Lymphocytic interstitial pneumonia associated with common variable immunodeficiency resolved with intravenous immunoglobulins

Lymphocytic interstitial pneumonia (LIP) is a rare form of interstitial lung disease. A few case reports have described an association with common variable immunodeficiency (CVID). Corticosteroids are usually used to treat symptomatic patients but their efficacy has never been studied in a controlled trial. We describe a patient with LIP and CVID who was treated monthly with intravenous immunoglobulins (IVIG) without steroids. The patient improved dramatically. We believe that, in selected cases of LIP and immunodeficiency, IVIG given monthly should be considered as the only treatment without adding steroids.     

Is Interstitial Pneumonia in Patients with Collagen Diseases a Contraindication to Lung Cancer Surgery?

Purpose

Lung cancer surgery can be dangerous in patients with interstitial pneumonia (IP) as acute exacerbation of the IP may prove fatal. It remains unclear if patients with collagen diseases (CD), who often suffer from IP, are also at increased risk during lung cancer surgery.

Methods

We retrospectively examined 17 (3.1%) patients with CD among 545 patients who underwent surgery for lung cancer at our institution.

Results

Nine patients with rheumatoid arthritis, five with systemic sclerosis, two with Sjögren's disease, and one with systemic lupus erythematosus were enrolled in this study. Eleven patients (65%) were taking corticosteroids at the time of surgery. Fourteen patients underwent lobectomy and lymph node dissection, and three patients with pStage IA lung cancer underwent pulmonary wedge resection. Pathologically, 11 (65%) patients had IP with various inflammatory cellular infiltrations, and three (18%) had honeycombing of the lung. Postoperatively, none of the patients suffered acute exacerbation of their IP.

Conclusions

Despite the high incidence of IP in patients with lung cancer and CD, our results suggest that CD is not a contraindication to the surgical resection of lung cancer.

     

腹腔镜在输卵管间质部妊娠早期诊断及治疗中的应用

目的:探讨腹腔镜在输卵管间质部妊娠早期诊断及治疗的临床价值。方法:回顾性分析2003年1月~2006年7月应用腹腔镜诊治输卵管间质部妊娠16例的临床资料。结果:16例B超及血β-HCG均异常,拟诊为输卵管间质部妊娠,经腹腔镜检查均得以确诊。16例均在腹腔镜下采用电凝切除患侧输卵管,无术中及术后并发症,临床治愈率100%。与剖腹组比较,无持续性宫外孕发生,且出血少、手术时间短、术后住院时间短。结论:输卵管间质部妊娠腹腔镜手术时可以在确诊的同时给予治疗,手术创伤小,疗效满意,优于开腹手术。     

慢性肾脏病合并肺孢子虫肺炎诊治分析

目的：提高对慢性肾脏病（CKD）患者合并肺孢子虫肺炎（PCP）的认识。方法：回顾性分析4例CKD合并PCP患者的临床症状、影像学及实验室资料,分析诊断及治疗转归情况。结果：4例临床均表现为发热、咳嗽、胸闷等,3例出现Ⅰ型呼吸衰竭,1例顽固性低氧血症。其中3例支气管肺泡灌洗液痰姬姆萨染色找到伊氏肺孢子菌,1例支气管肺泡灌洗液痰PCR检测伊氏肺孢子菌虫体DNA（＋）。4例中IgA肾病2例,肾淀粉样变性1例,膜性肾病1例。4例均应用激素治疗,有2例同时应用环磷酰胺（CTX）,激素及CTX均为常规用法、用量。4例均予卡泊芬净及复方磺胺甲唑治疗,均好转出院,无副反应。结论：PCP是接受激素和（或）CTX治疗的CKD患者肺部机会感染之一。典型的胸部X线尤其是CT征像对PCP的诊断具有重要意义,但早期胸部X线和CT征像多不典型。对接受激素和（或）CTX治疗的CKD患者,如出现发热、进行性呼吸困难,应尽早行痰或支气管肺泡灌洗液姬姆萨染色涂片找伊氏肺孢子菌或PCR检测伊氏肺孢子菌虫体DNA。卡泊芬净及复方磺胺甲唑治疗PCP效果均明确,无明显副作用,卡泊芬净可以作为治疗PCP的首选药物。     

A rare case of human pulmonary dirofilariasis with a growing pulmonary nodule after migrating infiltration shadows,mimicking primary lung carcinoma

IntroductionPulmonary dirofilariasis is a rare pulmonary parasitic infection by the nematode Dirofilaria immitis. It is characterized by an asymptomatic pulmonary nodule usually seen on chest X-ray. The differential diagnosis of pulmonary dirofilariasis includes other pulmonary diseases, primary lung carcinoma and metastatic lung tumor.Case presentationPulmonary dirofilariasis was diagnosed in a woman who presented with interstitial pneumonia. Growth of the pulmonary nodule was detected subsequent to hemoptysis. The histological diagnosis was made based on a wedge resection performed under video-associated thoracic surgery (VATS).ConclusionPulmonary dirofilariasis often varies in its clinical course. The diagnosis is best made using wedge resection under VATS.     

How does interstitial cystitis begin?

Background

Interstitial cystitis (IC) does not start as an endstage disease, it has a beginning when symptoms are milder, intermittent and the disease is misdiagnosed. To determine how IC develops patients were interviewed on when their symptoms began, what they were and are now as well as the various diagnoses that they received before they were determined to have IC.

Methods

One hundred female IC patients were screened. They filled out a questionnaire asking about the age their disease presented, their initial and current symptoms, what their original diagnoses were, effect of the menstrual cycle and sexual activity on their symptoms and about any relatives with bladder symptoms or a current diagnosis of IC.

Results

By age 30, 81% of patients had bladder symptoms, 21% before age 10. The first symptom was frequency in 81%, pain present in 59% and the symptoms were intermittent in 64%. Most common early misdiagnosis was UTI in 74% with 93% reporting negative urine cultures. Sex was painful and causes symptom flares in 82%, symptoms flared the week before the menses in 75%. Most common gynecologic diagnosis was yeast vaginitis, 42%. Urge incontinence was present in 33%. There were 51% that reported bladder symptoms in a first degree female relative.

Conclusions

IC begins primarily with frequency and is intermittent in most patients with symptom flares associated with sexual activity. Pain and urgency incontinence tend to be a later symptoms. When IC flares the most common misdiagnosis is UTI. Symptoms begin before age 30 in most but an IC diagnosis is often not made until age 40. Genetics appear to play a significant role. It is important to consider these facts when evaluating women with “early IC” because correct diagnosis will result in proper therapy and reduced health care costs.     

Clinical analysis of interstitial pneumonia after surgery for lung cancer

Objective: The postoperative development or exacerbation of interstitial pneumonia (IP) in lung cancer patients often affects prognoses. We analyzed the patients who suffered from IP after surgery, to determine treatment and prevention of IP. Methods: One hundred and one consecutive patients who underwent resection were enrolled in the study. Clinical background and post-, perioperative course were compared between patients who developed IP and those who did not. Results: If IP developed or was exacerbated, steroid pulse (SP) therapy, immunosuppressant (IS) therapy or nitric oxide (NO) inhalation therapy was employed. Of 101 patients, 20 had suffered from IP before surgery. In four of these 20 (20%), postoperative exacerbation was observed. SP therapy was given to all patients. To one patient, IS and NO therapy were added. Three of the four patients died. 81 patients did not have IP; three of them (3.7%) developed IP after the operation and were treated with SP therapy. To one patient, IS and NO therapy were added. Two of the three patients died. IP development or exacerbation after surgery was observed in seven of 101 patients, and five of them died. It was significantly more frequent in patients with poorly differentiated squamous cell carcinoma, restrictive change in pulmonary function tests, and a low percentage diffusion capacity for carbon monoxide. Postoperative development or exacerbation was observed in patients who had undergone lobectomy or pneumonectomy. Conclusions: Postoperative IP is a serious complication. Further studies are needed to determine definitive therapeutic options. For the patients with the aforementioned risk factors, limited surgery must be considered.     

Epidemiology of organising pneumonia in Iceland

BACKGROUND: Cryptogenic organising pneumonia (COP) has also been called idiopathic bronchiolitis obliterans organising pneumonia. In secondary organising pneumonia (SOP) the causes can be identified or it occurs in a characteristic clinical context. The aim of this study was to determine the incidence and epidemiological features of COP and SOP nationwide in Iceland over an extended period. METHODS: A retrospective study of organising pneumonia (OP) in Iceland over 20 years was conducted and the epidemiology and survival were studied. All pathological reports of patients diagnosed with or suspected of having COP or SOP in the period 1984-2003 were identified and the pathology samples were re-evaluated using strict diagnostic criteria. RESULTS: After re-evaluation, 104 patients fulfilled the diagnostic criteria for OP (58 COP and 46 SOP). The mean annual incidence of OP was 1.97/100 000 population (1.10/100 000 for COP and 0.87/100 000 for SOP). The mean age at diagnosis was 67 years with a wide age range. The most common causes of death were lung diseases other than OP, and only one patient died from OP. Patients with OP had a lower rate of survival than the general population, but there was no statistical difference between COP and SOP. CONCLUSIONS: The incidence of OP is higher than previously reported, suggesting that OP needs to be considered as a diagnosis more often than has been done in the past.     

Interstitial pneumonia and advanced age negatively influence postoperative pulmonary function

Open in a separate window OBJECTIVESChanges in postoperative pulmonary function vary among patients after lobectomy. We aimed to define preoperative factors that negatively influence postoperative % vital capacity (%VC) in patients treated by lobectomy.METHODSWe included 276 patients who had been treated by lobectomy at our institution between 2007 and 2018 and their preoperative and postoperative pulmonary function data were complete. We assigned them to groups based on postoperative pulmonary function defined as better (good) or worse (poor) than predicted %VC, then compared clinicopathological findings between them. Poor postoperative pulmonary function was also assessed using logistic regression analysis.RESULTSInterstitial pneumonia (IP) was diagnosed in 37 (13.4%) patients. The preoperative and postoperative %VC values were, respectively, 101.1% (interquartile range, 90.5–110%) and 87.6% (interquartile range, 73.8–99.1%). Logistic regression analysis revealed that IP, advanced age (≥75 years), and induction therapy were independent risk factors for reduced postoperative pulmonary function [odds ratios 3.01 (1.41–6.41), 2.49 (1.35–4.60), and 9.03 (2.43–33.5), P = 0.0044, 0.0035, and 0.001, respectively]. Postoperative %VC worsened with increasing IP severity and advanced age. Six (75%) of 8 patients aged ≥80 years with usual IP or suspected usual IP on preoperative computed tomography images had poor postoperative %VC.CONCLUSIONSSurgical indications for lobectomy based on predicted postoperative %VC require careful consideration for elderly patients with IP, particularly those aged ≥80 years.     

肝移植术后间质性肺炎的诊治经验

目的总结诊治肝移植患者术后间质性肺炎的经验。方法回顾分析2001年4月至2009年6月期间诊治的8例同种异体肝移植术后间质性肺炎病人的临床资料。结果8例肝移植术后间质性肺炎患者的发病时间为术后17～117 d,平均84 d,其中7例发生于术后2～4个月。8例均有发热,其中抗巨细胞病毒(CMV)特异性抗体CMV-IgM阳性及CMV-DNA阳性4例,胸部CT均有明显间质性肺炎表现。经调整抗排斥药物用量、使用更昔洛韦及呼吸支持治疗后,4例患者临床症状明显好转,胸部CT恢复正常;4例患者病情进展,继发细菌或真菌感染,死于呼吸衰竭。结论肝移植后间质性肺炎临床表现无特异性,病死率高,应及时予胸部CT检查,同时加强病原体的监测。确诊后予调整免疫抑制剂用量、早期抗病毒治疗及对症支持治疗,以提高治愈率。     

肾移植术后间质性肺炎的诊断与治疗

目的:探讨肾移植术后并发间质性肺炎的临床诊断和治疗方法。方法:回顾性分析15例肾移植患者术后并发间质性肺炎的临床资料。结果:5例血巨细胞病毒DNA阳性,4例血巨细胞病毒IgM阳性,2例找到卡氏肺孢子虫病体。经过综合治疗,12例痊愈,3例死于ARDS。结论:肾移植术后并发间质性肺炎病情凶险,寻找病原体是关键。在病原体确定前经验性使用抗生素治疗,找到病原体后改为降阶梯性治疗,撤减免疫抑制剂,使用免疫增强剂,加用甲基泼尼松龙,纠正低氧血症,效果较好。     

皮肌炎合并急性／亚急性间质性肺炎临床研究

目的了解合并急性,亚急性间质性肺炎（MSIP）的皮肌炎患者临床特点及转归。方法收集10例皮肌炎合并A／SIP患者（MSIP组）临床资料,与同期收治的非A／SIP皮肌炎肺间质病变患者9例（非A／SIP组）进行对照,对患者生存率进行统计分析。结果与非A／SIP组相比,A／SIP组患者病程较短,发热、眶周红斑发生率较高,而血清肌酸激酶不高,胸部CT多数可见毛玻璃样改变（P〈0．01或〈0．05）;A／SIP组患者生存率显著降低,至6个月时仅有1例存活（P=0．0001）。Logistic回归分析显示,激素、环磷酰胺、环孢素联合治疗病死率较低,但差异无统计学意义（P=0．107）。结论皮肌炎合并MSIP病情进展快、病死率高,需要早期进行诊治。对于发病初期即出现胸闷气急,尤其伴有反复发热、眶周红斑而血清肌酸激酶不高的患者须警惕其发展为A／SIP。激素联合环磷酰胺、环孢素可能是较为有效的治疗方案。     

Palliative Care in Diffuse Interstitial Lung Disease: Results of a Spanish Survey

Introduction

Interstitial lung diseases (ILD) and, in particular, idiopathic pulmonary fibrosis, may have a significant impact on patient survival. Recent studies highlight the need for palliative care (PC) in the management of ILD patients. The aim of this study was to determine the current situation of PC in patients in Spain.