RESUMO
Background: Diagnosis of malignant pleural mesothelioma (MPM) remains a challenge, especially when resources in pathology are limited. The study aimed to evaluate cost-effective tumor markers to predict the probability of MPM in plasma samples in order to accelerate the diagnostic workup of the tissue of potential cases. Methods: We conducted a case-control study stratified by gender, which included 75 incident cases with MPM from three Mexican hospitals and 240 controls frequency-matched by age and year of blood drawing. Plasma samples were obtained to determine mesothelin, calretinin, and thrombomodulin using enzyme-linked immunosorbent assays (ELISAs). We estimated the performance of the markers based on the area under the curve (AUC) and predicted the probability of an MPM diagnosis of a potential case based on the marker concentrations. Results: Mesothelin and calretinin, but not thrombomodulin were significant predictors of a diagnosis of MPM with AUCs of 0.90 (95% CI: 0.85-0.95), 0.88 (95% CI: 0.82-0.94), and 0.51 (95% CI: 0.41-0.61) in males, respectively. For MPM diagnosis in men we estimated a true positive rate of 0.79 and a false positive rate of 0.11 for mesothelin. The corresponding figures for calretinin were 0.81 and 0.18, and for both markers combined 0.84 and 0.11, respectively. Conclusions: We developed prediction models based on plasma concentrations of mesothelin and calretinin to estimate the probability of an MPM diagnosis. Both markers showed a good performance and could be used to accelerate the diagnostic workup of tissue samples in Mexico.
Assuntos
Biomarcadores Tumorais/análise , Calbindina 2/sangue , Proteínas Ligadas por GPI/sangue , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Neoplasias Pulmonares , Masculino , Mesotelina , Mesotelioma/sangue , México , Pessoa de Meia-Idade , Neoplasias Pleurais/sangueRESUMO
The development of thoracic surgery as a specialty is linked to the acquisition of knowledge and skills such as the resolution of the open pneumothorax with differential pressure and tracheal intubation, asepsis, antibiotic therapy and intensive care.Our pioneers in thoracic development were general surgeons who ventured into this field during the late nineteenth and early twentieth centuries, culminating in the transition to a full blown specialty during the second half of the 20th century.
Assuntos
Cirurgia Torácica/história , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , MéxicoRESUMO
The patient is a 21-year-old female, diagnosed with cryptogenic cirrhosis at the age of 9. She presented with left post-pneumonic empyema that did not remit with conventional medical management and evolved with fistulization to the skin in the 7th intercostal space in the left subscapular region. We performed an open thoracic window procedure, and on the 6th day the patient was sent home with a portable vacuum-assisted closure device, with changes of the material every 4 days until the cavity was completed obliterated (92 days). Imaging tests showed full expansion of the lung, and chest wall reconstruction was performed with titanium rods. The high mortality of empyema in patients with liver disease requires both implementing and searching for new adjuvant therapies, like the use of vacuum-assisted closure systems and reconstruction with titanium rods. Controlled studies with a wide range of cases are needed for proper evaluation.
Assuntos
Empiema Pleural/cirurgia , Cirrose Hepática/complicações , Tratamento de Ferimentos com Pressão Negativa , Procedimentos de Cirurgia Plástica/métodos , Infecções Estafilocócicas/cirurgia , Staphylococcus haemolyticus/isolamento & purificação , Parede Torácica/cirurgia , Antibacterianos/uso terapêutico , Terapia Combinada , Fístula Cutânea/etiologia , Drenagem , Empiema Pleural/tratamento farmacológico , Empiema Pleural/etiologia , Empiema Pleural/microbiologia , Feminino , Volume Expiratório Forçado , Humanos , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Osteomielite/etiologia , Osteomielite/microbiologia , Osteomielite/cirurgia , Derrame Pleural/etiologia , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Próteses e Implantes , Atelectasia Pulmonar/etiologia , Costelas/microbiologia , Costelas/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Capacidade Vital , Adulto JovemRESUMO
The discrepancy between organ availability and the increasing amount of patients on the waiting list has prompted the development of medical strategies to increase the usable organs, including the search for alternative sources of donation, organ optimization and extension of the criteria for donation. The recovery of lungs from non-heart-beating donors (NHBD) is a concept in which death is declared based on cardiopulmonary criteria rather than the currently used definition of "brain death." Obtaining NHBD lungs is currently practiced in many centers. In this review we discuss the current state of lung transplantation from uncontrolled NHBD.
Assuntos
Parada Cardíaca , Transplante de Pulmão/métodos , Doadores de Tecidos , Bronquiolite Obliterante/epidemiologia , Isquemia Fria , Soluções Cristaloides , Morte , Humanos , Soluções Isotônicas , Preservação de Órgãos , Perfusão , Complicações Pós-Operatórias/epidemiologia , Espanha , Taxa de Sobrevida , Coleta de Tecidos e Órgãos/instrumentação , Coleta de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/normas , Isquemia QuenteRESUMO
BACKGROUND: There are few studies regarding the measurement of tracheal dimensions. Most are focused on morphology and tracheal development. The aim of this study was to determine the length and tracheal diameter of adults in our population and its correlation with external measurements. METHODS: The study design was prospective, observational and descriptive. We included a nonrandom sampling of deaths of Mexican national citizens who were between 18 and 65 year old. The study period was from June 1 to November 30, 2009, and the study was carried out at the facilities of the Forensic Medical Service of the Federal District, Mexico. Standardized measurements of tracheal diameter and length were correlated with external measurements. RESULTS: We dissected 44 cadavers, 19 (43%) females and 25 (57%) males. In females the average age was 39.2 ± 13.9 years (range: 19-61 years), average height 161.9 ± 7.4 cm (range: 154-179 cm), tracheal length (TL) 8.6 ± 0.5 cm (range: 7.8-9.5 cm) and transverse diameter (TD) 1.7 ± 0.3 cm (range: 1.3-2.0 cm). Average age of males was 36.4 ± 14.4 years (range: 19-65 years), average height 169.8 ± 6.7 cm (range: 156-184 cm), TL 9.1 ± 0.9 cm (range: 8.0-10.7) and TD 1.9 ± 0.2 cm (range: 1.6-2.3 cm). TL was significantly correlated with sternal length (0.82, p <0.0001) and age (0.56, p = 0.0003). According to gender, there was no significant correlation between TL and height. CONCLUSIONS: We found a low average TL and no significant correlation with height. These data should be considered when carrying out direct procedures on the trachea.