Sustained dapsone-induced remission of hypocomplementemic urticarial vasculitis--a case report.

Hypocomplementemic urticarial vasculitis (HUV) is often misdiagnosed. The response to drug therapy may be unsatisfactory, and immunosuppressive therapy may be associated with significant side effects. A 35-year-old patient whose condition was resistant to cyclophosphamide, corticosteroids, pentoxyphylline, cyproheptadine, sulindac, and colchicine was maintained in remission with dapsone, which may be the drug of choice for HUV. Emphysema has been reported to complicate HUV, but this is the first account of vasculitis-related emphysema with no confounding history of tobacco smoke exposure. The relationship of proteolytic injury to the pulmonary and other manifestations is considered, as is the possible role for dapsone in reducing it.

Sarcoidosis involving the thyroid and pleura.

We report the coincidence of uncommon manifestations of sarcoidosis, each confirmed by percutaneous needle biopsy, revealing noncaseating granulomas. A patients presented with a thyroid nodule which demonstrated noncaseating granulomas on biopsy. When pleural effusion subsequently developed, pleural biopsy demonstrated noncaseating granulomas with no acid fast bacilli on stain or culture, and a diagnosis of sarcoidosis was made. Thyroid and pleural involvement are each rare manifestations of sarcoidosis, and are usually associated with extensive systemic disease. The diagnosis of sarcoidosis requires the appropriate clinical presentation, compatible histologic findings, and evaluation for other causes of granuloma formation.

Treatment of severe systemic inflammatory response syndrome and sepsis with a novel bradykinin antagonist, deltibant (CP-0127). Results of a randomized, double-blind, placebo-controlled trial. CP-0127 SIRS and Sepsis Study Group.

OBJECTIVE: To test the effect of a novel bradykinin antagonist, deltibant (CP-0127), on survival, organ dysfunction, and other outcomes in patients with the systemic inflammatory response syndrome (SIRS) and presumed sepsis. DESIGN: Multicenter, randomized, placebo-controlled, double-blind, parallel, dose-ranging trial. Follow-up for 28 days or until death. SETTING: A total of 47 US referral hospitals. PATIENTS: A total of 504 patients with SIRS and documented evidence of infection plus either hypotension or dysfunction of 2 organ systems. INTERVENTIONS: Three-day continuous intravenous infusion of either placebo or 1 of 3 doses (0.3, 1.0, or 3.0 microg x kg(-1) x min(-1)) of deltibant. Concurrent therapy at the discretion of the treating physician. MAIN OUTCOME MEASURE: Risk-adjusted, 28-day, log-normal intent-to-treat survival analysis. Risk adjustment was performed using a study-specific risk model derived from the APACHE III database. RESULTS: Deltibant had no significant effect on risk-adjusted 28-day survival. In a posthoc analysis, risk-adjusted 7-day survival showed a nonsignificant trend toward improvement (P=.09). The 28-day risk-adjusted survival in the prospectively defined subset of patients with gram-negative infections showed a statistically significant improvement (P=.005). CONCLUSIONS: Deltibant may have some effect on survival in patients with SIRS and gram-negative sepsis; however, additional studies would be required to prove this.

Reversal of intractable acute severe asthma by first-trimester termination of pregnancy.

A 19-year-old woman was admitted with acute severe asthma in her eleventh week of pregnancy. Despite vigorous therapy, severe hypoventilation and hypoxemia persisted with mechanical ventilation. Termination of pregnancy resulted in dramatic improvement in airflow. Her course was complicated by pneumonia, barotrauma, and atelectasis accompanying her moribund state. Although she immediately improved following abortion (within 2 hr, peak airway pressure fell from > 70 to 38 cmH2O, without change in plateau pressure), superimposed morbidities improved more slowly, and the patient made a complete recovery. The mechanism accounting for this observation is unknown but the rapid improvement following abortion suggests that increased bronchomotor tone predominated inflammatory changes in causing flow limitation.

Endotracheal intubation-induced upper airway obstruction.

We report a case in which endotracheal intubation performed for acute respiratory distress resulted in respiratory failure that completely resolved on removal of the endotracheal tube, with concomitant expulsion of a latex glove from the mouth. This case serves as a reminder that endotracheal intubation may promote the very complications that it is meant to prevent. Thorough visualization and careful inspection of the larynx before intubation of the trachea is essential.

Diagnosis of lymphangitic carcinoma to lung by sputum cytology: case report.

Documenting lymphangitic metastases to the lungs may be therapeutically important. Several techniques have been described to this end. Sputum cytology, the least invasive and expensive, is the most available. It has a role that may be overlooked but that should be emphasized, since abundant malignant cells in sputum may be associated with this pattern of tumor spread. This case is the first, to the authors' knowledge, in which the pathologic findings associated with malignant cells in lymphangitic carcinomatosis were demonstrated in sputum in the absence of tumor mass invasion of large airways.

Treatment of lupus interstitial lung disease with intravenous cyclophosphamide.

Intravenous pulse cyclophosphamide (IPC) was used to treat lupus interstitial lung disease in 2 patients. Vital capacity increased by 67-110% of baseline values with IPC treatment. Total lung capacity and diffusing capacity also improved. Dyspnea and other manifestations of lupus improved dramatically. This is the first report documenting the efficacy of the early use of IPC for acute and chronic interstitial lung disease associated with lupus.