RESUMO
BACKGROUND: Pulmonary mucormycosis (PM) is a life-threatening fungal infection with an increasing incidence among patients with acute leukemia. In some immunocompromised hosts, the reversed halo sign (RHS) has been described on the pulmonary computed tomographic (CT) scan of patients with mucormycosis. METHODS: This study reports a single-center experience with PM exclusively in patients with acute leukemia. Clinical records, laboratory results, and CT scans were retrospectively analyzed to evaluate the clinical usefulness of the RHS for the early identification and treatment of PM, with regard to outcomes in these patients. RESULTS: Between 2003 and 2012, 16 cases of proven PM were diagnosed among 752 consecutive patients receiving chemotherapy for acute myeloblastic or lymphoblastic leukemia. At the time PM was diagnosed, all patients but one were neutropenic. The study of sequential thoracic CT scans showed that during the first week of the disease, the RHS was observed in 15 of 16 patients (94%). Initially, other radiologic findings (multiple nodules and pleural effusion) were less frequent, but appeared later in the course of the disease (6% and 12% before vs 64% and 55% after the first week). After the diagnosis of PM, median overall survival was 25 weeks (range, 3-193 weeks), and 6 patients (38%) died before day 90. CONCLUSIONS: In the particular setting of neutropenic leukemia patients with pulmonary infection, the presence of the RHS on CT was a strong indicator of PM. It could allow the early initiation of appropriate therapy and thus improve the outcome.
Assuntos
Leucemia/complicações , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/patologia , Pulmão/patologia , Mucormicose/diagnóstico , Mucormicose/patologia , Neutropenia/complicações , Adulto , Idoso , Feminino , Humanos , Leucemia/tratamento farmacológico , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Pulmonary segmentectomy is becoming increasingly widespread but remains technically challenging. The aim of this study was to evaluate the impact of the surgical approach applied on postoperative complications after pulmonary segmentectomy. METHODS: All patients having undergone pulmonary segmentectomy by thoracotomy, videothoracoscopy or robot-assisted surgery from 1st January 2018 to 31st December 2021 were included. The primary endpoint was the occurrence of postoperative complications. Secondary endpoints were operative time, length of hospital stay, 30-day readmission rate, 30-day and 90-day mortality. RESULTS: Two hundred and twenty-three patients were included, 30% (n=67) in the thoracotomy group, 9.4% (n=21) in the videothoracoscopy group and 60.5% (n=135) in the robot-assisted surgery group. There was no difference in the occurrence of postoperative complications according to type of approach (P=0.564), 26.9% of patients (n=60) had at least one postoperative complication. There was no significant difference between the groups in terms of operative time (P=0.385), length of hospital stay (P=0.107), 30 and 90-day mortality (P=0.124 and P=0.249, respectively). Mini-invasive surgery significantly reduced the 30-day readmission rate (P=0.049). CONCLUSION: The surgical approach applied does not influence the postoperative complications of pulmonary segmentectomy.
Assuntos
Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/complicações , Pneumonectomia/efeitos adversos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Pulmão/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND: France is characterized by the dispersion of its technical surgical platforms, and it seemed interesting for us to obtain information on quality of care compared to other European countries, which often have different organizations and practices. The objective of the study was to compare the 30-day mortality of patients operated on for bronchial cancer in France with that of other European countries. METHOD: We conducted a literature review on practices in different European countries. The terms used for the selection were: lung cancer surgery, 30-day mortality in different hospitals in European countries. RESULTS: We selected 9 articles corresponding to 9 European countries. The correlation coefficient between the number of lung resections per year and the population of the country was 0.967. The linear regression model between number of annual lung resections and population showed that except for Great Britain, most of the countries were close to the linear regression line. Germany and France had a mortality rate of 2.887% and 2.937% respectively, whereas the average is 2.13%. Following sensitivity analysis, the mortality rates for Germany and France remained higher than the average. CONCLUSION: France is among the European countries with the highest postoperative mortality rates. These results should induce surgical teams to adopt quality-of-care measures focusing on outcome analysis.
Assuntos
Neoplasias Pulmonares , Europa (Continente)/epidemiologia , França/epidemiologia , Alemanha/epidemiologia , Hospitais , Humanos , Neoplasias Pulmonares/cirurgiaRESUMO
BACKGROUND: Readmission within 30 days is an indicator of the quality of care, because it often reflects post-discharge care that is not optimal. The objective of this work is to measure over time on the one hand the readmission rate and on the other hand the number of hospitals with a standardized readmission rate beyond the national average. METHOD: All patients with major pulmonary resection for lung cancer in France were extracted from the PMSI national database. Readmission within 30 days was defined as any new hospitalization either in the same hospital or in another establishment. RESULTS: From January 1, 2005 to December 31, 2018, 110,603 patients were included. The 30-day all-cause readmissions rate was 24.9% (n=27,540). Patients after pneumonectomy had a readmission rate of 37% (n=4918) and 23% after lobectomy (n=2684) (P<0.0001). For the first period, we counted 10 hospitals with a standardized readmissions rate above the 99.8 limit and 10 hospitals above the 95% limit. For the second period, 8 hospitals had a standardized readmission rate above the 99.8% limit and 11 hospitals above the 95% limit. For the third period, 7 hospitals had a standardized readmission rate above the 99.8% limit and 6 hospitals above the 95% limit. CONCLUSION: Readmissions to hospital 30 days after major lung resection for cancer in France declined little during these three periods. Measures to prevent readmissions should be introduced.
Assuntos
Neoplasias Pulmonares , Readmissão do Paciente , Assistência ao Convalescente , Humanos , Pulmão , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/cirurgia , Alta do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Estados UnidosRESUMO
INTRODUCTION: Sclerosing pneumocytoma is a benign and rare lung tumor affecting epithelial cells. In most cases, patients are asymptomatic and the diagnosis is made on an X ray or a CT scan performed for other enquiry. Sex ratio favors women. Epidemiological studies report that middle-aged Asian women are more frequently affected. Radiological investigations find a solitary nodule or a mass with peripheric localization. When performed, histological analysis shows a tumor composed of at least two of the four following architectures: papillary, sclerosing, hemangiomatous and solid, with two types of cells that can be round or cubic cells. CASES REPORT: We report two cases of multiple sclerosing pneumocytoma in two caucasien men. The first patient was asymptomatic, the second complain from moderate dyspnea. A wedge resection was performed in both, allowing diagnosis. Anatomopathology revealed respectively a predominant sclerosing and solid architecture and a sclerosing and papillary architecture. There was no progression of the other concomitant nodules after three years follow-up. CONCLUSION: Pneumocytoma is a benign, slow-growing tumor with good prognosis.
Assuntos
Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Hemangioma Esclerosante Pulmonar/patologia , Hemangioma Esclerosante Pulmonar/cirurgia , Progressão da Doença , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pneumonectomia , Prognóstico , Hemangioma Esclerosante Pulmonar/diagnóstico , Radiografia Torácica , Doenças RarasRESUMO
BACKGROUND: In recent years, improving the quality of care has been a concern for health professionals in France, through the certification of institutions, accreditation and continuous professional development. Evaluation of these different measures has rarely been carried out. The objective of the study was to evaluate the quality of surgical management of lung cancer in different regions using hospital mortality as an indicator. METHOD: From the national database of the Program of Medical Information Systems (PMSI), data on all patients who had undergone surgery for lung cancer were extracted as well as the characteristics of the centers. The main outcome criterion was hospital mortality. Logistic models allowed an estimation of the risk standardized mortality rate for each center. RESULTS: From January 1, 2015 to December 31, 2015, 10,675 patients underwent surgery for lung cancer in 158 French centers. The hospital mortality rate was 3.43% (n=366). Thirty-nine facilities (25%) performed fewer than 15 pulmonary resections. The minimum activity volume was a single pulmonary resection during the year and the maximum was 300 interventions with a coefficient of variation estimated at 147%. Hospital mortality ranged from 0 % to 50% depending on the entries with a coefficient of variation of 112%. For some regions, it is possible to count up to 5 centers per million inhabitants (Languedoc-Roussillon) or 4 centers per million inhabitants (Limousin, Pays-de-Loire). The majority of regions had 3 centers per million inhabitants. Eleven regions have no centers with a standardized mortality rate below 3%. Five regions (Languedoc-Roussillon, Pays-de-Loire, Aquitaine, Brittany and Provence Alpes Côte d'Azur) have at least two centers with a risk standardized rate of mortality above 4%. Among the academic centers, 20% have a risk standardized mortality rate of less than 3%. Among the centers with a risk standardized rate of mortality<3%, 20% performed more than 39 pulmonary resections, 7% between 39 and 15 procedures and 0% for centers with<15 interventions. CONCLUSION: This work confirms that hospital volume is one of the components of quality of care. The number of centers should be adapted to the actual needs of the population in order to enable patients to access effective services.
Assuntos
Mortalidade Hospitalar , Neoplasias Pulmonares/cirurgia , Pneumonectomia/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Idoso , Bases de Dados Factuais , Feminino , França , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: In acute leukaemia (AL), the occurrence of pulmonary mucormycosis (PM), the incidence of which is increasing, as a result of chemotherapy induced marrow aplasia, remains a life threatening complication. METHODS: Analysis of clinical, biological and thoracic CT characteristics of patients with PM developing during the treatment of AL between 2000 and 2015. Day 0 (D0) was defined as the day with first CT evidence of PM. RESULTS: Among 1193 patients, 25 cases of PM were recorded during 2099 episodes of bone marrow aplasia. At time of diagnosis of PM, 24/25 patients had been neutropenic for a median of 12 days. None of the patients had diabetes mellitus. On initial CT (D0), the lesion was solitary in 20/25 cases and a reversed halo sign (RHS) was observed in 23/25 cases. From D1 to D7, D8 to D15 and after D15, RHS was seen in 100 %, 75 % and 27 % of cases, respectively. A tissue biopsy was positive in 17/18 cases. The detection of circulating Mucorales DNA in serum was positive in 23/24 patients and in 97/188 serum specimens between D-9 and D9. Bronchoalveolar lavage contributed to diagnosis in only 3/21 cases. The antifungal treatment was mainly based on liposomal amphotericin B combined with, or followed by, posaconazole. A pulmonary surgical resection was performed in 9/25 cases. At 3 months, 76 % of patients were alive and median overall survival was 14 months. CONCLUSION: In AL, early use of CT could improve the prognosis of PM. The presence of a RHS on CT suggests PM and is an indication for prompt antifungal treatment.
Assuntos
Leucemia Mieloide Aguda/complicações , Pneumopatias Fúngicas/complicações , Mucormicose/complicações , Antifúngicos/uso terapêutico , França , Humanos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/terapia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/terapia , Mucormicose/diagnóstico , Mucormicose/terapia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Colorectal cancer is the 3rd commonest cause of death from cancer: 5% of patients will develop lung metastases. The management of oligometastatic disease is based on the objective of optimal local control. STATE OF THE ART: To date, no results from randomized control trials support the resection of pulmonary metastases in oligometastastic colorectal cancer patients. However, numerous series, mainly retrospective, report long-term survival for highly selected patients, with 5-year survival ranging from 45 to 65% in the most recent series. The consensual predictive factors of a good prognosis are: a disease free-interval>36 months, a number of metastases≤3, a normal level of carcino-embryonic antigen and the absence of hilar or mediastinal lymph node involvement. PERSPECTIVES: Around 20 to 40% of patients will develop recurrence, probably linked to the presence of undetectable micrometastases. Therefore, experimental work is being undertaken to develop new treatment techniques such as isolated lung perfusion, radiofrequency ablation and stereotactic radiation therapy. CONCLUSION: Highly selected patients suffering from colorectal cancer lung metastases could benefit from resection with improved survival and disease-control.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Pneumonectomia/mortalidade , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Terapia Combinada , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Seleção de Pacientes , Prognóstico , Fatores de Risco , Taxa de SobrevidaRESUMO
Invasive fungal infections (IFI) remain life-threatening complications in haematological patients. The aim of the study was to present the experience of a single centre in the surgical treatment of pulmonary IFI. Between 1992 and 2014, 50 haematological patients with IFI underwent pulmonary resection. In 27 cases it was an emergency procedure to avoid haemoptysis (if the lesion threatened pulmonary vessels). The remaining 23 patients underwent elective surgery before new chemotherapy or stem-cell transplantation. Among these patients (median age: 54 years; range: 5-70 years), 92% had acute leukaemia and 68% were on haematological first-line therapy (receiving induction or consolidation chemotherapies). Invasive pulmonary aspergillosis and pulmonary mucormycosis were diagnosed in 37 and 12 patients, respectively. One patient had IFI due to Trichoderma longibrachiatum. All of the patients received antifungal agents. In the month preceding IFI diagnosis, 94% of patients had been neutropenic. At the time of surgery, 30% of patients were still neutropenic and 54% required platelet transfusions. Lobectomy or segmentectomy were performed in 80% and 20% of cases, respectively. Mortality at 30 and 90 days post-surgery was 6% and 10%, respectively. After surgery, median overall survival was 21 months; median overall survival was similar between patients with emergency or elective surgery and between the types of IFI (invasive pulmonary aspergillosis or pulmonary mucormycosis). However, overall survival was far better in haematological first-line patients or in those achieving a haematological complete response than in other patients (p <0.001). In pulmonary IFI, lung resection could be an effective complement to medical treatment in selected haematological patients.
Assuntos
Doenças Hematológicas/complicações , Doenças Hematológicas/cirurgia , Infecções Fúngicas Invasivas/etiologia , Pneumopatias Fúngicas/etiologia , Procedimentos Cirúrgicos Pulmonares/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Doenças Hematológicas/terapia , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/mortalidade , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/mortalidade , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Modelos de Riscos Proporcionais , Procedimentos Cirúrgicos Pulmonares/métodos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
INTRODUCTION: Non-small cell lung cancer (NSCLC) remains a major health problem, with a 5-year overall survival of 25%. Surgical management of stage IIIA NSCLC is still controversial. We conduct a systematic analysis of the different management strategies for stage IIIA-N2 NSCLC. METHODS: We analyzed randomized control trials published between January 1990 to December 2013, comparing induction chemotherapy followed by surgery vs. surgery alone, and those comparing induction chemo or radiotherapy followed by surgery vs. induction chemotherapy followed by radiotherapy for stage IIIA-N2 NSCLC. RESULTS: A 16% significant increase in overall survival was found in favor of induction chemotherapy followed by surgery vs. surgery alone. However, there was no significant difference in overall survival between induction chemo- or radiotherapy followed by surgery and induction chemotherapy followed by radiotherapy. CONCLUSION: Current scientific data do not permit the exclusion of surgery as an option in the management of stage IIIA-N2 NSCLC.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimioterapia Adjuvante , Terapia Combinada , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Terapia Neoadjuvante , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Surgical resection of pulmonary aspergilloma is associated with symptoms control, complications prevention, and improved survival, given that the disease is localized and the patient fit enough to undergo surgery. In these operable forms, the impact of perioperative antifungal therapy remains controversial. The purpose of this study was to analyze the impact of antifungal therapy on postoperative morbidity and overall survival in patients with operable pulmonary aspergilloma. METHODS: The clinical records of 113 patients who underwent thoracic surgery for aspergilloma in our institution from January 1989 to December 2010 were retrospectively reviewed. Of these, 64 patients received antifungal therapy in the perioperative period and were included in group 1, and 49 patients did not receive antifungal therapy and were included in group 2. RESULTS: Postoperative complication rates were 31.2% in group 1 and 20.4% in group 2 (P = 0.30). Univariable analysis showed that immunocompromised status (P < 0.001), past history of cancer (P = 0.50), preoperative purulent sputum (P = 0.024), and pneumonectomy (P < 0.001) were significantly associated with postoperative complications, but that antifungal therapy was not. Five- and 10-year overall survival rates were respectively 78.3% and 57.8% in group 1 vs. 85.9% and 65.7% in group 2 (P = 0.23). Multivariate analysis revealed that age higher than 50, immunocompromised status and pneumonectomy were significantly associated with adverse long-term survival (χ(2) = 6.59, df = 5, P < 0.001), but that antifungal therapy was not. CONCLUSION: Antifungal therapy has no significant impact on postoperative morbidity or long-term survival following surgical resection of pulmonary aspergilloma. Such procedure is associated with acceptable postoperative morbidity and long-term survival.
Assuntos
Antifúngicos/uso terapêutico , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/cirurgia , Procedimentos Cirúrgicos Pulmonares , Adulto , Idoso , Feminino , Humanos , Pulmão/patologia , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias , Aspergilose Pulmonar/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
INTRODUCTION: The increase in the number of cancer survivors, together with the improvement of their follow-up, lead to the frequent diagnosis of resectable non-small cell lung cancer (NSCLC) in patients with history of previous malignancy. We sought to analyse the outcomes of these patients. METHODS: Patients undergoing surgical resection for NSCLC between January 1980 and December 2009 were retrospectively reviewed. For each patient, the presence of previous malignancy was noted, and classified into five groups: oro-pharyngeal cancer, lung cancer, haematopoietic malignancy, other organ malignancy, and more than two cancers. RESULTS: The overall population included 5846 patients. Among them, 1243 (21%) had a history of previous malignancy, of whom 383 (31%) presented with synchronous cancer. Patients with history of previous malignancy were more often female, older, with more adenocarcinomas, more limited disease, less pneumonectomies, but higher postoperative morbidity and mortality. Overall survival was worse in patients with a history of previous malignancy than in patients without (median, 5 and 10 year: 33 months, 34.3%, 17.8% versus 47 months, 44.6%, 28.8%). CONCLUSION: A history of previous malignancy impacted significantly the prognosis of patients operated on for limited NSCLC. However, only surgical resection led to improved long-term survival at 5 years.
Assuntos
Carcinoma Broncogênico/cirurgia , Neoplasias Pulmonares/cirurgia , Segunda Neoplasia Primária/cirurgia , Idoso , Carcinoma Broncogênico/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/epidemiologia , Pneumonectomia/estatística & dados numéricos , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço , Análise de Sobrevida , Sobreviventes/estatística & dados numéricosRESUMO
Lung abscesses and necrotizing pneumonia are rare complications of community-acquired pneumonia since the advent of antibiotics. Their management leans first of all on the antibiotic treatment adapted on the informed germs. However, in 11 to 20% of the cases of lung abscesses, this treatment is insufficient, and drainage, either endoscopic or percutaneous, must be envisaged. In first intention, we shall go to less invasive techniques: endoscopic or percutaneous radio-controlled. In case of failure of these techniques, a percutaneous surgical drainage by minithoracotomy will be performed. In the necrotizing pneumonia, because of the joint obstruction of the bronchus and blood vessels corresponding to a lung segment, the systemic antibiotic treatment will be poor effective. In case of failure of this one we shall propose, a percutaneous surgical drainage, especially if the necrosis limits itself to a single lobe. The surgical treatment will be reserved: in the failures of the strategy of surgical drainage, in the necroses extending in several lobes.
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Tubos Torácicos , Drenagem/estatística & dados numéricos , Abscesso Pulmonar/terapia , Pulmão/patologia , Pneumonia/terapia , Procedimentos Cirúrgicos Pulmonares/estatística & dados numéricos , Tubos Torácicos/estatística & dados numéricos , Drenagem/instrumentação , Drenagem/métodos , Humanos , Pulmão/cirurgia , Abscesso Pulmonar/cirurgia , Necrose/cirurgia , Necrose/terapia , Pneumonia/cirurgia , Procedimentos Cirúrgicos Pulmonares/métodosRESUMO
Surgery is part of the therapeutic strategy of aspergillosis and mucormycosis. The aspergilloma is defined as a rounded mass, developing in a cavity by the proliferation of spores of Aspergillus. The most common complication was haemoptysis reported in 50-95% of cases. The pleuropulmonary lesions predisposing are: tuberculosis, residual pleural space, emphysema and lung destroyed by fibrosis or radiotherapy or bronchiectasis. The indications for surgery depend on symptoms, respiratory function, the parenchyma and the type of aspergilloma (simple or complex). In a patient with an intrapulmonary aspergilloma, lung resection preceded by embolization is recommended based on respiratory function. For intrapleural aspergilloma, thoracoplasty is recommended according to the patient's general condition. The invasive pulmonary aspergillosis (IPA) is characterized by an invasion of lung tissue and blood vessels by hyphae in immunocompromised patients. The death rate of patients who have an API after treatment for leukemia or lymphoma was 30 to 40%, after bone marrow transplantation 60%, after solid organ transplantation from 50 to 60% and after any other cause of immunocompromising from 70 to 85%. The main cause of these deaths is massive hemoptysis. Surgery (lobectomy) is indicated for the prevention of hemoptysis when the mass is in contact with the pulmonary artery or one of its branches, and if it increases in size with the disappearance of border security between the mass and the vessel wall. The patient will be operated in an emergency before the white blood cells do not exceed the threshold of 1000 cells/µl. A persistent residual mass after antifungal treatment may justify a lung resection (lobectomy or wedge) before a new aggressive therapy. Mucormycosis affects patients following immunocompromising states--haematologic malignancy, diabetes mellitus, transplantation, burns and malnutrition. The treatment of pulmonary mucormycosis combines surgical and medical approach.
Assuntos
Pneumopatias Fúngicas/cirurgia , Aspergilose Pulmonar/cirurgia , Procedimentos Cirúrgicos Pulmonares , Algoritmos , Aspergillus/crescimento & desenvolvimento , Aspergillus/fisiologia , Guias como Assunto , Humanos , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/etiologia , Aspergilose Pulmonar Invasiva/terapia , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/etiologia , Modelos Biológicos , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/etiologia , Procedimentos Cirúrgicos Pulmonares/métodos , Procedimentos Cirúrgicos Pulmonares/estatística & dados numéricosRESUMO
OBJECTIVE: The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. METHODS: We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. RESULTS: The mean MSD and DAP were respectively 389 mGy and 65 Gy cm(-2) for CAs, and 916 mGy and 69 Gy cm(-2) for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r=0.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. CONCLUSION: Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions.
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Angioplastia Coronária com Balão , Angiografia Coronária , Doses de Radiação , Pele/efeitos da radiação , Fatores Etários , Idoso , Angioplastia Coronária com Balão/métodos , Índice de Massa Corporal , Angiografia Coronária/métodos , Feminino , Humanos , Masculino , Análise MultivariadaRESUMO
Myeloproliferative neoplasms are frequently associated with aberrant constitutive tyrosine kinase (TK) activity resulting from chimaeric fusion genes or point mutations such as BCR-ABL1 or JAK2 V617F. We report here the cloning and functional characterization of two novel fusion genes BCR-RET and FGFR1OP-RET in chronic myelomonocytic leukemia (CMML) cases generated by two balanced translocations t(10;22)(q11;q11) and t(6;10)(q27;q11), respectively. The two RET fusion genes leading to the aberrant activation of RET, are able to transform hematopoietic cells and skew the hematopoietic differentiation program towards the monocytic/macrophage lineage. The RET fusion genes seem to constitutively mimic the same signaling pathway as RAS mutations frequently involved in CMML. One patient was treated with Sorafenib, a specific inhibitor of the RET TK function, and demonstrated cytological and clinical remissions.