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Lung infiltrates and fever: Is it pneumonia or not? 肺部浸润和发烧:是不是肺炎?
IF 0.7 Q4 Medicine Pub Date : 2023-04-24 DOI: 10.18332/pne/157587
K. Lyroni, E. Vasarmidi, N. Tzanakis, K. Antoniou
1 A 62-year-old man presented in the emergency department with fever and dry cough. He was a current smoker (20 pack-years), obese (ΒΜΙ: 43 kg/m2), and he started treatment for benign prostate hyperplasia following an episode of macroscopic hematuria about two months ago (unavailable laboratory tests at that time). No other past medical history was reported. Physical examination on admission revealed crackles in lung lower parts. PCR test for SARS-CoV-2 was negative. Blood tests showed increased C-reactive protein, anemia, and hypoalbuminemia, while arterial blood gas analysis displayed hypoxemia (pO2: 69 mmHg, pCO2: 36 mmHg, pH: 7.47, HCO3: 26 mmol/L). The chest X-ray showed infiltrates in both lungs (Figure 1). He was admitted at the Respiratory Department, and he was treated with antibiotics with a provisional diagnosis of community acquired pneumonia. In less than 24 hours after admission, he experienced hemoptysis. A thorough work-up was initiated measuring urine dipstick, which showed proteinuria and hematuria, and blood autoantibodies titers were ordered. Chest CT scan findings included ground glass opacities (GGOs) and crazy paving; and patchy GGOs associated with smooth septal thickening. Additionally, ‘air bronchogram’; visualization of bronchial structures containing air in the context of consolidation areas, and ‘dark bronchus sign’; and darker bronchus in the context of GGOs, are shown (Figure 2). These findings indicate hemorrhagic alveolitis or edema, thus the provisional diagnosis was alveolar hemorrhage. Vasculitis was put forward as the most probable diagnosis, as those abnormalities, along with the bilateral, para-hilar distribution (Figure 2), are common in diffuse alveolar hemorrhage associated with vasculitis. Therefore, the patient was to be subjected to plasma exchange. At that time he was rapidly deteriorating, experiencing massive hemoptysis and severe respiratory failure, and was transferred to the intensive care unit. The patient was intubated but did not manage to be stabilized and died a few hours later. The next day, serology revealed high titer of MPO/p-ANCA antibodies and the final diagnosis was ANCA-associated vasculitis with lung and renal involvement. Herein, we described a patient who presented with symptoms typical for pneumonia, who deteriorated a few hours after admission. The rapid progression and the presence of hemoptysis led to a rethink of the provisional diagnosis. ANCA-associated vasculitis (AAV) represents systemic, small-vessel vasculitis and is characterized by the loss of tolerance to neutrophil antigens and the development of autoantibodies to the neutrophil proteins MPO and PR3. They are considered to be rare with a prevalence of 46–184 per million people1. Lung involvement is well described in ANCA-associated small vessel vasculitis2, and a recent study found that the majority of patients with ANCA-associated small vessel vasculitis, who were admitted with acute respiratory failure, experience
1 . 62岁男性,因发热、干咳就诊于急诊科。他目前吸烟(20包年),肥胖(ΒΜΙ: 43 kg/m2),大约两个月前出现肉眼血尿后开始治疗良性前列腺增生(当时没有实验室检查)。无其他既往病史报告。入院体格检查发现肺下部有裂纹。SARS-CoV-2 PCR检测阴性。血液检查显示c反应蛋白升高、贫血和低白蛋白血症,而动脉血气分析显示低氧血症(pO2: 69 mmHg, pCO2: 36 mmHg, pH: 7.47, HCO3: 26 mmol/L)。胸部x线显示双肺浸润(图1)。患者住进呼吸科,接受抗生素治疗,初步诊断为社区获得性肺炎。入院后不到24小时出现咯血。开始进行彻底的检查,测量尿试纸,显示蛋白尿和血尿,并责令血液自身抗体滴度。胸部CT表现为磨玻璃影(GGOs)和疯狂铺路;斑块状ggo伴有平滑的间隔增厚。此外,“空气支气管图”;在实变区显示含有空气的支气管结构和“支气管暗征”;(图2)。这些结果提示出血性肺泡炎或水肿,因此暂时诊断为肺泡出血。血管炎被认为是最可能的诊断,因为这些异常以及双侧门旁分布(图2)在血管炎相关的弥漫性肺泡出血中很常见。因此,患者将接受血浆置换。当时,他的病情迅速恶化,出现大量咯血和严重呼吸衰竭,并被转移到重症监护室。患者接受了插管治疗,但未能稳定下来,几小时后死亡。第二天,血清学结果显示MPO/p-ANCA抗体高滴度,最终诊断为anca相关血管炎伴肺和肾受累。在此,我们描述了一位表现出典型肺炎症状的患者,入院后几小时病情恶化。快速进展和咯血的存在导致了对临时诊断的重新思考。anca相关性血管炎(AAV)是一种全身性、小血管性血管炎,其特征是对中性粒细胞抗原的耐受性丧失,以及对中性粒细胞蛋白MPO和PR3产生自身抗体。它们被认为是罕见的,发病率为每百万人中46-184人。在anca相关的小血管炎中,肺受累得到了很好的描述2,最近的一项研究发现,大多数因急性呼吸衰竭入院的anca相关的小血管炎患者都经历了弥漫性肺泡出血3。然而,对于没有任何已知病史、表现为肺部浸润和发烧的病人,医生往往很难发现小血管炎。在我们的病例中,考虑到病情的迅速恶化和需要插管,在不到48小时内快速诊断是至关重要的。最后,应该强调的是,在出现肺部浸润和肾功能障碍的患者中,应怀疑系统性血管炎背景下的弥漫性肺泡出血。
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引用次数: 0
Surgery for pulmonary giant bullae 肺大泡的外科治疗
IF 0.7 Q4 Medicine Pub Date : 2023-03-29 DOI: 10.18332/pne/159280
R. Costa, Anita Paiva, J. Maciel, P. Fernandes, A. Magalhães
Elective bullectomy is rarely performed in chronic obstructive pulmonary disease patients. Selecting patients who will benefit the most from surgery is a challenging process. We report a case of a patient who underwent elective bullectomy to reduce symptoms and the severity of the exacerbations. One year after surgery he maintains improvement in quality of life despite the underlying emphysema. It is hard to identify only one test to predict which patients will benefit from the surgical treatment, but relief of symptoms in chronic obstructive pulmonary disease patients should be a priority over pulmonary function.
选择性大肿瘤切除术很少用于慢性阻塞性肺疾病患者。选择从手术中获益最多的患者是一个具有挑战性的过程。我们报告一例患者谁接受选择性大泡切除术,以减轻症状和恶化的严重程度。手术后一年,尽管有潜在的肺气肿,他的生活质量仍在改善。很难仅通过一种测试来预测哪些患者将从手术治疗中受益,但慢性阻塞性肺疾病患者的症状缓解应优先于肺功能。
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引用次数: 0
Pregnancy in cystic fibrosis in the era of CFTR modulators: A case series CFTR调节剂时代囊性纤维化妊娠:一个病例系列
IF 0.7 Q4 Medicine Pub Date : 2023-03-21 DOI: 10.18332/pne/157586
M. Sionidou
Table 2, her respiratory
表2,她的呼吸
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引用次数: 1
Massive hemoptysis in a patient with pulmonary tuberculosis complicated by cavitation with an air crescent sign 肺结核患者大咯血并空化伴气月牙征1例
IF 0.7 Q4 Medicine Pub Date : 2023-03-21 DOI: 10.18332/pne/157585
M. Tavares, Filipa Fernandes, É. Almeida
the air crescent sign is a characteristic imaging finding of aspergilloma, it can be found in other entities including tuberculosis 2 , neoplasms (particularly bronchial carcinoma), Rasmussen’s aneurysm, and intracavitary clots. Other, rarer causes include foreign bodies, thick pus, dehydrated caseous material, teratoma, and hydatid disease 3,4 .
空气新月形征象是曲菌瘤的特征性影像学表现,也可出现在肺结核、肿瘤(尤其是支气管癌)、拉斯穆森动脉瘤和腔内血栓等其他疾病中。其他较罕见的病因包括异物、浓脓、脱水干酪样物质、畸胎瘤和包虫病3,4。
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引用次数: 0
Knowledge of fractional exhaled nitric oxide use among doctors working in a local respiratory department 在当地呼吸科工作的医生中,分数呼出一氧化氮使用的知识
IF 0.7 Q4 Medicine Pub Date : 2023-02-15 DOI: 10.18332/pne/157588
Etienne Ceci Bonello, Rebecca Bianco, C. Gouder
cut-off of <12 months and ≥12 months working in our respiratory department was set to check whether there is a statistical significance in the knowledge of FeNO testing amongst these two categories. The participants working in the department for <12 months are junior trainees currently rotating in the ABSTRACT INTRODUCTION The aim of this survey is to assess the knowledge regarding fractional exhaled nitric oxide (FeNO) testing among our junior and senior physicians currently working within the respiratory department. METHODS All medical doctors above foundation level working in the respiratory department for at least 3 months at Mater Dei Hospital were asked to complete a questionnaire with a total of 19 true or false questions. Questions were based on current international guidelines and recommendations. RESULTS Our cohort included a total of 25 doctors. The mean age of experience working as a physician was 8 years; 84% of doctors (n=21) were aware that FeNO testing is available at our hospital. Questions assessing clinical indications and interpretation of FeNO in asthma and different respiratory conditions showed overall significantly better results between junior and senior trainees (p=0.013), though still lacking in certain aspects especially in conditions unrelated to asthma. CONCLUSIONS Our results show that doctors working in our department are overall knowledgeable about the use of FeNO in relation to the diagnosis and management of asthma. However, its use and interpretation in relation to other respiratory conditions and co-morbidities is lacking. This emphasizes the need to educate local respiratory trainees further on FeNO testing.
设置<12个月和≥12个月在我呼吸科工作的截止时间,检查两类患者对FeNO检测知识的了解是否有统计学意义。本调查的目的是评估目前在呼吸科工作的初级和高级医生对分次呼气一氧化氮(FeNO)测试的知识。方法对所有在马特戴伊医院呼吸科工作3个月以上的基层以上医师进行问卷调查,共19道题对或错。问题是根据目前的国际准则和建议提出的。结果:我们的队列共包括25名医生。从事医师工作的平均年龄为8岁;84%的医生(n=21)知道我们医院可以进行FeNO检测。评估哮喘和不同呼吸条件下FeNO的临床适应症和解释的问题显示,初级和高级学员的总体结果明显更好(p=0.013),尽管在某些方面仍然缺乏,特别是在与哮喘无关的条件下。结论:本研究结果表明,我科医生对芬诺在哮喘诊断和治疗中的应用有较全面的了解。然而,它在其他呼吸系统疾病和合并症中的使用和解释是缺乏的。这强调有必要进一步教育本地呼吸学受训人员进行FeNO测试。
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引用次数: 0
Ten years of the website for patients with asthma (www.myasthma.gr) by the Asthma Working Group ofthe Hellenic Thoracic Society 希腊胸科学会哮喘工作组为哮喘患者建立的网站(www.myasthma.gr)已有十年
IF 0.7 Q4 Medicine Pub Date : 2023-01-30 DOI: 10.18332/pne/157584
E. Fouka, K. Samitas, P. Bakakos
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引用次数: 0
Treatment for tuberculosis due to sensitive strains: To shorten or not to shorten? 敏感菌结核的治疗:缩短还是不缩短?
IF 0.7 Q4 Medicine Pub Date : 2023-01-26 DOI: 10.18332/pne/156697
K. Manika, A. Loukeri, M. Sionidou, C. Moschos, A. Papavasileiou
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引用次数: 0
A case of tracheobronchial amyloidosis presentingwith acute myeloid leukemia 气管支气管淀粉样变合并急性髓系白血病1例
IF 0.7 Q4 Medicine Pub Date : 2023-01-12 DOI: 10.18332/pne/155919
S. Demir, A. Kansu, A. Gemici, İrem Özöver Çelik
Flexible
灵活的
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引用次数: 0
Diabetes mellitus and hypertension as risk factors of acute kidney injury induced by COVID-19: A systematic review and meta-analysis 糖尿病和高血压是COVID-19致急性肾损伤的危险因素:一项系统综述和荟萃分析
IF 0.7 Q4 Medicine Pub Date : 2022-12-19 DOI: 10.18332/pne/154602
Ilham Setiawan, Sirin Salsabila, Buyung Prasetyawan, M. Ilmawan, Atma Gunawan, B. Daryanto, J. Fajar
INTRODUCTION Acute kidney injury (AKI) is one of the severe complications of COVID-19. The two distinct medical conditions sharing similar comorbidities are diabetes and hypertension. However, the correlation between AKI and COVID-19 patients with diabetes and/or hypertension, has not been extensively discussed. This study aims to assess the risk factors of AKI induced by COVID-19, using a meta-analysis approach. METHODS A meta-analysis was carried out by reviewing the latest relevant studies on online databases such as PubMed, Google Scholar and Medline, up to 21 March 2022. The required information related to hypertension and diabetes as the potential risk factors of AKI induced by COVID-19, was extracted. The association was analyzed using pooled odds ratio (OR) and a 95% confidence interval (95% CI). RESULTS We analyzed 29 studies consisting of 10698 AKI patients with COVID-19 and 20917 controls. Our results show that patients with diabetes test)=0.0001, pE (Egger test)=0.8074) and hypertension (OR=1.7921;95% develop AKI when infected with COVID-19. CONCLUSIONS Diabetes and hypertension are prominent risk factors of acute kidney injury induced by COVID-19.
急性肾损伤(AKI)是COVID-19的严重并发症之一。糖尿病和高血压是两种具有相似合并症的截然不同的疾病。然而,AKI与合并糖尿病和/或高血压的COVID-19患者之间的相关性尚未得到广泛讨论。本研究旨在通过荟萃分析方法评估COVID-19诱发AKI的危险因素。方法通过回顾PubMed、Google Scholar和Medline等在线数据库截至2022年3月21日的最新相关研究进行荟萃分析。提取所需的与高血压和糖尿病相关的信息,作为COVID-19诱发AKI的潜在危险因素。使用合并优势比(OR)和95%置信区间(95% CI)分析相关性。结果:我们分析了29项研究,包括10698例AKI合并COVID-19患者和20917例对照。我们的研究结果显示,糖尿病试验(test)=0.0001, pE (Egger检验)=0.8074)和高血压患者(OR=1.7921) 95%的患者在感染COVID-19后发生AKI。结论糖尿病和高血压是新冠肺炎致急性肾损伤的重要危险因素。
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引用次数: 0
A survival analysis of cutaneous metastases in lung cancer: A 25-year experience 肺癌皮肤转移的生存分析:25年的经验
IF 0.7 Q4 Medicine Pub Date : 2022-12-19 DOI: 10.18332/pne/155918
R. Natal, M. Oliveira, Adelino Amaral, Fátima Cabral, R. Gomes, Luís Ferreira
lesion confirmed histologically to be a cutaneous metastasis. Patients with suspicious cutaneous lesions without a skin biopsy, were excluded. Methods A retrospective study was conducted with patients diagnosed with lung cancer and cutaneous metastases, from January ABSTRACT INTRODUCTION Cutaneous metastases from lung cancer are rare and their presence has been considered a sign of an already disseminated and poor-prognosis disease. The main objective of this study is to evaluate the survival of the patients with cutaneous metastases from lung cancer. METHODS A retrospective study was conducted with patients diagnosed with cutaneous metastases from lung cancer, confirmed by skin biopsy, from January 1995 to December 2020, in our local health unit. Descriptive and survival analysis were performed, considering a level of significance of 5%. RESULTS From a total of 1172 cases of lung cancer, eleven patients (0.94%) had a skin tissue confirmation of cutaneous metastasis, predominantly male (63.6%) with median age of 78 years, and past or active smoking history in 63.6%. In 6 patients (54.5%), this finding was diagnosed simultaneously with primary lung cancer, and adenocarcinoma was the main histological type (63.6%). The most frequent presentation was a single nodule in the anterior chest wall, and all skin lesions had histological concordance with lung cancer. The median overall survival was 2 months (range: 0–27) and from the diagnosis of cutaneous metastasis was 1 month (range: 0–18). Survival analysis revealed that the simultaneous diagnosis of cutaneous metastases and lung cancer shortens survival (2.50 vs 13.20 months; p=0.032).
病理证实为皮肤转移。排除有可疑皮肤病变但未做皮肤活检的患者。方法回顾性研究1月以来诊断为肺癌和皮肤转移的患者。摘要:肺癌的皮肤转移是罕见的,它们的存在被认为是已经扩散和预后不良的疾病的标志。本研究的主要目的是评估肺癌皮肤转移患者的生存率。方法回顾性研究1995年1月至2020年12月在我们当地卫生单位进行的经皮肤活检证实的肺癌皮肤转移患者。进行描述性和生存分析,考虑显著性水平为5%。结果1172例肺癌患者中,有11例(0.94%)皮肤组织证实有皮肤转移,男性居多(63.6%),中位年龄78岁,有吸烟史或积极吸烟史的占63.6%。其中6例(54.5%)与原发性肺癌同时诊断,以腺癌为主要组织学类型(63.6%)。最常见的表现是前胸壁的单个结节,所有皮肤病变在组织学上与肺癌一致。中位总生存期为2个月(范围:0-27),从诊断为皮肤转移开始为1个月(范围:0-18)。生存分析显示,同时诊断皮肤转移和肺癌缩短生存期(2.50个月vs 13.20个月;p = 0.032)。
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引用次数: 0
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Pneumon
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