[Health policy goals in child and adolescent health reporting--evaluation with reference to an intermediate-term evaluation]

As a result of the first report on the health of children in Hamburg (1990) 14 primary health policy objectives were identified and related to specific intervention fields. The health information system group at Hamburg has prepared an interim evaluative statement for 1994 on whether and how far each objective has been achieved compared to the targets formulated for the years 1995 and 2000 respectively. 8 out of 14 objectives are considered remaining unchanged as before (i.e. unintentional conception), either proceeding towards the target (i.e. low birth weight, dental health) or having reached the target for 1995 (i.e. infant mortality, age-appropriate vaccination). With 4 objectives the trend deteriorated (i.e. body weight of teenagers, accidents). One objective was monitored on the basis of a new data source (violence against children) and for one objective information could not be proved or updated (breast feeding). In traditional areas of local health policy (i.e. dental health, infant mortality) the health information system and the health targets may be sufficient to help improve the health of the city. In non-lobbied fields (i.e. breast feeding) or those without a consensus on responsibilities (i.e. violence, health and social discrimination) health reports on their own do not invoke achievements, but need to be supported by additional measures.

Cefodizime stimulates subpopulations of cells mediating spontaneous or antibody-dependent cytotoxicity in patients with bacterial infections

The influence of cefodizime (CDZ) on spontaneous cell-mediated cytotoxicity (SCMC) and antibody-dependent cell-mediated cytotoxicity (ADCC) was investigated in nine patients with conditions predisposing to infection (T-cell deficiency, humoral immune deficiency, myeloproliferative syndrome, kidney or liver damage, or chronic pulmonary disease). SCMC, using the K562 and LIK cell lines as targets, and ADCC, using the LIK cell line, were measured at baseline and after ten days of therapy with CDZ for lower respiratory tract infections. Six patients were cured; clinical outcome was not evaluable in the other three. SCMC lysis of K562 cells did not change significantly. SCMC and ADCC lysis of LIK (lymphoblastoid) cells both increased significantly. CDZ selectively stimulated a subpopulation of NK cells in this population of immunocompromised patients with lower respiratory tract infections.

Treatment of severe chronic bronchitis with ceftazidime

The aim of this study was to determine whether ceftazidime is more effective than other antibiotics in the treatment of severe acute exacerbation of chronic bronchitis, particularly when other antibiotics have previously failed. Our investigations showed that ceftazidime is effective and well tolerated in patients with severe chronic bronchitis and purulent sputum. The effectiveness of ceftazidime was seen in a reduction of the volume of sputum produced daily and in a colour change from yellow-green to clear-white. The absence of an effect on parameters of lung function was not unexpected since our patients had long-lasting chronic bronchitis.

Controlled prospective study of oral amoxycillin/clavulanate vs ciprofloxacin in acute exacerbations of chronic bronchitis

This investigation compared the efficacy of oral formulations of amoxycillin/clavulanate and ciprofloxacin in acute exacerbations of chronic bronchitis. Forty patients were randomized to receive either Augmentin (1,000 mg amoxycillin +250 mg clavulanate) tds or ciprofloxacin (500 mg) bd. During and before therapy sputum samples were taken for bacteriology, sputum volume measurement and histamine determination. Lung function was also monitored. From sputum, 143 bacterial isolates and 15 yeast strains were obtained before therapy. During therapy with amoxycillin/clavulanate the incidence of Gram-positive isolates decreased significantly whereas ciprofloxacin left their frequency unchanged. On the other hand, ciprofloxacin more effectively diminished the incidence of Gram-negative isolates. Yeasts were grown from the sputum of several patients before and during therapy. Their number did not increase during amoxycillin/clavulanate therapy while it increased under ciprofloxacin. The groups showed no significant differences with regard to sputum production, histamine concentration or lung function. The majority of patients (28/40) acknowledged improvement of their symptoms. There was no significant difference between the groups. On the basis of these results both amoxycillin/clavulanate and ciprofloxacin appear of similar value for treatment of patients with exacerbations of chronic bronchitis.

Influence of picumast dihydrochloride on the ex vivo histamine release from leucocytes of allergic asthmatic patients

In a pilot study 8 patients with allergic obstructive airway disease were treated with the new compound picumast dihydrochloride (3,4-dimethyl-7-[4-(4-chlorobenzyl)piperazine-1-yl]propoxycoumarine++ + dihydrochloride) 2 x 2 mg daily orally during a period of 8 days additionally to a usual therapy of bronchodilators and corticoids in a steady state. It was demonstrated that the compound inhibited the allergen induced histamine liberation of patients basophils significantly. Compared with a collective of patients without an additional picumast dihydrochloride treatment the effect of the substance was shown more clearly. From reasons of these experimental data picumast dihydrochloride may be of a considerable value as a prophylactic agent in allergic bronchial asthma when given orally.

Simple pA2 estimation of partial agonists: comparison with the Kaumann-Blinks method

Estimation of KB and pA2 of partial agonists as antagonists of full agonists is hindered by their stimulant component of action. This reflects competitive synergism, i.e., an additive interaction with a full agonist. The antagonistic component of a partial agonist is seen as a parallel shift of the agonist curve to the right from a constructed additive dose-response curve, from which a dose ratio (DR) was determined for calculation of graphic estimation of KB or pA2 of partial agonists. Dose-response curves from eight studies were analyzed in this way, in comparison with the method of Kaumann and Blinks, and showed excellent agreement between pA2 values determined by either method (r = 0.994, slope = 0.999, n = 17).

Oral corticosteroids and histamine releasability of basophil granulocytes

The influence of oral corticosteroid therapy (7.5 and 15 mg prednisolon/day for 8 days) on basophil releasability by antigens was investigated in a series of 16 patients with chronic obstructive airway disease. A significantly smaller histamine release was observed after the treatment. Different types of releasing curves were observed which mostly persisted after treatment.

[Histamine content of the sputum of patients with obstructive bronchitis]

High histamine concentrations were measured in the sputum of patients with chronic obstructive bronchitis. The histamine concentration doubles or triples when the sputum is incubated for 24 and 72 h, respectively at 37 degrees C. The antibiotics therapy with doxycycline significantly inhibited the histamine formation in 8 patients, which was mainly caused by bacteria. In the sputum of one patient the histamine formation was reinforced in spite of the doxycycline therapy. The clinical importance of these findings is discussed.

Cloverleaf skull associated with Pfeiffer syndrome: pathology and management

The clinical and radiological findings in an infant with severe cloverleaf skull associated with a Pfeiffer syndrome are presented. The skull anomaly resulted in raised intracranial pressure and proptosis of the right eye within several weeks of birth. The child died at 3 months of age after subtotal craniectomy. At autopsy a detailed macroscopical and histological analysis of the skull base was conducted. The timing and value of surgery are discussed as well as the pathology of the cloverleaf skull anomaly.

Phage adsorption and productive lysis in stable protoplast type L-forms of Bacillus subtilis and Streptomyces hygroscopicus

Transferable productive lysis in stable protoplast type L-form cells of Bacillus subtilis was produced by 6 phages out of 14 strains virulent for the parent B. subtilis 170 and 1997. Most of these phages lytic for L-forms show the phi 29 morphology characteristic for the smallest B. subtilis phages containing double-stranded DNA. Among 31 actinophages, 23 of which were virulent for Streptomyces hygroscopicus, only SLE 109 and phi c 31 gave productive infection of the stable protoplast type L-form of S. hygroscopicus NG 33--354. Electron microscopic investigation and treatment by DNAse demonstrated that infection of L-form cells is an adsorption-injection process, and that it is not caused by transfection of free phage DNA or endocytotic uptake of phage particles. Because in both stable L-forms cell wall biosynthesis is blocked irreversibly the results allow the conclusion that specific receptors must be localized in the cytoplasmic membrane for those phages producing transferable lysis in protoplast type L-forms. Localization of receptors for certain phages in the cytoplasmic membrane seems to occur in many Gram-positive bacteria, but not in Gram-negative bacteria.

The role of vagus nerve on histamine- and acetylcholine-induced bronchoconstriction (experiments on cats)

During administration of highly concentrated acetyclcholine and histamine aerosol (20-40 min), different effects on tidal volume, respiratory rate, and bronchial tone could be demonstrated. Inhalation after vagotomy neither showed changes in respiratory rate nor in tidal volume. These results point out the importance of the nervus vagus in case of bronchoconstriction caused by mediators. It is discussed to which degree vagus activity is required for the direct effect of different mediators in living animals.

Cell instability in basophil leukocytes of patients with chronic obstructive airway disease

The histamine release from basophils induced by hypo-osmolarity was investigated in 75 healthy persons and in 43 patients with chronic obstructive airway disease. Leukocyte suspensions were diluted with destilled water in cell/water ratio volumen of 1:1, 1:3, and 1:7. Basophils, sequentially treated with increasing amounts of water, show an activation of the release process. A statistically significant age-dependent hypo-osmolar histamine liberation could be demonstrated. Furthermore, a significant higher cell stability was found for the group of patients.

Artificial surfactant in preterm rabbits with and without respiratory distress syndrome: difference of in vitro and in vivo activities

Sixty-eight rabbit fetuses of 27 days gestation were tracheotomised, artificially ventilated, and their lung mechanics studied in a body-enclosing plethysmograph. The animals were treated by tracheal instillation of natural surfactant concentrate or large unilamellar vesicles containing dipalmitoylphosphatidylcholine:egg phosphatidylglycerol, 9:1. Both preparations were highly surface active in terms of film adsorption and surface tension-lowering potential. Before treatment, the lung mechanics were analysed to indicate the presence of respiratory distress syndrome (RDS). Controls received 0.15 M saline. Differences were found between the in vitro and in vivo activities of both preparations in some animals. In 30 preterm animals with partial lung maturity and without respiratory distress syndrome, no significant effect could be achieved with either the natural or the artificial surfactant. In 38 animals with severe RDS, the tidal volume and compliance increased markedly within 15 min of substitution of both preparations. Compliance increased to 178% of the initial value in ventilated, control animals, to 391% in animals treated with natural, and to 344% in animals treated with artificial surfactant.

The correlation between allergen, acetylcholine and histamine-induced bronchoconstriction

A significant correlation between the degree of bronchial reactivity to ACH, Hi and A.E. was found in a series of 23 dogs. An increase in receptors sensitivity responsible for the organic manifestation of allergy must be assumed. This increased receptors sensitivity is an important phenomenon in asthma clinically relevant.

Effect of histamine, acetylcholine and compound 48/80 on bronchoconstriction and release of eicosanoids in the dog

The effects of Hi and ACH aerosol and of intravenous infusion of compound 48/80 on bronchoconstriction and plasma levels of Hi, TXB2, KH2PGF2 alpha and KH2PGE2 were investigated in 11 bastard dogs. Administration of Hi and ACH aerosol induced bronchoconstriction accompanied by an increase in the plasma levels of Hi and TXB2. No effect on the plasma levels of KH2PGF2 alpha and KH2PGE2 was detected. Release of endogenous Hi by compound 48/80 induced bronchoconstriction and significant increases in the plasma levels of TXB2 as well as of KH2PGF2 alpha and KH2PGE2. The effects of a second administration of Hi and ACH aerosols after compound 48/80 did not differ qualitatively from the effects of the first aerosol administration. However, quantitatively, the second Hi aerosol induced significantly less bronchoconstriction and TXB2 release. Similarly, effects of the second ACH aerosol tended to be decreased as compared to the first ACH aerosol, although the difference was not significant. The diminished effect of the agonists could be due to receptor desensibilization and/or release of adrenaline, which in turn decreases bronchoconstriction and eicosanoid release.

Local release of histamine, prostaglandin F2 alpha and thromboxane B2 into the tracheal lumen and its influence on airways reactivity

The influence of tracheal lavage with ascaris extract (AE) on airway response to acetylcholine (ACH) and histamine (Hi) was investigated in a series of 24 dogs. AE administered to a restricted area of the trachea resulted in a release of various mediators such as Hi, prostaglandin F2 alpha (PGF2 alpha, measured as the metabolite 15-keto-13, 14-dihydro-PGF2 alpha) and thromboxane B2 (TXB2) into the tracheal lumen. This differed from H2O administration which resulted in no increased release of these mediators. The relatively small concentrations of these substances measured in arterial plasma argue for the role of these mediators on a local basis. On the other hand, tracheal lavage with allergen induced changes in airway response to ACH and Hi aerosols which was not observed after tracheal lavage with water. An interaction between this allergen-induced mediator release into the trachea and peripheral airways reactivity could be demonstrated.

Influence of a minimal surgical transection around the trachea on bronchoconstriction in cats

The influence of a minimal surgical transection around the trachea on ACH- and allergen-induced bronchoconstriction was studied in a series of 21 cats. A significant smaller bronchoconstriction was observed after surgical transection around the trachea. The trachea isolation itself induced a smaller nonsignificant bronchoconstrictive response. This diminished response of the airways after this surgical intervention assumes an interruption of syncytial connections, which alters the response to bronchoconstricting stimuli of the whole bronchial system. The exact role of these syncytial connections has yet to be clarified.

Properties of Streptomyces phage SLE111

Phage SLE111 infecting Streptomyces levoris 1331 was morphological different from most actinophages described and yielded very high titres (10(11) p.f.u/ml) after lytic growth. Typical morphological changes of infected hyphae were observed by phase contrast and electron microscopy of ultrathin sections. The double-stranded, linear DNA (44.2 +/- 1.3 kb) was characterized, according to electron microscopic analysis, by absence of cohesive ends, of terminal redundance, and circular permutation. A stem-loop structure containing inverted repeats of about 200 bp was identified by electron microscopy in two alternative positions in the SLE111 genome.

[Influence of vagus nerve, histamine, prostaglandin and catecholamine on airway obstruction]

In three series of experiments, aerosols of acetylcholine, histamine, and Ascaris were administered in a maximal concentration before and after bilateral vagus transection. Vagotomy induced a clear reduction of the dynamic elastance increase by maintaining a constant breath volume. The persisting reaction of the dynamic elastance after vagotomy depends on the intensity of the reaction before vagus transection. Acetylcholine induced the largest reaction. Changes in epinephrine and norepinephrine were found to be variable, but an increase related to dynamic elastance increase could be assumed. Acetylcholine induced a maximal increase in thromboxane B2, and Ascaris induced preferentially a maximal increase in the prostaglandin F2 alpha metabolite 15-Keto-13, 14-dihydro-PGF2 alpha. Vagotomy showed no influence on changes of thromboxane B2, prostaglandin F2 alpha metabolite, or histamine in arterial plasma. The variability in changes of these metabolites may be the cause of the clinical differences in obstructive airway diseases.

[Bronchoconstrictor reaction pattern of the upper respiratory tract and peripheral bronchial system]

Ascaris suum hypersensitive dogs were exposed to ascaris aerosol, histamine, and acetylcholine at different time intervals separately to the upper part of the airtract and to the lower airways. Before and during the exposure the plasma histamine concentrations were measured. Acetylcholine and histamine delivered at the upper part of the airtract do not cause bronchoconstriction. Histamine diffuses in relatively high amounts through the mucosa of the upper part of the airtract into the arterial plasma. Ascaris extract causes bronchoconstriction from the upper part of the airtract as well as from the lower airways. Histamine possibly changes the diffusibility and the sensitivity of the histamine receptor. The correlation between Edyn during acetylcholine and histamine aerosol inhalation was statistically significant. The bronchoconstrictive reaction pattern caused by challenge of the upper part of the airtract is probably different from this caused by challenge of the lower airways.

Interception of lymphatic drainage by Nd: YAG laser irradiation in rat urinary bladder

Lymphatic drainage can be demonstrated by colloidal indian ink injection. A small intramural indian ink spot in the bladder dome is separated from the rest of the rat urinary bladder by encircling transmural Neodymium-YAG (Nd:YAG) laser irradiation. In untreated animals there is an ink flow via the lymphatic vessels to the regional lymph nodes within several hours. In treated animals, after laser irradiation, the indian ink remains in the bladder dome and a penetration of the irradiated area cannot be found by macroscopic and histologic examination. Indian ink will be found in the regional lymph nodes after the ninth day of absorption of the coagulation necrosis and recanalisation of the intercepted lymphatics. Evidence for the interception of the lymphatic drainage is demonstrated by the distinctly delayed ink flow and the injected ink's remaining in the irradiated area. From this, we conclude that Nd:YAG laser irradiation is especially suitable for tumor coagulation, since simultaneous interception of lymphatic drainage will inhibit the spreading of tumor cells.

Partial sensory denervation of the upper respiratory tract on allergen- and histamine-induced bronchoconstriction

The influence of partial denervation of the upper part of the respiratory tract on histamine- and antigen-induced bronchoconstriction was investigated in a series of 12 boxer dogs. To achieve this purpose, the superior laryngeal, hypoglossal and glossopharyngeal nerves were sectioned. The prophylactic effect of unilateral transection of these nerves on antigen-induced bronchoconstriction originating in the upper respiratory tract could be demonstrated.

Histamine release into tracheal lumen and bronchial reactivity. Effect of local allergen administration on histamine release and bronchial reactivity

The influence of tracheal lavage with an allergen on the airway response to bronchial challenge with histamine, acetylcholine, and ascaris extract was investigated in 36 dogs. High histamine concentrations were measured in the tracheal solution after lavage with allergen. This amine, released on the mucosal surface, was observed in only very small concentrations in the circulation. Airway response to acetylcholine inhalation was significantly increased after tracheal lavage with allergen. This hyperreactivity of the lower airways induced by tracheal lavage with an allergen suggests that a reflex mechanism is involved. After histamine inhalation a significantly larger antigen-induced histamine release to tracheal lumen was observed. No influence on airway response was found after tracheal lavage with H2O.

Histamine release into tracheal lumen and bronchial reactivity. The histamine liberation of proteolytic enzymes in the tracheal lumen in relation to the bronchomotoric reactivity

The influence of tracheal lavage in a restricted area, with a proteolytic enzyme (Pronase) on the bronchial response to challenge with ACH and AE was studied in 15 dogs. Histamine concentrations measured in the tracheal liquid after lavage with Pronase were smaller than the values after tracheal lavage with allergen. Airway response to ACH inhalation was significantly increased after tracheal lavage with Pronase. Effects of proteolytic enzymes and allergens on the tracheal wall are compared. Allergens and proteolytic enzymes evidence a different mode of action in increasing reactivity of peripheral airways.

[Therapy using delayed-action theophylline]

In a clinical study pure theophylline in retard pellets form (Afonilum retard, 1 capsule contains 250 mg theophylline in SR-form) was tested over 6 days in 2 groups with 5 patients each. The effect of theophylline in patients with severe airway obstruction (group A: Rt = 9,0 cm H2O/l/sec) and with slight airway obstruction (group B:Rt = 3,5 cm H2O/l/sec) should be studied as well as the possible reduction of beta 2-sympathomimetics in form of aerosol. The bronchospasmolytic effect of theophylline was registered after 3 days medication. Beta 2-sympathomimetics could be reduced from 12 lifts/day to average 2-4 lifts/day at the end of study. Theophylline serum levels are at 7,5 microgram/ml (group A, means) and at 11,0 microgram/ml (group B, means).

Effects of exogenous and endogenous histamine on the respiratory system

There is a statistically strong correlation between the increase of the histamine concentration in the arterial plasma and the increase of airway resistance. The histamine causes a reflex bronchoconstriction on the sensory receptors. Histamine in low concentration increases the unspecific reaction in the bronchial system. This can also be achieved using low concentrations of allergen aerosols. Patients with chronic obstructive bronchitis show high concentrations of histamine in the sputum. The bronchoconstrictive potency of this histamine was found to be not always active. Higher concentrations of histamine can be liberated by washing the inner surface of the bronchial tree. Histamine injected in similar concentrations as that measured in the sputum causes bronchoconstriction. There should be high concentrations of histamine receptors as well as mast cells near the surface of the mucosa of the bronchial wall. There are many questions remaining open, which will be discussed.

[Histamine concentration in the arterial and venous blood, plasma and basophile leucocytes on patients with chronic obstructive bronchitis and on healthy persons ]

Patients with chronic obstructive bronchitis (non atopics) show significant increased histamine concentrations in the plasma. In these patients the histamine concentration in the whole blood was also higher. The histamine concentration in the blood reflect primarily the concentration of basophiles. In individual patients very high plasma and whole blood histamine concentrations were found. The concentration of histamine in the venous plasma was about 2/3 of this of the arterial plasma. No difference in basophile histamine concentration was observed between patients and controls. The histamine concentrations in the plasma reflect primarily the high local histamine concentration in the bronchial mucosa. The plasma histamine concentration itself does not act as direct bronchoconstrictor. The histamine dependent bronchoconstriction is believed to be mostly reflex bronchoconstriction by challenge locally the sensoric receptors in the bronchial mucosa.

The action of disodium cromoglycate on allergen-induced bronchoconstriction

The influence of DSCG administered to the upper and lower area of the air-conducting system on antigen-induced bronchoconstriction was studied in 34 dogs. In high doses DSCG administered to the upper airtract blocked bronchoconstriction and histamine release induced from the lower airways. Bronchoconstriction and histamine release originating from the upper airtract were not completely blocked by this kind of drug administration. Effects were differently strong in the individual animals. High doses of DSCG, administered to the lower airways, showed significant effect on bronchoconstriction originating from the lower airways. There was some yet nonsignificant effect on histamine release. Inhibition of respiratory activity without parallel inhibition of histamine release might suggest that plasma histamine concentration does not reflect the mode of action of DSCG in antigen-induced bronchoconstriction.

Allergen-specific histamine release from whole blood in flour-sensitive bakers

We have studied the allergen-specific in vitro histamine release (HR) in 38 flour-sensitive bakers and in 10 controls without occupational exposure after whole blood incubation with native wheat and rye flour and compared the results with the findings in RAST, skin and bronchial provocation tests. The mean in vitro HR from whole blood after incubation with rye flour amounted to 38.1% (range 0-100%) in flour-sensitive bakers and to 8.2% in the controls (p less than 0.005). Concerning the quantity of HR, no significant differences were found when bakers with meal rhinitis or those with flour-induced asthma were compared. Qualitative analysis, however, showed a close correlation between the frequency of positive HR and the severity of the allergic disorder (rhinitis versus asthma). Comparison of in vitro HR with the findings in RAST and skin tests gave a strong correlation of concordant results with the severity of the underlying disease. The highest coincidence of tests was found in patients with flour-induced asthma. The sensitivity of HR was very high when compared with RAST, skin and provocation tests. Although the assay of HR from whole blood may be a very specific indicator of cell sensitivity in the field of allergy research, the present findings indicate that the conventional methods for diagnosing flour allergy in bakers such as inhalative provocation tests cannot be replaced by this in vitro technique.

[Histamine content of the sputa of patients with chronic obstructive bronchitis]

The sputa of patients with chronic obstructive lung disease show high histamine concentrations with large individual variations. The fluorometric and the biologic method correlate statistically significantly. Histamine concentrations decrease significantly, during 60 min at 37 degrees C, by different amounts in different patients. The measured histamine concentration can cause bronchoconstriction. The histamine and the NaCl control solutions have been found to liberate histamine into the blood, measured as free plasma histamine. There are still many questions open which should be solved because the histamine concentration in the sputum could play an important role in chronic obstructive lung disease.

A controlled trial of amoxycillin with clavulanic acid (BRL 25000) against doxycycline in chronic bronchitis

Thirty patients with acute exacerbations of chronic obstructive bronchitis were treated sequentially with 10-day courses of BRL 25000 (750 mg t.i.d.) and doxycycline (200 mg on Day 1, then 100 mg daily) in alternating order. BRL 25000 is a formulation of amoxycillin 500 mg with clavulanic acid 250 mg, a β-lactamase inhibitor which protects amoxycillin from destruction by these enzymes. BRL 25000 gave clinical results which compared favourably with those of doxycycline and should prove a useful antibiotic for patients with chronic obstructive bronchitis, especially against infections due to problem organisms.

Single and multiple dose kinetics of co-tetroxazine and co-trimoxazole in patients

In patients with chronic obstructive airway disease, the elimination half-lives of tetroxoprim (TXP) and sulfadiazine (SDZ) were found to be 8.6-9.0 h and 7.9-8.5 h, respectively, after administration of a single dose. The corresponding values for trimethoprim (TMP) and sulfamethoxazole (SMZ) were found to be 13.7 and 15.7 h, respectively. In the case of therapeutic multiple dosing, TMP and SMZ accumulate in patients' serum (tau = 12 h). Over a 10-day period of investigation, the serum levels measured were used to calculate half-life values of 12.9 h for TMP and 10.7 h for SMZ. Under the conditions of steady state, half-lives of 5.0 and 5.6 h were calculated for TXP and SDZ, respectively, which in the case of TXP might be explained kinetically. Due to the parallel change in the elimination-rate constants, no accumulation of TXP and SDZ in patients' serum (tau = 12 h) can occur.

Chronic obstructive airways disease: clinical evaluation of severity

A clinical, functional and therapeutic study was carried out in 80 patients with chronic obstructive airways disease. According to the clinical observation on admission they were divided in three different groups: mild, moderate and severe. There were some differences in the amount of sputum, purulence of the sputum, cyanosis and peripheral oedema between the three groups. Group III have had a lower PO2a and higher PCO2a. Airways resistance was nearly the same in all groups. However, the patients of the worse groups (II + III) were significantly older and their disease was of longer duration. "Clinical impressions" do not always agree with single functional tests. To plan a good therapeutic regime all the available data should be considered.

The site of action of beta-2-sympathomimetic bronchodilatators in patients with chronic obstructive airway disease

Administration of fenoterol aerosol limited to the upper respiratory tract during intubation produced the same bronchodilatating effect as the usual administration to the whole respiratory tract by the metered-dose aerosols used clinically in patients with chronic obstructive airway disease. The site of action of the beta 2-sympathicomimetic drugs in this area of the respiratory tract appears to be in the sensory limb of the bronchoconstriction reflex.

Effect of intravenous histamine, allergen (Ascaris suum Extract) and compound 48/80 and inhaled allergen-aerosol on bronchoconstriction and histamine release

The effect of a histamine releaser (48/80), an antigen (Ascaris suum extract) and of exogenous histamine infusion on antigen aerosol-induced bronchoconstriction was investigated in 24 mongrel dogs. During these substance infusions, the high values of arterial plasma histamine did not correlate with the degree of bronchoconstriction. Further, a severe bronchoconstriction with a relatively low arterial plasma histamine concentration was observed during antigen inhalation. During substance inhalation, a high local concentration of histamine is assumed to explain the increased bronchial "sensitivity" to actual plasma levels of histamine. Also, the responsiveness of the bronchial tree to antigen aerosol was observed to be reduced 90 min after induction of a strong histamine release. The importance of histamine in the first phase of immediate hypersensitivity is discussed.

[Effects of acetylcholine- and histamine inhalations also of hypoxia on the arterial plasma-histamine concentration (experiments on dogs). III. Communication (author's transl)]

Inhalation of acetylcholine causes increased histamine concentration in the arterial plasma. This increase is smaller than that following allergen inhalation. The increase in Edyn following ACH inhalation may be related to the histamine released to only a very limited extent. Comparison of the effects of histamine inhalation and allergen inhalation on Edyn and plasma histamine concentration leads to the assumption that sensory receptors are located nearer to the surface of the mucosa than that of the mast cells. Hypoxemia is followed by a slight increase in the arterial plasma histamine concentration. The increase in Edyn corresponds to that caused by allergen inhalation although the increase in Edyn and that in the plasma histamine are much smaller.

[Arterial plasma histamine concentration for airway obstruction due to different areas of the bronchial system. IV. Communication (author's transl)]

The separate inhalation of A.E. aerosol in the upper and the peripheral parts of the airways in allergic dogs is followed by an increase of the histamine concentration in the arterial plasma. The correlation between the plasma histamine concentration and dynamic elastance and the correlation between dynamic elastance and arterial oxygen pressure is very similar following the challenge of the upper and the peripheral parts of the airways. The results argue for reflex bronchoconstriction also by challenge of the more peripheral airways. The results are in accord with the idea that the answer of Edyn depends on a product of local histamine concentration and the area in which the histamine is released. The number of sensory receptors per surface area which is suspected to be greater in the upper part of the airways may also be important.

[Allergen-induced airway obstruction and histamine concentration in arterial and venous plasma. First communication (author's transl)]

In 19 dogs sensitized against Ascaris suum extract we measured dynamic elastance, arterial plasma histamine concentration, pressure in the A. femoralis, and arterial blood gases. In six dogs the venous plasma histamine concentration was also analyzed. Ascaris extract (A.E.) inhalation increased both the arterial and the venous plasma histamine concentration significantly. The venous concentration was 61% of that detected in the arterial blood. At the same arterial plasma histamine level a large variety of dynamic elastance was measured which shows great individual differences in the sensitivity of the bronchoconstrictive system. This histamine released by the bronchopulmonary system works mostly via reflex bronchoconstriction. There was significant correlation between dynamic elastance and arterial oxygen pressure as well as between arterial plasma histamine concentration and systemic blood pressure.

[Histamine concentration in arterial plasma in the course of repeated antigen challenges of the bronchopulmonary system. Second communication (author's transl)]

Repeated ascaris extract (A.E.) exposure on dogs sensitized against this allergen at intervals of 90, 180, and 360 min is followed by different increases in the histamine concentration in the arterial plasma. At 90 min, a significantly smaller amount of histamine becomes measurable in the arterial plasma. Edyn increases unproportionally strong. One hundred eighty minutes after the first exposure A.E. inhalation is again followed by a clearly increased histamine concentration in the arterial plasma. Edyn still increases unproportionally strong. Three hundred sixty minutes after the first A.E. exposure another exposure revealed a stronger increase in the histamine concentration in the arterial plasma, the Edyn increase being smaller than at the first exposure. These results are of importance with regard to the sensitivity of the airways and the investigation of antiallergic and bronchospasmolytic drugs.