[Revisiting iatrogenic damage in pneumology past and current implications compared]. / Le attuali implicazioni pneumologiche del danno polmonare iatrogeno alla luce di una rivisitazione rispetto al passato.

Current features of iatrogenic damage by pneumological practice are taken into account and compared with those traced in the past by Daddi and colleagues. The Authors stress the major chances occurred over time and moreover they emphasize the correlated implications that took place with prevention, therapies, informed consent and defensive medicine. Especially in oncological as well as non-oncological field the more relevant iatrogenic damages are represented by the pulmonary interstitial disease and pulmonary thromboembolism. However, from the revisiting is emerged that at present time are strongly increased the possibility and the means for preventing the onset of iatrogenic damage as well as the possibility of reducing the size of lesions consequent upon the pharmacological, surgical and radiotherapeutics treatments.

Effects of aerosolized interferon-alpha in patients with pulmonary tuberculosis.

Interferon-alpha (IFN-alpha) is a cytokine exerting pleiotropic activities, including antimicrobial effects, especially directed against intracellular infectious bacteria. It may be administered by aerosol to reach the lower respiratory tract without systemic side effects. The aim of the study reported here was the evaluation of aerosolized IFN-alpha treatment (3 MU/dose, given three times a week; total study dose: 72 MU/2 mo) in combination with conventional antimycobacterial therapy in patients with pulmonary tuberculosis. Two groups of 10 patients each were compared before and after 2 mo of conventional antituberculous chemotherapy with or without inhaled IFN-alpha. Several biologic (bronchoalveolar lavage fluid [BALF] cellularity, Mycobacterium tuberculosis [MT] number in sputum), biochemical (BALF concentrations of 10 cytokines, BALF IFN-alpha receptor levels), and clinical (fever, vital signs, high-resolution computed tomography [HRCT] images) measures were made in these patients at the time of their enrollment and at the end of the observation period of the study. Fever, MT number in sputum, and abnormalities in HRCT images showed significantly earlier resolution in the IFN-alpha-treated group, together with a more significant decrease in BALF interleukin-1beta (IL-1beta), IL-6, and tumor necrosis factor-alpha (TNF-alpha) concentrations and significantly greater pre- versus posttreatment variations in IL-2 and IFN-gamma. These data, taken together, suggest that IFN-alpha administration may favorably affect the evolution of pulmonary tuberculosis when combined with antimycobacterial therapy.

Spiral CT and endoscopic findings in a case of tracheobronchopathia osteochondroplastica.

The following is a report of CT and bronchoscopic findings in a 58-year-old man, a miner for approximately 30 years and suffering from pulmonary silicosis, admitted for a restaging of his lung disease. CT scans showed thickening of the interstitial structures and revealed a distorted trachea, with changes of its caliber, because of nodules of calcific density in the internal mucosa, clearly separated from the cartilaginous rings. The patient underwent fiberoptic bronchoscopy, confirming the presence of numerous nodules on the anterior and lateral walls, sparing the pars membranacea. Brushing and biopsies revealed a squamous metaplasia. 99mTc bone scintigraphy showed no abnormal mediastinal uptake. The radiological and endoscopic picture was compatible with the diagnosis of tracheobronchopathia osteochondroplastica.

Pulmonary microlithiasis. Report of two cases.

Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by widespread localization of calcispherites in the alveolar spaces. The patients are symptomless for a long time. Nevertheless, this disease slowly develops into pulmonary fibrosis and cardiac failure. The chest X-rays and high-resolution computed tomography strongly point towards a diagnosis of PAM. As for therapeutic approaches, repeated broncho-alveolar lavages (BAL) have been performed with improvement of symptoms but without recovery, and a new oral drug treatment is still under way. We report 2 familial cases of PAM. Both patients underwent chest X-ray examination showing diffuse bilateral micronodular opacities of calcific density. After 5 years, in May 1993, one of them developed exertional dyspnoea, cyanosis, dry cough and was admitted to our Division. Cardiokinetic and diuretic drugs as well as oxygen were administered with satisfactory results. Then repeated BAL were performed. The chest X-ray after 6 months of sodium etidronate (300 mg t.i.d.) administration was unchanged.

Multicystic dysplastic kidneys: spontaneous regression demonstrated with US.

In nine neonates, spontaneous regression of a multicystic dysplastic kidney (MCDK) was witnessed by means of repeated ultrasound (US) examinations. In three of these patients, the diagnosis was made in utero. Follow-up examinations at the ages of 3, 5, and 32 weeks post-partum showed what would have been called unilateral agenesis of the affected side if no fetal US study had been done. In the remaining neonates, the diagnosis was made postnatally, and marked reduction in size or complete disappearance of the MCDK was observed on serial US examinations. Three neonates underwent surgical exploration. No trace of a kidney, renal artery, or ureter was found in two. A small MCDK was removed in the third patient. US reveals new features of the natural history of MCDKs. Because malignant transformation of an MCDK is rare and because US provides a means of serial assessment, the authors believe a more conservative, nonsurgical approach is appropriate and recommend an observation time of 1 year before deciding on surgical intervention, unless other problems necessitate surgical removal of the MCDK.

[Frontal radiogram of the thorax in the present-day diagnosis of the mediastinum. Technic of execution and semeiology]. / Il radiogramma frontale del torace nella moderna diagnostica del mediastino. Tecnica di esecuzione e semeiologia.

The advantages of high kilovoltage and pulmonary filters in frontal chest X ray are described, underliing the possibility of a simultaneous demonstration of both pulmonary fields and mediastinal structures. A description is given of the most important mediastinal lines and of their semeiological value in pathologic conditions. The excellent results obtained by means of hemifiltration in patients with opaque hemithorax are stressed. An increased diffusion of such technique could be justified by its simplicity, and by the low cost and high benefit.