Thorax
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Comparative Study
Nasal mucociliary clearance and ciliary beat frequency in cystic fibrosis compared with sinusitis and bronchiectasis.
Nasal ciliary function and mucociliary clearance were studied in patients with cystic fibrosis and in three control groups. Ciliary beat frequency and nasal clearance time were measured in groups of 10 subjects with cystic fibrosis, sinusitis and bronchiectasis and age and sex-matched control subjects. Ciliary beat frequency was also measured in normal subjects matched as bronchiectasis controls. ⋯ Nasal mucociliary clearance in cystic fibrosis and bronchiectasis was slower than in the cystic fibrosis controls (p less than 0.001) and in patients with sinusitis (p less than 0.01). The finding of a normal beat frequency in cystic fibrosis cilia studied in vitro together with abnormal nasal mucociliary clearance measured in vivo in the same patients suggests the existence of an abnormality of mucus in vivo. The innate function of cystic fibrosis cilia, as measured in vitro by beat frequency, is normal.
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Comparative Study
Bronchial needle aspiration in the diagnosis of bronchial carcinoma.
Sixty consecutive patients with central bronchial carcinomas were studied by fibreoptic bronchoscopy. In all forceps biopsy and bronchial needle aspiration were performed, and in 54 bronchial brushings were obtained. The combination of bronchial brushings and forceps biopsy diagnosed bronchial carcinoma of a defined cell type in 80% of patients. ⋯ No major complications occurred using bronchial needle aspiration. Needle aspiration was particularly helpful when sampling from lesions in the upper lobes where forceps biopsies were technically difficult, from tumours lying submucosally, and from abnormalities caused by extrinsic compression. We conclude that bronchial needle aspiration should be used routinely, together with other sampling techniques, in the diagnosis of central bronchial carcinoma with the fibreoptic bronchoscope.
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Review of the history of auscultation of the lung reveals few scientific investigations. The majority of these have led to inconclusive results. The mechanism of production of normal breath sounds remains uncertain. ⋯ Lung sounds are complex signals that probably reflect regional lung pathophysiology. If they were understood more clearly important non-invasive diagnostic tools could be devised and the value of clinical auscultation could be improved. A multidisciplinary effort will be required to achieve this.
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Comparative Study
Radiographic, scintigraphic, and gas-dilution estimates of individual lung and lobar volumes in man.
We describe a method of separately determining the volumes of the right and left lungs from conventional chest radiographs and of determining the volumes of individual lobes and pathological spaces, whenever their boundaries are visible radiologically or can be displayed scintigraphically--for example, during fibreoptic bronchoscopy. Scintigrams of individual lungs, lobes, and segments are obtained by deflecting a stream of air marked with 81m krypton down the suction channel of the bronchoscope into the appropriate bronchus during inspiration, followed by a breath-hold during which the image is recorded with a gamma camera. ⋯ Used in conjunction with bronchoscopic soluble gas uptake studies, these volume measurements permit precise estimation of effective perfusion, tissue and water volume, and gas transfer at lobar and segmental level. Individual lung and lobar volumes can be used to quantify lung and lobar collapse and compression, mediastinal shift, regional ventilation and gas trapping, and phrenic paresis.
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An attempt was made to determine if emphysema and static lung recoil were related in a group of 65 excised human lungs. We studied 23 normal lungs, 24 lungs with an emphysema score of 5 or less, and 18 lungs with an emphysema score greater than 5. A comparison of the percentage of predicted elastic recoil revealed that both emphysema groups were significantly different from normal lungs. ⋯ In the group with an emphysema score greater than 5 we found a linear negative correlation between the extent of emphysema and percent of predicted elastic recoil at 90% total lung capacity (r = -0.696, p < 0.01). We found a negative correlation between the percentage of predicted elastic recoil and the lung volume (r = -0.612, p < 0.01). We conclude that a significant loss of elastic recoil and a significant increase in total lung capacity occurs in the early stages of emphysema.