TOPIK 1 (ORBITAL TUMOR)

RESEARCH

Ophthalmology. 2004 May;111(5):997-1008.

Survey of 1264 patients with orbital tumors and simulating lesions: The 2002 Montgomery
Lecture, part 1.
Shields JA1, Shields CL, Scartozzi R.
Source
Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia,
Pennsylvania 19107, USA.
Abstract
OBJECTIVE:
To determine the incidence of specific orbital tumors based on patients referred to an ocular
oncology center.
DESIGN:
Retrospective, observational case series.
PARTICIPANTS:
A total of 1264 consecutive patients referred to an ocular oncology service because of spaceoccupying orbital lesions.
METHODS:
A retrospective chart review was carried out for 1264 consecutive patients referred for a
suspected orbital mass over a 30-year period. The lesions were grouped into general
categories, as shown in "Results." The specific diagnosis in each case was based on clinical
findings, computed tomography scan results, magnetic resonance imaging results, and
histopathologic analysis results, when available. The number and percentage of benign and
malignant tumors per age group also was determined.
MAIN OUTCOME MEASURES:
The incidence of orbital tumors and pseudotumors.
RESULTS:
Among 1264 consecutive patients, the number and percentage of lesions in each general
category were as follows: cystic, 70 cases (6%); vasculogenic, 213 cases (17%); peripheral
nerve lesions, 23 (2%); optic nerve and meningeal tumors, 105 (8%); fibrocytic lesions, 13
(1%); osseous and fibro-osseous tumors, 21 (2%); cartilaginous lesions, 1 (<1%); lipocytic
and myxoid lesions, 64 (5%); myogenic tumors, 36 (3%); lacrimal gland lesions, 114 (9%);
primary melanocytic lesions, 11 (<1%); metastatic tumors, 91 (7%); lymphoma and leukemia
lesions, 130 (10%); secondary orbital tumors, 142 (11%); histiocytic lesions, 17 (1%);
thyroid-related orbitopathy, 67 cases (5%); other inflammatory lesions, 133 cases (11%); and
miscellaneous other lesions, 13 (1%). The most common diagnoses were: lymphoid tumor
(139 cases;11%), idiopathic orbital inflammation (135 cases; 11%), cavernous hemangioma
(77 cases; 6%), lymphangioma (54 cases; 4%), meningioma (53 cases; 4%), optic nerve
glioma (48 cases; 4%), metastatic breast cancer (44 cases;4%), orbital extension of uveal

melanoma (41 cases; 3%), capillary hemangioma (36 cases;3%), rhabdomyosarcoma (35
cases; 3%), dermolipoma (31 cases; 3%), herniated orbital fat (30 cases; 2%), dermoid cyst
(26 cases; 2%), varix (26 cases; 2%), dacryops (19 cases; 2%), and other less common
lesions. Of the 1264 lesions, 810 (64%) were benign and 454 (36%) were malignant. The
percentage of malignant lesions was 20% in children (age range, 0-18 years), 27% in young
adults and middle-aged patients (age range, 19-59 years), and 58% in older patents (age
range, 60-92 years). Rhabdomyosarcoma was the most common malignancy in children,
representing 3% of all orbital masses, and lymphoma was the most common malignancy in
older patients, representing 10% of cases.
CONCLUSIONS:
A variety of tumors and pseudotumors can involve the orbit. In this series of 1264 lesions,
64% were benign and 36% were malignant. The percentage of malignant tumors increased
with age, with malignancies being common in older patients because of the higher incidence
of lymphoma and metastasis in the elderly.
PMID:
15121380
[PubMed - indexed for MEDLINE]

ARTICLE REVIEW

Orbital Tumors: Diagnosis and Surgical Treatment

Source
Werner Hassler, Renate Unsld, Uta Schick
Summary
Introduction: A broad variety of tumors can involve the small, circumscribed orbit. Two thirds
of the lesions are benign and one third are malignant. The proportion of malignant tumors, e.
g. metastases and lymphomas, increases with age. In childhood dermoid cysts and
hemangiomas are commoner. Methods: Selective literature review and personal clinical
experience.
Results: In most cases a proptosis develops. Patients often report impaired vision and double
vision. Meningiomas are the most prevalent, benign, and slow growing tumors. The choice of
operative access depends on localization, size, boundaries, and the type of process. These rare
lesions should be treated only in specialized centers able to offer minimal invasive surgical
approaches.
Dtsch Arztebl 2007; 104(8):A 496501.

CASE

Malignant Peripheral Nerve Sheath Tumor of the Orbit: Case Report and Literature Review
Mehmet D. Aydin, M.D.,1 Umran Yildirim, M.D.,2 Cemal Gundogdu, M.D.,2 Osman Dursun,
M.D.,3 Hasan H. Uysal, M.D.,3 and Mete Ozdikici, M.D.4
Source
1
Department of Neurosurgery, Medical Faculty, Ataturk University, Erzurum, Turkey
2
Department of Pathology, Medical Faculty, Ataturk University, Erzurum, Turkey
3
Department of Ophthalmology, Social Security Hospital, Erzurum, Turkey
4
Department of Radiology, Erzurum State Hospital, Erzurum, Turkey

CASE REPORT
A 68-year-old woman suffered from gradually increased blurred vision and exophthalmos of
the right eye for 6 months. Six months before this presentation, proptosis developed on her
right side. Ten days before she was hospitalized, she was blind in her right eye and the
exophthalmos had advanced. Upon physical examination, visual acuity in her right eye was
1/20. In addition to amaurosis, the exophthalmic right eye showed limited upward gaze and
no lateral gaze. Her palpebras exhibited prominent chemosis. Her cornea was intact (Fig.
1A). The round pupil was 6 mm across and not reactive to light. The disc of the right optic
nerve was edematous.
Figure 1
(A) Prominent exophthalmos, chemosis, and flashing in the palpebras in the patient's right
eye. (B) T1-weighted MRI showing the lesion originating from the lateral part of the orbit.
Magnetic resonance imaging (MRI) of the orbits and brain with and without contrast
enhancement in the axial plane showed a large soft-tissue mass at the lateral side of the optic
nerve. The tumor invaded the lateral rectus muscle and right temporal pole (Fig. 1B). Other
systemic observations of the patient were normal.
Two years earlier, she had undergone resection of a painful tumor in the right calf. Histologic
analysis of the tumor had suggested a malignant neurofibroma. Macroscopically, the
resection was considered radical.
On this occasion, the tumor was exposed through a right orbitozygomatic approach. The
tumor was highly vascularized and had eroded the zygomatic and sphenoid bones, lateral
orbital muscle, sphenoid wing, dura, and temporal pole. The lesion was removed totally with
microsurgical technique, and the lateral rectus muscle was repaired using a flap of temporal
muscle. Duroplasty was performed using temporal fascia to repair the dural defect of the
temporal pole. Microscopically, malignant differentiation and infiltration into the lateral
rectus muscle were observed (Fig. 2A). The histopathological diagnosis was an MPNST
(Figs. 2B, C). Postoperatively, the patient recovered rapidly. At discharge, she had no
dramatic cosmetic facial problems. Vision and movement of her right eye were normal and
her neurological status was stable (Fig. 3A). Six months after surgery, computed tomography
(CT) showed no residual mass in the orbit (Fig. 3B), and radiotherapy was not recommended.
The patient died of progressive liver tumor 2 years later. An autopsy was not allowed.

Figure 2
(A) Malignant tumoral cells and infiltrated tissue of the lateral rectus muscle (hematoxylin
and eosin (H&E), 400). (B) Mixoid changes are visible (H&E, ...

Figure 3
(A) Postoperatively, the patient had no obvious cosmetic problems and deviation of her eye
resolved. (B) Postoperative computed tomography showed no residual mass in the orbit 6
months after surgery. The repaired lateral ...
DISCUSSION
Most MPNSTs are large, fleshy, often necrotic neoplasms that may involve proximal portions
of major nerve trunks of the neck, extremities, retroperitoneum, mediastinum, and viscera.

Less commonly, intradural nerves are involved. Although MPNSTs can develop in any
anatomical region, the sciatic nerve is most often affected.5 Such tumors usually occur in
large nerve trunks in patients with NF1 and are associated with a highly aggressive course of
recurrence, metastases, and death in most patients.8 To our knowledge, few patients with a
cranial or facial MPNST have been reported.1,2 Likewise, cranial nerves are rarely affected,
although tumors of the trigeminal and acoustic nerves have been reported.9
Biopsy is necessary to diagnose an MPNST definitively. The rhabdomyoblastic type is more
often encountered in the head and neck. The differential diagnosis between benign
schwannoma and neurosarcoma may be challenging: one must look for necrotic foci, the
number of atypical mitoses, and an absence of differentiated cells. Tumors larger than 5 cm,
histological grades II and III, an association with neurofibromatosis, and regional or distant
metastases suggest an ominous prognosis.
The treatment of choice is surgery, but postoperative radio- and chemotherapy are part of
adjunctive therapy.7 Gross total resection of the tumor is the most important therapeutic goal.
Wide excision or amputation (when extremities are involved) may be required in some cases.
When radical tumor removal is not possible, excision combined with high-dose radiation
therapy seems to be the best alternative treatment.11

TOPIK 2 (VERTIGO)

RESEARCH

Restor Neurol Neurosci. 2010;28(1):135-43. doi: 10.3233/RNN-2010-0510.

Institutional profile: integrated center for research and treatment of vertigo, balance and
ocular motor disorders.
Brandt T1, Zwergal A, Jahn K, Strupp M.
Source
1
Institute of Clinical Neurosciences, Ludwig-Maximilian University, Klinikum Grosshadern,
Marchioninistr. 15, D-81377 Munich, Germany. thomas.brandt@med.uni-muenchen.de
Abstract
In 2009 the German BMBF (German Ministry of Education and Research) established an
Integrated Center for Research and Treatment (IFB(LMU)) of Vertigo, Balance and Ocular
Motor Disorders in Munich. After the 10-year period of funding by the BMBF, it is
envisioned that the (IFB(LMU)) will continue over the long term with the joint support of the
University Hospital, the Medical Faculty, and the Bavarian State. Vertigo is one of the most
common complaints in medicine. Despite its high prevalence, patients with vertigo generally
receive either inappropriate or inadequate treatment. This deplorable situation is
internationally well known and its causes are multiple: insufficient interdisciplinary
cooperation, no standardized diagnostics and therapy, the failure to translate findings of basic
science into clinical applications, and the scarcity of clinical multicenter studies. The
(IFB(LMU)) will constitute a suitable tool with which these structural, clinical, and scientific
deficits can be overcome. It will also make possible the establishment of an international
interdisciplinary referral center. Munich has become the site of a unique concentration of
leading experts on vertigo, balance and ocular motor disorders, both in the clinical and basic
sciences. Academic structures have paved the way for the creation of an interdisciplinary
horizontal network that also allows structured, vertical academic career paths via the
Bachelor's and Master's degree programs in Neuroscience, a Graduate School of Systemic
Neurosciences, and the Munich Center for Neurosciences - Brain and Mind. The (IFB(LMU))
has the following objectives as regards structure and content: to create an independent
patient-oriented clinical research center under the auspices of the Medical Faculty but with
autonomous administration and budget; to overcome existing clinical and academic barriers
separating the traditional specializations; to establish a standardized interdisciplinary
longitudinal and transversal network at one site for the management of patients. This should
professionalize both the management and the international recruitment of patients (integrated
care, telemedicine); to organize the study infrastructure for prospective multicenter clinical
studies as well as to free clinical scientists from administrative tasks; to promote translational
research with a focus on the innovative topics of molecular, functional and structural
imaging, experimental and clinical pharmacotherapy, clinical research of vertigo and balance
disorders, mathematical modelling, interaction between biological and technical systems
(robotics), and research on functionality and the quality of life; to offer new attractive
educational paths and career images for medical doctors, students of the natural sciences, and
engineers in clinical research in order to overcome traditional hierarchical structures. This
should promote the principles of efficiency and self-reliance; to supplement the existing
excellence with up to eight groups of young scientists and up to eight professorships (tenure
track). This should also be seen as an incentive that will attract the best young scientists; to

incorporate (IFB(LMU)) competence into the existing medical and biological graduate
schools. The (IFB(LMU)) is a unique center - worldwide.
PMID:
20086290
[PubMed - indexed for MEDLINE]

ARTICLE REVIEW

Ochsner J. 2009 Spring; 9(1): 2026. Vertigo: A Review of Common Peripheral and Central
Vestibular Disorders
Source
Department of Otolaryngology Head and Neck Surgery, Ochsner Clinic Foundation, New
Orleans, LA
Introduction
Dizziness, a common symptom that affects more than 90 million Americans, has been
reported to be the most common complaint in patients 75 years of age or older.1 Dizziness,
however, is a common term used to describe multiple sensations (vertigo, presyncope,
disequilibrium), each having numerous etiologies. It is often difficult for a physician to
elucidate the quality of dizziness a patient is experiencing and decide how to proceed with
medical management. The focus of this article is the peripheral and central vestibular system.
We review the more common disorders specific to this system, describe how patients with
these disorders present, and discuss management protocols.
The Vestibular System
The vestibular system is broadly categorized into both peripheral and central components.
The peripheral system is bilaterally composed of three semicircular canals (posterior,
superior, lateral) and the otolithic organs (saccule and utricle). The semicircular canals detect
rotational head movement while the utricle and saccule respond to linear acceleration and
gravity, respectively. These vestibular organs are in a state of symmetrically tonic activity,
that when excited stimulate the central vestibular system. This information, along with
proprioceptive and ocular input, is processed by the central vestibular pathways (e.g.
vestibular nuclei) and maintains our sense of balance and position.
Peripheral Vestibular Disorders
Peripheral vestibular disorders are limited to cranial nerve VIII and all distal structures.
Patients with a peripheral disorder demonstrate nystagmus to the contralateral side which
suppresses with visual fixation. Nystagmus improves with gaze towards the lesion and
worsens with gaze opposite the lesion. Patients may also report a falling sensation. Vegetative
symptoms are not uncommon, and one can expect nausea, vomiting, and possibly sweating
and bradycardia. The rate of recovery typically decreases with age and severity, and with the
use of vestibulo-suppressive medications.
Meniere's Syndrome
The term Meniere's syndrome is often used synonymously with the terms Meniere's disease
(MD) and endolymphatic hydrops, although they are different. Endolymphatic hydrops
describes an increase in endolymphatic pressure resulting in inappropriate nerve excitation
which gives rise to the symptom complex of vertigo, fluctuating hearing loss, and tinnitus.
The exact mechanism by which this increase in pressure produces the symptoms of MD is

greatly debated and beyond the scope of this paper. Numerous disease processes can result in
endolymphatic hydrops; if there is a known etiology then it is termed Meniere's syndrome.
MD is a term used for endolymphatic hydrops of unknown etiology.

CASE

Benign paroxysmal positional vertigo after radiologic scanning: a case series

Source
1
Baskent University Faculty of Medicine, Department of Otorhinolaryngology, Ankara,
Turkey
2
Baskent University Zubeyde Hanim Practice and Research Center, Department of
Radiology, Izmir, Turkey
Journal of Medical Case Reports 2008, 2:92 doi:10.1186/1752-1947-2-92
Abstract
Introduction
Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. It is
frequently seen in elderly patients, and the course of the attack may easily mimic
cerebrovascular disease. A BPPV attack after a radiologic examination has not been reported
previously. We report the cases of two patients who had BPPV attacks after radiologic
imaging.
Case presentation
The first patient with headache and tremor was admitted to the radiology department for
cranial computed tomography (CT) imaging. During scanning, she was asked to lie in the
supine position with no other head movements for approximately 10 minutes. After the
cranial CT imaging, she stood up rapidly, and suddenly experienced a vertigo attack and
nausea. The second patient was admitted to the radiology department for evaluation of his
renal arteries. During the renal magnetic resonance angiography, he was in the supine
position for 20 minutes and asked not to move. After the examination, he stood up rapidly
with the help of the technician and suddenly experienced a vertigo attack with nausea and
vomiting. The results of standard laboratory analyses and their neurologic examinations were
within normal limits and Dix-Hallpike tests showed rotatory nystagmus in both cases. An
Epley maneuver was performed to the patients. The results of a control Dix-Hallpike tests
after 1 Epley maneuver were negative in both patients.
Conclusion
Radiologists and clinicians must keep in mind that after radiologic imaging in which the
patient is still for some time in the supine position and then helped to stand up rapidly, a
BPPV attack may occur.

TOPIK 3 (GASTRITIS)

RESEARCH

J Tradit Chin Med. 2007 Jun;27(2):87-91.

Clinical research on acupuncture and moxibustion treatment of chronic atrophic gastritis.
Source
1
Department of Acupuncture and Moxibustion, Henan College of Traditional Chinese
Medicine, Zhengzhou 450008, China.
Abstract
OBJECTIVE:
To observe the clinical therapeutic effects of acupuncture and moxibustion in treating chronic
atrophic gastritis.
METHODS:
Patients who met the criteria were randomly divided into the treatment groups consisting of
the acupuncture group (30 cases) and the acupuncture-moxibustion group (30 cases), and the
control group (28 cases). After two months of treatment, observed were safety and the
curative effects, through general physical check ups, routine examinations of blood, urine and
feces, and symptoms, pathology and gastrin before, during and after the treatment.
RESULTS:
(1) The treatment groups showed significant superiorities in the improvement of symptoms,
with the acupuncture-moxibustion group showing the best therapeutic effects. (2) The
acupuncture-moxibustion group showed marked differences before and after the treatment in
the improvement of glandular atrophy and intestinal metaplasia, with a total effective rate of
66.67%. (3) After the treatment, the three groups all showed marked improvement in the level
of serum gastrin, with the acupuncture-moxibustion group showing the best effects.
CONCLUSION:
Acupuncture and moxibustion have definite therapeutic effects for chronic atrophic gastritis,
especially in improving the symptoms. Acupuncture or acupuncture combined with
moxibustion can provide possibilities in reversing the pathologic changes of glandular
atrophy and intestinal metaplasia for patients with chronic atrophic gastritis. Acupuncturemoxibustion is really an effective and safe therapy for chronic atrophic gastritis.
PMID:
17710798
[PubMed - indexed for MEDLINE]

ARTICLE REVIEW

Aliment Pharmacol Ther. 1995 Aug;9(4):331-40.

Review article: the development of atrophic gastritis--Helicobacter pylori and the effects of
acid suppressive therapy.
Kuipers EJ1, Lee A, Klinkenberg-Knol EC, Meuwissen SG.
Source
1
Department of Gastroenterology, Free University Hospital, Amsterdam, The Netherlands.

Abstract
Helicobacter pylori is uniquely adapted to survival in the strongly acidic gastric lumen. In
vitro, both acid and certain acid suppressors affect bacterial growth. In vivo, there is little
evidence that acid suppressors have any effect on bacterial survival. In contrast, decrease of
acid secretion quickly leads to a spreading of the bacterial infection throughout the body and
fundus of the stomach, which is accompanied by an increase of the associated gastritis.
Helicobacter pylori gastritis may, in a substantial number of infected subjects, ultimately lead
to atrophy and intestinal metaplasia, conditions with an increased risk for gastric cancer. This
review summarizes the data on the interrelation between Helicobacter pylori, gastric acid
secretion and development of atrophic gastritis.

CASE

Source
1
Department of Surgery, National University Hospital, Singapore. tsuanhao@yahoo.com.sg
Abstract
INTRODUCTION:
Gas is rarely found within the viscera outside the lumen of the gastrointestinal tract.
Emphysematous gastritis is a rare form of infection of the stomach wall by gas producing
organisms.
CLINICAL PICTURE:
A 45-year-old Chinese lady underwent hepatectomy for hepatocellular carcinoma.
Postoperatively, she turned septic and encephalopathic with worsening liver function.
Computed tomography scan revealed a thickened, oedematous stomach wall with air pockets
within.
TREATMENT:
The patient was started on a course of broad spectrum antibiotics.
OUTCOME:
She responded and was discharged well.
CONCLUSION:
Emphysematous gastritis is a rare condition with high mortality. There is however, still no
preferable approach of treatment despite therapeutic advances.

TOPIK 4 (ANEMIA)

RESEARCH

Asia Pac J Clin Nutr. 2012;21(2):171-81.

Anemia in Cambodia: prevalence, etiology and research needs.
Source
1
Department of Biomedical Science, University of Guelph, Guelph, Ontario, Canada.
charlesc@uoguelph.ca
Abstract
Anemia is a severe global public health problem with serious consequences for both the
human and socio-economic health. This paper presents a situation analysis of the burden of
anemia in Cambodia, including a discussion of the country-specific etiologies and future
research needs. All available literature on the prevalence and etiology of anemia in Cambodia
was collected using standard search protocols. Prevalence data was readily identified for preschool aged children and women of reproductive age, but there is a dearth of information for
school-aged children, men and the elderly. Despite progress in nation-wide programming
over the past decade, anemia remains a significant public health problem in Cambodia,
especially for women and children. Anemia is a multifaceted disease and both nutritional and
non-nutritional etiologies were identified, with iron deficiency accounting for the majority of
the burden of disease. The current study highlights the need for a national nutrition survey,
including collection of data on the iron status and prevalence of anemia in all population
groups. It is impossible to develop effective intervention programs without a clear picture of
the burden and cause of disease in the country.
PMID: 22507602
[PubMed - indexed for MEDLINE]

ARTICLE REVIEW

APLASTIC ANEMIA
Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health
Bethesda, MD 20892
Abstract
Purpose of review
Most acquired aplastic anemia (AA) is the result of immune-mediated destruction of
hematopoietic stem cells causing pancytopenia and an empty bone marrow, which can be
successfully treated with either immunosuppressive therapy (IST) or hematopoietic stem-cell
transplantation (HSCT).
Recent findings
In AA, oligoclonally expanded cytotoxic T-cells induce apoptosis of hematopoietic
progenitors. T-bet, a transcription factor that binds to the interferon- promoter region, is upregulated in AA T-cells. Regulatory T-cells are significantly reduced in patients' peripheral
blood and in an AA murine model, infusion of regulatory T-cells ameliorates disease
progression. In a minority of cases, loss-of-function mutations in telomerase complex genes
may underlie disease development. Long term survival, once strongly linked to response to

immunosuppressive therapy, can now be achieved even among non-responders due to

significant advances in supportive care and better salvage treatments.
Summary
Evidence has accumulated in the recent years further corroborating an immune-mediated
process underlying AA pathogenesis. HSCT from a matched sibling donor is preferred for
children and young adults with severe AA, and IST is employed when HSCT is not feasible
due to age, lack of a histocompatible sibling, co-morbidities, or by patient choice.

CASE

J Korean Med Sci. 2006 Apr;21(2):365-7.

A case of autoimmune hemolytic anemia associated with an ovarian teratoma.
Source
1
Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon,
Korea.
Abstract
Autoimmune hemolytic anemia associated with an ovarian teratoma is a very rare disease.
However, treating teratoma is the only method to cure the hemolytic anemia, so it is
necessary to include ovarian teratoma in the differential diagnosis of autoimmune hemolytic
anemia. We report herein on a case of a young adult patient who had severe autoimmune
hemolytic anemia that was induced by an ovarian teratoma. A 25-yr-old woman complained
of general weakness and dizziness for 1 week. The hemoglobin level was 4.2 g/dL, and the
direct and indirect antiglobulin tests were all positive. The abdominal computed tomography
scan revealed a huge left ovarian mass, and this indicated a teratoma. She was refractory to
corticosteroid therapy; however, after surgical resection of the ovarian mass, the hemoglobin
level and the reticulocyte count were gradually normalized. The mass was well encapsulated
and contained hair and teeth. She was diagnosed as having autoimmune hemolytic anemia
associated with an ovarian teratoma. To the best of our knowledge, this is the first such a case
to be reported in Korea.

TOPIK 5 (PNEUMONIA)

RESEARCH

J Clin Invest. 2008 Apr 1; 118(4): 12911300.

Pneumonia research to reduce childhood mortality in the developing world
Source
1
Wellcome Trust/KEMRI Research Programme, Kilifi, Kenya. 2Nuffield Department of
Clinical Medicine, University of Oxford, Oxford, United Kingdom. 3Centre for Health and
Population Research, International Centre for Diarrhoea Disease Research, Dhaka,
Bangladesh. 4Department of Microbiology, University Pathology Building, Queen Mary
Hospital, University of Hong Kong, Hong Kong Special Administrative Region, Peoples
Republic of China. 5Infectious Diseases Development, Global Health Program, Bill and
Melinda Gates Foundation, Seattle, Washington, USA. 6Infectious Disease Epidemiology
Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Abstract
Pneumonia is an illness, usually caused by infection, in which the lungs become inflamed and
congested, reducing oxygen exchange and leading to cough and breathlessness. It affects
individuals of all ages but occurs most frequently in children and the elderly. Among
children, pneumonia is the most common cause of death worldwide. Historically, in
developed countries, deaths from pneumonia have been reduced by improvements in living
conditions, air quality, and nutrition. In the developing world today, many deaths from
pneumonia are also preventable by immunization or access to simple, effective treatments.
However, as we highlight here, there are critical gaps in our understanding of the
epidemiology, etiology, and pathophysiology of pneumonia that, if filled, could accelerate the
control of pneumonia and reduce early childhood mortality.

ARTICLE REVIEW

Thorax. 2013 Nov; 68(11): 10571065.

Risk factors for community-acquired pneumonia in adults in Europe: a literature review
Source
1
Servei de Pneumologia, Hospital Clnic de Barcelona, Institut d'Investigacions Biomdiques
August Pi i Sunyer (IDIBAPS), CIBER de Enfermedades Respiratorias (CIBERes),
University of Barcelona, Barcelona, Spain
2
Department of Internal Medicine, University Hospital, KU Leuven, Leuven, Belgium
3
CNR Institute of Clinical Physiology, Pisa, Italy
4
CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy
5
Department of Pathophysiology and, Transplantation, University of Milan, IRCCS
Abstract
Background
Community-acquired pneumonia (CAP) causes considerable morbidity and mortality in
adults, particularly in the elderly.

Methods
Structured searches of PubMed were conducted to identify up-to-date information on the
incidence of CAP in adults in Europe, as well as data on lifestyle and medical risk factors for
CAP.
Results
The overall annual incidence of CAP in adults ranged between 1.07 to 1.2 per 1000 personyears and 1.54 to 1.7 per 1000 population and increased with age (14 per 1000 person-years
in adults aged 65years). Incidence was also higher in men than in women and in patients
with chronic respiratory disease or HIV infection. Lifestyle factors associated with an
increased risk of CAP included smoking, alcohol abuse, being underweight, having regular
contact with children and poor dental hygiene. The presence of comorbid conditions,
including chronic respiratory and cardiovascular diseases, cerebrovascular disease,
Parkinson's disease, epilepsy, dementia, dysphagia, HIV or chronic renal or liver disease all
increased the risk of CAP by twofold to fourfold.
Conclusion
A range of lifestyle factors and underlying medical conditions are associated with an
increased risk of CAP in European adults. Understanding of the types of individual at greatest
risk of CAP can help to ensure that interventions to reduce the risk of infection and burden of
disease are targeted appropriately.

CASE

Crit Care Med. 2009 Apr;37(4):1470-4.

Acute eosinophilic pneumonia: A case report and review of the literature.
Source
1
Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN,
USA. david.janz@vanderbilt.edu
Abstract
OBJECTIVES:
Since its original description in 1989, clinicians have documented many cases of acute
eosinophilic pneumonia (AEP), but information regarding the appropriate timing of
diagnostic testing and treatment continues to be lacking. As a cause of respiratory failure in
relatively young individuals, AEP is one of the few diagnoses that will often dramatically
alter the intensivist's current therapy. Evidence for effective therapy is anecdotal and may
even suggest that the traditional treatment with steroids offers limited benefit. This review
uses a patient with AEP to emphasize certain aspects of this illness and discusses the current
literature regarding its features, diagnosis, and treatment.
DATA SOURCES:
A PubMed search from 1989 to 2008 was conducted using the search terms acute
eosinophilic pneumonia, respiratory failure, eosinophilic lung disease, bronchoalveolar
lavage, and smoking.

DATA EXTRACTION:
Twenty-two articles were included in this review and ranged from case reports to randomized
controlled trials. These studies demonstrate our current knowledge of this disease and, more
importantly, emphasize areas in which we are lacking.
CONCLUSIONS:
The diagnostic criteria and treatment of AEP is currently based on data from limited case
series. Although these criteria are rigid, a wide variation in symptoms, diagnostic findings,
and treatments reported further emphasizes our lack of knowledge regarding the
pathophysiology of this illness. Important questions remain regarding this disease, including
predisposing factors in patients with AEP and the benefit of treating with steroids.