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Objective@#To analyze the clinical characteristics, diagnosis, treatment and prognosis of patients with multisystemic sarcoidosis in order to improve the clinical diagnosis and treatment.@*Methods@#A multisystemic sarcoidosis patient presenting with cranial nerve involvement as the first symptom was admitted to Beijing Hospital, and the clinical manifestations, imaging and pathological features were analyzed.And the related literatures were reviewed and summarized.@*Results@#The sarcoidosis patient presented with weakness in the limbs, bilateral paralysis, visual floaters and subcutaneous masses.Chest CT showed multiple symmetrical lymph nodes in the mediastinum and bilateral hilum, with multiple ground-glass and grid-like densities in both lungs.The subcutaneous mass biopsy showed non-caseous granulomas, which was often considered as sarcoidosis.The condition improved after glucocorticoid treatment, while it relapsed after drug withdrawal, with new-onset of shoulder and knee pain.The endobronchial biopsy showed non-caseous granulomas.And the symptoms of the patient were relieved after the retreatment with glucocorticoid.@*Conclusions@#Multisystemic sarcoidosis is a rare clinic entity, and cranial nerve involvement as the first symptom is rarer.The diagnosis and treatment of multisystemic sarcoidosis are often delayed due to atypical symptoms.Although patients with sarcoidosis are sensitive to glucocorticoid therapy, those with extra-pulmonary involvement are more likely to relapse.Therefore, not only standardized treatment but also continuous monitoring of disease changes must be needed in clinic.
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Objective To analyze the clinical characteristics,diagnosis,treatment and prognosis of patients with multisystemic sarcoidosis in order to improve the clinical diagnosis and treatment.Methods A multisystemic sarcoidosis patient presenting with cranial nerve involvement as the first symptom was admitted to Beijing Hospital,and the clinical manifestations,imaging and pathological features were analyzed.And the related literatures were reviewed and summarized.Results The sarcoidosis patient presented with weakness in the limbs,bilateral paralysis,visual floaters and subcutaneous masses.Chest CT showed multiple symmetrical lymph nodes in the mediastinum and bilateral hilum,with multiple ground-glass and grid-like densities in both lungs.The subcutaneous mass biopsy showed non-caseous granulomas,which was often considered as sarcoidosis.The condition improved after glucocorticoid treatment,while it relapsed after drug withdrawal,with new-onset of shoulder and knee pain.The endobronchial biopsy showed non-caseous granulomas.And the symptoms of the patient were relieved after the retreatment with glucocorticoid.Conclusions Multisystemic sarcoidosis is a rare clinic entity,and cranial nerve involvement as the first symptom is rarer.The diagnosis and treatment of multisystemic sarcoidosis are often delayed due to atypical symptoms.Although patients with sarcoidosis are sensitive to glucocorticoid therapy,those with extrapulmonary involvement are more likely to relapse.Therefore,not only standardized treatment but also continuous monitoring of disease changes must be needed in clinic.
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Objective To evaluate the efficacy and safety of long-term nebulized corticosteroids and inhaled bronchodilators therapy on asthma in long term poor controlled elderly patients.Methods Prospective,randomized control study was conducted.63 elderly asthma patients,who received inhaled corticosteroids or combined with other long-term medication treatment for asthma control for more than 3 months but were still in moderate to severe persistent asthma state,were randomly divided into nebulizer treatment group (n=31) and dry powder inhalation group (n=32),and they were treated correspondingly with Budesonide inhalation suspension 1 mg and Salbutamol 2.5 mg BidorBudesonide/Formoterol powder 320/9 μg inhalation Bid.Patients in the two groups were evaluated for the differences in lung function,acute exacerbations of asthma,asthma control test (ACT) and adverse effects after 12-week treatment.Results The improvement in morning peak expiratory flow (PEF) and ACT score were better in the test group than in the control group [(29.2 ±14.4) ml vs.(15.8±13.5)ml,(4.8±2.2) vs.(3.0±2.7),t=3.715 and 2.897,P=0.000 and 0.005],but there were no statistical differences in average daily use of relievers and severe acute exacerbations between the test and control groups (t=1.512,P=0.136;x2=2.238,P=0.135).The local adverse effects caused by inhaled corticosteroids had no significant difference between the two groups.Conclusions Compared with the powder inhalation,the nebulizer inhalation administration of corticosteroids and bronchodilators could improve the asthma symptoms and lung function better in elderly patients with serious asthma condition and shows a good safety in tbe12 weeks of continuous treatment.
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Objective To evaluate the effects,safety and economic cost of long-term home noninvasive ventilation (NIV) therapy in elderly patients with chronic hypercapnic respiratory failure.Methods A total of 128 elderly patients with chronic hypercapnic respiratory failure were randomly assigned to two groups:the NIV group (n=66) with conventional therapy in addition to long-term home NIV therapy,and the control group (n=62) with conventional therapy alone.Compared were parameters before and after two year follow up,which included dyspnea grade,scale for accessory muscle use,scoring for emotional disorders,mean pulmonary pressure (mPAP) by electrocardiography,arterial blood gas,the times of pulmonary infection and hospitalization rates,the duration of hospitalization invasive ventilation,the duration of in RICU and in hospital stay,tracheal intubation rates and mortality.The medical cost was calculated.Results After two years,the differences in the dyspnea grade,scale for accessory muscle use,anxiety scores,depression scores,mPAP,arterial PaCO2 and PaO2,hospitalization rates,the times of pulmonary infection,the days of hospitalization for exacerbation in the home NIV group [2.2± 0.2,2.4 ± 0.3,4 ± 1,5.3 ± 1.2,(36.6±5.2)mm Hg,(50.2±4.5)mm Hg,(63.5±4.2)mm Hg,(1.3±0.2) times/year,(2.4±0.2) times/year,(15.8 ± 4.4) days/times] were statistically significant compared to the control group [4.1±0.2,4.9±0.5,12±3,11.3±1.6,(45.2±5.2)mm Hg,(67.3±4.5) mm Hg,(48.3±4.3)mm Hg,(5.4±0.4)times/year,(8.9 ±0.3) times/year,(38.5± 6.3) days/times] (all P＜0.01).The duration of invasive ventilation,the days in RICU and in hospital stay,tracheal intubation rates on admission to the hospital were significantly decreased in the home NIV group [(8.2 ± 2.2)days,(9.6±3.1) days,(15.8±4.4) days,(2±0.2) times/two years],as compared with the control group [(15.8±3.4) days,(18.6±4.4)days,(38.5±6.3)days,(8.0±0.8) times/two years].The mortality was decreased significantly in the home NIV group (3.0 ％)compared with the control group (29.0％) (P＜0.05).The medical cost in two years was significant lower in the home NIV group [(6.4 ± 0.5) thousand yuan],compared with the control group (18.4 ±0.6) thousand yuan (P＜0.01).Conclusions Long-term home NIV therapy in patients with chronic hypercapinc respiratory failure is effective,safe and can decrease the mortality and medical cost.
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Objective To study the diagnosis and treatment of Mycobacterium avium complex lung disease with severe renal insufficiency,and to provide a basis for improving the clinical diagnosis and treatment of MAC lung disease with severe renal insufficiency.Methods Clinical data of an elderly patient with MAC lung disease confirmed by induced sputum culture and complicated with chronic kidney disease (CKD 4) was reported.The related literatures at home and abroad were reviewed.Results A male patient aged 80 years with poor nutrition was suffering from progressive weight loss,exhaustion and night sweats.His weight was only 43-44 Kg.Chest CT showed that multiple small nodules,small spot pieces of shadow and ground glass shadows in bilateral lung tissues.PET/CT indicated that spot pieces and nodules with metabolic activity in high performance.Bronchoalveolar lavage fluid (BALF) inspection was negative.MAC was identified by induced sputum culture through high permeability brine induced sputum.It was difficult to choose drugs for the treatment of MAC lung disease due to his poor kidney function [GFR of left kidney:9.0 ml /min,GFR of right kidney:18.8 ml/min].Conventional anti-mycobacterium drugs showed a low to high resistance to MAC.Moxifloxacin was discontinued for renal insufficiency.His condition was stable after choosing trimodality therapy including azithromycin 0.25 g/d tiw,rifapentine 0.3 g/d biw,ethambutol 0.375 g /d tiw and the joining immunotherapy.Conclusions PET/ CT is not useful in identifying tuberculosis and MAC lung disease.The treatment of MAC lung disease is difficult in elderly patients with severe renal insufficiency and low weight.Individual therapy combined with immunotherapy and improving the nutrition state is a good choice for the treatment of MAC lung disease in elderly patients with severe renal insufficiency.The anti-MAC drugs should be carefully selected and the adverse reactions should be closely observed in order to obtain the satisfactory clinical results.
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Objective To evaluate the hematologic effects of linezolid in advanced aged patients with hospital onset of infection.Methods The clinical characteristics and complete blood routine examination results of 45 elderly patients aged(92.9±5.2)years treated with linezolid over 600 mg of lowest dose everyday for more than 72 hours were retrospectively analyzed.Results Among the 45patients,20 patients(44.4％)had substantially lower platelet,6 patients(13.3％)lower haemoglobin,1 patient(2.2％)lower absolute neutrophil,and the linezolid treatment in 19 patients were discontinued due to hematological system adverse reactions.The significant drop in platelet occurred at(10.2±3.3)days after treatment.The significant drop in hemoglobin occurred at(9.8±3.0)d after treatment.The lowest count of platelet and hemoglobin took place at(13.1±3.9)d and (10.5±3.5)d after treatment,respectively.The drops in platelet and hemoglobin of some patients took place after cease of treatment.Stepwise logistic regression analysis revealed that treatment duration(OR =1.407,P＜0.05)and creatinine clearance rate(OR=0.732,P＜0.05)were the risk factors for thrombocytopenia.Conclusions The elderly patients using linezolid more likely suffer from adverse reactions of hematological system,particularly thrombocytopeniawhich is significantly more common in patients with renal insufficiency and prolongation of treatment time.The blood routine examination should be monitored closely when elderly patients are treated with linezolid.
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Objective To explore the diagnosis and treatment of non traumatic chylothorax in non-Hodgkin's lymphoma (NHL) and to understand the differences in diagnosis and treatment between chylothorax and pseudochylothorax. Methods The patient aged 83 years was confrimed as chylothorax and NHL after lymph node biopsy.We reviewed literatures about chylothorax in NHL to analyse the possible mechanism,its diagnosis and treatment. Results The patient was sufferring from unilateral chylothorax diagnosed as true chylothorax by thoracentesis,and progressed to bilateral chylothorax after 1 year.PET/CT examination showed intrathoracic and right cervical lymph nodes enlargement and an increasing metabolic activity.Cervical lymph node biopsy revealed diffuse large B cell type non-Hodgkin's lymphoma.The patient refused any other treatment except the diet therapy and died after 19 months.We searched 19 cases with NHL chylothorax in associated literatures about the treatments including radiotherapy (6/6 improved),chemotherapy (6/11 improved),thoracic duct ligation (I/1 improved),thoracic duct ligation and drug pleurodesis(1/1 improved). Conclusions PET/CT is useful in finding the hidden clues of chylothorax in NHL.There is no standard mangement for NHL chylothorax and the treatment must be individualized. The overall prognosis of NHL chylothorax is similar to that of non-Hodgkin's lymphoma and the patient needs early diagnosis and general treatment in order to prolong the survival time.
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60 years, 13.3% of the total sarcoidosis patients) diagnosed as sarcoidosis based on national criteria from the year 1965 through 1999 were reviewed. Results The clinical degree was as follows: phase I, 8 cases; phase Ⅱ, 6 cases; phase Ⅲ, 2 cases. The elderly sarcoidosis patients manifested variously, with misdiagnosis rate being 50%. The active degree of pulmonary sarcoidosis was correctly evaluated after the diagnosis was confirmed and the patients was strictly observed during the treatment since it was very important for avoiding the occurrence of complications. Conclusions The early diagnosis in elderly patients with sarcoidosis should be emphasized to prevent them from missing and misdiagnosis. The elderly patients with treating indications in phases Ⅱ and Ⅲ could be given steroids and constant observation and regular examinations are important during the treatment.