The renal glomerulus in hypoxic cor pulmonale

We measured the mean capillary tuft area by a custom-built semi-automatic technique in postmortem sections from the kidneys of 16 patients with "blue and bloated" chronic bronchitis and emphysema and in seven patients of similar age who were free of respiratory and renal disease at death. Nine bronchitic patients had received domiciliary oxygen treatment while seven had not. The mean glomerular tuft area in these treated bronchitic patients (14 200 microns2) was not significantly different from that of the untreated patients (16 900 microns2) but the tuft area in the bronchitic subjects was significantly larger than that of the non-bronchitic controls (12 100 microns2, p less than 0 . 02). There was no reduction in glomerular cellularity to suggest passive venous distension, and glomerular size was not correlated with clinical or pathological indices of cor pulmonale (including red cell mass). The arterial oxygen tension (Po2), however, was correlated with glomerular size (r = 0 . 68, p less than 0 . 01) if allowance was made for the higher Po2 of the patients receiving oxygen. The percentage of glomeruli with an identifiable juxtaglomerular apparatus also increased with increasing glomerular size. These structural changes in the kidneys of patients with severe chronic bronchitis and emphysema may reflect changes in renal salt and water handling that are potentially reversible by oxygen treatment.

Disseminated aspergillosis occurring in patients with respiratory, renal, and hepatic failure

Respiratory, renal, and hepatic insufficiency developed in five patients who had been admitted to hospital for a variety of reasons. Although in four cases Aspergillus had been isolated from tracheal secretions before death, the significance of this finding was not fully appreciated, and in all five the diagnosis of aspergillosis was made at necropsy. Since treatment has to be started early if it is to be effective, patients with any combination of respiratory, renal, and hepatic failure should have their tracheal secretions examined daily. If Aspergillus is cultured, and hyphae are present in a fresh smear, and the patient has features of a generalised infection without an obvious site of infection, treatment for aspergillosis should be considered.

Effects of potassium and chloride on the membrane potentials of P815 mastocytoma tumor cells

The steady-state transmembrane potentials of P815 mastocytoma cells were recorded when the cells were bathed in salines of different compositions. In the normal growth medium (RPMI 1640 with added fetal calf serum) the mean membrane potential was -8.7 mV (SEM +/- 0.4, n = 22). A family of Tris-buffered salines (TBS), modeled from Dulbecco's modified PBS (289 mosmol, 169 milliionic strength units, pH 7.5), having different K+ and different C1- concentrations, were designed and used to bathe the tumor cells. All of the TBS solutions had constant, but reduced levels of ionized Ca2+. In the absence of external C1-, an increase of external K+ from 2 to 20 mM results in a 5.7 mV depolarization. In the presence of external C1- the same increase in external K+ results in a 2.1 mV depolarization. The presence of 145 mM C1- resulted in a steady-state depolarization (for either level of K) of about 50%. One explanation for these results would be the presence of an inward-going active C1- transport.

Psychotherapy with the younger adolescent girl: more than an intellectual exercise for the therapist

The author discusses the inappropriateness of insight psychotherapy with interpretative interventions in the treatment of young adolescent girls. Instead, these patients need help with strengthening their internal controls and in gaining a feeling of competence to deal with life's problem. Thus they develop a sense of mastery in both these crucial areas. Ways of achieving these goals are described.

Intra-epithelial mast cells in human airway epithelium: evidence for smoking-induced changes in their frequency

A morphological and quantitative study was performed on the respiratory epithelium of human distal airways in 20 lungs removed at operation for the treatment of carcinoma. Using 1 micron araldite sections stained with Toluidine Blue for light microscopy, with further electron microscopic study where required, we have described mast cells in the epithelium of bronchioles, terminal bronchioles, and respiratory bronchioles. Examination of these cells at both microscopic levels demonstrates many of the typical features of mast cells--namely, metachromatic granules on staining with toluidine blue at light microscopic level, surface microvillous processes, and numerous dense intracytoplasmic granules with a whorled substructure at electron microscopy. Furthermore, we have identified cells devoid of granular material which may be recognised as mast cells by virtue of their nuclear and cell surface characteristics--the occurrence of a spectrum of change between those cells devoid of granular material and those with full granule content; and a few cells in which we found both typical dense, whorled granules and large lucent vacuoles devoid of such material. Quantitation of all respiratory epithelial cells by light microscopy shows that mast cells comprise 0-2% of the total population. A higher proportion of mast cells was found in the epithelium of smokers than in non-smokers. Because of the presence of many epithelial mast cells devoid of granule content, we suggest that the use of traditional 4 microns paraffin sections stained with thiazine dyes to study mast cells would lead to a marked underestimation of the epithelial population.

Punk rocker's lung: pulmonary fibrosis in a drug snorting fire-eater

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Bronchial needle aspiration in the diagnosis of bronchial carcinoma

Sixty consecutive patients with central bronchial carcinomas were studied by fibreoptic bronchoscopy. In all forceps biopsy and bronchial needle aspiration were performed, and in 54 bronchial brushings were obtained. The combination of bronchial brushings and forceps biopsy diagnosed bronchial carcinoma of a defined cell type in 80% of patients. Bronchial needle aspiration was the most effective single technique giving a cytological diagnosis in 80% of patients, and when all three techniques were combined the positive rate increased to 92%. No major complications occurred using bronchial needle aspiration. Needle aspiration was particularly helpful when sampling from lesions in the upper lobes where forceps biopsies were technically difficult, from tumours lying submucosally, and from abnormalities caused by extrinsic compression. We conclude that bronchial needle aspiration should be used routinely, together with other sampling techniques, in the diagnosis of central bronchial carcinoma with the fibreoptic bronchoscope.

Pneumoconiosis of shale miners

Four patients are described in whom pneumoconiosis was diagnosed towards the end of a lifetime's work in shale mines. All developed complicated pneumoconiosis, diagnosed in two cases at necropsy, in one by lobectomy, and in one radiologically. Two of the patients were found at necropsy also to have peripheral squamous lung cancer. The clinical and histological features of the disease resembled the pneumoconioses of coalminers and kaolin workers and the lungs of three of the patients were shown to contain dust composed predominantly of kaolinite, mica, and silica. Shale miners' complicated pneumoconiosis has not previously been described. Although the British shale industry is now defunct, oil production from shale is expanding in other countries, notably the USA. It is suggested that control should be exercised over dust exposure levels in this industry and that epidemiological studies should be carried out to quantify the risks of both pneumoconiosis and bronchial carcinoma.

Relapse of fibrosing alveolitis (desquamative interstitial pneumonia) after twelve years

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Use of behavioral measures in anxiety research

While behavioral-observer ratings have been routinely used in anxiety research and, in particular, to note changes as a function of treatment, mixed findings have been reported. This study attempted to delineate specific behaviors which differentiated individuals who were highly prone to experience anxiety in a speaking situation from low prone individuals. No over-all differences on the behavioral measures were found between the two groups, and there were no consistent relationships found between the behavioral measure and other measures of state anxiety obtained during a test speech.

Aetiology of unresolved pneumonia

Preoperative histological or cytological confirmation of a diagnosis of bronchogenic carcinoma is not always possible, so occasionally non-neoplastic lesions are resected. Of these lesions a significant number are described by pathologists as 'unresolved pneumonia'. We studied the case notes and histopathology of 30 patients from whom lung had been resected and which had been classified as pneumonia. Other non-neoplastic lesions, such as pulmonary infarction, bronchiectasis, and tuberculosis, were excluded. All had a preoperative diagnosis of probable bronchial carcinoma. On review very few appeared to be the consequence of an infective, pneumonic episode. In 11, foreign material was identified, including one typical example of a paraffinoma. Aspiration of foreign material may lead to a localised lesion which simulates carcinoma of the bronchus both clinically and radiographically.

The malignancy of bronchial adenoma

The literature on bronchial adenoma has been reviewed and controversy found to exist about certain aspects of these tumors, particularly their malignancy. A retrospective study of 79 cases managed in Edinburgh since 1946 is presented. Seventy-one were of the carcinoid type, 7 were adenoid cystic carcinomas, and there was a single example of mucoepidermoid carcinoma. All types show a definite malignant potential, greatest in the rare mucoepidermoid tumor and least in the common carcinoid variety. Adenoid cystic carcinoma occupied an intermediate position in frequency and malignancy.

Subanaesthetic dosage of Althesin as a sedative for conservative dentistry. A controlled trial

A randomized partial cross-over clinical trial of two intravenous techniques for outpatient conservative dentistry was performed in 61 patients. Subanaesthetic incremental doses of Althesin were used at 52 sessions and a single sedative dose of diazepam at 45 sessions. Each technique produced similar cardiovascular and respiratory changes. With Althesin, recovery after operation was more rapid and there was some evidence of a stronger anxiolytic effect and of less frequent and less severe thrombophlebitis. In contrast, Althesin was sometimes associated with jaw tremor or shivering and was less frequently mentioned by those patients who expressed a strong preference for one of the two techniques.

Physiological/pathological correlations in coal workers' pneumoconiosis

There is remarkably little information about the direct relationship of physiological abnormality in coal workers' pneumoconiosis with structural changes in the lung and there are major difficulties in attempting such a correlation. The general population, including coal workers, has a regrettably high prevalence of pulmonary functional abnormalities attributable to chronic bronchitis or to emphysema occurring either separately or together. The pathological basis for the functional impairment in chronic bronchitis and possible functional sequelae to the anatomical changes of emphysema are not clearly understood, making it extremely difficult to identify separately the functional effects associated with coal workers' pneumoconiosis. Any study of coal workers' pneumoconiosis must take into account the background population. The published investigations relating the functional abnormalities and pathological changes in the lung in coal workers' pneumoconiosis are reviewed. The relationship of functional change to emphysema, chronic bronchitis, cor pulmonale and the specific lesions of coal workers' pneumoconiosis are dealt with. There is great need for further work in this field, both in the form of simple studies of pathological changes in miners' lungs as well as more complex attempts to correlate such pathological surveys with physiological abnormalities in life.