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D W Chamberlain

Publications and source records attributed to D W Chamberlain.

At least 37 records · Page 2Linked to original sources
PubMed1987

Small cell anaplastic carcinoma: cytological-histological correlations from percutaneous fine-needle aspiration biopsy.

Small cell anaplastic carcinoma (SCAC) is usually treated non-surgically and, therefore, diagnosis is best done by the least invasive means. Percutaneous fine-needle aspiration biopsy is very accurate in diagnosing malignancy and reasonably accurate in diagnosing malignant cell type. An unequivocal cytological diagnosis of SCAC has a positive predictive value of 0.90 at our institution. The accuracy is lowered by uncertain or suggestive cytological diagnoses.

Aged↗
PubMed1986

Diphenylhydantoin-induced lymphocytic interstitial pneumonia.

A patient developed diffuse lymphocytic interstitial pneumonia after receiving diphenylhydantoin therapy for 14 months. Withdrawal of medication resulted in reversal of the disease process. This case illustrates the value of combined transbronchial biopsy and bronchoalveolar lavage sampling in establishing a diagnosis, and the utility of serial bronchoalveolar lavage in monitoring disease evolution.

Aged↗
PubMed1986

Unusual radiologic presentations of bronchioloalveolar carcinoma.

Bronchioloalveolar carcinoma appears with variable radiologic features. The usual findings include a single nodule, multiple nodules, or areas of consolidation in lung. An air bronchogram in an area of nodular or mass-like density is also a well-known feature. We here report six patients whose disease illustrates interesting or unusual aspects of this neoplasm. The findings include: Minimal radiological signs despite diffuse disease found on CT scan or at surgery (two patients). Thickening of the wall of a preexisting lung cavity: presumed bronchogenic cyst. Expansile lobar consolidation without an air bronchogram simulating pleural disease. An elongated lobulated area of mass-like density resembling mucoid impaction. Homogeneous lobar atelectasis without an air bronchogram. Consideration of these varied features may aid in the radiological diagnosis of bronchioloalveolar carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1985

Does serum angiotensin converting enzyme reflect intensity of alveolitis in sarcoidosis?

Serum angiotensin converting enzyme activity is increased in many patients with pulmonary sarcoidosis and has been proposed as a measure of disease activity. Assay of serum angiotensin converting enzyme, bronchoalveolar lavage, and gallium scans were performed in 27 patients with biopsy proved pulmonary sarcoidosis. There was a positive correlation between serum angiotensin converting enzyme activity and an index of pulmonary gallium uptake assessed by the National Institutes of Health method (r = 0.7, p less than 0.001). There was no significant relationship (r = 0.19) between serum angiotensin converting enzyme activity and bronchoalveolar lavage lymphocytes expressed as a proportion of cells recovered. Increase in the enzyme activity had a sensitivity of 50% as a means of detecting high intensity alveolitis but specificity was only 45%. There was no significant difference in mean angiotensin converting enzyme activity between the following groups: those with positive and those with negative gallium scans; those with bronchoalveolar lavage lymphocyte counts less than or equal to 28% and those with counts greater than 28%. Although there was a significant correlation between the enzyme activity and one component of the alveolitis of sarcoidosis, the data suggest that serum angiotensin converting enzyme activity alone is neither sensitive nor specific enough for high intensity alveolitis.

Female↗
PubMed1985

Lung inflammation in scleroderma: clinical, radiographic, physiologic and cytopathological features.

Twenty-five patients with systemic sclerosis were studied by chest radiography, lung function, esophageal motility, gallium-67 (67Ga) lung scanning and bronchoalveolar lavage (BAL). Alveolar inflammation, as defined by an elevation of proportional BAL lymphocyte or neutrophil counts, or increased thoracic uptake of 67Ga was found in 16 patients. An NIH gallium index greater than 65 index units identified a subgroup of patients with a significantly higher proportional BAL lymphocyte count (13.7 +/- 8.5 vs 5.6 +/- 3.1, p less than 0.0005). The presence of an abnormal chest radiograph correlated with physiologic evidence of lung restriction (p less than 0.01), and an elevation of proportional BAL lymphocyte count (15.5 +/- 8.2 vs 6.6 +/- 5.1, p less than 0.01). Eight patients receiving oral penicillamine therapy had significantly lower BAL lymphocyte counts compared to untreated patients (4.7 +/- 3.6 vs 11.3 +/- 7.7, p less than 0.05). We suggest that alveolar inflammation in scleroderma is characterized by lymphocyte accumulation and increased thoracic uptake of gallium.

Adult↗
PubMed1984

Tuberous sclerosis with pulmonary involvement.

Pulmonary tuberous sclerosis produced interstitial disease in a woman with normal-sized lungs; numerous hemosiderin-laden macrophages were found in the fluid obtained through bronchoalveolar lavage. The pathological changes seen in the lungs were identical to those of pulmonary lymphangiomyomatosis, in which the constellation of clinical signs usually found in tuberous sclerosis is absent. The two conditions are sufficiently similar in clinical presentation, pathological changes and prognosis to be considered variants of the same disease. The recent findings of progestin receptors in lung tissue from patients with pulmonary lymphangiomyomatosis will likely direct future management towards hormonal manipulation.

Adenoma↗
PubMed1984

An in vitro gallium-67 lung index for the evaluation of sarcoidosis.

In the evaluation of the active alveolitis of pulmonary sarcoidosis, both the proportional lymphocyte count obtained by bronchoalveolar lavage and state of activation of the alveolar macrophage by gallium scanning are required. We injected 6 mCi (200 MBq) of 67Ga intravenously on 24 occasions in 13 patients with biopsy-proved sarcoidosis. Forty-eight hours later, patients were scanned with a rectilinear scanner and the generated scintigrams were evaluated using the NIH index. Seventy-two hours after injection, bronchoalveolar lavage was performed, and venous blood was sampled. The harvested lavage fluid was analyzed for absolute and proportional cell counts, and radioactivity was measured in blood and BAL fluid. An in vitro 67Ga index was generated and expressed as counts/100,000 alveolar macrophages/ml blood (mean, 0.0146 +/- 0.0087 SD). There was a significant relationship between the in vitro index and proportional lymphocyte BAL counts (r = 0.79; p less than 0.002) that was comparable to that obtained using the NIH index (r = 0.74; p less than 0.005). These data suggest that the in vitro index might offer a more objective assessment of 67Ga uptake by the lung, but this would require validation against clinical parameters in a prospective study.

Adult↗
PubMed1984

Percutaneous fine-needle aspiration biopsy of mediastinal lesions.

Percutaneous fine-needle aspiration biopsy (PNAB) of mediastinal masses was carried out in 116 patients. The technique yielded a high percentage of correct diagnoses, and the results were usually available within hours. More importantly, the procedure was well tolerated by patients, and in this series of 116 cases, only one serious complication was encountered. There was a high accuracy (90.3%) in the cytologic diagnosis of mediastinal metastases from lung and extrathoracic sites. Excellent results were also achieved with the cytologic diagnosis of thymoma (82.4%). Very good results were achieved with benign mediastinal cysts, and PNAB with aspiration of fluid proved to be a valuable tool in the diagnosis of these lesions. The results achieved with the cytologic diagnosis of lymphoma supported by pathology (66.7%) and with neurogenic tumors were acceptable, but less impressive.

Aged↗
PubMed1982

Cytologic diagnosis of radiographically occult squamous call carcinoma of the lung.

From 1978-1980, 20 patients with radiographically occult squamous cell carcinoma of the lung were admitted to Toronto General Hospital. Among them, five had in situ carcinoma, three had microinvasive carcinoma, and 12 early invasive. All cases were first diagnosed by cytologic examinations of sputum, localized by bronchoscopy, and had been verified histologically. It appears that a cytologic diagnosis of in situ squamous cell carcinoma of the lung could not be established on the basis of a single abnormal squamous cell or an occasional group of abnormal cells, but could be reached by putting together all the cytologic findings observed in the preparations. The criteria for the cytologic diagnosis are elucidated. Cytomorphologically there was no difference between microinvasive and advanced invasive carcinoma. However, in a patient with known localized in situ carcinoma and previous persistent cytologic findings of the same from that particular site, the finding of frankly malignant cells from the same site in the follow-up bronchoscopic examination was almost definitely an indication of microinvasive carcinoma, which usually showed evidence of both in situ and invasive carcinoma in the bronchial brushing specimens. None of the three microinvasive carcinoma cases had positive lymph nodes, but four of the 12 patients with early invasive carcinoma had metastases to the nodes at the time of surgery. Hence, the best time to effectively treat the invasive squamous cell carcinoma of the lung is at the microinvasive stage when the disease is considered curable.

Aged↗
PubMed1982

Proportional analysis of respiratory cells obtained by bronchoalveolar lavage.

Bronchoalveolar lavage was performed during fibreoptic bronchoscopy in 17 patients with biopsy-proven interstitial lung disease and in 12 control subjects who had focal lesions in the lung. The volume of fluid recovered was unrelated to disease activity or diagnosis. In the control subjects alveolar macrophages represented over 95% of the lavaged cells. The proportion of lymphocytes in the lavaged cells enabled a natural division of the diffuse interstitial lung diseases into two categories: active sarcoidosis, indicated by a large proportion of lymphocytes but a normal proportion of polymorphonuclear leukocytes; and idiopathic pulmonary fibrosis and asbestosis, indicated by a normal proportion of lymphocytes but a variable proportion of polymorphonuclear leukocytes. Bronchoalveolar lavage is a safe and well tolerated method for evaluating the role of alveolitis in diffuse interstitial lung disease through the sampling of respiratory alveolar cells.

Adult↗
PubMed1982

Arterial PCO2 as an index of activity in fibrosing alveolitis.

Alveolar hyperventilation is a characteristic feature of the interstitial lung diseases, yet its pathogenesis remains unknown. We examined the relationship between inflammatory alveolar acinar cell counts and the steady state, resting arterial PCO2 in patients with fibrosing alveolitis. To eliminate the influence of overwhelming mechanical lung restriction or resting hypoxemia, we studied 20 patients who, despite having clinicopathologically confirmed fibrosing alveolitis, had vital capacities exceeding 50 percent of predicted, and arterial O2 saturations above 90 percent. There was a significant inverse relationship between the proportion of polymorphonuclear leukocytes (PMNs) in the recovered BAL fluid and the arterial PCO2 (r = -0.67; p less than 0.01). When PCO2 was above 35 mm Hg, the BAL PMN count was 8 percent or less (mean = 3.4; SD = 2.5), while the mean BAL PMN count among those patients whose PCO2 was less than 35 mm Hg was significantly higher (mean = 11.7; SD = 3.7; p less than 0.01). PCO2 levels were unrelated to arterial O2 saturation or PaO2. No relationship was found between the PCO2 and BAL lymphocyte counts. The findings suggest that in fibrosing alveolitis, the arterial PCO2 may be used as an indicator of the state of the inflammatory component of the alveolitis.

Carbon Dioxide↗
PubMed1982

Pulmonary disposition of gallium-67 in humans: concise communication.

Pulmonary gallium-67 imaging for inflammatory and neoplastic diseases has become an important diagnostic tool in respiratory medicine. However, the extent to which Ga-67 is delivered to normal lungs has not been fully evaluated. Accordingly, we measured the disposition of Ga-67 using scintiscanning, bronchoalveolar lavage (BAL), and blood analysis in healthy subjects. Following an intravenous dose of 6 mCi Ga-67 citrate, the gallium scan showed no pulmonary uptake at 48 hr. In all subjects, radioactivity was detected in both blood and recovered BAL fluid at 72 hr, being predominantly in the cellular component of the BAL washings. We conclude that despite negative pulmonary imaging, Ga-67 accumulates in the cells that line the alveolar acini of normal nonsmoking individuals.

Adult↗
PubMed1981

Aspiration needle biopsy of thoracic lesions.

We reviewed our experience with 2,114 percutaneous aspiration needle biopsies of intrathoracic lesions. Aspiration was performed for cytological diagnosis employing biplane fluoroscopy and a 20 gauge needle, 0.9 mm in outside diameter. A satisfactory specimen was obtained in 88% of biopsies, and the chance of obtaining a correct diagnosis of a malignant lesion was 81.5%. The false positive rate was 2.3%, and the cytologists could always distinguish between primary and secondary neoplasms. A false negative rare of 13.6% (36 patients) resulted in only three delayed thoracotomies and two instances of interval metastases discovered at mediastinoscopy. Cellular specificity in primary tumors was not sufficiently accurate to affect therapy. Pneumothoraces occurred frequently (31.9% of patients) but wee generally small; 10.4% of patients required chest drainage. There were no recorded instances of tumor implantation in needle tracts. We conclude that a rapid and accurate diagnosis of intrathoracic pathology can be obtained by this technique. It is associated with an acceptable morbidity and may greatly expedite both patient care and investigation.

Biopsy, Needle↗