Pulmonary tuberculosis.
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Biomedical subjects
Publications and source records attributed to D Siegler.
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Two patients are described in whom selective deficiency of IgA coexisted with a clinical condition compatible with a diagnosis of sarcoidosis. The literature on the rare association of the two conditions is reviewed. Any such association is probably coincidental.
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Previous reports have documented the occurrence of reversible electrocardiographic changes including right axis deviation, P pulmonale, right bundle-branch block, and ST-segment and T-wave abnormalities in patients with acute attacks of asthma. In a further systematic study, the electrocardiographs of 63 patients admitted with severe acute asthma have been evaluated. The most consistent change was an abnormally vertical P-wave axis in 78% of the patients. P pulmonale was present in 22% and right ventricular enlargement in only one patient. Right axis deviation, right bundle-branch block, and rhythm abnormality were not present in any patient. In 11%, ST-segment or T-wave abnormalities suggesting myocardial ischaemia were noted. These abnormalities persisted for up to nine days and were unexplained. Other ECG abnormalities in acute asthma may reflec positional changes of the heart due to overdistension of the lungs. All ECG changes resolved after clinical improvement.
Simultaneous washouts of nitrogen (N2) and helium (He) boluses were performed in 9 seated symptom-free asthmatic patients. Recent work has indicated a correlation between the height of Phase IV (deltaIV) of a vital capacity washout and the end-inspiratory vertical concentration gradient of the gas in the lung. The deltaIV for both He and N2 washouts increased by a factor of 2 and 1.25, respectively, after isoproterenol inhalation. In addition, the amplitude of the cardiogenic oscillations increased from a mean of 0.32 per cent to 0.51 per cent for N2 and from 0.030 per cent to 0.051 per cent for He. Closing volume measured by the He bolus method was higher than that by the N2 method in 8 of 9 subjects, by 3.7 +/- 0.7 per cent vital capacity (mean +/- 1 SE, P less than 0.001). Similarly, He closing capacity was greater than N2 closing capacity in the same 8 subjects by 2.6 +/- 1.3 per cent total lung capacity (P less than 0.001). Despite a decrease in closing volume in 8 subjects, and in closing capacity in all 9 subjects after isoproterenol, the differences between the results obtained by the 2 methods remained unchanged. The slope of Phase III in both N2 and He washouts was influenced in an inconstant fashion, probably reflecting differing contributions from topographic and intraregional inhomogeneities of ventilation in these subjects. The results suggest that in patients with asymptomatic asthma the vertical gradient of regional residual volume as well as the pattern of airway closure is more uniformly distributed between apex and base of the lung. Furthermore, the slope of Phase III in either N2 or He bolus washouts may not reflect the degree of bronchoconstriction.
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