Bronchopulmonary amyloidosis--multiple tissue involvement and long follow-up

A 59-year-old man developed a large asymptomatic left hilar mass due to amyloidosis of bronchial lymph nodes. Nodular involvement of the left lung and infiltration of the mucosa of the left lower lobe bronchus followed very gradually and a monoclonal gammopathy (IgA--Type Kappa) was demonstrated. Despite slowly progressive radiologic changes, the disease has had no effect on his health during a 20-year period of observation.

[The effect of bronchofibroscopy on the mechanics of breathing during disorders of bronchial patency in the postoperative period]

Changes in lung ventilation and pulmonary mechanics have been studied after bronchoscopy (BS) performed in 22 patients with early postoperative bronchial patency disturbances. All in all the results of 27 BS procedures have been assessed. It has been found that according to the nature of respiratory changes the patients could be divided into 2 groups. In one group pulmonary mechanics improved right after the procedure. While in the other group BS was associated with an increase in aerodynamic bronchial resistance to inhalation, respiratory work and energy waste. The parameters returned to normal values within an hour. It was noticed that the second type of the reaction was characteristic of patients over 50 with low respiratory reserve, heart failure and hypoxemia. In such patients BS is recommended together with high frequency jet ventilation through a nasotracheal catheter.

[Bronchography in children. Methodologic, statistical and functional findings]

The value of bronchography in the various respiratory diseases of childhood is examined. After a brief critical review of the historical development of bronchography, 10 cases encountered in the Pneumology Unit of Regina Margherita Children's Hospital, Turin are examined in order to compare the indications to and results of bronchography. In the light of the results obtained guidelines for the selection of bronchography as a diagnostic procedure are presented, specifying the situations in which stratigraphy, CAT scans or NMR are not adequate substitutes and suggesting what should be the current role of bronchography in paediatrics.

Use of expandable metal stents in the treatment of bronchial obstruction

An expandable metal stent has been used to treat bronchial collapse due to polychondritis in one patient and extrinsic bronchial compression secondary to bronchogenic tumour in another.

[Membranous bronchiole diseases in patients without chronic air-flow limitation]

In order to investigate the relationship between pulmonary function and diseases involving membranous bronchioles (MB), we measured airway diameters and quantitated airway pathology scores in MB in 35 patients who required surgery for removal of a solitary nodule. The patients had FEV1 greater than 80% of the predicted value. Measurements of FEV1, nitrogen washout curve (delta N2/L), closing volume as a percentage of vital capacity (CV/VC%), and maximal flow rate at 50% of VC (V50) were made prior to the surgery. There were 21 smokers and 14 nonsmokers. There was 1.02 MB per cm2 of tissue. The mean internal diameter for MB cases was 0.55 +/- 0.05 mm. The total pathology scores for all MB cases were less than those found in North American populations. Inflammation scores were higher in patients with FEV1 less than 100% that of the predicted (p less than 0.05). FEV1 values correlated with goblet cell metaplasia (p less than 0.05). Tests specific for small airways did not correlate with the pathology scores in MB. We concluded. In 35 Japanese cases some diseases in MB were detected among cases whose average age was 59.5 years (42-78 yrs) and whose FEV1 was greater than 80% of the predicted value. The disease showed little effects of smoking and it was relatively minor in comparison with North American cases. This degree of abnormality is considered to be found in normal Japanese as well. It is supposed that an ordinary pulmonary function test would not reveal this abnormality in MB.

[Clinical aspects of peripheral airway diseases in chronic obstructive pulmonary disease]

We studied the site of obstructive impairment in chronic obstructive pulmonary disease (COPD). In chronic bronchitis peripheral airway inflammation caused obstructive impairment. Bronchial sensitivity increased in peripheral airways in chronic bronchitis. In bronchial asthmatics both allergic and increased bronchial sensitivity were observed in peripheral airways. The mucus occupying rat was higher in peripheral airways than central airways. Despite primary inflammation in peripheral airways in COPD, aerosolized bronchodilator dilated peripheral airway in cases of moderate asthenic.

[The relation of severe obstructive disorders to ventilation found in young patients with bronchitis and bronchopulmonary diseases in childhood]

Of the patients with chronic obstructive pulmonary disease (COLD) and severe obstructive syndrome, 39 whose age was under 40 were selected. In 23 of them, the anamnesis revealed bronchopulmonary affections in childhood, that required admission into the hospital (19 were non-smokers). Of the rest of 16 patients, 14 were hard smokers that started to smoke before the age of 14. The functional picture was severely modified, similarly to that of the COLD patients in the 6th decade of life. This suggests that the degradation process started in the childhood, and that the chronic respiratory diseases and/or smoking at an early age had an important role.

Subepithelial fibrosis in the bronchi of asthmatics

The epithelial basement membrane and underlying collagen were examined by immunohistochemistry and electron microscopy in endobronchial biopsy specimens from 8 asthmatic and 3 control subjects. There was an excess of interstitial collagens beneath the basement membrane in the asthmatic subjects. There was no evidence of any epithelial contribution to this abnormality, nor was there any correlation with epithelial damage, disease duration, or severity. These findings contradict the long-held notion of basement membrane thickening in asthma and indicate that the subepithelial fibrosis is a result of fibroblast activation rather than bronchial epithelial cell dysfunction.

Conventional versus high frequency jet ventilation with a bronchopleural fistula

A bronchopleural fistula (BPF) is an aberrant pathway through which inspired gas exits the lungs. A BPF may cause significant respiratory compromise, which in turn may result in the need of mechanical ventilation. The purpose of this study was to compare the efficacy of conventional positive pressure ventilation (CV) with high frequency jet ventilation (HFJV) using increasing increments of positive end expiratory pressure (PEEP) in the management of an induced BPF. A reproducible model of a BPF was surgically created in 10 mongrel dogs. Measurements of blood pressure (BP), cardiac output (CO), mean airway pressure (Maw), peak airway pressure (Paw), and fistula flow (FF) were carried out with the chest closed. Selective occlusion of the BPF allowed for blood gas stabilization at increased values of PEEP. Paired observations were performed at 0, 5, 10, 15, and 20 cm H2O of PEEP, while maintaining PaCO2 between 30 and 50 Torr. There was no difference in BP or CO between ventilation methods even though significantly lower Maw and Paw pressures were obtained using HFJV. While FF increased significantly with each increment of PEEP, there was no improvement in flows obtained using HFJV. This acute model of a BPF demonstrated that increasing PEEP dramatically increases FF irrespective of the method of ventilation.

Induction of bronchial hyperresponsiveness by Bordetella bronchiseptica infection in dogs

Six beagles were examined for time-related changes of bronchial responsiveness to methacholine, plasma histamine and thromboxane B2, and biopsy of bronchial tissues after intratracheal injection of Bordetella bronchiseptica. A progressive increase in bronchial responsiveness was induced after injection. The mediators, however, did not elevate and tissue neutrophil counts did not correlate with increased airway hyperresponsiveness. Intratracheal injection of heat-killed Bordetella bronchiseptica produced no alteration in these parameters. Thus, it is speculated that airway epithelial damage and effects on ciliostatic function induced by the organism are primarily involved in the pathogenesis.

Physiologic characteristics of malignant unilateral main-stem bronchial obstruction. Diagnosis and Nd-YAG laser treatment

To evaluate the effects of severe, unilateral main-stem malignant bronchial obstruction on airway dynamics, we obtained maximal expiratory flow-volume (MEFV) curves in 11 patients 59 +/- 18 yr of age (mean +/- 1 SD), three with and eight without underlying emphysema, before and after laser therapy (10 patients) or lung resection (one patient). Mean main-stem bronchial diameters before and after treatment were 1.1 +/- 1.3 and 9.0 +/- 0.8 mm, respectively (p less than 0.05). In the three patients with underlying emphysema, MEFV curves showed a diffuse intrathoracic obstructive pattern before and after treatment; in the other eight patients, MEFV curves demonstrated an apparently restrictive pattern, with associated airflow obstruction in four, reversible after laser treatment in three of these four. After treatment, all patients exhibited an increase in FVC with a roughly parallel shift of the MEFV curve and little change in the slope of the descending limb of the MEFV curve: FVC improved from 54 +/- 16 to 86 +/- 13% predicted in patients without emphysema and from 54 +/- 16 to 77 +/- 8% predicted in patients with emphysema, whereas the slope of the descending limb of the MEFV curve between 45 and 55% of FVC changed minimally from 2.0 +/- 0.6 to 1.8 +/- 0.5 s-1 in patients without emphysema and from 0.8 +/- 0.3 to 0.8 +/- 0.1 s-1 in patients with emphysema.(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of bronchial hyperresponsiveness following smoke inhalation injury

We report two subjects without previous evidence of asthma in whom wheeze, breathlessness and bronchial hyperresponsiveness occurred following an acute smoke inhalation injury.

Lung function in patients with tracheobronchopathia osteochondroplastica

We have analysed the ventilatory function of seven patients with tracheobronchopathia osteochondroplastica. One patient showed reversible airflow obstruction meeting the criteria of bronchial asthma. Another two patients yielded reduced percentage forced expiratory volume (FEV%) and features of small airways obstruction. The patients' previous spirometric measurements also made the rough estimation of longitudinal changes in lung function possible during a follow-up period of 1-8 yrs (mean 4.2 yrs). Although most patients had suffered severe chest infections, no deterioration in spirometric parameters was found during the follow-up. These findings suggest that tracheobronchopathia osteochondroplastica usually has a benign course.

Ozone-induced bronchial hyperresponsiveness in the rat is not accompanied by neutrophil influx or increased vascular permeability in the trachea

We determined whether ozone-induced bronchial hyperresponsiveness in the rat is accompanied by neutrophil influx or increased vascular permeability in the trachea. Three groups of female Long-Evans rats were studied. One group was exposed to 4 ppm ozone for 2 h and studied immediately thereafter, another group was similarly exposed but was not studied until 24 h after the ozone exposure, and a third group consisted of control rats that breathed room air. Increases in total pulmonary resistance caused by acetylcholine aerosol were measured to assess bronchial responsiveness in these 3 groups. In parallel studies, neutrophil influx into the tracheal mucosa was quantified by counting cells within whole mounts of tracheas that were treated histochemically to stain the myeloperoxidase in neutrophils, and tracheal vascular permeability was quantified by measuring the amount of Evans blue dye extravasated into the trachea. In the rats studied immediately after the ozone exposure, the concentration of acetylcholine required to increase total pulmonary resistance to three-fold the baseline value was only 6% of that required in the controls. In the rats studied 24 h after the ozone exposure, this provocative acetylcholine concentration was not significantly different from that of the controls. Neither the number of neutrophils in the tracheal mucosa nor the amount of Evans blue dye extravasated into the trachea was significantly different from the corresponding control values at either time. We conclude that rats exposed to ozone develop bronchial hyperresponsiveness without detectable neutrophil influx or increased vascular permeability in the trachea.

Inhibition of the 5-lipoxygenase pathway with piriprost (U-60,257) protects normal primates from ozone-induced methacholine hyperresponsive small airways

Weekly exposure to ozone in seven normal Rhesus monkeys led to induction of methacholine hypersensitive airways (RL increases 242 +/- 60% and Cdyn decreases 68 +/- 13% of baseline methacholine responses). It took 19 weeks to establish this hyperresponse that persisted for greater than 15 weeks once ozone was stopped. A second exposure led to similar response peaks in 6 weeks. At the peak of the second response, weekly 1% piriprost exposure before ozone led to a return to baseline that was not different between placebo and piriprost treated animals (9.4 +/- 1.0 and 4.3 +/- 2.9 weeks, placebo and treated, respectively P = 0.09 NS). A statistical difference in the mecholyl response in placebo and piriprost treated groups while on ozone was shown only in the Cdyn measurement (Cdyn% change 68 +/- 13 vs 24 +/- 14, placebo and piriprost, respectively P = 0.03). Off ozone (or return to baseline), a statistical difference could be detected both in RL and Cdyn (RL% changed 151 +/- 41 vs 31.1 +/- 49, P = 0.03, and for Cdyn 62.7 +/- 8 vs 9 +/- 10, P = 0.0006, placebo and piriprost, respectively). We conclude tha the primate provides a chronic model of airways reactivity in which the role of lipoxygenase is implicated because of the beneficial role of piriprost, and further that the ozone lesion is primarily in the smaller airways (possibly and alveolitis).

Impaired mucus clearance in patients with chronic bronchial sepsis, sinusitis and dextrocardia

Published reports have indicated that patients with Kartagener's syndrome (dextrocardia, sinusitis and bronchiectasis) have no significant lung mucociliary clearance. With a radioaerosol technique we measured over a 6-hour observation period the tracheobronchial clearance of 8 patients with dextrocardia, chronic bronchial sepsis and chronic sinusitis (DC). The tracheobronchial clearance of these patients was significantly reduced (p less than 0.02) compared with that of 29 healthy subjects of similar age. However, even when allowance was made for productive coughing during the observation period, the reduced clearance was much better than anticipated from published reports in patients with Kartagener's syndrome, which confined their observations to a 2-hour period. The tracheobronchial clearance of the DC patients, adjusted for productive coughing, was as bad as that found in an older group of patients with chronic obstructive airways disease who refrained from expectorating during the equivalent test period. Our study implies one or more of the following possibilities: (a) a spectrum of mucociliary impairment in patients with DC; (b) an effective cough clearance deeper in the lung than hitherto believed, and (c) two-phase flow of mucus cephalad as an effective clearance mechanism in patients with DC.

Interrupted aortic arch with a right descending aorta and right ductus arteriosus, causing severe right bronchial compression

We report here a patient with interrupted aortic arch and a right descending aorta, in whom the surgical management was complicated by the development of right bronchus compression and unilateral emphysema, due to the presence of the right ductus arteriosus.