The utility of fiberoptic bronchoscopy in the evaluation of the solitary pulmonary nodule.

To determine the value of routine, preoperative, fiberoptic bronchoscopy (FB) for diagnosing and treating patients (pts) with solitary pulmonary nodules (SPNs), we retrospectively reviewed the records of all pts with SPNs undergoing FB at Walter Reed Army Medical Center between January 1986 and December 1989. We defined SPNs radiographically as < or = 6 cm peripheral pulmonary lesions completely surrounded by pulmonary parenchyma. Of 191 charts reviewed, 91 (72 bronchogenic carcinomas [BC], 7 carcinoid tumors, 12 benign) constitute the study population. Fifty-four charts were eliminated because preoperative, clinical-radiologic staging revealed advanced (greater than stage I) BC or extrathoracic malignancy metastatic to the lung (44), the clinicians suspected benign disease and elected medical followup (3), the pt had medically inoperable disease (3), or the pt refused surgery (4). Forty-six charts were incomplete or unavailable. Fiberoptic bronchoscopy revealed one unsuspected vocal cord carcinoma and no occult synchronous BCs. Five pts had submucosal or endobronchial tumors and biopsy specimens showed BC in four of five tumors from which specimens were taken. Four of 66 (6 percent) cytologic evaluations of bronchial brushings or washings diagnosed BC. In pts shown at surgery to have BC, 9 of 30 transbronchial lung biopsy (TBBx) specimens showed BC. Diagnostic yield of TBBx specimens was not improved in the pts who underwent biopsies under fluoroscopic guidance. The 16 FB specimens positive for BC concurred 100 percent with the surgical specimens. The FB findings did not obviate the need for surgery nor alter the surgical stage of BC. A preoperative diagnosis of malignancy did not affect operative time or operative procedure, because many pts required frozen-section biopsy of mediastinal lymph nodes prior to lung resection. At our institution, routine, preoperative FB did not measurably benefit pts with SPNs.

Near-fatal hydrogen peroxide ingestion.

Fatal or near-fatal hydrogen peroxide ingestions are rarely encountered. We report the case of a 33-year-old woman who experienced seizure activity, respiratory arrest, and residual neurologic deficits after accidentally ingesting industrial-strength 35% hydrogen peroxide.

In utero meconium aspiration by the baboon fetus.

Meconium aspiration syndrome occurs more commonly in infants subjected to fetal distress. The baboon model was utilized to produce in utero aspiration of meconium in the presence of fetal acidosis. Fifteen fetal baboons underwent acute catheterization of the femoral artery and a Swan-Ganz balloon was placed in the maternal aorta. Meconium was added to the amniotic fluid and the balloon was repetitively inflated to produce hypoxemia in 3 fetuses and hypoxemia and acidosis in 4. Two fetuses served as controls and the balloon was not inflated. Acidosis alone was produced in 3 others by maternal cooling. Maternal administration of fentanyl, a narcotic analgesic and respiratory depressant drug, was found to reduce the degree of in utero meconium aspiration in 3 distressed fetuses by inhibiting gasping respirations. It is concluded that fetal respiratory depressants may be useful in this circumstance but only when expert resuscitative capability is present in the delivery room.

Prolonged shock in the monkey following live E coli organism infusion.

Responses of the rhesus monkey to the administration of live Escherichia coli organisms during an observation of 0--27 hours were studied. Nine monkeys were infused for 30 minutes with live E coli organisms, the dose ranging between 7.6 X 10(9) and 3.0 X 10(11) organisms/kg. Three of nine animals survived for 24 hours or longer. Nonsurvivors demonstrated significant hypotension, hypoglycemia, and hypoinsulinemia, while survivors showed lesser degrees of physiologic derangement. Findings were hepatic sinusoidal fibrin thrombi and hepatocellular damage accompanied by elevated serum enzymes. The kidney did not show glomerular fibrin thrombi; however, tubular lesions were clearly evident and increases in blood urea nitrogen levels and endogenous creatinine were documented. Lungs of animals surviving longer contained fewer polymorphonuclear leukocytes and platelets than were seen in acute shock studies. This study emphasizes the importance of monitoring the nonhuman primate during an extended time period, since many significant pathophysiologic responses occur after eight hours of observation.