Respiration; international review of thoracic diseases
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One of the consistently observed features in chronic obstructive pulmonary disease (COPD) are markedly increased neutrophils in the airways which are accompanied by increased levels of interleukin-8 (IL-8) in induced sputum and bronchoalveolar lavage fluid. To some extent, IL-8 may derive from bronchial epithelial cells since airway epithelium plays a crucial role in initiating and augmenting host defense mechanisms. ⋯ These results suggest that patients with chronic obstructive airflow limitation are characterized by a significant upregulation of bronchial epithelial IL-8 expression levels and secretion, indicating specific differences in epithelial cell activation in COPD patients compared to smokers and control subjects.
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Crohn's disease (CD) can be associated with respiratory involvement. Multiple pulmonary nodules are an infrequent finding in patients with CD. When they are found, histology usually shows sterile necrobiotic nodules, which are spherical aggregates of neutrophils, which frequently cavitate. ⋯ Transthoracic biopsy of one of the nodules disclosed a benign, nongranulomatous inflammatory lymphoid infiltration. The radiographic abnormalities responded well to oral prednisone. Focal, nongranulomatous lymphoid infiltration thus must be considered in the differential diagnosis of multiple pulmonary nodules in patients with CD.
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Conventional training in bronchoscopy involves a trainee performing on a real patient under supervision. This method of training is not only expensive, but there is also potential for increased patient discomfort. Simulators permit the acquisition of necessary technical skills required for the procedure. Virtual reality (VR) has been an integral part of training in aviation, and the application of this technology in medical training needs to be evaluated. ⋯ This study has been able to establish the face, construct and content validity of the simulator and the potential for it to be an effective training tool.
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Case Reports
Bilateral and unilateral spontaneous massive hemothorax as a presenting manifestation of rare tumors.
Spontaneous true hemothorax is quite a rare manifestation of a presenting disease. This is a report of two patients, one with bilateral spontaneous massive hemothorax as a presenting manifestation of angiosarcoma involving the lungs and pleura, and the other with unilateral spontaneous hemothorax and hemorrhagic shock as a presenting manifestation of 'cystic' chondroblastoma. Differential diagnosis of spontaneous true hemothorax and its evaluation and management are discussed.
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Congestive heart failure (CHF) patients experience dyspnea on exertion and therefore have decreased exercise tolerance. ⋯ CHF patients cannot utilize their full respiratory capacity during exercise secondary to expiratory flow limitation and an inability to increase EILV and EFVR.