A factor analysis of dyspnea indexes and lung function parameters in patients with chronic obstructive pulmonary disease.

The purpose of the present study was to investigate the correlation between dyspnea ratings and a large group of lung function parameters, and extract those factors that best reflect the functional profile of patients with COPD using factor analysis. Ninety nine patients with COPD in stable clinical condition (age 60 +/- 8 years, ATS score = 2.5 +/- 0.9, FEV1% pred. = 33 +/- 13%) were included in the study. The factor analysis of the results yielded 5 factors which accounted for 80.1% of the total variance of the changes. The highest coefficients found between the factors and the original group of variables after Varimax rotation are given in the following table: Factor 1: Oxygen-cost diagram: 0.92; ATS dyspnea score: -0.80; TL,CO/VA: 0.78; Factor 2: FEV1% pred.: 0.87; FEV1/VC%: 0.86; FEV1L: 0.79; Factor 3: MIF50% pred.: 0.85; FIV1% pred.: 0.76; PImax: 0.67; Factor 4: PaCO2: -0.81; SaO2: 0.77; Mean pulmonary arterial pressure: -0.67 Factor 5: Age: 0.88; Six minutes walk distance: -0.72 The factor analysis showed that the functional profile of COPD patients has several dimensions. Therefore, in order to have COPD comprehensively evaluated, assessment of dyspnea and the respective set of lung function parameters (exercise capacity, forced inspiration and pulmonary hemodynamics), should be included in the battery of tests, besides the conventional tests.

A patient with a severe chronic airway obstruction and preserved exercise capacity (a case report).

We report a patient with chronic obstructive pulmonary disease (COPD) in whom severe lung function disorders are combined with completely preserved exercise capacity. We assessed the exercise capacity of a 44-year-old man (height 155 cm, BMI 19.6 kg.m-2, FEV1%pred. = 30.9%, FRC%pred. = 158%, KCO%pred. = 46.2%, PaO2 = 64.0 mmHg, Medical Research Council Dyspnea scale = 1, Baseline Dyspnea Index = 10) by the 6-minute walking distance test (6MWD) and the symptom-limited cardiopulmonary exercise test (CPET) on a treadmill using the Bruce protocol. The patient was able to walk 667 meters in the test and achieved peak relative oxygen consumption (VO2/kg) of 21.9 mL.min-1.kg-1. We attribute the preserved exercise capacity of the patient to the combined beneficial effect of the following factors: 1. Efficient extraction of the hemoglobin-transported oxygen from the alveoli (P50 = 3.10 kPa). 2. Optimal right ventricle remodelling with mild hypertrophy, without dilatation and congestion. 3. Hypoxic normoxemia without polyglobulia, resulting in good rheologic properties of blood. 4. A preserved locomotory activity of the patient. Such a combination of severe lung function disorders with mildly pronounced dyspnea and preserved exercise capacity supports the concept that the function profile of COPD patients is multidimensional and therefore such patients should have a complete assessment of their disability condition.

A fifteen-month survey of directly observed therapy--short course and antibiotic drug resistance in the region of Plovdiv.

OBJECTIVE: This study addresses the issue of antituberculosis drug resistance in a cohort of 213 patients from Plovdiv included in the pilot phase of a DOTS based project for a 15-month period. Between July 1. 1998 and September 30, 1999, ninety three culture-positive patients participated in the study. 89 of them were tested for drug susceptibility to rifampicin, izoniazid, etambutol, and streptomycin. RESULTS: Resistance to at least one antituberculosis drug was established in 24.7% of the patients. Monoresistance was found in 13.5% of the cases. The median prevalence of combined resistance to rifampicin and isoniazid was 6.7%. The prevalence of resistance to rifampicin or isoniazid was 21.4%. Drug susceptibility testing results were obtained within 67 days. In 33% of the patients continuation treatment phase was initiated before drug susceptibility data were available. CONCLUSIONS: During the observed period a considerably high rate of drug resistant tuberculosis was registered among the patients included in the pilot phase of the program based on Directly Observed Therapy--Short Course. The percentage of resistance to R and/or I gives better information about the risk of inadequate treatment during the continuation treatment phase. The high percentage of this pattern of resistance in our region requires the continued use of four first-line drugs for therapy until the results of drug-susceptibility testing are received.

Functional parameters in pulmonary bullous emphysema.

OBJECTIVE: 1. compare a large set of functional parameters in patients with bullous emphysema and patients with nonbullous emphysema. 2. To compare a chest radiographs (CHR) and a high resolution computed tomography (HRCT) in the clinical assessment of bullous emphysema. MATERIAL AND METHODS: The study population included 43 stable COPD patients (age = 59 +/- 9 years; pack/year (P/Y) = 39 +/- 19; ATS dyspnea score = 2.3 +/- 0.9; FEV1%pred. = 30 +/- = 10%; KCO%pred. = 49 +/- 16%; 6MWD (six minute walk distance) = 395 +/- 103 m; mean +/- SD). The patients were divided into two groups (patients with and without bullae) by a HRCT. In most of the cases the size of the bullae, measured by CT scan, was less than 15 mm. Twenty two CHRs were read independently by three experienced chest radiologists who had no knowledge of the CT scan data. RESULTS: Statistically significant differences were found between the groups with bullous (n = 19) and nonbullous (n = 24) emphysema in FEV1 (p < 0.001); VC (p = 0.001); BMI (p = 0.018); Borg after exercise (p = 0.021); FEV1/VC% (p = 0.025) and P/Y (p = 0.034). The sensitivity of chest radiographs compared with CT scan regarding the small bullae was very low: 27.7% in radiologist I, 12.3% in radiologist II, and 21.5% in radiologist III. CONCLUSIONS: 1. The patients with bullous emphysema have statistically significant lower lung function indices (FEV1, VC, FEV1/VC%) and BMI than those with nonbullous emphysema. 2. Patients with bullous emphysema have higher level of dyspnea score after 6MWD and higher pack-year smoking status than those with nonbullous emphysema. 3. For the clinical evaluation of emphysema the information derived from a standardised reading of the CXR is not as valuable as that derived from the CT scan.

BCG immunotherapy of lung cancer in a district oncology dispensary. I. Study of 860 patients with histologic diagnosis.

The investigation refers to lung cancer patients registered in an oncology dispensary from 1965 to 1975. The conventional treatment (surgery, radiotherapy and chemotherapy) has covered 35.9% of all patients, whereas immunotherapy with BCG or with its soluble fraction has been applied in 46.2% of them. Immunotherapy has mainly been applied to epidermoid carcinoma and large-cell carcinoma. Comparing the survival of immunotherapy treated with non-immunotherapy treated patients it was found that in Stage I-II group the difference in favor of immunotherapy was significant in the second year of observation and in Stage III group a significant difference was found in all observation periods (1-5 years). In Stage I-II the 5-year survival rate of immunotherapy treated patients (13.2%) was similar to the survival rate of operated patients (13.7%). Immunotherapy in large cell carcinoma showed significantly better results than immunotherapy in epidermoid carcinoma. Immunotherapy with BCG and F70 was applied as an independent treatment of lung cancer. When applied to patients primarily operated, radiation or chemotherapy treated, the survival was significantly higher than the survival of patients submitted to conventional treatment or to immunotherapy separately.

Survival of lung cancer patients treated with BCG and/or a soluble BCG fraction (F70) after surgery, radiotherapy and chemotherapy.

243 lung cancer patients treated with routine therapy (surgery 54, radiotherapy 46 and chemotherapy 143) in Plovdiv's District Oncologic Dispensary (PDOD) were submitted to an additional therapy with BCG or with its soluble fraction F70. The survival rate of these patients was compared with the survival rate of 305 lung cancer patients following routine therapy alone (surgery 78, radiotherapy 113 and chemotherapy 114). The two groups were not randomized. Between patients treated and non-treated with BCG(F70) a significant increase of the survival rate was found for patients submitted to BCG(F70) treatment after surgery or radiotherapy in the 2nd and 3rd year survival period and for patients submitted to BCG(F70) treatment after chemotherapy -- in the 1st year survival period of patients with limited disease only. The effect of the additional BCG(F70) treatment was less dependent on the preceding routine therapy than upon the clinical stage of the disease at the moment of BCG(F70) treatment beginning. More salient results were observed in patients with undifferentiated histological forms.

Investigations on the methods of clinical application of a soluble BCG fraction (F70) in lung cancer.

Several parameters for an optimal treatment scheme of a soluble BCG fraction (F70) were investigated. Among lung cancer patients treated with F70 a restricted selection was made of patients treated with small doses (5--10 U) every second or third month (sparing scheme) and of patients treated every month with sharply increasing doses up to tens of thousands units (aggressive scheme). It was found that the survival rate and the rate of marked X-ray regressions were higher in the former group. As it was previously established for lung cancer patients treated with living BCG, in the group of sparing scheme-treated patients the longest survival period pertained to patients treated once and patients treated twice or three times and an inverse correlation existed between the number of applications of F70 and the mean survival period. It was concluded that, as with living BCG, a sparing approach to the immunotherapy of lung cancer with F70 is to be preferred to an aggressive approach. Illustrative cases treated once, twice and three times are presented.

Survival rate in lung cancer. / Vyzhivaemost' bol'nykh rakom legkogo

The authors followed the survival rate in 927 patients with lung cancer treated in the oncological dispensary of the Plovdiv City during 1965--1972. 41.3% of the patients were in stage 1--11, 19.9%--in stage III, 38.8%--in stage iv. Of all the patients 8.2% were operated upon, in 14.7%--radiotherapy was employed, 9.9% of the patients were treated pharmacologically, 67.5% of cases were not treated at all. As a result of all kinds of treatment 21.4% of the patients survived for one year, and 1.1%--for 5 years. It is concluded that the search for new methods of the treatment and early diagnosis of lung cancer is quite essential.

Therapeutic effect of a water-salt extract from BCG in two patients with advanced breast cancer.

Two cases of advanced breast cancer treated with a water-salt extract from BCG are presented, showing a positive response -- marked and durable regression of the breast tumor and of the axillar metastases, parallel in the second case with a disappearance of lung metastases.