RESUMEN
We report an unusual case of cardiac sarcoidosis demonstrated by interventricular septal thickening. A 64-year-old woman was diagnosed with sarcoidosis involving the lungs, eyes, and skin. Three years later, renal dysfunction was detected during a periodic examination and a renal biopsy revealed non-caseating granulomas. Electrocardiogram results were normal, but an echocardiogram revealed thickening of the interventricular septum. Abnormal accumulation of gallium-67 and a perfusion defect in tecnetium-99-methoxyisobutylisonitrile scintigrams occurred in the interventricular septum. Magnetic resonance images showed T2-high intensity in the lesion. We considered the thickening to represent cardiac involvement of sarcoidosis. Oral prednisolone therapy diminished the interventricular septal thickening.
Asunto(s)
Cardiomiopatías/diagnóstico , Sarcoidosis/diagnóstico , Tabique Interventricular/patología , Administración Oral , Diagnóstico Diferencial , Ecocardiografía , Electrocardiografía , Femenino , Glucocorticoides/administración & dosificación , Humanos , Hipertrofia/diagnóstico , Hipertrofia/tratamiento farmacológico , Imagen por Resonancia Cinemagnética , Persona de Mediana Edad , Imagen de Perfusión Miocárdica/métodos , Prednisolona/administración & dosificación , Tabique Interventricular/diagnóstico por imagenRESUMEN
We report a case of delayed massive hemothorax, a 72-year-old women, due to diaphragmatic injury by multiple lower rib fracture on 4th day aftrer traffic injury. We tried to stop bleeding by transcatheter arterial embolization, but the control of bleeding was difficult, necessitating the emergency surgery. The diaphragmatic injury about 3 cm diameter was found, and was sutured with absorption thread. The post operative course was uncomplicated. Patient was discharged on 51th day after injury. Careful observation is important for delayed hemothorax after lower rib fracture.
Asunto(s)
Diafragma/lesiones , Hemotórax/etiología , Fracturas de las Costillas/complicaciones , Accidentes de Tránsito , Anciano , Diafragma/cirugía , Femenino , Hemotórax/cirugía , Humanos , Factores de TiempoRESUMEN
Subcutaneous sarcoidosis is the specific subset of cutaneous sarcoidosis frequently associated with systemic disease. However, the disease activity, severity, and prognosis have not yet been elucidated due to the limited number of reported cases. The purpose of this study was to identify the clinical, laboratory, and prognostic differences between subcutaneous sarcoidosis and other type of cutaneous sarcoidosis. All patients with sarcoidosis diagnosed histopathologically from 2000 to 2012 at our institution were enrolled. The clinical, laboratory, chest X-ray, and pulmonary function test results were retrospectively evaluated in the patients with cutaneous sarcoidosis. In the 130 patients with sarcoidosis, cutaneous sarcoidosis was diagnosed in 37 patients (28.4 %), and 9 (6.9 %) of these patients had subcutaneous sarcoidosis. The serum levels of soluble interleukin-2 receptor (sIL-2R) were significantly elevated in the group of patients with subcutaneous sarcoidosis in comparison to the patients with other types of cutaneous sarcoidosis, whereas there was no significant difference in the severity score between the two groups. Following a 2-year observation period, three patients were in remission, five patients demonstrated stable disease, and one patient had progressive disease. Subcutaneous sarcoidosis may be associated with the disease activity, although it was not found to be associated with the disease severity and it was not a predictive factor for the prognosis. Furthermore, the prevalence of subcutaneous sarcoidosis may be higher than that in previously reported series.
Asunto(s)
Inmunosupresores/uso terapéutico , Sarcoidosis/diagnóstico , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Pruebas de Función Respiratoria , Estudios Retrospectivos , Sarcoidosis/tratamiento farmacológico , Sarcoidosis/fisiopatología , Adulto JovenRESUMEN
BACKGROUND AND OBJECTIVE: We hypothesized that increased pulmonary vascular permeability may play a role in the pathogenesis of an acute exacerbation of the idiopathic interstitial pneumonias (AE-IIPs). Angiopoietin-2 (Ang-2) promotes endothelial activation, destabilization, and inflammation. The purpose of this study was to examine whether Ang-2 expression was associated with the pathogenesis of AE-IIPs. METHODS: Twenty-three patients with AE-IIP patients, 18 acute lung injury/acute respiratory distress syndrome (ALI/ARDS) patients, 37 idiopathic pulmonary fibrosis (IPF) patients, and 33 healthy volunteers (HVs) were enrolled. The serum level of Ang-2 was measured by an enzyme-linked immunosorbent assay. RESULTS: The serum levels of Ang-2 were higher in AE-IIPs and ALI/ARDS patients than in IPF patients and HVs; the BALF levels of Ang-2 were also higher than in IPF patients. There was a positive correlation between the serum level of Ang-2 and the CRP in patients with AE-IIP patients, whereas a significant positive correlation was found between the serum Ang-2 level and the CRP or SOFA scores of the ALI/ARDS patients. Although the baseline Ang-2 level was not related to survival, the Ang-2 levels significantly declined in survivors during treatment, while they did not change in non-survivors. CONCLUSIONS: Increased pulmonary vascular permeability and inflammation due to Ang-2 may play a role in the pathogenesis of AE-IIPs.
Asunto(s)
Lesión Pulmonar Aguda/sangre , Angiopoyetina 2/sangre , Neumonías Intersticiales Idiopáticas/sangre , Pulmón/metabolismo , Síndrome de Dificultad Respiratoria/sangre , Lesión Pulmonar Aguda/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Permeabilidad Capilar/genética , Progresión de la Enfermedad , Femenino , Humanos , Neumonías Intersticiales Idiopáticas/diagnóstico por imagen , Neumonías Intersticiales Idiopáticas/fisiopatología , Fibrosis Pulmonar Idiopática/diagnóstico por imagen , Fibrosis Pulmonar Idiopática/patología , Inflamación/metabolismo , Pulmón/irrigación sanguínea , Pulmón/patología , Masculino , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria/fisiopatología , Estudios Retrospectivos , Análisis de Supervivencia , Tomógrafos Computarizados por Rayos XRESUMEN
A 74-year-old man was referred to our hospital because of a tracheal stenosis circumscribed with soft tissue density and a left pulmonary nodule. Open biopsy of a right submandibular lymph node revealed diffuse large B-cell lymphoma, and the malignant cells were positive for Epstein-Barr virus gene products. Bronchofiberscopy revealed a tracheal necrotizing ulcer. After chemotherapy, the tracheal ulcer resolved. To our knowledge, this is the first report of a case of Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly with a tracheal ulcer.
Asunto(s)
Herpesvirus Humano 4/aislamiento & purificación , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/virología , Enfermedades de la Tráquea/etiología , Neoplasias de la Tráquea/complicaciones , Neoplasias de la Tráquea/virología , Úlcera/etiología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Broncoscopía , Tecnología de Fibra Óptica , Herpesvirus Humano 4/genética , Humanos , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Masculino , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Enfermedades de la Tráquea/diagnóstico , Enfermedades de la Tráquea/tratamiento farmacológico , Neoplasias de la Tráquea/diagnóstico , Neoplasias de la Tráquea/tratamiento farmacológico , Úlcera/diagnóstico , Úlcera/tratamiento farmacológicoRESUMEN
We herein report a case of hard metal lung disease that was successfully treated with inhaled corticosteroids. A 46-year-old man was admitted to our hospital due to coughing and an abnormal shadow on a chest radiograph. He had worked as a hard metal tool sharpener for five years. Chest computed tomography scans showed centrilobular micronodules and areas of ground-glass opacity in the bilateral lung fields. Video-associated lung biopsy specimens revealed bronchocentric interstitial pneumonia and cellular bronchiolitis. A high-energy dispersion X-ray microanalysis detected tungsten. The patient was diagnosed with hard metal lung disease. Inhaled corticosteroid therapy (800 µg of ciclesonide hydrofluoroalkane daily) resolved the patient's symptoms, elevated KL-6 level, abnormal areas of chest opacity and obstructive, restrictive and diffusion impairments.