Dose effects of inhaled ipratropium bromide on the impedance of the respiratory system in normal subjects.

The influence of cholinergic receptor blockade on the impedance of the respiratory system was studied in 10 healthy volunteers in a frequency spectrum between 4 and 52 Hz by means of the forced pseudo random-noise oscillation technique. Ipratropium bromide was used in the inhaled form in two doses (0.040 and 0.200 mg). Both does caused a significant decrease in oscillatory airway resistance, Rrs. No dose effect on Rrs was found. Both doses caused an increase in the reactance of the respiratory system, Xrs. This increase in Xrs was significantly greater after the inhalation of the higher dose. The effect of both doses on the real part of impedance can be explained by a dilation of the central airways. Furthermore, inhaled ipratropium bromide, especially in the higher dose, led to an increase in the imaginary part of impedance suggesting a decrease in the capacitance of pulmonary structures in normal subjects.

Nutritional state and exercise performance in patients with chronic obstructive lung disease.

The relation between exercise performance and certain measures of nutritional state was investigated in 83 patients with stable chronic obstructive lung disease (mean age 62 (8) years). All patients had a forced expiratory volume in one second (FEV1) less than 50% predicted, an arterial oxygen tension of more than 7.3 kPa, and no severe locomotor, cardiovascular, neurological, or endocrine disorders. Exercise performance was assessed from a 12 minute walking test; body weight (as a percentage of ideal weight), creatinine height index, and serum concentrations of albumin, transferrin, and prealbumin were assessed as measures of nutritional state. Mean values of the nutritional variables were within the normal range. The mean (SD) 12 minute walking distance was 686 (254) metres. Walking distance was positively associated with serum albumin concentration and creatinine height index but not with body weight, serum prealbumin, or serum transferrin concentrations. When patients were categorised into low, medium and high performance groups on the basis of their walking distance, a very low creatinine height index (mean (SD) 59% (19%] was found in the low performance group. Albumin explained part of the variance in walking distance independently of pulmonary function in a stepwise regression analysis. The findings suggest that in patients with chronic airflow obstruction skeletal muscle mass and serum albumin concentration are positively associated with exercise performance as measured with a 12 minute walk.

Inventory of nutritional status in patients with COPD.

Assessment of nutritional status was performed in 153 patients with COPD, admitted to a rehabilitation center. All patients had moderate to severe COPD and were in stable pulmonary condition. Nutritional parameters studied were percentage of ideal body weight, creatinine height index, serum albumin, serum prealbumin, serum transferrin, and total lymphocyte count. A nutritional index composed of four commonly used parameters (PIW, ALB, PALB, TLC) was calculated. This NI was used to separate patients who had a compromised nutritional status (NI greater than or equal to 0.5; 29 patients, 19 percent) from patients who had a normal nutritional status. The results demonstrated a relation between impaired gas exchange and parameters used to assess nutritional status and not between the degree of bronchial obstruction and such parameters.

Superior vena caval syndrome due to substernal goitre.

Superior vena caval syndrome is usually due to malignant disease, however, benign cases do occur. Two patients with superior vena caval syndrome due to substernal goitre are reported, and the use of phleboscintigraphy and/or vena caval phlebography are advocated. A review of potentially helpful diagnostic procedures is given.

Once daily Theo-Dur in morning dippers.

In a group of 18 patients with a so-called "morning dip", one single dose of theophylline was administered at 10:00 p.m. by means of a sustained release formulation (Theodur Retard). The dosage of theophylline was adjusted according to the complaints of the patients. Plasma theophylline levels were determined at 10:00 a.m. to prevent theophylline intoxications. The results were objectivated by measuring the PEFR twice/day. When the optimal dosage was obtained, a once/day administration of Theodur Retard at 10:00 p.m. provided an improved peak flow in the early morning, less symptoms at night and a better quality of sleep.

Thoracoscopic pleurodesis in the management of spontaneous pneumothorax.

To assess the contribution of thoracoscopy in the management of spontaneous pneumothorax (SP) 101 consecutive cases treated in our department were reviewed. The patients were divided into two groups: group 1 was treated conservatively; in group 2 thoracoscopy was performed and in case of an idiopathic SP, pleurodesis was carried out with iodinated talcum. Group 1 consisted of 51 patients of whom 28 were considered to have a symptomatic SP (1A) and 23 an idiopathic SP (1B). The recurrence rate was 46 and 26%, respectively. Group 2 consisted of 50 patients of whom 12 had a symptomatic SP (2A) and 38 an idiopathic SP (2B). In group 2A, thoracoscopy provided the indication for primary surgical intervention in 3 patients. Patients in group 2B were treated by chemical pleurodesis with iodinated talcum. In only 1 did a recurrence occur. Complications of thoracoscopy and/or pleurodesis were not observed. We conclude that thoracoscopy enables accurate assessment of the type of pneumothorax, and can play an important role in the management of SP. Chemical pleurodesis causes a significant reduction of the recurrence rate in the treatment of idiopathic SP.

Endobronchial non-Hodgkin lymphoma: report of two cases.

Two cases of endobronchial localised non-Hodgkin lymphoma are presented. Pathogenesis, clinical history, diagnosis and treatment of this unusual localisation of non-Hodgkin lymphoma are reviewed.

The value of computed tomography to the staging of non-small-cell primary bronchogenic carcinoma: a prospective study.

The value of computed tomography (CT) for the diagnosis of non-small-cell primary bronchogenic carcinoma with regard to T and N classifications was prospectively evaluated in a series of 29 patients. The sensitivity of CT in evaluating the extension of tumor to pleura or mediastinum was 100%, with only a 76% specificity. Computed tomography demonstrated 73 lymph nodes greater than or equal to 10 mm and 55 lymph nodes less than 10 mm in 27 patients. Invasive staging showed 23 lymph nodes greater than or equal to 10 mm and 22 nodes less than 10 mm which were not visualized by CT. Malignant invasion was found at histology in only one of these lymph nodes. The majority of nodes not visualized by CT were localized in the left paratracheal group, right and left tracheobronchial groups and the aortopulmonary window.

Bronchopulmonary carcinoid tumors.

Two cases of bronchopulmonary carcinoid tumor are reported. The incidence, clinical presentation, histology and treatment are discussed.

Alternating chemotherapy, prophylactic cranial irradiation and late local thoracic irradiation for small-cell lung cancer.

28 consecutive patients with small-cell lung cancer (SCLC) aged 48-78 years (with exclusion of 4 patients over 80 years) were treated with combination chemotherapy in the schedule AAA-BBB-AAA-BBB, where A consisted of cyclophosphamide 1,000 mg/m2, adriamycin 50 mg/m2, and etoposide 100 mg/m2 X 3, and B of cyclophosphamide 1,000 mg/m2, methotrexate 50 mg/m2 and vincristine 1 mg/m2 X 2. Patients in complete remission after 3 courses received prophylactic cranial irradiation, and thoracic irradiation was given after completion of chemotherapy. There were 3 toxic deaths. Of the patients with limited disease, 71% reached complete remission and 24% partial remission; in extensive disease these percentages were 36 and 45%, respectively. Three patients survived more than 2 years, 1 with recurrence of squamous cell carcinoma after 125 weeks. It is concluded that this scheme of combination chemotherapy is as effective as those reported earlier in remission rate and survival in SCLC. However, the addition of thoracic irradiation failed to prevent local relapse in 83% of the patients.

Successful treatment of tuberculous brain abscess.

A case of tuberculous brain abscess occurred in spite of 4 months' treatment of pulmonary tuberculosis with a triple drug anti-tuberculous regimen. Surgical removal and further chemotherapy were successful.

The value of conventional radiography and computed tomography (CT) in diagnosis of pulmonary hamartoma.

No radiologic features are pathognomonic for hamartoma of the lung. Punctate or popcorn calcification, umbilication sign and CT density measurements should be helpful but are not diagnostic. Evidence of fat may suggest pulmonary hamartoma and CT density measurements may be helpful to detect this. A low CT number, however, may be the result of either the partial volume averaging or the presence of fat in the tumour. The definite diagnosis can be made only by histological examination after thoracotomy or transthoracic puncture.

Evaluation of the contribution of computed tomography to the staging of non-oat-cell primary bronchogenic carcinoma. A retrospective study.

In order to evaluate the contribution of computed tomography in the pre-operative staging of non-oat-cell primary bronchogenic carcinoma, the clinical T-classification by conventional methods only and after including CT was compared with the postsurgical T-classification in 21 patients. Furthermore, hilar or mediastinal lymph node enlargement as found by conventional methods only and after including CT was compared with the postsurgical N-classification. With conventional methods, T-classification was correctly evaluated in 15 of 21 patients (71%), 5 patients (24%) were underestimated and 1 patient (5%) was overestimated. Clinical T-classification including the results of CT, was correctly evaluated in 17 patients (80%), 2 patients (10%) were underestimated and 1 patient (5%) was overestimated. One patient (5%) was underestimated by bronchoscopy. Computed tomography demonstrated in 15 patients 31 lymph nodes in the mediastinum greater than 10 mm. and 18 lymph nodes smaller than 10 mm.; in 6 patients 9 lymph nodes smaller than 10 mm. were described. Only 4 patients with mediastinal lymph node enlargement were postoperatively classified as N2. Malignant growth was detected postoperatively in 10 lymph nodes smaller than 10 mm.