Smoking cessation strategies for real-life situations?
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
Chris T Bolliger
Publications and source records attributed to Chris T Bolliger.
Paraneoplastic bilateral proptosis in a case of non-small cell lung cancer.
We report the case of a 51-year-old woman with a large cell bronchial carcinoma with neuroendocrine differentiation (T3N0M0, stage IIB) and bilateral exophthalmos. A CT of the orbitae was compatible with Graves ophthalmopathy, but neither abnormalities in thyroid function nor thyroid antibodies could be found. The proptosis normalized 10 days after tumor resection. We conclude that the most likely cause of the reversible proptosis in this patient is paraneoplastic, a condition not previously described in the English-language literature.
Carcinoma, Large Cell↗
Use of an ultrathin bronchoscope in the assessment of central airway obstruction.
STUDY OBJECTIVE: To assess the utility of an ultrathin bronchoscope (UB) in the assessment of central airway obstruction (CAO). DESIGN: Prospective evaluation SETTING: Tygerberg Hospital, a tertiary teaching hospital. PATIENTS: Consecutive patients referred to the Lung Unit with CAO. INTERVENTIONS: Fiberoptic bronchoscopy (FOB) was performed with a prototype UB (Olympus BF XP40; Olympus Europe; Hamburg, Germany; outer diameter, 2.8 mm; working channel, 1.2 mm). The UB was used whenever a standard bronchoscope (SB) could not pass the obstruction or could not be tolerated by the patient. MEASUREMENTS AND RESULTS: Data relating to indication and performance of FOB, patient demographics, utility in establishing a diagnosis, and planning definitive management were documented. Twenty-four patients (17 men; mean age, 46 years) were studied. Twelve patients (50%) had malignant CAO, 8 patients (33%) had benign tracheal stenosis, 3 patients (12.5%) had stent occlusion, and 1 patient (4%) had bilateral vocal cord paralysis. In 42% of patients, an initial attempt at passing the obstruction with an SB had failed. Vocal cords or trachea were involved in 62% of patients. The mean luminal occlusion was 84% of the total airway lumen (range, 50 to 100%). One complication (desaturation) led to early termination of FOB. In all but three patients with complete obstruction, the UB was able to pass the CAO and allowed assessment of the obstruction and the distal airways (87%). CONCLUSION: UB-FOB was useful and safe in the assessment of patients with CAO from both benign and malignant disease. It aided in establishing a diagnosis and/or planning of definitive management in all patients examined.
Adult↗
Comparison of a new desktop spirometer (Spirospec) with a laboratory spirometer in a respiratory out-patient clinic.
BACKGROUND: The performance of spirometers is often evaluated under ideal conditions with computer-generated waveforms or in vivo testing with healthy subjects. Real-life conditions are less ideal because of comorbidities, age of the subjects, and a variety of air flow limitations. Evaluation of new spirometry equipment can also be performed under these less favorable conditions. The Spirospec is a new desktop spirometer that is commercially available, but its accuracy has not been evaluated in a clinical setting. OBJECTIVE: Test the Spirospec with subjects with normal and pathologic pulmonary function. METHODS: A group of 45 patients (mean age 38.4 years, 27 male) booked for evaluation in the pulmonary function laboratory of a tertiary care university hospital were tested with both a Spirospec and a standard Jaeger Masterlab 4.0 spirometer, according to the guidelines of the American Thoracic Society. Three subgroups (normal spirometry, obstructive air flow limitation, and restrictive air flow limitation) of 15 consecutive subjects each underwent spirometry. RESULTS: Pulmonary function measurements from the Spirospec correlated closely (r = 0.95-0.99) with those from the Masterlab 4.0, showing good limits of agreement and differences between the 2 devices: forced vital capacity 0.03 L, forced expiratory volume in the first second (FEV(1)) -0.01 L, peak expiratory flow -0.41 L/s, peak inspiratory flow 0.43 L/s, forced expiratory flow at 50% of total lung capacity 0.13 L/s, and forced expiratory flow at 75% of total lung capacity 0.12 L/s. With the exception of forced vital capacity and FEV(1), these differences were statistically significant (p < 0.05). CONCLUSION: The Spirospec is comparable to the Masterlab 4.0, with high accuracy for FEV(1) and forced vital capacity and clinically acceptable differences in the measured flow variables.
Adult↗
Functional evaluation before lung resection.
Advances in operative technique and perioperative care have reduced surgical morbidity and mortality considerably after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Patients with normal or only slightly impaired pulmonary function (FEV1 and DLCO > or = 80% predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these methods are recommended. Cardiopulmonary exercise testing, most frequently performed as a symptom-limited test with the measurement of VO2max, assesses the pulmonary and cardiovascular reserves. A VO2max of less than 10 mL/kg/minute generally is considered prohibitive for any resection, a value of greater than 20 mL/kg/minute or greater than 75% predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the ppo values of various parameters. The currently used ppo parameters are FEV1-ppo, DLCO-ppo, and VO2max-ppo. Suggested cutoff values for safe resection are: FEV1-ppo and DLCO-ppo 40% or greater than predicted, and V(r)O2max-ppo 35% or greater than predicted, combined with an absolute value of greater than or equal to 10 mL/kg/minute. The lowest acceptable ppo values remain to be confirmed by additional prospective studies. Resections involving not more than one lobe usually lead to an early functional deficit followed by recovery. The permanent loss in pulmonary function is small (approximately 10%) and exercise capacity is reduced only slightly or not at all. Pneumonectomy leads to an early permanent loss of about 33% in pulmonary function and approximately 20% in exercise capacity. Pulmonary function tests alone therefore overestimate the functional loss after lung resection.
Algorithms↗
Influence of long-term smoking reduction on health risk markers and quality of life.
We have recently published efficacy and safety data of a study using an oral nicotine inhaler in smoking reduction. The current analysis was undertaken to assess the secondary objectives of the trial: the influence of long-term smoking reduction on health risk markers. Four hundred healthy volunteers, unable or unwilling to stop smoking immediately, were enrolled in a double-blind, randomized, placebo-controlled trial in smoking reduction; 310 were evaluable up to 2 years. Participants were randomized to active or placebo inhalers as needed for up to 18 months, with subjects encouraged to reduce their smoking as much as possible; counseling took place over a 2-year period. For the current prospective cohort study, the number of daily cigarettes, carbon monoxide (CO), cotinine, cardiovascular risk factors, pulmonary function tests, and quality of life were compared between successful reducers (n = 25) and unsuccessful reducers (control group, n = 285). Success was defined as a reduction of daily cigarettes of at least 50% from week 6 to 2 years, verified by a decrease in exhaled CO at all visits compared with baseline. At 2 years, successful reducers showed a significantly greater decrease in cotinine levels (60% vs. 1%, p < 0.001), cholesterol/high-density lipoprotein (HDL) ratios (-2.42 vs. -1.67, p = 0.025), hemoglobin concentrations (-5.67 vs. -1.34 g/l, p = 0.023), pulse rate (-3.7 vs. +1.0 bpm, p = 0.043), and significantly improved general health score (9.40 vs. 2.34, p = 0.049); whereas no difference was found in forced expiratory volume during 1 s (FEV1) and forced vital capacity (FVC) compared with controls. The benefits of long-term smoking reduction of at least 50% of daily cigarettes were not offset by compensatory smoking, and the marked decrease in markers of smoke exposure had a positive influence on several cardiovascular risk markers and quality of life assessments.
Adult↗
Therapeutic bronchoscopy for treatment-resistant COPD.
Explore the source record for details and available documents.
Adult↗
Prediction of functional reserves after lung resection: comparison between quantitative computed tomography, scintigraphy, and anatomy.
BACKGROUND AND OBJECTIVES: We prospectively compared five techniques to estimate predicted postoperative function (ppo F) after lung resection: recently proposed quantitative CT scans (CT), perfusion scans (Q), and three anatomical formulae based on the number of segments (S), functional segments (FS), and subsegments (SS) to be removed. METHODS: Four parameters were assessed: FEV(1), FVC, DL(CO) and VO(2max), measured preoperatively and 6 months postoperatively in 44 patients undergoing pulmonary resection, comparing their ppo value to the postoperatively measured value. RESULTS: The correlations (r) obtained with the five methods were for CT: FEV(1) = 0.91, FVC = 0.86, DL(CO) = 0.84, VO(2max) = 0.77; for Q: 0.92, 0.90, 0.85, 0.85; for S: 0.88, 0.86, 0.84, 0.75; for FS: 0.88, 0.85, 0.85, 0.75, and for SS: 0.88, 0.86, 0.85, 0.75, respectively. The mean difference between ppo values and postoperatively measured values was smallest for Q estimates and largest for anatomical estimates using S. Stratification of the extent of resection into lobectomy (n = 30) + wedge resections (n = 4) versus pneumonectomy (n = 10) resulted in persistently high correlations for Q and CT estimates, whereas all anatomical correlations were lower after pneumonectomy. CONCLUSIONS: We conclude that both Q- and CT-based predictions of postoperative cardiopulmonary function are useful irrespective of the extent of resection, but Q-based results were the most accurate. Anatomically based calculations of ppo F using FS or SS should be reserved for resections not exceeding one lobe.
Aged↗