Biomedical subjects
Publications and source records attributed to E Russi.
A case of stomach rupture in a 47-year-old scuba diver is reported. Symptoms of gastrointestinal expansion during ascent are quite common and are caused by decompression of swallowed air. Gastric perforation is however rare, and needs to be promptly recognized and surgically repaired.
Bronchial hyperreactivity is considered to play a major role in the pathogenesis of asthma. Airway reactivity can be reproducibly quantitated by bronchial provocation procedures. Various physical or chemical stimuli may be applied, and inhalational challenge with methacholine is becoming a routine test in pulmonary function laboratories. The indications for, and clinical value of, measurement of bronchial reactivity are described, and possible mechanisms of hyperreactivity are discussed.
Medical complications of heroin overdose and the diseases of addicts play an increasingly important role in the daily routine of hospital medical departments. The percentage of drug-related admissions to the Medical Clinic of the University Hospital, Zürich, increased from 0.18% to 4.45% between 1972 and 1983. During this 12-year period, 492 patients were admitted 569 times because of heroin overdose or intoxications combined with other drugs, and 191 drug addicts were hospitalized 226 times for a variety of medical problems. Certain complications, such as heroin pulmonary edema and talc granulomas of the lung, occur only in parenteral drug addiction. Other diseases such as right heart endocarditis, Candida-endophthalmitis, septic arthritis and osteomyelitis are almost exclusively observed in intravenous drug abusers. Sexually transmitted infections and hepatitis B are frequently diagnosed in addicts.
Some allergic sheep respond to inhalation of Ascaris suum antigen with both immediate and late increases in airflow resistance (late response). The mechanism of the late response is unknown but recent evidence suggests that the initial generation of slow-reacting substance of anaphylaxis (SRS-A) immediately after antigen challenge is a necessary pre-requisite for the physiologic expression of this late response. Based on this evidence we hypothesized that airway challenge with leukotriene D4 (LTD4), an active component of SRS-A would produce acute and late airway responses in allergic sheep similar to those observed with antigen. In five allergic sheep with documented early and late pulmonary responses to Ascaris suum antigen, inhalation of leukotriene D4 aerosol (delivered dose (mean +/- SE) 0.55 +/- 0.08 ug) resulted in significant early and late increases in specific lung resistance (SRL). In three allergic sheep which only demonstrated acute responses to antigen, LTD4 aerosol (delivered dose 0.59 +/- 0.09 ug) only produced an acute increase in SRL. In the late responders pretreatment with aerosol cromolyn sodium (1 mg/kg) did not affect the acute response but blunted the late increase in SRL. Pretreatment with aerosol FPL-57231 (1% w/v solution) completely blocked both the acute and late responses. These data support the hypothesis that initial release of LTD4 in the airways of sensitive animals is important for the physiologic expression of the late response.
Some patients with allergic asthma exhibit late-phase responses to inhalation challenge with specific antigen. However, the duration of these responses is difficult to determine because of diurnal variations in airway function, a common phenomenon in patients with asthma. We therefore examined the pattern and duration of pulmonary function in six asymptomatic patients with a history of ragweed asthma and a documented late-phase response after specific and nonspecific bronchial challenge and compared them to responses after control challenge with normal saline. On 3 different days, specific airway conductance (SGaw) and gas distribution by the single breath nitrogen test were measured before (9:00 A.M.) and hourly for 24 hours after inhalation challenge with either normal saline, ragweed extract, or histamine at concentrations sufficient to decrease SGaw immediately by 35% or more. The fluctuations in SGaw after saline and histamine were considerable but failed to follow a typical diurnal or biphasic pattern. There was no difference in mean SGaw between the histamine and saline challenges from 1 to 24 hours after inhalation. In contrast, ragweed challenge produced a typical late-phase response followed by partial recovery of mean SGaw. However, mean SGaw remained subsequently lower than after saline challenge throughout the remaining observation period with fluctuations about this lower level. Gas distribution demonstrated marked intra- and intersubject variations and was therefore not different among the three challenges at any time of measurement. These observations suggest that a single specific but not nonspecific bronchial challenge causes prolonged airflow obstruction in subjects with allergic asthma that lasts 24 hours or longer, independent of variations in baseline airway function.
We investigated the comparative effects of oral and inhaled verapamil on specific airway conductance (SGaw) and allergic bronchial reactivity. Ten asymptomatic subjects with ragweed hypersensitivity and a history of bronchial asthma were studied on four different days, without and with pre-treatments by oral (160 mg) or inhaled (20 mg) verapamil. Bronchial reactivity was measured as the cumulative provocative dose of ragweed antigen which caused a 35 percent decrease in SGaw, ie PD35. The amount of inhaled verapamil actually deposited in the tracheobronchial tree was estimated to be 0.56 mg. Mean SGaw was not affected by either mode of administration; mean SGaw (SE) was 0.13(.02) and 0.12(.02) L/sec-1 before and .14(.02) and 0.12(.02) L/sec-1 after oral and inhaled verapamil, respectively. Mean (SE) PD35 was reproducible on two control days, ie 0.9(.4) and 0.8(.4) breath units, respectively. Inhaled verapamil increased mean PD35 to 18.8 (10.8) breath units (p less than 0.02), while oral verapamil had no significant effect on mean PD35. This study demonstrates that route of administration of calcium antagonist verapamil is an important factor in protection against antigen-induced bronchoconstriction. Inhalation of verapamil appears to be more effective than oral administration.
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Acute cyanide poisoning is a rare but usually fatal intoxication. Rapid diagnosis and immediate initiation of therapy are important, since a number of effective and potentially life-saving antidotes are available. Pathophysiology, signs, symptoms, course and therapy are discussed, and three personal observations are presented.
Principles of aerosol therapy are reviewed. Physical aspects and generation and deposition of aerosols in the tracheobronchial tree are discussed. Since pressurized aerosols are often used incorrectly, the author concentrates on their rationale and efficient administration.
Analbuminemia (idiopathic hypoalbuminemia) is a rare congenital anomaly of albumin characterised by very low levels of this protein. Only 21 cases have been reported in the literature. The lack of albumin is "compensated" by increased amounts of various circulating plasma proteins. Other not well understood regulatory mechanisms are responsible for the absence of severe clinical consequences. Clinical aspects, genetics and pathophysiology of this disease are discussed.
Despite very low amounts of albumin (1.7 mg/100 ml) the total plasma protein concentration of a patient with congenital analbuminemia was only slightly reduced to 6.3 g/100 ml. The lack of albumin is compensated by high concentrations of many other plasma proteins. Among the plasma proteins measured, alpha 1-antitrypsin showed a particularly high level. To investigate the underlying mechanism of this increase we purified plasma alpha 1-antitrypsin from the patient, labelled it with 125I, and studied its turnover in the analbuminemic patient and two normal volunteers. A half-life of 15 days in the patient compared with 7.5 and 8 days in the normal volunteers was found. The calculated synthesis rate of alpha 1-antitrypsin was about twice as high in the patient as in the controls. Therefore, both a longer half-life and an increased synthesis rate contribute to the high level of alpha 1-antitrypsin in the plasma of the analbuminemic patient.
Three cases of multiple opportunistic infections in previously healthy homosexual males were observed in 3 different University Hospitals in Switzerland. Two of the patients died. Infections were multiple, with P. carinii pneumonia (3 cases), chronic mucocutaneous ulcers probably due to Herpes simplex virus (2 cases), mucosal candidiasis (2 cases) and disseminated infections due to cytomegalovirus (1 case) and Mycobacterium avium (1 case). All patients had depressed cellular immunity with marked lymphopenia. These cases are similar to those recently observed in the United States, but two of the patients had never been to the USA although both had vacationed in Haïti where the syndrome has been described. These patients illustrate that this new syndrome should also be suspected outside the USA when a patient (especially a male homosexual) presents with persistent fever of unknown origin and develops opportunistic infections without obvious underlying disease.
A case of subacute endocarditis caused by Actinobacillus actinomycetemcomitans is reported. After successful treatment with ampicillin and tobramycin, the destroyed aortic valve was replaced and a communication between an aneurysm of sinus of Valsalva and the right atrium was closed. A further 23 well documented cases from the literature are reviewed.
Transbronchial lung biopsy using fiberoptic bronchoscope under fluoroscopic guidance was performed in 25 consecutive patients. 13 patients had diffuse lung disease and 12 exhibited infiltrates or nodules without endobronchial lesions. Satisfactory specimens were obtained in 22 of 25 cases. Diagnosis was accurate in 84% of diffuse and 58% of localized lung disease cases. The over-all diagnostic accuracy was 72%. 11 patients had malignant and 7 patients non-malignant interstitial diseases. In 4 patients with abnormal chest radiographs, normal lung biopsies were obtained. There were no serious complications. The fiberoptic transbronchial biopsy technique can be recommended as a safe and well tolerated method with a good diagnostic yield and a low complication rate. The indication, technique, prophylaxis for complications and problems of interpreting small biopsy specimens are considered.
Serological markers for hepatitis virus B (HBV) infection and the occurrence of hepatopathies were analyzed in 152 patients during the hemodialysis period and on average 3.8 years after receiving a renal allotransplant. At the beginning of hemodialysis, 25% of the patients showed signs of an ongoing or past infection with HBV (10% hepatitis virus B surface-antigen [HBsAG] positive and 15% anti-HBsAG positive). At the time of transplantation, 20% of the patients were positive for HBsAG and 25% had detectable anti-HBs. At the end of the study, 31% of the patients were positive for HBsAG and 25% had detectable anti-HBs. In 21 patients (14%) inflammatory liver disorders were observed: transitory hepatitis (7 patients), chronic persistent hepatitis (7 patients), chronic aggressive hepatitis (3 patients) and active cirrhosis (2 patients). Two patients had died in liver coma. All 21 patients with inflammatory hepatopathy had detectable HBsAG at the time of diagnosis, and all patients with chronic inflammatory liver disease were HBs carriers. In most of these patients the carrier state had been present for more than 3 years before diagnosis.
A case of giant cell arteritis of intracranial vessels diagnosed by autopsy is described. Giant cell arteritis of the proximal basal brain arteries was exceptionally marked in a man of 60 years. The clinical course, laboratory findings and the pathological alterations of the brain and intracranial blood vessels are described. The case is discussed on the basis of the literature on giant cell arteritis with cerebral symptoms as well as on granulomatous giant cells arteritis of the brain. A separation of these two entities does not seem justified.
A fatal case of Pneumocystis carinii pneumonia in a previously healthy homosexual man with no evidence of malignancy is reported. Despite appropriate treatment with high doses of i.v. trimethoprim-sulfamethoxazole, the patient died.
We assessed, by means of the [14C]-2-deoxy-D-glucose autoradiography method, the effect of whole-brain x-radiation on local cerebral glucose utilization in the rat brain. Animals were exposed to conventional fractionation (200 +/- cGy/day given 5 days a week) to a total dose of 4000 cGy. Metabolic experiments were made 2 weeks after completion of the radiation exposure. In comparison with control and sham-irradiated animals, cerebral metabolic activity was diffusely decreased following irradiation. Statistically significant decreases in metabolic activity were observed in 13 of 27 brain regions studied. In general, brain areas with the highest basal metabolic rates showed the greatest percentage drop of glucose utilization. Post-irradiation metabolic alterations possibly provide an explanation for the syndrome of early delayed deterioration observed in humans after whole-brain radiotherapy.