[Clinical features of 127 cases of novel influenza A (H1N1) infection in Fujian Province].

OBJECTIVE: to investigate the clinical features of 127 cases of the novel influenza A/H1N1 infection in Fujian Province. METHODS: this study included 127 human cases with the novel influenza A/H1N1 infection in Fujian Province from May 2009 to July 2009. Data were collected and reviewed from hospital medical records. The statistical analyses were performed with SPSS 11.5. RESULTS: the median age of the 127 patients (55 were females) was 21 years (range 0.4 - 58). The median incubation period was 2 d (range 1 - 12 d). The typical clinical symptoms included fever, cough, sputum, and sore throat. The duration of symptoms in patients less than 5 years old and in patients more than 5 years old were (8.2 +/- 4.1) and (5.4 +/- 3.0) d respectively, the difference between these 2 groups being significant (z = 3.182, P < 0.01). There was also a statistically significant difference in the duration of symptoms between the high-temperature group and the low-temperature group [(6.8 +/- 3.2) vs (4.8 +/- 2.1) d, Hc = 9.729, P < 0.05]. The duration of symptoms in the high, the normal and the low white blood cell groups were (6.3 +/- 4.7) d, (5.4 +/- 2.8) d, and (8.5 +/- 4.2) d respectively, but the differences were not statistically significant (Hc = 4.729, P = 0.094). However, the duration of symptoms in the higher lymphocyte count group was significantly longer than that in the lower and normal lymphocyte count groups [(6.8 +/- 3.3) vs (5.4 +/- 3.4), (5.2 +/- 3.2) d, Hc = 10.105, P < 0.01]. Chest radiography showed patchy infiltrates in 6 patients, and their duration of symptoms was longer than patients with normal chest radiography [(8.1 +/- 5.7) vs (5.6 +/- 3.1) d], but the difference was not statistically significant (z = 1.286, P > 0.05). 125 patients received antiviral treatment with oseltamivir and they all had a good prognosis. There was a statistical difference in the duration of symptoms between the patients who used oseltamivir within 48 h after disease onset and patients who used the drug beyond 48 h [(4.7 +/- 2.2) vs (7.4 +/- 4.1) days, z = 4.907, P < 0.01]. All of the patients survived. CONCLUSIONS: the clinical symptoms of this series of patients with the novel influenza A (H1N1) infection appeared to be mild. There were several factors associated with longer duration of symptoms, including aged 5 years or younger, higher fever (body temperature > 38 degrees C), higher white blood cell count and lymphocyte count. The early use of anti-retroviral treatment with oseltamivir was useful in shortening the duration. The novel influenza A (H1N1) infection was a self-limited disease, and patients with no complications had a good prognosis.

[Clinical characteristics and therapeutic experience of case of severe highly pathogenic A/H5N1 avian influenza with bronchopleural fistula].

OBJECTIVE: To summarize the clinical characteristics and therapeutic experience of A/H5N1 infected patient with intractable bronchopleural fistula. METHOD: The data of a patient with A/H5N1 infection complicated with bronchopleural fistula was collected and analyzed. RESULTS: A 44-year-old woman with pneuminian was diagnosed as A/H5N1 infection by reverse-transcription polymerase chain reaction (RT-PCR) in laboratory from the sample of secretion of respiratory tracts. She had exposed to sick or dead poultry 3 days before development of illness. She developed acute respiratory distress syndrome 7 days after onset of sickness. After comprehensive management with antiviral agents, antibiotics, convalescent serum and invasive ventilation, her clinical condition improved and turned to stable. However, 16 days after onset of illness, her clinical situation deteriorated due to ventilator-associated pneumonia, bilateral pneumothorax and persistent right bronchopleural fistula. After partly failure of beside assist thoracoscopy to fix the pleural fistula, transbronchoscopic bronchial occlusion by autoblood was explored and the air leakage stopped soon after occlusion. Three days after the autoblood clot was expectorated out and air leak recurred. Then, bronchopleural fistula on the surface of visceral pleura was successfully blocked by biogel and OB gel through pleural cavity by fibrobronchoscopy. The patient was discharged from the hospital 99 days after onset of illness (at the 94th hospital day). CONCLUSION: Bronchopleural fistula was an intractable complication for patient with A/H5N1 infection. Occlusion operation by biogel and OB gel through bronchoscopy might be an alternative choice for fixing the bronchopleural fistula.

[Dieulafoy's disease of the bronchus: a case report and review of the literature].

OBJECTIVE: To describe the characteristics of Dieulafoy's disease of the bronchus. METHODS: One patient with Dieulafoy's disease of bronchus was described and relevant literatures were reviewed. RESULTS: Bronchial Dieulafoy's disease is extremely rare, characterized by the erosion of an anomalous artery in the submucosa of bronchus. The etiology of Dieulafoy's disease of bronchus is still unknown, but congenital vascular malformation and airway chronic inflammation or bronchial injury have been postulated. The sudden onset of massive hemoptysis and fatal hemorrhage caused by biopsy injury are common manifestations. Bronchial and pulmonary angiography is a very useful examination before operation, and histopathological diagnosis can be made by the examination of the surgical specimen and the necroscopic specimen. Selective bronchial artery embolization could be proposed as a method for stopping the bleeding, but it may fail and bleeding may recur. At present, lobectomy of the lung is a fundamental approach. CONCLUSIONS: Bronchial Dieulafoy's disease should be included in the differential diagnosis of cryptogenic hemoptysis, and if a cone-shaped endobronchial protrusion is found by bronchoscopic examination, care should be taken for potential danger of a biopsy.