ABSTRACT
BACKGROUND: The aim of the study was to evaluate the reliability of bronchoalveolar lavage in the routine clinical assessment of patients with sarcoidosis. STUDY DESIGN: retrospective analysis. SETTING: 2 Divisions of Respiratory Medicine, both in the context of a public general hospital (Ospedale Morelli, Sondalo, Italy and Ospedale Civile, Piacenza, Italy). PATIENTS: 89 patients with definitely diagnosed diffuse infiltrative lung disease, who underwent bronchoalveolar lavage as part of their initial diagnostic work-up in the period 1991-2001. Fifty-one of them had biopsy-proven sarcoidosis. Diagnostic procedures were: transbronchial lung biopsy (n=26), bronchial biopsy (n=11), skin biopsy (n=6), surgical lung biopsy (n=4), superficial lymph node biopsy (n=3), mediastinal lymph node biopsy (n=1). In 38 patients various interstitial lung diseases were diagnosed, according to established criteria. MEASURES: we compared the percentage of BAL lymphocytes and CD4/CD8 ratio in the 2 groups. Sensitivity, specificity, positive and negative predictive value of BAL parameters were calculated with a cut-off value of 28% for BAL lymphocytes and 3.5 for CD4/CD8 ratio. RESULTS: The percentage of lymphocytes was similar in the 2 groups (p=0.19); CD4/CD8 ratio was 5.7+/-4.9 in sarcoidosis and 2.0+/-3.3 in the other patients (p=0.0001). BAL CD4/CD8 ratio in sarcoidosis had sensitivity 58%, specificity 86%, positive predictive value 85%, negative predictive value 61%. CONCLUSIONS: BAL has a low sensitivity in patients with sarcoidosis; CD4/CD8 ratio >or=3.5 strongly suggests sarcoidosis but is not specific enough if considered alone.
Subject(s)
Bronchoalveolar Lavage Fluid , Sarcoidosis/pathology , Adult , Aged , Aged, 80 and over , CD4-CD8 Ratio , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVES: To study posttraumatic disorders in children who were directly and indirectly involved in an industrial disaster; to assess the respective impact of traumatism exposure, parental disorders and sociodemographic variables on the posttraumatic disorders of the children. METHODS: The children were assessed with self-administered questionnaires (STAIC, CDI, IES) and questionnaires filled in by parents (CPRS, CBCL). Parents were assessed with the GHQ-28. Forty-three exposed children were compared with 44 children who were exposed to the same risk (indirectly exposed group) and with a control group of 50 unexposed children. RESULTS: The exposed group obtained significantly higher anxiety and trauma-related scores than the control group and the threatened group, as well as higher scores of behavioural symptoms and of parental disorders. Indirectly exposed children did not have higher rates of symptoms than control children. The younger exposed children exhibited the highest psychopathological scores. Low sociodemographic status was associated with more disorders. There were no differences on questionnaire scores between girls and boys. Children's disorders correlated with disorders in both parents; but this only accounted for part of the variance, a finding which supports the hypothesis of a direct impact of the trauma on the child, irrespective of parental clinical status, SES of the family, children's age and gender. CONCLUSIONS: Children's and parent's disorders interact in a complex fashion which needs further study.
Subject(s)
Child of Impaired Parents/psychology , Disasters , Iron , Mining , Personality Inventory/statistics & numerical data , Stress Disorders, Post-Traumatic/diagnosis , Adolescent , Child , Female , Follow-Up Studies , France , Humans , Male , Parent-Child Relations , Psychometrics , Stress Disorders, Post-Traumatic/psychologySubject(s)
Deoxycytidine/analogs & derivatives , Immunosuppressive Agents/adverse effects , Respiratory Distress Syndrome/chemically induced , Deoxycytidine/adverse effects , Fatal Outcome , Humans , Male , Pulmonary Alveoli/drug effects , Pulmonary Alveoli/pathology , Respiratory Distress Syndrome/pathology , Ribonucleotide Reductases/antagonists & inhibitors , GemcitabineABSTRACT
We report a case of sarcoidosis, occurred in a patient with chronic lymphocytic leukemia (CLL) shortly following the completion of initial chemotherapy, who relapsed shortly after a second course. Since bronchoalveolar lavage (BAL) demonstrated a predominance of CD4+ lymphocytes, it largely excluded spread of the malignant disorder to the lung, and strongly suggested that sarcoidosis was the cause of the pulmonary infiltrates. This diagnosis was confirmed by the finding of non-caseating granuloma on transbronchial lung biopsy.
Subject(s)
Leukemia, Lymphocytic, Chronic, B-Cell/complications , Lung Neoplasms/complications , Sarcoidosis/complications , Antineoplastic Agents/therapeutic use , Bronchoalveolar Lavage Fluid , CD4 Lymphocyte Count , Comorbidity , Female , Humans , Middle Aged , Sarcoidosis/drug therapy , Vidarabine/analogs & derivatives , Vidarabine/therapeutic useABSTRACT
Noninvasive mechanical ventilation has been suggested for the treatment of patients with respiratory failure. We describe the case of a patient affected by bilateral cystic bronchiectasis and acute hypercapnic respiratory failure, due to a cardiogenic pulmonary edema, successfully treated with bi-level nasal-CPAP. This report suggests that in some cases noninvasive ventilatory support may mean avoiding tracheal intubation, even with critically ill patients.
Subject(s)
Hypercapnia/therapy , Positive-Pressure Respiration , Pulmonary Edema/therapy , Respiratory Insufficiency/therapy , Acute Disease , Aged , Humans , MaleABSTRACT
Pulmonary actinomycosis is a rare disease. Of 2,247 patients presenting with a radiological pulmonary opacity, 13 (0.6%) were identified with pulmonary actinomycosis in a 13 year period. Twelve of the 13 patients underwent thoracotomy and one had clinical diagnosis and subsequent medical treatment alone. Neither mortality nor major complications were observed. One patient had recurrent disease after surgery. The other surgical patients are well and free from disease at a minimum 6 month follow-up. Diagnosis of actinomycosis is frequently difficult because it often infects pre-existing cavitary disease in the lung. As a consequence, the infection may progress to stages which will not respond to medical treatment alone. Surgery then provides the best method to achieve diagnosis and ultimate treatment.
Subject(s)
Actinomycosis/surgery , Lung Diseases/microbiology , Lung Diseases/surgery , Actinomycosis/drug therapy , Actinomycosis/epidemiology , Anti-Bacterial Agents , Causality , Drug Therapy, Combination/therapeutic use , Female , Follow-Up Studies , Humans , Lung Diseases/drug therapy , Lung Diseases/epidemiology , Male , Middle Aged , Time FactorsABSTRACT
Seven patients with lung cancer and two with breast cancer developed a symptomatic pericardial effusion and were treated with intrapericardial cisplatin (CDDP). In all of the patients, cytological confirmation of metastatic effusion was achieved. A single cycle with 10 mg of cisplatin diluted in 20 ml of normal saline was administered for five consecutive days via an intrapericardial catheter. Control of recurrent effusions was obtained in eight of the nine patients. No significant side-effects were observed.
Subject(s)
Breast Neoplasms/pathology , Cisplatin/therapeutic use , Lung Neoplasms/pathology , Pericardial Effusion/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Non-Small-Cell Lung/secondary , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/secondary , Catheterization/instrumentation , Cisplatin/administration & dosage , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplastic Cells, Circulating/pathology , Pericardial Effusion/etiology , Pericardium , RecurrenceABSTRACT
Occupational exposure to asbestos has been associated with an increased incidence of lung and gastric cancers, mesotheliomas, and myelolymphoid malignancies. A new observation of a patient with indirect exposure to asbestos who developed mesothelioma and plasmacytoid lymphocytic non-Hodgkin's lymphoma is described. This report and the previously described stimulation of B lymphocytes by asbestos suggests that the association of mesothelioma with lymphoid and plasma cell malignancies is not merely a coincidence.
Subject(s)
Asbestosis/complications , Leukemia, Lymphocytic, Chronic, B-Cell/etiology , Mesothelioma/etiology , Neoplasms, Multiple Primary/etiology , Pleural Neoplasms/etiology , Asbestosis/pathology , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Male , Mesothelioma/pathology , Middle Aged , Neoplasms, Multiple Primary/pathology , Pleural Neoplasms/pathologyABSTRACT
Between January 1983 and December 1988 67 patients presenting with solitary cerebral recurrence from lung cancer were observed in our Institution. Resection was possible in 21 cases (31%). The surgical treatment included craniotomy with radical thoracotomy in 10 patients, craniotomy alone (with thoracotomy not including radical lung resection) in 5 patients and craniotomy performed within months of the initial elective thoracic surgery in 6 patients. In our series routine brain CT was carried out as a part of the staging procedure for lung cancer. Based on our results, we recommend an aggressive surgical approach to both cerebral recurrence and lung primary (scheduling craniotomy before thoracotomy), followed by whole brain RT, in order to prolong survival and improve the quality of life.
Subject(s)
Brain Neoplasms/secondary , Brain Neoplasms/therapy , Lung Neoplasms , Adult , Aged , Brain Neoplasms/mortality , Combined Modality Therapy , Craniotomy , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/surgery , Male , Middle Aged , Survival Analysis , ThoracotomyABSTRACT
The authors report their eight-year experience on the methodical of fiberbronchoscopy in the evaluation of complete remission in 140 patients affected by small-cell lung cancer. The higher reliability of fiberbronchoscopy than of standard chest X-ray is emphasized.
