Acute, reversible left ventricular dysfunction in status asthmaticus.

Three cases of rapidly reversible severe myocardial depression are described in patients with status asthmaticus. Initial echocardiograms obtained within 1 day of hospital admission revealed global left ventricular hypokinesis with ejection fractions of 11 to 34%. Follow-up echocardiograms obtained only 3 to 8 days later revealed marked improvement of left ventricular function.

Predicting complications after pulmonary resection. Preoperative exercise testing vs a multifactorial cardiopulmonary risk index.

Recent studies have used preoperative cardiopulmonary exercise testing to improve risk assessment of pulmonary resection for lung cancer. These studies have demonstrated inconsistent correlation between peak oxygen uptake (VO2) and postoperative complications but have not systematically examined other methods of risk stratification. We analyzed the findings in 42 patients who had cardiopulmonary exercise testing prior to lung cancer resection.

N2 lung cancer: outcome in patients with false-negative computed tomographic scans of the chest.

Over the past 13 years 681 consecutive patients have undergone computed tomographic staging and surgical staging of the mediastinum. Five hundred one tested negative for mediastinal lymph node enlargement by computed tomographic staging, and 37 of these patients had cancerous mediastinal lymph nodes at thoracotomy (n = 36) or mediastinoscopy (n = 1). The survival in this group of patients was analyzed according to T status, central or peripheral location of tumor, cell type, areas of mediastinum that are involved, and extent of nodal involvement with tumor.

Controlled trial of a continuous irrigation suction catheter vs conventional intermittent suction catheter in clearing bronchial secretions from ventilated patients.

Continuous irrigation-suction catheter (Irri-cath) is a double-lumen device that allows for simultaneous saline solution infusion and aspiration. This system may theoretically be more effective than conventional dry intermittent suction due to its vortex principle. To test this hypothesis, we performed 200 suction maneuvers in 20 ventilated patients.

Bronchial stump disruption following inadvertent right mainstem intubation 9 years after pneumonectomy.

An 82-year-old man, with a history of right pneumonectomy 9 years prior to admission, was emergently intubated for respiratory failure resulting from rapid atrial fibrillation and congestive heart failure. Postintubation chest radiograph demonstrated the tube to be in the right bronchial stump. Over the next 48 hours gas exchange remained poor, endotracheal suctioning produced copious serosanguinous secretions, and chest radiographs showed increasing air, with air fluid levels, in the previously opacified right hemithorax.

Polymicrobial bacterial pericarditis after transbronchial needle aspiration. Case report with an investigation on the risk of bacterial contamination during fiberoptic bronchoscopy.

A 63-yr-old man developed pericardial effusion with tamponade after transbronchial needle aspiration (TBNA) of a subcarinal mass. A diagnosis of polymicrobial bacterial pericarditis was made when pericardiocentesis revealed purulent fluid that grew a mixed culture of anaerobes and aerobes, organisms that constitute part of the normal upper respiratory tract flora. To examine the possibility that contamination of the transbronchial needle (TBN) could lead to purulent pericarditis by inoculation of bacteria into the mediastinum, quantitative cultures of the TBN content were performed in seven consecutive patients.

Computed tomography-guided minithoracotomy for the resection of small peripheral pulmonary nodules.

Small peripheral pulmonary nodules ranging in size from 1 mm to 20 mm were excised in 58 patients. Computed tomography was used to mark the skin overlying the nodules to minimize the surgical exposure needed for operative identification. The nodules were 1 cm or less in maximum diameter in 76% of the patients.

Mediastinal lymph node evaluation by computed tomography in lung cancer. An analysis of 345 patients grouped by TNM staging, tumor size, and tumor location.

To more clearly characterize the role of computed tomography in staging the mediastinal lymph nodes of patients with lung cancer, we analyzed computed tomographic and surgical findings in the chest in 345 consecutive patients with lung cancer who underwent operative staging. Patients were grouped according to the TNM staging system of the American Joint Commission, central or peripheral location of the primary tumor, lobar location of the tumor, and maximum tumor diameter as determined by computed tomography or gross pathology. One third of patients with abnormal findings on the computed tomographic scan did not have mediastinal lymph node metastases.

Pulmonary rehabilitation--physical modalities.

This review assesses the role of controlled breathing techniques (breathing training) and chest physical therapy (PT) in the management and rehabilitation of patients with chronic obstructive pulmonary disease (COPD). The review focuses on pursed lip breathing, the head-down and bending forward postures, slow deep breathing, and diaphragmatic breathing exercises as methods of breathing training, and on postural drainage, chest percussion and vibration, and controlled cough as techniques of chest PT. These modalities may be beneficial in selected patients with COPD.

The value of the bone scan and bone marrow biopsy staging small cell lung cancer.

The charts of 112 patients with small cell lung cancer were reviewed in a retrospective fashion in order to define the role of the radionuclide bone scan and bone marrow biopsy in the staging of this disease. Both a radionuclide bone scan and bone marrow biopsy were performed on all patients at the time of diagnosis. Sixty-one percent of patients had a negative bone scan and negative biopsy; 22% had a positive bone scan and negative biopsy; 8% had a negative scan and positive biopsy; and 9% had a positive scan and positive biopsy.

A prospective randomized trial of combination vindesine and cisplatin versus single-agent vindesine in advanced non-small cell lung cancer.

Antineoplastic agents, used alone or in combination, are capable of achieving objective remissions in advanced nonsmall cell lung cancer. Response rates have been modest, however, and responses are generally not durable. Furthermore, the toxicity of some regimens has been substantial, creating a narrow therapeutic ratio and a questionable impact on survival.

Computed tomography. An effective technique for mediastinal staging in lung cancer.

Computed tomographic scans of the chest were utilized to stage mediastinal disease in 148 instances of bronchogenic carcinoma considered for resection in 146 patients. Nodes greater than or equal to 1.5 cm in diameter were interpreted as abnormal.

Computed tomography of the lung, pleura, and chest wall.

Because of rapid technologic advances, clearly defined clinical indications, and widespread availability, computed tomography of the lungs, pleura, and chest wall has become increasingly important in the imaging and subsequent management of numerous thoracic disorders. This article describes the current indications, common findings, and potential controversies in CT of the lung, pleura, and chest wall.

Treatment of chronic pancreatitic pleural effusion by percutaneous catheter drainage of abdominal pseudocyst.

A 53-year-old man entered the hospital with a large, right chronic pancreatitic pleural effusion. Computed tomographic examination of the abdomen and chest demonstrated a pancreatic pseudocyst that had extended into the mediastinum. After conventional closed-chest tube thoracotomy drainage failed to empty the pleural space, percutaneous abdominal pseudocyst drainage was instituted using computed tomographic guidance.

Genetic influences in the development of emphysema in persons with normal serum proteins.

This review has failed to uncover convincing evidence to support the existence of familial emphysema in patients with normal serum proteins. Although a large number of studies have documented that non-A1PI hereditary factors are important in the development of nonspecific chronic obstructive pulmonary disease, it is far less certain that emphysema accounts for this familial occurrence. To the contrary, most existing evidence fails to support this possibility.

Computed-tomographic-guided minithoracotomy. A preliminary report of a new approach to open lung biopsy.

The authors describe a simple computed-tomographic method, using precise surface localization, to locate small subpleural nodules or pulmonary lesions. This permits a guided minithoracotomy for chest lesions which are not visible on plain radiographs or are considered inaccessible by percutaneous or transbronchoscopic biopsy.

CT diagnosis of pulmonary arteriovenous malformations.

Pulmonary arteriovenous malformations (AVM) are unusual congenital lesions that may cause respiratory disability. Two cases of AVMs were diagnosed utilizing contrast enhanced computed tomography (CT). The potential role of CT as compared to conventional angiography is discussed, and the characteristic CT appearance of these abnormalities is described.