Guillermo A. doPico

Nitrogen dioxide-induced pulmonary disease: five new cases and a review of the leterature.

Twenty-three patients exposed to nitrogen dioxide in agriculture or industry were referred to the University of Wisconsin Medical Center. Eighteen experienced a transient upper respiratory tract syndrome; five developed pulmonary edema or bronchiolitis obliterans. This latter group responded to steroid therapy but all demonstrated evidence of persistent pulmonary dysfunction on follow-up studies. Combining our findings with those in the literature we concluded: (1) exposure to NO2 is more common than generally appreciated; (2) case fatality is high--29% for silo-fillers disease; (3) steroids are effective therapy and should be continued for at least eight weeks; (4) although the majority recover without significant sequelae, some individuals may develop persistent functional abnormalities; (5) there is no evidence that long-term exposure to low concentrations of NO2 leads to chronic airway obstruction; and, (6) NO2-induced pulmonary disease could be elminated with appropriate preventive measures.

A comparison of the efficacy and tolerance of pancrelipase and placebo in the treatment of steatorrhea in cystic fibrosis patients with clinical exocrine pancreatic insufficiency

A comparison of the efficacy and tolerance of pancrelipase and placebo in the treatment of steatorrhea in cystic fibrosis patients with clinical exocrine pancreatic insufficiency

Grain fever syndrome induced by inhalation of airborne grain dust

To study the clinical and physiologic manifestations of the grain fever syndrome and the potentially pathogenic role of complement activation, 12 subjects (six grain workers and six healthy non-grain workers) underwent inhalation provocations with airborne grain dust. The clinical response was characterized by facial warmth, headache, malaise, myalgias, feverish sensation, chilliness, throat and tracheal burning sensation, chest tightness, dyspnea, cough, and expectoration. Fever developed in four grain workers and two controls. Leukocytosis, ranging between 11,700 and 24,300 leukocytes/mm3 with left shift, developed in five grain workers and five controls. There was no evidence of complement activation by the classical or alternate pathway. None of the subjects had serum precipitins to grain dust. The pulmonary response was characterized by a decrease in FEV1, FVC, MMF, Vmax50, and Vmax75, with significant rise in pulmonary resistance and consistent change in dynamic compliance but without changes in static compliance or diffusing capacity. Hence, grain dust inhalation induced diffuse airways obstruction without detectable parenchymal reaction. The airways response to high concentrations of grain dust inhalation were unrelated to the presence of immediate skin hypersensitivity. Although we cannot exclude the etiopathogenetic role of an immunologic reaction to grain dust, our data do not support the hypothesis that the grain fever syndrome is a precipitin-mediated allergic pneumonitis. More likely, the manifestations of grain fever probably reflect the host reaction to grain dust bacterial endotoxins and/or nonallergic mediator release by grain or grain dust constituents.

Farmer's lung.

Excerpt We have previously described the clincal features of an acute granulomatous interstitial pneumonitis that occurred in 39 agricultural workers after exposure to moldy organic farm dusts (1)....

Low-dose radiation pneumonitis

A case demonstrating fulminant radiation pneumonitis following a course of prophylactic whole lung irradiation at doses below 2000 rads, resulting in death, is presented. The importance of predisposing factors and the suspected “sensitizing” factor in this case are discussed.

Bronchodilating effect of oral theophylline-ephedrine combination☆

Abstract Ten adults with mild but continuously symptomatic asthma were compared with 10 nonsmoking normal persons. In Phase I after 2 wk without oral bronchodilators and 8 hr without aerosols, each subject received on five different days and in a randomized sequence either placebo, ephedrine 24 mg, theophylline 130 mg, theophylline + ephedrine, or theophylline + ephedrine +phenobarbital 8 mg. During Phase II, the 20 subjects took the theophylline-ephedrine-phenobarbital compound 4 times a day for 2 wk and continued this schedule for an additional 10 to 14 days while the five drug administrations of Phase I were repeated. The drug effects were evaluated by spirometry and flow volume loops and correlated and blood levels of theophylline. A single dose of the combination produced therapeutically useful bronchodilation of central and peripheral airways without producing much more frequent or severe side effects than either drug alone. The greater improvement that occurred by combining a low dose of theophylline with a low dose of ephedrine does not preclude a conclusion that similar improvement could have been achieved with a larger dose of theophylline. Addition of phenobarbital did not reduce symptoms of nervousness, tremor, or nausea. After 2 wk or longer of repeated doses, the combination produced about as much bronchodilation as after a single dose. Before the second set of measurements, theophylline levels had reached steady state after regular administration of 130 mg four times a day. Eight hours after the single dose, the mean serum level was 2.3 μg/ml; after 2 wk of repeated doses, 8 hr after a dose the mean was 5.3 μg/ml. Each drug, and the combination more than either, had a bronchodilating effect on small airways of normal subjects.