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BACKGROUND: The escalating impact of diabetes and its complications, including diabetic foot ulcers (DFUs), presents global challenges in quality of life, economics, and resources, affecting around half a billion people. DFU healing is hindered by hyperglycemia-related issues and diverse diabetes-related physiological changes, necessitating ongoing personalized care. Artificial intelligence and clinical research strive to address these challenges by facilitating early detection and efficient treatments despite resource constraints. This study establishes a standardized framework for DFU data collection, introducing a dedicated case report form, a comprehensive dataset named Zivot with patient population clinical feature breakdowns and a baseline for DFU detection using this dataset and a UNet architecture. RESULTS: Following this protocol, we created the Zivot dataset consisting of 269 patients with active DFUs, and about 3700 RGB images and corresponding thermal and depth maps for the DFUs. The effectiveness of collecting a consistent and clean dataset was demonstrated using a bounding box prediction deep learning network that was constructed with EfficientNet as the feature extractor and UNet architecture. The network was trained on the Zivot dataset, and the evaluation metrics showed promising values of 0.79 and 0.86 for F1-score and mAP segmentation metrics. CONCLUSIONS: This work and the Zivot database offer a foundation for further exploration of holistic and multimodal approaches to DFU research.
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Aprendizaje Profundo , Diabetes Mellitus , Pie Diabético , Humanos , Pie Diabético/diagnóstico , Inteligencia Artificial , Metadatos , Calidad de VidaRESUMEN
OBJECTIVE: Purely exponential decay is rarely observed in conventional mono-exponential T2 mapping due to transmit field inhomogeneity and calibration errors, which collectively introduce stimulated and indirect echo pathways. Stimulated echo correction (SEC) requires an additional fit parameter for the transmit field, resulting in greater uncertainty in T2 relative to mono-exponential fitting. The aim of this study was to develop an accurate and precise method for T2 mapping using SEC. METHODS: The proposed method, called two-step SEC (tSEC), leverages spatial correlations in the transmit field to reduce the number of fully independent fitting parameters from three to two. The method involves a two-pass fit: the first pass involves a fast but standard SEC fit. The initially estimated transmit field is smoothed and provided as a fixed input to the second pass. RESULTS: Simulations and in vivo experiments demonstrated up to 38% and 27% decreases in relative T2 variance with tSEC relative to SEC. Average T2 values were unchanged between tSEC and SEC fits. The proposed method uses the same input data as SEC and exponential fits, so it is applicable to existing data. DISCUSSION: The proposed method generates reliable and reproducible quantitative T2 maps and should be considered for future relaxometry studies.
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Mapeo Encefálico/métodos , Encéfalo/diagnóstico por imagen , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética , Adulto , Algoritmos , Simulación por Computador , Femenino , Voluntarios Sanos , Humanos , Masculino , Modelos Teóricos , Fantasmas de Imagen , Reproducibilidad de los ResultadosRESUMEN
In this study, the interaction between the microbiota of the lower respiratory tract and the type of immune response against Mycobacterium tuberculosis were studied. Bronchoalveolar lavage (BAL) samples of 10 tuberculosis (TB) patients and 5 cases suspected of lung cancer as control were obtained. Clinical symptoms were recorded for the TB patients. Serial dilutions of samples were prepared and cultured on a selective medium in order to count Streptococcus spp., Neisseria spp., Haemophilus spp. and Veillonella in the lung. To determine the type of immune response of Th1/Th2, Real Time-PCR method was used. The prevalence of Streptococcus spp. in the lungs of patients with TB increased when compared with the control group and the Th1-response in this group may be influenced by Neisseria and Haemophilus. However, reducing the number of Streptococcus and Neisseria can be involved in the development of Th1-response in the control group. Prevalence of Neisseria and Veillonella of the lung microbiota in this group may be associated with fever. The chest x-ray influenced both Th1 and Th2-responses in the lung, but only Th1-response was involved in reducing the weight of patients. The relationship between each of the clinical symptoms with immune response and with each genus of microbiota were reviewed separately, and these data are the new information on TB disease and can be the beginning of the study on the impact of genus, different species and strains of microbiota on the clinical signs of disease.
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Microbiota/inmunología , Mycobacterium tuberculosis/inmunología , Sistema Respiratorio/inmunología , Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/inmunología , Infecciones del Sistema Respiratorio/microbiología , Tuberculosis/inmunología , Adulto , Bacterias/aislamiento & purificación , Líquido del Lavado Bronquioalveolar/microbiología , Femenino , Haemophilus/aislamiento & purificación , Humanos , Pulmón/inmunología , Pulmón/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/patogenicidad , Neisseria/aislamiento & purificación , Streptococcus/aislamiento & purificación , Balance Th1 - Th2 , Veillonella/aislamiento & purificación , Adulto JovenRESUMEN
Key Clinical Message: Infective endocarditis is an important differential diagnosis in patients with persistent fever and chills not responding to antibiotics and involvement of multiple organs. It can present without any specific signs such as valvular murmurs and no growth on blood cultures. Therefore, considering an echocardiography can be crucial and helpful in establishing the diagnosis. Abstract: Infective endocarditis (IE), a rare disease with high mortality, arises from microbial infection affecting the heart valves and endocardium. It exhibits diverse symptoms and can involve various organs, including the brain, lungs, spleen, and liver. Diagnosis is often intricate due to its polymorphic nature, and negative blood cultures can add complexity to the diagnostic process. In this report, we present an unusual case of IE in a 53-year-old male farmer with multi-organ involvement, including liver abscesses and pulmonary infiltration with cavities. Echocardiography showed a nodular mass attached to his bicuspid aortic valve, thus, playing a crucial role in confirming the diagnosis. This atypical manifestation highlights the necessity for increased clinical vigilance and further research to improve diagnostic approaches for uncommon IE cases.
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OBJECTIVE: This study evaluated the toe and flow model (TFM), a limb preservation program led by podiatric surgeons in Alberta, Canada, for its impact on hospitalization rates and length of stay (LOS) in patients with diabetic foot complication (DFC). Diabetes, a leading cause of non-traumatic lower extremity amputations (LEAs) in Canada, often results in diabetic foot ulcers (DFUs), a major cause of infection, amputation, and hospitalization. TFM has reportedly reduced amputation rates by 39% to 56%. METHODS: The study analyzed Alberta's health database from 2007 to 2017, focusing on diabetes patients aged 20 and above. It included patients with various DFCs and compared outcomes in regions using TFM and standard of care (SOC). The study also examined data from two major cities, one with TFM and the other without, including rural referrals to Calgary and Edmonton. The data were normalized for the diabetic population and analyzed using a standard Student's t-test. RESULTS: TFM regions showed significantly lower hospitalization rates (p = 1.22E-12) than SOC regions. Over 11 years, TFM maintained lower average and median LOS by 0.13 and 0.26 days, respectively. TFM access reduced hospitalization risk by up to 30%, and patients in TFM regions had a 21% shorter LOS compared to SOC regions. CONCLUSION: Despite similar demographics and healthcare systems, the TFM region benefited from a dedicated multidisciplinary program and comprehensive limb preservation services. The study shows that TFM effectively reduces hospitalizations and LOS for DFCs, with significantly better outcomes in the TFM region than in SOC regions.
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INTRODUCTION: Primary pulmonary angiosarcoma (PPA) is a highly aggressive and rare malignancy originating from the endothelial cells of blood vessels in the lungs. PPA is an extremely rare subtype, with less than 30 cases reported to date. PPA is not only challenging to diagnose but also has a poor prognosis, often resulting in a high mortality rate within a year of diagnosis, regardless of the treatment approach. METHOD: We present the case of a 33-year-old woman with no significant past medical history who presented with abdominal pain and was incidentally found to have a right hilar mass with pleural effusion and empyema. After undergoing surgery for a perforated gastric ulcer, her pulmonary lesions were further worked up. Despite an extensive diagnostic evaluation, including imaging, bronchoscopy, and thoracotomy, establishing a diagnosis was challenging. Ultimately, PPA was diagnosed on surgical lung biopsy, and the patient was started on pazopanib and paclitaxel chemotherapy but expired after 1 month due to multiple complications. CONCLUSION: This case highlights the difficulty in diagnosing this rare tumor and its poor prognosis regardless of therapy. Greater awareness of PPA and more research are needed to improve early detection and treatment options for this deadly disease.
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Hemangiosarcoma , Hallazgos Incidentales , Neoplasias Pulmonares , Humanos , Hemangiosarcoma/diagnóstico , Hemangiosarcoma/complicaciones , Hemangiosarcoma/patología , Femenino , Adulto , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Resultado Fatal , Tomografía Computarizada por Rayos X/métodos , Broncoscopía/métodos , Pirimidinas/uso terapéutico , Indazoles , Biopsia , Sulfonamidas/uso terapéutico , Paclitaxel/uso terapéutico , Paclitaxel/administración & dosificaciónRESUMEN
Key Clinical Message: In patients with poorly controlled diabetes, early recognition of rare fungal infections like pulmonary mucormycosis, especially when presenting with unusual complications such as broncho-esophageal fistula, is critical. Prompt intervention with antifungal therapy and consideration for surgical debridement significantly impact outcomes. Multidisciplinary management is paramount for such complex cases. Abstract: Mucormycosis is a rare fungal infection caused by the Mucorales. This infection is mostly observed among those with poorly controlled diabetes or immunodeficiency. The most common presentation of the infection among those with poorly controlled diabetes is rhino-orbit-cerebral involvement. In this case report, we provide the history and outcome of a rare case of pulmonary mucormycosis in a patient with poorly controlled diabetes who was simultaneously diagnosed with broncho-esophageal fistula. Our patient was a 32-year-old male with a history of poorly controlled diabetes. Over the months, he had complained of productive coughs and dyspnea, which had lately been joined by dysphagia. He also claimed to have lost considerable weight (10 kg) during the previous 3 months. Barium swallow showed an abnormal flow of contrast between the bronchus and esophagus, suggesting a broncho-esophageal fistula. Computed tomography of the thorax revealed a broncho-esophageal fistula between the left main bronchus (LMB) and esophagus. He had a bronchoscopy the next day, which revealed necrosis and a broncho-esophageal fistula in the LMB. A bronchial biopsy showed typical hyphae with necrotic tissue, indicating mucormycosis. The patient's antimycotic medication (liposomal amphotericin) was started and a prompt surgery consult was ordered. The patient, however, passed away from massive hemoptysis. We described a rare case of pulmonary mucormycosis with broncho-esophageal fistula in a patient with poorly controlled diabetes. The rarity of this combination highlights the associated diagnostic and treatment hurdles. Early detection, antifungal medication, as soon as possible surgical debridement of involved tissues, and a multidisciplinary approach could improve patient outcomes.
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Background: Increased vascular permeability is one of the main mechanisms in the production of pleural effusion (PE) and vascular endothelial growth factor (VEGF) has a significant role in its pathogenesis. This study aimed to compare pleural levels of VEGF in transudative and exudative PEs besides the other pleural markers. Materials and Methods: In this prospective cross-sectional study, 80 patients with PE were divided into 4 groups as transudative (N=15), parapneumonic (N=15), tuberculosis (N=25), and malignant (N=25) PE. Biochemical tests measured the pleural protein, LDH, cholesterol, glucose, polymorphonuclear cell (PMN), and lymphocyte. ELISA measured the pleural VEGF level. Results: Out of 80 patients, 51 were male, and the total mean age was 55.34±18.53. There were significant differences in pleural VEGF between exudative and transudative effusion (P<0.001) and between malignant and benign effusion (P=0.014). The highest mean difference in pleural VEGF levels was seen in the comparison of transudative and malignant groups (Mean difference=-136.56; P<0.002). The VEGF level in 3 groups was not significantly different; transudative vs tuberculous, parapneumonic vs tuberculous, and parapneumonic vs malignant. Furthermore, VEGF higher than 73.09 pg/ml had a 64% sensitivity and 82% specificity for the diagnosis of malignancy. Among pleural markers (VEGF, protein, LDH, and glucose), VEGF had the highest area under curve (AUC=0.734). Moreover, pleural protein, LDH, and glucose levels significantly correlated with pleural VEGF; however, pleural cholesterol, PMN, and lymphocyte were not correlated. Conclusion: VEGF is assumed as an important factor in the pathogenesis of exudative PE, especially malignant effusion. It can distinguish between lymphocytic exudative PEs.
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This is a report of established invasive Aspergillus rhinosinusitis in a patient diagnosed with COVID-19 and afflicted by AML, which was initially considered to be rhinocerebral mucormycosis.
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BACKGROUND: Diabetes-related lower limb amputations (LLAs) are a major complication that can be reduced by employing multidisciplinary center frameworks such as the Toe and Flow model (TFM). In this study, we investigate the LLAs reduction efficacy of the TFM compared to the standard of care (SOC) in the Canadian health-care system. METHODS: We retrospectively reviewed the anonymized diabetes-related LLA reports (2007-2017) in Calgary and Edmonton metropolitan health zones in Alberta, Canada. Both zones have the same provincial health-care coverage and similar demographics; however, Calgary operates based on the TFM while Edmonton with the provincial SOC. LLAs were divided into minor and major amputation cohorts and evaluated using the chi-square test, linear regression. A lower major LLAs rate was denoted as a sign for higher efficacy of the system. RESULTS: Although LLAs numbers remained relatively comparable (Calgary: 2238 and Edmonton: 2410), the Calgary zone had both significantly lower major (45%) and higher minor (42%) amputation incidence rates compared to the Edmonton zone. The increasing trend in minor LLAs and decreasing major LLAs in the Calgary zone were negatively and significantly correlated (r = -0.730, p = 0.011), with no significant correlation in the Edmonton zone. CONCLUSIONS: Calgary's decreasing diabetes-related major LLAs and negative correlation in the minor-major LLAs rates compared to its sister zone Edmonton, provides support for the positive impact of the TFM. This investigation includes support for a modernization of the diabetes-related limb preservation practice in Canada by implementing TFMs across the country to combat major LLAs.
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Amputación Quirúrgica , Diabetes Mellitus , Alberta/epidemiología , Diabetes Mellitus/epidemiología , Humanos , Incidencia , Estudios RetrospectivosRESUMEN
BACKGROUND: Despite the high prevalence of occupational airway disorders, they are usually underestimated by physicians. This study designed to study the prevalence of work-related symptoms (WRS) and their association with occupational exposure in outpatient pulmonary clinics. METHODS: Adults with more than one year of lower respiratory symptoms were included. Retired patients, housewives and those unable to perform spirometry were excluded. Demographic, anthropometric and medical data were documented. The Persian version of National institute for health and safety respiratory questionnaire was used to classify job titles. WRS were defined as 2 (or more) positive questions with improvement of symptoms on days off work. Job exposure matrix (JEM) was used for classifying the type of occupational exposure into one of three categories: high molecular weight (HKW), low molecular weight (LMW) and mixed. RESULTS: A total of 250 patients (69% male) with mean (±SD) age of 40 (±11.6) years, 178 cases of asthma and 59 chronic obstructive pulmonary disease (COPD) cases entered. Occupational exposure was seen in 51.2% of patients (26, 51 and 51 cases with HMW, LMW and mixed, respectively). WRS were lower in those who exercised regularly (24.6% vs. 39.4%) and higher in those with eczema (62.5% vs. 33.6%). Eczema had an odds ratio (OR) of 4.13 (95% CI 1.3 to 12.9, P = 0.01). Exposure to LMW almost tripled the risk of WRS (OR: 2.9, 95% CI: 1.4 to 5.9, P = 0.003) in our patients. CONCLUSION: Pulmonologists are firmly advised to take their patients' occupational and vocational exposures into consideration for treatment plans, especially in those with positive history of eczema and exposure to LMW.
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Enfermedades Profesionales , Exposición Profesional , Enfermedad Pulmonar Obstructiva Crónica , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/epidemiología , Exposición Profesional/efectos adversos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Factores de Riesgo , EspirometríaRESUMEN
Coronavirus disease 2019 (COVID-19) can present with a variety of symptoms. Severity of the disease may be associated with several factors. Here, we review clinical features of COVID-19 inpatients with different severities. This cross-sectional study was performed in Imam Reza hospital, Mashhad, Iran, during February-April 2020. COVID-19 patients with typical computed tomography (CT) patterns and/or positive reverse-transcriptase polymerase chain reaction (RT-PCR) were included. The patients were classified into three groups of moderate, severe, and critical based on disease severity. Demographic, clinical, laboratory, and radiologic findings were collected and compared. P < 0.05 was considered statistically significant. Overall, 200 patients with mean age of 69.75 ± 6.39 years, of whom 82 (41%) were female were studied. Disease was severe/critical in the majority of patients (167, 83.5%). Disease severity was significantly associated with age, malignant comorbidities, dyspnea, nausea/vomiting, confusion, respiratory rate, pulse rate, O2 saturation, extent of CT involvement, serum C-reactive protein (CRP), pH, pO2, and aspartate transaminase (P < 0.05). Moreover, complications including shock, coagulopathy, acidosis, sepsis, acute respiratory distress syndrome (ARDS), intensive care unit (ICU) admission, and intubation were significantly higher in patients with higher severities (P < 0.05). O2 saturation, nausea/vomiting, and extent of lung CT involvement were independent predictors of severe/critical COVID-19 (OR 0.342, 45.93, and 25.48, respectively; P < 0.05). Our results indicate O2 saturation, nausea/vomiting, and extent of lung CT involvement as independent predictors of severe COVID-19 conditions. Serum CRP levels and pO2 were also considerably higher patients with higher severity and can be used along with other factors to predict severe disease in COVID-19 patients.
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Proteína C-Reactiva/metabolismo , COVID-19/diagnóstico por imagen , COVID-19/epidemiología , Factores de Edad , Anciano , COVID-19/patología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Pacientes Internos , Irán , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Asthma is a common condition in which the patient requires self-management and teaching programs that lead to reduced prevalence and mortality. The main aim of this study was to improve the management knowledge of the disease through the use of educational tools, pamphlets and face-to-face lecture, concurrent with evaluating and comparing its effectiveness in response to treatment. MATERIALS AND METHODS: In this study, 82 asthmatic patients were enrolled. Training necessary to control the disease and use of drugs were provided to patients in one group by pamphlets (39 patients) and the other by face-to-face education (43 patients). After a month, Disease control examination and Asthma Control Test (ACT) scores were evaluated and compared. RESULTS: The mean age of participants was 39.12±14.25 years. There was no significant difference between the two groups in age, gender and education (P> 0.05) and no significant difference in asthma control between the two groups before the intervention (P = 0.065). The overall asthma control score in the pamphlet was increased from 15.43±4.99 at baseline to 20.58±4.47 in the assessment after one month education (P <0.001) and in face-to-face training an overall score was increased from 13.27±5.39 to 21.95±2.77 (P <0.001). After one month education, asthma control score was increased 5.23 ± 6.88 in pamphlets group and 8.9 ± 6.32 in face-to-face group (P = 0.014). CONCLUSION: Evaluation of both educational methods showed face-to-face training is more efficient.
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OBJECTIVE: Interictal epileptiform discharges (IEDs) are important to identify the epileptogenic zone and to define epileptic syndromes. However, not all patients show IEDs on scalp EEG. We evaluate the likelihood of not findings spikes on prolonged Video-EEG Monitoring (VEM) in patients with focal epilepsy, and explore clinical correlates. METHODS: We retrospectively reviewed the VEM reports for all the patients admitted to the seizure monitoring unit in the Calgary Epilepsy Program between July'10 and August'17. Adult focal epilepsy patients, using the diagnostic criteria of the International League Against Epilepsy, who had at least three consecutive VEM days and one recorded seizure were included. Patients were categorized as spikers or non-spikers if any or no spikes were seen on VEM. We compared demographic, neuroimaging, epilepsy risk factor and seizure data. RESULTS: Of 933 patients, 345 fulfilled our eligibility criteria, 17% [55% males] non-spikers and 83% [53% males] spikers. There were no statistically significant differences between non-spikers and spikers in the studied clinical variables at our epilepsy centre. Average age and average duration of epilepsy were 39 and 13 years for non-spikers and 38 and 16 years for spikers. The average duration of VEM was 8-9 days in both groups. The most frequent seizure focus was in the temporal lobe in both groups (53% in non-spikers vs. 64% in spikers, p = 0.06). An epileptogenic lesion on MRI was identified in 26 (46%) of non-spikers and 158 (57%) of spikers (p = 0.16). SIGNIFICANCE: Approximately one out of six patients with focal epilepsy showed no IEDs despite prolonged VEM. There was no significant difference among the investigated clinical variables between these two groups of patients in our epilepsy centre. We hypothesise that patients without IEDs on scalp EEG may have smaller, deeper generators with lower levels of neuronal synchrony, which precludes the expression of high amplitude spikes detectable on scalp EEG.
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Ondas Encefálicas/fisiología , Electroencefalografía , Epilepsias Parciales/fisiopatología , Cuero Cabelludo , Adulto , Epilepsias Parciales/diagnóstico por imagen , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Cuero Cabelludo/fisiología , Adulto JovenRESUMEN
OBJECTIVES: Lymph node metastases are the most significant prognostic factor in localized non-small cell lung cancer (NSCLC). Identification of the first nodal drainage site (sentinel node) may improve detection of metastatic nodes. Extended surgeries, such as lobectomy or pneumonectomy with lymph node dissection, are among the therapeutic options of higher acceptability. Sentinel node biopsy can be an alternative approach to less invasive surgeries. The current study was conducted to evaluate the accuracy of sentinel node mapping in patients with NSCLC using an intraoperative radiotracer techniques. METHODS: This prospective study was conducted on 21 patients with biopsy-proven NSCLC who were candidates for sentinel node mapping during 2012-2014. All patients underwent thoracoabdominal computed tomography, based on which they had no lymph node involvement. Immediately after thoracotomy and before mobilizing the tumor, peritumoral injection of 2mCi/0.4 mL Tc-99m- phytate was performed in 4 corners of tumor. After mobilization of the tumoral tissues, the sentinel nodes were searched for in the hillar and mediastinal areas using hand-held gamma probe . Any lymph node with in vivo count twice the background was considered as sentinel node and removed and sent for frozen section evaluation. All dissected nodes were evaluated by step sectioning and hematoxylin and eosin staining (H&E).The recorded data included age, gender, kind of pathology, site of lesion, number of dissected sentinel nodes, number of sentinel nodes, and site of sentinel nodes. Data analysis was performed in SPSS software (version 22). RESULTS: The mean age of the patients was 58.52±11.46 years with a male to female ratio of 15/6. The left lower lobe was the most commonly affected site (30.09%). Squamous cell carcinoma and adenocarcinoma were detected in 11 and 10 subjects, respectively. A total of 120 lymph nodes were harvested with the mean number of 5.71±2.9 lymph nodes per patient. At least one sentinel node was identified in each patient, resulting in a detection rate of 95.2%. The mean number of sentinel nodes per patient was 3.61±2. Frozen section results showed 100% concordance with the results of hematoxylin and eosin staining. CONCLUSION: Based on the findings, sentinel node mapping can be considered feasible and accurate for lymph node staging and NSCLC treatment.
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Background Malignant pleural effusion continues to be a common problem in patients with metastatic disease. This study was conducted to compare the efficacy and safety of bleomycin pleurodesis with povidone-iodine pleurodesis through a chest drain as palliative treatment for recurrent malignant pleural effusion. Methods Sixty cancer patients (36 males and 24 females) with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Thirty patients received povidone-iodine pleurodesis and 30 received bleomycin pleurodesis. Age, sex, side of the primary pathology, treatment outcome (recurrence and relapse time), and complications were analyzed. Results The mean age was 59.63 ± 7.68 years in the povidone-iodine group and 57.97 ± 9.27 years in the bleomycin group ( p = 0.452). The complications were identical in both groups: 2 (6.7%) patients had chest pain, 2 (6.7%) had fever, and one (3.3%) had hypotension. There was a good response to therapy in 20 (66.7%) patients in the bleomycin group and 25 (83.3%) in the povidone-iodine group ( p = 0.136). Conclusion The results of this study indicate that povidone-iodine should be considered as a selective chemical agent to perform pleurodesis in patients with recurrent malignant pleural effusion because it has the same effect but costs less than bleomycin.
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Bleomicina/administración & dosificación , Derrame Pleural Maligno/terapia , Pleurodesia/métodos , Povidona Yodada/administración & dosificación , Anciano , Bleomicina/efectos adversos , Femenino , Humanos , Irán , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Derrame Pleural Maligno/diagnóstico , Pleurodesia/efectos adversos , Povidona Yodada/efectos adversos , Estudios Prospectivos , Recurrencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Fibrosis that occurs in the chronic phase of pleural empyema restricts lung movement and impairs pulmonary function. It also leads to asymmetry of the chest wall. We evaluated the efficacy of decortication and pleurectomy in improving these adverse consequences. METHODS: Data of 50 patients (42 males, mean age 49.1 ± 19.46 years) with chronic empyema who underwent lung decortication via a posterolateral thoracotomy between 2004 and 2014 were reviewed in this study. All patients had pulmonary function tests before and after surgery. Computed tomography was used to determine transverse and anteroposterior diameters of the chest before and after surgery. RESULTS: The patients were followed up for 11.5 ± 4.5 months. Mean forced expiratory volume in 1 s was 62.5% ± 13.61% before surgery vs. 77.3% ± 13.31% after surgery (p < 0.001). Mean forced vital capacity was 60.6% ± 14.38% before surgery vs. 78.5% ± 12.64% after surgery (p < 0.001). The improvement in patients with reduced chest wall diameters was significant (p < 0.001). Improvements in pulmonary function tests and chest wall diameters were not significantly different between patients with tuberculosis (n = 10) and those with other diseases (n = 40; p < 0.05). CONCLUSION: Decortication and pleurectomy via a posterolateral thoracotomy significantly improves pulmonary function and chest wall diameters in patients with chronic empyema due to tuberculosis or other diseases.
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Desbridamiento , Empiema Pleural/cirugía , Empiema Tuberculoso/cirugía , Pulmón/cirugía , Toracotomía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Desbridamiento/efectos adversos , Empiema Pleural/diagnóstico , Empiema Pleural/fisiopatología , Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/fisiopatología , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Recuperación de la Función , Toracotomía/efectos adversos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Capacidad Vital , Adulto JovenRESUMEN
OBJECTIVES: Tuberculosis is one of the most important infectious diseases with high mortality rates worldwide, especially in developing countries. Interleukin17 (IL-17) is an important acquired immunity cytokine, which is mainly produced by CD4+TH17 cells. It can recruit neutrophils and macrophages to the infected site in the lungs. IL-23 is one of the most important inducers of IL-17. In the present study, the expressions of IL-23 and IL-17 were examined in the pathogenesis of tuberculosis. MATERIALS AND METHODS: Peripheral blood mononuclear cells (PBMCs) were isolated from subjects with latent tuberculosis infection (LTB) and newly diagnosed active tuberculosis patients (ATB). PBMCs were activated with purified protein derivative (PPD) for 72 hr. Activated cells were harvested, RNA was extracted, and cDNA was synthesized. IL-17 and IL-23 mRNA expressions were evaluated by real-time PCR. The frequency of Th17 cells was examined by flowcytometry. RESULTS: The expressions of IL-17 and IL-23 mRNA were lower in patients than subjects with LTB (P<0.05). The frequency of IL-17 producing CD4+ T cells in patients with active TB was lower than LTB subjects (P<0.05). CONCLUSION: The results of the present study might suggest that IL-17 and IL-23 play critical roles in the immune response against TB.
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OBJECTIVE: This study aimed to evaluate the efficacy and safety of video-assisted thoracic surgery in reaching a specific diagnosis in patients with interstitial lung disease. METHODS: Thirty-eight patients with interstitial lung disease (19 males, 19 females; mean age 47.73 years) who had undergone video-assisted thoracic surgery at Ghaem Hospital, Mashhad, Iran, between 2010 and 2013 were evaluated retrospectively in this study. Preoperative evaluations including cardiac and pulmonary assessments were performed. Data were recorded in forms prepared for this study and included age, sex, symptoms, imaging findings, operation duration, chest drain withdrawal time, postoperative hospital stay, hospital mortality, and specific diagnosis of the disease. RESULTS: The most common symptom was dyspnea (38 patients, 100%). The most common computed tomography finding was a reticular pattern (30 patients, 78.94%). Surgery complications included persistent air leak in 3 (7.9%) cases and wound infection in 2 (5.26%). There was no hospital death and no need for reoperation. The average of operative time was 50 min. The mean time for chest drain withdrawal and postoperative hospitalization was 4 and 5 days, respectively. The most common diagnoses were usual interstitial pneumonia in 9 (23.68%) patients and sarcoidosis in 6 (15.78%). A specific diagnosis was not reached in 2/38 (5.26%) patients after video-assisted thoracic surgery. CONCLUSION: Video-assisted thoracic surgery is a highly effective and safe method for establishing a specific diagnosis in patients with interstitial lung disease.
Asunto(s)
Fuga Anastomótica , Enfermedades Pulmonares Intersticiales , Infección de la Herida Quirúrgica , Cirugía Torácica Asistida por Video , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Biopsia/métodos , Femenino , Mortalidad Hospitalaria , Humanos , Irán/epidemiología , Tiempo de Internación , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/epidemiología , Enfermedades Pulmonares Intersticiales/cirugía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/etiología , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Lung metastasis is a rare cause of hemoptysis. Bronchial artery embolization is an effective intervention for treatment of hemoptysis with various underlying etiologies. A 28-year-old man with a known history of malignant melanoma in the neck from 6 years ago and lung metastasis from 1 year ago referred to the Emergency Department of our teaching hospital with the chief complaint of hemoptysis. Chest x-ray and pulmonary CT-scan showed multiple pulmonary nodules with different sizes in both lung parenchyma. The patient's hemoptysis did not resolve completely in spite of appropriate medical treatment. The patient was then referred to the endovascular unit of the vascular department in our hospital and underwent bilateral bronchial artery embolization. With this procedure his symptoms resolved completely and he was discharged after a week.