Nursing of children dermatomyositis complicated with interstitial pneumonia / 现代临床护理

Objectives To summarize the experience of nursing care to children with dermatomyositis complicated with interstitial pneumonia.Methods The nursing histories of 11 cases of children dermatomyositis complicated with interstitial pneumonia were retrospectively looked into for summarizing the nursing measures.Results The diseases were both effectively controlled in all the children,who were given maintenance therapy by oral taking of hormone after discharge.Conclusion Such nursing measures as close observation of disease,enhanced nursing and first aid of respiratory failure,nursing of infection and secondary infection,care after mesenchymal stem cells transplantation,strengthened disinfection and isolation,are of significance for controlling the disease.

Radiologic Approach to Diffuse Infiltrative Lung Disease

The Radiology approach to diffuse infiltrative lung disease (DILD) is based on a chest radiography and CT. Chest radiography can categorize DILD into five main patterns of abnormality: linear, reticular, cystic, nodular, and ground-glass patterns. The CT patterns of DILD can be classified into six patterns including thickened interlobular septa, reticular, cystic, nodular, ground-glass, and consolidation patterns. The pertinent differential diagnosis of DILD is based on the pattern recognition approach of abnormalities, and a specific diagnosis can often be made using chest radiography and CT. This pictorial essay illustrates the radiology pattern recognition approach for DILD using chest radiography and CT.

CT Analysis of the Anterior Mediastinum in Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia

OBJECTIVE: We wanted to determine whether the amount and shape of the anterior mediastinal fat in the patients suffering with usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP) was different from those of the normal control group. MATERIALS AND METHODS: We selected patients who suffered with UIP (n = 26) and NSIP (n = 26) who had undergone CT scans. Twenty-six controls were selected from individuals with normal CT findings and normal pulmonary function tests. All three groups (n = 78) were individually matched for age and gender. The amounts of anterior mediastinal fat, and the retrosternal anteroposterior (AP) and transverse dimensions of the anterior mediastinal fat were compared by one-way analysis of variance and Bonferroni's test. The shapes of the anterior mediastinum were compared using the Chi-square test. Exact logistic regression analysis and polychotomous logistic regression analysis were employed to assess whether the patients with NSIP or UIP had a tendency to show a convex shape of their anterior mediastinal fat. RESULTS: The amount of anterior mediastinal fat was not different among the three groups (p = 0.175). For the UIP patients, the retrosternal AP dimension of the anterior mediastinal fat was shorter (p = 0.037) and the transverse dimension of the anterior mediastinal fat was longer (p = 0.001) than those of the normal control group. For the NSIP patients, only the transverse dimension was significantly longer than those of the normal control group (p < 0.001). The convex shape of the anterior mediastinum was predictive of NSIP (OR = 19.7, CI 3.32-infinity, p < 0.001) and UIP (OR = 24.42, CI 4.06-infinity, p < 0.001). CONCLUSION: For UIP patients, the retrosternal AP and transverse dimensions are different from those of normal individuals, whereas the amounts of anterior mediastinal fat are similar. UIP and NSIP patients have a tendency to have a convex shape of their anterior mediastinal fat.

Usual Interstitial Pneumonia and Non-Specific Interstitial Pneumonia: Serial Thin-Section CT Findings Correlated with Pulmonary Function

OBJECTIVE: We wanted to demonstrate and compare the serial high-resolution CTs (HRCT) and the pulmonary function test (PFT) findings of the usual interstitial pneumonia (UIP) and the non-specific interstitial pneumonia (NSIP). MATERIALS AND METHODS: The serial HRCT scans and the PFT results were retrospectively analysed and compared for 35 patients having UIP without significant honeycombing (UIP-w/o hc, or = 5% of honeycombing), and 25 patients with NSIP. The mortality rates were also compared. Follow-up CT scans were available in 75 patients (29 UIP-w/o hc patients, 22 UIP-w/i hc patients and 24 NSIP patients) and the follow-up periods ranged from 150 to 2, 370 days. The initial and follow-up PFT data were available for 71 patients. RESULTS: On the initial CT, significant differences were present between the UIP-w/i hc patients and both the UIP-w/o hc patients and the NSIP patients in the overall extent, ground-glass opacity (GGO) away from the reticulation, reticulation and honeycombing (all p < 0.05). Improvement was noticed in five (17%) of 29 UIP-w/o hc patients, none of 22 UIP-w/i hc patients, and 9 (37%) of 24 NSIP patients; deterioration was noted in six (21%) UIP-w/o hc patients, two (9%) UIP-w/i hc patients and three (13%) NSIP patients (p = 0.044 between UIP-w/o and UIP-w/i hc; p = 0.637 between UIP-w/o hc and NSIP; p = 0.007 between UIP-w/i hc and NSIP). The serial changes of the pulmonary function in the NSIP patients were different from those noted for the UIP-w/i hc and UIP-w/o hc patients (p = 0.440 between UIP-w/o and UIP-w/i hc; p = 0.022 between UIP-w/o hc and NSIP; p = 0.003 between UIP-w/i hc and NSIP). Five (14%) of the 35 patients with UIP-w/o hc, 16 (46%) of the 35 patients with UIP-w/i hc and three (12%) of the 25 patients with NSIP died (p = 0.002, comparison for the three groups). CONCLUSION: On CT, NSIP and UIP-w/o hc patients have similar patterns of parenchymal abnormalities and a similar likelihood of change in the extent of disease on follow-up. Patients with UIP-w/i hc have distinctive features and a worst prognosis.

Three-year Follow-up of Niemann-Pick Disease with Pulmonary Involvement: A Case Report

Niemann-Pick disease is a rare inherited metabolic storage disease that causes excessive intracellular storage of sphingomyelin in various organs. We present the pulmonary imaging findings with particular emphasis on the CT findings in a case of Niemann-Pick disease type B with pulmonary involvement. The chest radiograph showed fine reticulonodular opacities in both basal lung fields, and the high-resolution chest CT showed centrilobular nodular opacities and smooth thickening of the interlobar fissure and interlobular septum with a basal lung predominance. Coronal reformatted CT revealed a prominent interlobular septal thickening around the diaphragm. The follow-up high-resolution chest CT showed no significant interval changes over a 3-years period.

Detectability of Various Sizes of Honeycombing Cysts in an Inflated and Fixed Lung Specimen: the Effect of CT Section Thickness

OBJECTIVE: We wanted to clarify the relationship between the visibility of air cysts on CT images, the CT slice thickness and the size of the air cysts, with contact radiographs as the gold standard, for the accurate evaluation of honeycomb cysts. MATERIALS AND METHODS: An inflated and fixed autopsied lung having idiopathic interstitial pneumonia was evaluated. The corresponding air cysts were identified on the contact radiographs of a 0.5 mm-thick-section specimen and also on the CT images of three different kinds of section thickness: 0.5, 1.0 and 2.5 mm. The maximal diameters of the air cysts were measured under a stereomicroscope. RESULTS: A total of 341 air cysts were identified on the contact radiograph, and they were then evaluated. Sixty-six percent of air cysts 1 to 2 mm in diameter were detected by 0.5 mm slice thickness CT, while only 34% and 8% were detected by 1.0 and 2.5 mm slice thickness CT, respectively. Only 28% and 22% of air cysts less than 1 mm in diameter were detected by 0.5 and 1.0 mm slice thickness CT, respectively. CT with a 2.5 mm slice thickness could not demonstrate air cysts less than 1 mm in diameter. CONCLUSION: The CT detection rate of honeycombing is significantly influenced both by the slice thickness and the size of the air cysts.

Clinical Value of HRCT in Staging Lung Interstitial Disease in Connective Tissue Diseases / 实用放射学杂志

Objective To study the clinical value of HRCT in staging of lung interstitial disease(LID) in connective tissue disease(CTD).Methods 222 patients with CTD confirmed clinically underwent HRCT scan.The staging of LID according to the HRCT features of LID were done and the therapeutic effect was compared between each stage.Results In 222 cases ,64 cases were negative on HRCT as stage 0,158 cases had disseminated LID in different degree,including stage Ⅰ in 107,stage Ⅱ in 36 and stage Ⅲ in 15.There were significant statistically between the therapeutic effect and staging of LID.Conclusion The staging of CTD with LID by HRCT is helpful for judging the extent of LID and clinical treatment.

Volume-Controlled Histographic Analysis of Pulmonary Parenchyma in Normal and Diffuse Parenchymal Lung Disease: A Pilot Study

PURPOSE: To evaluate the clinical usefulness of a home-made histographic analysis system using a lung volume controller. MATERIALS AND METHODS:Our study involved ten healthy volunteers, ten emphysema patients, and two idio-pathic pulmonary fibrosis (IPF) patients. Using a home-made lung volume controller, images were obtained in the upper, middle, and lower lung zones at 70%, 50%, and 20% of vital capacity. Electron beam tomography was used and scanning parameters were single slice mode, 10-mm slice thickness, 0.4-second scan time, and 35 -cm field of view. Using a home-made semi-automated program, pulmonary parenchyma was isolated and a histogram then obtained. Seven histographic parameters, namely mean density (MD), density at maximal frequency (DMF), maximal ascending gradient (MAG), maximal ascending gradient density (MAGD), maxi-mal descending gradient (MDG), maximal descending gradient density (MDGD), and full width at half maxi-mum (FWHM) were derived from the histogram. We compared normal controls with abnormal groups includ-ing emphysema and IPF patients at the same respiration levels. RESULTS: A normal histographic zone with +/-1 standard deviation was obtained. Histographic curves of normal controls shifted toward the high density level, and the width of the normal zone increased as the level of inspi-ration decreased. In ten normal controls, MD, DMF, MAG, MAGD, MDG, MDGD, and FWHM readings at a 70% inspiration level were lower than those at 20% (p<0.05). At the same level of inspiration, histograms of emphysema patients were located at a lower density area than those of normal controls. As inspiration status decreased, histograms of emphysema patients showed diminished shift compared with those of normal con-trols. At 50% and 20% inspiration levels, the MD, DMF, and MAGD readings of emphysema patients were significantly lower than those of normal controls (p<0.05). Compared with those of normal controls, his-tograms of the two IPF patients obtained at three inspiration levels were located in an area of higher density. CONCLUSION: Using a home-made histographic analysis system which included a lung volume controller, pa-tients with diffuse parenchymal lung disease could be distinguished from normal controls. The method may be useful for the diagnosis and follow up of diffuse parenchymal lung diseases.

Follow-up HRCT Findings of Ground-Glass Attenuation in Usual Interstitial Pneumonia

PURPOSE: To evaluate changes in lesions, as shown by follow-up high-resolution CT (HRCT) in patients withusual interstitial pneumonia (UIP), and the significance of ground-glass attenuation. MATERIALS AND METHODS: HRCTfindings in 23 patients with UIP were retrospectively reviewed. We quantitatively analysed the pattern and extentof lesions, as seen on HRCT, initially and during the most recent follow-up. We also compared pattern changesbetween group I (n=12; less than 25% of the initial extent of GGA) and group II (n=11, more than 26% of thisinitial extent). RESULTS: Initial HRCT findings included GGA and irregular linear density in all patients,honeycombing in 21 (91%), and consolidation in two patients (9%). During the most recent follow-up, HRCT showedthat the extent of GGA had decreased (p0.05). CONCLUSION: The greater extent of GGA, as seen on HRCT, of a patient with UIP shows much less fibrosison follow-up HRCT. In UIP, evaluation of the extent of GGA, as seen on initial HRCT, is a helpful indicator ofprognosis.

Idiopathic Pulmonary Fibrosis with Coexisting Emphysema: High-Resolution CT and Clinical Correlation

PURPOSE: To correlate high-resolution CT (HRCT) findings with smoking history and pulmonary function test (PFT) in patients with idiopathic pulmonary fibrosis (IPF) with or without coexisting emphysema. MATERIALS AND METHODS: The study included 24 patients who had undergone HRCT and in whom IPF had been confirmed pathologically (n=7) and clinically (n=17). The patients included 19 men and 5 women aged between from 44 and 78 (mean 59) years. HRCT findings were reviewed by two radiologists and assessed for the presence and extent of emphysema (CT emphysema score ; CES) and honeycombing (CT honeycombing score ; CHS). CES and CHS were retrospectively correlated with smoking status and pulmonary function test. RESULTS: Evidence of emphysema was seen on HRCT in 20 of 24 patients with IPF (83 %). CES was 14.3 and CHS was 18.1 in smokers with IPF, as compared with 1.8 and 6.7 in nonsmokers (p < 0.01). Pulmonary function tests showed lower percent predicted FEV1 (69.3 %), FVC (64.7 %), TLC(73.7 %), and RV (77.3 %), a lower percent predicted diffusing capacity of carbon monoxide (58.2%), and normal FEV1/FVC (99.1%). The pulmonary function test in smokers showed higher TLC and RV than in nonsmokers. Eight of nine patients whose CES was higher than their CHS, as seen on HRCT, were smokers and had a smoking history of 33.1 pack-years. Seven of 15 whose CHS was higher than their CES were smokers and had a smoking history of 16.8 pack-years. In patients with a higher CES than CHS pulmonary function test results showed normal TLC (85 %) and RV (100.7%) ; this contrasted with decreased TLC (72 %) and RV (68 %) in patients whose CHS was higher than their CES. CONCLUSION: Emphysema is a frequently associated finding in patients with IPF, as seen on HRCT, and emphysema is more frequent and extensive in smokers with IPF than non-smokers. HRCT is useful for detecting emphysema in patients with IPF, and the extent of emphysema on HRCT correlates with the results of the pulmonary function test and smoking status.