Document 6425441

Transcription

Document 6425441

MONDAY, JUNE14
TUESDAY, TUNE 15
(Occupational and Drug-induced Lung Diseasecontinued)
New Frontiers in Bade Science
Morning
EVALUATION OF y6 T CELLS IN PATIENTS WITH PULMONARY INFECTIONS
CAUSED BY MYCOBACTERIUM TUBERCULOSIS AND MYCOBACTERIUM AVIUMINTPACELLULARLE COMPLEX
I..ni..n . D . S H t i a of
ad Crit1c.l ?,r.c
with.
Y u t V i q i n L . Ol1.rrrie School of Medicine. k r y n t o m , Uest V b i n L .
TubecmlmL (includiq a r c r r l o r u a i t L d * r c u l w
p r M i t L ) .d -L
( h e w Tcaukei a t l i o a i m ) are
tb w s t i p r r m t rupiratory d l n u u in tL. Trmsbi in southera
U r h account* for a Mjor pmportia of the couotry's re8piratory
w mtrllq ad m r b m t y .
mmpintoq m c a . pdmnu-y k t i a e u t a . ad f l - l 9 .
mu
r
r
t a t d i d in fau bnndrd nunl Soatberm Afriua fin
tb maushi. Xbm mbjects a n l i v i q d wckiq in d-ulld traditional
hL.a d
to UCh I m l of indoor p o l l n t h r u n l t *
f r c l gtc
f m Moru fwl d for b a t *
ad eootis(l ad d x d drst f r o
s r i d h g r L u . Ilu population na folloml-up one par after the i o i t b l
atndy. Ib. rua t o w dost emcantration h i d e t b huts u 13.00
4cllbL r t b r . Ilu m u m clrbao laoxid. 1me1 in ch. bate na 366 part
per millIQ.ad rua sdfur diodd. 1-1
u 43 p u t per Dillion.
98x of cb. t o w dMt in tb L.u u rupimble. A l l f o d u p i n t o r y
idiru h-tin
subj.0- UN s w h . . t l y lor@ than the
..or..9.
L . p i r a c o w - ~ r o r~ c m d l .
pblem, bream-.
ad n a u l mror)L the a p m e d f a r m wn a i @ f i r m t l y M g b r
eh. tb e m t r o t . Tbrr u m i e F f i r m t d i f f e r a c e in the d rate
of &el*
of f o r e d u p i r a t q iadicu h t m n th exposed farrsra d
CL. CRtTDls. abstcmEtiw p a t t a m Of f l o r r o l l l . "
.nu hn. b.an
folrd
hut d u l l o n .
lbs r u r r l u Wiuta tb.t oecuprtimal -re
ad d-td
pollntioo hm a i a i f i u n t m f f c t s on tb lw of the e x p o a d f l a r s
L ch. Traasbi &o ua a t r i s k of d w e l o p i q l i r f l a obstrmctioo.
-
-a,
HIGH INCIDENCE OF MALIGNANT P W R A L ME3OTWELICM IN HETSOVO
(GREECE) FROM NON-OCCUPATIONAL ASBESTOS EXPOSURE. TOYARDS THE
END OF AN EPIDMIC?
S.H.Constentopoulos. J.A.Qoudevenos. J. Kalousls
University of Ioannine. Department of Internel Medlclne. Pulmonary Section. Ioennina 451 10. Ioennina. GREECE
Inheb~tantsof
Metsovo
(NorthJlest Greece, populatlon
5 000) have been exposed to asbestos slnce childhood from use of
a tremollte contalnlng whltewesh Thls materlal was used by most
ell households untll 1950 end slnce then gradually abandoned
The use of thls whltevssh has resulted In endemlc lncldence
of pleural celclflcatlons (46% of edult populatlon) In 1987 we
reported thet there was also very hlgh lncldence of mallgnent
pleural mesothellma ( W M ) ( 9 H
Constantopoulos. et el Resplration 1987) Based on 7 cases of ltPW In 5 years In a populetlon
of 5.000 we estimated a 300 fold Increased lncldence of WM.
than thet expected
In
a non-asbestos exposed
populatlon
(l/mllllon/year) Prlor to our study there had been no reports
of MPU In the area and we were able to find only one such case
before 1981.
Since 1985 we have dlegnosad only 3 addltlonel cases of
m s o t h e l l u w ( 2 W M end one peritoneal mesothelloma) (Flgure 1 )
Three ceses In 8 years represent a much lower lncldence than
whet we had reported for the perlod 1981-85 ( 7 cases In 5 years
vs 3 ceses in 8 years) Taklng lnto account that the fact the
tr-llte
whitewash has been gradually abandoned we may agrue
that we ere near the end of an epldamlc of W M from non-occupational asbestos expsure In Uotsovo
F i g w e 1. Cases of malignant mesothelloma from Metsovo (1981-92)
Masami Ito,MD,PCCP, Shoji Hashimoto,MD, Takashi Niju,MD,
Toshihiko Yamaguchi,MD, Toshiyuki Ikeda,MD,* Akihito Yokoyama,
MD,"
Soichiro Yokota,MD, Keizo Noma,MD, and Saburo Yano,MD.
Dept. of Internal Medicine, Toneyama Hospital, Osaka; *Dept. of
Internal Medicine, Kinki Central Hospital, Hyogo; **Second Dept.
3f Internal nedicine, Ehime University School of Medicine,
Zhime, Japan
Although most T cells express the at3 T-cell antioen receptor
(TCR), there is a small population of peripheral T cells bearinq
the 16 TCR. Recently, increased attention has focused on the
role of y6 T cells in the i m n e response to Ptycobacterium (M.)
tuberculosis. However, little information was available on the
y6 T cells in patients with mycobacterial infections. The
,,ieserrt study was designed to evaluate the l=cz:s of r i T cells
in patients with M. tuberculosis and in patients with M. aviumintracellularle complex (MAC). Peripheral blood samples were
obtained from patients with pulmonary infections caused by M.
tuberculosis or MAC, before and/or during chemotherapy using
two or more drugs. Control subjects were either free of disease
or suffered from mild hypertension with or without old tuberculous lesions. Blocd y 6 T cells were measured by the immunofluorescence assay. Briefly, 100 ul of blood.sampies were incubated
with 20 u1 of phycoerythrin-conjugated anti-CD3 and 5 p1 of
fluorescein isothiocyanate-conjugated anti-TCR61 (specific for a
6 chain framework determinant and representing a pan-TCRy6
marker) at 4'C
for 30 min. After treating with NH4C1 to cause
hemolysis, the blood samples were analyzed by flow cytometry.
The results showed that both untreated patients with MAC and M.
tuberculosis had significantly increased levels of y6 T cells as
compared to patients with drug-resistant MAC or M. tuberculosis,
and control subjects with or without old tuberculous lesions.
There was no difference in the levels of y6 T cells between
patients with druq-resistant U C / M . tuberculosis and control
subjects. In conclusion, the present study suggests that the
enhanced levels of y6 T cells could be related to T-cell
activation by mycobacteria-ligands during the early phase nf
mycobacterial pulmonary infections.
(Supported by grants f m the
Osaka Foundation for Promotion of Clinical Immunology and the Os&a
a,-ociation for Tuberculosis Research)
CYTOTOXIONATURAL K l W R CELLS. NAIVE/UEUORY SUBSETS.
G A M W E L T A T CELL RECEPTORS AND ADHESION MARKERS IN
TUBERCULOUS PLEURAL EFFUSION.
TK I im*, BW Lee+. CC %ah+, NK Chin*. SC W a g + & FL Sinl.
Deparbnents of Medidneb & Pediabicst, N
M Universay Haspital and
Departmentof Medine# Alexander Hospital,Singapore0511.
We weluated T d l subsets (CW, CW, 8 CD8), activation markers (IL-
2, HLA-DR), natural Mler (NK:CD16 + 58) end cytotodc T cells (CTL: CW,
CDl6 + 56), T cell recaptoc (TCR) subsets (alpha/beta versus gsmma/d6tta),
propwtion ot memory (CWSRO) venvs naive cells (CD45RA) and surface
adhesion molea& [LFA-lalphe(CDlla), LFA-lbeta (CDl&), W - 1 (CD54)]
hthe~fiuid(PF)and+blood(PB)of16~withbderadous
pleural effusions. Lymphocytes were stained with mebs and read by 2 d o r
Row cytometry. Thace was a Mnificantly greatec CM/CDB ratb and CTL (as %
of CD3 cab) in PF than PB (p<O.Wl). There were signilScantly lower
proportion of NK (% of lymphocytes)celk in PF than PB @<O.Wl). The TCR
(alpha/beta versus gamma/delta as % of CW +calls) subsets were present in
the samo pmpmtim in PF and PB. The adhesion merkers were posltivs in a
s i m i l a r ~ o f C W + c a l l s i n P F a n d P B .ThemeanchanndRvoreecence
intensity~CCDllaandCDl&wascJsothesameinPFandPB. NaiveTcels
(as % of total lymphocytes) were significantly !ess abundant in PF than PB
(p<O.Wl) while rnemwy T c& were signiflcanthl greater in the PF @<0.03).
We condude that tuberculous pleural emsiom are asociated with
wmpartrnentalirstim of T helper/inducer cell response with relatively greater
memory than naive csUs and more cytdoxk T cek but less NK csgs than PB.
W e was no inaease in the proportion of T cells with gamma/delta TCR or the
number of LFA-1 end ICAM-1 adhesion markers on T W.
(NUS grant # UP 900310)
IWI-82 91-04 63-M 81-W W-W 91-92
Abstrect$XVll World Congress on E%ass d Um Chest
Downloaded From: http://journal.publications.chestnet.org/ on 06/09/2014
TUESDAY, JUNE15
PPD-SPECIFIC
CYTOTOXICITY
THE
IN
.
I)+RR(E
.
.
Venture P.A. A .N. '"", Nunn P .' Nyangoto E! McAdam K. P .W.J .' 6
Dockrell H.U.' .
'Clinical Sciences. London School of Hygiene 6 Tropical
Medicine, London.
UK;
'Clinica
dns Dobnqas Tropicals.
Institute de Higiene e de Medicina Tropical, Lisbon. Portugal;
'Servico de Pnerrmaloala. HosDital Eaas Uoniz. Lisbon. Portuaal;
~elc& T r w t ~ e s e e ~ cLaboiatorlei.
h
Nairobl Kenya.
'Kenya lledical Research Institute. Nairobi. Kenya.
.
Antigen-specific
cytotoxicity to mycobacterial antlgens has
been demonstrated in a number of recent studles. although it
is still not clear if such responses are protective or
harmful.
PPD-stimulated peripheral blood lymphocytes from
healthv BCG vaccinated donors. showed an average of 50 %
specific cytotoxicity against PPD-pulaed autologow monocytes
Cytotoxicity was reduced if the
in a "Cr release assay.
effector cells were depleted of CD4' cells before stimulation
with antigen.
Patients with clinical tuberculosis (TB) tested
in Kenya, whether seropositive or seronegative for HIV. did
not show PPD-specific cytotoxicity.
These patlents showed
strong
lymphocyte proliferation
responses to
PHA.
but
responses to PPD
were reduced when campared to healthy
controls. and although these responses were still more than
thirty times the background values. Analysla of proportion of
T cells bearing a0 or y6 T cell receptors, present In the
peripheral blood of HIV-infected lndivlduals. demonstrated an
A lesser Increase was
increased percentage of ' y 6 T cells.
seen in TB patlents seronegative for HIV. As these patients
failed to demonstrate cytotoxicity. it seems unlikely that y6
T cells are functxoning as effector cells in this system.
It was thus demonstrated that PPD-specific CTL were present in
indrvlduals with
blood from healthy BCG vaccinated donors:
increased exposure to B. t u b e r c w showed greater CTL
activity.
Individuals infected wlth I
(
.
and/or
HIV failed
to shau detectable
cytotox~clty. under
the
conditions of thls assay, although a proliferative response to
PPD was still Dresent. Such CTL function. m d l a t e d bv C D 4 a0
T cells. may be a vital part of the protective rebponse to
tuberculosis, whlch is lost early in HIV ~nfectlon.
RESPOWSERONC)(O-VAXONYOWLATE8 THE TRANSCRlmON OF
INTERLEUWS AND TRANSCRIPTION FACTORS IN H U W
LUNG FIBROBLASTS. M. ROUI P M ~
R. W U D ~ E.
. Pammn~lmtkarR D ~ .
M. Sol61 MD'. LH. Bba @ nd A.P. Pufudmd MD1
m d h N l m k g y . ~ d ~ ~ n d - .
Kullonm~UBaal. CH-1
Baal.
2 Pumdopy. DepuVnnt of
l n t W M d i c h IV. Abanmha KmLmhur WINI. A-1090 W*n, AuMa.
Irn-rn
agwU u %oncho-Vuom (OU-85 BVl a m u s d In thm
thw.py of h*ctlous
of thr Icmg. OM.85 promotes thm
of
resbMa~htuUon.by~hortnponururduMclboc(rpodu&ion,
generation of c-ci
cs#r and .~ w t w m m n, h u been rrpohd that
OU65 b clp.W a hduo tw sycuhrr* ol rlnlerhron. tumor nomods factor and
in-ukln-2
(IL-2)in perph.rU blood a.
However. the mochaof
r*bn ol OM-85 II wknom. W e hvutlgnod wg0-e
polencln ol vulous
immunmobll(w~wcWvtlurbsYvdOU-85aroduWIh.Iruuulc(lon
and . c m r ~ o a
61I L 11.0~ mi ~ F - oThiw
.
m e ~rm
p*r an hponmi rob h
th.~norerpwea~wvhlhkcllonr.ln~,waInmlg.*dthr
brm~nma*dmRNA(och.-IrmC-FOSandGJUN.Omw
l m ~ -0B wrbmwd
aMol hi ImmubWl d IL.6. ILd and -?NF-a.A
wuertnaedndvuryoedbyNommndlo(.OM-SWtwwiond:(i)
c-bs wlth r mulnul 10 x anlunwd m w u l @ o n (w irons) at 30 mh.. (Y) IL.6
(mar lrrnr 15 x . at 4-8 hrr) and (lU)lL-8 (mu trMs 9 x; rt 8.8 hrs).
Fwh.mwre, h. mkdption d bolh itlWrim&kU *nr WmpbUy .boYlhed by Ih.
sddltion of 8 C-FOS inNbimc, but no( In thr peaarm ol an inhibltoc of C.JUWAP.1.
Tho conrUtuWe Iovd d tmCodpHon d c-jun w u not merwi by OM-85. Tho
( R I I I Q P ( i o n d T N F ~ m Q n k l 2 x ~ ~ n b O b b ( M d t W ~ ( r t l 2
hn). S y n W nd swwbn d IL-S and 11.8 waa drYrmlned by EUSA. The uctrclon
of ILB
4 r al8 hr8 .tYn h. h r W n d OM-85.* h r e ~h. u~eclonol
IL-Shcncsed 6 ~ . 1 1 0 - 1 2 ~ . ) l u r t m U l r ( l o n . ~ R s u f f l ~ t r . l r 1 h r t
I n d W of Uw vYlsorpoon and WumbWm, d IL-S and IL-8 by OM-85. R.pudhg
b b C.FOS MdnO (SRE) DNA.MI Vwir
t.a* ha 0 ) Om IU
pomo(ocragioa ( I i ) t r . r c s a p t i a n d ~ . b a b ~ b y O U . B S . a n d ( i i ) I h . t t l u
- -
O M - 8 5 - tnmcrip(ion
~
of boUl ILI b rbdbhed in lhe prrsmm 01 C.FOS
InhWoc. wa cwkrg h
t OM-85 uO do rPmulrW d C-FOS. Funher sl&
should hwHigaM thr
Of OM-85 and me oM-B5lnbced signal
prmwrv.
PSEUDOMONAS AERUGINOSA PIGMENTS INCREASE NEUTROPHIL MIGRATION
IN VITRO
GJ Ras, R Anderson, G Taylor and PJ Cole. MRC Unit for the
U b r t o 0intt.i P.h.D.(Z)
hmm Dm ~
c I.D.
~ Study eof Phagocyte Function, University of Pretoria, South
brio M u m t i I.D.(l)
Africa and the Host Defence Unit, flational Heart and Lung
(1) 0i.nb.fti.t. Mia I.D.(1)
-do
m
m M d o M.D.(l)
Institute, Brompton Hospital, London, United Kingdom.
?-to
*.lela I.D.(l)
Rourio LO(IPPD I.D.(l)
Milration of inflammatorv cells from the intravascular cornpart(1)
.A. lhlntdo.
LUCO
Itdl
mekt lnto the lung 1s an-essential pulmonary defence mechairsm.
(2) mivmmity Y mi-llor Italy
In patlents wlth chronic Pseudomonas aeruglnosa (Pa) lnfectlon
of the lung persistent production of neutrophil chemoattractXbm pusum of 7
ad tbe &ti=
of Um TCD4 allw r r r
ants could stimulate a chronic inflammatory process with hostnoticed &dog tbe tubaculaiw mmifnt.tim.
mile rcordfnp to t h r i m e
mediated damage to the bronchial tree. We have previously reit is aarddq. esbb1i.b.d a pmtretim role to TCM wllw, it is m tbe
ported on the in vitro effects of Pa-derived phenazine pigments,
pyocyanin (pyo) and 1-hydroxyphenazine (I-hp) on neutrophil oxiin tbe ~IDWI b~boreularim. It is
cmtru). tmb&m the hmetim of tbe
dative metabolism, degranulation and oxidative inactivation of
r l l M.
Atawd, U u t t h d+.
a tl* ~
~dme m a
tv i w
.
alpha
I-protease inhibitor. In this study the effects of pyo
prorid. bth TCD4 .ad ?cm . h i d 9 prot.st tba im mi. di.au. u8 -t
to
and 1-hp on neutrophil chemotaxis, intracellular Ca mobilizapoht w t t h clinic ell... of f l w ptiat. affectA by maumlfubsrcularis.
tion. alterations in membrane Dotential. leukotriene 84 (LTB4t
of alt.rrtim of t h collua~;ho of tb.u
-tiHnt, with cltnic a*
prodbction and prostaglandin E> (PGE:) production by neutroptienta hum Nwaled d d u m a of tbe ? a 4 I.d Tcm in u o c i s t m with
phils were investigated. A modified Boyden chamber technique
was used to measure chemotaxis and the results are shown in the
iolat.d .trdmdrtylis ad bm p..8t.de
clinic mPu .hi&q be
table as mean + standard error (SE) of cells per hlgh power
cmidmd rlmia tbe m t of -icy.
Tm otbar t k w e ptiate F l r W
field. f-met-Teu-phe (FHLPI-iO nM was included In the bottom
bm rmrld, not olj UN P.chrodrtyli.,
r v i a r eigr of altultim Of
chambers and pigments were present in both upper and bottom
t h c o l L O a ( - l u a u s Of th .rtinrL.tiar.
hl&b m
t..ad
chambers.
scoliaie) md a penis-t rs&oUm of Tcm in the p.rifaic blood, with
mrrl m
e adc-1
utivitir, but alw p.Sticulu ..rlourwu Cells only
4+1
Cells only
4,i
Cells + FMLP
4724
Cells + FVLP
49-12
Of the clinic original mru with clinic N d i 0 l ~ c r lnalutirn . N o h .y
Cells + pyo 2 5 un
3-1
Celle + 1-hp 12.5 un
7.8
b.cor ohraic. Ru
Of
.1p.-tic
rutoss ( d r y
Cells + pyo 12.5 uU
4+2
Cells
1-hp 6 uw
4T1
.ddictim. uguired i.lmodeficienty,
) panrW u to mr that tbe
Cells + 25 + P W P
80f10 Cells + 1-hp 125 + FMLP
96211
altultiap of th collaga~in cornlatian with t h Irhrtim of Tcm in the
Cells + pyo 12.5 + FKLP 9 3 ~ 4 Cells + I-hp 6 + FMLP
120+17
prifuic blood comtritute to UN nalutim of thil di-.
*. ngu&
-tiam
of Um Tcm. it adst s t
w i
a mMo om craPm t. (
role for
Addition of pyo or 1-hp to neutrophils did not affect transmembrane potential or mobilization of Ca from intracellular
wllw ia M c m r l a i s g . ltn
ow
p. 515.
1992). m fb.
pools. Exposure of neutrophils to pyo (13 and 6 uMl resulted
w
w p m t u t i n role of t h ?cm in tin -larim.
ltn hypotbtid
in complete inhibition of LTB4 production while I - h ~was with1-1
ia ptiaf. &a hum
8Irilu r l m t i m of t h m l m rL.o et
out effect. PGE? production was completely inhibited by pyo
a ldda .L.lmtdinTO1-t.
s w t e m to v w i f y thF. poribl. 1
s
(12 and 6 uM) but only partially inhibited by 1-hp.
l y w r g L . . ~ ~ t h ~ o f t h . ~ d i - .
we conclude that Pa-pigments appear to play an important role
in neutrophil function-and may-contribute to the chronlc Inflammation observed in the bronchial tree of patlents with
chronic Pa infection.
-
-
-
-
-
-
-
-
-
--
--
...
-
CHEST 1 103 1 3 1 MARCH. 1993 1 Supplement
1-
TUESDAY, JUNE 15
(New Frontiers in Basic Science-continued)
SIGNAL TRANSDUCTION OF FMLP RECEPTORS IN HUMAN ALVEOLAR
MACROPHAGES
M i c M Bdhm. Jingen Behr. Giinther hJwm.Peter Gisrschik'. Erland Erdmam
Wizinische Klinik I dsr Unibwsit8t MCnchen. Klinikm GroMsdem. MCnchen.
Germany. 'Deutsches Krebsforschunguentnnn HeWberg
CYFRA TM2 I.I :A NEW hVESllGAIX)N TOOL FOR LUNG CANCER
Introductian:Thn pulmonary alveolar m s c r m e is the lung's first line defence wainst
inhaled physical or onfectlow particles. One mechanism to initiate the M t i w t i o n of
rrkocddkr~dahadmlymlubkf~lpamsclabedaacdtuwn.
Commercially lvallsble. CYFRA TM21.1 is 1aew IRMA kicr allovlng a d i m l
alveolar macrophages is the stimubtion of receptors for the chemotactic peptide Nformylmethimh-Leu-Phe IFMLP). which is wxanpanied by an increase of nachidonic
acid rslsass, superoxide afum production and phagocvtic activity. In membranes from
myeloid differentiated human leukemia cells IHL 601, the coupling' of the FMLP receptor
to pertussis and choleratoxin-sensitive heterotrimeric Idly1 regulatory guanina
nucleotids binding proteins IG-proteins) is well characterized IGiwschik et al. J Bid
Chsm 264, 21470. 1989). Althwgh the knowledge of the- signal transduction
processes is of great pathophysidogical importance, date on h u M n alveolar
macrophages are sparse. The aim of this experimental study was t o characterize the
coupling of the receptors for the chemcdnractant FMLP t o G-proteina in human akvdar
macrophagas.
Human alveolar macrophages were obtained by routine bronchotllveolar
lavage in 8 patients. Only cell w s p e n s i w with a c o m M of mwophsges of greeter
than 95 % have been used. FMLPseceptors were characterized with BH-FMLP. FMLPmediated G-protein stimulation was studied with agonist facilitated 3sS-GTF'ySbinding.
G-proteins were characterized and covalently modified (ADP-ribosylated) with penussir
toxin IGil using NAD or "P-NAD as substrates.
BPUdll; In alveolar macrophage membams, 'H-FMLP l a w o~ h i ~ haffinity binding
site (Emax: 810 lmollmg protein, KO: 4.6 nmdnl. High affinity binding was markediy
reduced by 1 p-noln G T W . Scatchard analysis of G T W competition f u '5s-GTW
binding revealed a density of 21 pnollmg protein of binding sites. FMLP stimulated
binding of 3sS.GTPyS in the presence of GDP but not GTWs by a lector of 2.5.
Stimulation of 3%-GTPyS hnding by FMLP was critically depending on MgCll and was
reduced by about 70 % following treatment of t t membranes
~ ~
with pertussis todn. SIP.
labelling of Gloproteins demonstrated two pertussis toxin substretea (40, 41 kDa1
comigrating with ,,G
,
and Gat from HL 60 cell membranes and ventriculer myocardial
membranes.
SummanIn human alveolar macrophagas. FMLPseceptors are
CWW
to wrtuss~stoxin-ssnsitive G-protein *subunits, which are most likely identical
t o the penuuis toxin substrates in HL 60 cells and human myocardium and t h e f o r e ,
of the G,e and hsubtype. The Mgz* and GDPdependent GTPyS W n g to Gproteins following agonist stimulation might become a valuable t o d to study receptor-Gprotein i n t e r a c t i w and to elucidate pathophysiological mechanisms in human alveolar
macrophagas.
EVALUATION OF THE TUMOR MARKER CAI9
-9
I N SERUM AND TISSUE OF
PATIENTS WITH LUNG CANCER
. .
Y. lchi
K.
F ~ r s Dspartment
t
of Internal
c
'
'.
Medicme. Kwume University School of Medicine. Kurume 830. JAPAN.
Recently daveloped tumor marker CAI9 - 9 (carbohydrate antigen 19 - 9). which
was in~tiallystudled in gastro -intestinal malignancies. is known to be elevated in
the serum of part of patients with lung cancer. The purposes of Ulis study were (1)
to investigate relationship of CAI9 - 9 with lung carcinoma histological type and grade
Cy@kcdm~totbeInarmed&eRbmact.mily.?baecycoplrmk~.rr
wrunnenofcyotentia19l~inrm
T b e r p e d R c d c c c a i o a o f I h l s l ~b M k d a u b y t b r - d 2 m ~
urtlbod*rKS 19-1 mdBM 1 9 - 2 I . o b e b c d d k r ~ o f m k x w i U t M C F 7 a l k
I m m ~ m o d K m i i ~ a m e d w l t b t b a e ~ ~ c b c ~ o l c b c
~cy(oplrmddmpkcpithdWcdh.lvcll.linbcmcM.lepiQLhllupor~
OluLboclcayld.ba*IYpl*oowitb~~~cr~cr17.3%CES>IO
17.9%o f SCC >3.5 oghl d 7.5% o f NSE a20 n&l. In thh p r e l h a l ~Undy
~~
CYFRA Tu 21-1 wr assayed in sen l m m 50 bedthy ptkna M m c s o l k o
-1,
pulmavydbacadW~advcvmapecll~(26bdk,26-&
W i c h 1 r p c i & t t y o f 9 5 % ~ a u o f l n * e d M l U ~ 2 1 . 1b 3 . 3 r h h a w a i U v k y d
54%.For Ibc TPA the cut.ofl d u e is 178.5 Uhnl wilh 1muitiviw olU.S%. In I& ymc
GFPC :G m g F m p k & Fnauno.CmCrolqlk
Gnatl lmm CIS B i W d
GLUCOCORTICQID RBCEPTORS IN NONSMALL CEL& CARCINOMA OF THE
LUNG
P.T.Cegle,FCCP, D.R Mody, R Bmnn, MR S c h r a N
Departmat. of Pathology, Baylor Callego of Madidn. and Tha Metlwdbt h p i t a ,
Iiauton. Tema.
A&wauthormonal thernpb are used m x e d d y in wlslsted amhmm of the brsaat
and pmtate which erpress &mid holmone reaptom like t b w f d in the normal
o r g e ~ h m w h i r b t h e t n m ~ ~ o r i g i n e t Ideniifmtim~ofadagotnrseepLanin
e.
cuminof the lung wo~zldpdentially pmvida a bari. far @want hmmmd
thmapim in wleeted luug caum patieat.. Glnfocatimid mcapbm d t e the
emrarion of uRaa rhniobmiullr i m w t n s ~ a
in DPlmonan dtbakl cells
as well as (2) to compare values d serum CAI9 - 9 with the degree of tissue CAI9
-9
stain~ngby an irnmunohistochcmical procedure. We measured pretreatment CAI9
- 9 and CEA in serum of 40 patients (31M. 9F. age range 44
- 82. mean
6 4 ~ s wlth
)
Of the 40 patients. 35 patients
(88%) were classified as more than clinical stage II. The histopathological types of
lung cancer confirmed cytologically or histologically.
the tumors grouped according to the WHO classification, comprised 24. 8. 2 and 6
cases of admocaranomk squamous a U large all and small cell carcimmas respectively.
Serum levels of CAI9 - 9 and CEA were abnormally elevated in 25% and 50% of
patlmts respect~veiy.CAI9- 9 was significantly higher i n patients with adenocarcinoma
than In patients with other histological t w ( P < 0.05).The levels of CAI9 - 9 were
not mrrelated with ones of CEA In 16 patients with ademcarcinoma obtained histological
grading, the positive rate of serum CAI9 - 9 for well defferentiated was 67% : for
moderately dlfferentiated. 29% : and for poorly differentiated a d e n m i n o m a . 33%.
The labeled av~din- biotin (LAB) method was utilized for detection of tissue CAI9
-9
In adenocarcinoma cases. Conseguently, the all elevated cases of serum CAI9 -
9 showed positive staining of tissue CA19- 9. The results suggest that CAI9 - 9 may
be useful i n identifying the presence of lung cancer, especially adenaarcinoma.
ra-obtainsdhnm~beprimar~~;peeiman.ofl2prsriocla).rm~(ai~
stnon..m.d cell
d the lung. Tbae bdu&d 6 ad
mc, *
y ~ u u c a ; l ~ o ~ a n d 2 ~ d ~ d ~ 7 - ~ ~
TZNOMO and 1 m a hN1MO. The Datientd included 8 msn and 4 wmnea with an
e m m g d ~ o f 6 7 . 6 s e o r~ g l l m & k & b i Q d i n g p r o t 4 i M r s r a ~
nsinn an established ~relebeldsueme padisnt msthod and taitinm-hbehd
de&nabasone (C&,
hdody, Sch&m Res lW, M):669a). A mearkor
me on of greatar than 6.8 f m o b g cytceol protein nu c m d e d poaitiva
F & p o s i ~ ~ d n e t o ~ o r ~ r s d p t o r ~ r s n r n l e d m t b y
immmuAammgwith antrbodw to theea remptcm Eix(609b) oftha lungcanamrae
p i t i v e for gluma,rtimidrecqkmw i t h an amragw of 41 fmollmg egtaol protein and
a~ofl2to98fmol!mgcltosol,prptajo TheMdmervaWma~provideabaaia
r
o
r
a
d
j
~
t
~
m
t
h
~
~
a
n
~
i
n
~
e
c
t
e
TUESDAY, JUNE 15
2nd D.part.mt o f s u r g e r y , Univermity o f Vienna
-
Th. i n a c t i v a t i o n
of
the
tumr s u p p r o a s o r m n e p53 by
h t i a is na h#m to be th. most conon s t a p i n
6.tnlop.wnt o r acancor8. T h 8 u t a t i o c u u a C l U t a r O d
i n h i g h l y wncmrvd dcuinm s p u u l i n q f m u o c u f o u r to
n h . In l u n g
8n &3itiaul hot spot v i m f o r
-tia88 bwn 6.t.ct.d.
In o r d u to i n v n t i q a b tb. r o l m o f th. p53 m t a t i o n i n
s
-i
o f l u n g -,
u8
80 f u aruly..d 24
l u n g cucinau ( 1 1
all cucinmu, 1 c a r c i n o i d ,
s 1all md 7 = U r O i m m u ) .
*. uttac+.d
total
Rll& md DU f m f r v l r f r o m m t u i a l . A. c o n t r o l md i n
orb.r to dirtin(lui.h
-tic
f m purlin h t i a u , we
u s d normal timd pnipaarl blood f m ..ch p a t i o n t .
r o t . l m l A r u r m t w t r u a c r i b . d i n t o o D l A m d ~
np to tb. 11 am Of th. p53
DU ru d i m l y w l i f i d . Be=
..plwncing u8 p u f o r n d s i n q l e s t r u r d c o a i o r u t i o n
po y.xhi&
-1u a
f o r -ti-.
~ h .
t.cbniqma is
on ttmZFEat
a mutation i n a
p a t i c u l u -ion
of
w i l l a l t u tb.
or
t e r t i a r y stnla3mm Of th. W1.Nl.
which un th.n b.
tad a l w o a l l y from norm81 MIA.
a T w i l d typ. p53 mqumas *.t. found i n no-1
tissue
md p.riphurl blood Of l u n g -r
patiart., i n d i c a t i n g
that th. p53 -tiu8 found i n t m r t i u w (11/24) a m
em-.
-tic
*)YIY.
i n Otb.r ~ l i q m n e i u
TlB &"LATI(ILPHIP
CUlR&IXO W S 3 U l OBO'RB BOBl01 ( all ) L79XIb
m PPISSGPR YITB limo cum
I. Ura, 5. Durli, I. hey, A. l e r ~ a o l o ~ l u0611l.
.
BYtaUlui
E m t a r s i , Inir, Turry.
In t h i . at*
w . l u d t o duoamtratr th. rulrtioo.LJp botuo*n olu55bag
a d s a w OB l s v s b L l a g o e o o r pati-.
Y. p u f o r u d t h e mtudy a:
40 p
w l w ~ #oolou p a t i m t a Ln whom w diu1108.d the m.1IQI~oy by
r a r i o u eethodr. In 20 of 40 patimtm olubbhg rum rtLtina. Ph. other
20 who didnot h.rs olubbla# rrrv tern u th. o m t r o l coup S u u a OE
levalo wore i n r u t i g . t r d tgr ~ d i o - o m q
~n both g r o u p . 4 l a k l r d
a:! had k e n ~ i v mi a t r a v m o u l y and t h i . u u fo1lou.C by t h . I V &hi.t r a t i o n of 08 mtihcdy. S u m OB l a v s b r u a d s t u n l n s d bll r v u r i n a
tho labolod md m l a k l e d m t i a m i o ooeponmtm r i t b i a the innun oonplsxom
ln non of the p a t i . n t ~ merum OiI I r v e L r u m h i g h t h e the normal b i g b u t
V J ~ W which i
. 6.5 =/el.
I n the f i m t (roup uhioh ru o a s b t s d d lung
omoar pa:i.nta u i t h 01ubbkrC the r m 1 . 1 ~
of smu OE I s r 8 l vn.
2.612 1.36 ng/ml, w h u s r tho a u l . value rur 2.36+ L ~ 4.1
Y
a t th.
m8oond eroup.Ke r u e raable t o fiad a m U n i f i o e t diffsrsnoe batuosn
tho two gro-f
p)O.O5). Although it i~ o l r i w d tgr a n u b o r of authorw
t h a t sotopio OE is k i n g m e ~ r a t dh tLa patimtm u i t b 1-8 -Cop,
amp.oially in th. g r o u p rho have oat 0.11 owinoma, .d.noouoLnou mad
l m g e 0011o u o L n o u t h u v ara mom8 ruultm a t t h e opposite aids of thL.
findins. Aa a o a o l u i a we o m m q t b t it L p a m i b l r t o find msrua
On 1sv.t rabd h m
m lung o m o u patiant. a d n o r u l Ln mother
WOUY.
u c o l o n and b r a i n
truYitiom .n tb. &dnult h t i o n , u8 found G:C
T:A
t r u u v n r i a r m to b. th. m o m t f r o q u m t b...
OUY).r
to
.ub.titution i n l m q a n c u .
In vitro .rpaM patuleta
th. . u o c i a t i a
of
~ . m r i ~ cuoinogw
1 9
l i k e b m r o p y r a a w i t h G-T
trummrsi-.
(ku data d o r m w i t h t
b..w .rp.ri.art. u w found mat
q 8 u -11
u h i m t o r y of d i n g u u e u8ocietd w i t h the
ccmxwm8 Of -tiom.
n me DIPFEREN-~%LDIAGNOSIS OF S O L ~PULMONARYNODULE
GY
Aldn huuhrhl. UD..FCB ud Ann V. LeFever PhD. Thc Mcdiul College of
W
i ud Vetcnnr Affairs Medical. Ccnur. Milwaukee. Wtrconrin. U.$A.
Dapirc che recent d v u r m in d i a p x t i c proocdura, a solimy pulmaury nodule
(SPN) o f l a p s c n u a dignostic challenge to clinicians. When then is no previous
chest y n t g e n o g n m ( s ) avnilable for comparisoa and the result of CT-scan is
iad*cmunue
for k n i n n ~ ~ofvdK luion. invasive D ~ O C ~ ~ U sueh
ICS u a fibmtic
bronchosopy (FOB) d m o i n s h n x k mcdle aspvadon F A ) uchs oftcn employed.
Although rherc proccdum havc lmpmved the ovmll diagnosw yield of lung k u m , the
etiology of SPN rcnuins undcurmincd in a signtficant number of woenu. B s a u a~
Iarne &%omoin
of SPN's rcmsenu miman, luin cancer. and ~atieniswhose lunn cancer
prcrcnts'u SPN have the 'best chdnce of achieving long urm survival by ;urgtcal
rrscction, a "wauhful waiting' apprmfh is generally discouraged and an aggrcsrivc
e m w c b , i.e. a lhoraeotomy is recommended if FOB or M A fail to provide a defin~tive
dknosk. However. io & arb u &u
who uc under 40 ~ n ' o f u xa. I&
leu
&
I 2 m in d i m e t a , patunu wiih t d v d age MCI pabents w 6 have limited
pulmaury m a ocriau f a r d i o v d disuse. a d u l follow up with s c d cheu
nxnmonnmr m a y be justified. In these siautionr it would k very useful in clinical
In che mu& of our study of the b d immunoregulauon of lung m a ,we have
plcnauly obremd thu the p m s a g h d n 8 2 WEZ) m m t of bmchdwdar lavage
fluid (BAL-fluid) obtained at the ininal diagnostic FOB is uniformly elevated as
annoad to wticnts with nonl b n diwaces and n
d cbnoplr Chest
19!3& 98:139?-02). Funha obsmvuion in a l u ~ u e n rndy
t
imolving r
n
b
d p1;ient.s with lun unar w u consisunt with OUT initial obsuvu~on. ( A x VRupv
Dir 1992; 145:~42&. l h a c Thtreobsel~wnrs m g l y ruggeucd Ihu FGE2 content of BALfluid can k wed u a rclirbk NrLIOr nmrku in 6di&aenIid d i a d s of lunn lesions.
In thc Istud we invutigard the vallr ofPGE2 in the &alu&m of S P N ~
Among dK 1 5 puicnts who uadcnvent dignostic FOB benvcen lY9187 through
119192.28 fulfikd a a i h f
a SPN. A pcues8di.macr of 4 cm was used u the u p
limit to define SPN. These 28 wtients wac divided into IW wum. Groue A twisted
of 20 puients with prirmry lung cancaand Group B consisledof $ patienuhth d i m s
M h a than lung canca. Age and smoking h i n a y w r c similar between dK two groups.
FOB or TNA established a diagnosis in 14 of Group A and 2 of Gmup B but a
thorscommy was required in 6 of Group A and 4 of Gmup B patients. Two patients in
Group B who rcfuscd lharacomy showed regrcsicm of the lesions in subsequent c k t
roentgenogram. Had t h u c 2 patients consented for thoncotomy. 6 of 8 atients in
G m p B would L v e h d a h n b x l a n y . FGEl in Group A was 193.7 f 113.7 pg/rnl
(range 47.9 to 470.3) md 22.5 i 9.6 pghnl (range 8.9 to 38.5) in ( i m p B. This
diffmnce waa m h s h d y lughly signtficant aod lherc was no overtap. If w used FGE2
m m t for diagnosis. then we warld havc m t l y di.gnosd all 8 patients in Grarp B
u L v i n benign d i r u r s We amclude. lhudac. that PGE2 conlent of BAL-fluid is a
very usc!ul m-specifi ~ r mh
r a in the evaluation of SPN.
.
A COWPARATIVB SNDY O? ulmQ A W I T Y IN LWE TISSUE
OF P A T m S VIlll SQUAWUS C W W W i CANCER UNDBXOOIM
PUU(0NARY m s B c T I O Y
Dept. o f hiul Phymiology, U n i v e r s i t y of Vroolaw. V r o o l a r . PL
Dmpt. of I h o r a o i o Sureor)., W r o o L r H a d i m 1 & h o o l , Vroolmw, PL
Tho i n v o s t i 8 m t i o n of m o t i v i t t and a o m r t i o s o f e o i d and
aI*.lrnm
phompiiatmeom, ~ n o m m i opyro&ooph.tmeo. 5'- n u o ~ e o t ~ d u m , fruotose-1,6-dipboapb.tese & u i n o t r u u f e r a a e m /&I*?,
*#PAT/ i n h a o g u u t m m of no-1
and n w p l a m t i o pulmonary t i a m w
o b t a i n e d I r a p a t i u r t m w i t h w q u u w m o m i ~1&noor was porformod.
f b o s t u d y ~ r o u po o r u i e t o d of 26 pmtimnts t r o m t e d I n t h e Dopartmoat of f b o r 8 o i o Surgor).. Vroolaw Uodioal Sohool, Vroo law,
betromn M r o h 1990 .nd J a n u r w . 1992. A 1 1 tho*. p a t i e n t s ware
man, y o d 49 i o 69 y o u * /mean 57.5 yoarm/, w i t h h t m t o l o ~ i o m l l y
provon d i w n o o i s of mquuoum 0.11 a a r o i n o u , S t y e I
17 pat i e n t ~/65.C$/,
Sty* n
3 p a t i e n t . / l t . 6 V . S t y o 111.
)
p a t i e n t s /19.2$/,
and S t w e I I I b
one p a t i e n t /3.8%/. A11 pat i u r t a u n d o r r u r t p l l w a u y r m e o o t i o n , i n o l u d i w pnoumonmotoq
i n 12 oasom / 4 6 . 2 U , l o b o t o q i n 11 p a t i u r t m / 0 2 . 3 V . and 1 1 m i t s d mureory / i . m .
r e * romootion/ in 3 o a a e s /11.5$/.
semplms f o r dotmmLnFly 8 a 8 y u t i o a o t i v i t y r e r e o b t a l n o d from
poatoporat ivo m p o o t u l u .
R m l h i n 8 r y r o m u l t s M i o r t e t h t a o t i v i t i m s of i n o r ~ a n i c
p j r o p h o s p h a t a s s i n l u n g trnarr t i s s u m arm p o r o o p t i b l y i n o r e s a ad. end a t t h o e a r n t i m a p r o t m o l y t i o m o d i f i o r t i o a of f r u o t o s r -1.6-diphomph.taao
takom plaoo. No s i . n i f i o a n t
o u s m of thm
a o t i v l t y of tho r o u i n i n g u r w u m w e r e obs*rv.d.
-
-
CHEST 1103 1 3 1 MARCH, 1983 1 Sup9lemc#l(
- -
#nS
TUESDAY, JUNE 15
I)rpamcrmdRthdqy.adbkdr~dLmrHiUHo.pul.adComdlUarrna).
M e d d Cdkp. No, Y a k . No, Y&
d l m q -I
WL)rc M i d w rrpqca a hl- M i m ad
Lrmaodh~mnadrrir*odbrimrTRb.rr
bDcnuudmpmalbempy T o e b r n n a i o l l L v c o l l y r o d b y I l a ~ r m o a y m c i r
Tlmvr
A FLOW CYTOMFTRIC ASSESSMENT OF PUXDY IN PRIMARY LUNG
CANCER PATIENTS.
C.Oliani0, F.Paini8, kSmto*, G.Valato8*, A.CPadorig**,M.kaab***,
R.De Morcoe*,G.LG%oD.
Divisione di Oncologia Media*, Cattedra di Stotiatia Mediae*, Univasita di
Vaona, Smtido di Endoscopia Rgpirstoria**', Osptdale Civile Magghq
Vaona.
WWepoaDaK-.
#wmyp.adunamumI4i~~ad16brrOtarrimmY(BO
T. i * c r r
m z b m d y . l l l d v .ad whd m abad 1640. Ik.l a4a
.nr
por(&wilbmomld
.nibod*lIhr*hicbd~uaclyrod.adW
wmng Ihc Coulla lmmumpcp LevtoCyc Swan. Thc ctlb *m rml@ ma Covlla
Epia C llm qomclcr uuw 408 an hdhlm
#wmyp *rre
u p r o s d a s a ~ d L C A ( I Y 5 ) ~ m d h r n d r I ~ yMua
c .
d
~-allrbUlI9+(Edh) *ac 7S.(Yb4 md 64.691 b LC .ad BC
mpmtvdy. ( I Y + . C I ) 8 + . . a d C W C D B ~ * a c 3 Z 4 1 . 0 W . a d % , 2 ( . . a d 1 7 9
nLCmdBC. T h c & E a c n a b c m e n L C d B C m a u l a S + a d C D U C D O n t ~
rac ~ I t S u l l 1-y
Thc *rd.d o t &)-(
dHLA-DR. T
4
( m v a ~ c dIym@mve) wrr m uuakad). &-I
LC ad BC Thc
-
a+
Lrmg
#
16
72
7 17
28
Pd.k I7
667
16
Mun
39
14
0.W
0.642
7.24
12.9
I45
17.6
HIST0PATHOUX;IC. ULTRASTRUCTURAL AND FUlW CYIY)METRIC
CHARACll?RIWTION OF ilBERCL4S.S-INDUCED PLEURAL MESOntELlOMA I N
THE FlSCHER 344 RAT.
A.E. Fraire, S.D. Greenbe% HJ. Spjut. J. Carhvright. Jr.. V.L Roggli. R. Dodson and
G. Williams. From University of Massachusetts Medical Center. Worcester. MA; Baylor
College of Medicine. Houston. TX; Duke University Medical Center, Durham NC; and
University of Texas Health Center. Tyler. TX. USA.
Experimentally induced pleural mesothelioma developed in 3 (12.05%) of 25
Fischer 344 rats. following intrapleural inoculation with a single 20 mg dose of (JM-100)
fiberglass. The mesotheliomas developed in rats killed at 102. 408 and 416 days after
inoculation. Although fibergl:tu-induced mesotheliomas have been previously reported,
the histopathologic diagnosis >asoften made by one individual alone. and at times
graphic illustrations provided in such reports showed bland cellular proliferations. not
mnvincing for mesothelioma. In this study. the diagnosis of mesothelioma was validated
by a panel of 3 pathologists (HJS. SDG & AEF) and only eases diagnoxd by majority
(213) or unanimity (313) opinion were ampted as mesotheliomas. One of the 3
mesotheliomh w a diqn~nedby mujority opinion and two by unanimity opinion.
However. In the c a x which \+asdiagnosed by majority opinion. the third (dissenting)
pathologtsl also suspecled the dtagnos~sof (fibrous) mewthelioma but chox not to call
it a mes&helioma. Of the two cases diagnosed by unanimity opinion, one was mixed
(fibrous and epithelial), and the other epithelial. H o m e r , in the mixed ease, one
p;rthologist dissented in regaru, to cell type and chose to designate this mcsothelioma as
fibrous, rather than mixed. It was only in the case of the epithelial merothelioma that
true unanimity including cell type was achieved by the 3 reviewing pathologists. The
mesotheliomas were accompanied by microscopic mesothelial hyperplasia and dysplasia
in 213 and 313 instances, respectively, however, only one mesothelioma was suspected
from the gross examination cf the thoracic organs I n this ease, a rat with an epithelial
mesothelioma, g r w tan yellt~.inodules up to 1.1 c m were found on the diaphragmatic
surface. as well as on the pleural surface of the lung and the inner surface of the rib
cage. The epithelial tumor. cunsisting of a papillary malignancy. war made up of periodic
acid Schiff Positive. Mucicarmine Negative cuboidal cells. Thin papillary epithelial
mesothelioma was characterized ultnstmcturally and by flow cyromctry. Electron
microscopy showed numerous surface microvilli and well formed junctional complexes.
Flow cytometric analysis showed an aneuploid cell population, with a DNA index of 205,
a high (8.5%) S phase population and a G,M population of 83%. The diagnosis of
mesothelioma in man is diffie~ltand the findings presented herein suggest that the
diagnosis of experimentally induced merotheliomar may be just as dimcult. Validation of
diagnosis by panels of 3 or mure pathologists may help to establish the true frequency of
mesothelioma in some experimental models. Moreover, confinnation of diagnosis by
immunohistochemical. ultrastructural or flow cytometric studies may be required in some
c;lses. Supported in part by Baylor Grdnt #BRSGSZO-G16261.
PloidybssraratlybeenpoposedrciausdulppMwtain~agtbedinicll
outnrme of lung caoar path& From July 1990 to April 1992 we have analyzed
bmncoacopic biopsies of 138 pimay luag anar paticats. Samples have been
fixed in 70% etbmol and stand at 4- Just bcfae m a a m o r a t nudej
have been obtained by incubath with pepsin 0.4 mghnl for 20
minutes rad stained with pmpidium iodide (50 pglml) containing RNase (100
Uhnl) a d Noaidd P-40 (0.05%) Flov cytommic analysis bm been a x i d
outbymemsofaRrtccPASEl~cytomta.Oftbe112mddlung
C S S ~
IW gsve a valwbk hygollnm: n (692%)VRJC
MCUPIOI~ (5 with multipk s(em lines) and 32 (303%)w i d Of tbe 26 d
cell lung c m a (SCLC) spsdmcns, 21 had a v d d k hysto~prm:14 ( 6 6 % )
w a c llncuploid (3 with multiple stcm l k ) and 7 (33,4%) diploid. We bm
vaificd that DNA contcat can be mutincly d c m m h d Purthamore,tbe mtbod
described is particularly suitable for multianrric studies. A preliminary survival
analysis has been carried out in 64 paticats by means of Cox's proportional
h d m i o n model. Survival sppc~nto be indipadat of age, n u and
histology while is s i g n i f i d y affcud by stage (pO.002) end p h d y
(p4.013). Tbc possibk m k of this anal+ pioc to mrgay in NSCLC and ito
value as a rmrtQ with rcspd to pmgmnia d nspoasc to therapy in SCLC
have to be established in a larga saies of patients.
GENE ANALYSLS OF PUU(ONARY F'EUDOLYMPHOMA
Telsuhim Shiota M. D.. Wataru Chiba K D.'. Ssdm Btb' M. D, Nobuhiro lkei * * Dapt
of Rcspimtory Division, k w a H-ital.
Chest Disease Center. Kyoto KsUun Hmpital.
' Otsuka Auay Ldbontories
Diagnmis of malignant lymphoma has been totally d e m e n t m phenotype d y 8 i s d
tumor ells
blr histom-
or irnmunohirtdw, h t it is undergoing hip ehmga, 8ince
the invodwtim of pme w l n i s . Di.grosis of psndolympharu has bsa mntrmradU
So, the value of gene analysis was Isp+sed in ~@
eintU
.
with p u l psuddnnDhak
~
Matertals and Methods: Two patienu with histomthologid evidence d psudolnnpbmS
were cslectal for the study. High molecular weight DNA$ were lint axtrvted f m n
f r o m W m a s of each mtimts. There high molecular weight DNAs were digested with
restriction enzymes, auch as EcoR 1 . HindE, and 8.mH I followed by Southan bbtting.
Whether or not gene of immunogulobulins and T cell -ton
wan ravnnped was
investigated using DNA prober against 1%C K and C A of i m m m l i n ImIW ud
TcRB1 of T cell mta g~
Rsault :Fdlowing dimtion with BamH I.one rearranged band wu fcund in the k Chain
f m ptient I,and two rsarnnpcd bands f m patient 2 C48da-1 with EcoR I ud
Hind. rhornd two rsunnstd band in the JH chain in both mtlglU I ud 2 POUO*IM
E M
-tion
I digcrtion. one ramneed band a
h in the C 1 chain of p h t 1. Pdbrinp
with BamH I.om reamnged band was fcund in the Cr dvin d mtiant 2
Whether d
m with BamH I , EcoR I or Hind El, -n
band appand in the
TcR 0 I chain in eithex pdtimr In summary, gene of the H chain d immuMOulobulinr
were
in both ptients, stmngly suppestins that their diraroc rar not dated
to reactive lymphoid hyperplaria. but was tumor -related lymphaytc p m l i f a n t h
B
dl
lymphonu was dimwsed for both mtients instead of p s e u d o l ~ m ~
Conclusion : Cane analysis is a very valuable means of differentltinp tUrfIOr dated
l y m p m protifention fmm that which is reactive, in addition to iU role innndiif
whether proliferating celb .we derived fmm T or B cells. Gene analniS sermed to be
an improtant criteria for d i i i r of lymphoma
TUESDAY, JUNE 15
W e PT,Twbr LD.W h D. M
a D. Cartwnght J. M a d J. D w h g t o n C
Deoartmmtr of Patholm. Bavlm Collepe of Mediana. I h e Methodist Ham~(aland
O v e r e r p d o n of cmye may be involved in the pmgmmim of mall call lung cancer
(SCLC) and has been oboemed in nmcchtion with an eggmaim variant cell line
p i x m o m &lance to ehemothe.mpy and .hortarmmivd in mlapedpatient. (Little
et al., N a b 1989,308:lW. Johnson, et al., J Clin Invest 1987;79:16a9, Jdmmn,
Simmons.Luna C1@88.4:131). Abnmmalitiem ofthemveoneoaener arrrr in 11%
of nrmtmall& lung cam& (NS~LC), but tbair p o t . n ~ m l eiotbs pmqrsuirm or
diniad babaviorof NSCLC h not bunducidsred E
'
ofe-myc rossduated
in four mwlv ee&&hW N8CLC cell lines. The cell lium included two
cell carcinoma (cell line 2) derived
(cell linen 1 and 4) and one
from primary m u g i d muedona and onm admocardnome (cell line 3)derived horn a
mdignmt pleural etkioa Cell lines were grown in minimum -tin1
medium with
1- fohl calfat spC with 6%CQ,Ths mabpmnt qitbslial nature .'.hwll
lined wae conmmed by cyxogenetic, u l u a s t r u d and immunocytochemicnl atudied
of lwvmted eslb. Northam analJais uciug a " P - W e d ~ y probe
c disdmed a n
a p p m x h a t d y Cfold inensled axpreeaion of m y c mRNA in cell lined 1 and 3 an
compared to fibroblastmntmla and the other cell lines. Southan anal* veri6ed that
.
BRONCHOALVEOWR LAVAGE FLUID LEVEL OF CARCINOEMBRYONIC
ANTIGEN DOES NOT DISTINGUISH BETWEEN PNEUMONIA AND
PERIPHERAL LUNG CANCER.
C.M.Sanguineui. M.D.. F.C.C.P.. G.Riccioni Bio1.D.'. R,Pela. U.D.. LCewini. M.D..
S.Camevdini Biol.D.*. F . M a r c h m i M.D. Divis~onedl Pneumologir
and
*L.bonlaio di Analisi ChimicoClinick USL 13 Reg.-.
Osinm (Anconr), Italy.
. .
: Carcinounbryonlc M I I (CEA)
~ ~ assay In serum showed unsausfactory
s n s ~ u v ~and
t y spct~fic~ty.
b o d ~to nukc M urly d m p x s of priphenl lung cancer, and
to differentiate neoplastic fran mm-neoplastic pulmonuy lesions. To i n n c u e the
effectiveness of CEA detaminuion the inulra has been n k u d in bronchdveolu
lavage fluid (BALF) . The aim of the prrsent study has been to verify the usefulnus of
CEA mcasurcmnt in BALF and in m m of palienu @o) lHcctcd with lung tumors.
compared to ochas with pulmonuy infenions and to halthy subjects.
: 10 IS with histologiully proved pcriphcnl (not visible adoscopiully) lung
.
.
ml of sterile saline was instilled in 3 Iliquocs, and imnuiiately rurpinad .fpr each
infusion. Just before the BAL pmadure 10 ml of v m w Mood was taken for xrum
deurmination of CEA. Afur cenmfueation d BALF. thc s u m m n t m s examined for
CEA and albumin content. CEA
in BALF and In &an was performed wrth an
immunoenzymatic method (MEIA. Mictoplnicle Enzyme ImmunwAssay) using the
t h e i n o e a s e d a m r e s s i o n ~ t e d h ~ m ~ ~ d t h e ~ ~ i n t h ~ ~ 8IMX-Abboa
two
with IMX-CEA kit.Albunin content in BALF and In suum was damnined
~ ~ ~ e l l L i ; r e l h a d r s c e i v e d + m ~ ~ y ~ ~ a n a n a l o ~ g w~tha nephelwrnc method wm thc Mllyaaof spec~fuproolns APS-Bozkman
to haeased c-mve ewreuion in 8CLC cell lines mtablished after chemothanpy.
M u n values SEM of $A (nghnL) and C W d b u n u n (nglmg) tn BALF and
NWLC cell lineskith k c w a d c - w expression may be ussrul in underatanding ihe
of CEA ( n @ L ) m serum arc rrponcd In the following table
mled~ycapreuab
inthepmgmmionandhzapmticredpomeofNSCLC.
Gmup (no.of s u b p s )
BALFCW
BALFCWaIb ocrum CEA
*
Lung cancer (n= 10)
Pneumonia (n= IS)
Healthy s u b p s (n= 8)
30.5i8.W'
34.7f 10.7'
3.4iO.9
591.9f205.9
1064.W39.2
127.W3.5
30.3f20.6
230.4
1.2fD.3
p < 0.05 and **p < 0.01 vs healthy subjects ( u n p a i d I test)
M u n value of M in BALF was significantly i n c d in LC compucd to HS .while
not different fmm that in P.Afur calculating h e upper limit of the nornvl (rmn+3SD of
the vdue in HS), ynsitivity (SN) of BALF CEA IO meal LC was 0.91. specificity (SP)
0.72, positive prcd~ctivevalue (PPV) 0.53, md negative
cuve value (NPV) 0.96;
scrum CEA SN was 0.62. SP 0.96. PPV 0.91, and NW c u i n g W d b u m i n , or
BALF and m r n CEA togahu, did not impmvc thc resulls.
our findings indicate chat CEA meuurement in BALF, while more
sensitive than serum CEA to diagnose LC. has poor specifxity and it shows indequrte
IO distinguish puicnts with lung malignancy fran those with non-neoplastic d i s u s .
m:
km*notwg.ting with J Clurtor 1 Monoclonal Antibody. 123C3, In S d l Cdl
Lung Cumr (SCLC) xmogrr(b.
EXPRESSION OF W O R HISTOCOWPATIBILITY CUSS I AND C U S S I1
AWTIGENS AND INTERCBWIAR ADHESION mLEaJLE-1 ON 0PtRABL.E
WON-SHALL CELL LJJNC CARCINClUS
H.B K m N nnZudmjl.R.JA.M Michlda.A.H.M.VahaxqW.J MoqJG.W.Hikan
The Netherland Canar Inmwe. Drplnmmf of T u m r l o b md Medm1 Ondogv,
Plumanlaan 121, 1064 CXAmsfrnbm. Tht Nefherlands
B. P sslickl, J . R . lzbickil, S. siuell, K. pante12, 0.
Karg?, 0. ~hetterl
MomlrmlMboda(&)dusatd~SCU:bmounrrc~mlod~~tbc
~b~
M A b o b d o s e s n m c h r n a I b m d m t b c h e d d d r w o ~ R ( C A M IOne
of
nm&md d b o d k ; 123C3. hu ban mKaigmd onmrndy m -ul
radiamdrboma~reamvitywith.IISCLCtumunccardW e h * c t s t r d ' U I W
thac
l U C 3 t a ~ S C L C ( H 6 9 ) x s l o s n f t a m w w r m B J b / c n u d c m i aE x ~ u n r s a o f t b c
~r+-&wnhorrafw,daadlij~3hbd*dwnh600p~rof~11
rooslwd no mAb, ucllbdkd 123C3 ud M -tic
Wkd \vlth600 pC1 of "'I. lcYpA4y
~ u y t H69
s ~
Thmrtmlma
ambody (MWI)
A U n m c r s o a v l s g a a ~ d a . d l 2 3 C 3 W w t h 6 0 0 p C 1 d ~ ~ ' I ~ a r m p r l a n uAu o n
mnpkr~nuuont~bedoaenacdm2~0f6m
R a~ d t b c x s l o s n f t r o a u d I f t a 4
l ~ e ~ a r t m e nof
t Surgery and 2~nstituteo Immunology ,
University of Munich, Munich, Germany; {Dept. of Pulmonary
Medicine,~~entral
Hospital muting, Germany
Major histocompatibility complex (IRiC) antigens and
adhesion molecules such as the intercellular adhesion
molecule-1 (ICAII-1) appear to play an important role in the
immunological recognition and destruction of tumor cells.
It has been shown, that in some tumors the expression of
these antigens correlates with clinicopathological
oarantars and is of ~ r m t i sianificance.
c
W. therefore
bxamined the expressibn &ttmrns oI these proteins on
primary tumors (45 adenocarcinomas, 37 squamous cell
carcinomas, 6 adenosquamous carcinomas, 3 large cell
carcinomas) of 91 patients with operable non-small cell
luno cancer (NSCLCI at TIRI-staae HA.
~ppiying i&nohisfochemistry
;ithvwnoclonal antibody
(m&b) W6/32 against a c o w n framework determinant of WHC
class I antigins revealed a deficient expression in 32.98
of the cases analysed, whila nao-expression of either UHC
class I1 antigens (mAb TAL.lB5) or ICM-1 (mAb PA3.58-14)
was observed on 26.48 or 29.78 of tumors, respectively.
Analysis of consecutive t w r specimens indicated that IRiC
antigens and ICAII-1 w r e frequently cwxpressed on the same
tumor (pc0.01). With regard to cliniocopathological risk
factors. we could dewnstrate a referential ex~ressionof
those markers in patiants with l & a l l y restrictid and welldifferentiated t w r s or no lymph node metastases, which
was more pronounced in.adenocarcinomas than in squamous
cell carcinomas. Nevertheless, none of the analysed markers
correlated with the rate of early tumor recurrence or
overall survival following a maximal observation period of
27 months (median: 14 ws.). In conclusion, the coordinated expression of i.slunologically relevant cell
surface wlecules on primary NSCLC is a frequent event that
correlates with distinct parameters of favourable
prognosis. Hwever, we failod to provide evidence that the
i n u n e response facilated by these wlecules can
effectively influence the clinical course of the disease.
CHEST 1 103 1 3 1 MARCH. 1993 1 Supplement
203s
TUESDAY, JUNE 15
CD28 AND C D l l b EXPRESSION ON C W ' LYMPHOCYTES FROM BRONCHOALVWLAR
LAVAGE FLUID (BALF) OF PATIENTS WITH PULMONARY SARCOlDOSlS
Hldeyukl Kopa. Tomoaki Hoshino. Junichi Honda. Yasuyuki Tanaka. Shinya Sumita.
Yoichiro lchikawa and Kotaro Oizumi
From 1st Department of Internal Medlclne. Kurume University School of Medlclne.
Kurume. Fukuoka 830. Japan
It is known that CD28 peripheral T cell are a counter population of C D l l b
pripheral T cells namely. C m ' peripheral T cells dces not express C D l l b on their
surfaces. In adult w r ~ p h e r a l blood, approx~mately 95% of C W ' T cells and
approximately 50% of CDE' T cells were reported to express CD28 on their surfaces.
Approximately 1 - 5% of CD4' T cells and 59% CDE T cells show C D l l b ' CD28
surface phenotype. The natural ligand for CD2E is 87/BB1 which is known as B cell
activation antigen. Recent studies revealed that CD28 might be arwxiated with the
maturation of T cells or the interaction of T cells with antigen presenting e l l s (APC).
It has been reported that the population of lymphocytes in BALF from patients with
pulmonary vlrcoidosis were elevated. and most of the lymphocytes expressed CD4 on
their surfaces. In this study. the surface phenotype of CD4' lymphocytes in BALF from
patients with pulmonary sarcoidasis were analyzed. CD4' lymphocytes. which were
approumately 30 - 80% of the lymphocytes in the BALF from patients with pulmonary
sarcoidosis, expressed CD3
on their surfaces. These C W . CD3
lymphocytes
expressed CD28 -', but did not expressed CDl l b on their surfaces The expression
-
-
CW'lymphacytes in the BALF was s~cnificantly different from
lymphocytes in
that on CD4' wripheral lymphocytes. Moreover. these C W ' C D 3
of CD28/CDllb on
aypertbamieLoamBslbap~.~BO~.Initkl~
mdsllhothSew
*Blake O'Neill, Antohe Sartir, Ena Deutseh, Ray G
Md(ay. Jack L Martin. %vatore Battaglia.,Gilles Bayet. Jaan Ldon
Guermonprez. * Victona General Hosp~tal, Halifax, Canada.
Br0-8
Hospital Paris,France
.
W e have previously demonstrated in animals and human peripheral
vessels that the simultaneous application of heat at 60 O C and low
p ~ u r during
e
angioplasty m u l t ~in improved stenoms reduction and
l e in~
damage than mnventiod P E A .
To evaluate the feasibility of phyaiologie low stress angioplasty
(PMSA).30 patients (pta) underwent thermal angioplasty at 60%
Heating WM A e v e d t&ough the application of d ~ f i q u e & y energy
to a modif14 noneompliant eonventiollal amiodasty balloon. Twenty
seven pta had de noio leeionr and 3 hadreitendtic lesions. ~ e a n
maximum 7
for these lesions was 3.7 f 1.1 atmorpheres (ATM).
Mean beatmg time was 151 f 78 seconds. P M S A was sucoesnful in
24/30 pta. A mean initial s t e n d of 78.6 f 9.84 % was reduced to 21.93 f
10 (p.cO.001). In 2 canem, P
W limited to 5 A T M was inadequate to
dilate the lesion and w v e n t i o d P r C A wlu used. D i d o n occured
in 2 ptr and required prolonged conventional balloon inflation,
thromboois and subacute ocdusion each oecured in 1 pt. Twenty-four
hour poat-PLOSA angiograma performed in 11 pts did not l o w any
elPstie recoil ; initial and 24 hour residual stenoms were rerpectively
24.64 f 10.87 % and 29.72 f 12 % (~-0.6). Angiographie follow-upis
available in U1/30 pta. Reatenoah (dehned as a 60% luminal diameter
reduction) occured in 12/20 pts. Samples of atheroma removed by
athemdomy in 1 reatenotie pt did not & o w any thermal domage.
Thh initial experience demonstrates the feasibility and safety of
ar@iophty with PU)SA at 600C in human foronary arteries. There is
no elastic recoil at 24 houra. However, further studies with long tenn
follow-upam needed to estabbh whether the restends rate is reduced
by thia tdmique.
the BALF were TCR a / B -' cells. These results suggested that CD4' CD28- ".'
IymphaMcs in the BALF from patients with sarcoidosis might be functionally immature
or abnormal.
kwh
-
-
~~.
lYe Ilm of ar ab&
-
-
m to cktcrnnn the abillry of Exaclse Ecg
(~x-n)
mj a i w i 6 r m l c t h l l i m scsrnrng
In pstlmm ( p B ) free of c h s t pain.
Fifty e m ~ t o l a t i cpta with iwxmm W
e -1
(c-n)
to w
(h-sq)nu-.
r~ua*ir.m
e t
PN\ vrdavslt w
w
l
w
d
~ t i P s ~ C m r a Y ~ W ' t & ~ ~ ~ ~ s d 1 7 & _ 5 1 ~ . ~ v e l y .
b
m
.
5P7% b
*
&a' h of &>!in)
conmd in 1 5 M p t s (3%).
Detb2t.m of STtlmn. b r r g EX-,
m e t e cr pa-tial m j i s t r i w m in
G-e I*glm a b f m by
~ the & l a w rtay, rre cnmlhnd etrnrnal-.
S s s l t i v i Q (Sss). 9slnciry (*).
F m l t i ~ t i wW t i v e d m (RY-ERI) d
w
c b x u y (Peel of rrrrinvasiv Lsta m
matarsis ~sr
as foUoa:
Fw
9s
m
-rs
am
a-n
D-n
836
EE
%%
m
---
w
An
1%
era
696
7a
m
i
78%
ma
m
BX
h a ia thc k t , *hscss bn ia the most W C Q K of
tPStB. ~ W S
bldi
81% m
a rwhticn axwehrsivc of 8)nptolatic PB (w p w i ~ a l y-I.
M in this
diwtic
of c-n~s m l y shmd in -t
or ~x-n.
S l m the hrst
-im,
it s ~ n sa beOrol to d18cau~r
Mt K
mt
m& to lnin W a l is3rma. Fcr this r e a m all p t s n t h bn psitlvlw
shuld b cnmi&md fcr a m
pit- atti*,
qf
fm (tose of Oa dbLl a
e
i
m h f s t ftet W
d
htK
m-.
b
t CaG-eterimtim sd lrpeet PN\ m
eval
If -hxe
*.
RBPDIjm
Bernd Eber, Olef Luha, Mhrtin Schumacher, Roixrt Zweiker,
Robert Gasser, Werner Klein.
re of ttr mst apscihc M at ttr sw tme cne of the leest mitie
of
aRs mU. It.0, f l r c t i d reets se & M l e m btect I*glcral
wuadhl k&ada, M ttr k t m W l w tart m
r
r
s still
~
m
wbx-ls is
AUGIOPLASTY IN PA TI^^
BYPASS SmGWT
m ~ P U I ( R Q n ( I R I ( I W ~ : H I O W I B - s l e n ~
VnKn Baldnlll. m
a
ia hmuu. E l i s & e t eYersu. A
m
l
m m .
Rvleim of Csdiolw m
e ps 011 Infenni Fasea Italy.
m aasrxa,
RESULTS OF CORO~UIIY
WY
PTCA and Echocardiography
Morning
d be ramrrsded in 0- v i t h
a-nw s t r l h r t l m .
Department of Internal Medicine, University of Graz, Austria
Out of a total of 701 consecutive wtients treated bv
coronary angioplasty ( P T U ) in the course'of 18 months at thi
Cardiology Division Graz Univeraity Clinic, 16 subjects (2.39;
14 males, 2 females, mean age: 66 years) were refused by
surgeons due to diffuse nultivessel disease and severely
depressed left ventricular function (ejection fraction <40%).
All of these showed unstable angina (one having been treated
by aortic balloon counterpulsation), 12 out of them had
dyskineaia of the left ventricle and 4 showed left main
involvement (6 left main-equivalents). In total, 27 culprit
lesions ( I A D 11, CX 7, RCA 7, bypass ves8els 2) ware treated,
but only in tvo cases FTCA was unsuccessful. During PTCA no
complications (i.e. death, myocardial infarction, ventricular
fibrillation) occurred, one patient died two days following
procedure due to cardiqenic shock. During follow-up (ranger
8
20 months) one further patient died due to nyocardial
infarction 6 months after PTCA, but 12 improved substantially
without any cardiac event (i.e. death, myocardial infarction,
re-PTCA), 8 of them were without angina. In 4 patients reangiogram due to silent ischemia showed patent dilated
vessels; 2 patients were lost in follow-up. Thus, P T U
represents a 8afe and effective therapy with improved outcome
for patients with severe coronary artery disease that had been
refused bypass surgery.
-
TUESDAY, JUNE 15
-QI
OF 0XIDII.D
M A
1 L 6 m o 8 I s ~ m c a
Bornd Ebmr, W l r t i n B c h u u c h r , P r m a t a t a h ' , Pour mu*,
I(. #Qw, T&lU Cr-,
-ttm
Crorr, John H. Ilorpan,
D.p.rtYnt of C . r d i o l q y , Bmumnt Ilapit.1, Dublin 9 , I r o l a n d .
-urn
to w r k (MU) i m a wi&ly umod i n d i c a t o r o t t r u t v n t
m ~ w in
u ooravy artmry dl(CAD).
Thim mtudy w m p o r d
-1-t
kfot.
ud
tW0 0-rd
f.*..~~Iari~tiOM
ptbalbuw f o r W r ooravry u t u y
w a f t (CAM) and
traIUlmilu1
W
v
aqi0phOty
( m ) .
C a r u a u t i v m patiena t o m aurtn (I = 111 CAW and 119 PTCA)
intrnimd 6-18 aontb. f o l l w i n p t r u t n n t . E a ud m o d a l
01propol+iau
8iriL.r in +b. ho qroupm. m p a t i e
-.l i k m l y to rso)u, hh,hvm 1-• d v d CAD
Wim to .top w X n g f o r wiul rum- prohvm
trutnnt
-
-
.
-
31
59
46
48.
68
w-trutnnt
55
73.
llun aqm ( 8 . 0 . )
I n f u l l tiw .gloyunt (8)
.ustou (8)
mcrh
win.
Olof
Luha, R o b u t
hickor,
Robrt
Gaamer,
R.IYM
~ a t o r b u e r * ,hrnmr Xloin.
Depnrtamnta of I n t e r n a l I C d i c i n o and ~ i o c h n i a t $ , m)i*.rsity
of Graa, A u s t r i a
O r i d i s d LDL-cholertmml (oLDL) p l a y . M Lportant mlo
i n the pathagonoaim of a t h e m a c l u o m i a . Rocontly, o l . r a t r d
~ W n - a u t o u r t i b o d i o a (AB) i n sorum r r a a h a m i n p a t i a t . with
rovere pmriphoral athmrrwclmrrwis. To w a l u u tho influmncm
of oLoL i n rmatonosis a t t a r Pl'CA, oLDL-autourtibodiu
(sandwich ELI-) wrr d e w r r l r u d in a r a n d d y seloctmd muiu
of 48 ~ 1 . 8 f 0 l l d n g n u c ~ a f Pl'CA.
~ l
F0ll-u~
~piograpb
a s wll a a blood -ling
n m donm 12 w m t h a a f u r PrCI;
rastmnoaia was d o f i n d a 8 a % O I r d u c t i a i n d i m t a r of tho
coronary a r u r y by hm b1ind.d 0b.erVars. nmnty-mix p a t i . n t .
of t h i s nriu (man age: 56 yearm) a h o n d r a a t e r s ~ i a(
A), *emam 22 (agmr 53 yearm) d i d n o t (proup B 1 . m
group. wra c a p a r a b l e a s to ago, p o t wdical h i s t o r y
(smoking, h y p r t . n a i o n , di.k+..,
poaitive f&ly
history),
fibrinogen and l i p i d prof110 ( t a b l a ) am nll a 8 roguding
i
(8)
MUl f u l l t h W P l O y n n t (8)
o f tbom w i t h lngirv p o m t - t r u t n n t
of tbom w i t h o u t win.
m
z
57
b o a CAW and F?Ca -1t
in mimilar, and inorammod,
of q l o y u n t pomt-trutnnt.
fiIWAI. C O R W Y ARTERY PERRISIQI DURING PTCA
ARSIUI, N.,
OZRAN,
n.,
E W L , C.,
D E H t W , D.
-
The ST segrmnt e l e v a t i o n on ECC d u r i n g FTCA by using d l 8 t . l
parfusod b a l l o o n c a t h e t e r a r e t h e l e s s compared with conventional
PTCA procedure ( P < 0,001) and score of c h e s t p a i n is a l s o l e s s
---.
ip < 0.001b-,
h a c o n c l u s i o n , during t h e PTCA with t h o u s i n g d i s t a l
p r f u s s b o n c o r o n a r y d i l a t a t i o n c a t h e t e r s , i n p a t lent. with
u l t l w s a e l d i s e a s e a r e n w r e p r o x i c a l l a s i o n may be o b t a i n e d more
b a l l o o n i n f l a t i o n t i m e and l e a s c o ~ n p l l c a t i o n s .
420 + 148
+
1
A
d
-
e
HAZW YA., R m c h a n d r a n , Usha P.,
Arthur L a l , neora n., Valiathan Its.
The most important f a c t o r s i n t h e performing of =A
are
i n f l a t i o n t i m of b a l l o o n and t o reach t h o e f f e c t i v e balloon size.
I n t h o mrn of c o n v e n t i o n a l PTCA m y be cauaed p o r t ischemic
anglna p a c t o r i s and ECG changes, e s p e c i a l l y i n p a t i e n t s v i t h
m u l t l v a s n 1 d i s e a s e u n s t a b l e angina p a c t o r i s and proximal l e s i o n of
t h e i r coronary a r t e r y . I n t h i s s i t u a t i o n , a l l symptoma and f i n d i n g s
a r e due t o ischemia.
D i s t a l p r f u r i o n d i l a t a t i o n c a t h e t e r provi&s blood f l o v
i n t o ischemic myorandium during PTCA and c l i n i c a l symptoms a r e
disappared.
1 5 p a t i e n t s (14 male, 1 f e w l a , m a n agar 47)'. who have ST
a l e v a t i o n i n t h e i r ECG1s and p o s t iachemlc angina p e c t o r i s d u r i n g
convmntional PTCA were included t o t h e study. Th main g o a l v a s t o
extond t h e d u r a t i o n of b a l l o o n i n f l a t i o n t i a a while achiowad d i s t a l
a r m r i a l perfusion.
9 c a s e s hold p r o x i m l l e s i o n on t h e i r LAD, 4 c a m s on RCA,
1 c a m on CX. he narrowing of the coronary l u m n was 908 o r uppar
in u c h patient.
Findings a r e i n below:
Distal
Conventional
Perfused PITA
PTCA n i l 5
P
n: 15
ST n p l v n t
aAevation (on ECC)
0 , s :0 , l
3.7
0.2
'0,001
<0,001
1 , 3 ;0.4
&or* of chmst p a i n
9 , 3 ;0 , s
(Angina p e c t o r i s )
.-
tam
DIRECT WOCARDIAL R ~ ~ I Z A T I B
O
Y IM-YAG LASn
GATA Cardiology ANKARA-TURKEY
-.
1
351 + 100
n 9-P
Pmup74:?)%%d
O1kA?;
i10 U
+
6
o u t of 26 i n group A and 3 of 22 i n group B (n...).
Althaugh ua found a tandmncy t o m r d a a l w a t d oLDGII i n
males w i t h r m s w a i m of coa r u r i u . oLDL. hclmr.
fibrhogem
-11,
1-1.
.a
Sree Chitra Tirunal I n s t i t u t e f o r M i c a 1
Sciences L Technology, India.
D i r e c t l a s e r r e v a s c u l u i z a t i o n of t h e myocardium i s an
a t t r a c t i v e s u r g i c a l approach aimed a t providing a mourca of
t r a n s v o o t r i c u l a r c o l l a u r a l blood f l w t o t h e i a c h a d c
myocardium.
Over t h o l a s t f e v yeara, t h e r e ha0 bcon
i n c r e a s i n g awareness of t h i s w d e of r e v a s c u l a r i t a t i o n a s a
adjunct to ooron.ty
M-yAG
this concept in is*dc
canine
F i f t e e n dogs v i t h i s c h a r i c myocardium were s u b j e c t e d
f o r t r a n a e n d o c a r d i a l and t r a n s e p i c a r d i a l p d i n g with MYAC l a s e r .
hnothcr ischaarric a-nt
ws stlbj.etad f o r
needle acupuncture.
A l l t h e dog8 e r e a l i v e a f t e r t h o
procedure. Autopsy was done a t t h e end of 3 months. P a t e n t
channel8 v e r a seen i n two cases (group 11) r h o r o l a s a r
channel8
-re
created i l u d i a t c l y
after
the
acuto
infarction.
n i s t o l o g i c a l e x u i ~ t i o n ano
paturt
channels i n 10 dogs and evidence of l a s e r i n j u r y r c r c soan
i n 3 dogs, (group I ) a t t h e end of 3 months.
the
T h i s experimental w r k conducted t o w a l u t o
f e a s i b i l i t y of using Nd-YAG l a s e r energy on t h e h u r t
i n d i c a t e d t h a t , (1) t h e l a s e r could br used on t h e booting
h e a r t , ( 2 ) by both t r a n s e p i c a r d i a l and t r a n s endocardia1
approach, l a s e r energy could p e o e t r a t e f r a tbe e p i c u d i u a
t o endocardium and v i c e v e r ~ a ,with minimal d a v g u t o t h o
surrounding t i s s u e , ( 3 ) bleeding f o l l o r i n g c r e a t i o a of t h e
channels van not a major problen and ( 4 ) channel s i r e could
be c o n t r o l l e d by t h e o p t i c a l f i b e r s i z e .
tld-YAG l a s e r channeling of t h e i s c h a d c p y o ~ r d l u mm y
s e r v e a s an a d j u n c t t o standard CoroMry a r t e r y byp.aa
surgery
a But
t
providing
caaplote
myocardial
r e v a s c u l a r i zaa tii odn .
t h e p r e s e n t experimental
d a t a does
not
s i g n i f i c a n t p a t e n t i a s e r channels t o p a r f u s e
the
i s c h a a a i c myocardium.
TUESDAY, JUNE 15
(PTCA and Echocardiogmphycontinued)
CORONARY ARTERY INTERVENTlONS USlNG NEW TECHNOLOGIES
AND STANDARD ANalOPLASN
CORONARY ANGIOPLASTY IN PATIENTS 75 YEARS A N D OLDER :
COMPARISON OF RESULTS FOR SINGLE AND nuLTIvesseL DISEASE.
Xavier Tabone*, C h a r l y Guenichee*, J e a n P. Metzqer*,
n i c h e 1 S. Slams*., Andre Vacheronb, G i l b e r t nottC**.
' ~ 6 p i t a l Necker
* * ~ 6 p i t a lA . B e c l e r e
Paris (Prance).
Antonb Cobrnbo, M.D., Yaron Almagor, M.D., Luigi Maielb, M.D.,
Renato Ginarossi. M.D., Surtino Zerboni, M.D., Leo Find. M.D., F.C.C.P.
Contra Cuore Columbus, Milan, Italy
-
The lesion oriented approach has become possible due to the
development of new technologies. However, there is only limited
clinical experience with most of new devices and only few
comparative studies with standard angioplasty have been done. We
analyzed our experience using standard angioplasty (A) and the
following technologies: stenting (S), rotablator (R), directional
atherectomy (DCA). excimer laser angioplasty (L) and transluminal
extraction (TEC). The lesion morphology, the success and
complication rates were as follows:
A
S
R
DCA L
rrC;
N
3390 280 250
32
25
5
Success Rate
(%)
92
98
97
100 9 0
75
LesiontypeWandC (%)
34
37
63
38
64
50
8
0
Comp4ications: -MI
(%)
0,5
1.7
0
0,8
0
4
0
aUrgentCABG (%)
0,7
0,8
0
Death
(%)
0,4
4
0
0.8
0
0,4
0
20
0
Minor: Urgent PTCA. (%)
1,6
1,9
5
-oN
1%)
7.4
1 .S
12
0
24
Q
Prom 1087 t o 1091, 100 p a t i e n t s IPTS) 7 5 y e a r s o r more 175-90
mean 79 +_ 3 ) underwent c o r o n a r y a n g i o p l a s t y (PTCA). S i n g l e
v e s s e l d i s e a s e (SVD) was p r e s e n t i n 39 P"S ( g r o u p 1 ) and m u l t i v e s s e l d i s e a s e IWD) i n 61 PTS ( g r o u p 2 : two v e s s e l d i s e a s e :
n
4 1 ; t h r e e v e s s e l d i s e a s e : n = 2 0 ) . Group 1 and 2 were
comparable f o r s e x , u n s t a b l e a n g i n a 173 v s 78 % ) , a g e 178 v s
80 y e a r s ) and e j e c t i o n f r a c t i o n ( 5 6 v s 60 8 ) . The SVD group had
more Q wave i n f a r c t i o n ( 5 9 v s 24 8 p < 0 . 0 5 ) . S i n g l e v e s s e l
PTCA was a t t e m p t e d i n 86 PrS and m u l t i v e s s e l WCA i n 1 4 . WCA
was s u c c e s s f u l 1 i n 80 PTS w i t h no d i f f e r e n c e i n c l i n i c a l succ e s s r a t e between t h e groups ( 8 3 v s 78 % I . Complete r e v a s c u l a r i z a t i o n was achreved i n o n l y 12 I V D FTS ( 1 9 8 ) . A t 24 months
( r a n g e 1-48) t h e r e had been 1 0 c a r d i a c d e a t h s , 6 non f a t a l myoc a r d i a l i n f a r c t i o n s ( M I ) , 7 bypass g r a f t s u r g e r y (CABC) and 1 5
second PTCA p r o c e d u r e s . R e c u r r e n t NYHA c l a s s I 1 1 o r IV a n g i n a
a t follow-up was more f r e q u e n t i n group 2 0 5 v s 27 6 p < 0.05).
Secondary c o m p l i c a t i o n s i n c l u d i n g d e a t h o r MI 112 % v s 16 % )
and t h e need f o r CABG ( 7 v s 6 6 ) o r r e p e a t PTCA 117 v s 1 3 \ )
were n o t s t a t i s t i c a l l y d i f f e r e n t between t h e groups.
Conclusions : 1 ) I n e l d e r l y PrS, t h e mid term r e s u l t s of PTCA
a r e t h e same f o r SVD and MVD i n terms of c l i n i c a l s u c c e s s ,
d e a t h , MI and CABG. 2 ) Angina a t follow-up i s more f r e q u e n t
i n I V D P r s . 3 ) D e s p i t e f r e q u e n t incomplete r e v a s c u l a r i z a t i o n
PTCA is s a f e and e f f e c t i v e i n e l d e r l y PrS w i t h MVD.
-
.
The cumulative rates of major complications with laser (16%) were
ten times higher than with angioplasty (I,&). The incidence of a
non-occlusive dissection and the need for urgent angioplasty were
highest with laser (44%), followed by rotablator (17%)- and stent
(3.4%). However, the most complex kdons were done by laser and
rotablator, and 12% of the stent pts would have previously been
referred for urgent CABG. In conclusion, a large percantage of
complex coronary lesions can be treated with new technologks. The
overall results are better than historically reported by standard
angioplasty, when dealing with lesion type 82 and C. The rotablator
and stenting in our opinion give the best immediate results.
CLINICAL FOLLOW-UPSTATUS AFTER F'l'CA M MULTIVESSEL DISEASE
DEPENDS ON FUNCTIONAL B W NOT ANATOMIC DEGREE OF
REVASCULARIZATION
S e v d studies have shorn bettcr clinical follow-up in pu. with complae rcvlsculvintion
llta bypass surgery. h f o r c we studied in this pros tive nonnndomtcd hid IIK
influence of d e w of reywularization (REV) on clinical E o w - u p of PTCA in multivwwl
dioeue (MVD). A n u o m ~complete ( A 0 REV was rhimd wbur m Iaim ~ 5 0 %
was left
in any caqavy ancry. Anatomic incompkoc REV w suMividcd in funaionrl sarpk
hqrurc (FA), ud f w t i a v l incampkc (lR) REV.
!??hewas p a f d in 283 ps with MVD 0 4 % 2-VD and 26% 3-M): age
5 9 2 ~ 8 . 2y ~'2%
:mn [88%]and 33 women [12%]). CLinial nraa was rhievcd in 247
(87.2%): in 239 pu (84.4%)all rtanpcd ksions and in 8 pu (2.8%) u last the culprit
-
f2m
a u u y m d *& ~ r i t M n s
in 15 p(5.35)7 p
undawent emergency CABG. 1 pt had CAB 8 hrr
FTCA b u s of m urly rcafta
occlusion. 5 pu suffed AMI, and 2 pts died. Follow-up status was achieved in d pu If=
30525.5 months.
REV:
Pu (a):
m
AC
F€
39
35
PA
IU
0
26
7.7
29
29
20
2.7
4.4
11.4
23.1
3.8
6.1
ULS
304
522.
923
g 8 ~
a73
61.4
46
Cldir mM 1%):
.Ikmh
- AM1
.CAB01
- PTC.42
U
CIinkrl h
pwarra~ap
vrAK.FX.UdFA
Condusion: 1) Rimary success of PTCA in pu with MVD is comparable to pu with 1-VD.
2) Compared to anatomic complete REV anatomic inwmplnc but funnional complac or
deqrutc REV show no advuw c f f a on mortllity and mabidity during mid-tam followup.
-
DIAGNOSIS OF PUIPlOBARI ATWIOVEIIOOS F I S W
BY CONTRAST BZIOCARDIOORAPHP
Wang P e l - x i a n
Cong Hong-liang
Department o f C a r d i o l o ( g ~ T i a n j l n M i e n 1 C o l l e g . R o s p i t a l
C o n g e n i t a l p u l m o n ~ r ya t e r i o v e n o u a fiatula(CPAVF) i n two boys
were diagnosed by two-dimensional o o n t r a s t echocardiography and
confirmed by pulmonary angiogiaphy in t h i s paper.
Case 1. A 4 y e a r o l d boy, c y a n w i s , d i g i t a l c l u b b l n g and exert i o n dyspnea. C a r d i a c examination was normal e x c e p t f o r a m e
1/6 murmur heard over t h e a n t e r i o - l e f t upper l u r g f l e l d . Hb
17g/dl. Pa& 43.7mmHg. Fluoroscopy r e v e a l s p u l s a t i o n o f t h e
aneurysmal s h a d w i n t h e l e f t upper-middle l u n g f i e l d . P e r i p h e ral v e i n c o n t r a s t echooardiography Was p e r f o m e d . I n t h e a p i c a l
four-ohumber view, t h e c o n t r a s t m u t e r i a l was f i r s t seen in t h e
r i g h t atrium.then r i g h t v e n t r i o l e , 2 seoonds l a t e r i n t h e l e f t
a t r i m , a n d , i n t e r e s t i n g l y , i t c l e a r l y c a n e s fios l e f t upper
pulmonary v e i n . Pulmonary a n g i o m a p h y r e v e a l e s m u l t i p l e B A Q F ,
muinly i n t h e l e f t upper l u n g f i e l d .
Case 2. A 15 yetir o l d boy. c y a n o a i s , d i g i t a l clubbing. 3 4 4 9 . 8
ImnHg. C o n t r a s t echooardiography: u l t r a s o n i c r e f l e o t i o n were
v i s u a l i z e d i n t h e l e f t h e a r t 4 seconds a f t e r t h e i r appearanoe i n
t h e r i g h t h e a r t . Pulmonary angloSraphy confirmed CPAVP.
C e n t r a l o y a n o s i s c a w e d by CPdVF i s r a r e . and i t i s o f t e e werlooked even by e x p e r i e n c e d d o c t o r s . S o , t h e c l i n i c a l t r i a d
c o n d e n i t a l c e n t r a l o y s n o s i s , shadow in l u n g f i e l d s on Xand ab8BnCB o i r i g h t t o l e f t i n t r a e n z a a c s h u n t on w h 3 i o paphy
s h o u l d s u g g e s t t h e d i a m o s i s of CPAVF. The appearonce o f c o n t r a s t m a t e r i a l d e l a y s f o r a few seconds i n l e f t
a t r i u m i n this d i s e a s e , which c a n be used f o r t h e d i f f e r e n t i a t i o n from i n t r a c u r d i s c r i g h t t o l e f t s h u n t .
To our knowledge. this is t h e f i r s t r e p o r t i n f i n d i n g t h e echo
o o n t r a s t m u t e r i o l ( H t h ) i n t h e l e f t a t r i u m coming from pulmonary v e i n . T h o r e f o r e , i t can b e c o n s i d e r e d t h a t t h e t e c h n i q u e
m y a l s o be h e l p f u l i n c o n f i r m i n g t h e l o c a t i o n of CPAVP. and i t
i s 1 s i m p l e s t method i n f o l l o w i n g t h e e f f i c a c y o f o p e r a t i o n .
---
----
TUESDAY, JUNE15
THE BERNliEIll
:-P
VALIDATIOW BY DOPPLER iDWARDIO(IRAPHY
IN HYPPITEHSIVE PATI=
WITH Lm -1CULAR
mPERlROPRI
SrnRU. FmLA.m.~NAwAR.m.mI(ABIN.MD.~
HASSAW. HXHB. HMW4 RAWIEB. m. Aleundria Faculty of I(rdicine
Cardiology Department. Egypt.
PRE AND POSTOPeUTM ASSESMDIT OF Lm
MNTRlCULAR MASTWC NNCTON BY PULSED DWPLER
E~~~~,~~~~GF~R~INCORO(IURYARTERYMSEASE
rJaxrndr
MD.Nab krganabubl* MD.FCCP,
QWQS Larrldrr MD.Pnor Clpfm08 MD.
Right ventricular affection in hyporteruiva pt8 with left
ventricular hypertrophy (LVH) is known u the Bornhoim
phenomimn. validation of thi8 phenainon by Doppler echocudiography is not fully etudiod bafore. Thirty hyp.rten8ive ptm. 15
with LVH (group I ) and 15 without (group If) *.re
u8eoord by
Doppler-echo. RV diutolic function rcu u8e88.d by triclupid
W A ratio and C deceleration. RV .y.tolic function m s e8eese.d
by fractional u e a contraction (FAC). preejection p.riod/
ejection t i w ( P E P / R ) and ejection fraction (EP). Pulmonuy
premeure (Pul.Pr.) was calcu1et.d from acceleration tip..
Remulte:
RV dia8tolic diunoter
RV dia8tolic volume (d.v.)
RV ;joction traction
W n P u l w n u y pressure
LV mas8 index (LVIII) g/mZ
Septum in diastole (.p)(ST)
LV W A ratio
LV PEP/EI
LV posterior wall thinning
25 1 4
199 k59
15.422.8
0 . 8 k0.3
0 . 3 20.1
88 k20
20 29
94 223
9 . 3 k1.4
1.06k0.31
0.3320.11
109 232
WB
0.000
0.000
0.02
NS
0.05
Correlation8 of data in the 30 pt8 a8 one proup: RV W A ver8w
( w ) LVIU p(O.006. RV E deceleration w LVNI p(0.04. RV d.
v o l r w w LVIU WO.03. RV d. volum w Pu1.R. WO.02. Septa1
thickrun in diutole (BT) w RV W A W0.01. 91 v e n w RV E
deceleration p<O.OZ. ST va RV d. volum p-NS.
Conclwioru: In pte with LVH t h e m m e RV diastolic dyefunction.
and incrauod RV dia8tolic diameter. The 8ignificant correlation
batwen RV diutolic dymfunction and LV ma88 index and septa1
thickno8s uplain8 the w c h a n l u of the krnhoim pheminon.
Thuv w u rignificant cormlation batmen increuod RV wluw
and inareasod p u l w n u y pnnw. t h w RV change8 a n due not
only to LVH but 0180 to p u l w n u y hyportemion. Sy8tolic
function of RV u u o r o o d by FAC. REP/EI. and EP was not
ahnorm1 in tho group with LVH. The w-nt
of RV .y.tolic
and diutolic function is prornd to ba feuible by Doppler-echo.
ANAUDIERG Ph V\CROUC P.VIROT. E.CORNU. C.CHRISTIMS. P.GUERET.
M.USKAR. CHU hrpuyhen, Limages, France.
amtrol ahjects md aaard BP, OIi. H- uh. M i m a i o n l , p r l d md m l o h i o r
edaeadl&.
Pntimts rrs mistad far prlsad Doppler -imtim.
I f b at tb u i t r r i a
in d i d , HL <BQP or m mifatation d r s i d u l effmim ad aruk r r r r i t a t i m vlBr
tblDdatcdEm€Q.
b l t : l l i t r a l n l r a &lltim
i
d in SJ? mtimta tarn dfh mntrols ( I D 3 6 US
6 pa). 05) ;Viamid ulve b l l t i a : S J ? mtlmts 10"8 VS anbols 3/56 pa).Q;btic n l r s
dm- r l i t i a r : SJ? m i m a %?4 VS -1248
r(O. Q ad th m i d tb, m t i a t r with
n l w k hn- m i i t l a W W 6 ill56 p(O.Ol).llitral w l i t i r m h i d a in W
R( m t i n t . tbn &ls
(323 6 5/58 W. W ad S m t i d Id m s b i f i c a t diffmcrd with &I
Ih incidrn d psiadl.1 &la is mtlrrtr d t h SJ?. SM
OMW m 10.77%.19.*4 rafftivlr ad hd m s i m i f i m t d i f f a m in mil of thr.
A n M i m in tb pat f i l l l n Oralocity,E:A rrlocitr ratio. h l m t i e nt.d E nad
a wolauin in i s a o l u b i c n l m t i m L l r La SJ? S PUlW m t i a t r &to tb mntrol.
Ih pat I r t . f i l l i s IIU allcity a s i m i f i m t l r h i d a ta SJ? dbcta thn tb r u m 1 . W
f i l l l n rrtsw) , l b r l i a d pat f i l l i n rrtsOWl) d e n m d rcPsLinlr in SJ? S mtimta.
b i d f i l l i n iadpWI) a lor^ in SJ? S PUlW mtimts.
a t o l i c t i n iatcrral a
simifiumt diffbtm SJ? S dbcta ad rmfm1s.k th L
W m IDSddiflancs
&mm th SJ? S mtiastri ad mntrois.lh L B in OMW m t i d m hida tbn mb-01.
Conclmim: I . l h s d i d l 8 inrolrrrA la W! is f r s O r t s c r h l l r La W ad %:OMW mink
dtheaitral -itsrim.
It's d r m l i t y s be related with tb t a r d i m t i c LV
prld i d n u l t i n in 8Itral I d l e t tcrrd to U in a t o l r ; 2. p i d i m m imolved
in tb thss ti& of diara.but the SJ? S m t i d *rs m dtm tbn PUlW:J.lhe F0'I.fW I
LMAp-
9r
pratrve
9i-&
either m the
w o r n davicular .-f
the first, the second and M i third lmereostel wace.
Trbaducsr m s positknnedto obtain the bast velodty wawe fonn.
on b&s o D exarninatlon. Botk IMA worm
stud(ed
We audled 37 patienti (60 t 11 e m ) 30 men and 3 women. 4 w e n
exdudedinnsronolpowecho-.k.IIhMWrdeclana
Prt.y
(LAD) was narruwed. 6 7 % had a rlnht coronaw arlew s t e n o s l s . ? ~ % a
drcwnlkx and 12 %left a main Senmi& 30 % hadem mkcadld Infardlm. 27
%.had infer0 posterlor. 42 % had a m w
1 5 hdliierd.
~ ~
h t oprrjlhn
coronary angiography w a s not pertormed b e c a u s e t h e patients were
asvmptomatic and b o c w s e the reliabilltv of cJ6wlor method c o m w r d to
We analywd 3 Bf(ennts mupe of w
m
s
:group I and II: lMA was grafted
inaninfarded~um~butlnwwr,ithon~~mwcardlum'lrn
beneftIwasob(aikc41ntheaarte~ivithirndlcel
mycardurn'). Gmup III had m m
s
gmup II -(
orPfCAwn~&yto
Infadon.
Each gmup had his own flow pattern:
L~L~andtbUFTrdradinSJ?Smti~ftdidtlrt~brilrolvedinSE
S
patients but tb Sn in OMW diL't diffw f r o th motmls. lb L W in OMW mtimta a
h i a t h mbols. It aswrtd tht ths mocl~~ion
includal t
h n M l m of d t s l a d b
atsih t i m rmas imrlvd rlrelstal v r l e ba8 ad hid! artnn statm
to
-I
d l i c M of d i d dplatal u s l e in OMW mtimta4. SJ? S OMW mtimta
M d r m l i t r of LV diastolic fillim attrn in n i a r Boa. b Y s mrlldd:SJ? S OMW
all hd the LV diastolic d r d m t i m ad d i d Wtb dimtolic abDlriity dtm
nntolic dnfurtlm o -t
t b mtimb hd m a b n r r l nntolic function.
-*-
WBU(lOda7Mhznwchanicalpodocmrorkr2Dimeai~caJdod~a
demased dasldic velocities and time vebdty
.0.09 rmceC vs 0.2.3.3vs 5).
-
.- - .
.
- .- -,.
dktolic now behavlouf; edlaatok veWtie8 and M
2. Q.6vs 5).
uy fiow behaviouf; enhanwd dasldic (low and tvi (0.47 5 0.15
Sy#dic vebdes were deaeesed in the 3 g r o u p (0.8 rmsec w 1).
We condude that echo d6ppkr of IMA g r a b in the earl pwt operatlve
perlod may pmvide as a m n invascve saeening test valuable ~ k o n about
s
graft patency a n d viability of revascularlsod myocardium. A systematic
examinatkn would dlow a bng term ldkw up for each patient and, as his own
relerence, detection of early w o n e n i of
~ the IMA grafts.
CHEST 1 103 1 3 I MARCH. 1993 1 Supphed
207s
TUESDAY, JUNE 15
(PTCA and Echocardlogmphycontinued)
IDENTIFICATION AND LOCALIZATION OF CORONARY ARTERY LESIONS
BY EXERCISE ECHOCARDIOGRAPHY
S u i r I. A l i , Prank SteensgArd-Hansen, Kari S a u n d k i ,
S t i g Haunae, Henrik Egeblad.
Medical department B , d i v i s i o n o f c a r d i o l o g y , R i g s h o s p i t a l e t .
U n i v e r s i t y of Copenhagen, Denmark.
AIM:
To e v a l u a t e t h e c a p a b i l i t y o f e x e r c i s e echocardiography i n
i d e n t i f i c a t i o n and l o c a l i z a t i o n o f s i g n i f i c a n t c o r o n a r y
a r t e r y l e s i o n s (>SO\ s t e n o s i s l
METHOD:
B i c y c l e e x e r c i s e echocardiography was p e r f o r m d p r i o r t o
c o r o n a r y a r t e r i o g r a p h y i n 30 c o n s e c u t i v e p a t i e n t s r e f e r r e d
f o r angina p e c t o r i s . Image l o o p s were o b t a i n e d a t r e s t , peak
and i m t e d i a t e l y a f t e r e x e r c i s e . A 16 segment d i v i s i o n o f t h e
l e f t v e n t r i c l e was used w i t h a descending s c o r e from 3 f o r
h y p e r k i n e s i a and -1 f o r d y s k i n e s i a . E x e r c i s e echocardiography
was c o n s i d e r e d p o s i t i v e when w a l l motion d e c r e a s e d a t l e a s t
one s c o r e i n a t l e a s t one s e a a e n t iras r e s t t o tmak o r wst
e x e r c i s e . The i n f e r i o r w a l l ;as c o n s i d e r e d s u p p i i e d by k i g h t
c o r o n a r y a r t e r y IRCA), t h e p o s t e r o l a t e r a l by c i r c u m f l e x (CX),
and t h e remaining o f t h e l e f t v e n t r i c l e by t h e l e f t a n t e r i o r
descending a r t e r y (LAD)
RESULTS:
There was s i g n i f i c a n t c o r o n a r y a r t e r y s t e n o s e s i n 26 p a t i e n t s .
I n p a t i e n t s w i t h 1 - v e s s e l d i s e a s e , 1 1 o u t of 12 p a t i e n t s were
c o r r e c t l y i d e n t i f i e d a s having 1 - v e s s e l d i s e a s e . A l l 14
p a t i e n t s w i t h more t h a n one v e s s e l d i s e a e s were c o r r e c t l y
i d e n t i f i e d . A l l 22 LAD l e s i o n s , 8 o f 1 3 CX l e a i o n s and 1 3 o f
1 5 RCA l e s i o n s were c o r r e c t l y l o c a l i z e d . Pour CX and 2 RCA
l e s i o n s i n p a t i e n t s w i t h ) - v e s s e l d i s e a s e were unrecognized
by e x e r c i s e echocardiography.
CONCLUSION:
E x e r c i s e echocardiography demonstrated a h i g h l e v e l of
accuracv i n t h e l o c a l i z a t i o n of c o r o n a r y a r t e r y s t e n o s e s and
i n d i s t i n c t i o n between one and more th$,one v;ssel d i s e a s e .
However, i n p a t i e n t s w i t h t h r e e v e s s e l I s e a s e , RCA o r CX
l e s i o n s may remain u n d e t e c t e d and t h e y may be i n d i s t i n g u i s h a b l e by e x e r c i s e echocardiography. T h i s c o u l d probably
be due t o v a r y i n g d e g r e e of c o r o n a r y a r t e r y dominance.
.
.
IMTEQBblXD APPROACH TO THE DETECTION 0 1 INPARCTlD AND/OR
VIABLE MYOCARDIAL ARMS OSINQ SBSTMIBI SCINTIQRAPHIC I MQINQ AND LCHOCARDIWUAPHY.
Caasone R., Horonl C . . Cavaciocchi B.. Heck R.. I e r a r d i
S c h i l l a c i O.**, Scopinaro C.**, H a m a r e l l a A . . Aff r i o a n o C.*. Cordova C.
ll.,
*
l a d i c a l Iharapy I n s t . .
S t a t i s t i c s Dept..
dloine
O n k v e r s i t r of Row "La Sapienza" ITALY
**
Nuclear Me-
l i o c a r d i a l s c l n t i g r a p h y w i t h r e s t - i n j e c t e d Sastamibi
((M).haa been widely used to e v a l u a t a w o c a r d i a l v i a b i l i ty and to d e t e o t i n f a r o t o d a r e a s . To v e r i f y t h e u t i l i t y
of LUI a s a p e r f u s i o n a m n t , 20 p n t i e n t s w i t h p r e v i o u s
y o c a r d i a l i n f a r c t i o n wera s u b c i t t e d t o s c i n t i g r a p h y a t
r e s t . u s i n g b o t h SH ( 2 0 .Ci i . v . 1 and 201 T l ( 2 .Ci
l . v . ) , and a l s o to echocardiography.
L e f t V m t r i o l e (LV) was d i v i d e d i n t o 1 1 seg.ent.8.
L e f t v e n t r i c u l a r u p t a k e was graded ( 0 - a b s e n t . l = r e d u c e d .
2 = n o r u l ) f o r b o t h a g e n t 8 on each segment and c o l p a r e d
w l t h c o r r e s p o n d i n s s e m n t a l w a l l w t i o n s c o r e (O=aklnes l a . l = ~ k i n e s l s , 2 = n o ~a ls s) e s s e d by echocardiography.
mn was an o v e r a l l a a r w m n t between 20121 u p t a k e and
rnll m t l o n . I n c o n t r a s t , u s l n g SM, t h e s e r e s u l t s were
found :
4 B I o f segments graded 0 showed a n h m k i n e s i s
:;<0.001)
2 ) 12% segments graded 0 and 55% o f t h o s e graded 1
( p < 0 . 0 0 9 ) . p r e s e n t e d a normal wall motion.
I n oonolusion :
1 ) LUI a c i n t i g r a p h 9 a t r e s t seems to o v e r e s t i m a t e t h e a r e a of n e c r o s i s and to a c t a s a p e r f u s i o n and n o t a v i a b i l i t y a g e n t , s u s g e s t i n g t h a t maintained c o n t r a c t i l e funo t i o n is p o s s i b l e when a radnced SM myocardial uptake i s
found.
2 ) An i n t e g r a t e d approach, u s i n g b o t h myocardial w r f u a i o n and w a l l w t l o n i ~ s i n g ,seems to be s u i t a b l e t o a
o o r n c t e v a l u a t i o n of coronary a r t e r y d l s e a s e .
VALIMTIOU cf KPICAIIDIAL aaaR m
P
L
W W U I G In PwIPlplmi X U n
~ICIBIICI
Jules a. r a s t , De waver-mrpit.1 a u r l m
Petex van Keulen, I n t e w i v e r s i t y of Qrdioloqy (ICM), O t r r h t .
lul9AL
In t h i s study the usa of *picardial color D o p p l u upping for avalurtiog
the M n r i t y of mitral insufficirncy ( M I ) was n l i & t e d apainst a gold
standard for absolute rawarnt of r-itatim
fractim.
In 15 h u l t h y wags an . l r M u p n * t i c flow pmb. m a pla8.d m the
ascend* aorta end an ultraamic t r a n s i t - t i r wan-er
a t the l e f t s i b
of the AV-qroove OW the mltral nln r q i m a f t e r thoracotow in 0rd.r
to
both forward aortic f l w (Cao) ~d f i l l l w a o l u of the 1*ft
ventricle ( e l s i r r l t u u x l s l y . ?he mitral mgurgitant fraction
R R f l a 1 0 0 . (-0)
.P. -1 ( 8 ) .
In tha control aru -flow
0btaln.d m a s u r . m t s m s
0.09 f 7.6% (t . d l . Rh-flw n s asmmed to b. our gold sund.rd
for * a r u t i m of the d.pm of HI.
m e r . r f u r increasing steps of MI w r e created u t i f i c l r l l y In 9 out of
MI r a g w a l u a t d by Rh-flw and by Doppler using total r a p l r p i a t
15 -a.
jet area a s a percenuqa of l e f t a t r l r l u e a .
Y-.
A nonlinear relationship misted betnun raqucqitant
jet araa/left a t r i a l a r m ratio and Rh-flw
(y-2.25%-0.02~'. R-0.978 n-93). Using a semi-qtant~tiv*qradlng area
ratios Ln the r m c of 0-208 v i e l d d an estL.at.d TU-flw of 0-10%.
for a r m ratios i;l the range bf 20-408, Rh-flw n s 10-308 and for ~ r a a
ratios g r ~ t a than
r
408 R h - f l o w my ba o.srbu*between IO-8(N.
-TS:
CQ1(WsIaw: -lor Dopplu ~ p p l n qU Y
m r r o r e the n-r
of a n i u l s with
ecvsre U ,rhaa using n m i -tiutiw
qradinq. rrm a
hyperbolic rclatimship R B - f l
can be e s t m t e d Mlrmctly b y 3
color Dwpler nppinq
4
w
PULSED DQPPLER EVALUATION OF PREVENTIVE EFFECTS O? ALLQPURINQL
LEPT VENTRICULAR
DIASTOLIC FUNCTIONS AFTER REPERPUSIa
~RoCrw~es
APBWI, Y., OZXAN, I., ERDOL, C., DEIiRMN, D.
G A U C a r d i o l o g y ANKARA-TURXEY
I n n c e n t y e a r s , it is known t h a t f r e e oxygen r a c i d a l s
p l a y a n i m p o r t a n t r o l e i n myocardial damage and d e t e r i o r a t i o n
Of d i a s t o l i c f u n c t i o n s d u r i n g n p . r f u s i o n f o l l o w i n g . m l i t l C
t h e r a p y . The most i m p o r t a n t o r i g i n e o f f r e e oxygen r a d i c a l s i s
x e n t h i n e o x i d a s e enzyme (XOE)
Wa u s e d P u l s e d Doppler t e c h n i q u e t o d e t e c t t h e prWantiV*
a t f o o t s o f s l l o p u r i n o l on l e f t w n t r i c u l a r d i a s t o l i c f u n c t i o n 8
a f t e r r e p e r t u s i o n procedures.
Por t h i s p u r p o s e , 40 p a t i e n t s u e r e i n c l u d e d i n t h e s t u d y .
Wh.n a d m i t t e d t o t h e h o s p i t a l , t h e m p a t i e n t s had beon
maffering from c h e s t p a i n f o r 4 hours. The p a t i e n t s w n g l m
1 500 000 UJ s t m p t o k i n a n e w i t h i n 45 m i n u t e s o r i n a a h o r t o r
t h , i n t r a v b n o u s l y . 20 o f them were s e l e c t e d a t random, and
t h q w r e g i v e n A l l o p u r i n o l 300 ng. d a i l y f o r 10 days. Other
20 p a t i e n t s were s t u d i e d a s t h e c o n t r o l s , a n d t h e y were n o t
m b , o c t t o t h e A l l o p u r i n o l t h e r a p y . At t h e e n d o f t h e 10 days,
P u l w d Doppler e c h o c a r d i o q r a p h i c e v a l u a t i o n gava US t h e
following r e s u l t s :
CrntrolslA R . - ? h w ( B )
Ret-ParapylC) P
P
N: 20
N: 20
N:a
A e . 0
OY
.
A b l r v i a t i o n s : W :A c c e l e r a t i o n h a l f t i m .
Dm: D e c e l e r a t i o n h a l f time.
DR : L m c e l e r a t l o n r a m .
N.S: Not s i g n i f i c a n t .
Cur c o n c l u s i o n is t h a t A l l o p u r i n o l improves t h e l e f t
ventricular d i a s t o l i c functions i n the reparfusion a f U r
t h r a p b o l i t i c t h e r a p y . I t is thought t h a t A l l o p u r i n o l shows i t s
e f f c t by p r e v e n t i n g f r e e oxygen r a d i c a l s , by ahowing a
v a n o d i l a t o r e f f e c t and by b e i n g changed i n t o o x y p u r i n o l .
TUESDAY, JUNE15
Eccontrlc lntracoronary Stent Depioyemmt md lntimal
Hyp~rplaala A s u s u d by Ultraround Imaging
SeQe M&rmki,
Nicole Maufmy, Antoine Sarkis, Salvatore
Bettsglia. Gilks Bayet, T h b y L8pmhe, Bsnol Diebold, J u n
LBon Gwmonprez. Elmuusis Hospital. Paris, F n m .
In order to a w u both atmt deployement and intimal
hyperp(ori., intmcororury uhaound waa pcHformed using a
5.5 or 3.5 French 20 MHz catheter. 6 months after e P8ImuSchatz stent implantation in 8 patients. There was no
restenoris In this gmup of pal&nta (defined as a loss of + 50%
of the gain in krmiml d i e t e r after stenting). IntrsComnPry
ultncound muauremonta were a w e d by 2 independent
obrcmsn uaing pl8ninwtry in 3 d i i sites of ..ch atent. A
dradsr Jup. factor (CSF) was wd to detsnnine the dogof
deviation of the stent crou aectbn from a pefbcl circle : CSF
I the a q u m of tho mtio of th. alculated perimeter to the
obunod peritnetor. Intimal hyperplaaia was the difference
belween luminal area and extorrul a@nt arer.
CSF aigniiiuntly difhmd from 1 (pc0.01) : CSF I 0.87 0.1
(ramp 0.59 to 1) but no diflerenco waa observed between the 3
different sites . Intimal hyperpluia appears to be a bright
ochogenk 8tructure. This hyperplui. did not differ between
th. 3 different sit- but waa different between stento : 5.5 f
2.1 mi& (range 1.4 to 9.4). Intercorrelation was good
(r I 0.96).
Thw, wm with mtirfsdory angkgraphb controls. (1) atant
depkycmnt 8ppe8ra to be often eccentric a d (2) intimal
hyperplasia can be import8nt. lntracoronary ultrasound
conWned to angiognphy auld npr.rent an interesting tool to
aaaoss atent depbyermnt and bng-hn w .
CHEWITH HIGH DOSE CARBOetATlN (CBDCA) FOR UNRESECTABLE
NON-SMALL CELL LUNG CANCER
Kazuhiro DAIDO. Ken-ichi ARITA. PCCP. Tsuyoshi EJIMA.
Department of Respiratory Disease, Hiroshima Red Cross Hospital and
Atomic Bomb Survivors Hospital. Hiroshima. Japan
A high dose of carboplatin (CBDCA) was administered to unresectable
non-small cell lung cancer patients. Of the 35 patients given more than
two courses of CBDCA a t SOOmg/d each, w r t i a l responses (PR) were attained
in 10 cases and complete responses (CR) were in I case, of whom were
patients with sguamous cell carcinoma of the lung. Although a maximum
of 18 courses were administered, none of the s u b i e c t s experienced any
serious clinical side e f f e c t s nor required hydration, and the d r u g could
thus be given on an outpatient clinic The molt commonly h r v s d hemtolwical
side effect was platelet reduction, and platelet nadir war in proportion
to indivisual AUC of CBDCA. As a result of this chemotherapy, we obtained
t h e following actual survival curve. without harm their QOL.
*
0
0
MO
600
)W
Survival time (Days)
Chemo- and Radiotherapy of Lung Cancer
Morning
CHEHOTHERAPY VERSUS CHEMOTHERAPY WITH RADIOTHERAPY
/"SANDWICH" TREATXBNT/ IN SUL
CELL LUNG CANCER
Gy. O s t o r o s , I . T a l l b s y , ~ . ~ H o r v & t hCs.
,
Mthd
"Budai" H o s p i t a l o f H g n g a r i a n s t a t e R a i l w a y s a n d N a t i o n a l
Ontological I n s t i t u t e
B u d a w s t , Hungary.
,
5 5 p a t i e n t s / 4 6 m a l e 9 f e m a l e / With S m a l l C e l l Lung C a n c e r
/SCLC/ h a v e b e e n t r a i t a d . 1 6 p a t i e n t s r e c i e v e d c h e m o t h e r a p y
/CT/ o n l y , w h i l e t h e o t h e r 39 p d t i e n t s r e c i e v e d "Sandwich"
t r e s t w n t /ST- two c y t o s t a t i c t r e a t m m t s f o l l o w e d by r a d i o t h e r a p y and s u b s e q u e n t
a g a i n / . The
r e g i m e n was VCR
1 m g / m ; EpiADM 5 0 mg/m ; CPPl 6 0 0 n q / m ; 4.4 weeks. The RT
d o s i a was 30 Gray. The two g r o u p s h a v e b e e n i n a n e a r l y i d e n t i c a l TNII o n C O l o g i c a 1 s t a g e , whereby i n b o t h g r o u p s owes o n e
t h i r d of t h e p a t i e n t s had d i s t a n t metastases. C r i t e r i a f o r t h e
t r e a t m e n t was a minimum 4 0 S K a r n o f s k y P e r f o r m a n c e S t a t u s . I n
t h e g r o u p o f CT o n l y t h e r e s p o n s e r a t e was 7 o u t 1 6 /44 t / ,
w h i l e i n t h e ST g r o u p 3 0 o u t o f 39 1 7 7 % / r e s p o n s e r a t e h a s
b e e n a r c h i e v e d . The a v e r a g e s u r v i v a l t i m e was 7 mounts i n t h e
CT g r o u p , w h i l e 1 3 m o u n t s i n t h e ST g r o u p . T h e r e was n o
s i n g n i f i c a n t d i f f e r e n c e i n t h e amount a n d s e v e r i t y o f s i d e
e f f e c t s w i t h i n t h e two g r o u p s .
Based on t h e t h e r a p e u t i c response, s u r v i v a l r a t e , and change
i n P e r f o r m a n c e S t a t u s we c a n c o n c l u d e t h a t t h e "Sandwich"
t r e a t H n t o f SCLC s h o u l d be c o n s i d e r e d e v e n i n c a s e s o f d i s t a n t
metastases.
P
SYNSRGIC ACTION WITH @XRk%7IDK
AND V IN SMALL CBLL L W CANCKR
(SCLC): A P I L E ; m y .
B. Soremi* G.Invsmizri*
R.Boffi*
A.Liurzi^
U.Borghini*
P.V.*Mtellini*.
P ~ v o l o ~Deputaont*
y
Bndocrimlogy @ u t a n t ^
Iliguarda Hoapitd
C.P.A. *ileao.
-
-
-
-
-
-
-
Several iuunocytochwical o r i r u n o l o g i c a l w k e n w currently w e d t o ch._
m t a r l w d i f f e r e n t endocrine -re.
Sac. much M neumn s w c i f i c e m l u e
(NSP), sinaptophysln and c h m o g r a n i n A. .ppsw t o b. widespmd i n all t ~ p a
of n e m n d o c r i n e I W ) t u o m and proved t o b w e h l t o q w n t i f y t h s W c o c
w e n t i n u l i g n ~ pult
neop1.o. A.arp thew. only NSK h u c l s w l y pro_
the progression of tumors with
ved t o be u s e m serum w k e r f o r &toring
)IB caponent. In our experience, pstient. with lung u l i g n M c i e s .hor )(81 pos i t i v i t y r a t e s ( 20 ng/ml)rwngine fro,lOOI ( c u c l n o i d s ) t o 90% (SCLC)and 12!4
(nac8CL.C). i n good a g m e w n t with tiesue expression for the w k s r . O c t r + o t i
de ( o m ) , a long acting s o u t o s t a t i n analogue, s h a d prcrising r e s u l t s rh.n
used for the t r e a t a e n t of ME tuwrs. In view of what sbovs. we have undmrtaken s t r i a l aiming a t assessing the v a l i d i t y of an WE-inhibition t a s t t o identify the wst s u l t . b l e patient. for CCT treatment. Sow patinrt. c u r i e r
ru observed: thay have m s i v e d
of SCLC with s value of s e r u NSX .XI&ml
500 r g of CCT 3 tins per day f o r 6 days. Lot w c w i d o r m e p a u i v e t o the
t a s t tha p a t i e n t s with s e N level reduction of WIW than MI v e n w b u i c
value during CCT thew)., t o upturn s i g n i f i c a n t l y s f t a r 48 h from tJm phYucologic interruption. In cur study. Wrist 20 patient. c u r i e r of SCLC, only
15 have basic WK 2 0 4 . 1 ; tha responrivs w u 8. C a u l d e r i n g t h i s , w have
improved a p i l o t study on 20 p t i s n t . c u r i e r of SCLC, that i n w l v s s a s p r g i c m r a p y with CCT 500 r g 3 tins per day f o r the 7 days t h a t pncced th.
chemotherapy, following CBM's d i a a ~ A~ t . the end of the 6 c i c l e s of w r w y
the p a t i e n u i n CR o r PR maintain chmnical therapy with OCT 200 r g 3 timen
per day u n t i l sickness progr*asicn. R s l i m i n w y r e s u l t . shor the good t o l a m nee st the synergic therapy sxplained above and, f o r the . o r n t . i t ' s 1t ~ t ot notice that the result. m e i v s d with t h i s t h a w y uu the s w of
rhich that a r e produced with c h s w t h e r w y alone.
WEST I 103 1 3 1 MARCH, 1993 1 Suppkmsnt
-
208s
TUESDAY, JUNE 15
(Chemo- and Radiotherapy of Lung Cancer-continued)
THE ANTIEMETIC EFFECT OF ONDANSETRON /ZOFRAN/
IN CYTOSTATIC THERAPY
Imre Tall6sy
"Budai" Hospital of Hungarian State Railways, Budapest,Hungary
The most irritating side effect of cytostatic therapies is
the drug induced nausea and vmitinq.
The antiemetic effect of ondansetron Itofran/ was administered
during and d t e r cytostatic treatment of 30 patients I12 females and 18 males, mean age: 62 years (27-71)/.
Distribution of diagnoses: lung carcfioma / 25 cases/, breast
carcinoaa/2 cases/, urogenital carcinoma/2 cases/, metastasis
lone casql. Protocols: 48 CAP ldty 1:cyclophosphamidq
500 mg/m , epiadriamycin 60 mglm , cisplatin 40 yg/m /,15 VAC/
day 1:vincristinf 1 mg/m2, epiadriamycin 6 0 mgim , cyclophosphamide 500 mglm I, 14 VIP Ietoposide 100 mg/m , day 1.3.5
ifosphamide 1.000 mg/m2, days 1-5, cisplatin 40 mg/m2day 11
other 49.
Before and during the first 1-2 days of the cytostatic treatment patients were also given ondansetron in a dose of 8 to
48 mg, either intravenous, or orally.
The antiemetic effect was evaluated according to the scoring
system of WHO.That is 0:81%, 1:129, 2:5%, 3:2%-
...,,n
I* I r k af r m l i l n l a f f ~ *ml t* v*nii af # S I C p t l n t a d btl chmt*r*r ad r r * i e k w ,
c m m a WWmad f u n ~ n tl r u t d ~ l l l l fnn ~ b t an l r m l y mnm ww nf u l i ~ i nIU
. ba
b m (.Ia1 t* *rl nlminlr s W I d anal Y a I w i c a l k*uu U l f l u s , krr i t b a bm *r b
mm mull I r r r q @ l a l n r rlirllin did ,la; u i&lrt rale *rinl a w-.
l a W i )mr Il el*,
Il-Ius *.lnlalnd
i a c m t n t l a f n i n 6 t h a mtnl w i n k . L l e lac a w s
e l a Cr e l hlk (rim Y.tlsl.LICy. I@
a m I I 1 Twlblllif,
tl f f f r h r ) . l r u y f r l l w t $1
I r r l q l c dfcrh,
41 hllku a f f r t .
h I d R t i WIN
~
af I1(rv rrl # I d t w b w, af b davs a l t k r ~ # y , f a I I n d h m +rut, ail&
e m b We ef cmbwl imfninc n u c m l i n l y , e l H a pane af 9 4 s htIs1 ad &
cycle,
I M k 3
N h s 4u(rlwe csln
uWld, #ub rr af b L m ef cmW ldnlu. II-I*.lmihatin
W
b h I w k r q b d l a c m ef mmin *ur, clinical Vtblm, vlld'i 1-1.
II )climb nth
a111-11 W, ntr, d i m *r rn v s , a11 hI t m n i r n l y kuu, r k d l a b ue s W r .
W piint, klhc e m t i * m l b l n d
radialalqical Inti, -t
r t u l a l bled
mlflis,
m l m r krlln tesh, b r a r h e a l m l a f Iary., alwrrdiaqr*11, b f w * , krl* a d a f l n 1 U iafnin.
llL bbI af 21 c y c l n IIS il(rti*n 14b u m b i u r a i'wsl m a W d a h r d . bum e l Ma w t l n t s a1
a l e h cw1*1* I*b PI- c w w s af k v y h 1 1 3 p l l r 1 a wl 1
. t* u l l M w r a W md ale&
Nt t*rw f u r M c w l i n t . I* r m n af t* I.tnn)tlm af a t * r 8 p t l n l s r r e I 8 l c a a
) n ( m r l v a *Hw. mi l a 3 c n n m h i i c i l y tbmni *riq IW f i r s t c p l r l i n t p t l n l s m l a W
llPl r d d wllmpl. I* McI u u SICd f r h ar f e w , .Ll)rtairr a l l p i a , m d a . H*r 4
l b ~mt mlm n a . Ic m . r m a l l n l i . c u H r HM~.
m e u n i t i s . t r u l l n l e dsin.
.
-
-
h h a i r *tn w c w r r l .
tl h c t m c d j r r e ~ w n pt ~ w n sy: ~ - a f f a t a s e b w i d . L I ~ & * ~ a t l r ri ~ e i , n d i f t c a l t a n
l a ) r l w r f n t i l n lnli l d t c a l a I I t e l hl r i q m l f l c n t rstr1ctI.r C f r t ,
d 8f*r Urw: n
n r l s k d t* lrrm d f i l m l a - u l n t a l r a d i a l f u w. lh v l l l r l
e l b(L V?bl
~
In 21 treatments the antiemetic effect of the drug was compared to formerly administered antiemetics. In self control
73 9 of the patients have found ondansetron to be superior to
the combination of dexamethason+metoclopamide.
Side effect rttributable to ondansetron was observed at alll
&am
~ l l s . l nI@
i q l a , rn Wni, d i f f u n t l y f r n
u lln-
d a-mmstricM
lyttc
rtldhl Z t i c ~ l n l yq a l n t W ,
41M m l e t q * ( f l c I*r ~Hdr)
.n ilill r t *
In.
I* dl%
rviral
H h Q4 m t **m q k i d ef w t i t r~q w n i n hi s w , k t a nav~tr(
I t # r t h l ui -Id. l a H i s r u l l H)w I l l ) ef p t i r t s a d i n t* a h r a e af I c n t r a l we, n c-I
u y 11 n i s WII i s
EUROSCAN, THE EUROPEAN CHEMOPREVPJnON STUDY IN LUNG
CANCER
N. van Zpndwijk'. U. Pasmid. N. dc Vrid ud 0 .
Dplcdol
') The Netherlands C a m Institute,Amsterdam, The Netherlands
')
')
lnstituto Nazionale Tumori, Milano, Italy
Free Univenity Hospital, Amstdam, 'The Ndhcrhds
Knowledge gplhacd during the pprt few dmder from Ihe fieW of cpnm
epidemiology, cartinogenesir, biochemirtry and rrantly moleculrr biology, pmvidtr
powerhrl new strategies f w cpnm p l ~ ~ ~ l t i oFn . t M n refat to
~ntavcntimwith chunial agents, atha natural or rynlheac, W can inhibit or
reverse the minogenesis process. Several chemical agents have been idartifid that
h w promire as polatid c h e w e n l i v e agents. This hPr Rsulted in Ihe m t
initirtion of t e v d national ud inlernatiaul drmoprrnntion trials aimed nt
d u d n g the incidence of a nriay of ancat in d i f f a c n t pcrplltions.
The European chmMprmntion h d y EUROSCAN in patients previously mated for
had and neck anca and lung cpnm,smtd in June 1988 undu
of the
Eumprn Organintion of R*reprch and Trratmat of C a k x (EORTC). An
m m i c 2 x 2 hctorial design was chosen to investigate the posPible &mopmentive effa:ls of N-Pcetylcyudne WAC) and natural Vitamin A (retiny1 plmitaic). On
the basis of previous studies in animals and humans a choioe w mde for a dos of
600 mg daiiy for NAC and 300.000 N daily for Vit A.
On SepIcmba m. 1992. 1620 of the MOO planned ptients had atad the rtudy.
The mean s c c r d nte a t prrpnl is more chm 50 ptimts pr month and 55 antm
in 13 Eurqean countries are involved. Interim analysis of ddc effearltoxicity show
that boch single d ~ g and
s t h e combination arc rauonably well tolerated. The main
toxicities elicited by Vit A refer to the &in, causing intmuptbn of medication in
. b o u l S % of t h e ptimls. NAC awes mild gashic d i m f o r t , rcldomly W i n g to
i n m p t i o n of protocol erumcnl. Updated rcsulls of this d l l y running study
will k presented.
I#
a
WIKIM
bias ar 18 ~IIIWUIIVI
I W LYMPHAnC P A W A Y S OF LUNG CANCURATlYe UtRADIAnON IREAIMENT.
112 IMVV.
AND 'RIEIP UWlXlllONIN
Kiricuu LCMueUer G, Stiess 1, BohnQrt W.
Departwnt of Radiation Therapy of che Univurity of Wwrtburg,
Josef Schnei&r.Str. 11.8700 W u a z b q , Fed Rep. of Germany.
A moditled
R(M d a s s i h h for lung cancer and its imlhiou
for anrtRe
rumors. For d&t loated armors tbe invdsemcm of tbe comnlrtsnl
d t i n a l LN is equivalent with &taut mtPaueb whom for MIl a u e d tPmm
tbere is no differcnoe if +e ipsi. +/or mprnluerPlmediasdnal.LN are inrdvod Tbe
swvirpl rates correspond108 to uanena wtb lnvdwd suarlmeulu a coamLtsnl
md rirrht lc-ated
is riven foi metastask to idlateral m e d i h i d md m b c d d for cbs rbht
Iwy-and/or 6 e c o o t d a t e d mcdmiind mdes for tbe kh l w The, d + i i
'M Oymph)"e given for metastasis to tbe contnlPted hilu and/or m e d u m d LNa for
the righi lung -diiai*ted
d l o r ooamlateral INSfor the kf~lunn as rell n
d a v i &
LNs for d&t and leh i d
Th amcquenoes of t h e t b e ~ Te d N druihiadoo
~
f
a cum+ mdirtia
L - 1
are: the hc arPacrrt has to hdage,the
I l . , N 2 - d f o r W mawu the n d a a m d ~ m " ; r " L N 3 2
d&natim
LN.
Tbe upper border of the mediastinal treatmnt field baa to be che s t e m o c h t i d u
Pniculatioa The contralateral hilar lymph nods if not involved have m to be induded
in the treatment volume. 'lbe i m o k m i n t d imi- andlor cwtrpLteral suomcladah
nodes and conudateral hifar lymph mdes Li a sign' of advaned disedte and oLy
p d i a h tm+mcnt is recommended Their kadmtio11 will improve loal cormol
without affectlag the global survival.
~
TUESDAY, JUNE 15
(Asthma: Pathophysiotogk Mechanisms)
m mlumIacmrw saanrmanrcna a r s n u I C B .
n . ~ . ~ . n o u s n m . c . ~ ~ ~ ~ , ~ . a ; l c r o . n . a u m . n .
JET-NEBULIZED WATER IN ASTHIUTICS:
FnuaIm.
S a v i x i o 61 T i ~ i a m t L
a.p
~-.
00 b.r. RAN.
Ue invmstigatod the m l e of m i - 4
P i t a n g a NKN, Rizzo A, Rizzo JA. C e n t r o d e Aama e A l e r g i a and I
Pneumology department. O n i v e r a i d a d e F e d e r a l d e Pernambuco.
Recife
Brazil.
-
Ultraaonicaly nebulized water ( V m l i s c a p a b l e t o p r o d u c e
b r o n c h o c o n a t r i c t i o n i n more t h a n 908 o f asthmatic p a t i e n t s (And e r s o n Thorax, 1 9 8 3 ) . The o b j e c t i v e o f t h i s s t u d y . was t o obaerv e i f JET n e b u l i z e d w a t e r (JNU) c o u l d g i v e t h e aame r e a c t i o n . I
12 a t a b l e a a t h m a t i c a were s e l e c t e d ( 7 male and 5 female, mean a
ge
2755 y e a r s ) and a u k i t a d t o t h e f o l l o w i n g p r o t o c o l : Day 1:
i f t h e PEV was more t h a n 70% o f t h e p r e d i c t e d t h e p a t i e n t waa
g i v e n a c a i b a c h o l b r o n c h i a l c h a l l e n g e a c c o r d i n g t o C h a i ' a ma
t h o d (J.Allergy.Clin.Iuanuno1. 197511 IMy 2
a f t e r 2 daya o f t h e
Carbachol c h a l l e n g e a b a a a l ?SV waa o b t a i n e d and , i f t h e va
r i a b i l i t y was l e a s t h a n 5% o f day 1, t h e p a t i e n t was g i v e n a n)
b u l i z a t i o n w i t h w a t e r by a j e t n e b u l i z e r (Hudaon,O8A), w i t h a
'To m u t h p i e c e and n o s e c l i p p e d f o r p e r i o d s o f 2,5,10 and 1 5 ml_
n u t e a . A f t e r e a c h p e r i o d a new PBV a u a a u r u m n t was m d e and
t h e t e a t atopped i f a f a l l i n m o r e l t h a n 208 waa obaerved.
-
-
-
-
RESULTS r A l l 12 p a t i e n t s had a f a l l o f m r e t h a n 20% i n PBV I
a f t e r C a r b a c h o l b r o n c h i a l p r o v o c a t i o n (mean f a l l 2553% b e t v d n
t h e 0.50 and 2.50mqlnl c o n c e n t r a t i o n a l . With JNY a f a l l o f mr e t h a n 208 o f b a a a l PEV was o b a e r v e d i n 2 p a t i e n t a a f t e r 2 m i n
i n 2 a f t e r 5 mln. and in12 a f t e r 10 min. 6 p a t i e n t a i n h a l e d I
JNU f o r a t o t a l p e r i o d o f 32 min. w i t h o u t a f a l l i n PgVl o f mr e t h a n 108 o f b a s a l .
CONCLUSION : JNU was c a p a b l e t o produce b r o n c h o c o n a t r i c t i o n i n
h a l f o f o u r p a t i e n t s , t h i s d i f f e r e n c e i n r e l a t i o n t o rmW may be
e x p l a i n e d by t h e f a c t t h a t u l t r a a o n i c a l n e b u l i z e r s make a more
d e n a e n e b u l i z a t i o n w i t h more w a t e r n e b u l i z e d p e r u n i t o f t i m a .
arb.
A.
d
Qao.
t o puwnchlu interdepmdurcm. wgallywdiatod bronchial n f l e x . and c a l c i u on airway n v r o r i n g following d n p
inhalation (DI) i n five uthmatice (28.6t3 y r . . -1.
At baaold m
WU 3.24iO.5 (SE) 1 (86.5i14 1 of pmd). SO.. WU 0.1UO.06 m H oZ1.
and thm r a t i o of maximal to partial mxpimtor). forsod n o n a t & of wc
(M/P ) ru 1 . Y M . u . Dn thrw occuiona. an m k a p u t a t 1.ut.
blm%onstriction
ras induced by a a a r i n of five 01 urrm-n,
m d RV
and MIP
wen recorded evew 5 min during M. f i r a t 30 min. P l m b o (P)!
~ i f m d i p f R( N ) 20 .s sublingually 30 min b f o n th. *at, and i n m o d
I p r a w i u B m i d e (IP) 160 r g 45 min b f o n the toat rua glm i n a
npRolliud order. After P, f a l l of RV P m O n u i n l J n a M it- u x i u a t
20 nin (29t5 1) and then began alarlb ncovwing ( a n t . b l m ) ( p < ~ . ~ l ,
MOVA). WP d i d not show any significant i n c n w during M. airway
-wing
8 conatu~tlyr s u i n o d above the unity (p( 0.001, MOYAI,
indicating that no unbalance bebronchial and w c h i r r l h y a t . n m
oscuwed during the rholo time of b m c d m c a a t r i c t i m . M a i f i f i c m t l y
inhibited M. doof aim4 -ins
indued by DI Tpc 0.001 w PI, but
left unchanged WP c a p u d t o P. b the s o n t r v y IP uaa m t able t o
p r o t w t eubject.
m c h ~ ~ - t ; i c t i o n (p m vr ~;nd
p 0.001 w I().
Uld l e f t */Pa CaUtMtly above unity.
Minutes
5
10
15
1%
1.7iO.2
24t6
1.720.2
29t4
l.7M.2
l.7M.1
r ~ v ~ f a i i , x4t4
Y/P
1.8M.5
m& En.
f a l l . X l4t9
1.8f0.5
ins
1.6iO.4
iu6
l.6iO.4
20f5
1.7M.3
2225
1.5iO.3
21f4
1.7M.5
m
PEV1fall.X
25
30
24t4
1.7M.1
2ZW
l.6M.1
irts
1.w
1.3t0.3
1.5t0.2
lor*
1.3.0.2
2225
l.bM.4
21t6
l.gM.4
20
-5
conclude that airray n u n r i n g following DI i n u t h u t i c a i a m i w r
u d i s b d by an unbalance betwen airway and - h i d
h y a t n r m , m r by
wgally-mediatd mechanins, but i m n1af.d to rchYrimn involving m i r r y
UCle ~ t r u t i m
86 it i s pmvmted by v o l t . p . - d . p m d . n t d c i u cburwla
antapniats.
We
DETECPIIII T I I ~NJNJYL3IIIC BH,J~CI~IAL
kl;n(r'l'IVI'PY I N 14-19 A06
IR9'IP STUULI'!';.
n.Akin, S.Aktogu, A.Ozsar, S . C e u i g . I e m ~ r 0 6 g b H a s t a l i k l a r i Hast a n e s i , I z m i r , Turkey.
I t h a s been d e m o n s t r a t e d i n many s t u d i e s t h a t a i r w a y h y p e r r e a p o n s i v e n e a ? is g e n e r a l l y e a s o c i a t e d w i t h b r o n c h i a l a a t h m , c h o n i c
b r o n c h i t i s , t h e up,Jer r e s p i r a t o r y t r u c t i n i e c t i o n e , c i g a r e t t e
s m o k i n l and a number of s p e c i a l c o n d i t i o n e . R e c e n t l y t h e e p i d e m i o l o ~ i c a la s p e c t 01 b r o n c h i a l h y p e r r e a c t i v i t y of t h e community
b e become t h e f o c u s of i n t e r e e r . I t , netura'l'ly w i l l s t i m u l a t e
many o i u s t o d t t e r l n i n e t h e s p e c t r u a o f rlsY f a c t o r s which
c a u s e t h e b r o n c n i a l h y p e r a e e p o n s i v e n w a . I n t h i s a t u d y wenaimed
t o d e t e c t t h e b r o n c h i a l reactivity s t a t u s among t h e 14-19 y e a r
af a = e students. S t a n d a r t q u e a t l o n n i a r e o f American T h o r a c i c
S o c i e t y which I s e s t a b l i s h e d f o r e p i d e m i o l o g i c a l r e a e a r c n e s was
uaed t o c!et t h e n e c r s d a r y knOWlOdde r e l a t e d t o r e s p i r a t o r y s y a ptos1.1, d i r e e a r 3 a114 smoalng h a b i t s . R e s p l r a t o r y r o n c t i o n end t n e
l e p r e e o f b r o n c h i a l r e a c t i v i t y t o cnethaooline were a s s e a e d a c c o v i i n n t o C o c x c r o l t ' s t i d a l volume method s t a r t i n g from O.OMg/
ml t o 10 m < / u i l . c o n c e n t r a t i o n I n e v e r y EubjeCt. A t o p i c s t a t u e
wes e v n l u t e d by s k i n t e s t s . I a t r a d e r m e l t e s t a o o r e s and serum
e o s i n o p h y f c o u n t were r e c o r d e d . LO s u b j e c t e who d i d n o t a c c e p t
t o 7 e t t h e > < I n t e s t s were take11 a 3 t h z C o n t r o l group. PC ' I V ,
v , ~ , , ~2., ,j ; L I A Ion. i c i ~ > l i c ~ tell I L ~ tCi ) ~w a ~ . j 3oranchiul'@~
I I V I , C I I . ~ ~ C L ~ V ~ 101
~ ~ 27
.
of 7 3 i t u d t n t s ( U J )PC FBV Were l o w e r
t h a n 4 m ~ / a L wheread t h e Same v a l u e s were h i g h e r t h a n lbm#/ml
I n 35 a u b j u c t s (;37).ue
iound i e t c l t i s t i C ~ l l y a i n n i f i c a n t r e l a t i l u n ; l h I p between t h e symptouls l i k e wheezing s n f d i s p n e and
b r o n c l l i a l h y p e r r e a c t i v i t y (p(u.35)..
A l s o t h e r e were i a t a t i s t i c a l l y s i m i i i c u n t r e l a t l u t l r h l p between o r o n c h i a l hy e r r e e c t i v i t y
arld r a d i ; l o ~ i c a l l y proven s i t ~ ~ r i t (i sp(0.05 ). I n 1 3 o f 9 3 s u b j e c t s ( 6 1 4 ) ' l ~ o j i t i v es r i n t e a t s were d e t e c t e d a g a i n s t o n e o r
more a n t i Tenj. I s t a t i s t i c a l l y e t g n l f i c a n t r e l a t i o n s h i p c o u l d n o t
o r foulid dLtweell b r o n c h i a l h y p e r r e a c t i v i t y and p o r i t l v e s K i n
t e s t s ( p)0.35 ).
PC Ed ha8 ;e 77.5 sensitivity and
51.7 a p e s i i i t y i n d e t e c t i n g
p e j t > l L t o r y sylr~ytom=.
~
A
~
M
N
D
a
S
T
~
n
€
r
v
R
f
f
A
mPEFIRCSPONSRlENESSNAUWGK:m
R.PI*. M.D.. L.Cec8rlnl. M.D., F.U.rch.uni. M.D.. D . W d o l l , M.D..
C.Msrp**ai. M.D.. F.C.C.P.
Rmoy Mv*im. OlkP MqU (Anoocq).
F
g
F
N
md
w.
Y n H w a m r d v : n 4 W ( t h r b v a W y d p m b * m d ~
allergen for th. d.vr(oprm1
of twoncMl lyp.m#lvny In rub).c(r WPA .Hrg(c
mlnltlr. If ellerg0 InWmmatiom of th. airways b Lnpomnt, th. longu h.
swm&&m
porlod th. g m l a r MI be thr I k W ol bronch(.l-.
thu.
Wconpndthre(kcbG44#(mnl~d~~q.nb(pwnnWud~on
~pnrrrondh*d~hypemoclklhl.
M M 14 F. M o p 18.7 i i.2 ( s w m m r a u s i *a(oc i s M'H ig F
~~1op~.7ii.~mwuea~ldbypam*muocl.rmwb~lopmcy
w e n u p o h . M wb).asund.nrenta sran*pwmmnp***rtl(ormo
aunmomt wwam
in our region of ~ l n
dq,vld ( h r r ~
a bronom
durrnOI~hawhO~dmrtuchoh.wy.4*r(pmb*bmnWncmb..
~~wr.pw(omwd6m0thrpol*lrraonhawdwn)lhrlonbpmcy
ndlwgnu.PDZOFEVlwaa*u*tedrh.nM*.nWa
q a m m l d o d
m m u l h W ~ + ~ B w h o u F E V l d d n @ d n n uahstZmmU1ng.d(D0*
b.whe a D r W u * l g t h r b l d o r e d U C H .
BLlYltE
munopinHDMgmup'*ls~bwathanhpolw,gloup.~a
PD20d3200mcgdMCH(ornwmplns(on.~mrrn~olPWOTrVl(orpmb*HDU
gcwp wu 2471f195.3 mag of MCH. rrhb hn of polw, gloup w n 2692.8i178.7 (na
s i @ f i w ~ t d m e r e ~ ) . i o(3%) HEM ma~tll~~
a d s ( m ) po*m
W a C m r r n n d bronch(olhypneclc(iv*r.md t h a m m r w a n o ( ~rPI
t h . p . r e M g . o l ~ e ~ h . C h g ~ ~ p w t h r n ~ n v l * . d P O Z O F N l
Waa Okm hlo raoun(.
TUESDAY, JUNE 15
(Chemo- and Radiotherapy of Lung Cancer-continued)
ALTERNATING NON-CROSS RESISTANT CHBIOTHERAPY FOR SNALL CELL
LUNG CANCER
Reury-Perng Psrng,U.D. ,FCCP., Shinn-Liang Lai,M.D.
Chest Department. Veterans General Hospital-Taipei,Taiwan, R.0.C
123 non-treated patiente with m a l l cell luna cancer oroved
b pathology or cytology were dlvided into 2 s o u p s nt i-andom.
6 8 patiente underwent stud# A(Soquentia1 r e imen:Cytoxan 1000mg
h2/IIl+ Epirubicin -5
/Dl + Etoposide f h n g j ~ 2 b l - 3+ Vincriatin 1.4&2/D1)
by i.v injoction q.4 weeks for 8 courses.
55 pntiente underwent Study B(A1ternating regimen:(o) name as
sequential regimen (b) Cytoxan 1500 mg/ll2/~1 + ACNU 60mg/112/D1
+ Methotrexate
1D/2&1%1
by turns a.4weeko for 8 couraes.
After patients o r both grbupo finishing the chemotherapy, the
onee of limited stage received chest irradiation (4000 rado) &
P.C.I. (3000 rads),while the other onee of extensive s t e e were
rads) only. Por patiente in Study A, the over
given P.C.I.(3000
-all response rate was 79$, the median survival time was 12 m
and the 2 year survival rate was 8.%, uhlle they were 44$, 9 m
and 5.5% respectively for patiente in Study 8 . Only the overall
renponoe rate haa significant difference in statietico.Differr.
entiating by stage, we got 7 0 patiente of limited stage and 5 3
patients of extensive stage. No matter whatever regimen was
applied,the overall reeponse rate for those of limited etage was
7015 the median e w i v a l time wna 12 m and the 2-year s w i v a l
rat: was lo$, while i n contrnot, those were 55$, 9 m and 3.8s
for patiente of extensive etage. In comparison the first two
haveoignificant difference. The ovcrall response rate was 87%
for patiente of limited atage in Study A and the medinn survival
time was 12 m. I n contraat, they were 50$ and 9.5 m respectively
for thoae in Study B. In comparison only the overall response
rate shows eignificant difference. A8 for those of extensive
otsge in Study A, the overall responee rate wns 70$, the medion
survival time was 9.8 m,while they were 33s and 9 m in Study B.
In comparioon, only the overall reaponse rnte ehowe s i m i f i c a n t
differenco.
In conclueion,( 1 ) ' h e alternating non-croso resistant regimen
is not botter than standard sequential regimen (2) The survival
time ond reeponae rate of limitod stage are better t h m those
of extensive stage. no matter whutever regiemn applied.
BONE NARROW BIOPSY
USEFUL ?
IN SNALL CELL LUNG CANCER
-
I S I T REALLY
PASTORE VINCENZO M.D. F.C.C.P., SANTlNl MARIO, Dl CRESCENZO
VINCENZO G., CESARANO TERESA, VlClDOMlNl GIOVANNI, POSTlGLlONE
FLAVIA
THORACIC SURGERY. FIRST MEDICAL SCHOOL. UNIVERSITY OF NAPLES
ITALY.
In the staging of patients with a anall-cell lung cancer, an important
role is reserved to the research of bone marrow metastasis for a correct
therapeutic programmatian.
From arch 1986 up to December 1991 we have submitted to marrow biopsy
40 patients with S.C.L.C., aging less than 70 ?ears. The diagnostic protocol was: cito-histologic specimen by bronchoscopy or other invasive
diagnostic procedures, accurate staging by T.C. "total body". enrrow and
bone ecintigraphy, marrow biopsy and liver ecography.
Eighty bone marrow biopsies ware performed in 40 patients and 22 were
positive (13140 patients 32.5%). Bilateral examination was indispensable
for a correct diagnosis.
Diffuse disease was diagnosed in 14 patients (35%). in 13 by bone marrow
biopsy and only in LO patients by all the others diagnostic methods.
Harrow biopsy has given very important results for the staging with
a sensibility of 92.8% and a specificity of 100% with a consequence
diagnostic accuracy of 96%.
Significative is the correlation awng survival and biopsy's positivity
and much m r e the correlation among survival and biopsy result in posttherapeutic staging.
We can affirm the utility of the bone narrow biopsy as a basic examination in first staging of S.C.L.C. and in the post-treatwnt follorup,
even more when no other .etastatic sites have been found.
-
RESECTED SMALL CELL LliNC CANCER CASES
H. MIURA. C. KONAKA. N . KAWATE. M. SAITO. H. TAKAHASHI.
Y. YATSUSHIMA. T. MIURA. S. HIRAGURI. K. NAGAI. H. K A M
Department of Surgery. Tokyo Medical College Hospital. 6-7-1
NishlshinJuku. Shlnjuku-ku. Tokyo 160 JAPAN.
From June 1976 to December 1991. 44 cases of small cell lung
cancer were treated surgically in Tokyo Medical College
Hospltal. There were 39 male and 5 female patients. Age
dlstrlbutlon was 39 to 73 years old and mean was 61.5 years
old. A total of 11 patlents were in pathological stage 1. 5
in stage 2. 15 in stage 3A. 7 In stage 38 and 4 In stage 4 .
Tumor had completely disappeared In 2 patients due to
preoperative therapy. Pathological subtype was oat cell
carclnoma in 10, Intermediate cell type in 26 and combined
type In 8. Tumor locatlon was central in only 3 whereas
perlphoral In 41. Lobectomy was performed in 26 patients.
Pneumonectomy was in 16 and tumorectomy in 2. Preoperative
therapy was performed in 15 patlents. Chemotherapy alone was
performed in 7. radiotherapy alone in 2 and both in 6. The
tumor slzes were decreased in all cases and therapeutic
effect was observed in the pathological flndings in 14
patients. Down staging was succeeded In 3. In 2 of them
tumor was completely disappeared.
One year survival rate of the total patients was 64.6%.
3-year survival rate was 40.3% and 5-year survlval rate was
32.19. Flve-year survival rate of stage 1 patients was
80.0%. That of stage 2 was 40.0% and stage 3A was 11.1%.
There was no survivor over 4 years in stage 3 8 or 4
patlents. Over 5 year survivors were 7. Among them 4 were in
stage 1 and 1 showed complete response to preoperative
therapy. After 1986 when CODP was used for small cell
carcinoma, early period death after Operation was decreased.
Long survlval was expected in stage 1 small cell lung
cancer or in patlents whose preoperative therapy succeeded
in down staging. Progress of chemotherapy will lead
extention of tho Indication of surgery for small cell lung
cancer.
THE A C T U A L ORGANIZATION O F T H E T R E A T M E N T W l T H R A D I O T H E R A P Y OF
PATIENTS W l T H INOPERABLE L U N G C A N C E R IN T H E NETHERLANDS. T H E
RESULTS O F A W R I T E N INQUIRY.
F a I*. Schipper R M . Noordijk E M . Bahker W, Schaake-KoningC. Zandwijk N van.
Schustcr-UiturhoeveL, Breukelen FJM van. Members of the ad-hoc commitlfe for the
preparation of a consensus meeting on the role of radiotherapy in lungcancer. *Academic
Hospital Nijmegen St. Radboud, Nijlnegen.The Netherlands.
Many patients with lungcancer are inoperable.Why patients are treated with radiotherapy and
how these decisions are made, is not clar. The opinion of pulmonologiw seems different
from that of radiotherapists. To get more insight we made an inquiry under the du(ch
pulmonologists and radiotherapists.Questions asked were: how takes the consultation plsctq
who brings the patient in for consultation?;how long is the interval between (he decision to
treat and the actual stan of the treatment?;who takes care of the patient during and aAa the
radiohpy?; and who is satisfied with the actual way of consultation?. Of the 276
pulmonologists to whom was send the questionnaire, 166 (60%)responded and of the 107
radiothrapira 70 (65%) responded. The consullatio~iis institutionalized in 70% P (P=
according to the pulmonologists) and in 84.5% R (R= according to the radiotherapists),
mostly per institution 58% P and 68% R. Not all patients with lungcancer (1 1 % P and 25%
R) are brought in, but only who are candidate for radiotherapy according to the
pulmonolog~sts70% P and 54% R Dunng the tratnient the ndlMherapsts alone taka care
of the ~at~urt:
51% P and 78% R but after the treatnmt both Imk a f k h e auient. 73%
P and %.5% R. In 25% P and 19k R the radiotherapistsdo not see the patier;u later. 7he
interval between the decision to treat and the start of the treatment is leu than two Mekr:
39% P and 43% R. and less than four weeks: 41% P and 45.7% R. Pulmonologistt are
satisfiedwith this form of consultation (85%), but only 68% of the radiothaapiw. Many
pulmonologists lake the decision whether a patient with inoperable lungshould be
irradiated alone, although many radiotherap~slsthink all patients with inoprable lungcancer
are brought in for consultation.Solnetilnes the interval between consultation and actual slan
of the treatment is too long. W e conclude, that a institutionalized consultalion over every
patient with lungcancer in all early stage 1s deslmble. There seems to be enough
understanding to con= to a consensus on the organization and the role of radiotherapy in
inoperable lungcancer patients.
TUESDAY, TUNE 15
BROHCHOGBNIC C A R C I W AMONG GERIATRIC POPULATIONi CLINICAL
STUDY AND RADIATIOR THERAPY. H. W. Chin, W, and r . Ampil, W,
Radiation Oncoloqy, Overton Brooks VA Medical Cantar and
Louisiana State University, Shreveport, Louisiana, U. S. A.
Pediatric Pulmonary Diseases
Morning
As the incidence of bronchogenic carcinoma and the geriatic
population arm rapidly increasing, the nunbers of bronchogenic
carcinoma in aldarly patients are rapidly increasing. ~ e - c o n ducted a retrospactive study of 460 patients with bronchcqenic
carcinoma seen at this Institution
between 1988 and 1991.
Ninety-threm percent of patients were older than 50 years of
age; 16% of patients were age 50-59; 4 9 t age 60-69; and 191 age
70-79. About 85t of patients had non-small cell carcinoma and
the 1st of them had small call type. The rest of patients had
unclassified cell types. The distribution of stages showed
that 9t of small cell carcinead were limited diseases (Stages
I and 11). and roughly 90t were advanced diseases (Stages I11
and N). Por non-small cell carcinaas, twenty-nine percent of
patients had Stage I: 33t Stage 111: and 37% Stage IV. The
incidence of bronchcqenic carcinaa in geriatric population was
axt-ly
high, and rapresented almost one-third of all
malignantdiseasas in this medical center. They also presentad
with more advanced stager compared to the general cancer
population. The unique characteristics and treatment outcomes
will be presented in this group of geriatric population studied
in this institution.
NEONATAL SCREP(MG FDR CYSTlC FIBROSIS: EVALUATION OF TESTING
PROCEDURES AND RANDOMRED INVESTIGATION OF BENEFITS AND RISKS
Fwl.P M. Mihkr. E H. F w . Wilfond. B S. N C. Bruns. W T. Splungd. M L. Wei. L 1.
L.nghwgh RHPaPmr. D I. k i g . R H and G r w , R G. Univasity d Wironrin Medical
School and Medical College d Wisfauih h W k m and M i l a n u k WI, USA
The benefiu and risks of ncwban snrming f a cyaic f i b i s (CF)arc being i n d g p l e d in a
randomid, conuolkd sudy of children born in Wiwnrin since 1985. Thew
ib
efef
being
arsesJed relate lo nutritional nnd pulmonary Wus. while t k risks under investigation involve
l m o r y erron. paeni.l medical nulpwricr and d v a s e psychosocial impsct. Rior to 1991.
t k screening prosram dcpuded on m u t u n m m of immu-tive
vypsinogen (IRT) using a
"cul-ofP of IS0 ndml which was daamined by prcviouc e x p r i e m . On Ihc basis of d y
5&3.& IRT d&~.
ve hvc concluded Ihc & d thc 1RT ltS 8 1 0 ~
-a be d \ U 8
KoMlnl x m n n lechniaue tn the Uniud .Stam tcuulc d i s indequre ocrrriltvlty nnl
positive prrdinive value..
On Ihc aha ~uK
PC I
have
. applied mokcuk ga-aics gaaicclshndogy to develop a t w o - l i d
w i n g sywun combining the IRT m e a t u m m (using a Iowa 'cut-&) wilh D N A mulation
d y s i s to dacn Ihc nujar CF muutim (Ihc AF yle d k k ) . Our exprienac i n d h l a lhnt Ihc
IRT/DNA rppmrh d m n u j a dvamga. Resulu f m n Ihe T Iycu of two-liaed scrrening
reveal M incrrPred sensitivity nnd M i
m
m in Ihc positive prdiQive value cmpuad to
IRT tcsl d m .
o~ulPlionin 93
We have also utiliacd DNA anrlygs to daermine the f q u a w y d Ihc AF
m l yd
i CF putnu and in I poplkion of M Q m I y sda~cdnewborn i n f m RcsulU
indicole thn ~ p p r o x i d half
y d Ihc p d m paiaus
~
in this thisudy arc homo~ygowfor Ihc
AFylemu~mand0~906haveulanmAF~dkkudchuscpnbedaavdbythc
IRTIDNA mahod. CPlfulrion of Ihc CF incidence in W i n s i n indicws a Me d I:3944 live
biihs for t k enlire ncocrP(nl populalion a when adjusted f a the 87% Crmcorion bis. 1 3 3 1
(95% c d inWval= 1:2682 to 1:4543). Usins lk W - W e i n b e r g quPcion and our
dim; lechniques, we d y d 1.531 conssutive rronatal blwd sample3 for the A F m mulation
and found thpl it ws plt~emin 1:44 specimfns:djuging this figurn by a f r t a to account for
d CF mucniau rcvcals a haaooygae uma f~qucncyd 1:31(95% d~
irraval
-. - = 124 to 1:43. P > 0.39.ar sided c o m d t o k psdiacd 1:30 f ~ ~ u c n c y ) .
We therefore carlude Ihac thc tncldure offf in Wtsomtn. nnd probably throughout the
Untud S w ISsign~fronly ley than hu t a n pndvcd In Ihc blcnture Thu h u implKPlmns
for scrocrung pmgnmc deslgnai to dcnrlry rllaud newtums and CF h m q g a c m r r
rslrng dnaulll blood sampler .ppunpmmulng and
We also conclude Ihl
m y provide signif-I
b e d i u wilholn&vem impa. CF newad sracning d m u r m i v e
feuurn in Rgard to g w i c c w n u l h g snd n u u i r i d mmagemen. and r lepu thmaicdly
pwides Ihc opponunity to prcvcnl irrmnible m
a
y dis*uc d young childtm with CF.
H o w v a , thus ru. w have na ban pbk to daronaw l i g m 7 m puhnmay berrfiu in (hr
s c r d populalion. U l t h ~ c l yns
. in all m d i d decicMn-mPlringpuraccc. Ihe decision "to
scm or n u to sm' should be b a d on the &mined benefithisk rclaiauhip in defined
populslioni and ~eoolpphicdregions.
LATE CARDIOPVLIM(ARY CCUPLICATIONS F O W Y I N G "-"
IRRADIATION FOR HONKIN'S DISEASE
SAUIR II. RAFLA.IID.FCCP. ANWAR M. S W . M D . SAIED EL-NowEIDI.MD
HANM KOHAIL. MD. YASSER EL-=.
MBUiB. Alexandria Faculty of
M i c i n e . Radiotherapy and Cardiology Lmpts. Alexandria. Egypt.
The reliability of "arterialized" capillary blood gasas during
oxygen therapy in children, as a substitute for arterial
D.an, Alexander Spock, Marc Ilajura.
puncture.
LMpartaent of Padiatrics, Duke University Medical Cantar,
Durham, North Carolina USA.
The aim of this study was to evaluate the late cardiopulmonary
cccnplications in pts previously treated by "IUntle' irradiation
for Hodgkin's disease. The study included 40 ptr fullfilling the
entry criteria of being above 15 yrr and below 35 at t i w of
initial diagnosis and below 45 yrs at t i w of evaluation and an
interval of at least three yrs between ccmpletion of therapy and
cardiopulmonary avaluation. The lungs w r e evaluated by X-ray
labelled macro-aggregated albumln
chest. lung scan uaing Tc
(in 20 pts) and pulmonary function tests using forced
expirogram. The heart was assessed by ECQ and echo-Doppler study
(in 20 pts).
R m u l t s : Pulmonary evaluation: Radiology: Out of 40 ptr 20
(50%) developed mild to moderate degrea of pulmonary fibrosis.
(8/20l of them w r e in the wdxastinal and para-diastinal
region. 30% (6/20) in the apical region and 30% 16/20) in both
sites. The incidence of pulmonary caaplicatlons was increasing
with highar dosss received by the patient, but tha dlfferances
were statirtically insignificant. Mast of the pta were
amymptooutic ao this lung fibrosis was of no clinical
significance. Radio-nuclide study: 30% (6/20) of pts had
pulmonary hypo-parfusion. Cut of 10 pts with radiologic evidence
of pulmonary chngas. In only 5 pts the diagnosis was confirmed
by Tc*-, on the other hand. 5 out of 6 pts with posltive
radio-nuclide study s h a d evidence of radiological pulmonary
changes (X2-3.01. pcO.05). So plain radiography was more
sanmitive in diagnosis of late pulmonary reactions. Spirumtric
data were within no-1
predicted values except in two pts who
showad mild degree of diminished FVC, FEVl and FEVlS. Chest
radiography s h m d apical and parastarnal fibrosis In both of
these 2 pts and diaphragmatic elevation in one.
Cardiac evaluation: ECO changes: ST-T changes in 40% 18/20).
LV hyportrophy in one (5%). ventricular tachycardia in one
(treated succesafuly). Echocardiographic changes: Pericardial
e f f w i o n in 10% 12/20]. LV diastolic diamuter > 5 7 m in 5%
oosterlor
wall thickness > 11.5 IQ in 10% (2/201.
11/20).. LV
sjaction fraction < 55% in 10%. LV E/A ratro (1 in 10%;
Tricwpld regurge in 10%. and pulmonary hypartansion (assessed
by Doppler acceisration time) in none of the ptr.
Conclwionm: The late respiratory and cardiac complications of
"IUntle" irradiation are mild in most ptm. it should not
discourage the radiation oncologist from considering primary
radiotherapy in early stages of Hodgkin's disease.
The aeasurement of pH, Pco,, oxygen saturation and Pao, are
iaportant indices of clinical relevance in dateraining acid
bas* status and respiratory gas exchanqe. Although comparative
studias of acid base status and oxygen saturation of arterial
and capillary blood on room air have s h a m similar composition,
few involva coapariaons whila on oxygen. Seventeen childran
(8P, 9M) who ranged in age from 1 w n t h to 16 years of age Vera
studied from the inpatient s e ~ i c eat Duke Univarsity Childrens
Hospital who had a m a n supplauental oxygan requirament of 40%
(range 24-65%). Our patient population consistad of 8 patients
with conqenitnl henrt disease, 4 with rcopiratory distress, 4
who warm neurologically devastated and 1 with congenital
diaphragmatic hernia. Capillary samples were obtained from a
warmed finger in children under 1 year of aqa and tha great toe
in children over 1 year of age by techniquas previously
Arterial blood samples warm obtained from the
described'.
brachial artery in sealed, haparinired syringes. Ths arterial
and capillary blood samplas were obtained within five minutes
of each other and run without delay. We measurmd pH, oxygan
An excellant
tension (Pao,), Co, and oxygen saturation.
correlation between capillary and arterial specimens was found
with a correlation coefficient (r) .9990 for Pao, and (r) of
.9986 for oxygen saturations.
Statistically significant
correlations were also found for the measurements of pH (r)
.9666 and PaCq (r) .9644.
All of the above values were
We conclude that "artarializadn
significant to a P<.0001.
capillary blood gases corralate extreaely wall with arterial
blood gases aven during oxygen therapy therafore avoiding tha
techniquely difficult and potentially dangerous consoquances of
arterial puncture in pediatrics.
~~
References
1. Sp0ck.A. et al.
990.
The Journal of Pediatrics 1966;68:6,987-
CHEST 1 103 I 3 1 MARCH, 1993 1
213s
TUESDAY, JUNE 15
(Pediatric Pulmonary Diseases-continued)
RESPIRATORY MANIFESTATIONS OF T H E RIGID SPINE SYNDROME
GJ Ras, C S c h u l t z , 0 J a n n a s c h , P S t U b q e n a n d B Lotz.
L u n g Ilnlt, D e p a r t m e n t o f I n t e r n a l M e d l c l n e and D e p a r t m e n t of
N e u r o l o q y , Unlverslty o f P r e t o r r a . S o u t h Afrlca.
T h e rlqld s p l n e s y n d r o m e IRSS) 1 s a r a r e childhood-onset,
m u s c u l a r d i s o r d e r characterized by a m a r k e d l l m l t a t l o n of
f l e x l o n of t h e d o r s o l u m b a r and c e r v i c a l s p l n e probably s e c o n d ary t o m u s c l e contraction o f t h e e r e c t o r truncl m u s c l e s , without s e v e r e w e a k n e s s . M o d e r a t e t o s e v e r e s c o l l o s r s 1 s present
a s well a s mlld n o n p r o q r e s s l v e p r o x l m a l m u s c l e w e a k n e s s a n d
l i m b c o n t r a c t u r e s especially of t h e e l b o w s . A rnyopathlc
p a t t e r n o n e l e c t r o m y o q r a p h y 1 s associated w l t h non s p e c l f l c
m y o p a t h ~ c c h a n g e s o n m u s c l e biopsy o f t e n w l t h m a r k e d m u s c l e
f r b r o s l s . We h a v e r e c e n t l y ldentlfred n l n e p a t l e n t s w l t h RSS
a n d a u n l q u e constellation of n o n pathognomonic h l s t o p a t h o l o g i c a l observations of w h l c h t h e p r e s e n c e o f a u t o p h a g l c v a c u o l e s
In m u s c l e f l b r e s w e r e t h e outstanding feature.
In t h l s s t u d y
we .c;ort on lung a n d r c s p l r a t o r y m u s c l e f u n c t ~ o n In this h o m o q e n c o u s g r o u p of p a t l e n t s . Respiratory m u s c l e s t r e n g t h w a s
m e a s u r e d a s t h e maxlmal i n s p l r a t o r y p r e s s u r e IMIPI a t r e s l d u a l
v o l u m e , t h e maxlrn3l e v p l r a t o r y p r e s s u r e IMEP) a t t o t a l lung
capaclty and the transdlaphragmatlc pressure change generated
d u r l n y a maximal sniff m a n e u v r e IPdisI a t functional r e s i d u a l
capacit}
Deak l n s p i r e t o r y (PIFI a n d e x p l r a t o r ) IPEFI f l o w
r a t e s w e r e a l s o measured a s l n d l c a t l o n s o f m u s c l e recruitment.
Respirator) m u s c l e e n d u r a n c e w a s a s s e s s e d us1ng a 12-second
maxlmal v o l u n t a r y ventilation I M W ) test.
R e s u l t s a r e s h o w n In
t h e t a b l e a s p e r c e n t a g e of predlcte? v a l u e s and s h o w mean
standard d e v ~ a t l o n .
.
,
F e m a l e s In.2)
M a l e s ln.71
S e v e r e r e s t r l c t l v e lung d l s e a s e w a s p r e s e n t In slx p a t l e n t s
a n d hypoventllatory r e s p i r a t o r y f a l l u r e in t h r e e p a t l e n t s .
E x e r c l s e c a p a c i t y w a s m e a s u r e d In 5 p a t l e n t s a n d t h e m e a n
V02max 70 r 1 9 % .
W e c o n c l u d e that p a t l f n t s wlth RSS h a v e s e v e r e r e s t r l c t l v e
c h c s t wall d y s f u n c t l o n a n d respiratory m u s c l e d y s f u n c t l o n .
NEBULIZED AWDnALllP VS
VlRlL W P IN CHIWIPrn
Nuanchm Prapphl, IB); Supot Shevllruenuk, YD:
J i t l d d . DeeroJ.na*ool. YD.
A pmepectire double bllnd randemid cootrol t r i a l r u p.rfoned to
compare the efficlmcyof .abullaed d m l l n e (B.P. 1:1000) to
nobullad r-lc
eplnepbrlm In 46 p t i e n t . aged 3 month. to 3
years r l t h .od.rately m e r e viral croup rho wen .d.ltted
to
Chulalongkorn R a p i t r l during January 2, 1990 D e c h r 30, 1991.
The patient* wen r u d a l y allocated into two Imup..
Twenty-four
patlents received nebulisd racemlc epinephrlne while twenty-two
patlmts recelred nebullaed adrenaline.
Cmup . c o r n , heart ratas,
respiratory rates before and i d l a t e l y after, a t 30, 60 .ad 120
minutes a f t e r t r w t . w t were commrcd betueen the two Ironpa.
-
Mrenallm w u u effective u r a c a i c eplnephrlne in ~ u c t i o n of
cmup .cores l r s d i a t e l y after, a t M and 60 minutes post-treatment
(p tO.O1).
Both dmnaline and r m a i c epinephrlne a t i l l hd
pharmacological effect a t 120 mlnutea after dminietratlon in I 6
patlent. (p (0.05).
h p l r a t o r y r a w elmlficantly decreued a t 60
slnutes p o s t - t m a t m t wlth nebulised d n n a l l m (p tO.OS), rhil* no
s I p l f l c . n t c b a q w In heart rat- wen demonstrated. Yorsorer,
t b r e usre no e I n l f l u a t dlffein n h r of m t l m t .
mqulrln; dditlon& doses of dm# t b r q or sterold tkahmnt,
&ration of ~ t r i d o r , duration of hospitrliaatlon and k e l - t
of
pnwmnla b t m a tbe two treatmnt group..
Ye conclude tht wbuliaed d r n u l i l u im u effectlre and male u
racwic eplwpbrim In alleviating m p l n t o w d l a t r e u f m upper
airray obetratlon In c h l l d m with r l r a l croup.
HSALTH 3JJCATION ?OX A3TAb!.;TIC CiiIL3dniN
Z.R6nai, L.&ne. S.Tar, K.Gyurkovits
C h i l d r e n ' s H o s p i t a l f o r Chest Diseases, Idosdds, itungary
The f i r s t Hungarian education-program f o r a s t h m a t i c c h i l d r e n
s t a r t e d i n iday 1992 a t the C h i l d r e n ' s H o s p i t a l f o r Chest D i s e a s l s i n Moadbs. The c o u r s e s a r e organlaad f o r o h i l d r e h
between 10-14 y e a r s . During t h e t h r e e weeks of t h e c o u m e t h e
c h i l d r e n l e a r n t o swim, t a k e p a r t i n water-gymnastics and
b r e a t h - & r m a s t i c s , g e t acquianted w i t h t h e methods of r r l a x a t i o n , d a i l y p a r t i c i p a t e i n t h e o r e t i c a l l e s s o n s about t h e
s t r u c t u r e and f u n c t i o n o f t h e a i r a a y s , t h e pathophysiology o f
asthma, t h e use o f a n t i a s t h m a t i c d r u g s and t h e =st important
q u e s t i o n s o f t h e way o f l i f e , a t t e n d a t p r a c t i c a l c l a a s e a ,
where t h e p r o p e r t e c h n i q u e s o f i n h a l a t i o n a r e taught. The t e a
c o n s i s t s of a d o c t o r . two p h y s i o t h e r a p e u t i a t e and two teachere
I n t h e t h o r a t i c a l l e s s o n s every c h i l d h a s h i s own p r e - p r i n t e d
exercise-book. % f o r e and a t t h e end of t h e program l u n g funct i o n t e s t s a r e p e r f o m e d , t h e t h e o r e t i c a l knowlrdgr of t h e
p a r t i c i p a n t s is a s t i m a t e d w i t h the h e l p of q u e a t $ o n a r i e s and
the technique o f d o a 6 - a e r o s o l - i n h a l a t i o n i s e v a l u a t e d . Our r e s u l t s show a s i g n i f i c a n t i n c r e a e e i n t h e l e v e l o f knowled&es
about the a i r a a y s . the asthma. t h e use o f medicaments and t h e
way o f l i f e . Almost a l l of t h e p a r t i c i p a n t s made himaelf mast e r of t h e p r o p a r doae-aerosol-inhalation. There i s a queation
how l o n e t h e c h i l d r e n k e e p t h e i r new knowledgea and how l o n g
t h a s e w i l l have an a d v u a t a g e o w e f f e c t on t h e c o n d i t i o n of the
a s t h s a t i c c h i l d r e n . The answer l a t o be expacted from t h e lon,:
t e n n s t u d i e s mads by f a l i l y d o c t o r e .
YEGENER'S GRANULWIATOSIS IY PED14TRIC PATIENTS: MAYO CLINIC EXPERIENCE.
A Adlakha, M.O.. JH Ryu. M.0.. FCCP, EC Rosenow, M.O.. FCCP, Mayo Graduate
Ychool of Medicine. Rochester, Minnesota.
Since t h e f i r s t p a t h o l o g i c c h a r a c t e r i s t i c s of Uegener's g r a n u l m a t o s i s
(UG) d e s c r i b e d by Uegener i n 1936 and 1939. hundreds of cases of ffi have
s i n c e been r e p o r t e d i n t h e a d u l t s . The disease appears t o be u n c m o n i n
c h i l d r e n w i t h o n l y 45 cases of documented ffi h a v i n g been r e p o r t e d i n t h e age
group of 16 years and l e s s I n t h e E n g l i s h l i t e r a t u r e . The aim of t h i s s t u d y
was t o e l u c i d a t e t h e c l i n i c a l p r e s e n t a t i o n of t h e s e young p a t ~ e n t s .
Of t h e n e a r l y 400 cases of ffi seen a t our i n s t i t u t i o n f r a n 1959 t o
oresent. 10 ( - 2 . 5 % ) o c c u r r e d i n t h e age group of 16 years and l e s s . The
d i a g n o s i s of ffi was confirmed by b i o p s y and/or t h e presence of d i f f u s e
q r a n u l a r Cytoplasmic ant i - n e u t r o p h i li c a n t i b o d y (c-ANCA). Of these t e n
D a t i e n t s seven were female and t h r e e were male. The mean age of t h e
o a t i e n t s was 12 years (range. 9 t o 16). Two had l i m i t e d disease w h i l e t h e
o t h e r e i g h t had g e n e r a l i z e d WG. The mean p e r i o d from onset o f s j m p t m s t o
d i a g n o s i s of ffi was 4 months (range, 1 t o 48 months). P r e s e n t a t i o n s a t t h e
onset of t h e disease were: fever (70%). r h i n i t i s (70%).
a r t h r a l g i a s f a r t h r i t i s (40%). o t a l g i a f o t i t i s media 140%). pulmonary (40%).
weight l o s s (40%). e p i s t a x i s (30%). r e n a l (#)%), s i n u s i t i s (30%).
ga:trointestinal
t r a c t (20%). l a r y n x / t r a c h e a (10%). n e u r o l o g i c a l (10%).
o c u l a r (10%). o r a l u l c e r s (10%). and s k i n l e s i o n s (10%). During t h e c w r s e
of UG, c l i n i c a l m a n ~ f e s t a t i o n swere: fever (100%). pulmonary ( 8 0 % ) . r e n a l
I%)%), o t a l g i a f o t i t i s media (70%). s i n u s i t l s (70%). s k i n l e s l o n s (70%).
a r t h r a l g i a s f a r t h r i t i s 160%), o c u l a r (60%). weight l o s s ( 5 0 % ) . o r a l u l c e r s
(30%).I a r y n x l t r a c h e a (30%), neurological 130%). nasal s e p t m
d e f o r m i t y f p e r f o r a t i o n and m a s t o i d i t i s (20% each), t h r m b o e n b o l i s m (20%).
c a r d i a c (10%). e n d o c r i n e (10%). and jaw mass (10%). c-ANCA was p o s i t i v e i n
two out of two m t i e n t s t e s t e d . Of these ten p a t i e n t s t h r e e d i e d a f t e r a
mean of f i v e m n t h s f r a n t h e t i m e of onset of symptans (range, 4 t o 8 ) . Two
d i e d f r m massive pulmonary hemorrhage and one d i e d frm uremic c m a . Of
t h e r e m a i n i n g seven. two a r e l o s t t o f o l l o w - u p . O v e r a l l , f i v e p a t i e n t s
r e c e i v e d steroids; two r e c e i v e d s t e r o i d s and Bactrim: two were t r e a t e d w i t h
s t e r o i d s and Cytoxan; one r e c e ~ v e ds t e r o i d s . Cytoxan. Bactrim, and IV g d m a
g l o b u l i n s . The t h r e e who d i e d were b e i n g t r e a t e d w i t h s t e r o i d s alone ( t h e y
were t r e a t e d i n t h e e a r l y 1960s). A l l t h r e e p a t i e n t s who a r e on B a c t r i m
have had improvement/stabilizdtion of t h e i r disease.
I n c o n c l u s i o n . t h e p e d i a t r i c WG qroup of p a t i e n t s d i f f e r f r a n a d u l t cases
i n t h a t t h e y t e n d t o have more o f - - r e f r a c t o r y upper a i r w a y symptoms, f e v e r ,
weight l o s s , s k i n l e s i o n s , o r a l u l c e r s , p r o p t o s i r , abdominal pain, and
hematochezia (mimicking Henoch-Schonlein p u r p u r a ) , thranboembolism,
n e u r o l o g i c a l , and symptomatic r e n a l i n v o l v e n e n t ( a t t h e o n s e t ) . B a c t r i m
seems t o be a u s e f u l d r u g i n combiqation w i t h o t h e r s . Ye a l e r t t h e
Dhyslcians t o perform a b i o p s y and/or check c-ANCA t o make a p r m p t
d i d g n o s i s of ffi ( w i t h e a r l y i n s t i t u t i o n of t r e a t m e n t ) i n any of t h e above
n s n t r o n e d sflptom complexes i n p e d i a t r i c p a t i e n t s .
TUESDAY, JUNE15
A NON-X-LMD. EPSTEIU-B*WI VRVS-*SSOCIATED
LYLIPHOPROClFERATM
S m O R W E WITC( PREDOUmAKnY RKYONCRllNVoLVEMErn
d M. Lackmaw 1. ~m 1 6 ~ ' Chrsban
.
~-r2
~ 0 U t m a nof
t Pediatrics. Stidtiaches Kllnlhw Fulda. and 2Cmpartmcnl of PeJtatncs. University of Marburg
Eostein-Barr vlrur 1EBV)-assoc6atcd Ivm~hoorol~feraltons
are rare d~sordersdue to
conpcnltal or acqunM ~ m m u n o d e l ~ c ~ e ~Itc ~
Iraknown
s
that males wtth the x-l#n~ea
lymDhwrol~lara(nesyndrorru ( U P ) are p r w lo lalal EBV-mduced hlmcnomap.nesnr
For the h s t t ~ r r u*. r e m i on an 1 I mmms wgw~n t h a xLP-10he sfnarome (tala
mfectms mooonucko.osrs1 and ~ e d o m u u n l l vwlmonaw lnvohmenl The asease
was confwlrm by INdetectmn ot EBV-swcohc wrtace a.rlownr on the
r B-sa'e
( m e numbraw protun of EBVI No u q u ~ r M
mmum4efictencr Iemang to EBV-associaled ~ M u a b o could
n be n t a b k h + d a our pattent. Bccauw both parents.
their no.( rel.tiws. .ndMe vrl's sibbga -re an of pood heanh, a Iamtlul rmmunodcf l c i v r v alw is un(ik&.
A l a u t ~ a~g .e n u a & d mfdlratm of all t a s w r n t h bmphad cells was found In our
~ U m In
t c o n t r u l lo fownef c a w r W s . the Imps were affected to a w e n elten(
w WOW
c a u n d ma aeath of me prl. such -pu(monan, tp-whold n y w o i s t e has bm d.mcnbW on palmnts n t h AIDS aac)us#re)yuntd nor T h e m s r a c 0sarmnatlon revealed an ~nhnrawn01 1-cells I ~ SCD4
D and na1,ral h11Iercellst and a
dapcaon of 0-cells of our o.ti.m's t r r w s . The e w e s m of LMP on there cells
would 51
llm Presence of wrne h x e e of T-cell functwn w!lh subseownt ell~nnm
i i m t w c e a 0-c&
T-cell r e c o & ~ t mhmay have been ~m&len due
l o the lack of eapr*ssIon ot EBNA-2 I
the EBV-induced proltferal~ngT-cell$ would
have failed l o al~minateall infectmi 6-cells resun~naIn a oroaresuve lnfiltraton of all
organs wilh 6- and 1-cells.
In summuy. these m u l l s suggest a no- t y m of congenilal XLP-l~kedtsorder wlth an
a u t o m a l pcna defect rnuning m lymphoid hyparplas~a
and prtmary pulmmav ~nvolvement lriaaerul bv an EBV ~nfectim.The assumed i m m u n o l a ~
anerat~onscomblned
rMI me oniimMl. axoressMn of E m - r w c k rurtace anll&nr IEBIIA- & N A - ~
and EBNA- 3 to -8 could not M damonslratedl on the Intmcted 6-calk may have led to
t
PERSISTENT W E E Z I N G AND CASTROESOPHAGEN, REFLUX IN
IN P r n S
Authors: j%idJS.
.
Althouah the association k t w e e n
g a s t r o e ~ o ~ h a g e areflux
l
(GER) and w h m r i n g has
been recognized, many physicians r a i n skeptical
about cause and effect- relationship. T u r t h i m r e ,
when GER is not suapocted as a cause, or an
aggravating factor for wheezing, significant
morbidity, such as prolonged hospitalization for
refractory wheezing,multiple .rrrgency m d i c a l
visits, and chronic usage of multiple ndicatione
including oral steroids occurs. We studied the
presence of GER in 7 infants ( m a n age 8.21 m;
range 4.50-18 m: W:F::5:2) with intractable
wheezing not responding to n l t i p l e udicationa
including beta agonists, c r o w l y n sodium and
corticosteroide. Pulmonary function studies
(sensor Wedlcs 2600, Yorba Linda, CA) at
presentation were compatible with moderate to
severe peripheral airflow ohtruction, terminal
flow/ peak expiratory flow (25/PF) 0.42+0.098;
Wormal>6Ol. Diagnostic evaluation for GER
included upper GI series and 24-hours pH probe
monltoring. A11 infants had moderate GER on upper
GI, and significant acid-reflux on pH probe ( m a n
fraction time gastric pH below 4, 25.13+218;
N o m a l < 4 0 . All infants were treated ladicallv
with met&lorpramide,
and ranitidine along witjl
reflux precautions; 1 infant who was found to have
erosiveesophagitis continued to have severe
wheezing and required fundoplication. Pulmonary
function improved significantly 6 weeks after
therapy (251PF 0.58+0.078; P-0.015, Wilcoxon signrank test). There Gas siqnificant decrease in
hospltalizatlons and in emergency m d i c a l visits.
The concomitant use of a s t m medications was
decreased substantially in 2 patients, and
completely stopped in 3. Tvo patients were only
treated with rerlux medications. We conclude that
GER is an aggravating, and may be, a casual factor
in infants with protracted wheezing.
-
PREDICTING COIIPLIME WITH CIUZST P H Y S I C T H E m Y IN CYSTIC
FIBROSIS. J. F. Kanga, W.D., FCCP., S. L. D'Angelo, Ph.D.
and C. Yatea. Department of Pedlatrics. University of
Kentucky, Lexington, KY, U.S.A.
Chest Dhvsiotheraw ICPT) is ~ r o b a b l vthe most Imwrtant
corponent oi iherapy fb; the respiiatory ilsease in cy;tlc
flbrosis (CP). It Is also the most t l m consumlnq and thus
frequently neglected part of a patlent's treatment realmen.
In this study-we surveyed 33 faillies of children wltfi CF,
age range Infancy to 17 years, to determine compllance with
CPT. Coapllance as a percentage of that prescribed by the
phyaiclan was rated Good (>758), Palr ( 5 0 - 7 5 0 , and Poor
( ~ 5 0 8 ) . In-depth interviews were used to assess ( 1 ) parents'
perceptlon o f severity of child's Illness, ( 2 ) famlly
demographic data, and ( 3 ) understanding of the Importance of
CPT. Compliance wlth physlclan rec-ndations
for CPT was
assrsacd with five randomlv collected 14-hour recall
interviewe. The subjects bere assured full confidentiality
and that responses would not be disclosed to their child's
physician. The physician rated each subject for severlty of
dlsease and importance of CPT for that child.
3 . m . p<.as). ~a
(20.02* 10 21.491, ps.05) and
lo 32.33%.pc.05).
nrrlrk h lroatdkwc u m (1h
amchk-& H@0:4nd) h PblW (29.-
Compliance in these families was as follows: Oood In
508, Palr in 21.48 and Poor In 28.6%. Contrary to our
expectatlone, no correlation was found between compliance and
disease severlty as perceived elther by parents (gm.26) or
phyelcian (gm.18). Parents' perceptlon of the importance of
CPT in the chlld's treatlent was moderately correlated with
compliance (gm.39) as was the physlclan's rating of CPT
Importance (rm.35). Compliance deterlorated as chlldren grew
older (r--.27). Chlldren living in single parent homes
r e c e l v d slgniflcantly less CPT (348 prescribed) as compared
to those In two-parent horns (88.58). In those two-parent
homes in which both mother and father provided therapy,
children received more CPT (95.7% prescribed) than in those
in whlch the mother was the sole provider (758).
Thls study justifies the need for repeated and
continuing education of parents and children on the
importance of CPT in CF. Provislon of cheat therapy is
factors than by
Influenced more by social and d-graphic
disease eeverlty.
CHEST / 103 / 3 / MARCH. 1983 I Swpphwd
215s
TUESDAY. lUNE 15
--
-
(Pediatric Pulmonary Dlseasescontinued)
ALLCROIC BRONCHOPULHONARY ASPERGILLOBIS I N CHILDREN WITH
CYSTIC CIBROSIS
,
M . 1 . 8 . r r l o . A.Mmrt1n.
P e d l a t r l c Pneumoloqy U n l t
Children's H o s p l t a l La Paz. H a d r l d . Spaln.
Allerglc
bronchopulmonary
asperglllosls
(ABPAI
in
p a t l e n t s v l t h c y s t l c f l b r o s l s ICFI has been r e p o r t e d s i n c e
1965.Dlaqnostlc
c r l t e r l a I s made v l t h s e v e r a l c l l n l c a l and
l a b o r a t o r y markers, specially d l f f l c u l t I n these p a t l e n t s .
Crom Decemhr 1989 t o February 1992,
11 p a t l e n t a I n:l,
F:4 ) were dlaqnosed as h a v l n g ABPA, between 1 4 5 c h l l d r e n v l t h
CF f o l l o w e d by our U n l t I 7 . 5 8 I.
The ages ranged from 0 t o 18 years ( mean 12 years
I. A l l
t h e d l a g n o s l s were ~ d I en autumn and w l n t e r . 4 l l v e I n r u r a l
areas.
3 have h l s t o r y o f wheerlng o r a t o p y . A l l
o f them had
pancreatic
Insufflclency.
9
of
1 1 were
colonized w i t h
P.aeruglnosa and t r e a t e d v l t h a e r o s o l l r e d a n t l b l o t l c s . 6 had
r e c e i v e d 1 . v . a n t l b l o t l c t r e a t m e n t I n t h e l a s t y e a r . Shwachman
and B r a s f l e l d scores a t t h e moment o f t h e d l a q n o s l a had a mean
o f 72 and 17 respectively.
1008 had Increased serum t o t a l IgE,
Asperqlllus-speclfic
IqC and p o e i t l v e s k l n - t e s t . Increased s p e c l f l c IgG I n Y O \ . 6 3 \
I n t e r m l t e n t wheerlng,
peripheral b l o o d e o s l n o p h l l and new
Infiltrates I n c h e s t x - r a v I n 5 4 % . A.fumlaatus was I s o l a t e d I n
sputum c u l t u r e . A11 were i r e a t e d v l t h p r e i n l s o n e d u r l n q e I x o r
seven months. C l l n l c a l Improvement was observed I n 10 cases.
Recurrence o c u r r e d I n 2 c h l l d r e n .
The d l a q n o a l s o f ABPA I n CF p a t l e n t s may be d l f f l c u l t
because t h e c l l n l c a l c r l t e r l a a l a o c a n be caused by t h e
p r l u r y lung dlsease.
Vhen a
new pulmonary
Infiltrate I s
found,
or
a
respiratory exacerbation I n a CF p a t i e n t does n o t respond t o
t h e r a p y as
expected,
the dlagnosls
o f ABPA s h o u l d
be
considered
.
PULMONARY SEQUESTRATlON - A MISSED DlAONOSlh
R.K.Balnra MO, FCCP. D.V. SchiiowMD. FCCP: J.M. DunnMD. P.A. RuuoMO:
St. Christopher's Hopsitsl for Children. Philadelphia, PA USA
Pulmonary sequestrationismuncommon M distinct dinicsl amity that may
be m umecognized cawe of recurrent pulmonary infation w haan failure.
B s t w m 1968rnd 1 9 9 1 . 1 9 ~ t i a n t ~ i n g i n a g e t r o m Z m t h r t o 1ysam(avg
1
2.9 vm) were found to have Intmlobar (16), Extralober (2) & C o m b i d Illcuo of
sequeatmtion. Lobaa involved (12) &M 6 (81 left.
Symptornatdogy was varied: 8 pta had wmpkintr attributable to reapintory
system & consisted of wugh, recurrent infection rndlor pneumonia in the aame
area of the lung. Two pta presented with cocgsnive heart failure and workup
revealed pulm. sequestration. Remaining 9 pta had combination of recpintory &
wrdiac eymptoms. Diagnosis was wspected on chest x-rays b u r e of
peninant, localized, pulm, M o w and/or cadiomagaly.
In all pta pnop,
aonography delineated the systemic aneMl supply from d a r c w d i thoracic or
abdomirul aorta and halped prevent any catastrophic surgical W i n g . Echognphy
& CAT acan were wed more recently as adiunct diagnostic modalities.
Broncho.copy & bronchogwhy w e n wed sparingly and in early &ence
only.
W c i a t a d defect8 in this group were aortic valve 8tanosia (2)).FDA (11. Scimitar
Syndmme (1) and mi.cdbneous 141.
Treatment w n surgical. Nine pts had lobectomy becam of recurrent pulm.
infections, while 3 pts had sagmentectomy (localized 6 minimal infaction). Ssva
pts underwent ligation of feeder ~ a s e b
only. Thsrs pta had symptoms chiefly
attributable to wrdiovasculer system. The single pt with Scimitar Syndrome &
sequestration underwent Rt. pneumonectomy (recurrent infections in
There
lung). Three caret of extralobar sequestration had excisibn of their
were no operative death.. Only complication war 1 an of blading requiring ra
exploration. There were 4 late deaths; (1I pnevmonia & (3) ralated to heart defects
at 2 wks, 2 mtha, 4 mths. & 9 ym. Fifteen long term aurvivom remain
asymptomatic at 1 0 mths to 20 ym followup (avg 10.5 yml.
Conclusion: Pulm sequestration is a rare but an important cause of
reapiretory & or cardiac symptoms. Aortography should be performed in all c a w
to delineate the number & distribution of feeder venwb. Surgery is treatment of
choice & type of approach should be dictated by syrnptomatology. Morbidity &
mortality of surgery are low and long term results appear to be gratifying.
-.
TUESDAY. lUNE 15
RISCKY NEWBORN: ENVIRONMENT'S INTERVENTION PROPOSAL
MOMENT ANALYSIS OF MULTIPLE BREATH YITROCEY WASHOUT
PIEDLER, PATRICIA TEMPSKI; B E L T R A W , BEATRIZ; PRANCK, AILEMA L.
Paculdade Evangilica d e Medicina d o Parani e Unidade d e Terapla 1 2 I N
tensiva Neonatal Curitiba-BRAZIL.
Masahlro Yotaukura.Yoboru Uatanabe.Hldehlko Yakajlma.
T h e authoress describe their observations after
500 hours o f
accompaniment in the neonatal intensive care unit Curitiba. in the
investigaperiod from October/l991 until July11992, besides the
tion o f a l l cases slnce January/l990.
T h e assessed the newborns psychological and physical growth, pa
rents and child interaction, parents and medical team interaction,
a s well a s the environment's effects.0bserving the harmful effects
o f superstimulation and precocious separation.
After a wide review o n literature discuss the observed results
and DroDose interventionsin the neonatal intensive care unit inten
dings- i e s s rigorous visiting schedules, parents participation i n
t h e treatment, writen information, visual, hearing and tactile s t i
rnulation
t o reduce the damages o f the early hospltallzation.
s his research intends aware professionals who work with Prematl!
r e newborns about the importance o f their life quality rn the neonatal period, assuring a normal physical, psychological and social
devoloptuent.
-
Yuujl Satou.Ilnoru
OSada'
of
Umehara.Katsunor1 Ilnoura.
Sekine'Maaato
iatr
itasato U n
v e r a lt y
School of
Med~cine.Sagamlhara.Kanagawa.Japan
V e n t l l a t l o n inhomogeneity In a s t h m a t i c c h l l d r e n on a t t a c k
But lt
that q u a n t i f y i n g
h a s been
V e n t l l a t l o n lnhomogenelty at bedalde. The purpose o f t h i s
.cudy
to .ase..
o f r ~ n t i l a t i o n ~ n h o m o g e n e i t y in
"thmatlc
chlldren on attack by moment analysis o f multiple
breath nltorogen washout (MBYU). Ten healthy chlldran
lcontorol a u b J e c t s ) and 10 asthmatlc chlldren on attack were
studled. MBYY was performed in aittlng positlon and ~t was
proceeded untll e n d - t l d a l nitrogen concentration uas
c o n s ~ s t a n t l y less than 2 s or untll I minutes. These results
Yere expressed a s t w o moment r a t l o I /M and I . / M e The
mean value of M / I . and M /M f o r healthy c h l l d r e n was
13.4
1.3ISD) and 3 0 0 . 6 2 and for asthmatlc cblldren 1t was
15.6 + 1.4 and 391 , 4 9 . T h e m o m e n t r a t l o s f o r a s t h m a t l c
chlldren were aignlfrcantly higher than the moment ratlos for
healthy children. And the moment ratio o f asthmatic children
w h o w e r e s t u d i e d r e p e a t l y s h o w e d e x a c t l y t h e c h a n g e of
severlty o f ventilation 1nhomogenaity.Thesa results suggested
t h a t m o m e n t a n a l y s i s of MBYY is u s e f u l m e t h o d t o a r s e s a
aeverlty o f ventilation inbomogenelty In asthmatic chlldren at
bedside.
-
WBDICXWt8 OF BPOl(aaDILA109 RBPUNSIVENBS IN INFANTS WITH
WKEZIIIO ASSOCIATED RBPIBATOOY INFECTION.
Faculty of Medicine.
Cbulalongkorn University, 8.ogkok, T b i L d .
J . MtEBOJNlA*Orm.
I(.
PPAPWL.
tbc responsivenmmm to bmncbodilator is varimble in infanta wltb
wbeering aswciated reapIratow Infection IWMIJ. Factors for
prediction of the responw will l e d to more cost-effective use
of broncbodllator in these infanta.
We exuined rumsibla
predictive futora in 44 children m d c r 2 y e a n of we who hmd
first epilodc of YMI.
A11 of them e r e treated uitb 0.15 W k g
of nebulired u l b u t w l .
Thirty patients (68x1 with decreuing
clinical score 1 3 after treatment were emaidered u the
mponders while the reuindera 114 infantsJ were non responders.
Bjr using Chi-muare tast. Fisher e x u t teat d unpaired T-teat
to compare the data of the 2 group., the significant factors for
the responders were older age 110.5t3.9 vs 6.0t2.5 months) and
history of previwa LPI lp (0.05).
The significant factors for
the om-responders iaclded amcurrent diarrhea, patchy pulmonary
infiltration and positive W V in the nlaophrmgeal Mcretion (p
c0.05).
The= reaulta a u U n t e d effective broncbodllator therapy in
infmts older thmn 6 mt~tb.or batring bintory of previous LPI.
Those who hd u u t e W V infection or patchy infiltration in cheat
x-ray mnd uwciated diarrhea were Iema likely to respond.
Asthma: Pathophysiologic Mechanisms
Morning
b t b u t l c patlenta ultb slmllar d q r w of elrwy b).puructlrlty
bare
a dlffermnt wnaltlrltr to c w b stlwull. Manly. t w U b p o ~ ~ I a t i o nof
a
aatbutlcs bare b w n identifled; o m s b w l q lncrirwd c o q h ~naltlvlty.
and o m u ~ t b cougb wnaitlvity q r u l to tbat ublblted by n a u l u b l c t s
tPullu W . Inr Tbe Luq. Emvmn R u s . 1Wl). k bypotbUIUd tbbtln
~ I I U ~ I uCt b u t i c s tbls d l f f a e m e in c o q b wnaitiiity could be tmletmd
to ruent rlluqen sxpoarrs. To t u t tblm byQotbUls w studlad 1b u l s
nonnok~rq ~ t h u t l c m y a c t s
(aqe 2 C 3 6 yrs.) u ~ t b poaitlve skin
prlck-test to q r r u pollen. Subjutm w r e u p p t w t l c at tbe t i n of tbe
study (m, ) 73% of tbe predicted value). In a prmllmlnuy mtudy day.
sub>uta underwnt w t b u b o l l n ILM) innelatlorn1 cballmqe. On the ncond
study day tba C w b tbrubold W dmtU8lnd. --IS
Of b7pOCblWlC
I-1ar
alutlon (dextron 6.1% in d1at111ed uatu. pH 7.b. Sll m a )
w r m generated by an ultramnic mbulluc. anb Inbaled tbrouqb a f u e u m k
for 3 min pulods nparated by 2 min intarals. Tbe mbul1l.r w r t at 4
I m e u l q outputmr b.4. b.8, 1.6 and 3.2 mllmln. A pr-• t r e w u c a WM
connbcted to tbe face mask. and tbe pr-e
signal w r u a d m d . Couglm
w e counted duriq the 3-min knbalation pulods by ldentlfylq -8
in
tbm pr-• signal. l'bm cougb t b r a o l d wu Pafin6 u the 1-t
nmbul~aer output c u l q at 1-1
o m couqb. prwlded t b t u b ~ c t sa l m
coqbed at hlgber outputs. Subjects uitb bypxblorlc mlutton-induced c o q b
w r m randalsod In 2 groups. O m group t r r 5 ) underwnt c o q b cballeqe
before and 6. min after alluqen e w e . Tbm otbu group ( w 5 1 control)
underwnt c w b cballeqe beform and 6b Bin a f t u UCb inbalatlon. Botb
allaqen and L M c b a l l e q u uere stoppad uben FgV, d m by 2 U of
control. n a 2 groups s b m a e i m ~ ~ cu w b rmsponn to b7p0~blorlc
w r o m ~ s . h e m n r a l w ti 9 ~ )of cougb tbrubold w r e 1.98 t b.U
mI/min. and 2.84 1 8.36 mI/sin in the allergen and thm LIQ group.
raspectlrmly. Tbe w n valuea (f SEI of cough tbruhold obtalnd In t h 2
eroupm
.
. befora and after broncboconatrictor mtiull u e rmwrtmd bolwr
ccwb
Rfore
After
2.W i e.48
b.48 f b.21'
Allergen
LIQ
1.92 t 8.54
2.W t b.54
Only allergen lnbalatlon caund a slqnlflcant d u r w In c o q b tbr..bold
(*
p ( ).-I. h e n raults indicate tbat allergen Inbelation incrmana
cough mnaitlvlty In aIlar(1c aatbutlca. Tbls lncreaae Is not related to
bromhoco~trlctlon but could depend on airway udlator relean andlor
Inf1aautory call rmcrultnnt.
(Supoorted by the Yatlonal -ch
COUKII of ~talytOtP grant no. 91.W692.M)
CHEST 1 103 1 3 1 MARCH, 1993 1 % p p k ~ ~ I
217s
TUESDAY, JUNE 15
(Asthma: Pathophysiotogk Mechanisms)
m mlumIacmrw saanrmanrcna a r s n u I C B .
n . ~ . ~ . n o u s n m . c . ~ ~ ~ ~ , ~ . a ; l c r o . n . a u m . n .
JET-NEBULIZED WATER IN ASTHIUTICS:
FnuaIm.
S a v i x i o 61 T i ~ i a m t L
a.p
~-.
00 b.r. RAN.
Ue invmstigatod the m l e of m i - 4
P i t a n g a NKN, Rizzo A, Rizzo JA. C e n t r o d e Aama e A l e r g i a and I
Pneumology department. O n i v e r a i d a d e F e d e r a l d e Pernambuco.
Recife
Brazil.
-
Ultraaonicaly nebulized water ( V m l i s c a p a b l e t o p r o d u c e
b r o n c h o c o n a t r i c t i o n i n more t h a n 908 o f asthmatic p a t i e n t s (And e r s o n Thorax, 1 9 8 3 ) . The o b j e c t i v e o f t h i s s t u d y . was t o obaerv e i f JET n e b u l i z e d w a t e r (JNU) c o u l d g i v e t h e aame r e a c t i o n . I
12 a t a b l e a a t h m a t i c a were s e l e c t e d ( 7 male and 5 female, mean a
ge
2755 y e a r s ) and a u k i t a d t o t h e f o l l o w i n g p r o t o c o l : Day 1:
i f t h e PEV was more t h a n 70% o f t h e p r e d i c t e d t h e p a t i e n t waa
g i v e n a c a i b a c h o l b r o n c h i a l c h a l l e n g e a c c o r d i n g t o C h a i ' a ma
t h o d (J.Allergy.Clin.Iuanuno1. 197511 IMy 2
a f t e r 2 daya o f t h e
Carbachol c h a l l e n g e a b a a a l ?SV waa o b t a i n e d and , i f t h e va
r i a b i l i t y was l e a s t h a n 5% o f day 1, t h e p a t i e n t was g i v e n a n)
b u l i z a t i o n w i t h w a t e r by a j e t n e b u l i z e r (Hudaon,O8A), w i t h a
'To m u t h p i e c e and n o s e c l i p p e d f o r p e r i o d s o f 2,5,10 and 1 5 ml_
n u t e a . A f t e r e a c h p e r i o d a new PBV a u a a u r u m n t was m d e and
t h e t e a t atopped i f a f a l l i n m o r e l t h a n 208 waa obaerved.
-
-
-
-
RESULTS r A l l 12 p a t i e n t s had a f a l l o f m r e t h a n 20% i n PBV I
a f t e r C a r b a c h o l b r o n c h i a l p r o v o c a t i o n (mean f a l l 2553% b e t v d n
t h e 0.50 and 2.50mqlnl c o n c e n t r a t i o n a l . With JNY a f a l l o f mr e t h a n 208 o f b a a a l PEV was o b a e r v e d i n 2 p a t i e n t a a f t e r 2 m i n
i n 2 a f t e r 5 mln. and in12 a f t e r 10 min. 6 p a t i e n t a i n h a l e d I
JNU f o r a t o t a l p e r i o d o f 32 min. w i t h o u t a f a l l i n PgVl o f mr e t h a n 108 o f b a s a l .
CONCLUSION : JNU was c a p a b l e t o produce b r o n c h o c o n a t r i c t i o n i n
h a l f o f o u r p a t i e n t s , t h i s d i f f e r e n c e i n r e l a t i o n t o rmW may be
e x p l a i n e d by t h e f a c t t h a t u l t r a a o n i c a l n e b u l i z e r s make a more
d e n a e n e b u l i z a t i o n w i t h more w a t e r n e b u l i z e d p e r u n i t o f t i m a .
arb.
A.
d
Qao.
t o puwnchlu interdepmdurcm. wgallywdiatod bronchial n f l e x . and c a l c i u on airway n v r o r i n g following d n p
inhalation (DI) i n five uthmatice (28.6t3 y r . . -1.
At baaold m
WU 3.24iO.5 (SE) 1 (86.5i14 1 of pmd). SO.. WU 0.1UO.06 m H oZ1.
and thm r a t i o of maximal to partial mxpimtor). forsod n o n a t & of wc
(M/P ) ru 1 . Y M . u . Dn thrw occuiona. an m k a p u t a t 1.ut.
blm%onstriction
ras induced by a a a r i n of five 01 urrm-n,
m d RV
and MIP
wen recorded evew 5 min during M. f i r a t 30 min. P l m b o (P)!
~ i f m d i p f R( N ) 20 .s sublingually 30 min b f o n th. *at, and i n m o d
I p r a w i u B m i d e (IP) 160 r g 45 min b f o n the toat rua glm i n a
npRolliud order. After P, f a l l of RV P m O n u i n l J n a M it- u x i u a t
20 nin (29t5 1) and then began alarlb ncovwing ( a n t . b l m ) ( p < ~ . ~ l ,
MOVA). WP d i d not show any significant i n c n w during M. airway
-wing
8 conatu~tlyr s u i n o d above the unity (p( 0.001, MOYAI,
indicating that no unbalance bebronchial and w c h i r r l h y a t . n m
oscuwed during the rholo time of b m c d m c a a t r i c t i m . M a i f i f i c m t l y
inhibited M. doof aim4 -ins
indued by DI Tpc 0.001 w PI, but
left unchanged WP c a p u d t o P. b the s o n t r v y IP uaa m t able t o
p r o t w t eubject.
m c h ~ ~ - t ; i c t i o n (p m vr ~;nd
p 0.001 w I().
Uld l e f t */Pa CaUtMtly above unity.
Minutes
5
10
15
1%
1.7iO.2
24t6
1.720.2
29t4
l.7M.2
l.7M.1
r ~ v ~ f a i i , x4t4
Y/P
1.8M.5
m& En.
f a l l . X l4t9
1.8f0.5
ins
1.6iO.4
iu6
l.6iO.4
20f5
1.7M.3
2225
1.5iO.3
21f4
1.7M.5
m
PEV1fall.X
25
30
24t4
1.7M.1
2ZW
l.6M.1
irts
1.w
1.3t0.3
1.5t0.2
lor*
1.3.0.2
2225
l.bM.4
21t6
l.gM.4
20
-5
conclude that airray n u n r i n g following DI i n u t h u t i c a i a m i w r
u d i s b d by an unbalance betwen airway and - h i d
h y a t n r m , m r by
wgally-mediatd mechanins, but i m n1af.d to rchYrimn involving m i r r y
UCle ~ t r u t i m
86 it i s pmvmted by v o l t . p . - d . p m d . n t d c i u cburwla
antapniats.
We
DETECPIIII T I I ~NJNJYL3IIIC BH,J~CI~IAL
kl;n(r'l'IVI'PY I N 14-19 A06
IR9'IP STUULI'!';.
n.Akin, S.Aktogu, A.Ozsar, S . C e u i g . I e m ~ r 0 6 g b H a s t a l i k l a r i Hast a n e s i , I z m i r , Turkey.
I t h a s been d e m o n s t r a t e d i n many s t u d i e s t h a t a i r w a y h y p e r r e a p o n s i v e n e a ? is g e n e r a l l y e a s o c i a t e d w i t h b r o n c h i a l a a t h m , c h o n i c
b r o n c h i t i s , t h e up,Jer r e s p i r a t o r y t r u c t i n i e c t i o n e , c i g a r e t t e
s m o k i n l and a number of s p e c i a l c o n d i t i o n e . R e c e n t l y t h e e p i d e m i o l o ~ i c a la s p e c t 01 b r o n c h i a l h y p e r r e a c t i v i t y of t h e community
b e become t h e f o c u s of i n t e r e e r . I t , netura'l'ly w i l l s t i m u l a t e
many o i u s t o d t t e r l n i n e t h e s p e c t r u a o f rlsY f a c t o r s which
c a u s e t h e b r o n c n i a l h y p e r a e e p o n s i v e n w a . I n t h i s a t u d y wenaimed
t o d e t e c t t h e b r o n c h i a l reactivity s t a t u s among t h e 14-19 y e a r
af a = e students. S t a n d a r t q u e a t l o n n i a r e o f American T h o r a c i c
S o c i e t y which I s e s t a b l i s h e d f o r e p i d e m i o l o g i c a l r e a e a r c n e s was
uaed t o c!et t h e n e c r s d a r y knOWlOdde r e l a t e d t o r e s p i r a t o r y s y a ptos1.1, d i r e e a r 3 a114 smoalng h a b i t s . R e s p l r a t o r y r o n c t i o n end t n e
l e p r e e o f b r o n c h i a l r e a c t i v i t y t o cnethaooline were a s s e a e d a c c o v i i n n t o C o c x c r o l t ' s t i d a l volume method s t a r t i n g from O.OMg/
ml t o 10 m < / u i l . c o n c e n t r a t i o n I n e v e r y EubjeCt. A t o p i c s t a t u e
wes e v n l u t e d by s k i n t e s t s . I a t r a d e r m e l t e s t a o o r e s and serum
e o s i n o p h y f c o u n t were r e c o r d e d . LO s u b j e c t e who d i d n o t a c c e p t
t o 7 e t t h e > < I n t e s t s were take11 a 3 t h z C o n t r o l group. PC ' I V ,
v , ~ , , ~2., ,j ; L I A Ion. i c i ~ > l i c ~ tell I L ~ tCi ) ~w a ~ . j 3oranchiul'@~
I I V I , C I I . ~ ~ C L ~ V ~ 101
~ ~ 27
.
of 7 3 i t u d t n t s ( U J )PC FBV Were l o w e r
t h a n 4 m ~ / a L wheread t h e Same v a l u e s were h i g h e r t h a n lbm#/ml
I n 35 a u b j u c t s (;37).ue
iound i e t c l t i s t i C ~ l l y a i n n i f i c a n t r e l a t i l u n ; l h I p between t h e symptouls l i k e wheezing s n f d i s p n e and
b r o n c l l i a l h y p e r r e a c t i v i t y (p(u.35)..
A l s o t h e r e were i a t a t i s t i c a l l y s i m i i i c u n t r e l a t l u t l r h l p between o r o n c h i a l hy e r r e e c t i v i t y
arld r a d i ; l o ~ i c a l l y proven s i t ~ ~ r i t (i sp(0.05 ). I n 1 3 o f 9 3 s u b j e c t s ( 6 1 4 ) ' l ~ o j i t i v es r i n t e a t s were d e t e c t e d a g a i n s t o n e o r
more a n t i Tenj. I s t a t i s t i c a l l y e t g n l f i c a n t r e l a t i o n s h i p c o u l d n o t
o r foulid dLtweell b r o n c h i a l h y p e r r e a c t i v i t y and p o r i t l v e s K i n
t e s t s ( p)0.35 ).
PC Ed ha8 ;e 77.5 sensitivity and
51.7 a p e s i i i t y i n d e t e c t i n g
p e j t > l L t o r y sylr~ytom=.
~
A
~
M
N
D
a
S
T
~
n
€
r
v
R
f
f
A
mPEFIRCSPONSRlENESSNAUWGK:m
R.PI*. M.D.. L.Cec8rlnl. M.D., F.U.rch.uni. M.D.. D . W d o l l , M.D..
C.Msrp**ai. M.D.. F.C.C.P.
Rmoy Mv*im. OlkP MqU (Anoocq).
F
g
F
N
md
w.
Y n H w a m r d v : n 4 W ( t h r b v a W y d p m b * m d ~
allergen for th. d.vr(oprm1
of twoncMl lyp.m#lvny In rub).c(r WPA .Hrg(c
mlnltlr. If ellerg0 InWmmatiom of th. airways b Lnpomnt, th. longu h.
swm&&m
porlod th. g m l a r MI be thr I k W ol bronch(.l-.
thu.
Wconpndthre(kcbG44#(mnl~d~~q.nb(pwnnWud~on
~pnrrrondh*d~hypemoclklhl.
M M 14 F. M o p 18.7 i i.2 ( s w m m r a u s i *a(oc i s M'H ig F
~~1op~.7ii.~mwuea~ldbypam*muocl.rmwb~lopmcy
w e n u p o h . M wb).asund.nrenta sran*pwmmnp***rtl(ormo
aunmomt wwam
in our region of ~ l n
dq,vld ( h r r ~
a bronom
durrnOI~hawhO~dmrtuchoh.wy.4*r(pmb*bmnWncmb..
~~wr.pw(omwd6m0thrpol*lrraonhawdwn)lhrlonbpmcy
ndlwgnu.PDZOFEVlwaa*u*tedrh.nM*.nWa
q a m m l d o d
m m u l h W ~ + ~ B w h o u F E V l d d n @ d n n uahstZmmU1ng.d(D0*
b.whe a D r W u * l g t h r b l d o r e d U C H .
BLlYltE
munopinHDMgmup'*ls~bwathanhpolw,gloup.~a
PD20d3200mcgdMCH(ornwmplns(on.~mrrn~olPWOTrVl(orpmb*HDU
gcwp wu 2471f195.3 mag of MCH. rrhb hn of polw, gloup w n 2692.8i178.7 (na
s i @ f i w ~ t d m e r e ~ ) . i o(3%) HEM ma~tll~~
a d s ( m ) po*m
W a C m r r n n d bronch(olhypneclc(iv*r.md t h a m m r w a n o ( ~rPI
t h . p . r e M g . o l ~ e ~ h . C h g ~ ~ p w t h r n ~ n v l * . d P O Z O F N l
Waa Okm hlo raoun(.
TUESDAY, TUNE 15
(Asthma: Pathophysiologic Mechanisms)
m a l R P R M ' R R e S K P D I N D ~ C ~ C ~ m
D.Behera,PD,FaS; S.ta.9h.m;
lxprvmlts of
S.K.JFndal,PD,FCW:
R.J.Dash*,ED,M
hdicine 1 * ~ i n o l c g y ,Pcrrtgraduate Inatitute
M impeotMt -use
of autaxmuc -thy.
often precssh salaoly nurcpathy, and i s often asyneecmatlC. Atnonlal
requlatim of the cardiovascular and gastrointestiM1 systsn has
teen well docusnted in such pstimvr.
Hanver, infomarim m -1
dysfunctim of the reapiratory s ~ t a nin Vaac patients i s s w t y . A l t b q h
respiratory 8llnpear dre nx a fedture of didbetic autaunic neuropathy,
inpaired respiratory reflexam m y haw iapoMnt clinical
like mmps=tdmdimsrpiratcay asmeat..
the e f f e of au-c
neuropathy
st*
uas ur&rtaka to
in ~L&&XS m the cagh reflex elicited by inhalation of c l t r i c acid
emwol. me autmaric f m c t h ~sardied inclrded
like gu~tatory
aaatirq; diabetic diarrhota, p t u r a l hypmtsim, gastxpamsis and
blaaaer qansis and a i q u like heaR rate resprnse to standing, hbvt
rate W
~
t toy ,deep brsathing, Wnlva m m c y u e and p a t u r a i
hyp?temrim.
Cmmmtant --le
ua? &~Au-& d u r i q theme
tcsts. Cmgh reflex t h r d u l d war Naluaeed by mhalatim of c i t r i c acid
-1s
&ainhtsrsd in incrssaing
of I\, 2t, 5%. lM,
by ~
wlw) ~
m inhalad air
a DcWilbua
.54% andn100% (might
d
ultrascnic n e t u l i r u .
~ n ycagh during inhalatim and for the neat ha
minute4 were mntsd.
Diabetes m l l i t u s i s
*dl
-1
p
i m y n r & ~ c o k b ~ ~ ~ ~ m - m
8-WIumundhSSpH*UMR
h~.UASwnnpohdby47pl*n.
POBr*iO
(48%).
h h
h. kd*idJ
U d P C 1 O F E V l mplOd
qhthardK2wmhp4hm
m
~
~
~
(opnctc*r).m*UAS**.
dl&yculakdahrrlgh(dh.
i d m ~ ybm la.tmd g n W~H R
hl~*hou(uAS.u..nHlud
P Q O F E V 1 m ~ h h . h o
pmp(u&-o.e6+/-.OIlogr~
ws*O.cn++ng.~R;2YIIRO
A A
40 4 1 0
010
-wm
1.10
1.m
+/-/-mlopmg~n+/-m
pdImM).nnmyul)r d 1hp.ddngdn=b-Qnumh
w d - h p n d b
h~urSnu03X.8broutdkl2plc**IhnoMtmdVA-WR.~hd
ygH
-mr*rd**lh-.
THE NATURALCOURSEOF BRONCHUL FEKTMV TO INHALED HISTAMINE IN
CHEMICAL INDUSTRY EMPLOYEES
A'. Bmimma R', .scwI?S
Mwget, R', E l y e h a d c;. Kuba R'.
wrdndmmG.KnnuA.BuHR'
'me st*
w i 8 e d of 3
with b r a t y subjecw eech: IJrr
n r v q a t h i c diabetics (HO)i NcNmpathic diabetics (m) and -1
a n M s
(N). Age, sex and Qratim of d
w r e m p x a b l e in the f l m t ha
grarps. -ic
am@icatime of d u b t e a b e r e nure Erequart l n the H,
of urtaunic neaqathy and rn evidence
grarp. ~n m p x p 25t had
w pnaant i n a l l . 7 subjects 0 5 % ) in the nurcpathic diabata qrarp
had cargh reflax Uvsshold bymd 100% of c i t r i c acid aarogl 1.e. they
did not cuqh a t any oonontr8th-m a t a l l .
'me ha &her gra*. (HO
al-d controls) tad ax$l d1.x Uueabld of 10% or lees. and them w
m s t a t i s t i d l y siPlifi-t
diffof the cargh reflex i n theae 2
m.
lhis stu3y shand that diabatic autmaoic neurcpathy i s f m t l y
a q @ o m t i c and p r a ~ t h a t i c dmervatim i s mxe frequent than
s y p t h e 5 c . mugh raflex i s s i w i o ~ t l ymxe -red
in dzabetic
mmnslic -thy
mrggating
-tion
Of the
trM.
my -fit & f a of di&etic stat. par se m the ax$l reflex
mlikely as the nm-mxqathic diabetics and n a n d untrols had similar
cargh reflex thresbld.
-
CRYOPRESERVATION OF HUMAN AND
PHARMACOLOGICAL STUDIES
PORCINE
BRONCM FOR
"Predinical Research. Sandoz Pharma Lld. CK4002 Basel. Swikarl8nd
Wlinikum der Albert-Ludwigs-UniversitY Freiburg, 0-7800 Freiburg. FRG
Cryopceservatii has been shorn to be a useful lechnique to store M e d organs
tw subsequent pharmawbgcalexperiments ( M l k - S d w e i n i i e r , 1992). Most of
these inws3gations, however, have been prbrrned on vasarlar smooth muscle.
while cornparalivepharmacolcgd s t u d i i on functional changes fo(bwhg slwage
at subzero temperatures ofairway smooth muscles have not been peftormed up
to now.The purpose of the prewnl study was, tJmfe(ae, to assess how rreW the
function of aimay srooth muscle was omwved after qostorag. in Wid
nitrogen and whether thi technique can be used to store airway smooth muscle
for subsequent pharmawloglcal experiments.
Humanand porcine bronchi have been investgated in vim without or after storage
at -196% in foetal celi serum W i n i n g 1.8 M dunethyl sulphoxide and 0.1 M
sucrose. After ayopceservabonmaximal contractile responses of human bronchi
to carbachol and histamine were reduced by a h 1 25%. Responser to relaxaxant
agonists such as boprenaline, papaverine and the potassium channel activator
bimakalim were anenuated by up to 50%, r e h d ! q considerable reduction In
compliance c4 frozmhhawed human bronchi as compared to unfrozen tissues.
The post-thaw respwses of pordne broochi to toth contract~leand re(axanl
agmsts proved to be &her unchanged ofonly skghtiy diminished and respomes
to relaxant agents as well as tissue compliance w r e only slightly attenuated.
of bronchi at
In conclusion. the evidenm sUOgeStS h t after cryopt-ati
-196% mechanisms of toth w n t r a c l i and rehatlon are well maintained though
the compliance of human bronchi seems to be reduced after the Ireez~ngnhawing
process.
TUESDAY, JUNE 15
(Asthma: Pathophysiobgk Mechanisms)
I m m u n o s t i m u l s t i o n by s o f t l o f i e r i n a i r w a y i n f l e n m e t i o n
THE
AIRWAYS DIVALENT CATIONS
TREAMENT OF BRDNCtlIAL ASTllPlA
IN
PATBCGKNKSIS.
CLINIC
AND
Imre A u c s i , F1.D.
S.'olno::,
2 n d P u l m o n o l o ~h p a t r m e n t o f C h e a t I l o s p i t e l .
llunl~ag.
'me i m m ~ ~ n s t i m u l a t i negf f e c t o f f i o f t l o s e r is w e l l 1mown.In c a s e
o f o l t e r o t i o n i n t h e u p p e r r e a p i r o t o r g t r o c t a wo a d o p t e d t h e
n r o r w l u r e o f l o c r l . t r b a t m e n t \!it11 lie-Ne 7-?0 m\l 760 nm d i o d a
i a s e r . J n t l l e l a s t two y e e r a 1 0 4 o e t i e n t s were b e s t e d t h r o u g h
t h e m o u t l ~o r t m n w a s e l by b r o n c l l o f i b e r s c o p e . A l t o r a t h e r t h e s e
v e r e rM o c c a s i o n s . E e c h t e r a t m e n t t o o k 3 - 5 minutes'. We ronnd
t h a t r e r u l a r treatments r e s u l t e d n w m p t o ~ s t i c s t a t e - a n d
t i e n t s >om l e i n e d a b o u t v s r i o b l e time p e r i o d s The d o s a e o r o u r r s t i e n t s s u f f e r i n g f r o m c h r o n i c 0 b s t r u c t i ; s h r o n -e h-l r -i a and
s ~ t h m eutea r e d u c e d o r - e v e n q u i t t e r l . The d o u b l e - b l i n d e x p e r i m e n t
justified o u r uatienta s u b j e o t i v o r x w r i o n c e . We f o u-n d- i- -t n
r o d ed.iuvant t r e a t m e n t ,
Inmuno o c a r e e s s r c : CAhor S - a h & , V.D.Aunrerg,Debrecen
~nlrer:l$/
coheren: d m u n e o y c t e m b r l o n p s - t o t h e mucous'msmb r e n e , w h i c h h a s q u i t e e lax-ee s u r f a c e / w " m C / .
~ccordinr-to-..
i n d i s t i d u e l f e e t u n s w c a n d i s t i n q u i e h NALT e n d EALT.
The e s s e n c e of t h e c o h e r e n c e : i f t h e r e wee a n immune r e a c t i o n i n
o n e P e r t o f t h e mucous membrane, t h e bound c e l l s , which t o o k
h n r t i n it o r wen s p r e a d w i t h t h e h e l p o f s o - c e l l e d h o m i n ~rec e p t o r s , F e t b a c k t o t h e mucous membrane f r o m t h e systematic
c i r c u l n t i o n . And t h e r e t h e y make n r e a c t i o n f o r t h a t c e r t a i n
e n t i r e n a s i f t h e i m m u n i z a t i o n worrld h a p p e n e d t h e r e . F o r e x a m p
1e:t:le s t i m u l a t i o n o f t h e b r o n c h r ~ s mucous membrane i n o n e p l a c e
c a n c a u s e s i m i l a r s t a t e i n o t h e r p l a c e s . The c o h e r e n c e i s more
s o p h i s t i c s t e d . it seems t o b e neuro-immuno-endocrin.
The i m m u n o l o g ~ c a lr e a c t i o n c a n c h a n g e f o r t h e e f f e c t o f I A m .
llow no me thin^ s b o u t o u r r e s e e r c h e 8 : t h e y a r e i n t e n d e d t o b e f o r e e x r e r i m e n t s / e f t e r o n e m i n u t e i r r a d i e t i o n we e x a m i n e d t h e
f u n c t i o n on monocyates and g r s n u l o c y b e s e e p s r s t e d f r o m t h e blood o f h e a l t h y p e r s o n s a n d p a t i e n t s s u f f e r i n g f r o m non-immunoloricsl d i s e a s e s . We o b s e r v e d : t h e e f f e c t o f USER o n t h e o p s o n i c
h s k e r y e o s t p h e g o c y t o s i e of p e r i p h e r i e l b l o o d m o n o c y t e s i s
eiqnificent.
no-'.-
- - - ..-
A . Q r t t a , W , A . m , R I P , A . P B C I , m , C . - . I I . m
DnD, n,
D. anrreu, rap.
,-
W i
miw,
U l i w a i t y of para,
Italy.
h a t e l l s in h m a bronchial mmsa a r e heterogeneous with repar,
to
histochemical c h a s s t e r i s t i c s and an ongoing r e l e a s e of K d a t o r s accurs
i n asthna. b r m w r , K) degranulation may c o n t r i b u t e to n o n s p c i f i c
b r a d i a l ~ r r e s p c n s i v e n e s s .Sinoe an o r n o t i c s t d u s is kmm t o in&ce
K: &qranulaticn we studied m
r astmvltic s u b j e c t s , wha shwed a
p o s i t i v e respcnse t o UMW, had evidence of an increased i n f i l t r a t i o n and
g g r a n u l a t i o n of K in bronchial mmsd. we s e l e c t e d 13 d s t h n a t i c s (6F; age
rarqe 22-29 yr; 10 a t c p i c ) &ring c l i n i c a l renission. (HY chdllenge was
performed with 5 increasing w l m o u t p t s (€?on0.5 to 5.2 mllmin) and the
r e s p m r given as t h e p r m a t i v e outpat causing a 20% f a l l in Fevl tFo2O
F N 1 ) . Bronchial b i c p s i e s vere stained with 22 t o l u i d i n e blue f o r 30 min
dnd 7 days. K Md K subsets (degrdnulated, p a r t l y &qranulated, and
granulated) = r e counted i n t h e e p i t h e l i u n and lamina p r c p r i a separately
(celllmn2). Fo2O LMW was measurable i n only 8 s u b j e c t s (range: .71-4.14
mllmin). 'mere was no d i f f e r e n c e i n M
: counts after e i t h e r s t a i n i n g mthod
b e t r c n W+dnd LMW-subjects (epitheliun: 24.4 dnd 26.1; 30.5 and 28.8,
respectively; lanind prcpria: 75 and 74.4; 133.5 Md 138.9, r e s p g t i v e l y ) .
m r m v e r , K) subsets in the t w graps were rat d i f f e r e n t . FO20 FEVl was
not s i g n i f i c a n t l y c o r r e l a t e d with any K) count. We mnclude that a p o s i t i v e
r e a p n s e to LMW is not associated with an increased i n f i l t r a t i o n and
degranulation of K) in bronchial m m ~ .
G . F e d o s e e v , A . Emelyanov. V . C o n c h a r o v a , K . b l a k a u s k a s , M . D l d u r .
T . S i n i t c i n a . A.Kaklugin
H o s p i t a l Tllerapeutic C l i n i c o f Pavlov S t . - P e t e r s b u r g Medical
I n s t i t u t e , St.-Petersburs. Russia
Maenesium a n d c a l c i u m c o n c e n t r a t i o n s i n t h e e x h a l e d a i r
c o n d e n s a t e ( M C ) as w e l l a s l i q u i d o f b r o n c h o a l v e o l a r l a v a g e
(LBAL) w o r e d e t e r m i n e d by t h e a t w i c a b s o r ~ t i o nm t h o d i n 44
htierrt w l t h b r o n c h i a l a ; t h
(BA).
~ i v a i e n tc a t i o n s l e v e l s
i n BAS d i d n ' t sl n i f i c a n t l y d i f f e r f r w t h o s e i n LBAL a n d v e r e
d e c r e a s e d (P~o,o!)
i n a t o p i c BA p a t i e n t s ( ~ 2 8 c) o n w r e d w l t h
c o n t r o l g r o u p (11-18) a n d n o n a t o p i c BA ( n - 1 6 ) . Magnesium a n d
c a l c i u m c o n c e n t r a t i o n s i n EAC h a v e n ' t b e e n f o u n d t o d e p e n d o n
the
power
of
bronchoconstructive
syndroae
a n d mucosa
inflanoatlon activity.
but
siOnificaatly correlated
with
r r r t , . y l h o ! ! ~ i r 1ACC)-ind~rced i n c r e m e n t of h l s t a a i n e l e v e l i n t h e
EAC a s w e l l a s b r o n c h i a l h y p a r r e s c t i v i t y t o ACC i n a t o p i c
pntienls. W
e h a v e a r r i v e d 1.0 t h e c o n c l u s i o n t h a t e n d o b r o n c h i a l
mayr~esltiln d o f i c i t
unlike the
low c a l c i u m
conuentration
promotes n o n s p e c i f i c h y p e r r e a c t i v i t y
o f . b r o n c l l i a l t r e e find
m a s t c e l l s ill a t o p i c BA p a t . i e n t . 3 .
A c c o r d l r ~ gt o t h e d a t e o b t a i n e d 27 a t o p i c BA w t i u n t s w a r e
examined f o r
t h e effect.5
of ,mgnesium
s u l f a t e ael'osol
( s u l u t 1 0 1 1 o s m o l a l l t y 260 m m o l / l ,
pH-6,6)
on t h e bron~:liial
~ . u a c L i v i L y t o ACC a n d g r a d e d p h y s i c a l e x e r c i s e a s w a l l a s o n
Lhe b r u n c l r i a l p a t e n c y r e c o r d e d by g e n e r a l p l e t y s m o R r a p l r y a n d
~ I I ~ ~ ~ I U U C I I L I I1111ulatlon
U ~ ~ Z L J IoY
f . t h e drug (dose ct~rrtained3
~nmul u u u n u s i u m ) h a v e b e e n f o u n d t o e x e r t n o b r o n c l r o d i l a t . a ~ r y
aotiu~~
b u t r e d u c e as
compared w i t h p l a c e b o
nunspecific
h y p u r r ~ r t i v l t y of
tlie
bronchial
tree
and block t h e
ACC-induced i n c r e a s e o f h i s t a m i n e l e v e l i n t h e BAC. T h e d a t e
obtirl~ruda l l o w b r o n c h i a l
~ n l o o t hm u s c l e s a n d m a s t c e l l s t o b e
r e g a r d e d t ~ t l t a r g e t f o r mmgnesium s u l f a t e a e r o s u l . The d r u g
p r o v e l . t i c o d i s c o v e r e d may r . e r v e a s p r e r e q u i s i t e f o r i t . s u s e i n
t h e treal.mc?rrt o f BA p a t i e n t s .
.
m m r c r n I n im a ~ r
nmcrrm rr
a r n m Ac n a c ~ s s - m o a oASIRIA.
h i - h u u g a t (FCCP), S.T.lhbar. II.l.ICdt.r, V.I.Qurl.
D.P.Kh.tri, D.S.Salgaonkar, H.R.Kadam. S.R.Prabhu.
Oepts. of Uedlcine 6 Pathology, Nair Hospital, Bomb.,. India.
A.J.
In 35 young s u b j e c t s , p l a t e l e t a c t i v i t y 6 pulmmary f u n c t i m a
were studied in c l i n i c a l asthma 6 exercise-induced asthma ( K I A ) .
The
m ~ b j s t shad a s t h u following allergens 6 a e r c i s e with r w e r s i b i l i t y
a f t e r bronchodilators.
A l l drugs were w i t t e d for a day bafore each
test.
Curing
c l i n i c a l asthuo,
pulmonary functions
(WC.
QEVI,
FEF 25-75, QEF 75-85, PEQB), p l a t e l e t a c t i v i t y ( p l a t e l e t clumps1150 MC
onsmear, p l a t e l e t adhesiveness 6 aggregation, kaolin c l o t t i r q time f o r
PF3 a v a i l a b i l i t y , blood r e c a l c i f i c a t i o n time) 6 msinophil count were
studied before 6 30 minutes a f t e r inhaling 500 pg of t e r b u t a l i n e
(Bricanyl H i s t h a l e r ) . Clinlcal asthma was graded as Hild (a-15) 6 severe
(n-20). the demarcation being FEVl
$ 65% of predicted normal with
FEVllWC ( 60%.
Subsequently, the subjects performed a submaximal
treadmill & e r c i s e t e a t during r a i s e i w of a s t h u . Pulmonary functions
wert recorded throughout the t e s t 6 a
15% drop from h w a l FEV1
indicated EIA which was s i m i l a r l y grad& as mild (n-19) 6 severe (11-16).
P l a t e l e t a c t i v i t 9 6 eoainophil count were studled before 6 i m d i a t e l y
a f t e r exercise.
Curing E U , XX) pg of t e r b u t a l i n e was inhaled 6 i t s
e f f e c t s were recorded 30 minutes l a t e r .
The following conclusims were derived :1. Clinical asthma predominantly narrow sllall airways while a e r c i s e induced asthma a f f e c t s l a r g e 6 small a t n a y s equally.
2. P l a t e l e t hyperactivity 6 m s i n o p h i l i a a r e observed on bQth occasions,
belng more in c l i n i c a l a s t h u of similar s e v e r i t y .
3. Terbutaline aerosol i s beneficial
in both types of aattma,
p a r t i c u l a r l y c l i n i c a l asthma, with a maximal e f f e c t oa 8-11
airway
obstruction 6 a concordant l m p r o v a m t in p l a t e l e t a c t i v l t y 6
msinophil l a .
4. A time course analysis indicates t h a t p l a t e l e t hyperactivity occurs
well before EU.
PLATELET 6 PUL~O+U+RYQ~ANGES
MEAN t sen)
P A m l E T R (*P c0.01)
C L I ~ U ASIWA
R-IEWUD ASIRIA
KAOLIN CLMTINC T I H E ( S U ) 5 1 . ~t 1.85
78.23 f 2.30.
PLATELET CLUUPSII SO UBC
118.57 t 10.26
60.24 f 3.51.
FEVL (L)
1.80 t 0.21 (75%)
1.67 t 0.15 (69X)+
FEF 21-75 (L-Sec)
1.59 t 0.21 (47.)
1.98 t 0.16 (U)%)*
EOSlNORiIL CWHTICM
880.83 t 90.85
671.05 f 36.88
( % Predicted normal)
--
TUESDAY, JUNE 15
WDN%SLlY IYMJlTIW 1YCllUgsS PVUMYARY RES1ST)JICO WITlWT UUSIUG
AIRWAY W A U
IY MO PlT.
G.U. DL W i a .
S. 8.llOfioCe. 11.0. (i.1U.o. Y. CiWKiO, S. YOTO,
5. R i r l t e c a , A. M l s t r a t t a . CCCP.
~ r u t i t u t eof n e s p i r a t a y DL-.
u n i r a r m i t y of c a t a n l a . I t a l y
m,
l U x l c o D.?.
and D.P. o f
-1ton.
Ont,
-.
Phyelol
ud P h . r u c o l ,
YOUltor
Unlvorolty.
klrwoy a o o c h a m o l e s o n t r a c t l o n l n d u c d by c b o l l r u r p l c . p a r l e t e N N l t a
a rim. m cyt-lic
a2+
initiated by ca'+ i n f l u x f r o , outold.
1 n m t i q a t . d th. p m i b l e r o l e o f b r o n c h i a j + c u t l l . 9 .
l a th. o u o t a l n d
c o n t r a c t i o n l n d u c d by e a r b a e h o l (Eeh) i n Ca
f r n dl-.
Itrlp. of l a t
0rd.r b r o n c h i em dop wd1.uct.d
and t o u r t y p n of o t r l p w r o
m t u d l d a w l t h cart1l.g.
and u l t h . p i t h . l l u m (+CAR+IIPI), w l t h c a r t l l a 9 .
and w i t h o u t m p l t l m l l u (+CAR-WI), w i t h o u t cArtll.9. and w l t h m p l t h o l l u r
( - V S + C P I ) and w l t h o u t c u t i l . 9 .
and w l t h o u t o p l t h . l l u (-CAR-CPII.
B r q n c h l a l r e a p g l r r w e t o Cch lCsO w r a w a 1 u a t . d i n Krob. ( 2 . 5 I*I
f r n ( 0 . 1 .)I WT&) molutlon w l t h l n d o c r t h a c l n (10-~11
Ca ') and i n Ca
th.
-1 *tore. wre -id
by m i t i v o o t i l u l r t i o n w i t h Cch in fa"
f r w n d i u m ( 4 tL..., 20 mAn u c h ) . A f t o r & p l u l o n of i n t e r n a l c a 2 +
mton.
bronchlal propuatlon.
wlr stlmu1at.d w l t h d l t f o r o n t c a a *
concentr.tlon0 (10,30,100,300,1000 an? 2000 pH). ca2+ b l n d l n q and o f f l u x
T h . a d d l t l o n of Ceh t o h r o n c h l a l
f m cartllw r o mtud1.d w i t h
+CAR+CPI i n c a 2 + f r n n c ~ ~ u mp r o d u d a e u e t a i n r d
pt.p.rationof m bronchlal
strlp
(a-@PI)
contractlon.
Spltheliu
rrmal
e i p n l f l c a n t l y dir>loh.d
th. E e h - l n d u c d b r o n c h l a l ouotalnod c o n t r a c t l o n
i n th. lot and 2
o t h l a t l o n I n Ca2* f r r ..dl- -md
w l t h +CM+CPI
group. E.rtll.9. and m p l t h m l l u -a1
(-2hR-EPI) o r c a r t l l a p ( EM+IIPI) -a1
c a u u d a t r a n e l o n c c o n t r a c t l o n t o th. 1'
Cch
e t l m u l a t l o n i n W2* f r n molutlon. Th. a d d l t l o n o t h o f l u l d c a s l n q f r m
th. o t h 1 a t . d t i o a w o *-+#PI
w l t h Cch I n W'*
f r n d 1 - m t o the
p r a p r a t l o n o -VS-CPI dmp1U.d o f i n t o r n a l Ca2+ s t o r e s d l d
produce
any r n p o m u . Ru a d d l t l o n o f n l f . d l p i r u ( I O - ~ M )o r D i l A ( 1 0 11) d u r l n p
th. b r o n c h l a l o u m t a l d c o n t r a c t i o n produced a c o l p l e t e r e l u a t l o n o f
t h l e r n p o n n . Ru p r c l n c u b a t l o n w l t h n l f . d l p l r u produced a t r a n e l o n t
c o n t r a c t l o n t o Eeh s t h l a t l o n i n a t u d of th. o u o t a l n d c o n t r a c t l o n
Obuw l t h o u t n l f . d l p l r u . B-hl.1
e t r l p m w l t h c a r t l l q a w r o .or.
u n o l t i v o t o Eeh w i t h l a W * (10-100 M ) c o n c m t r a t l o n .
preparation.
w l t h a u t cartllaq..
I n e u b a t l o n of c a r t l l a g o w l t h 45a:f'
r.eu1t.d
Ln a t*
6.p.mt b i n d ~ n q . ~ l c r r e r , rambout o f 4 5 ~ 2 +f r c a r t 1 1 ~ ) . was rrry t a n oupp.etinq t h a t th. uptaka and ro1u.o p r o c a o u s
arm po*.ro.d by p h y o l c a l r a t h . r t h a n a b l o l o p i c a l K h a n i n .
In
conclusion, o u r r n u l t m mupp.ot t h a t cartll.9.
I. not p r o v l d i n q $a2' t o
th. d ~ u dru r l n q th. s u o t a ~ n dc o n t c a c t ~ a n i r r d u c d by c c h i n c a
f r u
molutlon. T h q r a l u m p w s t i o a e .bout
ha ca2+ 1 s "1ntaln.d
In
b r o n c h l a l .u.cle d u r l n q o i p o o u r o t o W2. f r n M l u t l o n s .
+.
y
I). b a r e p r a r i o u n ~ y d e m r u t r a t e d t b a t inbaled e n d o t b e l i n - I (R-1)
b u a
p o t e n t and l o n g - l u t l n q b r o n c b o e o n e t r i c t o r e f f e c t i n a m m t b a t i z e d rat.
(Eur P e a p i r J 4152&31~19911. m e o b n r r a t l o n of UICUS pluqm i n t b e airway
l u m n of q u ~ m ap ~ q mc h a l l e n g e d u ~ t b-1
(J ~ b u v c o9.p
~ nu m:7m-5
19891 u p q e a t m t b a t t b e u t a i n d b r o n c b o e w t r l c t l o n induced by R-I
could p t 1 a 1 1 7 depend on rrru b y p u a u r e t i o n and a i r m y w a l l e d w . rn
aim of t b l s atlldy w t o d m t u m i m t b e a f f u t m of a e c c a o l i a ~R - 1 on pulm n u y n c b a n i c a and airway wall t b i c k r w r . Eight S p r q u c m u l q f e m l e
rat* ( & l o weha) wra a ~ t b e t ~ z( nml o~p . n t a 1 d i u s
q / k q . 1.p.) and
i n t u b a t e d . m t a l p u l w n u y r e a l s t a n c e (%I w w e d d u r l q apontamOU. b r e a t b ~ n q . ~ f t e r b a s e l i n w r u r e u n t a of 5 . 4 rat. i n b a l e d m o m l m of - 1 i m
and of I n c r e a a l n p c o n c e n t r a t i o r u of R - I (from 1to
4x1011). s h u a u . 4 rat. ( c o n t r o l ) u n d u w n t 4 c o n u u t ~ r ai n h a l a t i o w
of m l i m . a ~ w o I m . Aeromlm m a p a m a t e d by a ) a t m b u l l r a r ( o u t p u t
0.18 m l / m l n ~ . IL u u -ed
15 .In a f t e r e u b I n b a l a t l o n and 15 and 30
min a f t e r t b s I a a t l n b a l r t l o n . htm m e tbmn s a c r i f i c e d and t b e l r l u q s
wra f i x e d by I n t r a b r o n c b l a l p a r f r u i o n w i t b 10% f a u l l n a t a pr-a
of
25 c a w f o r 24 b a r r s . tuo r c t i o n e of 5 um m e c u t from . r h l u q and
s t a i r a d v l t b e a a t q l l n - e c a i n . K o r p b o u t r l c a n a l y s i s w u d o n by light microscopy u a i q a r2e o b j e c t l r a and a xlo e y e p i r e u i t b a c a l i b r a t e d micron t a r . A l l alruaym not c o n t a l n i n q c u t l l q a and b a r l q a c l o w d c l r c w f c
renco wltb t h e r a t i o of minor t o -)or
d i m e t o r q r m t e r than 1/3 w r e
c o n e i d u a d f o r a n a l ~ m l s . PQr . r b airway t b e u)cx e x t u n a l and I n t e r n a l
d l a w t a r a a n 4 t b e minor e x t e r n a l an4 i n t e r n a l d i a n t e r s m e s o d . Tbe
m n airway -11 t h i c k n e s s w c a ~ c u ~ a t mfdo r u e b a i r r a y by a r u q ~ n qt h e
d l f f e r e n c e a betueen u t u n a l and l n t a n l d i a ~ t e r s . R - l c e u n d r
c o n c e n t r a t i o n d e p e n d e n t i n c r c u of P, i n a l l r r t m from 0.18 f 0 . e
CW&/ml/m
t o 1.29 f 0.28 C.ICO/mI/a
(p(O.051 a f t e r R 4x111. Tb*
i n c r e u e In P, induced by R - 1 p u a i m t e d up t o 30 mln. P, a v e r w e d
0.75 f 0.12 mlW/ml/m a t 30 min a f t e r OM l u t I n b a l r t l o n of P I .
Repeated 1 n h . l a t i o M of m l i m d l d not a f f u t P, In c o n t r o l r a t s 0 . 1 7 f
0.03 rs 0.16 f 0.04 cat1.0). mo t o t a l number o f a i r w a y s examined w %
and 84 i n R - 1 c b a l l e n q e d and i n c o n t r o l r a t s , r w p o c t l r e 1 y . ma frequency
d l s t r l b u t l o n of minor I n t u n a l d l a ~ t e r ad l 0 not d l f f e r I n t h e tw qroupa.
t b r u i n d i u t l n q t b a t a i r w a y s of e a p . r a b l a mtxe w r a a u ~ n d no
. dlfferonc e In a l r w y w l l t b l c k m a s b e t m n t b a 1 warp. u u o b m r a 6 . In f u t .
t b e n a n airway w a l l t b i c k m u u u 35.1 i 3.7 ps and 45.0 t 4.4 w i n R - 1
c b a l l s n q e d and i n c o n t r o l ratm. r e s p u t i r a l y . l'h r e s u l t s of t b l a mtM?
i n d i c a t e t h a t t b a w t a i n d i n c r e a s e i n 4 e 1 i c l t . d by R-I i n h a l a t i o n
doea not 6 . p . ~ on airway wall a 6 . u .
t h r p w r t e d DT t b e u a t i o n l
R e n u c h Council of I t a l y 8 CUP g r a n t No. W.03177.041
w
C H A N G E S I N MEDIATOR LEVELS FOLLOWItVG E N D O B R O N C H I A L
C H A L L E N G E WITH ADENOSINE 5'-MONOPHOSPHATE (AMP) IN MILD
THE EFFECT OF NIPEDIPINE
R P d a v f . W.H. Ngt. S.T.Holguc~. M.K. Church#. A. MisMitsl
lInrciac*d~~UniHnitydCaUniLITALY
@ I m m u m p h u m w l o g y G m p . Univenity of Soo~hrmp~~.
U.K.
and R.P. PLRNG. M.D..Ph.D..F.C.C.P.
UM- A
.A-. S- -l-.
.-W
-. .
AMP is r d l y o c e h n g purine nuc*aidc whifh provdrcs brorrhamNUrOon when
inhaled by vrbmur subjecu bul nu no&
The mechanism by which AMP mcdlaks
bmnchoc~&tion
in u t h n u i i c subjcc~.sis nci clear bul a role for m w cell derived
mediama is c W y supponed by 8 number of wudier. Mediala relea?e from .ccivaud m w
cells is a l t o likelv l o ukc ~ l inw che airways in vivo d u n n n A M P - i n d u c e d
bmnchocan&a&.
Nuw s u b i i u wilh ruMe ulhm.volunlceled lo i n d e m o BAL a f t u
chalkn@ WIB'AMP and d m v u e f k x ~ b kbronchar&ucdgcd
Into
subsegmenlnl urways The r n e d ~ a r measured
o~
w u e h a m l n e . tryplsse and PGD2 whlch
am, hdicaunof mut a U raivocion md albumin which is a m d m of vasculnr leakage
The scudv cohtivcd of t h m s e w v u i u at h i 72 hours uwn Dnv I consisted of h e
clinical k m n i n g . alkrgen &in w i n g . and h i s m i n e chailcnge. bn Day 2 s u b j a u
auendcd the laboncory,to u n d e A M P inhalalion challenge to duive their individual
vocative c ~ c e n ~ ocausang
t l
20% fall from W i n e FEVl (PCM).and on Day 3
mr pufomvd bdmand 3 min inW AMP and saline (cmml)instillation. The
c
h
d
l
e
n
lavages
obuind
from
b a h che middle and upper ri hi bronchi were
'OU- '
n d centrifuged a1408x for 10 min u
&
! -cd
lhrough a 0.9 mm
the d s from thc fluid BAL fluid lhua massed was &en diauolrd into
;di
6
& m a LO thc s l l i r r c ~ ~ ~ ~ & ~ s e g r n cmponsc
n ~ ~ ~ h10
c AMP I N U I I ~ U M I WBS
c h u n c r i z e d by a m p r rcducuon In a w a y collbrc pmlklcd by a slgn1ficanl4 2.fold
increase in POD2 ievels.in che BAL fluid (d=0.M4jand by a I:kfoD rise in albumin
levels (D r 0.031). There was .L.O an inc&
in che m e d i h hisumire (from 200.1 lo
433.6 $ml) and rrypr+ k d . 5 ( f m n 0.3 1 to 0 46 nglml) r s o v a c d a f l u AMP c h d k n p .
bul h s us fdcd LO m h ugn~f(p values of 0 068 and O 07 1 for histamine and
rrspcfu~ely)
findrnga s u p p m che v u v Ihuw e b m h o r p s r u ~nxponsc lo AMP In vlhmauc
u m y s u due w the bul rrktr of m a s oclk dcnved pmducu p p n r u l u l y PCD2
Rz=
M IPRATROPINE
BROUIDe AND FENUTEROL HYDROBRGIIIDE
IHDUCED AIRWAY SWUTH MJSCIP REIAXATICH. C.H. SHUE. U.D..
Ph.D.,
H o s p i t a l . T a i p e i . Taiwan, Republic of Chins.
T h i s s t u d y was undertaken t o determine i f n i f e d i p i n e mieht p o t e n t i a t e
i p r e t r o p i n e brcmide and f e n o t e r o l h v d r o b r a i d e induced m w t h muscle r e l a x a t i o n . For L s a t r i c f a r c e r s s u r e r n t s , r a t t r a c h e a l c v c l l n d e r ~( 3 - 4 mm
i n d i a m e t e r . average wet n i g h t 0.015 ap) e r e suspended in i n c u b a t i o n
chambers i n o x v ~ e n a t e dKrebs' s o l u t i o n . A f t e r 90 minutes of e q u i l i b r a t i o n
under 2 ur-s
of r e a t l n g t e n ~ i o n .a t a temperature of 37
c
and PH of 7 . 4 .
l s w e t r i c c o n t r a c t i o n of rat t r a c h e a l smooth muscle was induced bv aubmaximal c o n c e n t r a t i o n of r.ethachollne (100 30. Next c o n t r a c t i o n was
obtained a f t e r r 15-min i n c u b a t i o n wlth L p r r r r o ~ ~ i nbrcmlde
e
I I U - l l a ) nsU),
f e n o t e r o l h y d r a b r m i d e (1-10 p H ) . n i f e d i p i n e (1-100 p U ) . i p r a t r o p i n e bromide
+
n i f e d i p i n e and f e n o t e r o l h y d r o b r m i d e + n i f e d l p i n e . Data were
analyzed "sine t h e p a i r e d "t" t e s t . (Xlr d a t a show t h a t i p r a t r o p i n e b r o a i d e
(10 nqM) end f e n o t e r o l hydrobromide ( I NU) induced a i r v a y smoath muscle
r e l a x a t i o n i s enhanced i n t h e presence of n i f e d i p i n e (10-LOOM)
to a
s i n n i f i c a n t d e g r e e i n muscle p r e c o n t r s c t e d w i t h mcthacholine (100 DM).
Thaec p r e l i m i n a r y r e s u l t s euR8e.t
that nifadiptne Is useful for t r e a t i n l
c a r d i a c d i s e a s e i n p a t i e n t with airway & s t r u c t i o n .
CHEST I 1W I 3 I MARCH, 1993 I Supp(emerrt
F.C.C.P.
m e e t Department. Veteran Ccneral
221s
TUESDAY, JUNE15
(Asthma: Pathophysiologic Mechanisms)
TEE POSSIBLE EELATIcllSElP BEY!PMZIAL ALPHA-1-AHTITRIPSIIs
DBPICIEICY AID SXPIUZQBI DISmB).
MIDBY, I. U V Oy ermelyyo((yhas, B u a a p s t . Hungary
The a u t n o r found 1 c h i l d w i t h s e v e r e ana 9 w i t h p a r t i a l a l p h a
- 1 - a n t i t r y p a i n /MT/ a e f i c i e n c y among 52 c h i l a r e n aurveyed w i t h
a s t h a a t i c a i s e a s e . 4 of t h e 10 p a t i e n t s w i t h t h i s d e f i c i e n c y
u i d n o t respond t o t n e c o n p l e x of p n t i a a t h m n t i c t r e a t m e n t s
c u e t o a a r i l y a d m i n i s t e r e d t o aethtmatic p a t i e n t s . The f a c t , that
low l e v e l s o t asrum AAT c o u l d be a a e o c i a t e d w i t h f a i l u r e t o
re8pOnd t o t r e a t m e n t , l e d hlm t o i n v e s t i g a t e t h e possibility
t n a t some ~ r o t e o l y t i ce n s p e e , n o t i n h i b i t e d by a n t i p r o t e a s e e
such a AAZ, c o u l a i u a u c e t h e r e l e a a e of v a s o a c t i v e s u b s t a n c e s
lrom lung m a t c e l l o w i t h o u t an a n t i g a n i c c h a l l ~ g e .
The a b i l i t y of i r e e p r o t e o l y t i c e n a y w s / t h o s e n o t i n h i b i t e d
by a n t i - p r o t e a s e a / t o lnduce h i a t u l n e /E/ r e l e a s e was s t u d i e d
i n v i t r o w i t h t n e uae of P-615 maetocytoaa c e l l o and mouse l u n g
Xieaue and Ln vivo w i t h s u i u e a piga.
p u a n t i t a t i o Z 7 ? T E e H r e l e a s e a i r o n t h e P-815 c e l l s was d e t e r n i n e a by f l u o r e e c e n t spactrophotometry. The r e s u l t ware e r preeaea a s per c c n t of t o t a l /lorn/ H r e l e a a e d upon b o i l i n g
the c e l l a .
Corpouna 4o/bO caused 52+1C$, w h i l e t r y p a i n a t a c o n c e n t r a t i o n
of 1 q / m 1 inauced 166+2% E r e l e a a e in t h e absence of any
o t n e r curyound aurThe name time. Thia p r o c e s s a l a o occured
i n Ca-free n d i u m , and i s thought be a p a s e i v s p r o c e s s on t h e
p a r t or mast c e l l s .
Mouse lun& t i s s u e ws i n c u b a t e d Ln t h e preeence o r a b s e n c e o f
1 d m 1 t r y p a i n ana t h e n w s h e d w i t h c h i l l e d b u f f e r b e f o r e
being aeaayea l o r E c o n t e n t . B c o n t a t of l u u g t i a r u a i n c u b a t e d
in t n e p r e s e n c e of t r y p a i n was decreased /10.32+1.6 ug/g/
c o r p a r e a LO c o n t r o l 1uui.g t i e e u e incubated in t h z absence of
t r y p a i n / l >i,l 2 d . l 4 8 , p-0,02/.
In in v i v o s t u d i e s , O,:, mg t r y p s i n o r 0.5 mg e l a s t a a e in B o r a t e
buf?ar r o e i n j e c t e d D i r e c t l y i n t o t h e lunga of t h e guinea p i g s
v i a t h e t r a c h e a . Both o f t h e s e compound8 were found t o induce
an a c u t s H r e l e a a e . The H c o n t e n t of lung t i s r u e r , rO&oved 20
n i n u t e e a f t e r t h e p r o t e o l y t i c enzyme i n s u l t , was i n c r e a s e d
232% f o r e l a r t a s e and 176% f o r t r y p a i n , compared t o t h e c o n t r o l
i r r i t a n t saline.
Tne a u t h o r V e r i f i e d t h a t p r o t e o l y t i c maymee a r e c a p a b l e of
i n a u c i n ~t n a r e l e a s e of v a s o a c t i v e subetancee i n t h e b r o n c h i a l
t r e e arrd t n u a m y be r e s p o n s i b l e f o r t h e i n a u c t i o n of bronchoayooaa o r a r e c a p a b l e of enhancing t h e development of bronchos p a a m inouced by o t h e r r a c t o r e .
SOr AND N&-INDUCED CHANGES O F THE BEAT FREQUENCY O F
M. KW&
I
HUMAN AND GUINEA-PIG CILIARY C E L L S K . t
'
"
-R v .
of Pneumology, IllrJ D q . of Medicine and Dcpt. of Otdmyegdogy*.
Job- Gutenberg Univmity. Munz. FRG.
.J. -
Mechanisms of Human Airway Gobbt Cell W i n Secretion: SNdies with C&ed
Human Bronchial Epithalial Cells
KwanTay Luh, ChmrrWen Wu
NatioMI Taiwan University Hospital and Institute of Biomedical Sciences.
Acedamla Sinica. Taipei. Taiwan. Rewbllc of China
^
Mucociliuy transport is an important non i m m r n o l g i m l
defense mechanism of the reapintory m c t which m y be i m p a i d by
p d l u w wch u S& and N q . Tbe urn of this study w u to compuc
the efica of diffacat umcenmtMar of S02 and N& on the frcqumq
of bating of human and guinea-pig ciliated cells. Single ciliated cells
were obtained from 35 guinea-pig tracheae m d 8 h ~ mn u l ~
l
mucoue and the frequency of ciliuy b u t w u quantified using videointerference micrwcopy. Ciliated cells were expored to 2.5 to 12.5
ppn $& a 3.0 to 15.0 ppm N& in an cxpowrc c h r m b a s t 37* C and
5 % C& in humidified etrnosphac f a 30 minutes. Tbe ciliary b u t
frequency of single cells were evrluated before and after e x p u r e .
Control experiments were performed under identical conditions
w i h u l toxic gas. In t k c coalrol e x p r i m m u we did not rec any
significant change of ciliary b u t frequency. In marted c o n m s t
exposure of human ciliated cells to 2.5 ppm SO2 yielded
38.7%
dscrrue of bating frsqumcy. No inflon tbe beat fiCqPQ.CY of
guinea-pig cells w u obsened at this c m e n t n t i o n . 10.0 ppm S&
rerultcd in the human system in a 90% and in the guinm-pll syin e 73% redoction of ciliuy beat frequcacy. After .a exof 30
minuta to 12.5 ppm S a the ciliary buting of both species ceued In
c o a m t to tbcre rcsulu we did not o b w e m y significant diffof guina-pig ciliuy b a t frsqumcy before and &&a e x p u r e to N&
in e range of 3.0 to 15.0 ppm. In the human system, however, undu
identical experimental conditions a 24% increwe of ciliuy beat
frepumcy w u obKned Thae dala suggest thrt h coatnrt to N&
the highly w a t a sduble S& reduced the pH of the broachi.l mucus
l e y a with a c o a m t i v e reduction of c i l i hul, A good cmeletioe
between the concentration of SO2 a d the reduction of ciliuy but
could be documented.
AIDS
Afternoon
,-
H w n airwey goblet cells hywplasia and e-ve
mucin secretion we the
pathognomonic feetues of multiple inflammatory airway diseases which haw been
~mplicatedin the chronic alrway ebstruction. The mechanirns which control the
human airway goblet cell mucin m e t i o n are poorly derstood. Thia study arsassed thm rOU(dtofy mechanirns of human airway goblet cell secretion by wirq
primary culture of human bronchial epitheloal cells. The human airway epime(il
cells were dissociated from tissue by protease treatment and were plated on tissue
cdture dish coated with collagen gel substrata on F12 medium supplamented with
insulin, tranaferrin. epidermal growth factor, hydroconisone,cholera toxln, bovone
hymhalamic extract and retindc acid. Ektron microscopy and ~mmunohistochemimy demonsmted that human airway epittbalial cells cultured on collagen gel submete cwld express differentiated phenotype with cilioOemsis and mucin aecration.
The m u c w cell. aa defined by immuoofluoreaence staining with mucin-specific
monodonel entibody 117021, rescimd 10-26% of total cell popdation at confluent
a t e . Biochemical characterization with mucin pecurws ~'~lglucoaamim
and
Western Mot analysis demonstrated that cultwed human lurway mucous cells could
synttbasize h i ~ hmdecdsr weight Ik* > 200 kDI glvcoproteln molecules which were
mmilar to authentic aorway muclnr. An E L S A method, which der~vedfrom mucon.
specific monoclonel antlbody 1702, was mad to quantitate mucins released from
cultwed airway epithelial goWt calls. We found that ~soproterenolahowed most
promlmnt stimulatofy effecton main production, while the stimulatofy effectcwld
be blocked by propranolol. Atropine and acetylcholine had lime effect on mucln
secreton in cultued goblet cells. Preudomo~sendotoxin, histamine, prostaglandin
E2. leukotriene C4, leukotriene 04. 8-btomo-CAMPand calcium ionophore A231 87
coidd also atimulste mucon secration from cultwed mucous cells. There results
indicate that mucin releaoe from huMn airway goblelt cells could be enhsnced by
multiple humoral mechanisms. Thew humad regulations of mucln secretton may
play a role in airway mucan releare in inflammatory airway disorders.
- - - -
-
NcIror M ra-11 K L..-Pack
L,
TO-o
-'co.ol ~ t " i dc l i~n i c ,
Olrti.., TO dmteL-mIn. th. *LYl
ealbut-1
iuchllm A L W r P Oun a I-).
~ni*.r.lt; o f +omto',
~ ~ r c n tE
o. D.~..
douqm
.06. Of ~ i * t l . t hOf
f o r tb. p r n r n t i o n o f u-1
p a t r l d i n i a d u d bmaclmspaa
u l t l - c r o s s - o v e r &slpn.
r o r t y oru u l e , RIV-Infected Indlvlduala, r a n a* 39 (19-SS) wlth
-8
PIB IM r 8 c ~ i t . d . A11 M t i e n t a r m I & 60 ma o f uroml rmL.rldlrW I-)
using r1.on.b p 2 r r h - f o l l a i n g 5 loading - h o e ow-r i2-k
pried;
m u m 1 without p r e - n d l c a t l o n with a a l b u t w l (0) r w 0 a l . d a drop f r m
81n pre-AP t o 61n pat-AP, a u r n rodustion In n V 1 o f 25% (13-44q).
Each p a t i e n t r m i v e d i n ror&r om o f 5 L
c o r c e m p d i n p plat* 1 ) 200 ug
a, 2 ) 2W ug @I 1 w E Z 2 2 d E :
(AICI,3) 400 up no1 a wlth r/C, 4 ) 1.25 s a n a u l i a e d v i a ?I-.
5 ) 2.5
q s n a u l i u d v i a ?ison&.
m 1 w u r a s u r d prior t o 5 , AP was a b i n i e t e m d 15 m10ut.a f o l l a r l
I,
p s t - m 1 was obtailUd 15 minute* a f t e r AP. P a t i e n t s a l s o nco%a.ff.Ct.
u a i m a v l s ~ a l analoe .oale.
Aftor a11 t r e a u n t M
corpleted, th; p a t i e n t s ware a i k d t o Indlcate t h i s o v e r a l l preferau-.
-
lunp. o f Qlanp In m1
NO S
ZOO up no1 s
200 up no1 S A/C
400 up nor s A/C
1.25 q n& 8
u n-b
C m p r e d t o no S p <
-25%
-z\
-2%
-1%
3%
3s
0.0001
9%
a*
6%
'la
5%
7%
for a l l t r e a t u n t e
-13 t o
9 to
9 to
11 t o
14 t o
20 t o
-44%
-21%
-21\
-17%
-7%
-19%
s l g n i f l c a n t prevention o f PI0 was achleved uelnq S, 1.25 q nebuliaed S
aa i q n l f i e a n t addltion.1 Impro-nt
In f l a r a t e s -rod
t o 2W up
rmr s ( p o . o i ] .
Tho o v e r a l l patl-nt preferenc. warn f o r t h 1.25 q nobull@ 8 .
S a&miniet*red by e i t h e r *DI or neb e I p n i f i c a n t l y prevents PIl.
1.25 q s lubu1is.d 15 minute. prior t o AP t h o r a w not only e l I ~ i r u t e aPI0
but hpr0.m. f l a rate. and i s t h e p . t i e n t e ' proferenee duo t o & c d
.I&e f f . c t e C-red
t o 2 . 5 q.
Supported by a grant f r o l CMIAP.
TUESDAY, JUNE15
SERIm P I M U P I R A m r M MTW -IN0
UPINTAMIDIN8
MsIvor RA, r a v e l 1 I,-Pack
L, R a c h l l s A, mcqer P, Chan a (-1.
Toronto M-1
P o n t u l d l n C l l n l c , U n l v a r e l t y of Toronto. Toronto, Canada.
F u n t n l d l n i n d u e d b r o n c h o e p a r (?ID) o c c u r # I n up t o 338 o f I n d l r l d u a l a
r u e l v l n g nmwl p n t n i d l ~(LC) t h o c a w .
I t I # wll known t h a t P I 0 c a n
be r e d u e d l p r m n t o d by p r w d i c 8 t l o n w l t h b r o n c h o d l l a t o r , however th.
e x a c t den Ud r r g L r n v . r l a e froll n n t e r t o c a n t e r . ?or t h o u w i t h -ere
P I 3 o r p r s l s t m n t e y q t m In th. t r u t n n t f a c l l l t y , e x t r a t h . r a p y n y bo
a&lnieterod,
h a m e r arn t h o u p . t l 8 n t 8 l e a v e t h y have n o r e s c u e
rdlcatlon.
I n o r & r t o asseem whmthor PIE r e 8 u l t e i n d e l a y . d l p r m l 8 t 8 n t
a i r f l w o b o t r u c t l o n a f t e r AP, 41 males, r a n ago 39 (19-551 w l t h m I g n l f i c a n t
P I l , r a n r c d u c t l o n i n ?N1
pat-U t b r a p y
24.78 w r e r o c ~ 1 t . d .
Each p a t l e n t w m 1 n s t r u c t . d i n th. u n of a Wrlpht. mini p9.k f l o r r t e r
and a . M
t o r w r d th. b e t of t h m pmak e x p i r a t o r y f l w r a t e (PKCR)
att-8
h o u r l y f o r t h o f l r m t 4 hours a f t e r r m l v l n q AP ( 6 0 q v l a
r1-l.
. 1ndi;ldual p a t l m t s r m i v o d o n of 5 b r o n c h o d l l a t o r r o q l m 8 15 minutea
pre-AP th.rapy i n a r a n d m o r & r a t Conncutlvm C l l n l c v l m l t 8 , e 1 t h . r 1 ) 200
uq s a l b u t u o l ( 6 ) . 2 ) 200 ug'll v i a a e r o c h n b r (AIC), 3 ) 400 uq S v l a AIC,
4 ) 1.25 mg S v i a n e b u l l z o r (nob). Md 51 2.5 q 8 v i a n b u l l a a r .
-
DO.O*S
1.
2.
3.
4.
5.
**-
rum
2wug
2WugA/C
4C4 ug A/C
1.25 q nab
2.5 .q n r b
Poak ErDIratOw l
1 hr
- 2 hrs485
490
488
498
521
517
530
524
516
518
l Rat~
3 hrs
500
50s
530
521
522
I?WRl
. 4 h;e
503
521
521
510
521
Qm&mk@:S i g n i f i c a n t i n c r e a s e I n b r o n c h o d l l a t l o n
a. a s n s s o d by t h e Pin
a t 1-4 hours folla,Lnq AP Im o b t a l t u d f o r a11 t r a a t u n t am..
The mmt
s l q n l f l c a n t e f f u t occurrod w l t h t h e v r l u d o u S, 1.8. 2.5 .p S v i a nab,
-ugpestinq a d o u r e s p o n u curve.
T h . r e e u l t e .ha, t h a t v i t h a m l i t t l e
a 8 200 up S v i a KDI, normal PElR n o r e obtalnod 1 hour post-AP. 1rr.mpctlv.
o t t h e doeage o r mode of a d a l n i e t r e t l o n o f 8, no r o d u c t l o n In p a k f l a , was
0bnrv.d up t o 4 hour8 post-AP. Those f l n d l n g e 8uqqe.t t h a t PI0 1. an a c u t e
I r r l t a n t e f f u t , no d.1ay.d b r o n c h o c o n e t r l R i o n va. found.
aama
..,
.DOT-,
MO.
me
m a ~ r r . , ronn r.,
..llOII ?., C.U a.
Toronto c e n t r e 1 Auowl H a t u i b i a e C l i n i o
.e11.1.1
mapita1 An4 mnnybmok Irdiaal c e n t r e
O l l i v u e i t y Of Toronto, Toronto, Canada
OBJECTIVE: T o d e s i a n a D r o t o c o l t o e n s u r e a s a f e work
e n v i r o n a e n t f o r h e i l t h 'care w o r k e r e ( H a ) a d a i n i s t s r i n g
a e r o s o l i r e d p e n t m i d i n e (AP).
HETHODS: T w e l v e h u n d r e d p a t i e n t s h a v e e n r o l e d i n a
c e n t r a l i z e d AP c l i n i c i n T o r o n t o which h a s a d m i n i s t e r e d
50+ t r e a t a e n t s p e r day over t h e l a s t 3 years.
G e n e r a l u a s u r e s : 1 ) P i s o n e b s y s t e m a d a i n i s t e r i n g 60.9
p e n t a m i d i n s q 2 weeks, 2 ) e e l f - a d m i n i s t r a t i o n i n t r e a t m e n t
rooms, 3 ) n e g a t i v e p r e s s u r e v e n t l l a t i o n i n t r e a t m e n t
r o o u , 4 ) HEPA a i r f i l t r a t i o n u n i t s i n t r e a t a e n t rooms,
a n d 5 ) no s w k i n q p o l i c y .
P a t i e n t u a s u r e s : 1 ) Screening f o r Ilycobacteriua t u b e r c u l o s i s
b y q u e s t i o n n a i r e , 5 u n i t t u b e r c u l i n test w i t h muap8 c o n t r o l ;
i f m g a t i v e , 2 5 0 u n i t t u b e r c u l i n test e v e r y 6 w n t h s , 2 )
8 c r e e n i n g f o r cough a n d b r o n c h o s p a n by m o n i t o r i n g f o r c e d
e x p i r a t o r y v o l u e i n 1 s e c o n d p r e - a n d po8t-AP w i t h
p r o p h y l a c t i c s a l b u t a w l i f a drop o f 1 5 * o c c u r s , a n d 3 )
pulmnary function t e s t i n p regularly.
H e a l t h care w o r k e r s : 1) U n i v e r s a l body p r o d u c t p r e c a u t i o n ,
2) qlovee and a a s k s f o r m n t a t a d i n e reconstitution,
3 ; i e s ~ i r a t o r va u e s t i o n n a i r e . 4 ) W v c o b a c t e r i r u t u b ; r c u l o s i s
& r e e n i n g e v e i y - 6 w n t h s , a14 5i p h m n a r y f u n c t i o n t e s t i n g
a n n u a l l y , 6) w n t h l y e p o t u r i n e a n a l y s i s f o r pentamidine.
CONCLUSION: W i t h w i d e s p r e a d a c c e p t a n c e o f AP p r o p h y l a x i s , we
c o n s i d e r it e s s e n t i a l t o w n i t o r f o r e f f e c t s i n H a .
We
p r e s e n t o u r p r o t o c o l a n d r e s u l t * i n d i c a t i n g minimum t o x i c i t y
even a f t e r 34,000 i n d i v i d u a l t r s a t a e n t s .
W s s u g g e s t this be
a d a p t e d a s a s t a n d a r d f o r a 1 1 AP c l i n i c s .
CARDIAC INVOLVEhENT M HUMAN EMWNODEFlCIENCY
UWEClWN ASSESSED BY ECHOCARDIOGRAPHY
JcrC S. Cardoso, Ant6nio M. Miranda. Nuno P. Oliveirn Maria H. G o m u , Brenda E
Mourn Jorge Puik Antbnio Crur J d o Banolomeu, Luis F. Manins Pedro van Zclkr,
Francisu, R. Gon@ves. Henrque L Menew. MBrio C. Gomcr. Faculdade de Medicina,
P o w Portugal.
M-mode, ZD, p u k d and continuous Doppkr Efkxardiograpiy w s performed in 60
HIV infected patienu (pu) (13 HIV2) and in 40 normal non-H1V infected mntrob (NC).
Twenty six (43%) pts hsd AIDS. 16 (27%) AlDS related mmpkx (ARC) and 18 (30%)
were arymptomalic s e r o p o s i k individuak (AS). Cardiac ~ p t o were
m &served in 4
(46%)pu, manifested as c o n g w t k hean failure. G m p r i n g NC with HIV p u as a
whok the last showed increases in kft ventrmlar systdic dimension (LVSD) (p<0,001),
interventricular septum thickness ( I T (p<O,O5), kfl vcnuicular mass i n d a (LVMI)
(p<0,0005) and isovolumic relaxation time (IRT) (p<0,001). Fractional shortening (FS)
was denrased in HIV population (pcO,001). In 9 (15%) p u there was dilatation of the
right venuick (RV), in 23 (383%) p u AV valve insufkiency and in 33 (55%) pericardial
effusion (PE). Forty wven (78%) p u presented at least one abnormality on M-mode and
2 0 echocardiographic examination. Except for PE (p<O.OS) and abnormal WA ratio
(pcO,OS), which were more frcqucntly obxwed in AlDS pts, there was no statistically
significant difference in echocardiqraphic parameters in ARC as o p p d to AlDS pu.
On the contrary, AS p u had smaller LVSD (p<0.05), LVMl (pcO.05) and PEPLVET
ratio (p<O.OS) and bigger FS (p<0,001) and ejection fraction (pcO,OO5). Right ventricular
dilatation (pc0,OOOI) and abnormal U A ratio (p<0,001) were l a frequent in AS pa. In
HlVl infected p u we found b i u e r LVSD(pc0,Ol) and LVMI (pcO.05) than in HlVZ p u
and PE was more often &served (pcO.05). We d u d e that although only a small
proponion of HIV infected p u has cardiac symptoms, subclinical involvement detected by
echocardiography is frequent, manifested by LV systolic and diastolic disfunction,
inneased LVMI. RV dilatation. AV valw insuff~iencyand PE. Cardiac ~nvolvement h
leu evident in earlier stages of HIV infection (AS) and does not seem dependent on
opportunistic infections and neoplauns. the distimtive feature of AIDS. Cordiac
involvement wenu more pronounced in HlVl as o p p d to HlV2 ~nfection.
TUESDAY, JUNE 15
FOLLOW-UP OF PATIENTS WITH HIV-ASSOCIATED
PRIMARY PULMONARY HYPERTENSION (PPH)
E H O C A R D T O G R A P H I C F I N D I N G S IN HIV P O S I T I V E PRB-AIDS PATIENTS.
P i e r 0 Bertoncelli. Maria G r a r i a Modena, G l o r g i o I a t t i o l i
E.W. R t d . FCCP
~.pectmmt~l--nmjInrtlM.W~,U-dm.-
R. Spekh,R. Jenni, M. Opravil, P. Vogt, R.
Dpt o f Cardiology. l o d e n s U n i v e r s i t y , Italy.
T o a s s e s s t h e incidence o f c a r d i a c m a n i f e s t a t i o n s o f AIDS, we
PPH seems be to associated with HIV infection. In a prospective
study, we have demonstratedan incidence ol PPH of 0.5% in our
HIV+ patient grou (Chest 100:1268,1991 Between 1190.4/92
PPHwesdetect~n12HIV+pat&nt~.Ano~rcasehasbeendagnoaed In 1988.7 pts were f e w and 6 male, the mean age
was(24-52) years. Ten were I V d qusers and 3 male homosexuals. Dyspneaonexeltionwaspresent in 10, pedaledemain5,
pulmonary artely enlargement on chest X-ra in 11 and ECG
& a n y of dght ventricular h pertrophy in 7. {he median CD4coun (1pJ)wasl ~ . ~ ~ ~ c w n & w m f e > 2 0 0 .and
i n b >500in3.
0.Md htventriculars llc -re(RV$over
htatnal
pressure Wl 1 38-76cmqwes doaimented by%oppler
" V r a p h y . h w e m m
of anorectic agents use
a n d n o d nceofotmuaiworin?%i al lung disease, thromboembolism, congenital or valvular heart disease, cardiomyopaenskn or collagen vascular disease. The pts.
e l 4 (2-52) months.
consisted in antiulabion(2), diuretics (4), digitalis (2) and antiretrwid
within 2-9 months (mediansurvival 3m).;%1
pts,
an autopsy was done and it revealedtypical plexogenic ch
There was no evidenceof significant foreign body emboli.
u echocardiographywes available in 6 pts. It showed regressior.
in 2gs after 6m (49 -> 36mmHg) and 14m (46 ->
1BmrnHg). RV Premainedunchangedin1andima.sedin3pts.
b 5,B and 11mmH reqechly).
b8H is frequent In
pts. and occurs in advanced as well as in
early stagesof HIV infection. Prognosisof PPH in HIV+pts. and of
idiopathic PPH seems to be comparable. Spontaneous regression of RVSP may occur.
e v a l u a t e d 2 8 8 c o n s e c u t i v e p a t i e n t s ( p t a ) H i v positive. r e f e r r a d
a t o u r e c g o c a r d i o g r a p h i c laboratory f o r heart e v a l u a t i o n in t h e
l a a t o 5 yoeare. P t s p o p u l a t i o n c o n s i s t e d o f 1 9 8 m a l e s a n d 7 0
f e m a l e s , mean a g e 2 7 2 1 0 , el1 d r u g addicts. H e a r t i n v o l v e m e n t
a t the Echo-Doppler e x a m i n a t i o n w a s found in 8 2 pta. all H i v
pro-AIDS,
2
%?%?&I
&
3 2 presented s i g n s o f m y o c a r d i t l a (end-diastolic d i a m e t e r dtl.1
end-ayatolic diameter 521.2 cm..
-ecrom:
r-HrrD.TYIC,*L..rr,?-,
~
e j e c t i o n f r a c t i o n 3526%). 24
only a i g n a o f u p p e r limit d i a m e t e r s a n d mildly r m d u e e d performance. 1 0 normal d l m e n a i o n s and function, but p a r t c a r d i a l eff u s i o n o f d i f f e r e n t degree. 1 6 pta e n d o c a r d i t i s only.
%&
m D l c n n V M W
~ l S W ~ W I M V
D I~N C
~
G ~
WA PN ID T
~ A
W Y l KS\L~NDINIX
l L W P I W I L N t C C ~ l C L U X ) . .
d u e t o P n e u m c y a t i a Carinii.
Cytomegalovirus. S t a p h i l o c o c c u a Aureua etc. A m o n g t h e 8 2 pta.
my
JRVSP
.
HI^+
w h o a l s o ahowed infectious m a n i f e s t a t i o n s o f o t h e r
o r g a n s ( b r a i n , lung, l i v a r etc.).
E n d o c a r d i t l a n e v e r t h a l e a a w a s present In 47 pta.
W i t h v i s i b l e vegetations of t h e tricuapid v a l v e in 3 2 cases.
o f pulmonary v a l v e in 5. of mitre1 v a l v e in 8 , o f a o r t i c v a l v e
in 7. P o a i t i v e blood c u l t u r e s were o b t a i n e d in 2 5 pts.
In c o n c l u s i o n heart i n v o l v e m e n t in f r e q u e n t s l y found in H I v
p o s i t i v e pro-AIDS pts..
l
S
D
with a large s p e c t r u m o f presentation.
VALUE OF N U W MEMCiNE,PRFOR DIAGNOSIS AND
FOLLOW-UPOF HIV-REIA?ED OPPOR'IUNISIIC PULMONARY
IMECnoNSOR UAUGNANCIES
ID.h
Dcpt. of NudcP McdidDs WiUwlmbmpbI,U. Dqd. of Medicine'. Pulrndogkbta
Zclmum,ViAunrL
~ o d d ~ D o r b u l i ~ m ~ 6 7 h r c r m o n t h c a v ~ ld
f t MPAW
tr8
demanadta10-12'*ceh,whik~~hnqondbuc~pthdoP
alfamaethn3maDtb67hrpoIpcrialol#G~mthcfba~dtbe
hi@cad*cbloodpodofthclana.WhilclaradPBwac~witb6704oaly
UwaedaSlcdby99mTc-IgG g G U ~ ~ o f 6 7 rrnc8G a
~&ff&bomogoaurrrpelcrp&oauain~wichCMV~uUP,
whik PCP afta prophylaxuwith v m d h c d patmDidioc lbopredIodized (uppa loba)
u p r l c e . A ~ c ~ c 6 7 G a a ~ n ~ w i 99mTc-mPAdeamantcrdr
t b r n ~
p a i t i v c M l T I i ~ - m b c ~ f a ~ s ~ : t h i O ~ ~ E Q l o d i .
.USpsliedsritb~k-dchrIq~y,adi@yM~a
M67l3~(1.36+-0.19)a~DTPAde~mpentcsbctoukgmobmr,
~nfirmmrimudrugrert~wacfouadmivdrug~&~
d lung p&ogas. lmreng with anti-granulocyte .abbodig or IgG was wcful to dakl foal
brtcrLl infsQioa in p l i a l l s pnscating with p*
of uaddcrmiDsd ai*.
N&inudurm~djejllCpOCcdurroarcurdultoaramlkthcd*goaicpmpr*m
fdlorw-uppaiaQdm~lbaqydFao.
TUESDAY, JUNE15
ANALYSIS OF BRONCHOALVEOLAR LAVAGE FOR THE
DIAGNOSIS OF MYCOBACTERIAL DISEASE IN AIDS
PATIEMS. Ro#rio Xavkr MD. FCCP, Ann C Coromori, OcPvio
PHclhar, Cub jKkrrdmkl MD and Oaudlo Crupo MD. Sanlco
de Pnaumdogh. Horpitrl da Clinlcas da Porto Abgra BRAZR,
Tubemlosk and othar mlrobacfctial dulst (MD)
the mmt common infeujam in AIDS p o w . Brwhoelvddv
lavage ( E N ) Is tha mathod d M
c
e to dhgnow tuberculosb
when sputum k unhrlptul. We have wdkd 135 IndhddW
submi& to flbaropdc bmdmwpy with BAL i m d ) d p t h
pulmonary condldonr bewem Jmuar). 1989 md July 1991. Thc
prssu#lrrkcbcunpadby32~dMDldsndaadinBAL
by acid fut W
W
I (AFB) or cukure. Clinld findmeal&
90.9% wlth #nstftutlorPI symptom and 81.8% wlth rsrplntoy
rymptcm. Gmed hadth rerrrrc was modemdy or sew*
amprunbad In 59.3% m p l r a t q sounds lbnonml In 68% and
r o m p w p m In 929%. Endorcopk bndlnp wen prosam in
36.TXThe~nricMyd BALws,57.IXforAFBand933Xfor
culturn. Mommm&dm and Mlhkurn graved In 2
tPmQkl. hwmmduonronr d # u m l 4 a s e s d
-nd
shwmadlmdmtPined2crcecd
PxorkS Fdkw-up data shmed 10 d d l s betwean 1-12 week
dl but 2 wem nhad eo MD; ahor 10 cbrrhr bowem 1453
WhdO:Ql(rorte~toMD;4lndMdurharedlnaker 105
~.Wehrvrconduddthlt~durtoMDInAHXk
nhnpomnc#rbJmtobe~~BALrhdptultodto
MAXIMAL INSPIRATORY (MIP) AND EXPIRATORY PRESSURES
(MEP) IN HIV PATIENTS
CHINER E, CALPE JL, LARRAMENDI CH, PUIGCERVER T,
CHILLARON P. GONZALEZ M. VILAR A.
HOSPITAL DE LA VILA JOIOSA. ALICANTE. SPAIN
.
OBJECTIVE: Malnutrition. weakness and wasting. are common
patients. Indlrect infornation about nuritional
In HIV
status could be obtained with NIP and PlEP measurements
as direct tests of respiratory muscles strength.
PATINTS AND METHODS: Measurement of MIP and PlEP was carried
consecutlve out-patients. 16 male and 11
out in 27 HIV
female. with a mean age of 3 3 ~ 7years (ranqe:22-53).
Patients were distributed in three orouDs: A) 13 with
nonactlve respiratory opportunistlc~~nf&tlon. B) 1 1
asslmptomatlc carriers. C ) 3 patlents k ~ t hextrapulmonary
opportunlstlc ~nfectlons MIP was measured from RV and MEP
from TLC in cm HZ0 with a portable electrocnanometer. and
expressed in b of teorical values. Non-pareated Student-?
was apllcated to statistical cmparations.
RESULTS: Mean MEPt was 69218 and mean MIPt 80.25 for all
for
patients. For sex M E B was 78+15 for males and 56:14
females (p-0.0009). and MIPt was 73.19 for males and 91.29
for females (p-0.06). No difference; were observed in M 1 k
or MEPt comparing group A with B. nelther with BtC. MEPt
was significantly lower in C (59:l) than In A ( 7 9 ~ 1 9 )
(P.0.02).
CONCLUSIONS: Abnormalities of MIPt and M E n were observed in
all groups regardless of respiratory Involvement. Abnormallties in nutritional and wtabollc status of HIV. patients or
subclinical neuromuscular disease could explain these
findings.
+
rmdythhccmwoa
Coresti V. PCCP. Villa A. De Pilippi G . Numaroso R *.
I11
Uedical Department and
Respiratory
Physiopathology
Service. Fetebenefratelli Hospital, Ililan. Italy.
A reduction in the Dco has been frequently found in intravenous drug addicts IIVDAs) and in subjects with HIV infection
or
a
who
showed an HIV-related lymphocytic alveolitis
superimposed disease, most likely an opportunistic infection.
Since also cigarette smoking decreases Dco. we studied a group
of street IVDAs hospitalized for a disaddiction propram, who did
not show respiratory symptoms and/or infiltrates on chest x-ray
film, with clinical examination, blood tests, chest x-rays.
pulmonary
function tests and blood gas analyses. sixty-two
patients were presently smoking. 7 had never smoked. h e n t y seven were HIV-negative and 37 HIV-2ositive. The 2 groups did
not show statistically significant differences for age. lenght
of intravenous drug use, number of cigarettes smoked, hemoglobin
concentrations and CD8 lymphocyte counts, but HIV-positives had
lower CD4 lymphocyte counts compared to HIV-negatives. Uean
values for TLC. PEV, , W C , PEV, l W C (percent of predicted
values).using both predictive equations derived from normal nonsmokers and Miller's smoking specific regression equations for
currant smokers and gas-analytical date, were not significantly
different in HIV-positive IVDAs compared to HIV-negatives. Mean
values for Dco (percent of predicted values) were 78r16.4 in
BIV-positives compared to 97.9r17.6 in HIV-negatives (p<0.0001)
ueing smoking specific equations and 71.8+15.4 in HIV-positives
compared to 80.7213.4 (p<0.00011 using non-smokers equations.
Dco was t80 percent in 19 of 35 (54.38) HIV-positive subjects
end in 4 of 76 (15.48) HIV-negative subjects (p<0.0091 using
predicted values for smokers, and in 18 of 35 (805) HIV-positive
subjects and in 6 of 76 (73.15) EIV-negative subjects (p<O.O001)
using predicted values tor non-smokers. Thase data suggest that
Dco alterations observed in HIV-positive subjects ere due, in
absence
of
respiratory
symptoms
andlor
chest
x-ray
abnormalities. to an interstitial pneumopathy due to HIV or to a
subclinical pulmonary disease. We conclude that the knowing of
smoking in I M A s is useful. and that it could be included in the
analysis of their pulmonary function, but the knowing of
seropositivity is much more important. since a marked reduction
of Dco in these subjects suggests an HIV-related lymphocytic
alveolitis. an opportunistic infection or a malignancy.
T H E SPECTRUM OF H U M A N IMMUNODEFICIENCY VIRUS
PRESENTATION IN A HETEROQENOUS HOSPITAL P O W L A T I O N
JJ Jansen, JR Joubert
University of Stelbnbomh and Tygerberg Hospital,
Cape T o w n ,South Africa.
A retrospective study of 148 Human Immunodeficiency Virus (HIV)
aeropositiie patients dlagnoaed between 1985 to August 1991 was
done in a tertiary W m i c hospital, South Africa. Demgraphic data
shoved an exponential rise in HIV seroprevalence, mostly in negroid
and mixed race groups. A change from a homosexual to a heterosexual
IAfriican)spread was documented. Respiratory symptoma and signs
were the most c o m m o n prosantation. Forty nine episodes of lung
infection were recorded in 44 Datients of which 59% were o u l m o n a ~
tuberculos~s(TBI. 20% were b6cterlal. 12% were unknown organlsmi
and 8% were P n e u m y s t ~ rcarlnll p n e u m o n ~(PCP) Tho rad~olopkal
picture of puimomry TB coum be devided into a group kith
lymphadenopathy, pleural effusionsor a miliry pattern (primary type
TB) (38%); opacifiitionwith cavition (secondary type TB) 138%) and
a diffusegroup more Suggestive of PCP and fungal infections (21%).
Lymphocyte counts of patients with prlmary type TB were significantly
lower in Comparison to those with the secondary type T B Ip<0.05) end
also when compared to HlV seroposifives with no lung infection
(p<0,0011. This suggests that the degree of immunosupprbssion in
HIV seropositive patients determines the clinical and radiological
presentation of pulmonary TB. Patients with lung infections and
lvmphopenia as well as pulmonary TB patients in areas with high HlV
seroprevalence, should thus be testad for HlV.
CHEST 1
1 W 131
MARCH. 1993 1 Supplement
2255
TUESDAY, TUNE 15
TUBERCULOSIS ASSOCIATED WITH AIDS I N R I O CRANDB, SOUTHERN
BRAZIL.
J . U . S i l v e i r a M.C.B.
N v a r i s a , C. S. Moss, Y.M.S. Boffo,
E.P. Yoraes ~ . N . o . Coch P.A.P. O l i v e i r a , T.M.Y. T e i x e i r a
and L.P. ~ i ; l o , ~ u n d a p i o ' ~ n i v e r s i d a d ado Rio Crande. RS.
Brazil.
Tuberculosis oontinues t o be a major problem i n develOping c o u n t r i e s and t h e r e l a evidence t h a t t h e r i s k of tuberc u l o s i s is si&aifioantly increased in persons with H I V infection.
This study wan designed t o i n v e s t i g a t e t h e praralenoe
of mycobaoterial dieeaeee i n p a t i s a t e with AIDS, o l a s s i f i e d
acoording CDC M belongi- t o group IV-C.
Prom Auguet 1991
t o A w s t 1992, 24 n a c m e s of AIDS were diagnosed a t PURG
University Hospital i n Frlo Crande. a 170,000-people c i t y i n
Pulmonay and e x t r a p u l m n a r y e p e c i m n s
Southern B n s i l .
were obtained from 1 2 p a t i e n t s ! we obtained only extrapulepeoimne from 7 p a t i e n t a and only pulmonary s p e o i m n a
p a t i e n t s . Culture was performed in bewenstein-Jensen
and Stonebrink media according a t a n d u d rocedum.
Standard
biochemical t e s t s were performed t o oonffrm t h e i s o l a t i o n of
oobacterium t u b e m u l o e i s .
Hyoobacteria were i s o l a t e d from
P monary speolmene of Ir(5OI) p a t i e n t s , of whom 9 (37.5%)
had a l s o i s o l a t e s from extrapulmonary s i t e s .
Two p a t i e n t s
(8.33%) had i s o l a t e s only from extrapulmonary specimens.
A
t o t a l of 24 specimens from 14 p a t i e n t s y i e l d a d w c o b a c t e r i a .
Fourteen (58.33%) s t r a i n s were i d e n t i f i e d a s g. t u b e r c u l o s i s ;
one (4.17%) wae i d e n t i f i e d by I n e t i t u t o Adolfo Lute. Sa0
Paulo B r a z i l , a s Y. ordonae and t h e i d e n t i f i c a t i o n of t h e
Y. tuberculosis was
remoiAing s t r a i n s Ts k e g s .
i s o l a t e d from pulmonary specimens ev?n rrom patient's with
normal cheat roentgenogram.
YG3
UnbBrpui, I.D., hmrIruitt,I.D., *c.WI.
Sdixabk, I.D., Slilt Udnl's Wal w M,
m
~ a v rmu zoi
*
dido& femum. AIR 1984: 143: 115-22.
2) Mumy IF. Felw 8. Gamy SM. a .I.Putpoury eocsplicviom of tLe vprirtd
immunedefuiency ayndmmc. N U M 1984; 310: 1682-88.
3) Stavcr DE. Whiw DA. R o m m PA. Odlenc RA. Robtsca WA. Speanm of p a l m
discucr uaociaed with the acquired immncdcficieocy apdmsc. AIM 1985; 78:
-
429-37.
4) MeClellan MD. Miller SB. Parsans PE, Cohn DL. Pacumotborrx with Rnumosynir
carinii Pneumonia in AIDS: Incidence and Clinical Chmctcrinics. Chest 1991; 1ilCI:
1224-28.
5) Johnam RE. G m n RA. F'neumahoru. In: B.um GL. Wotillsty E. eda. Tellbod of
pulmonary diacwr. 3rd cd. Boaoo: Liuk. Bmwn. 1983: 1327-41.
6) Light RW. Pncumolbonr. In Light RW, cd. Pleunl diacuu. Phildelpbir: h a d
Febipr. 1983; 187.204.
radahdtat*06/.
mgLIc*rtbttharrm~Mirnrch
m~rmmp~~hptimtsawumlized
M b i w . It L rlrs or d m i a tbt ptiY
~
~
~
~
t
a
~
s
P
~
d
t
~ b ~ d t b C m t i d ~ ~ t d r
mmc&qltllol)m~molt*brtmap.
lborr pltiatr uitb b1Wd SP hutd with 1bm
~ ~ ~ M I b i g ~ i t y I l t ( , t W m
1 mrqial k m w i m IlDCld b d&d
Ldicll
.
mantiardprllMiratim~idaprbUlpa
mxblditl ad DNIity. It 11 m twllq t
M
wu
rrpltr tm a m lal~u*
crg~iusc
br to ~ U t i I plpvzl
I
flltalr mltl*(Im
rqwt.d 1-c
Ilfutlor rim m.
carinii
pneumonia (PCP) is the most common
opponunistic infection in AIDS. occurring in 50 to 85 percent of p8khta
(1-3) and the incidence of pncumothonx in AlDS patients with PCP is
evaluated round 9.0 percent. compared with 0 percent in AIDS patients
without PCP. Thus, AlDS without PCP is not m rppucnt risk for the dcvelopment of pneumothorax. Moreover, patients with AlDS lad PCP
don't seem to have preexisting conditions known to be associated with
the developmant of secondary pneumothoru (4-6).
The case of a rccumnt bilateral pneumothonx in a patient with AlDS
and PCP, treated with aspirative thoracic tube and rifarnycine, is
described.
C. 0.. male. 34, haoine-dependent. HIV+ doe 1986. diagwlsd 8s PCP
in AlDS in 1991, presented for the third time to the Infectious
Department of the Irccs-Policlinico S. Matteo. Pavia (Italy). with
hyperthermia. A .chest x-ray revealed multiple shadows on both RUL
and RLL; m d marked interstitial involvement referred u recurrent PCP.
The patient was given Ticucilline + Clavullaic acid and Co*imouzol.
Lab findings were altered as usual in these cases. Search for CMV w u
negative and ecg was normal. Eight days later a sudden. dysplea with
intense cyanosis occumd. PO2 and S a m deerused to 33 and 13,
respectively. 14 Llmin 0 2 was administered by a nasal mask. A
massive. 75 percent. left pneumothorax was showed to the chest x-ray
and efficacily drained by aspirative lhorrcic tube. PO2 and Sat02 r i d
to 77 and 75. respectively: the dyspnea ceased. 4 days later. the lung
was still adherent to the wall and the drain was removed, but J relapse
occurred after 7 days and drained again. In the meantime r
pneumothorax. that was drained, occumd at the right side, aggravated
by the complele collapse at the left side. A second dnin was. then, put.
Because of sudden. severe dyspnea and subcuuneous emphysema.
both drain were changed and I g diluted Rifamycine introduced into
both pleurae. nK partial pneumothoru was still present at the left slde
after the patient had accidentally removed the drain, that was chmged.
The treatment with Rifamycine was, then, reputed. The bilateral
pneumothorax completely recovered after 26 days: and the drain:
removed. After a 3 months, no signs of pneumothonx f w d to the chest
x-ray control. From this experience we conclude: 1) Pneumothoru in
AlDS with PCP patients may not be casual; 2) in this patients, the
respiratory distress syndrome is severe and must be immediuely
treated by aspirative drain: 3) introducing Rifamycine in pleura is a
good chance to recover the pneumothonx. w in this case. and should be
performed soon, more times in Ihe first week.
Pncumocystis
References
I ) Cokn BA. Pomem S. Rlbimwiu JG, a d. Pulmmuy complicuimr of AIDS:
tn-n,)
I l ~ ~ C l l i r i i . I r i . ( Ik tQ
*l
u t ~ ~ l ~ ~ M u U a h p t i e s d t b ~
-1ciw
l U l , rpatrrq plrpQar
(sPl naadwy to this m
i c
br bra
w t o b ~ r m o c a r r r .rmindhlmhhd
)rCirbkmmtobIhb*.itbmmrirrltaht
u ~ l a W c l l O r ( r M r r J a N q l .I # & I, 1w1. ?him pRl* c2.m M
Ihi,kUOthmcorplt*lm
& i d r a o ( S ? k t h @ ~ . 1Wbmpnim
cglrodrof-pWatllrticLduUo.lritb
hP. 7 H o l t M a a ~ h p t i r a r b p r a l o t m
popbVWc RtPidlv Ww. IIn Watr m hutd
rid obunltla rlor, urr dtb I d
l )a bYid trbr
rd~wPtadrnInFbontrbr-.
rim d m ar(rd rib bllrblnl mmam & or
-.
B M ' E R A L RELAPSMG PNWMOTHORAX WlTM PNEUMOCYSnS CARINU
PNEUMONIA IN AIDS. A CASE REPORT.
S. R i w MD.FCCP. A. Dei Gas MD*,G.fk& MD*.
Dept. of PMurnology, IRCCS-Policlinico S. k(rttco, 1-27100 Pavia. Iuly.
Institute of Infectious Diseases. University of Rvia. 1-27100. Italy.
b
U
,
TUESDAY, JUNE 15
AIDS-ASSOCIATED CYTOMEGALOVIRUS PNEUMONIA:
SIGNIFICANCE Of CMOPATHOGENICVIRAL EFFECTS
IN BRONCHOALVEOLAR LAVAGE BAL CELLS
, M. OpraviI. u. -&.
P.
+.Hes.
E. a e w i . R. Luemv. E.w ussi. FccP
~epartr?& of ~ n t e Medidni.and
d
Institute of Pathdogy,
Unwersty Hospital of Zurich, Switzerland
Ja.
:; E.
tients, and tt idicahs an advanced immuhbsii. ssive state. t h e
detectiono f CPE+ BALcells in a HIV+ Datient s o t h e w i s e unexdained wlmonarv infiltratesmakesfudher invasive m d u r e s fie.
hen*ol an antiviralUierapy o f A * ~ S
lung b b g ) n&.
assodat CMV pneumonia rernans to be demonstrated.
Physiology and COPD
Afternoon
RESPONSE TO IHHALED BOP I 8 DlFFLRBWT BBTWBEN COPD PATIENTS
WHO DO AND WHO DO NOT RESPOND TO AN ORAL METHYL PREDNISOLONB
TRIAL
O.Oilflu, A.8aylner
mt of Chwt D i s a m , S g e University. Faculty of Medic~ne.Barnova.
ismir, TURKEY
I t i s known that up to US of COPD patlents on a stable cllnical
m r w #iY. a pamitiw m p o n u to syenmlc cortlcaterolds. I t IS not
w l l l benefit from
yet w r y clear thoush which COPD patient.
Ion#-term treatment w i t h inhaled cortimteroids.
We poatu1at.d
that individual reaponto an oral methyl
pndnimlone (UP) t r i a l tl(ka#lday for two m k s ) asswwd by
pulmonary function t w n (FBVI. FVC. FEF25-75.VmaxY).~Raw) could
prrdict patients' subsrquent rnponse t o Inhaled steroids. We
performed the oral MP t r i a l to 15 consrcutlve COPD patl+nts Grven
of t h r n patien(Group
1)
showtd sl#nrficant
(p<O.Oa)S)
improvcmnt dcfinrd as increasu In FBVl of XI5 or 200 ml, whHeas
no ei.nificant c h a n p was obwrvrd I n the pulmonary functlon tests
of r m a i n i n g 8 patienn (Group 2 ) . Follow~ng thrs t r l a l we
administer.d beclamthamne dipropionate (BDP 500 u# brd) to a l l
at the end of whrch, we
patients for a period of 6 month.,
canpared p u l m a r y fuction tmt results of the two group..
We
ob.rrvcd that the .ff.cte of BDP m e siunlflcantly different far a l l
parametus b c t m n oral UP-rwponders and non-rwponders as shown
b l o w . We also obmerved that thwe patrents whae l n r t l a l
n v e n r b i l i t y was over XI5 ~ m r dto have a hlgher chance of
m i m n d i n s to corticasterolds.
Wo conclude that not a l l COPD patlents s h w o b j r c t ~ v e mprovement
with inhaled BDP therapy and an initla1 trial of oral MP can be
u s 4 to pre-determine the sub#roup
who w l l l brneflt from BDP
therapy
d, FNl(e1)
A M(m1)
AU.axY)(al) A nFKn(.I) A s
R
a
SrarPI
3 4 7 t ~
0e1tm 2 4 , y n
12~13.7
23,9519
(&.pond.rs)
6ro42
(Mnn-raWers)
P<
-Ytl27
0.m
St246
0.05
-10,JtlB
-5.6216
0.05
0.05
b.St5.3
T R l l l l t l l Q L a t UUSES RAT 01AlROPtfV. YLliW P(ttD((1YICat K C S IlOT.
PW;( Oekhuijzen. 6 Gryan-Ramimz, R Dm, A Bisschop, N Buts, V & b c k , 4
I
k r u c r . Respiratory lluscle RISH~C~
Unit, Laboratory for Pnemology, and
Dept. of buropltholow. Katholieke Universiteit, Lwven. Belgium.
Corticosteroid-Induced atrophy and -thy
am knobm to occur In skeletal
uscles, especially when fluorinated steroids are used. Recent a n i u l
studies have sham that the diaphrag. u y be affected i n a similar way. I n
these studles, h a v e r , u s s i v e doses r r e a ~ i n i s t e dduring short
porlods. The alm of the present study was to investiwte the effects of
prolonged t r e a t r n t 111th mderately high f l u o r l ~ t e dand non-fluorinated
sterolds on contractile proporties and histopathology of r a t diaphrag..
Sixty u l e adult rats were randaly assigned to receive saline (5). trimcinolone 1.0 @g (TR), prednisolone i n la (1.25 ng/kg. LP) or hlgh dose
(5 @g.
W) I... daily during 4 m t s . BodJ r i g h t incmased similarly I n
the 5. LP and W groups. I n the TR proup body r i g h t d.cmased by 38%
(Pa.WI), and 7 a n i u l s died. k s n s of the diaphrag.. parasterruls, scaI m s . and gastrocnemius u s c l e s docmasod i n proportion to body r i g h t .
Twltch (P) and u x i u l tetanlc tensions (P.) of the dlaphrapatic bundles
wen slmi\ar i n a l l proups, although them were .ore bundles with P values
less than 2.0 kg/cm i n the HP group (PtO.05). The force-frequerky (FF)
curve of the TR qrwp was shifted to the l e f t at 25 Hz c m r e d to the
other groups (Pa.05). I n contrast. f a t i g l b i l i t y during the FF-protocol was
highest I n the W group (P<0.05 c m m d to 5 and TR qrwps). Histological
examination showed a n o w 1 u s c u l r r pattern i n S and LP diaphrag.s. I n
contrast, severe nyoprthlc charges (0.9. increase i n connective tissue.
scattered necrotic fibers and incmsed m r of nuclei) wen found i n the
TR group. Mrogcnlc alterations (variations I n fiber sizes of a11 types)
were noticed i n tho W groups. Sections wen also stained for myosin ATPare after preincubation at pH 4.5 and 9.3. F i k r s were classif led as type I
(SO), I l a (F06) or I l b (F6). and the d i u t e r and cross-sectional ama
(CU) *ere &terninad using c a q u t e r i z d i u g o analysis. Distribution of
fiber t m s , tm I and I I a flber diameters and CSA wen the same i n a l l
groups. I n S. LP and HP groups trpe I l b f i k r d i m t o r and C U were similar, but i n TR group I l b fiber d i u t e r u s reduced to 22.8 (SD 4.1) p
( c m r e d to S: 37.5 (6.0) m, Pt0.001). Reduction of I l b fiber C U was
evrn .ore pronounced. k i n g 1025 (278) CI' (vs. 5: 2604 (873) p'. PtO.OO1).
Ue conclude that: I ) prolonged t n a t n n t with a fluorinated steroid (TR)
induced severe wasting of the respiratory and peripheral skeletal uscles;
.onover i t Increasrd force-gomration at lo* fmquencies, c m t i b l e with
the histochemically daonstrated tm I l b f l k r atmphy i n the dlaphrag.;
2) a m-fluorinated steroid (prrdnisolon 5 @g)
caused yoprnic changes
i n the diaphrag. without fiber atrophy, decmased P values and increased
fatigue during the FF-protocol. ruggosting intrinsic alterations i n
dlaphragptic contractile proportier. (Supported by the 'Dutch Asthma
Foundation' and 'Fonds voor b m s k u n d i g Uetensctuppelijk Ondcrzoek').
DOUBLE BUND. CROSS-OVER STUDY OF THE ENDOCRINE-METABOLIC.
RESPIRATORY AND CARDIOVASCULAR EFFECTS OF BAOXATEROL VS
SALBUTAMOL WRING CARDIOPULMONARY EXERCISE TEST IN ~ v m a E
CHRONIC OBSTRUCTIVE LUNQ DISEASE PATIENTS.
Malerba Mario. Boni Enrico. Filiooi b u m . Tentwxl Claudio. Borre Emanwle.
Politi Antonio.
- - . Grassi
- -. Vinorio
~ e p a r t m n of
t Internal ~ e 6 s l n eI, Unlverslty of Brescu, Italy
BACKGROUND - Beta-2-sympsthet~commticagents may affect endocrine
system end lntermdlery mtabollsm whnh are sl~ghtly s t u d M so tar In
chronlc obstructive pulmonary disease ICOPDl patlents A m of this study was
to evaluate the endocrine, mtabolm, respratow end cardmvasculer etfects of
two beta-2-sympathaticomimtic selective egints, such as broxaterol and
salbutamol, before and after cardiopulmonary exercise test ICPXI.
METHODS Twelve inpatients I 9 males and 3 females, average age: 55 yrs) of
whom 9 COPD reversible end 3 asthmatic patients were included. Bfoxeterol
10.4 rngl end salbutarnol 10.4 rngl were administered in rapid lfwe minutes) i.v.
according to double blind, crossover study. Before and sixty minutes after the
administration of each agent, incremental CPX by bycicle ergomter to the
maximum tolerable threshold followed. In bas81 conditions, a n w o b i c threshold
and maximum exercise ware assessed: wntilation IVE), 0 consum~tion
IVO I co production IVCO~I, vwo ratio end o2,pulse. &ore and sixty
mnit?&
eder each CPX were a h es$essed glycemle. ~nsulinemia, p(.sma
norepinephrine INE) and epinephrine (€1 Pa0 PaCO plasma lactates end
spirometric tests IFVC. FEVI. FEF max.'FEF 95%. F& 50%. FEF 25.75%).
heart rate IHRI. systolic ISBP) and diastolic IDBPI blood pressure.
RESULTS CPX brought about a significant increment of WE, VO , O2 pulse
(p<0.011, of Pa0 Ip<0.051, of NE end plasma lactates lp<0.01? Broxaterol
or salbutamol azministration did not significantly modify the increments
caused bv CPX concernina these oarameters.
S~xtym~nbtesafter CPX b i t h bronchod~latorscaused a slgn~flcantIncrement to
glvcemla l p < 0 05). A slgn~fnent reducllon of Pa0 l p < 0 021 and POCO
Ip<O 051 was observed respectlvelv after broxatero? and salbutamol
CPX ended the broxaterol significantly reduced the insulin levels lp<0.01) and
salbutamol caused a significant rise lp<0.01) of E levels. On the contrary both
agents caused no modifcation to kelemia.
Broxaterol and salbutamol caused a significant improvement Ip<0.05) of
FEVI, FEF max and FEF 25.75%. No s i g n i f i n t difference was observed as to
the rise of HR for both agents; yet broxeterol brought about a s i g n i f i n t
reduction to OBP Ip<0.05). Broxaterol and salbutamol caused a significent
reduction tp<0.051 to SBP to the acme of CPX.
We observed no negative effects after broxaterol administratton, while a
syncopa rn reported after salbutamol.
CONCLUSONS
Thls study shows that broxaterol, in comparison to
salbutamol, is an effective end safe bronchodiletor since it causes no rhythm
cardiac and endocrinemetabolic alterations in reversible COPD patients during
CPX.
-
-
-
0.05
CHEST I 103 1 3 I MARCH, 1993 1 Supplemen(
2275
TUESDAY, JUNE 15
(Physiology and COPPcontinued)
AUTONOMIC NERVOUS SYSTEM IN PATIENTS WITH CHRONIC OBSTRUCTIVE
LUNG DISEASE (COLD)
Pondazione Clinica Del Lavoro.Dvt.of Medical Rehabilitation.
Cardiopulmonary Division, ~ u s s a i o ( 0 ~;)
+Dpt o f Bioenginering, +*Cardiac Rehabilitation Division,
Veruno (NO), Italy.
The study of heart rate variability either spontaneous or
induced by deep breathing and postural changes is considered
one of t h e best tool t o evaluate autonomic nervous system
function.
Previous studies have
established
that modulation
of
autonomic neuronal control o n the human airways are mediated
by parasympatetic colinergic,adrenergic o r -non adrenergic
fibers a s well a s the umoral svstemtvasoactive intestinal
peptide)and P substance.So an abn'ormai autonomic control of
cardiopulmonary function may make an important contribution
t o the~pathophysiolcqy of C O ~ Dpatients.
Aim o f this study is t o evaluate the possible autonomic
dysfunction in normoossiemic COLD patients and t o determine
Whether the pattern of HR variability in this population is
different from normal subjects.
(FEV1 < 60%) and thirty normal
Thirty COLD patients
subjects,matched for sex and age were studied in the morning.
interval was recorded
through the
Variability
of RR
autoregressive spectral analysis of 6 0 0 beat ecg samples
while the subjects were
1) quietly recumbent;Z) breathing in controlled way (15
actslmin) ;
3) in passive orthostatism after tilt manoeuvre 80° t o
upright position.
Analysis of variance shoved:A)a
significant reduction in
RRSD,with equal mean RR, was recorded in COLD patients in
c o m ~ a r i s o nwith normal subiects:Blat base1ine.a statisticallv
~-~ - eighificant
increase
i n - ~ ~ ~ ~ ( h frequency
l g h
normalize:
unit)(p<O.Os)in comparison with normal subjects;C)controlled
breathing and passive orthostatism d o not provoke any changes
in LP,HP and the ratio LF/HF a s in normal subjects.
in RR
I n conclusion,COLD patients showed a reduction
variability and are not able t o answer t o the sympathetic and
vagal stimulus in comparison with normal subjects.
Zeidl nd UT Vallmi. Dwartmnts of Physiolo~yand *Medicine.
The Aga Khan Univarsity Medical Centre, Karachi, PAKISTAN.
.g(
DIsoita iwortant awlications of brmhodilator responsa testing in
patients with obstructive airway disease, there is no agramnnt how the
reaults s h l d ba expressed. The indicator of the response such as
FEVI should ba discriminative and be indepadnt of the initial valw
(Brand et a1 1992 Thoru. 47: 429-436). In view of this difficulty, we
pmpow the ccmbination of airway resistance and expiratory f l a rates
as indicators of the bronchial responsiveness u d r resting tidal
breathing and forced expiratory Mnoouver respectively. The response Of
N C , F N I and PEFR and airway resistance Ros. Rr and Rc using
oscillorasistoutry (Sirernst. Siemens) and mmotachography
(Vitalosraph-colpact) was testad in 21 arthatics (group A), 21 M P O
patients (smup B) and 12 patients with mall airway disease (srwp C)
after tm minutes of inhalation of 200 m i c m g r a salbutmol. man(S0)
FVC, FEVI and PEFR ( t prsd) incmo.d f r m pre bronchodilator values
of 73t16. 54.89f12.85. 53fi6.7 to post brmchodilator valmS of
89.48fll. 70i12. 73.6tl3.6X rescmctlvely (P for thrw indices
0.0005, unpaired t test) in group A with an average age 36.6t15 yrs.
The post bronchodilator percentage increase for N C , FEVI. and PEFR
rrre 23. 27 nd 39 and all variables r a n greater than the standard
deviation of the resmtive pre bronchodilator oms. m a n (SO) Rr
h and Ros decreased f r m 4.46fl.U. 6.Wil.W. 5.Wil.W to 3S.9.
4.81i1.6, 3.76f1.07 Ibar/l/s (P c 0.0002) with an average decrease by
33 percent. In group B. man(S0) NC. FEVI and PEFR (delta 1 pred)
incnasad f r a 63.7fi4.6. 30.2i13.4, 30.5i13 to 64f16 (P = 0.05)
42.St13 (P ) 0.05) 42i14 (P > 0.05) resp.ctively with a M a n age of
49f16 yrs. The post-dilator percentage increase in FVC, FEV, and PEFR
were 19, i t and 15 respectively and *ere cloraly awroximating SO of the
pro-bronchodilator valuss. Howver. man(S0) RI, RE and Ros
rsspon6.d with a decrease f r a 4.5fi.6. 6.00Y.10. 5.Wi1.8 to 3.291,
Stl.86. 3.9fl.36 Ibar/l/s (P for 3 indices < 0.0005) with an average
decrease by 301. Tha patients in g r w p C with %all airway disease
(man(S0) age a t 1 5 yrs) shaed m m l values of airway resistance and
axpiratory f l a rates except reduced FEFIs-rs of 49i1.51 of predicted
values, which increased to 59ilU prad. upon bronchcdilation (P )
0.05). It m y ba concluded that the cabination of oscilloresistaetry
and muotachography or peak flarrtry is of added advantage in search
for the origin of obstruction as well as detection of m-responder to
bronchcdilation. The interpretation of bronchial responsiveness test
using forced expiratory mnoeuvers a l m should be done with cautloun.
.
A LONLlTUDlNAL STUDY OF PUSHA CORTISOL CONCENTRATION AN0 PULMONARY
FUNCTION DECLINE IN MEN. D SPARROW. CT O'Connor, FCCP. B Roaner.
D DeHollcs. ST Ueiss. FCCP. The Normative A~inpStudy. Depart~nt
of Veterans Affaire Outpatient Clinic; Channing Laboratory. Brigham
6 Y o w n ' s Hospital; Hsrvard Medical School, Boston, HA
Because of the important role of peripheral airways inflawtion
in the pathogenesis of asthma and COPL at-d because of the knom
anti-inflsmacory actions of corticostaroida. w e hypothesirad that
endogenous cortisol may influence the rate of decline of pulmonary
function with aging. Ue examined the basal p1a.u cortisol concantration
.nd serial apirometric measurewnta of 86 healthy r n participating in
the .4ormstive Aging Study. Subjects selected for this study verr free
01 day clironic illnesses and denied chronic use of any medications.
blood for cortisol derermination was obtained with the subjsct ir the
sup:ne position at 8 A.M. T w consecutive epirmetric examanations
thrt ~ a place
k
an average of 4.7 years apart were erployed in the
analysis. Cross-sectional andlyais reveal& a weak (p .On) direct
relat~onahip between the basal plasma cortisol conccntratlon end F E Y , .
The ->rtLc.l .oncc..!r.tlcr
IC F\'C epprared unrelpted. Longitudinal
a ~ l y s i srevealed 8 signiflrant (p .00@) relitionship between the
plasmn cortisol ~ o ~ ~ ~ e n t r a tand
i o n the rate of declim of P N I over tha
Follorcup interval after adjuament for age. height, m k i n g status,
and initial FEVl in a multivariate regression wdcl. Subjects with
cortisol concet.tration one standard deviation (23.3 ngld) below the
mean exptlienced PEVl decline 71.6 mL/year grcater char subjects with
cortisol concentration one standard deviation above the meen. lhis
difference was compilrsble to the estimated 69.5 dlyear difference
between current and never smokers. Cortisol concentration was unrelated
to the rate of decline of W C . The data suaest that physiologic
cancentrat:ons of cortisol may modulate the processes respons,blc for
ttsc deterioration of ventilatory function with aging.
.
-
-
EFFECTS DF ORAL AND INHALED CORTICMTEROIE O!4 RESPONSIVENESS TO
BETAZ - AGONISTS
G. ~icl". A. Sayiner
~D.pt.of Chest Diseases. Ege University. Faculty of Medicine, Bornova,
Izmir. TURKEY
-
brticosteroids are knan to have positive effects on beta 2
responsiveness. The purpose of this study was to determine. in COP0
patients, the s p i m t r i c responses to salbutml before and after
treatment with oral and inhaled corticosteruids. 19 patients on a stable
clinical course were enrolled in the study and pulmnary function tests
were performed at the beginning and following treatments with oral
methyl prednisolone (i4P. 40 mg/ day. for two weeks) and with inhaled
beclmthasone dipropionate (BDP 500 pg bid for four months) and
changes that were produced in re;ponse to inhaled salbutml, $00 p g .
were noted. Ye found that the mean FEVl was initially increased by
21.7 2 3.5% with salbutamol. hwever. following HP and BDP treatments,
idlbutaaul oroJu~rJ smd;lcr inc~tases in FiVl 1 1l.i 2.01 and
13.7 2.2%'. respectively). In association with these decreases in
beta 2 - responsiveness the initial mean FEVI value of 1389 83 ml
and 1627 t 97 ml, with !4P and BDP therapy,
increased to 1672 f 90
respectively (both values being significantly different from initial
value. D < o . o ~ N~O .sianificani differences were observed between the
effecis'of orai and inialed steroids on flowrates measured before and
after salbutamol inhalation.
These results suaaest that. althouah corticosteroid thera~vdoes not
seem to increase-the responsivenes; to beta 2 agonists.';t decreases
the need for their use.
il
-
TUESDAY, JUNE 15
EFFECTIVENESS OF CORTICOSTEROIDS THERAPY I N PATIENTS WITH
STA~ILE CHRONIC
OBSTRUCTIVE PULYONARY DISEASE
(c.o.P.~)
A. EL W E L , N. ROUETBI, N. DERBEL, A . CHERIF, R. SLAM
SERVICE DE PNEUUOLOCIE
- C.H.U
YONASTIR
- TUNISIA.
C o r t i c o s t e r o i d s o r e e f f e c t i v e therapy f o r t h e t r e a t m e n t o f
asthma. T h i s f a c t i s w e l l e s t a b l i s h e d . I n s t a b l e COP0 t h e i r
r o l e i s l e s s c l e a r . The a i m o f t h i s s t u d y i s t o e v a l u a t e t h e
p o s s i b l e i n p r o m n t of FEVl under c o r t i c o s t e r o i d therapy, i n
14 p a t i e n t s w i t h s t a b l e COPD.
F i r s t day ( D l ) , t h e i n i t i a l s p i r o w t r y showed severe a i r f l o w
o b s t r u c t i o n i n a l l cases ( m a n volue o f FRVl : 726 1 1 ) . The
broncho d i l a t i n g t r e a t m e n t was ad u s t e d o r c o n t i n u e d
( t h ~ o p h y l l i n eand Beta 2 a g o n i s t s j . At t h i r d day (03). 0
s p i r o u t r y was r e p a t a d and t h e n o c o r t i c o s t e r o i d t h e r a p y was
s t a r t e d by i n f u s i o n w i t h h y d r o c o r t i r 6 n e (10 mg/Kg/day) g i w n
t w i c e d a i l y , d u r i n g 10 days. A s p i r o m e t r y was r e p e a t e d a t day
theLueow
14. I m p r o v w n t of FEVl was n o t e d i n 1 2 c o r e s (a&),
v a r i e s from 7 t o 71% r e f e r r i n g t o i t s i n i t i a l v o l u e . T h e mean
v o l u e o f inprovment i s 30%. An o d d i t i o n n o l improvment i n FEVl
r e f e r r i n g t o t h e r e s u l t s o f t h e s p i r o m e t r y performed a t 03 was
n o t e d i n 11 c o r e s (78,5%), i t v a r i e s from 8% t o 86%. The mean
v a l u e o f t h i s i n p r o v m n t was 30,5%. These f i n d i n p a demomtrate
t h e e f f e c t i v e n e s s o f s o r t i c o s t e r o i d s i n s t o b l e COPD. The
f u n c t i o n n e l Improvment I r s u p p l e w h t o l t o t h a t o b t a i n e d by
b r o n c h o d i l o t o t o r s . However t h e e f f i c a c y of l o n g term s t e r o i d
a d m i n i s t r a t i o n i n D o t i e n t s w i t h s t o b l e COP0 remain t o be
elucidated.
T M FLOW-VOLUME LOOP IW WLATER*L VOCAL CORD PARMVslO
C.T.BoUigu, J.Sopko, P.Maurer, M.S& FCCP, A.P.Rmchad FCCP
W m d Fmmdogy. De~mVnmt of l M d k d k i m and Dapwmunt of
O t ~ d g y University
.
HWtal. Bud S w i t z a n d
The Rmv.Mknw loop u m f J in the hr of upper airway obmuctim (UAO). The
ratio bsMwr mmdmd expiratory md in@ratory flows at W v i W ca&
(MEFmF,)
is moat wldalv ured to differentiate between h a - and emathuecic 8itWav obmwtiar
with vsluu > 1 indiufino vari8bk unathorocic abmuctim. *nothw indu of UAO
propod by Ernpy (Br Med J 1972;3:503-05) is FN,iPEF ~rniAMn)
with vlkrr > 10
indicairq oOnfuntabanrtiar.lnw*W
exvathurc* UAO. MEF.,MF,m)yaxw6r
1.5 at the tr.ch.al Ion(, Bul i.usually > 2 in bilatnd vocal c u d pardyPr.
of a 3 8 - w - d d man who had aufferad a blunt m k injury ur a car
We present a
tnunr nwmd in bilanrd vocd c u d paralysis and in a
Iccidsnt. Severe
complete d t i m of the trachea M o w the uicoid wrdkge mesaimtirq luugkel
renutomash of the mch.a. Twehm wars Mu ha presented with a Wtt inaeaaa in
uvbaul dvapnu (gm3s 11). Ph@cal oxunhutim nuu*d hosnenurnd I marked
inrpimory u t i d u m f a d m.dmim. A ch.n x-ray. an ECG, the ditturion - p a w ud
ut6d.d blood 0.u~
WHO
Th. Uble shows the kng hmctim parameters obuhed.
he w
of the p a f a d y mproduab(. flow-vokme loop (Figural showed m
expintory cuvr with a m k d y dacruad PEF. m e w a t o r y &t-u
and flow
Mdlbtianr. The inapiratory c u ahowad
~
w w d y reduced flows thrcqhcut the
nunoewsr. The v d w a f a FEV, and FVC were normal. the FEV,iPEF ratio w u 11
mlNmin a d the MEFflF,
4.55.
-.
m
m
. ."
TLC U
6.8
iTGV a)
3.1
FVC U
5.13
FN, u
4.04
PEF Dh)
6.14
Raw ( c m ~ l o m ) 8.97
FEV,IPEF Imlhk) 10.97
MEF&4IFW
4.55
102
94.5
112
106
68
293
Endoscopy of the larynx and trachea showed paradoxical behviour of the vocal cuds
which caused new total obstruction of the hrynx on forced inspiration. The trochea war
nmnd. Wa conckd.that the flow-vdwne loop obtained in au patient with normal FEV,
and FVC values. e FEV,IPEF ratio > 10, and oscillatiw on the plateau part of the
expiratw w e was typiul for vairable UAO. The additiond extremely high MEFflIF,
> 4 helped to locate the obrVuctim at the level of the v o u l c u d r racher than at the
trachea. fhia pattnn m y be apecifi for bilrteral v o u l c u d paralysis.
Title:
-Q
-mlrrmlrur
Q
Wurio. ?h.D..
(Iceti- of
and C r i t i c a l Car* W i c i n a .
Yut Virginia University Scbool of W i c i n a . bry.tm. U u t V i r l i n f r
II 8
2
6
m
.mu.
(WC), force4 expiratory -1in 00. d ( r n l ) .
f-ed
-in~ t i o
(~IIIIC x IW).
-iretow
flow kt...n
251 d 751 of WC ( I B 25-751). forced crpimtory flow batwan tln f i r s t
200 md 1200 m l of WC ( I B 200-1200), md peak axpiretory f l o u ( I B ) r r e
DU.Md C. 3000 W e h a g v ? z ablack SmtbIrn A f r i u n a t 8 aged
2040 p a n f r a Ilrt.t.4 in tbI Wllc of T n u 8 b i L Smthern A f N . .
m. ml. IB 25-751. IB ZOO-1200. and m? r r m b w y cornlared r i t b
urh o t b r and a l l r r e
correlated with w e and s d i s g b e w t . T h
mmd rfor 8p-trlc
n r e -r
th. in
pmiolu s t d i e s . B k n foread vital e q u i t y L tL. p-t
e t d y m .bat
13Z L*
t h the p r d i c t e d rrlDu f r a other A f r i u u d u . ¶h
p.nt
e t d y ia tb, m o t want rd tln m
t study o: black Smtlnrn A f r W
-lug ths I r r % u a T b r . c i r Society 1987 n l r c t l o n c r i t e N of w u y
k t i m enmu and e n b. u8d as .n @ a t e rsfere@sa relfor black
Smtlnrn Af*
d t .
tio on.
Authars:
Forced vital -1ty
8.8. m*ID PII lIIP; 8.
ma D.D.8.
Respiratory DivIeion, llsdicinc I*rpsrtmnt
I W h Azad M i d CDllage and -iatod
Neu D2lhi ll0002 (India)
-
It was M d x e r v a t i c i u l d e a c r i ~ t i v eca9e a m t m l &udy.
IO lIIP
6wpitals
'Panty f i v e
of u w r ainry obstruction (LW) of U f e n n t dimaman and
ten mc#l henltby a m t r o l s were studied ty deriving p a r m t a r s f r a
T a u data on Gould 9y.t-21
RIlmnary Work Station. A l l Ur
otstcuctim l e d a r ure mnfirrd urdar direct v l u a l f s a t $ o n by
Pibercrptic BmncfDecqy or Indirect.-aL
It va. oteerPrd
tht W 5 W m 508 r a t i o above 1 ra. the best di.(plostie indicator
for fixed and variable e x t r a t h a r d c LW (p valm C 0.02). m
l
m
us altrred eigrdficantly ( p s 0.001) a l d palw abovt
l c l a l h i t r e h i n . was the aaund teat w e e r t o r m m LW.
RYlW 0.Sc 1.5(p e .W1) ad PIP 50( 4 100 Lit.hih. e r e alw
-rive
of LW. ?lwv o l m loop rclraind eha oa m m i t i v e
athod t o d e w mD tut.only 15 p a t i d oplld a n m t n r t it. l7mm
altered par-ratucmd t o mllal after the u r g i c a I rarval o f
otatruction which van p m i b l e i n riven cues.
I t um c m c l u i d that upper a i r m y a t e t r u a i o n may bc dingmad in
m e d a m e by m i n v ~ i v tool
e
l i k e pulrcimry function testing
t o avoid m i v e p t m Q l r e s and t o ~ e a npt s t i m t e progrousing t o
r r s p i r e t o w f a i l u r e by early d i q p ~ . i s .
CHEST 1 103 1 3 I MARCH. 1993 1 Suppbamenl
TUESDAY, JUNE15
(Physioiogy and COPPcontinued)
A PROTOTYPE KNOWLEDCE SYSTEM FOR SUPPORTING DIAGNOSTIC
DECISIONS IN PNEUMONOLKY
M E Sbrwia. ? h . D . . Secticm of Ptalwoary and C r i t i c a l -re Withe,
~ . p l r t m m tof m i c i n e . west virh i v a r s i t y k b m l of medicine.
k r 8 m t a m . Weat Viqinia 26506. USA.
K. SgirOpQllos, G. Garatzlotis, D. Lymberopulos
Pulmonary Division of Internal Medlcin Department Patraa Medlcdl School
Electrical Enginsaring Department. Schml of Engineering, PatraB
University
and
lorced v i t a l c a w i t y (WC). forced upirmrory m l in
mold ( m l ) .
f o r c d expiratory ratin (FEVLIWC x LOO), forced rid-srpiratory flow b e m n
252 and 752 of WC (W25-752). forced q i r a t o r y f l a hetween M(*l ad
1200 rl of RC (IB 200-I=).
and p a k expiratory f l a (m)m r e -ed
in -thy
elderly black S m t b r n A f r i u o u b j c e t a (550 u l c s , 490 f d u )
I r a mtata in t b -public of I ~ a a s k e iin h t h m f f r i u . A l l m 1 1 1 ~ t ~ r e
r r e 60 y u r s and shove rbo r r e load*
n isdepmdeat d a c t i v e l i f e ia
t b c a u n i t y . U a l u ad f a l .bolad
~
m .bed related decline in all forcad
u p i r a t o r y indices. %re m. a i g n i f i u n t sorrclatiof WC and FZVI r i t h
a M *
h b b t . A l l forced upi1'8Lory Mica r r e s i a i f i c q s a t l y 1-r
t h
-h. Lifclomg A
r
e bad s L & f i c u t l y
W
r ml. FSF 25-752.
and P Q -red
r i t b d r m . ?rediction aquaticme bare hem derived f o r
forced expiratory i s d i c e s for both u l e a and f c u l e s vhich cu b. used a#
reference val-a
for b u l c b y elderly b l r k Smthem Afri-.
DUES THE STRESSED CHRMllC FATIGUE SYI4DROIIE (CFS) PATIENT HYPERVENTILATE?
Lavietes HH, FCCP, Cordero DL, Tapp m. Natelson BH. Department of Medirinc
(Pulmonary). Neuroscience, an4 the CFS Center, New Jersey Medical Schwl,
Newark, NJ.
M n y sfllptms of CFS. e.g.. nunbness, lightheadedness, paresthesias,
and weakness. are s i m i l a r t o the s m t m s of hyperventilation. Because of
t h l s , same authors have suggested t h a t the synrptms o f CFS r e l a t e t o the
p a t i e n t s ' k i n g ~ h r o n i c a l l ystressed and then hyperventilating.
Ye have measured minute v e n t i l a t i o n (Ye). end-tidal pCOp (PetCOp),
t i d a l v o l m ( V t ) , frequency i f ) , i n s p i r a t o r y time ( t i ) , explratory time
( ~ e ) ,and mean inspi!.atory flow ( V t / t i ) via a mouthpiece i n 10 CFS patiellis
(CFS) and 9 n o m l s (N) under the fol101,ing conditions: q u i e t breathiry;
brea&hing wlille perfonning twc stl.essfu1 tasks (one, nunerical; the other.
c ~ g n i t i v e ) ; and re-breathing Cu2. LFS and N groups were evenly metclicd lfiil,
respect t o aye. sex ( a l l F), socioeconmic status, and s p i r m t r y . Baseline
Yc f o r CFS ( 9 . 9 , t / - 1.1 $En l/m) and N (8.8 +/- 0.5) were similar. 6).
contrast. baseline PetLOz for CFS (31 +/- 1 arnHg) was less than that for :i
(36: ./- 1). p <0.025. Both V t and f f o r the two groups were s i m i l a r . Ve
incrcdsea ( p ;0.001) for N patients during both tasks but d i d not chansc ft,,
LFS subje~.-. Frequency increased f o r N group subjects during the n u l e r i c a i
l ~ u llot
t
toe r u y n i t i v c Stressor ds well. PetC02 d i d not change thrGdghout
Lie pru~bcG1. No difference was seen between CFS and N groups durinp C02
lnhalbL801l 141th respect t o :he slope or x-intercept f o r Ve/pCOp, Vt/pCOz,
or t i p . F i n a l l y , t i f o r CFS (1.5 +/- 0.7) was greater than h
This difference persisted throughout both tasks.
61.2 t/- 0.2). 1' 'r.05.
Thew \Ere no differences i n e i t h e r t e o r V t / t i between CFS and N. Of note,
.I,J v d r i d b l l i t y (measured as coefficients o f v a r i a t i o n ) f o r t i , t e and V t / t i
f o r bat11 CFS and N increased above baseline f o r both tasks.
ue conclude: CFS patients do not hyperventilate (compared t o N)
r l ~ ~ r i nI~.Lmrc!oty
r
. ? r ~ s s . .iever;heler> the, arc. cj* c&mp..riscz,, liypocap;~alc.
,criai m d s u r m n t s 0 8 ie, V t ddcl f suggesL that CFS patients m y a c t u a l l y
Since
M m r e s p o n s i v e t o psycholobicrl stressors when contpared t o N.
t k r e are no differences between N or CFS w i t h respect t o mechanics o r
v e n t i l a t o r y drive, the difference seen i n baseline PetC02 measurements i s
d i f f i c u l t t o explain.
R m t e Y v e m in intelligent handling of data opsns new perspective4
In medical diapwsis oriented dscision slrpport prOcsdurea
The present paper deals with the development of a prototype k n o w l e w
&a (KB) System which supports racursive medical evaluation methods
focOu88d on Chronic Obstructive Pulmonery Diseam (COPD) Md Bronchial
Asthma (BA).
The develc?md KB is a s w i f i c software packcontaining academic
kanWlOd!p3, medical expertim and actual medical r e w l t s and f i n d l n g
(paraclinical examinations, lab t&s, etch
The atm of thls package is t o assist doctws in arriving in a dlagnmis
state by evaluating accuratelly a patient's dsta (history, phytical eraminatlonp. lab tests). Data Caluation is performed by the inherent reasoniw
I<B mechanism, which is a m t of aoftware procedures bnmd on logical
Rules, Constraints and Fact& The D o c t o r / w is a410 throum a w i a l y
wigred user interface:
a. TO select appropriate d l s g w t i c and evaluation procedure&
.b Enter and retrieve data (medical facts, p e t i e n ~data) into and from
the system.
C. Evaluate thw above data in accordance to the knowleinformation
contanned in KB.
It should be clarified that the developed system is able t o handle v a r i a n
typea of d a t q . w h as images (generated by different image m o d a l i t b
X-RAY. CT, Bronchoscopy), qaphics and measurable data valuer
The overall System structure has taen w i g n e d t o be incorpaated withln
novel telemediclne m f i p a t i o n s In order t o arpport remote eqart -1tations and training procssses, and has beon applied in actual medical
environmmt at the Regional Patraa University Hospital. The System' s
imptemmtatim h m bb(n financially uppwted by the European CommunC
ties as part of the RACE-TELEMED and RACE-APTITUDE projects
COR PUIXONALE I N
The p u r p o s e o f t h i s i n v e s t i g a t i o n was t o d e t e r m i n e t h e
aswciated with
l e v e l o f s e v e r i t y o f r e s t r i c t i v e lung d i - u
c o r p u h o n a l e . I n v e s t i g a t i o n s w e r e p e r f o r m d o n 27 c o n m m u t i v e
patient. w i t h r e s t r i c t i v e lung disease n o t a s s o c i a t d w i t h
o b 8 t r u c t i v e lung d i w a s e .
P u r e r e s t r i c t i v e lung dl-e
w u
defined as a for&
v i t a l c a p a c i t y ( W C ) 5 808 p r e d i c h d and a
n o r m a l P W , / W C r a t i o (PW,
one eecond f o r c e d e x p i r a t o r y
volume).
The p r e d i c t e d W C i n thau p a t i e n t . was 60 2 1 2 8
(mean 2 SD)
( r a n g e 29-79C).
R e a l ti..
tw d i w u i o m l
e c h o c a r d i o g r a m w u e p r r f o M d i n a l l p a t i e n t s o n t h e 8e8e d a y
a s pulmonary f u n c t i o n studiea.
B o t h t h e r i g h t v e n t r i o l e (RV)
a n d l e f t v e n t r i c l e (LV) v e r e s t u d i e d w i n g t h e p q l . a s t a n u l l o n g
a x i s , p a r a s t e r n a l s h o r t a x i e , and a p i c a l f o u r c b u b . r v i e w .
Among t h e s e p a t i e n t m , 14 h a d n o h e a r t d i s e a s e . Priury c a r d i a c
diagnoses i n t h e r e m a i n i n g p a t i e n t s ( 1 d i a g n o s i s / p a t i e n t ) vere:
7 h a d h y p e r t s r u i o n (3 w i t h L V w a l l t h i c k e n i n g ) , 3 had a a g i r u ,
1 h a d a n a o r t i c v a l v e r e p l a c e m e n t but n o LV h y p e r t r o p h y , 1 h a d
a n o l d i n f e r i o r m y o c a r d i a l i n f a r c t i o n w i t h n o r m e l LV f u n c t i o n
a n d d i m e n s i o n s , 1 h a d a slall p o r i c a r d i a l e f f w i o n w i t h -1
LV f u n c t i o n .
Pulmonary diagnoses were a s f o l l o w s : 8 h a d
i n t e r s t i t i a l l u n g disease o r pulmonary f i b r o s i s , 7 had c h e s t
deformity o r reepiratory ~ u s c l d
eysfunction o r ecoliosis, 1 had
c o l l a g e n diseaee, 4 had sarcoidomis, 1 had morbid o b u i t y , 1
h a d a s b e s t o m i s , 1 h a d a l u n g tlwr, i n 4 t h e Cause was unknown.
RV e n l a r g u e n t was d e f i n e d a s RV d i m e n s i o n > 2.6 a. Along
patients w i t h m i l d r e s t r i c t i v e lung diuase,
( W C 65-808
p r e d i c t e d ) none h a d W e n l a r g m e n t ;
among p a t i e n t .
with
m o d e r a t e r e s t r i c t i v e l u n g d i s e a s e ( W C 51-64C p r e d i c t d ) 3 o f
1 2 (258) h a d RV e n l a r g e m e n t , a n d among p a t i e n t % w i t h s e v e r e
r e s t r i c t i v e l u n a d i s e a s e ( W C c508 ~ r e d i c t e d l1 o f 4 (258) h a d
I n c o n c l u e i o n , ~ o r ~ ~ u l m o n aal si , i n d i c a t e d by
RV e n l a r g e m e n t .
RV e n l a r g u e n t o n t h e e c h o c e r d i o g r u i n p a t i e n t s w i t h p u r e
r e s t r i c t i v e l u n g d i s e a s e , was o b e e r v e d o n l y u o n q p a t i e n t . w i t h
a moderate o r s i v e r e r e s t r i c t i v e impairment o f i t k g function,
a n d a l l h a d a p r e d i c t e d W C < 58%.
-
-
RESTRICTIVE LUNG DISEASE
Kalyanam s h i v k u m a r , PID, J e r a l d W. Henry, M i c h a e l E i c h e n h o r n ,
PID, PCCP, P a u l D. S t e i n , MD, ?CCP, Iimnry l o r d E o s p i t a l ,
D e t r o i t , M I 48202, USA
TUESDAY, JUNE15
Exercise Testing and Physiology
Afternoon
~ L A T I O N W I WBETWEEN VENTILATION AND CARBON DIOXIDE
PBODUCnON DUIUllQ RAMP mmRZRCISE IN P A m N T S
aEAafFAauRt.
Maaslmo Romano. Alberto Cuocolo. Emanuele Nlcolal. Stefanla Cardel.
Antonio Nappi. Ida Monteforte. Carmlne Morlsco. Marco Salvatore.
Bruno Trlmarco. Marto Condorclll FCCP. I CUnlca Medlca and Medlclna
Nucleare. 2nd Medlcal School. Untverslty of Naples -Federico 11". Italy.
F h t e r , I. , A. Wrster, D. Drem, I. Xothe
Clinic of Internal lledicine , Emboldt-University
Chuith Bospital, Borlin, 6e-y
eas etesting in chronic h
e failure can
k used to provide objective a s s e s m n t of disease
sovuity which is directly relatod to prognosis.
For that reason74 patients with moderate he&
failure (llYHA 11) (18 m l e , 46 fsule, a w m g e age 50
+/- 8 yeus) carried out a s p i m r g o M t r y .
Tha aetiology af heart failure w a s specific heart
muscle diseaacl. The bicycle exercise tests were
puforud not only with a ramp protocol (20 watts/
rin) bat also during steady state conditions (65 t
of maximal exercise in watt of the rup protocol)
*ith mas-nt
of 02-consumption (VO2 max).
The mean left ventricular ejection fraction (W
nasured) was 52 % +/- 8 $.
The patients obtained an exercise of 1 2 4 +/- 1 2 watt
and a V01 max of 1 6 . 5 +/- 2 . 7 mlfig min.
That m a n s 62 % in contrast to a norvll control
group with comparable work capacity.
Conclusions: In ambulatory patients with heart
failure, exercise is limited early fatigue, feebleness or dyspnea. Ye could demonatrated that these
slrrptoma are associated with early achievement of
the anaerobic threshold and limited VO2 max.
This is not dependent on type of exercise (raap
or steady state). The noninvasive measurement of
anaerobic threshold , which could not influenced
by patients motivation, is very useful to better
characterise patients heart failure.
DIAGNOSTIC VALUE OF CARDIOPULMONARY EXERCISE TESTING
(CPEX) IN THE DVIGNOSIS OF DYSPNEA ON EXERTION (DOE). Acao
R, W a c z FJ. F C 8 . Sunopdous I, Pictcnng R.
JF. FCCP. Unimity of
Miehigm AM A r b . MI,ud Lahcy p i n k M
c
d
e
i Cam. B u r l i n p . MA.
Dyspnu oo ucmon (DOE)
u r frusuwng symptom hat mou commonly arises
b ndisuse d the b c m a lun a tuh. 'Ihe opiml chnid evalruDon ranains unclar.
F@ patients (mcdh age 47.&ars;23 waocn. 27 &; d a n duntion of symptoms
23 months. nnee 3-240 m t h s ) were evaluated for W E . In 11L extensive. m i d
ewsluauon lncl&ng hlstay md phys~cdexarmnst~on.chestfadlographs md k c
pulmonary funcooo tern d ~ dm result I n 8 d~sgnos~s
felt aduluate 10 explsln the
symptomr. AU underwent sympwn LuD~tedBW( w~thm u w r r m ~of
t exhaled g.ru
Subxauent tcstine was dirccted~bvthe uaticnt's mhonarv ~hvsicianbawd on the d u
of &.
The d s e ten was &view& im!&ndently bj'at,~leantwo inurprrtua and a
pmumpdve diagnks was madc. FoUow up wu oba~ncdm 111 pauenu ( d m 9.1
months. range 2.5-80 months). Subwaucnt d~aanosticusts were noted and reviewed
whencvadble ud swnrmmalic inmkmmtawas rsordcd A rcview
puui cxaniincd the subsbp&t sdies,'clinical course, responx to rhaapy uddccided
the most likely diagnosis. The final dia nores lncluad oksityldeconditioning (n-16).
away di(n-13). psychogenic (n-8). cardiac (n=7),normal ( n d ) , inmsotial lung
dim& (0-4). Eve paiienu hid two diagnosis. Improvement occurred with specifiE
t r e s m t in 90 pacent of the patienu. The dhposis of the CF'EX rtud corresponded to
the final diagnosis in 36/50 (72%). In 111 patlenu in whom the CP& study smmgly
suggnrcd a d a c says (41SO;Spaificity 1008,sensitivity 57%))or pulmonq sours
(91SQ.Spcifldty 1008. rensitivity 52%)this was confumed on follow up. Of thc remining
8 puienu with eventual diagnosis of pulmonary disease, asthma was diagnosed by
broncho~mvocadmtcsdne in s m . In the lamen w u of~ mtienu 04/50) the BU( was
felt m&ncnt with either-&mnditioningor a &k l~mitahon.~ f l e su&uent
r
tcsdng
and trcanncnt the f i ddiagnosis in this group included deconditioning (15R4),aimy
d i x a x (624).
psychogenic (a)
and wdiac d i m (3R4). When thc &X was totally
normal ( ~ 1 3S: a d f d w 92%. rnsitiviw 10081. no diww was identified in ten. In the
r e n u Fy flnaj diagnosis, in h e nc&
&up & ' V O ~ %pr&cud (107>15%;*
Zpuk % p r d c d (128 + 12%)was significantly higher than In lhox wticaa wth
&di&
a dLcadidonr (DQ.O(H).-NOdiff&& in exhaled e u c&mua was
seen bctwr.cn the cudir L
i
G
dud
with otuitvldtconditi&ini. In ddition.
abmmml~oam the elecmrardwpm dunng ex(nhz) and sigrof~htdccruxs
FEV1 pon -x
(f14)
anc diagnosnc for cuduc l~numnonand u t h n u . rerpcuvely.
In cooclusion: 1) an rbnamalBW( d y dearly luggem disuse and can direct funha
tcstinp; 2) a n o d uudy suggest no disc& in ihc Gjotity; 3) a study which suggerts
obclitv/dsondidon~is rcladvelv nauadtic ud indiutes the need fcr funha evaluation.
Our data su csrs i i i t twelve iead e k i r t r o c a r d ~ o ~and
~ hprc/post
~
CPEX s p i m u y
routi~ly
duin tesong fa DOE m y signifiuntly improvc the xnsitiv~tyud
srdficirv of Lhc Study a, Llect d a c or vmtilauv limitation. Funhu tednn, includiin
-on
&&
m y add infmmion a d d o a v ~
larger pmpstive studies.
In patients with heart fallure IHFI and low peak exercise oxygen
uptake (V021 has been described an abnormal venulatory response
during cardlopulmonary uccrclse stress test. The aim of this study was
to assess the relationshlp between venUlatlon and carbon dloxlde
production (VC02) dudng exerdse. Twenty-two subjects I13 patlents
with HF. resting ejection fracuon. EF. 17-3896 and 9 age and sex
ma phed normal subjects. NL) were studied durlng maxlmal symptom
llmked upright blcgcle ramp exerclse. Heart rate IHRI. mlnute
ventilation WE). V02 and VC02 were measured "breath by breath" using
MGC 2001. Left ventricular EF and cardiac ouiput (CO) were
continuously measured "beat by beat" using a radlonu~hdeambulatory
equipment (Vest).
Peak exercise HR. VO2/kg/mln and resplratory exchange ratlo
were: 14M4 bpm. 21.li2. 1.W.05 In NL and 13M16 bpm. 16.9t2.
l.2f.04 In HF. EF Increased hom rest to peak exercise l6Oi8% versus
7M8%) In NL. whlle dld not change In HF (30f8% versus 28i11%).
lndlvldual slope between VE and VC02 (every 30 sec) was calculated and
plotted against peak exerclse V02 (Peak V02) and changes of CO
ledv/mln)lACO). In the enare group, slopes were slgnlflcantly related
) not wlth Peak V02 I--0.37. NS). In HF.
wlth ACO lr=-0.58, ~ 0 . 0 1and
no slgnlflcant relationshlp between slopes and Peak V02 (r=-0.40)and
ACO lrr-0.411 was observed.
In conclusion, our results suggest that during continuously
Increased exerclse ramp protocol the relationshlp between ventllatlon
and C02 production I s not useful to estimate Peak V02 In patients with
HF. The weak correlation coefRclents among slopes and ACO may
suggest a relation behueen increased ventilatory response and severity of
HE
ERGOSPIROMETRY IN PNEUMOLOGV
E . Krlegar
LVA-Klinik, Bad Reichanhall. Germany
The most usual form of exercise t e s t i n g i s t r i a n g u l a r w l t h Increasing workload without l n t a r r u o t l o n f o r recreation as lons
the proband i a able t o work (.symptom lrmitated exarclsa
t e s t & n g g ) .The prnconditlon of t h i s klnd of exercise tentlng
1s a well cooperating probend, who i s willing t o do h i s b a s t .
Obpctive c r l t e r l s of axhaustion s r a the r i s e of heart frequency
t o a c e r t a l n limit (usually 200
age) and the anaerobic
threshold. The minute v e n t i l a t ~ o n i s generally out of conslderatlon.
P a t i e n t s w ~ t hlungfunction rmpairment however cannot lncrense
t h e l r v e n t l l a t ~ o n i n the same ray as other p a t l e n t s . e i t h e r in
coqsaquence of a high axrway r a s i s t s n c a or of l o r gas elchange
areas In the lungs. These patxonta f e e l lncreaslng dyspnea the
more they approximate t h e l r maximal mlnute v e n t l l a t l o n , cause
of t h e i r lapaired lungfunction they cannot reach t h e i r ma~imal
heart frequency nor the anaerobic threshold. In addxtion aoma
of these p a t i e n t s devalope pathologic blood gas changes during
exerclse. eapacrally durlng the f l r s t minutes, p a r t l y wrth a
recovery I n the following time. For technical reasons l t i s
lmposslble t o get useful blood semplsa durlng the t r l a n p u l a r
exercise t a s t l n g .
Therefor we conclude t h a t i n p a t i e n t s w l t h lungfunctlon impairments only the rectangular axercise t a s t i n g f o r a t l e a s t s l r
qlnutes w i t h s p e c i a l conrlderation of the mlnute v e n t r l a t i o n
A n comparison t o the maxlmsl mznute ventilation w l l l produce
useful r e s u l t s t o prove wether a p a t i e n t i S r e s p i r a t o r y i n s u f f i c r e n t 11 a c e r t a l n work load.
-
as
-
&
-
CHEST 1 103 1 3 1 MARCH, 1993 1
Suppbment
2315
TUESDAY, JUNE15
-
-
(Exercise Testing and PhysioIugyc~ntinued)
crcu
bp. of
W
C
V-W*I
t ~ n~ g
am, PA.D . n d j . m . I. ?ol8ar*.
C. V 8 a LrurQ.
Dlsaasas. W W C s i t y Of lih.Il. % b t b . r h d 8 .
-ISEAT
r.
J. l o q . C b t 8 .
J
h l p r w i o l ~study r h a w .baa that In m m n mm p t i m t s ac ~ c l em r c i s e a t 6SX
r s c a p r a b l e r i c h uirl h U 1
m r c i s a . W i q both t m s of m r r r i u a w n t i l a t o t 7 l i r i u t i m r m
prasmt. minute w n t l l a t i m incrmasd t g 1
prdictd n l w s d a
s t u d y s u t m r m not reach&. Sn aim of W s study r e to & t e d a c h
I n t a a 8 i t ~-in# u 8 r c i s a a t a cms-t
wrk load n d t s S
s a didmiahad
mtihtoq r e s p a u or s t d y s u r e c m d i t i a u . Y t b . n f o n s t a d i d 15
stable. s m r e COPD p t i m t s yd 62
yrs
W ) , R V , 1.1 m . 4 1.
A l l p t i m t s uadmrrmt a m
m 1idt.d d
l lrrrarnul t e s t (MI?) m
a c p l e a q m t e ; w i t h lrr-ta
of a r t load of 5-10 U t t l r i n .
76
t4lltrttt.
f m r s a p r a t e dsym m
twst ( R ) r s p r f o d a t
wtt loads of IS. 30. 45 ud 60 IYu r e s p c t i w l y . h c p t f o r tb f i r s t
b u t * (unlmded s u 8 e ) . tb w r t load u s b p t c m s u n t throqJmnt tha
t a s t . ?be p t i r n t s cmtintvd till d l u U m or uirl 15 minutas. W
h u r t rat* (W).
minute m t i l a t i m (m).
m
-c
(-1.
prf-s
t i r ( ? t i n ) ud tb. dmgm of bmatblesmuss (-1
m
-surd.
A P t i r of IS rin. and m i n c r u u of VX of l e s s tb.n 7Z d u r 4
tho l a s t 9 minutas of tha t e s t r s cmsidarad steady s u t a .
RELATIONSHIP BETWEEN WASTING AND EXERCISE TOLERANCE AND GAS
EXCHANGE IN COPD PATIENTS.
Simard M, Desmeules M, LeBlanc P.
U n i t e d e r e c h e r c h e , C e n t r e d e pneumologie, H b p i t a l L a v a l e t
U n i v e r s i t 6 L a v a l , S a i n t e - ? o y , CANADA.
M o r t a l i t y i n COPD p a t i e n t s is i n f l u e n c e d by body w e i g h t .
We
s t u d i e d 22 s u b j e c t s i n s t a b l e c o n d i t i o n t o e v a l u a t o t h e e f f e c t of
weight on e x e r c i s e c a p a c i t y and g a s exchanges i n COPD p a t i e n t s .
A l l had a FEVl l o w e r t h a n 456 p r e d i c t e d ( % P I . T h e r e were 1 2
u n d e r w e i g h t s u b j e c t s ( < 8 6 t o f p r e d i c t e d w e i g h t , 5 4 . 2 i 8 . 6 kg
[ m e a n f l s l , g r o u p U) a n d 1 0 w i t h a n o r m a l w e i g h t (95-120\ of
p r e d i c t e d , 1 2 . 8 2 6 . 9 kg, g r o u p N )
I n e a c h s u b j e c t we measured
f o r c e d e x p i r a t o r y f l o w s , v o l u w s , DLCO, maximal i n s p i r a t o r y and
e x p i r a t o r y p r e s s u r e s , r e s t i n g e n e r g y e x p e n d i t u r e (REEI, and
maximal e x e r c i s e c a p a c i t y (MC) w i t h g a s exchanges a t r e s t , a t I(C
and d u r i n g r e c o v e r y .
There was no d i f f e r e n c e between two groupa
f o r a g e , h e i g h t , a n d FEVI p r e d .
T h e r e was n o s i g n i f i c a n t
d i f f e r e n c e i n v o l u m e s a n d maximal i n s p i r a t o r y a n d e x p i r a t o r y
p r e s s u r e s . DLCO was s i g n i f i c a n t l y l o v e r i n g r o u p 0 t h a n i n group
N ( 5 6 . 7 + 1 1 . 7 1 P vs 79.1*16.6% P, p<0.011.
At r e s t , t h e r e was nc
d i f f e r e z c e between the-two g r o u p s f o r oxygen consumption ($02)
e x p r e s s e d i n a b s o l u t e v a l u e ( 2 2 8 . 2 i 4 0 . 9 ml/min v s 2 4 4 . 5 2 2 5 . 6
ml/min) o r c o r r e c t e d f o r body a r e a (D~z/m'). However, ~ C O Zwaa
s i g n i f i c a n t l y lower i n g r o u p U (177.lrt32.7ml/minl t h a n i n g r o u p N
( 2 0 7 . 9 + 2 1 . 3 ml/min, p-019)
The r e s p i r a t o r y q u o t i e n t (RQ) war
s i g n i f i c a n t l y lower i n group U t h a n i n grqup N (0.78i0.04 vs
0.8420.05 p-0.01).
Pa02 a t r e s t was a l s o s i g n i f i c a n t l y lower i n
g r o u p U ( 7 3 . 5 2 1 . 6 v s 8 3 . 8 i 6 . 6 mmHg).
At a 30 w a t t s workload,
t h e r e was no s i g n i f i c a n t d i f f e r e n c e i n h 2 and VOz/m' between t h e
two g r o u p s b u t 002 max was l o w e r i n g r o u p U t h a n i n g r o u p N
( 7 5 3 i 2 4 1 ml/min v s 1 0 0 5 i 2 2 9 ml/minl
Nevertheless, t h e l a c t i c
a c i d c o n c e n t r a t i o n ( L a ) a t UC was t h e same i n b o t h g r o u p a
( 2 . 6 4 + 1 . 0 6 mmol/L i n g r o u p U v s 2 . 8 7 i 0 . 7 6 m o l l L i n g r o u p N l .
Pa02 ( 8 1 . 3 i 9 . 5 mmHg v s 61.3+10.0 mmRg1 a n d SaOz ( 8 8 . 5 2 5 . 2 1 vs
95.222.9 0 a t MC were lower i n g r o u p U t h a n i n g r o u p N .
During
r e c o v e r y , tOz/ml was significantly h i g h e r i n group U t h a n i n group
N ( 3 5 0 . 6 i 5 7 . 3 ml/min/m2 v s 2 9 0 . 5 i 4 9 . 0 ml/min/m2, p - 0 . 0 2 )
We
c o n c l u d e t h a t : 1) underweight COPD s u b j e c t s have worse e x e r c i s e
c a p a c i t y and g a s exchanges a t r e s t and d u r i n g e x e r c i s e 2 ) t h e r e
i s no s i g n i f i c a n t d i f f e r e n c e between VOz a t r e s t n e i t h e r betweer
V0z d u r i n g e x e r c i s e , 3 ) An i n c r e a s e i n La i s f o u n d a t a lowex
l e v e l o f e f f o r t i n g r o u p U and may e x p l a i n h i g h e r 60z/rm a f t e r 3
minutes of r e c o v e r y . I t i s not p o s s i b l e t o conclude i f t h e s e
a b n o r m a l i t i e s a r e t h e cause o r t h e consequence o f e m a c i a t i o n .
( S u p p o r t e d by Fonds de r e c h e r c h e e n S a n t 6 du QuBbecI
.
.
.
Blu r s s-fiuntly
b e l a predictad Blu (220-we) m all t e s t s . a l e
(F8V1+37.5) a l y a t R4SX d RSOZ
(po.002). ? o u p t i m t a -re not able t o r u c h a stead7 s u r e a t a l l .
Urns, p t i m t s r0ach.d s s t a d y s u t a a t both m S Z d RWZ. 8 p t i s n t s
a t R4SZ. The m x of the 4 p t i m t s rho a c h i e n d a steady s t a t e a t R60X
varied f r m 18-66 1.
lh cmcluda that tb. o b j s c t i w ud ~ b j o c t raspooses
i ~
t o .rdrrr.nca
.rarcise d i f f e r d f r m u l r l L D c r . m u l r u r c i s a m l y a t a r k l o d e of
la intermicy (30-45Z). At U#ur 1-18
tb. r a a p a ~ s e sr r e .qrul. altboqlh
a staady s u r e r s r r c h o d by 8 m p t i m t n (271). ipd.p.oQmt1y of 1 q
flmctim.
Supported by tb. Dutch A 8 t h ? o u d a t i m .
W a x differed f r m p r d c t e d
.
PREDICTION OF EXERCISE HYPOXlA IN COPD-PATIENTS.
H.FWenng. J.Rooyakkers. A.H~lmans,C.v.Herwaarden
Dept. h h m o b g y 'Moerrwzlld'. Uruv, d Nqmegen. The Netherlands
Exeruse hypoxla In COPD-pat~entscan be caused by relattve hypovenslaton
by dl(hrswm p W m s through the reduced alveolar membrane area and by
ventrlatton.petlum [VaIQ] ~nhomogenettms The purpose
of this study was to
m e s g a t e whether the measwement of the smgle bream CGtransferfaclor [KCO] can
predrct exerase hypoxla due to dlfluslon poblems
KC0 wwld be negahvely cotreiated
n was hypothes~sedmat resbng
the tncremenl
In
(A-a)DO, durlng exerase
MA-a)DO,l
Hneteen patents rvlth COPD ( 11 m 8 I.age 52.3
+
13 5 yrs FN, 64 3 +
265 wed) performed a mwmal ~ncrernentai bicycle ergometer test Art&
bloodgassamples
wre
taken, and g a s exchange was measured wlth a
mtxlg-
chamber ergosplrometer
Mean
resting KC0 was 60 7
maumal &load
was 106
2
+
24 9 % p e d (range 14 0
101 0%) Mean
58 Wan Mean d(A-a)DO, was 3 06 s 1.8 kPa (range
0 8 . 6 3 kPa) Mean l r a e a s e In P,CO, (dP,CO,) was 0 62
kPa) Mean decrease In P,O, (dP.0,) was 2 2
= 0 49 kPa (range 0 1 . 2 0
= 1 3 kPa (range 0 2 - 4 5 kPa)
The (pearson s ) wrrelalton between exerase hypovent~latton (dP,C02) and
e x e r a w hypoxta (dP.0,) was 0 57 After cwrecrlng for hypovenldaton by calculaung
the (A-a)DO,. the uxre!atlon between KC0 and d(A.a)DO, durlng exercise was 0.04
The corrdatron between KC0 and dP,O, was -0 20
In a muLple regresson analys~s ne~therKCO, nor dPCO, were slgnlflcant
coefficmnts In predlcttng d(A-a)DO,
p-values baetng > 0 85 ProbaMy
an
mprovement m Val0 rato s durlng exerase counteracts the effectof a reduced KC0
on
exerase hypoxla
In COPD-patmnts
Coocl!nior: 'lbc pUopbyaidoCy Miry IO d y p n i. p W vioh M T is IL d m m d v a * i L p y
a m I ~ d b ~ h C r r o C d u ~ o b . m n i a a d ~ c b r & d L T L s d m * d V d M ~ ~
TUESDAY, JUNE 15
UEECISE,
Ex-
. i.e.
-
rrduced,natllq
I
C AIRWAY M5lWCIIOI
Depts. of tlediclne 6 Pharmacology. b l r H o s p l t a l . Bombay. I n d l a .
,m Qmaic a b a m c t h p l d l a r y d i i
(COPD)is M
y l
W by
7
. @pi+
7
= t ~ ~ h e c o w a v b v d .~ i .
v a. h D a y b n w , s v n m - v
olapco
Ill m
J.V. P a l - h u n g a t L C.H. tlathrv, S.A. Deaal. S.R. t l e l g l r i ,
A.J. Pal-Dhungat (FCCP).
T h i r t y p a t l e n t s havlng c h r o n l c o b s t r u c t i v e pulmonary d l s e a s e
(COPD) by c l i n i c a l c r i t e r i a were observed t o compare t h e l r e x e r c l s e
e r f o n a n c e wlch t h e s e v e r i t y of airway o b s t r u c t l o n .
None of rhea had
y p e r t e n s i o n o r I s c h a l c h e a r t d i s e a s e . The p a t l e n t a were e v a l o a t e d f o r
pulmonary f u n c t i o n s , (FVC, FtV1. PEFR) n c r c l e e performance b a r t e r i a l
blood g a s e s a f t e r a l t t i n g b r o n c h o d l l a t o r s f o r a day.
Ye a l s o a s s e s s e d
20 u t c h e d c o n t r o l s f o r comparison. Airway o b s t r u c t l o n v a s c o n s l d c r e d a s
mild (n-9). moderate (n-8) 6 s e v e r e (11-13) a c c o r d i n g t o FEVl 2 o f
p r e d i c t e d "0-1
(65-75.
YJ-64, 6 ( 5 0 r e a p e c t l v e l y ) .
The n e r c l s e
c o n s i s t e d of s u p i n e b i c y c l e ergometry, b e g l n n l n ~a t 0 w a t t s . 6 I n c r e a s e d
by 25 w a t t s e v e r y 2 minuter u n t l l a d o u b l e product of 25000 was reached
o r i f f a t i g u e occured. During e x e r c l s e , c a r d l a c f u n c t l o n war a s s e s s e d by
symptoms, p u l s e , blood p r e s s u r e , Ea: 6 r a d l o n u c l l d e (MUGA) s c a n .
The
e x e r c l s e p r o t o c o l was completed by a11 c o n t r o l s 6 23 COPD p a t i e n t s w h i l e
7 COPD p a t i e n t s developed symptom l l m i t i n g f a t l g u e . Pulmonary f u n c t i o n s ,
a r t e r l a l blood nasea 6 l e f t 6 r l n h t ventricular e i e c t i o n fractions (LVEF
The C ~ P Dp a t l e n t s had ~ s l g n i f l c ~ nhyporla
t
at
6 RVEF) were co-rrelated.
t h e time n f t h e t e a t . T h d r LVEF 6 RVEF were < WZ (n-11) 6 < 402 ("-14)
respectively.
They had s m a l l e r post e x e r c l s e r l s e s In LVEF 6 RVEF than
n o n s l ( P < 0.001).
I s o l a t e d l e f t 6 r i g h t v c n t r l c u l a r d y s f u a c t i o n was
n o t l c e d in 5 6 8 p a t l e n t a r e r p e c t l v e l y .
An e x c e l l e n t c o r r e l a t i o n was
a e n between FEVI, a r t e r i a l blood g a s e s 6 postexercise r l s e in e j e c t i o n
f r a c t l o n , p a r t i c u l a r l y LVEF ( r
0.6).
i
Table
-
I t I s concluded t h a t COPD p a t l e n t a have abnormal r e s e r v e of both
v e n t r i c l e s , due t o hypoxla.
Plpmlwm
i y
-
in both povp (I9m d 12/16)mchd mamcbic rhrclbdd (AT) dwiq CPX.
I*P
(
w i q ~ ~ ~ i a 1 9 ~ . l b a s * a e o d y 9 p u c a r i n
#je:.TAW
&
?
- 'm-!"glaym*Rya
2.
< 0.0011 CABDIOPULl4ONAr). PMW!XTLRS IN COPD PATIENTS
HEAN t SD )
PMAluma
--
FEVI 2 FWD. N
Pa02 (I.H~)
Baaal LVEF Z
P o s t e r LVEF 5
Basal RVEF I
P o s t u RVEF X
WLkb w3dd d
lin bdur qwlity oi life.
Exercise Tolerance in Patients with Chronic Pulmonary Disease
Acccmpanying FWN.
Pulmonary Circulation Aspect
Yoshihiko Araki, Shouhei Nakano, Tatsuyuki Sugawa, Keita
Kunisada, Shirou Wbiara, Tohru Arai, w s a k o Yoshikawa, Nobuhisa
Awata, -aka Prefectural Habikino Hospital, Habikino-city,
Osaka, JAPAN
In view of ventilation, many clinical studies of exercise
tolerance in patients with chronic pulmonary diseaae have been
reported. However pulmonary hemodynamics which closely relate
to ventilation. eswciallv durina exercise. have not been
studied in dethi1.- we inkstigated the role of pulmonary
circulation in 15 patients (chronic pulmonary auphyscma 8
wtients. wlmonarv tuberculosis-.&el
7 patients) with RVH.
-Pulmonary hemodymdcs, radial artery pressure and arterial
blood gases were measured, and simultaneously the expired gas
analysis was monitored during each staae of incremental bicycle
ergometer exercise until endpoint. Peak oxygen consumption
(30,) varied widely between 350 to 1084 (ml/min). Patients were
divided into No groups. The first was that which registered
more than 600 (ml/rnin) of Peak Vo, (High- roup, 8 patients) and
the other less than 600 (ml/min) of k a k 80, (LOW-group, 7
patients). Maximal oxygen pulse IVo,/heart race) of the L-group
was less significant ccmpared with the H-group at the maximal
stage of the exercise. Pulmonary artery pressure (PAP) and
total pulmonary vascular resistance (TPVR) were significantly
higher at rest in the L-group canpared with the H-group. There
were no statistical differences in PAP and T W R b e t m n the
A-group and the L-group at the stage of maximal exercise. But
PAP and TPVR of the L-group were significantly higher moon after
the start of the exercise. We concluded that the disturbance of
the pulmonary circulation had an important role as a limiting
factor during exercise in patients with chronic pulmonary
disease accompanying RVH especially in those whose exercise
tolerance was low.
CHEST 1 103 I 3 1 MARCH. 1963 1 SuppltMw#ll
233s
TUESDAY, JUNE 15
(Exercise Testing and Physiologycontinued)
-X.
Drab.pp.I,
V-A.M. Rmrt.ru. D.putart of
I-b
d i u u r , st-ratooim Wbl, liawqoill, thm Mha-.
In o r d u to predict th. postopuativ8
morbidity and
mrtality
after ruoction for p u l m n u y carcinaa, m
p.rforwd incronntal ererein tutinq with V02 wu-t
am3 convmntional lung function in
70
patients.
Ru
8-limited
v02 uaa considerod as Wtru. In &ition
tho - 0 b i c
trullold (AT) ru estiut.d from VCO2/VD2
ratio and
u A T p O t r u prodictd ( 8 ) . P.ti.n+.
po8toporativr co~~plicatioru. Croup 1 : no complications:
group 2 : minor corplicutions (e.q. atrial fibrillation,
st.lK+Uis,
r d r a i n a ~ , pro1onp.d air leak); group 3 :
major complicatioru (0.q. death, septicaia, myocardial
infarction, stroke, cardiorespiratory iruufficimcy).
Group 1 n-42
Group 2 n-29
Croup 3 n-7
YQzmX
ml/.in/*g
(0
20.2 (72)
18.7 (63)
18.6 (S6)
rn
*59.2
51.6
49.0
*
83
73
67
If OM considers only the cudiompiratory prub1.r
group 3 (n-4, 3 dowand), tho m u l t m a m u follow :
ia
can concluda that pmopuativ8 acerciu w i n g for
patient.
undergoinq pulwnary m e i o n gives a m r e
disCti.i~tiw analysis
w i n g
thr
postqmrativ8
cudiorupiratory
capliwtionm
rather than
p ~ a l
pulmonary
function alom. B a r n r strict a i t u i a a m
difficult to .aka. Apart from W 2 w , the deterrination of
AT s n n also praising as a reliable pmdictor.
W.
Superiority and Safety of Maximal Exercise. Testing Early
After Myocardial Infarction.
Avanlndra Jain.G. Hunter Myers. Peter M. Sapin, Robert O'Rourke. The
University of Texas Health Science Center-San Antonio. San Antonio.
TX USA.
A predischarge low level (HR<70)6of age predicted) exercise treadmill
test (m)is commonly performed for risk suatification after
myocardial Infarction (MI). To assess the added benefit and safety of
eafly predUlarge maximal ElT, we performed symptom limited ElTs
uslng a modified Bruce p r o w l in a c o a ~ t i w
group of 150 p n (111
men and 39 women). The ETTs were performed a mean of 6.4t3.1
days after the MI. The mean age of the patients was 58+13 years.
Mywardial infarction was Qwave in 85 pts and nonQin 65 pts. Most
pts (83%)achieved a HR >70W of age predicted. The average exercise
duration war 9.7H.2 min with the peak HR of 122i23 beatshin and
peak systollc BP of 158+31 mmHg. No patient had infarct extension.
sustained ventricular tachycardia or death. Chest paln developed in
22 pts (13 pts with positive ElT). ElTs were posltive in 34 pts (23%)
(25 Qwave and 9 non-Qwave) at a HR<70% of age predicted. A
significantly more, 26 pts ( 9 Qwave and 17 nonQwave) had positive
ElTs only after HR >70%. The incidence of positive tests among
patients with Q and non-Qwave MI was the same (40%) at peak
exercise. With the mean follow up of 15 months in 138 pts (92%)
there were 50 cardiac events. Nine patients had recurrent MI, 14
patients had coronary artery bypass surgery, 26 patients had balloon
angioplasty. and one patient cardiac transplantation. Of the 9 pts with
cardiac wents only 2 had a positive FIT at low level but 7 had a
positive ElT at peak symptom limit end-point. Of the patients with
wents only 16 had a positive test at low level but 30 pts (p<.001) had
a positive test at peak exercise. Only 5/32 pts with negative exercise
tests had a cardiac event. Conclusion: Symptom limited exercise
treadmill test early after MI appear to be safe and will identify
additional patients with ischemia who are at risk for cardiac events.
- --
Thirthy patimnta who survivod a Tirst Antuior #11
Myocardial Infarction
followd in tbo first t a r n month..
Loft Vmntricular EWmymtolic and Enddiutolic volru,
u1cu1at.d by
Of ..ria1 Bohocudiograpby. L w r c i n
Tolru ruorrd by
of cudioprlmuy xxorcin
Tating using thm macm pratmal m a trwbi11at
diand a f t u thm .onth.. Peak Oryp.n [IpWu (Pw,) u
M u n d and the AM.robic Ihrw)rold (AT) u c.ala111at.d
ucordinq to the v-Slop. w+bod.
MOUl
u 59 f 8 par,
Yn L.it V . n t r i C U l ~
Sjoction m c t i m (lam) at tho thm .onth. p a i d cru 0.43 f
0.14. PW, incxmand significantly f m 21.3 f 1.5 vs 24.5 f
S.3 ml/min/kg(p0.02), w did tbo m
i
c =ld
(13.4 f
3.1 tn 14.6 f 3.0 ml/lin/Lp, pru). m
i
.
.
T i r -i
(7.0 f2.6 m 9.3 22.2 min, p0.01). and a u i m l effort is
dooumt.d by a
of 1.26 f 0.11 tn 1.28 i 0.14.
MOUl Loft V o n t r i d u EMsystolio Val- did not
(40.6 f 23 v8 48.3 f 20 m l , p n ) altbooph tlmm WON ..p.ndrrr
and nonup.ndar. nu Enddiutolic Volumn did not -i
sigmifioujtly Oitbr(lO4 f 34 m 112 f 28 d,-). I Y . ~
-11
lbtion Saon I n d u ru 1.77 f 0.44 at thmmtb..
Ih.m ru no cornlation brtmn tb. En&ystolia or Diddiutolic v o l u w at r w t and tb. ultirtm Peak
0
.
AppouuIt1y a c u c i n to1is pmnrvd in tbo firmt thm
month. a f t u a firat anterior n i l m i a l infarction,
dnpitm i n c r u u d LV vol-.
m l l a u p PW, by
of cardiopllrPnuy m i m a M i n g oould m i d . a valuable
tu,
futum -in
intolrill b. tb. r u n i t im
iMro.wd left vmltriculu vo1-.
-- -

Document 6425441

Transcription

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