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A 41-year-old man who currently smokes with previous sporadic use of cocaine and cannabinoids was admitted at the hospital suffering from hemoptysis which had developed 4 days before. The patient was on anticoagulant therapy with rivaroxaban due to paroxysmal atrial fibrillation diagnosed in 2018, for which he had undergone pulmonary vein electrical isolation by radiofrequency and ablation of cavotricuspid isthmus in January 2019. The procedure was completed in July 2019. Treatment with flecainide was introduced due to recurrences of atrial fibrillation. In February 2021, a new attempt at ablation was performed by electrical isolation of the left atrial posterior wall. The latest cardiologic checkup documented an echocardiographic framework of mild left atrial dilatation and normal-sized right ventricle with longitudinal shortening index at the lower limits, and a recurrence of asymptomatic atrial fibrillation at Holter ECG (March 2022). [ABSTRACT FROM AUTHOR]

Objectives: A combination of functional measurements reflecting a decrease in maximum flow, a degree of lung hyperinflation, the relationship between maximum inspiratory and expiratory flows, bronchodilator response, and diffusing capacity of the lung for carbon monoxide (DLCO) was used to quantify the extent of emphysema, as assessed by high-resolution CT (HRCT) scanning.Design: Forced inspiratory and expiratory spirometry, lung volumes, reversibility test, and single-breath diffusing capacity were assessed before and after inhaling albuterol, 200 microg. Relationships between lung function variables and emphysema extent, as determined by HRCT scanning, were tested by univariate and multivariate analyses.Subjects: Thirty-nine COPD outpatients with moderate-to-severe obstruction.Measurements and Results: Emphysema extent, as assessed by HRCT scanning, ranged from 18 to 70%. All of the lung function parameters that were studied, except for the change in FEV1 percent predicted after salbutamol inhalation, correlated significantly with the extent of emphysema (r2 range, 0.19 to 0.44). Functional residual capacity, forced expiratory flow at 50% of FVC/forced inspiratory flow at 50% of FVC, DLCO/alveolar volume ratio, and bronchodilator-induced change in FEV1/FVC ratio were the only variables retained by stepwise multiple regression analysis. The multiple regression model explained 71% of the variability of emphysema extent measured by HRCT scanning.Conclusions: The combination of lung function measurements reflecting lung hyperinflation, bronchial collapsibility, lung diffusing capacity, and bronchodilator response provides a good estimate of the extent of emphysema, as evaluated by HRCT scanning. These data suggest that pulmonary function tests are useful in assessing and monitoring parenchymal damage in COPD patients. [ABSTRACT FROM AUTHOR]

Study objectives: To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (VO[sub 2]max) as a criterion for operability and as a predictor of long-term disability. Design: Prospective study. Setting: Outpatients and inpatients of a university hospital. Participants: Sixty-two consecutive patients (mean ± SD age, 62 ± 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). Measurements: Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV[sub 1] (ppoFEV[sub 1]) was < 40%, patients underwent exercise testing; if VO[sub 2]max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. Results: All the patients with ppoFEV[sub 1] &Ge; 40%—even those patients (26%) with FEV[sub 1] < 80%— underwent thoracotomy without further tests. Seven patients with ppoFEV[sub 1] < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV[sub 1] ≥ 40%. ppoFEV[sub 1] significantly underestimated the actual postoperative FEV[sub 1] (poFEV[sub 1]; p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV[sub 1] after lobectomy. Two patients with predicted postoperative VO[sub 2]max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. Conclusions: ppoFEV[sub 1] ≥ 40% reliably identifies patients not requiting further tests and not at long-term risk of respiratory disability. VO[sub 2]max, effective for defining the immediate surgical risk, is not useful in... [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about an article by Zieliñski and Bednarek about chronic obstructive pulmonary disease screening for high-risk patients which appeared in the March 2001 issue.