The origin, course, diagnosis and treatment aspects of acute pneumonia have been studied in 394 patients with chronic bronchitis and 158 bronchial asthmatics. In chronic bronchitis, acute pneumonia was diagnosed resting on clinical physical data in one-third of the patients, the rest cases simulated exacerbations of bronchitis and were detected only at x-ray. Clinical relationships between acute pneumonia and bronchial asthma are variable (prepneumonic asthma aggravation , its early and late severe episodes because of pneumonia). Chronics with nonspecific diseases of the lungs are referred to high-risk-for-pneumonia groups, while acute pneumonias are considered affections negatively influencing background bronchopulmonary disorders.
Ventilation/perfusion (V/P) single-photon emission computed tomography (SPECT) is recognized as a diagnostic method with potential beyond the diagnosis of pulmonary embolism. V/P SPECT identifies functional impairment in diseases such as heart failure (HF), pneumonia, and chronic obstructive pulmonary disease (COPD). The development of hybrid SPECT/computed tomography (CT) systems, combining functional with morphological imaging through the addition of low-dose CT (LDCT), may be useful in COPD, as these patients are prone to lung cancer and other comorbidities. The aim of this study was to investigate the added value of LDCT among healthy smokers and patients with stable COPD, when examined with V/P SPECT/CT hybrid imaging. Sixty-nine subjects, 55 with COPD (GOLD I-IV) and 14 apparently healthy smokers, were examined with V/P SPECT and LDCT hybrid imaging. Spirometry was used to verify COPD grade. Only one apparently healthy smoker and three COPD patients had a normal or nearly normal V/P SPECT. All other patients showed various degrees of airway obstruction, even when spirometry was normal. The same interpretation was reached on both modalities in 39% of the patients. LDCT made V/P SPECT interpretation more certain in 9% of the patients and, in 52%, LDCT provided additional diagnoses. LDCT better characterized the type of emphysema in 12 patients. In 19 cases, tumor-suspected changes were reported. Three of these 19 patients (ie, 4.3% of all subjects) were in the end confirmed to have lung cancer. The majority of LDCT findings were not regarded as clinically significant. V/P SPECT identified perfusion patterns consistent with decompensated left ventricular HF in 14 COPD patients. In 16 patients (23%), perfusion defects were observed. HF and perfusion defects were not recognized with LDCT. In COPD patients and long-time smokers, hybrid imaging had added value compared to V/P SPECT alone, by identifying patients with lung malignancy and more clearly identifying emphysema. V/P SPECT visualizes comorbidities to COPD not seen with LDCT, such as pulmonary embolism and left ventricular HF.
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The article covers differential diagnostic features of pulmonary tuberculosis and pneumoconiosis in workers engaged into mullite refractories production. The authors suggest that the disease courses as a new form of lung disorder--mullitosis.
Blastomyces dermatitidis is a dimorphic fungus endemic to north-western Ontario, Manitoba and some parts of the United States. The fungus is also endemic to parts of Africa. Pulmonary and extrapulmonary findings of a 24-year-old African man who presented with weight loss, dry cough and chronic pneumonia not resolving with antibiotic treatment are presented. The unusual occurrence of pulmonary blastomycosis associated with skin lesions and a moderate pleural effusion is reported.
To give an X-ray pattern of single lung foci revealed by computed tomography (CT) in children and adolescents examined for tuberculosis.
The results of CT in 52 children and adolescents infected by Mycobacterium tuberculosis were analyzed. All the followed up children and adolescents underwent X-ray study using a two-slice spiral Somatom Emotion Duo (Siemens). The study used first the conventional chest spiral CT scanning procedure for children according to the Thorax Routine program and then reconstruction. Target spiral scanning of the area of interest was, if needed, carried out by employing high resolution CT with 2-mm thick images taken at 1.5-mm spacing. A maximal intensity project program was used to separate vessels and foci.
The single foci were encountered frequently in the lung of the examinees and characterized by a perilymphatic site; in 88.0% they were connected with the interlobular interstitium, interlobar fissure, and paracostal pleura; in 92.2% the foci were detectable in the subpleural and cortical parts of the lung, had a moderate intensity, well-defined outlines, and were 2-6 mm in size. At the same time, there were no pathological changes in the lymph nodes of the lung roots and mediastinum. The long-term (2-month-to-5-year) followup in this group of children indicated that there were no X-ray changes in the lung foci revealed by CT.
The single foci in the lung of Mycobacterium tuberculosis-infected children without X-ray changes in the lymph nodes of the lung roots and mediastinum may be manifestations of the normal lung structure--these may be intrapulmonary lymph nodes. Further follow-up in this group of these children must be in agreement with the management tactics of those infected with Mycobacterium tuberculosis.
The findings of a previous chest X-ray screening, determined without using standardized criteria, were reassessed by means of the ILO classification. Of 470 radiographs that had been determined as showing asbestos-related changes, 430 were categorized according to the ILO Classification. Small opacities with profusion greater than or equal to 1/0 were described in 39 (52%) of 75 participants who, on the original clinical reading, had been determined as having lung fibrosis, and in 45 (12.7%) of 355 who were determined as having pleural changes only. When considering circumscribed pleural thickening at the chest wall or diaphragm, as categorized by the ILO Classification, such changes were present in 401 (93.7%) of 428 subjects with pleural changes as determined on the clinical reading. In addition to the improved sensitivity and specificity achieved, the ILO Classification also allows comparison with other studies. The most apparent disadvantage of the ILO system is that it cannot firmly separate the various types of asbestos-related pleural changes. The study revealed that the previous asbestos exposure of the case subjects had occurred in many different workplaces and occupations.
One hundred thirty patients with Siberian silicosis occurring under exposure to large amounts of dust at labor in a siberian mine were analyzed for 67 clinical and 122 laboratory data. Eighty-eight of 130 patients are now alive, but 42 have already died. When they started work, 122 of the patients were under thirty years of age. The duration of work was 7 to 12 months for 17 patients, 13 to 18 for 43, and 19 to 24 for 40. Seventy-six of 99 patients were initially diagnosed with lung tuberculosis and 23 with silicosis. Almost all patients have complained of respiratory symptoms such as shortness of breath, cough, sputum, and cyanosis. All of the pulmonary function tests including %VC, FEV1.0/FVC, V25/height, RV, TLC, and DLco showed abnormal values. The chest roentogenograms showed 3 of type 1, 22 of type 2, 55 of type 3, and 124 of type 4. Of 124 type-4, large opacities, 84 were type A, 28 B, and 12 C. Of 416 small opacities, 144 were type P, 191 Q, and 81 R. The complications and secondary changes that appeared with progression of the disease were lung emphysema, hilar and mediastinal lymphnode enlargement, egg shell calcification in lymphnode, and bulla or bleb.
Severe acute respiratory syndrome (SARS) is an emerging infectious disease that first manifested in humans in China in November 2002 and has subsequently spread worldwide.
To describe the clinical characteristics and short-term outcomes of SARS in the first large group of patients in North America; to describe how these patients were treated and the variables associated with poor outcome.
Retrospective case series involving 144 adult patients admitted to 10 academic and community hospitals in the greater Toronto, Ontario, area between March 7 and April 10, 2003, with a diagnosis of suspected or probable SARS. Patients were included if they had fever, a known exposure to SARS, and respiratory symptoms or infiltrates observed on chest radiograph. Patients were excluded if an alternative diagnosis was determined.
Location of exposure to SARS; features of the history, physical examination, and laboratory tests at admission to the hospital; and 21-day outcomes such as death or intensive care unit (ICU) admission with or without mechanical ventilation.
Of the 144 patients, 111 (77%) were exposed to SARS in the hospital setting. Features of the clinical examination most commonly found in these patients at admission were self-reported fever (99%), documented elevated temperature (85%), nonproductive cough (69%), myalgia (49%), and dyspnea (42%). Common laboratory features included elevated lactate dehydrogenase (87%), hypocalcemia (60%), and lymphopenia (54%). Only 2% of patients had rhinorrhea. A total of 126 patients (88%) were treated with ribavirin, although its use was associated with significant toxicity, including hemolysis (in 76%) and decrease in hemoglobin of 2 g/dL (in 49%). Twenty-nine patients (20%) were admitted to the ICU with or without mechanical ventilation, and 8 patients died (21-day mortality, 6.5%; 95% confidence interval [CI], 1.9%-11.8%). Multivariable analysis showed that the presence of diabetes (relative risk [RR], 3.1; 95% CI, 1.4-7.2; P =.01) or other comorbid conditions (RR, 2.5; 95% CI, 1.1-5.8; P =.03) were independently associated with poor outcome (death, ICU admission, or mechanical ventilation).
The majority of cases in the SARS outbreak in the greater Toronto area were related to hospital exposure. In the event that contact history becomes unreliable, several features of the clinical presentation will be useful in raising the suspicion of SARS. Although SARS is associated with significant morbidity and mortality, especially in patients with diabetes or other comorbid conditions, the vast majority (93.5%) of patients in our cohort survived.