William E. Ruth

Effects of corticosteroids in the treatment of patients with gastric aspiration

Forty-three of 88 patients suspected of having aspirated gastric contents met stringent criteria for the diagnosis of aspiration of gastric contents. One group of 25 patients was treated with corticosteroids and a second group of 18 patients was treated without corticosteroids. The two groups were clinically well matched according to all variables except that the patients who did not receive corticosteroids had greater hypoxemia and a higher incidence of infiltration on chest roentgenogram which would indicate that these patients had received greater pulmonary injury from aspiration of gastric contents. Thirty-two per cent of the patients who received steroids died compared to 28 per cent of those who did not receive steroids. Although the mortality rate difference was not statistically significant, the occurrence of gram-negative pneumonia five days after aspiration was more frequent in the patients treated with steroids.

Desquamative interstitial pneumonia following long-term nitrofurantoin therapy☆

Two patients with diffuse interstitial lung disease after long-term nitrofurantoin therapy were characterized clinically by exertional dyspnea and basilar rales, roentgenographically by diffuse interstitial infiltrate and physiologically by a restrictive lung defect. Pathologically, light microscopy revealed desquamative interstitial pneumonia. In one patient electron microscopy was characteristic of desquamative interstitial pneumonia. Immunofluorescent studies of one biopsy specimen showed specific fluorescence of interstitial cells with immunoglobulin E and third component of complement. In in vitro studies, nitrofurantoin therapy failed to induce lymphoblast transformation or histamine release. Treatment consisted of discontinuing the administration of nitro=furantoin and adding corticosteroids. Both patients felt better and showed clinical improvement. Our findings suggest that in some cases desquamative interstitial pneumonia may be drug related.

Flexible Fiberoptic Bronchoscope

Excerpt To the editor: The availability of a flexible fiberoptic bronchoscope has extended the area of the bronchial tree that can be examined, by several orders of branching and with improved qual...

Oropharyngeal candidiasis in patients treated with triamcinolone acetonide aerosol

Thirty asthmatic patients participating in a trial of triamcinolone acetonide aerosol were evaluated to determine the relationships among symptons of sore throat or hoarseness, the appearance of the throat on physical examination, and the presence of yeasts on pharyngeal culture. Observations were recorded prior to aerosol therapy and repeated after 2 wk, 4 wk, 6 wk, 4 mo, and 6 mo of therapy. A total of 15 patients (50%) experienced sore throat or hoarseness, 15 (50%) had yeasts cultured from the pharynx on at least one occasion, and 11 (37%) at some point had an abnormal throat examination; however, there was no predictable relationship between symptoms or abnormal physical examinations and the presence of a positive culture. The frequency of positive cultures did not change significantly during the observation period. Twelve patients had positive yeast cultures on 50% or more of their samples. The incidence of symptoms was not sigficantly increased in these chronically colonized patients. Symptoms were usually transient, and discontinuation of the aerosol or antifungal therapy was unnecessary. Triamcinolone aerosol was not associated with significantly increased pharyngeal colonization with yeasts in this 6-mo study. Existing chronic colonization is not necessarily a contraindication to triamcinolone therapy. Sore throat and hoarseness are usually unrelated to yeast infection in patients using triamcinolone acetonide aerosol.

Clinical Experience with Pleuroscopy Utilizing the Bronchofiberscope

The gas sterilized bronchofiberscope has been utilized as a pleuroscope for visual exploration of the pleural space and forceps biopsy of abnormal lesions in 16 patients with undiagnosed pleural disease. The instrument was inserted through a small (1–2 cm) incision. Aspiration of pleural fluid and instillation or aspiration of air to produce a controlled pneumothorax are easily accomplished through the instruments suction channel. In eight patients with undiagnosed pleural effusion, biopsy of visualized nodules established the diagnosis of carcinoma. Three patients with bronchogenic carcinoma and pleural effusion had no pleural metastases at pleuroscopy which was confirmed in two patients who had thoracotomy and lung resection. Parenchymal subpleural nodules of metastatic carcinoma were confirmed by pleuroscopic biopsy in one patient. Biopsy via the pleuroscope was unsuccessful in two patients, one with pleural fibrosis, probably related to asbestosis, and one with mesothelioma. Both required open surgical biopsy of the pleura. There has been minimal patient discomfort and no serious complications.

Chronic pulmonary artery thrombosis with features of unilateral hyperlucent lung syndrome

Abstract A patient with long-standing thrombosis of the left main pulmonary artery complicated by unilateral pulmonary disease and bronchial-pulmonary arterial shunt is described. The benign clinical course, roentgenologic findings of equal density of both lung fields and elements resembling a unilateral hyperlucent lung syndrome contrast markedly with the usual malignant course of chronic pulmonary artery thrombosis. The pathophysiology is discussed.

The Oxyhemoglobin Dissociation Curve in Type A and Type B COPD

Patients with chronic obstructive pulmonary disease (COPD) have been clinically separated into Type A and Type B COPD. Type A patients are characterized by the presence of anatomical emphysema or an increased total lung capacity, low sputum production, late onset of cough, rare hypercapnia, rare cor pulmonale and absent polycythemia. In contrast, Type B patients are characterized by roentgenographic evidence of chronic inflammation or smaller total lung capacity, significant sputum production, frequent hypercapnia with cor pulmonale and the presence of polycythemia. We studied whole blood oxygen transport (P50, 2,3-DPG, and ATP) in 11 Type A patients and 13 Type B patients. Whole blood oxygen transport was not different in the two groups of patients. Type A patients with higher hemoglobin values had a lower 2,3-DPG. Type A patients with a higher hemoglobin value also had a higher ATP level. In all patients, Type A and Type B, 2,3-DPG was inversely related to hemoglobin concentration. Despite other distinguishing clinical and laboratory characteristics, whole blood oxygen transport was not different in Type A and Type B patients.