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Objective To improve the understanding of pulmonary mucormycosis by analyzing the clinical manifestations,imaging features,diagnosis,treatment and prognosis of this disease.Methods The clinical data of eight patients diagnosed as pulmonary mucormycosis by histopathologic examination were retrospectively analyzed.Results Eight patients included six males and two females with age from 36 days to 66 years.Underlying conditions covered diabetes (n =4),renal transplantation (n =3),premature (n =1) and long-term corticosteroid treatment in two cases.Imaging manifestations revealed multiple irregular lumps or nodules in three cases,multiple cavities with thick wall in three cases,diffuse lung infiltrate in one case and lung opacities in one case.The diagnoses of seven patients were confirmed by percutaneous needle lung biopsy and the remaining one was diagnosed with fiberoptic bronchoscopy biopsy.Surgery combined with amphotericin B liposome(60 mg/d for three weeks)was applied to one patient who was cured with no recurrence after a 22 month follow-up.Three cases were given amphotericin B liposome (a newborn with 7mg/d for 62 days,the other two 60 mg/d for 31 days and 70 mg/d for 71 days respectively).All had achieved marked response with follow up from 8 to 29 months,but one patient relapsed and died of recurrent lung mucormycosis.The other three patients were treated with itraconazole 400-200 mg/d from 21 days to 1 year with duration of follow up from 1 month to 20 months.One patient was not evaluable due to missing.Two patients relapsed and one died.Conclusion Pulmonary mucormycosis is difficult to diagnose and treat with a high mortality.Percutaneous tranthoracic lung biopsy is a useful diagnostic method.Amphotericin B liposome or itraconazole may be active against mucus.Early control of causes is essential to improve the prognosis and reduce the recurrence in patients with pulmonary mucormycosis.
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Objective To investigate the clinical features,radiology,diagnosis and treatment of postkidney-transplant pulmonary mucormycosis.Method Three cases of post-kidney-transplant pulmonary mucormycosis were successfully diagnosed by histopathologic examinations.The clinical features of the cases were analyzed.The patients consisted of 2 males and 1 female,aged 39 to 54 yearn All patients were subjected to renal transplantation due to uremia,one was complicated with with diabetes,and pulmonary mucormycosis occurred 6 months,2 years and 6 years after kidney transplant respectively.Fever,cough,bloody sputum and chest pain were the main clinical manifestations.Multiple irregular massive or diffuse infiltrates in the lungs were the early CT findings.In a shoot time,multiple thick-walled cavities occurred in the pulmonary lesions.Pleural effusion was found in one patient.The lung specimens of patients were obtained by CT-guided percutaneous biopsy.Result The first patiem was cured after one year therapy by hraconazole,but recurred after 8 months.The second patient had a marked effect after a 21-day therapy by Itraconazole,but died of disseminated mucor for excessive immunosuppressant against the renal transplantation rejection.The third patient also had a marked effect,and was still in follow up.Condusion The post-kidney-transplant pulmonary mucormycosis is difficult in diagnosis and treatment.CT-guided percutaneous biopsy is one of effective ways for diagnosis.Itraconazole appears to be effective in treatment of pulmonary mucormycosis.Early diagnosis and an appropriate immune ftmction are the keys to improve prognosis and reduce recurrence
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Objective To screen the clinical factors affecting the malignant probability of solitary pulmonary nodule (SPN) with univariate and multivariate Logistic regression analysis,and to establish a clinical prediction model,evaluate its test effectiveness in the differential diagnosis in SPN.Methods A retrospective cohort study included 182 patients with diagnosis of SPN (group A).Clinical data included gender,age,smoking history,quitting smoking,history of tumor,serum carcinoembryonic antigen (CEA),location,diameter,density,vacuole sign,cavity,airbronchogram,calcifcation,lobulation,spiculate sign,spiculation,pleural indentation sign,vascular convergence sign,enhanced CT value,the maximum standard uptake value (SUV~x) of positron-emission tomography (PET),pathological diagnosis were collected.The independent predictors of malignancy were estimated with univariate and multivariate analysis,then the clinical prediction model to identify malignant was established.Other 45 SPN patients (group B) were used to tested value of the model.Results Univariate analysis showed that gender,age,no lower lobe location,diameter,density,airbronchogram,calcification,lobulation,spiculation,pleural indentation sign,enhanced CT value ≥ 15 HU,SUVm,≥ 2.5 of PET significantly affected judgment of SPN of benign or maligant (P ＜ 0.05).Multivariate analysis revealed that female,age,lobulation,short spiculation,pleural indentation sign was the independent predictors of malignancy in patient with SPN,solid nodule suggested benign.The clinical prediction model to identify malignant was established:P =ex/ (1 + ex),x =-3.399 +1.382 × gender + 0.056 × age + 1.377 × lobulation + 1.498 × spiculation-2.096 × solid + 1.005 × pleural indentation sign,e was natural logarithm.P =0.663 was as cut-off point,group B was used to test value of the model:the sensitivity was 86.5％,the specificity was 62.5％,the positive predictive value was 91.4％,the negative predictive value was 50.0％,the accuracy was 82.2％.Conclusions As for SPN,female,age,lobulation,short spiculation and pleural indentation sign is the independent predictor of malignancy in patient with SPN,solid nodule suggests benign.The prediction model is sufficient to estimate the malignancy of patient with SPN.
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To analyze the clinical characteristics,imaging and pathological features of 1 case with partial right lung atelectasis and summarize the relevant domestic reports on the false positive of positron emission tomography-computed tomography (PET-CT) and tumor markers.The patient was diagnosed by PET-CT as partial atelectasis and there were progressive increases of CEA,CA199 and CA242.But site of lesion biopsy showed no malignancy.After treatments of anti-inflammatory and eliminating phlegm,the tumor markers returned to normal and the lesion site had excellent re-expansion.The detection of PET-CT plus tumor markers may have false positive probability.The reason is probably related with inflammation and glandular secretion of lesion site.
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Objective To study the cerebral energy metabolism changes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) through hydrogen magnetic resonance spectroscopy examination (1 HMRS ) and its relationship with partial pressure of oxygen / carbon dioxide tension.Methods Totally 13 cases of AECOPD patients and 10 cases of age-matched healthy people underwent HMRS examination.The ratios of n-acetyl-aspartate(NAA)/creatine(Cr),choline (Cho)/Cr,myo-inositol(MI)/Cr of parieto-temporal and occipital areas of brain were detected.Blood gas analysis were also used to detect partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2).Results NAA / Cr of parieto-temporal and occipital areas of brain (1.32±0.12,1.48±0.12) were lower in AECOPD group than those in control group (1.45±0.11,1.58±0.10) (P＜ 0.05),MI/Cr (0.23±0.07,0.30±0.11) were also decreased compared with control group (0.40±0.14,0.46±0.12) (P＜ 0.01),while Cho/Cr of parieto -temporal and occipital areas of brain between the AECOPD group and control group showed no significant difference (P＞0.05).NAA/Cr of parieto temporal and occipital areas of brain were positively correlated with PaO2 (r=0.46 and 0.44),and MI/Cr of these areas of brain were also positively related with PaO2 (r=0.63 and 0.50),but MI / Cr of parieto tempora was negatively correlated with PaCO2 (r =- 0.472). Conclusions Cerebral metabolite changes may occur in AECOPD patients,and this has relationship with hypoxia and carbon dioxide retention.
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Objective To evaluate the efficacy of Budesonide/formoterol to control asthma under real-life conditions.Methods A muhi-center, open label, non-interventional study was conducted.Asthma control after 12 week therapy with Budesonide/formoterol was assessed by Asthma Control Questionnaire (ACQ) and modified Asthma Control Questionnaire (ACQ5).Results A total of 360 asthma patients were recruited,including 228 adult patients and 132 child patients.After 12 weeks' therapy,all the patients' medium value of ACQ was decreased significantly from 2.03 (adults 2.20, children 1.74) at baseline to 0.60 (adults 0.78, children 0.29) (P < 0.0001), and the medium value of ACQ5 was also decreased significantly from 2.4 (adults 2.24, children 1.76) at baseline to 0.47 (adults 0.62, children 0.20) (P < 0.0001).Conclusion Budesonide/formoterol is effective in asthma treatment, by which most asthma patients obtain and maintain clineal control.
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Objective To evaluate the effect of the de-escalation therapy of antimicrobial agents combined bronchoalveolar lavage on the treatment of acute stroke complicate pulmonary infection.Methods 80 patients of acute stroke complicated pulmonary infection were randomized into two groups.The method of the de-escalation therapy of antimicrobial agents combined bronchoalveolar lavage was used in therapeutic group(n=40)while the patients in control group(n=42)received routine therapy of antimicrobial agents.The effective rate,the bacteria1 eradication rat,the average time of pneumonia absorption and the average time NICU stay between two groups were compared and analyzed.Results The effective rate and the bacteria1 eradication rat in therapeutic group were significantly higher than those in control group(P
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<p><b>BACKGROUND</b>Pathology is the "gold standard" of the diagnosis of lung cancer, but at present there are few articles about evaluating the value of cytopathological check. The aim of this study is to evaluate the value of cytopathological check in the diagnosis of primary bronchogenic carcinoma of the lung.</p><p><b>METHODS</b>A total of 552 samples' cytopathological results of 248 patients from January 2003 to May 2005 in this hospital were retrospectively analyzed. The samples included pleural fluids (110 for 68 patients), materials from lung puncture (33 for 31 patients), smears of transcatheter bronchial brushing (152 for 138 patients), bronchoalveolar lavage fluids (30 for 26 patients) and sputa (227 for 118 patients).</p><p><b>RESULTS</b>The positive results of different specimens were as follow: the pleural fluids was 69.12%, the materials from lung puncture 67.74%, the smears of transcatheter bronchial brushing 65.22%, the bronchoalveolar lavage fluids 23.08% and sputa 21.19% respectively. The positive rates of the pleural fluids, the materials from lung puncture and the smears of transcatheter bronchial brushing were higher than that of the bronchoalveolar lavage fluids and sputa (P < 0.01). There was no significant difference among the positive rates of the pleural fluids, the materials from lung puncture and the smears of transcatheter bronchial brushing, and between the positive rates of the bronchoalveolar lavage fluids and sputa (P > 0.05).</p><p><b>CONCLUSIONS</b>The cytopathological examination is helpful for the diagnosis of primary bronchogenic carcinoma of the lung, and is one of the important ways to the diagnosis of primary bronchogenic carcinoma of the lung.</p>
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Chronic obstructive pulmonary disease(COPD) is a common condition among the old,which remains a main cause of death due to its high fatality.Airway remodeling is one of its pathological features.This article reviews the pathological changes and imageological assessment of COPD airway remodeling,its correlation with microbes and its pathogenesis and therapies.
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<p><b>OBJECTIVE</b>To study the status of oral pharyngeal carriage and characteristics of Haemophilus influenzae (Hi) in healthy preschool children in Fuzhou.</p><p><b>METHODS</b>Six hundred and three healthy children in two representative kindergartens in Fuzhou were studied as research subjects, and the rates of oral pharyngeal carriage of Hi were studied in four seasons. All Hi strains were serotyped and biotyped.</p><p><b>RESULTS</b>The oral pharyngeal carriage of Hi in day care nursery healthy children were 36.7% in winter, 18.0% in autumn, 12.4% in summer and 10.9% in spring respectively. Serotype Hib was preponderant in autumn (6.9%). In winter, the carriage rates of NTHi and Hib were 17.1%, 5.4% respectively. The carriage rates of other serotypes were low. Biotype VII and VIII were preponderant in autumn, spring and summer but biotype VII and VIII were decreasing evidently in winter.</p><p><b>CONCLUSION</b>There was evident seasonal difference in the rates of oral pharyngeal carriage and type of Hi in healthy preschool children. The carriage rate of Hi strains was high in autumn and winter. Results suggested that while the inoculation of Hib-binding bacterial vaccine was expanded the study on new bacterial vaccine of Hi still needs to be augmented.</p>
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Child , Child, Preschool , Female , Humans , Male , Carrier State , Epidemiology , China , Epidemiology , Haemophilus influenzae , Classification , Pharynx , Microbiology , Seasons , SerotypingABSTRACT
Objective To learn the domestic investigation into pulmonary cryptococcosis in the 22 years.Methods We retrieved the literature about pulmonary cryptococcosis included in CMCC,and summarized the clinical data of 67 patients suffering from pulmonary cryptococcosis.Results The clinical situation and radiological manifestation of pulmonary cryptococcosis were diverse and nonspecific.Cryptococcal meningitis was the commonest complication(31.34%).Almost all patients with pulmonary cryptococcosis were once misdiagnosed.Final diagnosis mainly depended on the smear,culture or pathological examination of various clinical specimens.Therapeutic tool involved resection with operation and the application of anti-fungi drugs.Conclusion To increase the cognition to the disease is the key to increase the final diagnosis rate.Therapeutical effect of anti-fungi drugs should be emphasized,especially the application in preoperation and postoperation can decrease the dissemination of cryptococcus after operation,which might result in cryptococcal meningitis.
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Objective To investigate antibiotic resistance of Klebsiella pneumoniae and Escherichia coli in old patients with lower respiratory tract infections. Methods Kirby Bauer agar diffusion method was used to evaluate the drug sensitivity in 240 strains of Klebsiella pneumoniae and Escherichia coli isolated from patients with lower respiratory tract infection. Phenotypic confirmatory test recommended by NCCLS1999 was used to detect extended spectrum beta lactamases(ESBLs). Results The resistant rates of Klebsiella pneumoniae and Escherichia coli to 14 antibiotics in old patients and in non old patients with lower respiratory tract infections were amoxicillin 93 2% vs 87 3%, piperacillin 57 1% and 42 9%, cefuroxime 51 4% and 33 3%, cefotaxime 40 1% and 17 5%, ceftazidime 13 6% and 3 2%, ceftriaxone 39 0% and 17 5%, cefoperazone 37 3% and 15 9%, cefepime 10 2% and 3 2%, amikacin 47 5% and 34 9%, ciprofloxacin 54 2% and 38 1%, imipenem 0, cefoperazone/sulbactam 0, piperacillin/tazobactam 1 1% vs 0, and cefmetazole 9 6% and 4 8% respectively. Out of 240 clinical strains of Klebsiella pneumoniae and Escherichia coli, 78(32 5%) were considered ESBLs producers by phenotypic confirmatory test. The prevalence of ESBLs in old patients was 38 4%, which was much higher than that in non old patients(15 9%). The resistant rate of ESBLs producing strains to imipinem, cefoperazone/sulbactam, piperacillin/tazobactam and cefmetazole was the lowest, being 0, 0, 2 6% and 12 8%. Conclusions The resistant rates of Klebsiella pneumoniae and Escherichia coli to most antibiotics and the prevalence of ESBLs in old patients with lower respiratory tract infection were higher than that in non old patients. Imipinem, cefoperazone/sulbactam, piperacillin/tazobactam and cefmetazole were the effective antibiotics to infections caused by ESBLs producing strains.
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To evaluate the clinical therapeutic effect of limited bronchus granuloma caused by foreign body with medication in trachea, 6F tube was put in sick trachea under fibrobronchoscopy in 26 patients with bronchus granuloma due to foreign body, and 5ml of 2% lidocaine + 10ml of sterile Saline + 5mg dexamethasone +antibiotics (Amikacin0 2g or ceftriazone1 0g) were injected into sick trachea through 6F tube twice a day. 25 were cured, the cure rate was 96 2%,and the other one had to be operated; the course was 6～15d. Other 29 patients were treated with routine antibiotics intravenation+aerosol inhalation or medication in trachea under fibrobronchoscopy every other day, and 24 were cured, the cure rate was 82 8%; the other 5 had to be operated, the course was 6～32d. It is suggested that the former method has good effect in local anti inflammation, and can decrease the intravenous antibiotics dosage and side effect.