Cigarette smoking and women's respiratory health.

Cigarette smoking is claiming an increasing health toll among women, with rising morbidity and mortality related to lung cancer and COPD. Whether women are more susceptible to the effects of cigarettes with regard to carcinogenesis and development of COPD remains controversial. Gender differences clearly exist in certain aspects of cigarette-related disease, including histologic distribution of lung cancer and the ability of smokers to quit. It is likely that gender differences also exist in the reasons that individuals choose to smoke. Understanding those reasons will be important in developing targeted programs for smoking cessation and in addressing the challenge of the prevention of smoking initiation in women.

Preoperative evaluation of the high-risk surgical patient for lung cancer resection.

Surgery is the treatment of choice for patients with stage I or II non-small cell carcinoma of the lung. Many such patients will have concurrent chronic obstructive pulmonary disease, the presence of which may increase the risk of lung resection. Prediction of surgical morbidity and mortality related to impaired pulmonary physiology should be based on evaluation of physiological parameters. Such measurements can be derived from a variety of studies including pulmonary function testing, assessment of split lung function, and measurements of exercise capacity. While there does not exist uniform agreement about threshold levels of risk related to individual tests, judicious use of widely available physiological measurements including FEV1, DL (CO), and V (O2)max should enable clinicians to make reasonable assessments of operative risk. Because surgery is clearly optimal treatment for stages I and II non-small cell lung cancer, thoughtful consideration should be given to the decision of operability in each individual case.

Assessment of cardiac and pulmonary function in adult patients with Hodgkin's disease treated with ABVD or MOPP/ABVD plus adjuvant low-dose mediastinal irradiation.

We evaluated the long-term effects of combined modality therapy (CMT) with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) or mechlorethamine, vincristine, prednisone, procarbazine (MOPP)/ABVD plus adjuvant low-dose (< 30 Gy) involved-field radiation therapy (LDRT) on cardiac and pulmonary functions in adult patients with Hodgkin's disease (HD). Adjuvant LDRT (mean dose, 2340 cGy) to the mediastinum was administered to 24 patients after chemotherapy with MOPP/ABVD (n = 10) and ABVD (n = 14). The mean doses of doxorubicin and bleomycin were 233 mg/m2 and 92 IU/m2, respectively. Cardiac and pulmonary function tests were performed in all patients and, when available, were compared with pretreatment studies. After a median follow-up of 6.3 years, none of the patients had cardiac or pulmonary symptoms. A 4.7% overall decrease in left ventricular ejection fraction (LVEF) was observed (p = 0.03), but only one patient had a mildly decreased LVEF (47%). Diastolic function, LVEF, and left ventricular volume remained within the normal range in the other 23 patients. Mild pulmonary function study abnormalities occurred in 8 of 24 patients, 6 of whom were cigarette smokers. There were no significant changes in total lung capacity and forced vital capacity (FVC) values, but there was a 3% overall decrease in FEV1/FVC ratio (p = 0.05). In adult patients with HD, adjuvant LDRT after chemotherapy with ABVD or MOPP/ABVD did not result in a significant incidence of permanent pulmonary or cardiac toxicity after more than 6.3 years of median follow-up. Further studies are warranted to fully evaluate the impact of such therapy on cardiopulmonary function.

Pulmonary manifestations of rheumatoid arthritis.

Rheumatoid arthritis (RA) is the most common of the classic connective tissue diseases. Its manifestations in the chest are varied as the pleura, lung parenchyma, airways, and pulmonary vasculature can all be involved. The approach to a patient with RA and respiratory complaints, radiographic findings, or physiologic abnormalities requires a broad understanding of these manifestations. Moreover, the potential for therapy-related toxicity adds further complexity to the pulmonary evaluation of these patients.

Use of neodymium yttrium aluminum garnet laser in long-term palliation of airway obstruction.

Palliation of acute airway obstruction using the neodymium yttrium aluminum garnet (Nd-YAG) laser was studied in 54 patients who presented over a 42-month period to the Yale cardiothoracic surgery service. Thirty-seven patients had bronchogenic carcinoma; 27 had stage IIIB or IV disease. Nine patients had endobronchial metastases from a primary nonbronchogenic carcinoma. Eight patients had benign disease. A total of 109 Nd-YAG laser tumor ablations were performed. In addition, 32 patients underwent postoperative brachytherapy. Median survival for all patients was 12 months. Patients with bronchogenic carcinoma had a median survival of five months. Fifteen of 20 patients (75%) alive at the time of follow-up reported continued palliation as shown by an improved postoperative Karnofsky score. There was no survival benefit from Nd-YAG laser ablation of endobronchial bronchogenic carcinoma; however, the Nd-YAG laser provided good to excellent palliation in the majority of patients on long-term follow-up.

Pulmonary involvement in collagen vascular disease: a review of the pulmonary manifestations of the Marfan syndrome, ankylosing spondylitis, Sjögren's syndrome, and relapsing polychondritis.

The pulmonary manifestations of collagen vascular diseases span an enormous range of clinical and radiographic findings. The breadth of these abnormalities is as diverse as the underlying diseases themselves. A comprehensive discussion of pulmonary involvement in four of these diseases, the Marfan syndrome, ankylosing spondylitis, Sjögren's syndrome, and relapsing polychondritis, is presented.

Lung transplantation.

Advances in solid organ transplantation over the last several decades have made human lung transplantation a realistic possibility for selected patients with end-stage lung disease. A review of clinical indications, proper patient selection, and long-term management is presented. Infection and rejection continue to represent 2 major areas of posttransplantation complications and merit particular attention.

The effect of diuretics on extrarenal potassium tolerance.

A potassium loading study was performed in acutely nephrectomized rats to determine the extrarenal effects of diuretics on potassium tolerance. Four diuretics were evaluated: hydrochlorothiazide, furosemide, bumetanide, and spironolactone. Following an intravenous potassium load (0.17 mEq/100 g over one hour), plasma potassium concentration rose by 2.69 +/- 0.26 to 3.67 +/- 0.20 mEq/L in all groups. There was no difference in the observed increment in plasma potassium concentration between animals receiving diuretics and control animals. These results demonstrate that, at the doses used, diuretics do not impair extrarenal potassium disposal in the rat.