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Objective To evaluate the role of transbrochial needle aspiration (TBNA) in the diagnosis of patients with enlarged mediastinal and/or hilar lymph node. Methods Patients with mediastinal and/or hilar lymphoadenopathy proven by CT scan were eligible for TBNA as reported. All specimens were directly and instantly smeared for pathological examination. Results From June 1 2004 to December 31 2007, 164 patients were examined: including 80 lung cancers, 69 lung bengin diseases, 2 other malignancy tumor, and 13 without definite diagnosis. Total 260 lymph nodes were punctured. TBNA procedures were successfully carried out in 445/463(96.1%). Sensitivity of TBNA was 82. 5 % (66/80) in patients who had been proven to suffer from bronchogenic carcinoma. There were 25 patients that diagnosis of lung cancer was pathologically determined by TBNA only. A total of 122 lymph nodes in the 80 lung cancer patients were aspirated by TBNA with a positive rate of 65. 6% (80/122). Severe complications were rare except small amount of bleeding at the TBNA site (100/164, 61.0%). From June 1 2006 to December 31 2007, lymph node tissues able to make histology diagnosis were yield in 73.5% (64/87) patients. Through histology pathology, the sensitivities of TBNA were 53. 3% (8/15) for sarcoidosis and 78.6% (33/42) for lung cancer. Conclusion TBNA is quite safe and helpful in diagnosis and staging of bronchogenic carcinoma, and in diagnosis of benign lung diseases.
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Objective To evaluate the guidance role of the CURB-65 criteria in the management of community-acquired pneumonia(CAP) in adults. Methods The clinical date of 13 patients with CAP from January 2007 to January 2008 were analysed, the diagnosis and treatment of 3 patients were enumerated. Evaluated the effect of CURB-65 criteria on CAP. Results According to the CURB-65 criteria, the scores of 3 patients with CAP were 0, 2, 5 scores respectively.After the proper treatment based on CURB-65 criteria,each patient got a good prognosis. Conclusions The CURB-65 criteria plays an encouraging role in assessing the severity of CAP. But the veracity of identifying severe CAP is poor. In this situation the criteria for severe CAP is needed to make the decision.
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Objective To study the clinical features of pulmonary Langerhans cell histiocytosis.Methods Restrospectively review of 7 cases of pulmonary Langerhans cell histiocytosis proved by pathology with the clinical,physical,radiological,pathological and pulmonary function presentation.Results Seven cases were all male,aged from 17 to 37.Four of them are cigarette smokers.The major symptoms were cough and laboring dyspnea,and pneumothorax presented in five cases.As to pulmonary function presentation,obstructive pattern presented in three cases,restrictive pattern and mixed pattern presented in two cases respectively,and the carbon monoxide diffusing capacity was decreased in four cases.The abnormalities present predominantly in the upper and middle lung fields on chest high-resolution CT scan.Lung cysts and reticular changes presented in six cases and nodules presented only in one case.The diagnosis was established by surgical lung biopsy.The positive cases of staining for the S-100,CD1a antigens,and CD68 were 7/7,4/5 and 5/6 respectively.Conclusion PLCH patients are typically young adults,often present with cough,laboring dyspnea and pneumothorax.Pulmonary function presentation is nonspecific and the carbon monoxide diffusing capacity may be decreased.The characteristic features of HRCT are bilateral reticulonodular areas and cysts change that predominantly involved the upper and middle lung zones with relative sparing of the lung bases.The pathologic feathers are interstitial infiltration of bronchiole walls and epithelium by LCH cells and cyst formation.The staining for CD1a antigens and the S-100 proteins is positive by immunohistochemical analysis.
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Objective To identify a potential correlation between cold hemoagglutinin(CHA) and diffuse panbronchiolitis(DPB) in Chinese patients.Methods Eighteen patients diagnosed as DPB from December 1996 to July 2008 in Peking Union Medical College Hospital and 60 cases of DPB reported in mainland of China from 1996 to 2008 were enrolled in the study.Results Of 18 patients diagnosed as DPB in Peking Union Medical College Hospital,only one patient showed a titer of CHA≥1:64.Of 60 cases in mainland China,48 cases were CHA positive.CHA was positive in 54.1% all cases.There may be some correlation between positive rate of CHA and medication as well as population.Conclusion Low positive rate of CHA in Chinese subjects,which is different from that of Japanese DPB patients,suggests that CHA may not be applied as a diagnostic criteria for Chinese patients.
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ObjectiveTo comprehend the clinical presentation s of systemic amyloidosis in respiratory tract MethodsThe rec ords of all patients with biopsy-confirmed systemic amyloidosis admitted to our hospital between 1985 and 2003 were retrospectively reviewed All relevant info rmations of respiratory tract,such as clinical,image,and demographic,were an alyzed ResultsAmong 46 cases of systemic amyloidosis,respira tory amyloidosis was diagnosed in 37 patients (27 men and 10 men) clinically,in vovling upper respiratory tract,tracheobronchial,lung parenchyma,pleura,medi asteinal and hilar,with a mean age of 51 49 years 12 cases were confirmed by the characteristic Congo-red staining of respiratory biopsies The most common sites at presentation were lung parenchyma and pleura ConclusionsThe respiratory tract was involved in about 80 4% of patients with systemic amylodosis meaning a higher prevalence than previously reported It is necessar y to pay more attention to respiratory amyloidosis to diagnose and treat early
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Objective To evaluate the appearance of CT in patients with severe acute respiratory syndrome (SARS) in the recovery phase, and to study the correlation of CT findings with pulmonary function.Methods From June to August in 2003, 100 patient with confirmed SARS accepted examination in our hospital. Among them, 91 patients (39 men, 52 women, mean age 36.4 years, age range 19- 66 years) received CT examination and pulmonary function test on the same day. The interval between SARS onset and the examination ranged from 52 to 125 days (mean 87.4 days). CT appearances of pulmonary parenchymal abnormalities including distribution and extent of involvement were quantitatively analyzed, and four levels on CT scan including the aortic arch, the tracheal carina, the pulmonary venous confluence, and the dome of right diaphragm were selected to score the lesions. The correlation of CT scores with the results of pulmonary function tests was studied.Results Of the 91 cases, 47 patients had normal CT appearance in the recovery phase, whereas the other 44 patients still had parenchymal abnormalities, including residual ground-glass opacification and reticular shadow. CT visual score had correlation with DLco% ( r =-0.618, P
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Objective To investigate the characteristics of lung involvement in microscopic polyangiitis(MPA)patients and its influence on treatment and prognosis.Methods From Jan 2006 to Dec 2007,29 patients were diagnosed with MPA in Peking Union Medical College Hospital.Their clinical data,including clinical manifestations,radiologic and laboratory test results,were retrospectively analyzed.Results The patients included 14 males and 15 females.The mean age was(63.7?10.1)years;28 patients(96.6%)were involved in the lung;20 patients(69.0%)had respiratory symptoms and 15 patients(51.7%)had respiratory signs.Two kinds of patterns were found in radiology:hemorrhage and fibrosis.Seventeen patients(17/27)were hypoxemia in room air blood gas analysis.Five patients(5/18)were diagnosed with pulmonary hypertension by echocardiograghy.Seven patients(7/10)were abnormal in lung function test.Four patients(4/6)were abnormal in BALF.Ten patients(34.5%)were diagnosed with alveolar hemorrhage and 18 patients(62.1%)were complicated with pulmonary infection.Totally 10 patients(34.5%)died,2 patients of diffuse alveolar hemorrhage and 8 of pulmonary infection.Conclusion Most MPA patients have pulmonary involvement and the clinical manifestations vary.There is a high mortality in MPA patients and the main causes are pulmonary infection and diffuse alveolar hemorrhage.