Christopher M. Stafford

Exercise-Induced Asthma May Be Associated With Diminished Sweat Secretion Rates in Humans

BACKGROUND Muscarinic receptor agonists increase water secretion from the acinar cells of respiratory, sweat, salivary, and lacrimal glands. Mice lacking the gene for aqueous water channel aquaporin (Aqp) 5 exhibit methacholine-induced bronchiolar hyperreactivity when compared to normal mice. Individuals with asthma also have enhanced airway responsiveness to methacholine and diminished airway hydration. Because Aqp5 in humans is also expressed in respiratory, sweat, salivary, and lacrimal glands, we hypothesized that those individuals with exercise-induced asthma and excessive bronchiolar reactivity should also have decreased muscarinic receptor-dependent sweat, salivary, and tear gland secretions. METHODS Healthy, athletic subjects who are suspected of having exercise-induced bronchospasm were recruited, and FEV(1) values were determined following provocative airway challenges with methacholine. Measurements of pilocarpine-induced sweat secretion were taken in 56 volunteers, and some additional subjects also had timed collections of saliva and tear production. RESULTS Subjects manifesting excessive airway reactivity demonstrated by exaggerated methacholine-induced reductions in FEV(1) also had diminished values for pilocarpine-induced sweat secretion (n = 56; r = - 0.59; p < 0.0001). The rate of pilocarpine-stimulated sweat secretion in our subjects correlated highly with salivary flow rate (r = 0.69; p < 0.0001) and tearing rate (r = 0.86; p < 0.001). CONCLUSION Hyperhidrosis, sialorrhea, and excessive tearing are traits that may indicate a phenotype that predicts resistance to hyperactive airway diseases such as exercise-induced asthma in humans.

Granulocytic sarcoma of the tracheobronchial tree: Bronchoscopic and pathologic correlation

Granulocytic sarcoma (GS) is an extramedullary, solid tumor composed of immature granulocytic cells, which occurs in association with myeloproliferative or leukemic disorders. GS can precede, accompany, or complicate the presence of hematologic malignancy in the blood or bone marrow. The anatomic distribution commonly includes bone, nerve, lymph node, and skin, but may involve a variety of soft tissues. Pulmonary involvement is uncommon but may invade the parenchyma, pleura, mediastinum, and airways. We report a rare case of endobronchial granulocytic sarcoma with bronchoscopic and pathologic correlation.

Population Characterization, Histological Evaluation, and Timeliness of Care of Surgical Nonsmall Cell Lung Cancer Patients in a Military Academic Medical Center

UNLABELLED Lung cancer remains a major medical impediment in which early diagnosis and timely treatment are key factors in its management. This study evaluated nonsmall cell lung cancer (NSCLC) patients in a large military medical center to determine the timeliness to diagnosis and curative surgery in comparison with published guidelines. A retrospective record review of tumor registry NSCLC surgery cases at Navy Medical Center San Diego (NMCSD) from 2004 to 2009 was conducted. Of the 84 patients, 49% were women, the median age was 63, 58% were Caucasian, and 71% represented ex- or active smokers. A significant number of women were Asian (30%) and nonsmokers (77%). The predominant histology was adenocarcinoma (86%) with positron emission tomography-computed tomography (PET-CT) nonavid (57%). Median time for pulmonologist evaluation was 8 days, median time for PET-CT was 13 days, median time for cardiothoracic surgery evaluation to thoracotomy was 25 days, and median time from pulmonologist evaluation to thoractomy was 59 days. CONCLUSIONS Except for the pulmonary specialist referral time (8 vs. 7 days), timeliness of diagnosis and curative surgery for NSCLC patients at NMCSD was within international guideline recommendations. Additional proposals have been made to improve the evaluation and treatment of lung cancer patients.