Interstitial fibrosis and collateral ventilation.

Interstitial fibrosis may increase resistance to collateral flow (Rcoll) because of decreased lung volume and destruction of collateral channels or it may decrease Rcoll because of emphysematous changes around fibrotic regions. In addition, if interstitial fibrosis involves a small region of lung periphery, interdependence from surrounding unaffected lung should produce relatively large changes in volume of the fibrotic region during lung inflation. We studied the effects of interstitial fibrosis on collateral airflow by measuring Rcoll at functional residual capacity (FRC) in nine mongrel dogs before and 28 days after the local instillation of bleomycin into selected lung segments.

Primary adamantinoma of rib: thoracic manifestations of a rare bone tumor.

Adamantinoma is a rare tumor of long bone that has not previously been reported to involve primarily the chest wall. We have described a patient who had primary adamantinoma of the rib and who showed a spectrum of pleuropulmonary manifestations of this uncommon neoplasm.

Efficacy and safety of naloxone in septic shock.

We evaluated the effectiveness and safety of iv naloxone in 12 septic patients who remained hypotensive despite volume replacement, appropriate antibiotics, and vasopressor therapy. Only four patients responded positively to naloxone, by increases in mean arterial pressure of between 10 to 15 mm Hg that lasted for 15 to 60 min. These patients could not be distinguished from the others on the basis of underlying illness, laboratory or physical findings, length of preceding hypotension, or glucocorticoid therapy.

Streptococcus milleri empyema.

A 58-year-old woman who had recurrent aspiration due to atlantoaxial subluxation, a complication of rheumatoid arthritis, had S milleri empyema. This organism has been associated with purulent disease in previous series, and may be a relatively common but unrecognized cause of empyema.