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The correlations between semi-automated sputum cytometry (ASC), conventional cytology and the final diagnosis was investigated in industrially-exposed workers. Slides of sputum samples from 201 former uranium miners with silicosis, 100 patients with asbestosis, 103 workers resected for lung cancer, and 200 controls (50% smokers), were stained using the Papanicolaou (Pap) method and the Feulgen reaction with thionin. Cytometry was performed using the Cyto-Savant automated system. Atypical nuclei were found in 72 of 404 patient samples, 327 samples were normal and five were inadequate for ASC analysis. Thirteen tumours (Pap IV, Pap V) and 11 cases of severe dysplasia were identified by cytology. Lung cancer was confirmed in 20 patients. Compared to the final diagnosis of lung cancer, the sensitivity of ASC was 75% (15 out of 20) and specificity 89.8% (520 out of 579). The results represent a diagnostic efficiency of 89.3%. The combination of ASC with cytology increased sensitivity to 80% (16 out of 20) without significant loss of specificity (89.7% or 523 out of 581).In this investigation of a limited number of patients with occupational radon or asbestos exposure, semi-automated sputum cytometry appears to be sensitive and reliable for the detection of malignant changes in the tracheobronchial mucosa. Together with conventional cytology, it would be reasonable to test the validity of the combined methods in a large-scale feasibility study of early lung cancer detection. Eur Respir J 2001; 18: 942-950.

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Using the modified radiographic teflon particle method the tracheal mucociliary clearance velocity (TCV) was found to be 13.5 +/- 4.5 mm/min in 36 normal probands. In 18 "normal" smokers there was a statistically slightly significant diminution when compared with 18 age-matched non-smokers (12.1 +/- 5.7 vs 15.0 +/- 4.2 mm/min; P less than 0.1). Some smokers with values below 7 mm/min could be "potential chronic bronchitis". Acute exposure to cigarette smoke led to a decrease of TCV from 19 to 8 in healthy smokers, and from 20 to 5 mm/min in nonsmokers. Whereas TCV was equally diminished to values between 0 and 5 mm/min in chronic bronchitis (n = 42), bronchial carcinoma (n = 8) and advanced bronchial asthma (n = 8), patients with bronchiectasis (n = 8) showed marked negative tracheal clearance of up to -25 mm/min.

A retrospective study of 60 bronchofiberscopic lavage procedures following lung surgery showed an increase of prebronchoscopy oxygen partial pressure from 64.2 mmHg (S.D. +/- 16.2) to 69.9 mmHg (S.D +/- 18.0) after bronchoscopy (P less than 0.01), while carbon dioxide partial pressure did not change significantly. Lobectomied patients tended more often to develop ipsilateral atelactases, invariably responding well to lavage; this group may benefit from prophylactic fiberoptic lavage. Cases are presented to demonstrate this point and to show the need for repeated lavage in some instances. Administration of a standard premedication dosage to patients sedated for other reasons occasionally led to worsened respiratory status; pre-medication should be reduced or eliminated in sedated patients. The effective application of lidocain and salbutamol intrabronchially is discussed. The bronchofiberscope is an important tool in optimal post-operative management of lung surgery patients.