Utilidad del lavado broncoalveolar para la detección microbiológica, y factores asociados, en receptores de trasplante de precursores hematopoyéticos: estudio de cohorte retrospectivo / Usefulness of bronchoalveolar lavage for microbiological detection and asssociated factors in hematopoietic stem cell transplant receivers: a retrospective cohort study

INTRODUCCIÓN: Las opacidades pulmonares en receptores de trasplante de precursores hematopoyéticos (TPH) representan un desafío diagnóstico y son una causa de morbimortalidad. Existen grandes discrepancias con respecto a la sensibilidad diagnóstica del lavado broncoalveolar (LBA), sus complicaciones, y los factores asociados a la identificación microbiológica. OBJETIVO: Conocer la utilidad del estudio microbiológico del LBA en el diagnóstico, modificación de la conducta médica y estimar las complicaciones y mortalidad asociada al procedimiento, en receptores de TPH con opacidades pulmonares. PACIENTES Y MÉTODOS: Estudio de cohorte, retrospectivo, en adultos receptores de TPH a los que se les realizó una broncoscopía con LBA por presentar opacidades pulmonares, en el Hospital Italiano de Buenos Aires entre el 01/01/2011 y el 31/12/2020. RESULTADOS: De los 189 procedimientos analizados, en 79 se logró un hallazgo microbiológico (41,8%) y 122 permitieron modificar la conducta médica (64,6%). En 11 casos se observaron complicaciones graves dentro de las 12 horas (5,8%) de efectuado el LBA. La mortalidad intrahospitalaria fue de 16,8% (N = 21/125). El valor de neutrófilos en sangre previo al LBA (p = 0,037) y la presencia de nódulos pulmonares como lesión tomográfica predominante (p = 0,029) se asociaron independientemente al hallazgo microbiològico global. CONCLUSIONES: Nuestra investigación apoya la realización del LBA como herramienta diagnóstica en pacientes que reciben un TPH y presentan opacidades pulmonares.

BACKGROUND: Lung opacities are a cause of morbimortality in bone marrow transplant patients, and represent a diagnostic challenge. There are large discrepancies regarding the diagnostic sensitivity of bronchoalveolar lavage (BAL), its complications, and the factors associated with microbiological detection. AIM: To know the usefulness of the microbiological study of BAL in the diagnosis, in the modification in medical behavior and to estimate the complications and associated mortality of this diagnostic procedure in patients transplanted with hematopoietic progenitor cells with pulmonary opacities. METHODS: Retrospective cohort study in bone marrow transplant adult patients who underwent bronchoscopy with BAL due to lung opacities at Hospital Italiano de Buenos Aires between 01/01/2011 and 12/31/2020. RESULTS: Of the 189 BAL analyzed, 79 presented a microbiological detection (41.8%) and 122 allowed to modify the medical behavior (64.6%). Severe complications were observed within 12 hours after the procedure in11 cases (5.8%). In-hospital mortality was 16,8% (N = 21/125). The value of blood neutrophils prior to bronchoalveolar lavage (p = 0.037) and the presence of pulmonary nodules as the predominant tomographic lesion (p = 0.029) were independently associated with global microbiological detection. CONCLUSION: Our research supports the performance of BAL as a diagnostic tool in bone marrow transplant patients with lung opacities.

The differential diagnosis of pulmonary infiltrates in cancer patients during the outbreak of the 2019 novel coronavirus disease / 中华肿瘤杂志

Objective@#To investigate the principles of differential diagnosis of pulmonary infiltrates in cancer patients during the outbreak of novel coronavirus (2019-nCoV) by analyzing one case of lymphoma who presented pulmonary ground-glass opacities (GGO) after courses of chemotherapy.@*Methods@#Baseline demographics and clinicopathological data of eligible patients were retrieved from medical records. Information of clinical manifestations, history of epidemiology, lab tests and chest CT scan images of visiting patients from February 13 to February 28 were collected. Literatures about pulmonary infiltrates in cancer patients were searched from databases including PUBMED, EMBASE and CNKI.@*Results@#Among the 139 cancer patients underwent chest CT scans before chemotherapy, pulmonary infiltrates were identified in eight patients (5.8%), five of whom were characterized as GGOs in lungs. 2019-nCoV nuclear acid testing was performed in three patients and the results were negative. One case was a 66-year-old man diagnosed as non-Hodgkin lymphoma and underwent CHOP chemotherapy regimen. His chest CT scan image displayed multiple GGOs in lungs and the complete blood count showed decreased lymphocytes. This patient denied any contact with confirmed/suspected cases of 2019-nCoV infection and without fever and other respiratory symptoms. Considering the negative result of nuclear acid testing, this patient was presumptively diagnosed as viral pneumonia and an experiential anti-infection treatment had been prescribed for him.@*Conclusions@#The 2019 novel coronavirus disease (COVID-19) complicates the clinical scenario of pulmonary infiltrates in cancer patients. The epidemic history, clinical manifestation, CT scan image and lab test should be combined consideration. The 2019-nCoV nuclear acid testing might be applicated in more selected patients. Active anti-infection treatment and surveillance of patient condition should be initiated if infectious disease is considered.

Comparison of the safety and efficacy of topical Tacrolimus (0.03%) versus dexamethasone (0.05%) for subepithelial infiltrates after adenoviral conjunctivitis

Purpose: To compare the safety and efficacy of tacrolimus 0.03% ointment with dexamethasone 0.05% ointment for subepithelial infiltrates (SEIs) following adenoviral keratoconjunctivitis (AK). Methods: A randomized, double blind trial was done. Eligibility criteria was corrected distance visual acuity of 6/9 Snellen or worse for at least 4 weeks with corneal SEIs following AK. The grading of SEIs was done on a scale of 0 to 3; 0, no infiltrates, 1 mild infiltration, 2 moderate infiltration and 3, severe infiltration. Consecutive patients with SEIs following AK were randomized to receive either topical tacrolimus 0.03% or dexamethasone 0.05% ointment twice daily for 6 months. Treatment was successful if there was reduction of SEIs and improvement in vision. Results: A total of 45 patients each were assigned to the Tacro and Dexa groups, respectively. Baseline characteristics of patients did not differ significantly (P > 0.001). There was a significant change in symptoms, vision and SEIs in both the groups. However, the magnitude was greater in tacro group. Treatment was successful in 37 (92.5%) patients in Tacro and 34 (85%) patients in dexa group. In dexa group, after a period of 1.24 ± 0.24 months, 7 (15.6%) patients developed a significant rise in intraocular pressure (IOP). Three (7.5%) eyes in tacro and 6 (15%) eyes in dexa group had recurrence of SEIs after cessation of therapy. Conclusion: Tacrolimus 0.03% is an effective alternative to dexamethasone 0.05% with low recurrence rate, no significant rise in IOP but may cause burning and foreign body sensation in some patients.

Quilty Lesions in the Endomyocardial Biopsies after Heart Transplantation

BACKGROUND: The aim of this study was to investigate the clinical significance of Quilty lesions in endomyocardial biopsies (EMBs) of cardiac transplantation patients. METHODS: A total of 1190 EMBs from 117 cardiac transplantation patients were evaluated histologically for Quilty lesions, acute cellular rejection, and antibody-mediated rejection. Cardiac allograft vasculopathy was diagnosed by computed tomography coronary angiography. Clinical information, including the patients’ survival was retrieved by a review of medical records. RESULTS: Eighty-eight patients (75.2%) were diagnosed with Quilty lesions, which were significantly associated with acute cellular rejection, but not with acute cellular rejection ≥ 2R or antibody-mediated rejection. In patient sdiagnosed with both Quilty lesions and acute cellular rejection, the time-to-onset of Quilty lesions from transplantation was longer than that of acute cellular rejections. We found a significant association between Quilty lesions and cardiac allograft vasculopathy. No significant relationship was found between Quilty lesions and the patients’ survival. CONCLUSIONS: Quilty lesion may be an indicator of previous acute cellular rejection rather than a predictor for future acute cellular rejection.

Algoritmos útiles para el diagnóstico histopatológico de la enfermedad hepática con base en los patrones de daño hepático / Useful Algorithms for Histopathological Diagnosis of Liver Disease Based on Patterns of Liver Damage

En los anteriores artículos, se revisaron las patologías hepáticas más frecuentes desde el punto de vista morfológico y la importancia de una adecuada correlación, para lograr un mejor entendimiento entre clínicos y patólogos. El ejercicio que se hará a continuación, se basa en establecer una aproximación al diagnóstico histopatológico de algunas de las patologías hepáticas a las que se les realiza biopsias con mayor frecuencia, teniendo en cuenta algoritmos basados en patrones de daño hepático

Previous articles have reviewed the most frequent liver pathologies from the morphological point of view and looked at the importance of adequate correlation for obtaining better understanding between clinicians and pathologists. The next exercise is directed toward histopathological diagnosis of some of the liver diseases for which biopsies are performed most frequently. It takes into account algorithms based on patterns of liver damage

Histological features of the placenta and their relation to the gross and data from Thoroughbred mares / Achados histológicos da placenta e sua relação com seus aspectos macroscópicas e dados de éguas Puro Sangue Inglês

The placenta is a transitory organ that originates from maternal and fetal tissues, the function of which is transporting nutrients from the mother to the fetus. The aim of this study was describe the histological features of placentas in healthy Thoroughbred mares at foaling and evaluate their relation with the gross placental and data of these mares. For this study 188 Thoroughbred mares were used. It was performed clinical observation for signs of placentitis during daily health checks and ultrasonic examination monthly to assess the fetus and placenta. All of the mares that exhibited clinical signs of placentitis were treated during gestation. The parturition was assisted, the placentas were grossly evaluated and samples were collected immediately after expulsion. The following data were considered for each mare: age, gestational age, number of parturition, time for placental expulsion, umbilical-cord length, placental weight and clinical signs of placentitis. Histological evaluation of the placentas revealed extensive cytoplasmic vacuolization of the epithelial areolar cells, presence of inflammatory infiltrates and hypoplasia-atrophy of the microcotyledons. Most of the gross placental findings were consistent with the histological results. In conclusion the mares with a vacuolated placental chorionic epithelium were older and had experienced a larger number of births. Great part of the mares with inflammatory infiltrates did not showed any clinical signs of placentitis during gestation.(AU)

A placenta é um órgão transitório originado do tecido fetal e materno, com função de transportar nutrientes da mãe para o feto. O objetivo deste estudo foi descrever os achados histológicos das placentas de éguas Puro Sangue Inglês (PSI) a termo e avaliar sua relação com a macroscopia da placenta e dados dessas éguas. O estudo utilizou 188 éguas PSI. Foram realizadas observações clinicas diárias para presença de sinais clínicos de placentite e ultrassonografia mensal para avaliar saúde do feto e placenta. As éguas que apresentaram sinais clínicos de placentite durante a gestação foram tratadas. Os partos foram assistidos, as placentas avaliadas macroscopicamente e coletadas imediatamente após sua expulsão. Como dados das éguas foram considerados: idade, tempo de gestação, número de partos, tempo de eliminação da placenta, comprimento de cordão umbilical, peso da placenta e sinais clínicos de placentite. A avaliação histológica das placentas demonstrou extensiva vacuolização citoplasmática das células do epitélio coriônico das regiões areolares, presença de infiltrados inflamatórios e hipoplasia-atrofia de microcotilédones. A maior parte dos achados macroscópicos da placenta foram condizentes com os resultados de histologia. Como conclusão, a vacuolização do epitélio coriônico foi característica de éguas mais velhas e com maior número de partos. Grande parte das éguas com infiltrados inflamatórios não demonstraram sinais clínicos de placentite.(AU)

Vitreoretinal lymphomas misdiagnosed as uveitis: Lessons learned from a case series.

Purpose: To present challenging cases of vitreoretinal lymphoma (VRL) that was misdiagnosed as uveitis because of the apparent intraocular inflammation. At the light of the new classification of intraocular lymphomas, we detail the characteristics that masqueraded the tumors and the clinical aspects that guided us to the correct diagnosis. Materials and Methods: We retrospectively reviewed the patients referred to our uveitis service between January 2006 and December 2014. Results: Seven patients referred with a presumptive diagnosis of idiopathic uveitis received a final diagnosis of VRL. The median time between the onset of symptoms and definitive diagnosis was 25 months for these complex cases. The median time from presentation at our clinic to final diagnosis was 1 month. The described clinical features including dense vitreous cells and subretinal infiltrates were characteristic and tend to be present in all these chronically ill patients. Vitreous samples were collected, and all demonstrated the pathognomonic tumor cells, the specific immunoglobulin heavy chain gene rearrangements, and an interleukin (IL)‑10 to IL‑6 ratio >1. Conclusion: VRLs are severe diseases with a poor prognosis that may be misdiagnosed as idiopathic inflammatory conditions of the eye. Treatment with steroids may occult the tumors and delay the correct diagnosis. Appropriate evaluation may prompt to a timely vitreous sampling and therefore to a faster diagnosis in these peculiar cases where the correct diagnosis was delayed by several months.

Primary pulmonary diffuse large B-cell non-Hodgkin's lymphoma in a child.

A 3-year-old girl presented with a history of intermittent fever of six months duration associated with respiratory symptoms consisting of recurrent cough, fever, wheeze and a suspected history of contact with tuberculosis (TB). Chest radiograph revealed pulmonary infiltrates mimicking miliary TB. She was started on anti-tuberculous treatment, but in view of clinical deterioration, a further work-up including a lung biopsy revealed non-Hodgkin’s lymphoma (NHL). This case documents the extremely rare occurrence of pulmonary involvement and miliary infiltrates on the chest radiograph in NHL.

A comparative study of apoptosis in reticular and erosive oral lichen planus

The oral lichen planus (OLP) is a chronic inflammatory disease, probably autoimmune, with different clinical forms. The most common types are the reticular and the erosive ones. Apoptosis participates in the destruction of basal keratinocytes, but its role in the perpetuation of the subepithelial lymphocytic infiltrates was not yet investigated. To evaluate the involvement of apoptosis in the epithelium and in subepithelial lymphocytic infiltrates, 15 samples of reticular and erosive OLP and 10 samples of healthy oral mucosa were collected and processed histologically. Apoptosis was quantified in the epithelium and in inflammatory cell infiltrates. TUNEL reaction was used to measure apoptosis in the infiltrates. Erosive OLP showed more intense epithelial apoptosis than reticular OLP and controls. In contrast, apoptosis in the inflammatory cell infiltrates was more frequent in reticular than in erosive OLP. Lymphocytes were the predominant cells within the inflammatory cell infiltrates and were more frequent in erosive OLP than in reticular type. These results suggest that different apoptotic levels are involved in the erosive/reticular switch in OLP, determining different clinical presentations. In conclusion, decreased apoptosis in inflammatory infiltrates may contribute to the persistence of T lymphocytes, worsening the attack to the epithelium in erosive OLP.

O líquen plano oral (LPO) é uma doença crônica inflamatória, provavelmente auto-imune, com diferentes formas clínicas. Os tipos mais comuns são o reticular e o erosivo. A apoptose participa da destruição dos ceratinócitos basais, no entanto o seu papel na perpetuação do infiltrado linfocitário subepitelial ainda não foi investigado. Para avaliar o envolvimento da apoptose no epitélio e no infiltrado linfocitário subepitelial, quinze amostras de LPO reticular, quinze de LPO erosivo e dez amostras de mucosa oral saudável foram coletadas e processadas histologicamente. A apoptose foi quantificada no epitélio e nas células do infiltrado inflamatório. A reação de TUNEL foi usada para mensurar a apoptose no infiltrado. A intensidade da apoptose no epitélio mostrou ser maior no LPO erosivo que no LPO reticular e estes foram maiores que no controle. Em contraste, a apoptose nas células do infiltrado inflamatório foi mais freqüente no LPO reticular que no LPO erosivo. Os linfócitos foram as células predominantes dentro do infiltrado inflamatório e foram mais freqüentes no tipo erosivo de LPO que no tipo reticular. Estes resultados sugerem que diferentes níveis de apoptose estão envolvidos no tipo erosivo e reticular de LPO, determinando as diferenças nas apresentações clínicas. Em conclusão, a diminuição da apoptose no infiltrado inflamatório pode contribuir para a persistência dos linfócitos T, piorando o ataque ao epitélio no LPO erosivo.

Manifestaciones pulmonares en el lupus eritematoso sistémico / Pulmonary manifestations of systemic lupus erythematosus

RESUMEN Introducción: El lupus eritematoso sistémico (LES) es una enfermedad autoinmune, caracterizada por inflamación y daño de tejidos mediado por el sistema inmunitario.En el LES las alteraciones respiratorias son comunes y pueden ser primarias, las cuales están relacionadas con los mecanismos fisiopatogénicos del LES, o aparecer como consecuencias de las complicaciones de la enfermedad. Objetivos: Describir la prevalencia de afectación pulmonar en pacientes con LES. Identificar las afecciones pulmonares en pacientes con LES y sus hallazgos radiológicos. Materiales Y Métodos: Diseño observacional, descriptivo, de corte transverso, retrospectivo realizado en pacientes con LES internados en el Servicio de Clínica Médica del Hospital Nacional, durante el periodo de Enero-2005 y Diciembre-2010. Resultados: Se revisaron 201 casos de pacientes con diagnóstico de LES, de los cuales 35 (17%) pacientes tuvieron compromiso pulmonar. Las manifestaciones clínicas más frecuentes fueron: disnea 28 pacientes (80%), fiebre 24 (68%), dolor pleurítico 13 (37%). En las imágenes radiológicas se observaron consolidación pulmonar en 14 casos (40%), infiltrado intersticial en 8 (22%), derrame pleural en 5 (14%) y elevación del diafragma 1 (3%). Las causas de afectación pulmonar secundaria fueron: 24 (68%) casos de infección pulmonar, 2 (5%) con tuberculosis pulmonar. Conclusiones: La frecuencia de afectación pulmonar fue 17% en los pacientes con LES. La afectación renal y cardiaca predominaron sobre las manifestaciones pulmonares. Las formas de presentación clínica más frecuentes fueron la disnea y fiebre, seguidas por el dolor pleurítico y el derrame pleural. Las manifestaciones pulmonares primarias encontradas fueron la pleuritis, el derrame pleural, la hemorragia pulmonar, el tromboembolismo pulmonar, el pulmón encogido y la hipertensión pulmonar. Las manifestaciones pulmonares secundarias encontradas fueron la neumonía adquirida en la comunidad y la tuberculosis pulmonar. Los patrones radiológicos más observados fueron la consolidación pulmonar, seguido por infiltrado intersticial y derrame pleural.

ABSTRACT Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by inflammation and tissue damage mediated by the immune system. In SLE respiratory disturbances are common and can be primary, which are related to the pathophysiologic mechanisms of SLE, or appear as consequences of the complications of the disease. Objetives: To describe the prevalence of lung involvement in patients with SLE. Identify lung diseases in patients with SLE and radiological findings. Material and Methods: We performed an observational, descriptive, cross-sectional, retrospective study in 33 patients hospitalized in the Department of Clinical Medicine of the National Hospital during the period January-2005 and December-2010. Results: We reviewed 201 cases of patients with SLE, of whom 33 (16%) patients had clinical manifestations of pulmonary commitment. The clinical manifestations found were dyspnea in 26 (78%) patients and fever in 24 (72%), followed by pleuritic pain in 13 (39%). In the radiographic images, pulmonary consolidation were observed in 14 cases (42%), interstitial infiltrate in 7 (21%), and pleural effusion in 5 (15%). It had been found in 24 (72%) patients pulmonary infection, 6 (18 %) reported pulmonary hemorrhage, 2 (6%) patients pulmonary tuberculosis and 1 (3%) patient pulmonary embolism. Conclusions: The frequency of lung involvement was 17% in patients with SLE. Renal and cardiac involvement predominated over pulmonary manifestations. The forms of clinical presentation were dyspnea and fever, followed by pleuritic pain and pleural effusion. Primary pulmonary manifestations were found pleuritis, pleural effusion, pulmonary hemorrhage, pulmonary embolism, lung and pulmonary hypertension. The secondary pulmonary manifestations found were community-acquired pneumonia and pulmonary tuberculosis. The radiographic patterns observed were pulmonary consolidation, followed by interstitial infiltrate and pleural effusion.

Pronóstico de pacientes ingresados a Unidad de Cuidados Intensivos por falla respiratoria asociada a presencia de infiltrados pulmonares / Prognosis of patients with acute respiratory failure and pulmonary infiltrates admitted to intensive care unit

En la unidad de cuidados intensivos (UCI), la insuficiencia respiratoria aguda (IRA) asociada a infiltrados pulmonares de causa desconocida se relaciona con alta morbilidad y mortalidad. El objetivo principal de este trabajo fue conocer el pronóstico de pacientes con IRA, infiltrados pulmonares y necesidad de ventilación mecánica (VM) ingresados a UCI. Como objetivo secundario se planteó evaluar la utilidad de medios diagnósticos de uso habitual en este grupo de pacientes en relación al pronóstico y la conducta terapéutica. Se realizó un estudio observacional retrospectivo que incluyó todos los pacientes ingresados a la UCI del Hospital Naval Almirante Nef por IRA de causa desconocida asociada a infiltrados pulmonares en radiografía de tórax y que tengan necesidad de VM entre los años 2006 y 2010. Se incluyeron 90 pacientes de los cuales 45,6 por ciento fueron de sexo masculino. La edad promedio fue 66 años (DS 17,1). El puntaje promedio de score APACHE II fue 20,6 (DS 7,7). La mortalidad fue 52,2 por ciento y el tiempo promedio de estadía en UCI fueron 14 días (DS 14,4). La principal causa de IRA fue síndrome de distress respiratorio agudo (32 por ciento).Otras causas fueron neumonía adquirida en la comunidad (28,2 por ciento), neumonía aspirativa (12,2 por ciento), neumonía nosocomial (7,8 por ciento) y neumonía criptogénica organizada (6,7 por ciento). La realización de tomografía computarizada de tórax, lavado broncoalveolar y biopsia pulmonar determinó cambio de conducta terapéutica en 31 por ciento, 58 por ciento y 88 por ciento de los casos, respectivamente. En conclusión, los pacientes con IRA tienen alta mortalidad. La causa más frecuente fue el síndrome de distress respiratorio agudo. El uso de procedimientos diagnósticos pueden cambiar las medidas terapéuticas empleadas, en especial la biopsia pulmonar.

In the intensive care unit (ICU), acute respiratory failure (ARF) associated with unexplained pulmonary infiltrates is associated with high morbidity and mortality. The main objective of this study was to determine the prognosis of patients with ARF and pulmonary infiltrates admitted to ICU. The secondary objective was proposed to evaluate the usefulness of diagnostic methods frequently used in this patient group and correlated them with prognosis and therapeutic management. We performed a retrospective observational study that included all patients admitted to ICU of Almirante Nef Naval Hospital with ARF of unknown cause associated with pulmonary infiltrates on chest radiography during the years 2006-2010. We included 90 patients of which 45 percent were male. The average age was 66 years. The average APACHE II score was 20.6. Mortality was 52.2 percent and the average length of stay in the ICU was 14 days (SD 14.4). The main cause of ARF was acute respiratory distress syndrome (32 percent). Other causes were community-acquired pneumonia (28.2 percent), aspiration pneumonia (12.2 percent), nosocomial pneumonia (7.8 percent) and cryptogenic organized pneumonia (6.7 percent. The performance of chest computed tomography, bronchoalveolar lavage and lung biopsy determined therapeutic behavior change in 31 percent 58 percent and 88 percent of cases, respectively. In conclusion, patients with ARF have high mortality. The most common cause was acute respiratory distress syndrome. The use of diagnostic procedures may change the therapeutic measures used, particularly lung biopsy.

Pulmão do crack: manifestações clínicas e radiológicas após inalação

O crack é considerado a forma mais potente eviciante da cocaína, sendo os pulmões os principais órgãosacometidos após a sua inalação. Relata-se o caso de umpaciente masculino que evoluiu com insuficiênciarespiratória aguda após o uso do crack. Após três diasde internação, o paciente evoluiu com melhora clínica eradiológica evidente, sugerindo tratar-se de pulmão docrack: síndrome respiratória aguda após inalação dadroga. Paciente foi mantido em oxigenioterapia e recebeualta hospitalar assintomático sete dias após a internação.

Crack is considered the most powerfull and addictiveform of cocaine, with the lungs being the main organaffected after the inhalation. We report the case of amale patient who developed acute respiratory failureafter crack use. After three days of hospitalization, thepatient improved clinically and radiologically, suggestingit was the crack lung: acute respiratory syndrome afterinhalation of the drug. The patient was treated withoxygen and was discharged asymptomatic seven daysafter admission.

A Case of Drug Induced Interstitial Pneumonitis by Gemcitabine / 결핵

Gemcitabine is an effective newly developed chemotherapeutic agent, which is increasingly being used to treat non-small cell lung, ovarian and breast cancers. Pulmonary toxicity is usually self-limiting mild dyspnea, bronchospasm, but severe pulmonary toxicity is rarely reported. Herein, we report drug induced interstitial lung disease associated with gemcitabine treatment. High resolution computerized tomogram (HRCT) showed an increased ground glass opacity and thickened septal lines. The patient showed a rapid good response with prednisolone treatment.

Clinical Characteristics of Hospitalized Cases due to Asthma Attack Combined with Pneumonic Infiltrates / 소아알레르기및호흡기학회지

PURPOSE: The respiratory tract infections including pneumonia have been the major contributing factor for bronchial asthma, and are frequently involved in hospitalization due to asthma attack. We studied clinical characteristics of hospitalized cases due to asthma attack with and without pneumonic infiltrates. METHODS: Over 5 years between January 1993 and December 1997, 628 patients were hospitalized due to asthma attack. 315 of them had pneumonic infiltrates on chest X-ray (defined as pneumonia group) and 197 patients had no pneumonic infiltrates (uncomplicated group). The clinical characteristics of both groups were reviewed retrospectively. RESULTS: The age on admission and first attack in pneumonia group were significantly younger than those of uncomplicated group (P<0.05). The incidence of male was higher than that of female in both groups. The interval from attack to admission and duration of hospitalization were much longer in pneumonia group (P<0.05). The bronchial asthma attack was most frequently occurred between September and November. The atopy-perennial type was predominant in the both groups, and the incidence of non-atopy type was higher in the pneumonia group. The mild asthma attack was predominant in the pneumonia group and moderate one was predominant in the uncomplicated group. The incidence of fever and inflammatory reaction (peripheral blood WBC count, serum CRP level) were higher in the pneumonia group (P<0.05). There was no significant difference in the serum IgE level between two groups. CONCLUSION: Frequency and duration of hospitalization due to asthma attack might be lessened by prevention against respiratory tract infection.

2 cases of idiopathic BOOP associated with rare radiologic finding / 결핵

Idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP) is a specific clinicopathologic syndrome characterized by a pneumonia-like illness, with excessive proliferation of granulation tissue within bronchioles, alveolar ducts and alveoli. The changes are most numerous in alveolar ducts. The presence of intraluminal tufts of organizing connective tissue in alveolar ducts and more distal airspaces has been termed organizing pneumonia The radiologic manifestations are distinctive with bilateral, diffuse alveolar opacities predominantly in the subpleural and lower lung zone. Patchy migratory pneumonic foci or solely nodular infiltrates are rarely present in BOOP. BOOP is a diagnosis of importance because of its dramatic response to steroids.