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By Jonathan R. Webb MB, MRCP (auth.), Jonathan R. Webb MB, MRCP (eds.)

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The inspiration will cause the gas in the subject's chest to be decompressed while the gas in the box outside the subject will be compressed as a result of an increase in the chest volume. Any volume change in the gas in the lungs will be equal and opposite to that in the air surrounding the subject during inspiration against the closed valve. The pressure change in the gas in the subject's lung is measured in the mouthpiece on the subject side of the shutter (see Figure 3). This method is quick and accurate and is not affected by airways obstruction, but it does require expensive equipment.

A positive Mantoux test is a typical type N hypersensitivity reaction. Heavy chain +. ........ -. I I Pepsin cleavage ............... I I ~ I I I I StS I Papain cleavage --------+--- Light chain I ~ Fe sts r I I I I Fd I I I I •I I• B A I • Fab I I I •• •• I B Plate 6. Immunoglobulin structure (after Porter). Papain cleava~e (dashed line) produces two Fab portions and one Fe portion. Pepsin cleavage (dotted line) produces F(ab')X. Disulphide bond reaction produces two light and two heavy chains.

Aspergillus fumigatus and A. niger Aspergillus fumigatus and A. niger may colonize lung cavities (tuberculous or carcinomatous), forming aspergillomata. These organisms are very rarely invasive though they can produce systemic infection in the immunosuppressed patient. They may be cultured from sputum, and precipitins are frequently demonstrable in serum. Candida albicans Candida albicans is a yeast found in small numbers as part of the normal mouth flora. It tends to overgrow when a patient is on antibiotic therapy, and may be grown in large numbers in sputum specimens.

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