Diseases of the chest最新文献

Sporotrichosis usually affects the subcutaneous tissues and lymphatics of extremities and rarely involves the lung. We report a case of primary pulmonary sporotrichosis because the rate of recognition of this condition appears to be increasing. Treatment consisted of amphotericin B and pneumonectomy. The patient died of a postoperative bronchopleural fistula and Pseudomonas infection.

The frequent occurrence of idioventricular tachycardia has been documented during the evolution of experimental myocardial infarction in the dog, complementing such observations in humans. The nonvulnerability to fibrillation and the benign hemodynamic nature of this type of ventricular tachycardia is stressed. The influence of the rate of the supraventricular pacemaker on the emergence of this arrhythmia has been demonstrated and the recognition of this arrhythmia with regard to the effect of antiarrhythmic agents has been emphasized.

Primary mediastinal choriocarcinoma is a rare entity and is peculiar only to man. Although rigid criteria such as serial biopsies of the gonads are essential to rule out the possibility of such mediastinal tumor as a metastatic lesion, a review of the literature shows that anterior mediastinum is rarely involved by the metastasis from gonadal tumors. The clinical diagnosis of such a tumor can be made by the presence of the triad of chest pain, cough and gynecomastia in a man in the third decade. The prognosis of such a lesion is uniformly hopeless irrespective of the mode of treatment. A case of primary mediastinal choriocarcinoma in a 22-year-old man has been described. This case brings the total number of cases to 16.

Seventy-eight patients with locally recurrent or disseminated lung cancer were treated with cyclophosphamide therapy. Only eight patients showed objective tumor regression. Five of the objective responses occurred in patients with small cell anaplastic carcinoma and three in patients with squamous carcinoma. No objective responses were seen in adenocarcinoma or alveolar cell carcinoma. An additional 26 patients manifested a stable or subjectively improved status during therapy. Hemorrhagic cystitis was seen in six of 36 patients receiving the drug orally but in none of those receiving monthly intravenous courses. Hematologic toxicity was acceptable though there was one death from sepsis associated with leukopenia. There was no evidence that life was prolonged by this drug. Because there seemed to be frequent subjective benefit, we recommend that symptomatic patients with recurrent or disseminated lung cancer receive monthly intravenous courses of cyclophosphamide as palliative therapy.

A double-blind study of the effect of 0.250 gm aminophylline on pulmonary function was performed on nine patients with asthma. The aspects of pulmonary function studied comprised lung volume and flow rates, arterial blood gas tensions, arterial pH, the ratio of physiologic dead space to tidal volume, the alveolar arterial O₂ gradient and the venous admixture-like effect. All patients had reduced flow rates and increased venous admixture. Seven of nine patients had decreased arterial O₂ tension and saturation. Total lung capacity and forced vital capacity increased slightly after aminophylline administration. There was, however, no statistically significant difference between aminophylline and placebo on flow rates, arterial blood gas tensions, arterial pH or venous admixture. The results suggest that a dose of 0.250 gm aminophylline does not produce maximal bronchodilatation.

Double Master's exercise tests were performed in the course of general or periodic examinations on 1,375 patients without angina pectoris. These patients were either asymptomatic or had nonspecific chest pain, and patients with angina pectoris or previous myocardial infarction were specifically excluded. Initial tests were negative in 1,269 (92 percent) and positive in 106 (8 percent). Follow-up information (average duration 30 months) was obtained from clinical reexamination in 833 patients. Of 763 patients with negative tests, 740 (97 percent) were well at last follow-up, 16 (2 percent) had developed clinical signs of ischemic heart disease and seven (1 percent) were dead. Of 70 patients with positive exercise tests, only 21 (30 percent) were living and well at last follow-up, while 42 (60 percent) had signs of ischemic heart disease and seven (10 percent) were dead. It appeared that the double Master's exercise test may have been a valuable adjunct in screening essentially asymptomatic patients for ischemic heart disease. A negative exercise test in such patients seemed to be associated with low rate of development of clinical ischemic heart disease in immediate future months, while a positive exercise test frequently seemed to presage clinical disease in this group of patients.

The main advantages of the UKL-40 apparatus for mechanical amputation of the bronchus are described: tight closure with two rows of tantalum staples, aseptic, closed, rapid and secure management. Bronchopleural fistula developed in five out of 650 cases (0.7 percent), one after lobectomy, and four after pneumonectomy. Empyema was noted in 26 cases (4 percent). The UKL60 stapling apparatus may be used for atypical resection of pulmonary parenchyma, for wedge resection of isolated tuberculomas, small cavities; for multilobar excision of tuberculous lesions even from disseminated areas; for resection of benign tumors, solitary carcinoma metastasis, cysts, apical bullous changes, concomitant lingular bronchiectasis, etc. Two hundred and seventy atypical resections were performed without mortality and incidence of bronchopleural fistula. Minor complications occurred in 17 cases.

Nine cases of pulmonary cryptococcosis unassociated with meningitis or other underlying disease have been discussed regarding the place for medical and surgical management. Seven patients survived. Resection was the only therapy in five with unilateral disease. No complications resulted. Amphotericin B was the only therapy in two patients with diffuse bilateral disease, one of whom died, and in one patient with unilateral disease. One additional patient with bilateral localized disease died after attempted bilateral resection. Symptoms were not reliable in determining the activity of disease nor in selecting the therapeutic program. Amphotericin B should be given for diffuse bilateral disease or with extension of a localized lesion. It has not been needed following resection of unilateral disease.

A case is presented of a 74-year-old woman who had carcinoma of the breast metastatic to the mid-thoracic esophagus 19 years after radical mastectomy. Symptoms of prolonged intermittent dysphagia over a fiveyear period led to esophagoscopy, during which iatrogenic perforation occurred in the mid-esophagus without visualizing obstruction or tumor. Emergency thoracic esophagectomy and esophagogastrostomy with pyloroplasty resulted in a successful outcome. The case represents the longest interval to be reported between removal of a primary tumor and the appearance of a solitary metastasis in the esophagus.