Thorax
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A 53-year-old man, who had been exposed for 23 years to polyvinyl chloride (PVC) in the bagging area of a vinyl chloride polymerisation plant, presented with a diffuse micronodular infiltrate on his chest radiograph. Light microscopy of lung obtained by drill biopsy showed a diffuse infiltration with histiocytes and multinucleated giant cells, with some collagen formation. Ultrastructural studies showed foreign particles in the macrophages, which were identical with PVC powder viewed under the electron microscope. Incubation of PVC powder with human lung macrophages in vitro showed that the macrophages englufed the powder to give a similar ultrastructural appearance.
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The effect of unilateral vocal cord paralysis and intracordal Teflon injection on maximum expiratory and inspiratory flows was studied in 15 consecutive patients. Ten patients had a ratio of forced expiratory flow to forced inspiratory flow at 50% vital capacity (Ve50/Vi50) more than one. Of the remaining five, four had low Ve50 consistent with underlying bronchial disease. ⋯ In patients with an FEV1 less than 75% FVC, no consistent changes could be seen. We conclude that a high Ve50/Vi50 suggestive of variable extrathoracic airways obstruction is a frequent finding in the presence of unilateral vocal cord paralysis. Teflon injection does not cause a significant reduction in forced expiratory flows and improves inspiratory flows in subjects without evidence of underlying bronchial disease.