Regional distribution and lung clearance mechanisms in smokers and non-smokers.
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Biomedical subjects
Publications and source records attributed to J Sanchis.
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To assess the validity and reproducibility of determining total and differential cell (DC) counts and of eosinophilic cationic protein (EPC) levels in induced sputum. Clinical analysis of validity and reliability of a measurement tool. Twenty-one asthmatics [age: 31(14) years; FEV1: 78(21)% of reference value; PC20FEV1: 0.02(1.1)mg/ml] and 10 healthy subjects [age: 30(3) years, FEV1: 99(12)% of reference value, PC20FEV1: > 8(3.7)mg/ml]. A sputum sample was collected from each individual using hypertonic saline. Sputum was separated from saliva and then divided into two portions as uncontaminated as possible by squamous cells. Both portions were treated independently and simultaneously within two hours with a solution of bithiothreitol to disperse the cells, and then centrifuged. The supernatant was poured off and frozen al -70 degrees for later determination of EPC. The sediment was stained with Papanicolaou stain, toluidine blue and eosinhematoxylin. DC count was expressed as a percentage of total inflammatory cells. ECP was determined with a CAP-System and a commercial kit (Pharmacia Diagnostics SA, Uppsala, Sweden). Two subjects in each group were unable to produce valid sputum samples (20% of healthy subjects and 10% of asthmatics). The validity of the method was demonstrated by significant differences between asthmatics and healthy subjects in both eosinophil and EPC levels. The reproducibility of method was verified by comparing the results for the sputum fractions; no significant differences were found in cell counts or EPC levels. The within-group correlation coefficients for the sputum fractions ranges between 48 and 77% for all cell types, except squamous cells, which gave a coefficient of 18%. For EPC the correlation coefficient was 98%. DC and EPC determinations in sputum induced by hypertonic saline are valid and reproducible.
The case of a patient with suspected atrial septal defect is presented. Echocardiographic-Doppler study confirms the defect associated with mitral stenosis (Lutembacher syndrome) and shows an atrial septal aneurysm through which the shunt is revealed.
A dog weighing 15 kg and anesthetized with intravenous sodium thiopental was subjected to transcatheter ablation of the AV junction with high-frequency currents, in order to induce a partial alteration in AV conduction (first degree AV block). Two conventional bipolar electrode-catheters were introduced through the right femoral vein and used one for atrial pacing and the other for His bundle recording and current delivering. The catheter used for ablation was situated in the AV junction where the distal monopolar recording of the His bundle electrogram showed an A/V ratio close to one in the presence of His bundle deflection. Three discharges were delivered under continuous electrocardiographic monitoring. The output power used was 15 watts and current application time was up to five seconds after attaining complete AV block; 1:1 AV conduction was quickly restored on concluding discharge. After the second discharge, a discontinuous nodal function curve of the dual AV nodal pathway type was obtained (absent in control and after first discharge studies). Following the third discharge the conduction through the slow pathway was abolished. The study was repeated after four weeks, an a dual AV nodal pathway type curve similar to that found during the acute phase was obtained. The histologic findings showed a collagen scar partially replacing nodal tissue and creating a partial septation of the AV node. To conclude: The structural alterations of the AV node may induce a dual AV nodal pathway response.
Pulmonary function studies were performed in 10 patients undergoing surgery for heart transplantation. The study was repeated 6 to 12 months after surgery. The comparison between data before and after transplantation showed an overall improvement in lung function indices, except for the lung diffusing capacity (DLCO). A mean 14% reduction (p less than 0.01) of DLCO was observed. In the absence of evidence of other lung disease or rejection reaction in these patients, this finding may be related to a side effect of cyclosporine on the lung and deserves further investigation.
Maximal expiratory flow-volume (MEFV) curves were measured in 1044 healthy nonsmoking volunteers living in the Barcelona area, as part of a larger interhospital project to obtain reference values of pulmonary function tests. Forced vital capacity (FVC), one-second forced expiratory volume (FEV1), FEV1/FVC, %, forced maximal mid-expiratory flow (FEF25-75%), peak expiratory flow rate (PEF) and maximal expiratory flow at 50 and 75% of FVC (MEF50% and MEF25% respectively) were obtained and expressed at BTPS conditions. Techniques and equipments followed both the recommendations of the American Thoracic Society (ATS) and of the European Community for Coal and Steel (ECCS). Prediction equations for age 20 through 70 were calculated for both sexes from a final sample composed of 870 adult subjects, 443 males and 427 females. Simple linear equations using height, age and body weight predicted all spirometric variables as well as more complex equations except MEF25%. Logarithmic equations were proposed for MEF25% to correct for the heteroscedasticity shown in a simple linear model. To our knowledge, this study provides reliable spirometric equations from a large urban Mediterranean sample which were lacking so far in the literature.
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The spirometric response to inhaled salbutamol was assessed in 492 healthy volunteers 6 to 20 yr of age. Mean and standard deviation of the changes, expressed as percentage of prebronchodilator values, were as follows: forced vital capacity (FVC): 1.7 +/- 2.8; forced expiratory volume in one second (FEV1): 3.3 +/- 3.4; (FEV1/FVC): 3.1 +/- 3.2; peak expiratory flow: 6.4 +/- 8.6; maximal mid-expiratory flow: 10.1 +/- 8.8; maximum expiratory flow at 50% of FVC: 8.8 +/- 9.5 and maximum expiratory flow at 25% of FVC: 14.0 +/- 14.7. The changes were significant (p less than 0.005) for all parameters and similar to those observed in adults.
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A new dry spirometer (DS) incorporating a microcomputer for automatic calculation and direct read-out of spirometric parameters was compared to a calibrated Fleisch pneumotachograph (PT). Twenty-eight volunteers, including healthy subjects, obstructive and non-obstructive patients, performed a total of 48 spirometric tests with the two apparatuses randomly alternated. DS values for FVC were lower than those of the PT with a mean difference of 0.177 1 +/- 0.171 SD (p less than 0.0001). Mean FEV1 values were very similar in both apparatuses with a non significant difference of 0.003 1 +/- 0.182 FEF25-75 values were higher with the DS, showing a mean difference with the PT of 0.407 1 . s-1 +/- 0.324 (p less than 0.00001). The DS also gave slightly higher PEFR values than the PT, with a mean difference of 0.310 1 . s-1 +/- 0.830 (p less than 0.02). Differences in FVC readings between DS and PT were greater in severely obstructed patients (0.350 1 +/- 0.084, p less than 0.0001) than among healthy subjects (0.120 1 +/- 0.051, p less than 0.0002). On the contrary, in absolute figures DS values for FEF25-75 showed a greater difference with those of the PT in normals (0.547 1 . s-1 +/- 0.320, p less than 0.001) than in obstructed patients (0.288 1 . s-1 +/- 0.244, p less than 0.05). DS flow resistance was 2.67 cmH2). s. 1-1 for a flow of 8.8 1. s-1. Based on the spirometric differences observed, and on the high flow resistance and volume limitation imposed by its 6 1 capacity, we concluded that the apparatus tested cannot be recommended for clinical spirometry.