Diagnostic value of bronchoalveolar lavage and postbronchoscopic sputum cytology in peripheral lung cancer

Abstract The objective of this study was to evaluate the value of bronchoalveolar lavage (BAL) and postbronchoscopic sputum cytology in diagnosing peripheral lung cancer. We performed a prospective study in 55 patients with lesions on chest radiographs who were suspected of having lung cancer and had non-endoscopically visible lesions on fiberoptic bronchoscopy. The sequence of procedures in all cases was BAL and transbronchial forceps biopsy. The final diagnosis of these patients were primary lung cancer in 30 patients, metatastic lung cancer in five and benign diseases in 20. In the primary lung cancer group, BAL was positive for malignant cells in 14 of the 30 patients (46.7%). In seven (50%) of these patients, the cell type diagnosed by BAL agreed with the final diagnosis. The diagnostic yield of BAL was influenced by the size and segmental location of the lesion. Bronchoalveolar lavage provided a higher diagnostic yield (46.7%) than transbronchial biopsy (16.7%). In five patients with metastatic lung cancer and 20 patients with benign disease, BAL gave negative results in all. Postbronchoscopic sputum cytology was positive in only two of the 26 patients (7.7%) from whom samples could be obtained. Bronchoalveolar lavage cytology proved to be a valuable diagnostic tool in detecting peripheral, primary lung cancer. Postbronchoscopic sputum cytology provided no significant additional information.     

The efficacy of doxycycline as a pleural sclerosing agent in malignant pleural effusion: A prospective study

Abstract To determine the efficacy of doxycycline in producing pleuroedesis in patients with malignant pleural effusion (MPE), 31 documented cases of MPE, aged 19–82 years were prospectively studied. Pleural sclerosis was done with 500 mg of doxycycline. Response regarding respiratory symptoms and pleural fluid accumulation were evaluated monthly. At one month, 27 patients were evaluable (4 dropped out). All responded and required no therapeutic thoracentesis. At 3 months, 13 patients dropped out, only 14 patients were evaluable. It revealed that 13 out of 14 patients (92%) responded. Only one patient failed and required therapeutic thoracentesis. Five and two patients came for assessment at 6 and 12 months, respectively. They still benefited from doxycycline pleurodesis. Side effects including low grade fever in 30% of patients, moderate to severe pain in 60% and troublesome cough with hemoptysis in one patient (3%) were noted. Doxycycline is an effective agent in controlling MPE. It was successful in every patient at 1 month and in 92% at 3 months. At 6 and 12 months quite a few patients survived for evaluation. However, they still benefited from doxycycline pleurodesis. Side effects were tolerable.     

Effect of nedocromil sodium on the immediate response to antigen challenge in asthmatic patients

In this double-blind placebo controlled crossover study the protective effect of nedocromil sodium against bronchial allergen challenge was evaluated in ten asthmatic patients. Single doses of 0.5, 1.0 and 2.0 mg nedocromil sodium, administered as a pressurized aerosol 3 hr prior to challenge, were each significantly more effective than placebo in inhibiting allergen-induced bronchoconstriction. The 1.0 and 2.0 mg doses of the active drug were significantly more effective than the 0.5 mg dose. No significant difference was demonstrated between the 1.0 and 2.0 mg doses. Duration of protection beyond 3 hr was not tested. The results suggest that nedocromil sodium may be a potentially useful therapeutic agent and is worthy of further evaluation for the treatment of reversible obstructive airways disease.