S82 How do specialists treat hypersensitivity pneumonitis in britain?

Background Although immunosuppression is commonly used in HP, there are no studies that compare treatment regimes. Aims and objectives The aim of this study was to survey specialist ILD consultants to determine how HP is treated in Britain. Methods British ILD consultants were provided with clinical scenarios, and asked how they would treat patients with HP. They were also asked to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ and ‘majority agreement’ were defined as at least 70% and 50% respectively of participants replying that they ‘Strongly agree’ or ‘Tend to agree’. Results 54 consultants took part in the survey from 27 centres. The choice of first line immunosuppression in progressive HP was relatively evenly split between dual therapy with corticosteroids plus a ‘steroid-sparing’ immunosuppressant (46%) and monotherapy with oral corticosteroids (39%). On average, the initial starting dose of oral prednisolone (for an 80 kg patient) was 40 mg continued for 6 weeks prior to weaning, aiming for a maintenance of 10 mg. 75% of participants reported that mycophenolate mofetil was their first choice ‘non-corticosteroid immunosuppressant’ for the long-term management of HP. A number of statements relating to the treatment of HP reached consensus or majority agreement (table 1). Conclusions This survey has demonstrated a degree of variation in the treatment of patients with suspected HP in Britain, but has found consensus and majority agreement for some key areas

Presumed solitary intraocular or conjunctival lymphoma in dogs and cats: 9 cases (1985–2013)

ObjectiveTo determine prevalence, reason for evaluation, treatment, and outcome for dogs and cats with presumed solitary ocular lymphoma (PSOL).DesignRetrospective case series.Animals7 dogs and 2 cats with PSOL.ProceduresMedical records were reviewed. Progression-free survival time (PFST) and overall survival time (OST) were determined.ResultsAnimals with intraocular (4 dogs and 1 cat) or conjunctival (3 dogs and 1 cat) lymphoma represented 0.1% and 0.08% of patients with lymphoma evaluated at the hospital during the study period, respectively. Animals with intraocular lymphoma represented 0.19% of all patients with uveitis; animals with conjunctival lymphoma represented 0.16% of all patients with conjunctivitis. Tumors included B-cell (2 intraocular and 1 conjunctival), non-B-cell, non-T-cell (1 intraocular), and T-cell (3 conjunctival) neoplasms; immunophenotype of 2 uveal lymphomas was not determined. Treatments included enucleation (4 intraocular) and chemotherapy (3 intraocular and 2 conjunctival). All dogs with intraocular lymphoma developed neurologic signs. Lymph node metastasis was detected in 2 patients with conjunctival lymphoma. Median PFST and OST were 178 days for all animals with PSOL, dogs with PSOL, and animals with intraocular lymphoma. Median PFST and OST for animals with conjunctival lymphoma were 221 and 549 days, respectively.Conclusions and clinical relevanceResults indicated PSOL was uncommon, but should be considered a differential diagnosis for animals with uveitis or conjunctivitis. Performance of MRI and cytologic analysis of CSF and regional lymph node aspirate samples may be beneficial for such patients. Prognosis seemed to be better for animals with conjunctival lymphoma than it was for those with intraocular lymphoma

Identifying causation in hypersensitivity pneumonitis: a British perspective

Background Establishing whether patients are exposed to a ‘known cause’ is a key element in both the diagnostic assessment and the subsequent management of hypersensitivity pneumonitis (HP). Objective This study surveyed British interstitial lung disease (ILD) specialists to document current practice and opinion in relation to establishing causation in HP. Methods British ILD consultants (pulmonologists) were invited by email to take part in a structured questionnaire survey, to provide estimates of demographic data relating to their service and to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ was defined as at least 70% of participants replying that they ‘Strongly agree’ or ‘Tend to agree’. Results 54 consultants took part in the survey from 27 ILD multidisciplinary teams. Participants estimated that 20% of the patients in their ILD service have HP, and of these, a cause is identifiable in 32% of cases. For patients with confirmed HP, an estimated 40% have had a bronchoalveolar lavage for differential cell counts, and 10% a surgical biopsy. Consensus agreement was reached for 25 of 33 statements relating to causation and either the assessment of unexplained ILD or management of confirmed HP. Conclusions This survey has demonstrated that although there is a degree of variation in the diagnostic approach for patients with suspected HP in Britain, there is consensus opinion for some key areas of practice. There are several factors in clinical practice that currently act as potential barriers to identifying the cause for British HP patients

Sinonasal cancer

International audienceSinonasal cancer, the cancer of the nose and paranasal cavities, is rare with an incidence below 2/100,000 person-year; the incidence is lowest among women and with distinct differences between countries. These variations in incidence are mostly explained by differences in occupational exposure, in particular exposure to wood dust, which is by far the major risk factor. This chapter gives an overview of epidemiological studies on sinonasal cancer dealing with epidemiological evidence for various occupational risk factors, exposure characteristics, tumor pathology, findings from experimental and human studies contributing to understanding of cancer mechanisms, and, finally, with molecular alterations observed in sinonasal cancer tissue available as potential molecular markers. The main studies and their findings as well as the principal pathological features of sinonasal tumors are summarized in tables and exemplified in illustrations. © Springer Nature Switzerland AG 2020