The clinical respiratory journal
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Review Case Reports
Cryptogenic organizing pneumonia in Sweet's syndrome: case report and review of the literature.
Sweet's syndrome or acute febrile neutrophilic dermatosis is characterized by fever, leukocytosis and tender erythematous plaques, which show infiltration by mature neutrophils on histological examination. Pulmonary involvement is rare in Sweet's syndrome. ⋯ Cryptogenic organizing pneumonia is a rare manifestation of Sweet's syndrome, which may be complicated by respiratory failure. Prompt treatment with corticosteroids usually leads to clinical and radiographic improvement.
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Idiopathic pulmonary fibrosis (IPF) is characterized by hyperplasia of type II alveolar epithelial cells, aggregation of activated (myo)fibroblasts and excessive deposition of extracellular matrix, which will ultimately lead to lung architecture destruction with no proven effective therapies. Despite a significant increase in our understanding on the etiology and pathogenesis of IPF, the real triggers that initiate epithelial cell injury and promote fibrosis evolution are still elusive. We wanted to discuss the evolution of hypothesis on IPF pathogenesis and to suggest some new directions which need to be further elucidated. ⋯ Epithelium-dependent profibrotic milieu formation and mesenchymal activation is the current view on the pathogenesis of IPF. New evidence from more analogous animal models may emerge and shift our thinking to a new and more faithful concept in the future.
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Review Meta Analysis
Efficacy of intrapleural instillation of fibrinolytics for treating pleural empyema and parapneumonic effusion: a meta-analysis of randomized control trials.
The effects of intrapleural fibrinolysis for treating pleural empyema and parapneumonic effusion remain uncertain. ⋯ The present results show that intrapleural fibrinolysis with urokinase may be potentially effective for reducing the need for surgery. Intrapleural fibrinolytic therapy is effective for shortening the lengths of hospital stays without increasing the incidence of severe side effects.
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Current guidelines recommend tailoring of asthma management according to disease control, which is largely defined by increased symptoms and deterioration in lung function. These features do not reflect the severity nor the type of the asthmatic airway inflammation. Fractional exhaled nitric oxide (FE(NO)) is a simple, non-invasive and cost-effective online test applicable in both adults and children. In addition to symptoms and lung function measurements, FE(NO) reflects airway eosinophilia and hence allows online assessment of the corticosteroid-sensitive T helper 2 type airway inflammation in asthmatic patients. FE(NO) can thus be applied to aid asthma diagnosis and treatment monitoring both in clinical practice and for research purposes. ⋯ In several studies, FE(NO) measurements provided additional information on aspects of asthma including phenotyping, corticosteroid-responsiveness and disease control. Thus, if correctly applied and interpreted, FE(NO) can aid asthma diagnosis, identify patients at risk of exacerbation and support customized treatment decisions. A simple and reliable tool to quantify peripheral nitric oxide will further aid to identify patients with small airways inflammation.
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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published a strategy for diagnosis and for management of chronic obstructive pulmonary disease (COPD) since 2001 and this has formed the basis for numerous national and regional guidelines. ⋯ A more clinically oriented GOLD document will hopefully improve assessment and management of COPD.