Chest
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Neutrophils are delayed in transit in the pulmonary circulation during smoking which could reflect smoke-induced changes in local hemodynamics. The purpose of this study was to measure the changes in pulmonary hemodynamics during cigarette smoking in both healthy smokers and patients with COPD with and without pulmonary hypertension. ⋯ However, pulmonary vascular resistance fell. These changes in pulmonary hemodynamics during cigarette smoking could not account for the increased neutrophil sequestration that has been observed previously in the lungs during smoking.
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Randomized Controlled Trial Clinical Trial
Screening for lung cancer re-examined. A reinterpretation of the Mayo Lung Project randomized trial on lung cancer screening.
In the 1970s, three randomized trials, each involving approximately 10,000 male subjects, were carried out to determine the value of lung cancer screening in cigarette smokers. These studies have been widely interpreted as providing strong evidence that screening does not contribute to decreased death rates, and, accordingly, the American Cancer Society firmly recommends against lung cancer screening. No randomized trial, however, has evaluated screening for lung cancer in women, who currently comprise 39% of the lung cancer population. ⋯ This explanation is statistically plausible, but, given the status of lung cancer as the most lethal of malignancies, is biologically unlikely. An alternative hypothesis is that chance alone might have accounted for the observed 0.98% difference in lung cancer detection rates. Were this the case, then 46 additional cases would have been detected in the control group had this chance event not occurred.(ABSTRACT TRUNCATED AT 400 WORDS)
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Currently, only a few chemotherapeutic agents (ifosfamide, mitomycin, vinblastine, and vindesine) have consistently produced single-agent response rates greater than 15% in patients with non-small-cell lung cancer (NSCLC). While combination chemotherapy with these and other agents may prolong survival in some patients with advanced disease, complete responses and long-term disease control are achieved only infrequently. ⋯ These results have brightened the prospects for chemotherapy against NSCLC. This article reviews available data for several of these agents: navelbine, which is an analogue of vinblastine, the camptothecins CTP-11 and topotecan, and taxol, the first of a novel class of antimicrotubule drugs.
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Comparative Study
Performance of a reservoir nasal cannula (Oxymizer) during sleep in hypoxemic patients with COPD.
To determine whether a reservoir nasal cannula (RNC) (Oxymizer) provides an arterial hemoglobin oxygen saturation as measured by pulse oximetry (SpO2) equivalent to that provided by the standard nasal cannula (SNC) during sleep in hypoxemic patients with COPD while reducing oxygen flow requirement and cost. ⋯ The difference of 2 percent in mean SpO2 is within the range of SpO2 measurement error. Therefore, the two devices are equally effective when the sample is considered as a whole. Nighttime oximetry is necessary prior to prescription, since nighttime efficacy of the RNC cannot be predicted on the basis of daytime pulse oximetry.
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A study of 51 patients undergoing elective major abdominal surgery was carried out to determine the incidence of postoperative respiratory failure requiring mechanical ventilation for more than 24 h and which preoperative and intraoperative factors are associated with this respiratory complication. Mechanical ventilation for more than 24 h was required in 12 of the 51 patients. ⋯ Preoperative abnormalities in FEV1 did not identify which patients were destined to require postoperative ventilation. Significant differences for the ventilated versus the nonventilated patients included a longer history of cigarette smoking, a lower preoperative PaO2, and a large intraoperative blood loss.