The human mouth has been utilized as a new and significant in vivo open bioassay system for tracing undesirable substances present in tobacco smoke, in an exact milieu where the smoking "problem" begins and must be dealt with directly. The associated in vitro closed test systems described herein have provided new, sensitive bioassays that help to explain the in vivo effects.

No abstract

No abstract

Two separate acute bacterial exacerbations of chronic bronchitis or chronic asthmatic bronchitis were treated in 20 patients in a double-blind crossover study. One course of treatment consisted of 320 mg of trimethoprim (TMP) plus 1,600 mg of sulfamethoxazole (SMZ) daily and the other of 2 g of ampicillin daily; each drug was given for 14 days. Patients were observed initially, twice a week during therapy, and weekly after therapy. Observations that were recorded included graded chest symptoms and physical findings, vital signs, pulmonary function, hematologic parameters, and objective sputum measurements (daily volume, purulence, differential quantitative cytology, quantitative bacterial counts, physical properties, levels of lactate dehydrogenase with its isoenzymes, levels of myeloperoxidase, and presence of deoxyribonucleic acid fibers). Both antibiotic regimens were effective in resolving these acute bacterial exacerbations. Paired z-test analysis revealed few and minor differences between TMP-SMZ and ampicillin during therapy, although three patients did not complete TMP-SMZ therapy because of adverse reactions. However, the period between the two bacterial exacerbations was significantly longer after ampicillin therapy. Innovative in this investigation are the study design and the objective quantitative measurements of inflammatory response and bacterial populations in sputum.Acute bacterial bronchitic exacerbations are important clinical events in chronic bronchitis because of their contribution to morbidity. Although Koch's postulates are difficult to prove in this setting, the overwhelming conclusion based on experience is that treatment with antibiotics is temporally related to clinical recovery. Many antimicrobial agents appear to be effective in treatment of these acute bacterial exacerbations, and trimethoprim-sulfamethoxazole (TMP-SMZ) is among the more recent additions to this list. Like most of these antibiotics, TMP-SMZ has been experimentally demonstrated to be effective in acute bacterial bronchitic exacerbations by means of a limited number of objective measurements in randomly assigned, parallel investigations. To a large extent, the objective criteria of sputum volume, This research was supported by a grant-in-aid from Hoffmann-LaRoche, Inc., Nutley, New Jersey.Please address requests for reprints to Dr. Sanford Chodosh, Sputum Laboratory, ACC Building, Boston City Hospital, 818 Harrison Avenue, Boston, Massachusetts 02118. 517 gross sputum purulence, bacterial culture, pulmonary function, and vital signs are only indirect measures of the infectious process. As such, they lack the preciseness needed for the determination of possible differences between alternative methods of therapy.Methods developed by Chodosh and colleagues have been used to compare the efficacy of various types of antimicrobial therapy in acute bacterial exacerbations of chronic bronchitis. Some of the measurements provide criteria that more closely reflect the level of bronchopulmonary inflammation and the size of bact...

No abstract