Cases reported "Lung Diseases"

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1/17. Early onset of acute immune-mediated lung injury in a child undergoing allogeneic peripheral blood transplantation.

    Animal models have recently clarified the lung injury after allogeneic hematopoietic transplantation. These works have confirmed the role of donor T lymphocytes in immune-mediated inflammatory reactions in the lung. We report here a fatal case of a 3-year-old child who developed acute respiratory failure coinciding with the onset of hyper-acute graft versus host disease (aGVHD) after allogeneic peripheral stem cell transplantation. aGVHD was refractory to treatment and the patient died on day 28. Lung necropsy showed interstitial pneumonia and peribronchial and perivascular infiltration by mononuclear cells, with no viral inclusions. These findings are not specific but have been found by some authors in animal models with acute immune-mediated lung injury related with donor T lymphocytes. Immune-mediated lung injury, as defined by animal models, should be considered in patients with severe signs of systemic aGVHD while excluding other known etiologies of pulmonary disease.
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2/17. pneumonectomy: four case studies and a comparative review.

    pneumonectomy is the resection of all lung lobes in either the left or right lung field. The surgical technique and postoperative results of pneumonectomy for clinical disease have not been reported in companion animals. pneumonectomy was performed in three dogs and one cat to treat pulmonary or pleural disease, and the postoperative outcome compared with the complications and results reported in the human literature. One dog died immediately postoperatively due to suspected respiratory insufficiency and the remaining three animals survived the perioperative period. postoperative complications were reported in two animals. Cardiac complications occurred in the cat, with perioperative arrhythmias and progressive congestive heart failure. Gastrointestinal complications were diagnosed in one dog, with mediastinal shift and oesophageal dysfunction. Left- and right-sided pneumonectomy is feasible in companion animals, and the postoperative outcome and complications encountered in this series were similar to those reported in humans.
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3/17. Alveolar damage due to inhalation of amitrole-containing herbicide.

    amitrole-containing herbicides are commonly used by home and cottage owners for spraying grass. They are manufactured and distributed in the united states, canada and throughout the world by several pharmaceutical/chemical industries under many different trade names, such as amitrole-T, Amizol, Azolan, Cytrol and Weedazol. They have not been previously associated with pulmonary toxicity in man or laboratory animals. We describe the first case in which inhalation of amitrole herbicide resulted in diffuse, asymmetric, severe alveolar damage, which was reversed after treatment with high-dose corticosteroids.
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4/17. Alveolitis due to hair-spray. Ultrastructural observations in two patients and the results of experimental investigations.

    observation of two patients with hair-spray induced lung disease have prompted us to study the ultrastructure of the lung lesion. We have compared the results with experimental lesions in animals injected with hair-spray extracts and with human monocyte cell cultures exposed to hair-spray. The lungs show a chronic alveolitis with a striking granulomatous reaction including macrophages and multinucleated giant cells of the foreign body type. The intraalveolar and interstitial macrophages and the giant cells all contain PAS-positive material. Ultrastructurally distinct lamellar inclusions are found in the secondary lysosomes of the macrophages and giant cells. Identical structures can be produced in animals injected with hair-spray extracts and with polyvinyl-pyrrolidone and -acetate (PVP/PVA), which are regular ingredients of hair-sprays. Large, presumeably polymeric particles (PVP/PVA) are ingested by giant cells. This "gigantophagocytosis" is associated with the fusion of mononuclear phagocytes and leads to the genesis of giant cells. In cell cultures of human blood monocytes hair-spray extracts and PVP/PVA induce maturation and aggregation of these cells, with PAS-positive cytoplasmatic inclusions. The development of multinuclear giant cells in these monocyte cell cultures is also seen. These observations suggest that hair-spray induced lung disease is caused by the prolonged and extensive body response of the local mononuclear phagocyte system (MPS). Overstimulation of the MPS leads to a quantitative and qualitative change which is followed by a partial blockade of this system. The alveolitis is a consequence of the foreign body response to inhaled hair-spray substances.
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5/17. Electron microscopic demonstration of lysosomal inclusion bodies in lung, liver, lymph nodes, and blood leukocytes of patients with amiodarone pulmonary toxicity.

    The mechanism of amiodarone-induced pulmonary toxicity is unknown. Two cases of amiodarone pulmonary toxicity are presented in which abnormal inclusion bodies containing whorls of membrane were seen on electron microscopy of extrapulmonary tissues. These cytoplasmic lysosomal inclusion bodies were observed in lymphocytes, plasma cells, granulocytes, tissue macrophages, and hepatocytes. These widespread histopathologic changes in extrapulmonary tissues and in a variety of cell types are similar to more extensively investigated findings in animal models that are thought to represent a drug-induced lysosomal storage disease, phospholipidosis.
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6/17. Hemorrhagic pulmonary edema associated with meat tenderizer treatment for esophageal meat impaction.

    We describe a case of acute hemorrhagic pulmonary edema caused by aspiration of Adolph's meat tenderizer, used in an attempt to relieve an esophageal meat impaction. We performed an animal experiment in which bronchial instillation of a similar solution reproduced the clinical findings in our patient. This is a previously unreported and potentially lethal complication of a therapy that has never been submitted to clinical trials. We recommend against the use of this therapy for patients with complete esophageal obstruction or in those otherwise at risk for aspiration.
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7/17. Electrolytic tissue destruction and external beam irradiation of the lung. An experimental and clinical investigation.

    In order to evaluate possible benefits of local therapy of lung tumors--electrolysis at Pt-electrodes percutaneously inserted in the tumor, followed by radiation therapy--6 pigs were used as test objects. Two died of lung hemorrhage due to too fast electrolysis causing lung rupture but the other 4 survived when electrolysis was performed at a lower speed. No complication was observed of the combination of electrolysis and external beam irradiation. One human primary lung tumor was treated and probably destroyed by two electrolytic procedures and irradiation to 64 Gy. The evidence of the limited series of animal experiments and of single human tumor case would indicate that further investigations seem worthwhile.
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8/17. Systemic complications of MER immunotherapy of cancer: pulmonary granulomatosis and rash.

    BCG immunotherapy often has severe complications in cancer patients despite lack of toxicity in the immunocompetent individual. MER, a cell wall fraction of BCG, has been reported to cause immunopotentiation similar to that of BCG without equivalent toxicity. Recently, animal models have been reported to develop MER complications, especially disseminated granuloma formation, like those of BCG. For the past several years, MER has been used as adjuvant immunotherapy for treatment of malignant tumors with minimal systemic toxicity reported. A patient with malignant melanoma was treated with intralesional MER at the site of local metastases. He developed military pulmonary granulomatosis and a severe cutaneous eruption in association with MER therapy. The toxicities of BCG and MER therapy were compared with the pathogenesis of granuloma formation reviewed. This patient's complications were consistent with a hypersensitivity reaction to MER. Pulmonary granulomatosis and rash must be added to the list of known MER toxicities.
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9/17. Unusual infections caused by pasteurella multocida.

    Three cases of infection with pasteurella multocida included acute epiglottitis, septic arthritis, and pleuropulmonary infection. Human infections with this microorganism are commonly related either to animal contact (eg, wound infections) or to the presence of underlying chronic respiratory tract disease. Although septic arthritis and pleuropulmonary infections have previously been attributed to this pathogen, to our knowledge, this is the first reported case of acute epiglottitis caused by P. multocida.
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10/17. Steatosis of granular pneumocytes in alcoholics with acute alveolar injury.

    Accumulation of neutral lipid in the type II alveolar epithelial cells of the lung has been described in experiments involving animals with conditions such as hypoxia or on alcohol administration. In two cases involving human subjects, this change was observed at autopsy by histochemical stains and electron microscopy. In both instances, the patients had had severe alcoholic liver disease, as well as extreme hypoxia resulting from acute alveolar injury. The lungs of six alcoholic patients with liver disease but without acute alveolar injury showed no lipid vesicles on histochemical staining. These observations suggest that a metabolic insult or combination of insults, such as alcohol or hypoxia, might lead to accumulation of neutral lipid, especially in regenerating alveolar epithelial cells that may be more susceptible to such injury.
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