Diagnostic procedures for small pulmonary nodules detected by mass-screening.

BACKGROUND: A retrospective study was performed to evaluate the diagnostic procedures performed in small peripheral pulmonary nodules that were detected at mass screening. PATIENTS AND METHODS: The medical records were reviewed of patients who had peripheral pulmonary nodules < or =20 mm detected by mass screening between 1995 and 2007. RESULTS: A total of 41.7% of patients were diagnosed based on pathological findings of specimens obtained by bronchoscopic procedures (bronchoscopy group), while the remainder were diagnosed using specimens obtained by surgical biopsy (surgery group). The median diameter of lung tumors in the bronchoscopy group was 20 mm, while that in the surgery group was 15 mm. Of patients with lung cancer in the bronchoscopy group 22.9% had tumors < or =15 mm, however, 63.8% of patients in the surgery group had tumors < or =15 mm. CONCLUSION: Pulmonary nodules < or =15 mm in diameter found in specimens obtained by bronchoscopic procedures should be diagnosed by surgical biopsy.

Co-morbid illnesses in patients with respiratory disease.

With the rising age, more patients will be diagnosed with one or more other serious illnesses. This study was undertaken to evaluate the frequency of co-morbid illnesses in patients with respiratory diseases, and to compare the frequency between the elderly and the younger patients. We performed chart review of 2764 patients with respiratory disease who admitted in three hospitals in Japan between January 1990 and March 2005. Co-morbid illnesses were observed in 69.5% of 2764 patients with respiratory disease. In 1150 patients 70 years or older, 83.9% of them had co-morbid illnesses. The prevalence of co-morbid illnesses in patients with respiratory disease clearly rose with increasing age (p= 0.0001), the largest increase occurring after the age of 50. Charlson index in patients with respiratory disease clearly rose with increasing age (p= 0.0001). In both elderly (>or= 70 years) or younger (< 70 years) groups of patients, co-morbid illnesses did not influence on the choice of diagnostic procedure. Although the presence of co-morbid illnesses in our patients with non-malignant respiratory disease did not influence on the choice of treatment, however, the presence of co-morbid illnesses in elderly patients with malignant respiratory disease apparently discouraged the choice of standard therapy. Clinical research should address appropriate therapies not only for the elderly patients without co-morbid illness but also for those with co-morbid illnesses. Being aware of the co-morbid illnesses will allow improved management and the planning of appropriate support to a wide range of elderly patients with respiratory disease with important and peculiar needs for care.

Psychotropic drugs for terminally ill patients with respiratory disease.

Utilization of psychotropic drugs including hypnotics, sedatives, and parenteral morphine for terminally ill patients with respiratory disease has not been reported precisely. To better understand these drugs for dying patients with respiratory disease, we focused on the last month of life of them. A chart review, which was focused on symptoms and managements, in the last month of life of 337 patients who died of respiratory disease between April 2000 and March 2005 were performed. Hypnotics were prescribed in 35.8% and 23.2% of patients with malignant and non-malignant disease, respectively. Sedatives such as haloperidol and midazolam were utilized in 34.4% of patients with malignant disease, and 30.4% of those with non-malignant disease. Sixty-seven percent of patients with malignant and 22.4% of those with non-malignant disease had parenteral morphine. In patients with malignant disease, three of the main reasons for administration of morphine were pain, dyspnea, or terminal restlessness. In all of the patients with non-malignant disease, however, parenteral morphine was prescribed for the treatment of dyspnea. Our results showed that psychotropic drugs and parenteral morphine are required in some of terminally ill patients with respiratory disease. Although careful individualization of medication is appropriate, guideline for the prescribing psychotropic drugs for these patients will be required.

Small intestinal metastasis from small cell lung cancer.

A 71-year-old man who had small cell lung cancer was referred to our institution. Before starting chemotherapy, anemia progressed and stool examination was positive for occult blood. An abdominal computed tomography scan with contrast medium enhancement of the gastrointestinal tract disclosed a small intestinal tumor. Histological examination after the surgery confirmed that the tumor was metastasis of lung cancer. The patient survived for 3 years after the resection. Although clinically apparent metastases of lung cancer to the small intestine are rare and are reported to have a poor prognosis, early detection and intervention might enhance the chance of survival.

Prospective study of fever and pneumonia after flexible fiberoptic bronchoscopy in older people.

OBJECTIVES: To assess the frequency of fever and pneumonia after fiberoptic bronchoscopy (FOB) in older people and to evaluate increased risk for these two adverse events with increasing age. DESIGN: Prospective study. SETTING: University hospital system. PARTICIPANTS: Three hundred fifty-eight patients, with 165 (46.1%) patients aged 70 and older, undergoing bronchoscopy. MEASUREMENTS: Indications, abnormal bronchoscopic findings, sampling procedures, final diagnosis, and fever and pneumonia after bronchoscopy. RESULTS: With regard to the indication for bronchoscopy and abnormal bronchoscopic findings, there was no statistical difference between elderly patients (> or =70) and younger patients (<70). Procedures such as forceps biopsy, brushing, and curetting were not performed more often in elderly patients, although final diagnosis of lung cancer was significantly more common in the elderly group (P=.002). The overall incidence of fever after FOB was 6.7%, and that of pneumonia after FOB was 5.6%. The patients aged 70 and older had an incidence of fever after FOB of 3.6% and an incidence of pneumonia of 4.2%, which were not higher than those in patients younger than 70. CONCLUSION: Increasing age is not associated with increasing fever and pneumonia after FOB, and chronological age should not be considered a limiting factor in the decision of whether to perform FOB when it is clinically indicated.

[Severe community-acquired Acinetobacter pneumonia].

A 62-year-old man with atrial fibrillation, hypertension, and fatty liver was admitted to a hospital in October 2002 complaining of productive cough and fever up to 38 degrees C for 2 days. He was a heavy smoker and drank alcohol regularly. He was dyspneic at rest, and chest radiography showed lobar pneumonia in the right upper lobe. Despite the administration of antibiotics, his condition deteriorated rapidly, and he was transferred to our hospital on the next day. On admission, he had multi-lobar pneumonia, septic shock, and disseminated intravascular coagulation. Despite the ventilatory support and the administration of carbapenem, macrolides, and catecholamine, he died 9 hours after admission. Later, all cultures from sputum and blood grew Acinetobacter species. Although community-acquired Acinetobacter pneumonias are rarely reported in Japan, physicians must be aware of this disease because of its fulminant clinical course and high mortality.

Chemotherapy in a patient with prior history of idiopathic thrombocytopenic purpura.

We described a 67 years old small-cell lung cancer patient with a prior history of idiopathic thrombocytopenic purpura (ITP) who was treated with successful chemotherapy. It is probably safe to administer chemotherapeutic agents for some cancer patients with prior history of ITP, but it is important to prevent or minimize the toxicities of these chemotherapeutic agents.

[Thromboembolism in lung cancer patients].

We reviewed 649 primary lung cancer patients with special reference to the occurrence of thromboembolism. Thirteen episodes of thromboembolism were detected in 12 (1.8%) of the 649. Eight of the 12 were men, and their mean age was 63. Adenocarcinoma was the predominant cell type. Most patients had an advanced stage of the disease, but in some in the cancer was at an early stage. In 5 cases, the finding of thromboembolisms led to diagnosis of the lung cancer (38.5%). Anticoagulant therapy was performed in 9 cases, of which 8 responded without serious complication. We emphasize the importance of anticoagulant therapy as a therapy indicated for thromboembolism in patients with lung cancer.