[Clinical application of the forced inspiratory volume-time curve. A preliminary study]

The forced inspiratory volume-time curve in 25 health subjects with normal ventilation function and 25 patients with COPD were determined, and MMIF, FIV were calculated from the curves. The PImax was measured in the same 50 subjects by modified Blac method sequentially. A close relationship between MMIF, FIV and PImax was found. This result indicated that MMIF and FIV could be indeed for evaluation of strength of respiratory, muscles. Additional observations of MMIF, FIV and PImax in 50 patients with COPD before and after inotropic drugs, aminophylline and CNB, further proved the validity of MMIF and FIV.

[The diagnostic value of transbronchial needle aspiration in patients with extrabronchial bronchogenic carcinoma]

Tissue pathologic and cytologic examination of 47 cases with suggestive extrabronchial bronchogenic carcinoma using the four technics of transbronchial needle aspiration (TBNA), bronchial biopsy, brushing and washing through the fiberoptic bronchoscopy were reported. For any one case, any one or more of the above said technic showed positivity will be regarded as positive case. The results showed that the total positive rate was 82.9%. The diagnostic rate of using TBNA alone was 68.1% that of bronchial biopsy 63.8% and bronchial brushing 70.2% (P > 0.05), but obviously higher than the bronchial washing (34.0%) (P < 0.05). Thus the deficiency of any one above said technic will be complemented by one of the other technics. The results also showed that TBNA is especially suitable for use in the squamous and small cell types of lung cancer. Complications of pneumothorax or bleeding were not found with the TBNA technic. We, therefore, recognize that the TBNA is one of a high positive rate, easily performed and with few complications diagnostic technic for extrabronchial bronchogenic carcinoma, and it should be recommended for clinical application.

[The diagnosis of smear negative pulmonary tuberculosis in superior segment of lower lobe]

20 cases of tuberculosis in the superior segment of the lower lobe of the lung were misdiagnosed as lung cancer, pneumonia, bronchiectasis and inflammatory pseudoneoplasm were reported. The final diagnosis were confirmed by fiberoptic bronchoscopy (FOB). The causes of the misdiagnoses were: (1) the hilar mass shadow found on the PA chest film, mistaken for central type lung cancer; (2) the mass shadow found on the lateral chest film, mistaken for peripheral lung cancer; (3) the patients with fever, cough and expectoration accompanied by exudative infiltrative shadow, mistaken for pneumonia; (4) patients with recurrent attacks of hemoptysis but the lesions overshadowed by the spinal column on the lateral chest film were misdiagnosed as bronchiectasis. The author suggested PA and lateral chest films taken simultaneously were needed. The special points, to which should be pay attention during reading the films were listed and noted. FOB examination including TBLB, brushing and BALF for pathologic and AFB determination could be of help to confirm the diagnosis.

[Aggressive fibrous histiocytoma of bone--report of two cases]

Three osseous tumors multicentrically arising in the radius, ulna, and metacarpal bones of a 10-year-old girl and another in the femur of a 75-year-old man are reported. These lesions were designated as aggressive fibrous histiocytoma because of the benign cytological appearance with aggressive roentgenographic findings. These tumors were composed mainly of spindle cells tightly packed in a storiform pattern. Clear histiocytes and multinuclear giant tumor cells were occasionally seen. Variable amounts of collagen fiber were found. Both patients have been followed for 32 and 21 months respectively without evidence of local recurrence or distant metastasis.

[Evaluation of three multiple regression equations of rheogram of pulmonary impedance for pulmonary artery pressure measurement]

This paper reports the use of 3 multiple regression equations (designated as A, B, and C), established by right cardiac catheterization and rheogram of pulmonary impedance examination simultaneously, for the determination of mean pulmonary artery pressure (PAP) in 100 healthy persons and 129 cases of chronic cor pulmonale on exacerbation. By analysis and comparison of the PAP values obtained from these 3 equations, the results showed that on equation B the upper limit of the PAP in 95% normal value range was 2.439 kPa (18.34 mmHg), which correspond to the upper limit of normal value range of the PAP 2.394 kPa (18.0 mmHg) as measured by right cardiac catheterization. Also, the range 1.032-2.597 kPa (7.761-19.530 mmHg) and standard deviation 0.383 kPa (+/- 2.88 mmHg) of PAP value in healthy persons, using the equation B for measurement were less than those on equation A and C. Thus, it was illustrated that the values of PAP were more stable on equation B than those on the other equations. On the other hand, the results obtained from the PAP test with these 3 equations in 100 healthy persons and 129 cases of chronic cor pulmonale on exacerbation, indicated that the specificity on equation B for healthy persons was higher, while using equation B the sensitivity and specificity for cor pulmonale patients were higher than those equation A or C. Therefore, we suggest that equation B is more conformable to the actual circumstances and suitable for clinical application.

[Mucus histochemical study of bilirubin cholangiolithiasis in rabbit model]

Sulfated mucopolysaccharides have an important role in pigment gallstone formation. In this experiment, the animal model of bilirubin cholangiolithiasis was made with Japanese hybrid big-ear white rabbits. The source, nature, quantity and distribution of sulfated mucopolysaccharides in the cause of bilirubin cholangiolithiasis were observed by means of mucous histochemical study. There were three characteristic pathologic changes observed in this experiment: 1. In normal condition, the sulfated mucopolysaccharides were secreted by epithelium of biliary tracts and the quantity was minimum. When bacterial infection was present in the biliary tracts, they were secreted mainly by the proliferative glands in submucosa of the bile duct; 2. In 26 rabbits where the bilirubin cholangiolithiasis developed, there were many proliferative glands in submucosa of the bile duct. Most of the glands produced sulfonated acid mucin. In 5 rabbits where the gallstones did not develop in the stone growing stage, the proliferative glands were not present in the bile duct. It was suggested that there was a close relationship between the proliferative glands and the formation of bilirubin cholangiolithiasis, and 3. The glands in submucosa of the biliary tract provided the refuge where the bacteria could not be cleaned out easily and so it was difficult to control the infection of the biliary tract.

Measurement of serum transferrin by the gamma-gamma perturbed angular correlation method. Differences between normal and cancer serum

In this work, the average perturbed angular correlation integral attenuation factor G2 of the transferrin in the serums from the normals and the patients with liver cancer were determined using time integral perturbed angular correlation method (PAC). The average values of G2 were 0.1945 +/- 0.0155 for the cancer serum transferrin and 0.2865 +/- 0.0411 for the normal serum transferrin. The difference between these two groups is significant. Mathematical deduction and theoretical analysis suggested that the equivalent radius of the transferrin molecules in the serum of cancer patients becomes smaller than normal, because of a change in the molecular conformation. Similar results were also observed in experiments with rat serum transferrin.

[Clinical and pathologic comparison of adult respiratory distress syndrome and infant respiratory distress syndrome]

The authors compared the clinical and pathological findings between adult respiratory distress syndrome (ARDS), and infant respiratory distress syndrome (IRDS). In ARDS, the most common causes were injury, infection, shock and acidosis. The clinical course was longer. The weight of the lungs increased markedly, the hyaline membrane formation in the alveoli was late in the clinical course, and the degree of edema in the interstitium of the lungs and microthrombosis within the blood vessels was more serious. The pathogenesis of ARDS was related to the activation of the complements and neutrophils by inflammation in which proteinase, oxygen radical, thromboxane, leukotriene and prostaglandin were released. Thus the endothelial cells of the blood vessels and capillary-alveoli membrane were damaged by these mediators. On the other hand, the main contributory factors of IRDS were suffocation of premature fetus by various reasons in the uterus and aspiration of meconium during delivery by the infant. The clinical course was shorter, alveolar hemorrhage and collapse were severe and hyaline membrane in alveoli was formed in early stage of the clinical course. Insufficiency of surfactant in premature fetus, damage of the surfactant system by hypoxia, aspiration of foreign materials and defect of the epithelial cells of infant were the pathogenic factors of IRDS, they resulted in increase of permeability of fluid and, as a result, led to pulmonary edema and atelectasis.

[The uremic lung]

27 cases of uremia with abnormal appearances on the chest films were analysed. The results showed that the clinical features were cough, expectoration dyspnea and hemoptysis. However, the degree of these symptoms was relatively mild as judged from the amount of pulmonary edema found on the chest films. The chest X-ray finding in these group of patients were characterized by pulmonary blood stasis, interstitial edema of the lung and edematous alveoli. The pathogenesis of uremic lung was said to be related to blood urea nitrogen and creatinine retention and the concurrent presence of left side heart failure may also play a role. Hemodialysis and other comprehensive treatments could help the patients with uremic lung for relief the symptoms. But the fundamental managements to improve the prognosis for this disease are early treatment of the primary renal diseases, in order to prevent the occurrence of renal failure. Kidney transplantation should be advised.

[The clinical significance of serum creatine phosphokinase measurement in patients with chronic cor pulmonale]

The values obtained from the measurement of serum creatine phosphokinase (SCPK) in 70 cases of chronic cor pulmonale in exacerbation and 72 cases in remission were compared with the normal value as measured in 160 healthy adults at the same period. The results showed that the normal value of SCPK was 46.50 +/- 12.71 u/L in male, while 32.51 +/- 10.8 u/L in female. The differences of the values of SCPK in male and female are highly significant statistically (P less than 0.001). Although the values of SCPK were within normal limits (M +/- 2SD) in most patients with chronic cor pulmonale (72.38-84.10%) in this paper, the values of SCPK of some of them (13.60-22.36%) were higher than normal. But in a few of the patients in exacerbation (2.27-5.26%) the SCPK values were lower than normal. The increased activity of SCPK in patients with chronic cor pulmonale may be related to the vigorous movement of the respiratory muscles. While the level of SCPK decreased to extremely low degree may indicate that the respiratory muscles may be excessively fatigue. So we suggest that the levels of SCPK which are markedly higher or lower than normal could be served as an reference index for the excessive activity or fatigue of the respiratory muscles respectively in chronic cor pulmonale.

["Effort index"--estimating abilities of respiratory muscles]

This paper analyzes the actual values of FEV1 and MBC in 240 normal subjects, 147 patients with COPD and 85 cases of cancer tumors, and shows that the actual values of MBC in both COPD patients and cancerous cases are much lower than the calculated values from FEV1. The authors believe that the ratio between the actual values of MBC and its calculated values may be used to reflect the strengths or abilities of the respiratory muscles efforted, called "Effort Index". The formula of MBC calculated from FEV1 is based on the linear regression equation formulated from the actual values of FEV1 and MBC in 240 normal subjects (aged 16-80 yrs). The "Effort Index" is equal to the actual value of MBC/the calculated value of MBC. The "Effort Index" in 240 normal subjects is 1.00 +/- 0.14 (M +/- SD), in mild, moderate and severe cases of COPD being 0.907, 0.807 and 0.626 respectively, and in markedly wasted cancer cases, 0.861 +/- 0.130. The results show that the formula of MBC calculated from FEV1 is useful only for the subjects with normal respiratory muscular abilities; while in COPD patients and markedly emaciated cancerous cases, owing to the chronically tired-out or exhausted respiratory muscular strength, the actual values of MBC are actually lower than those calculated from FEV1, hence the decreased "Effort Index".