Prospective population-based study on the survival of patients with lung cancer.

The purpose of this study was to evaluate the change, over 20 yrs, in the survival of lung cancer patients in a population-based study. Information on all patients with lung cancer in a defined geographical area during 1990-1992 (n=602) was prospectively gathered. The survival of these patients was assessed and also compared with the results of a similar study in the same area during the years 1968-1971 (n=446). The 5-yr survival had improved during 20 yrs from 4% to 12%. The 5-yr survival of the patients with squamous cell carcinoma had increased from 6% to 16%, and adenocarcinoma from 4% to 19%, whereas the survival of small cell carcinoma had remained the same (2% and 3%, respectively). Even though the recent patients were older than those of the earlier series the proportion of surgically treated patients had remained the same (16% and 20%), but the 5-yr survival of patients who had been operated on had increased significantly from 23% to 48%. The differences in survival in the second cohort (1990-1992) between histological types (Chi-squared logrank=59.2), tumour, node, metastasis stages (Chi-squared logrank=199.6), symptomatic stages (Chi-squared logrank=120, p<0.001) and treatment (Chi-squared logrank=277) were significant. Based on this study the independent prognostic factors for better survival of lung cancer patients are tumour, node, metastasis stages I and II, surgical treatment and Feinstein's symptomatic stages I and II.

An epidemiological study of lung cancer: history and histological types in a general population in northern Finland.

A prospective epidemiological study was conducted to assess the incidence, diagnosis, histology and surgical treatment of lung cancer in northern Finland. The results were compared with those obtained in a similar survey 20 yrs earlier. Most of the patients with a suspected lung tumour were interviewed (72%) and the information was combined with that obtained from the national cancer registry. All pathological specimens were re-evaluated by a pathologist. A total of 602 new lung cancer cases (85% male, 15% female) were diagnosed during the years 1990-1992, the annual incidence per 100,000 being 63 for males and 9.5 for females. The number not reported to the Finnish Cancer Registry was low (<1%). Lung cancer was confirmed histologically in 381 cases (63%) and in addition cytologically in 135 cases (23%). Squamous cell carcinoma was the most common histological type (40%), the proportion of adenocarcinoma being 26%, small cell carcinoma 24% and large cell carcinoma 4%. The incidence of lung cancer had decreased significantly among males (from 87 to 63 per 100,000) compared with 20 yrs earlier but had increased among females (from 4.1 to 9.5), chiefly on account of adenocarcinoma. The findings of this prospective study show an increase in the incidence of lung adenocarcinoma among females, a histological type which is less closely related to smoking than the other cancers. This suggests that other risk factors may play an increasing role in the aetiology of lung cancer.

Benign intrathoracic tumours. A population survey in northern Finland.

Benign intrathoracic tumours are uncommon, but their occurrence in unselected populations is poorly defined. We reviewed all cases of suspected intrathoracic tumour in a population (440,000) in northern Finland during 1990 through 1992. Diagnostic investigations included fiberoptic bronchoscopy and computed tomography in all cases. Of the 653 intrathoracic tumours, 36 were benign. The male/female ratio in these 36 cases was 1.25; the mean age was 54 years. Twenty-three of the lesions were symptomless, found at health check or examination for other disease. Bronchoscopy did not confirm the diagnosis of any benign tumour. Thoracotomy was considered necessary in most cases and histologic diagnosis was therefore available in 24 (67%). Hamartoma was the most common benign lung tumour. This prospective study in an unselected population confirms previous findings in surgical series concerning benign intrathoracic tumours and their histology.

Chronic obstructive pulmonary disease and cognitive impairment in the elderly.

In a cross-sectional epidemiological study in Lieto, Finland, 61 men and 21 women with chronic obstructive pulmonary disease (COPD) were compared with age- and sex-matched controls from the same community to analyze the associations between COPD, cognitive performance, and occurrence of dementia. The cognitive assessment was based on the Mini-Mental State Examination (MMSE), previous clinical documents, and the assessment made by the research nurse after she had interviewed and tested each subject. These three measures revealed no differences between the COPD patients and the age-matched controls, and MMSE subtest scores did not differ significantly between the patients and controls. The findings suggest that the relative contribution of COPD to the occurrence of cognitive impairment and dementia in the elderly may be none or minimal at the community level.

Chronic obstructive pulmonary disease and self-maintaining functions in the elderly--a population-based study.

OBJECTIVE: To describe and analyse the problems in self-maintaining activities among chronic obstructive pulmonary disease (COPD) patients aged 64 years and over. DESIGN: A case-control study. SETTING: Health Centre in Lieto, Finland, 1990-91. SUBJECTS: 61 men and 21 women with COPD and 183 male and 63 female sex- and age-matched controls. The COPD group included 8 men and 11 women who also had asthma. MAIN OUTCOME MEASURES: Numbers of subjects with difficulties or dependence in self-maintaining activities. RESULTS: The number of subjects with difficulty or dependence in the activities of daily living (ADL) was similar among the patients and the controls, but some differences between the two groups were seen on items of mobility and instrumental activities of daily living (IADL). The COPD patients had more difficulties or showed dependence in moving outdoors or walking at least 400 m. In addition, the male COPD patients reported more difficulty or dependence in doing heavy housework and the female patients in even doing light housework than the controls. CONCLUSION: The study indicated that the female COPD patients in particular have a great need for assistance in self-maintaining functions. This information is valuable for local primary health care planning.

Prevalence of asthma in elderly Finns.

There is uncertainty about the prevalence of asthma even in countries in which extensive epidemiological surveys have been carried out and attention has been drawn to a probable increase in prevalence. A cross-sectional epidemiological survey of asthma in the population aged 64 years or over was carried out in the rural district of Lieto, Finland. All 1196 participants (488 men and 708 women, 93% of those eligible) were examined and individually assessed using a set of criteria for asthma. The prevalence of current asthma was 2.9% in the men and 3.8% in the women and it accounted for about 40% of the cumulative (life-time) prevalence of self-reported asthma. Current asthma was uncommon in men aged 75 years or over and no cases were found in men who smoked. Current asthma in women was associated with low social status, smoking and dusty working conditions in the past. The difference in prevalence between the men and women was greatest among the smokers, which may be due to a previous high mortality among elderly asthmatic men who had been smoking, or a lack of the typical characteristics of asthma in men with long histories of smoking. The prevalence of asthma was similar to that obtained earlier in Finland and elsewhere.

Contribution of chest and paranasal sinus radiographs to the management of acute asthma.

In order to evaluate the clinical utility of chest and paranasal sinus radiographs on admission in cases of acute asthma, the radiographs of adult patients admitted to our hospital for acute asthma over a period of 1 year were studied. The findings were specified afterwards by a senior diagnostic radiologist and their impact on the management of asthma was evaluated by reviewing the medical records of the patients retrospectively. Abnormalities were detected in 50% of the chest radiographs (55 of 110) and these resulted in management changes in 5% of cases (6 of 100). Abnormalities in any paranasal sinuses were detected in 85% of the sinus radiographs (93 of 100), and maxillary sinus abnormalities in 63% (70 of 100). 29% of the sinus abnormalities (32 of 110) resulted in an immediate alteration in treatment. Hence abnormalities were more common in the paranasal sinus radiographs than in the chest radiographs (p < 0.001), and the impact of the sinus radiographs on the treatment of asthma was also greater (p < 0.001). We recommend that while obtaining a chest radiograph routinely may be advisable in severe cases of acute asthma, at least when the patient is admitted to hospital, serious thought should be given to routinely obtaining a sinus radiograph in these cases as well.

Prevalence of chronic obstructive pulmonary disease in elderly Finns.

The prevalence of chronic obstructive pulmonary disease (COPD) in the elderly is poorly known. The aim of this study was to determine the prevalence of COPD and to analyse the factors associated with it in an elderly Finnish population. The population consisted of persons resident in Lieto, Finland, born in or before 1926. One thousand one hundred and ninety-six individuals (488 men and 708 women, 93% of those eligible) participated in the survey, which was carried out in 1990-91 at the Lieto Health Centre. The methods included a nurse's interview and spirometry with a bronchodilator test. The participants were also clinically examined, and the number of subjects with COPD was determined using simple diagnostic criteria. Sixty-one men and 21 women with COPD were found. Thus the prevalence was 12.5% for the men and 3.0% for the women. In both sexes only about 2% of those who had never smoked suffered from COPD, but among the current smokers the prevalence was 35% for the men and 13% for the women. In a stratified analysis COPD was commonest among those with a low social status and histories of smoking and working in dusty occupations. In a majority the obstruction was only minimally reversible when tested with salbutamol inhalation. The study confirmed that the prevalence of COPD in the elderly with negative histories of smoking is low, and emphasizes the importance of reducing smoking as the only effective preventive measure.

p53 protein accumulation in lung carcinomas of patients exposed to asbestos and tobacco smoke.

Primary lung carcinomas often carry mutations in the p53 tumor suppressor gene. Most of these mutations alter the conformation of the p53 protein into a more stable phenotype that makes it immunohistochemically detectable. Asbestos is a carcinogen that can cause deletions in chromosomes and possibly also gene mutations. In this study we examined 70 primary lung carcinomas for p53 protein accumulation using a polyclonal antihuman p53 antibody, CM-1. Patients were interviewed about their occupational and smoking history and classified according to their anamnestical asbestos exposure. Presence of asbestos bodies (AB) was evaluated from histologic samples of peripheral nontumorous lung tissue using both 5-microns-thick sections stained with Perls' iron and 30-microns-thick unstained sections. Abnormal accumulation of p53 protein was found in 36 tumors (51%), more often in patients exposed to asbestos than in patients without exposure (67% versus 40%, p = 0.027). Significant association was also noticed between the accumulation of p53 and the asbestos content of lung tissue: 35% of the p53-positive patients had more than one AB/cm2 compared with 14% of p53-negative cases (p = 0.046). Patients with strongly p53-positive tumors were heavier smokers (57.2 +/- 38.2 pack-years) than patients with p53-negative or lightly positive tumors (38.9 +/- 19.9 pack-years) (p = 0.017). Our findings indicate that both asbestos exposure and heavy smoking can cause abnormal p53 protein accumulation suggestive of mutated p53.

Respiratory viral and Mycoplasma infections in patients hospitalized for acute asthma.

We evaluated the involvement of viral and Mycoplasma infections in severe attacks of asthma in 112 adult patients admitted to Oulu University Central Hospital for an exacerbation of asthma, during a period of one year. The total number of admissions was 151, and specimens for viral identification were collected from 142 of these. Although the methods for diagnosis of rhinoviruses and coronaviruses were lacking, the diagnosis of a viral or Mycoplasma infection was confirmed in 41 patients (29%) by one or more of the three methods; viral serology, viral culture from a throat wash or viral antigen detection from a nasopharyngeal aspirate. Thirty six of these patients (88%) with confirmed infection also had symptoms suggestive of a viral infection. We conclude that viral and Mycoplasma infections are so often involved in severe asthma attacks of adults that they may play an important role in the induction of such attacks.

Sinus aspirates and radiographic abnormalities in severe attacks of asthma.

We evaluated the occurrence of abnormalities in paranasal sinus radiographs in acute asthma by taking a radiograph of the sinuses of 110 consecutive patients admitted to a medical ward a total of 149 times for asthma. Maxillary sinus infection was assessed by taking aspirate from radiologically abnormal maxillary sinuses. An abnormal finding in any paranasal sinus was detected on 87% (130 of 149) of admissions and the yield of maxillary aspirate was macroscopically mucous, purulent or mucopurulent in 60% (42 of 70) of aspirates. A positive bacteriological culture was obtained from 23 aspirates and a virus was detected in 15, there being 7 aspirates in which both a bacterium and a virus could be detected. Although the correlation between radiographic findings and the aspirates was not very close we conclude that radiographic abnormalities of the paranasal sinuses are common in acute asthma as are infections of maxillary sinuses with an abnormal radiographic finding. There is an obvious need to look for sinusitis when a patient with an exacerbation of asthma is being evaluated.

Association of severe asthma attacks with weather, pollen, and air pollutants.

BACKGROUND: The association between exacerbations of asthma and weather or air pollution is not well understood. The relationships between visits to the emergency room for asthma attacks and the meteorological, aerobiological, and chemical characteristics of the outdoor air have been evaluated. METHODS: The number of daily attendances for asthma attacks at the emergency room of Oulu University Central Hospital was recorded over one year together with daily meteorological readings (temperature, humidity, barometric pressure, rainfall), levels of air pollutants (nitrogen dioxide (NO2), sulphur dioxide (SO2), hydrogen sulphide (H2S), total suspended particles (TSP)), and pollen counts (birch, alder, pine, willow, total pollen). The relationship between the number of attendances and the measured variables was then analysed by multiple regression and stepwise discriminant analysis. RESULTS: The total number of attendances during the year was 232, with lower figures in summer and higher in winter. No association was found between visits for asthma attacks and airborne pollen levels or meteorological factors except for temperature, which had a low inverse correlation with attendance. The most significant correlations were found between asthma visits and the levels of NO2; those for SO2, TSP, and H2S were also significant. Intercorrelations between SO2 and temperature or NO2 and between temperature and TSP or NO2 were also found, but only NO2 correlated significantly with attendances after standardisation for temperature. CONCLUSIONS: Increased levels of pollutants, especially NO2, were associated with attacks of asthma, but the explanation for this is unclear. Air pollen levels were not associated with asthma attacks and only temperature among the meteorological factors had a small association with asthma.

Emergency room visits for acute attacks of asthma: characterization of patients and visits.

To characterize asthma emergencies, all patients attending the hospital because of an asthma attack in 1 year were studied. Of the 212 patients concerned, 148 attended the hospital once, 34 twice and 30 three times or more. The total number of visits was 351. The mean age of the patients was 50 (15-85) years, and 32% of those under 65 years were receiving a pension because of asthma. Eleven patients (5%) had drinking problems, and 62 (29%) had treatment for other diseases. Atopy was diagnosed in 83 patients (39%). Of the patients with one, two or more numerous visits 39, 74 and 90%, respectively, were taking oral steroids, whereas the corresponding figures for those using inhaled steroids were 34, 71 and 61%. Medical treatment seemed to be inadequate more often among the frequent visitors. Seasonal variation in visits was evident, the rates being lowest in July and highest in March. Time-of-day variation was also found, visits being most common from 10 to 11 a.m.

Open lung biopsy of patients with rheumatoid arthritis.

In order to shed light on the histological changes occurring in the lungs of patients with rheumatoid arthritis (RA), we scrutinized an open lung biopsy file of 199 patients and selected the patients with RA. The histopathological patterns observed were: pulmonary rheumatoid nodules (4 cases, including one with rheumatoid pneumoconiosis); usual interstitial pneumonia (UIP) (2 cases); desquamative interstitial pneumonia (2 cases); bronchiolitis obliterans with patchy organizing pneumonia (2 cases); follicular bronchiolitis (1 case); organizing pneumonia always associated with bronchiolitis (3 cases); granulomatous reaction (3 cases); obliterating vasculitis (3 cases); granulomatous vasculitis (1 case); lymphoid hyperplasia (2 cases); and localized pulmonary fibrosis (1 case). The clinical data and laboratory findings for the histopathological groups overlapped and did not properly predict the anatomical picture. Both patients with UIP died of lung disease. Otherwise the prognosis in the series was good.

Course and outcome of ocular sarcoidosis.

In a series of 281 patients with histologically confirmed sarcoidosis, 79 initially had ophthalmic sarcoid manifestations. Of 22 patients with uveitis, 21 were seen regularly as long as the inflammation was active, and 71 of the 79 patients (90%) underwent a follow-up study five to 16 years (mean, nine years) later and using the same protocol. In the 21 patients with uveitis, the disease exhibited either a monophasic course (eight patients) with favorable visual outcome or a relapsing course (13 patients) with severe visual loss in five eyes. Thirty-three patients showed chronic ophthalmic changes at the follow-up examination, including conjunctival granulomas (13 patients), lacrimal gland involvement (22 patients), uveitis (four patients), and involvement of lacrimal passages (three patients). In 15 of these 33 patients, the general physical examination and the chest x-ray showed no evidence of systemic sarcoidosis. However, the serum angiotensin converting enzyme level was increased in a significantly greater proportion of these 15 patients than in the patients assessed as totally recovered from sarcoidosis.

Fatal asthma in two regions of Finland.

To determine the factors associated with deaths from asthma we surveyed retrospectively all the death certificates issued in two regions of Finland (the province of Oulu and the province of Turku and Pori) over a ten-year period in which asthma had been given as the main cause of death. We then examined patients' records to check whether asthma was the main cause of death. A total of 156 deaths could be ascribed to asthma, 87 in patients under 65 at death and 69 over 65. More deaths tended to occur during the weekends, and in the younger age group more occurred during the night than by day. Previous drug treatment was considered inadequate in 45% of the cases. The management and drug treatment of the final exacerbation phase were also often inadequate, at least among the younger victims, and the terminal attack was usually short, death often occurring in three hours or less. Despite the shortcomings in treatment, the number of deaths from asthma in the younger age group has fallen in the province of Oulu over the last 20 years.

Prognosis for sarcoidosis in a defined geographical area.

One hundred and ninety-nine cases of sarcoidosis were diagnosed from July 1970 to December 1976 in a defined geographical area in northern Finland. At the follow-up examination at least 5 years later (range 5-12 years) a chest röntgenogram was obtained from 179 patients (90%) and lung function tests were performed by 169 patients (85%). A normal röntgenogram was achieved by 94 of the 113 patients with stage I sarcoidosis (83%), and by 36 of the 62 patients with stage II (58%). Two patients in the former group (2%) and 14 in the latter (23%) had progressed to the fibrotic stage III, but the fibrosis was usually slight. FEV1 and FVC had increased during the follow-up period, DCO showing the largest number of abnormal results in the final examination. Lung function largely normalized with a normal röntgenogram, whereas the functional outcome was worst where fibrosis had developed. Only two patients had been granted a disability pension because of sarcoidosis. Six patients had died, but none of sarcoidosis. The results show a favourable prognosis for sarcoidosis in this comprehensive series of patients.