We reviewed the records of 58 patients with haemoptysis and normal chest roentgenograms who underwent fibreoptic bronchoscopy. A diagnosis of malignancy was made in six patients at bronchoscopy. Three patients had bronchogenic squamous cell carcinoma, one a carcinoid tumour and two laryngeal carcinoma. Sputum for cytology was negative for malignant cells in all six patients. Follow-up data were available for the other 52 patients for an average period of 55.7 +/- 29.6 (SD) months. Two patients had a subsequent diagnosis of bronchogenic carcinoma at 2 and 6 years after initial evaluation. Three patients died from conditions not related to pulmonary malignancy and the remaining patients followed a benign course. Our patients come from a predominantly male, elderly population of cigarette smokers. Among such patients, we conclude that bronchoscopy is indicated in the evaluation of those with haemoptysis and a normal chest roentgenogram.

Bronchoscopy↗

PubMed1987

Transcutaneous needle aspiration of solitary pulmonary masses: how many passes?

In 46 consecutive patients undergoing transcutaneous needle aspiration of the lung, we evaluated the number of passes required to reliably predict the presence of malignancy. A diagnosis of malignancy was made in 38 of the 46 patients (84%), none of whom required more than 6 separate aspirations for a positive cytologic diagnosis to be made. The remaining 8 patients with a nonmalignant cytologic diagnosis on 6 separate aspirations were subsequently shown to have a benign lesion, either by surgical excision (5 patients), fiberoptic bronchoscopy (2 patients), or clinical follow-up (1 patient). Pneumothorax occurred in 12 of 46 patients (26%). We confirm that TCNA is a safe and reliable procedure in the valuation of lung masses and that, when adequate cellular material is obtained, 6 separate aspirations reliably predict the presence of malignancy.

Biopsy, Needle↗

PubMed1987

Prostaglandin E1 as a screening vasodilator in primary pulmonary hypertension.

Pulmonary vasodilators are variably efficacious in primary pulmonary hypertension (PPH). None has consistently improved hemodynamics enough to obviate the need for complex and potentially hazardous testing of several vasodilators. Prostaglandin E1 (PGE1), a potent, short-acting pulmonary vasodilator, was administered to seven patients with PPH in order to determine whether PGE1 could accurately predict the hemodynamic and gas exchange effects of other commonly used vasodilators. Prostaglandin E1, nifedipine and hydralazine were administered to the patients while measuring pulmonary and systemic hemodynamics and arterial blood gases. Prostaglandin E1 was easily titrated but was inconsistent as a predictor of the effects of the other vasodilators with respect to pulmonary artery pressure, cardiac output and adverse effects on arterial oxygenation. This study suggests that patients with PPH must still receive carefully monitored trials of several vasodilators to determine whether there is a beneficial response and to select the appropriate treatment.

Adult↗

PubMed1986

Aspiration lung biopsy with ultrathin needles.

Aspiration lung biopsy with ultrathin needles (gauge 24-25) was performed in 232 patients. A diagnosis was established with ultrathin needles in 134 of 164 patients with malignancy. Comparison of cytologic diagnosis and histologic diagnosis was made in 49 patients. There were no false-positive results, and histologic diagnosis was similar to cytologic diagnosis in 69% of cases. Only 8 of 55 patients with non-malignant conditions had the specific diagnosis established with ultrathin needle biopsy. Our data support the safety and efficacy of the procedure in patients with malignant disease. Although the yield in non-malignant conditions was low, the relative safety of the procedure justifies its use since patients may be spared of more invasive procedures.

Biopsy, Needle↗

PubMed1982

Two cases of allergy to aminophylline.

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

AIDS patient given baboon bone marrow.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Primary pulmonary hypertension.

Primary pulmonary hypertension (PPH) is a condition characterized by sustained elevation of pulmonary artery pressure (PAP) without demonstrable cause. The most common symptom at presentation is dyspnea. Other complaints include fatigue, chest pain, syncope, leg edema, and palpitations. Right heart catheterization is diagnostic, showing a mean PAP >25 mmHg at rest and >30 mmHg during exercise, with a normal pulmonary capillary wedge pressure. In the National Institutes of Health-PPH registry, the median survival period was 2.8 years. Treatment is aimed at lowering PAP, increasing cardiac output, and decreasing in situ thrombosis. Vasodilators have been used with some success in the treatment of PPH. They include prostacyclin, calcium-channel blockers, nitric oxide and adenosine. Anticoagulation has also been advised for the prevention of deep vein thrombosis, pulmonary embolism, and in situ thromboses of the lungs. New drug treatments under investigation include L-arginine, plasma endothelin-I, and bosentan. Use of oxygen, digoxin, and diuretics for symptomatic relief have also been recommended. Patients with severe PPH refractory to medical management should be considered for surgery.

Female↗