[The last breath. The decision to ventilate patients with severe chronic obstructive pulmonary disease or not].

Three patients, a 74-year-old man and 2 women aged 40 and 58 years, were admitted to the hospital on a number of occasions due to respiratory insufficiency as a result of progressive debilitating COPD. Weaning from mechanical ventilation became increasingly difficult. Therefore, in two patients it was eventually decided not to apply mechanical ventilation again; they died after the next COPD exacerbation.

An Epstein-Barr virus-associated pulmonary lymphoproliferative disorder as complication of immunosuppression.

Inherited or acquired immunodeficiencies as well as autoimmune diseases treated with cytotoxic drugs are associated with an increased incidence of lymphoma. Non-Hodgkin's lymphomas that occur in the context of drug-induced immunosuppression, acquired or congenital immunodeficiency, are frequently associated with Epstein-Barr virus infection. This report describes the occurrence of an Epstein-Barr virus associated pulmonary B cell lymphoma in a patient with longstanding rheumatoid arthritis treated with methotrexate.

Sonographically guided needle biopsy in peripheral thoracic masses: results in 50 patients.

50 patients with thoracic lesions were selected for percutaneous biopsy guided by real-time sonography. The indications were pulmonary, pleural and mediastinal lesions which made contact with the chest wall and sonographically accessible. Included were lesions near vital structures in the mediastinum (n = 3), in the apex of the lung (n = 8), small pulmonary nodules in contact with the chest wall (n = 24), lesions with intervening pleural fluid (n = 2), pleural nodules (n = 9) and masses arising from the chest wall itself (n = 4).

Chronic obstructive pulmonary disease and abdominal aortic aneurysms.

In a prospective study during the period January-May 1992, 362 consecutive out-patients above 65 years of age, attending the pulmonary department for chronic obstructive airways disease (COPD), were ultrasonographically screened for an aneurysm of the abdominal aorta (AAA). Data from pulmonary function tests together with history of cardiac disease, diabetes mellitus, hypertension, hypercholesterolaemia, peripheral arterial obstructive disease, smoking and corticosteroid medication were collected. 30/282 men and 6/80 women with COPD had an AAA > or = 30 mm in diameter, which equals a prevalence of 9.

[Spontaneous pneumothorax; to operate or not?].

Disagreement remains on the best mode of therapy for spontaneous pneumothorax (SP). Treatment options vary from observation alone to thoracotomy depending on the stage of the disease and the preference of the physician. Between 1983 and 1988, 122 patients with SP were treated at the Elisabeth Hospital Tilburg according to a fixed protocol.

Conjunctival sarcoidosis.

A biopsy from the lower conjunctival fornix, whether or not taken from follicles, is a method which yields a positive result in +/- 25% of cases of suspected sarcoidosis. We saw a patient with chronic recurrent follicular conjunctivitis of the upper eyelid, without further ocular symptoms. He was known to suffer from allergy and chronic respiratory disease.