Pulmonary fibrosis presenting as an early manifestation of microscopic polyangiitis

Microscopic polyangiitis (MPA) is a systemic small vessel vasculitis that is included in the pulmonary-renal syndromes. Although glomerulonephritis represents the major clinical feature of MPA indicative of renal involvement, diffuse alveolar haemorrhage is the classic manifestation of pulmonary involvement. However, pulmonary fibrosis is a less frequently reported pulmonary manifestation. Herein we describe a patient who was diagnosed with MPA presenting with radiographic evidence of pulmonary interstitial fibrosis as an early clinical manifestation accompanied by constitutional symptoms such as fever and weight loss. We also include a short literature review focusing on the association between pulmonary fibrosis and MPA

Simultaneous pulmonary and intrathoracic lymph nodal granulomatosis of unknown significance (GLUS)

A case of a 30-year-old male with a fever, dry cough and associated abnormal findings in imaging modalities (bilateral hilar lymphadenopathy and nodular parenchymal opacities) is described. After a further and scrutinized work-up, the diagnosis of GLUS syndrome was made. Clinical, etiological, pathological and therapeutical aspects of the disease are discussed, demonstrating the paramount importance of the use of the immunohistochemical methods in the diagnosis of this disorder

Breath biomarkers in idiopathic pulmonary fibrosis:A systematic review 11 Medical and Health Sciences

Background: Exhaled biomarkers may be related to disease processes in idiopathic pulmonary fibrosis (IPF) however their clinical role remains unclear. We performed a systematic review to investigate whether breath biomarkers discriminate between patients with IPF and healthy controls. We also assessed correlation with lung function, ability to distinguish diagnostic subgroups and change in response to treatment. Methods: MEDLINE, EMBASE and Web of Science databases were searched. Study selection was limited to adults with a diagnosis of IPF as per international guidelines. Results: Of 1014 studies screened, fourteen fulfilled selection criteria and included 257 IPF patients. Twenty individual biomarkers discriminated between IPF and controls and four showed correlation with lung function. Meta-analysis of three studies indicated mean (± SD) alveolar nitric oxide (CalvNO) levels were significantly higher in IPF (8.5 ± 5.5 ppb) than controls (4.4 ± 2.2 ppb). Markers of oxidative stress in exhaled breath condensate, such as hydrogen peroxide and 8-isoprostane, were also discriminatory. Two breathomic studies have isolated discriminative compounds using mass spectrometry. There was a lack of studies assessing relevant treatment and none assessed differences in diagnostic subgroups. Conclusions: Evidence suggests CalvNO is higher in IPF, although studies were limited by small sample size. Further breathomic work may identify biomarkers with diagnostic and prognostic potential

Popliteal Valvular Construction Using a Silastic Sling (Technique II) for Deep Venous Insufficiency of the Lower Limb

Objective: To establish the safety and efficacy of a silastic sling procedure for reconstructing popliteal vein. Design: Prospective survey of patients undergoing surgical treatment for popliteal vein reflux. Setting: Department of Surgery, County Hospital, Bad Karlshafen, Germany. Patients: 209 patients undergoing surgery for popliteal vein incompetence. Interventions: Silastic sling procedure (Technique II) for correction of popliteal vein incompetence. Main outcome measures: Continuous wave Doppler ultrasound examination of popliteal vein, ambulatory foot vein pressure measurements, lower limb venography. Results: One week following surgery 202 patients (of 209) reported relief of pain and reduction of limb oedema. 77 patients with ulcers (of 85) healed following the surgical procedure. Ambulatory venous pressure improved from 71 SD 11 mmHg to 36 SD 17 mmHg. There was prolongation of the venous refilling time from 9 SD 5 seconds to 27 SD 17 seconds. Postoperative phlebography in 92 patients was performed on the tenth post-operative day and in no patient was deep vein thrombosis observed. In 82 of these patients phlebography demonstrated that the constructed popliteal valve was patent. Conclusions: Construction of a popliteal valve using the author's silastic sling technique is a satisfactory method for managing patients with otherwise uncontrolled popliteal vein reflux due to either primary valvular failure or previous deep vein thrombosis. </jats:sec

Right-sided Bochdalek Hernia Presenting as a Solitary Pulmonary Nodule

Bochdalek hernia is a well-known disorder, which represents visceral herniation through a posterior diaphragmatic defect. In this report we present an adult man with a right-sided Bochdalek hernia mimicking a solitary pulmonary nodule. Furthermore, we perform a brief review of the literature, with emphasis on novel imaging techniques that establish the diagnosis. In conclusion, Bochdalek hernia should be considered in the differential diagnosis of a posterior diaphragmatic or paraspinal opacity. Correct diagnosis is of paramount importance and can be easily established by non-invasive imaging techniques