RESUMO
Non-small cell lung cancer (NSCLC) is the most common pulmonary malignancy, frequently diagnosed at an advanced stage (III/IV). Patients in the Locally Advanced Stage Subgroup (IIIA) are relatively few, yet compose heterogenic phenotypes, posing a diagnostic and treating challenge, leading to a lack of clinical guidelines regarding the optimal standard of care. Several approaches exist, with a general agreement that a combined oncological and surgical modality approach is required. In this current retrospective descriptive study, patients with operable stage IIIA NSCLC who underwent surgery between 2013 and 2020 were evaluated on several aspects, including the initial diagnosis, neoadjuvant regimens, outcomes of surgical intervention, and overall survival at 2 years and 5 years following treatment. A total of 35 patients had neoadjuvant oncological treatment (mostly chemoradiation therapy) prior to surgery, out of which 28 patients were diagnosed with stage IIIA NSCLC. In post-operative assessment of pathological staging, downstaging was reported in 19 patients, of which 25% of cases were defined as a complete pathological response. The 2-year overall survival rate was 65% and the 5-year overall survival rate was 62%. The main pattern of disease recurrence was distant metastasis.
RESUMO
Nocardiosis is a rare infectious disease caused by bacteria of the genus nocardia, which causes considerable morbidity and mortality. We report two unusual cases of nocardiosis in young, immunocompetent patients; the first case involved a nocardia farcinica pulmonary and chest-wall infection, while the second was an anterior mediastinal nocardia asiaticum infection mimicking a mediastinal tumor. These cases reflect the need for a broad differential diagnosis during exploration of thoracic findings, white the potentially ambiguous presentation of nocardiosis must be considered.
Assuntos
Imunocompetência , Nocardiose/diagnóstico , Nocardia/isolamento & purificação , Adulto , Diagnóstico Diferencial , Humanos , Pneumopatias/diagnóstico , Pneumopatias/microbiologia , Pneumopatias/fisiopatologia , Masculino , Neoplasias do Mediastino/diagnóstico , Mediastino/microbiologia , Nocardiose/microbiologia , Nocardiose/fisiopatologia , Parede Torácica/microbiologiaRESUMO
BACKGROUND: Pediatric empyema necessitates prompt resolution and early hospital discharge with minimal morbidity. However, the most effective treatment approach is not yet established. OBJECTIVES: To assess the efficacy of an intrapleural streptokinase washing protocol as a non-operative treatment for stage II pediatric empyema as compared to operative decortications, by the number of pediatric intensive care unit (PICU) admissions, length of PICU stay, and hospitalization duration. METHODS: We retrospectively evaluated 75 consecutive pediatric empyema cases for the period January 2006 to December 2009. Since July 2007 we have used repeated streptokinase-based pleural washing for stage II patients whose condition did not improve with chest drainage RESULTS: Before July 2007, 17 of 23 stage II empyema patients underwent decortication, compared to only 1 of 21 after July 2007. Non-operated children were admitted to the PICU less frequently than those who were operated (83% vs. 31%, p = 0.0006) and spent less time in the PICU (2.56 +/- 1.92 vs. 1.04 +/- 1.9 days, P= 0.0148); there was no significant statistical difference in overall hospitalization (13.33 +/- 3.69 vs.11.70 +/- 5.74 days, P= 0.301). CONCLUSIONS: Using intrapleural streptokinase washing as a non-operative treatment for stage II pediatric empyema yielded comparable success rates to the operative approach, with less morbidity.