Our News

Antibiotic Therapy of Pulmonary Infections In Cystic FibrosisDotage Schedules and Duration of Tteatment
It is widely agreed that antibiotic therapy is beneficial in the treatment of exacerbations of pulmonary infections in patients with cystic fibrosis (CF). Frequent antibiotic treatments have been shown to increase patient survival. Randomized, double-blind, crossover trials, which have shown the benefit of antibiotic therapy in acute exacerbations in patients with chronic obstructive pulmonary disease, have usually been considered unethical in CF. Difficulties in eradicating the colonizing microorganism from the lower respiratory tract have led to interest being focused on the dosages of antibiotics or special characteristics of the bacteria involved, but little attention has been devoted to the characteristics of the internal environment of the bronchi in the patients. …Read the rest of this article

The Value of Bronchial Washings and Bronchoalveolar Lavage in the Diagnosis of Lymphangitic Carcinomatosis: DiscussionDiffuse interstitial pulmonary infiltrates in patients with underlying malignant disease has a wide differential diagnosis. Transbronchial lung biopsy has been advocated as being the procedure of choice for establishing the diagnosis. Ventilation-perfusion lung scan demonstrating an irregular peripheral perfusion defect has been suggested to be helpful in raising the suspicion of lymphangitic carcinomatosis but has poor specificity and undocumented sensitivity. Bron-choalveolar lavage is a safe, commonly used procedure which has been referred to as a “liquid biopsy of the lung.” A wide variety of inflammatory and infectious diseases have been documented by BAL, but its use in diagnosing neoplastic disease has been limited. …Read the rest of this article

The Value of Bronchial Washings and Bronchoalveolar Lavage in the Diagnosis of Lymphangitic CarcinomatosisIn patients with underlying neoplastic disease, the presumptive diagnosis of lymphangitic carcinomatosis is usually based on a characteristic but not pathognomonic radiographic pattern of progressive diffuse reticular interstitial pulmonary infiltration with or without hilar enlargement. Invasive diagnostic procedures that are used to confirm the diagnosis include open lung biopsy, percutaneous aspiration needle biopsy, and transbronchial lung biopsy;2 however, these procedures pose significant risks and may be deemed unacceptable in patients with underlying advanced malignant neoplasms. Less invasive methods of confirming the diagnosis would clearly be desirable. Bronchoalveolar lavage (BAL) is a generally safe and well-tolerated procedure. The purpose of this study is to assess the sensitivity of bronchial washings and BAL in confirming lymphangitic spread of cancer. …Read the rest of this article

In patients with a primary bronchogenic tumor, fatal hemoptysis was frequently associated with a necrotic squamous cell carcinoma. Previously, investigators have shown an increased tendency in this cell type to cause tissue necrosis and subsequent hemorrhagic infarction. A proposed mechanism for the development of necrosis in squamous cell carcinoma is tumor invasion of vascular structures leading to ischemia and avascular necrosis, a process similar to that demonstrated in patients with a hematologic malignancy and a fungal pneumonia. …Read the rest of this article

Factors Associated with Fatal Hemoptysis in Cancer Patients: OutcomeCandida spp may also play a causative role in pulmonary hemorrhage as demonstrated by two patients with hemoptysis and a Candida pneumonia. One of these patients had a C tropicalis pneumonia and developed fatal hemoptysis, whereas the patient with a C albicans pneumonia experienced only selflimited hemoptysis. The increased virulence of C tropicalis has been previously described in granulocytopenic patients, the basis for which may be elaboration of extracellular proteases. …Read the rest of this article

Unfortunately, diagnosis of fungal infections is difficult in immunocompromised patients. An antemor-tem diagnosis of fungal pneumonia was achieved in seven of eight patients in our study, but in two patients this diagnosis was made only from a sputum culture relatively late in the clinical course. Further, autopsies were not performed on all of our patients, and hence, cases of fungal pneumonia might have been undetected. Recent studies, however, have shown that bron-choalveolar lavage is superior to conventional bron-choscopic techniques in identifying fungal infections. The presence of pulmonary hemorrhage in immunocompromised patients with undiagnosed pulmonary infiltrates may also serve as a clue to the presence of a fungal infection, as 33 percent of our patients with a hematologic malignancy and hemoptysis had a fungal pneumonia. Similarly, Kahn and colleagues observed with bronchoalveolar lavage that 50 percent of patients with significant occult pulmonary hemorrhage had an Aspergillus pneumonia. …Read the rest of this article

Factors Associated with Fatal Hemoptysis in Cancer Patients: Solid TumorsSolid Tumors
The clinical characteristics of patients with fatal hemoptysis or nonfatal hemoptysis are presented in Table 3. The two groups contained similar proportions of patients with a bronchogenic carcinoma or a malignancy metastatic to the lung. Two patients with esophageal carcinoma and contiguous extension to the tracheobronchial tree had fatal hemoptysis. In patients with bronchogenic cancer, necrotic squamous cell carcinoma was strongly associated with fatal hemoptysis (p<0.01). Of the seven patients with necrotic squamous cell carcinoma, evidence of tissue necrosis was demonstrated on autopsy specimens (two), at bronchoscopic study (four), or by roentgenographic evidence of cavity formation (one). …Read the rest of this article