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COPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations.

The COPD Assessment Test (CAT) is a valid disease-specific questionnaire measuring health status. However, knowledge concerning its use regarding patient and disease characteristics remains limited. Our main objective was to assess the degree to which the CAT score varies and can discriminate between specific patient population groups.

Ever since a lung cancer epidemic emerged in the mid-1900s, the epidemiology of lung cancer has been intensively investigated to characterize its causes and patterns of occurrence. This report summarizes the key findings of this research.

Research on the effects of cigarette smoking on sleep architecture is limited. The objective of this investigation was to examine differences in sleep EEG between smokers and nonsmokers.

Clinical, physiologic, and questionnaire approaches can be used to identify subjects with asthma in an epidemiologic investigation. Each method, however, may select differing subsets of the population. At present, a comprehensive asthma questionnaire is unavailable; the difficulty of defining asthma in operational terms has been a major obstacle in the development of such a questionnaire. This review describes the questionnaires prepared by the British Medical Research Council and the American Thoracic Society and suggests modifications.

Why are corticosteroids used in patients with IPF? There is evidence that corticosteroid therapy is associated with clinical improvement in only a small percentage of IPF patients. This improvement is seen primarily in patients with a cellular histologic pattern on lung biopsy specimens, but no clinical, physiologic, or pathologic finding has been consistently associated with corticosteroid response. For IPF patients with a fibrotic histologic pattern on lung biopsy specimens, there is little evidence that corticosteroids are of any benefit, and available reports suggest that the cost of therapy in terms of both morbidity and mortality may be high. Little is known about the effect of corticosteroids on long-term clinical outcomes, and even less is known about their effects on the overall quality of life. Although current treatment regimens are based on the rationale that IPF is due to alveolar inflammation, which is probably an accurate assumption, the treatment to suppress the alveolitis should have an outcome that patients consider favorable. Data from the New Mexico ILD Registry and from other researchers suggest that the paucity of useful clinical data in IPF has resulted in a hodgepodge of diagnostic approaches and therapeutic criteria, as well as a fatalistic approach to treatment.

Cardiac disease associated with congestive heart failure was found to be the most common cause (22 of 76) of pericardial effusion in patients referred for echocardiography. Parameters of left heart function were markedly abnormal in these patients with congestive heart failure and pericardial effusion, but were not significantly different from a group of patients with congestive heart failure without pericardial effusion. Clinical findings consistent with cardiac decompensation also failed to discern between these two groups. Nonetheless, patients with congestive heart failure with pericardial effusion had significantly larger right ventricular internal dimensions than those without effusion. Patients with pericardial effusion related to congestive heart failure (P < .01), heart disease without congestive heart failure (P < 0.001) and those patients post recent myocardial infarction (P < 0.05) had significantly larger right ventricular internal dimensions in diastole than normal subjects. Patients with pericardial effusions related to recent open heart surgery, idiopathic pericarditis or of miscellaneous causes had normal right ventricular internal dimensions. It is likely that right ventricular dilatation indicates abnormal volume/pressure relationships of the right heart and that this abnormality, through alterations in venous and lymphatic drainage, underlies the accumulation of pericardial effusion in these patients with heart disease with or without congestive heart failure.

Of 1125 patients with acute myocardial infarction admitted to Mount Sinai Medical Center in 1971 and 1972, 292 (28.8 percent) had intraventricular conduction defects. In 210 of the 292 patients with intraventricular conduction defect, it was possible to determine if the conduction defect was present before the infarction (Group 1, 123 patients) or developed acutely with the infarction (Group 2, 87 patients). Of the 210 patients, 52.8 percent died (mean age 72.1 years). Fifty-three patients in Group 1 and 18 patients in Group 2 had isolated left axis deviation (LAD). The mortality was 35 percent and 28 percent respectively. This difference was not significant (p > 0.60). Sixty-four of the 210 patients presented with a left bundle branch block (LBBB) pattern. The overall mortality of 54 percent was the same in both groups. Right bundle branch block (RBBB), with either normal axis, left (LAD) or right axis deviation (RAD), was found in 74 patients. Of 40 patients in Group 1, 62 percent died, and of 35 patients in Group 2, 80 percent expired. Again this difference was not significant (p > 0.10). In 13 of 25 patients with RBBB in Group 1, death was possibly related to progression of the conduction defect The use of prophylactic temporary pacing is suggested for these patients.

This article presents the data of a patient who manifested the phenomenon of intermittent and transient left bundle branch block (LBBB) and subsequently Mobitz type II-like block in the left bundle branch (LBB). The assumption is made that this uncommon tachyarrhythmia occurs only in hearts with latent localized organic His-Purkinje system disturbance and made evident by the effect of supraventricular tachycardia. The regularity of the R-R interval, occurrence of two consecutive aberrant QRS complexes of similar duration without altering the R-R interval, and the conversion of the tachycardia to normal sinus rhythm with normal QRS complexes by application of carotid massage, all lend support to a unifocal, supraventricular origin of tachycardias with alternant QRS complexes. The constant and stable duration of all the ventricular beats with LBBB pattern, preceded and followed by normal ventricular complexes along with changing conduction ratios of 3:1 and 2:1 LBBB suggested Mobitz type II-like response in the LBB.

The diagnosis of familial cardiomyopathy was established by cardiac catheterization and cineangiography in six patients belonging to the same family. Five patients exhibited obstructive cardiomyopathy of the idiopathic hypertrophic subaortic stenosis type, while one displayed myocardial hypertrophy with a dilated poorly contractile left ventricle without obstructive phenomena. These observations support the concept that idiopathic hypertrophic subaortic stenosis and idiopathic myocardial hypertrophy represent different manifestations of the same disease. The disease was transmitted as an autosomal mendelian dominant with incomplete penetrance.

Pulmonary arteriovenous fistulae and cardiomegaly in a patient with Rendu-Osler-Weber disease is reported with hemodynamic data. Indicator dye dilution curves showed the expected right-to-left shunt and also revealed the unusual coexistence of a probable bronchial artery to distal pulmonary arterial bed fistula, in effect establishing a bidirectional shunt. The cardiomegaly was considered to be secondary to the left-to-right shunt Partial resection of the fistulae ten years prior to this admission failed to relieve cyanosis and symptoms. Diffuse pulmonary involvement prevented further surgical therapy and medical treatment was recommended.

Cardiac catheterization procedures may be associated with serious complications, even when performed in a technically flawless fashion. This prospective study investigated all complications associated with 1,036 diagnostic catheterizations over a 12-month period. Complications which occurred in the 48 hours before or the 24 hours after scheduled but unperformed catheterizations were termed “pseudo complications.” There were 24 (2.3 percent) pseudo complications, including 12 (1.2 percent) sudden deaths. There were 26 (2.6 percent) catheterization procedure-related complications, including six (0.6 percent) deaths. Similar types of complications were noted in both groups. The incidence of annual complications would have doubled and the mortality rate would have tripled if the procedures had been performed on schedule or up to 48 hours earlier in the patients of the pseudo complication group. The incidence of complications after cardiac catheterization is materially influenced by the unexpected complications resulting from severe cardiac disease.