Hydrocarbon ingestion: an unusual cause of multiple pulmonary pseudotumors.

I have reported a case of multiple pseudotumors seen on chest x-ray film after ingestion of roach killer in a suicide attempt. Hydrocarbon ingestion should be added to the list of causes of multiple pulmonary mass lesions.

Sarcoidosis.

Sarcoidosis continues to be a disease defined descriptively rather than by etiology. Bronchoalveolar lavage has brought new understandings of the pulmonary inflammatory process and its pathogenesis and defects in immunoregulation. Much is known of the clinical characteristics of sarcoidosis, its diagnosis and management. Spontaneous remissions are common, but when treatment is required, the response to corticosteroids is often dramatic, although long-term treatment may be required. The appropriate use of corticosteroids is discussed fully, as are special clinical problems.

Serial lung function testing in patients treated with amiodarone: a prospective study.

PURPOSE: Amiodarone has proven to be effective in many cases of cardiac arrhythmias, refractory ventricular tachycardia, and ventricular fibrillation. Pulmonary toxicity is a possible side effect of the drug, with a reported incidence of 2 to 15 percent per year. To determine the effect of amiodarone on lung function, we prospectively studied serial lung function tests in a cohort of 91 patients with refractory cardiac arrhythmias treated with this agent. PATIENTS AND METHODS: Spirometry and carbon monoxide diffusing capacity (DLCO) were measured at zero, three, six, 12, 18, and 24 months, with a mean follow-up of 351 days. RESULTS: For the whole population taking a mean dose of amiodarone of 367 mg daily (range: 136 to 512 mg), there was no accelerated rate of decline in spirometric indices or DLCO. Analysis of lung function changes by multivariate analysis demonstrated that an accelerated decline in DLCO values occurred in elderly patients (p less than 0.05) but not in patients with pre-existing lung disease or cigarette smokers. In four patients (4.5 percent), clinical evidence of amiodarone pulmonary toxicity developed that was associated with a fall in DLCO of greater than 20 percent. All four patients recovered after the drug was stopped. Another 15 patients, without clinical evidence of pulmonary toxicity, had a sustained decline in DLCO of greater than 20 percent. These 15 patients remained asymptomatic over the next 11 months without interruption of therapy. A greater than 20 percent fall in DLCO was a sensitive test for clinically evident amiodarone pulmonary toxicity, but had a positive predictive value of only 21 percent. CONCLUSION: An isolated fall in DLCO, in the absence of clinical evidence of toxicity, does not necessitate stopping amiodarone. An unchanged DLCO value appears to be a reliable negative predictor of pulmonary toxicity.

Recurrent pulmonary infections in patients with chronic lymphocytic leukemia and hypogammaglobulinemia.

We describe two patients with concomitant recurrent pulmonary infections due to encapsulated organisms and chronic lymphocytic leukemia and hypogammaglobulinemia. We discuss the cases as a subset of acquired hypogammaglobulinemia in adults, focusing on the possible role of impaired defense mechanisms and emphasizing the importance of aggressive therapy with gamma globulin, antibiotics, and good pulmonary toilet to reduce morbidity.

Modelling time-series of British road accident data.

The paper reports analyses of road accident data in Britain in which time series of monthly accident data for the period 1970-1978 have been related to a number of explanatory variables. Two sets of results are presented. Two-vehicle accidents were modelled by regression; because the time trends in this data appeared to be reasonably consistent, the resulting model was regarded as adequate. In the case of single-vehicle accidents, trends were not consistent over the period, and it was considered that the Box-Jenkins time series method might be more appropriate than simple regression. The principles involved in fitting Box-Jenkins models to this data are explained and the results compared with the regression method. The tentative conclusion drawn from this comparison is that because accident series are generally very "noisy" and autocorrelation among the residuals from standard regressions not very strong, Box-Jenkins models are unlikely to represent the series appreciably better than regression based on the assumption of uncorrelated residuals. Predictions of the alternative models for the years 1979-1981 are presented and discussed.

Longitudinal study of chronic sarcoidosis with low-dose maintenance corticosteroid therapy. Outcome and complications.

A series of 181 patients with chronic persistent sarcoidosis for more than 5 years have been reviewed, with a mean follow-up period of 14 years, and 77% followed for more than 10 years. Efforts to identify more white patients meeting the criteria of such persistent disease were unsuccessful. Seventy-eight percent were black, and 69% were women. Pulmonary disease was the major manifestation in 70% and was present in 88%. The early major disease feature predicts the nature of the long-term manifestation in 94%. Ninety-four percent were treated with prednisone, with 63% for more than 5 years. Fifty-three percent required continued treatment, and of those receiving continued treatment, 91% were maintained on doses of no more than 15 mg daily and 65% on no more than 10 mg of prednisone daily. Relapses were frequent as prednisone was withdrawn, occurring at least once in 75% and several times in 51%. Low-dose prednisone treatment with 5-15 mg daily provides significant benefit. A mean treatment period of 8 years was observed (range: 10 days to 24 years). The benefits of treatment greatly exceed the infrequent complications. In Baltimore, chronic sarcoidosis with persistent disease seems to be more frequently encountered in black patients than in white patients.

Isolated nodular pulmonary amyloidosis: diagnosis by percutaneous needle aspiration biopsy.

We have reported three cases of isolated nodular pulmonary amyloidosis, a rare condition whose roentgenographic presentation frequently mimics tumor metastatic to the lung or primary lung cancer. Computerized tomography is not helpful in diagnosing this condition. In our experience, the specific diagnosis could be made by aspiration needle biopsy, avoiding thoracotomy.

The longitudinal study of chronic sarcoidosis.

Although spontaneous remissions are frequent in sarcoidosis, chronic persistent disabling disease is also observed. This feature seems more frequent and more severe in black patients, as has been previously reported (10). The more extensive and severe the initial disease manifestations, the more likely it is that the disease will continue. Corticosteroids are usually beneficial and complications are infrequent. Delayed or interrupted treatment seems to allow progression or irreversible disease or both. Patient compliance is an obvious important factor. Relapses are frequent as treatment is withdrawn but are usually at least partially reversible. Some deterioration is observed with repeated relapses. Low dose daily prednisone (5-15 mg) seems to prevent relapses. Patient compliance is facilitated with daily treatment rather than alternate day therapy. Prolonged treatment for 10 to 15 or more years is often required. Chloroquine is particularly helpful in skin and mucosal disease. The necessity for long-term thoughtful management is obvious.

B-scan ultrasound in the diagnosis of popliteal aneurysms.

Sonography gives a characteristic picture of popliteal aneurysms, with an easily demonstrable connection of the sonolucent aneurysmal sac with the popliteal artery. It is a good screening procedure for suspected aneurysms and for patients with popliteal pain, mass, or sudden distal ischemia. Three case reports of five popliteal aneurysms diagnosed by ultrasound are presented. A case of neurofibrosarcoma occurring in the popliteal fossa is shown for comparison.