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Objective To summarize and evaluate the clinical feature and misdiagnosis of pulmonary granulomatosis with polyangitis (GPA).Methods The clinical data of 47 patients of pulmonary GPA were analyzed retrospectively.The clinical feature and misdiagnosis were summarized.Results These patients were most commonly misdiagnosed as pulmonary infectious disease (61.8％,34/55) and pulmonary malignancy (27.3％,15/55) was the next in line.70.2％(33/47) patients had nose and sinus involvement,40.4％(19/47) patients had kidney involvement,25.5％ (12/47) patients had rash,19.1％(9/47) patients had eyes involvement,6.4％ (3/47) patients had peripheral neuritis,6.4％ (3/47) patients had gastrointestinal bleeding,4.3％(2/47) patients had pericardial effusion,87.2％(41/47) patients had positive for antineutrophil cytoplasmic(cANCA),76.6％(36/47) patients had positive for proteinase-3.Conclusions Almost all pulmonary GPA patients have extra-pulmonary multi-systemic involvement.They are often misdiagnosed as pulmonary infectious diseases and malignancy.Educating doctors on GPA constantly and screening possible patients with cANCA testing may help reduce the misdiagnosis.
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Objective To evaluate the efficacy of itraconazole combined with glucocorticosteroid in allergic bronchopulmonary aspergillosis.Methods The clinical characteristics and data of 11 allergic bronchopulmonary aspergillosis patients treated with itraconazole combined with glucocorticosteroid were retrospectively collected before treatment and two months after treatment.Then the clinical characteristics and data before and after treatment were compared to evaluate the efficacy of the treatment.Results The symptoms and signs got better after two months' treatment.C reactive protein,IgE and eosinophile granulocyte count after two months' treatment were significantly lower than that before treatment [(7 ±2) mg/L vs.(42± 13) mg/L,(742 ± 236) kU/L vs.(1 685 ±477) kU/L,(343 ± 112) × 106/L vs.(1 925 ± 318) × 106/L],and forced expired volume in one second percentage of predicted and arterial partial pressure of oxygen after two months' treatment were significantly higher than those before treatment [(77.5 ± 8.6)％ vs.(32.4 ± 9.1)％ and (81 ± 12) mmHg (1 mmHg =0.133 kPa) vs.(53 ± 6) mmHg],there were statistical differences (P ＜ 0.01 or ＜ 0.05).The inflammatory exudates resolved as demonstrated in pulmonary CT scan.Conclnsion Itraconazole combined with glucocorticosteroid can effectively neat allergic bronchopulmonary aspergillosis.
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Objective To evaluate the clinical value of pulmonary embolism severity index (PESI) in non high-risk acute pulmonary thromboembolism (APTE) patients treated with sequential anticoagulation.Methods Non high-risk APTE patients treated with sequential anticoagulation were divided into two groups according to PESI:high-value group and low-value group.Prognosis and treatment response was compared between two groups.Results There were 82 cases in high-value group,and 76 cases in low-value group.The rate of adverse events in high-value group was significantly higher than that in low-value group [23.2％(19/82) vs.7.9％ (6/76)] (x2 =5.0698,P =0.009),and 30 days cumulative hazard was also significantly higher than that in low-value group (P ＜ 0.05).The sensitivity of predicting adverse events by PESI was 76.0％,specificity was 52.6％,positive predicting value was 64.6％,and negative predicting value was 65.9％.The mortality in high-value group was significantly higher than that in low-value group [9.8％(8/82) vs.1.3％ (1/76)] (P =0.022).After 30 days of anticoagulation,the pulmonary artery systolic pressure,internal diameter of right ventricle in high-value group was significantly higher than that in low-value group [(39.4 ± 8.1) mm Hg (1 mm Hg =0.133 kPa) vs.(27.2 ± 5.5) mm Hg,(33.0 ± 7.8) mm vs.(21.7 ± 4.6) mm] (P =0.034,0.021),and arterial oxygen partial pressure was significantly lower than that in low-value group[(75.15 ± 12.41) mm Hg vs.(86.36 ± 9.22) mm Hg](P=0.016).Conclusions PESI can effectively predict short-term prognosis of non high-risk APTE patients treated with sequential anticoagulation.At least some of these patients might need treatment other than sequential anticoagulation.