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21/29. Interstitial lung disease--an underdiagnosed side effect of chlorambucil?

    A case of recurrent interstitial pneumonia following re-exposure to chlorambucil therapy for chronic lymphocytic leukemia is presented. chlorambucil is a rare cause of pulmonary disease. The onset of symptoms may occur after only some weeks or after up to several years with no dose-response relationship. Therapy involves the discontinuation of the offending drug and the administration of steroids. The prognosis is poor, with a mortality greater than 50%.
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ranking = 1
keywords = exposure
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22/29. Lymphocytic alveolitis in a crematorium worker.

    An asymptomatic cremator was found incidentally to have lymphocytic alveolitis by bronchoalveolar lavage, and the basis for this finding was investigated. No known causes of lymphocyte alveolitis including sarcoidosis, hypersensitivity pneumonitis, berylliosis, tuberculosis, or fungal diseases of the lung were found. By exclusion, therefore, exposure to formaldehyde and/or to compounds in the residual ash likely were etiologic in the development of the lymphocytic alveolitis.
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ranking = 1
keywords = exposure
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23/29. Pulmonary infiltration after exposure to home renovation dust: histopathology and microanalysis.

    A subacute self-resolving illness associated with bilateral pulmonary infiltration developed in a patient following renovation in her home. This may have been related to exposure to silicaceous plaster dust which was found in an environmental sample as well as on microanalysis of a transbronchial lung biopsy specimen and bronchoalveolar lavage fluid.
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ranking = 5
keywords = exposure
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24/29. Suspected hypersensitivity pneumonitis after exposure to a biologic forage inoculant.

    A 44-year-old farmer had respiratory symptoms and bibasilar pulmonary infiltrates after three exposures to a new biologic forage inoculant. Open lung biopsy revealed chronic interstitial pneumonitis and bronchiolitis obliterans with organizing pneumonia. The patient responded to oral corticosteroids but acutely worsened after an inadvertent reexposure to the forage inoculant. He later recovered, with return of lung function and chest radiograph toward normal. This case suggests that biologic forage inoculants may be associated with hypersensitivity pneumonitis.
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ranking = 6
keywords = exposure
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25/29. Fatal chemical pneumonitis due to cadmium fumes.

    Acute exposure to high concentrations of cadmium fumes may cause acute chemical pneumonitis with a possibly fatal outcome. The etiologic diagnosis of acute cadmium intoxication from inhaled fumes may be difficult and can be confused with other forms of acute respiratory failure. We report on a case of a fit 53 year-old man who was exposed to cadmium fumes after flame-cutting an alloy containing around 10% of cadmium for a period of 60-75 minutes. He developed severe chemical pneumonitis and died 19 days after exposure.
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ranking = 2
keywords = exposure
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26/29. Contact dermatitis with cervical lymphadenopathy following exposure to the hide beetle, Dermestes peruvianus.

    Contact with beetles of the family Dermestidae can produce a variety of disorders including skin, gastrointestinal and respiratory tract disease. Dermatological disorders include dermatitis, vesicular, pustular and vasculitic lesions. In addition, there may be pruritus, desquamation and urticaria. We report a patient who developed dermatitis, a vasculitic eruption, cervical lymphadenopathy and pulmonary nodular interstitial infiltration as a result of contact with the 'hide beetle' Dermestes peruvianus.
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ranking = 4
keywords = exposure
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27/29. Interstitial pneumonitis and fibrosis associated with the inhalation of hair spray.

    We describe a 49-year-old female Japanese hairdresser who presented with a 5-year history of exertional dyspnea, a nonproductive cough, and occasional febrile episodes. Histological analysis revealed interstitial fibrosis with mononuclear cell infiltration, foreign body granuloma, and numerous intra-alveolar macrophages and multinucleated giant cells of foreign body type. Arterial blood gas, pulmonary function studies and computed tomographic findings demonstrated improvement 6 months after cessation of exposure to the salon. bronchoalveolar lavage fluid findings suggested that the development of lung disease in this case was triggered by an allergic mechanism rather than the storage of hair spray ingredients in the lung.
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ranking = 1
keywords = exposure
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28/29. Interstitial lung disease more than 40 years after a 5 year occupational exposure to talc.

    A 62 yr old woman was initially diagnosed with sarcoidosis until a thoracoscopic biopsy revealed the presence of numerous birefringent particles in fibrotic areas of the centrilobular lung zones. These particles were examined by electron microscopy and X-ray spectrometry and characterized as impure talc. Further inquiry into her occupational history revealed that she had worked from the age of 14-18 yrs in a factory making rubber hoses, where she had had an intense exposure to talc. There was no evidence of silicosis or asbestosis, and other significant causes of interstitial lung disease were excluded. This case emphasizes the importance of a thorough occupational history, which may reveal a remote and forgotten exposure to a significant cause of interstitial lung disease. Although this presentation of talcosis is unusual, this case suggests that even a relatively short, but presumably intense exposure to talc more than 40 yrs previously may be a cause of progressive lung fibrosis.
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ranking = 860.40246721241
keywords = occupational exposure, exposure
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29/29. Giant-cell interstitial pneumonia in a gas station worker.

    Giant-cell interstitial pneumonia (GIP) is a very uncommon respiratory disease. The majority of cases of GIP are caused by exposure to cobalt, tungsten and other hard metals. In this report, we describe GIP in a patient who worked in gas station and dealt in propane gas vessels. He presented with clinical features of chronic interstitial lung disease and underwent an open lung biopsy that showed DIP-like reaction with large numbers of intra-alveolar macrophages and numerous large, multinucleated histiocytes which were admixed with the macrophages. Analysis of lung tissue for hard metals was done. cobalt was the main component of detected hard metals. Corticosteroid therapy was started and he recovered fully.
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ranking = 1
keywords = exposure
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