Objective To observe the clinical features of death cases which caused by tuberculosis.Methods This study was performed retrospectively with data collected over the years 1980 to 2015 in Beijing hospital.There were 11 disseminated TB patients diagnosed by autopsy,none of them was correctly diagnosed before death.Clinical data and autopsy result were recorded to analyze the causes of misdiagnosis.Results Male/female ratio was 2.7 ∶ 1.The average age was 73.09 ± 13.38.Four cases were long-term health care residents,nine cases suffered from other chronic diseases.Multiple organs were found with diffused granulomatous nodule and caseous necrosis in autopsy.The main cause of death was hematogenous disseminated tuberculosis.The common involved organs were lung (100％),spleen (91 ％) and liver (82 ％).Fever (10 eases) and fatigue (8 cases) were the most common symptoms,while cough and sputum were not serious.Pulmonary rales (7 cases) and hepatosplenomegaly (7 cases) were the most common signs.Chest X-ray was done in 9 cases and all were negative for typical evidence of miliary TB.TB related specific tests were done in 6 cases and all negative.Conclusions The main cause of TB death is hematogenous disseminated pulmonary tuberculosis with extra pulmonary tuberculosis.Elderly people are easy to be affected.Clinical symptom and imaging are atypical.Positive rate for auxiliary exam is low.Both lead to difficulties in early diagnosis and poor prognosis.

Recently awareness of the importance of Aspergillus colonization in the airway of patients with chronic obstructive pulmonary disease (COPD) was rising. The aim of this study was to investigate the clinical features and short-term outcomes of COPD patients with Aspergillus colonization during acute exacerbation.

OBJECTIVE To explore the relationship between desmosine plasma levels and exacerbation risk in patients with chronic obstructive pulmonary disease (COPD). METHODS COPD patients and normal subjects were recruited from Beijing Hospital during March 2013 to March 2014. COPD patients were divided into COPD low risk and COPD high risk groups according to the criteria of Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy. The plasma concentrations of desmosine were measured by enzyme-linked immunosorbent assay (ELISA) for exploring the inter-group difference in desmosine levels. RESULTS Sixty-three COPD patients (COPD low risk group, n = 30; COPD high risk group, n = 33) and 50 normal subjects (24 healthy non-smokers, 26 healthy smokers) were recruited. The plasma desmosine concentrations in healthy non-smokers, healthy smokers, low risk and high risk COPD patients were (200 ± 159), (191 ± 105), (197 ± 118) and (131 ± 47) ng/L respectively. The plasma concentration of desmosine was significantly lower in COPD high risk group than healthy non-smokers (mean difference -70, 95%CI: -128--11, P = 0.021), healthy smokers (mean difference -60, 95%CI: -118--3, P = 0.039) and COPD low risk group (mean difference -67, 95%CI: -122--12, P = 0.018). The plasma concentration of desmosine was negatively correlated with exacerbation frequency (r = -0.409, P = 0.002), mMRC scores (r = -0.447, P = 0.010) and emphysema severity (r = -0.386, P = 0.047) in COPD patients. No significant correlation existed between desmosine plasma levels and forced expiratory volume in one second (FEV1%pred) in COPD patients (r = 0.225, P = 0.084). CONCLUSIONS The plasma levels of desmosine are lower in high risk COPD patients than those in normal subjects or low risk COPD patients. And it is negatively correlated with exacerbation frequency in COPD patients.

BACKGROUND:Exacerbations of chronic obstructive pulmonary disease (COPD) increase the decline in lung function, deterioration in health status and risk of death. The assessment of exacerbation risk is important in the grading of COPD. The most common cause of COPD exacerbation is respiratory tract infection. The only known human cathelicidin antimicrobial peptide, LL-37, play an important role in innate defense against infection. Its gene expression is regulated by the bioactive form of vitamin D. The objective of the present study was to explore the relationship between LL-37 plasma levels, vitamin D status and exacerbation risk in patients with COPD.METHODS:COPD patients and normal subjects were recruited from Beijing Hospital for this study. COPD patients were divided into low risk group and high risk group according to the criteria of GOLD strategy. The plasma concentrations of LL-37 were measured by ELISA technique to explore the difference in LL-37 levels between groups. The plasma levels of 25-hydroxy vitamin D [25(OH)D] were analyzed using electrochemiluminescence immunoassay (ECLIA).RESULTS:A total of 84 COPD patients and 51 normal subjects (control group) were recruited. COPD patients were divided into low risk group (37 cases) and high risk group (47 cases), depending on forced expiratory volume in one second (FEV1)%pred and exacerbation frequency in the previous year. The plasma concentrations of LL-37 in control group, low risk group and high risk group were 20.7±5.8, 19.5±4.1 and 17.9±3.9 µg/L respectively. The plasma concentration of LL-37 was significantly lower in high risk group than in control group (P=0.006). But there was no significant difference between low risk group and high risk group (P=0.152). The plasma concentrations of 25(OH)D in control group, low risk group and high risk group were 18.1±9.4, 13.1±6.9 and 9.3±5.8 ng/mL respectively. The plasma concentration of 25(OH)D was significantly higher in control group than in low risk group (P=0.004) or high risk group (P<0.001). The plasma concentration of 25(OH)D was significantly lower in high risk group than in low risk group (P=0.031). Hospitalization frequency for COPD exacerbations was negative correlated with plasma levels of LL-37 (r=-0.290, P=0.048) and 25(OH)D (r=-0.341, P=0.020) in high risk group. There was not significant correlation between LL-37 and 25(OH)D in COPD patients (r=0.115, P=0.303).CONCLUSIONS:The plasma levels of LL-37 and 25(OH)D were lower in COPD patients with high risk of frequent exacerbations than normal subjects. Low plasma levels of LL-37 and 25(OH)D might be predictors of exacerbation risk in COPD patients.

OBJECTIVE To explore the clinicopathological characteristics of aspiration pneumonia in the elderly. METHODS The clinical data of 30 cases of autopsy-proven aspiration pneumonia in Beijing Hospital from 1973 to 2002 were reviewed. The patients consisted of 28 males and 2 females, aged from 63 to 103 [mean (83 ± 9)] years. RESULTS Only 15 cases were clinically diagnosed as aspiration pneumonia before death. Concomitant diseases were severe and complex, mostly coronary disease, cerebrovascular disease, hypertension, COPD, and diabetes mellitus. All the patients suffered from at least 3 concomitant diseases. Long-term bedridden and nasogastric feeding was seen in 11 and 17 patients respectively. The clinical presentation and chest X-ray of aspiration pneumonia in the elderly were nonspecific and variable. Mixed infections were common . The main bacteria isolated were Gram-negative bacilli, in particular Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Escherichia coli and Candida albicans. By pathology, macrophages with foreign bodies were found in all the 30 cases and multiple small abscesses were found in 14 cases. The lesions were adjacent to the bronchioles and in the lung tissue around the bronchioles, mostly multi-lobar and bilateral. Unilateral or bilateral pleural effusion developed in 20 patients. The accordance between radiological and pathological diagnosis of aspiration pneumonia was very poor. The foci of infection detected by X-ray were proven by autopsy in 13 patients, while pleural effusions in X-ray were proven by autopsy in 15 patients. CONCLUSIONS Multi-concomitant diseases, mixed infection and extra-pulmonary presentations were common in elderly patients with aspiration pneumonia. Multiple small abscesses were the pathological characteristics of aspiration pneumonia in the aged. A definite clinical diagnosis of aspiration pneumonia was difficult. Recurrent silent microaspiration was a feature of aspiration in the elderly. The assessment of risk factor of aspiration played an important role in the clinical diagnosis of aspiration pneumonia.

Objective To explore the clinical characteristics,relationship between treatment and prognosis of sarcoidosis and relationship of relapse to prednisone.Methods The clinical data of 165 patients with sarcoidosis were collected.The clinical characteristics,treatment process and prognosis,relationship of relapse with prednisone maintenance dose and course of treatment were retrospective analyzed.Results Among them,the most common involved systems were lung and lymph nodes.The involvement rates of lung,extra-thorax lymph nodes,cutaneous,ocular,salivary glands,liver & spleen,kidney and nervous system was 87.3％,51.5％,6.7％,6.1％,6.1％,4.2％,1.2％ and 1.2％ respectively.Unilateral tonsil,breast,ovary and bone involvement was seen in only 1 patient respectively with an involvement rate of 0.6％.A retrospective analysis was made for 114 cases with complete follow-up data.The mean follow-up period was (11.7 ± 5.7) (5-32) years.And 46 cases had no symptom on routine medical examinations.The most common consulted departments were respiratory,dermatological and general surgery departments.Among 74 patients on prednisone,48 patients (64.9％) were cured while 13 patients (17.6％) relapsed.Whereas in the observation group,25/38 patients (65.8％) remitted spontaneously and only 1 patient (2.6％) had recurrence.Relapse occurred more often in prednisone therapy group than in observation group (P ＜ 0.05).Longer prednisone 10-15 mg daily maintenance and a longer total course of treatment were associated with fewer recurrence(P ＜ 0.05).Conclusions The clinical manifestations of sarcoidosis vary and many patients have a self-limiting course.The most common involved systems are lung and lymph nodes.Stage Ⅰ / Ⅱ disease should be observed before prednisone therapy.Prednisone 10-15 mg daily for at least 6 months and a total course of treatment over 18 months may prevent relapse.

Objective To compare clinical features,pulmonary functions,chest imaging and prognosis between combined pulmonary fibrosis and emphysema syndrome (CPFE) and idiopathic pulmonary fibrosis(IPF) without emphysematous changes in elderly patients.Methods 88 elderly IPF patients in Beijing hospital from January 2000 to October 2012 were divided into CPFE (n=30) and IPF (n =58) groups according to the CT imaging.Clinical features,blood gas analysis,pulmonary function,chest CT and survival time were compared between the two groups.Results 30 CPFE patients with the mean age of(75.5 ±7.6) years and 58 IPF patients without emphysema with the mean age of(73.7±6.8) years were enrolled.The proportions of male patients,smoking history and mortality were higher in CPFE patients than in IPF group(86.7％ vs.63.8％,28 vs.36,76.7％ vs.43.1％,x2 =5.09,9.74,8.98,P＜0.05 or 0.01).CPFE patients had a higher force vital capacity(FVC) and total lung capacity(TLC) as compared with IPF group [(2.6±0.9) L vs.(2.1± 0.5) L,(5.4±1.9) L vs.(4.4±1.1) L,t=2.69,2.35,P＜0.01 or 0.05].There were no significant differences in forced expiratory volume in one second(FEV1) and the diffusion capacity for carbon monoxide(DLCO) between the two groups.The main type of emphysema by HRCT scan were centrilobular emphysema in CPFE patients.There were lower median survival time in CPFE group than in IPF group [(3.0±0.2) years vs.(4.0±1.0) years,x2=4.50,P＜0.05].Conclusions The majority of elderly CPFE patients are males and smokers.The lung volume is increased in elderly CPFE patients as compared with IPF patients.Centrilobular emphysema is the primary type in CPFE patients.The prognosis is worse in elderly CPFE patients than in IPF patients.

患者男性,81岁,体重61 kg.因咳嗽、咳痰伴气短1周,肉眼血尿1次于2010年5月21日入我院.入院后胸部CT:双肺多发斑片状磨玻璃影.血清抗中性粒细胞胞浆抗体阳性.经院内外专家会诊诊断:系统性坏死性肺血管炎.予甲泼尼龙(静脉滴注500 ～ 120 mg/d,5周,继之口服72～28mg/d,6周)联合环磷酰胺(静脉注射0.2g,2次/周,12周,总量4.6g)及抗感染(静脉滴注美罗培南1.5g/d,9d;静脉滴注头孢哌酮-舒巴坦3 g/d,6d)、无创机械通气治疗后,患者症状逐渐缓解,复查胸部CT:双肺多发斑片状磨玻璃影逐渐吸收.8月16日患者诉右胸部肋间酸胀感,伴咳嗽、咳少量白痰.

Objective To explore the cause and clinical manifestation of bronchial anthracofibrosis.Methods The clinical features,radiological findings,bronchoscopic natures,and histological characteristics of four cases of bronchial anthracofibrosis were analyzed and summarized,and the relevant literatures were reviewed.Results The principal finding of bronchoscopy was anthracotic pigmentation of bronchial mucosa with bronchial stenosis.Chest CT revealed lobal or segmental consolidation,segmental or subsegmental atelectasis,calcified and uncalcified lymph nodes.Pathologic examination of the specimens obtained by bronchoscopic biopsy showed chronic mucosal inflammation,or granulomatous inflammation,dense mucosal fibrosis with anthracotic pigmentation.Conclusions Bronchial anthracofibrosis is a clinical syndrome rather than a disease.The precise cause of bronchial anthracofibrosis is unknown.Bronchial anthracofibrosis might be associated with active or old tuberculosis,mineral dust exposure and autoimmune diseases.

OBJECTIVE:To describe the clinical manifestations and diagnosis of pulmonary mucormycosis.METHODS:We presented 5 proven diagnosed cases of pulmonary mucormycosis in our hospital and reviewed all proven cases of pulmonary mucormycosis previously reported in mainland China. Publications in the form of case reports and articles between January 1982 and December 2011 were searched from Wan Fang Data and China Hospital Knowledge Database.RESULTS:Of the 5 patients in our hospital, the main symptoms included cough, fever, and hemoptysis. Two cases were diagnosed by transbronchial lung biopsy (TBLB), 1 by surgery, 1 by CT-guided percutaneous lung biopsy, and 1 by blood culture. Three patients were cured by antifungal chemotherapy alone, 1 was cured by surgery, and 1 died. Forty-six proven diagnosed cases of pulmonary mucormycosis were retrieved from Wan Fang Data and China Hospital Knowledge Database using key word (pulmonary mucormycosis). Of the 51 patients in total, there were 31 males and 20 females, with a mean age of (47 ± 13)years. The most common risk factors for pulmonary mucormycosis were poorly controlled diabetes mellitus (18 cases), administration of immunosuppressants (7 cases), malignancy (5 cases) and kidney diseases (5 cases). Chest CT showed nodules (27 cases), infiltrates (21 cases), and cavities (18 cases). White blood cell count and neutrophil percentage were elevated in 26 patients. Eighteen cases were diagnosed by histological study of transbronchial biopsy or TBLB specimen. The diagnosis was proven with surgical specimen in 15 patients, CT-guided percutaneous lung biopsy specimen in 7 patients, autopsy in 4 patients, skin biopsy in 1 patient, and renal biopsy in one patient. Three cases were diagnosed by pleural effusion cultures and 2 were diagnosed by blood cultures. Administration of low-dose liposomal amphotericin B (AMB) alone or combined with posaconazole in 12 patients were effective and safe. Fourteen patients who had received surgical resection were cured.CONCLUSIONS:There were no specific clinical features of pulmonary mucormycosis. Transbronchial biopsy and CT-guided percutaneous lung biopsy are useful diagnostic tools for pulmonary mucormycosis. Surgical resection and administration of low-dose liposomal AMB alone or combined with posaconazole were all effective and safe.

OBJECTIVE:To describe the epidemiology of endobronchial lipoma and to propose appropriate diagnostic and therapeutic policies for this tumor.METHODS:Two cases of endobronchial lipoma were presented and 38 cases reported in literatures published in mainland China were reviewed.RESULTS:Thirty-one male and 9 female patients were included, with a mean age of (53 ± 11) years. The overwhelming majority of the tumors (n = 37) were found in the trachea, left or right main bronchi and lobular bronchi. The main symptoms included cough, dyspnea, fever and hemoptysis. Chest CT showed fat or soft tissue density endobronchial masses in 75% (21/28) cases. Eight patients (22.2%) were diagnosed by histological study of the transbronchial biopsy specimen. Thirty-two patients underwent surgical resection. Bronchoscopic resection was carried out in 7 cases.CONCLUSION:CT and bronchoscope are highly useful diagnostic tools for endobronchial lipoma. Bronchoscopic resection should be considered as the first choice of treatment for endobronchial lipoma.

目的 了解气管支气管脂肪瘤临床特征,分析误诊原因,寻求早期诊断方法及合理诊治方案.方法 回顾分析我院2例气管支气管脂肪瘤及国内文献报道病理检查确诊的38例气管支气管脂肪瘤临床资料.结果 本组40例,22例误诊,误诊率55.0％.误诊为支气管哮喘7例、支气管炎6例、肺炎及肺癌各4例、支气管息肉1例,中位误诊时间12个月.经支气管镜活检病理确诊8例(20.0％),经支气管镜介入治疗后取出气管内肿物病理检查诊断3例(7.5％),行外科手术后病理检查确诊29例(72.5％).误诊原因主要与临床表现无特异性、胸部X线检查未显示气管内肿物、支气管镜活检病理诊断率低等有关.结论 气管支气管脂肪瘤临床诊断困难,胸部CT、MRI等影像学检查可发现气道内肿物,CT值测定有助于诊断.经支气管镜活检病理诊断率较低,需多点活检,必要时行手术探查.本病首选经支气管镜介入治疗.

Objective To describe the epidemiology of endobronchial lipoma and to propose appropriate diagnostic and therapeutic policies for this tumor.Methods Two cases of endobronchial lipoma were presented and 38 cases reported in literatures published in mainland China were reviewed.Results Thirty-one male and 9 female patients were included,with a mean age of ( 53 ± 11 ) years.The overwhelming majority of the tumors (n =37) were found in the trachea,left or right main bronchi and lobular bronchi.The main symptoms included cough,dyspnea,fever and hemoptysis. Chest CT showed fat or soft tissue density endobronchial masses in 75％ ( 21/28 ) cases. Eight patients ( 22.2％ ) were diagnosed by histological study of the transbronchial biopsy specimen.Thirty-two patients underwent surgical resection.Bronchoscopic resection was carried out in 7 cases.Conclusion CT and bronchoscope are highly useful diagnostic tools for endobronchial lipoma.Bronchoscopic resection should be considered as the first choice of treatment for endobronchial lipoma.