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Review article on indwelling pleural catheter 胸腔留置导尿管的综述
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_22_22
Vignesh Ashokan, SivanthiSapna Rajendran, RAjay Narasimhan
Lymphomas, malignancies of the lung, breast, and ovaries, most frequently give rise to malignant pleural effusions (MPE). The prognosis is often bad when an MPE is present. Malignant cells found in the pleural fluid or tissue can be used to confirm the diagnosis of MPE. Palliative care should emphasize on symptom relief, quality-of-life enhancement, and acceptance of an initial intervention to drain an MPE or prevent recurrence and affordability. Our preferred initial treatment for the majority of patients with recurrent MPE is the placement of an IPC (also known as a tunneled pleural catheter), with intermittent outpatient drainage performed by the patient or attender. Patients with expandable lung are candidates for both IPC drainage and pleurodesis, but those with nonexpandable lung are often only eligible for IPC drainage. IPC requires interventional expertise and may not be available in some institutions. IPC can produce spontaneous pleurodesis and gives good symptom alleviation, according to many randomized trials and one meta-analysis. Effective pleurodesis occurs in up to 70% of patients.
淋巴瘤,肺、乳腺和卵巢的恶性肿瘤,最常引起恶性胸腔积液。当MPE存在时,预后通常很差。在胸腔液或组织中发现的恶性细胞可用于确认MPE的诊断。姑息治疗应强调缓解症状,提高生活质量,接受最初的干预措施,以排除MPE或防止复发,并负担得起。对于大多数复发性MPE患者,我们首选的初始治疗是放置IPC(也称为隧道胸膜导管),由患者或护理人员进行间歇性门诊引流。可扩张肺的患者可同时进行IPC引流和胸膜固定术,而非可扩张肺的患者通常只适合IPC引流。IPC需要干预性专业知识,某些机构可能无法提供。根据许多随机试验和一项荟萃分析,IPC可以产生自发性胸膜切除术,并能很好地缓解症状。有效的胸膜切除术发生率高达70%。
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引用次数: 0
A study on common aeroallergens in a coastal city of south india by skin prick test 用皮肤点刺试验研究印度南部沿海城市常见空气过敏原
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_13_22
V. Moleyar, A. Bali
Introduction: Airborne allergens are the major cause of allergic respiratory diseases worldwide, they are present all around, suspended in the air we breathe, spanning different regions, invisible to the naked eye, while causing allergic respiratory flare-ups in susceptible individuals. Although present globally they have a unique distribution which depends on geographic and climatic factors. Hence, a select broad group of allergens cannot be accountable for causing allergic responses worldwide. It is therefore imperative to identify the offending allergens causing flare-ups in patients living in a particular region, to effectively tackle exacerbations. Objectives of Study: (1) To study the clinical profile of patients with rhinobronchial allergies, (2) To determine endemically common aeroallergens for patients with rhino bronchial allergies from Dakshina Kannada District, presenting at A. J. Institute of Medical Sciences, Mangalore, by means of skin prick test (SPT). Materials and Methods: A total of 170 patients with preexisting allergic airway diseases were included in the study over a duration of 12 months. These subjects were screened, history was taken, and then subjected to an SPT after acquiring an informed consent. A customized panel of 55 allergens was used in the test comprising dust/dust mite, animal, fungal, insect, and plant-based allergens. A wheal size of more than 3 mm was considered as a positive reaction and the findings were recorded. Results: This study included 97 male and 73 female patients, with the mean age of the patients being 33.7 years. The most common aeroallergen was found to be, Parthenium hysterophorus, followed by Dermatophagoides farine a dust mite, Typha angustata, Cyperus Rotundus, Mangifera indica, Ischaemum, and Prosopis juliflora. Cockroach, dog epithelia, and Aspergillus fumigatus were found to be most allergenic in each respective group, i.e., insect, animal, and fungal group. Conclusion: Our study showed predominantly pollen-based allergens from mainly invasive wild grasses and small plants to be causing allergic respiratory diseases in susceptible individuals, especially young adults, living in Dakshina Kannada District, Karnataka. Allergic respiratory diseases due to Dust mite D. Farine were found to cause allergic manifestation in mainly urban population included in the study. A. fumigatus, dog epithelia, and cockroach were found to be the most common antigens causing allergic reactions in each respective category.
导读:空气中的过敏原是全世界过敏性呼吸道疾病的主要原因,它们无处不在,悬浮在我们呼吸的空气中,跨越不同的区域,肉眼看不见,同时在易感个体中引起过敏性呼吸道疾病发作。尽管它们在全球范围内都有独特的分布,这取决于地理和气候因素。因此,不能对全世界范围内引起过敏反应的一组选定的过敏原负责。因此,必须确定导致特定地区患者发作的恼人过敏原,以有效应对病情恶化。研究目的:(1)研究鼻支气管过敏患者的临床特征;(2)通过皮肤点刺试验(SPT)确定在印度Mangalore A. J.医学科学研究所就诊的Dakshina Kannada地区犀牛支气管过敏患者的地方性常见空气过敏原。材料与方法:本研究共纳入170例既往存在过敏性气道疾病的患者,研究时间为12个月。对这些受试者进行筛选,记录病史,然后在获得知情同意后进行SPT。测试中使用了55种过敏原的定制面板,包括粉尘/尘螨、动物、真菌、昆虫和植物性过敏原。车轮尺寸大于3mm被认为是阳性反应,并记录结果。结果:本组患者男性97例,女性73例,平均年龄33.7岁。最常见的气致过敏原为子宫Parthenium hysterophorus,其次为尘螨,其次为皮食螨(Dermatophagoides farine a尘螨),其次为麻霉(Typha angustata),圆形香柏(Cyperus Rotundus),芒果(Mangifera indica), Ischaemum和Prosopis juliflora。蟑螂、狗上皮和烟曲霉的致敏性最高,分别为昆虫、动物和真菌组。结论:本研究表明,在卡纳塔克邦Dakshina Kannada地区的易感人群中,花粉致敏原主要来自入侵的野草和小植物,尤其是年轻人,引起了过敏性呼吸道疾病。尘螨引起的变应性呼吸道疾病在研究对象中以城市人群为主。烟曲霉、狗上皮和蟑螂是引起过敏反应的最常见抗原。
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引用次数: 0
Left pulmonary artery sling in an adult 成人左肺动脉悬吊
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_23_22
Vinod Govindasaami, Dhanasekar Thangaswamy
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引用次数: 1
Prevalence of coexistent allergic rhinitis in schoolchildren with bronchial asthma and its association with asthma control 小学生支气管哮喘并发变应性鼻炎的患病率及其与哮喘控制的关系
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_9_22
A. Shanmuganathan, Kumaran Gopalakrishnan, N. Ganga
Introduction: Bronchial asthma (BA) is a common chronic respiratory disease in children with a wide variation in global prevalence due to differences in environmental and genetic factors as well as differences in diagnostic criteria. Allergic rhinitis (AR) is one of the major risk factors associated with childhood asthma, with coexistent AR reported in 60%–70% of children with asthma in India. According to the one airway hypothesis, with evidence from epidemiological and clinical studies, the upper and lower airways share the same pathophysiological changes. This similarity results in inflammatory changes in either airway to have an effect on each other. Very few Indian studies have reported on increasing prevalence of childhood BA. Hence, it is essential to diagnose and treat concomitant AR in patients with BA to achieve good asthma control. Aim: To study the prevalence of coexistent AR in schoolchildren with BA and its association with asthma control. Materials and Methods: This prospective cross-sectional study was done during 3 months period from June to August 2018 in five randomly selected schools from a semi-urban area. A total of 1417 students of both genders belonging to 8–14 years of age were included. Demographic details were noted and spirometry was done. BA was diagnosed and control of asthma was assessed based on the Global Initiative for Asthma guidelines. Children diagnosed with BA were administered AR and its Impact on Asthma (ARIA) questionnaire to determine the prevalence and severity of AR. Data were analyzed using SPSS Version-20 and the severity of ARIA was correlated with asthma control using Pearson's correlation test. Results: The prevalence of BA among 1417 schoolchildren was 5.86% and majority of the asthmatic children were not well controlled (95%). 97.5% of children with BA had coexistent AR. There was a significant (P < 0.001) correlation between the severity of AR with asthma control. Conclusions: Our study showed a high prevalence of coexistent AR in children with BA. Children with greater severity of AR were found to have poor asthma control.
简介:支气管哮喘(BA)是一种常见的儿童慢性呼吸道疾病,由于环境和遗传因素的差异以及诊断标准的差异,全球患病率差异很大。过敏性鼻炎(变应性鼻炎)是儿童哮喘相关的主要危险因素之一,据报道,印度60%-70%的哮喘儿童同时存在变应性鼻炎。根据单气道假说,根据流行病学和临床研究的证据,上、下气道具有相同的病理生理变化。这种相似性导致任一气道的炎症变化相互影响。很少有印度研究报告儿童BA的患病率增加。因此,对BA患者合并AR进行诊断和治疗,以达到良好的哮喘控制是至关重要的。目的:了解小学生BA并发AR的患病率及其与哮喘控制的关系。材料和方法:本前瞻性横断面研究于2018年6月至8月的3个月期间在半城市地区随机选择的5所学校进行。共纳入8-14岁男女学生1417人。记录人口统计学细节并进行肺活量测定。根据全球哮喘倡议指南对BA进行诊断和哮喘控制进行评估。对诊断为BA的儿童进行AR及其对哮喘的影响(ARIA)问卷调查,以确定AR的患病率和严重程度。使用SPSS Version-20对数据进行分析,使用Pearson相关检验将ARIA的严重程度与哮喘控制进行相关性分析。结果:1417名学龄儿童哮喘患病率为5.86%,大部分哮喘儿童控制不佳(95%)。97.5%的BA患儿合并AR, AR严重程度与哮喘控制有显著相关性(P < 0.001)。结论:我们的研究显示BA患儿并发AR的发生率很高。AR严重程度较高的儿童哮喘控制较差。
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引用次数: 0
Assessment of pleural effusion quantity, assistance for quality, and management by clinical examination, sonography, and laboratory parameters in a super specialty hospital 超级专科医院临床检查、超声检查及实验室参数对胸腔积液数量、质量协助及处理的评价
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_20_22
Sudhakar Kattoju, R. Narasimhan, A. Narasimhan, A. Kattoju
Introduction: This study is the easiest and fastest; patient and observer comfort level increase with the convenience of evaluation of pleural effusion (PE) qualification, and assessment of quality and guidance for management is taken into consideration. Four plus one formula are taken for the existing literature, and the patient imaging evaluation and all the four plus one measurement are taken and calculated and kept for comparison. Later, the patient has aspirated patient PE catheter drainage done and calculated with the above four plus one measurement, and statistical analysis correlation is done. Aim: The aim of this study was to find the quantity, quality, and nature of PE in planning the management. Objectives: Primary objective - study to assess the nature of PE by clinical, sonography laboratory results. Secondary objective - To decide the mode of management and follow-up by diagnostic, therapeutic, closed pleural biopsy, pleuroscopy, video-assisted thoracoscopic surgery, and surgical decortication. Need of the Study: Because of the shape of pleural space and its anatomy, the PE volume variability in the estimation of actual quantity is complex subjectively even for an experienced clinician estimation or by computed tomography scan and sonography. Hence, instead of many available complicated clinical estimation and imaging formulae, the sonography formulae showed a wide spectrum of values in measuring the actual PE amount. This observational study was performed utilizing and comparing the available references and formulae. Sonography is modified to give the best comfort to patients and the most accessible and fastest sonographic t estimation and comparison with other groups of studies and to arrive at a consensus value for the purpose of our institutional uniformity. Study Site: Department of Radiology and Imaging Sciences and Department of Pulmonary Medicine, Apollo Hospitals, Chennai-06. Study Design: This was an observational, cross-sectional study. Study Duration: The duration of the study was March 2020–September 2021. Inclusion Criteria: patients with clinical suspicion of PE are taken up for study. Exclusion Criteria: patients with noncooperation and restless severe hydropneumothorax. The total number of patients is 181, both male and female, Equipment: High-end EPIQ-7G, PHILIPS ULTRASOUND machine with advanced feature and with broadband convex C5-1 transducer used, and all parameters are recorded systematically. If the fluid is beyond the image frame, we utilized a panoramic software view for any length of fluid, heightens the advantage in the study. Results: Balick et al. and our single measurement study were correlated, and we found in this study stresses on any axis, longest single measurement and position of the patient made easier for the estimation utilizing, highest hand equipment, having panoramic view software. Conclusion: Single-free longest axis measurement in this study is useful with the standard deviation of the sin
本研究是最简单、最快的;随着胸膜积液质量评价的便利性,患者和观察者的舒适度提高,并考虑质量评价和管理指导。现有文献取四加一公式,取患者影像学评价及所有四加一测量值计算保存比较。随后,对患者进行了抽吸式患者PE导管引流,并对上述四加一测量进行了计算,并进行了统计分析相关性。目的:本研究的目的是发现体育运动在计划管理中的数量、质量和性质。目的:主要目的-通过临床、超声和实验室结果来评估肺动脉栓塞的性质。次要目的:通过诊断、治疗、闭式胸膜活检、胸膜镜检查、电视胸腔镜手术和手术脱屑来确定治疗和随访模式。研究的需要:由于胸膜间隙的形状及其解剖结构,即使对于经验丰富的临床医生或计算机断层扫描和超声检查,估计实际数量的PE体积变异性也很复杂。因此,代替现有的许多复杂的临床估计和成像公式,超声公式在测量实际PE量时显示出广泛的值谱。本观察性研究是利用和比较现有文献和公式进行的。超声检查经过修改,为患者提供最好的舒适度,并与其他研究组进行最方便和最快的超声评估和比较,并为我们的机构统一性的目的达成共识值。研究地点:钦奈阿波罗医院放射与影像科学部和肺内科。研究设计:这是一项观察性横断面研究。研究时间:研究时间为2020年3月至2021年9月。纳入标准:临床怀疑为PE的患者纳入研究。排除标准:伴有不配合和躁动的严重气胸患者。患者总数181人,男女均有,设备:高端EPIQ-7G,功能先进的PHILIPS超声机,采用宽带凸面C5-1换能器,系统记录各项参数。如果流体超出图像框架,我们使用全景软件查看任何长度的流体,增加了研究的优势。结果:Balick等人与我们的单次测量研究是相关的,我们在这项研究中发现,在任何轴上的应力,最长的单次测量和患者的位置使用,最高的手设备,有全景视图软件更容易估计。结论:本研究中单自由最长轴测量与其他研究中单固定轴测量的标准偏差是有用的。
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引用次数: 0
Kartagener's syndrome presenting with secondary spontaneous pneumothorax: A rare case report 以继发性自发性气胸为表现的Kartagener综合征:一例罕见病例报告
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_31_22
N. Prabhakar, R. Anand, Preetha Ramesh
Kartagener's syndrome (KS) is a part of a larger family of diseases classified as primary ciliary dyskinesia (PCD). The triad of KS consists of bronchiectasis, chronic sinusitis, and situs inversus, which is likely underdiagnosed, as a limited amount of centers have resources to provide an accurate diagnosis. Symptoms are more prevalent in children that too in the first decade of life. Pneumothorax might be one of the rare complications of the PCD. A review of literature revealed that few patients are diagnosed with PCD complicated with secondary spontaneous pneumothorax. In this case report, we describe a PCD patient with spontaneous pneumothorax and how we treated him in our institution.
Kartagener综合征(KS)是一个更大的疾病家族的一部分,被归类为原发性纤毛运动障碍(PCD)。KS的三联征包括支气管扩张、慢性鼻窦炎和倒位,由于有限的中心有资源提供准确的诊断,这可能未被充分诊断。症状在儿童中更为普遍,在生命的头十年也是如此。气胸可能是PCD的罕见并发症之一。回顾文献发现,很少有患者被诊断为PCD并发继发性自发性气胸。在这个病例报告中,我们描述了一个PCD患者自发性气胸和我们如何治疗他在我们的机构。
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引用次数: 1
Cavitating lung cancer with underlying lung fibrosis treated as case of post-COVID-19 lung fibrosis with invasive mucormycosis 新冠肺炎后肺纤维化合并侵袭性毛霉病治疗空化肺癌伴肺纤维化
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_26_22
S. Patil, D. Patil, G. Gondhali
The pulmonary cavity is caused by infective, inflammatory, and malignant lung pathologies. In the currently ongoing COVID-19 pandemic, the most common cause for pulmonary cavities would be tuberculosis and fungal infections in the presence of exposure of high-dose steroids given during the course of hospitalization for COVID-19 pneumonia. In the present case report, an 86-year-old male presented with cavitating lung mass with hemoptysis who had received high-dose steroids for acute hypoxic respiratory failure due to COVID-19 pneumonia. He was treated with high-dose steroids during and after hospitalization for post-COVID-19 lung fibrosis with oxygen dependency and continuous oxygen supplementation. The right upper lobe mass was underevaluated, and developed cavitating consolidation in 3 months. He was evaluated and treated as a case of right upper lobe invasive aspergillosis and mucormycosis infection documented on sputum culture. He was treated with amphotericin B and higher antibiotics and discharged with oral voriconazole. Intermittent hemoptysis was a clinical clue to workup further with bronchoscopy for protocolized diagnosis of cavitating lung mass. Bronchoscopy documented moderately to poorly differentiated squamous cell carcinoma as a cause for cavitating consolidation. A high index of suspicion is must while dealing with pulmonary cavities. The currently ongoing COVID-19 pandemic may result in an underestimation of malignancy as a cause for cavitating lung pathology due to the rampant use of steroids during treatment of these cases and more documentation of fungal lung infections in post-COVID-19 care settings. We recommend bronchoscopy in cavitating lung disease for exact 'etiopathology documentation' of tropical and or malignant lung disease.
肺部空洞是由肺部感染、炎症和恶性病变引起的。在目前正在进行的COVID-19大流行中,肺空洞的最常见原因是在COVID-19肺炎住院期间暴露于高剂量类固醇的结核病和真菌感染。在本病例报告中,一名86岁男性因COVID-19肺炎引起的急性缺氧呼吸衰竭接受大剂量类固醇治疗,出现肺空泡性肿块并咯血。患者因covid -19后肺纤维化住院期间和住院后接受大剂量类固醇治疗,伴氧依赖和持续补氧。右上肺叶肿块被低估,3个月后出现空化实变。他被诊断为右上肺叶侵袭性曲霉病和毛霉病感染,经痰培养证实。给予两性霉素B及高级抗生素治疗,出院时口服伏立康唑。间断性咯血是进一步支气管镜检查诊断肺空化肿块的临床线索。支气管镜检查证实中度至低分化鳞状细胞癌是空化实变的原因。在处理肺腔时必须高度怀疑。目前正在进行的COVID-19大流行可能会导致低估恶性肿瘤作为空化肺部病理的原因,因为在治疗这些病例期间大量使用类固醇,并且在COVID-19后护理机构中有更多真菌肺部感染的记录。我们推荐支气管镜检查空化肺病,以获得热带和/或恶性肺病的确切“病因病理学文件”。
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引用次数: 0
A rare case of adult pulmonary Langerhans' cell histiocytosis 成人肺朗格汉斯细胞组织细胞增多症1例
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_29_22
K. Prakash, A. Narasimhan, Sivanthi Sapna
The most common organ affected in smokers is lungs. The usual presentations are obstructive airway disease, interstitial lung disease, and malignancy. Rarely, some individuals with specific genomic characteristics may develop pulmonary Langerhans' cell histiocytosis, which commonly presents as bilateral upper lobe predominant cystic lung disease. The main array of treatment is cessation of smoking.
吸烟者最常受影响的器官是肺。通常表现为气道梗阻性疾病、肺间质性疾病和恶性肿瘤。罕见的是,一些具有特定基因组特征的个体可能会出现肺朗格汉斯细胞组织细胞增多症,这通常表现为双侧上叶显性囊性肺疾病。主要的治疗方法是戒烟。
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引用次数: 0
Cavitating lung lesion 肺空化病变
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_16_22
M. Sharma, S. Mohammed
{"title":"Cavitating lung lesion","authors":"M. Sharma, S. Mohammed","doi":"10.4103/japt.japt_16_22","DOIUrl":"https://doi.org/10.4103/japt.japt_16_22","url":null,"abstract":"","PeriodicalId":348236,"journal":{"name":"Journal of Association of Pulmonologist of Tamil Nadu","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134450411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Recurrent pleural effusions: A vexing problem 反复胸腔积液:一个令人烦恼的问题
Pub Date : 2022-05-01 DOI: 10.4103/japt.japt_36_22
R. Narasimhan, N. Narasimhan, A. Narasimhan
{"title":"Recurrent pleural effusions: A vexing problem","authors":"R. Narasimhan, N. Narasimhan, A. Narasimhan","doi":"10.4103/japt.japt_36_22","DOIUrl":"https://doi.org/10.4103/japt.japt_36_22","url":null,"abstract":"","PeriodicalId":348236,"journal":{"name":"Journal of Association of Pulmonologist of Tamil Nadu","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115823603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Association of Pulmonologist of Tamil Nadu
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