Showing papers by "Talmadge E. King published in 2003"
TL;DR: Evaluated changes in clinical and physiological variables over time for survival time in 81 patients with biopsy-proven idiopathic pulmonary fibrosis found that changes in dyspnea score, total lung capacity, FVC, partial pressure of arterial oxygen, oxygen saturation, and alveolar-arterial oxygen gradient were predictive of survival time after adjustment for baseline values.
Abstract: There is significant heterogeneity in survival time among patients with idiopathic pulmonary fibrosis. Studies of baseline clinical and physiologic variables as predictors of survival time have reported inconsistent results. We evaluated the predictive value of changes in clinical and physiologic variables over time for survival time in 81 patients with biopsy-proven idiopathic pulmonary fibrosis. Six-month changes in dyspnea score, total lung capacity, thoracic gas volume, FVC, FEV1, diffusing capacity of carbon monoxide, partial pressure of arterial oxygen, oxygen saturation, and alveolar–arterial oxygen gradient were predictive of survival time even after adjustment for baseline values. Analyses were repeated on 51 patients with 12-month change data. Twelve-month changes in dyspnea score, total lung capacity, FVC, partial pressure of arterial oxygen, oxygen saturation, and alveolar–arterial oxygen gradient were predictive of survival time after adjustment for baseline values. Evaluation of changes in c...
682 citations
TL;DR: In patients presenting with a clinical syndrome suggestive of IIP, CT findings of lower-lung honeycombing and upper- lung irregular lines are most closely associated with a pathologic diagnosis of UIP.
303 citations
TL;DR: A structured, clinicopathological approach to the diagnosis of idiopathic interstitial pneumonia, with particular attention to the identification of idypathic pulmonary fibrosis, ensures proper therapy, enhances prognosis, and allows for further investigation of therapies aimed at the distinct pathophysiology.
Abstract: Careful histopathological evaluation has shown the traditionally clinical diagnosis of idiopathic interstitial pneumonia to be more heterogeneous than once thought. Its subclassification, based on clinicopathological criteria, has important therapeutic and prognostic implications. The most important distinction is the presence of usual interstitial pneumonia, the histopathological pattern seen in idiopathic pulmonary fibrosis. Idiopathic pulmonary fibrosis has a worse response to therapy and prognosis. New insight into the pathophysiology of idiopathic pulmonary fibrosis suggests a distinctly fibroproliferative process, and antifibrotic therapies show promise. Although the clinical and radiographic diagnosis of idiopathic pulmonary fibrosis can be made confidently in some cases, many patients require surgical lung biopsy to determine their underlying histopathological pattern. A structured, clinicopathological approach to the diagnosis of idiopathic interstitial pneumonia, with particular attention to the identification of idiopathic pulmonary fibrosis, ensures proper therapy, enhances prognosis, and allows for further investigation of therapies aimed at the distinct pathophysiology.
93 citations
TL;DR: The development of the chronic granulomatous inflammation of sarcoidosis appears to depend on the preservation or restoration of the peripheral CD4-helper lymphocyte count and that in most cases the CD4+ lymphocytes count exceeds 200 cells/ microL.
61 citations
TL;DR: Clinical, radiographic, and histopathologic findings of the bronchiolar syndromes that are secondary to inhalation of chemicals or organic dust, that is secondary to infection, that are drug-induced, and that have no known etiology (idiopathic) are reviewed.
Abstract: Bronchiolitis is increasingly recognized as an important clinical syndrome that encompasses the broad spectrum of histopathologic processes which show some degree of inflammation, narrowing, or obliteration of the small conducting airways. It has an extremely variable clinical course, etiology, and histologic appearance. Understanding of this entity has been limited because until recently only case reports described this lesion in several diverse clinical settings. In addition, there has been considerable confusion as a result of the different terminologies applied to the many syndromes. This article reviews the clinical, radiographic, and histopathologic findings of the bronchiolar syndromes that are secondary to inhalation of chemicals or organic dust, that are secondary to infection, that are drug-induced, and that have no known etiology (idiopathic).
17 citations
TL;DR: In this article, Gay et al. define fibrose pulmonar idiopática (FPI) as a forma única pneumonias intersticial idiopatológico (PIU) with resposta mínima ao tratamento and a prognóstico particularmente ruim.
Abstract: 336 J Pneumol 29(6) – nov-dez de 2003 Fibrose pulmonar idiopática (FPI) é uma doença pulmonar crônica difusa caracterizada por dispnéia progressiva e padrão histológico de pneumonia intersticial usual (PIU). A proeminência da histopatologia na sua definição ressalta o recente reconhecimento de que FPI/PIU é uma forma única de pneumonia intersticial idiopática com resposta mínima ao tratamento e um prognóstico particularmente ruim. Além disso, há evidências crescentes sugerindo que o paradigma tradicional da inflamação crônica levando a fibrose (relevante para muitas formas de doença pulmonar difusa) pode não se aplicar à FPI/PIU. Ao invés disso, anormalidades de remodelamento tecidual e reparo podem levar a um distúrbio primariamente fibroproliferativo. O padrão histopatológico da PIU é definido pela heterogeneidade temporal da fibrose, com áreas de pulmão normal adjacente a áreas de fibrose em fase terminal, e pulmão em favo de mel. Uma característica do padrão PIU é a ocorrência de coleções subepiteliais de tecido conectivo frouxo e miofibroblastos, as quais têm sido denominadas “focos fibroblásticos”. O foco fibroblástico parece ser relativamente único à FPI/PIU, já que ele ocorre raramente, se realmente isso acontece, em outros padrões histológicos de pneumonias intersticiais idiopáticas. Tem sido proposto que o foco fibroblástico represente o principal elemento para o desenvolvimento da doença com a eventual progressão dessa lesão para fibrose terminal. Devido à hipótese de que FPI/PIU seja um distúrbio primariamente fibroproliferativo e que os focos fibroblásticos possam representar áreas de deposição ativa do colágeno e remodelação tecidual, vários centros têm investigado a relação entre características histológicas, incluindo os focos fibroblásticos, e a sobrevida em populações cuidadosamente definidas de pacientes com FPI/PIU. Em 1998, Gay et al., da Universidade de Michigan, reviram biópsias pulmonares cirúrgicas de 38 pacientes com FPI/ PIU e não encontraram relação entre “tecido conectivo intersticial jovem” (ou seja, focos fibroblásticos) e sobrevida. Esse estudo, muito provavelmente, incluiu casos de PINS (pneumonia intersticial não específica) e o tamanho da amostra era provavelmente pequeno para identificar uma relação significante. Em 2001, publicamos dados relativos a 87 pacientes vistos no National Jewish Medical and Research Center com diagnóstico de FPI/PIU. Usando o mesmo sistema de escore histopatológico empregado no estudo de Gay, encontramos uma relação significante entre focos fibroblásticos e sobrevida (razão de risco: 1,93; 95% IC: 1,31 a 2,83; p = 0,0009). Em 2002, Nicholson et al., do Royal Brompton Hospital, revisaram 53 pacientes com FPI/PIU usando um diferente sistema de escores histopatológicos e encontraram uma relação significante entre focos fibroblásticos e sobrevida (p = 0,006). Mais recentemente, Flaherty et al., novamente da Universidade de Michigan, revisaram 99 pacientes com FPI/PIU e, usando um terceiro sistema de escores histológicos, não encontraram relação entre focos fibroblásticos e sobrevida (razão de risco: 1,33; 95% IC: 0,86 a 2,05; p = 0,20).