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A patient with far-advanced oral, lymph node and pulmonary infection with Paracoccidioides brasiliensis was treated with amphotericin B because of hypersensitivity to sulfonamides. Oral lesions dis- sappeared with minimal scarring. Initially spectacular radiographic infiltration improved markedly. Minimal physiologic abnormalities remained unchanged.With increasing population mobility, South American blastomycosis is likely to be found more often in non-endemic areas. Clinical features, fungal characteristics and therapy are discussed

Lung volumes and ventilatory capacity of 9,076 coal miners were determined during the period 1969-1971. The data collected indicate that, while coal mining may in certain instances lead to very minor reductions of ventilatory capacity, such reductions are minimal in the absence of complicated pneumoconiosis and would not be associated with respiratory disability. (CIS Abstr.)

Bei der inhalatorischen Zinknebelvergiftung handelt es sich im wesentlichen um eine Veratzung der Atemwege und Lungen durch Zinkchlorid bzw. Salzsaurenebel. Durch das chemisch-toxische Lungenodem und eine evtl. akut auftretende interstitielle Lungenfibrose ist nach 5–12 Tagen mit bisweilen deletaren Folgen zu rechnen. Anhand von 3 charakteristischen Eigenbeobachtungen werden Klinik, Verlauf und Komplikationen beschrieben. Durch gezielte therapeutische Masnahmen (Dexamethason-Inhalationen, hochdosierte parenterale Corticosteroid-Therapie, antibiotische Abschirmung und Elimination des inkorporierten Zinks durch den Chelatbildner D-Penicillamin) konnten die Vergiftungsfolgen wesentlich gemildert werden. In einem Fall gelang es den bereits eingetretenen generalisierten fibrotischen Lungenprozes durch eine Langzeit-Therapie mit kleinen Corticoid-Dosen bis auf einen minimalen Restbefund zu bessern.

Twenty-two women and 18 men, nonnative, longterm Denver residents* ranging in age from 11 to 56 years, who took diphenylhydantoin (DPH) for two or more years, underwent pulmonary function testing. Forty-five percent of the subjects had reduced steady-state diffusing capacities (D LCO ) and abnormal blood gas tension during exercise. In addition, half of the subjects studied had widened resting and exercise alveolar-arterial oxygen (A-aDO 2 ) tension differences, and/or failed to increase D LCO as expected with exercise. Macrocytosis and abnormal lung functions occurred together with remarkable frequency. However, lung function abnormalities persisted after the mean corpuscular volume (MCV) returned to normal, which suggests that macrocytosis and abnormal lung function are independent responses to DPH in a susceptible host. Subjects receiving DPH before eight years of age exhibited abnormalities twice as often as those beginning therapy fatter in life.

Imbus, H. R. and Suh, M. W. (1974).British Journal of Industrial Medicine,31, 209-219. Steaming of cotton to prevent byssinosis—a plant study. Pulmonary function tests, respiratory questionnaires, and dust measurements were made in a cotton spinning plant during the processing of steamed cotton and after its discontinuance. During steaming the average drop in FEV1 (Δ FEV1) from the beginning to six hours into the work shift was 19 ml, and after steaming was discontinued 62 ml. In addition, the FEV1 measurements, before work on the first day of the work week, were 60 to 100 ml higher during the time of steaming. The improvement in Δ FEV1 with steaming was much greater for males than for females. Improvement was greatest in the higher dust areas, namely, opening, picking, blending, and carding, and less in spinning, winding, and twisting. Questionnaire results did not reveal any significant difference in the incidence of symptoms of byssinosis during the two periods, the reasons for which are not clear. There was an approximately 30% reduction in elutriated and total dust.

To determine the long-term effects of air pollutants on adolescents, 42 high school students from an urban industrialized area (Barberton, Ohio) were compared with 50 from a rural area (Revere, Ohio). The comparative measures were vital capacity (VC), forced expiratory volume (FEV1.0), maximal midexpiratory flow (MMF), and maximal indirect oxygen consumption ([Vdot]o2 max). The subjects were all males and were drawn from original populations that were studied three years ago with VC and FEV0.75 being the tests of pulmonary function used. The results of this study were similar to those of the first. The Barberton group had a mean VC that was lower than the mean of the Revere group (P < .01). Neither FEV1.0 nor MMF were significantly different but [vdot]o2 max was P < .01). Since values for air pollutants are consistantly higher in Barberton, it is concluded that such pollutants should be considered important contributory factors in the impairment of cardiopulmonary functions.

Lung function and structure were studied in anaesthetized rabbits subjected to endotracheal instillation of Hartmann's solution (Group I) or 0.1 N HCl (pH 1.0) (Group II) in order to differentiate mechanical effects from those caused by the chemical burn. In both groups a marked and similar decrease in static lung compliance and Pao2 was observed 10 minutes after the instillation. During the subsequent hour the measurements changed towards recovery in Group I, while in Group II they fell to approximately 50% of baseline, and profound metabolic acidosis developed. The lungs showed histological changes similar to those of the clinical acid aspiration syndrome with the possible presence of a localized consumption coagulopathy. The data suggest a biphasic response to acid aspiration. The early disturbance, independent of the pH of the aspirate, is attributed to airway closure and alveolar collapse following contact between the fluid and airway receptors, and to alveolar instability resulting from an alteration in alveolar surface forces. Subsequent deterioration resulted from the acid burn.

Five patients were examined with respect to pulmonary mechanics before and after laryngectomy. Methods were used, the results of which were not influenced by the laryngeal stenosis before and by any stenosis of the tracheostoma after the operation. It was shown that the pulmonary resistance from trachea to pleura was normal before operation. Postoperatively pulmonary resistance increased and reached a maximum after six months, when it was about ten times as high as preoperatively. One year after operation it was not more than about twice the original value. At that time lung function was normal as concerns working capacity and arterial blood gases. A great adaptability of the airways was thus shown. The dangers and problems during the period of adaption are discussed.

The prevalence of bronchitis was found to be unrelated to dust level but for women was related to years of exposure. The change in symptoms of bronchitis was unrelated to dust level or to length of exposure. There was, however, an increased prevalence of bronchitis in the cotton mills when compared with the man-made fibre mills, and also over the two-year period a greater proportion of symptom-free workers developed symptoms and a lower proportion of those with symptoms lost their symptoms in the cotton mills than in the man made fibre mills. The prevalence of byssinosis was related to smoking habits, the smokers having about 1 -4 times as much byssinosis as the non- and ex-smokers after allowing for exposure. Byssino sis was associated with the dust level and years of exposure, more so for the women, and an association between the incidence of new cases over the two years and dust level was also found. After allowing for dust level, years of exposure, and smoking there were still differ ences between the occupational groups in byssinosis prevalence. Strippers and grinders had the highest prevalence followed by drawframe tenters. Speedframe tenters, card tenters, and comber tenters had similar prevalences and ring spinners the lowest. In the three-year prospective survey of cotton workers described by Molyneux and Tombleson (1970) the prevalence of byssinosis was found to be higher in coarse mills than in medium mills and to vary with occupation. Also the prevalence of bron chitis was higher in those with byssinosis. The analysis of the acute and chronic changes in lung function was given by Berry et al. (1973), and the Monday fall in forced expired volume during the

Lyons, J. P., Ryder, R. C., Campbell, H., Clarke, W. G., and Gough, J. (1974). British Journal of Industrial Medicine, 31, 36-44. Significance of irregular opacities in the radiology of coalworkers9 pneumoconiosis. A correlation study of ventilatory, morbid anatomical, and radiological findings 95 deceased coal miners who suffered with simple pneumoconiosis during life was undertaken using the new ILO U/C International Classification of Radiographs of Pneumoconiosis, which now provides for the occurence of irregular opacities in addition to the classical rounded opacities. The study was carried out with a view to ascertaining the frequency of occurrence and the significance of irregular opacities in coalworkers9 pneumoconiosis. Two ϰ-ray films with an average interval of 11 years between them were reported on in each case. The results showed that irregular opacities amounting to category 1 or more were present in 20% of the earlier films and in 48% of the later ones. Exceptionally they occured alone but were usually admixed with classical rounded opacities. Irregular opacities correlated positively with the extent of emphysema and the impairment of FEV 1 whereas rounded opacities did not. Possible pathological causes for the irregular opacities are discussed and it is maintained that coalworkers9 pneumoconiosis is the most probable one. Finally, it is suggested that the significance of these irregular changes may have been underrated in certain cases hitherto, with consequent underestimation of pneumoconiosis and its related effects. Morphological findings in a typical case showing radiologically mixed irregular and rounded opacities are demonstrated.

The experiments in this paper pertain to theory developed in a preceding article of Respiration Recording of expiratory gas concentration curves yield parameter values with good reproducibility, e. g. RHe, MHe, He1.5, measures for several aspects of uneven ventilation, and Rco2 a measure for unequal distribution of ventilation-perfusion ratio in the lung. The minimum radius of curvature of He and CO2 curves, RHe and Rco2 resp., is compared with clinical diagnoses and a correlation is shown of RHe, Rco2 and emphysema. The values of RHe and Rco2 correlate significantly with other lung function parameters. The pathological slope (M) of the alveolar plateau is suggested to be caused by a gradual change in ratio between the flows from individual lung regions. This is proved with bronchospirometry. With the parameter He1•5 it might be possible to reveal disturbances in small parts of the lung.

(1964). Lung Function in Talc Workers. Archives of Environmental Health: An International Journal: Vol. 9, No. 5, pp. 559-566.

Lung function was studied in 19 male workers with heavy exposure to B. subtilis enzyme during the manufacture of detergents containing the enzyme. Physiologic impairment of lung function was found in 17 of the 19. All 17 subjects showed impaired pulmonary gas exchange with reduced CO-diffusing capacity and increased alveolar-arterial O2 gradient. Seven of the 17 showed reduction in air-flow rates in addition to abnormal exchange. The other 10 had normal air flow rates, but six showed premature airway closure when this test was performed. It is postulated that heavy exposure to B. subtilis enzymes produces abnormalities in lung function by affecting the small airways (

Standard tests of pulmonary function were carried out in 6o subjects exposed to asbestos dust for a prolonged period. The results of these tests have been correlated with the clinical and radiographic findings. In 10 patients, while the chest radiograph was compatible with asbestosis, the dominant functional pattern was characteristic of airways obstruction. These subjects did not admit to symptoms of cough and sputum of greater severity or to heavier smoking than was found in other subjects with a restrictive ventilatory defect and no airways obstruction. Possible explanations for airways obstruction occurring in patients with radiographic evidence of asbestosis are suggested.

SUMMARY Lung function studies were made on a total of 173 patients before and after elective surgery. Functional residual capacity was reduced postoperatively and this reduction was most severe in those patients who underwent an upper abdominal operation. In this group, the postoperative reduction in functional residual capacity was related to the concomitant increase in alveolar/arterial Po2 difference. Studies of the distribution of ventilation showed that the alveolar/arterial Po2 difference was related to the amount of closure of small airways. The increase in alveolar/arterial Po2 difference following upper abdominal surgery was associated with an alteration in the relationship of functional residual capacity to the volume at which small airways close.

Lung function, body muscle, levels of habitual activity and exercise performance were measured in young adult men and women of African origin in Jamaica and Trinidad. The results were compared with those of men and women of European descent studied by the same methods in Leeds, England. Lung function was very similar in Jamaicans and Trinidadians. Vital capacity was smaller in Africans than in Europeans and smaller in women than in men, even after standardization for age and height. There was no sex difference in residual volume. The single breath transfer factor was larger in men than women but there was no ethnic difference. The effects of age and height on lung function appeared to be similar in the two ethnic groups. Exercise tidal volume relative to minute volume was larger in Europeans than in subjects in the Caribbean but this difference disappeared when allowance was made for vital capacity. When allowance was made for differences in body muscle the heart rate during standard sub-maximal exercise was lowest in Jamaican men and highest in Trinidadian men and Jamaican women, with English men and women intermediate. These differences may have been related to the levels of habitual activity in these groups, which were judged to have been highest in the Jamaican men. Maximal heart rate during exercise was similar in all male groups but relative to body muscle, maximal exercise performance was impaired in the subjects in the Caribbean. It is postulated that this may have been owing to the higher temperatures in Jamaica and Trinidad than those in England. We conclude that while ethnic and sex differences affect ventilatory capacity and tidal volume these are less important for maximal oxygen uptake than habitual activity, environmental temperature and body muscle.

Apart from the common measures in patients with obstructive-destructive lung disease, ‘emphysema’2, which includes breathing exercises, a rehabilitation program in addition means training. Training of ‘emphysema’ patients needs a careful selection of the patients and a good insight in the physiological and psychological problems. The risks and limits of these patients are defined and the rules to protect their vulnerable lung parenchyma stated. The benefits of a similar treatment consist of both a better coordination of the breathing act and of breathing with activity. This may result in an important psychological effect. Although, as could be expected because of the permanently damaged lung tissue, no improvement of the lung function pattern as such was found, occasionally a favourable effect on the mechanics of breathing and a more efficient ype of ventilation could clearly be demontrated.

The results of lung function studies in nineteen cases of pulmonary South American blastomycosis are presented. In three patients the lesions were slight and localized and did not appear to have any functional consequences. The remaining sixteen patients had diffuse infiltrates; in eleven of them there was a predominance of obstructive signs; of the remaining five only one had noteworthy spirometric changes (vital capacity restriction). Impaired oxygen transfer was common among the patients with diffuse infiltrates, although it was usually slight. There was no significant difference in this respect between the "obstructive" and the "nonobstructive" type. Carbon dioxide retention was rare, mild and of questionable significance. These functional data were correlated with the clinical and roentgenologic findings. Symptoms were consistently and almost exclusively related to the presence of airway obstruction. Diffuse pulmonary infiltrates without obstruction were not necessarily attended by symptoms, even when accompanied by obviously impaired oxygen transfer. It was not possible to determine whether obstruction was due to South American blastomycosis (SAB) or to concomitant disease, mainly chronic bronchitis secondary to smoking.

A simple method is proposed to obtain, phenomenological values of lung function time constants. Assuming that washout curves at a fixed respiratory rate suggest subdivision of lung volume indifferent

In connection with the discussion of five cases of pneumoconiosis occurring in an aluminium powder mill the authors refer to the possibility of aluminium dust pneumoconiosis being a distinct disease entity. The cases under review have been followed up to 7 years after the first positive X-ray picture. The progress of the disease seems to be initially rapid, but if exposure ceases it seems to be arrested after some time. In mild cases the symptoms may regress. In severe cases the changes in the lungs may cause an increased load on the right ventricle, ultimately leading to failure. Not even in these severe cases is there evidence of continuous progress of the changes in the lungs.