Kinetics of oxygen consumption during maximal exercise at different muscle temperatures

The aim of this study was to test at maximal exercise the hypothesis of the temperature-dependence of the kinetics of O2 consumption (VO2), which predicts a greater O2 deficit as muscle temperature is decreased. Six male subjects underwent 3 min exercise bouts at the minimum power eliciting maximum O2 consumption (VO2max), at normal temperature (A) and after cooling the thigh muscles by water immersion (C). Breath-by-breath VO2 was measured together with muscle blood flow (Qm), blood lactate accumulation ("early lactate", eLa), heart rate and muscle temperature (Tm). The O2 deficit was calculated by standard procedure. Net VO2max was 2.92 +/- 0.85 (SD) and 3.19 +/- 0.71 l center dot min-1 in C and A respectively (P < 0.05). Correspondingly, maximum power was 20 W lower in C than in A. At exercise start, Tm was 35.0 +/- 1.2 and 27.5 +/- 1.8 degrees C in A and C respectively. O2 deficit was 2.25 +/- 0.53 and 3.05 +/- 1.12 l in A and C respectively. The corresponding eLa was 7.7 +/- 2.5 and 13.8 +/- 2.5 mM, (P < 0.05) while Qm was 376 +/- 92 and 290 +/- 50 ml center dot kg-1 center dot min-1 (P < 0.05) in A and C, respectively. The eLa increase in C is associated with an impaired muscle blood flow and decreased muscle O2 unloading, and does not completely explain the greater O2 deficit in C. The unexplained fraction of the latter is perhaps accounted for by a greater net alactic O2 deficit, in agreement with a temperature-dependent decrease of the velocity constants of oxidative reactions, as suggested by the tested hypothesis.

Human intramuscular temperature and heat flow transients at rest

A general model for heat exchange, comprising the major models in the literature, was developed. Temperature changes as a function of space and time were determined in six resting humans (age 32.7 +/- 4.5 yr) during temperature transients by magnetic resonance imaging (MRI), so that the exact solution of the model was obtained. These results allowed application of the model, e.g., the analysis of transient muscle heat flow changes, which could not be assessed by previous steady-state analyses. A microthermocouple was inserted in muscle vastus lateralis 2-3 cm below the skin surface. The measured temperature was used for calibrating the pixel intensity of a temporal series of transaxial magnetic resonance images obtained with a spin echo sequence around the microthermocouple position. After muscle temperature was increased by immersion in a controlled water bath, MRI acquisition was performed while muscle temperature was decreasing. Temperature maps relative to space and time inside a homogeneous region of interest were reconstructed by neural networks, showing specific temperature patterns. Subsequently calculated heat flows (with negative sign) appeared to increase linearly as temperature decreased, until a maximum was attained at a critical temperature, below which dramatic consistent heat flow changes were found. In conclusion, MRI is indeed a powerful technique, useful to study the determinants of muscle temperature and heat flow changes in space and time.

Benign noninflammatory bronchial stenosis: treatment with balloon dilation

PURPOSE

To assess the efficacy of balloon dilation in the treatment of acquired, noninflammatory bronchial stenosis of benign origin.

MATERIALS AND METHODS

Balloon bronchoplasty was performed with fluoroscopic guidance 36 times in 19 bronchial stenoses in 16 consecutive patients, with use of a local anesthetic.

RESULTS

Initial technical success was attained in all cases; clinical success was achieved in 13 (68%) of 19 bronchial stenoses. Six of the 19 stenoses were dilated unsuccessfully because they were caused by localized bronchomalacias. Of these initial successes, seven stenoses recurred but were redilated with success in four cases. At a mean follow-up of 21.6 months (range, 7-60 months), improvement in both fiberoptic bronchoscopy and respiratory status was seen in nine (69%) of 13 patients with fibrous stenoses.

CONCLUSION

Balloon bronchial dilation can be proposed as the primary treatment in acquired, noninflammatory bronchial stenoses of various benign origins including stenoses after lung transplantation.

Successful stenting of a pulmonary arterial stenosis after a single lung transplant

A 44 year old patient with end stage idiopathic pulmonary fibrosis underwent single left lung transplantation. A perfusion lung scan performed 13 days after transplantation revealed deficient perfusion in the transplanted lung. Pulmonary angiography showed severe pulmonary artery anastomotic stenosis. Percutaneous insertion of a balloon expandable stent improved both pulmonary perfusion and respiratory function.

Physico-chemical properties of membranes of recovered erythrocytes in blood autologous transfusion: a study using fluorescence technique

Using fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene (DPH) and its derivative trimethylammonium-1,6-diphenyl-1,3,5-hexatriene (TMA-DPH), we have investigated the fluidity in erythrocyte membranes isolated from intraoperatively and postoperatively recovered erythrocytes, compared to membranes isolated from untreated erythrocytes or stored red blood cells (RBCs). Fluorescence polarization (Pf) of DPH and TMA-DPH was not significantly modified in membranes isolated from intraoperatively and postoperatively recovered RBCs compared to membranes isolated from untreated fresh RBCs or stored RBCs. However, using 2-dimethyl-amino-6-lauroyl-naphtalene (Laurdan), a very sensitive molecule, a significant increase in polarity in membranes from stored RBCs compared to untreated, intraoperatively and postoperatively recovered RBCs was observed. Moreover, there was significantly higher susceptibility to oxidative stress in membranes isolated from stored RBCs, compared to untreated and intraoperatively or postoperatively recovered RBC membranes, both at baseline and after oxidative stress. Our results suggest that intraoperative and postoperative recovered RBCs are less damaged than stored RBCs.

The role of pulmonary CO2 flow in the control of the phase I ventilatory response to exercise in humans

To gain an insight into the origin of the phase I ventilatory response to exercise (ph I) in humans, pulmonary ventilation (VE) and end-tidal partial pressures of oxygen and carbon dioxide (PETO2 and PETCO2, respectively) were measured breath-by-breath in six male subjects during constant-intensity exercise on the cycle ergometer at 50, 100 and 150 W, with eupnoeic normocapnia (N) or hyperpnoeic hypocapnia (H) established prior to the exercise test. Cardiac output (Qc) was also determined beat-by-beat by impedance cardiography on eight subjects during moderate exercise (50 W), and the CO2 flow to the lungs (Qc.Cv-CO2 where Cv-CO2 is concentration of CO2 in mixed veneous blood) was estimated with a time resolution of one breathing cycle. In N, the initial abrupt increase of VE during ph I (delta VE approximately 18 1.min-1 above rest) was followed by a transient fall. When PETCO2 started to increase (and PETO2 decreased) VE increased again (phase II ventilatory response, ph II). In H, during ph I delta VE was similar to that of N. By contrast, during ph II delta VE kept gradually decreasing and started to increase only when PETCO2 had returned to approximately 40 mmHg (5.3 kPa). Thus, as a result of the prevailing initial conditions (N or H) a temporal shift of the time-course of VE during ph II became apparent. No correlation was found between CO2 flow to the lungs and VE during ph I. These results are interpreted as suggesting that an increased CO2 flow to the lungs does not constitute an important factor for the initial hyperventilatory response to exercise. They are rather compatible with a neural origin of ph I, and would support the "neurohumoral" theory of ventilatory control during exercise.

Loss of muscle oxidative capacity after an extreme endurance run: the Paris-Dakar foot-race

We measured changes in maximal oxygen uptake capacity (VO2max), ventilation, heart rate, plasma lactate and speed at the end of an incremental exercise test as a consequence of a relay foot race from Paris to Dakar in 6 subjects. Additionally, anthropometric measurements were taken and muscle biopsies from M. vastus lateralis were obtained before and after the race. The latter were analyzed with morphometric methods for fiber size, capillarity and muscle ultrastructural composition. Weight specific VO2max was significantly reduced from 62.4 to 60.5 ml/min.kg after the race while absolute VO2max and the other endurance related functional variables remained unchanged. Body fat, thigh cross-sectional area and thigh volume showed tendential reduction immediately after the race but regained pre-race values within a few days. Fiber size and capillarity were not affected by the race. Volume density of total mitochondria was significantly reduced from 6.98 to 4.89% of fiber volume. Both subsarcolemmal and interfibrillar mitochondria were significantly reduced by 59 and 21%, respectively. The volume density of satellite cell was increased about three-fold whereas the content of lipofuscin remained constant. It is concluded that extreme endurance events such as a multi-stage relay race may induce a considerable loss of oxidative capacity of skeletal muscle tissue.

Maximal rate of blood lactate accumulation during exercise at altitude in humans

The lower peak lactate accumulation in blood ([La(b)]p) at altitude may be associated with a reduced maximal glycolytic flux. Based on certain assumptions, the latter can be indirectly evaluated in vivo, during short supramaximal exercises, by measuring the maximal rate of lactate accumulation in blood (delta [La(b)]max). delta [La(b)]max was determined on six white subjects at sea level (SL1), after approximately 1 wk (Alt1) and 4 wk (Alt2) of a 35-day sojourn at 5,050 m, and 1 wk after return to sea level (SL2). The subjects performed exercises of increasing duration (5, 15, 25, 35, 45 s or until exhaustion) on a bicycle ergometer at loads = 200% of the individual Wmax. The latter was previously determined in each condition as the greatest work rate that could be sustained for 2-4 min during an incremental exercise. Net [La(b)] accumulation (delta [La(b)]) was measured after each exercise bout. delta [La(b)] resulted to be linearly related to exercise duration. The slopes of the individual delta [La(b)] vs. exercise duration lines were taken as delta [La(b)]max. Exhaustion times were approximately 30-45 s in all conditions. [La(b)]p (in mM) during recovery after the exhaustive load was higher at SL1 (10.22 +/- 1.09; means +/- SD) than at Alt1 (5.08 +/- 0.82), Alt2 (8.13 +/- 2.67), and SL2 (8.18 +/- 1.43). delta [La(b)]max was lower at Alt1 (0.09 +/- 0.02) and at Alt2 (0.17 +/- 0.05) than at SL1 (0.25 +/- 0.05) and SL2 (0.23 +/- 0.06). Both [La(b)]p and delta [La(b)]max increased during acclimatization.(ABSTRACT TRUNCATED AT 250 WORDS)

Training in hypoxia vs. training in normoxia in high-altitude natives

To determine the interactions between endurance training and hypoxia on maximal exercise performance, we performed a study on sedentary high-altitude natives who were trained in normoxia at the same relative (n = 10) or at the same absolute (n = 10) intensity of work as hypoxia-trained subjects (n = 10). The training-induced improvement of maximal oxygen uptake (VO2max) in hypoxia-trained subjects was similar to that obtained in normoxia-trained sea-level natives submitted to the same training protocol (H. Hoppeler, H. Howald, K. Conley, S. L. Lindstedt, H. Claassen, P. Vock, and E. W. Weibel. J. Appl. Physiol. 59: 320-327, 1985). Training at the same absolute work intensity in the presence of increased oxygen delivery failed to provide a further increase in VO2max. VO2max was not improved to a greater extent by simultaneously increasing absolute work intensity and O2 delivery during the training sessions. In addition, training in normoxia is accompanied by an increased blood lactate accumulation during maximal exercise, leading to greater drops in arterial pH, bicarbonate concentration, and base excess. We conclude that, in high-altitude natives, 1) training at altitude does not provide any advantage over training at sea level for maximal aerobic capacity, whether assessed in chronic hypoxia or in acute normoxia; 2) VO2max improvement with training cannot be further enhanced by increasing O2 availability alone or in combination with an increased work intensity during the exercising sessions; and 3) training in normoxia in these subjects results in a reduced buffer capacity.

Maximal exercise performance in chronic hypoxia and acute normoxia in high-altitude natives

Maximal O2 uptake (VO2max) was determined on a bicycle ergometer in chronic hypoxia (CH) and during acute exposure to normoxia (AN) in 50 healthy young men who were born and had lived at 3,600 m altitude (La Paz, Bolivia). VO2max was significantly improved (approximately 8%) by AN. However, the difference in VO2max measured in CH and AN (delta VO2max) was lower than that reported in sea-level natives (SN) who exercised in chronic normoxia and acute hypoxia. It is shown that high-altitude natives (HN) and SN have a similar VO2max in normoxia, but highlanders can attain a greater VO2max when O2 availability is reduced by altitude exposure. In addition, in HN, the higher the subject's VO2max in hypoxia, the smaller his delta VO2max. These results contrast with the data obtained in 14 lowlanders acclimatized to high altitude who showed that their delta VO2max was positively related to their VO2max in hypoxia, as previously reported in SN who exercised in acute hypoxia (A. J. Young, A. Cymerman, and R. L. Burse. Eur. J. Appl. Physiol. Occup. Physiol. 54: 12-15, 1985). Furthermore, arterial O2 saturation of HN behaved differently from acclimatized lowland natives, inasmuch as it fell less during exercise both in CH and AN. HN with high aerobic capacity display a lower exercise ventilation and a reduced arterial saturation, which could explain their inability to improve VO2max with normoxia.(ABSTRACT TRUNCATED AT 250 WORDS)

Hunter's syndrome and oral manifestations: a review

Review of the literature on Hunter's syndrome and oral manifestations in pediatric dental patients including the primary and secondary systemic manifestations are presented. Numerous oral manifestations are presented as well. Based on the cases presented in the reviewed studies, little information is available on oral considerations and treatment of these children. Early restoration of the oral cavity is important prior to treatment of the disease itself.

Factors limiting maximal O2 consumption: effects of acute changes in ventilation

The response of the O2 transport system to acute changes in alveolar ventilation (VA) was analysed. The fractional limitations to maximal O2 consumption (VO2max) imposed by the lungs (ventilation, FV, and lung-blood transfer, FL), the cardiovascular system (FQ), and peripheral O2 diffusion (Fp) were calculated according to a multifactorial model. A reference set of data, describing the status of O2 transport at maximal exercise in normoxia was used. The effects of VA on VO2max were assessed on the assumption of a constant reference O2 flow in mixed venous blood (QVO2). The changes in reference data after given independent changes in VA were calculated by an iterative procedure, until the VO2max value compatible with the constant reference QVO2 was found, at PIO2 values of 150 (normoxia), 130, 110 and 90 Torr. The VO2max changes in normoxia were less than expected assuming a linear O2 transport system, because of the flatness of the O2 dissociation curve around normoxic PO2. This affected the cardiovascular resistance to O2 flow, and its changes counterbalanced the effects on VO2max of induced changes in VA. This phenomenon was reversed in hypoxia, as the steep part of the O2 dissociation curve was approached. The fractional limitations to VO2max in normoxia resulted as follows: FV and FL provided between 5 and 12%, FQ between 59 and 78%, and Fp between 13 and 19% of the overall VO2max limitation. In hypoxia, FV and FL increased and FQ decreased. At PIO2 = 90 Torr, when VA was halved, FV, FL, FQ and Fp amounted to 0.35, 0.31, 0.20 and 0.14, respectively.

Mild iodine deficiency during fetal/neonatal life and neuropsychological impairment in Tuscany

The neuropsychological performance of schoolchildren living in areas with present and past iodine deficiency in Tuscany was investigated. Children were submitted to: a) block design subtest of the Wechsler Intelligence Scale for Children-Revised (WISC-R) and a modified version of the WISC-R coding subtest which evaluate the general neuropsychological and cognitive performance, independently from familial cultural background; b) simple reaction time (RT) session which evaluates the efficiency of the whole information processing and nervous transmission mechanisms. Neuropsychological performance was tested in 107 children living in Borgo a Mozzano, an area of mild iodine deficiency (IDA) with a median urinary iodine excretion (UIE) of 64 micrograms/L (mean +/- SD: 80.1 +/- 57). One hundred and six sex and age-matched children living in Marina di Pisa, an iodine sufficient coastal village of Tuscany (ISA) with a median UIE of 142 micrograms/L (mean +/- SD: 173 +/- 95) were used as controls. Tests for neuropsychological performance were performed in 57 children living in the village of Vagli, an area with past iodine deficiency (PIDA): 30 children born before iodine prophylaxis (Group 1), when the median UIE was 32 micrograms/L (mean +/- SD: 47 +/- 22), 27 children born after the institution of iodine prophylaxis (Group 2), when the median UIE was 109 micrograms/L (mean +/- SD: 130 +/- 73). Sex and age-matched ISA-children were used as controls for each group. RTs were significantly delayed (p < 0.05) in IDA than in ISA children, while block design and coding subtests showed no significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased susceptibility to lipid oxidation of low-density lipoproteins and erythrocyte membranes from diabetic patients

The aim of the present study was to determine if low-density lipoproteins (LDLs) and red blood cell (RBC) membranes from diabetic patients present an increased susceptibility to lipoperoxidation, which might be related to the increased incidence of atherosclerosis in diabetes. LDLs and RBC membranes were isolated from 11 insulin-dependent (IDDM) and 18 non-insulin-dependent diabetic (NIDDM) patients and exposed to a peroxidative stress by incubation with phenylhydrazine. The susceptibility to peroxidation was determined by measuring the production of thiobarbituric acid-reactive substances (TBARS) after the incubation. The following parameters were also evaluated: plasma glucose, triglycerides (TG), phospholipids (PL), total and high-density lipoprotein (HDL) cholesterol, apolipoprotein (apo) A-I, apo B, hemoglobin A1c (HbA1c), LDL PL and cholesterol, LDL fatty acid composition, and RBC membrane PL and cholesterol. Although they were apparently normolipidemic, diabetic patients showed an increased susceptibility to peroxidation in LDLs and erythrocyte membranes as compared with control subjects. The amount of arachidonic acid in LDLs and the PL concentration of RBC membranes from diabetic patients were significantly higher than in normal subjects. The increased lipoperoxidability of both RBC membranes and LDLs might play a central role in the pathogenesis of the vascular complications of diabetes mellitus.

Is interhemispheric transfer time related to age? A developmental study

In simple visuomotor reaction time tasks, the difference between reaction time (RT) in the uncrossed hand/hemifield condition from RT in the crossed hand/hemifield, known as CUD (crossed-uncrossed difference), has been interpreted as reflecting interhemispheric transmission time (IHTT). Several studies in normal adults have found a CUD of a few milliseconds (3-4), while an abnormally long CUD has been reported in patients who underwent a surgical section of the corpus callosum or in congenital acallosal subjects. The corpus callosum, which is the most important structure for interhemispheric transfer of information, completes its myelination approximately by age ten. It has been hypothesized that the functional maturity of the corpus callosum coincides with the termination of the myelination cycle. No developmental study has focused on the development of IHTT, in relation to callosal maturation. The purpose of our study has been to investigate the development of interhemispheric transfer of visuomotor information in children aged seven to eleven, using a simple RT task with lateralized visual stimuli. The results indicate an age-related decrease of CUD, which we interpret as reflecting the maturation of the corpus callosum during childhood years.

[Diagnosis of broncholithiasis. Role of high resolution tomodensitometry]

PURPOSE

to evaluate high resolution computed tomography (HRCT) in the diagnosis of broncholithiasis.

PATIENTS AND METHODS

10 patients with broncholithiasis underwent chest X ray, fiberoptic bronchoscopy (FOB), CT and HRCT.

RESULTS

in 9 cases, chest X rays were abnormal but the diagnosis of broncholithiasis can't never be affirmed. In 9 cases, FOB was abnormal: broncholith were identified in only 2 cases; the other diagnosis were tumor like stenosis (n = 3), inflammatory stenosis (n = 3), extrinsic compression (n = 1). On conventional CT scan, broncholithiasis was suspected in 8 patients but because of volume averaging the relationship between calcified lymph nodes and bronchial tree was difficult to determine exactly. Only HRCT sections, sometimes tilted in the axis of the middle lobar bronchus, can affirm the endobronchial or peribronchial location of calcified lymph nodes in all patients.

CONCLUSION

conventional CT scan can suggest the presence of broncholithiasis but HRCT sections are need to affirm the diagnosis.

Modified fluidity and lipid composition in lipoproteins and platelet membranes from diabetic patients

The interaction between lipoproteins and the platelet membrane has been proved to cause a modification in cellular functions. We studied 12 men with insulin-dependent diabetes mellitus (IDDM), 14 men with noninsulin-dependent diabetes mellitus (NIDDM), and 26 age-matched healthy men on the same diet. We determined fluidity by measuring the fluorescence polarization (P) of the probe 1,6-diphenyl-1,3,5-hexatriene (DPH) both in platelet membranes and in lipoproteins isolated by ultracentrifugation in NaBr density gradient. The lipid composition of lipoproteins and of platelet membranes was determined by enzymatic methods. The fluidity of platelet membranes was significantly increased both in patients affected by NIDDM and in subjects with IDDM compared with normal subjects. Low-density lipoproteins (LDL) showed an increased fluidity only in NIDDM patients. A percent increase in the triglyceride content was observed in all lipoprotein fractions in diabetic subjects. Increased phospholipid content was found in the platelet membranes from IDDM and NIDDM patients. The change in LDL fluidity observed in NIDDM patients might determine altered interactions between the lipoprotein and cellular receptors. The role of lipoproteins in the modulation of the platelet membrane properties in diabetes mellitus deserves further studies.

Ventilatory responses to hypercapnia and hypoxia in elite breath-hold divers

It was recently hypothesized that elite breath-hold divers may display blunted ventilatory responses to hypoxia and/or hypercapnia (Ferretti et al., J. Appl. Physiol. 70: 794-802, 1991). To test this hypothesis, the following measurements were made on three elite breath-hold divers (members of the same family), and on 9 healthy untrained control subjects (C): (1) Steady-state pulmonary ventilation (VE) at rest in the supine posture while breathing room air or normoxic CO2-enriched mixtures. (2) Breath-by-breath VE changes (delta VE), with respect to baseline conditions, after 4 breaths of 100% O2, under the following conditions: normoxia (PIO2 = 146 Torr) at rest (NR); normoxic exercise (60 watt on a bicycle ergometer) (NE); hypoxia (PIO2 = 77 Torr) at rest (HR); hypoxic exercise (HE). The results were as follows: (1) In hypercapnic experiments VE (normalized per unit of body surface area) was significantly lower in the divers than in C (4.32 +/- 0.04 [mean +/- SD]L.min-1.m-2 vs. 5.31 +/- 0.62 at FICO2 = 1.5%; 5.21 +/- 0.17 vs. 7.72 +/- 1.39 at FICO2 = 3%; 8.86 +/- 0.76 vs. 13.14 +/- 2.27 at FICO2 = 5%), as well as than in subjects described by previous authors as being characterized by 'low CO2 sensitivity'. (2) The 100% O2-breathing maneuvers did not induce significant delta VE both in NR and in HR, whereas peak delta VE were -6.73 +/- 1.38 L.min-1 (divers) vs. -5.24 +/- 3.10 (C) in NE, and -17.39 +/- 4.92 (divers) vs. -17.52 +/- 6.32 (C) in HE (no significant differences). It is concluded that the divers, compared to C, had a blunted ventilatory response to hypercapnia, but not to hypoxia. The former may represent an adaptive or genetically inherited phenomenon.

Reduced Na(+)-K(+)-ATPase activity and plasma lysophosphatidylcholine concentrations in diabetic patients

A fraction from normal human plasma inhibiting Na(+)-K(+)-ATPase has been recently identified as lysophosphatidylcholine (LPC). The aim of this study was to investigate the existence of a relationship between the activity of the cellular membrane Na(+)-K(+)-ATPase and plasma LPC in human diabetes. We studied 10 patients with insulin-dependent-diabetes mellitus (IDDM), 14 patients with non-insulin-dependent diabetes mellitus (NIDDM), and 10 sex- and age-matched control subjects. Plasma LPC concentrations were increased in both IDDM and NIDDM patients compared with control subjects. Na(+)-K(+)-ATPase activity was reduced in both groups of patients in erythrocyte and platelet membranes. There was a significant correlation between the concentrations of plasma LPC and Na(+)-K(+)-ATPase activity in both erythrocyte and platelet membranes (P < 0.01). To investigate the effect of LPC on the enzyme, Na(+)-K(+)-ATPase activity was determined in erythrocyte membranes obtained from six healthy subjects after in vitro incubation with increasing concentrations of LPC (1-10 microM). Enzymatic activity was significantly reduced by in vitro LPC at a concentration of 2.5 microM, with a further decrease at 5 microM. These data suggest that the decrease in Na(+)-K(+)-ATPase activity in diabetes might be due to increased LPC concentrations.

Hard metal lung disorders: analysis of a group of exposed workers

The experience gained during the last 5 years in the study of 36 male workers exposed to hard metal dusts (10 engaged in mixing, 12 in presintering, three in sintering and 11 in grinding) is presented. The mean age was 33.2 years (S.D., 11.8) and the mean number of years of exposure was 9.4 (S.D., 7.6). All subjects received a physical examination, chest X-rays, pulmonary function test (VC, FEV1, expiratory flows, RV, DLCO, and metacholine bronchial provocation test), skin tests, bronchoalveolar lavage (BAL) and determination of trace metals in BAL, blood, urine, pubic hair and toe nails. Two cases of bronchial asthma, six cases of interstitial lung disease and one case with both disorders were identified; eight of these cases presented at BAL signs of alveolitis with different cytologic features. Among the other 27 asymptomatic subjects, two showed an aspecific bronchial hyperreactivity, four showed a reduced DLCO, 12 showed an inverted ratio of CD4/CD8 lymphocytes in BAL without signs of alveolitis while one subject presented both an aspecific bronchial reactivity and a reduced DLCO. The presence of aspecific bronchial hyperreactivity in asymptomatic subjects might represent a preclinical indicator of a possible evolution towards bronchial asthma. An altered DLCO, alone or associated with an inverted CD4/CD8 ratio of BAL lymphocytes, might constitute an early sign of a possible evolution towards interstitial lung disease. The association of aspecific bronchial reactivity and reduced DLCO might indicate the possible evolution towards a mixed form.(ABSTRACT TRUNCATED AT 250 WORDS)

[The dynamics of pharyngeal structures in obstructive sleep apnea (during spontaneous, continuous positive pressure and BiPAP ventilation)]

Obstructive sleep apnea results from a pharyngeal collapse. Upper airway can be investigated using either static or dynamic methods during wakefulness or when the patient is sleeping. Somnofluoroscopy is one of the dynamic methods allowing a visualization of the upper airway during sleep. A lateral projection of the pharynx is obtained during fluoroscopic examination which allows visualization of the upper airway dimensions and the bone structures (hyoid bone, cervical spine, mandible). Standard polygraphic parameters (EEG, EOG, flow rate, thoracic and abdominal movements) and fluoroscopic image are simultaneously acquired on the same videotape. Using this technique, we have described the typical pattern of events occurring during an episode of apnea: 1-beginning of airway occlusion in the oropharynx with anterior or posterior hooking of the soft palate, 2-suction on the uvula downwards and complete occlusion of the oropharynx with further extension to the hypopharynx, 3-active movements of the cervical spine and hyoid bone as if the patient is choking, 4-overcoming of the occlusion usually accompanied by opening of the jaw and occurring either as a sudden event throughout the length of the pharyngeal airway or as a progressive reopening from the hypopharynx. In a recent study, we have investigated upper airway dynamics when a continuous positive pressure with one level (CPAP) or two levels of pressure (BiPAP) was applied. When using CPAP with pressure below the optimal pressure, uvula movements were the first changes we observed, preceding the pharyngeal collapse. Lowering the expiratory pressure alone lead to a significant reduction in pharyngeal dimensions starting at expiration and extending also to inspiration when the expiratory pressure is further reduced. Using BiPAP may lead to upper airway instability. The frequency and the variability of this phenomenon need further studies to be established.

Abnormalities of plasma lipoprotein composition and fluidity in psoriasis

We have studied the lipoprotein chemical composition and fluidity, using the fluorescence polarization of the probe 1,6-diphenyl-1,3,5-hexatriene (DPH) in two age- and sex-matched groups of subjects (14 healthy normolipidemic children and 15 psoriatic children). The compositional study has shown a significant increase of the percentage content in triacylglycerol and a significant decrease of the apo-protein content in all lipoprotein fractions of psoriatic children compared to the controls. A significant increase of the percentage content in total cholesterol and of the cholesterol/protein ratio has also been observed in low-density lipoproteins (LDL) and in high-density lipoproteins (HDL) of psoriatic children. The compositional changes were associated with alterations of fluidity in LDL and HDL of psoriatic patients. The modifications of lipoprotein composition and fluidity observed in psoriatic patients could be of physiopathological and clinical relevance in relation to the pathogenesis of the disease.

Susceptibility to in vitro lipid peroxidation of low density lipoproteins and erythrocyte membranes from liver cirrhotic patients

The aim of the present study was to investigate the susceptibility of low density lipoprotein (LDL) and red blood cell membranes (RCM) from liver cirrhotic patients and control subjects, to the peroxidative stress, induced in vitro by phenylhydrazine. The susceptibility to peroxidation was determined by measuring the formation of the thiobarbituric acid reactive substances (TBARS) after incubation with phenylhydrazine. Moreover the levels of cholesterol (C) and phospholipid (PL) were evaluated in plasma and isolated LDL and RCM. A significant decrease in plasma C, LDL-C and RCM-C content (p < 0.001, p < 0.01 and p < 0.05 respectively) and RCM-PL content (p < 0.01) were found in cirrhotic patients compared to controls. The lower susceptibility to in vitro peroxidation was shown by the TBARS levels significantly lower in LDL and RCM from cirrhotic patients with respect to controls (p < 0.0001 for both of them). Moreover significant positive correlations were found between TBARS-LDL and LDL-C or LDL-PL (r = +0.72, p < 0.0001; r = +0.58, p < 0.001) and between TBARS-RCM and RCM-C (r = +0.35, p < 0.05) or RCM-PL (r = 0.37, p < 0.05) from combined patients and controls. Our data seem to ascribe the lower in vitro peroxidability to the lower levels of plasma lipids.