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Cancer Stage Splitting: Future Predictions
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Cancer Stage Splitting: Future Predictions To the Editor: Thank you for your recent note advising me that my letter on lung cancer staging has been accepted for publication in CHEST. While the letter addresses a serious issue, a spirit of whimsy led me to construct the enclosed graph. As you can see, simple extrapolation predicts that lung cancer staging will arrive at 18 stages by the year 2055 given the current rate of stage splitting. My proposal, if adopted by the year 2000, would save the pulmonary oncology community 55 years of confusing, timelimited interim schema. I rest my case!
Correspondence to: Mitchell L. Margolis, MD, FCCP, Pulmonary/Critical Care Medicine, VAMC, University and Woodland, Philadelphia, PA 19104
Cough Reflex in the Night To the Editor: Cough protects the lung against aspiration and aids in the removal of excessive bronchial secretions. Absence or attenuation of the cough reflex has been, therefore, implicated in the development of aspiration pneumonia. 1 Aspiration of pharyngeal secretions occurs frequently in patients with depressed sensorium, and also in normal adults during sleep. 2 However, the influence of sleep on the cough reflex has not been studied in elderly patients at risk for aspiration. We, therefore, examined the cough reflex during day and during the night in elderly patients with aspiration pneumonia, and compared the results with those in age-matched healthy control subjects. Eleven patients, mean age 81 ± 3 (SD) years, had at least one episode of aspiration with chest radiographic evidence of inflammation in the lower pulmonary segments. CT scans revealed various degrees of cerebral atrophy and lacunar infarction. Eight control subjects, mean age 80 ± 3 (SD) years, were healthy volunteers who led an active daily life. Each subject was isolated
80
e
Patients
0 Controls
18 16
,, ,.,·
14 12 Lung cancer stages plue substages
10 8 6
4
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20
2 0
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1974 1984 1994 2004 2014 2024 2034 2044 2054 2064
YEAR
0 Mitchell L. Margolis, MD, FCCP Pulmonary and Critical Care Philadelphia VA Medical Center Philadelphia, PA 1496
*
60
*
~ Day
Night
FIGURE l. Threshold of cough responses to citric acid in control subjects and patients. Asterisk indicates significant differences between day and night (p < 0.01).
Communications to the Editor
Cancer Stage Splitting: Future Predictions To the Editor: Thank you for your recent note advising me that my letter on lung cancer staging has been accepted for publication in CHEST. While the letter addresses a serious issue, a spirit of whimsy led me to construct the enclosed graph. As you can see, simple extrapolation predicts that lung cancer staging will arrive at 18 stages by the year 2055 given the current rate of stage splitting. My proposal, if adopted by the year 2000, would save the pulmonary oncology community 55 years of confusing, timelimited interim schema. I rest my case!
Correspondence to: Mitchell L. Margolis, MD, FCCP, Pulmonary/Critical Care Medicine, VAMC, University and Woodland, Philadelphia, PA 19104
Cough Reflex in the Night To the Editor: Cough protects the lung against aspiration and aids in the removal of excessive bronchial secretions. Absence or attenuation of the cough reflex has been, therefore, implicated in the development of aspiration pneumonia. 1 Aspiration of pharyngeal secretions occurs frequently in patients with depressed sensorium, and also in normal adults during sleep. 2 However, the influence of sleep on the cough reflex has not been studied in elderly patients at risk for aspiration. We, therefore, examined the cough reflex during day and during the night in elderly patients with aspiration pneumonia, and compared the results with those in age-matched healthy control subjects. Eleven patients, mean age 81 ± 3 (SD) years, had at least one episode of aspiration with chest radiographic evidence of inflammation in the lower pulmonary segments. CT scans revealed various degrees of cerebral atrophy and lacunar infarction. Eight control subjects, mean age 80 ± 3 (SD) years, were healthy volunteers who led an active daily life. Each subject was isolated
80
e
Patients
0 Controls
18 16
,, ,.,·
14 12 Lung cancer stages plue substages
10 8 6
4
//
..,.·'
/
.-'
,,
,,
,/"
-
0)
E
'0
'(j
40
as
u ·;:
:!::
(.)
20
2 0
-
1974 1984 1994 2004 2014 2024 2034 2044 2054 2064
YEAR
0 Mitchell L. Margolis, MD, FCCP Pulmonary and Critical Care Philadelphia VA Medical Center Philadelphia, PA 1496
*
60
*
~ Day
Night
FIGURE l. Threshold of cough responses to citric acid in control subjects and patients. Asterisk indicates significant differences between day and night (p < 0.01).
Communications to the Editor