The article describes the clinical case of Langerhans cell histiocytosis with lesions in lungs and flat bones in a 40-year-old smoker. During 4 years, all stages of the disease were followed. The diagnosis was made basing on the results of thoracoscopic lung biopsy. Treatment with a cytostatic drug and smoking cessation resulted in positive X-ray changes.
Ground glass opacities, mosaic perfusion, areas of air-trapping on a computed tomography of the lung are one of the most frequent x-ray syndromes. It`s are one of the kind of syndromes increase the density of pulmonary parenchyma. It is important to remember that the syndromes of ground glass opacities, mosaic perfusion, areas of air-trapping involve the differential diagnosis and not a diagnosis in itself. Differential diagnostic range very wide, since this syndrome commonly occurs in diseases that affect small bronchi, pulmonary vessels, alveoli and interstitial tissue. It is often observed a combination of lesions of various components of the pulmonary parenchyma. These combinations often help the doctor find the key to the correct diagnosis. Another problem in the evaluation of these syndromes are the distinction between pathological and “healthy” areas of lung tissue. Thus, in certain diseases, regions with higher density of the lung tissue may be normal lung parenchyma. The aim of this lecture is to analyze the reasons for the formation of the CT-types of ground glass opacities, mosaic perfusion, areas of air-trapping in norm and pathology, selection of distinctive features, allowing determining the elements of the lung parenchyma, the underlying pathological process, thereby narrowing the differential diagnosis of several diseases.
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality in the world. Exacerbations of COPD is considered an independent risk factor for pulmonary embolism (PE). PE is also significant problem of modern medicine, because mortality in PE remains at a high level. Exacerbations of COPD are heterogeneous as by etiology as by phenotype of the inflammatory response. It is presents the clinical case of PE in patient with acute exacerbation of COPD with eosinophilic phenotype of inflammation. It was the presence of a floating venous thrombus in the patient, which could become a source of repeated PE at any time. The patient underwent endovascular intervention — thrombus fragmentation and thromboaspiration. Given the signs of eosinophilic inflammation, systemic glucocorticosteroids have also been prescribed. The result of the intervention was a regression of respiratory failure and pulmonary hypertension.
Arterial hypertension (AH) is highlighted as a complication of bronchopulmonary dys-plasia (BPD) in children. The review provides information on the incidence, pathophysiology, diagnosis and treatment of AH in children with BPD. After analyzing the studies, were identified risk factors for hypertension in children with BPD, the role of endothelial dysfunction in raising systemic blood pressure, analyzed therapy and consequences of AH in children with BPD.
The purpose of this study is to evaluate the ability of systemic glucocorticosteroids administered during the exacerbation of the disease to have a modifying effect on the qualitative and quantitative composition of the oropharyngeal microbiota. Material and methods. The study included 88 patients with COPD and 50 patients with stable asthma. The patients have had a history of observation for twelve months or more; they are characterized by the absence of exacerbations and systemic antibiotic therapy for four weeks or more prior to inclusion in the study. Also, all patients participating in the study were taken samples of oropharyngeal microbiota for isolating bacterial DNA and sequencing 16S rRNA gene sequences followed by the analysis of the taxonomic composition of the microbiota. Generalized linear model implemented in the R programming language version 3.1.0, glm2 package was used to identify the relationship between taxonomic composition of metagenomes and metadata. Results. The study suggests that the use of systemic glucocorticosteroids administered during the exacerbation of asthma and COPD modifies the composition of the respiratory microbiome in the period of stability increasing the oropharyngeal representation of non-pathogenic bacteria such as Bacteroidetes (including members of the genus Prevotella) and reducing bacterial contamination of oropharyngeal swabs by proteobacteria especially Streptococcus, and Haemophilus, which includes pathogens.
Aim. To establish biomarkers for clinical, radiological, and laboratory severity of COVID-19 infection and to identify their relationships. Materials and methods. A retrospective study was carried out which included 155 patients undergoing treatment at the Hospital for War Veterans No. 3 with a confirmed diagnosis of novel coronavirus infection caused by nCoV from April 6 to June 10, 2020. All patients underwent clinical and laboratory examination. An intergroup statistical analysis of clinical and laboratory parameters was carried out depending on the criteria of clinical severity and severity of radiological signs of chest organ pathology according to computed tomography (CT). Results. Patients with mild COVID-19 showed a lower level of leukocytes, urea, creatinine, bilirubin, and aspartate dehydrogenase (AsAT), as opposed to the corresponding levels in patients with extremely severe course of the disease. A lower level of calcium in the peripheral blood was found in patients with severe COVID-19, along with an increase in blood glucose. Patients from the CT1 group as well as patients with a clinically mild course of the novel coronavirus infection had significantly lower levels of neutrophils, urea, creatinine, AsAT, and blood glucose and a higher level of blood calcium in comparison with patients with various CT patterns. In the group of patients with a fatal outcome, cardiovascular diseases were significantly more often detected, as opposed to the discharged patients. Conclusion. A number of biomarkers characterizing the severity of the novel coronavirus infection caused by the SARS-CoV-2 virus have been identified. However, the revealed differences in the laboratory markers of the clinical and radiological severity of the disease do not currently allow to give a clear answer about the nature of the relationship between the clinical severity of the disease, CT findings, and laboratory indicators of COVID-19 severity.
This review summarizes the results of studies on the composition of microbial communities in the airways of healthy individuals and patients with asthma. Modern molecular genetic technology of the microbial identification, which are based on a sequence determination of encoding proteins genes conserved regions. These regions form the 16s-subunit ribosomal RNA in microorganisms of different species. These genes are detected by sequencing markers characteristic of individual microorganisms and their phylogenetic groups, and allow to perform a deep analysis of the microbiota in healthy volunteers and patients with chronic bronchoobstructive diseases. So, apparently healthy human bronchial tree is characterized by low bacterial contamination (most typical representatives here are the genera Pseudomonas, Streptococcus, Prevotella, Fusobacteria and Veilonella, much less potentially pathogenic Haemophilus and Neisseria are represented). In bronchial asthma patients the lower respiratory tract microbiota undergoes a qualitative transformation: as compared to healthy individuals the number of Proteobacteria increases and the number of Bacteroidetes decreases. Severe asthma in children is associated with significant respiratory tract Staphylococcus spp. insemination. Association between the asthma developing higher risk in young children and organisms such as Haemophilus, Moraxella and Neisseria spp. It is of considerable interest to determine the role of the microbiome in the development of human diseases of the bronchopulmonary system, and to understand the impact of the microbes communities as a course of disease and the important factor for the development of resistance to therapy.
Hepatopulmonary syndrome is a severe complication of chronic liver diseases, significantly reducing the quality and duration of patient’s lives, the pathogenetic manifestation of which is hypoxemia and intrapulmonary vasodilation. The disease is widespread enough: according to some authors, up to 35 % of patients with the terminal stage of liver damage suffer from this syndrome. The main clinical manifestation is progressive dyspnea with possible occurrence of platypnea and orthodexia. Diagnosis is difficult, since the “gold standard” — transthoracic echocardiography with intravenous injection of contrast agent — is an invasive procedure requiring specific equipment, that’s why it is poorly used in medical institutions of the Russian Federation. Physical examination is used as an additional method, in which we see dyspnea, cyanosis, spider nevi, digital clubbing, but these manifestations are not highly specific. Therefore, there is an urgent need for minimally invasive, widespread diagnostic methods and clinical markers that can provide early verification of the diagnosis. This review presents data on the prevalence, pathogenesis, clinical presentation, diagnosis and treatment of this syndrome. The aim of this review is to structure the current data and the accumulated experience for an earlier verification of the diagnosis and accordingly, to apply the optimal management tactics for patients with this pathology. Liver transplantation is currently the main effective method of treatment. Patients with hepatopulmonary syndrome who underwent liver transplantation have been proven to have better survival rate.
As a rule, heart damage in patients with sarcoidosis of respiratory organs (SOD) is not diagnosed in time, so a very important and urgent task is to identify common heart rhythm and conduction disorders. The aim of the study was to investigate the main clinical manifestations of sarcoidosis in SOD, depending on the peculiarities of the disease course and to compare the frequency and severity of pulmonary and extrapulmonary manifestations of sarcoidosis, including myocardial lesions and electrocardiographic (ECG) signs of heart rhythm disorders. Methods . In the period 2006– 2016, the pilot open prospective uncontrolled study conducted at the Pulmonology Department of the Regional State Autonomous Healthcare Institution "Tomsk Regional Clinical Hospital" included patients (n = 84) aged 20–67 years with the diagnosis of SOD. Patients were divided into 2 clinical groups: the 1st comprised 45 (53.5%) patients with a favorable course of sarcoidosis, the second one included 39 (46.4%) patients with an unfavorable course of the disease. A full range of studies was carried out, including the analysis of medical history and clinical and epidemiological data, instrumental methods (including ECG and Holter ECG monitoring (HM), pathomorphological study of lung biopsy samples. Results . According to the data of frequency analysis of occurrence of pulmonary and extrapulmonary clinical manifestations in ODS, it was shown that the leading clinical manifestations, most frequently occurring in patients of both groups, included asthenia syndrome (72.6%), bronchial syndrome (66.7%) and fever syndrome (33%). In 33% of cases, clinical manifestations of myocardial damage were detected. In 41 (51.2%) patients in both groups, changes on ECG were recorded at rest. Regardless of the course of the disease, in 23.5% of patients of both clinical groups, according to the results of the HM ECG, rhythm and conduction disturbances were found – a combination of ventricular arrhythmias and conduction disorders (ventricular extrasystole and right His bundle branch block of various degrees) and a combination of supraventricular arrhythmias and conduction disturbances (supraventricular extrasystole and right His bundle branch block of various degrees). Conclusion . Thus, regardless of the severity of the disease course, SOD patients are concerned about complaints from both respiratory system and extrapulmonary manifestations, including cardiac complaints, as well as heart rhythm and conduction disorders (according to the results of ECG and HM ECG), the frequency of which, according to the comparative analysis, has not significantly changed in both clinical groups, which indicates the non-specific character of clinical manifestations.
