Respiration; international review of thoracic diseases
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Case Reports
Hypersensitivity pneumonitis concomitant with acute airway obstruction after exposure to hay dust.
The case of a non-atopic farmer who had developed severe respiratory as well as systemic symptoms upon exposure to hay dust during the past several years is presented. Inhalation challenge by his own hay induced an unusual association of peripheral and central airway obstruction beginning immediately, and hardly susceptible to therapeutic control, as well as the typical hypersensitivity pneumonitis reaction several hours later. ⋯ Only minimal aspergillus-specific IgE antibodies were found in the patient's serum. This case demonstrates that hay dust can cause bronchial obstruction as well as hypersensitivity pneumonitis in the same individual, with symptoms beginning immediately and lasting up to 2 days.
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Comparative Study
Pulmonary resistance and dynamic compliance as functions of respiratory frequency.
The behavior of pulmonary resistance (RL) and that of dynamic compliance (Cdyn) as functions of respiratory frequency (f) were compared in normal subjects and in patients with chronic obstructive pulmonary disease (COPD). Although both RL and Cdyn varied with f in most COPD patients and in some normal subjects, Cdyn appeared to be more sensitive than RL to variations of frequency; no significant changes in RL could be demonstrated in subjects in whom Cdyn was frequency dependent. ⋯ Compared with Cdyn, RL was more commonly nonlinearly related to respiratory frequency, often increasing at high breathing rates. Our results indicate that changes in RL with frequency are less predictable and more difficult to detect than the corresponding changes in Cdyn.
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We have previously reported a drop on wasted ventilation fraction (VD/VT) during exercise in patients with pulmonary vaso-occlusive diseases associated with collagen vascular disorders, despite an abnormally high mean pulmonary artery pressure and pulmonary vascular resistance at rest and during exercise. To further evaluate the diagnostic value of VD/VT measurements, we studied 8 subjects with normal spirometry, lung volumes and single-breath diffusing capacity who had previously demonstrated a high VD/VT at rest and during exercise. We found normal pulmonary hemodynamics in these subjects despite an abnormal rest and exercise VD/VT. Our findings effectively exclude hemodynamically significant pulmonary vascular obstruction, and do not support the use of VD/VT as a screening method for detecting diffuse pulmonary vaso-occlusive diseases.
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Case Reports
Bilateral hilar enlargement as a presenting sign of multiple primary bronchogenic carcinoma.
An asymptomatic patient presented with a chest roentgenogram showing bilateral hilar enlargement compatible with stage II sarcoidosis. However, evaluation revealed double primary bronchogenic carcinoma. A possible pitfall in the non-pathologic diagnosis of sarcoidosis and the implications of double primary bronchogenic carcinoma are discussed.
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The purposes of this study were (1) to confirm whether there were any differences between observed and predicted scores based on age, height, and sex in forced vital capacity (FVC), 1-second forced expiratory volume (FEV1.0), FEV1.0/FVC ratio, functional residual capacity (FRC), total lung capacity (TLC, FRC/TLC ratio, residual volume (RV), RV/TLC ratio, diffusing capacity of lungs for carbon monoxide (DCO), alveolar-capillary permeability (k'CO), and alveolar volume (VA) for 2 middle-aged non-smoking men who trained for and competed in three annual 26.2-mile marathon races and (2) to determine the magnitude and direction of changes in the observed scores for the three annual tests. The subjects trained from 45 to 70 miles/week for 52 weeks during the 3-year period. In the week after their annual marathon run they were measured in the above pulmonary variables. ⋯ Likewise, subject B improved three pulmonary variables (FRC, FRC/TLC ratio, and k'CO) and had small decreases in function of the other eight variables. It is not possible to draw statistical inferences to other populations from this data, but it does indicate that these subjects are in a state of good-to-great pulmonary health. Although random variations may account for some of the changes for these 2 subjects, it is possible that marathon training has inhibited some of the deterioration in pulmonary function as predicted from the regression with age by Kory.