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Exposure to resinous woods away from the place of production has been little studied, or poorly recognised as creating allergy. The dusts are involved in bronchial and ocular pathologies. The significance of tests to wood must take into account the state of oxidation. Symptoms vary as a function of occupation, post, dustiness and pathological history. Atopy has no effect on the symptoms.

We assessed the relationship between exposure to silica dust and chronic airflow limitation in an epidemiological survey conducted among pottery workers and controls who were of the same socioeconomic status (average age: 35 y; 78% males). Data were collected by questionnaire for respiratory symptoms, allergy, respiratory history, smoking habits, and occupation. Lung function was measured with a computer-equipped Gauthier spirometer. We excluded subjects with silicosis or doubtful chest x-ray, and two exposure levels were defined. No differences were observed between exposed subjects and controls with respect to respiratory conditions. Mean pulmonary function values for men and women were significantly lower, after adjustment for age, height, and smoking habits, in even indirectly exposed pottery workers, compared with controls. These results suggest that exposure to silica dust is a risk factor for chronic airflow limitation and is independent of radiographic changes.

Tests using inhaled particles assess ventilatory nonuniformities and may be sensitive to early changes in the small airways of cigarette smokers. We measured aerosol bolus behavior in 20 asymptomatic smokers and 20 age- and sex-matched nonsmokers for comparison with pulmonary function parameters including the single-breath nitrogen test. Narrow boluses containing 1-micron particles were introduced into 1-I breaths and inhaled to varying lung depths. We examined changes in bolus shape between inhalation and exhalation using plots of aerosol concentration versus respired volume for measurement of bolus dispersion, volumetric change in mean location (mean shift), and quantitative particle deposition. We found exhaled bolus dispersion to be significantly increased in smokers compared with nonsmokers. Volumetric mean shift was significantly different in smokers at shallow lung depths, with the center of bolus mass occurring later in exhalation. FEV1/FVC in smokers was significantly inversely correlated with dispersion at deeper lung depths and with mean shift at all lung depths. Smokers with abnormal spirometry (n = 4) or an abnormal single-breath nitrogen test (n = 7) had significantly increased dispersion compared with smokers with normal pulmonary function tests. We conclude that aerosol bolus dispersion is a useful tool for examination of small airway function in asymptomatic smokers.

Objective: To determine if preprocedure coagulation testing predicts bleeding in patients undergoing flexible fiberoptic bronchoscopy (FOB) with biopsy., Design: Retrospective chart review., Setting: Southeastern, urban Veteran Affairs Medical Center., Measurements and Main Results: Two hundred seventy-four patient charts representing 305 FOB with biopsy were reviewed for clinical predictors of bleeding, prebronchoscopy laboratory abnormalities, and incidence of bleeding complications. Thirty-five patients bled, and 3 had abnormal results of coagulation studies. Normal results of coagulation studies and no clinical risk factors were noted in 68 percent of patients who bled., Conclusion: Patients undergoing flexible FOB with biopsy do not benefit from preprocedure coagulation testing.

To investigate the value of CT in depicting endobronchial mucoid collections, the authors retrospectively reviewed the CT scans of 22 patients, 14 with mucous plugs, 7 with mucoid pseudotumors, and one with a bronchocele due to bronchial atresia. Atelectasis could be seen in 11 of 14 patients with mucous plugs. In 12 of 14 patients with mucous plugs CT showed the involved bronchi filled by fluid representing abnormal mucus accumulation. In the patients with atelectasis CT showed mucus-filled bronchi as low-attenuation branching structures (mucoid bronchogram). All the mucoid pseudotumors appeared as low-attenuation (< 20 HU) polypoid wall lesions with no involvement of the bronchial walls. In a patient with bronchial atresia CT showed a solitary pulmonary nodule (representing the obstructed and dilated bronchus filled by mucus) surrounded by peripheral pulmonary hyperinflation. Characteristically, the endobronchial mucoid collections never enhanced after bolus contrast medium. Endobronchial mucoid collections had to be differentiated from endobronchial neoplasms. In some cases bronchoscopy was necessary to make the differential diagnosis. In conclusion, CT is a valuable tool with good sensitivity and specificity in diagnosing endobronchial mucoid collections.

This study investigated the morbidity associated with respiratory virus infections in patients with well-documented chest disease, and the risk of transmission between close contacts. Patients informed the study team if they were exposed to a family member or colleague with a cold. Patients and symptomatic index cases recorded respiratory symptoms during the study period. Acute nasopharyngeal swabs and paired sera were obtained for viral diagnosis. Twenty-five (43%) of 58 recorded exposures resulted in a symptomatic illness and 16 (28%) patients developed lower respiratory tract symptoms. Sixteen (64%) of the 25 symptomatic patients contacted their general practitioner, 14 (56%) received antibiotics and 4 (16%) were hospitalized. Mean duration of illness was 10.6 days in symptomatic patients and 5.7 days in their corresponding index cases (P < 0.005). Mean symptom scores were 100.6 in symptomatic patients and 62.2 in index cases (P < 0.01). Respiratory viruses were identified in 19 (33%) episodes. Rhinovirus, coronavirus and respiratory syncytial virus infections were all associated with lower respiratory tract exacerbations. Respiratory tract symptoms following exposure to a cold were comparatively severe in these patients with chronic chest disease. This group of patients might gain particular benefit from the introduction of effective vaccines or antiviral therapy.

Out of 404 patients with pulmonary and/or tracheobronchial tuberculosis treated during the last 10 years at Kurume University Hospital and St. Mary Hospital, in 41 patients, who had been histopathologically or bacteriologically diagnosed as having active tracheobronchial tuberculosis, tracheobronchial lesions were examined by use of bronchofiberscope. Most patients were treated by a combination of three antituberculous agents (INH, RFP and SM or EB). In 31 patients out of the 41 patients, broncho-fiberscopic examinations were performed twice or more. We observed the ulcerous lesions of bronchial tuberculosis at various stages of healing, and could classify the ulcerous lesions into the following three stages. Active Stage: stage A; ulcer formation without regenerating epithelium, Healing Stage: stage H; ulcer formation with regenerating epithelium, Scarring Stage: stage S; and no ulcer formation. Only the lesions of stage A were observed before treatment. In many patients during the first and second month of treatment, the lesions were stage A or H. It was found that healing of the lesions of tracheobronchial tuberculosis progressed through the stages A, H, and S, in this order. The smear positive rates in sputum were 88.5% in stage A, 12.9% in stage H and 5.0% in stage S. The culture positive rates in sputum were 88.5% in stage A, 20.0% in stage H, and 0% in stage S. We conclude that at least 3 months were generally required for the healing of tracheobronchial tuberculosis with ulcerous lesion. However, it seems that the period of time for healing of ulcerous lesions is shorter in patients who are treated by aerosol therapy with SM.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficiency of computed tomography in differentiating between a bronchial compression due to tumour formation and an endobronchial tumour was tested in comparison to bronchoscopy results. 624 bronchial segments were evaluated in 65 patients with masses in the pulmonary hilus area. Computed tomographical identification of pathological lesions (n = 71) was achieved with a sensitivity of 83% and a specificity of 96%. Out of 52 bronchial segments with endobronchial tumour, 90% showed pathological lesions and 85% were classified correctly. When the morphology of the bronchial lesions (endoluminal mass, smooth or irregularly demarcated bronchostenosis or bronchial displacement) was assessed with CT, only the CT identification of an endoluminal mass could distinguish endobronchial tumour growth with a probability of 91% from bronchial narrowing due to external causes and normal bronchi.

Wheezing lower respiratory tract illness in infancy and asthma share the clinical findings of wheezing and respiratory distress. Although the link between wheezing lower respiratory tract illness in infancy and the subsequent development of asthma is a limited one, both conditions do share some common risk factors, including exposure to environmental tobacco smoke, difficult living conditions (low socioeconomic class, crowding, allergen exposure), and increased risk in males. The impact of baseline lung function on wheezing lower respiratory tract illness risk is substantial and may be independent of airway reactivity. In contrast, the development of chronic airway inflammation mediated by allergic sensitization plays a central role in the development of persistent asthma. Although the endogenous risks for these two outcomes may be fixed, it is clear that caregivers may help to reduce or eliminate the exogenous risks listed earlier by parental education and improvement of the living conditions of young children.

Bronchus-associated lymphoid tissue (BALT) is thought to affect local immunologic defense mechanisms. Studies of BALT, however, have mainly been focused on animals, and information detailing the BALT structure and functions in humans is scanty. Therefore, the purpose of this study is to clarify BALT morphology and immunologic findings in patients with diffuse panbronchiolitis (DPB) and compare them with BALT findings in animals. Thus, in 17 patients diagnosed with DPB, open-lung biopsy specimens were reviewed, and lymphoid follicles with a lymphoepithelium that was determined as BALT were identified in 12 patients. BALT was found mostly at bifurcations from nonrespiratory bronchioles to respiratory bronchioles. This lymphoepithelium was devoid of cilia and was diffusely infiltrated with CD4-positive (helper/inducer) T cells. The majority of T cells were confined to the parafollicular area with a predominance of helper T cells. Also, a few high endothelial venules were recognized in the parafollicular area. Further, in a follicular area situated in the center of the BALT, a number of sigM-positive cells were found to be heavily distributed, suggesting that this follicular area has the characteristics of a B cell zone equivalent to a germinal center of the peripheral lymph nodes. These observations are comparable with BALT findings in animals and suggest that BALT is at least partially related to the local immune response.

Double lung transplantation with bilateral bronchial sutures is an increasingly popular therapeutic alternative for endstage, bilateral, septic pulmonary disease; however, surgical outcome has been hampered by mechanical complications at the level of the airway anastomoses. In our institution, therefore, the protocol for surveillance includes frequent flexible fiberoptic and rigid bronchoscopy under general anesthesia in all patients. Since 1988, there were 24 double lung transplantations (mean age, 19 yr) performed at the University of Marseille Hospitals using bilateral sutures without omental wrapping. Nineteen patients had cystic fibrosis; of the ten individuals (53 percent) with cystic fibrosis who ultimately developed bronchial stenosis, six required therapeutic endoscopic intervention including dilatation or Nd:YAG laser resection. Five patients required endobronchial silicone stents. Statistically significant risk factors for postsurgical airway narrowing included young age (mean, 14.3 yr vs 24.0 yr in patients without stenosis) and prolonged mechanical ventilation prior to transplant (all five patients ventilated before surgery developed stenosis). Results of interventional bronchoscopy were good, and an excellent level of physical activity was maintained in most patients. A team familiar with all aspects of therapeutic bronchoscopy is essential to ensure proper management of airway complications in patients after lung transplantation.

We report our recent findings on the diagnosis, incidence, appearance of the trachea at autopsy, and surgical treatment of acquired trachobronchomalacia. In the diagnosis of this disease, continuous dynamic CT scanning (1 slice/0.6 second) from inspiration to deep expiration was better than X-ray cine recording. It is difficult to observe the most collapsed airway on coughing using bronchofiberscopic recording, because its duration time was estimated to be 1/10 second by X-ray cine recording, whereas the findings at one instant were easily recorded by video-bronchoscopy on coughing. The degree of severity of this disease was classified into three groups. 1st degree 0-50% narrowing of airway caliber, 2nd degree 50-75%; and 3rd degree 75-100%. Severity of 2nd or 3rd degree was present in 542 (12.7%) of 4283 patients suffering from chest disease who underwent bronchoscopy. Seventy-two percent of patients were aged 50 to 80 years. Third degree tracheomalacia was found in 131 patients with an incidence of 3.1%, which increased from 2.2% at 50 years to 6.2% at 80 years. The autopsy findings of the trachea consisted of fragmentation of the tracheal cartilage and extension of the membranous portion. The pathogenesis may be varied with different types of collapse of the airway, including the saber sheath type and the crescent type. Surgical treatment consists of prevention of the airway collapse by wrapping the airway with Marlex mesh and bonding Lyodura (lyophilized dura mata) with fibrin glue, which is more reliable than the span plasty proposed by Nissen.

Despite omental wrap and avoidance of prophylactic administration of corticosteroids in the early postoperative phase, ischemic bronchial complications still represent an important source of early morbidity and mortality following lung transplantation. In a retrospective analysis, the effect of pharmacological enhancement of pulmonary collateral flow on bronchial healing was investigated. Thirty-nine consecutive unilateral or bilateral transplant procedures (Tx) were analyzed. Immunosuppression consisted of rabbit antithymocyte globulin (RATG), cyclosporine A, and azathioprine. In group 1 (10 Tx, 12 anastomoses) routine immunosuppression was employed and the anastomoses wrapped with an omental or pericardial pedicle. In group 2 (29 Tx, 41 anastomoses) PGI2 (4 ng/kg per min x 48 h), heparin (200 U/kg per day), and prednisolone (0.5 mg/kg per day) were added to the therapeutic regimen. The 2 groups were comparable with respect to age and sex of the patients, primary diagnosis, type of transplant, intraoperative use of extracorporeal circulation, graft ischemia, duration of mechanical ventilation, and mortality. Bronchoscopic evidence of a significant bronchial ischemia (extending more than 1 cartilaginous ring beyond the anastomosis) was seen in 8 of 12 anastomoses in group 1 vs 14 of 53 anastomoses in group 2 (P = NS). In group 1, significant bronchial stenosis required implantation of an endobronchial silicone stent in 6 of 12 anastomoses, whereas in group 2, no significant bronchial stenosis occurred (P less than 0.01). No negative effects possibly related to the prophylactic administration of corticosteroids could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

A total of 36 patients (16 male and 20 female) with tracheobronchial tuberculosis were admitted during the last nine years and were evaluated for their clinical features. The chief complaint in three quarters of the patients was intractable cough, in particular, in those with tracheal tuberculosis. One of three patients who suffered from wheezing was prescribed steroid, being diagnosed as having bronchial asthma instead of tuberculosis. Plain chest X-rays of two patients revealed no abnormality. Pleural effusion was observed in three patients, and miliary tuberculosis in two patients. Bronchial biopsy was carried out in 23 patients, however, in only 11 patients a histopathological diagnosis of tracheobronchial tuberculosis could be made. In contrast, in all 36 patients smear and/or culture for tubercle bacilli were positive. Therefore, bronchial biopsy was considered not to be essential in making a definite diagnosis of bronchial tuberculosis, although it did not exacerbate the lesion to lead to endobronchial stenosis. Only seven out of 36 patients were in the habit of smoking but three of the four had already broken the habit at least one year before being diagnosed as having the disease. The remaining four patients were still smoking but less than 10 cigarettes a day, with one exceptional patient who was smoking 30 cigarettes on average a day. It has been well known that there is a sexual difference in the incidence of bronchial tuberculosis, namely among females with relatively low population of smokers, the incidence is high. Another probable reason for the higher female incidence is assumed to be due to the structural susceptibility of the bronchus with smaller diameter lumen.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of this study was to measure, in workers in the chemical industry, the frequency of symptoms and/or alteration in respiratory function according to the Pi phenotype and the occupational environment of each subject. 188 men (mean age 33) participated in a cross sectional study which included: a questionnaire on the working conditions, smoking habits and respiratory symptoms, a lung function test assessing bronchial flow rates, residual volume and CO lung transfer, laboratory investigations with determination of the Pi phenotype, blood concentration of alpha-1-antitrypsin (alpha-1-AT) and antielastase activity in the serum, a study of outdoor environment in each occupation. The Pi phenotype was divided as MM (75.5%) and non MM (24.5%). Both serum alpha 1AT concentration and antielastase activity were lower in non MM subjects than in MM ones. There was no difference between the 2 groups for age, smoking, working conditions, bronchial symptoms or respiratory function values that were within a normal range. The MM subjects stated that they were more exposed to dust, gas and cold; their absence from work for respiratory disorders was more frequent although in a non significant manner and their flow rates at low lung volumes was paradoxically worse than in non MM subjects. It is concluded that neither the outdoor environment nor the Pi phenotype play a role in the respiratory risk which requires, to be more comprehensively evaluated, a prospective study.

Lung specimens were taken at autopsy from 214 subjects aged 35 years and over who had died from nonpulmonary causes in Athens or the surrounding countryside. The samples were coded and examined for entities thought to be linked to environmental exposures, reflecting epithelial, possibly precancerous, lesions, as well as for morphological features, which were summarized using Reid's index. Of the 214 specimens, 142 were suitable for pathological examination. Next-of-kin of 101 of the dead people were identified and asked about the subject's exposure to active smoking, passive smoking, possible occupational hazards, dietary factors and proxy indicators of air pollution (residence). Preliminary analysis, controlling for age and sex, indicates that active smoking is related, although not statistically significantly, to both the Reid index (difference, 0.28, corresponding to a one-tailed p value of 0.07) and epithelial, possibly precancerous lesions (difference, 16.7, corresponding to a one-tailed p value of 0.09). Nonsignificant differences were found in the preliminary analysis of this ongoing study with respect to the other environmental factors examined.

An attempt was made to determine: (i) the prevalence of exercise-induced bronchoconstriction among white and coloured schoolchildren in Cape Town; and (ii) the validity of an exercise test for the diagnosis of asthma in the general population. Children (698 white and 494 coloured) were randomly drawn from schools in the northern suburbs of Cape Town. Each child participated in a standard 6-minute exercise test and spirometric measurements were taken before and 10 minutes after exercise with a portable spirometer. The diagnosis of asthma was based on a questionnaire and personal questioning and included those children who, in the past or at present, suffered episodic or continuous airflow obstruction, which was responsive to a bronchodilator. The criterion for the diagnosis of exercise-induced bronchoconstriction was a 10% decline in forced expiratory volume in 1 second after exercise. The prevalence of exercise-induced bronchoconstriction was significantly higher among white children (5.87%) than coloured children (4.05%). The sensitivity of the exercise test was 0.31 and the specificity 0.97. In contrast to the results of hospital-based studies, the negative predictive value of an exercise test (95%) was found to be greater than the positive predictive value (46%). It is therefore concluded that exercise testing is not a useful screening test for epidemiological use; it is probably useful as a challenge test for detecting asthma in the individual patient when the likelihood of the disease is high.

The above epidemiological study was undertaken with the object of establishing the proportion of respiratory pathology represented by chronic bronchopulmonary obstructive bronchitis, emphysema, bronchial asthma in a highly industrialized city such as Taranto. The period covered was the years 1988, 1989 and first half of 1990. In addition, the distribution of chronic obstructive bronchopulmonary disease according to sex and age and the influence of smoking were analyzed.

Outbreaks of a canine distemper-like acute disease brought high mortalities to seal populations in north-west Europe and Lake Baikal from late 1987 to 1988. During these outbreaks three seals which were introduced from Lake Baikal to an aquarium in Japan developed a distemper-like disease and other seals raised in the same room were similarly affected. Clinical signs of dead seals were anorexia, diphasic fever, dyspnea, and neuromuscular tics. Characteristic microscopic lesions of acute interstitial pneumonia seen in the lung were accompanied with hyperplasia and syncytial giant cell formation of type II pneumocytes. Eosinophilic intranuclear and cytoplasmic inclusion bodies were present in bronchial epithelial cells, type II pneumocytes, epithelial cells of bile ducts and interlobular ducts of pancreas, transitional epithelium of renal pelvis, and reticular cells of lymph nodes. Ultrastructure of inclusion bodies was similar to that seen in cells infected with morbilliviruses. Serum samples from recovered seals had virus-neutralization antibodies against canine distemper virus. The present cases were the first report of morbillivirus infection of aquarium seals in Japan.

Altogether 16,539 sputum specimens were examined microbiologically from 1980 to 1984. Out of these 12,588 were screened by Ziehl-Neelsen's staining technique and 782 were (6.3%) found AFB-positive. Age and sex distributions of the AFB-positive individuals were statistically significant (at 0.05), incidence being most prevalent among those 20 years and above (90.2%) and among males (61.2%). From other specimens cultured, non-AFB organisms were isolated at the following frequencies: coliform-like organisms (15.1%), Streptococcus pneumoniae (55.5%). Klebsiella pneumoniae (5.3%), Streptococcus pyogenes (3.9%), Pseudomonas aeruginosa (3.4%), Haemophilus influenzae (3.0%). Proteus Spp. (0.7%) and Escherichia coli (0.5%). The antibiogram of these isolates revealed a high incidence of multiple antibiotic resistance, a situation that has most probably arisen from the high degree of antibiotic misuse in Nigeria.

A questionnaire study regarding airway morbidity in children and environmental factors was performed in April 1985. The parents of 5301 children, aged 6 months to 16 years, from different rural areas in mid Sweden were sent a validated questionnaire and 4990 (94%) responded. The cumulative prevalence of bronchial hyperreactivity was 9.7% and of allergic asthma 5.2%. Children living near a paper pulp plant more often had symptoms suggesting bronchial hyperreactivity (124 (13.0%), relative risk 1.3) and allergic asthma (68 (7.1%), relative risk 1.3). In children living in a damp house problem bronchial hyperreactivity was found in 76 (19.0%) (relative risk 1.9) and allergic asthma in 35 (8.7%) of the children (relative risk 1.9). Children living in a damp house with parents who smoked had the highest figures: bronchial hyperreactivity was found in 44 (23.5%) (relative risk 2.8) and allergic asthma in 22 (11.6%) (relative risk 2.5). The results indicate that various moderate environmental pollutants may act synergistically to increase bronchial hyperreactivity and allergy especially in children with a family history of allergy.

A methacholine bronchial provocation test was administered to 290 subjects obtained from the 1,900 male volunteers participating in the Normative Aging Study. A positive response (less than 20% decline in FEV1) was obtained in 83 subjects. A positive response was associated with current smoking, presence of wheeze and reduced FEV1. Bronchial responsiveness, cigarette smoking, normal subjects, FEV1.

An epidemiologic health study was carried out on 652 cedar mill workers and a control group of 440 male office workers not exposed to air contaminants. Participants completed a medical-occupational questionnaire with trained interviewers, had allergy skin tests, performed spirometry, and had bronchial reactivity assessed by methacholine inhalation testing. After adjusting for differences in age, race, and smoking, cedar workers were found to have significantly higher prevalences of cough, phlegm, and dyspnea than did office workers. Symptoms of asthma and work-related asthma, but not persistent wheeze or doctor-diagnosed asthma, were reported in a significantly higher proportion of cedar workers than of office workers. Cedar workers also had significantly lower lung function test results than did office workers after controlling for height, age, race, and smoking. Bronchial hyperreactivity, defined by a methacholine PC20 less than 8 mg/ml, was more prevalent among cedar workers than among office workers, with the increase being limited to the nonatopic subgroup of workers. The prevalence of bronchial hyperreactivity increased with duration of employment among cedar workers but not among office workers. We conclude that exposure to western red cedar dust is harmful to the respiratory health of the workers, causing asthma and other respiratory symptoms, bronchial hyperreactivity, and lower levels of lung function.

Data from various different types of cross-sectional studies are reviewed in order to examine hypotheses about the etiology of asthma and to more precisely define its relationship with nonspecific bronchial hyperreactivity (NSBH). Although cross-sectional studies have not clarified the precise etiologic links, they have established that NSBH and atopy are linked to the occurrence of asthma and to each other. In children, evidence supports the hypothesis both that atopy is a cause of asthma and that atopic diathesis is the most frequent trigger for NSHB. In adults, the associations are more complex, although in a small subset findings are similar to those in children. It is concluded that further general population-based or clinical epidemiologic cross-sectional studies based on questionnaires will contribute little more to explaining these associations. Criteria are presented for the further application of case-control studies to maximize their use in examining hypotheses of asthma etiology.

In a random population sample of 1905 subjects we studied the occurrence of respiratory symptoms in relation to airways responsiveness. Responders (PC10 FEV1 to histamine at 16 mg.ml-1 or less) had crude prevalence rates two to three times higher than nonresponders. In logistic regression analysis, odds ratios were estimated for each threshold value, compared to the reference value (greater than 32 mg.ml-1), controlling for age, sex, area of residence, and smoking habit. Odds ratios increased with decreasing threshold values in a dose-response relationship for all symptoms, except for bronchitis periods. We analysed the association of airways responsiveness to pulmonary function level by multiple linear regression, controlling for age, sex, height, area of residence, and smoking habit. There was an inverse relationship of FEV1 level to threshold value. Male subjects within a threshold value of 1 mg.ml-1 had a mean adjusted FEV1 of 1170 ml less than males with a threshold value of greater than 32 mg.ml-1. The relationship of responsiveness to decline of FEV1 with time was studied in 186 male subjects who took part in five consecutive surveys from 1967 to 1981. The greatest mean adjusted yearly decline was noted in responding smokers: 35.3 ml per yr, compared to nonreactive nonsmokers: 10.9 ml per yr. Regression analysis of the yearly decline in 169 subjects with at least two pairs of two consecutive threshold tests revealed that the more positive tests subjects had, the greater was their mean adjusted yearly decline. It is concluded that airways responsiveness may be an important factor in the development of chronic obstructive pulmonary disease.

The authors report a retrospective study of 34 cases of bronchial tuberculosis observed between 1981 and 1985 with precise endoscopic and histological data. Analysis of the population showed a male predominance (71 p. 100) and a high incidence of black Africans (54 p. 100), much higher than that observed in the general population of tuberculosis in our department (20 p. 100 of black Africans). Three groups of patients were identified with respect to age: group I, 23 patients aged 18 to 32 years; 22 of these patients were black Africans (98 p. 100) with primary tuberculosis; group II, 4 patients aged between 44 and 56: all were immunocompromised; group III, 7 patients over 65 years of age with reinfections: 6 of these 7 patients were French nationals. Apart from the specific problem of immunodepression observed in group II, two distinct features were identified: the primary lympho-bronchial infection of the young African and tuberculous bronchial reinfection of European women over of the age of 65.

In 3 districts of the county of Halle and in the cities of Halle and Halle-Neustadt about 18,000 children of different groups of age were examined wether they were suffering from recurrent or chronic nonspecific lung diseases (CNSLD). Among the 18,000 children we found 4.3% with lung diseases. The morbidity rate was the lowest in the city of Halle and in the district of Quedlinburg, while in Bitterfeld, the district with the highest air pollution, about two times more children had fallen ill. In all districts the prevalence of CNSLD in young children was much higher than in elder ones. In the district with the highest air pollution with increasing age of the children the rate of prevalence lowered more slowly than in the other districts.

The prevalence of asthma and allergic responsiveness in rural and urban children of the highlands of Papua New Guinea was studied. Bronchial provocation studies with histamine demonstrated significant bronchial hyperreactivity in 0.5% (1 in 195) rural and 1.7% (1 in 59) urban children, rates which were significantly lower than those observed in corresponding adult populations (7%). Urban children demonstrated a higher incidence of skin test reactivity toward Dermatophagoides pteronyssinus, Aspergillus fumigatus, and dog dander than did the rural children. However, there were no significant differences between these populations with regard to total serum IgE levels, the degree of parasitism as judged by stool examination, or allergic responses to Ascaris suum, plantain, and coffee bean husk. A more detailed study demonstrated age- and sex-related differences in total IgE and mite-specific RAST scores in the rural but not the urban population. These data suggest an active suppression of the capacity of children to mount an IgE response to environmental allergens such as the mite manifesting itself as low asthma prevalence. The data also indicate that, although the underlying defect of bronchial hyperreactivity in asthma may be genetically inherited, it is not revealed until the lung has received an allergen-induced inflammatory insult.

The authors report a case of pasteurellosis with abscess of the brain consecutive to a bronchopulmonary infection in a woman with old-standing bilateral bronchiectasis. The prevalence of respiratory infections caused by Pasteurella multocida is low, but it is certainly underestimated. Bronchial and/or pleuro-pulmonary infections occur in subjects with reduced local and/or systemic defences. The respiratory system is colonized by direct or indirect contagion, usually in contact with pet animals carrying the organism.

Previously we described a lesion of the small airways that appears related to mineral dust exposure and is found in asbestos and nonasbestos dust-exposed populations. To determine the usefulness of this lesion as a marker for mineral dust exposure, and to determine whether it produces functional consequences, we examined a group of 53 workers who had been either hard rock miners or in the asbestos, construction, and shipyard industries. The specific lesion (mineral dust airways disease (MDAD] consists of marked fibrosis and pigmentation of the respiratory bronchioles and was found in 13 of 53 workers with dust exposure, but only in 1 of 121 without dust exposure. Compared with age and smoking-matched dust-exposed control subjects, patients with this lesion had significant abnormalities of forced expiratory volume in one second (FEV1), forced expiratory flow during the middle half of the forced vital capacity (FEF25-75), vital capacity (VC), and nitrogen washout. In addition to fibrosis in the walls of respiratory bronchioles, these patients also had significant increases of fibrosis in the walls of membranous bronchioles, indicating that changes in the small airways are widespread in this subset of workers. We conclude that markedly abnormal small airways are present in some workers with mineral dust exposure; pathologic observation of this lesion is a good indicator of dust exposure, and its presence is associated with abnormalities of air flow greater than those induced by smoking alone. The presence of this lesion in only a portion of dust-exposed workers may account for contradictory results in past studies that attempted to demonstrate air flow abnormalities associated with mineral dust exposure.

Screening of secundary school children and the general opulation of the V. Monaldi Hospital Preventive and Social Medicine Centre,Naples showed a by no means negligible incidence of chronic bronchopneumopathy, particulary in infants. It is felt that, if untreated, these forms may be responsible for chronic respiratory insufficency in adulthood. Marker success in this respect has been obtained with anti-inflammatory and anti-bronchospastic substances, particularly a diethyl-aminoethoxyethylic ester of alpha-phenylbutyric acid. Preventive and social management is thus primarily directed at infants and the aged.

A multivaried statistic process, the linear discriminant analysis, applied to VEMS, CV, I.T., FEF 25-75, pH, PaO2, PaCO2, was used by the authors to foresee, in 42 patients suffering from bronchogenous carcinoma, the arising or absence of respiratory complications after operation. With such method, the falsely positive or negative previsions, resulted to be 13 with a total percentage of error as high as 30%. These results suggest that, even when elaborated through the multivaried analysis, the parameters studied do not allow to adequately discriminate the patients who would develop, after operation, bronchopulmonary complications from those who would be exent from them.

The state of the bronchial system was examined in 1066 patients within the period of 1964 to 1984. Infiltrative tuberculosis of the lungs predominated in the patients. There was a high incidence (30.1 per cent) of specific affections of the bronchial system complicating infiltrative tuberculosis. Within the last decade the incidence of tuberculosis of the bronchi complicating disseminated tuberculosis has markedly lowered. The incidence of newly detected inactive posttuberculous lesions on the bronchial mucosa and nonspecific endobronchitis increased.