Utility of the Wang 18-gauge transbronchial histology needle in the staging of bronchogenic carcinoma.

Use of the Wang 18-gauge histology needle in TBNA was employed as a staging procedure in 29 patients with bronchogenic carcinoma and mediastinal adenopathy demonstrated on chest CT. Twenty patients had malignant aspirates; 12 had both histologic and cytologic specimens demonstrating malignancy; six patients had malignant histologic specimens; two had cancerous cytologic specimens as their only evidence of mediastinal disease. Of the nine negative aspirates, four were true negative at surgery. Five patients had false-negative aspirates. Overall sensitivity of the Wang 18-gauge histology needle in the mediastinal staging of patients with bronchogenic carcinoma was 80 percent. When patients with small cell carcinoma were excluded, sensitivity was 82 percent. The enhanced yield of the 18-gauge histology needle warrants its use in mediastinal staging of bronchogenic carcinoma. We conclude that all patients with bronchogenic carcinoma and mediastinal adenopathy demonstrated on chest CT accessible via TBNA should undergo histology needle aspiration as an initial staging procedure.

Aeromedical decision-making for aviators with malignant melanoma: an update and review.

A review of the recent medical literature on malignant melanoma yielded sufficient information to correlate readily identifiable tumor characteristics to disease-free intervals, and in turn to subsequent risk of cerebral metastasis and neurologic incapacitation. These data were used to construct a new decision table to help guide flight surgeons considering a flying waiver for aviators with a history of melanoma.

Peptic ulcer disease in the military aviator: a management approach.

The recognition of Helicobacter pylori as etiologic for most cases of peptic ulcer disease requires a reevaluation of policies for flying eligibility and waiver status in affected aviators. We present a suggested algorithm for managing military aviators with ulcer disease.

Nonsustained ventricular tachycardia in 193 U.S. military aviators: long-term follow-up.

BACKGROUND: Despite its importance to the aeromedical community, the occupational implications of asymptomatic, nonsustained ventricular tachycardia (VT) are not well described. We sought to clarify this issue via a review of military aviators evaluated for nonsustained VT by defining event rates for sudden cardiac death, syncope, presyncope and sustained VT, and by determining whether any cofactors predicted a subgroup at increased risk for such outcomes. METHODS: We reviewed the records of 193 military aviators evaluated at the U.S. Air Force Aeromedical Consultation Service for nonsustained VT from September 1960 to December 1992. Follow-up information was available on 192 of the 193 aviators over a mean of 10.6 yr. Cofactor analysis focused on idiopathic VT (no associated underlying cardiac disease) and VT associated with mitral valve prolapse (MVP). RESULTS: There was no documented sustained VT; 9 (4.6%) had events including syncope (1), presyncope (5) and sudden death (3). Of these 9, 4 had idiopathic VT. The 3 deaths were associated with coronary artery disease, MVP and cardiomyopathy. No cofactors predicted events in aviators initially presenting with asymptomatic nonsustained VT. For asymptomatic nonsustained VT, the maximum predicted annual event rate was 0.33% for idiopathic VT and 2.3% for VT with MVP (95% confidence limit). CONCLUSIONS: Nonsustained VT did not predict future documented sustained VT. Cofactors failed to predict a subgroup at increased risk for events. Idiopathic nonsustained VT appeared to be a low risk population for whom expanded waiver criteria are proposed with suggested limits on duration and number of episodes of VT.

Glutathione disulfide formation occurring during hypoxia and reoxygenation of rat lung.

To study changes in glutathione redox status as an indicator of oxidant stress during hypoxia and reoxygenation, we perfused isolated rat lungs with a high or low oxygen perfusate and measured the release of total glutathione and glutathione disulfide (GSSG) into the perfusate. Lungs were perfused for a 20-minute baseline period with a perfusate equilibrated with 95% O2 and 5% CO2 and ventilated with a 95% O2 and 5% CO2 gas mixture. Only very low amounts of oxygen were measurable in this hypoxic perfusate. The lungs were then perfused from a second reservoir containing perfusate equilibrated with 95% N2 and 5% CO2 and ventilated with a 95% N2 and 5% CO2 gas mixture. After the period of hypoxia, the lungs were reperfused with the 95% O2 and 5% CO2 equilibrated perfusate and ventilated with a 95% O2 and 5% CO2 gas mixture for the remainder of the experiment. Glutathione was measured in the perfusate serially throughout the experiment, and lactic dehydrogenase (LDH) was also measured to assess cell membrane rupture during the infusion. GSSG release remained stable in the baseline and hypoxic period but rose significantly in the reoxygenation period, to concentrations approximately two times basal release. Lung tissue concentrations of GSSC also rose in the reoxygenation period. Decreasing lung glutathione reductase activity by pretreating animals with 1,3-bis-2-chloroethyl)-1-nitrosourea (BCNU) increased GSSG release into the perfusate during reoxygenation. We conclude that GSSG formation and release is increased in the lung during the reoxygenation period after lung hypoxia, suggesting the presence of hydroperoxide and free radical metabolism. These data support the hypothesis that alterations in lung metabolism occur during hypoxia that allow free GSSG formation and release during the reintroduction of oxygen.

Comparison of the Wang 19-gauge and 22-gauge needles in the mediastinal staging of lung cancer.

Transbronchial needle aspiration (TBNA) offers the unique opportunity to pathologically stage patients with lung cancer at the time of diagnostic bronchoscopy. The purpose of this study was to compare the staging sensitivities of the Wang 22-gauge and 19-gauge needles. We studied 64 patients with bronchogenic carcinoma and mediastinal adenopathy. Before bronchoscopy each patient underwent chest CT. Three to four aspirates were obtained with each needle from endotracheal sites adjacent to paratracheal lymphadenopathy. In 47 patients malignant mediastinal adenopathy was confirmed by the 19-gauge needle. A total of 29 patients had malignant 22-gauge needle aspirates. Of the 64 patients, 9 had benign, reactive mediastinal lymph nodes. There were 20 patients in whom only the 19-gauge needle demonstrated malignancy and 2 patients with malignant 22-gauge needle aspirates as the sole identifier of paratracheal malignancy. As a staging tool, the 19-gauge needle was significantly more sensitive than the 22-gauge needle, 85.5 versus 52.7% (p = 0.0001). Overall, in 49 of 55 patients (89.1%) with malignant mediastinal lymphadenopathy paratracheal tumor was confirmed by TBNA. The 19-gauge TBNA staging of the mediastinum is an effective, safe, and cost-saving alternative to surgical mediastinal exploration that can be performed during initial diagnostic bronchoscopy.