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September 1963

Pulmonary Alveolar Proteinosis: A New Technique and Rationale for Treatment

Author Affiliations


Assistant Chief, Medical Service, Veterans Administration Hospital, and Assistant in Medicine, The Johns Hopkins University School of Medicine (Dr. Ramírez-R.); Associate Professor of Pathology, University of Maryland School of Medicine (Dr. Schultz); Clinical Investigator, Veterans Administration Hospital, and Instructor in Environmental Medicine, The Johns Hopkins University School of Hygiene and Public Health (Dr. Dutton).

Arch Intern Med. 1963;112(3):419-431. doi:10.1001/archinte.1963.03860030173021

Since the description by Rosen, Castleman, and Liebow1 of pulmonary alveolar proteinosis, various empiric methods of treatment have been proposed. Clinical improvement was noted in 3 of 21 cases during therapy with corticosteroids 1-10 and radiographic improvement on two 11,12 of seven patients 9,11,12,14 treated with potassium iodide. One of the two patients 12 who improved while receiving oral iodides also received streptokinase-streptodornase by aerosol. Aerosol therapy has been associated with clinical and rediographic improvement in three other cases—one received streptokinase-streptodornase 15 and two trypsin.8,9 One patient 8 tolerated trypsin aerosol therapy for only six days, but the oral intake of 400 units of trypsin-chymotrypsin daily was associated with progressive clearing of the chest x-ray film. The efficacy of these regimens is still in question, however, since spontaneous remissions have been reported1 and clinical observations in this rare disease have been, by necessity, limited and uncontrolled.

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