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Classification
Patients were grouped by the type of neoplasm: hematologic malignancy or solid tumor. These groups were further subdivided by the severity of hemoptysis: fatal hemoptysis or nonfatal hemoptysis. Inadequate documentation of the quantity of hemoptysis in the medical records prevented further grading of the severity of hemoptysis.
Statistical Analysis
Differences in frequencies of various occurrences were analyzed by a Fishers exact test A p value less than 0.05 was considered significant
Results
Of 58 cancer patients found to have hemoptysis, 24 had a hematologic malignancy, while 34 had a solid tumor. …Read the rest of this article

Factors Associated with Fatal Hemoptysis in Cancer PatientsPulmonary hemorrhage occurs frequently in patients with neoplastic diseases and may become life-threatening in a significant proportion of these patients. The factors contributing to the development of fatal pulmonary hemorrhage in patients with malignant disease have not been well delineated. To address these issues, we reviewed the clinical records and available pathologic specimens from patients with a malignancy and evidence of pulmonary hemorrhage.
Material and Methods
During the period from January 1980 to June 1986, patients with a diagnosis of malignancy and hemoptysis were identified from the medical records, bronchoscopy records, or reports of the pulmonary consultation service at the University of Maryland Hospital. Complete autopsies were obtained in 26 cases and post-mortem lung biopsies were available in another two cases. …Read the rest of this article

Rapid Mucosal Absorption of Topical Lidocaine During Bronchoscopy in the Presence of Oral Candidiasis: ConclusionThese values are total concentrations, both bound and free lidocaine, and give no information about free fraction, which we did not investigate. The major plasma protein which binds lidocaine and several other basic drugs, alpha!-acid glycoprotein is an acute-phase protein that is elevated in certain situations such as stress, neoplastic disease, acute and chronic inflammatory diseases, hepatic damage, and trauma. The free fraction of lidocaine in plasma is inversely related to plasma AAG concentrations. This patients adenocarcinoma and trauma associated with chest tube insertion might have elevated his AAG concentrations and decreased the free fraction of lidocaine. That physiologic change might explain the absence of signs or symptoms of lidocaine toxicity. …Read the rest of this article

This case is remarkable in that lidocaine solution and jelly applied to the oropharynx and bronchial tree were rapidly and extensively absorbed attaining a peak plasma concentration of 7.1 μg/ml within 0.67 hour of the start of drug administration (Fig 1). Furthermore, for four hours after the procedure, the plasma levels remained greater than 1.5 μg/ ml, which is within the antiarrhythmic “therapeutic” range of 1.5 to 5.5 μml. These plasma concentrations are greater than most literature reports of 1 to 4 μg/ml during bronchoscopy and higher than what we observed in a study of 19 bronchoscopy patients receiving a total average lidocaine dosage of 1,240 mg administered in a regimen similar to the regimen described here. In that study, the average peak plasma concentration was 2.6 ± 1.0 μg/ml. …Read the rest of this article

Rapid Mucosal Absorption of Topical Lidocaine During Bronchoscopy in the Presence of Oral CandidiasisSystemic absorption of lidocaine following its topical application during diagnostic procedures can produce central nervous system or cardiac toxicity. Objective signs of toxicity are more likely at plasma concentrations above 6 μml, which are only rarely reported during bronchoscopy. It is useful, therefore, to identify patient populations at risk for developing these undesired effects due to high plasma concentrations.
Case Report
A 55-year-old white man weighing 65 kg was admitted with the chief complaint of increasing shortness of breath, chest pain, and an 18 kg weight loss over the prior eight months. He had an 80 pack-year smoking history. The admission chest x-ray film was suggestive of a right-sided empyema and a thoracentesis was performed. Pleural fluid was cultured and grew out Streptococcus pneumoniae, for which benzylpenicillin, 2 million units IV q 4 h was given. A chest tube was placed in the right chest for drainage. The patient was also noted to have candidiasis in the oral cavity for which topical nystatin suspension was prescribed, lo rule out the possibility of a neoplasm causing a postobstructive pneumonia, bronchoscopy was conducted. On the prior day, remarkable serum chemistry values were a slightly elevated alkaline phosphatase of 163 U/L (normal range: 50 to 145 U/L) and low serum protein, with 4.7 g/dL total protein (6.5 to 8.4 g/dL), 2.0 albumin (3.5 to 5.0 g/ dL), and 2.7 globulin (3.2 to 4.8 g/dL). Other liver function tests were normal. …Read the rest of this article

Discussion
Amyloid deposition in the vascular wall is commonly seen in amyloidosis and is known to make vessels fragile. Amyloidosis has been reported to cause massive hemorrhage in the skin, urinary bladder, gastrointestinal tract, and central nervous system.* As for pulmonary amyloidosis, amyloid deposition in the vascular wall is well known in diffuse septal amyloidosis. Road et al reported a case of diffuse septal amyloidosis with massive hemoptysis caused by a ruptured pulmonary artery. Amyloid deposition in the vascular wall was regarded as having caused the rupture. In case of nodular amyloidosis, vascular deposition is also known, but few bleeding cases have been reported. read …Read the rest of this article

Twelve patients with lymphangitic carcinomatosis who satisfied the criteria for inclusion and exclusion in this study were identified. There were ten women and two men whose ages ranged from 37 to 74 years, with a mean of 58 years (Table 1). The primary lesion was adenocarcinoma of the breast in eight (67 percent) of the 12 patients, adenocarcinoma of the prostate in one, adenocarcinoma of the colon in one, transitional cell carcinoma of the bladder in one, and squamous cell carcinoma of the lung in one patient. The tumor was classified as an adenocarcinoma in a total of ten (83 percent) of the 12 patients. One patient had prolongation of the prothrombin time, and another had thrombocytopenia precluding transbronchial lung biopsy. Severe agitation and uncontrolled cough precluded brushings and transbronchial lung biopsy in an additional patient. add comment …Read the rest of this article