[Pulmonary emergency medicine at Okinawa Chubu Hospital, including care of patients with primary, secondary, and tertiary emergency problems].

In the emergency department of Okinawa Chubu Hospital, 32,088 patients were seen between November 1992 and October 1993. Of these patients, 19,306 were over 16 years old. About 20% of the patients seen in the emergency department had pulmonary diseases. In decreasing order of frequency, the five most commonly seen conditions were: upper respiratory tract infections (19%), bacterial pneumonia (12%), acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease, and chest trauma. Medical (i.e. nonsurgical) treatment was required by 10,034 patients. Thirty five percent of those had pulmonary disorders, and the mortality rate was 0.9%. A total of 747 patients were hospitalized, and 65 were admitted to the intensive care unit. Of those admitted to the intensive care unit, 9% died of respiratory problems. Surgical treatment was required by 5587 patients. Only 5.1% of them had pulmonary problems, and the mortality rate was 3.5%. However, the mortality rate among the 25 patients admitted to the intensive care unit for surgical pulmonary problems was 8%. Among patients with medical problems who were hospitalized via the emergency department, 36% had pulmonary disorders (mainly pneumonias, asthmatic attacks, acute bacterial bronchitis, and acute exacerbation of chronic obstructive pulmonary disease), but only 7% of patients with surgical problems had chest trauma (mainly due to traffic accidents of falls).

Acute pneumonitis presumed to be silicone embolism.

A 39-year-old housewife who underwent intramammary injections of a proprietary silicone fluid mixture showed clinical and novel transbronchial lung biopsy (TBLB) findings. She presented with complaints of progressive dyspnea, dry cough, and pleuritic chest pain 2 days after the last silicone injections. The chest X-ray and CT scan showed diffuse interstitial infiltrates. TBLB demonstrated translucent, presumably silicone globules embolized within the pulmonary capillaries. The documentation of intramammary injections, the clinical and radiographic features of acute pneumonitis, and the histopathologic evidence by TBLB, may support the causal relationship between illicit injections and the silicone embolism. We discuss the pathogenesis and urge that this potentially toxic source of pulmonary embolism be removed.

[Diagnosis and significance of ARDS].

Adult respiratory distress syndrome (ARDS) is defined as a syndrome of acute respiratory failure following generalized or localized catastrophic events, without a past history of underlying pulmonary diseases, which is manifested by acute onset of dyspnea, laboured breathing and non-cardiogenic lung edema. This syndrome is also characterized by preceding pulmonary or extrapulmonary insults, an almost normal lung function immediately after the catastrophic events, and acute and progressive hypoxemia, decreased pulmonary compliance with chest radiographs showing bilateral diffuse pulmonary infiltrates, associated with very poor outcome. The diagnostic modalities for obtaining pathognomonic findings indicative of ARDS are not established as yet, hence the only way to diagnose ARDS is to evaluate the pathophysiological status, as mentioned in the definition above, by various laboratory examinations. Although there are many reported modifications, the diagnostic criteria suggested by Petty, et al are still widely used in practice. However, it is unknown whether they are strictly followed or not. Nowadays, the significance of making a diagnosis of ARDS on the basis of the above criteria is questioned by some physicians. To address these questions, the authors reported on an overview of ARDS cases seen at ICU of our institute which is providing acute and emergency care services in Okinawa. In the past 10 years (1979-1988), 4500 patients were admitted to our ICU and 170 of them were diagnosed as either having ARDS or their course in ICU were complicated by ARDS. These cases were retrospectively studied.(ABSTRACT TRUNCATED AT 250 WORDS)

[Physical signs and lung function tests in patients with chronic obstructive pulmonary disease (COPD)].

We examined 40 consecutive patients with chronic obstructive pulmonary disease (COPD) admitted to our institute between April and September 1985 for acute exacerbation, when they recovered from acute exacerbation and became cooperative to undergo lung function tests. Additionally, a follow up study was also done 4 years later, for assessing whether the physical signs were indicative of poor prognosis or not, correlated with survival rate, frequency of acute exacerbations and mechanical ventilation required and application of home oxygen therapy (HOT). Four physical signs, including increased activity of strap muscle, recession of supraclavicular fossae in inspiration, loss of pump-handle movement and loss of bucket-handle movement were associated with significantly low values in all lung function parameters tested but other signs were correlated with only in 2 or 3 parameters. The long-term prognosis was poor in the patients with more physical signs (abnormality score), namely the patients, who were on HOT because of development of chronic respiratory failure had significantly more frequent episodes of acute exacerbation and mechanical ventilation, had definitely higher scores than others who did not need HOT.