Pathological and high resolution CT findings in Churg-Strauss syndrome / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the Churg-Strauss syndrome (CSS) associated lung involvement, concentrating on clinical characteristics, pathological findings of lung involvements, response to treatment, and prognosis.</p><p><b>METHODS</b>We retrospectively analyzed the characters of the clinical manifestations, thin-section CT and pathological findings of CSS. The study involved 16 patients. Clinical data were obtained by chart review. All patients underwent transbronchial lung biopsy (TBLB). Six of them underwent surgical lung biopsy as well.</p><p><b>RESULTS</b>The patients included 7 men and 9 women, aged from 14 to 61 years (median, 47.5 years). Extrathoracic organs involved included nervous system (7/16) and skin (5/16). Respiratory symptoms included cough (12/16), exertional dyspnea (11/16), hemoptysis (4/16), and chest pain (3/16). CT findings included bilateral ground-glass opacities (12/16), bilateral patchy opacities (12/16), and centrilobular nodules (6/16). The pathological findings of TBLB demonstrated increased eosinophils (3/16), vasculitis (3/16), and interstitial pneumonia (16/16). The pathological findings of surgical lung biopsy of 6 cases showed necrotizing vasculitis in 4 cases, capillaries in 5, eosinophilic pneumonia in 3, granulomas in 2, and airway abnormalities in 3. All patients improved in symptoms after therapy during the study period (range, 3 to 51 months; median, 15 months).</p><p><b>CONCLUSIONS</b>Asthma may be present in CSS patient when there is bronchial involvement. Ground-glass opacities and consolidation seen on high-resolution CT reflect the presence of eosinophilic pneumonia, vasculitis, and pulmonary alveolar hemorrhage. TBLB has significant limitations for the diagnosis of CSS. Early diagnosis and therapy can result in satisfactory prognosis.</p>

Diagnostic specificity of dynamic assessment and monitoring of spirometry in asthma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the diagnostic specificity of dynamic assessment and monitoring using a portable spirometer in diagnosis and differential diagnosis of asthma.</p><p><b>METHODS</b>We retrospectively reviewed the results of dynamic monitoring of spirometry in 145 symptomatic patients with physician-diagnosed asthma. Flow-volume curve and simultaneous symptoms and mood were measured in a fixed-time thrice-daily assessment schedule for 2 weeks. Patients were allowed to make additional measurements in case of symptom exacerbations.</p><p><b>RESULTS</b>The clinical data of 51 males and 94 females with a mean age of (39.1 +/- 13.0) years (ranged from 10 to 65 years) were analyzed. Duration of asthma before study was (6.7 +/- 9.9) years. Of 145 patients with physician-diagnosed asthma, 126 (87%) could be conclusively confirmed for a diagnosis of asthma. Asthma was misdiagnosed in 14 patients (9.7%). Overdiagnosis of asthma was observed in 5 patients (3.4%).</p><p><b>CONCLUSION</b>Dynamic assessment and monitoring using a portable spirometer by revealing variability and reversibility of airway obstruction may provide an additional tool for diagnosis and differential diagnosis of asthma.</p>

Clinical features and prognosis in 21 patients with extrinsic allergic alveolitis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To assess the spectrum of causes, clinical features, differences between disease phases, and prognosis of extrinsic allergic alveolitis (EAA).</p><p><b>METHODS</b>Patients with EAA diagnosed at Peking Union Medical College Hospital from August 1983 to May 2007 were analyzed retrospectively. Their medical records were examined to gather clinical, laboratorial, radiological, and histopathological data. Patients were divided to three phases (acute, subacute, and chronic) according to clinical presentations. Follow-up data regarding treatment response, subsequent radiological and pulmonary function studies, and clinical outcomes were collected.</p><p><b>RESULTS</b>A total of 21 cases were enrolled. Among them, 11 were subacute, 10 were chronic. The most common exposure was pet birds (6 cases, 28.6%). The primary abnormality of pulmonary function was restriction and/or reduction in diffusing capacity (12 cases, 63.2%). The most common findings on high-resolution computed tomography (HRCT) were ground-glass opacities (13 cases, 68.4%) and centrilobular nodules (8 cases, 42.1%). Airway obstruction in pulmonary function test, emphysema, lung cysts, and fibrosis on HRCT were more frequently seen in chronic than in subacute patients, though the differences were not statistically significant. Bronchoalveolar lavage fluid (BALF) showed lymphocytosis. The total cell count and the percentage of neutrophils were significantly higher in subacute than in chronic patients (P<0.05). Nonnecrotizing granulomas were seen in 8 (47.1%) cases. Improvement or normalization in symptoms, radiography, and pulmonary function test after treatment were seen in all 18 patients with available follow-up data. Five patients recurred.</p><p><b>CONCLUSIONS</b>The characteristic abnormalities of pulmonary function, findings on HRCT, and pathology are essential for all phases of EAA, and the atypical manifestations such as obstruction and fibrosis can also be present frequently, particularly in chronic cases. Differential cell counts of BALF are related to the phase of the disease. The treatment response and prognosis of EAA are good.</p>

Clinicopathologic manifestation of amiodarone-induced lung injury / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinical, pathologic and radiologic features of amiodarone-induced lung injury.</p><p><b>METHODS</b>The clinical, pathologic and radiologic features, including treatment and follow-up information of three cases diagnosed as amiodarone-induced lung injury from October 2004 to October 2005 in the Peking Union Medical College Hospital were reviewed.</p><p><b>RESULTS</b>All the patients were males, with age ranging from 35 to 64 years. The duration of symptoms varied from 20 days to 3 years. All presented with cough. Worsening dyspnea and inspiratory crackles were noted in two patients. Computerized tomography showed bilateral patchy infiltration, ground-glass appearance and accentuation of bronchovascular markings. The most common pathologic manifestations included cellular interstitial pneumonia associated with intra-alveolar collections of macrophages and type II pneumocyte hyperplasia. Some of the macrophages contained finely vacuolated cytoplasm. An organizing pneumonia pattern was seen in one patient.</p><p><b>CONCLUSIONS</b>Amiodarone-induced lung injury has characteristic pathologic features which may provide clues to diagnosis. Correlation with clinical and radiologic findings is also important.</p>

Thoracic high resolution CT findings of 100 SARS patients in convalescent period / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study thoracic high resolution CT findings of severe acute respiratory syndrome (SARS) patients in convalescent period and the relationship between the features with laboratory and pulmonary function results.</p><p><b>METHODS</b>All the 100 SARS patients who had been discharged from hospital for about 2 months underwent thoracic high resolution CT examinations. Among them, 65 also had laboratory results and 91 underwent examinations of pulmonary function.</p><p><b>RESULTS</b>Forty-nine SARS patients (49.0%, 49/100) in convalescent period still had abnormal findings in CT examination. And ground-glass opacification (95.9%, 47/49) and reticular opacification (59.2%, 29/49) were common. There was no significant difference in the level of lymphocytes and CD4 cells among groups divided according to severity of CT findings (P > 0.01). Diffusing capacity for carbon monoxide (DLco%) of level 2 and 3 were statistically lower than that of level 0 (P < 0.01).</p><p><b>CONCLUSIONS</b>The features of CT findings of SARS patients in convalescent period are not the same as those of patients in period of apparent manifestation. The high resolution CT can reflect pulmonary diffusing function to some degree.</p>

Assessment of health-related quality of life in cured SARS patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To assess the quality of life in cured patients with severe acute respiratory syndrome (SARS).</p><p><b>METHODS</b>One hundred and nineteen SARS outpatients, including 64 men and 55 women, with mean age (34.1 +/- 11.4) years and average days of discharge from hospital (28.0 +/- 12.8) days, were assessed by the St George's respiratory questionnaire (SGRQ), and 72 patients with spirometry test.</p><p><b>RESULTS</b>The patients had a moderately degree physiological impairment and increased SGRQ score. Scores of all four part of SGRQ correlated significantly with diffuse capacity of the lung for carbon monoxide/pre (DLco%). The correlation coefficients between the activation, impaction, total score, and diffuse capacity of the lung for carbon monoxide/alveolar ventilation/pre (DLco/Va%) were resembled (r = 0.47-0.54, P < 0.01). There was a significant relationship between the score of SGRQ and patients age, and gender. The time leaving hospital only had a significant relationship with the symptom score of SGRQ.</p><p><b>CONCLUSIONS</b>SGRQ is a sensitive tool for assessing quality of life in cured SARS patients. The cured SARS patients' quality of life decrease moderately.</p>

Assessment of pulmonary function in SARS patients during the convalescent period / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the pulmonary function in severe acute respiratory syndrome (SARS) patients during the convalescent period.</p><p><b>METHODS</b>Followup 89 outpatients of SARS. The follow-up study included interview, physical examination, and pulmonary function test.</p><p><b>RESULTS</b>The interval between hospital discharge and functional assessment was 1.75 +/- 0.53 months (0.5-3.4 months). Mild to moderate abnormalities in pulmonary function were found in 48 patients (53.9%). Diffusion capacity for carbon monoxide (DLco) was impaired in 38 patients (42.7%); in 7 patients (7.9%), lung function was restrictive defect combined DLco impairment; Other patterns of impairment were revealed in 3 patient. Dyspnea during acute phase and CT during the convalescent period were found to have significant influences on DLco and total lung capacity (TLC).</p><p><b>CONCLUSIONS</b>Diffusing capacity impairment as well as restrictive defect persist in convalescence SARS.</p>

Clinical diagnosis, treatment and prognosis of elderly SARS patients / 中国医学科学院学报

<p><b>OBJECTIVE</b>To discuss the clinical manifestations, therapeutic strategy and prognosis of patients with severe acute respiratory syndrome (SARS) older than 60 years.</p><p><b>METHODS</b>Elderly patients diagnosed as SARS in Peking Union Medical College Hospital were compared with younger patients.</p><p><b>RESULTS</b>Twenty-four elderly patients and 53 younger patients were analysed. Elderly patients had more coexisting conditions, such as hypertension, diabetes, coronary heart disease, and renal disease than control group (P < 0.05). Rate of respiratory failure in elderly patients was higher than that in control group (P < 0.05). Elderly patients had more respiratory symptoms, such as cough, sputum, and shortness of breath (P < 0.05). Rate of lymphocytopenia and thrombocytopenia in elderly patients was higher than that in control group. All patients were given ribavirin and antibiotics. More patients in elderly group were given 3rd generation cephalosporin and imipenem. Mortality rate in elderly group was higher than that in control group (33.3% vs 3.8%, P < 0.05). Univariate analysis showed that age, respiratory failure, and thrombocytopenia were risk factors of death, but logistic analysis did not find any independent risk factor.</p><p><b>CONCLUSIONS</b>Though the elderly patients have a lower morbidity of SARS, they have more coexisting conditions. The therapy of elderly patients is more difficult than that of control group, and the mortality in elderly patients is high.</p>