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At least 235 records · Page 13Linked to original sources
PubMed2003

Efficacy of thoracoscopic lung biopsy in interstitial lung diseases: comparison with open lung biopsy.

OBJECTIVE: To determine the efficacy of video-assisted thoracoscopic surgery (VATS) compared to open lung biopsy. DESIGN: Descriptive, observational case series. PLACE AND DURATION OF STUDY: The Cardio-thoracic Centre, Liverpool, UK, from January 1995 to December 1999. PATIENTS AND METHODS: One hundred consecutive patients, undergoing lung biopsy for interstitial lung disease during this period, were included in the study. Thirty patients underwent open lung biopsy, while 70 patients had VATS lung biopsy. Patient characteristics, site, size, number and laterality of biopsy, complications, morbidity, mortality and diagnostic yield was compared. P-value was determined to assess significance of findings. Statistical analysis was performed on SAS for windows version 8. RESULTS: Seventy-five percent had diagnostic yield in VATS group, while 37% in open group (p=0.04). Mean FEV1 was 3.2 litre in VATS group and 1.92 litre in open group (p=0.05). Right side was selected in 58.6% in VATS group and 36.7% in open group (p =0.04). Right lower lobe was the main site for biopsy in the VATS group compared to open group (18.6% versus 3.3%, p=0.04). Mean volume of biopsy was 15.6 cm3 in VATS group and 12.5 cm3 in open group (p=0.04). Two or more biopsies were carried out in 37.1% of the VATS group compared to 16.7% of the open group (p=0.04). Chest drain duration was in 1 day in VATS group compared to 2 days in open group (p=0.01). Length of stay was 3 days in VATS group and 4 days in open group (p=0.003). CONCLUSION: Patients undergoing thoracoscopic lung biopsy had a significantly reduced chest drain duration and post-operative length of stay. Thoracoscopic lung biopsy is beneficial in determining a diagnostic yield with an advantage of greater volume and selection of biopsy sites.

Adult↗
PubMed2001

[Treatment and results of interstitial lung diseases in video assisted thoracoscopic lung biopsy].

In order to establish treatment of interstitial lung diseases in video assisted thoracoscopic lung biopsy, we retrospectively reviewed our experiences. The present study included 7 patients with a mean age of 46.4, range from 24 to 61, who were treated at our department from 1996 through 1999. They were 5 men and 2 women. The pathologic diagnosis was nonspecific interstitial pneumonia in 3 patients who responded to steroid therapy. Three other patients had usual interstitial pneumonia. One patient had lymphocytic interstitial pneumonia. No complications occurred. The results indicate that video assisted thoracoscopic lung biopsy is an effective and safe way to diagnose interstitial lung diseases.

Adult↗
PubMed2004

Capacity building for research: report on a UNION Strategic Planning Workshop. Report of a workshop held during the International Union Against Tuberculosis and Lung Disease World Conference on Lung Health, Montreal, Canada, 7 October 2002.

The International Union Against Tuberculosis and Lung Disease (UNION) has a decade of experience in conducting short courses on research methods for the promotion of lung health. In a parallel initiative, the UNION has collaborated with the American Thoracic Society (ATS) to develop courses on international respiratory epidemiology that have been expanded by the ATS throughout Latin America. The two initiatives have similar aims, and the courses offered by the two organisations have intentionally been similar in terms of focus and complementary in regions targeted. The target regions of the UNION, drawing on several decades of experience in offering short courses on tuberculosis, have been Africa, the Black Sea Rim, the Middle East and Asia, while the target regions of the ATS have been Central and South America. This workshop aimed first to provide an opportunity for those who have taught on the courses and those who have participated to share their experiences and learn from them, and second to provide a basis on which to develop a strategic plan for future courses. This report summarises the contributions of the workshop participants and the conclusions reached.

Education, Medical, Continuing↗
PubMed2005

[Usefulness of transbronchial and surgical biopsies for the management of interstitial lung disease].

Interpretation of lung material can be very difficult in patients with interstitial lung disease. The pathologist must be particularly familiar with this type of situation since, unlike tumor diseases, the diagnosis is not purely histological and must always be established in correlation with the clinical and radiological presentation. In patients with suspected interstitial lung disease, the first diagnostic step is to perform a transbronchial biopsy or bronchoalveolar lavage. In many cases the two minimally invasive techniques can be combined to guide the diagnosis or establish confirmation. The indications for surgical biopsy can thus be limited to very exceptional situations. We recall here the requirement for rigorous handling of the endoscopic or surgical specimens and discuss the specific difficulties in interpreting the pathological material, focusing on the contribution of the pathological study to clinical surveillance of the disease course and its complications, particularly in treated patients. A close collaboration between clinicians and pathologists is essential for optimal diagnosis and management of interstitial lung disease.

Biopsy↗
PubMed1995

The safety of air transportation of patients with advanced lung disease. Experience with 21 patients requiring lung transplantation or pulmonary thromboendarterectomy.

Air travel can cause severe respiratory decompensation in a patient with advanced lung disease due to high altitude hypoxemia. We report our experience in flying 21 patients with advanced lung disease to a medical center remote from Israel for lung transplantation or pulmonary thromboendarterectomy (PTE). All patients had severe lung disease with marked hypoxemia (PaO2, 40 to 59) and 16 had significant pulmonary hypertension. Nine patients (with emphysema and pulmonary fibrosis) required single lung transplant, four (with cystic fibrosis and emphysema) required double-lung transplant, six (with primary or secondary pulmonary hypertension) required heart-lung transplant, and two (with major vessel pulmonary thrombosis) required PTE. All patients were flown by commercial aircraft to centers located 2,634 to 13,181 km away from Israel. Length of flight was between 4 and 21 h. Patients were given oxygen supplementation during the flight and were monitored by portable oximeters. All but three patients were hemodynamically stable and 19 of them were escorted by physicians. All but one hemodynamically unstable patient who died on board arrived safely at their destinations. We conclude that with careful preparation, sufficient oxygen supply, oximetric monitoring, and medical escort, almost any patient with severe lung disease can travel by air to any necessary destination.

Adult↗
PubMed1994

The differential diagnosis of hard metal lung disease.

Hard metal lung disease is usually easy to diagnose, on the basis of occupational history, chest X-ray appearance of interstitial lung disease and, if necessary, by bronchoalveolar lavage (BAL). However, other interstitial lung diseases may affect patients with an occupational history of exposure to cobalt. In hard metal disease, the hylar lymphnodes may enlarge due to high draining of hard metals from the lung tissue via lymphatic vessels. Also, the presence of Giant Cells (even if Langhan's type) in the BAL fluid of sarcoid patients may be high. We present four patients with a history of exposure to hard metals and whose chest X-rays suggest sarcoidosis, stage II; in each, a pulmonary biopsy was necessary to confirm the diagnosis. Final diagnosis was sarcoidosis in one (showing typical granulomata in the lung tissue), and hard metal disease in three: two of these had foreign body-type granulomata in the lung tissue. Neutron activation analysis (NAA) study was carried out on these four patients using specimens of BAL fluid, blood, urine, toenails, pubic hair and sperm. In the light of available data, the concentration of elements may not be useful in differentiating between sarcoidosis and hard metal pneumoconiosis. However, NAA on BAL fluid or other specimens may be helpful in confirming the presence of the offending agent in suspected cases when the occupational history is not clear.

Adult↗
PubMed2006

Circulating peripheral blood fibrocytes in human fibrotic interstitial lung disease.

Fibrotic interstitial lung diseases are illnesses of unknown cause characterized by progressive decline in lung function. Fibrocytes are bone marrow-derived, circulating progenitor cells capable of differentiating into diverse mesenchymal cell types. Prior work has shown fibrocytes to traffic to the lung via the CXCL12-CXCR4 chemokine axis in an animal model of pulmonary fibrosis. We therefore assessed the relevance of fibrocytes in patients with fibrotic interstitial lung disease. We found enhanced expression of CXCL12 in both the lungs and plasma of patients with lung fibrosis. CXCL12 levels were associated with an order of magnitude higher number of circulating fibrocytes in the peripheral blood of these patients. Most of the circulating fibrocytes in patients with interstitial lung diseases were negative for the myofibroblast marker alpha-smooth muscle actin, suggesting a relatively undifferentiated phenotype. Taken together, these data suggest that fibrocytes are involved in the pathogenesis of human lung fibrosis.

Blood Cells↗
PubMed1987

Vertebral compression fractures and mineral metabolism in chronic obstructive lung disease.

Chronic obstructive lung disease has been reported as a cause of osteoporosis, though whether this association is due to the disease itself or to corticosteroid treatment has not been elucidated. We studied 44 male patients with chronic obstructive lung disease (mean (SD) FEV1 39% (14%) of predicted normal) who were not having long term corticosteroids. No differences in a vertebral deformity score or in metacarpal index were found between them and a control group of similar age. Indices of bone formation (serum osteocalcin) and bone resorption (urinary hydroxyproline) were normal and parathyroid hormone and 1,25-dihydroxyvitamin D were also normal. Serum 25-hydroxyvitamin D was decreased, indicating depleted vitamin D. Calcitonin concentrations were higher in the patient than in the control group of the same age. There was no increase in the prevalence of osteoporosis in patients with chronic obstructive lung disease who had not received long term corticosteroid treatment. Increased concentrations of calcitonin may protect the skeleton from the detrimental effect of hypovitaminosis D.

Bone and Bones↗
PubMed2006

Diffuse pulmonary amyloidosis that mimics interstitial lung disease in a patient with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is an autosomal-recessive disorder characterized by recurrent attacks of fever, serositis, and arthritis. Amyloidosis, which mostly affects the kidneys, represents the most serious complication of the disease. The lungs, particularly after the onset of renal failure, may be asymptomatically involved in some of the patients with AA amyloidosis secondary to FMF. However, clinically detectable pulmonary amyloidosis is quite rare, and only 2 cases of pulmonary amyloidosis secondary to FMF have been reported so far. We describe a patient with pulmonary amyloidosis who had pulmonary hypertension and presented with clinical and radiologic features highly suggestive of interstitial lung disease. Amyloidosis was diagnosed only after lung biopsy. FMF was confirmed by molecular analysis.

Amyloidosis↗
PubMed1984

Particles causing lung disease.

The lung has a limited number of patterns of reaction to inhaled particles. The disease observed depends upon the location: conducting airways, terminal bronchioles and alveoli, and upon the nature of inflammation induced: acute, subacute or chronic. Many different agents cause narrowing of conducting airways (asthma) and some of these cause permanent distortion or obliteration of airways as well. Terminal bronchioles appear to be particularly susceptible to particles which cause goblet cell metaplasia, mucous plugging and ultimately peribronchiolar fibrosis. Cancer is the last outcome at the bronchial level and appears to depend upon continuous exposure to or retention of an agent in the airway and failure of the affected cells to be exfoliated which may be due to squamous metaplasia. Alveoli are populated by endothelial cells, Type I or pavement epithelial cells and metabolically active cuboidal Type II cells that produce the lungs specific surfactant, dipalmytol lecithin. Disturbances of surfactant lead to edema in distal lung while laryngeal edema due to anaphylaxis or fumes may produce asphyxia. Physical retention of indigestible particles or retention by immune memory responses may provoke hyaline membranes, stimulate alveolar lipoproteinosis and finally fibrosis. This later exuberant deposition of connective tissue has been best studied in the occupational pneumoconioses especially silicosis and asbestosis. In contrast emphysema a catabolic response, appears frequently to result from leakage or release of lysosomal proteases into the lung during processing of cigarette smoke particles. The insidious and probably most important human lung disease due to particles is bronchiolar obstruction and obliteration, producing progressive impairment of air flow. The responsible particle is the complex combination of poorly digestive lipids and complex carbohydrates with active chemicals which we call cigarette smoke. More research is needed to perfect, correct and quantify our preliminary picture of the pathogenesis of lung disease by particles, but a useful start has been made.

Animals↗
PubMed2002

Diagnostic approach to the patient with diffuse lung disease.

Detecting diffuse lung infiltrates on chest radiography is a common clinical problem. Many diverse pathological processes can cause diffuse lung disease. The presentation of these diseases can vary from acute to chronic and includes a side array of radiological patterns that are optimally evaluated on high-resolution computed tomography of the chest. In diagnosing diffuse lung disease, it is helpful to focus on a few pivotal parameters to narrow the broad differential diagnosis. We describe the diagnostic approach to a patient with diffuse lung disease usingthe following key parameters: tempo of the pathological process, characteristics of the radiological pattern, and clinical context.

Cryptogenic Organizing Pneumonia↗
PubMed1991

Interstitial lung disease.

The interstitial lung diseases are comprised of a group of pulmonary disorders characterized clinically by diffuse infiltrates on the chest radiograph and histologically by distortion of the gas exchanging portion of the lung. The physiologic correlates are restriction of lung volumes and impaired oxygenation. The term "interstitial" when applied to these diseases is actually a misnomer because it implies that the inflammatory process is limited specifically to the area between the alveolar epithelial and capillary endothelial basement membranes. The diseases currently grouped as "interstitial" also frequently involve the alveolar epithelium, alveolar space, pulmonary microvasculature, and less commonly, the respiratory bronchioles, larger airways, and even the pleura. The enormous differential diagnosis of interstitial lung disease can be made manageable by understanding that pneumoconiosis, drug-induced disease, and hypersensitivity pneumonitis account for over 80% of the responsible entities and can usually be identified from the patient's history. The nine remaining diseases/disease categories include: sarcoidosis, idiopathic pulmonary fibrosis, bronchiolitis obliterans-organizing pneumonia, histiocytosis X, chronic eosinophilic pneumonia, collagen vascular disease-associated interstitial lung disease, granulomatous vasculitis (Wegener's granulomatosis, Churg-Strauss syndrome, lymphomatoid granulomatosis), Goodpasture's syndrome, and pulmonary alveolar proteinosis. The diagnosis of a specific interstitial lung disease can be made via various means including the patient's history, specific serologies, bronchoalveolar lavage, transbronchial biopsy, and biopsy of extrathoracic tissues or open lung biopsy. A directed diagnostic approach can be formulated based on an understanding of these techniques and a thorough knowledge of the clinical presentations and specific diagnostic criteria for each of the major diseases. This monograph will serve as a guide for the clinician to use in evaluating and treating patients with interstitial lung disease. We begin by reviewing the clinical presentation, diagnostic criteria, and management of specific interstitial lung diseases excluding pulmonary infection, neoplasm, and sarcoidosis. Pneumoconiosis and drug-induced syndromes are not discussed in detail, but the agents responsible and pertinent exposures are presented in tabular form in the discussion of the general diagnostic approach.

Biopsy↗
PubMed2005

Exhaled breath measures of inflammation: are they useful in neonatal chronic lung disease?

Neonatal chronic lung disease is a common problem for surviving infants of extreme prematurity. Although the precise pathophysiology is still not known, it is clear that inflammation provides a common link that amplifies the injury to the premature lung. Current invasive measures of pulmonary inflammation include markers in blood and airway effluent, with the cellular composition of tracheal fluid being the "gold standard". In this article available exhaled breath measures, particularly nitric oxide, carbon monoxide, volatile hydrocarbons, and exhaled breath condensate, are reviewed with particular reference to sample collection, analysis, and common pitfalls as they apply to the ventilated premature newborn at risk of chronic lung disease. Although they have great potential, all measures require thorough validation before being used clinically.

Biomarkers↗
PubMed2004

Exhaled nitric oxide levels in infants with chronic lung disease.

UNLABELLED: Chronic lung disease (CLD) is an inflammatory disorder; in patients with other inflammatory disorders exhaled nitric oxide (NO) levels are elevated. The aim of this study was to test the hypothesis that prematurely born infants with CLD would have elevated exhaled NO levels compared to those without CLD and healthy term-born infants. Ten infants with CLD (median gestational age 26 weeks; CLD group), ten infants without CLD (median gestational age 32 weeks; non-CLD group) and ten term-born infants (term group) were examined at post-conceptional ages between 36 and 45 weeks. NO levels were measured during spontaneous tidal breathing. A facemask was positioned over the infant's nose and mouth and a sampling catheter was inserted through a small leak-free valve into the facemask. To measure nasal NO, the tip of the sampling catheter was placed in the nasal space and to measure facemask NO, the catheter tip was positioned inside the facemask at the infant's lips. Nasal compared to facemask NO levels were higher in all three groups (CLD; non-CLD; term: P=0.017, P=0.012 and P=0.017, respectively). The CLD group had higher peak nasal and facemask NO levels than the non-CLD ( P=0.011 and P=0.034 respectively) and the term ( P=0.005 and P=0.01 respectively) infants. Regression analysis demonstrated that facemask NO levels were significantly related to CLD, independent of gestational, post-natal and post-conceptional age ( P=0.006). CONCLUSION: our results suggest that exhaled nitric oxide levels are elevated in chronic lung disease infants. Facemask measurement of nitric oxide levels might be a potentially useful method to monitor infants with chronic lung disease.

Case-Control Studies↗
PubMed2002

Winter viruses: influenza- and respiratory syncytial virus-related morbidity in chronic lung disease.

BACKGROUND: Chronic lung disease predisposes to serious consequences of respiratory viruses. While increasing influenza immunization rates in older adults signals an awareness of the impact of influenza, children with asthma are infrequently immunized. While respiratory syncytial virus (RSV) is recognized as an important target of vaccine development for infants, its impact on adults is underappreciated. METHODS: We performed a retrospective cohort study to estimate rates of hospitalizations, deaths, outpatient visits, and antibiotic courses due to influenza and RSV in persons with chronic lung disease in the Tennessee Medicaid program from 1995 to 1999. Differences between study event rates when influenza was cocirculating with RSV and event rates when RSV was circulating alone were used to calculate influenza-attributable morbidity. Differences in rates when RSV was circulating alone and during summer months were calculated to assess the effect of RSV. RESULTS: Influenza- and RSV-associated hospitalizations were highest at the extremes of age. There were an estimated 8 and 23 hospitalizations per 1000 children younger than 5 years annually due to influenza and RSV, respectively. There were 23 and 18 hospitalizations, as well as 2 and 5 deaths per 1000 persons 65 years or older annually due to influenza and RSV, respectively. Both viruses were associated with an excess of outpatient visits in children, and antibiotic prescriptions in all age groups. CONCLUSION: Among persons with chronic lung disease, influenza virus and RSV accounted for 15% to 33% of acute respiratory hospitalizations in children, 7% to 9% of such hospitalizations in adults, and 9% of deaths in those 65 years or older.

Adolescent↗
PubMed1990

[Differentiation of infiltrates between lung cancer and noncancerous lung disease by 123I-IMP lung imaging].

Lung imaging with N-isopropyl-p-123I-iodoamphetamine (123I-IMP) was performed to estimate the pulmonary lesion imaging findings in 3 patients with bronchogenic carcinoma (2: bronchioloalveolar carcinoma and 1: adenocarcinoma) and 18 with noncancerous lung diseases (10: bacterial pneumonia, 1: viral pneumonia, 1: aspiration pneumonia, 1: radiation pneumonitis, 4: pulmonary tuberculosis and 1: obstructive pneumonitis due to an endobronchial lipoma) at 30 min and 4 hr after i.v. injection of 111 MBq of 123I-IMP. These patients all exhibited infiltrates only in the chest radiograms. Decreased uptake of 123I-IMP was observed in the cancerous infiltrating lesions in 3 patients with bronchogenic carcinoma at 30 min and 4 hr, while the uptake of 123I-IMP was normal or increased at 30 min and intense at 4 hr in all 18 noncancerous infiltrating lesions. Therefore 123I-IMP lung imaging can be used to differentiate bronchogenic carcinoma from noncancerous lung disease in patients who exhibit infiltrates only in the chest radiograms.

Adult↗