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For a number of years various clinicians at this institution have been aware of a seemingly high incidence of peptic ulcer in patients with pulmonary emphysema. Little documentation of this association has appeared in the literature, and we have noticed that many physicians are not alert to it. Unrecognized peptic ulceration has been found at postmortem examination in patients with pulmonary emphysema, and in a few instances death has been due to complications of such ulceration. The present review was undertaken to determine the extent of this association in a large representative group of patients. METHODS AND MATERIALSProtocols of all patients with the diagnosis of chronic diffuse pulmonary emphysema hospitalized during the years 1950 to 1953 were reviewed. A total of 586 patients was included. Of these, 479 were studied clinically and 107 were autopsied. The clinical diagnoses were recorded at time of discharge by resident physicians and represent the opinions of at least two physicians, one generally being the consulting staff physician. In the majority of in-stances ordinary clinical criteria such as dyspnea, obstructive breathing on auscultation, anteropos¬ terior enlargement of the chest, decreased cardiac dullness, retraction of rib interspaces on inspiration, and prolonged and slow exhalation at time of vital capacity measurement were used for diagnosis. In many instances specialized respiratory studies were carried out. Chest films were often corrobora¬ tive.Such review of records has its weaknesses, which we are well aware of. It is likely that an occasional nonemphysematous patient was included in error. This however is much less likely than the exclusion of milder, and occasionally even severe, cases of emphysema that go undiagnosed. There is thus an un¬ avoidable selective process whereby the sample becomes weighted with patients hav¬ ing moderate or severe emphysema. The autopsy group included all patients examined post mortem during the aforementioned period who had evidence of diffuse emphysema upon gross examination of the lungs. In 19% the diagnosis was not made clinically, though it was clearly evident at autopsy. As might be expected, a larger propor¬ tion of the autopsied group had severe emphysema.Both the clinical and autopsy emphysema groups were divided into three subgroups : (1) those having a demonstrated peptic ulcer or a demonstrated duo¬ denal deformity at the time of active symptoms, (2) those having symptoms and signs consistent with peptic ulcer but no evident ulcer on a gastro¬ intestinal x-ray series, and (3) those without symptoms or signs or other evidence of an ulcer. There were no significant age differences among the groups or subgroups. The mean age of the nonautopsied patients was 60 ± 8 years (range, 27-82 years), and that of the autopsied group, 61 ± 9 years (range, 26-80 years). Most of the patients were in their sixth decade.The information available for analysis included the duration and severity of emphysema ; the occur¬ rence of cyanosis ; vital capacity and carb...
For a number of years various clinicians at this institution have been aware of a seemingly high incidence of peptic ulcer in patients with pulmonary emphysema. Little documentation of this association has appeared in the literature, and we have noticed that many physicians are not alert to it. Unrecognized peptic ulceration has been found at postmortem examination in patients with pulmonary emphysema, and in a few instances death has been due to complications of such ulceration. The present review was undertaken to determine the extent of this association in a large representative group of patients. METHODS AND MATERIALSProtocols of all patients with the diagnosis of chronic diffuse pulmonary emphysema hospitalized during the years 1950 to 1953 were reviewed. A total of 586 patients was included. Of these, 479 were studied clinically and 107 were autopsied. The clinical diagnoses were recorded at time of discharge by resident physicians and represent the opinions of at least two physicians, one generally being the consulting staff physician. In the majority of in-stances ordinary clinical criteria such as dyspnea, obstructive breathing on auscultation, anteropos¬ terior enlargement of the chest, decreased cardiac dullness, retraction of rib interspaces on inspiration, and prolonged and slow exhalation at time of vital capacity measurement were used for diagnosis. In many instances specialized respiratory studies were carried out. Chest films were often corrobora¬ tive.Such review of records has its weaknesses, which we are well aware of. It is likely that an occasional nonemphysematous patient was included in error. This however is much less likely than the exclusion of milder, and occasionally even severe, cases of emphysema that go undiagnosed. There is thus an un¬ avoidable selective process whereby the sample becomes weighted with patients hav¬ ing moderate or severe emphysema. The autopsy group included all patients examined post mortem during the aforementioned period who had evidence of diffuse emphysema upon gross examination of the lungs. In 19% the diagnosis was not made clinically, though it was clearly evident at autopsy. As might be expected, a larger propor¬ tion of the autopsied group had severe emphysema.Both the clinical and autopsy emphysema groups were divided into three subgroups : (1) those having a demonstrated peptic ulcer or a demonstrated duo¬ denal deformity at the time of active symptoms, (2) those having symptoms and signs consistent with peptic ulcer but no evident ulcer on a gastro¬ intestinal x-ray series, and (3) those without symptoms or signs or other evidence of an ulcer. There were no significant age differences among the groups or subgroups. The mean age of the nonautopsied patients was 60 ± 8 years (range, 27-82 years), and that of the autopsied group, 61 ± 9 years (range, 26-80 years). Most of the patients were in their sixth decade.The information available for analysis included the duration and severity of emphysema ; the occur¬ rence of cyanosis ; vital capacity and carb...
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