Wilmot C. Ball

Pleural Effusions: The Diagnostic Separation of Transudates and Exudates

Abstract In this prospective study of 150 pleural effusions, the utility of pleural-fluid cell counts, protein levels, and lactic dehydrogenase (LDH) levels for the separation of transudates from e...

CT findings in bronchiolitis obliterans organizing pneumonia (BOOP) with radiographic, clinical, and histologic correlation.

The CT features of 12 patients with bronchiolitis obliterans organizing pneumonia (BOOP) were reviewed and correlated with clinical history, histologic specimens, and chest radiography. From our series, a spectrum of CT findings of parenchymal lung involvement in BOOP emerged. Focal nodular or mass-like opacities were found in 42% (5 of 12). Areas of consolidation resembling pneumonia were seen in 33% (4 of 12). Peripheral subpleural reticular opacities were identified in 25% (3 of 12). Patchy ground glass infiltrates were seen in 8% (1 of 12). One patient demonstrated a mixed pattern consisting of nodular opacities and areas of pneumonic consolidation. In 4 of the 5 cases demonstrating the nodular form of BOOP either a feeding vessel or bronchus sign could be identified. This feature consisted of a pulmonary vessel leading to a nodular opacity or an air bronchogram entering into a nodular opacity. Correlation of the CT findings of BOOP with histologic specimens showed nodular opacities and areas of consolidation to be associated with classic pathologic features of BOOP including bronchiolar plugs of granulation tissue and surrounding organizing pneumonia. Cases demonstrating peripheral subpleural reticular opacities showed, in addition to pathologic evidence of BOOP, other features such as interstitial disease and fibrosis. From the Russell H. Morgan Department of Radiology and Radiological Sciences (L. M. Bouchardy, J. E. Kuhlman, and S. S. Siegelman), the Division of Pulmonary and Critical Care Medicine (W. C. Ball, Jr.), and the Department of Pathology (R. H. Hruban and F. B. Askin), Johns Hopkins Medical Institutions, Baltimore, MD. Address correspondence and reprint requests to Dr. J. E. Kuhlman at Department of Radiology, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287, U.S.A.

Sputum cytopathology: use and potential in monitoring the workplace environment by screening for biological effects of exposure

Sputum cytopathologic monitoring detects squamous cell lung cancers at an extremely early stage (x-ray negative). It holds further potential for preventing disease by detecting epithelial alterations which reflect environmental hazards. The addition of sputum cytology screening to screening by chest x-ray film does not significantly reduce mortality from all types of lung cancer, but preliminary analysis of Johns Hopkins Lung Project data suggests that mortality from squamous cell carcinoma is reduced. Quantitative automated cytopathology systems and biochemical/immunological cell markers enhance understanding of these precursors and offer great promise for increasing capacity, accuracy, and usefulness in cytopathology screening of workers. Cytological specimens collected over years of screening workers considered at risk may be important to eventually understanding development and prevention of major occupational diseases.

EXTENDED EXPERIENCE IN THE LONG‐TERM CORTICOSTEROID TREATMENT OF PULMONARY SARCOIDOSIS*

A 15-yr experience with symptomatic pulmonary parenchymal sarcoidosis treated with corticosteroids has included 250 patients. Within the past 5 yr 192 patients have been actively studied and these are reported in detail. Varied clinical observations are described. Serial measurements of vital capacity and steady-state carbon monoxide diffusing capacity were performed. All of these patients were sufficiently symptomatic and incapacitated to require treatment. Ninety-one percent were Black, 72% were female, and 72% were in the third and fourth decades. In response to treatment there was overall clinical improvement and an increase in vital capacity in 150 (83%) of 180 patients, although only a temporary increase in 12 of these patients. By contrast, only 82 (46%) showed an increase in carbon monoxide steady-state diffusing capacity and only temporarily in 19 patients. Changes in vital capacity correlate well with changes in symptoms and the radiographic appearance and are of great assistance in assessing the clinical course and need for continued treatment. The diffusing capacity is more difficult to interpret. Continued treatment was required in 74 patients (48%) because of recurrent clinical relapses as treatment was withdrawn. Such relapses were observed in 70% of the patients. Improvement and discontinuation of treatment was achieved in 66 patients (42%). In the 44 in whom there was no observed relapse, 34 were treated for less than 2.5 yr. In the total group, longer periods of treatment, 2.5-10 yr or more, were required in 104 patients (54%). In this series of 192 patients there were 7 deaths, with 22 deaths in the total 15-yr series of 250 patients. Of these, 18 were directly attributed to the sarcoidosis. Clinical improvement coincident with corticosteroid treatment and the frequency of relapse as treatment is withdrawn strongly support the benefits of corticosteroid treatment for symptomatic pulmonary sarcoidosis. When relapses occur and recur, retreatment is necessary and often long-term maintenance doses of prednisone (10-15 mg daily) are required for many years. The relatively infrequent problems related to this treatment are greatly exceeded by the clinical benefits.

Pulmonary cytologic alterations in toxic environmental inhalation

Abstract Toxic elements of the environment adversely affect tissues, structures, and functions of the respiratory system. Many of these changes are reflected in cells and other elements of pulmonary secretions. Natural defense mechanisms of the respiratory tract are impaired, rendered less effective, and eventually invalidated by toxic inhalants. Tissue changes in response to these toxic inhalants and irritants, especially of the, epithelium can be studied and evaluated cytologically with detection and identification of the various degrees of atypia. These cytologic alterations appear to be valid indications of the carcinogenic potentialities of environmental toxins. In three occupational groups increased frequency of these changes appear to parallel the presence of known or suspected carcinogenic environmental substances. Their cytologic identification may thus help to indicate those individuals or groups for whom preventive or other measures are most needed.

Measurement of Regional Lung Function in the Early Detection of Chronic Obstructive Lung Disease.

Excerpt A major characteristic of radioactive tracer studies of the lung is that they permit measurement of regional as well as total lung function. Because of the potential importance of the early...