Postoperative pulmonary complications: risk assessment, prevention, and treatment.

Patients with pre-existing pulmonary disease and certain other conditions are at increased risk of postoperative pulmonary complications. This article surveys how internists can identify high-risk patients clinically, use pulmonary function studies, use specific therapy to reduce risk, and manage postoperative complications.

A practical approach to chronic fatigue syndrome.

Chronic fatigue may have several physical causes, but a psychiatric condition is often involved. A substantial minority of patients are not diagnosed by conventional tests and do not respond to antidepressant therapy. These patients should be referred for psychiatric opinion or observed for new developments. Extensive virologic testing and unorthodox treatment approaches have no scientific basis at present. Claims of dramatic new diagnostic tests or therapy should be treated with caution because of the long history of unsuccessful attempts to categorize chronic fatigue into one diagnosis and the strong placebo effect shown in controlled trials.

MR imaging characteristics of tuberculous spondylitis vs vertebral osteomyelitis.

Retrospective evaluation was made of four patients with tuberculous spondylitis who had been studied by MR with T1- and T2-weighted images in the sagittal plane and spin-density-weighted images in the axial plane. Evaluation was made of the distribution of abnormal signals within the body and posterior elements of the vertebrae, the intervertebral disk, and the associated paraspinal and epidural areas. In two of the cases, three-level involvement was seen with noninvolvement of intervening disks; metastases were misdiagnosed. One patient had anterior/inferior erosion of the vertebral body without visualization of the disk. The last patient had the more typical MR characteristics of intervertebral disk infection. Plain film examination showed only degenerative changes in three of the four cases. MR revealed more extensive involvement than the plain films did. Involvement of the posterior element and posterior vertebral body was prominent in three of the four cases. This is a significant finding since these patients are more likely to have neurologic symptoms and require laminectomy. Follow-up examinations in two cases showed increased signal on T1-weighted images, suggesting infiltration of hemopoietic marrow with fat, as has been described for degenerative osteoarthritis. The anatomy of the microcirculation of the vertebral body is related to the patterns of vertebral osteomyelitis, and discrepancies can be seen between the findings in our cases and the MR criteria previously noted for pyogenic vertebral osteomyelitis. The MR findings in our patients generally were more typical of neoplasm than of infection. These findings may reflect the characteristics of the tuberculous organism relative to the age-dependent pattern of vertebral microcirculation. Correct diagnosis of tuberculous spondylitis in young to middle-aged adults requires correlation of MR and clinical findings.

Respiratory symptoms and pulmonary function of welders in the engineering industry.

We have studied respiratory symptoms, smoking habits, chest radiographs, sickness absence, and pulmonary function among 258 welders and an equal number of matched control subjects in three engineering factories. Welders who smoked had a higher frequency of chronic phlegm production than control subjects but there was no difference in cough or dyspnoea. The frequency of abnormality on chest radiographs was low and similar in welders and controls. Upper respiratory infections were a more frequent cause of sickness absence in welders than in controls but no difference was found in other respiratory diseases. FEV1 and peak expiratory flow rate were similar in welders and controls. In a subset of 186 subjects the maximum expiratory flow rate at low lung volumes was significantly less in welders who smoked than in control subjects who smoked, but there was no difference in non-smokers. Welders working under these conditions in the engineering industry appear to have no increased risk of chronic obstructive lung disease.

Normal values of transfer factor and transfer coefficients in healthy males and females.

A population study was performed to obtain local normal values of the transfer factor for a respiratory laboratory providing a routine hospital service. Statistical analysis of the results obtained showed similar results to those of previous investigators for the transfer factor and alveolar volume. The transfer factor was found to be dependent on height, age and sex, while the alveolar volume depended only upon height and sex. Unlike previous investigations, however, the present study showed that the transfer coefficient was the same for women as for men and was related solely to age.

An assessment of the place of follow-up pulmonary tuberculosis.

I n 1971--4 forty-four patients were found to have drug-susceptible tubercle bacilli in their sputum more than one year after a previous positive result. Comparison of their case records with those of 45 controls showed that inadequate chemotherapy was by far the most important cause of relapse. Most patients who have had adequate chemotherapy for pulmonary tuberculosis should be discharged. Patients who have certain risk factors or who have had inadequate or irregular chemotherapy should be followed up indefinitely.