Eero Tala

Prevalence of chronic obstructive pulmonary disease in elderly Finns

The prevalence of chronic obstructive pulmonary disease (COPD) in the elderly is poorly known. The aim of this study was to determine the prevalence of COPD and to analyse the factors associated with it in an elderly Finnish population. The population consisted of persons resident in Lieto, Finland, born in or before 1926. One thousand one hundred and ninety-six individuals (488 men and 708 women, 93% of those eligible) participated in the survey, which was carried out in 1990-91 at the Lieto Health Centre. The methods included a nurses interview and spirometry with a bronchodilator test. The participants were also clinically examined, and the number of subjects with COPD was determined using simple diagnostic criteria. Sixty-one men and 21 women with COPD were found. Thus the prevalence was 12.5% for the men and 3.0% for the women. In both sexes only about 2% of those who had never smoked suffered from COPD, but among the current smokers the prevalence was 35% for the men and 13% for the women. In a stratified analysis COPD was commonest among those with a low social status and histories of smoking and working in dusty occupations. In a majority the obstruction was only minimally reversible when tested with salbutamol inhalation. The study confirmed that the prevalence of COPD in the elderly with negative histories of smoking is low, and emphasizes the importance of reducing smoking as the only effective preventive measure.

Prevalence of asthma in elderly finns

There is uncertainty about the prevalence of asthma even in countries in which extensive epidemiological surveys have been carried out and attention has been drawn to a probable increase in prevalence. A cross-sectional epidemiological survey of asthma in the population aged 64 years or over was carried out in the rural district of Lieto, Finland. All 1196 participants (488 men and 708 women, 93% of those eligible) were examined and individually assessed using a set of criteria for asthma. The prevalence of current asthma was 2.9% in the men and 3.8% in the women and it accounted for about 40% of the cumulative (life-time) prevalence of self-reported asthma. Current asthma was uncommon in men aged 75 years or over and no cases were found in men who smoked. Current asthma in women was associated with low social status, smoking and dusty working conditions in the past. The difference in prevalence between the men and women was greatest among the smokers, which may be due to a previous high mortality among elderly asthmatic men who had been smoking, or a lack of the typical characteristics of asthma in men with long histories of smoking. The prevalence of asthma was similar to that obtained earlier in Finland and elsewhere.

Overt and Cryptic Miliary Tuberculosis Misdiagnosed until Autopsy

Autopsy confirmed deaths due to miliary tuberculosis in Finland were analysed in order to improve the diagnosis of the disease. Tuberculosis deaths from mortality statistics were examined in order to identify miliary tuberculosis deaths, and the medical records of the autopsied cases were studied. The deceased were divided into 2 groups, ‘overt’ disease and ‘cryptic’ disease, on the basis of chest X-ray findings. There were 114 overt (mean age 79 y) and 140 cryptic (mean age 78 y) miliary tuberculosis cases. The majority of patients in both groups were females. There was no difference between the groups in history of previous tuberculosis, in predisposing factors or in symptoms. Suspicion of tuberculosis was recorded before death in 86% in overt form and in 53% in cryptic form. In overt disease 50% of the patients received chemotherapy, but in cryptic form only a quarter were treated. In one third of cases autopsy had been carried out without suspicion of tuberculosis. Suspicion of tuberculosis had arisen too seldom, especially in the cryptic group. On the other hand, those suspected to have tuberculosis were not promptly treated with the appropriate chemotherapy. Absence of suspicion and delayed diagnosis mean increased risk in health care and at autopsy.

THE ROLE OF MEDIASTINOSCOPY IN THE TREATMENT OF LUNG CARCINOMA

At the University Central Hospital, Turku, 398 mediastinoscopies were performed during the years 1959—1970 on patients in whom lung carcinoma was verified before, at or after mediastinoscopy. The latter revealed mediastinal lymph node metastases in 40.7% of the cases. It was positive in 13.4% of those with negative bronchoscopies.A positive mediastinoscopy finding was the principal reason for not operating in 17.1% of the non-operated cases. The proportion of exploratory thoracotomies declined from 24.3% in 1952–1958 to 17.0% in 1959–1970 and to 9.8% in 1965–1970. In the cases in which mediastinoscopy was negative and resection was undertaken, the operative finding regarding lymph nodes was also negative in 77.6%. Of the resected negative mediastinoseopy cases 36.5%, and of the patients whose operative finding was negative for lymph nodes 43.8% survived for over 5 years. Only one of the 14 patients, on whom resection was performed after a positive mediastinoscopy finding, lived over 2 years, and the resul...

Indispensability of mediastinoscopy in intrathoracic tuberculosis

An analysis of 33 patients with histologically confirmed intrathoracic tuberculous lymphadenopathy was made. Tuberculosis could have been diagnosed without mediastinoscopy only in 3 patients: 2 had positive bronchial cultures and 1 simultaneous cervical lymph node tuberculosis. Bacteriological confirmation is conclusive, but seldom possible. Mediastinoscopy provides the best method to obtain tissue samples, and consequently, it is still necessary in the diagnosis of intrathoracic tuberculous lymphadenitis.

Pulmonary Infiltrates Associated With Gold Therapy: Report Of A Case

A case report is presented concerning diffuse pulmonary infiltrates due to sodium aurothiomalate therapy in a 67-year-old woman suffering from rheumatoid arthritis. After the gold treatment was stopped, prednisolone therapy produced complete remission of the pulmonary reaction.

LATER DEVELOPMENT OF ASTHMA IN PATIENTS WITH A NEGATIVE METHACHOLINE INHALATION CHALLENGE EXAMINED FOR SUSPECTED ASTHMA

A negative methacholine inhalation challenge (MIC) in a patient with suspected bronchial asthma is generally considered to make this diagnosis unlikely. Nevertheless, the patient may later develop asthma. To estimate the proportion that eventually becomes asthmatic, a 10 year follow-up study was carried out on 334 consecutive MIC-negative patients aged 14–80 years. The development of asthma among these patients was assessed on the basis of entitlement to preferential refund from the cost of antiasthmatic therapy granted for them under national health insurance. During the follow-up 30 patients (9%) were granted the refund. There was no significant difference between men and women in this respect. Patients who developed asthma were somewhat older than those who did not. A family history of allergy, allergic rhinitis, and positive reactions to skin prick tests were significantly more common in patients with future asthma. These patients also had a lower mean forced expiratory volume in 1 sec (FEV1) (% of predicted) and a higher mean increase in PEF after an inhaled sympathomimetic than those remaining free from asthma. In multivariate analyses with a logistic model, 3 risk indicators proved independent predictors of future asthma: age, positive family history of allergy, and FEV, (% of predicted).

A new method for testing tuberculin skin reactivity—chamber test

The Mantoux test and a chamber tuberculin test applied to the surface of the skin in 4 concentrations were performed on 229 children and 516 adults. The results were recorded at 72 hours. There was a significant correlation between the two tests. The chamber tuberculin test is technically easy, painless and atraumatic. It gives an opportunity of using a full range of concentrations of tuberculin resulting in a quantitative measurement of sensitivity in one and the same test procedure.

Facilities for surgery and survival prospects in lung carcinoma. A study from South-west Finland between 1952 and 1970.

1293 cases of carcinoma of the lung were diagnosed in South-west Finland during the years 1952–1970. 94.6% of the patients were men and 5.4% women. Their mean age was 60.0 years. Bronchoscopy was positive for carcinoma in 66.7% of the cases, sputum specimen in 55.1% and aspiration biopsy in 77.8%. Carcinoma of the lung was detected as an incidental finding in 19.4% of the cases in connection with mass miniature roentgenography, a health check-up or examination for another disease. The proportion of incidental findings was 10.6% in the earlier part and 27.8% in the later part of the material. The operability rate was 29.3% and the resectability rate 24.0% in the total series. Of the operations, 17.9% were exploratory thoracotomies. The frequency decreased from 27.4% in the earlier to 9.8% in the later series. Lobectomies accounted for 42.1% of the resections. The post-resection operative mortality rate was 9.0%; 16.5% in 1952–1964 and 3.8% in 1965–1970. 26.6% of the patients lived for over 5 years after th...

Clinical Value of Radioactive Lung Scanning

Radioisotope scanning with I131 labelled mac-roaggregated human serum albumin was performed in a series of 177 patients. Scan indications were suspected pulmonary embolism, suspected or verified pulmonary tumors and miscellaneous conditions. Scanning was negative in only one of 38 patients with demonstrated pulmonary embolism. The scan data in combination with clinical picture and radiological findings greatly improved both recognition and localization of lung emboli, thus providing a basis for early and correct treatment. In the group of malignant tumors 48 out of 50 patients had positive findings on scanning. Little information was gained in the group of small and peripheral lung tumors, whether malignant or benign. Lung scanning seemed to be of doubtful value in the early diagnosis of pulmonary tumors. The examination was useful in tumor patients as a safe and simple method in the preoperative evaluation of some aspects of pulmonary function.