Zwi S

Transbronchial biopsy during mechanical ventilation

The diagnostic yield and risks of transbronchial biopsy (TBB) during mechanical ventilation were assessed in 13 patients with progressive pulmonary infiltrates. TBB was of considerable diagnostic value in ten patients and useful in excluding potentially treatable infections in the remaining three patients. Complications included two pneumothoraces, pulmonary hemorrhage in one case, and supraventricular tachycardia in another. No fatalities were attributable to TBB. TBB proved to be a relatively safe procedure, with a high diagnostic yield in these critically ill patients.

Ethnic differences in the occurrence of the M1(ala213) haplotype of alpha-1-antitrypsin in asthmatic and non-asthmatic black and white South Africans.

An ethnic study of 175 individuals, comprising 65 black and 110 white South Africans, has shown a conclusive difference in the frequency of the M1(ala213) haplotype of α1‐antitrypsin (P < 0.00001). The M1(ala213) haplotype occurred more frequently in the black group. In the latter group, the frequency of the M1(ala213) haplotype was the same in both controls (0.55) and asthmatics (0.53). However, there was a significant difference in the frequencies (0.19 and 0.36) for the respective white groups (P < 0.01), the frequency of the M1(ala213) haplotype being much higher in the asthmatics. Apart from the above differences, there was also a difference in the elastase‐inhibitory capacities of the homozygote phenotypes M1(val213) vs M1(ala213) (P < 0.0001), this capacity being lower in the latter phenotype. We conclude that the occurrence of the M1(ala213) allele of α1‐antitrypsin differs in various ethnic groups and may play a role in asthma.

Cryptogenic Fibrosing Alveolitis. A Study of an Indigenous African Population

Cryptogenic fibrosing alveolitis (CFA) has not been described previously in any large group of indigenous African patients. This was a retrospective study of 46 such patients diagnosed as having CFA during a 73-month period. The clinical spectrum of illness was similar to that of other groups studied worldwide. Cigarette smoking was associated with a poorer outcome and is a potentially preventable cause of deterioration.

Ankylosing spondylitis lung disease and Mycobacterium scrofulaceum

The development of apical pulmonary fibrosis and bullous disease is a rare but well recognized extra-articular manifestation of ankylosing spondylitis (AS). The fibrobullous disease is usually asymptomatic and diagnosed at an incidental radiological examination. When symptoms do develop, they are usually due to superimposed colonization or infection by bacteria, fungi or mycobacteria. Only six cases of non-tuberculous mycobacterial superinfection in AS have been reported. We report a patient with AS and progressive apical fibrobullous disease in whom Mycobacterium scrofulaceum was repeatedly cultured over a 12-year period.

Studies on the Nature and Aetiology of Respiratory Disability in Witwatersrand Gold-Miners Free of Radiological Silicosis

In an investigation into the cause of symptoms in gold-miners who have no radiological silicosis, the relationship of dyspnoea and physiological disturbances to dust exposure was examined. Forty-five subjects, aged 41 to 45 years, with normal chest radiographs and long service underground were chosen for study from the population of miners past and present. Thirty-four men only were tested, but the validity of the sample was checked by comparison with a similar group of miners reported previously. Each individuals dust exposure was estimated in “particle-hours”. A detailed history, including smoking habits, was followed by a clinical examination and a battery of lung function tests in each case. No significant relationship was found between dyspnoea and dust exposure or smoking. However, a negative correlation was observed between dust exposure and effort tests, implying that exercise capacity appeared best in those men whose dust exposure was greatest. Possible reasons for this finding are discussed. On the other hand, dyspnoea did correlate with airway obstruction and hyperventilation on effort, indicating a physiological rather than a psychological basis for the symptoms. Further, the higher incidence of cough, sputum, and rhonchi in the more disabled subjects suggested that chronic bronchitis might be the basis of their symptoms, but the cause of the bronchitis remains to be identified. It seems that dust exposure alone was not the cause, but the findings do not exclude the possibility of its being related to the occupation of mining with stresses such as inhalation of fumes and rapid changes in temperature, humidity, and altitude.

Respiratory Function of Witwatersrand Gold-miners: A Comparison between Radiologically Normal Miners and Control Non-mining Subjects.

The diagnosis of pneumoconiosis during life depends upon an industrial history and radiological examination (Carpenter, Cochrane, Gilson, and Higgins, 1956). However, many miners complain of dyspnoea but have no radiological changes at all. This has led to the supposition that long exposure to industrial dust hazards may lead to pulmonary disability which is not typical pneumoconiosis (Carpenter, and others, 1956; Pemberton, 1956). This disability might be due to a forme fruste of pneumoconiosis or something different, such as chronic bronchitis and emphysema (Pemberton, 1956). It is obviously important in the first place to establish whether, in the mining population as a whole, there