With more than 150,000 cases every year, lung cancer represents today s major oncologic chal­lenge. There are more than 120,000 deaths annually and most therapeutic approaches result in a high incidence of local failure that frequently manifests as malignant airway occlusion. According to one esti­mate, 20 to 30 percent of newly diagnosed lung malignant neoplasms will present with atelectasis and pneumonia due to endobronchial disease. Other estimates suggest that because of a high rate of local failure following conventional therapy, up to 50 percent of patients with lung cancer will eventually develop symptomatic endobronchial disease. Death from air­way occlusion is often a painful process of slow asphyxiation, frequently complicated by obstructive pneumonia and hemoptysis. The majority of these patients have previously received high-dose radiation, and tissue tolerance concerns frequently preclude further external radiation. We report herein the results of our experience with endobronchial radiation therapy (EBRT) for malignant airway occlusion.

…Read the rest of this article

The data reported in this study do not support the notion of a strong relationship between hypoxemia per se and an objective measure of EDS in a group of patients with chronic daytime and nocturnal hypoxe­mia. Taken together, this group of patients with COPD did not reveal any evidence of subjective or objective EDS as assessed by a reliable physiologic measure of sleepiness. Furthermore, Guilleminault et al, in a recent study, also found no relationship between hypoxemia and mean sleep onset latencies with MSLT defined mild vs severe sleepiness in patients with OSAS.

…Read the rest of this article

Table 1 presents a comparison of the age, weight, and waking respiratory measures. Overall (n=14), there was no significant correlation between mean sleep onset latencies on the MSLT and waking Pa0₂ (- .13), PaC0₂ (.02), FEV, (.04), or mean spontaneous desaturation during sleep (.31). The mean sleep onset latencies were well within the published normal range as well as the normal range for our laboratory (unpub­lished data). Only two subjects exhibited a single sleep onset REM period.

…Read the rest of this article

Fourteen male patients with stable COPD were randomly se­lected from the Chest Medicine Clinic at the Veterans Administra­tion Medical Center in Oklahoma City. Patients were selected without regard to the presence or absence of daytime sleepiness. The mean age was 60 years (range, 48 to 72 years). Patients were selected with a waking Pa0₂ of less than 70 mm Hg and less than 50 percent predicted FEV,. All patients were in stable condition receiving optimal therapeutic measures with no evidence of acute pulmonary disease or respiratory failure. None of the patients was receiving sedatives or psychotropic drugs at the time of the study. Clinically, none of these patients had complaints of significant daytime sleepiness.

…Read the rest of this article

The common occurrence of excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea remains perhaps the most enigmatic aspect of what has been called the obstructive sleep apnea syndrome (OSAS). Initial speculation related EDS to the most obvious cause, ie, sleep deprivation, since it had been noted that these patients have numerous arousals from sleep secondary to obstructive apneic events. In a subsequent study from our laboratory, it was found that patients with equivalent sleep disruption (matched on the basis of the number of upper airway obstructions per unit time) had markedly different subjective complaints of EDS. This study documented the fact that patients with complaints of EDS had a significantly greater degree of nocturnal oxyhemoglobin desaturation than those who were without subjective daytime sleepiness.

…Read the rest of this article

In two of the remaining 11 patients, the result of FOB was considered as possibly false negative. One patient (No. 2) recovered only after a change of treatment from oral penicillin to cefuroxime and from another (No. 10), pneumococcal antigen was detected in sputum after bronchoscopy had been performed. It is possible that an increased sensitivity could have been obtained by the use of bronchoalveolar la­vage. However, culture results from BAL fluid may be difficult to interpret since strict quantitation is impossible to perform because the amount of bronchial secretion sampled with the lavage is un­known.

Although, during the main study, patients with probable atypical pneumonia received erythromycin or tetracycline as initial therapy (30 patients, 11 percent) mycoplasmal pneumonia was the most com­mon cause of both early and late therapy failure, with eight of 18 and five of 19 cases, respectively. Of these 13 patients, ten were preliminarily identified clinically and only three underwent bronchoscopy (No. 1, 6, 14). However, a sensitive and rapid diagnostic method for Mycoplasma would clearly facilitate the handling of these patients.

…Read the rest of this article

In this prospective study, we tried to evaluate the usefulness of diagnostic FOB in patients with CAP A significant decline in arterial oxygen pressure (Pa0₂) is common following FOB, with a subsequent risk of cardiac arrhythmia in particular. This could be especially hazardous in patients with pneumonia, in whom fever, tachycardia, and an already lowered Pa0₂ are common. However, by adding supplemental oxygen to patients at risk, no cardiac complications were seen in any of our patients, nor were there any other complications, which supports the safety of the bronchoscopic procedure reported earlier.

Injection of lidocaine through the inner channel of the bronchoscope has been claimed to introduce a larger amount of bacterial contaminants into the lower airways than if the anesthesia is performed by nebu- lization. However, Winterbauer et al found injec­tion of lidocaine to be a minor problem if the volume was small (<=3 ml) and if there was no suction through the side channel until the PB culture was obtained.

…Read the rest of this article