Biomedical subjects
Publications and source records attributed to W L Morrissey.
Increasing tenderness of the sternum developed four years after pulmonary sarcoidosis has been diagnosed in a 34-year-old woman. Sternal tomography and bone scanning demonstrated abnormalities in the area. Sternal biopsy confirmed the diagnosis of osseous sarcoid. Involvement of the sternum by sarcoidosis has not been previously reported.
To evaluate the factors that contribute to inhibition of airways reactivity, we compared the effect of inhaled isoproterenol, 125 micrograms, on the response to methacholine-induced bronchoconstriction in 10 normal and 10 asthmatic subjects. We measured in each subject baseline lung function, response to inhaled bronchodilator, dose of bronchodilator causing 50% maximal response, and degree of airways reactivity to inhalation of methacholine before and after isoproterenol. In asthmatics, but not normal subjects, inhalation of isoproterenol led to significant inhibition of methacholine-induced bronchospasm. In asthmatics, the greater the airways reactivity to methacholine the greater the inhibition by isoproterenol (p less than 0.05). In both groups, there was significant correlation between baseline lung function and level of airways reactivity. In neither normal subjects nor asthmatics did the maximal bronchodilator response to isoproterenol inhalation correlate with inhibition of airways reactivity. Studies evaluating inhibition of airways reactivity should take into account the population tested, baseline lung function, and baseline level of airways reactivity.
The heavy use of chlorine gas in industry and water purification poses the constant threat of mass gas exposure. In a recent experience with a chlorine gas disaster involving over 100 patients, 64, including six subsequently requiring admission, were treated in the main emergency unit facility. The remainder were triaged to a safe area away from the emergency unit with instructions for symptomatic treatment. Injuries were limited to four organ systems: pulmonary, gastrointestinal, ophthalmic, and cutaneous. Current treatment methods are compared with those in the literature and a protocol for management provided.
The electrocardiogram was monitored in 51 patients during fiberoptic bronchoscopic procedures and was compared to recordings made before premedication. Sixteen of the patients had heart disease. During the bronchoscopic procedure, the heart rate increased by 154 "/- 5 percent (+/- SE). The frequency of atrial ectopic beats was minimally increased, by an average 0.15 +/- 0.12 beats per minute (not significant). Ventricular ectopic beats became less frequent during the bronchoscopic procedure (-0.17 +/- 0.41 beats per minute; not significant), and there was no ventricular tachycardia. Frequent ventricular ectopic beats were seen mainly during bronchoscopic procedures in patients with coronary heart disease, but even in this group, ventricular ectopic beats became less frequent than at rest (-1.13 +/- 1.46 beats per minute; not significant). The nearly uniform sinus tachycardia that was observed was well tolerated but could predispose coronary patients to ischemia; however, the fiberoptic bronchoscopic procedure per se does not enhance prior ectopy.
The effects of oxides of nitrogen inhalation are reported in a 21-year-old gardener exposed to silage gas. Initial nausea, cough and fever remitted, but respiratory failure developed 3 weeks later. Roentgenograms and lung function studies revealed pulmonary edema, volume restriction, and severely impaired gas exchange. Needle biopsy showed a nonspecific interstitial pneumonia. With steroid therapy all functional parameters except diffusing capacity returned to normal. Failure to inquire about non-occupational activities led to delayed diagnosis. A brief review of toxic effects of nitrogen oxides is presented.
An association between migratory pulmonary infiltrates and peripheral eosinophilia has been known for at least 40 years. Diagnostic challenges still exist in the classifications within this syndrome. We describe a 33-year-old female without asthma but with definite "atopy" who had a 4-year history of recurring pulmonary lesions. These were sometimes segmental, at other times dense and peripheral, and once there was lobar atelectasis due to mucoid impaction. Diagnosis by lung biopsy revealed eosinophilic pneumonia with bronchiolitis obliterans as a prominent feature. Steroid treatment resulted in promt improvement; during a 5-year follow-up the infiltrates have not recurred but there has been persistent mild obstruction.