Articles: chronic.
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Atrial fibrillation (AF) is more likely to develop in patients with chronic kidney disease (CKD) than in individuals with normal renal function, and patients with CKD are more likely to suffer ischemic stroke (IS)/thromboembolism (TE). To our knowledge, no prior study has considered the impact of estimated glomerular filtration rate (eGFR) on bleeding. We investigated the relationship of eGFR to IS/TE, mortality, and bleeding in an AF population unrestricted by age or comorbidity. ⋯ Incidence rates of IS/TE, mortality, and bleeding increased with reducing eGFR across the whole range of renal function. OAC use was associated with a lower incidence of IS/TE and mortality at 1 year compared with individuals not receiving anticoagulants in all categories of renal function as measured by eGFR. The NCB balancing IS against serious bleeding was positive in favor of OAC use among patients with renal impairment.
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Comparative Study
A Comparison of Health-Related Quality of Life in Idiopathic Pulmonary Fibrosis and Chronic Hypersensitivity Pneumonitis.
Patients with interstitial lung disease (ILD) have poor health-related quality of life (HRQL). However, whether HRQL differs among different subtypes of ILD is unclear. The aim of this study was to determine whether HRQL was different among patients with idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis (CHP). ⋯ HRQL is worse in CHP compared with IPF. HRQL differences between ILD subtypes are explained in part by differences in sex, dyspnea, and fatigue.
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Hyperinflation refers to a nonspecific increase in absolute lung volumes and has a poor prognosis in COPD. The relative contribution of increased airways resistance and increased parenchymal compliance to hyperinflation of each absolute lung volume is poorly understood. We hypothesized that increased residual volume (RV) and RV/total lung capacity (TLC) would be associated with reduced airway lumen dimensions, whereas increased functional residual capacity (FRC), TLC, and reduced inspiratory capacity (IC)/TLC would be associated with emphysema on CT scan. We examined whether clinical characteristics differed accordingly. ⋯ Gas trapping and hyperexpansion on plethysmography were associated with distinct differences in lung structure and clinical characteristics. Absolute lung volumes should not be considered equivalent in their estimation of hyperinflation and provide insight into the extent of airway and parenchymal abnormalities in COPD.
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Semin Respir Crit Care Med · Jun 2014
ReviewSarcoidosis and chronic beryllium disease: similarities and differences.
Chronic beryllium disease (CBD) is a granulomatous lung disease that may be pathologically and clinically indistinguishable from pulmonary sarcoidosis, except through use of immunologic testing, such as the beryllium lymphocyte proliferation test (BeLPT). Similar to sarcoidosis, the pulmonary manifestations of CBD are variable and overlap with other respiratory diseases. Definitive diagnosis of CBD is established by evidence of immune sensitization to beryllium and diagnostic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. ⋯ Extrapulmonary manifestations of CBD are rare today. Since lung-predominant sarcoidosis can very closely resemble CBD, CBD is still misdiagnosed as sarcoidosis when current or past exposure to beryllium is not recognized and no BeLPT is obtained. This article describes the similarities and differences between CBD and sarcoidosis, including clinical and diagnostic features that can help physicians consider CBD in patients with apparent lung-predominant sarcoidosis.
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Case Reports
Small Airway-Centered Granulomatosis Caused by Long-term Exposure to Polytetrafluoroethylene.
To date, there have been no reports of chronic pulmonary granulomatosis associated with exposure to polytetrafluoroethylene (PTFE). Here, we report three cases of small airway-centered granulomatous lesions in workers employed at facilities that apply coatings to pans and other utensils. The workers were repeatedly exposed to PTFE particles that were probably generated by the drying process when PTFE coatings are dried in a convection oven at high temperatures (380-420 °C). ⋯ Analysis of the spectrum extracted from the position of the foreign particles enabled precise identification of the foreign bodies as PTFE. Fourier transform infrared revealed that all of the lung tissue samples had bands at 1,202 to 1,148 cm(-1) and 1,202 to 1,146 cm(-1), which are characteristic of the asymmetric and symmetric stretching vibrations of the C-F bonds of PTFE. These cases suggest that recurrent inhalational exposure to PTFE particles causes chronic pulmonary granulomatosis.