纤维支气管镜在肺不张诊断与治疗中的意义

目的:探讨纤维支气管镜(纤支镜)在肺不张的诊断及治疗中的意义.方法:对经X线、CT诊断为肺不张的67例患者行纤支镜检查和治疗.结果:纤支镜病因诊断符合率为98.5%.其中肺癌38例(56.7%),炎症19例(28.4%),结核9例(13.4%),异物阻塞1例(1.5%).病变部位以右上叶16例最多(23.9%),接着依次为右肺下叶(19.4%),右肺中叶(17.9%).对肺不张患者经纤支镜吸痰、灌洗、局部给药、取出异物等治疗后,患者症状均有不同程度的改善,且炎症、结核、异物所致的肺不张肺叶均有不同程度复张,呼吸功能改善.结论:纤支镜对肺不张的诊断及治疗具有重要意义,且经纤支镜辅助治疗可促进肺复张.     

Abortion,Gas Embolus,and Sudden Death

In Los Angeles County, almost one-third of abortion deaths are due to gas embolus. Whenever a gas or a gas-producing liquid is injected into a pregnant uterus, a fatal gas embolus is possible because the utero-placental bed is an open avenue to the maternal circulation. The usual sequence of events is collapse, rapidly followed by death. By the time the rescue squad is summoned, the patient is either dead or beyond possibility of resuscitation.In the six years 1962-1967 there were 27 gas embolus deaths associated with abortion in the Los Angeles area. All the women were the victims of ignorance or indifference. Wider public knowledge of this lethal danger is the only means by which mortality can be reduced.     

Serum Fibrin/Fibrinogen Degradation Products Associated with Postoperative Pulmonary Embolus and Venous Thrombosis

A total of 76 “high-risk” surgical patients were studied for evidence of venous thromboembolic disease. Episodes of deep vein thrombosis and of pulmonary embolism were related to changes in blood levels of fibrin degradation products (F.D.P.). When diagnosed either by ordinary clinical means or by venography and isotope scanning significantly raised F.D.P. levels were found in all cases. Serum F.D.P. estimations are unlikely to help in detecting deep vein thrombosis, but may prove valuable in diagnosing pulmonary embolism.     

The Hypersomnic Syndrome: (Classification,Clinical Aspects,Pathogenesis, Treatment)

In neurological practice one often encounters various forms of disturbances of the waking state. Sometimes somnolence is one of the manifestations of a pathological process, and in others it is the major and dominant symptom bringing the patient to the doctor. Our experience in the study of hypersomnia (we have observed 120 patients in recent years) demonstrates that physicians have inadequate familiarity with this problem. Sometimes somnolence is regarded not as the result of pathology, but as a manifestation of excessive fatigue. There is inadequate differentiation of the forms of hypersomnic disorders. One of the causes of these errors is the absence of a logical classification. The most thorough classification is that of A. Epshtein, (1) etiological in nature: 1) random sleep disorders; 2) secondary sleep disorders; 3) constitutional neuropathic; 4) reactive; 5) symptomatic; 6) essential disorders; and 7) sleep disorders associated with psychosis. It has become obsolete, and does not cover the clinical forms of hypersomnia. We have deemed it desirable to make a classification based on clinical principles, with due consideration for etiology.     

The Surgical Treatment of Pulmonary Emphysema

Emphysema may be focal or multifocal. In either type an area of disease may enlarge and reduce the function of adjacent lung.Thirty patients who required treatment for emphysema and its complications are described. Fifteen patients with focal emphysema that did not constitute a space-occupying lesion required operation because of recurrent pneumothorax or infection in the affected area. The results were excellent. Ten patients with focal emphysema and progressive “space occupation” complained of moderate but increasing dyspnea. Removal of the enlarging lesion resulted in marked improvement. Five patients with multifocal emphysema and progressive space occupation in one focal area suffered from severe dyspnea and poor general health. The space-occupying lesion was removed by lobectomy. The results, measured by pulmonary function tests and subjective improvement, were rewarding in most cases. No patient with multifocal emphysema but without a space-occupying lesion under-went operation.     

Durations and Delays in Care Seeking,Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai,India

BackgroundTimely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai.MethodsA population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values.ResultsThe mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation.ConclusionAchieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be singularly effective in curbing pathway delays.     

Pathogenesis of Invasive Pulmonary Aspergillosis in Transplant Recipients

Purpose of Review

Transplant patients are at high risk for invasive pulmonary aspergillosis, and the associated mortality is high. The purpose of this study is to review the pathogenesis of invasive pulmonary aspergillosis (IPA) in transplant patients.

Recent Findings

The pathogenesis of aspergillosis is multifactorial and results from a complex interplay between the pathogen and host. It is well recognized that Aspergillus causes IPA in immunocompromised patients. Recent studies have shown that Aspergillus might also cause diseases likely attributed to an unmodulated immune response in certain transplant recipients such as bronchopulmonary aspergillosis or bronchiolitis obliterans syndrome in lung transplant recipients.

Summary

This review focuses on two crucial axes of the damage response framework applicable to aspergillosis: (1) Aspergillus virulence attributes that enable it to survive and proliferate in the host (thermotolerance, stress and hypoxic response, secretion of secondary metabolites) and (2) host response with specific focus on innate immunity and angiogenesis.