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Several small, independent FORTRAN programs, written for interactive use on a time-sharing PDP-10 computer, perform statistical calculations and display functions associated with the analysis of data obtained in clinical trials of the efficacy of experimental treatment regimens in chronic asthma. All programs have access to a common data file, which contains numerical parameters collected from each patient every two weeks. The nature and design of the programs and the structure of the data file is explained. Because of its modularity and simplicity the system can be modified for research into other chronic diseases that share with chronic asthma a course of exacerbations and remissions over long time sequences.

Five patients with severe chronic obstructive pulmonary disease (COPD) underwent detailed evaluation of pulmonary function (PF), respiratory mechanics and hemodynamics before and after 18 weeks of physical training (PT). PT consisted of daily progressive upright bicycle exercise. All patients demonstrated marked subjective and objective improvement in exercise tolerance. After PT exercise heart rates were significantly decreased (p

A homogeneous group of 64 patients with advanced chronic obstructive pulmonary disease (COPD) and hypercapnia was followed from 2 to 15 years. Three quarters of the patients died during the period of study. Fourteen functional parameters were repeatedly measured under stable clinical conditions. Their importance for prognosis was assessed by means of a discriminant analysis performed on the initial values and the evolution with time of the parameters. The initial values, closely related to a bad prognosis (average survival of 6 years), are arterial carbon dioxide tension and oxygen saturation during exercise, especially variation of the latter caused by exercise, and the diffusing capacity for carbon monoxide. Once chronic hypercapnia has been reached, evolution of the disease is characterized, first, by a period of stability of all functional parameters, but with an evolution of the electrocardiogram towards cor pulmonale. This period is followed, on the average 8.5 years before death, by a rapid deterioration of one second forced expiratory volume, vital capacity, arterial carbon dioxide tension, oxygen saturation during exercise and diffusing capacity. Finally, during the last years of life, the functional condition of the patients is dominated by a marked decrease in oxygen saturation at rest.

In this report, we shall describe our use of the flexible fiberoptic bronchoscope in thoracoscopy. This device is superior to the earlier type of thoracoscope because it is not rigid. The high yield of accurate diagnoses, ease of application, and minimal discomfort to the patient make this technique preferable to other nonthoracotomy forms of diagnosis. With further refinement, the flexible fiberoptic bronchoscope may limit the need for formal thoracotomy in the diagnosis of pulmonary disease.

Twenty patients in whom the determination of right and left lung function was advisable for management of their pulmonary disease underwent lateral position testing, quantitative ventilation/perfusion radionuclide studies, and bronchospirometry. An excellent correlation existed between the radionuclide perfusion study and the differential oxygen uptake measured by bronchospirometry. Similarly, there was excellent correlation between the radionuclide single-breath ventilation study and vital capacity measured by bronchospirometry. The lateral position test was statistically inferior in both areas. There was no difference between the lateral position test and the radionuclide rebreathing ventilation study in predicting differential minute ventilation. The routine use of quantitative radionuclide studies along with preoperative pulmonary function studies in patients with marginal pulmonary reserve is encouraged since it provides a simple, accurate method of determining differential pulmonary function and is well accepted by the patient.

Nonspecific thickening of the apical visceral pleura and subpleural lung associated with fibrosis and sometimes with calcification, was found in 20.3% of cases. This thickening could not be shown histologically to be the result of tuberculosis. The frequency of such scarring increased significantly with age. Such localized pleural thickening may be related to healing of pulmonary disease in the presence of chronic ischemia. This subpleural scarring appears to be the cause of the apical cap shadow reported by many authors; other possibilities include (a) irregular projection of the lung into the overlying soft tissues and (b) other apical pulmonary disease.

This study compares electrocardiographic changes with right ventricular mass rather than thickness of the ventricular wall in 71 patients with an unequivocal clinical and pathologic diagnosis of severe chronic obstructive pulmonary disease. Specific heart chamber weights were determined in all patients. Pathologically, 30 patients had definite right ventricular hypertrophy and 3 probable right ventricular hypertrophy; 20 patients had normal ventricular weights and 18 patients had left ventricular hypertrophy. Using 20 suggested ECG criteria for the diagnosis of right ventricular hypertrophy, 226 ECG's were analyzed. Four criteria were found to be most reliable: S 1 Q 3 pattern, right axis deviation ≧ 110°, S 1 -S 2 -S 3 pattern, and R/S ratio in V 6 ≦ 1.0. These four simple ECG criteria can be used effectively in predicting right ventricular hypertrophy in patients with chronic obstructive pulmonary disease.

Of 41 patients with lung cancer and chronic pulmonary disease who underwent radiotherapy, 31 had tumor regression and 20 had subjective improvement. Radiation-induced complications developed in nine cases. Patients with chronic pulmonary disease and lung cancer usually had an early death. The pulmonary disease may have had an adverse effect on survival, negating the benefit of radiotherapy. Patients who had hemoptysis, chest pain or superior vena cava syndrome benefitted from radiotherapy. The median survival was five months. Radiotherapy was of no value for patients with a peripheral tumor location or for patients who did not have symptoms caused by lung cancer.

The ratio of lecithin to sphingomyelin (L/S ratio) in amniotic fluid has been used to determine lung maturity. However, the L/S ratio has not been determined postnatally in either tracheal or pharyngeal fluid of infants with RDS. In this report L/S ratios in tracheal and pharyngeal aspirates of 30 infants have been correlated with their clinical state. Eight infants with no pulmonary disease (Group I) had ratios of ≥1 in 98% of 45 determinations. Four infants with pulmonary diseases other than RDS (Group II) had ratios of ≥1 in 100% of 28 determinations. Five infants with moderate RDS (Group III) had ratios of ≥1 in 94% of 15 determinations. Thirteen infants with severe RDS (Group IV) had ratios of ≥1 in only 53% of 101 determinations; 35% of the ratios in this group were zero. These preliminary results indicate that infants with severe RDS (Group IV) have a significantly higher number of pulmonary effluent L/S ratios below 1 than infants in Groups I, II, and III (p

Pleural thickening is a very frequent manifestation of Aspergillus superinfection in patients with cavitary or cystic pulmonary disease. It was seen in all 33 cases in this series.The presence of pleural thickening in pulmonary disease not usually associated with it, or an increase in the amount in diseases in which pleural thickening is commonly seen, both suggest Aspergillus superinfection. When such pleural thickening is seen, diligent search should be made for this fungus.

The early development of chronic obstructive pulmonary disease in individuals with alpha-1-antitrypsin deficiency may be potentially preventable. A general screening for alpha-1-antitrypsin in patients with chronic obstructive pulmonary disease and their family members seems advisable because these families have a high incidence of alpha-1-antitrypsin deficiency. After a comparison study of electrophoresis, trypsin inhibitory capacity, phenotyping, and radial immunodiffusion technics, the authors recommend radial immunodiffusion as a screening test for alpha-1-antitrypsin deficiency. It is simple, correlates well with trypsin inhibitory capacity and phenotyping, and provides quantitative information for preliminary classification. A parallel determination of stimulated and non-stimulated alpha-1-antitrypsin levels is suggested.

The majority of premature infants with patent ductus arteriosus will undergo spontaneous closure of this structure regardless of whether pulmonary disease has been present (40 out of 57). Excluding the 5 infants with more complex associated congenital heart disease, 15 of 52 required surgery. Of the 37 infants not requiring surgery, 26 had definite spontaneous closure of the ducts. (Four were lost to follow-up, but the ducts are presumed closed.) Six infants in this group died, and in 2 the patent ductus arteriosus was the direct cause of death. Although surgery can be lifesaving, the selection of patients ideally must be made over a period of time. This is usually possible except in extreme cases. Even though division of the duct is associated with a low operative mortality rate, the late mortality (50 per cent) and the morbidity rates are high. Nevertheless, this risk should not be a contraindication to surgery, since most of the operated infants clearly would have died without ligation of the duct.

Glucose intolerance preceding pulmonary disease in a child with cystic fibrosis is de scribed. After glucose intolerance was con trolled with tolbutamide, the pulmonary infec tion resolved. Early recognition and treatment of "diabetes" in children with cystic fibrosis is emphasized.

Mean pulmonary capillary wedge absolute pressures relative to atmosphere were compared with effective wedge pressures in 19 patients with respiratory failure secondary to chronic obstructive pulmonary disease to determine whether a mean wedge or effective wedge pressure provided the most useful diagnostic information when intrathoracic pressure changes were great. The effective wedge pressure was determined by subtraction of the esophageal pressure from the measured wedge pressure. In 16 of 19 patients the actual or estimated difference between the mean wedge and effective wedge pressure ranged within ±3 mm Hg. In three patients, however, all with intrathoracic pressure changes of greater than 20 mm Hg, the mean wedge elevated (range=+6 to +17 mm Hg) in relation to the effective wedge pressure. In patients with chronic obstructive pulmonary disease with loss of lung recoil and airways obstruction, a simple mean of the wedge pressure can be elevated secondary to positive intrathorack pressures which are generated during expiration and influence the recorded absolute wedge pressure. However, in most patients, the use of the electrical mean appears to be a useful method to compensate for respiratory fluctuations in wedge pressure.

Three patients with tuberculous enteritis, 2 of whom developed free perforation, have been presented. The continued presence of tuberculous enteritis in our western society, especially in emigres to the United States from endemic areas, is emphasized. Awareness of tuberculous enteritis in the differential diagnosis of granulomatous gastrointestinal disease and in perforation of the bowel is stressed. Tuberculous enteritis should be considered in all patients with abdominal masses that present clinically or radiographically, particularly in the presence of pulmonary disease.

Eleven tumors of the carotid body and I chemodectoma of the ganglion nodosum of the right vagus nerve were encountered in six members of two consecutive generations of a family. All affected members had bilateral tumors of the carotid bodies with a single exception; one member had in addition a similar neoplasm occurring in the ganglion nodosum of a vagus nerve. Four of these patients had associated chronic obstructive pulmonary disease and exhibited persistently high arterial pCO2 and low pO2 levels. The hypothesis is advanced that chemodectomas of the carotid bodies and other chemoreceptive structures begin as hyperplasias initiated by variations of these physiological stimuli in individuals unable to maintain their normal values or control their oscillations, perhaps because of genetically mediated incompetence. Evidence from the literature supporting this interpretation is discussed. Cancer 33:1635–1641, 1974.

Twenty healthy term newborn infants born at St. Anthony Hospital in Denver, Colorado were examined by echocardiography during the first 72 hours of life. All infants were without cardiac or pulmonary disease and were appropriate for gestational age within the classification of Battalion and Lubchenco. Measurements of intracardiac dimensions, including right ventricular cavity, left ventricular cavity, left atrium and aortic root, as well as thickness of the intraventricular septum and posterior wall of the left ventricle, were determined by three independent observers. The data correlated with other studies performed at centers located at lower elevations.

The bronchoscopic phases of suppurative pulmonary disease can best be presented under two heads: (1) bronchoscopic aid to diagnosis in pulmonary suppuration, and (2) bronchoscopic aid in treatment of pulmonary suppuration. The diseases of the lung in which the pathologic processes result in suppuration are numerous. The suppurative lesion may be primary or secondary, and is always a matter for careful differential diagnosis. The etiologic factors are many and are often obscure. Two or more conditions may coexist. In arriving at a final, positive diagnosis, one should use every available diagnostic aid. The most valuable aid in all diagnostic fields is inspection of the lesion by direct vision. In a great many of the patients with suppurative disease of the lung, this can be done by bronchoscopic examination. Some of the conditions in which the bronchoscope has been of special aid in a positive diagnosis are: 1.

Attention is drawn to the rather common occurrence of bradycardia in children undergoing eye or oro-pharyngeal surgery. This incidence is increased by inadequate atropinization, too much reliance on ether as the main anaesthetic agent, and cardiac or pulmonary disease. Demerol, Flaxedil or Mecostrin have a protective action in this respect.

We have discussed the problems of a 66-year-old white man with presumed silicosis and Mycobacterium kansasii infection. Special emphasis was given to: 1. The role of co-existent atypical acid-fast infection in patients with silicosis. 2. The significance of pulmonary function data in making disability evaluations. 3. The importance of specific historic data in determining the presence and type of pneumoconiosis. 4. Some current industrial hygiene practices and problems of interest to chest physicians. 5. The distinction between pneumoconiosis and silicosis.

A parallel piped compressed air and oxygen system for use in a chronic pulmonary disease section is described. The advantages in terms of improved patient care, safety, convenience, and economy are summarized.

Wilks and Moxon1in 1889 gave a good pathologic description of inflammatory lesions of the esophagus. More recent textbooks, by Adami and Nicholls,2Kaufmann and Reimann3(1929) and Bassler4(1922) have given detailed descriptions of the various types of esophagitis. According to these writers, simple acute catarrhal esophagitis is rarely seen at necropsy. The pathologic process consists in exfoliation of the superficial epithelium and congestion of the mucosa. Chronic catarrhal esophagitis is described as occurring most commonly in alcoholic addicts and persons with pulmonary disease. According to these workers, esophagitis is the result of repeated congestion brought on by other diseases. Wood5(1932) even stated that it may be a factor in the production of muscular hypertrophy, with narrowing of the lumen of the esophagus. Follicular esophagitis is a name often used to describe a process in which the mucous glands participate markedly in

The use of lung biopsy under local anesthesia for investigation of diffuse pulmonary lesions in 50 patients is presented. A specific diagnosis of the pulmonary lesion was possible in 27 of the 50 by histologic study of the biopsy tissue. The procedure was well tolerated and produced minimal complications except in one case which ended fatally. It has its greatest applicability in those diseases where a specific pathological entity is present. In general it affords a rapid accurate method for the diagnosis, determination of the medico-legal status, and determining the prognosis of diffuse pulmonary lesions. Eight cases illustrating the value of this procedure are described in detail.

Excess gas in the hepatic flexure or splenic flexure of the colon, although in itself not unusual nor necessarily significant, may at times be the explanation for symptoms suggesting cardiac, stomach, gall bladder, kidney or pulmonary disease. The concept of the hepatic and splenic flexure syndromes has proved to be of positive clinical value.

Summary Six cases of intestinal tuberculosis, occurring in association with moderately extensive pulmonary disease, are recorded. An account is given of their treatment with a low-residue, high-vitamin diet, calcium and ultra-violet light. It is suggested that this regime is of considerable value in such cases, but that the permanency of any result achieved is dependent upon effective control of the parent lesion in the lung.

Nine cases in which electrocardiograms showed downward deflection of the main initial ventricular complexes are presented. Eight of the patients had had recent coronary occlusions, and one had pericardial effusion. In four cases this electrocardiographic abnormality seemed directly dependent upon the presence of pleural or pericardial effusion, and in the remaining cases there was evidence of chronic pulmonary disease. To produce downwardly directed initial deflections in the limb leads, it seemed necessary to have both myocardial disease causing an abnormal spread of contraction impulses, and changes in the tissues about the heart interfering with the conduction of these impulses.

(1967). The Immune Reaction in Pulmonary Disease. Archives of Environmental Health: An International Journal: Vol. 14, No. 1, pp. 97-110.

Frequent and thorough drainage of secretions from the lungs, so important in the treatment of chronic pulmonary disease, can be achieved most successfully if the chest wall over the affected area is clapped and vibrated while the patient is in the position for postural drainage indicated by the specific site of his illness. Because precision in all phases of this therapy is imperative, specific instructions like those included in

1.1. A case of spontaneous hemopneumothorax in a twenty-seven year old woman who was apparently well prior to the attack is reported. Careful follow-up for fourteen months subsequently failed to reveal any evidence of pulmonary disease. 2.2. The literature on this relatively rare condition is discussed briefly, with relation to etiology, clinical course and treatment.

A peculiar pulmonary disease of infants, usually called plasma cell pneumonia, has been recognized in Europe for many years. The clinical syndrome and lesions in the lungs seem to be specific. The pulmonary alveoli contain an acidophilic fibrillary material in which there are myriads of tiny bodies, and this finding led Dvorak and Jirovec and othersto implicate a parasite, Pneumocystis carinii, as the causal agent. Only 1 case that resembles this disorder has been previously described in the United States, but the alveolar exudate with the tiny bodies was apparently not observed in the tissues.

A morphologic study of three lungs from patients with homozygous deficiency of serum alpha1 antitrypsin was undertaken to determine the presence, type, and distribution of emphysema and the coexistence, if any, of airway disease in the form of chronic bronchitis or bronchiolitis. All three lungs had panlobular emphysema, involving most severely the dependent portions of the lower lobes and to a lesser extent the upper lobes. The lungs also showed microscopic features of chronic bronchitis. The three lungs were from patients who had been cigarette smokers. Previous reports concerning the association of serum alpha1 antitrypsin deficiency and chronic obstructive pulmonary disease have emphasized the panlobular emphysema and may have overlooked accompanying coexistent chronic bronchitis. The exact effect of cigarette smoking in antitrypsin deficiency remains to be defined, but it apparently accelerates the development of emphysema and is also involved in the pathogenesis of coexistent chronic bronchitis. The bronchioles studied showed remarkably little airway disease.

A patient hospitalized with shortness of breath and chronic productive cough did not improve on symptomatic management with bronchodilators and expectorants. The chest x-ray showed diffuse linear d...

Adverse pulmonary reaction to systemically administered drugs is a common occurrence. The roentgen patterns produced by adverse drug reactions can be grouped into five major categories. Agents known to cause pleuropulmonary complications are listed. A careful drug history should be as much a part of the evaluation of a patient with disseminated or recurrent pulmonary disease as is the occupational history.

An epidemic of disseminated pulmonary disease which occurred at Camp Gruber, Oklahoma, in 1944, following common exposure in an abandoned storm cellar, is reviewed. On the basis of the results of the comprehensive followup study reported here and certain other data which have accumulated in the literature since the occurrence of the epidemic, it is concluded that the outbreak was due to H. capsulatum. This is the first epidemic finally proved to have been caused by histoplasmosis.

IT is an undisputed fact that the roentgen examination of the chest is a distinct aid in the diagnosis of pulmonary disease, particularly so in conditions which manifest themselves as discrete lesions, some of which are so small that they are frequently overlooked on ordinary physical examination. It is also true, however, that the nature and differentiation of these shadows cannot always be recognized on the roentgenogram alone, yet if they are correlated with all the clinical and laboratory data, a proper interpretation of the pathologic condition may be made. Discrete pulmonary lesions appear on the roentgenogram as variously sized, isolated, more or less circumscribed areas of increased density. Many of these disease processes have been described by Sante. These discrete shadows are manifestations of some of the following pathologic processes: Round foci type of tuberculosis; Exudative type of tuberculosis; Miliary tuberculosis—acute, chronic, and healed; Miliary bronchopneumonia; Embolic pneumonia; M...