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Four hundred and sixteen open pulmonary biopsies through limited thoracotomies are reported. Tissue sufficient for diagnosis was obtained in all cases. Case selection, operative technique, spectrum of diagnoses, complications, and comparisons with other techniques are defined. Diagnoses by category were as follows: occupational, 105 patients (25 percent); neoplastic disease, 80 patients (19 percent); specific histologic diagnosis, (ie, sarcoidosis), 70 patients (17 percent); specific infection, 23 patients (6 percent); vascular diagnosis, 16 patients (4 percent); and nonspecific pulmonary disease, 122 patients (29 percent). Pneumothorax, minor in most cases, was the most common complication. It occurred in 97 (23 percent) of the patients, but only 24 (6 percent) required the placement of a chest tube. Pleural effusion occurred in 106 patients (25 percent) and was minor. Hemothorax occurred in two (0.5 percent) and superficial wound infection in three (0.7 percent). Overall mortality was 4.5 percent (19 patients). Only two deaths (0.4 percent) were related to the procedure. Open pulmonary biopsy remains our diagnostic method of choice in diffuse lung disease of undetermined etiology.

Mycotoxicosis is a term used to define a toxic reaction due to the ingestion of toxins produced by fungi. Oral ingestion, however, may not be the sole means of exposure. We have recently observed ten patients who had inhaled massive amounts of fungi, which resulted in an apparent toxic pulmonary reaction. Immunologic studies showed no sensitivity to various fungal antigen preparations and histologic study of the lung showed a multifocal acute process, with primary involvement of the terminal bronchioles containing large numbers of various spores. Cultures from lung biopsy material revealed at least five fungal organisms. A one to ten year followup indicates that avoidance of massive reexposure to fungal dust is the key to the prevention of recurrent pulmonary mycotoxicosis.

Using venography as the reference procedure, this study examined the utility of fibrinogen I 125 scanning for the detection or demonstration of deep venous thrombosis. The results demonstrate the inability of leg scanning to detect accurately the presence or absence of thrombi in the deep venous system. Most striking was the lack of sensitivity of this procedure in areas where the propensity for embolization is greatest. Sensitivity is extremely low in the anatomic areas where leg scanning demonstrates reasonable specificity. The results are nearly identical in the extremity not operated upon.The validity of all prior studies relying heavily or exclusively on125I leg scans to determine the presence or absence of thrombi must be critically reassessed.(Arch Intern Med 139:148-153, 1979)

Since the introduction of the phentolamine (Regitine) methanesulfonate test1 for the diagnosis of pheochromocytoma, it has generally been regarded as a safe and reasonably accurate procedure. No reports of fatality after its use in patients with pheochromocytoma have been found in the literature, although there are reports of prolonged hypotension with its use during surgery for pheochromocytoma2 and of one death from ventricular fibrillation after the test in a patient without pheochromocytoma.3 This report describes a prolonged period of hypotension, cardiac arrhythmia, and death after intravenous administration of 5 mg. of phentolamine to a patient shown to have a pheochromocytoma at autopsy. REPORT OF A CASE The patient, a 65-year-old woman, was admitted to the hospital on July 9, 1955, because of "weak spells and convulsions" that appeared one year before admission. The spells were characterized by palpitation, nervousness, cold and clammy hands, profuse perspiration, and then

Urokinase, an enzymatic fibrinolytic activator, was used as the principal form of therapy in the treatment of ten patients with acute pulmonary thromboembolism. Although an absolute statement cannot be made about the efficacy of the drug in the management of this disease, this study seems to demonstrate that lysis of thromboemboli is considerably hastened by the use of this drug. Rapid lysis of emboli is necessary for the successful management of acute massive pulmonary thromboembolism. Three patients in this series previously could have been considered candidates for pulmonary embolectomy. All survived following urokinase therapy. After this experience, we have modified our surgical indications for the treatment of pulmonary thromboembolism to consider for urokinase therapy all patients with massive bilateral pulmonary emboli in shock and those in whom inferior caval ligation is usually recommended for the prevention of further embolization.