Idiopathic pulmonary lymphoid diffuse hyperplasia.

We describe a 70-year-old woman affected by diffuse pulmonary lymphoid hyperplasia (DPLH). DPLH is a rare clinical-pathological entity generally associated with connective tissue diseases, but we diagnosed our case as an idiopathic DPLH. To the best of our knowledge, this is the first case of idiopathic DPLH reported in medical literature.

Acute fibrinous and organising pneumonia in Whipple's disease.

We report a case of acute fibrinous and organising pneumonia in Whipple's disease with lung improvement after antibiotic therapy. In our knowledge this is the first report of Whipple's disease with acute fibrinous and organising pneumonia.

Respiratory bronchiolitis associated with interstitial lung disease.

Respiratory bronchiolitis associated with interstitial lung disease (RB-ILD), first described by Niewoehner et al in an autopsy study of cigarette smokers who died from non pulmonary causes in 1974, is a rare entity that should be distinguished from the other interstitial lung diseases and in particular from desquamative interstitial pneumonia, although the two conditions share a similar histopathological pattern. RB-ILD is clearly connected with tobacco smoking and has been inserted in the "smoking related interstitial lung diseases" together with DIP and Cell histiocytosis of Langerhans; it may also be associated with occupational exposure to machine fumes. The following is a case report of a patient with both smoking and occupational exposure.

Massive unilateral hydrothorax as the only clinical manifestation of ovarian hyperstimulation syndrome.

We describe the case of a 36 old woman with a right massive hydrothorax resulting from Controlled Ovarian Hyperstimulation (COH) for infertility. This complication is defined as Ovarian Hyperstimulation Syndrome (OHSS) which usually includes abdominal pain, nausea and ascites, rarely involving the respiratory apparatus. The usual determining factors of OHSS are the presence of high serum estradiol levels and pregnancy. In the case that we describe the serum estradiol levels during COH were monitored and were slightly higher than the COH alarm threshold and the patient was not pregnant.

Perception of methacholine-induced airway obstruction in asthmatics.

The main objective of this study was to examine the perception of the first symptom during methacholine bronchoconstriction as soon as it occurred, and in the second instance to quantify the intensity of the breathlessness by means of the Borg Scale performed at the end of challenge so to not determine any difficulties for identification of the first symptom. A methacholine challenge test was carried out in 139 symptom-free asthmatics with a normal pulmonary function. When the first symptom was reported by the subject, the forced expiratory volume in one second (FEV1) was measured immediately. FEV1 was expressed as a percentage of the best personal value (FEV1%BPV). The intensity of the breathlessness was rated using a modified Borg Scale at the end of the challenge test so as not to confuse the patient. Seven subjects felt nothing during challenge. The first symptoms varied: constriction behind the breastbone (49%), inspiratory shortness (16.5%), coughing (10%), wheezing, throat constriction, general chest tightness, pain behind the sternum, and a sensation of rheum behind the sternum. FEV1%BPV at the first symptom was 80.5 +/- 10 (range 41-99). No symptom was perceived by 42% of the subjects within the 80-100 range of FEV1%BPV. FEV1%BPV at the first symptom was related to the log of the provocative dose causing a 20% fall in FEV1 (r = 0.2, p < 0.05). An inverse correlation between Borg Score and final FEV1%BPV (r = -0.25, p < 0.01) was found at the end of challenge. A subgroup of 39 subjects with similar final FEV1%BPV values (68-72) showed a correlation between the Borg Score at end of challenge and FEV1%BPV at the first symptom (r = 0.59, p < 0.001). The first symptom of the methacholine-induced bronchoconstriction varies in asthmatics and may be atypical, the bronchoconstriction level at which it is felt also varies among individuals, highly methacholine-responsive subjects perceive the bronchoconstriction later, while late perceivers of the first symptom show less intense breathlessness at the end of challenge. The measurement of the patient's ability to perceive asthmatic symptoms during the methacholine challenge test could be used to single out poor perceivers.

[Mesothelioma registry of the Liguria region. Incidence and occupational etiology in a high risk area]. / Registro mesoteliomi della Liguria. Incidenza ed eziologia professionale in un'area ad alto rischio.

This paper presents the epidemiological analyses based on the first 5 years of activity of the Mesothelioma Registry of Liguria (REM). REM is a population-based cancer registry specialized in the study of both the incidence and etiology of primary pleural and peritoneal mesothelioma in Liguria (Italy). The REM completes normal clinical information with occupational and environmental anamnestic data in order to identify working and living areas at risk for asbestos-related pathologies. The REM started its activity in 1994 describing the incidence of pleural mesothelioma (PM) exclusively in the population resident in the city of Genoa (660,000 inhabitants); since 1996 the REM has studied the entire Liguria Region (1,640,000 inhabitants), where nearly 120 new cases of PM are diagnosed annually (20% are women). In the city of Genoa, between 1986-1987 and 1997-1998, PM crude incidence rate rose from 13.8 to 26.7 per 100,000 males over 40 years old. From 1994 to 1998 the REM registered 495 new patients with histologically (62%) and cytologically (9%) confirmed diagnosis of PM. 54% of them were immunocytohistochemically evaluated. Occupational information has been gathered for 248 subjects, i.e., 61% of cases with sure or probable diagnosis of PM. For 126 patients, occupational asbestos exposure (direct, indirect or only presence in the workplace) was identified on average 40 years before diagnosis. In particular, asbestos exposure was documented in shipyards, docks and cargo handling settings, building trades, iron and steel industries. Interestingly, during the same period (1955-1960), a large fraction of subjects without proved or declared direct asbestos exposure claimed to have worked in the same occupational settings. This suggests a possible unconscious indirect exposure to asbestos fibers in the workplace.

A phase II study of a three-drug combination (cisplatin, ifosfamide and vinorelbine) plus granulocyte-colony stimulating factor in advanced non small cell lung cancer.

Twenty-nine patients with advanced non-small-cell lung cancer (NSCLC) were treated with a combination of cisplatin 20 mg/m2 days 1-3, ifosfamide 1500 mg/m2 days 1-2 (plus mesna as uroprotector) and vinorelbine 25 mg/m2 days 1 and 5; filgrastim was given at the dose of 300 microg subcutaneously from day 8 to day 15. A response rate of 28% was observed. The activity of this combination in an outpatient setting, with acceptable toxicity, has been demonstrated.

Pulmonary tumourlets and microcarcinoids in bronchiectasis.

A 66 year old woman underwent a left lower lobectomy for bronchiectasis. Histology revealed the presence of multiple endocrine lesions, such as neuroendocrine cell hyperplasia, tumourlets and microcarcinoids, which were widespread in bronchi, bronchioles and alveolar tissue. This case confirms the occurrence of neuroendocrine proliferations, in the setting of bronchiectasis, ranging from neuroendocrine cell hyperplasia to carcinoids, and suggests tumourlets as an appropriate model for neuroendocrine lung tumour genesis.

[Mantoux intradermal reaction and lymphocyte populations in asymptomatic HIV-seropositive subjects]. / Intradermoreazione alla Mantoux e popolazioni linfocitarie in soggetti HIV sieropositivi asintomatici.

Individuals who are infected with human immunodeficiency virus (HIV) are at high risk of developing tuberculosis, probably due to the reactivation of latent infection associated with HIV-induced immunosuppression. Tuberculin skin test is the best diagnostic means to assess a previous tuberculous infection, but this test may be falsely negative in HIV seropositive subjects. To assess the validity of a non-reactive tuberculin skin test in asymptomatic HIV seropositive subject, we performed Mantoux test 5 TU, chest x-ray, HIV serologic tests on 141 asymptomatic prisoners. Determination of lymphocyte subsets in HIV seropositive carriers had already been performed. Chest x-ray film showed no pleuro-pulmonary lesion in any subject. We found 101 HIV seronegative subjects (89 men and 12 women; 30 +/- 6 yrs with 18-39 range; 34 Mantoux reactive and 67 non-reactive) and 40 HIV seropositive individuals (30 men and 10 women; 29 +/- 6 yrs with 21-39 range; 7 Mantoux reactive and 33 non-reactive). By subdividing HIV seropositive subjects in two groups (reactive and non-reactive to tuberculin test) a significant decrease of CD 4 lymphocytes and CD 4/CD 8 ratio was found in HIV seropositive/Mantoux non-reactive group, without changes in total lymphocytes and CD 8 subset. We conclude that: 1) a non-reactive tuberculin skin test cannot be confidently explained in asymptomatic HIV seropositive subjects with a T helper lymphocyte count decrease; 2) T helper cells are important to keep alive delayed hypersensitivity reaction.

[Bronchial reactivity and cough due to ACE inhibitors]. / Reattività bronchiale e tosse da ACE-inibitori.

The occurrence of a dry, nonproductive cough during ACE inhibitors therapy has been described in several reports. However, the mechanism of this effect is still unknown. In order to clarify whether ACE inhibitor-induced cough is a symptom of an asthmatic disturbance, six patients (age 54-68) with cough related to captopril or enalapril were rechallenged with ACE inhibitors after an adequate washout period. Baseline airway function and bronchial reactivity to metacholine were measured at the end of the washout period and on the fourth day of rechallenge which was accompanied by the reappearance of cough without wheezing. Rechallenge did not cause changes in dynamic lung function; a low and not significant (p less than 0.1) increase in metacholine dose causing a 15% and a 20% reduction in baseline FEV 1 was observed. It is concluded that cough and bronchoconstriction are likely to be mediated through different nervous pathways and that ACE inhibitor-induced cough is not a variant of asthmatic cough.

Pneumoconiosis (silicosis) in the confectionery industry.

Pneumoconiosis is not reported in food industry workers, and more specifically in the confectionery industry. We diagnosed diffuse pulmonary interstitial nodular fibrosis due to inhalation of powder containing quartz in a 54 year-old asymptomatic woman. Silicosis was due to a 5-year period of talc dust exposure 35 years earlier in the confectionery industry. The diagnosis was supported by a history of exposure, transbronchial lung biopsy specimen, 67Gallium scan, and CT scan. Our patient had an unusual history of exposure, which was not readily disclosed until the patient's memories, and after consultation with an expert in confectionery techniques, indicated she had been exposed to talc powder during her employment in the confectionery industry.

Primary acute pulmonary cavitation in asymptomatic sarcoidosis.

Sarcoidosis has a large variety of chest x-ray manifestations, but primary acute cavitation is very rare. We report a case of cavitary sarcoidosis occurring in an asymptomatic 25 year-old white patient. The diagnosis was established from chest x-ray, transbronchial biopsy specimen, bronchoalveolar lavage and gallium 67 scan. The peculiarities of this case are: 1) the presence of hilar adenopathy; 2) the cavitation occurred during the decreased activity of the disease; 3) the resolution of cavity without therapy. We suggest asymptomatic sarcoidosis should be considered in the differential diagnosis of pulmonary cavitation.