RESUMO
COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.
Assuntos
Encefalopatias/etiologia , COVID-19/complicações , Convulsões/etiologia , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Adulto , Alanina/análogos & derivados , Alanina/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antivirais/uso terapêutico , Encefalopatias/diagnóstico , Encefalopatias/terapia , COVID-19/diagnóstico , COVID-19/terapia , Confusão/complicações , Humanos , Imunização Passiva/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Reação em Cadeia da Polimerase , Radiografia/métodos , SARS-CoV-2 , Convulsões/terapia , Resultado do Tratamento , Soroterapia para COVID-19Assuntos
Amiloidose/patologia , Oclusão com Balão/métodos , Hemoptise/terapia , Pulmão/diagnóstico por imagem , Idoso , Amiloidose/complicações , Amiloidose/diagnóstico por imagem , Broncoscopia , Feminino , Hemoptise/diagnóstico por imagem , Hemoptise/etiologia , Humanos , Pulmão/patologia , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Lung cancer is the major cause of cancer death worldwide. Mediastinal lymph node staging is important for pretreatment lung cancer management. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well established method for mediastinal lymph node staging. Although EBUS-TBNA samples are much smaller than surgical lymph node biopsies, histopathological evaluation and molecular testing can successfully be performed. One step nucleic acid amplification (OSNA), which measures cytokeratin 19 (CK19) mRNA concentration, is a target marker that is gaining importance in quick detection of lymph node metastases in breast cancer and other cancers. Recent publications suggest accurate and rapid detection of lung cancer metastases in surgically removed lymph nodes. In this study we aimed to investigate if CK19 mRNA detection via OSNA is feasible to accurately detect lymph node metastases in lung cancer patients using EBUS-TBNA samples. MATERIALS AND METHODS: A total of 102 EBUS-TBNA samples of 55 patients were collected. EBUS-TBNA was performed in lymph nodes exceeding 5 mm. OSNA was performed using a ready to use amplification kit (Lynoamp; Sysmex, Kobe, Japan) in the RD-100 I, an automated real-time detection system (Sysmex). RESULTS: Histopathological analysis confirmed malignancy in 90 cases and excluded malignancy in 12 cases. Overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 78.9%, 58.3%, 93.4%, 26.9%, and 76.5%, respectively. CONCLUSIONS: One step nucleic acid amplification is feasible for EBUS-TBNA lymph node samples of lung cancer patients, but CK19 mRNA is an inaccurate marker, which is unlikely to be useful as an adjuvant test for EBUS-TBNA. Further studies are required to define the optimal sample size and sampling method.
Assuntos
Adenocarcinoma/diagnóstico , Biomarcadores Tumorais/genética , Queratina-19/genética , Neoplasias Pulmonares/diagnóstico , Linfonodos/fisiologia , RNA Mensageiro/análise , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Sensibilidade e Especificidade , UltrassonografiaRESUMO
Endobronchial ultrasound (EBUS) plays a pivotal role in the minimally invasive staging of non-small cell lung cancer. The role of EBUS is progressively expanding to include the evaluation of peribronchial lesions, pulmonary nodules, and other mediastinal abnormalities. Recently, EBUS has assisted in the diagnosis of many other disease entities, including malignancies and various infections such as tuberculosis and sarcoidosis. This article reviews the indications and contraindications of EBUS, with emphasis on the technique and complications encountered during the procedure.
RESUMO
Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammatory disease characterized by incompletely reversible airway obstruction. This clinically heterogeneous group of patients is characterized by different phenotypes. Spirometry and clinical parameters, such as severity of dyspnea and exacerbation frequency, are used to diagnose and assess the severity of COPD. The purpose of this study was to investigate whether volatile organic compounds (VOCs) could be detected in the exhaled breath of patients with COPD and whether these VOCs could distinguish COPD patients from healthy subjects. Moreover, we aimed to investigate whether VOCs could be used as biomarkers for classifying patients into different subgroups of the disease. Ion mobility spectrometry was used to detect VOCs in the exhaled breath of COPD patients. One hundred and thirty-seven peaks were found to have a statistically significant difference between the COPD group and the combined healthy smokers and nonsmoker group. Six of these VOCs were found to correctly discriminate COPD patients from healthy controls with an accuracy of 70%. Only 15 peaks were found to be statistically different between healthy smokers and healthy nonsmokers. Furthermore, by determining the cutoff levels for each VOC peak, it was possible to classify the COPD patients into breathprint subgroups. Forced expiratory volume in 1 second, body mass index, and C-reactive protein seem to play a role in the discrepancies observed in the different breathprint subgroups.
Assuntos
Testes Respiratórios , Expiração , Pulmão/fisiopatologia , Compostos Orgânicos Voláteis/análise , Adulto , Idoso , Biomarcadores/análise , Índice de Massa Corporal , Proteína C-Reativa/análise , Estudos de Casos e Controles , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Índice de Gravidade de Doença , Adulto JovemRESUMO
Acute esophageal necrosis (AEN) or "black esophagus" is a clinical condition found at endoscopy. It is a rare entity the exact etiology of which remains unknown. We describe a case of 'black esophagus', first of its kind, in the setting of liver cirrhosis and hepatic encephalopathy.
Assuntos
Doenças do Esôfago/patologia , Esôfago/patologia , Encefalopatia Hepática/patologia , Hepatopatias/patologia , Fígado/patologia , Diagnóstico Diferencial , Doenças do Esôfago/complicações , Doenças do Esôfago/psicologia , Encefalopatia Hepática/psicologia , Humanos , Hepatopatias/complicações , Hepatopatias/psicologia , Masculino , Pessoa de Meia-Idade , NecroseRESUMO
Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a (99m)Tcsulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy.