Pneumomediastinum: a complication of exposure to bromine.
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Biomedical subjects
Publications and source records attributed to R Breuer.
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To establish the progenitor role of bronchial epithelial cells in the steady state, we undertook a quantitative autoradiographic study in normal hamsters. Groups of 7 hamsters were killed 1 h and 1, 2, 3, 4, 7, and 14 d after an intraperitoneal injection of [3H]thymidine (2 microCi/g body wt). Autoradiograms were prepared from 861 Epon sections, 2 microns thick, of left intrapulmonary hilar bronchi. Epithelial cells were classified into 1 of 7 categories: basal-1 (B1) and basal-2 (B2), depending on nuclear height; secretory cells denoted as S1 with zero to 4 granules, S2 with 5 or more granules with intervening cytoplasm, and S3 with abundant granules completely filling the cytoplasm; ciliated (C); and indeterminate (IN). Mean silver grain counts decreased significantly over time only for B1 cells (P less than 0.05), with a cell cycle time of 20.6 d and a DNA synthetic time of 7.5 h. Labeled cells, 1 h after thymidine injection, comprised 30.5% S1, 27.8% B1, 22.8% B2, 6.8% IN, 6.4% S2, 5.7% C, and 0% S3 cells. Labeling indices of individual cell categories (LIc), at 1 h after labeling, were highest for B1 followed by B2 cells, reflecting their proliferative intensity. Labeling index of all epithelial cells combined did not change with time, indicating that there was no major cell death or label dilution. The LIc decreased significantly over time only for B1 and B2 cells (P less than 0.001 and P less than 0.002, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Hamsters exposed to an intratracheal instillation of human neutrophil elastase (HNE) accumulate an abnormally high number of secretory granules in bronchial but not tracheal epithelial cells. We employed lectin cytochemistry to investigate possible differences in the epithelial cell surface glycoconjugate layer in trachea compared to bronchus which might explain the regional dissimilarity in response to HNE. Portions of glutaraldehyde-fixed trachea and bronchi were incubated in one of several ferritin-labeled lectins prior to embedding for transmission electron microscopy. Lectins from Ricinus communis, Helix pomatia, and Triticum vulgaris bound to the surface of tracheal secretory cells in moderate to profuse amounts, while most bronchial secretory cells showed little or no label with these lectins. Gold-labeled Helix pomatia agglutinin (HPA), a lectin specific for secretory cells, showed a decrease in surface binding to all tracheal secretory cell types within 2 h of HNE instillation, compared to saline controls. In contrast, the majority of bronchial secretory cells showed an HNE-induced increase in surface label from extremely low levels in saline controls. The low levels of lectin binding to bronchial cells, in contrast to the trachea, may indicate the lack of a protective surface glycoconjugate coat, thus explaining the vulnerability of these cells to HNE. The rise in number of accessible HPA binding sites on the surface of bronchial secretory cells exposed to HNE may represent an important event in the pathologic accumulation of secretory granules by these cells.
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Pneumocystis carinii is a common cause of pneumonia in the immunosuppressed patient. Its radiological findings are usually homogeneous, diffuse and bilateral. We present a 27-year-old woman with non-Hodgkin's lymphoma presenting with unilateral right lung parenchymal infiltrates due to Pneumocystis carinii. In the immunosuppressed host, pneumonia limited to one lung should not preclude the diagnostic possibility of Pneumocystis carinii infection.
Studies were undertaken to evaluate the in vitro properties of recombinant human secretory leukocyte-protease inhibitor (rSLPI) that had been made in Escherichia coli in an inactive form and refolded, and to determine whether emphysema and bronchial secretory cell metaplasia, induced in hamsters by intratracheal treatment with human neutrophil elastase (HNE), could be amelio-rated by prior intratracheal instillation of rSLPI. Chromatographic studies indicated that 3H-rSLPI formed a 1:1 complex with HNE. Blockage of the active site of HNE by a covalently bound tetrapeptide chloromethyl ketone reduced complex formation with 3H-rSLPI by more than 98%. Incubation of 3H-rSLPI-HNE complex with alpha 1-protease inhibitor for 3 hours at 37 degrees C decreased the amount of complex compared with incubation in the presence of bovine serum albumin (70% vs 27% dissociated). The calculated dissociation rate constant was 1.1 x 10(-4) sec-1, indicating a 1.8 hour dissociation half-life. Dissociated 3H-rSLPI retained its ability to recombine with HNE. rSLPI was as effective at inhibiting HNE released from stimulated neutrophils as 3H-rSLPI was at inhibiting purified HNE. Intratracheal pretreatment of hamsters with 3000 micrograms of rSLPI as long as 8 hours before the intratracheal instillation of 250 micrograms of HNE, resulted in significant protection against induction of emphysema and secretory cell metaplasia. One and 4 hours after instillation of rSLPI, 59% and 44%, respectively, of the initial functional activity was recovered in lung lavage supernatant, indicating a half-life of approximately 2 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
A study was undertaken to determine whether emphysema and airway secretory cell metaplasia, induced in hamsters by intratracheal treatment with human neutrophil elastase (HNE), could be moderated by pretreatment with human alpha 1-protease inhibitor (API). API (4.9 mg) was given intratracheally to hamsters 1 h before 0.3 mg HNE. Eight weeks later, lung volumes and pressure-volume relationships were measured in the anaesthetized animals. Mean linear intercepts and secretory cell indices were measured in lung sections. API given 1 h before HNE moderated the development of bronchial secretory cell metaplasia. The severity of emphysema was reduced by 75%. Clearance studies indicated that 80% of the functional activity of instilled API could be lavaged from the lungs after 1 h, indicating a 4 h half-life in the lavageable compartment of the lungs. We calculate that for 50% protection from emphysema the molar ratio of lavageable API to HNE at the time of HNE instillation was 4.8 as compared with 0.78 for 50% inhibition of elastolytic activity in vitro, indicating that API is only 16% as efficient in vivo as compared with its in vitro HNE inhibitory effectiveness. Nevertheless, we conclude that human API given intratracheally is efficacious against HNE-induced emphysema and secretory cell metaplasia.
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It is known that human neutrophil elastase (HNE) treatment of hamster tracheal explants causes the release of glycoconjugates, most of which appear to have the characteristics of mucus glycoproteins. This study was designed to determine the origin of HNE-induced glycoconjugate release from 1-day-old cultures of adult hamster trachea. After confirming that HNE treatment released glycoconjugates from cultures labeled with tritiated glucosamine, light microscopic autoradiograms and electron micrographs were prepared. Untreated cultures and cultures treated with inactivated HNE served as controls. HNE treatment caused a 40 to 50% decrease in the silver grain count on the external apical surfaces of secretory cells (p less than 0.05) and ciliated cells (p less than 0.01). Silver grain counts in secretory and ciliated cell cytoplasm, submucosa, and nontissue background were not significantly different from controls. The percentage of nongranulated secretory cells and the number of secretory granules in granulated secretory cells were similar in the HNE-treated and untreated controls. There was no evidence of constitutive release of radiolabeled glycoproteins, or of discharge of secretory granules from the secretory cells. We conclude that HNE releases mucins and other glycoconjugates from the external surfaces of both secretory and ciliated cells in tracheal organ culture.
Human neutrophil elastase (HNE) causes secretory granule discharge and conversion of many Clara cells to mucous cells in hamster bronchi. We investigated whether the trachea responds to HNE in a similar manner because of its abundance of Clara cells. By light microscopy, the tracheal epithelium of animals exposed to a single intratracheal injection of HNE was normal at 21 days, although bronchial secretory-cell metaplasia (SCM) was present. An ultrastructural differential cell count showed no increase in the proportion of granulated secretory cells in HNE-treated animals at 8 and 21 days postinjection compared to saline or untreated controls. At 2 h, the percentage of granulated secretory cells was lower and that of granulated secretory cells was higher in HNE-treated animals than in controls. The HNE-treated animals had fewer secretory granules per cell profile and more surface undulation than controls. By 1 day, the differential cell count and number of granules per cell profile were normal. Saline did not affect the differential cell count or granule number at any time. Ultrastructural study of untreated trachea disclosed the same three types of Clara cell that are found in the bronchus, but their frequencies, with one exception, are significantly different in the two regions. We conclude that HNE acts as a secretagogue in both trachea and bronchus but that an amount of enzyme sufficient to cause bronchial SCM does not induce a similar lesion in trachea. Heterogeneity of Clara cell types in hamster airways may explain the regional variation in secretory-cell modulation by HNE.
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Pulmonary complications of lymphangiography are not uncommon. Clinical manifestations vary from asymptomatic radiological pictures to severe hemorrhagic pneumonitis or a syndrome resembling massive pulmonary embolism. We report a 17-year-old girl with Hodgkin's disease who developed pneumonitis following lymphangiography.
We report an unusual case of unresolved pneumonia in a 59 yr old woman due to endobronchial lipoma and actinomycosis, two rare diseases that have never been described before in the same person.
Hamsters were exposed to an intratracheal instillation of 0.5 ml of 0.08 N nitric, hydrochloric, or sulfuric acid to determine their airway epithelial response. Three weeks after exposure, the left intrapulmonary bronchi in Alcian blue/PAS-stained paraffin sections were evaluated for the amount of secretory product in the airway epithelium as a measure of secretory cell metaplasia (SCM). Compared to saline-treated control animals, all three acids caused statistically significant SCM. In addition to the bronchial lesion, all three acids caused similar interstitial fibrosis, bronchiolectasis, and bronchiolization of alveoli that varied in individual animals from mild to severe. In a separate experiment to study the persistence of the SCM, hamsters treated with a single instillation of 0.1 N nitric acid showed significant SCM 3, 7, and 17 weeks after exposure. There was a high correlation (r = 0.96) between a subjective assessment of SCM and objective assessment using a digital image-analysis system. We conclude that protons induce SCM independently of the associated anion; the SCM persists at least 17 weeks. Sulfuric acid is an atmospheric pollutant and nitric acid may form locally on the mucosa of lungs exposed to nitrogen dioxide. These acids may contribute to the development or maintenance of the SCM seen in the conducting airways of humans with chronic obstructive pulmonary disease.