ObjectiveTo improve the diagnosis and treatment of pulmonary alveolar proteinosis (PAP). MethodsThe clinical data of 34 PAP cases diagnosed between May 2008 and June 2015 in Hunan Prevention and Treatment Center for Occupational Diseases were retrospectively analyzed. ResultsThere were 34(52.9%)patients with a history of dust exposure. Cough and progressive dyspnea were common clinical symptoms. The incidence rate of hypoxemia and lung function damage was 87.9% and 90.9%,respectively. High resolution CT clearly demonstrated the characteristic map-like changing and paving-stone sign. Arterial blood oxygen partial pressure increased from (62.5±12.9)mm Hg to (73.0±12.2)mm Hg,and DLCO%pred increased from (50.1±14.9)% to (64.6±14.4)% after large-volume whole lung lavage. The recurrence rate was 38.2%. ConclusionThe etiology of PAP is unknown,dust exposure may be associated with secondary PAP. The effect of whole lung lavage is remarkable but the recurrence rate is high. It is needed to study further on etiological treatment of PAP.
ObjectiveTo explore the clinical value of Goddard CT grade for comprehensive evaluation of emphysema-type COPD. MethodsA total of 150 patients with emphysema-type COPD were recruited in the study. Chest CT scan was performed with German Siemens Difinition 64-slice spiral CT machine. The Goddard scoring of lung CT manifestations was used to grade lung emphysema. Lung function indexes were measured including FEV1, FVC, FEV1/FVC, RV, TLC, RV/TLC, DLCO, FEV1% pred, FVC% pred and DLCO% pred, etc. The correlation between Goddard scores and pulmonary function indexes were analyzed. The incidence of hospitalizations, length of hospital stay, severity of illness and complications in the previous year were compared between the patients with different Goddard CT grade. ResultsThere were 57 cases of mild emphysema, 53 cases of moderate emphysema, and 40 cases of severe emphysema judged by Goddard scoring. The pulmonary Goddard scores were positive correlated with RV, TLC, and RV/TLC which reflecting pulmonary function (r value was 0.385, 0.349, 0.455, respectively, all P < 0.05), and negatively correlated with DLCO and DLCO% pred which reflecting pulmonary diffusing capacity (r value was-0.771, -0.787, respectively, P < 0.05). Compared with the mild and moderate emphysema-type patients, the incidence of hospitalization more than one time due to acute exacerbation was significantly higher (χ2 value was 44.69, 25.66, respectively, P < 0.05), the average length of hospital stay was significantly longer [(13.5±4.2) d vs. (6.4±3.1) d and (9.0±3.8) d, P < 0.05] in the severe emphysema-type COPD patients. The severe emphysema-type COPD patients suffered from more severe acute exacerbation, and higher incidence of heart failure, ischemic heart disease and respiratory failure than the mild and moderate emphysema-type patients (P < 0.05). ConclusionsGoddard CT grade in complement with pulmonary function evaluation can provide more comprehensive evaluation of emphysema-type COPD. The higher Goddard score is, the more frequently and severe the acute exacerbation occurs, more easily the COPD patients complicated with respiratory failure, heart failure and other complications.
ObjectiveTo observe the influence of three postoperative analgesia methods on the survival rate of replanted finger by flat digital subtraction angiography (DSA) medical imaging detection system. MethodFrom July 2014 to July 2015, 342 patients were classified into gradeⅠ and gradeⅡ replantation in accordance with their physical condition and they were randomly divided into routine oral group, muscle injection group and analgesia group with 144 patients in each. Flat DSA was used to dynamically observe replantation after revascularization. Then we compared the three different analgesia methods in terms of psychological status of the patients, incidence of vascular crisis, occlusion rate, survival rate of replanted fingers. The function score of replanted fingers was evaluated for clinical efficacy. ResultsCompared with the conventional oral group and muscle injection group, the incidence of vascular crisis in replanted fingers and thrombosis rate were significantly lower in the analgesia group which had a replanted finger survival rate of 96.69% and a normal mental condition rate of 78.07%. Six months after surgery, the rate of excellent and good follow-up was significantly higher than the conventional oral group and muscle injection group (P<0.017) . ConclusionsThe 3-D technology of flat DSA can provide clear and reliable pictures of vessel revascularization status for replanted fingers. The use of continuous brachial plexus analgesia performs better than other methods of analgesia. Good analgesia can stabilize patients' anxiety and negative emotions, which is helpful to avoid excessive fluctuations in blood pressure induced by small artery spasm caused by blood clots and vascular crisis, thereby increasing the survival rate of replanted fingers and facilitating early rehabilitation of their function.
ObjectiveTracheobronchial foreign bodies (TFBs) aspiration is rare in adults,although it can occur at any age. This study aimed to report our experience in airway foreign body removal by flexible bronchoscopy in adult patients of central south China. MethodsA total of 244 patients with TFBs over the age of 14 years were reviewed retrospectively from January 1997 to February 2012. The incidence,risk factors,clinical manifestations,radiological findings,types and locations of TFBs were analyzed. ResultsAmong the 27719 patients,TFBs were found only in 0.88%(244) cases. The prevalence of TFB aspiration increased steadily with age beginning in the fifth decade. The incidence of TFBs was 0.62% among people aged 70 to 80 years. Risk factors such as cerebrovascular diseases and neural degenerative disease were found among 32 (6.6%) patients. Among 153 patients with clear history of foreign body aspiration,135 patients (88.2%) were addicted to the hot pepper. Paroxysmal cough (81.1%) was the most common clinical manifestations of TFBs. Only 12 cases (4.9%) were found with non-opaque foreign bodies by chest X-ray but 106 cases (43.4%) were found with opaque foreign bodies by chest CT. The most common indirect chest imaging findings were recurrent infections and consolidation of the same area.Bone fragments of animals was the most common type in foreign bodies (47.2%). The most common position of foreign bodies was the right bronchial (65.6%). Total foreign bodies of 234 patients (95.9%) had been successfully removed by flexible bronchoscopy. ConclusionAlthough TFBs is rare in adults in south China,but yield by flexible bronchoscopy (0.88%) is much higher than that is reported in western countries (0.32%-0.33%). Addiction to the hot pepper and speaking loudly when having dinner may be the major risk factor for high incidence in central south China.