Chest
Volume 105, Issue 2, February 1994, Pages 339-342
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Clinical Investigations
Cardiology
Clubbing of the Fingers and Smooth-Muscle Proliferation in Fibrotic Changes in the Lung in Patients With Idiopathic Pulmonary Fibrosis

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In our study of 52 patients with idiopathic pulmonary fibrosis (IPF), we found that the incidence of clubbing of the fingers was significantly more frequent in male than in female patients and in patients who showed lesser grades of honeycombing and higher grades of smooth-muscle proliferation in the pulmonary fibrotic changes (p< 0.01). Smooth-muscle proliferation in fibrotic changes of open lung biopsy specimens correlated with the mode of detection of IPF and the presence of clubbing of the fingers, duration of symptoms of the lower respiratory tract, and a higher extent of pulmonary infiltrates on chest radiographs (p< 0.05). However, the presence of clubbing of the fingers or grades of smooth-muscle proliferation in the pulmonary fibrotic changes did not correlate with the 2-year survival after open lung biopsy.

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Patients

Fifty-two patients (42 male and 10 female) who underwent open lung biopsy and were diagnosed as having IPF clinically and UIP pathologically were studied.2, 3 Mean age of the patients was 57.7 years (range, 38 to 72 years) at the time of lung biopsy. Twenty-six patients (25 male and 1 female) were smokers, 15 male patients were ex-smokers, while 11 patients (2 male and 9 female) had never smoked.

Open lung biopsy specimens were fixed using 10 percent formalin and were embedded in paraffin.

Results

A significant correlation was found between clubbing of the fingers and smooth-muscle proliferation in pulmonary fìbrotic lesions in patients with IPF (Tables 1 and 2). Patients (34) with clubbing of the fingers showed higher grades of smooth muscle proliferation than patients (18) without clubbing (p < 0.01). Clubbing of fingers was noted more frequently in male than in female patients (p < 0.01). However, patients with clubbing of the fingers had lesser grades of honeycombing in the open lung

Discussion

Clubbing is defined as a painless uniform swelling of soft tissues of the terminal phalanx.8 Since the antiquity of Caelius Aurelianus (circa 200 AD), certain changes in the fingers have pointed toward a probable coexistence of serious internal diseases.9 It was also pointed out that clubbing due to bronchopulmonary disease was not associated with an increase of the volume of blood in the distal segment of the finger in contrast to clubbing due to congenital heart disease.10 Bigler9 noted that

ACKNOWLEDGMENTS

The authors are grateful to the physicians and staff of the Chest Disease Research Institute, Kyoto University, for the close collaboration during, the study. They are also grateful to Ms. S. Yamane and Ms. M. Yamada for their technical assistance, Ms. A. Fujimura for her statistical analysis of the data, and Ms. A. Germeraad for revising the English manuscript. This study was supported by a grant from the Smoking Research Foundation in Japan.

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