1,721,380 research outputs found
Transbronchial lung cryobiopsy for the diagnosis of interstitial lung diseases
No full textPurpose of reviewTransbronchial lung cryobiopsy has shown promise in several studies in providing meaningful histological information in the multidisciplinary team diagnosis of fibrotic interstitial lung diseases. The purpose of this review is to describe recent literature providing support for the formal integration of cryobiopsy into the algorithm for interstitial lung disease diagnosis.Recent findingsHistopathological concordance between cryobiopsy and surgical biopsy and diagnostic agreement at multidisciplinary discussion have been reported good; furthermore, cryobiopsy may provide an increased diagnostic confidence to a level likely to influence management. Finally, although cryobiopsy is more likely to provide a probable usual interstitial pneumonia (UIP) pattern than a definite UIP pattern, given the limited sampling of sub-pleural lung parenchyma in most cases, finding of a probable UIP pattern at cryobiopsy samples is strongly predictive of a definite UIP pattern in the corresponding surgical biopsy and when a UIP pattern is found on cryobiopsy sample, this is associated with higher mortality compared with other histological patterns.SummaryCryobiopsy is becoming a valid alternative to surgical lung biopsy for making histopathological diagnosis in patients with interstitial lung diseases of undetermined type in experienced centres, with standardized protocols, in order to have the best risks/diagnostic yields ratio
Recent advances in the management of acute bronchiolitis
No full textAcute bronchiolitis is characterized by acute wheezing in infants or children and is associated with signs or symptoms of respiratory infection; it is rarely symptomatic in adults and the most common etiologic agent is respiratory syncytial virus (RSV). Usually it does not require investigation, treatment is merely supportive and a conservative approach seems adequate in the majority of children, especially for the youngest ones (<3 months); however, clinical scoring systems have been proposed and admission in hospital should be arranged in case of severe disease or a very young age or important comorbidities. Apnea is a very important aspect of the management of young infants with bronchiolitis. This review focuses on the clinical, radiographic, and pathologic characteristics, as well as the recent advances in management of acute bronchiolitis
Bronchiolitis and bronchiolar disorders
No full textBronchioles are noncartilaginous small airways with internal diameter of 2 mm or less, located from approximately the eighth generation of purely air conducting airways (membranous bronchioles) down to the terminal bronchioles (the smallest airways without alveoli) and respiratory bronchioles (which communicate directly with alveolar ducts and are in the range of 0.5 mm or less in diameter). Bronchiolar injury, inflammation, and fibrosis may occur in myriad disorders including connective tissue diseases, inflammatory bowel diseases, lung transplant allograft rejection, graft versus host disease in allogeneic stem cell recipients, neuroendocrine cell hyperplasia, infections, drug toxicity (e.g., penicillamine, busulfan), inhalation injury (e.g., cigarette smoke, nylon flock, mineral dusts, hard metals, Sauropus androgynous); idiopathic, common variable immunodeficiency disorder, and a host of other disorders or insults. The spectrum of bronchiolar disorders is wide, ranging from asymptomatic to fatal obliterative bronchiolitis. In this review, we discuss the salient clinical, radiographic, and histological features of these diverse bronchiolar disorders, and discuss a management approach
Methodological issues are important in cannabinoids determination in bronchoalveolar lavage.
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Differential diagnosis between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) assessed by high-resolution computed tomography (HRCT)
No full textDifferential diagnosis between usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) assessed by high-resolution computed tomography (HRCT). Radiologia Medica, vol. 19, n. 5-6, 2005, pp. 472-487 Bna C, Zompatori M, Poletti V, Spaggiari E, Chetta A, Calabro E, Ormitti F, Berti E, Cancellieri A, Chilosi M. Sezione di Scienze Radiologiche, Dipartimento di Scienze Cliniche, Universita degli studi di Parma, Parma, Italy. PURPOSE: The aim of this study was to assess the accuracy of high-resolution CT in the differential diagnosis between UIP and NSIP, and the correlations with histological and functional findings. MATERIALS AND METHODS: Patients underwent thin-collimation spiral CT (1 mm), with 10-mm interval. Pulmonary function was assessed with a pneumotacograph and body plethysmograph connected with a computer for data analysis. Three pathologists, blinded to the clinical and functional data, provided a histological diagnosis based on established criteria reported in the literature. The study group only included patients with a histological diagnosis of either UIP or NSIP. RESULTS: We achieved a correct diagnosis of NSIP in 86.6% of cases (76.4% sensitivity; 84.6% specificity), whereas UIP was correctly diagnosed in 73.3% of cases (84.6% sensitivity; 76.5% specificity). An 80% agreement was achieved between the HRCT and histological findings in the whole case series (73% sensitivity, 87% specificity, p<0.01). CONCLUSIONS: The most important finding of our study was that a ground glass appearance equal to or greater than 15% is highly suggestive of NSIP. Therefore, our results could be useful to confirm a suggested diagnosis of NSIP
Pulmonary complications in patients with hematological disorders: Pathobiological bases and practical approach
No full textPulmonary complications occur in up to 40 to 60% of patients with hematological disorders during the disease course and considerably influence morbidity and mortality. The main factors making the lung a clinically significant targeted organ in these patients may be summarized as follows. In the lung parenchyma a variety of inflammatory cells whose precursors are in the bone marrow pass through, park in, proliferate, and release microbicidal and cytohistotoxic substances. Constitutive parenchymal lung cells (bronchiolar and alveolar epithelial cells, endothelial cells, "interstitial" cells) may be a distinctive target for toxic substances or may have an important part in the inflammatory/reactive and reparative processes after an injury event. Pathogenic agents are allowed to reach the lung very easily through either or both the airways and the vascular bed and accumulate there in large amounts. Inflammatory/immunologic reactions may be particularly weak or, on the contrary strong, in the lungs either spontaneously or due to toxic action of drugs and radiation or to the immunodeficiency induced by hematological disorders, and finally to the presence of immunomodulatory viruses. The distinctive anatomical structure and function of the lung parenchyma (interactions between air spaces and capillary bed-gas exchange units) may render localized parenchymal damage clinically relevant. Allogeneic reactions may be overexpressed in the lung or the kinetics of the developing of graft versus host disease (GVHD)-related lung injury may be markedly different from the kinetics of GVHD in other organs. Hematological disorders may harbor in lung parenchymal structures at the onset (i.e., lympho-/myeloproliferative disorders primary in the lung) or during the disease course. Genetic predisposition, although probably involved, is not yet well understood. This article reviews the pathobiological bases of lung injury occurring in subjects with hematological disorders and suggests a practical diagnostic approach to these pulmonary complications
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