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Alveolar cell carcinoma, a neoplasm associated with pre-existing inflammatory lung disease, has not been reported previously in patients with sickle cell disease. We present such a patient and suggest that chronic pulmonary scarring in this setting predisposed to development of his malignancy. As survival increases in individuals with sickle cell disease, alveolar cell carcinoma must be considered in these differential diagnosis of otherwise unexplained chronic pulmonary infiltrates.     

Practical approach to establishing pulmonary rehabilitation for people with non‐COPD diagnoses

Pulmonary rehabilitation is a core aspect in the management of patients with chronic respiratory diseases. This paper describes a practical approach to establishing pulmonary rehabilitation for patients with non‐COPD diagnoses using examples from the interstitial lung disease (ILD), pulmonary hypertension (PH), bronchiectasis and lung cancer patient populations. Aspects of pulmonary rehabilitation, including the rationale, patient selection, setting of programmes, patient assessment and training components (both exercise and non‐exercise aspects), are discussed for these patient groups. Whilst there are many similarities in the rationale and application of pulmonary rehabilitation across these non‐COPD populations, there are also many subtle differences, which are discussed in detail in this paper. With consideration of these factors, pulmonary rehabilitation programmes can be adapted to facilitate the inclusion of respiratory patients with non‐COPD diagnoses.     

晚期肺癌合并肺部感染的临床研究

目的探讨晚期肺癌合并肺部感染的临床特点。方法对近4年收治的130例晚期肺癌合并肺部感染病例的临床资料进行分析。结果本组患者年龄≥60岁、性别为男性、住院天数≥15天、合并基础疾病、外周血白细胞计数<4×109/L、低蛋白血症者易并发肺部感染。当病人出现中度以上发热、血氧饱和度降低时要高度警惕可能合并肺部感染。血CRP、PCT升高可作为肺部感染的炎症预测指标。革兰氏阴性杆菌(67.23%)是肺部感染的最常见致病菌,存在多药耐药,根据药敏试验结果及时调整抗生素的使用。结论晚期肺癌合并肺部感染存在多种危险因素,应加强预防,要重视病原学检测及药敏试验,合理使用抗生素。     

单肺移植术治疗终末期肺纤维化

目的 报告山东省首例单肺移植术治疗终末期肺纤维化。方法 对32岁终未期肺纤维化患者在全麻下行同种异体右全肺移植术，术后给予三联免疫抑制剂。结果 术后肺功能恢复良好。术后24d出现急性、重症呼吸窘迫综合征（ARDS），经全力救治转危为安，现在康复治疗中。结论 单肺移植是治疗终末期肺纤维化的有效方法。     

肺癌患者放疗前后肺功能检测及其临床意义

目的通过肺癌患者放疗前后肺功能检测来评价其临床意义。方法放疗前一周及放疗后1个月和3个月分别检测肺功能，指标包括：用力肺活量（FVC）、一秒内用力呼气量（FEV1）、肺一氧化碳弥散量（DLCO）。结果放疗后1月，在基础肺功能正常组，FVC，FEV，值明显高于放疗前，而DLCO值有下降趋势（P〉0．05）；在基础肺功能异常组，FVC，FEV1，DLCO值均有下降趋势（P〉0.05）。放疗后3个月时，在基础肺功能正常组，FVC，FEV1值较放疗前有下降，但无统计学差异，而DLCO下降明显。在基础肺功能异常组，FVC，FEV1，DLCO均较放疗前下降明显，有统计学差异。结论放疗能导致肺功能损伤，基础肺功能异常的患者做放疗计划时可能需要适当地减少放疗剂量。     

An unusual case of rapidly progressive primary pulmonary hypertension in childhood

A 7-year-old child died with primary pulmonary hypertension only 6 months after the onset of symptoms. Autopsy demonstrated severe pulmonary arterial medial hypertrophy and intimal proliferation. This case emphasizes the rapidity with which pulmonary vascular obstruction may occur, death resulting from potentially reversible structural abnormalities. It also demonstrates the variability in pulmonary vascular pathology in primary pulmonary hypertension and the necessity of biopsying the lung in order to predict those in whom vasodilator therapy might be helpful.     

Clinical characteristics of combined pulmonary fibrosis and emphysema

Background and objective: Patients with combined pulmonary fibrosis and emphysema (CPFE) are sometimes seen, and we speculate that these patients have some different clinical characteristics from COPD patients. This study clarifies the clinical characteristics of CPFE patients. Methods: This was a retrospective study of 47 stable patients with concurrent emphysema and diffuse parenchymal lung disease with fibrosis, based on the findings of chest CT (CPFE patients). The clinical characteristics of CPFE patients were compared with those of emphysema‐dominant COPD patients without parenchymal lung disease (COPD patients). Results: Forty‐six of the 47 CPFE patients were male. Paraseptal emphysema was particularly common in the CPFE group. Honeycombing, ground‐glass opacities and reticular opacities were present in 75.6%, 62.2% and 84.4% of CPFE patients, respectively. Twenty‐two of the 47 CPFE patients (46.8%) had lung cancer. Pulmonary function tests showed that the CPFE group had milder airflow limitation and lower diffusing capacity than the COPD group. Desaturation during 6‐min walking test in CPFE patients tended to be more severe than in COPD patients, if the level of FEV₁ or 6MWD was equal. Conclusions: CPFE patients had some different clinical characteristics in comparison with COPD patients and may also have a high prevalence of lung cancer.     

A review of pulmonary involvement in rheumatoid arthritis

Pulmonary involvement in rheumatoid arthritis (RA) is a recognized complication but not often well described in the literature and also in major medical textbooks. Thus, for most medical practitioners who look after RA patients, pulmonary complications are often missed and not given much attention. This article will review the current literature of pulmonary involvement in RA and to increase awareness of its existence.     

Antenatal corticosteriods decrease forced vital capacity in infants born fullterm

Antenatal corticosteroids (ACS) administration to pregnant women for threatened preterm labor is standard obstetric care to reduce neonatal respiratory distress syndrome and the associated respiratory morbidity. While ACS stimulates surfactant production in the fetal lung, the effects of ACS upon the subsequent growth and development of the lung are unclear. Follow‐up studies outside of the neonatal period have been primarily limited to spirometry, and most subjects evaluated were born prematurely. To our knowledge, no study has assessed both airway and parenchymal function in infants or adults following ACS exposure. We hypothesized that ACS impairs lung growth and performed infant pulmonary function testing, which included spirometry, alveolar volume (V_A) and lung diffusion (D_L). As a pilot study, we limited our assessment to infants whose mothers received ACS for threatened preterm labor, but then proceeded to full term delivery. This approach evaluated a more homogenous population and eliminated the confounding effects of preterm birth. We evaluated 36 full‐term infants between 4 to 12 months of age; 17 infants had ACS exposure and 19 infants had no ACS exposure. Infants exposed to ACS had a significantly lower forced vital capacity compared with non‐ACS exposed infants (250 vs 313 mL; P = .0075). FEV_0.5 tended to be lower for the ACS exposed group (205 vs 237 mL; P = .075). V_A and D_L did not differ between the two groups. These findings suggest that ACS may impair subsequent growth of the lung parenchyma.     

肺癌晚期合并肺部感染的临床研究

目的探讨晚期肺癌合并肺部感染的特点和治疗方法。方法分析了110例晚期肺癌合并肺部感染患者的临床资料。结果晚期肺癌合并肺部感染临床比较常见,表现多样性致病菌以革兰氏阴性杆菌和革兰氏阳性球菌,真菌为主,其中革兰氏阴性杆菌阳性率达59.1%（65/110）,本病预后差。结论晚期肺癌合并肺部感染临床表现不典型,病原菌以革兰氏阴性菌最常见,对不同抗生素有一定的耐药性,临床上应根据药敏试验选择抗生素。     

Pleuroparenchymal fibroelastosis in an 8‐year old treated for neuroblastoma

Pleuroparenchymal fibroelastosis (PPFE), which is primarily diagnosed in adults, is a progressive lung pathology associated with significant morbidity and mortality. PPFE is characterized by pleural and subpleural parenchymal disease causing dyspnea, cough, and recurrent pneumothoraces. PPFE can be precipitated by autoimmune disorders, recurrent respiratory infections, chemotherapy, and transplant. We describe the youngest recorded patient to develop PPFE, whose symptoms began several years after treatment for neuroblastoma. Her symptoms were initially mistaken for worsening asthma, and multiple comorbidities developed during the prolonged time to recognition of PPFE and she progressed to fatal lung disease before potentially curative lung transplantation could occur.     

Association of pulmonary artery agenesis and hypoplasia of the lung

Pulmonary artery agenesis and hypoplasia of the homolateral lung occasionally occurs as an isolated lesion, but more often has associated congenital cardiac anomalies. We present a case where pulmonary artery agenesis was the sole lesion in an asymptomatic child. Pulmonary artery agenesis should be suspected in asymptomatic patients if a plain chest X-ray shows asymmetric lung fields, lung hypoplasia, or hyperinflation of the contralateral lung. Echocardiography is the best tool to establish the diagnosis. In our opinion, invasive procedures, such as cardiac catheterization, may be postponed if there is no echocardiographic evidence of pulmonary hypertension.     

‘Lung age’ predicts post‐operative complications and survival in lung cancer patients

Background and objective: The Japanese Respiratory Society recently proposed ‘lung age’ as an easily understood concept of respiratory function. In this study, we evaluated whether ‘lung age’ could be a useful predictor of post‐operative respiratory complications and survival patients with lung cancer treated surgically. Methods: The study recruited 308 patients who underwent surgery for primary non‐small‐cell lung cancer. All patients had preoperative pulmonary function testing. ‘Lung age’ was determined using the methods advocated by the Japanese Respiratory Society. Based on the difference between ‘real age’ (R) and ‘lung age’ (L), patients were classified into five groups: group A: R?L > 15 (n = 37), B: 5 < R?L ≤ 15 (n = 50), C: ?5 ≤ R?L ≤ 5 (n = 73), D: ?15 ≤ R?L < ?5 (n = 54), E: ?15 > R?L (n = 94). Clinicopathological factors, post‐operative respiratory complications and survival were compared between the groups. Results: Gender, smoking status and index, histology, operative approach and FEV₁ were significantly associated with the group classification. The incidence of complications was significantly higher in group E compared with other groups (P = 0.003). Multivariate analysis showed that the group classification by ‘lung age’ was an independent predictor of post‐operative respiratory complications (P = 0.02). Overall survival differed significantly between the groups (P = 0.03). Conclusions: ‘Lung age’ could be useful for the prediction of post‐operative respiratory complications and survival in patients with lung cancer treated surgically.     

Experimental Evidence of Mechanical Isotropy in Porcine Lung Parenchyma

Pulmonary injuries are a major source of morbidity and mortality associated with trauma. Trauma includes injuries associated with accidents and falls as well as blast injuries caused by explosives. The prevalence and mortality of these injuries has made research of pulmonary injury a major priority. Lungs have a complex structure, with multiple types of tissues necessary to allow successful respiration. The soft, porous parenchyma is the component of the lung which contains the alveoli responsible for gas exchange. Parenchyma is also the portion which is most susceptible to traumatic injury. Finite element simulations are an important tool for studying traumatic injury to the human body. These simulations rely on material properties to accurately recreate real world mechanical behaviors. Previous studies have explored the mechanical properties of lung tissues, specifically parenchyma. These studies have assumed material isotropy but, to our knowledge, no study has thoroughly tested and quantified this assumption. This study presents a novel methodology for assessing isotropy in a tissue, and applies these methods to porcine lung parenchyma. Briefly, lung parenchyma samples were dissected so as to be aligned with one of the three anatomical planes, sagittal, frontal, and transverse, and then subjected to compressive mechanical testing. Stress-strain curves from these tests were statistically compared by a novel method for differences in stresses and strains at percentages of the curve. Histological samples aligned with the anatomical planes were also examined by qualitative and quantitative methods to determine any differences in the microstructural morphology. Our study showed significant evidence to support the hypothesis that lung parenchyma behaves isotropically.