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Although it is known that abnormalities of the esophagus (the muscular canal between the throat and stomach) can cause aspiration accompanied by breathing or respiratory symptoms, it is not known how often respiratory symptoms are caused by occult gastroesophageal reflux. Occult (without signs or symptoms) gastroesophageal reflux refers to the backflow of stomach acid into the esophagus. A study was undertaken of 73 patients with respiratory symptoms (cough, wheezing and/or recurrent pneumonia) to determine if they had occult gastroesophageal reflux. There were 54 patients (70 percent) who were found to have increased esophageal exposure to gastric juice in the distal esophagus. Respiratory symptoms occurred during or within three minutes after an episode of gastric reflux; this occurred significantly more often in patients with increased acid exposure (28 percent) than in patients with normal acid exposure (9 percent). The respiratory problems were apparently due to aspiration. In the group of patients with increased stomach acid exposure, the number of respiratory symptoms reported was directly related to the presence of a motility abnormality of the esophagus. This motility disorder may contribute to aspiration by promoting the upward flow of stomach secretions. Surgery was performed on 17 patients to relieve their respiratory symptoms. Only patients who had normal esophageal motility were helped by the surgery. The results of this study appear to indicate that most patients with chronic unexplained respiratory symptoms have occult gastroesophageal reflux, and most are not helped by surgery. Careful testing of esophageal function is needed to identify patients likely to benefit from surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

• Esophageal function was assessed with manometry and 24-hour pH monitoring of the distal esophagus in 22 patients with histologically proven Barrett's esophagus (BE), 31 consecutive patients with endoscopic grade 2 or 3 esophagitis, and 33 normal volunteers. Patients with BE had less lower esophageal sphincter (LES) pressure, but similar length of sphincter exposed to the abdomen, than patients with esophagitis. Both groups had significantly less LES pressure and abdominal length than normal subjects. Patients with BE had statistically more esophageal acid exposure than patients with esophagitis, and both differed markedly from normal subjects. They also had a greater number of reflux episodes lasting longer than five minutes than patients with esophagitis, suggesting that the severity of acid exposure was due to a defect in esophageal clearance. The extent of Barrett's mucosal change was related to the level of LES pressure and the number of reflux episodes that were five minutes or longer in duration. We concluded that BE is related to a mechanical incompetency of the cardia and a decrease in esophageal clearance that requires reconstruction of the cardia for effective therapy.(Arch Surg 1983;118:543-549)

A guided biopsy technique has been developed for evaluation of solitary bone abnormalities, identified by gallium 67 or technetium 99 bone scans, in patients with normal or ambiguous x-ray findings. Continuous gamma camera monitoring is used to guide staining of the bone abnormality and overlying tissues with methylene blue. This staining is followed by open biopsy of the marked bone. This technique was utilized in 15 patients, 12 of whom had bronchogenic carcinoma. The most commonly involved bones (13/15) were ribs. None of the patients had an identifiable, gross abnormality at operation, and the marked area was indistinguishable from neighboring tissues. Diagnostic tissue was obtained by each biopsy and there were no complications associated with this technique. The primary applicability of this technique is for both pretreatment and re-treatment staging of bronchogenic carcinoma in patients who have ambiguous nuclear bone scan abnormalities.

Current procedures to determine the clinical staging of disease in patients with lung cancer are lacking in accuracy, particularly regarding the presence of metastatic disease. We have evaluated the use of computed tomography (CT) of the chest, brain, and upper abdomen for clinical staging of the extent of disease in 113 consecutive patients with histologically confirmed carcinoma of the lung. Comparisons with mediastinoscopy and surgical findings were made regarding the extent of primary tumor in 47 patients and nodal involvement in 41 patients. The CT scan showed a sensitivity of 86.9%, a specificity of 91.6%, and an accuracy of 89.3% for extrapulmonary extension of the primary tumor and a sensitivity of 50%, a specificity of 96.5% and an accuracy of 82.9% for mediastinal node involvement. Thirty-two of the 85 patients studied by total body CT scan had distant metastasis, of which 24 (75%) were clinically silent. Thus 28.2% of the 85 patients studied had asymptomatic metastatic disease. We conclude that CT of the chest, brain, and upper abdomen is a reliable procedure for staging lung cancer.

A statistical comparison between survival and type of resection: Lobectomy and pneumonectomy was made out of 108 patients who had undergone curative resection for lung cancer (with a minimum 3 years follow-up). Analysis was first made on the whole series, then the patients were classified according to histological type (W-PL) or staging (TNM) and finally stratified in 2 control levels (stage and histological type). There was a better prognosis for lobectomy than for pneumonectomy, referring to a single subgroup, but not in a statistically significant way. There was a better prognosis for patients who had been operated for lobectomy S (2) 2 LOB with a 36 months survival for 85 %. There were better results for squamous cell carcinoma stage I and II S(2) 1 PNE, for those patients who had been operated for pneumonectomy with a median survival of 32 months and over 3 years survival for 41.7 %.