Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Oct 2007
ReviewTechnical aspects of bronchoalveolar lavage: recommendations for a standard procedure.
Bronchoalveolar lavage (BAL) has been used widely in the diagnosis of infection. More than 30 years after its description, its use in the clinical management of interstitial lung disease remains controversial. ⋯ This article summarizes these recommendations and discusses the variable effects they have on BAL results. The final recommendations provide a standard methodology that can be used by the largest number of pulmonologists.
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Semin Respir Crit Care Med · Aug 2007
ReviewPulmonary complications of polymyositis and dermatomyositis.
Polymyositis and dermatomyositis are systemic inflammatory diseases with unknown etiology and prognosis. Pulmonary involvement is increasingly recognized to be a major complication and a common cause of morbidity and mortality in these diseases. Thus a thorough pulmonary evaluation is necessary to permit appropriate management. ⋯ ILD is a frequent pulmonary complication in patients with myositis, and respiratory symptoms are not reliable signs for diagnosis. The strongest predictive factor for ILD in patients with myositis is the presence of antihistidyl transfer ribonucleic acid (tRNA) synthetase antibodies (anti-Jo-1), but ILD may also be present in patients without these autoantibodies. Therefore, all patients with polymyositis or dermatomyositis should be investigated with chest radiography, high-resolution computed tomography, and lung function tests.
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The interpretation of pulmonary function tests (PFTs) in patients with connective tissue disease poses considerable difficulties in clinical practice. In established lung disease, several characteristic PFT profiles are recognized for individual complications, including pulmonary fibrosis, pulmonary vascular disease, extrapulmonary restriction, and intrinsic airway disease. PFTs play a central role in the investigation of respiratory symptoms and are sensitive in the detection of interstitial lung disease and pulmonary vascular disease. ⋯ Maximal exercise testing has an ancillary role in selected patients and is most often useful in demonstrating that limited disease is not clinically significant. The interpretation of PFTs is most difficult when, as is commonly the case, two or more pulmonary complications coexist, each having separate functional effects. Finally, the use of PFTs in routine monitoring is discussed.
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Rheumatoid arthritis (RA) is a systemic disease, characterized by symmetric joint involvement, but it can also affect other organ systems, including the lungs. The better-known pulmonary manifestations of RA are interstitial lung disease, rheumatoid nodules, and pleural effusions. Less common manifestations include bronchiolitis obliterans and crycoarytenoid arthritis. ⋯ Other pulmonary manifestations in RA patients can ensue as a result of the treatments used for it, mainly methotrexate. This article discusses the most common pulmonary manifestations of RA and their treatment. A discussion about the increasing impact that cigarette smoking is having on RA is also provided.
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Semin Respir Crit Care Med · Aug 2007
ReviewComputed tomographic imaging in connective tissue diseases.
The connective tissue diseases are a group of autoimmune mediated disorders characterized by multiorgan damage. High-resolution computed tomography (HRCT) plays an important role in identifying patients with respiratory involvement. ⋯ The clinical utility of HRCT is discussed with respect to the detection of disease, diagnosis, staging of disease severity, prognostic evaluation, and monitoring of disease progression. The difficult problem of establishing the clinical significance of CT abnormalities is also addressed.