- Email: [email protected]
The pathophysiology of acute high-altitude illness
Biopsy,
needle Ftestrictfve
Systemic lung disease
sclerosis Pulmonary
Scleroderma function tests
Altitude
pressure
Complex physiologic responses occu as nonacclimatized lowland dwellers ascend above 10,000 feet, with a resulting partial pressure of arterial oxygen of less than 60 mm Hg. There are marked hemodynamic changes and shifts in body fluids that may result in organ dysfunction. The suspected pathogenesis of these acute hypobaric hypoxic-induced illnesses is discussed. Cerebral dysfunction may present as acute mountain sickness or high-altitude cerebral edema. Usually asymptomatic high-altitude retinal hemorrhage and noncardiogenic high-altitude pulmonary edema also are described. All of these illnesses apparently represent a spectrum of pathologic states initiated by an exaggerated vascular response to hypoxia. With the exception of retinopathy. high-altitude illness can be prevented by slow ascent. Early recognition of cerebral or pulmonary edema and immediate descent will prevent serious consequences of nonacclimatized persons who are acutely exposed to hypobaric environments.
of acute high-altitude illness. Am J Med
Atmospheric
Mountaineering
Meehan RT. Zavala DC: The pathophysiology 1982: 73: 395-403.
Oxygen deficiency
Hypoxia
Small cell lung cancer
Forty patients with extensive small cell lung cancer randomly received either high-dose or lowa methotrexate with leucovorin rescue in combinatii with cycles of cyclophosphamii. doxorubicin. and vincristine alternating with cycles of VP-18. vincristine, and hexamethylmelamine. Nineteen patients were treated with the h@hdose methotrexate regimen, and 21 received the lowdose methotrexate treatment protocol; both treatment groups were similar in median age, performance status, and spread of disease. Response rates (74 percent for high-dose therapy; 67 percent for low-dose therapy), median survival (nine months versus nine months), and overall survival were similar for the two @eatmerIt goups. Myelosuppression was equivalent in both treatment groups. This study indicates that, when used with other antineoplastic agents, high-dose methotrexate therapy does not improve the remission rate or survival nor does it decrease central nervous system metastasis in patients with small cell lung cancer when compared with standard doses of methotrexate.
Hande KR. Oldham RK. Fer MF. Richardson RL, (;reco FA: Randomized study of highdose versus lowdose methotrexate in the treatment of extensive small cell lung cancer. Am J Med 1982: 73: 413-419.
Methotrexate
The natural history of the pulmonary involvement in systemic sclerosis is not well studied. Reported here are the serial measurements of pulmonary function in a well defined population of patients with systemic sclerosis followed over a mean of 63 months. The mean rate of loss of vital capacity (0.10 liters per year) for the 38 patients serially studied was more than three times the expected rate of loss for a normal population. The moan rate of less of diffusing capacity (0.33 ml/min/mm l-l9 per year) for the 27 @ii serially studii was similar to that for a ncumal population. The percent forced vital capacity expired in the first second increased 0.53 percent per year consistent with a progressive restrictive ventilatory defect. Smokers tended to lose vital capacity at a slightly greater rate than nonsmokers (p = 0.069). Individual variability in the course of pulmonary function was observed. Although the overall trend in our population was towards a slowly prcgressive restrictive ventilatory defect. pulmonary hnctii in the nonsmokers did not change at rates different from those In a nonsmoking reference population.
Cytology, thyroid
We studied the impact of fine-needle aspiration biopsy on the management of patients with solitary thyroid nodules. Sixty-four patients were examined before the introduction of fine-needle aspiration biopsy, and 147 patients were examined after its introduction. The percentage of patients who underwent thyroid operation decreased from 67 percent to 43 percent, while the yield of carcinoma increased from 14 percent to 29 percent. Cost of medical care per patient declined by 25 percent. The resuits suggest that fine-needle aspiration biopsy provides valuable information to assist in the selection for surgery of patients with solitary nodules. Fine-needle aspiration appears to be safe, reliable, and cost-effective. The merits of the technique command it for routine use in the evaluation of thyroid nodules.
neoplasms
Schneider PD, Wise RA, Hochberg MC, Wigley FM: Serial pulmonary function in systemic sclerosis. Am J Med 1982; 73: 385-394.
Thyroid
Costs and cost analysis
Hamberger B, Gharib H, Melton W III, Goallner JR, Zinsmeister AR: Fine-needle aspiration biopsy of thyroid nodules: impact on thyroid practice and cost of care. Am J led 1982; 73: 301-384.
lhyroidectomy
needle Ftestrictfve
Systemic lung disease
sclerosis Pulmonary
Scleroderma function tests
Altitude
pressure
Complex physiologic responses occu as nonacclimatized lowland dwellers ascend above 10,000 feet, with a resulting partial pressure of arterial oxygen of less than 60 mm Hg. There are marked hemodynamic changes and shifts in body fluids that may result in organ dysfunction. The suspected pathogenesis of these acute hypobaric hypoxic-induced illnesses is discussed. Cerebral dysfunction may present as acute mountain sickness or high-altitude cerebral edema. Usually asymptomatic high-altitude retinal hemorrhage and noncardiogenic high-altitude pulmonary edema also are described. All of these illnesses apparently represent a spectrum of pathologic states initiated by an exaggerated vascular response to hypoxia. With the exception of retinopathy. high-altitude illness can be prevented by slow ascent. Early recognition of cerebral or pulmonary edema and immediate descent will prevent serious consequences of nonacclimatized persons who are acutely exposed to hypobaric environments.
of acute high-altitude illness. Am J Med
Atmospheric
Mountaineering
Meehan RT. Zavala DC: The pathophysiology 1982: 73: 395-403.
Oxygen deficiency
Hypoxia
Small cell lung cancer
Forty patients with extensive small cell lung cancer randomly received either high-dose or lowa methotrexate with leucovorin rescue in combinatii with cycles of cyclophosphamii. doxorubicin. and vincristine alternating with cycles of VP-18. vincristine, and hexamethylmelamine. Nineteen patients were treated with the h@hdose methotrexate regimen, and 21 received the lowdose methotrexate treatment protocol; both treatment groups were similar in median age, performance status, and spread of disease. Response rates (74 percent for high-dose therapy; 67 percent for low-dose therapy), median survival (nine months versus nine months), and overall survival were similar for the two @eatmerIt goups. Myelosuppression was equivalent in both treatment groups. This study indicates that, when used with other antineoplastic agents, high-dose methotrexate therapy does not improve the remission rate or survival nor does it decrease central nervous system metastasis in patients with small cell lung cancer when compared with standard doses of methotrexate.
Hande KR. Oldham RK. Fer MF. Richardson RL, (;reco FA: Randomized study of highdose versus lowdose methotrexate in the treatment of extensive small cell lung cancer. Am J Med 1982: 73: 413-419.
Methotrexate
The natural history of the pulmonary involvement in systemic sclerosis is not well studied. Reported here are the serial measurements of pulmonary function in a well defined population of patients with systemic sclerosis followed over a mean of 63 months. The mean rate of loss of vital capacity (0.10 liters per year) for the 38 patients serially studied was more than three times the expected rate of loss for a normal population. The moan rate of less of diffusing capacity (0.33 ml/min/mm l-l9 per year) for the 27 @ii serially studii was similar to that for a ncumal population. The percent forced vital capacity expired in the first second increased 0.53 percent per year consistent with a progressive restrictive ventilatory defect. Smokers tended to lose vital capacity at a slightly greater rate than nonsmokers (p = 0.069). Individual variability in the course of pulmonary function was observed. Although the overall trend in our population was towards a slowly prcgressive restrictive ventilatory defect. pulmonary hnctii in the nonsmokers did not change at rates different from those In a nonsmoking reference population.
Cytology, thyroid
We studied the impact of fine-needle aspiration biopsy on the management of patients with solitary thyroid nodules. Sixty-four patients were examined before the introduction of fine-needle aspiration biopsy, and 147 patients were examined after its introduction. The percentage of patients who underwent thyroid operation decreased from 67 percent to 43 percent, while the yield of carcinoma increased from 14 percent to 29 percent. Cost of medical care per patient declined by 25 percent. The resuits suggest that fine-needle aspiration biopsy provides valuable information to assist in the selection for surgery of patients with solitary nodules. Fine-needle aspiration appears to be safe, reliable, and cost-effective. The merits of the technique command it for routine use in the evaluation of thyroid nodules.
neoplasms
Schneider PD, Wise RA, Hochberg MC, Wigley FM: Serial pulmonary function in systemic sclerosis. Am J Med 1982; 73: 385-394.
Thyroid
Costs and cost analysis
Hamberger B, Gharib H, Melton W III, Goallner JR, Zinsmeister AR: Fine-needle aspiration biopsy of thyroid nodules: impact on thyroid practice and cost of care. Am J led 1982; 73: 301-384.
lhyroidectomy