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In an attempt to formulate indications for mediastinoscopy, the histologic tumor type and the radiographic manifestations of the tumor were correlated with the occurrence of mediastinal node metastases in 121 patients who had potentially resectable bronchogenic carcinoma. Our results demonstrated that mediastinal metastases occur commonly in patients with central lesions irrespective of cell type, but that the histologic tumor type has a definite influence on the frequency of mediastinal involvement in patients with parenchymal masses or peripheral lesions. Our results also demonstrated that the absence of radiographic evidence of mediastinal involvement cannot be given strong consideration when selecting patients for mediastinoscopy, because almost 50 per cent of patients with mediastinal involvement did not have mediastinal widening on the chest roentgenogram. Our results, in conjunction with currently accepted principles governing the management of patients with bronchogenic carcinoma, have allowed us to propose a logical approach for the use of mediastinoscopy in the prethoracotomy evaluation of patients with potentially resectable lung cancer.

Mycobacterium malmoense was isolated from pulmonary material from 4 patients. Two patients had repeatedly positive smears and cultures along with roentgenographic progression of pulmonary disease in the absence of another pathogen. These 2 patients therefore meet the criteria for diagnosis of pulmonary mycobacteriosis. Isolation of the organism may represent colonization in a third patient, and M. malmoense has been isolated from a fourth patient on 2 occasions. It is not yet definite, however, that the pulmonary process is due to mycobacterial disease. Although uncommon, pulmonary disease caused by this organism has been reported from Europe. Only 1 prior case of pulmonary disease caused by M. malmoense, however, has been reported in the United States.

A 53-year-old patient with lymphoblastic lymphoma developed progressive interstitial pulmonary infiltrates. The patient was believed to have Pseudomonas bronchitis and was given parenteral gentamicin. Transbronchial lung biopsy performed through a fiberoptic bronchoscope was complicated by the development of Pseudomonas septicemia. The organism isolated on blood culture, like the one isolated on sputum culture, was fully susceptible to gentamicin in vitro. A prophylactic antimicrobial drug did not prevent bacteremic Pseudomonas infection in our immunosuppressed patient with pre-existent Pseudomonas bronchitis.

Carboxyhemoglobin concentrations were compared in 3 groups of outpatients who had inhaled cigarettes in the past. Group 1 consisted of 16 current nonsmokers; group 2, 24 inhaling cigarette smokers; group 3, 10 inhaling cigar smokers. An arterial blood sample was analyzed for carboxyhemoglobin and hemoglobin, and oxygen saturation was calculated and measured. Mean +/- SE carboxyhemoglobin concentrations were 1.0 +/- 0.1, 4.6 +/- 0.5, and 8.4 +/- 1.4 per cent, respectively, for the 3 groups (P less than 0.005). Although calculated oxygen saturation values were not significantly different, measured oxygen saturation values were 96.7 +/- 0.7, 93.0 +/- 1.0, and 88.4 +/- 1.8 per cent, respectively (P less than 0.025). Hemoglobin concentrations in smokers were higher than in nonsmokers (P less than 0.001). This study indicated that cigar smokers who intentionally inhale have higher carboxyhemoglobin concentrations and lower measured oxygen saturation values than cigarette inhalers. This may be even more detrimental to their health than cigarette smoking.