Open lung biopsy in patients with diffuse pulmonary infiltrates and acute respiratory failure.

Patients with diffuse pulmonary infiltrates and acute respiratory failure (ARF) potentially can benefit from diagnostic information provided by open lung biopsy (OLB). To better quantify possible benefits and risks, we reviewed an 11-yr experience with 80 such patients. Although OLB did provide a specific etiologic diagnosis in 53 patients (66%) and did influence therapy in 56 patients (70%), only 24 patients (30%) survived to hospital discharge, and 9 patients (11%) survived for 1 yr or more.

Intrathoracic lymphangioma.

Of 14 cases of intrathoracic lymphangioma, 4 occurred in the anterior, 5 in the superior, and 4 in the posterior mediastinum. One lesion was diffuse and associated with disappearing bone disease (Gorham's disease). The anterior mediastinal lymphangiomas occurred in adults and seemed to arise from the mediastinum.

Clinical outcome of respiratory failure in patients requiring prolonged (greater than 24 hours) mechanical ventilation.

Patients requiring prolonged (greater than 24 hours) mechanical ventilation have various conditions that result in respiratory failure. All patients requiring prolonged mechanical ventilation were subdivided into the following six groups: uncomplicated acute lung injury; respiratory failure complicated by multisystem failure; previous lung disease; trauma; other medical causes; and routine postoperative ventilation. During a one-year period, 327 patients required prolonged mechanical ventilation; acute lung injury and chronic obstructive pulmonary disease were the predominant conditions.

Usual interstitial pneumonitis is a T-cell alveolitis.

Usual interstitial pneumonitis (UIP) is an idiopathic inflammatory disorder that produces scarring of the lung parenchyma. We studied open-lung biopsies of 13 patients with UIP using immunohistological staining and monoclonal antibodies. T lymphocytes (Leu 4+) accounted for 59% of cells in the alveolar septal infiltrates in UIP and OKT8+ cells accounted for the majority of T lymphocytes in most cases.

Intrathoracic manifestations in mixed connective tissue disease.

A high frequency of occurrence of pleuropulmonary manifestations in mixed connective tissue disease (MCTD) has been reported in the literature. A retrospective analysis of 81 adult patients with the diagnosis of MCTD who were examined at our medical center from 1973 through 1977 revealed that pleuropulmonary involvement occurred in 20 (25%). Thirteen patients (16%) had dyspnea, six (7%) had chest pain, and four (5%) had cough.