隐源性机化性肺炎18例临床分析

目的 分析我院经活检确认的18例隐源性机化性肺炎患者,总结其在临床、治疗及预后方面的特点.方法 收集我院2008年1月至2012年10月间经肺活检证实的18例隐源性机化性肺炎患者的所有资料,回顾性分析本组患者的临床资料、易患因素、影像学表现、病理、实验室检查等的特点.结果 18例患者平均年龄（59±11）岁.本组18例患者临床症状主要为咳嗽、咳痰、胸闷、气短等呼吸系统症状,少数有盗汗、乏力、消瘦等全身症状.影像学表现多种多样,可有斑片影、实变影、磨玻璃样变影等,最初发病多以斑片影为主.肺功能表现为轻度限制性通气功能障碍,弥散功能受损.14例（77.8％）患者治愈,4例（22.2％）患者复发,对糖皮质激素效果较好.结论 隐源性机化性肺炎容易误诊为肺部感染,诊断需要综合临床-影像-病理三方面分析,病理具有早期指导治疗作用,但是本病预后良好.     

弥漫性泛细支气管炎2例临床分析并文献复习

目的 探讨弥漫性泛细支气管炎(DPB)的临床特点及治疗.方法 回顾性分析我院2例确诊为DPB患者的临床特点及治疗,并复习相关文献.结果 2例均以慢性咳嗽、咳痰伴活动后气促为主诉,肺部听诊均闻及湿啰音,HLA-B54均阳性,但冷凝集试验均阴性,肺功能均以阻塞性通气功能障碍为主;1例经病理确诊,胸部影像见典型弥漫小叶中心性结节影,但无慢性鼻窦炎病史,口服阿奇霉素0.25g,隔日1次,治疗12个月后肺部病灶明显吸收;1例经临床确诊,胸部影像见典型弥漫结节影伴支气管扩张和间质性肺纤维化,既往有慢性鼻窦炎病史,口服阿奇霉素0.25 g,隔日1次,治疗7个月后肺部病灶明显吸收;2例患者初期均长期误诊.结论 2例患者具有DPB典型临床表现,但某些特征有别于一般日本DPB患者,2例病例均显示长期口服小剂量阿奇霉素治疗DPB效果显著.     

弥漫性泛细支气管炎9例临床分析

目的 增强对弥漫性泛细支气管炎(DPB)临床特征的认识及诊断. 方法 收集南京医科大学第一附属医院呼吸科9例曾被误诊的DPB患者,通过实验室检查、肺功能及动脉血气检查、影像学检查等分析其临床特点. 结果 所有患者均有慢性咳嗽、咳痰、活动后气促的症状,合并副鼻窦炎.9例患者用阿奇霉素(500mg/d),联合抗生素、氧疗和对症、支持疗法等方法治疗后症状均有明显改善、痰量减少,肺部高分辨CT提示明显好转. 结论 DPB具有一定的临床特异性,只有正确地认识及诊断才能改善其预后.     

弥漫性泛细支气管炎误诊为肺结核11例临床及误诊原因分析

目的 通过分析弥漫性泛细支气管炎(diffuse panbronchiolitis,DPB)的临床特点及误诊为肺结核的原因,提高对两种疾病的鉴别诊断能力。方法 对11例误诊为肺结核的DPB临床特点及误诊原因进行回顾性分析。结果 11例患者主要症状为长期咳嗽、咳痰及气促,均合并有慢性副鼻窦炎,胸部影像表现主要为两肺弥漫性散在分布的颗粒样结节状或粟粒状阴影,肺功能检查结果为阻塞性通气功能障碍及低氧血症,3例血清冷凝集试验(CHA)效价增高(1:64以上),11例均被误诊为血行播散性肺结核,抗结核药物治疗无效而大环内酯类抗生素治疗病情好转明显。结论 误诊原因主要是对DPB缺乏认识,以及DPB与肺结核在临床表现与胸部X线影像表现相似。对诊断为血行播散性肺结核患者经抗结核治疗效果不佳且痰抗酸杆菌阴性时,结合临床表现应考虑到DPB。     

煤工尘肺合并肺癌21例临床分析

肺癌是煤工尘肺(CMP)常见的合并病之一,近年来临床观察,煤工尘肺并发肺癌有逐渐增多趋势.由于患者肺部基础病变长期存在,经常并发感染而症状反复加重,并发肺癌时临床表现特异性不强,症状多不典型,影像学表现复杂多样,易与肺部其他病变相混淆,早期诊断困难,临床误诊率较高.本组通过21例CMP并发肺癌的临床及影像学检查资料分析,探讨煤工尘肺合并肺癌的临床与影像学特征,以提高对CMP并发肺癌的认识和早期诊断水平.     

19例胃肠结核的影像学分析

目的 探索胃肠结核的影像学特点。方法回顾分析经确诊为胃肠结核19例病例,从病灶部位、形态、边缘、周围组织的影像改变进行分析。结果19例患者中,胃窦部结核1例,空肠结核1例,末端回肠、回盲部结核15例,回盲部及升结肠同时受累1例,横结肠结核1例。本组病例影像诊断,除胃结核、回盲部结核各1例误诊外,其余均与病理诊断相符合,误诊率为10.5%,准确率89.5%。结论胃肠结核的影像表现有一定的特征性,但必须结合临床病史,进行病理、细菌学检查才可做出明确的诊断。     

弥漫性泛细支气管炎12例临床分析

目的探讨12例弥漫性泛细支气管炎(diffuse panbronchiolitis,DPB)患者的临床特点及诊断方法。方法参考日本厚生省1998年第二次修订的临床诊断标准,对12例DPB病例的临床资料进行回顾性分析。结果 12例患者中,病理组织学确诊8例,临床诊断4例。最初被误诊为慢性支气管炎的病例(8/12),被误诊为支气管扩张症的病例占(9/12);采用红霉素序贯阿奇霉素治疗后,取得良好效果。结论 DPB误诊率高,大环类酯类抗生素能显著改善患者预后,及时治疗是可以治愈的。     

弥漫性泛细支气管炎的CT诊断及鉴别诊断

目的探讨CT对弥漫性泛细支气管炎(DPB)的诊断及鉴别诊断价值。方法总结和分析42例DPB患者胸部及鼻窦的CT表现,其中病理活检确诊5例,临床诊断确诊37例。结果 DPB胸部CT主要表现为:①弥漫性细粟粒样影伴树芽征;②小气道细支气管扩张;③炎性斑片影。鼻窦CT检查多伴随有副鼻窦炎表现(37例,88.1%),最常累及上颌窦。结论DPB胸部CT表现具有一定的特征性,多数患者合并副鼻窦炎,有助于DPB的早期诊断和鉴别诊断。     

隐源性机化性肺炎14例临床分析

目的 回顾性分析14例经肺活检确诊的隐源性机化性肺炎(COP)的临床资料及随访情况,总结COP的临床、影像、病理学、转归和预后的特点.方法 回顾性分析2003年1月至2010年12月期间经肺活检证实的14例COP患者的临床表现、实验室资料、影像学表现、组织病理学特点、治疗和转归.结果 14例COP患者的男女比例相当,主要症状为咳嗽(100.0％)、呼吸困难(78.6％)、发热(85.7％)、乏力(78.6％)等.8例(57.1％)体检肺部有湿啰音.常规实验室检查结果异常有:血沉增快(71.4％)、C反应蛋白升高(64.3％)和贫血5例(35.7％).胸部CT示:病变双侧分布10例(71.4％),多发10例(71.4％),实变5例(35.7％),斑片状影8例(57.1％),条索状或毛玻璃影改变各2例,肿块状影1例,伴支气管充气症6例(42.9％).经糖皮质激素治疗,11例治愈,2例复发,再次治疗后治愈,1例随访中病情变化诊断为真菌感染.结论 本组COP患者临床表现缺乏特异性,胸部影像学以双侧、多发、实变和斑片状影为主.一般预后良好,糖皮质激素治疗有效.经支气管镜或经皮肺穿刺肺活检是诊断COP的主要手段.     

弥漫性泛细支气管炎9例临床分析

目的 探讨我国弥漫性泛细支气管炎（DPB）的临床特点及诊断方法。方法 将经开胸或胸腔镜肺活检证实的9例DPB患者的临床特点与13本修订的临床诊断标准进行比较分析。结果 本组9例中8例有持续性咳嗽、咳痰及劳力性呼吸困难，7例有慢性鼻窦炎，7例肺部可闻及湿啰音，1例肺部可闻及哮鸣音；所有患者胸部CT均可见小叶中心性结节影，4例第一秒用力呼气容积／用力肺活量比值〈70％，5例动脉血氧分压（PaO2）〈80mmHg（1mmHg=0．133kPa），1例冷凝集素滴度≥1：64。4例符合临床确诊标准，3例符合一般诊断，2例不符。其中8例接受了经支气管镜肺活检，均未获得明确的病理诊断。结论 多数根据临床诊断标准拟诊本病的患者可给予大环内酯类药物治疗。本病误诊率高的根本原因是对本病的临床特点、诊断标准不熟悉。经支气管镜肺活检对本病的诊断帮助不大，临床诊断困难者可行开胸或胸腔镜下肺活检。     

Diffuse panbronchiolitis in China

OBJECTIVE: Diffuse panbronchiolitis (DPB) is a progressive inflammatory disease, well recognized in Japan, that is characterized by chronic sinusitis and obstructive small airway disease. A total of 40 patients with DPB in mainland China were reviewed in order to describe the epidemiology of DPB in China and to compare their clinical characteristics with those of cases reported in Japan. METHODOLOGY: A systematic search was conducted of the Chinese language literature published in mainland China from 1996 to 2003. The 40 subjects who fulfilled the diagnostic criteria for DPB were retrospectively analysed for clinical, physiological, radiological, and pathological features and their geographic distribution. RESULTS: The 40 patients included in this study (31 male and nine female) were distributed in 12 provinces and three other cities in China. All presented with chronic cough, sputum production, and 32 had exertional dyspnoea. All but three had a history of sinusitis. Lung function assessment showed a mixed obstructive-restrictive pattern in 30 cases. CXR revealed diffuse fine nodular shadows in all patients. Human leukocyte antigen-B54 was positive in five patients (n = 12). A total of 30 (75%) patients had been misdiagnosed prior to their diagnosis of DPB being made. CONCLUSIONS: DPB is not rare in China but its incidence is relatively low. Poor recognition and/or genetic factors may be the reason. The clinical, radiographic and histological features of Chinese patients resemble those described in Japanese patients.     

Long-term macrolide antibiotic therapy in the treatment of chronic small airway disease clinically mimicking diffuse panbronchiolitis

OBJECTIVE: In the current studies, we investigated the clinical effects of long-term macrolide antibiotic therapy for patients with chronic small airway disease (CAD) that clinically and radiologically mimics but is pathologically distinct from diffuse panbronchiolitis (DPB). PATIENTS AND METHODS: Twenty-one Japanese patients were selected on the basis of clinical criteria for DPB and were categorized as DPB or CAD following histological evaluation of surgical lung biopsies. All patients received long-term macrolide therapy, and therapeutic results were compared for the DPB and CAD groups. RESULTS: Clinical, laboratory, radiological, and bacterial features, as well as neutrophilia in bronchoalveolar lavage fluid were strikingly similar in both groups. Long-term treatment with macrolides improved the clinical symptoms and PaO(2) in both groups. There was a significant improvement in forced expiratory volume in one second (FEV(1)), vital capacity (VC), and %VC in patients with DPB but not in patients with CAD. Neutrophilia in bronchoalveolar lavage fluid was also reduced following therapy in DPB patients but was refractory in CAD patients. CONCLUSION: Based on the different responses to macrolides, CAD might be associated with conditions distinct from those of DPB. Nevertheless, low-dose macrolide therapy may be applied in CAD to achieve clinical improvement, such as in respiratory symptoms and PaO(2).     

A case of the bare lymphocyte syndrome with clinical manifestations of diffuse panbronchiolitis

Touraine et al reported some cases lacking HLA-class I antigens on the cell surface of their lymphocytes as "Bare lymphocyte syndrome" (BLS). Recently we experienced a case of BLS the clinical features of which are very similar to those of diffuse panbronchiolitis (DPB). Namely, she had chronic pansinusitis, diffuse nodular shadows on her chest X-ray film, obstructive impairment of pulmonary function tests and continuous increase of cold hemagglutinin titer. The pathogenesis of DPB is not confirmed. However, this case and other cases with sino-bronchial syndrome suggest that patients with DPB may have some immunodeficiencies. In addition the immunosuppressive action of erythromycin and its effectiveness on DPB were interesting. From these points of view, we discussed the relationship between this case and DPB, and the pathogenesis of DPB.     

Analysis of peripheral lymphocyte subsets and changes due to erythromycin therapy in patients with diffuse panbronchiolitis

It is well known that patients with diffuse panbronchiolitis (DPB) have various immunological abnormalities. The authors evaluated the peripheral lymphocyte subsets using two-color analysis by FACS. Convening percentages of activated CD3+, CD8+, and CD4+ cells in DPB patients, all, especially that of CD8+ cell, were greater in number before therapy compared to healthy controls. After erythromycin therapy, all three parameters decreased in all patients. Therapy with other antibiotics did not obtain any effects. These results suggested that patients with DPB had some immunological hyperreactivity and that erythromycin was effective in these patients by suppressing this activity. From these results, together with the fact that DPB is a type of sino-bronchial syndrome, the possible pathogenesis of DPB was thought to be related to some immunological defect and hyperreactivity in the respiratory system.     

SCREENING FOR MULTIPLE ENDOCRINE NEOPLASIA SYNDROME (TYPE 1) IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM

In 63 consecutive patients with primary hyperparathyroidism (HPT) a prospective screening study was undertaken for coexistent multiple endocrine neoplasma-(MEN)-syndrome type 1. The screening consisted of a clinical examination, a radiological examination of the sella turcica with skeletal tomography (and in equivocal cases computed tomography), visual field examination by perimetry and a hormonal evaluation including measurements of the serum levels of prolactin, gastrin, pancreatic polypeptide (PP) and subunits of human chorionic gonadotrophin (HCG-alpha and -beta). Clinical examination did not reveal any signs of endocrine disease suggestive of a MEN-1 syndrome. In only one case there was a radiological abnormality of the sella turcica; this patient had an empty sella syndrome and a raised serum prolactin value. All other prolactin values were within the normal range. In 41% of the patients raised serum gastrin levels were found; these tended to normalize after parathyroidectomy. As a group, patients with raised gastrin values were older than the others and generally they had hypo- or achlorhydria. The serum PP levels were raised in 28% of the patients but there was no clinical evidence of a pancreatic tumour in any of these cases, and the serum HCG-alpha and -beta levels were within the normal range in all patients but two. We conclude that the incidence of MEN-1 syndrome in unselected patients with primary HPT must be low, and that investigations for this syndrome are justified only in HPT patients with specific symptoms or with a positive family history.     

The first report of diffuse panbronchiolitis in Korea: five case reports.

Diffuse panbronchiolitis (DPB), which is prevalent in Japan, is known to be rare outside Japan. Although a case of diffuse panbronchiolitis in a second generation Korean was reported in Japan in 1986, no case has been reported in Korea. Recently we found 5 cases of diffuse panbronchiolitis in Korea, two histologically proven and three clinically and radiologically suspected. All 5 cases had the typical respiratory symptoms and signs and a history of chronic sinusitis. In three clinically and radiologically suspected cases, high resolution computed tomography showed the typical findings of DPB and other diseases such as pulmonary emphysema, bronchial asthma, chronic bronchitis and bronchiectasis could be ruled out. More cases of DPB are expected to be found in Korea in the near future.     

Comparison of immunological aspects in diffuse panbronchiolitis and cystic bronchiectasis

We examined immunological parameters in 35 patients with diffuse panbronchiolitis (DPB) and 20 patients with cystic bronchiectasis (CBE) to analyze the relation between local immune responses and subsequent clinical courses. Patients with DPB showed more impaired cell-mediated immunity than those with CBE. On analysis of peripheral blood lymphocytes from DPB and CBE, the significant increase in CD4 positive T-cells and Fc alpha R positive T-cells and decrease in Leu-11 positive cells were recognized. The observation of humoral immunity revealed a tendency for local immunity to be accelerated such as increases of IgA and IgG2 in both diseases. The titer of serum cold agglutinin and rheumatoid factor were elevated in DPB. However, these fluctuations of immunological factors were normalized according to improvement of inflammatory processes by chemotherapy. The analysis of the distribution of lymphocyte subsets in lung tissues taken from DPB showed that CD4 positive T-cells always overwhelmed CD8-positive T-cells and that secretary IgA-positive B-cells were abundant in bronchioles. On the other hand, bronchiolitis was recognized in about 80% of cases with CBE, although to a less striking degree than DPB. Lymphocyte subsets were similarly distributed in the respiratory tract. DPB and CBE could be considered as the same disease entity in the spectrum of chronic respiratory tract infection based on mucociliary disorder. Sinusitis and immunological abnormalities are often complicated by both diseases. However, precise analysis demonstrated that there are some obvious differences of systemic and local immune responses between DPB and CBE, probably due to the conditions of each diseases such as primary focus, severity and causative microorganism.     

Cholescintigraphy in Acute Acalculous Cholecystitis

Acute acalculous cholecystitis is a relatively rare but potentially lethal condition if not treated promptly. Since stones are not present, diagnostic procedures such as ultrasound or other radiological procedures are frequently not helpful. Tc-99m iminodiacetic acid scan results were analyzed in 11 proven cases of acute acalculous cholecystitis. All had positive tests with nonvisualization of the gallbladder giving a sensitivity of 100%. Tc-99m iminodiacetic acid cholescintigraphy is a highly reliable test and is easily performed even in acutely ill patients and should be the test of choice in all patients predisposed to and suspected of acute acalculous cholecystitis.     

Childhood diffuse panbronchiolitis: a case report

Diffuse panbronchiolitis (DPB) is a chronic, potentially life-threatening lower respiratory tract disease that is particularly common in Japanese people. If left untreated, it progresses to bronchiectasis, respiratory failure, and death. Lack of familiarity with DPB in the non-Far East may result in a failure to correctly diagnose and treat this disorder. We describe a child with DPB. We suggest that DPB is a sinopulmonary disease that is not exclusive to the Asian population and to adults. Its clinical and radiological features should be better known by pediatric pulmonary physicians.     

A different experience of hepatic adenoma in Taiwan with emphasis on clinical manifestations and ultrasonographic features

BACKGROUND/AIMS: Hepatic adenoma is a rare benign hepatic tumor and it is difficult to differentiate it from other focal hepatic tumors. Ultrasonography has become the choice of methods to detect focal hepatic lesions. The study aims at analyzing ultrasonographic features of hepatic adenoma. METHODOLOGY: A total of 8 patients with pathologically proven hepatic adenoma were studied retrospectively during an 8-year period. The ultrasound scanners used were Toshiba SSA-100A, Toshiba SSA-240 and Aloka 630. The ultrasonographic features and clinical data were analyzed. RESULTS: There were 7 males and 1 female. The mean age was 50 years. Of the 8 cases, 2 symptomatic cases had a tumor larger than 10 cm. The remaining 6 cases were asymptomatic and had tumors smaller than 5 cm. The echogenicity was variable in these tumors. An irregular sonolucent was only noted in a 15 cm tumor and was histologically proven to be internal bleeding. All the tumors were well-defined, however, a hypoechoic rim was obvious only in the isoechoic and hyperechoic tumors. CONCLUSIONS: Ultrasonographic features of some hepatic adenomas are different from those of hepatocellular carcinomas and hemangiomas, although the differential diagnosis cannot be made in small hypoechoic tumors. When ultrasonography is used more widely, more asymptomatic patients with small-sized hepatic adenoma will be detected, even in male subjects. The concept about the pathogenesis of hepatic adenomas may be changed.