Oxygen desaturation during fibreoptic bronchoscopy.

One hundred consecutive patients, who underwent bronchoscopic examination for diagnostic purposes, were studied with regard to various aspects of possible SaO2 deterioration. Relevant findings are as follows: (1) The pulse oximeter is as good as the conventional blood gas analyser for quantitating SaO2; (2) oxygen desaturation in the range of 1 to 25 per cent (median 5, mean 5.6 +/- 4) occurred in approximately 97 per cent of the bronchoscopy examinees; recuperation time of SaO2 was 1 to 34 minutes (median 6, mean 8.2 +/- 6.5); (3) the factor aggravating desaturation included the examination of patients in the sitting position; the fact that bronchial washing was connected with greater SaO2 deterioration in the non-hypoxaemic group of patients needs further investigation with regard to its role in the mechanism of oxygen desaturation; (4) the amount of fluid instilled intra-tracheally, bronchial biopsy and duration of the procedure were not related to the decline in SaO2. Based on the results of the present study, the authors suggest that all procedures ought to be performed on patients undergoing examination in the supine position, and that the patients should be supplemented with low-flow oxygen.

Bronchoalveolar T-lymphocytes and subsets in pulmonary tuberculosis and bronchogenic carcinoma.

Analysis of T-lymphocytes and their subsets in the blood and bronchoalveolar lavage fluids from 12 patients with active pulmonary tuberculosis, 12 patients with bronchogenic carcinoma and 11 healthy volunteers was aimed at identifying their immunologic functions and interrelationships. In patients with active pulmonary tuberculosis, there was a significant increased in the percentage of T-cells bearing IL-2 receptor both in the blood and bronchoalveolar lavage fluids, whereas patients with bronchogenic carcinoma exhibited an increase in the suppressor T-cells and T-cells bearing IL-2 receptor in the blood only. The presence of T-cells bearing IL-2 receptor is generally accepted to be the hallmark of recently active specific antigen activation of the helper T-lymphocytes together with monokine IL-1 stimulation. Suppressor T-cells, on the other hand, play a role in the immunopathogenesis of lung cancers and lung metastasis.

The association of adenosine deaminase activity with T-lymphocytes and subsets in pulmonary tuberculosis and bronchogenic carcinoma.

Simultaneous determination of blood/lung ADA activity and T-lymphocyte subsets was conducted in 12 patients with active pulmonary tuberculosis, 12 patients with bronchogenic carcinoma and 11 healthy volunteers. Differences were significant only in the tuberculosis patients, namely, increased mean enzyme values in both the peripheral blood (36.68 +/- 10.90 U/L) and in the BALF (4.25 +/- 2.19 U/L), and correlation of ADA activity between the blood and the diseased lung only; the difference in elevated enzymatic activity between the tuberculosis group and the cancer group was of no statistical significance. We conclude that simultaneous ADA analysis of the blood and the BALF may be of diagnostic value in cases suspected of having tuberculosis as yet undiagnosed by other means. Based on the lowest value of enzymatic activity in the blood of patients with tuberculosis (28 U/L), the test has a sensitivity of 75 per cent and a specificity of 100 per cent; whereas the lowest value in the BALF of tuberculosis patients (2.9 U/L), the test has a sensitivity of 77 per cent and a specificity of 82 per cent. Findings that there was a blood-lung correlation of elevated ADA activity and a correlation of enzymatic elevation with increased numbers of T-cells bearing IL-2 receptor in cases of pulmonary tuberculosis only provide evidence in support of T-lymphocytes actively participating in the ongoing immune process.

Lung function tests in splenectomized beta-thalassemia/Hb E patients.

Pulmonary function tests were performed on 30 patients with beta-thalassemia/Hb E. Only one patient had normal pulmonary function. Arterial hypoxemia at rest was present in 22 of 30 patients (73.3%). Abnormal VC, FEV1, FEV1/FVC, and end tidal FEV1 were found in 29 (96.7%), 17 (56.7%), 6 (20.0%), and 17 (56.7%) patients, respectively. Single-breath carbon monoxide diffusing capacity was abnormal in one out of 11 patients (9.1%). These results suggest the presence of abnormal ventilatory function included restrictive, obstructive, and combined defects. The hypoxemia in thalassemia was probably due to ventilation/perfusion mismatch and a diffusion defect.

The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: a prospective study.

To determine the efficacy of doxycycline in producing pleuroedesis in patients with malignant pleural effusion (MPE), 31 documented cases of MPE, aged 19-82 years were prospectively studied. Pleural sclerosis was done with 500 mg of doxycycline. Response regarding respiratory symptoms and pleural fluid accumulation were evaluated monthly. At one month, 27 patients were evaluable (4 dropped out). All responded and required no therapeutic thoracentesis. At 3 months, 13 patients dropped out, only 14 patients were evaluable. It revealed that 13 out of 14 patients (92%) responded. Only one patient failed and required therapeutic thoracentesis. Five and two patients came for assessment at 6 and 12 months, respectively. They still benefited from doxycycline pleurodesis. Side effects including low grade fever in 30% of patients, moderate to severe pain in 60% and troublesome cough with hemoptysis in one patient (3%) were noted. Doxycycline is an effective agent in controlling MPE. It was successful in every patient at 1 month and in 92% at 3 months. At 6 and 12 months quite a few patients survived for evaluation. However, they still benefited from doxycycline pleurodesis. Side effects were tolerable.

Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer.

The objective of this study was to evaluate the value of bronchoalveolar lavage (BAL) and postbronchoscopic sputum cytology in diagnosing peripheral lung cancer. We performed a prospective study in 55 patients with lesions on chest radiographs who were suspected of having lung cancer and had non-endoscopically visible lesions on fiberoptic bronchoscopy. The sequence of procedures in all cases was BAL and transbronchial forceps biopsy. The final diagnosis of these patients were primary lung cancer in 30 patients, metatastic lung cancer in five and benign diseases in 20. In the primary lung cancer group, BAL was positive for malignant cells in 14 of the 30 patients (46.7%). In seven (50%) of these patients, the cell type diagnosed by BAL agreed with the final diagnosis. The diagnostic yield of BAL was influenced by the size and segmental location of the lesion. Bronchoalveolar lavage provided a higher diagnostic yield (46.7%) than transbronchial biopsy (16.7%). In five patients with metastatic lung cancer and 20 patients with benign disease, BAL gave negative results in all. Postbronchoscopic sputum cytology was positive in only two of the 26 patients (7.7%) from whom samples could be obtained. Bronchoalveolar lavage cytology proved to be a valuable diagnostic tool in detecting peripheral, primary lung cancer. Postbronchoscopic sputum cytology provided no significant additional information.