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Periods of pharmacy online of the disease, accompanied by a deterioration in general well-being, fever, should probably be considered as the addition of superinfection. The disease proceeds, as a rule, chronically, however, acute forms are also described. An objectAn indirect study reveals a shortening of the percussion sound mainly over the lower lung fields. Auscultation reveals weakened vesicular breathing, sometimes gentle crepitus.
Diagnosis of alveolar proteinosis is difficult, as a result of which the period between the onset of best rated canadian online pharmacy and the diagnosis is often several years. Changes in the hemogram, biochemical blood parameters are nonspecific. The parameters of the immunological status of the patient practically do not change.
- X-ray examination reveals small-focal (small-dotted) shading that tends to merge.
- The changes are usually bilateral; predominant localization - middle and lower lung fields.
- There is no correlation between clinical and radiological data: pronounced radiological changes are accompanied by poor clinical symptoms.
- In advanced cases, radiological signs of online pharmacy store fibrotic changes are revealed.
- The ventilation capacity of the lungs is impaired in a restrictive manner, the diffusion capacity of the lungs decreases, and hypoxemia increases.
- Bronchoscopy does not reveal any signs characteristic of proteinosis.
- In sputum and bronchial washings, a PAS-positive substance can sometimes be detected.
- Verification of the diagnosis is helped by the study of the lavage fluid, in which a multiple increase in the protein content is detected, as well as the study of biopsy materials (transbronchial, open) of the lung tissue.
- The detection of a PAS-positive substance in the biopsy material confirms the diagnosis of proteinosis.
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Electron microscopic examination of lung tissue biopsy material is of great importance in diagnosis. The detection of surfactant in the form of lamellar bodies in the alveoli and in alveolar macrophages is considered pathognomonic. The latter are characterized by the presence of pointed holes - traces of cholesterol crystals released during processing of the material.
Differential diagnosis should be carried out primarily with secondary proteinosis. Most often, secondary proteinosis occurs in patients with leukemia, lymphoma and other hematological diseases in the presence of Canadian Online Pharmacy Without Prescription caused by Pneumocystis carinii, with long-term chemotherapy.
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Pathologically, primary proteinosis differs from secondary proteinosis in uniform staining of the PAS-positive substance contained in the alveoli, while granular (focal) staining is characteristic of secondary proteinosis.
However, the reaction with immunoperoxidase is now considered more specific, which is always positive in patients with primary proteinosis and negative in secondary proteinosis. It should be noted that this reaction is positive not only in the study of biopsy material of the lung parenchyma, but also in the lavage fluid. Differential diagnosis should also be carried out with some other disseminated processes in the lungs (disseminated pulmonary tuberculosis, sarcoidosis, exogenous allergic alveolitis, etc.).
Patients with proteinosis should be considered contraindicated in the appointment of antibacterial drugs (in the absence of bacterial complications), corticosteroids and immunosuppressants.
One lung is ventilated with pure oxygen, and the second lung (lobe, segment) is washed with an isotonic solution containing heparin, enzymes (acetylcysteine, streptase, streptokinase, etc.). The total volume of liquid depends on the size of the washed area and ranges from 1 to 10 liters.
The procedure is performed under general anesthesia.
An effective method of treating patients is therapeutic bronchoalveolar lavage, which has been used since 1964. As a result of effectively performed therapeutic lavage, shortness of breath decreases, indicators of the ventilation capacity of the lungs and blood gases improve, and positive X-ray dynamics are revealed.
Significantly worsen the prognosis erroneous diagnosis and prescription of antibacterial drugs or corticosteroids, immunosuppressants. Spontaneous recovery is possible. The addition of bacterial or fungal superinfection (which is largely due to improper treatment) also worsens the prognosis.
Dispensary observation should be long-term with X-ray and functional control every 8-10 months. If necessary, repeated therapeutic bronchoalveolar lavage is performed. The prognosis is usually favorable. The disease progresses slowly.