U• ..oo-l .8.o-fold increo... (3.52=0.-18 ut./~ cell protein ill Q~rtz treated Crout' WQ()iil,t!d to O•.s.t=O.U Ui/ilC cell &H"otelo ill "",.lrol """".P la .10Il& .ilb • 2.7-rold Iller... "" or IlIIl& coIlOl:. ... for IICI. t.re.ted ral.8.l.oth t.be IbP in BAI. cell. and U.. lung ",,1I'lell s1......J 110 slg,ICicanl d~fli. As for the oUter ._raa.ete.r.althoud, t.he cellular coe~...·ut,..tiOil • tJlI8 [leI'cent..lt.&e of ~. U.e a,taunts of total vro\.tdn lihd <::etulopJ8Sl1in and the l.lIf

'*....

in 8Al. supernetaut. .11 iI.cr ......"
" B S"-aalD. Ph~D•• SectlOll of Put.o.ary . . . Critic.l Car Depar~t of lledlcl_ .....t Yirat.ia Uai'W'erait,. Scllool of IIor....tOlfD. ' "

26S06.

leu.. lci...

USA~

aea,lr.tory .,..t~ (coup........... phI br••t .. l . . . . . . . . . . . _ _1 .,..,tc.e) til.tory capacities (forced It.l ca,.clt,. -nc-. forc" ezpir.c:ory yo1 iD ODe aecood -rDI-. forc" .Kplr.tory r.tio ntl/nc .. 100 -. forcN .Kpiratory flow Mtweea ~1200 -PIP 200-1200-, forced .l.uplr••ory flow Joe. . . . 2S1 _ 7S1 of nc -nF 25-7Sl-. . . . peak .zplr.~ory flow r.t. -PIF-) . .r. at_l" i. 91 . . . . carpet _wer. iD ............. carpet inlbIatry l.a Uauu 1IIl tIM Tr_ul t. Soutltera Afrlca~ 11M espoeed ra lfleaatl,. l . . .r fore" ezplratory ~1c•• t tlte COIItrolL PIli. n:r 2S-75%, PEP 200-1200. ... nF . . ill r. 26.0%. 39.0%. 36.4% . . . . 2B.Sl l ...r tbaa tIM c:oatrol.e _il. _ _ nc' ... PIIl/nc .. 100 re n.OJ .... 6~6% lCNer t .... tile eoatrol.a~ 1'he perc_t.a. pr"ictH ••1 _ of rvc. FDI. Fnl/nc .. 100. PEP 2.S-75%. PEP ~1200 . . . . PEl' . .r. '2~9%. 17~1%. 9S~6%. 64~61. 12~21. aM .2~U. r ••pectlwel,.~ ther. . . . 80 .lplflc:aat corr.latl~ bettleea fore" explr.tory i.lie t_ --.o-n tt.e . . . . .r.eI •• -.Iter of , . .r. of lo,.eat~ 1'he ,r leec. of .... I/nc ratlo 1 _ tuo 70% 1. the .ap0ee4 r. _ ]1 ..21. 11M ,r l--=•• of all reaplratory .,..t~ . .re aiplflca.tl,. "1aIMr 1. t'" al'Olll' c_red ri.b .Joe cOll"ol•• CoaP _ 1 .,...... . - . .Ioa bl...... pr.....leoc.. (62 ~81) ~ 11M 'r••••t . t ,. llluatr.t•• that wera in tbia t..taatry ha.... el1alau. . . r ••,lr.tory ....It. . . . . t ..... of alnr-,. _rrov1... ~

1_.

.a1_ ..

.1_

11011'" .fter O. OIX IICI. inlrachoall> actr,inislratiOft. Thb ioclIcet.f'CI U.. l u.es. ~111_lerS &ilhl -... ..si I> i.fl-..oed b>. UK- acute infl_too· a>.0.567 .... 0.724 II&/ac cell prott-ill for s1.a(e of 0-.1-1',11-11- .... III (acconIilll: 10 tile Oli_ ClasslClcation Slandanl f... po_iosb).reopecthel>·. r... U.. &II. oells Is dlrecll>· leI out r...... tile I,"" the c1elerainaU"" of Ibi' In i l 80) be hilhlr Sl>eClCic pO.-ler for lung callacen 1&1.01 i oIocI for B.lL oells &\IF 80) be ea.i 1>. _ 1....UOII II) """ltif_ll... of U.. B.U the IbP In II 80). be accuratel> dct..er.i •.ed \lith ~Ib bed d.-ical .,.UIOd.u..- det.ert.iDatiOil of I)" in B.\L celJs aipl be ......ral pOnaeler for llle dlOl:/>OSis.... U.. diff........l i.1 dl_1s of hire fiLrout.k di~~ fro.lt oUler lUi" diliit',IUill!S.

CHEST I 103 I 3 I MARCH, 1993 / Supplemenl

1975

MONDAY, JUNE 14

TUESDAY, JUNE 15

(OCCupational and Drug-Induced Lung Diseasecontinued)

New Frontiers in Basie Science Morning

USPIUlllU zrncrs
EVALUATION OF y6 T CELLS IN PATIENTS WITH PULMONARY INFECTIONS CAUSED BY MYCOBACTERIUM TUBERCULOSIS AND MYCOBACTERIUM AVIUMINTRACELLULARLE COMPLEX

... a-.a1.D.

"'.D.

8ec:t:1.oD of lIut 'tra1a1.a lIR1"nity ~ 1

26506. 11K.

a,~

IIl'OSlJUS D

Pa.1aDaaI'7 ... Crt.t1.cal Care "'1.c1ae. of _1A:1De. " ' r s - t _ . lIut ytra1a1.a

Tal>ercuIo.ia (iDc1Dcl1lll

TaI>e~ MIl1a&1tia ..... Taberc:ul..... ,.ric:ar1Utia) ... ,al _a I:aaioeia (iaclacliD& TraIuIbi .U~la) are tile - . t .....rt.aD.t ~f.r.eory ~ 1D tile rr-ket. 1.D SoatHr1I Afr1c:a aecoaattDa for. _jor proportioD of tbe COQD;tzy'. r • .,lratory . - -rtality _ .m.1Al1ty. . . . .1ratory .,.,tc... ~ h:Det1.oD teat. . . . . f1olr-9o~ eun-e.

. . . .bld1ed 1D foar .....re4 rura1. Soadlem: Afr1call f ...... 1D

tile Tr_i.,!be auloject. an linDa _ lIOdiDa fa _ .._11ed treditioaal _ .. to Il1P Unl of iIIdoor pollatiDe raR.lt1lll fraa _ fraa _ _1 . . . for -t1lll _ coolt1IIa _ abaci _ t fraa

_iaa.

ar1aol1III !be popoalatiDe ... f o l ~ _ yaar aft.r the lait1al .bId,. !be _ total _ t _tr.tiDe balAle tbe ....t 13.00 -.Jeab1c _br. 1'be _ _ c:.arboIl --.ide 1 1 1a tbe bta 366 part per anu-. _ _ aa1flar _ 1_1 43 pert per aU.liDe. irule. All forced _irately 911 of tile total _ t ia tile _ 1adiA:ea ta,·tIle._..b.,.jeo_ _n .tpU"""'t1,.~.. tileD the

1n...,..IIpto_ .,.._>

_role...... (c:oaaIo. -1111. pille... breadU_. _ UM1 10 tile _ _ f.... n _n .tpU1A:eah, b1Per tta. tile CGDtrola. '!'ben . . . a:lp1ftc.at d.1ff.~e'1a tbe aaaaal rate

of decl1De of foreed ap~.tCR'J' :ladle.. betweeD the espoaed far.era aod eM eoatrola. OItetnICtl. . . .tt.~ of fJ.Gw-oowol_ COrY" lIn'e been f _ ' _ _ t _llan.

!be raR.lu 1ad1A:ate tIlet oc~tioaal -....are _ ..... - t e l pollatiDe ban .1p1f1A:eat effec.. OD tile 1_ of tbe _ _ f....r. 10 tile Tr-ui _ an .t rialt of _IOP1lll air-fl_ obetrecl:iDe.

Masami Ito,MD,FCCP, Shoji Hashimoto,MD, Takashi Niju,MD, Toshihiko Yamaguchi,MD, Toshiyuki Ikeda,MD,* Akihito Yoko?aIDa, MO,*· Soichiro Yokota,MD, Keizo Noma,MD, and Saburo Yano,MD. Dept. of Internal Medicine, Toneyama Hospital, Osaka; *Dept. of Intern4l Medicine, Kinki Central Hospital, Hyogo; **Second Dept. ~f Internal Medicine, Ehime University School of Medicine, !::hime, Japan Although most T cells express the a8 T-cell antiaen receptor (TCR), there is a small population of peripheral T cells bearinq the yo TeR. Recently, increased attention has focused on the role of yo T cells in the immune response to Mycobacterium (M.) tuberculosis. However, little information was available on the y6 T cells in patients with mycobacterial infections. The I-'L·E:8121I1t study was de s Lqned to evaluate the lc·".:;:15 of ·to 'i' cell::! in patients with M. tuberculosis and in patients with M. aviumintracellularle complex (MAC). Peripheral blood samples were obtained from patients with pulmonary infections caused by M. tuberculosis or MAC, before and/or during chemotherapy using two or more drugs. Control subjects were either free of disease or suffered from mild hypertension with or without old tuberculous lesions. Blood y6 T cells were measured by the immunofluorescence assay. Briefly, 100 ~l of blood. sampJes were incubated with 20 ul of phycoerythrin-conjugated anti-CD3 and 5 ul of fluorescein isothiocyanate-conjugated anti-TCR6l (specific for a 6 chain framework determinant and representing a pan-TCRy6 marker) at 4°C for 30 min. After treating with NH4CI to cause hemolysis, the blood samples were analyzed by flow cytometry. The results showed that both untreated patients with MAC and M. tuberculosis had significantly increased levels of y6 T cells as compared to patients with drug-resistant MAC or M~ tuberculosis, and control subjects with or without old tuberculous lesions. There was no difference in the levels of y6 T cells between patients with drug-resistant MAC/M. tuberculosis and control subjects. In conclusion, the present study suggests that the enhanced levels of y6 T cells could be related to T-cell activation by mycobacteria-ligands during the early phase ~~ mycobacterial pUlmonary ~.nfections. (Supported by grants f1'tm'l the

Osaka Foundation for Promotion of Clinical IDlnUnology and the Osaka )l.",,-ociation for Tuberculosis Research)

HIGH INCIDENCE OF MALIGNANT PLEURAL MESOTHELIOMA IN METSOVO (GREECE) FROM NON-OCCUPATIONAL ASBESTOS EXPOSURE· TOWARDS THE END OF AN EPIDEMIC? S.H.Constantopoulos. J.A.Goudavanos. J. Kalousis University of Ioonn1no. Deportment of Internol Medlcine. Pulmonary Section. I08nnina 451 10. Ioannina. GREECE Inhabitants ot Metsovo (North-west Graece. population 5.000) hove been exposed to osbestos since childhood from use of a tremolite containing whitewash. This matarial was used by most all households until 1950 and since then gradually abondoned. The use of this whitewash hos resulted in endemic incidence ot pleural calcifications (46_ of adult population). In 1987 we reportad that thare was also very high incidenca of malignant pleural masothelioma (MPM) (S.H. Constaptopoulos. et al.Respiration 1987). Based on 7'cases ot MPM in 5 years in a population of 5.000 we estimeted a 300 fold increosed incidence of MPM. than thot expected in 0 non-osbestos exposed population (1/.illion/yeor). Prior to our study there hod been no reports of MPH in the oreo ond we were oble to fInd only one such cose bofore 1981. Since 1985 we hava diagnosed only 3 additional casas of . .sothelia.a (2 MPM and one peritoneal mesothalioma) (Figure I). Three coses in 8 yeors represent a much lower incidence thon what we had raported for the period 1981-85 (7 cases in 5 years vs 3 cases in 8 years). Taking into account that the fact the tr.-olita whitawash has boen gradually abondoned we may agrue thot we ore neor the end of on epidemic of MPH from non-occupational asbestos expsure in Metsovo. Figura 1. Cases of malignant mesothelioma from Metsovo (1981-92)

eo...

1988

of

CYTOTOXlClNATURAL KILLER CELlS. NAlVElMEMORY SUBSETS, GAMMAIDELTA T CEll RECEPTORS AND ADHESION MARKERS IN TUBERCULOUS PLEURAL EFFUSION. ~. BW Lee+.

CC 8eah+. NK Chin·. SC Wong+

& FL Sin#.

Depattmenls of Medicine· & Pediatrics +, Nalional Universily HospItal and

Department of Msdlcine# Alexander Hospilal. Singapore 0511.

We evaluated T ceU subsets (COO, CD4. & CD8). activa1lon marl
AbstracIs, XVII WorkICongnIss

on Diseases of the Chest