Outcome of incidentally detected airway nodules.

Low-dose chest computed tomography (LDCT) screening increased detection of airway nodules. Most nodules appear to be secretions, but pathological lesions may show similar findings. The National Comprehensive Cancer Network (NCCN) recommends repeating LDCT after 1 month and proceeding to bronchoscopy if the nodules persist. However, no reports exist about incidentally detected airway nodules. We investigated the significance of airway nodules detected by LDCT screening.We screened patients with incidental airway nodules detected by LDCT in the Seoul National University Hospital group. The characteristics of computed tomography, bronchoscopy, pathology and clinical findings were analysed.Among 53 036 individuals who underwent LDCT screening, 313 (0.6%) had airway nodules. Of these, 186 (59.4%) were followed-up with chest computed tomography and/or bronchoscopy. Seven (3.8%) cases had significant lesions, including leiomyoma (n=2), endobronchial tuberculosis (n=2), chronic inflammation (n=1), hamartoma (n=1) and benign granuloma (n=1). The remaining 179 lesions were transient, suggesting that they were secretions.The use of LDCT for lung cancer screening demonstrated the low incidence of airway lesions. Most lesions were transient secretions. True pathological lesions were rare, and no malignant lesion was found. The current recommendation of the NCCN guideline is a reasonable approach that can avoid unnecessary bronchoscopy.

Respiratory system deposition with a novel aerosol delivery system in spontaneously breathing healthy adults.

BACKGROUND: Intravenous magnesium sulfate (MgSO(4)) in children and adults with refractory acute asthma is effective, but therapy may be limited by systemic hypotension that might be avoided with the aerosol route. Inhaled MgSO(4) has a relatively high dose (volume) requirement. This, plus the use of inefficient delivery systems, may explain the lack of efficacy of inhaled MgSO(4) in some studies. An in vitro study suggested that the AeroNeb Go with the Idehaler Pocket and a face mask would deliver 16 mg/min of MgSO(4) to the respiratory system in older children, and approximately a fifth for toddlers, but no in vivo data exist. METHODS: Saline mixed with a radiolabel was used as a proxy for the 100 mg/mL MgSO(4) solution. In 5 adult males the rate of deposition was measured using nuclear medicine techniques. The radiolabel deposition below the vocal cords was converted to the rate of deposition of MgSO(4) and compared to the results from an in vitro model using adult respiratory patterns. RESULTS: The mean ± SD rate of deposition was 12.6 ± 1.9 mg/min. The reasons for this lower deposition, compared to the in vitro estimate, was most likely the exhalation of anatomical dead space aerosol, which would have been captured on the inspiratory filter in vitro. CONCLUSIONS: These in vivo data confirm the deposition data predicted in the in vitro study, although caution should be used in extrapolating the results to children. This device appears suitable for the clinical trial of inhaled MgSO(4) in children and adults with refractory asthma.

Study of chest radiographs and pulmonary ventilatory function in perlite workers.

A review of chest films from 152 workers who had been employed five or more years in perlite mining or processing showed none with small opacities of profusion 1/0 or higher. There were 14 films with doubtful changes (0/1), but these showed no correlation with type or duration of employment. Pulmonary function was measured in 122 current employees from the same plants. Multiple regression analysis showed no significant association between years of employment in perlite and either forced vital capacity (FVC) or forced expiratory volume (FEV1). There was a significant association between pack-years of cigarettes and both measurements. In 66 workers tested in 1975 and again in 1983, there was an average annual decrease in FVC of 32 mL, with 26 mL predicted by the Knudson formula, which is based on nonsmokers. The average annual decrease in FEV1 was 24 mL with 26 mL predicted. Comparison of groups with differing smoking patterns showed that the decreases in both FVC and FEV1 were associated with smoking. The 28 men who had added four or more pack-years in the interval between tests showed decreases in FVC and FEV1 of 44 mL/year and 31 mL/year, respectively, with 26 mL/year predicted for both groups. Those with less than four added pack-years (which included 26 nonsmokers) had decreases in FVC and FEV1 of 23 mL/year and 19 mL/year with 26 mL/year and 27 mL/year predicted.