A safe high-yield technique for cutting needle biopsy of the lung in patients with diffuse lung disease.

Unlabelled: The approach to the diagnosis and management of patients with diffuse infiltrative lung disease (DILD) is controversial. The results of transbronchial biopsy are often unsatisfactory. The role of open lung biopsy is highly variable.

The technique of percutaneous transthoracic needle aspiration biopsy.

Consider percutaneous transthoracic needle aspiration biopsy when specimens of pulmonary malignancies or infections are needed and bronchoscopy is contraindicated or the lesion is in a peripheral location. Percutaneous needle aspiration biopsy can be performed rapidly, and its diagnostic yield is good to excellent. The chief limitation of this procedure is the high incidence of pneumothorax, which makes the technique unsuitable for ventilated patients.

Albumin lung/heart ratio change. A simple clinical means of documenting increased pulmonary endothelial permeability to protein.

We investigated a simple method that can be used at the bedside for documenting the net accumulation of albumin in the lung. The technique employs measurement with a computer-linked gamma camera of the activity ratio in an area of the right lung compared with the same-sized area in the heart at 20 minutes and three hours following intravenous injection of technetium Tc 99m albumin. We applied this measurement to three groups of patients: a control group and patients with roentgenographic evidence of edema classified according to clinically available criteria as either hydrostatic edema or permeability edema to see if we could document differences among these groups.

Transtracheal aspiration in diagnosis of sputum-smear--negative tuberculosis.

Of 4,200 patients admitted to an acute-care county hospital, 126 (3%) were proved to have pulmonary tuberculosis, among whom 35 (28%) had several sputum smears negative for acid-fast bacilli. On transtracheal aspiration, 31 to 35 had acid-fast bacilli in the aspirate. Eighteen of these 35 (51%) patients had associated infections caused by aerobic or anaerobic bacteria.

67Ga lung scan. An aid in the differential diagnosis of pulmonary embolism and pneumonitis.

Twenty-three patients patients with clinical signs of pulmonary embolic disease and lung infiltrates were studied to determine the value of gallium citrate Ga 67 lung scan in differentiating embolic from inflammatory lung disease. In 11 patients without angiographically proved embolism, only seven had corresponding ventilation-perfusion defects compatible with inflammatory disease. In seven of these 11 patients, the gallium 67 concentration indicated inflammatory disease.

Treatment of anaerobic pulmonary infections; carbenicillin compared to clindamycin and gentamicin.

Twenty-three patients with anaerobic infections of the lung were treated with either two antibiotics, clindamycin and gentamicin (11 patients) or with a single antibiotic, carbenicillin (12 patients). Cultures were obtained prior to therapy, either by transtracheal needle aspiration (17 patients) or thoracocentesis (six patients). Anaerobic bacteria were found in all.

Bronchiolar and large alveolar cell in pulmonary phospholipid metabolism.

The nonciliated bronchiolar cells (Clara cells) lining the terminal airways actively secrete a phospholipid. In contrast, the large alveolar epithelial cells (type II, granular pneumonocyte) are active phagocytic cells. It is proposed that the Clara cell is the main source of pulmonary phospholipid production (presumably surfactant) while the large alveolar cell is responsible for its subsequent breakdown.