Salt-wasting bronchorrhea and its mechanisms.

A 56-year old woman, with the diffuse form of bronchioloalveolar cell carcinoma, developed massive bronchorrhea, resulting in severe fluid and electrolyte depletion when her oral intake was compromised. Chemical analysis of the bronchial secretions and the ultrastructural features of the tumor cells support the concept of an active secretory process. The lactic dehydrogenase (LDH) isoenzyme pattern of the fluid is similar to that found in fetal cells. The neoplastic cells may acquire a more primitive LDH pattern.

Pleurodesis in metastatic pneumothorax.

A 57-year-old woman with bilateral pneumothoraces secondary to pulmonary metastases from leiomyosarcoma of the uterus was treated successfully by intrapleural instillation of tetracycline.

Spectrum of advanced upper airway obstruction due to goiters.

Five patients with advanced upper airway obstruction due to goiter were identified in our institution. All had symptoms of respiratory insufficiency to such a degree that surgery was clearly indicated. Functional characteristics of this group were compared with prior series of goiter patients who had less severe respiratory symptoms. A peak inspiratory flow less than 1.5 L/sec characterized this group who required surgery.

Painful leg syndrome (pseudo-phlebitis).

Lower extremity venography is essential to confirm the diagnosis of phlebitis when the clinical situation is not completely typical. 8 patients are presented, 6 of whom had been given prolonged prior anticoagulant therapy for phlebitis and pulmonary embolus. Normal venograms and reassurance led to resolution of symptoms in all cases.

Hepatic angiography in a patient with tuberculosis of the liver.

The hepatic angiographic features of a 45-year old black woman who was found to have abdominal tuberculosis are described. The clinical and arteriographic findings were similar to those found in malignant disease. A histological diagnosis is essential in such cases.

The bronchodilator response to inhalation of increasing doses of aerosolized albuterol.

Forty-four asthmatic patients were treated on separate days with increasing doses of albuterol in four double-blind studies that included placebo controls. Twenty-six subjects received one, two, four, six, and eight inhalations from a metered dose inhaler; 18 subjects received 1.25, 2.5, 5, 10, and 15 mg delivered by IPPB. There was a significant linear relationship in both groups between the maximum increase in FEV1 and the log dose of albuterol. The response to four, six, and eight inhalations from the metered dose inhaler was significantly greater than the response to one inhalation, and the response to 15 mg by IPPB was significantly greater than the response to any other dose by IPPB. The results suggest that in many patients maximum possible bronchodilation is not achieved by customarily recommended doses.