Biomedical subjects
Publications and source records attributed to J M Stinson.
Although endobronchial tuberculosis has been thought to be a common childhood illness, this report is of endobronchial tuberculosis in an adult, who presented with chronic cough, a normal chest radiograph, and tuberculin conversion. The lesions were discovered at bronchoscopy, which showed complete resolution when repeated after six months of antituberculous therapy.
Tests of small airway function (closing volume, forced expiratory flow in the middle half of the vital capacity, specific airway conductance, and peak expiratory flow) and routine spirometric tests (forced vital capacity, forced expiratory volume in one second, and residual volume) were performed in 848 adult black subjects of both sexes. The group included 422 smokers and 426 nonsmokers. No significant difference was found between smokers and nonsmokers for any of the tests, although some values were higher for men than for women. These findings suggest that reported abnormalities in small airway function in smokers in the general population may not be applicable to black smokers. This may be an important finding in ethnic variability in the incidence of chronic obstructive pulmonary disease.
Patients with sickle cell anemia have a restrictive ventilatory pattern, with reduction in diffusion capacity of the lung (DLco) and lung volumes. Diffusion capacity and lung volumes are reported as either normal or reduced in subjects with sickle cell trait. Thirteen subjects with sickle cell trait, age range 25 to 79 years, were compared with 13 normal subjects matched for age, sex, height, and smoking patterns. There was no significant difference in mean values of DLco or lung volume for the two groups. Neither was there a consistent difference for age-matched individuals. Normal lung function in sickle cell trait as opposed to sickle cell disease is probably related to the fact that the former have fewer, if any, pulmonary infectious and infarctive episodes.
A patient presented with wheezing, evidence of vascular congestion on physical examination, and leukocytosis. A chest x-ray film suggested pneumonia. When unilateral pulmonary edema was revealed on a repeat chest film, the patient was given diuretic therapy and responded favorably. This case thus differs from the usual pattern of symmetrical homogeneous density on the chest roentgenogram in pulmonary edema of cardiac origin.
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Blastomycosis is a fungal disease with an endemic area identical to that of histoplasmosis in the United States. Disease states range from a subclinical pulmonary illness to a rapidly progressive and fatal disease. Cutaneous lesions are common although the lung is the portal of entry for blastomyces. The organisms are easily demonstrated with potassium hydroxide preparations of fresh sputum, pus from skin lesions, or other biologic material. Skin and serologic tests are unreliable, largely because of cross-reactivity with antigens of histoplasmosis. Because of the ever present potential for milder forms of illness to progress to severe disease, it is recommended that all patients with symptomatic or culture proven disease be treated with amphotericin B.
Fiberoptic bronchoscopy was performed in 46 patients in the evaluation of pulmonary lesions. Twenty-five of the patients had lung cancer; the remainder had benign lesions. Definitive diagnosis was established in all patients by a combination of forceps biopsy, brush biopsy, bronchial aspiration, and post-bronchoscopy sputum studies. All endoscopically visible lesions were diagnosed by forceps biopsy. Fluoroscopic localization of biopsy forceps and brush made the yield in peripheral, nonvisualized lesions almost equal to that of more central lesions. Fluoroscopic control markedly increases the diagnostic yield in fiberoptic bronchoscopy.
A case is presented of a 28-year-old woman with right upper lobe atelectasis secondary to sarcoid adenopathy. As most chest surgeons and physicians would currently remove the offending lymph nodes for lung reexpansion and more definitive diagnosis, the case is considered primarily for its historical interest.
Forced expiratory spirometric studies were performed on 512 nonsmoking black adult men and women with negative cardiorespiratory histories. Regression equations were calculated for forced vital capacity (FVC), percent vital capacity in 1 second (% FEV(1)), and forced midexpiratory flow rate FEF(25-75)%), using height and age. These equations resulted in predicted values 3.5 to 23 percent lower than commonly used standards. The wide range of variation means that a single correction factor is inadequate when considering ethnic differences. In contrast, FEV(1)/FVC was within the accepted range of normal for all ethnic groups. In the 30 percent of subjects in whom sitting height was measured, it was not significantly different from one half the standing height; thus, sitting height is also an inadequate correction factor. Tables of predicted values were constructed for easy reference, with the hope that use of racespecific standards for pulmonary function testing will become widespread.
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A 64-year-old woman presented in severe respiratory failure along with congestive heart failure, chronic obstructive lung disease, and hypothyroidism. Any of the latter may lead to acute respiratory failure, and all may have played a role in the patient reported here.
The rare occurrence of alpha 1-antitrypsin deficiency in black Americans has led to the suggestion that routine screening of such subjects in needless. Our report of a black teen-ager with deficiency of this protease inhibitor in association with status asthmaticus suggests that at least relatively young black patients with otherwise unexplained chronic pulmonary disease should be tested for this defect.
The fungus Histoplasma capsulatum produces a spectrum of disease forms ranging from a benign self-limited illness to progressive disseminated disease with a 50 percent mortality rate. The drug of choice, amphotericin B, must be given intravenously over a prolonged course and carries a high incidence of toxicity. Thus, optimal managment of serious forms of histoplasmosis requires considerable clinical judgment.
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Two patients with obstruction of the pulmonary veins by bronchogenic carcinoma, an unusual cause, are presented. These and other cases reported have had features suggestive of mitral stenosis. The differential diagnosis is discussed.
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