Progressive tubulointerstitial nephritis and chronic cholestatic liver disease

We report the clinical and morphological features of a distinctive hepatorenal disorder in four patients and review the five similar patients in the literature. The main clinical characteristics were early onset of cholestatic liver disease and progressive tubulointerstitial nephritis leading to renal death in early childhood. Liver histology showed disturbed architecture with nodular and acinar formations and portal fibrosis and bile duct proliferation. Histological abnormalities in the kidney were severe interstitial fibrosis and tubular atrophy and dilatation, while the typical features of nephronophthisis were lacking. These clinical and morphological characteristics distinguish our patients from the majority described, as having nephronophthisis and congenital hepatic fibrosis or any other known syndrome with concomitant hepatorenel involvement. We suggest that the association of cholestatic liver disease and progressive tubulointerstitial nephritis represents a new syndrome.     

The bacteriology of chronic destructive pneumonia

Thirty-four patients with chronic destructive pneumonia (CDP) were investigated bacteriologically and mycologically; specimens were obtained by transtracheal aspiration, percutaneous lung puncture, and open lung biopsy. Anaerobes were isolated in the absence of aerobes in 1 case while specimens from 9 patients yielded aerobes only. In 16 patients both groups of organisms were cultured. Streptococcus viridans was isolated in 12 cases and fungi in 2 cases. Specimens from 8 patients were sterile on culture. All patients had been treated with various antibiotic combinations before specimens were taken. Aerobes, particularly Gram-positive cocci, and anaerobes probably play an important synergistic role in the pathogenesis of CDP.     

Characteristics and management of chronic destructive pneumonia.

In 12 years 627 patients presented to Wentworth Hospital, Natal with chronic destructive pneumonia (CDP). Common symptoms were haemoptysis, the production of foul-smelling sputum, and chest pain. The disease pursued a chronic course with acute exacerbations which may be lethal. The majority of patients were African men aged between 20 and 50 years who were free from other significant disease apart from dental infection. Radiographically and pathologically CDP had the characteristics of a necrotising pneumonia, and microbiological investigation showed mixed aerobic and anaerobic flora in the lower respiratory tract. Gram-positive aerobic cocci and Bacteroides species were the predominant organisms. In 120 patients treatment regimens were based on chloramphenicol, in 429 cephalosporins, and in 78 on combination therapy with cephalosporins, penicillin, and metronidazole. One hundred and seventy patients also required operative management in an attempt to control progress of the disease. The overall inpatient mortality rate from CDP was 7.8%. In the group of patients treated with combination therapy the mortality rate was 1.3%.     

Use of interstitial antibiotic electrophoresis with chronic pneumonia patients

Interstitial electrophoresis of antibiotics included in the complex of curative measures was shown to be highly effective for the treatment of chronic pneumonia. The conclusion was made on the basis of an analysis of results of treatment of 128 patients with chronic pneumonia.     

An acute respiratory distress syndrome revealing a chronic eosinophilic pneumonia

Idiopathic chronic eosinophilic pneumonia (ICEP) is one of the idiopathic hypereosinophilic lung diseases. ICEP differs from idiopathic acute eosinophilic pneumonia (IAEP) by its progressive onset, and the absence of severe hypoxemia. We report a case of acute respiratory distress syndrome revealing an ICEP, which needed a 48h of mechanical ventilation. ICEP is an exceptional cause of acute respiratory failure. Symptoms always improve with corticosteroids. But relapses are frequent after stopping corticosteroid treatment, as well as the occurrence of severe asthma. Distinction between ICEP and IAEP is essential because of its impact on treatment duration and on prognosis.