RESUMEN
We report a case of primary Sjögren's syndrome with lymphocytic interstitial pneumonia and multiple cystic lesions. The patient was a 64-year-old woman. Abnormal chest shadows were detected by x-ray and computed tomographic (CT) examinations. The patient had no family history of disease and had never smoked. She had complained of dryness in the eyes and mouth for about 10 years. Laboratory tests were positive for anti-nuclear antigen, anti-SS-A antigen, and anti-SS-B antigen. Sialography revealed marked destruction of the salivary glands, yielding a diagnosis of Sjögren's syndrome. Chest X-ray films and CT scans showed multiple cystic lesions in both lungs, measuring from a few mm to 3 cm in diameter, as well as fine centrilobular nodules. Slight anemia and hyper gamma globlinemia were also detected. Pulmonary function tests showed mild obstructive disturbance. Bronchoalveolar lavage analysis disclosed an elevated lymphocytic fraction (28.6%), but transbronchial lung biopsy provided no adequate specimens for diagnosis. Thoracoscopic lung biopsy specimens demonstrated marked infiltration of lymphocytes and histiocytes through the interstitium of alveolar walls and peri-bronchovascular sheath, with some lymphoid follicles. The overall appearance was compatible with lymphocytic interstitial pneumonia. The cysts themselves were nonspecific, and no cellular infiltration was noted in the cyst walls. Because of the predominantly peribronchial distribution of the lesions, we suspected that the cysts were formed by the check valve mechanism. However, no definitive evidence was obtained.
Asunto(s)
Quistes/etiología , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares/etiología , Síndrome de Sjögren/complicaciones , Femenino , Humanos , Pulmón/patología , Persona de Mediana EdadRESUMEN
With a limited number of beds for patients undergoing medical and surgical treatment for respiratory diseases, we set aside 6 of 45 beds on one floor to be used as a respiratory care unit. During the past 5 years, 1820 patients (1225 medical and 595 surgical) were admitted to the respiratory care unit; they were treated for an average of 5.02 days. Of the patients being treated medically, 451 received mechanical ventilatory support. The majority of those patients had acute exacerbations of chronic respiratory failure due to emphysema or to sequelae of pulmonary tuberculosis. Acute respiratory distress associated with asthma or with pneumonia were also relatively common, as was the adult respiratory distress syndrome. A total of 119 patients on home oxygen therapy are being seen as out-patients, and the respiratory care unit was found to be quite useful whenever they needed intensive management. Only 148 (8.1%) of the patients admitted to the respiratory care unit died before discharge, and the ratio of cost to performance was good. The respiratory care unit was most effective in allowing for continuity of care from the onset of respiratory distress, and including exacerbations, surgical interventions, postoperative management, and out-patient care.