Pneumonectomy in Nigeria: Indications and Results

This report reviews the authors'' experience with 35 pneumonectomies over a ten-year period at the University College Hospital, Ibadan, Nigeria. The most common indications for pneumonectomy were TB-destroyed lung and life threatening pulmonary hemorrhage due to suppurative lung disease. Malignant tumors of the lung were featured twice as the cause for pneumonectomies in this study.     

CT Findings in People Who Were Environmentally Exposed to Asbestos in Korea

Asbestos related pleuropulmonary disease has been emerging health problem for recent years. It can cause variable clinical symptoms and radiological abnormalities. However, there has been no report for their characteristics in subjects who were environmentally exposed to asbestos. We reviewed the CT images of 35 people who were environmentally exposed to asbestos in Chungnam province, Korea. The study result showed high incidence of pleural plaque and pulmonary fibrosis on chest CT (94% and 77%, respectively). The common CT findings of lung parenchymal lesions were as follows: centrilobular opacities (94%), subpleural dot-like or branching opacities (80%), interlobular septal thickening (57%), intralobular interstitial thickening (46%), parenchymal bands (43%) and subpleural curvilinear line (29%). There were no significant differences in the prevalence of pulmonary fibrosis and pleural plaques according to sex, age and duration of exposure. In conclusion, pleural plaque and pulmonary fibrosis are common asbestos-related CT finding in the exposed people. Asbestos related lung parenchymal CT findings in the participants with environmental exposure show similar to those observed in the occupational exposure.     

Central venous catheter-related sepsis: one year experience in a large university hospital

Five hundred two central venous catheters (CVC) inserted in 366 patients were evaluated prospectively over a one-year period to determine the frequency and risk factors associated with CVC-related sepsis. A CVC-related infection was suspected in 190 cases (190/502, 38%). A catheter-related sepsis was established in 50 patients (10%). The infection rate was 0.8 cases of sepsis per 100 catheterdays. Staphylococcus epidermidis, Staphylococcus aureus, and Candida spp. were the most frequently isolated etiological agents of sepsis. On univariate analysis, six variables affecting the rate of catheter-related sepsis were identified: neutropenia > 8 days (p < 0.01); AIDS (p < 0.001); haematological malignancies (p < 0.001); total parenteral nutrition (p = 0.001); duration of site use (p = 0.04); high APACHE II score (p = 0.04). The logistic regression analysis revealed that AIDS and haematological malignancies were independent risk factors of catheter-related sepsis. In conclusion, although the incidence of established catheter infection is much lower than the incidence of suspected infection, in most cases it is wise to change the catheter with the guidewire technique and wait for culture of the tip, rather than to remove the catheter immediately.     

急性阑尾炎合并艾滋病患者临床病理特点及其对手术方式的影响

目的 探讨艾滋病患者阑尾炎病理分型特点及与临床手术方式选择的关系。方法 将2013年3月~2018年3月在广州市第八人民医院外科住院治疗的37例急性阑尾炎合并艾滋病患者设为实验组,选取同期同科室治疗的非HIV感染阑尾炎患者50例设为对照组,比较两组病理类型、临床表现和手术方式等方面特点。结果 与非HIV感染患者相比较,艾滋病患者急性阑尾炎病理类型包括急性化脓性阑尾炎、急性坏疽性阑尾炎、结核,马尔尼菲蓝状菌病,巨细胞性病毒性肠炎;其中结核,马尔尼菲蓝状菌病,巨细胞病毒性肠炎发病率高于非HIV患者,差异有统计学意义（P＜0.05）,在艾滋病患者中,导致患者腹腔镜手术中转开腹的主要病理类型包括结核、马尔尼菲蓝状菌病和急性坏疽性阑尾炎。结论 艾滋病患者急性阑尾炎病理类型包括急性化脓性阑尾炎、急性坏疽性阑尾炎、结核、马尔尼菲蓝状菌病、巨细胞病毒性肠炎;其中结核、马尔尼菲蓝状菌病和急性坏疽性阑尾炎等是艾滋病患者LA中转开腹的主要病理类型;术前建立合理的评判标准有助于减少中转开腹可能。     

Central venous catheter-related sepsis in a cohort of 366 hospitalised patients

Five hundred two central venous catheters inserted in 366 patients were evaluated prospectively over a one-year period to determine the frequency and risk factors associated with catheter-related sepsis. For study purposes, in cases in which catheter infection was suspected but the initial blood cultures were negative, the catheters were replaced by guidewire technique; otherwise, the catheters were routinely changed after 21 days by guidewire technique. A catheter-related infection was suspected in 190 cases (190/502, 38%). A diagnosis of catheter-related sepsis was established in 50 patients, which represents 10% of the total number of lines (502). Over a total of 6428 days of catheter use, the infection rate was 0.8 cases of sepsis per 100 catheter-days.Staphylococcus epidermidis, Staphylococcus aureus, andCandida spp. were the most frequently isolated aetiological agents of sepsis. On univariate analysis, six variables affecting the rate of catheter-related sepsis were identified: neutropenia for more than eight days (p<0.001); AIDS (p<0.001); haematological malignancy (p<0.001); administration of total parenteral nutrition (p=0.001); duration of site use (p=0.04); and high APACHE II score (p=0.04). The logistic regression analysis revealed that AIDS and haematological malignancies were independent risk factors of catheter-related sepsis. Catheter replacement over a guidewire was no more likely to be associated with sepsis than was percutaneous catheter insertion. In conclusion, although the incidence of established catheter infection is much lower than the incidence of suspected infection, in most cases of suspected infection it is wise to change the catheter with the guidewire technique and wait for culture of the tip, rather than to remove the catheter immediately. Such a policy may help reduce the number of unnecessary catheter removals.     

High-dose therapy and autologous hematopoietic cell transplantation in children with primary refractory and relapsed Hodgkin's disease: atopy predicts idiopathic diffuse lung injury syndromes.

The use of high-dose therapy (HDT) and autologous hematopoietic cell transplantation (AHCT) for children and adolescents with primary refractory and relapsed Hodgkin's disease is increasing. The purpose of this retrospective analysis was to: (1) evaluate the outcome of HDT and AHCT in pediatric patients with Hodgkin's disease, and (2) identify factors that predispose patients to the development of transplantation-related complications. We describe the experiences of 34 pediatric patients from a single institution with primary refractory or relapsed Hodgkin's disease. HDT regimens consisted of cyclophosphamide and etoposide combined with either carmustine, chloroethylcyclohexylnitrosurea, or fractionated total body irradiation. Kaplan-Meier survival predicts that 67% (95% confidence interval [CI] 47%-87%) of patients will be alive and disease-free at 5 years. Nine patients had disease recurrence, of whom 5 relapsed after 1 year (1.5-6.3 years). Five patients succumbed to treatment-related toxicities, of whom 4 died of pulmonary failure. Fifteen patients (44%) developed post-AHCT idiopathic diffuse lung injury syndrome: acute alveolitis (n = 2); diffuse alveolar hemorrhage (n = 2); acute respiratory distress syndrome (n = 2); delayed interstitial pneumonitis (n = 8); and bronchiolitis obliterans (n = 1). The following factors did not predict for the development of a diffuse lung injury syndrome in univariate analysis: prior treatment with bleomycin, pre-HDT pulmonary function tests, and prior thoracic irradiation. Of the patients in our cohort, 44% had a history of atopy (allergic rhinitis and/or asthma). Multivariate logistic analysis revealed that a preexisting history of atopy was highly predictive of idiopathic pulmonary complications (P = .0001, odds ratio = 21, CI 3.6-125). Our experience shows that HDT followed by AHCT results in durable remissions in two thirds of pediatric patients with refractory and relapsed Hodgkin's disease, and a history of atopy is associated with post-AHCT pulmonary complications.     

Direct immunofluorescent detection of Legionella pneumophila in respiratory specimens.

Respiratory secretions from patients with clinically suspected Legionnaires pneumonia were examined by direc immunofluorescent tests at the Medical Center Hospital of Vermont and at the Center for Disease Control. No fluorescent bacteria were found by either laboratory in eight specimens from eight patients who were seronegative. Twenty specimens were obtained from seven patients who had serologically confirmed Legionnaires disease. Four of the seven cases were identified at the Medical Center Hospital of Vermont, and six of the seven were identified at the Center for Disease Control. Of 20 specimens, 8 were positive at the Center for Disease Control (six or more bacilli per slide), and 7 specimens were suspicious (one to five bacilli per slide); at the Medical Center Hospital of Vermont, 4 of 20 specimens were positive, and 2 were suspicious. The inclusion of a rhodamine-conjugated counterstain at the Center for Disease Control facilitated the examination and may have improved the sensitivity. Smears from transtracheal aspirates, bronchoscopic aspirates, transcutaneous lung aspirates, pleural fluids, and tracheal aspirate-expectorated sputum produced positive results. Several specimens contained fluorescing bacilli when stained for serogroup 2 as well as serogroup 1, perhaps reflecting the presence of cross-reacting antigens in vivo.     

食管癌患者放射性肺损伤预测因素分析及其与 COPD的相关性研究

目的 分析食管癌患者放射性肺损伤（RILI）预测因素,以及其与慢性阻塞性肺疾病（COPD）的相关性。方法 选取2014年1月~2017年12月我院收治的食管癌患者265例为研究对象,均行立体定向放射治疗（SBRT）治疗,治疗前均行肺功能检查,治疗后均行HRCT检查随访RILI的发生情况,回顾性分析RILI的预测因素及其与COPD是否存在相关性。结果 0、1、2、3、4、5级RP发生率分别为38.49%、38.11%、17.74%、5.28%、0.38%、0,其中12例患有间质性肺疾病的患者,9例（75.00%）发生例3级以上的RILI;发生RILI≥1级的相关因素有年龄、总剂量、V20、GOLD分级;重度及极重度COPD组患者的0级RILI的发生率为54.17%,高于轻中度COPD组（42.31%）及无COPD组（30.22%）。结论 年龄、总剂量、V20、GOLD分级与1级以上（有影像学变化）的RILI有相关性,重度COPD的RILI较正常或轻度COPD患者相对较轻,患有间质性肺疾病的患者多发生3级以上的RILI。     

Some new aspects of the pathology,pathogenesis, and aetiology of disseminated lung lesions in slaughter pigs

From 40 pigs rejected for human consumption at slaughter due to an apparent presence of pyemic lung lesions (defined as disseminated processes containing pus and/or necrotic material), the lungs, spleen, liver, and kidneys were subjected to an extended macroscopic examination. Several lung lesions were sampled from each animal for histological and bacteriological examination. Samples from the kidneys and spleens were also subjected to bacteriological examination. At gross level, four groups of lung lesions were identified: 1) disseminated foci with contents of pus and/or necrotic material (n=26); 2) disseminated or multifocally located ecchymoses with a central area of fibroplasia (n=9); 3) non-pneumonic lesions, i.e., disseminated areas of atelectasis (n=1) or haemorrhagic areas developing due to the process of slaughter (n=1); and 4) suppurative lesions without a disseminated distribution pattern (n=3). Histologically, the disseminated suppurative/necrotic foci were identified as: A) abscesses (n=10); B) necrotic lesions (n=6); and C) ectatic or ectatic-like bronchioles with contents of pus and necrotic material (n=10). The macroscopic observation of disseminated centres of fibroplasia with peripheral ecchymoses (n=9) was confirmed histopathologically. The livers of five pigs contained multiple areas of chronic interstitial fibrosis related to migration of Ascaris suum larvae ("milk spotted liver"). Such hepatic lesions were significantly (p<0.01) related to the simultaneous occurrence of disseminated pulmonary ecchymoses with a central area of fibroplasia. Generally, all lung lesions of each individual animal contained identical monocultures of bacteria following this pattern: Staphylococcus aureus (abscesses); Actinomyces hyovaginalis (necroses); S. aureus, A. hyovaginalis, and Arcanobacterium pyogenes (ectatic and ectatic-like bronchioles). Areas with fibrosis were sterile or contained bacteria considered to be a result of contamination. Apart from one kidney, from which S. aureus was cultured, all other organs were sterile. It is concluded that difficulties exist in differentiating pulmonary pyemic lesions from non-pyemic lesions at the gross level. Thus, it was not possible to distinguish between abscesses/necroses and ectatic bronchioles, the pathogenesis of the latter being uncertain. However, the chronic non-pyemic lesions related to the migration of A. suum larvae should be identified by the absence of pus/necrosis. S. aureus was predominantly isolated from abscesses, whereas, and most surprisingly, A. hyovaginalis was the dominant bacterium isolated from the pulmonary necroses.     

Management of Post-Pneumonectomy Empyema and Bronchopleural Fistula in Nigeria

This report reviews our experience with six patients with post-pneumonectomy empyema and bronchopleural fistula over a ten-year period (1969-1978) at the University College Hospital, Ibadan. The most common indications for pneumonectomy in this environment are TB-destroyed lung and suppurative diseases of the lung complicated by massive hemoptysis. Five of the six patients who developed these complications presented with life threatening hemoptysis due to lung abscess and pulmonary aspergillosis. The sixth patient presented with TB destroyed lung.     

Sudden and unexpected death in infancy and childhood due to pulmonary thromboembolism. An autopsy study

Because massive pulmonary thromboembolism is a rarely described cause of sudden and unexpected death in the pediatric age group, a 50-year retrospective review of autopsy cases at the Hospital for Sick Children, Toronto, Canada, was conducted to determine the local incidence and clinicopathologic features of such patients. Only 8 cases (0.05%) from a total of approximately 17,500 autopsies were found. The ages ranged from 1 month to 13 years and predisposing factors included recent surgery, congenital heart disease, in-dwelling venous catheters, sepsis, an arteriovenous malformation, occult malignancy, and prolonged immobility. This study confirms that pulmonary thromboembolism is a diagnosis that must be considered in cases of sudden and unexpected death in the pediatric age group. Its incidence, however, appears to be extremely low even in a relatively high-risk population.     

Impact of Lung Function on Bronchiolitis Obliterans Syndrome and Outcome after Allogeneic Hematopoietic Cell Transplantation with Reduced-Intensity Conditioning

Lung function deterioration contributes to treatment-related morbidity and mortality in patients after allogeneic hematopoietic cell transplantation (allo-HCT). Better understanding of impaired lung function including bronchiolitis obliterans syndrome (BOS) as chronic manifestation of graft-versus-host disease (GVHD) might improve outcomes of patients after allo-HCT.To detect early pulmonary function test abnormalities associated with BOS incidence and outcome after allo-HCT, we performed a retrospective analysis of homogenous-treated 445 patients (median age, 61.9 years; range, 19 to 76 years) with a reduced intensity/toxicity conditioning protocol. The cumulative incidence of BOS was 4.1% (95% confidence interval [CI], 2.6 to 6.4) at 1 year and 8.6% (95% CI, 6.3 to 11.6) at 5 years after allo-HCT with a median follow-up of 43.2 months (range, 3.3 to 209 months). In multivariate analysis, pre-existence of moderate small airway disease reflected by decreased midexpiratory flows before allo-HCT was associated with increased risk for BOS development. In addition, severe small airway disease before allo-HCT and combined restrictive/obstructive lung disease at day +100 after allo-HCT were associated with higher risk for nonrelapse mortality (NRM) due mainly to pulmonary cause of death.In summary, we identified novel pulmonary function test abnormalities prior and after allo-HCT associated with BOS development and NRM. These findings might help to identify a risk population and result in personalized GVHD prophylaxis and preventive or early therapeutic interventions.     

Experience of children with sickle cell anemia in a regular summer camp

The Sickle Cell Program of the Queens Hospital Center Affiliation of the Long Island Jewish-Hillside Medical Center arranged for a group of children from the hospital Sickle Cell Clinic to spend one week during the summer of 1978 in a sleepaway camp for healthy children. This paper analyzës the results of the experience.     

Increased numbers of pulmonary megakaryocytes in patients with arterial pulmonary tumour embolism and with lung metastases seen at necropsy.

AIMS: To compare the number of pulmonary megakaryocytes in patients with local malignant disease without metastases with the numbers in patients with pulmonary tumour emboli without lung metastases and with those with pulmonary metastases. METHODS: The prevalence of pulmonary megakaryocytes was studied in 40 necropsies divided into four groups of 10 cases each: normal lungs (I); localised malignancies (II); pulmonary tumour embolism without lung metastases (III); pulmonary tumour embolism and lung metastases (IV). Five fragments (one of each pulmonary lobe) of tissue lung were collected, embedded in paraffin wax, sectioned, and stained by an immunohistochemical method to detect factor VIII related antigen. The number of megakaryocytes was evaluated in 500 high power fields/case. RESULTS: No differences were observed between groups I and II or between groups III and IV, but there was a 3.5-fold increase in the number of megakaryocytes in the groups with pulmonary tumour embolism or lung metastases compared with those with local neoplasms or normal lungs. CONCLUSIONS: An increased number of pulmonary megakaryocytes correlated with the presence of tumour cells in the microcirculation of the lungs or parenchymal metastases, but not with local malignancies without lung disease. The permanent siting of tumour emboli may stimulate megakaryocytes to migrate to the lungs, and may increase the release of platelets into the pulmonary circulation.     

The effectiveness of sickle cell education in New York City public elementary schools

The present study attempts to ascertain the effectiveness of the health education component of the Queens Hospital Center Sickle Cell Education & Screening Program. The study is limited to children in grades four through six in the New York City public school system. Such elementary school students, representing a large segment of the population, are easily accessible and can be effectively educated about sickle cell disease. The findings indicate that professional sickle cell educators can successfully teach young children about the disease and can do so more effectively than the average schoolteacher.     

Clinical manifestations and predictors of disease progression in drug users with human immunodeficiency virus infection.

BACKGROUND AND METHODS. To examine the clinical course of human immunodeficiency virus (HIV) infection in injection-drug users, we conducted a prospective study of a cohort of patients in a methadone-treatment program in New York City from July 1985 through December 1990. The patients underwent standardized evaluations at base line and semiannually thereafter and received on-site primary medical care. Rates of progression to the acquired immunodeficiency syndrome (AIDS) and major outcomes before the development of AIDS were examined by univariate analyses; the risk of AIDS was also assessed by product-limit survival analysis and proportional-hazards regression. RESULTS. Of 318 HIV-seropositive patients who did not yet have AIDS (171 men and 147 women), 90 were black, 179 were Hispanic, and 49 were white; the median age was 33 years. Over a median of 3.0 years of follow-up, 55 (17 percent) received a diagnosis of AIDS (incidence per 100 person-years, 5.8). Major outcomes before the development of AIDS included oral candidiasis (incidence per 100 person-years, 11.2), pyogenic bacterial infections including pneumonia and sepsis (8.0), pulmonary tuberculosis (1.2), multiple constitutional symptoms (13.6), and herpes zoster (1.3). There were 41 deaths from AIDS, and 13 seropositive patients without AIDS (4.1 percent) died of bacterial infections, as compared with only 1 of 411 seronegative patients studied (P < 0.001). The incidence of AIDS was 62 percent lower among those who took zidovudine than among those who did not (P = 0.02). In the multivariate analysis, progression to AIDS was best predicted by low numbers and percentages of CD4+ lymphocytes, nonuse of zidovudine, and the presence of oral candidiasis, bacterial infections, or tuberculosis. There was no consistent relation between progression to disease and the continued use of injection drugs. CONCLUSIONS. HIV-infected injection-drug users have progression to AIDS at rates comparable to those of other HIV-infected groups, but they have substantial pre-AIDS morbidity and mortality, particularly from bacterial infections, which also appear to predict disease progression.     

The pulmonary pathologic manifestations of the CREST syndrome

This report evaluates the histopathologic alterations of a series of 17 patients with the CREST syndrome and relates these alterations to clinical and functional abnormalities. Histologic abnormalities were classified into the following four distinct patterns: pulmonary vascular changes, primarily intimal fibroelastosis, associated with and without pulmonary hypertension; a pattern of fibrosis indistinguishable from usual interstitital pneumonia (UIP); small airways disease; and mixtures of these three patterns. Five patients (29%) had clinical and morphologic pulmonary hypertension, while five others showed mild reductions in diffusing capacity, presumably due to vascular compromise. Five patients had UIP-like interstitial fibrosis, with vascular alterations and restrictive lung disease. Only one patient had small airways disease exclusively. Concentric fibrointimal proliferation and occlusion of arterioles was worse in patients with clinical pulmonary hypertension and interstitial fibrosis of the UIP type, and was not always associated with pulmonary fibrosis. Twenty-one percent of patients developed primary lung carcinomas. The CREST syndrome is unique in the spectrum of pulmonary alterations seen in progressive systemic sclerosis for its high incidence of clinical pulmonary hypertension and propensity for the development of pulmonary carcinomas.     

Burn wound infections

Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices.     

Carcinoma of the esophagus seen in a 12-year period at Queens Hospital Center.

One hundred forty patients with carcinoma of the esophagus treated over a 12-year period at Queens Hospital Center were reviewed. Comparable numbers of patients were assigned at random to radiation therapy alone, surgical treatment with radiation, or treatment with combinations of radiation and chemotherapy pre- or postoperatively. Surgical mortality (survival 1 month or less) was 9 patients of 34, or approximately 26%. Mean survival including the early deaths was 7.5 months. Deaths were primarily due to respiratory tract complications, either alone or in combination, with three cases of anastomotic leaks, sepsis, inanition, and progressing carcinoma. Fifty-two patients received radiation therapy alone. Although there were only six deaths (10%) within the first month of treatment, average survival was 8.4 months, only marginally greater than those treated by surgery. Of 13 patients treated with combined radiation and chemotherapy, no deaths occurred within the first month of treatment, but the average survival was only 6.5 months. Of nine patients treated with chemotherapy alone, no deaths occurred within the first month of treatment, but mean survival of this small group was only 4.9 months. Efficacy of chemotherapy and radiation therapy as definitive, adjuvant, or palliative therapy, in spite of recent somewhat optimistic reports, remains to be proven. Exploratory surgery should be retained as an essential staging and therapeutic modality in those patients in whom definite evidence establishing inoperability is lacking; ie, tumor fixation to vital structures, distant metastases, and other medical contraindications to surgery. Endoscopic instrumentation with the yttrium aluminum garnet laser appears to have a future as preliminary to surgery or definitive (palliative) management of obstructing esophageal carcinoma.     

Inflammatory pleuropulmonary fibrosis in essential fatty acid deficient rats and the lack of response to methysergide

In view of the association between essential fatty acid (EFA) deficiency and human cystic fibrosis, we have investigated the possible occurrence of pulmonary disease in rats fed an EFA deficient (EFAD) diet for 40 weeks. In contrast to a few slight spontaneous lesions consisting of pleural membrane hyperplasia, which were found in the lungs of control rats, a much greater incidence of fibrotic lesions was observed in the lungs of EFAD rats. These pleuropulmonary fibroses extended from the hyperplastic pleural membrane into the alveoli and were characterized by collagen deposition and marked macrophage infiltration to the exten that, in some cases, the alveolar septa were completely obstructed by inflammatory exudate. These findings lend indirect support to the contention that EFA deficiency plays a role in the aetiology of cystic fibrosis, at least with regard to pulmonary lesions.Administration of methysergide (10 mg/kg/day, p.o.) for a total of 11 weeks, did not alter the incidence of fibrosis in the lungs of EFAD rats, despite the finding that a man who had developed pleuropulmonary fibrosis as a result of chronic methysergide treatment exhibited a relative serum EFA deficiency. While a relative EFA deficiency may be a predisposing factor for the induction of fibrosis by chronic methysergide treatment, our data are not sufficient to make a decision upon this hypothesis.