FEV1 over time in patients with connective tissue disease-related bronchiolitis

SummaryBackgroundFibrosis or inflammation of the bronchioles is a well-known manifestation of connective tissue disease (CTD). However, the natural history of CTD-related bronchiolitis is largely unknown.MethodsWe analyzed consecutive patients evaluated at National Jewish Health (Denver, CO) from 1998 to 2008 with CTD and surgical lung biopsy-confirmed bronchiolitis. Linear mixed effects models were used to estimate the longitudinal postbronchodilator FEV1 %predicted (%pred) course and differences between subjects with or without constrictive bronchiolitis (CB).ResultsOf 28 subjects with a mean age of 53 ± 9 years, fourteen (50%) had CB. The most common CTD diagnosis was rheumatoid arthritis (n = 14; 50%). There were no significant differences in demographics, smoking status, underlying CTD diagnoses, 6-min walk distance, dyspnea score or drug therapy between subjects with CB and those with cellular bronchiolitis. Three subjects with CB (11%) and four with cellular bronchiolitis (14%) died. Compared with subjects with CB, those with cellular bronchiolitis had higher mean FEV1 %pred at all times. There were no significant differences in FEV1 %pred slope within- or between-groups (CB vs. cellular bronchiolitis) preceding surgical lung biopsy or afterward.ConclusionSubjects with CTD-related CB had lower FEV1 %pred values than those with CTD-related cellular bronchiolitis at all time points, but FEV1 %pred remained stable over time in both groups regardless of therapy received

Necrotizing osteomyelitis in a man with disseminated Mycobacterium chelonae infection

Cases of disseminated nontuberculous mycobacterial (NTM) infection are difficult to treat. We encountered an elderly man with disseminated Mycobacterium chelonae infection. The clinical evaluation and treatment of patients with this type of systemic infection pose unique challenges. Disseminated NTM infection with bone involvement often requires surgical intervention in addition to antimicrobial therapy. Keywords: Skin nodules, Necrotizing osteomyelitis, Nontuberculous mycobacteria, Mycobacterium chelonae, Disseminated infectio

Gastrin-releasing peptide receptor expression in lung cancer

Context.—Gastrin-releasing peptide receptors (GRPRs) activate mitogen-activated protein kinase signaling pathway primarily through epidermal growth factor receptor activation and are under investigation as a molecular target because they are overexpressed in several solid tumors. Objective.—To determine GRPR expression in both non–small cell lung carcinoma and small cell lung carcinoma, comparing results with clinical stages and demographic data. Design.—We analyzed the immunohistochemical expression of GRPR in 200 non–small cell lung carcinoma and 38 small cell lung carcinoma archival cases from 2004 to 2008. Results.—Non–small cell lung carcinoma cases tended to be higher GRPR expressers at a rate of 62.5% (weak, moderate, and strong expression in 41.5%, 13.5%, and 7.5%, respectively), compared with 52.62% in small cell lung carcinoma cases (weak, moderate, and strong expression in 34.21%, 15.78%, and 2.63%, respectively; P = .30). In non–small cell lung carcinoma there was a trend for higher percentages of strong expression in adenocarcinoma cases (10%; P = .67), and in patients with advanced stages (III and IV; 9.43% and 6.9%; P = .01). Conclusions.—To the best of our knowledge, this is the first study to demonstrate GRPR tissue expression in a large population of patients with lung cancer. Although GRPR expression was similar in small cell and non–small cell carcinoma, the expression was more pronounced in an advanced-stage lung cancer, particularly in adenocarcinoma cases, and may represent a potential target for the development of new treatment approaches in this population