The clinical and physiological effect of whole-lung lavage in pulmonary alveolar proteinosis: a ten-year experience

We have utilized whole-lung lavage in the successful treatment of 18 patients with pulmonary alveolar proteinosis. Our ten-year experience includes serial evaluations of patients with disabling lung dysfunction who had a total of 49 whole-lung lavages under general anesthesia. Clinical and physiological responses were documented both before and after each lavage. There were no complications or deaths. All patients were radiographically, physiologically, and symptomatically improved within hours after the procedures. Five patients required from two to four repeat lavages one to three years later. The treatment of this disorder has included a wide variety of techniques. We attribute our results to the use of a lung lavage technique that includes: (1) unilateral whole-lung lavages at two to three day intervals; (2) isotonic saline as the lavage solution; (3) use of a mechanical chest percussor during lavage; and (4) measuring the total thoracic compliance of each side in the immediate postlavage period as a guide for extubation. We conclude that whole-lung lavage is a safe, highly effective, repetitively applicable treatment for pulmonary alveolar proteinosis.     

Water-soluble copolymers. V. Compositional determination of random copolymers of acrylamide with sulfonated comonomers by infrared spectroscopy and C13 nuclear magnetic resonance

Compositional analyses of random copolymers of acrylamide with sodium-2-sulfoethyl methacrylate and with sodium-2-acrylamido-2-methylpropane sulfonate have been performed utilizing elemental analysis, infrared spectroscopy, and C¹³ NMR. A mathematical method involving nitrogen to sulfur ratios has been developed to eliminate errors which often arise from associated water in hydrophilic copolymers. The ratios of infrared absorbances at 1043 cm^?1 and 1664 cm^?1 were used to determine the composition of AM—NaAMPS copolymers; likewise, absorbance ratios at 1040 cm^?1 and 3200 cm^?1 were utilized for determination of the AM—NaSEM copolymer composition. Carbon-13 NMR spectra of the copolymers were also obtained, and characteristic peaks were utilized to quantitate copolyer composition. The results obtained by elemental analyses, infrared spectroscopic studies, and NMR were in excellent agreement. These techniques are of great value for determining composition of hygroscopic copolymers which can crosslink or form strong intramolecular hydrogen bonds, often precluding further characterization.     

Factors affecting the sensitivity of e-beam resists

In order to determine the effects of chemical structure on electron beam resist sensitivities, a series of polymers with different reactive components and additives has been investigated. The results, based on a larger number of exposures varying over five orders of magnitude, point out several interesting facts. The data indicate that the sensitivity of negative resists is not a linear function of molecular weight as previously supposed. Also, the negative electron resists tend to be more sensitive and cover a broader range of sensitivities than positive resists. The results further show that olefin and epoxy groups greatly enhance the crosslinking rate of these exposed polymers. However, additives, which are good energy transferring type sensitizers, have little effect on resist sensitivity. This last result is not surprising considering the nonselectivity of the exciting electrons.     

Ordering and precipitation effects in the specific heat and magnetization of copper-iron alloys

There is evidence in the specific heat of dilute copper-iron alloys of magnetic interaction phenomena whose behavior varies according to the range of solute concentration. At temperatures well below T_Kondo and at low concentrations two essentially independent contributions to the specific heat are found. One arises from the thermal excitations in the solid solution and the other from those in a rudimentary fine-scale coherent precipitate.The research was supported by the Science Research Council by provision of a Research Studentship, and by the Ministry of Technology, through the National Physical Laboratory, under Contract No. AD 34/8/04/26, by a Research Studentship (D.J.E.) and a Research Grant.     

Motor neuron syndromes in cancer patients

Previous reports indicate that motor neuron disease (MND) may rarely be associated with systemic cancer. We have encountered 14 patients with MND and cancer who formed three distinct groups. Group 1: Three patients developed a rapidly progressive MND, less prominent symptoms of involvement of other areas of the nervous system, and anti-Hu antibodies. Group 2: Five women developed signs of upper motor neuron (UMN) disease, initially resembling primary lateral sclerosis (PLS), and breast cancer. In 4, symptoms of UMN occurred within 3 months of cancer diagnosis or tumor recurrence. They had no metastases or spinal cord compression. Serum anti-neuronal antibodies were negative. Three patients are alive (follow-up of 156, 15, and 12 months), and 2 remain without lower motor neuron signs. Group 3: Six patients developed MND resembling amyotrophic lateral sclerosis between 47 months before and 48 months after their cancer diagnosis. In group 1, the MND associated with the anti-Hu antibody is unequivocally paraneoplastic. In group 2, the proximate onset of MND with the diagnosis of cancer or its recurrence, its pure or long-lasting UMN signs, and its association with breast cancer, suggest that the disorder may be paraneoplastic. Although for most cancer patients who develop MND the occurrence of both disorders is probably coincidental, in some patients with MND a careful search for an underlying cancer is warranted (ie, patients in groups 1 and 2).     

Residents' management of the symptoms associated with terminal cancer

The principal aim of palliative care is to bring symptomatic relief to patients with progressive disease. Residents graduating from a university general surgery training program should be competent to manage common symptoms associated with advanced cancer. This study used performance-based testing to evaluate the skills of resident physicians in managing common symptoms of a patient with advanced cancer. Thirty-three resident physicians (PGY 1 to 6) were presented with four clinical symptoms of a patient with advanced cancer: (1) nausea and vomiting associated with regular morphine use; (2) lack of appetite in the last weeks of life of a terminally ill patient; (3) constipation associated with codeine analgesia; and (4) dyspnea associated with diffuse lung metastases. The management plan for the symptom problems was evaluated by using a predefined checklist. A significant number of residents showed deficits in the management of common symptoms of advanced cancer. Scheduled dosing of antiemetics was infrequently prescribed for opioid-related nausea and vomiting. Most physicians inappropriately managed lack of appetite by using forced feeding. Opioids were infrequently used in the management of terminal dyspnea. The absence of difference in scores between junior and senior residents suggests that adequate management of the symptoms of terminal cancer is not being effectively taught in postgraduate training programs.