The article presents a brief review of literature which shows the characteristic of bronchopulmonary and cardiovascular diseases that most often cause secondary absolute hypoxic erythrocytosis. The information about pathogenesis of blood changes at this nosology is given. The principles of differential diagnosis between secondary absolute hypoxic erythrocytosis and chronic myeloproliferative diseases, i.e. polycythemia vera and idiopathic myelofibrosis in erythremia stage are set. As an example three clinical cases of personal experience of the authors are given: 1) the patient who developed hypoxic erythrocytosis against chronic pulmonary heart disease formed due to a combination of COPD and Pickwick syndrome and "sleep apnea"; 2) the patient admitted to hospital initially only in connection with changes in the blood (erythrocytosis) for differential diagnosis and who was revealed to have arteriovenous malformation of the lung vessels; 3) the case of primary pulmonary hypertension diagnosis in a young patient with multiple comorbidities.
Hematogenous thrombophilia is often encountered in the clinical practice of doctors of all specialties. The article presents current data on the diagnostic of this pathology. In most cases pulmonary embolism is a clinical onset of hereditary hematogenous thrombophilia. According to the authors of this article, pulmonary embolism occurred in 60% of surveyed patients with hereditary thrombophilia hematogenous. Current antithrombotic therapy is quite effective in this category of patients. Three cases of personal experience of the authors when there was diagnosed a combined form of hematogenous thrombophilia with serious thrombotic complications in anamnesis are shown. Adequate secondary prevention of thrombosis contributed to further disease-free course of the disease.
In 185 patients with chronic hemoblastosis (chronic lymphocytic leukemia, chronic myeloid leukemia, idiopathic myelofibrosis, multiple myeloma) after autopsy, the pathology of the bronchopulmonary system was studied. It was found out that in addition to immunodeficiency, an important role in the occurrence of respiratory diseases in chronic lymphocytic leukemia, as well as in chronic myeloid leukemia and idiopathic myelofibrosis in the stage of blast crisis is played by specific leukemic infiltration of the lungs, bronchi, pleura and diaphragm; the presence of leukostasis in the vessels of medium and small caliber with violation of microcirculation; compression of the diaphragm by significantly increased spleen and liver; in some cases (especially in chronic lymphocytic leukemia) hyperplasia of the lymphoid follicles of the bronchial tree. In chronic myeloid leukemia and idiopathic myelofibrosis, hyperthrombocytosis with the development of the sludge syndrome in small vessels of the lungs is essential. Pulmonary localization of inflammatory processes in patients with multiple myeloma is facilitated by lymphoid and plasma cell infiltration of the lungs, paraproteinosis of the lungs, localization of myeloma nodes in the ribs, lung tissue and bronchi.
A brief review on respiratory damages in systemic scleroderma (SDS) is presented. The characteristic of the most frequent pathology – interstitial lung injury (ILI) is given. Pulmonary hypertension, pleural lesions, tuberculosis, secondary tumors are also described. Multispiral computed tomography in patients with SDS allows not only to identify the characteristic symptoms of ILI, but also to assess the extent of the lesion and the stage of development of the pathological process in the lungs for the timely treatment of ILI. In the two given clinical observations, lung involvement or ILI was the debut of systemic scleroderma and was ahead of other clinical symptoms of the disease; the course of alveolitis was progressive in nature, there was a significant decrease of lung volumes and an increase of fibrosis.
Based on the literature data and our own observations, the features of the lung damage in patients with drug dependence have been studied. It was found out that the pulmonary manifestations of drug addiction are secondary, depend on the type of drug used and ways of drug administration. In most cases, pneumonia develops, characterized by an aggressive course, often complicated by the formation of destructive cavities, suppuration and empyema of the pleura, respiratory failure. Pneumonia is often a manifestation of sepsis (in most cases, injecting drug users) and is accompanied by other syndromes: bacterial endocarditis, renal, hepatic insufficiency, and other manifestations of multiple organ pathology. Interstitial pneumonia can develop with the development of pneumofibrosis, bullous pulmonary degeneration, granulomatous inflammation, pulmonary edema. In a number of cases (more often with inhalational drug use) toxic alveolitis may develop. The defeat of the lungs can be irreversible and lead to death. Three clinical observations from the personal practice of the authors are presented.
Academy, 95 Gor'kogo Str., Blagoveshchensk, 675000, Russian Federation 2 Amur Regional Clinical Hospital, 26 Voronkova Str., Blagoveshchensk, 675028, Russian Federation The article presents the literary overview dedicated to the diaphragmatic hernias. As an example, a case of the traumatic diaphragmatic hernia with the clinical picture of the pleurisy was described. The thoracoabdominal knife injury of the diaphragm was the feasible reason of this hernia. In this case, a long asymptomatic course of the disease with some gastroenterological symptoms was the reason for the early diagnostics not to be performed. Firstly, the patient was hospitalized to the pulmonology department because of the pleurisylike clinical picture of his case. A diaphragmatic hernia was found only after examination of the patient. A laparoscopic operation failed and the patient was successfully treated by the surgery.
A brief review of the literature devoted to the rare eosin-filed granulomatous necrotizing vasculitis ChurgStrauss syndrome is given. Two clinical cases of this disease are presented from the personal practice of the authors. The complexity of diagnostics was emphasized; it contributed to the fact that the disease lasted for a long time under the guise of other nosologies which later turned out to be syndromes of vasculitis ChurgStrauss. When pulmonary infiltrates occur in patients with asthma with allergic rhinitis or rhinosinusopathy in combination with high eosinophilia of peripheral blood and neurologic symptoms, it is necessary to suspect the Churg-Strauss syndrome and conduct appropriate diagnostic measures.
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