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Describing a Pneumothorax
vir 2X5 mg/kg body weight per day was reinstituted. Within 2 weeks, pneumatosis and pneumoperitoneum had completely resolved. We suggest that a smouldering gastrointestinal CMV disease proven by biopsy 8 weeks before and incompletely suppressed by oral acyclovir was the cause of pneumatosis in our patient. Leukocyte CMV immediate early antigen remained negative, but this is known in an isolated gastrointestinal CMV disease, even if no specific suppressive therapy is used. 3 Our observation is strikingly similar to the case reported by Mannes et aJI and emphasizes the fact mentioned by Rubin 4 that gastrointestinal CMV infection may present in this peculiar form and may respond to antiviral treatment. An additional symptomatic therapeutic effect of metronidazole, however, cannot be excluded.
ing the lung from the anterior chest wall by 3 em. These findings demonstrate minimal change in the size of the pneumothorax seen on the x-ray film done 6 h earlier. Inspiratory effort is similar on both films. Such descriptive reports would allow the clinician to visualize the problem and would obviate the need for an esoteric or inaccurate calculation of percent pneumothorax.
Annette Bohler, MD, Rudolf Speich, MD, Erich W . Russi, MD, FCCP, Christa Meyenberger, MD, and Walter Weder, MD; Department of Internal Medicine, Division of Pneumology and Gastroenterology, Department of Surgery, University Hospital Zurich, Switzerland
1 Lopez AJ, Wood VS, Roddie ME. Determining the size of pneumothorax [letter]. Chest 1994; 105:1908-09 2 Engdahl 0, Toft T, Boe J. Chest radiograph-a poor method for determining the size of a pneumothorax. Chest 1993; 103:26-9
Reprint requests: Dr. Bohler, Dept. Int. Med., Div. of Pneumology, University Hospital, CH8097 Zurich, Switzerland REFERENCES
1 Mannes GPM, de Boer WJ, van der Jagt EJ, eta!. Pneumatosis intestinalis and active cytomegaloviral infection after lung transplantation. Chest 1994; 105:929-30 2 Balfour HH, Chace BA, Stapleton JT, et a!. A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts. N Eng! J Med 1989; 320:1381-87 3 The TH, van den Berg AP, Klompmaker IJ, et a!. Monitoring for cytomegalovirus after organ transplantation. Transplant Proc 1993; 25:5-9 4 Rubin RH. Impact of cytomegalovirus infection on organ transplant recipients. Rev Infect Dis 1990; 12:S754-S766
john P. judson, MD, FCCP, Capital Area Cardiovascular Surgical Institute, Camp Hill, Pennsylvania REFERENCES
Should Supplemental Estrogen be Used as Steroid-Sparing Agents in Women With Asthma? To the Editor: I read with interest in the July 1994 issue of Chest the report by Myers and Sherman 1 because their report adds support to the reports of others for the conclusion that levels of sex hormones affect bronchial inflammation. For example, Rubio et al2 concluded after measuring levels of steroid hormones levels in women with asthma that "bronchial asthma is associated in a high proportion with abnormalities in the production or metabolism of steroid hormones in women during their reproductive life." Therapeutically and similar to the report by Myers and Sherman, 1 levels of sex hormones have been manipulated in women with asthma using danazol with beneficial results.3-5 Therefore, Iagree with their conclusion that further studies concerning the role of sex hormones in women with asthma are needed.
Neil L. Kao, MD, University of Illinois College of Medicine , Rockford, Illinois
Describing a Pneumothorax
REFERENCES
To the Editor: The letter of Dr. Anthony Lopez et al 1 commenting on the article by Engdahl et al 2 illustrates a common clinical problem. As physicians and surgeons, we frequently receive reports from radiologists stating that there is a "mild," " tiny," "moderate," "large," or some other pneumothorax. The terms are all subjective and mean different things to different radiologists. Quantifying the pneumothorax by some of the esoteric, expensive, and possibly dangerous techniques described by the two authors does very little to help the clinician. The need for intervention will be based on the clinical condition of the patient as well as the absolute size of the pneumothorax. I would suggest that, in clinical situations, less attention be paid to the numerical (percent) description of the pneumothorax. More attention should be given to description of the resultant air space within the hemithorax and whether that space is changing in size, eg, the left hemithorax contains a pneumothorax that separates the lung from the chest wall4 em at the apex, 2 em in the upper lateral area, and 1 em at the base of the lung. There is no separation at the base. Lateral view shows a pneumothorax separat-
2
3 4 5
Myers JR, Sherman CB. Should supplemental estrogens be used as steroid-sparing agents in asthmatic women? Chest 1994; 106:318-19 Rubio RL, Rodriguez GB, Collazo JJ. Comparative study of progesterone, estradiol and cortisol concentration in asthmatic and nonasthmatic women. Allergol Immunopathol (Madr) 1988; 16:283-86 Pride SM, Yuen BH. Relief of asthma in two patients receiving danazol for endometriosis. Can Med Assoc J 1984; 131:763-64 Gorrell GJ. Relief of asthma with danazol. Can Med Assoc J 1985; 132:100 Kao NL, Zeitz HJ. Effect of danazol on asthma in patients with endometriosis and asthma. Ann Allergy 1993; 71:247
Management of Obstructive Sleep Apnea To the Editor: We read with interest the article in the July, 1993 issue of Chest by Coppola and Lawee 1 concerning the use of portable sleep apCHEST I 107 I 2 I FEBRUARY, 1995
583
ing the lung from the anterior chest wall by 3 em. These findings demonstrate minimal change in the size of the pneumothorax seen on the x-ray film done 6 h earlier. Inspiratory effort is similar on both films. Such descriptive reports would allow the clinician to visualize the problem and would obviate the need for an esoteric or inaccurate calculation of percent pneumothorax.
Annette Bohler, MD, Rudolf Speich, MD, Erich W . Russi, MD, FCCP, Christa Meyenberger, MD, and Walter Weder, MD; Department of Internal Medicine, Division of Pneumology and Gastroenterology, Department of Surgery, University Hospital Zurich, Switzerland
1 Lopez AJ, Wood VS, Roddie ME. Determining the size of pneumothorax [letter]. Chest 1994; 105:1908-09 2 Engdahl 0, Toft T, Boe J. Chest radiograph-a poor method for determining the size of a pneumothorax. Chest 1993; 103:26-9
Reprint requests: Dr. Bohler, Dept. Int. Med., Div. of Pneumology, University Hospital, CH8097 Zurich, Switzerland REFERENCES
1 Mannes GPM, de Boer WJ, van der Jagt EJ, eta!. Pneumatosis intestinalis and active cytomegaloviral infection after lung transplantation. Chest 1994; 105:929-30 2 Balfour HH, Chace BA, Stapleton JT, et a!. A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts. N Eng! J Med 1989; 320:1381-87 3 The TH, van den Berg AP, Klompmaker IJ, et a!. Monitoring for cytomegalovirus after organ transplantation. Transplant Proc 1993; 25:5-9 4 Rubin RH. Impact of cytomegalovirus infection on organ transplant recipients. Rev Infect Dis 1990; 12:S754-S766
john P. judson, MD, FCCP, Capital Area Cardiovascular Surgical Institute, Camp Hill, Pennsylvania REFERENCES
Should Supplemental Estrogen be Used as Steroid-Sparing Agents in Women With Asthma? To the Editor: I read with interest in the July 1994 issue of Chest the report by Myers and Sherman 1 because their report adds support to the reports of others for the conclusion that levels of sex hormones affect bronchial inflammation. For example, Rubio et al2 concluded after measuring levels of steroid hormones levels in women with asthma that "bronchial asthma is associated in a high proportion with abnormalities in the production or metabolism of steroid hormones in women during their reproductive life." Therapeutically and similar to the report by Myers and Sherman, 1 levels of sex hormones have been manipulated in women with asthma using danazol with beneficial results.3-5 Therefore, Iagree with their conclusion that further studies concerning the role of sex hormones in women with asthma are needed.
Neil L. Kao, MD, University of Illinois College of Medicine , Rockford, Illinois
Describing a Pneumothorax
REFERENCES
To the Editor: The letter of Dr. Anthony Lopez et al 1 commenting on the article by Engdahl et al 2 illustrates a common clinical problem. As physicians and surgeons, we frequently receive reports from radiologists stating that there is a "mild," " tiny," "moderate," "large," or some other pneumothorax. The terms are all subjective and mean different things to different radiologists. Quantifying the pneumothorax by some of the esoteric, expensive, and possibly dangerous techniques described by the two authors does very little to help the clinician. The need for intervention will be based on the clinical condition of the patient as well as the absolute size of the pneumothorax. I would suggest that, in clinical situations, less attention be paid to the numerical (percent) description of the pneumothorax. More attention should be given to description of the resultant air space within the hemithorax and whether that space is changing in size, eg, the left hemithorax contains a pneumothorax that separates the lung from the chest wall4 em at the apex, 2 em in the upper lateral area, and 1 em at the base of the lung. There is no separation at the base. Lateral view shows a pneumothorax separat-
2
3 4 5
Myers JR, Sherman CB. Should supplemental estrogens be used as steroid-sparing agents in asthmatic women? Chest 1994; 106:318-19 Rubio RL, Rodriguez GB, Collazo JJ. Comparative study of progesterone, estradiol and cortisol concentration in asthmatic and nonasthmatic women. Allergol Immunopathol (Madr) 1988; 16:283-86 Pride SM, Yuen BH. Relief of asthma in two patients receiving danazol for endometriosis. Can Med Assoc J 1984; 131:763-64 Gorrell GJ. Relief of asthma with danazol. Can Med Assoc J 1985; 132:100 Kao NL, Zeitz HJ. Effect of danazol on asthma in patients with endometriosis and asthma. Ann Allergy 1993; 71:247
Management of Obstructive Sleep Apnea To the Editor: We read with interest the article in the July, 1993 issue of Chest by Coppola and Lawee 1 concerning the use of portable sleep apCHEST I 107 I 2 I FEBRUARY, 1995
583