Subject(s)
Carcinoma, Squamous Cell/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Lung Neoplasms/pathology , Vena Cava, Superior/diagnostic imaging , Venous Thrombosis/diagnosis , Carcinoma, Squamous Cell/diagnostic imaging , Humans , Incidental Findings , Lung Neoplasms/diagnostic imaging , Male , Middle Aged , Superior Vena Cava Syndrome/diagnosis , Superior Vena Cava Syndrome/pathology , Venous Thrombosis/pathologyABSTRACT
Between November 2003 and January 2004 in the North of France a large outbreak of legionnaire's disease affected 85 patients. The clinical, biological and radiological characteristics of the patients were investigated to determine factors associated with mortality. Two populations were defined and compared: patients who died within 28 days and those who survived. Eighty-five patients were included in this study. The median age was 75 years. The median fever was 39.3 +/- 0.1 degrees. Fifteen patients (17.6%) had at least 3 underlying co-morbidities. Cough, dyspnoea, confusion and diarrhoea were found in respectively 46, 68, 47, and 15% of the patients. The median of urea was 0.7 +/- 0.05 g/L, creatinine 16 +/- 1.5 mg/L, CRP 332 +/- 15 mg/L. On the chest X-ray, lung infiltrates were present in 64% and multilobar in 40%. The overall mortality rate was 21%. In univariate analysis, diabetes mellitus, dyspnoea, urea>0.90 g/l and CRP>350 mg/l were predictive factors of mortality. In multivariate analysis, diabetes mellitus, urea>0.90 g/l, and bilateral infiltrates on chest X ray were retained as independent risk factors for death.
Subject(s)
Legionnaires' Disease/mortality , Adult , Aged , Aged, 80 and over , Diabetes Mellitus/epidemiology , Disease Outbreaks , Female , France/epidemiology , Humans , Lung/diagnostic imaging , Lung/microbiology , Male , Middle Aged , Multivariate Analysis , Radiography , Risk Factors , Urea/analysisSubject(s)
Granuloma, Respiratory Tract/diagnostic imaging , Lung Diseases/diagnostic imaging , Vasculitis/diagnostic imaging , Adult , Biopsy , Female , Granuloma, Respiratory Tract/pathology , Humans , Lung Diseases/pathology , Necrosis , Remission, Spontaneous , Tomography, X-Ray Computed , Vasculitis/pathologyABSTRACT
The anti-synthetase syndrome comprises the association of an inflammatory myopathy (polymyositis, dermatomyositis), interstitial pneumonitis, skin lesions characteristic of "mechanics hands", Raynaud's phenomena, inflammatory polyarthritis and, at the biological level, antinuclear antibodies known as anti-synthetases. We report our observations of two patients, one with a typical anti-synthetase syndrome and one with an incomplete form. Two men aged 49 and 47 presented with increasing dyspnoea upon effort, muscular weakness, arthralgia, bilateral pulmonary crackles and, in the first case, typical hairless skin lesions. In both cases the chest x-rays and CT scans confirmed the presence of interstitial lesions, predominantly in the lower lobes. Lung function tests showed a restrictive pattern with reduced gas transfer. At the biological level both patients presented an inflammatory picture with elevated muscle enzymes and anti-Jo-1 antibodies. Immuno-suppressive treatment with cortico-steroids and cyclophosphamide lead to a symptomatic improvement, regression of the radiological changes and improvement in the measurements of pulmonary function.