Perfect Health News - Part 5

HLA-DQw Alloantigens and Pulmonary Dysfunction in Rheumatoid ArthritisRheumatoid arthritis is associated with several pulmonary manifestations, including pleural effusions, interstitial pulmonary fibrosis, intrapulmonary rheumatoid nodules, Caplans syndrome, and bronchiolitis obliterans. An increased prevalence of obstructive or restrictive ventilatory defects (or both) has also been found in patients with rheumatoid arthritis. The relationship of these abnormalities to smoking in these patients remains controversial. We and others have reported that both abnormal pulmonary function and clinical pulmonary disease are associated with the presence of the HLA-DR4 antigen and keratoconjunctivitis sicca (secondary Sjogrens syndrome) regardless of smoking status. zyrtec tablets Read the rest of this entry »

Clinical Characteristics of the Patient with Nonspecific Pleuritis: ConclusionIt has been suggested previously that pleural biopsy will be a rewarding procedure in patients suspected. of having malignancy or granulomatous pleural disease. However, the reliability of clinical suspicion will vary depending on the expertise of the physician. To facilitate the recognition of patients in whom this procedure is likely to yield a specific diagnosis, we advocate combining all five objective criteria identified in this study into a single test which is positive when any criterion is present. When used in this manner, the criteria are extremely sensitive, as 97 percent of the patients with either cancer or granulomatous pleuritis had at least one criterion (Fig 2). buy levlen online Read the rest of this entry »

Repeat pleural biopsy was a rewarding procedure in those patients whp were ultimately diagnosed to have either malignant or granulomatous pleuritis. The yield of the second pleural biopsy, 55 percent, was actually slightly higher than the 48 percent obtained on the first pleural biopsy. Pleural involvement in both these disorders usually is due to focal seeding with numerous malignant nodules or granulomas. Therefore, it should not be surprising that a second biopsy performed at a different site would increase the frequency with which a diagnosis is obtained. Malignancy can also produce blockage of the mediastinal lymphatics and interfere with the reabsorption of pleural fluid, thereby causing the accumulation of the pleural fluid in the absence of direct pleural invasion. This presumably was the reason for the effusions in the 14 patients with documented endobronchial cancer. Their rapidly progressive course, which was similar to that of the patients with documented pleural dissemination, argues against a coincidental nonmalignant etiology for their effusion and is consistent with the previously observed poor prognosis for patients with bronchogenic carcinoma and pleural disease. read more Read the rest of this entry »

Clinical Characteristics of the Patient with Nonspecific Pleuritis: DiscussionThe results of the present study are consistent with previous studies indicating that closed needle biopsy of the pleura is a valuable diagnostic technique in the evaluation of the unexplained pleural effusion. However, in contrast to many of these earlier reports, the patients in this study represented a highly selected population. Virtually all of the patients in the present study had a diagnostic thoracocentesis performed prior to the first pleural biopsy. Pleural fluid from this initial thoracocentesis was generally submitted for both bac-teriologic studies and cytologic examination. If the results of either of these tests had been positive, a pleural biopsy would not have been performed. Furthermore, many other patients with exudative effusions who were seen in consultation by the pulmonary service during the period of the study did not have a pleural biopsy because the etiology of their effusion was obvious, eg, a parapneumonic effusion in a patient with pneumonia. Thus, most of the patients in the present study truly had an unexplained pleural effusion after initial evaluation including a diagnostic thoracocentesis. However, since thoracocentesis is routinely performed by most physicians, the patients in the present study were probably representative of those who would be referred to a specialist for biopsy. cipro tablets Read the rest of this entry »

The 53 patients with nonspecific pleuritis were followed for a mean of 33 (±3) months. Forty-six (87 percent) of these 53 patients were no longer symptomatic and 34 (64 percent) had complete roent-genograhic resolution of their pleural disease. The other 12 asymptomatic patients still had residual pleural thickening and/or small effusions which were markedly improved when compared to their roentgenogram at the time of the pleural biopsy. Three patients with nonspecific pleuritis on biopsy had progressive pleural disease. The effusion of the patient with lymphoma who clinically was a false negative had increased in size at the time of his death, two months after a nondiagnostic biopsy. Another patient died of an acute myocardial infarction five months after pleural biopsy; autopsy confirmed the cause of death and revealed no evidence of malignancy or granulomatous disease in this individual. The third patient with nonspecific pleuritis on biopsy and progressive symptoms is suffering from severe biventricular heart failure 48 months after his original pleural biopsy. alesse birth control Read the rest of this entry »

Clinical Characteristics of the Patient with Nonspecific Pleuritis: PPDThe reaction to intermediate strength PPD was tested in 22 of the 23 patients with tuberculous granulomatous pleuritis and was positive in 20 (91 percent) of these individuals. Two additional patients with granulomatous pleuritis secondary to blastomycosis and sarcoidosis both had negative PPDs. The frequency of a positive PPD was significantly higher (p<0.001) in the patients with granulomatous pleuritis when compared to the other two groups. The white blood cell count of the pleural fluid was similar (p>0.2) in all three groups. The percentage of cells in the pleural fluid which were lymphocytes was significantly higher in the patients with granulomatous pleuritis than in the patients with nonspecific pleuritis, but the overlap was considerable (Fig 1). add comment Read the rest of this entry »

The first pleural biopsy was diagnostic of malignancy or granulomatous pleuritis in 32 (48 percent) of the 66 patients who were ultimately diagnosed to have either of these disorders. Eighty-seven patients had an initial pleural biopsy consistent with nonspecific pleuritis. Pleural tissue was identified in each of these biopsy specimens. Forty-five of the 87 patients underwent another closed pleural biopsy; 20 of these patients were ultimately diagnosed as having either malignant or granulomatous pleuritis, and this second procedure indicated a specific etiology in 11 (55 percent) of the 20 patients. In three of the 11 patients, the pleural biopsy was nondiagnostic, but the pleural fluid cytologic findings were positive. Read the rest of this entry »