1/58. Pulmonary intravascular lymphomatosis: presentation with dyspnea and air trapping.Intravascular lymphomatosis (IVL) is a rare lymphoid neoplasm that is typically of B-cell lineage and characterized by proliferation of malignant cells within small arterioles, capillaries, and venules. We report a patient with pulmonary IVL who presented clinically with progressive dyspnea, fever, and a dry cough. Pulmonary function tests revealed a marked decrease in diffusion capacity with airflow obstruction and severe air trapping. High-resolution CT (HRCT) of the chest with inspiratory and expiratory images revealed mosaic attenuation consistent with air trapping. Transbronchial biopsies revealed the diagnosis of IVL with capillary expansion in the alveolar and peribronchiolar interstitial tissue. IVL should be considered in the differential diagnosis of a patient with an interstitial lung disease, air trapping on pulmonary function tests, and mosaic attenuation on HRCT. Transbronchial biopsies may be the initial diagnostic procedure of choice.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/58. Severe pulmonary toxicity in patients treated with a combination of docetaxel and gemcitabine for metastatic transitional cell carcinoma.BACKGROUND: Both gemcitabine and docetaxel have been associated with pulmonary toxicity when used as single agents. We report a study in which three of five cases developed pulmonary toxicity (which proved fatal in one case) when these drugs were used in combination to treat metastatic transitional cell cancer. patients AND methods: Three patients developed dyspnoea, in two cases associated with pulmonary infiltrates, whilst receiving the combination of gemcitabine and docetaxel in a phase I trial. The case notes of all five patients entered into this trial were studied. A literature review was undertaken to gain information on reported pulmonary toxicity with the deoxy-cytidine analogues and taxanes given alone or in combination with or without radiotherapy. RESULTS: Three patients developed delayed dyspnoea whilst receiving gemcitabine/docetaxel in combination. This settled with cessation of treatment in one patient, however in the remaining two cases significant hypoxia developed, associated radiologically with evidence of progressive pulmonary infiltrates. One of these patients developed respiratory failure after bronchoscopy and biopsy and died. His chest X-ray changes were consistent with adult respiratory distress syndrome. The transbronchial biopsy and post mortem lung histology in this patient showed diffuse alveolar damage. The remaining patient settled with high dose prednisolone but died subsequently of progressive metastatic disease. CONCLUSION: The combination of gemcitabine and docetaxel showed promising activity in this small study. The development of pulmonary symptoms in three cases with radiological lung infiltrates in two other cases was cause for concern. patients receiving this drug combination should be closely monitored for similar problems.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
3/58. nitric oxide successfully used to treat acute chest syndrome of sickle cell disease in a young adolescent.OBJECTIVES: To report a case of acute chest syndrome (ACS) of sickle cell disease treated successfully with nitric oxide and to review the physiologic effects of nitric oxide and its potential ability to improve outcome in ACS. DESIGN: Descriptive case report. SETTING: Eighteen-bed pediatric intensive care unit in a university children's hospital. PATIENT: A 15-yr-old black male with sickle cell disease, bilateral pulmonary infiltrates, refractory hypoxemia, and unstable hemodynamics. INTERVENTION: In addition to exchange transfusion, invasive hemodynamic monitoring, and aggressive ventilatory support, inhaled nitric oxide was administered in the gas mixture in a concentration of 20 ppm for 72 hrs. MEASUREMENTS AND MAIN RESULTS: cardiac output, pulmonary arterial pressure, pulmonary artery occlusion pressure, systemic vascular resistance, pulmonary vascular resistance, shunt fraction, and alveolar-arterial oxygen gradient were compared with and without inhaled nitric oxide. Marked reductions in pulmonary arterial pressure and pulmonary vascular resistance were noted. cardiac output improved, and shunt fraction and alveolar-arterial oxygen gradient were markedly reduced. The patient required decreased ventilator and hemodynamic support and rapidly made a complete recovery. CONCLUSIONS: nitric oxide may be beneficial for patients with ACS because of its ability to ameliorate pulmonary hypertension and ventilation/perfusion mismatch. nitric oxide may confer some protection against polymerization of sickle hemoglobin and exert a reversible antiplatelet effect that may be beneficial in ACS. Further study is necessary to determine the safety and efficacy of inhaled nitric oxide as a treatment for ACS.- - - - - - - - - - ranking = 2keywords = alveolar (Clic here for more details about this article) |
4/58. ozone exposure: a case report and discussion.A 45-year-old man working with ozone presents with evidence of sinusitis, mucus membrane irritation, sleep disturbance and shortness of breath. Naturally occurring or manmade, ozone may damage pulmonary alveolar type I cells at significant exposure levels. EPA and OSHA regulate exposure concentrations. Studies show dose responses with exposures. Supporting epidemiological studies are reviewed briefly. Limiting potential for excess exposure is key to prevention. Recognition of ozone as a potential exposure in the oklahoma workplace is key to symptom management.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
5/58. Takayasu disease with predominant pulmonary involvement.We report a case of Takayasu's arteritis with predominant pulmonary involvement, which led eventually to complete obliteration of the right pulmonary artery. Subsequently, cavitation and chronic inflammation developed in the nonperfused right lung. A right pneumonectomy was performed to control the infectious process, leading to functional improvement and better control of the underlying immunologic disorder.- - - - - - - - - - ranking = 0.0028036946244478keywords = process (Clic here for more details about this article) |
6/58. Nitrate anaphylaxis.BACKGROUND: Nitrate and nitrite salts are commonly used to preserve and sustain color in a number of processed meats. To date there have been no described cases of anaphylaxis to either nitrates or nitrites in the literature. OBJECTIVE: We report a patient with anaphylaxis to nitrates and nitrites documented by double-blind, placebo-controlled capsule challenge. methods: A 22-year-old previously well male, presented to a tertiary referral center with a 4-year history of recurrent anaphylaxis after eating take-out food. No further episodes occurred while adhering to a strict elimination diet. We performed a double-blind, placebo-controlled capsule challenge both with food substances and starch placebo. These occurred in a hospital setting with full resuscitative procedures available. RESULTS: An acute anaphylactic reaction occurred following a challenge to nitrates and nitrites. Generalized allergic reactions were observed on separate occasions following administration of artificial colorings and metabisulfite. There was a mild urticarial reaction following salicylates. He was placed on a diet free of sulfites, nitrates, nitrites, and low in salicylates and he has had no further reactions. A computer based search of the medline, Current Contents and EMBASE databases found no previously reported cases of urticaria, angioedema, or anaphylaxis to either nitrates or nitrites. CONCLUSION: The ingestion of processed meats containing nitrate or nitrite salts may be associated with angioedema and anaphylaxis and should be considered when investigating patients with suspected food allergy.- - - - - - - - - - ranking = 0.0056073892488955keywords = process (Clic here for more details about this article) |
7/58. Chronic eosinophilic pneumonia: a case report.Chronic eosinophilic pneumonia (CEP) is a disorder, characterized by a history of pneumonia (> 2 months) and eosinophilic pulmonary infiltration without any organic causes. We describe a 28-year-old woman who presented with cough, dyspnea and fever for 2 months. She was diagnosed with mild asthma and allergic rhinitis 2 years before being diagnosed with CEP. For a period of 9 months she took no medication. Her chest roentgenogram at this admission revealed patchy infiltration in both upper lung fields. Laboratory data revealed blood eosinophilia (4,284/mm3), and her serum IgE was mildly elevated (245.8 IU/ml). A computerized tomography of the chest did not show bronchiectasis. CEP was diagnosed from significant eosinophilia in bronchoalveolar larvage fluid and transbronchial biopsy revealed eosinophilic infiltration without any demonstrable infectious agent. The patient was treated with prednisolone 45 mg/day. Her symptoms disappeared and her chest roentgenogram showed nearly complete resolution in 2 and 4 days, consecutively.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
8/58. Diffuse alveolar hemorrhage in acute promyelocytic leukemia patients treated with ATRA--a manifestation of the basic disease or the treatment.All-trans-retinoic acid (ATRA) is considered the recommended induction treatment for acute promyelocytic leukemia. In the pre-ATRA era pulmonary bleeding was a common cause of death in these patients, mostly due to disseminated intravascular coagulation which was further exacerbated by the administration of chemotherapy. Although ATRA syndrome, the most serious adverse effect of ATRA treatment, involves the lungs, pulmonary hemorrhage has only rarely been reported as a manifestation of ATRA syndrome. Here we describe 2 patients who developed diffuse alveolar hemorrhage during treatment with ATRA. The possible mechanisms of pulmonary bleeding in these cases are discussed.- - - - - - - - - - ranking = 5keywords = alveolar (Clic here for more details about this article) |
9/58. Acute interstitial pneumonitis. Case series and review of the literature.Acute interstitial pneumonitis (AIP) is an acute, idiopathic interstitial lung disease characterized by rapidly progressive diffuse pulmonary infiltrates and hypoxemia requiring hospitalization. The case-fatality ratio is high. Previous reports suggested that survivors of the acute event have a favorable outcome. We undertook this study to examine the natural history of survivors. We had observed several patients who experienced recurrent episodes of AIP and chronic progressive interstitial lung disease. We sought to determine longitudinal survival in these patients and to compare our experience with that in the medical literature. overall, we identified 13 biopsy-proven cases of AIP. The mean patient age was 54 years in our review, which is identical to previous reports. Twelve patients were hospitalized and all 12 required mechanical ventilation. overall hospital survival was 67%. All patients demonstrated abnormalities in gas exchange at presentation. Radiographs typically demonstrated bilateral patchy densities that progressed to a diffuse alveolar filling pattern in nearly all cases. All biopsy specimens showed organizing diffuse alveolar damage. Longitudinal data were available for 7 patients. Two died of AIP recurrences. A third died of complications of heart failure shortly after hospital discharge. One patient progressed to end-stage lung disease and required lung transplantation. Two patients experienced persistent pulmonary symptoms, accompanied in 1 by progressive lung fibrosis. One patient had nearly complete recovery of lung function 2 years following AIP. (Follow-up information was unavailable for 2 survivors.) In our literature review, 5 of 7 patients reported experienced some recovery of lung function. One case of progressive interstitial lung disease requiring lung transplantation was reported. The reported mortality was much higher than in our experience (74% versus 33%). The mean time from symptom onset to death was 26 days, compared with 34 days in our experience. The use of corticosteroids did not appear to influence survival, although this has not been tested in a rigorous manner. The better survival in our series may be related in part to a survivor selection bias. In contrast to previous reports, we found that survivors of AIP may experience recurrences and chronic, progressive interstitial lung disease. We did not identify any clinical or pathologic features that predict mortality in these patients. Likewise, there were no features that predicted the longitudinal course in survivors. Further study to identify causal factors is required in the hope of preventing morbidity and mortality related to this disease.- - - - - - - - - - ranking = 2keywords = alveolar (Clic here for more details about this article) |
10/58. Clinical presentation of inhalational anthrax following bioterrorism exposure: report of 2 surviving patients.The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.- - - - - - - - - - ranking = 0.0028036946244478keywords = process (Clic here for more details about this article) |
| | Next -> |