Pulmonary Affectation of Vasculitis

Respiratory tract affectation is frequent in some types of vasculitis, fundamentally in those associated with anti-neutrophil cytoplasmic antibodies (ANCA). The clinical, radiological and histopathological presentation is also heterogeneous and conditions the evolution. It is therefore necessary to establish an early diagnosis based on the symptoms because, thanks to new treatments, and despite them being potentially serious diseases, their prognosis has improved considerably in recent years.The present paper updates the diagnosis and the new therapeutic options for pulmonary vasculitis.     

Silica and Asbestos Exposure in ANCA-Associated Vasculitis with Pulmonary Involvement

Silica and asbestos exposure are thought to belong to the triggering factors of antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis. We carried out a study to find out whether patients with pulmonary involvement attributable to ANCA-associated vasculitis (AAV) have been exposed to silicon-containing materials. Thirty-one patients (12 women, 19 men, median age 51 years) were interviewed using a structured questionnaire. Occupational exposure to silicon-containing chemicals was reported by 22.6% of the patients (12.9% to SiO₂, 9.7% to asbestos), compared with 0% of control subjects (p < 0.05). Our findings support the pathophysiologic role of silica in AAV.     

Idiopathic Pulmonary Hypertension After Liver Transplantation

Pulmonary hypertension is one of the problems that can be encountered before liver transplantation. It is not expected in cases with no additional disease in postoperative period. Herein, we report on a 43-year-old woman who developed idiopathic pulmonary hypertension in the early postoperative period. Further investigation both pathologically and clinically is needed in patients undergoing living donor liver transplantation that may help to solve the problems such as pulmonary arterial hypertension before it occurs and manage complex hemodynamic changes successfully in the future.     

Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis

Background

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease of unknown origin that affects about 40,000 new patients every year in the USA. Albeit the disease is labelled as idiopathic, it is thought that pathologic reflux, often silent, plays a role in its pathogenesis through a process of microaspiration of gastric contents.

Aims

The aim of this study was to review the available evidence linking reflux to IPF, and to study the effect of medical and surgical therapy on the natural history of this disease.

Results

Medical therapy with acid-reducing medications controls the production of acid and has some benefit. However, reflux and aspiraion of weakly acidic or alkaline gastric contents can still occur. Better results have been reported after laparoscopic anti-reflux surgery, as this form of therapy re-establishes the competence of the lower esophageal sphincter, therefore stopping any type of reflux.

Conclusions

A phase II NIH study in currently in progress in the USA to determine the role of antireflux surgery in patients with GERD and IPF. The hope is that this simple operations might alter the natural history of IPF, avoiding progression and the need for lung transplantation.

     

特发性肺间质纤维化患者的护理

对18例特发性肺间质纤维化患者采用糖皮质激素、免疫抑制剂及对症支持治疗,在此基础上给予心理护理、呼吸功能训练、氧疗、药物治疗等措施.结果 18例患者住院期间临床症状明显缓解,无护理并发症发生.     

牛黄解毒片乙醇浸泡液外敷治疗小儿输液外渗

对18例特发性肺间质纤维化患者采用糖皮质激素、免疫抑制剂及对症支持治疗，在此基础上给予心理护理、呼吸功能训练、氧疗、药物治疗等措施。结果18例患者住院期间临床症状明显缓解，无护理并发症发生。     

PFTS在青少年特发性脊柱侧凸术前检查中的临床意义

目的：探讨青少年特发性脊柱侧凸后路矫正融合术患者术前肺功能检查异常发生率,以及其与术后肺部并发症相关性,方法：回顾性复习了１３１例符合条件青少年特发性脊柱侧凸患者的病历记录和影像检查如术前、术后出现的心肺系统的症状和体征。结果：绝大多数患者术前ＰＦＴｓ正常（７３．２８％）,术前出现的呼吸系统症状和ＰＦＴｓ结果异常显著相关（Ｐ〈０．００１）。１３１例患者中仅４例发生了术后肺部并发症（发生率３．０１％