气道中心性肺间质纤维化

患者男,53岁。因咳嗽、咳痰,进行性气促3年于2004年3月入院。既往体健,无职业接触史,吸烟指数400支/年。2001年初无明显诱因出现咳嗽,少量白色黏痰,同时伴有活动后气喘。经抗生素治疗后,病性时轻时重,呈进行性发展。2004年2月起咳黄痰,气喘进行性加重,外院诊断“继发性肺结核”,     

全髋置换术治疗低龄Ficat Ⅴ期股骨头缺血性坏死一例

1临床资料1．1一般资料患者，男，18周岁，因左髋摔伤后疼痛、左下肢跛行2年，伴左髋疼痛及活动受限进行性加重半年入院。患者系高中学生，于2004年春季从学校约2米高的院墙上摔下，左侧髋部着地，当即感左髋部烈疼痛并左髋活动受限，行一般抗炎、止痛等保守治疗后疼痛减轻，左髋仍活动受限，左下肢跛行。     

吸烟相关性肺间质纤维化1例

吸烟相关性肺间质纤维化是吸烟引起的间质性肺疾病, 相关病例报道较少。现报道1例发生于62岁男性的吸烟相关性肺间质纤维化。CT显示胸膜下呈过度充气改变, 可见薄壁囊肿。病灶镜下可见肺泡间隔明显增宽, 增宽的肺泡间隔由致密透明样变的胶原组成, 其内相对无细胞成分。病变主要分布于胸膜下肺实质内, 深部肺实质中病变具有小叶中心性分布的特点。     

A case of localized persistent interstitial pulmonary emphysema

Interstitial pulmonary emphysema is a well-documented complication of assisted mechanical ventilation in premature infants with respiratory distress syndrome. Localized persistent interstitial pulmonary emphysema (LPIPE) confined to a single lobe was incidentally presented in a 4-day-old female infant. This patient was a normal full-term baby with no respiratory distress symptom and no experience of assisted mechanical ventilation. Chest radiograph showed radiolucent area in right lower lobe zone, which needed differential diagnosis from other congenital lesions such as congenital cystic adenomatoid malformation and congenital lobar emphysema. CT scan showed irregular-shaped air cystic spaces and pathologically, cystic walls primarily consisted of compressed lung parenchyma and loose connective tissue intermittently lined by multinucleated foreign body giant cells.     

Diffuse interstitial pulmonary fibrosis and lung cancer

Forty-two cases of lung cancer complicated with diffuse interstitial pulmonary fibrosis (DIPF) were selected from 13,056 autopsy cases. They were divided into primary (Group I and II) and secondary (Group III) DIPF, and histopathologic and clinicopathologic studies were made. The prevalence of lung cancer with primary DIPF was 17% (8/47) which was significantly (p less than 0.01) higher than that without DIPF (7% or 886/13,009). All eight cases of lung cancer in Group I and II were male, and 7 had cigarette-smoking history. The anatomical sites of lung cancer and DIPF were all peripheral in origin, and in 7 cases located primarily in the lower lobes (left:right = 6:1). Adenocarcinoma was the most common type. The study suggests that male DIPF patients with long clinical history should be followed thoroughly for lung cancer.     

Chronic pulmonary interstitial fibrosis in Amazon parrots

In the Netherlands, a syndrome affecting several species of older Amazon parrots (Amazona sp.) has been described. This syndrome was characterized as a chronic respiratory disease resulting in exercise intolerance. Pathological examination revealed loss of functional lung tissue, pulmonary interstitial fibrosis, and right heart failure. Haematology revealed an elevated packed cell volume as a result of an increase in erythrocyte size and an increased haemoglobin mass per erythrocyte. In two patients, hypoxia and hypercapnia were demonstrated. The aetiology of this syndrome is currently not known. The microscopic lesions resemble those found in Diffuse Interstitial Fibrosis in humans.     

A new model of diffuse interstitial pulmonary fibrosis in the rat

We have produced experimental diffuse interstitial pulmonary fibrosis in rats with a combination of low and repeated doses of paraquat plus continuous exposure to normobaric 74% O2 in the breathing air for several weeks. Pulmonary fibrosis was evaluated histologically and biochemically, through the determination of total collagen content in the lung. Our procedure is characterized by low initial mortality, the development of extensive distortion of the pulmonary architecture, and the presence of severe and diffuse interstitial fibrosis. The model was compared with bleomycin-induced pulmonary fibrosis in the same rat strain, in which the process is focal and leaves most of the lung unaffected. We conclude that lung damage produced by the combination of low doses of paraquat plus normobaric 74% O2 concentration in the breathing air is an adequate experimental model of diffuse interstitial pulmonary fibrosis as it occurs in many of the human cases of this condition.     

The detection of etiologic agents in interstitial pulmonary fibrosis

A multiplicity of etiologic factors can induce interstitial pulmonary fibrosis. A number of cases are associated with the inhalation and deposition of mineral dust and fumes. Many of these are apparently not related to occupational environmental pollution.Systematic investigations of lung tissue (autopsy and biopsy material) from patients suffering from interstitial pulmonary fibrosis of primarily unknown causes often discloses the presence of small amounts of mineral deposits. The methods used for the detection and identification of these substances in isolated lung dust and in thin tissue sections include electron microscopy, electron and x-ray diffraction, and x-ray fluorescence and infrared spectroscopy.     

Carcinoma of the lung and diffuse interstitial pulmonary fibrosis

The clinical and histopathological findings are presented in two cases of diffuse interstitial pulmonary fibrosis in which carcinoma of the lung developed. In one case with rheumatoid arthritis and diffuse interstitial pulmonary fibrosis there was ;malignant pulmonary adenomatosis', an association which does not appear to have been reported before. In the second case idiopathic diffuse interstitial pulmonary fibrosis was complicated by large cell anaplastic carcinoma of the lung.It is suggested that in both cases the development of carcinoma of the lung was a complication of the epithelial hyperplasia and scarring that occurs in diffuse interstitial pulmonary fibrosis.It is also suggested that carcinoma found in the main bronchi in patients with diffuse interstitial pulmonary fibrosis should not be regarded as coincidental unless careful search has excluded a carcinomatous change in the periphery of the scarred lungs.