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The development of flexible transbronchial needles for hilar and mediastinal aspiration had made possible noninvasive staging at the time of the initial diagnostic bronchoscopic examination. Combining the specificity of TBNA with the sensitivity of thoracic CT scanning greatly enhances the utility of this procedure. A bronchoscopically oriented staging system that utilizes the complementary advantages of both of these techniques is outlined. The staging of bronchogenic carcinoma by TBNA is a safe and cost-effective technique that can be routinely utilized to stage lung cancer. Ultimately, its value will depend upon whether the initial encouraging reports of its use can be reproduced by bronchoscopists in practice.

Spiral or helical computed tomography (CT)-generated multiplanar reconstructions were used in the radiological assessment of the pulmonary hila in patients with central lung cancer. Twelve patients with non-small-cell lung cancer and hilar abnormalities were examined with contrast-enhanced spiral CT. Studies were performed on a Siemens Somatom S or Plus-S scanner using either a 24- or 32-second spiral. The study volume was from the arch of the aorta to the inferior pulmonary veins done in a single breath-hold, using 4-mm collimation, and reconstructed at 2-mm intervals. We assessed the quality of vascular enhancement and of multiplanar reconstructions. Bronchoscopic, surgical, and pathological findings were correlated. Excellent vascular opacification and good-quality reconstructions were obtained in all patients. No interscan motion was detected. No problems were encountered with the breathholding technique or in the reconstruction of images, even in patients with poor respiratory function. Multiplanar reconstructions were useful for the evaluation of mediastinal including vascular and airways invasion, for optimal definition of lymph node groups, for the planning of bronchoscopically guided biopsy, as well as for endobronchoscopic laser coagulation therapy and surgical treatment. Spiral CT-generated multiplanar reconstructions of the hila are helpful for staging, solving problems, guiding bronchoscopy, and planning surgery. Even patients with limited respiratory reserve can successfully complete the examination.

In summary, knowledge of the exact location of lymph nodes in mediastinum and hilar areas and their relationship to the puncture site of TBNA is the first step to a successful TBNA. The necessity to determine the N3 status and multistation status of patients with bronchogenic carcinoma being evaluated for surgery and the current financial restraint of the medical care system further highlight the potential of this simple, effective, and safe procedure. TBNA can markedly enhance the diagnostic yield of flexible bronchoscopy. TBNA and PCNA are complimentary procedures.

Transbronchial needle aspiration (TBNA) for diagnosis and staging of bronchogenic carcinoma has evolved in the USA since the late 1970's. Initial reports advised that aspirated specimens be flushed into a container by normal saline or Hank's solution and processed in a cytology laboratory usually by Millipore filter and other techniques. A highly sophisticated cytology laboratory is the key to the success of this procedure. This study was designed to assess a simpler alternative method of processing the specimen by a direct smear technique. From June 1990 to September 1990, 40 procedures were performed on 34 consecutive patients. Seventy two paired direct smear and fluid specimens for cytology examination were collected. Fifty specimens were found to be negative in both types of specimen preparation. Fifteen were found to be positive in both types of specimens preparation, and six specimens were found to be positive only in the direct smear preparation. One of the 72 specimens was found to be positive in the Millipore and other preparation techniques. Based on our data, we conclude that the use of the direct smear for TBNA specimen preparation is an effective, simpler, and improved method. Proper use of it may increase the diagnostic yield and result in better acceptance of this new procedure.

Percutaneous fine needle aspiration biopsy was performed on a woman with multiple bilateral lung nodules. The cytology and histology showed a benign spindle cell tumor compatible with benign metastasizing leiomyoma. The patient had a history of hysterectomy 14 years earlier for a cellular leiomyoma with atypia. No significant mitosis was present in either the uterine tumor or lung metastasis.

We report the successful closure of a small bronchopleural fistula, which developed following right lower lobe lobectomy for squamous cell carcinoma. The patient underwent fibreoptic bronchoscopy diagnosis of possible bronchopleural fistula, manifested by cough and hydropneumothorax, following right lower lobe lobectomy. A small fistula was found at the stump of the right lower lobe. A chest tube with suction was placed for drainage before the therapeutic fibreoptic bronchoscopy. Through the flexible bronchoscope, using the tip of the bare laser fibre, a superficial erosion and bleeding around the fistula was created and coagulated by using a defocused yttrium aluminium garnet (Yag) laser beam. Close follow-up of the patient showed air leakage had stopped completely in 48 h. The chest tube was removed and the fistula never recurred. We suggest that this procedure may be used in selective patients with a small bronchopleural fistula. If successful, it can reduce the morbidity of more invasive surgical procedures.

Both coronary arteriography (CAG) and myocardial emission computed tomography (ECT) were performed in 58 patients. According to CAG findings and clinical manifestations, 47 patients were diagnosed as coronary heart disease (CHD), while 11 not. CAG was abnormal in 39 patients of the 47. The sensitivity and specificity of CAG were 83% and 100% respectively. The diagnosis of CHD was made without any doubt in patients with abnormal CAG. The sensitivity of ECT was 97.9%, the specificity only 45.5%, and the predictive value of negative ECT 83.3%. Therefore, abnormal ECT should be closely related to the clinical manifestations in order to evaluate its significance and a normal ECT may rule out CHD with more reliability.

This 9-year-old boy had a three-year history of vernal keratoconjunctivitis. A shield ulcer developed in the superior part of the cornea. The shield ulcer is a rare manifestation of the disease. Although the cause of shield ulcer is unknown, the association of shield ulcer with large papillae suggests a mechanical cause. The symptoms of itching and mucous discharge were relieved after medications with topical steroid and cromolyn sodium, but the large shield ulcer was persistent. The vernal ulcer was treated with a 72 hours collagen shield. The ulcer healed rapidly within 5 days, leaving a corneal opacity about the level of Bowman's layer.

A method for calculating the density of states of substitutional binary alloys is presented. It essentially consists of successive applications of Beeby'st-matrix formulation of the KKR theory to the single-impurity problem. This method is applied to calculate thed-densities of states of Cu-Ni alloys of various concentration. The results are in reasonable agreement with both experimental photoemission and soft-X-ray emission data and with the theoretical calculations of Stockset al. and Bansilet al. via different approaches.

The electronic structure of the intermetallic compound ${\mathrm{Ni}}_{3}$Ti was investigated theoretically with self-consistent-field (SCF)-$X\ensuremath{\alpha}$ calculations on the appropriate four-atom tetrahedral cluster. The calculations show a $d$ band consisting of filled Ni $d$ orbitals, empty Ti $d$ orbitals, and half-filled Ni-Ti antibonding orbitals near the Fermi level. We obtain from the calculations a charge transfer from Ti to Ni and to the interatomic space so that ionic and covalent components are added to the metallic bond. The energy distributions of photoelectrons from the polycrystalline compound ${\mathrm{Ni}}_{3}$Ti were obtained at $h\ensuremath{\nu}=11.7, 16.8, 21.2, 26.8, \mathrm{and} 40.8$ eV and reproduce the features of the calculated electronic structure, namely, a relatively low density of states at the Fermi level and a bandwidth of 3 eV. The Auger peaks of nickel and titanium were obtained at the same energies as for the elemental metals and are in agreement with the theoretical finding that the core levels in the compound are at the same energies as in the elements.

In order to determine whether larger biopsy forceps improve the diagnostic yield over smaller standard forceps, we performed 30 transbronchial biopsy procedures in 28 patients with lung infiltrates using three types of instruments. We found that compared to the standard forceps specimens the large forceps acquired larger specimens in 22 of 29 procedures and that the alligator forceps acquired larger specimens in 7 of 10 procedures. However, in only 2 of the 29 procedures did the larger biopsy specimen alter the pathologic diagnosis. Four of the patients subsequently underwent open lung biopsy which did not alter the pathologic diagnosis rom the transbronchial biopsy procedure. We conclude that the large forceps do not significantly improve the diagnostic yield of transbronchial biopsy in our patients.

Previous research on the theoretical electronic structure of ordered beta brass (${\ensuremath{\beta}}^{\ensuremath{'}}$ CuZn) has been systematically extended to other ordered beta-phase alloys belonging to groups $\mathrm{I}B$ and $\mathrm{II}B$ of the periodic table, and also to disordered beta brass ($\ensuremath{\beta}$ CuZn). In the case of the ordered alloys, the band structures and Fermi surfaces of ${\ensuremath{\beta}}^{\ensuremath{'}}$ AgZn and ${\ensuremath{\beta}}^{\ensuremath{'}}$ AgCd have been computed by the Kohn-Rostoker (K-R) technique and compared with results similarly obtained for ${\ensuremath{\beta}}^{\ensuremath{'}}$ CuZn. The bands are qualitatively alike, differing principally in the locations of the $d$ bands relative to the conduction bands. The sensitivity of these locations is given special attention in the material ${\ensuremath{\beta}}^{\ensuremath{'}}$ CuZn. The problem is partially resolved by resorting to a semiempirical "adjustment" of the $d$ bands. The Fermi surfaces, which are close to the one-orthogonalized-plane-wave prototype, are relatively insensitive to the exact nature of the potential. The bands of ${\ensuremath{\beta}}^{\ensuremath{'}}$ AuZn and ${\ensuremath{\beta}}^{\ensuremath{'}}$ AuCd have not been calculated explicitly, although it is reasonable to assume that their electronic structures are basically similar to those of the Cu and Ag alloys. The optical properties of the ${\ensuremath{\beta}}^{\ensuremath{'}}$ alloys, including their variations with temperature and composition, are discussed on the basis of the computed bands. The bands and Fermi surface of disordered beta brass have been determined to first order of approximation by combining the K-R method with the "virtual-crystal" model. The electronic structure of $\ensuremath{\beta}$ CuZn differs from that of ${\ensuremath{\beta}}^{\ensuremath{'}}$ CuZn in the following respects: The energy gap across the zone boundary is absent, corresponding to an absence of both the discontinuity in the Fermi surface across that boundary and the "holes" in the corners of the cube. The gap across each face of the dodecahedral zone boundary is reduced from 3.5 to 1.5 eV. Both these effects imply a somewhat more free-electron behavior for the disordered alloy. Finally, the bands are used to discuss the relative importance of electronic contributions and order to the stability of the beta-phase alloys.

A simple model capable of studying the order dependence of the electrical resistivity of noble-metal and transition-metal alloys is proposed. The limit of this model and its connections to other models are discussed.

It is generally understood (Kubo) that the linearized version of the memory function approach of Mori and Zwanzig is equivalent, through the application of the fluctuation–dissipation theorem, to the corresponding linear response theory of correlation function calculations developed in the work of Kadanoff and Martin. We give here a simple example of spin diffusion to show this explicitly, which reflects the general connection between these two approaches.

We prospectively evaluated the ability of the plugged telescoping catheter (PTC) brush and the single sheathed nonplugged catheter brush to provide sterile lower respiratory tract samples during fiberoptic bronchoscopy in 19 noninfected patients with cancer. Both brushes were evaluated, in random order, in each of the 19 patients. The PTC brush and the single sheath brush were sterile in 12 and 5 patients, respectively, and in 7 patients, the PTC brush alone was sterile (p = 0.016, two-sided). Patients were anesthetized by lidocaine administered through the bronchoscope (6 patients), via an aerosol (3 patients), or by transtracheal injection (10 patients). The advantage of the PTC brush was evident only when aerosol or transtracheal anesthesia were used; the PTC brush was sterile in 9 of 13 patients, whereas the single sheathed brush was sterile in only 2 of these 13 (p = 0.016, two-sided). The plugged telescoping catheter brush is therefore more suitable than the single sheathed brush catheter for delivering sterile brushes to the lower respiratory tract during fiberoptic bronchoscopy.

Primary lung carcinoma adjacent to the trachea and paratracheal nodal metastasis without evidence of the primary tumor or airway invasion require invasive surgical procedures to obtain adequate diagnostic tissues. Adequate diagnostic tissue was obtained in 3 of 5 patients with paratracheal masses by means of a bronchoscopic needle aspiration technique. There were no complications.

Lung cancer often requires an invasive surgical procedure to document inoperability. Using a fiberoptic bronchoscope with a flexible needle that can penetrate the walls of the trachea and major bronchi, we sampled mediastinal and hilar lymph nodes in 32 patients. Of 18 patients presenting with a diagnostic problem, 11 had aspirates that were positive for cancer. Surgery in 6 of the remaining 7 showed cancer in 4 (false negative). Ten other patients presented with a staging problem. Four had positive mediastinal aspirates; 3 of these 4 had a normal or equivocally normal mediastinum on chest roentgenogram. Surgery in 4 of the remaining 6 showed no cancer in 4 (true negatives). The procedure was also diagnostic in 2 of 4 patients with recurrent mediastinal small cell carcinoma and in 3 patients with intrabronchial necrotic tumors. There were no complications. We conclude that this is a safe, easily performed procedure that can replace more invasive procedures in the diagnosis and staging of lung cancer.

To investigate the importance of fiberoptic bronchoscopy with transbronchial biopsy (TBB) in clinical decision making, we reviewed 242 consecutive TBB procedures with respect to clinical presentation, roentgenographic pattern of disease, bronchoscopy result, and patient outcome. The specific yield of TBB was greatest in patients with multilobar disease and suspected sarcoidosis, metastatic neoplasm, or opportunistic infection. The value of a nonspecific TBB was estimated from its influence in changing clinically-derived suspicions of disease. Using pretest probabilities based on prebronchoscopic suspicions and likelihood ratios derived from our TBB results, Bayes's theorem was applied to estimate posttest probabilities. Nonspecific TBB reduced the probability of granulomatous pneumonitis. However, only small differences in posttest probabilities were associated with this bronchoscopy result in other patients with multilobar infiltrates, and no differences were observed in those with localized disease.

Ce cas illustre l'utilisation de l'aspiration a l'aiguille transbronchique dans le diagnostic d'un kyste mediastinal bronchogenique localise pres des voies respiratoires centrales

The mechanisms of reentrant ventricular tachycardia were studied in canine post-infarction model. In 15 dogs that weighed 10-20 kg, the anterior descending coronary artery was ligated. 3 to 7 days after coronary artery occlusion, the dogs were reoperated to set up a composite electrode or a patch electrode with 32 bipolar electrodes. The composite electrode was utilized to record ventricular late potentials (VLPs) from the epicardial surface of the infarction zone (IZ) and adjacent normal zone (NZ). The bipolar electrodes were used to record the epicardial isochronal maps. 16 bipolar electrodes were placed over the area of infarction and its bordering zone and the other 16 bipolar electrodes were distributed over the remaining surface of the ventricle. Reentrant ventricular tachycardias were induced by programmed electrical stimulation. The VLPs and epicardial isochronal activation were recorded by SC-16 oscillograph and computerized mapping system during sinus rhythm and programmed stimulation. The experiments showed; 1) VLPs were demonstrated in 11 of the 15 dogs (73.3%) during programmed stimulation. 2) The reentrant circuit has a characteristic figure-8 configuration in the form of two circulating wave-fronts around arcs of functional conduction block that coalesce into a slow commun reentrant wave-front. One of the two synchronous circuits traveled clockwise and the other counter-clockwise. 3) VLPs represent a delayed depolarization at the ischemic myocardium, where the impulse conducts slowly in the reentrant circuit. It is clear that the present study may increase the understanding of the mechanism of ventricular arrhythmias in the late myocardial infarction period.

From March 1986 to April 1987, 70 percutaneous needle aspiration (PCNA) procedures were performed in 66 consecutive patients. Seven immunocompromised patients had the procedure performed to obtain culture material from the lung, and 59 patients with chest lesions were analyzed. This includes 49 patients with either a lung nodule or mass. In the remaining ten patients, there were three chest wall or pleural lesions, two aortic pulmonary window lesions, two right hilar lesions, and three anterior mediastinal lesions. Forty of these 59 patients were ultimately proven to have a malignancy. The diagnostic yield for malignant disease by cytology and histology of PCNA was 97.5 percent (39 of 40). Twelve patients had a final diagnosis of benign disease. The diagnostic yield in benign diseases by PCNA was 91.6 percent (11 of 12). The remaining seven patients do not yet have a final diagnosis, though the clinical course favors benign disease in six of these patients. We attribute the major reason for this high specific diagnostic yield in both malignant and benign diseases to the ability of obtaining histologic specimens for interpretation.

Transbronchial needle aspiration of cytopathological specimens has proven useful in the diagnosis and staging of bronchogenic carcinoma, but its value in conditions requiring histologic confirmation has been hampered by the small size of the sample provided. To expand the utility of this procedure, we designed a larger (18 gauge) needle with a beveled stylet with which tissue cores for histologic study can be obtained during rigid bronchoscopy, and we have evaluated the safety and efficacy of this technique. Diagnoses of five neoplastic and three granulomatous diseases were established in eight of the ten patients with this procedure, and there were no complications. These findings suggest that transbronchial needle aspiration biopsy is relatively safe and effective, further extending the bronchoscopic approach to selected patients with mediastinal disease.

In order to determine if the diagnostic yield of the transbronchial lung biopsy in sarcoidosis is dependent upon the number of biopsies, a study was designed to examine individual specimens from 6 biopsies in patients with Stage II sarcoidosis. It was found that the probability of obtaining a positive specimen per biopsy was 46%, and this percentage remained constant for each biopsy. The diagnostic yield followed a logarithmic curve, gradually increasing from 1 through 4 biopsies until about 90% of true positive diagnoses were obtained, then approaching a plateau with successive biopsies. We therefore recommend that 4 transbronchial lung biopsies are sufficient to diagnose stage II sarcoidosis in the majority of patients with diffuse lung disease.

Thirty-two consecutive patients with mediastinal lesions suggestive of bronchogenic carcinoma underwent transbronchial needle aspiration. Eighteen of 20 patients (90 percent) with proved bronchogenic carcinoma had malignant cytology specimens or tissue fragments. Of 12 patients with normal cytology specimens, six were subsequently proved to have nonneoplastic disease. Transbronchial needle aspiration appears to offer a sensitive and specific alternative to more invasive surgical techniques used in the diagnosis of malignancies with mediastinal involvement.

We present a simple model for calculating the order dependent part of the thermoelectric power of binary alloys.