Sputum sol-phase proteins and elastase activity in patients with cystic fibrosis

Sputum and serum samples were obtained from 38 patients with cystic fibrosis seen as out-patients at routine follow-up, or from patients admitted with acute pulmonary exacerbations of their disease. Elastolytic activity was measurable in the sputum of 13 of 16 out-patient samples and detectable in 21 of 22 patients admitted with pulmonary exacerbation. The enzyme activity was inhibited by soy bean trypsin inhibitor and alpha 1 antitrypsin, but not by ethylenediamine tetracetic acid, suggesting that it was predominantly a serine proteinase, probably leucocyte elastase. The mean sputum/serum albumin ratio was 2.53 X 10(-2) (SD +/- 2.4) for the out-patients and this was not significantly different from those of patients admitted with pulmonary exacerbation. However, those patients admitted with fever had increased sputum/serum albumin ratios (mean = 4.66 X 10(-2); SD +/- 3.19) compared with those admitted with a normal temperature (mean = 1.52 X 10(-2); SD +/- 0.41. 2p less than 0.01). The albumin ratios of the pyrexial group fell with antibiotic therapy. The sputum/serum alpha 1 antitrypsin ratios were generally greater than expected (by comparison with albumin) and evidence is presented suggesting that this is due to immunological over-estimation.

Lung secretion sol-phase proteins: comparison of sputum with secretions obtained by direct sampling

The protein content of tracheal secretions and of bronchial lavage and bronchoalveolar lavage fluid was compared with that of sputum in 33 patients who underwent fibreoptic bronchoscopy. The secretion-to-serum concentration ratios for albumin, alpha 1-antitrypsin, alpha 1-antichymotrypsin, and immunoglobulin A (IgA) fell progressively as samples were obtained from further down the bronchial tree, probably reflecting greater sample dilution. The secretion-to-serum protein ratios when standardised for the corresponding albumin ratio were similar in all secretions studied. In particular, the IgA ratios were about eight times those of albumin and alpha 1-antichymotrypsin ratios were about twice those of albumin, suggesting similar degrees of "local production" of these proteins in all secretions studied. Some patients showed considerable differences in IgA ratios between sputum and bronchial lavage fluid. The significance of these differences is not clear.

The measurement of extravascular lung water by thermal-green dye indicator dilution

The theory and practice of the thermal-dye indicator-dilution method for measurement of EVLW has been discussed, and all available animal data from our laboratory correlating EVTV and gravimetric EVLW have been presented. The method appears to function well over the entire range of edema seen , and to be minimally dependent on cardiac output. Thermal-indicator loss does not seem to be a significant problem and does not impair the accuracy of this method. Out results are consistent with earlier works in the field in identifying significant differences between the isotopic EVLW methods and the thermal-dye method, and it seems likely that these differences are due to the much greater diffusion rate of the thermal indicator.

Recurrent aortoduodenal fistula: a lesson in management

Aortoenteric fistula (AEF) is a rare but often lethal complication of aortic reconstructive surgery. The diagnosis is often delayed due to the high percentage of false-negative using upper gastrointestinal series, angiography, and endoscopy. The diagnosis of AEF must be considered in any patient with a prosthetic graft and gastrointestinal bleeding. There are essentially two modalities of treatment: replacement of the graft or total removal of all prosthetic material and the construction of an extra anatomic bypass. A case report of a recurrent aortoduodenal fistula is presented that illustrated both delay in diagnosis and inappropriate treatment. We agree with the general trend in the literature that the appropriate management of this devastating complication is complete removal of the prosthetic graft, wide drainage, high-dose antibiotics, and extra anatomic bypass. Any deviation from these basic treatment steps - such as replacement of the graft - ignores the infectious component of this complication and can result in the devastating lethal complication seen in this patient. With appropriate suggested management this once uniformly fatal complication can be treated effectively, resulting in an acceptable morbidity and mortality.

Asthma associated with a circulating IgG antibody to Calliphora maggots

The case report of an angler with delayed onset asthma, following fishing with Calliphora (Blue Bottle) maggots, is presented. The investigations showed that the symptoms were associated with the presence of a circulating IgG antibody to a crude water soluble maggot extract. The patient progressed to develop symptoms suggestive of immune complex disease.

Effect of cardiac output on extravascular lung water

Extravascular lung water (EVLW) and cardiac output (CO) were determined in 21 mongrel dogs using the thermal-green dye double indicator dilution technique. In 12 of the animals the renal vessels were ligated bilaterally to increase peripheral resistance and reduce cardiac output without altering actual EVLW. Measurements before and after renal pedicle ligation revealed an average 47 per cent decrease in cardiac output with an 11 per cent increase in measured lung water. In the remaining nine animals an external arteriovenous fistula was constructed to reduce afterload and increase cardiac output. In the baseline state, opening the fistula caused a 63 per cent increase in cardiac output with a simultaneous five per cent decrease in measured EVLW. This second group of animals was then given intravenous acid sufficient to cause 30-50 per cent increases in EVLW. Measurements of EVLW and CO with the fistula open and closed were continued for three hours. The inverse relation between cardiac output and EVLW continued. The results of these experiments show that cardiac output does exert a small effect on the measurement of EVLW.

Effect of canine immune serum on the growth of Ehrlichia canis within nonimmune canine macrophages

The effect of canine immune serum (CIS) on the growth of Ehrlichia canis was studied in macrophage cultures derived from peripheral blood monocytes of normal dogs. Ehrlichiae treated with canine normal serum and then introduced into normal macrophage cultures maintained in canine normal serum multiplied within the macrophages and destroyed them. Immune serum, collected from E canis carrier dogs, suppressed ehrlichial growth in normal macrophages. An inverse relationship existed between the amount of CIS to which ehrlichiae were exposed and the growth of the organism in normal macrophages. The anti-E canis activity was most prevalent in the 7-S fraction of immune serum. Fresh CIS had a greater suppressive effect on the growth of E canis than did heat-inactivated CIS. Antibody cytophilic for canine monocyte-derived macrophages was not detected in CIS.