肝移植术后非感染性肺部并发症原因及其防治

肝移植现已被广泛应用于肝硬化、Wilson病、肝细胞肝癌等的治疗,术后出现的肺部并发症非常常见,且对术后肝功能的恢复及围手术期病死率有重要影响。现重点针对肝移植术后的非感染性肺部并发症——胸腔积液、急性肺水肿、急性呼吸衰竭、肺不张的原因及其防治作一综述。     

血液疾病的肺部病变

血液疾病,特别是血液系统肿瘤合并肺部病变的发生率较高,临床表现多种多样,且诊断与治疗目前尚存在不少难点。本文拟以白血病和恶性淋巴瘤为主的肺部病变（分成感染性和非感染性）进行综述。     

血液疾病的肺部病变

血液疾病,特别是血液系统肿瘤合并肺部病变的发生率较高,临床表现多种多样,且诊断与治疗目前尚存在不少难点.本文拟以白血病和恶性淋巴瘤为主的肺部病变(分成感染性和非感染性)进行综述.     

造血干细胞移植后肺部非感染性并发症

造血干细胞移植现已在临床上广为应用,移植后肺部非感染性并发症的发生率和死亡率较高,已受到广泛关注。本文综述了造血干细胞移植后的多种肺部非感染性并发症的特点,以期为临床工作提供帮助。     

实体器官移植后非感染性肺部并发症的诊断与治疗

实体器官移植现已被广泛应用于重要器官功能衰竭、恶性肿瘤和遗传性疾病的治疗。移植术后出现的肺部并发症是引起移植后发病和死亡的重要原因,与移植患者的免疫抑制状态;外科手术术式;以及术前大剂量的放化疗预处理等密切相关。本文分别对实体器官如肝、肺、肾和心脏移植后的非感染性肺部并发症的诊治、肺部感染性和非感染性并发症的鉴别作一综述。     

非HIV感染免疫损害宿主肺部感染的诊断

肺部并发症是影响实体器官移植和其它HIV阴性免疫损害宿主长期疗效的主要因素之一。其病因众多,包括感染性病变和非感染性原因。其中感染性病变占2/3以上。病因包括细菌、真菌和病毒、卡氏肺孢子菌等。早期使用侵袭性诊断措施,尤其是支气管镜的检查在病因的鉴别诊断中起了较大作用。而诊断延迟5天以上,死亡率增加3倍以上。本文对合并肺部感染的诊断措施和诊断原则进行了综述。     

成人急性腹泻诊治

急性腹泻的病因众多,本文仅就成人急性感染性腹泻作一回顾。 急性感染性腹泻可分炎症性和非炎症性两类,前者主要侵犯结肠,粪内含大量白细胞;后者是由病毒或产生肠毒素的细菌粘附于小肠粘     

HIV／AIDS患者非感染性肺部并发症研究近况

肺部并发症是HIV／AIDS患者发病和病死的主要原因，尸检发现肺是AIDS患者最常受累的器官。众所周知，AIDS患者的感染性肺部并发症非常多见，例如肺孢子菌肺炎（PCP）、肺结核、严重的细菌性肺炎等等。非感染性并发症，如恶性肿瘤、肺动脉高压、淋巴增生性疾病等，在AIDS患者中也很常见。本文就这方面的研究近况进行综述。     

老年急性发热住院患者的病因分析

目的探讨老年急性发热住院患者的病因。方法回顾性分析2010年6月1日至2011年5月31日因急性发热人住我院接受治疗的800例老年患者的临床资料。结果感染性发热患者676例（84．50％），其中呼吸系统疾病385例（48．13％）、消化系统139例（17．38％）、卒中相关性感染61例（7．63％）、泌尿系统疾病50例（6．25％）。非感染性疾病占124例（15．50％），其它为常见肿瘤疾病57例（7．13％）、结缔组织病13例（1．63％），另有37例患者（4．63％）具体发热病因不清楚。结论感染性疾病是老年急性发热入院的主要病因，尤其以呼吸道肺部感染多见、并随着年龄的增加肺部感染的发病率进一步增加。老年人急性发热患者显示有自身的病因及特点。     

急性白血病的肺浸润

急性白血病是一种循环中的血细胞疾病,因此,体内发现白血病细胞浸润多个器官是不足为奇的。有效化疗问世前,尸检时在许多器官见到白血病的浸润。但是这些浸润很少影响正常器官功能,因而临床意义不大。在连续50例急性白血病尸检的肺脏中,发现66%病例有白血病性浸润,仅2例有症状可能与白血病性浸润有关。肺白血病的细胞浸润可发生在肺泡、支气管周围、血管周围或胸膜下。肺浸润程度与外周血循环中的白血病细胞数有关。曾观察到肺血管有白血病细胞停滞者,其白细胞计数常超过100,000/mm~3。这些损害与高白细胞数病者的脑部现象相似,此并发症常致死亡。个别报告有广泛肺部浸润者,其肺部的并发症非常显著,表现为呼吸困难、紫绀、缺氧和 X 线胸部体征异常。由于病者出现异常白细胞增多,急性白血     

The spectrum of noninfectious pulmonary complications following hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation (HSCT) is an established treatment for a variety of malignant and nonmalignant conditions. Pulmonary complications, infectious and noninfectious, are a major cause of morbidity and mortality in these patients. The recent advances in prophylaxis and treatment of infectious complications increased the significance of noninfectious pulmonary conditions. Acute lung injury due to diffuse alveolar hemorrhage or idiopathic pneumonia syndrome are the main acute complications, while bronchiolitis obliterans remains the most challenging pulmonary complications facing clinicians who are taking care of HSCT recipients. There are other noninfectious pulmonary complications following HSCT that are less frequent. This report provides a clinical update of the incidence, risk factors, pathogenesis, clinical characteristics and management of the main noninfectious pulmonary complications following HSCT.     

Pulmonary infections complicating hematological disorders

Pulmonary infections are second in importance only to septicemia as a cause of infectious morbidity and mortality in patients with hematological disorders. The differential diagnosis of the pneumonitis syndrome includes not only infection but also a multitude of noninfectious causes. In addition, the diagnosis may be difficult, owing to the subtlety of the clinical signs as a consequence of the impaired inflammatory response. Radiographic findings are often nonspecific, and invasive procedures and microbiological exams are required to establish the cause of pulmonary disease and to choose a specific therapy. However, invasive diagnostic procedures are often precluded by the poor general conditions and (particularly in acute leukemia patients) by concurrent thrombocytopenia. The approach to all infectious complications, including those of the lower respiratory tract, in immunocompromised patients with hematological diseases, is based on aggressive prevention strategies and the empirical administration of broad-spectrum antimicrobials eventually followed by a clinically or microbiologically guided treatment modification. With regard to the antimicrobial treatment, given the variety of infectious and noninfectious causes of pulmonary infiltrates in patients with hematological diseases, the diversity of the underlying immunocompromised state, and the spectrum of clinical findings, no single general therapeutic algorithm can be applied.     

Bronchiolitis obliterans following haematopoietic stem cell transplantation.

The aim of the present article is to review the available clinical data on bronchiolitis obliterans following haematopoietic stem cell transplantation (HSCT). The data sources used were the Medline database and references from the identified articles related to bronchiolitis obliterans, noninfectious pulmonary complications and HSCT. HSCT is an important treatment for a variety of malignant and nonmalignant conditions. However, the procedure is limited by significant complications that may involve every organ of the body. Pulmonary complications are seen in 40-60% of HSCT recipients. The recent advances in prophylaxis and treatment of infectious complications have increased the significance of late noninfectious pulmonary conditions. Currently, bronchiolitis obliterans is one of the most challenging pulmonary complications facing clinicians who are taking care of haematopoietic stem cell transplantation recipients. This article reviews the clinical and pathological features of this condition, sheds some light on potential mechanisms of pathogenesis, and discusses the available management options.     

HIV-associated lung infections and complications in the era of combination antiretroviral therapy

The spectrum of lung diseases associated with HIV is broad, and many infectious and noninfectious complications of HIV infection have been recognized. The nature and prevalence of lung complications have not been fully characterized since the Pulmonary Complications of HIV Infection Study more than 15 years ago, before antiretroviral therapy (ART) increased life expectancy. Our understanding of the global epidemiology of these diseases in the current ART era is limited, and the mechanisms for the increases in the noninfectious conditions, in particular, are not well understood. The Longitudinal Studies of HIV-Associated Lung Infections and Complications (Lung HIV) Study (ClinicalTrials.gov number NCT00933595) is a collaborative multi-R01 consortium of research projects established by the National Heart, Lung, and Blood Institute to examine a diverse range of infectious and noninfectious pulmonary diseases in HIV-infected persons. This article reviews our current state of knowledge of the impact of HIV on lung health and the development of pulmonary diseases, and highlights ongoing research within the Lung HIV Study.     

Pulmonary complications following hematopoietic stem cell transplantation: diagnostic approaches

Pulmonary complications are a significant cause of morbidity and mortality in hematopoietic stem cell transplant recipients. Pulmonary infiltrates in such patients pose a major challenge for clinicians because of the wide differential diagnosis of infectious and noninfectious conditions. It is rare for the diagnosis to be made by chest radiograph, and commonly these patients will need further invasive and noninvasive studies to confirm the etiology of the pulmonary infiltrates. This review describes the role of the different diagnostic tools available to reach a diagnosis in a timely manner in this patient population.     

Pulmonary complications in adult blood and marrow transplant recipients: autopsy findings

STUDY OBJECTIVE: To describe the pulmonary findings at autopsy of blood and bone marrow transplant (BMT) recipients. DESIGN: Retrospective. SETTING: An academic medical center. PATIENTS: Seventy-one deceased adult BMT recipients. INTERVENTIONS: None. MEASUREMENTS: Antemortem and postmortem pulmonary findings. RESULTS: The transplants were allogeneic in 39 patients (55%), with a peripheral stem cell source in 43 patients (61%). Death occurred at a median of 1.30 months after transplant. Ninety-six pulmonary complications were noted in 63 patients (89%): 27 infectious (bacterial bronchopneumonia, n = 13; pulmonary aspergillosis, n = 11; cytomegalovirus pneumonia, n = 2; and Candida bronchopneumonia, n = 1) and 69 noninfectious (diffuse alveolar damage, n = 35; diffuse alveolar hemorrhage [DAH], n = 10; amyloidosis, n = 9; pulmonary embolism, n = 5; lymphoma/leukemia, n = 4; bronchiolitis obliterans, n = 2; bronchiolitis obliterans organizing pneumonia, n = 1; pulmonary alveolar proteinosis, n = 1; aspiration pneumonia, n = 1; and acute and organizing pneumonia, n = 1). Twenty-seven of the 96 complications (28%) were diagnosed antemortem. Infectious complications were more likely to be diagnosed antemortem compared to noninfectious complications (48% vs 20%, p = 0.006). Six of the 13 patients with bronchopneumonia (46%), 5 of the 11 patients with pulmonary aspergillosis (45%), and 7 of the 8 patients with DAH (88%) at autopsy were not receiving treatment for these conditions at the time of death. Ten patients being treated for suspected pulmonary aspergillosis, 7 patients treated for suspected pulmonary cytomegalovirus infection, 22 patients treated for suspected bacterial pneumonia, 2 patients treated for suspected Pneumocystis carinii pneumonia, and 12 patients treated for DAH at the time of death had no evidence of these conditions at autopsy. The most common immediate cause of death was respiratory failure (n = 37, 52%). CONCLUSIONS: Pulmonary complications, the majority not diagnosed antemortem, are the most common cause of death in BMT recipients. As the result of underdiagnosis, BMT recipients may not receive appropriate therapy for potentially treatable pulmonary complications.     

Chronic lung disease after hematopoietic stem cell transplantation

Tens of thousands of patients undergo hematopoietic stem cell transplantation (HSCT) each year, mainly for hematologic disorders. In addition to the underlying diseases, the chemotherapy and radiation therapy that HSCT recipients receive can result in damage to multiple organ systems. Pulmonary complications develop in 30% to 60% of HSCT recipients. With the widespread use of prophylaxis for certain infections, the spectrum of pulmonary complications after HSCT has shifted from more infectious to noninfectious complications. This article reviews some of the noninfectious, chronic pulmonary complications.     

Impact of open lung biopsy for undiagnosed pulmonary infiltrates in patients with hematological malignancies

Pulmonary complications are frequently encountered in patients with hematological malignancy. The optimal therapeutic decision including open lung biopsy (OLB) for such patients is uncertain. We herein examine the clinical impact of OLB on these patients. Seven patients with progressively diffuse pulmonary infiltrates despite aggressive medical treatment were examined. The underlying diseases, prior treatment for presumptive pneumonia, the change in therapeutic approach after operation, and clinical outcome were reviewed retrospectively. Diffuse pulmonary infiltrates were caused by infection in two patients and by noninfectious etiology such as alveolar proteinosis, idiopathic interstitial pneumonitis, leukemic involvement, and drug-induced alveolar damage in the others. Four patients who had serious underlying hematologic diseases such as myelodysplastic syndrome, acute and chronic myeloid leukemia, and T cell lymphoma died. Three patients with acute lymphoid leukemia survived. In two of these three, change of therapeutic strategies after OLB was created for the survival. OLB in patients with hematological malignancy may be useful in selected patients with a treatable hematologic disease who have treatable underlying causes of the pulmonary infiltrate.     

Noninfectious pulmonary complications of liver, heart, and kidney transplantation

Because of their chronically immunosuppressed status, solid organ transplant recipients are continually at risk for infectious pulmonary complications. In addition, however, a number of noninfectious pulmonary complications plague the transplant recipient. These complications arise because of numerous factors, including the underlying conditions that preceded transplantation, the transplant surgery itself, and toxicity of post-transplantation medications. This article focuses on noninfectious pulmonary complications in the three largest recipient populations: liver, kidney, and heart.     

NIH conference. Respiratory disease in the immunosuppressed patient.

Pulmonary complications, both infectious and noninfectious, are an important cause of morbidity in patients with various types of immunosuppression. The appropriate response to these clinical problems requires an understanding of pulmonary host defense and of the various types of systemic immunosuppression. Infectious and noninfectious pulmonary complications may vary according to the type of immunosuppression as well as to the degree and duration of immunosuppression. Appropriate clinical management also requires an understanding of the clinical problems commonly seen in specific groups of immunosuppressed patients and an understanding of the sensitivity, specificity, and potential complications associated with the available diagnostic approaches to those patients. Because respiratory disease in these patient groups may progress rapidly to respiratory failure, an expeditious evaluation based on the knowledge of likely causes of respiratory disease and prompt specific or empiric therapy are indicated. Specific sets of algorithms for the evaluation of both focal and diffuse pulmonary disease may facilitate such an evaluation. In addition, an aggressive approach to the prevention of pulmonary disease including immunization, prophylaxis, and immunomodulation (for example, colony stimulating factors) may be warranted in specific subgroups at risk.