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Fifteen years ago we began a prospective study using alternate case treatment with prednisone in patients with pulmonary function abnormalities due to sarcoidosis. Twenty-five patients were divided into treatment and control groups that were similar in sex, age, race, degree of pulmonary dysfunction, and duration of disease. Evaluation included complete spirometric studies, single-breath carbon monoxide diffusion capacity, and arterial blood gases. Follow-up studies at six months, one to two years, and ten to 15 years show no difference between the treated and untreated groups. Improvement or deterioration in pulmonary function of individual patients in the treated group was reflected in the control group, even in those patients with a diffusing capacity and forced vital capacity less than 65 percent of predicted. Data from this long-term study fail to show any benefit of short-term use of steroids in therapy for pulmonary sarcoidosis.

SUMMARY Ten patients without underlying pulmonary disease were studied before and after lymphangiography on 11 occasions. Each showed a modest decrease in total lung diffusion and capillary volume as measured by the single breath carbon monoxide technique. These changes persisted for periods up to 28 days and were still measurable in two of three patients more than one year later. This probably represents a minimal but permanent alteration in the pulmonary capillary bed. An additional case, presenting as a pulmonary embolus after lymphangiography, in whom oily contrast media was visualized in the pulmonary arteries was described. Although this procedure generally may be considered to be benign in people with normal lungs, it does cause a modest, consistent, and possibly persistent decrease in diffusing capacity. In patients with severe underlying lung disease, increased morbidity and possible mortality must be anticipated.

Pulmonary function and work capacity were evaluated in nine young adult men with straight thoracic spines noted on inspection and confirmed by x-ray. Subjects with pectus excavatum or scoliosis were excluded. Only one subject had a pulmonic systolic heart murmur. In the straight back group (SB), the observed total lung capacity (TLC), percent of predicted TLC, and FEV 3.0 were reduced significantly (P 1.0, FEF 0-25, FEF 25-75 , D L , or arterial blood gas studies. Working capacity data obtained on a level one mile run and on a treadmill showed no differences from control subjects before and after training. Despite a reduced TLC and a tendency to reduced terminal air flow, the young adult man with absent physiologic dorsal thoracic kyphosis does not have a significant decrease in working capacity and can undergo effective physiologic training.

Bleomycin is an antineoplastic, antimicrobial drug originally developed in Japan. A high incidence of pulmonary toxicity in the form of acute, occasionally fatal pulmonary fibrosis has been reported in humans. Toxicity is greatly enhanced when more than 400 mg of the drug is administered. In a 45-year-old woman with metastatic adenocarcinoma, an acute interstitial pulmonary process developed only after 180 mg of bleomycin was administered. The diffuse lung process was suspected from changes in serial pulmonary diffusion capacity for carbon monoxide and forced vital capacity. The chest radiograph remained stable, and the patient had no pulmonary symptoms. The histologic appearance of the lung is presented in detail and the value of serial pulmonary function tests in patients taking bleomycin is stressed.

A patient with chronic lung disease became cyanotic following right pneumonectomy for cancer. He was found to have right-to-left shunting through a patent foramen ovale in the absence of pulmonary hypertension, and he improved remarkably after surgical therapy. This case vividly illustrates the subtlety with which acquired right-to-left shunting may appear in the setting of chronic hypoxemia. The frequency of patent foramen ovale in the general population (20 percent) and the ease and efficacy of treatment for this lesion underscore the need for general awareness of this potential problem in the chronically or critically ill.

Glucocorticoid therapy has long been advocated for treatment of pulmonary dysfunction in sarcoidosis. No controlled prospective study in current medical literature establishes the efficacy...

In three obese patients with sleep disturbance and somnolence, upper airway obstruction appeared to play the primary pathophysiologic role. The somnolence in these patients was caused by s...

During an investigation of pulmonary dysfunction in 41 consecutive patients with classical or definite rheumatoid arthritis, it was found that 41.4 percent had abnormalities of pulmonary diffusion. Generally the physiologic profile was one of decreased vital capacity, decreased total lung capacity, and arterial hypoxemia; these abnormalities were supported by the pathologic findings of percutaneous lung biopsy. All patients showed changes of interstitial fibrosis. Usually, the patients were not symptomatic, and 47.0 percent had normal chest roentgenograms. The type of treatment received, level of rheumatoid factor, duration of disease, and American Rheumatism Association (ARA) stage of disease failed to correlate with the presence or absence of pulmonary dysfuntion. The clinical significance of pulmonary fibrosis in rheumatoid patients is unknown, and the disease seems to be mild clinically and only slowly progressive. It is concluded that pulmonary fibrosis is common in rheumatoid disease and should be regarded as an expected manifestation, rather than an unusual complication, of the systemic process connoted by the term rheumatoid disease.

• The effect of intravenous sedation on oxygen saturation and ventilation was studied in 11 patients undergoing peritoneoscopy. Oxygen saturation (mean ± SD) decreased from baseline (94.7% ± 1.7%) to nadir (78.6% ± 10.7%) after sedation. Respiratory depression was evident in these patients by concomitant decreases in minute ventilation and tidal volume. Baseline to nadir arterial blood gas changes in eight patients were consistent with hypoventilation and also suggested a superimposed ventilation perfusion mismatch. Mean respiratory rate did not significantly change during peritoneoscopy. Peritoneal gas insufflation stimulated increased ventilation and oxygen saturation, but no further changes in Pco 2 or pH. We conclude that serious arterial oxygen desaturation and possibly some ventilation perfusion mismatch occur after sedation with intravenously administered meperidine-diazepam for peritoneoscopy with resultant hypoxemia, hypercarbia, and acidosis. ( Arch Intern Med . 1989;149:1029-1032)

Excerpt Steroid therapy has long been advocated for treatment of pulmonary dysfunction in sarcoidosis. Current medical literature, however, reveals no controlled prospective study which establishes...

Excerpt Forty-one consecutive patients with classical or definite rheumatoid arthritis were studied in an attempt to determine the prevalence of pulmonary dysfunction in rheumatoid disease. Routine...

Seven patients had central airway obstruction of varied causes. The diagnosis was established early in some, but in others, because of either atypical clinical or physiological features or the lack of suspicion, the diagnosis was delayed. These cases emphasize that central airway obstruction may simulate asthma or chronic obstructive pulmonary disease and is not a rare clinical problem. Prime suspects are patients with dyspnea and wheezing without a well-defined cause.