George F. Unger

Allergic bronchopulmonary aspergillosis in cystic fibrosis

One hundred patients with CF were screened for ABPA. Forty-eight male patients and 52 female patients with age range of 2 to 34 yr (mean 14.2) were studied. Patients were evaluated for skin reactivity and serum precipitating antibodies to Af, predominant sputum organisms, total blood eosinophil levels, total serum IgE, and Af-specific IgE and IgG, as well as abnormalities of pulmonary function and chest x-ray films. Careful evaluation of all patients with CF demonstrated that 10% had features indicative of ABPA, which is another potentially destructive pulmonary disorder. Thus careful evaluation of patients with CF, especially those with asthma, may be rewarding in uncovering a disorder that may slow progression of CF when it is appropriately treated.

Interstitial Lung Disease Due to Contamination of Forced Air Systems

Eight patients had hypersensitivity pneumonitis due to contaminated home or office forced-air heating or air-conditioning systems. We studied their clinical and laboratory features, and the results indicated that this disease may occur as an acute or insidious form differing in type and intensity of respiratory and systemic symptoms. Thermophilic actinomycetes contaminatinf the forced air systems were identified as the sensitizing agents in most cases. Precipitating antibodies to the organisms could be shown in the serums of the patients and the antigen identified by immunofluorescent studies in the three lung biopsies examined by this method. Inhalation challenge studies with the cultured organism or other materials obtained from the forced air systems reproduced the clinical syndrome in the four patients tested. Avoidance of the contaminated system, and the use of corticosteroids in more severe cases,seems to be appropriate therapy for patients with this disease.

Early detection of hypersensitivity pneumonitis in office workers

Symptoms of hypersensitivity pneumonitis in three employees in an office building led to an investigation of their work environment. An open spray water air cooling system was implicated when inhalation challenge with the spray water caused acute illness in one of them. A questionnaire survey of the 4,023 co-workers identified 48 other suspect cases, and laboaratory studies confirmed hypersensitivity pneumonitis in three additional workers of this group. A significant change in pulmonary function, occurring only after exposure to the work environment, was the most useful laboratory finding and was found in five workers with no other pulmonary abnormalities, but not is asymptomatic workers or controls, since five of the six patients with hypersensitivy pneumonitis worked in offices cooled by the spray water system and since three had positive responses to inhalation challenge, use of the spray water system was discontinued. The affected workers improved after they were removed from the office complex.

Experimental production of arachnoiditis with water-soluble myelographic media.

After myelography with either metrizamide (300mg l/ml) or meglumine iocarmate (280 mg l/ml), mild to severe arachnoid fibrosis was demonstrated radiographically and histologically in primates. Intrathecal injections of metrizamide (170 mg l/ml) or autologous cerebrospinal fluid produced less arachnoiditis. The risk of arachnoiditis is probably minimized by the use of reduced volumes and concentrations of water-soluble media. Controlled studies of arachnoiditis following myelography are probably more reliable in the primate model than in other experimental animals.

Gram-negative pneumonia.

Abstract The chest films of 58 patients with proved pneumonia due to Pseudomonas, Klebsiella, Enterobacter, Escherichia coli, Proteus, or Bacteroides were reviewed. Pseudomonas pneumonia was characterized by diffuse alveolar involvement with rapid progression to extensive macrocavitation. Fulminating lobar consolidation with bulging of adjacent fissures, massive cavitation, and empyema occurred in only a few cases of Klebsiella pneumonia but were felt to constitute the most diagnostic findings. No specific roentgenographic features could be attributed to the remaining pathogens, with the exception of massive empyema and lobar consolidation in Bacteroides infection.

Pigeon Breeder's Disease: A Review of the Roentgenographic Pulmonary Findings

In 1965 Reed et al. (21) reported an acute respiratory illness with systemic manifestations in 3 patients who raised pigeons as a hobby. Since that time, we have had the opportunity to study 9 additional patients. A number of these pigeon breeders had significant pulmonary changes on chest roentgenograms. It is the purpose of this communication to report these findings. Symptomatically and immunologically, pigeon breeders disease appears to belong to a group of pathologic entities which include farmers lung (7), bagassosis (5), mushroom pickers disease (4), maple bark strippers disease (8, 10), and pituitary snuff takers disease (18), all of which seem to involve a hypersensitivity reaction to a variety of inhaled organic dusts. Affected individuals develop specific precipitating antibodies in their sera to the materials associated with the respective disease. This is in contrast to the more common human hypersensitivity associated with skin sensitizing antibody but without precipitins (1). Eosinophi...

An Evaluation of the Effect of High-Dose Urography on Previously Impaired Renal and Hepatic Function in Man

Abstract The authors studied the effects of three common urographie contrast agents on the renal and liver functions of 82 patients with renal and/or liver disease as evaluated by standard function tests. Gross “before-and-after” measurements as well as a correlation of the log of the serum iodine with each laboratory test serially obtained during the period of excretion of contrast medium failed to reveal any systematic effect. The data suggest that angiographic procedures and the levels of contrast medium utilized in infusion urography are safe even when applied to patients with liver or renal failure.

Apparent reformation of the base of the skull following radiotherapy for nasopharyngeal carcinoma.

Skull radiographs of 11 selected patients with carcinoma of the nasopharynx were reviewed before and after radiotherapy. Apparent bone reformation was seen at the initial sites of osteolytic destruction within four to six months after delivery of cancericidal radiation dosages.

Ineffectiveness of Prophylactic Intrathecal Methylprednisolone in Myelography with Aqueous Media

The effectiveness of prophylactic intrathecal methylprednisone (MP) in preventing arachnoiditis from iocarmate myelography was studied. Monkeys were injected intrathecally with locarmate, MP, or a combination of the two. Twelve weeks later the severity of arachnoiditis was determined in each animal. There was no significant prophylactic effect of intrathecal MP on arachnoiditis from locarmate. Some arachnoiditis was found in control animals treated with MP alone.

Fractures of the pterygoid processes accompanying severe facial bone injury.

Abstract Twelve patients with severe facial fractures of the Le Fort II and III types or fractures of the zygomaticomaxillary compound were examined roentgenographically using multidirectional laminagraphy and found to have associated fractures of the pterygoid processes. Detection of damage to the pterygoids is considered significant because of the relationship of important adjacent anatomical structures. A brief discussion of pertinent facial fractures and anatomy is included.