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- Postoperative Pulmonary Complications after Surgery in Patients with Interstitial Lung Disease. [JOURNAL ARTICLE]
- Respiration 2014 Feb 21.
Background: Patients with interstitial lung disease (ILD) have a high incidence of postoperative pulmonary complications (PPCs) after lung resection, but there is little data about these complications in ILD after other types of surgery. Objectives: The aim of this study was to examine the characteristics and predictors of PPCs after major surgery in patients with ILD. Methods: We included 336 patients with ILD who underwent major surgery between January 2005 and December 2010 at two tertiary hospitals in Korea. All types of surgery that had been performed under general anesthesia were included. Demographic characteristics, preoperative lung function, and operative conditions including anesthesia time and estimated blood loss were compared between patients with and without PPCs. Results: PPCs occurred in 37 patients (11%). Thirteen patients developed pneumonia, the most common PPC, and 11 had acute exacerbation of ILD. In multivariable analysis, BMI <23 (OR = 2.488, 95% CI: 1.084-5.710, p = 0.031), emergency surgery (OR = 23.992, 95% CI: 2.629-218.949, p = 0.005), lung surgery (OR = 5.090, 95% CI: 1.391-18.628, p = 0.014), and longer anesthesia time (OR = 1.595, 95% CI: 1.143-2.227, p = 0.006) were statistically significant risk factors. Conclusions: The incidence of PPCs detected over all surgeries was not as high as that reported for lung surgery alone in ILD patients. Lower BMI, emergency surgery, lung surgery, and longer anesthesia time were risk factors. Operative conditions as well as lung function should be considered in preoperative planning and management for ILD patients undergoing major surgery. © 2014 S. Karger AG, Basel.
- Efficacy of Combined Therapy with Cyclosporin and Low-Dose Prednisolone in Interstitial Pneumonia Associated with Connective Tissue Disease. [JOURNAL ARTICLE]
- Respiration 2014 Feb 22.
Background: The optimal treatment method for interstitial pneumonia (IP) with connective tissue disease (CTD) remains controversial. In addition, a clinically meaningful end point to judge drug efficacy has not been fully investigated. Objectives: The aim of this study was to evaluate, from various aspects, the therapeutic benefit and tolerability of combined therapy with cyclosporin A (CsA) and low-dose prednisolone (PSL) for chronic fibrosing CTD-IP patients. Methods: A total of 26 CTD-IP patients diagnosed by surgical lung biopsy and subsequently treated with the above combination therapy were retrospectively reviewed. The therapeutic regimen comprised methylprednisolone induction therapy for 2-4 weeks, followed by a combined therapy of CsA with low-dose PSL for 1 year. Evaluation of the therapeutic benefit was based on not only pulmonary function but also exercise capacity, health-related quality of life and dyspnea. Results: After 1 year of therapy, clinically significant improvements in forced vital capacity (≥10%), carbon monoxide diffusing capacity of the lung (≥15%), 6-min walk distance (≥28 m), and St. George's Respiratory Questionnaire (≤-7) were observed in 61.5, 69.2, 61.5 and 69.2% of the patients, respectively. All measurements showed statistically significant improvements compared with baseline values. The 1-year treatment did not need to be discontinued in any patients due to unacceptable toxicity, and no deaths occurred. Conclusions: Combined therapy with CsA and low-dose PSL for CTD-IP patients was well-tolerated and patients displayed a noteworthy response. © 2014 S. Karger AG, Basel.
- Simultaneous Assessment of Airway Instability and Respiratory Dynamics with Low-Dose 4D-CT in Chronic Obstructive Pulmonary Disease: A Technical Note. [JOURNAL ARTICLE]
- Respiration 2014 Feb 14.
Background: Advanced-stage chronic obstructive pulmonary disease (COPD) is associated with severely altered respiratory dynamics. Dynamic airway instability is usually diagnosed by invasive bronchoscopy. Cine-computed tomography (CT) may be used alternatively, but is limited to predefined anatomical positions. Also, a paradoxical diaphragmatic motion has been described in patients with emphysema. Objectives: As the airways and chest wall show inherently high contrast to airway lumen and lung tissue, low-dose CT acquisitions potentially suffice for depicting tracheobronchial and chest wall motion. Therefore, we propose low-dose dynamic respiratory-gated multidetector CT (4D-CT) of the whole chest as a new method to assess respiratory dynamics. Methods: 4D-CT was performed in 3 patients (52, 62 and 76 years old) with suspected tracheal instability due to COPD or tracheal stenosis at minimal pitch (0.09) and radiation exposure (1.4-1.9 mSv) during regular tidal breathing registered by a belt system. Image reconstruction involved a raw data-based iterative algorithm (1.5-mm slice thickness, 1.0-mm z-axis increment, 5% respiratory increment), resulting in a stack of 6,700 images, which were evaluated with a 4D-viewing tool. Results: An excessive dynamic collapse of the trachea in combination with tracheobronchomalacia (TBM) of the main-stem and segmental bronchi, and a paradoxical diaphragmatic motion were demonstrated in 1 case. Moreover, we detected a saber-sheath trachea and main-stem TBM in another case. The third case showed a fixed tracheal stenosis. Conclusions: 4D-CT provides unprecedented z-axis coverage and time-resolved volumetric datasets of the whole chest. Airway instability, stenosis and paradoxical diaphragmatic motion may be assessed simultaneously, preceding interventions such as airway stabilization or lung volume reduction. © 2014 S. Karger AG, Basel.
- Ayurvedic Medicine and the Lung. [JOURNAL ARTICLE]
- Respiration 2014 Feb 18.
A middle-aged Indian woman with knee pain had consumed ayurvedic medicine (Ostolief and Arthrella tablets) daily for 6 months. She presented to the respiratory clinic with worsening dyspnea, cough and weight loss of 2 months' duration. She was a homemaker, never-smoker and did not keep birds. Physical examination detected fine end-inspiratory crackles. There was no clubbing of the fingers, joint deformity or swelling, skin lesion or enlarged cervical lymphadenopathy. High-resolution computed tomography showed diffuse centrilobular nodules with ground-glass attenuation. Restrictive ventilatory defect (FVC 44% predicted, FEV1/FVC ratio 93%) was observed on spirometry, and the autoimmune screen was negative. Bronchoalveolar lavage fluid revealed lymphocytosis with an increased CD4/CD8 (T helper:T suppressor) ratio. Cultures for bacteria, mycobacteria, fungi, viruses and Pneumocystis carinii were negative. Alveolitis with infiltration of interstitium by lymphocytes and peribronchiolar noncaseating granulomas were observed on bronchoscopic lung biopsy. A diagnosis of hypersensitivity pneumonitis as a result of ayurvedic medicine was made. She was advised to stop the offending medicine; high-dose steroids and bactrim prophylaxis were commenced and tapered over 3 months with good response and radiological resolution. She was followed for 1 year without relapse. © 2014 S. Karger AG, Basel.
- Breath Analysis in Real Time by Mass Spectrometry in Chronic Obstructive Pulmonary Disease. [JOURNAL ARTICLE]
- Respiration 2014 Feb 19.
Background: It has been suggested that exhaled breath contains relevant information on health status. Objectives: We hypothesized that a novel mass spectrometry (MS) technique to analyze breath in real time could be useful to differentiate breathprints from chronic obstructive pulmonary disease (COPD) patients and controls (smokers and nonsmokers). Methods: We studied 61 participants including 25 COPD patients [Global Initiative for Obstructive Lung Disease (GOLD) stages I-IV], 25 nonsmoking controls and 11 smoking controls. We analyzed their breath by MS in real time. Raw mass spectra were then processed and statistically analyzed. Results: A panel of discriminating mass-spectral features was identified for COPD (all stages; n = 25) versus healthy nonsmokers (n = 25), COPD (all stages; n = 25) versus healthy smokers (n = 11) and mild COPD (GOLD stages I/II; n = 13) versus severe COPD (GOLD stages III/IV; n = 12). A blind classification (i.e. leave-one-out cross validation) resulted in 96% sensitivity and 72.7% specificity (COPD vs. smoking controls), 88% sensitivity and 92% specificity (COPD vs. nonsmoking controls) and 92.3% sensitivity and 83.3% specificity (GOLD I/II vs. GOLD III/IV). Acetone and indole were identified as two of the discriminating exhaled molecules. Conclusions: We conclude that real-time MS may be a useful technique to analyze and characterize the metabolome of exhaled breath. The acquisition of breathprints in a rapid manner may be valuable to support COPD diagnosis and to gain insight into the disease. © 2014 S. Karger AG, Basel.
- Validation of a Photoacoustic Gas Analyser for the Measurement of Functional Residual Capacity Using Multiple-Breath Inert Gas Washout. [JOURNAL ARTICLE]
- Respiration 2014 Feb 13.
Background: The respiratory mass spectrometer is the current gold-standard technique for performing multiple-breath inert gas washout (MBW), but is expensive and lacks portability. A number of alternative techniques have recently been described. Objectives: We aimed to validate, using an in vitro lung model, an open-circuit MBW system that utilises a portable photoacoustic gas analyser, with sulphur hexafluoride (SF6) as the inert tracer gas. Methods: An acrylic glass lung model was utilised to assess the accuracy of functional residual capacity (FRC) measurements derived from MBW. Measurements were performed in triplicate at 20 combinations of simulated FRC, tidal volume and respiratory rate. FRC measured using MBW (FRCmbw) was compared to FRC calculated from the known dimensions of the model (FRCcalc). MBW was also performed in 10 healthy subjects and 14 patients with asthma. Results: The MBW system measured FRC with high precision. The mean bias of FRCmbw with respect to FRCcalc was -0.4% (95% limits of agreement of -4.6 and 3.9%). The mean coefficient of variation of triplicate FRC measurements was 4.0% in vivo and 1.0% in vitro. MBW slightly underestimated low lung volumes and overestimated high lung volumes, but this did not cause a significant error in lung clearance index except at lung volumes below 1,500 ml. Conclusions: The open-circuit MBW system utilising SF6 as the inert tracer gas and a photoacoustic gas analyser is both accurate and repeatable within the adult range of lung volumes. Further modifications would be required before its use in young children or infants. © 2014 S. Karger AG, Basel.
- Medical Publications: Walking a Thin Line. [JOURNAL ARTICLE]
- Respiration 2014 Feb 11.:177-178.
- Pulmonary Cryptococcosis with Trachea Wall Invasion in an Immunocompetent Patient: A Case Report and Literature Review. [JOURNAL ARTICLE]
- Respiration 2014 Feb 13.
Cryptococcosis causes significant morbidity and mortality in the world. Pulmonary cryptococcosis is a kind of subacute or chronic pulmonary fungal disease. We present a case of pulmonary cryptococcosis with a trachea wall invasion-like malignant tumor in an immunocompetent patient and a literature review. The 44-year-old man, a nonsmoker, suffered from mild dyspnea and white sputum with intermittent blood streaks. A computed tomography (CT) scan of his chest showed two possibly malignant lesions in the right hilum and upper-right field of his lung, which have higher uptake values of fluorodeoxyglucose on positron emission tomography (PET)/CT. Lung biopsy pathology showed scattered fungal spores and positive periodic acid-Schiff (PAS) staining. The immune status and blood tumor markers were all normal in this patient. The titer of Cryptococcus antigen latex agglutination test was 1:1,280. Under fiberoptic bronchoscopy, a prominent new mass on the right wall of the trachea blocked most of the right main bronchus. To reduce the symptoms of airway obstruction, treatment by bronchoscopy, i.e. ablation and endotracheal stent, was used. As his symptoms were aggravated by the use of itraconazole, amphotericin B liposome was used as antifungal treatment. All these methods led to a better prognosis. We conclude that pulmonary cryptococcosis may mimic lung neoplasms radiologically and bronchoscopically, even in immunocompetent patients. © 2014 S. Karger AG, Basel.
- Authors' Reply. [LETTER]
- Respiration 2014 Feb 13.