An investigation was performed to determine whether symptom free patients with previously diagnosed extrinsic allergic alveolitis had signs of inflammation in the lung. Pulmonary clearance of inhaled technetium-99m labelled diethylene triamine pentaacetic acid (DTPA) was measured in seven patients with a history of extrinsic allergic alveolitis but with no symptoms at the time of the study and in 12 control subjects. Monoexponential clearance curves were obtained in all 12 control subjects. In contrast, lung clearance was abnormal in five of the seven patients: biexponential clearance curves were noted in four and an abnormally rapid monoexponential curve in one. Bronchoalveolar lavage was performed in all patients. Fluid from the second and third aliquots showed increased concentrations of albumin and urea in fluids from the patients, suggesting increased plasma leakage through the alveolocapillary membranes. More eosinophils and more eosinophil cationic protein were also found in the lavage fluid from the patients. The trend towards increased numbers of eosinophils in patients with abnormal lung clearance of DTPA suggests that this may be due to a continuing inflammatory reaction. Lung inflammation was also suggested by the fact that less leukotriene B4 was secreted by cultured alveolar macrophages obtained from patients than by control macrophages. It is concluded that symptom free patients with previous extrinsic allergic alveolitis have continuing alveolar disease as shown by lung clearance and lavage findings.Extrinsic allergic alveolitis, or hypersensitivity pneumonitis, is an inflammatory lung disease caused by hypersensitivity to inhaled organic agents.' Exposure to the antigen may cause an acute response characterised by general symptoms such as fever, cough, dyspnoea, and malaise. The disease may also run a subacute course with the insidious onset of breathlessness, lassitude, and weight loss. The inflammatory reaction affects the mechanical properties of the lung and impairs gas exchange.2 Prolonged alveolitis ultimately leads to structural changes in the lung with development of fibrosis.The alveolitis in this disease is characterised by an accumulation of inflammatory cells and oedema.2 Bronchoalveolar lavage provides information about cellular events in the alveoli as well as about alveolar accumulation of plasma proteins and other substances related to the oedema. Increased permeability of tissue barriers in the lung can also be measured non-invasively with nuclear medicine techniques. The transfer of technetium-99 labelled diethylene triamine penta-acetic acid (99mTc DTPA) can be measuced by means of the lung retention curve after inhalation of the nebulised tracer and its external detection. The aim of the present study was to use lung lavage and measurement of the alveolocapillary transfer of 99'Tc DTPA to assess the intensity of alveolitis in patients with a past history of extrinsic allergic alveolitis. Methods SUBJECTSWe studied seven patients (mean age 49 7 (range 39-59) years) wit...

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In a two-year prospective therapeutic trial 13 patients with systemic sclerosis (SSc) were treated with penicillamine, 9 with cyclofenil, and 7 with neither. At entry skin involvement and esophageal, lung, heart, and kidney function did not differ significantly between the groups. Reevaluation after one and two years did not show any significant changes in skin, esophageal, heart, and kidney manifestations, while lung function had slightly improved in both drug-treatment groups. This study thus shows little overall effect of penicillamine and cyclofenil, although both drugs may arrest worsening of pulmonary dysfunction.

The characteristics of oesophageal dysfunction were studied with manometry and cine radiography in a recumbent position in 21 patients with typical progressive systemic sclerosis (PSS). Manometry was also performed in a matched control group. Only one patient had a completely normal manometry. Mean resting pressure in both the upper and lower oesophageal sphincters were significantly decreased in PSS. Twelve patients had no detectable peristalsis in the lower oesophagus. In the upper oesophagus, the mean pressure amplitude of the peristalitic wave was found to be lower than normal in all patients with detectable peristalsis. In some patients, the only feature of oesophageal dysfunction observed was an increased speed of the peristaltic wave in the middle and lower oesophagus. This is interpreted as an impaired coordination of the propulsive peristalsis. Neuromuscular dysfunction of the oesophagus in its full length was thus clearly demonstrated. At cine radiography, three patients were judged as normal, and 13 patients had severe impairment of the peristaltic function in the distal two-thirds of oesophagus. Oesophageal scoring based on manometry correlated well to scoring based on radiography. Cine radiography of the recumbent patient gives adequate information for clinical purposes. Detection of early changes in the amplitude and speed of the propagation wave requires manometry.