Informative value of a cytological method of examination in lung diseases

A total of 8055 cytological examinations of the sputum, bronchial secretion, pleural exudate, aspirate of the puncture of the lungs and peripheral lymph nodes were performed in 6525 patients with different pulmonary diseases. Neutrophilic, macrophagal and eosinophilic types of changes on cytograms were of clinical importance in patients with inflammatory bronchial and pulmonary diseases and bronchial asthma. In sarcoidosis epithelioid cells in the bronchial secretion were found in 11%, specific elements in tuberculosis in 5% of the patients. Comparison of the cytological and histological data in cancer patients showed coincidence in 94% of the patients. A possibility of a wide use of cytological studies in comprehensive diagnosis of pulmonary diseases was proved and their clinical importance shown.     

以咯血为突出表现的COPD并侵袭性肺曲霉病误诊一例

目的 分析慢性阻塞性肺疾病（COPD）并侵袭性肺曲霉病（IPA）的临床特征及误诊原因,以期提高早期诊治水平.方法 对以咯血为突出表现的COPD并IPA误诊1例的临床资料进行回顾性分析.结果 本例以咯血为突出表现,经相关医技检查拟诊为肺部感染、支气管扩张症,予广谱抗生素、糖皮质激素治疗无效且病情加重,3次痰培养提示曲霉菌感染,真菌葡聚糖及内毒素检查阴性,行抗真菌治疗后,临床治愈.确诊为COPD并IPA.结论 COPD并IPA临床诊断较困难,综合分析患者临床表现及多次行影像学、微生物学、血清学检查是提高该病诊断率、改善患者预后的有效手段.     

恶性血液病患者肺部并发症的手术治疗及病理结果

目的 通过外科手术或胸腔镜技术去除恶性血液病肺部并发症患者的肺部病灶,并明确病灶性质.方法 对17例血液系统恶性肿瘤有肺部并发症,诊断不明和内科治疗无效患者进行开胸手术或胸腔镜肺叶全切、部分切除或病变部位楔形切除术,并对所取组织标本行常规苏木精-伊红染色病理形态学观察.结果 术后组织病理结果证实:9例患者为肺部曲霉菌感染;3例为亚急性炎症,纤维化伴血肿;1例为肺梗死,周边局部肉芽肿改变;1例为肉芽肿性炎症伴钙化结节;1例为肺泡腔扩张伴出血,间质纤维化,灶性血管炎;1例为肋间神经鞘瘤;1例为中分化腺癌伴肺内转移.术前术后诊断符合率达64.3%(14例中9例).手术并发症包括真菌种植1例、胸腔积液伴胸膜黏连3例,肺内血肿2例.术后8例患者接受异基因或自体造血干细胞移植(HSCT)7例移植顺利.证实为曲菌病感染的5例患者,接受真菌再发预防治疗的同时实施移植,4例移植顺利,始终未出现真菌复发,1例肺部真菌感染再发死亡.结论 恶性血液病患者合并迁延不愈或内科保守治疗无效或咯血的肺部感染,或诊断不明的肺部病变,应及时接受手术治疗清除病灶,明确诊断,为血液病后续治疗创造条件.     

同轴微导管超选择性支气管动脉栓塞治疗大咯血

本文报道同轴徽导管超选择性支气管动脉插管治疗8例内科治疗无效的大咯血病人。8例均达到立即止血的目的,一例首次选择性支气管动脉栓塞3天后复发出血,行超选择栓塞后未再次出血。随访2～9个月,一例栓塞两月后原发病恶化并复发出血拒治死亡,其余病人无复发出血,无严重并发症发生。结果表明超选择性支气管动脉栓塞止血操作简单,止血迅速,效果确切,并发症少,是一值得推广的技术。     

特发性肺含铁血黄素沉着症的误诊及对策

目的：探讨特性肺含铁血黄素沉着症（IPH）的临床特点、误诊原因及对策。方法：对误诊的23例IPH病例进行回顾性分析。结果：本组病例临床表现上主要为面色苍白、乏力（91．30％）、咳喘（69．57％），咯血或呕血（52．17％），肝脾肿大（39．13％）及肺部罗音（34．78％）。23例中先后误诊为：缺铁性贫血、肺结核、肺炎、支气管扩张，误诊时间最短10d，最长6a。对IPH认识不足是误诊的主要原因，对反复性持续性或进行性加重的小细胞低色素性贫血以及反复咳喘、咯血、常规抗炎治疗效果不佳，均应考虑本病，耐心、多次检查小儿痰液及胃液中含铁血黄素巨噬细胞是提高确诊率的关键。     

纤支镜活检和痰液标本FHIT基因检测对肺癌诊断的意义

目的：明确检测肺癌手术标本、纤支镜活栓和痰液标本FHIT基因转录本缺失在肺癌诊断中的意义。方法：应用RT-PCR法检测41例肺癌手术标本癌组织和9例良性肺疾病肺组织手术标本以及80例肺癌和30例良性肺疾病纤支镜活检标本及全部的160例患者痰液标本FHIT基因转录本缺失，并与病理组织学、刷检细胞学和痰液细胞学检查结果比较。结果：肺癌组织FHIT基因转录本缺失的阳性率[70．7％（29／41）]高于癌旁正常组织（5／41）和良性肺疾病组织（0／9）（P〈0．005）；纤支镜活检标本FHIT基因转录本缺失阳性率[70．0％（56／80）]高于良性肺疾病（2／30）（P〈0．005）；痰液FHIT基因转录本缺失联合痰液细胞学检查诊断肺癌的敏感性（73．6％）高于单独痰液细胞学（47．1％）或痰液中FHIT基因转录本缺失（52．1％）（均P〈0．005）。与单独痰液细胞学相比。两者联合检测使诊断肺癌的敏感性由原来的47．1％提高至73．6％（P〈0．005）．阴性预测值由原来的37．9％提高至54．9％（P〉0．05），特异性不变。结论：在肺癌组织中检测FHIT基因转录本缺失可能成为肺癌诊断的分子标志物之一。痰液中FHIT基因转录本缺失检测为肺癌无创诊断提供了一个新的辅助指标。[著者文摘]     

Sputum cytology.

The primary purpose of sputum cytology is to detect preinvasive and invasive malignancy. Candidates for the screening procedure include long-time smokers with productive cough, patients chronically exposed to asbestos, patients with hemoptysis, persistent cough and/or weight loss, and asymptomatic patients with x-ray lesions or unexplained pleural effusions. The procedure is inexpensive and highly diagnostic. Five consecutive specimens produced by deep coughing are required for adequate evaluation.     

Solitary pulmonary metastasis presenting 20 years after primary resection of Wilms tumor

Wilms tumor is the most common renal malignancy of childhood. Relapse occurs most often within 4 years of initial diagnosis, and the most common site of metastasis is the lung. We describe a 22-year-old man who presented with hemoptysis and a solitary pulmonary lesion 20 years after primary resection of Wilms tumor. Computed tomography of the chest showed an indeterminate pulmonary mass of heterogeneous attenuation with no other intrathoracic abnormalities. Surgical resection revealed a solitary pulmonary metastasis from Wilms tumor. Further evaluation yielded no evidence of extrathoracic metastases. This case shows that late relapse in the form of a solitary pulmonary mass can occur in patients with Wilms tumor.     

微生物检验在肺曲霉菌感染患者临床诊治中的应用价值

目的分析微生物检验在肺曲霉菌感染临床诊断及治疗中的应用价值。方法回顾性选择2017年8月至2019年9月接收的75例肺曲霉菌感染患者为研究对象,采用GM试验、G试验及痰培养三种方法予以微生物检验,比较三种检测方法及联合检验对肺曲霉菌的阳性检出率。同时,比较寄生型和侵袭型肺曲霉菌感染患者的临床表现、治疗方法及预后。结果GM试验对寄生型、侵袭型肺曲霉菌的阳性检出率均高于G试验和痰培养(P<0.05);三项联合检验对寄生型肺曲霉菌的阳性检出率均高于三项单独检验(P<0.05);三项联合检验对侵袭型肺曲霉菌的阳性检出率均高于G试验和痰培养单独检验(P<0.05)。寄生型肺曲霉菌感染患者咯血发生率高于侵袭型肺曲霉菌感染患者,发热、咳嗽、胸闷及肺啰音发生率均低于侵袭型肺曲霉菌感染患者(P<0.05)。寄生型肺曲霉菌感染患者以手术治疗为主,药物治疗为辅,治愈率为94.00%;侵袭型肺曲霉菌感染患者以药物治疗为主,治愈率为92.00%。结论微生物检验方法的联合应用可有效提高肺曲霉菌感染的诊断率,并为寄生型和侵袭型肺曲霉菌感染患者的治疗方法及预后评估提供参考依据。     

Hemoptysis: diagnosis and management

Hemoptysis is the spitting of blood that originated in the lungs or bronchial tubes. The patient's history should help determine the amount of blood and differentiate between hemoptysis, pseudohemoptysis, and hematemesis. A focused physical examination can lead to the diagnosis in most cases. In children, lower respiratory tract infection and foreign body aspiration are common causes. In adults, bronchitis, bronchogenic carcinoma, and pneumonia are the major causes. Chest radiographs often aid in diagnosis and assist in using two complementary diagnostic procedures, fiberoptic bronchoscopy and high-resolution computed tomography, which are useful in difficult cases and when malignancy is suspected. The goals of management are threefold: bleeding cessation, aspiration prevention, and treatment of the underlying cause. Mild hemoptysis often is caused by an infection that can be managed on an outpatient basis with dose monitoring. If hemoptysis persists, consulting with a pulmonologist should be considered. Patients with risk factors for malignancy or recurrent hemoptysis also require further evaluation with fiberoptic bronchoscopy or high-resolution computed tomography. In up to 34 percent of patients, no cause of hemoptysis can be found.     

A primary tracheal carcinoid tumor masquerading as chronic obstructive pulmonary disease

Primary tumors of the trachea are rare and can be missed because of the paucity of symptoms and findings and the difficulty in detecting them with chest radiographs. A 31-year-old male patient was admitted with complaints of shortness of breath, coughing, phlegm, and blood in the sputum. He stated that he was being treated for chronic obstructive pulmonary disease. Fiberoptic bronchoscopy revealed a vegetative mass with a wide base on the posterolateral wall of the distal one-third of the trachea. Postoperative histopathological examination revealed a typical carcinoid tumor. In patients with an unexplained cough, dyspnea, infrequent hemoptysis, and normal pulmonary imaging findings, tracheal carcinoma should be suspected. In such cases, early thoracic computed tomography and bronchoscopic examination can provide a rapid diagnosis and treatment options and prevent a false diagnosis.     

Coughing up a stone. What to do about broncholithiasis

Broncholithiasis, a disease that is probably much more common than has been reported, is most often associated with pulmonary infections, for example, tuberculosis and histoplasmosis. Stones originate from calcified peribronchial lymph nodes that erode into the tracheobronchial tree, but lithoptysis occurs infrequently. The most common symptoms are persistent cough and hemoptysis, sometimes followed by findings of obstructive pneumonia (fever, chills, and purulent sputum). Physical findings are nonspecific, and radiologic findings are varied. Complications include formation of a fistula between the respiratory tract and the esophagus or aorta and obstructive pulmonary symptoms. Treatment ranges from conservative management (simple observation) to thoracotomy for patients in whom complications from stone erosion develop. The prognosis of patients with broncholithiasis is generally excellent.     

浸润型肺癌的CT诊断

目的为提高对浸润型肺癌的诊断水平。方法回顾23例经病理证实的浸润型肺癌,临床表现发病初期有咳嗽、咯痰、胸痛、咯血或痰中带血等症状,还有发热,血象偏高。首诊为肺炎16例,肺结核4例,待诊3例。结果23例浸润型肺癌的CT表现分为局限性磨玻璃影、斑状影、双肺弥漫性斑片状影3种。结论浸润型肺癌容易与肺炎、肺结核混淆,诊断应特别注意病史的采集和系列CT片的比较。对双肺斑片状影,经正规抗炎或抗结核无效的患者应考虑到浸润型肺癌的可能。     

THE SIGNIFICANCE OF THE EPITHELIAL CELLS AND SAPROPHYTES IN SPUTUM

1. Microscopical examination of sputum that has been washed with isotonic salt solution indicates its source. Sputum from above the vocal cords contains polygonal flat epithelial cells and numerous species of non-pathogenic microorganisms. Sputum from below the cords is clear of saprophytes, although it sometimes contains bronchoalveolar cuboidal cells. 2. The source of the sputum can be determined by the erythrocytes and the bacilli that are contained in it, and the site of the lesion can also be ascertained. 3. In every instance I found erythrocytes in the pulmonary sputum after severe pulmonary hemorrhage. 4. Six of the cases of laryngeal affection referred to in the presentpaper had had no subjective symptoms, but microscopical examination showed tubercle bacilli in the laryngeal sputum. All the six cases were examined by Dr. Tanaka and were found to have tuberculous lesions in the larynx. In the laryngeal sputum of most cases of laryngeal tuberculosis with symptoms, tubercle bacilli have been frequently demonstrated, while in some cases contaminated laryngeal sputum was obtained only after a long series of examinations. 5. Microscopical examination of the sputum plays a significant part in the diagnosis of tuberculosis.     

纤维支气管镜筛查胸部X线"三阻征"早期中央型肺癌的结果分析

目的 探讨纤维支气管镜检查对胸部X线"三阻征"早期中央型肺癌的诊断率、病理类型分布及痰找癌细胞的阳性率.方法 对326例胸部X线"三阻征"的肺癌高危患者采用螺旋CT扫描、纤维支气管镜活检以及痰细胞检查进行中央型肺癌筛查.结果 确诊为中央型肺癌32例,患病率9.8%;其中阻塞性肺炎21例(65.6%),阻塞性肺不张7例(21.9%),阻塞性肺气肿4例(12.5%);病理类型为鳞癌16例(50.0%),小细胞癌9例(28.1%),大细胞癌3例(9.4%),腺癌2例(6.3%),腺鳞癌1例(3.1%),支气管腺体癌1例(3.1%);32例痰找到癌细胞5例,其中阻塞性肺炎21例痰找到癌细胞3例(14.3%),阻塞性肺不张7例痰找到癌细胞1例(14.3%),阻塞性肺气肿4例痰找到癌细胞1例(25.0%).结论 胸部X线"三阻征"可以作为早期中央型肺癌的筛查指标.病理类型以鳞癌、小细胞癌多见,筛查可提高早期肺癌的检出率.     

The Emergency Department Presentation of Patients with Active Pulmonary Tuberculosis

OBJECTIVE: To determine the clinical presentation of emergency department (ED) patients with active pulmonary tuberculosis (TB). METHODS: This was a retrospective medical record review of adult patients, identified through infection control records, diagnosed as having active pulmonary TB by sputum culture over a 30-month period at an urban teaching hospital. The ED visits by these patients from one year before to one year after the initial positive sputum culture were categorized as contagious or noncontagious, using defined clinical and radiographic criteria. The medical records of patients with contagious visits to the ED were reviewed to determine chief complaint, presence of TB risk factors and symptoms, and physical examination and chest radiograph findings. RESULTS: During the study period, 44 patients with active pulmonary TB made 66 contagious ED visits. Multiple contagious ED visits were made by 12 patients (27%; 95% CI = 15% to 43%). Chief complaints were pulmonary 33% (95% CI = 22% to 46%), medical but nonpulmonary 41% (95% CI = 29% to 54%), infectious but nonpulmonary 14% (95% CI = 6% to 24%), and traumatic/orthopedic 12% (95% CI = 5% to 22%). At least one TB risk factor was identified in 57 (86%; 95% CI% = 76 to 94%) patient visits and at least one TB symptom in 51 (77%; 95% CI = 65% to 87%) patient visits. Cough was present during only 64% (95% CI = 51% to 75%) of the patient visits and hemoptysis during 8% (95% CI = 3% to 17%). Risk factors and symptoms that, if present, were likely to be detected at triage were foreign birth, homelessness, HIV positivity, hemoptysis, and chest pain. CONCLUSIONS: Patients with active pulmonary TB may have multiple ED visits, and often have nonpulmonary complaints. Tuberculosis risk factors and symptoms are usually present in these patients but often missed at ED triage. The diversity of clinical presentations among ED patients with pulmonary TB will likely make it difficult to develop and implement high-yield triage screening criteria.     

无基础疾病的肺曲霉病52例临床分析

目的 分析无基础疾病的肺曲霉病患者的临床特征,提高对该病的认识及诊治.方法 选取2009年1月—2019年1月郑州大学第一附属医院无基础疾病的肺曲霉病患者为研究对象,对相关资料进行回顾性分析.所有患者均获得病理学诊断依据.结果 52例患者中,侵袭性肺曲霉病临床症状出现时间多在10～15 d,慢性坏死性肺曲霉病和肺曲霉球...     

无基础病的原发侵袭性肺曲霉病19例临床诊治分析

目的通过收集病例资料并进行总结分析以加强临床医师对原发性侵袭性肺曲霉病（IPA）的认识。 方法回顾性分析2012年1月至2018年9月在广西医科大学第一附属医院诊断IPA患者的临床资料。 结果19例患者中,男性6例,女性13例,平均年龄（42±14）岁;主要症状为咯血（84.2%,16/19）、咳嗽（73.7%,14/19）、咳痰（63.2%,12/19）、呼吸困难（10.5%,2/19）、胸痛（31.6%,6/19）、发热（21.1%,4/19）,仅1例（5.3%,1/19）可闻及肺部啰音。实验室检查主要发现白细胞计数升高（15.8%,3/19）、C反应蛋白浓度升高（53.8%,7/13）、半乳甘露聚糖（GM）抗原检测试验阳性（60.0%,3/5）。接受肺功能检查14例：4例通气功能障碍并弥散功能障碍。接受支气管镜检查10例：8例黏膜充血,4例镜下出血,9例异常分泌物。胸部影像学主要表现为空洞（47.4%,9/19）、结节（52.6%,10/19）、实变（78.9%,15/19）、空气新月征（31.6%,6/19）。11例曾被误诊为肺结核、肺炎、炎性假瘤。 结论原发性IPA可发生在无基础病的群体,极易误诊,当患者出现咳嗽、咳痰、咯血、GM抗原检测试验阳性,CT表现为结节、空洞、空气新月征,且抗细菌治疗无效时,应警惕此病的发生。     

III 型活动性肺结核病人气道高反应性与肺功能康复关系研究

Itwasrarelyreportedaboutthebroncho－hyperreactivity（BHR）inpatientswithpulmonarytuberculosisinChina．Accordingtomea－surementvalueofBHRin１０３patietswithactivepulmonarytuber－culosis，weinvestigatecorrelationbetweenBHRandobstructionoflittleairway．TheobjectivewastostudyeffectofincreasedBHRonpulmonaryrehabilitationinpatientswithactivepulmonarytubercu－losis．１Subjectandmethods１．１Subject１０３patientsconsistingofoutpatientsandinpatientsparticipatedinourstudy．Amongthesepatients，５８…     

Bronchopulmonary endometriosis: a rare cause of hemoptysis

We have reported a case of hemoptysis caused by pulmonary parenchymal endometriosis which was apparently successfully treated with danazol. Bronchopulmonary endometriosis is a very unusual cause of hemoptysis, and should be suspected on the basis of cyclic hemoptysis with menstruation. Danazol is effective therapy, but information regarding optimal dosage and rates of recurrence after completion of therapy is limited at this time.