1/10. Drug-induced lung disease.Since there are no diagnostic studies to confirm the presence of a drug-induced lung reaction the physician will make a correct diagnosis only if he is aware of the drugs which have been identified to cause pulmonary reactions and their specific manifestations. Failure to recognize a drug-induced lung disease can lead to significant morbidity and in some cases mortality. The major drug-induced lung diseases are reviewed, the drugs being presented in the context of their clinical use and the reactions on the basis of common pathogenetic mechanisms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. autoantibodies and the spectrum of sjogren's syndrome.In studies reported recently, the sera of patients with sjogren's syndrome were found to contain precipitating antibodies to nuclear antigens that can be identified by immunodiffusion analysis. These precipitating autoantibodies have been termed SS-A and SS-B antibodies. We show that identification of these autoantibodies helped in establishing the diagnosis of sjogren's syndrome in 12 of 30 patients in whom the diagnosis had not been considered at the time of the physician's initial examination. The reasons for this were related to lack of spontaneous complaints of keratoconjunctivitis sicca and xerostomia and prominence of symptoms associated with arthritis, myalgia, pulmonary fibrosis, and cardiac disease. This study re-emphasizes the importance of multisystem disease in sjogren's syndrome and shows that specific serologic assays for autoantibodies aided in diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Acute lung reaction due to zinc inhalation.A 27-yr-old man began work at a company that produces concrete pipes in April 1987. The pipes are linked with rings covered with zinc. In September 1987, he was transferred to a new job in the same plant where he had to heat zinc wires and shoot the heated zinc in powder form onto the iron rings. He had no past personal nor family atopic history. Two weeks after he began in his new job, he experienced an episode of chills with muscle aches and dyspnoea at the end of a working day. The fever persisted until the next day, at which time he saw a physician. A chest radiograph revealed diffuse interstitial shadows. He was off work for 10 days. His symptomatology disappeared and his chest radiograph cleared. He went back to work and experienced a similar episode. He remained away from work for one month, after which specific inhalation challenges were performed. On a control day, there were no significant changes in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), or buccal temperature. Two white blood counts (WBC) showed 8,400 and 8,500 white cells. He was exposed to his usual work environment for one hour on two consecutive days. On both occasions, there were significant falls in FEV1 (16% and 20%) and FVC (10% and 11%), occurring 4-6 h after exposure. Buccal temperature reached 38.1 and 38.7 degrees C on the two occasions, and WBC were 17,000 and 15,900 at the end of each day. precipitins were negative and specific IgG antibodies could not be detected.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. The clinical diagnosis of acute graft-versus-host disease: a diversity of views amongst marrow transplant centers.The diagnosis and grading of acute graft-versus-host disease (AGVHD) is based on a spectrum of clinical and laboratory features. To evaluate the reliability of current diagnostic and scoring criteria, six clinical vignettes were evaluated by 49 transplant physicians from 42 bone marrow transplant center worldwide. Responses were analysed to determine: (1) the degree of concordance among transplanters in diagnosing, scoring and treating AGVHD, and (2) the degree of concordance in assigning primary and contributing causes of death in patients with multiple complications of bone marrow transplantation. Concordance for the diagnosis of AGVHD ranged from 24 to 76%; concordance for grading AGVHD was 55%. Concordance for the decision to treat for AGVHD ranged from 43 to 55%; concordance for assigning the primary cause of death ranged from 71 to 100%. The findings demonstrate the need for (1) improved uniformity of reporting complications of bone marrow transplantation; (2) periodic revision and validation of diagnostic and grading criteria, and (3) methods of analysis that allow for multiple causes of death.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. gallium scanning in lymphoid interstitial pneumonitis of children with AIDS.Lymphoid interstitial pneumonitis (lip) is a frequent pulmonary complication in the child with the acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (hiv) infection. We report the gallium scan findings in two children with AIDS and lip. gallium scintigraphy in both children demonstrated increased radionuclide concentration throughout the lungs, a pattern indistinguishable scintigraphically from that of pneumocystis carinii pneumonia (PCP). This should alert nuclear medicine practitioners and referring physicians to another cause of diffusely increased gallium uptake in the lungs of patients with AIDS.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Fatal pulmonary reaction from low doses of bleomycin. An idiosyncratic tissue response.There were two cases of fatal interstitial pneumonia secondary to bleomycin sulfate administration. Although bleomycin pulmonary toxicity is generally thought to be dose-related and occurs infrequently with a total cummulative dose less than 300 to 400 units, the two reactions reported here occurred with doses of 105 and 165 units. Fatal bleomycin-induced pneumonia has been previously reported at these low dosages, and physicians should be aware that this toxic reaction may occur as an idiosyncratic response. Previous thoracic irradiation may be a predisposing factor. patients receiving bleomycin should be meticulously monitored by interrogation for cough, dyspnea, and chest pain; by auscultation for rales; by serial chest roentgenograms; and by determinations of vital capacity and single-breath carbon monoxide diffusing capacity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Rapid progression of fibrosing alveolitis and thyrotoxicosis after antithymocyte globulin therapy for aplastic anemia.Antithymocyte globulin (ATG) therapy is an established form of treatment for aplastic anaemia and has also been used as prophylaxis against graft rejection of bone marrow and renal allografts. Administration of ATG preparations has been associated with many mild clinical reactions, as have other forms of immunomodulatory therapy. However, serious adverse effects appear to be rare. We report a case of rapidly progressive fibrosing alveolitis and thyrotoxicosis in relation to ATG therapy, highlighting its potential toxicity and emphasising that its administration should be undertaken by experienced physicians in specialised centres.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. Mineralogical analysis of the respiratory tract in aluminium oxide-exposed workers.A retrospective study was conducted in order to characterize the retention of fibrous and nonfibrous mineral particles in the respiratory tract in subjects with previous occupational exposure in the aluminium industry. bronchoalveolar lavage (BAL) fluid (three samples) or lung parenchyma (two samples) were studied using analytical transmission electron microscopy in five patients. A high concentration of aluminium fibres (> 10(7) fibres.g-1 dry lung) was identified in two lung tissue samples, and aluminium fibres were also identified in BAL fluid in three patients. All fibres were short (mean length: 1-2 microns), with no fibre longer than 5 microns. Some biopersistence of these fibres in the respiratory tract is suggested from these observations, since fibres were identified in biological samples collected more than 4 yrs after cessation of exposure in four out of five patients. Occupational physicians should be aware of possible exposure to short, thin aluminium fibres during primary aluminium production. Further studies are needed to assess the potential health effects of these fibres. Industrial hygiene measurements should also be performed to document the potential sources of exposure to aluminium fibres in this industry.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Tuberculous pneumonia with the syndrome of inappropriate secretion of antidiuretic hormone: cause of the adult respiratory distress syndrome.Bilateral tuberculous pneumonia with the syndrome of inappropriate secretion of antidiuretic hormone was the cause of the adult respiratory distress syndrome in an elderly patient. Early recognition and prompt therapy enabled the patient to make a complete recovery without the necessity for mechanical ventilation. With the shift of care of tuberculous patients out of the sanitorium, the practicing physician should be aware of the varied manifestations of tuberculosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Lung hernia.Lung hernia is an uncommon entity usually resulting from trauma or inadequate healing from recent or remote thoracic surgery. A small percentage may be congenital. Four cases are reported, each demonstrating lung herniation resulting from either accidental or postsurgical trauma. Most of the previous cases have been reviewed in various surgical and radiological journals with only rare mention in the emergency medicine literature. Because emergency physicians may be the most immediate contact for patients who develop a lung herniation, they should be cognizant of this entity as a possible delayed complication to chest wall injury. awareness of the clinical and radiological appearance of lung hernia will help to avoid its confusion with other conditions such as subcutaneous emphysema, chest tumor, pneumothorax, or a focus of infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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