Subject(s)
Hypertension, Pulmonary , Pulmonary Disease, Chronic Obstructive , Humans , Lung , Microcirculation , Pulmonary ArterySubject(s)
Adenocarcinoma/diagnosis , Anti-Infective Agents, Urinary/adverse effects , Cystitis/drug therapy , Lung Diseases, Interstitial/chemically induced , Lung Diseases, Interstitial/diagnosis , Lung Neoplasms/diagnosis , Lung/drug effects , Lung/pathology , Nitrofurantoin/adverse effects , Adenocarcinoma/complications , Adenocarcinoma/pathology , Adenocarcinoma of Lung , Anti-Infective Agents, Urinary/administration & dosage , Carcinoma, Non-Small-Cell Lung/pathology , Chronic Disease , Cough/etiology , Cryptogenic Organizing Pneumonia/diagnosis , Diagnosis, Differential , Dyspnea/etiology , Fatigue/etiology , Female , Humans , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/pathology , Lung Neoplasms/complications , Lung Neoplasms/pathology , Middle Aged , Neoplasm Staging , Nitrofurantoin/administration & dosage , Positron-Emission Tomography , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed , Weight LossABSTRACT
OBJECTIVE: Previous investigation demonstrated predominantly lymphocytic inflammation in sinus mucosa of young children with chronic rhinosinusitis (CRS) rather than eosinophilic inflammation typical of adult CRS. Immunohistopathological study was undertaken to define further the cellular response in pediatric CRS. STUDY DESIGN: Maxillary mucosal biopsies from children and adults with CRS were stained for CD3 (T lymphocytes), CD4 (helper T lymphocytes), CD8 (cytotoxic T lymphocytes), CD20 (B lymphocytes), CD68 (monocytes/macrophages), CD56 (natural killer cells), kappa and lambda (plasma cells), and myeloperoxidase (MPO; neutrophils). RESULTS: Nineteen children with CRS (median age, 3.0 years; range, 1.4-8.2 years) had more CD8+, MPO+, and CD68+ cells (P < or = .03) and a trend toward more CD3+ and CD4+ cells (P = .06) in their epithelium and more CD20+, kappa+ and lambda+, MPO+, and CD68+ cells (P < or = .05) and a trend toward more CD4+ cells (P = .06) in their submucosa compared with adult control subjects. Immunostains from children with positive sinus cultures were similar to those with negative cultures except for more MPO+ cells in the submucosa (P = .04). CONCLUSION: The inflammatory response of young children with CRS is characterized by a mixed lymphocyte population, macrophages, and neutrophils. Differences between pediatric and adult CRS suggest differing pathogenic mechanisms or progression in the inflammatory response with protracted disease.
Subject(s)
Nasal Mucosa/immunology , Rhinitis/immunology , Sinusitis/immunology , Adult , Antigens, CD/immunology , B-Lymphocytes/immunology , Biopsy , Case-Control Studies , Child , Child, Preschool , Chronic Disease , Humans , Infant , Macrophages/immunology , Maxillary Sinus/immunology , Maxillary Sinus/metabolism , Nasal Mucosa/metabolism , Natural Killer T-Cells/immunology , Neutrophils/enzymology , Neutrophils/immunology , Peroxidase/metabolism , Plasma Cells/immunology , Staining and Labeling , T-Lymphocytes/immunologyABSTRACT
BACKGROUND: The clinical and physiologic features of respiratory bronchiolitis (RB)-interstitial lung disease (ILD) have been previously described; however, the natural history and outcome have not been systematically evaluated. The majority of published reports consider RB-ILD to be a nonprogressive ILD that clinically improves with smoking cessation and antiinflammatory treatment. In this study, we sought to determine the outcome of RB-ILD patients with and without smoking cessation and with and without corticosteroid therapy. METHODS: Thirty-two RB-ILD cases confirmed by surgical lung biopsy were identified from a prospectively enrolled cohort of subjects with ILD. Initial and follow-up data on symptoms, physiology, treatment, and outcome were collected and analyzed. RESULTS: Kaplan-Meier analysis revealed that at least 75% of RB-ILD patients survived > 7 years after diagnosis. Clinical improvement occurred in only 28% of cases, and physiologic improvement occurred in 10.5% of cases. One patient died of progressive ILD, and two patients died of non-small cell lung cancer. While physiologic improvement was limited to those who had ceased smoking, corticosteroids and/or other immunosuppressive therapy had little effect on symptoms or physiology. CONCLUSIONS: This study shows that prolonged survival is common in RB-ILD. However, symptomatic and physiologic improvement occurs in only a minority of patients, and neither smoking cessation nor immunosuppressive therapy is regularly associated with clinically significant benefit.