RESUMO
OBJECTIVE: To evaluate the usefulness of procalcitonin (PCT) for diagnosing infection in patients with liver cirrhosis admitted to an Intensive Care Unit. DESIGN: A retrospective study was carried out. SCOPE: Intensive Care Unit. Versatile, twenty-four beds. Participants Patients with liver cirrhosis admitted to our Intensive Care Unit in the last four years with suspected infection and measurement of PCT. RESULTS: Among the 255 patients with cirrhosis admitted to our unit, PCT was determined for the differential diagnosis of infection in 69 cases (27%). Three patients were excluded from analysis due to a lack of clinical data. The average stay was 10.6 ± 9.2 days, with a mortality rate of 65%. The origin of cirrhosis was mainly viral (57%) or alcoholic (37%). The Child-Pugh and MELD scores were 9.5 ± 2 and 23 ± 8, respectively. Infection was diagnosed in 54 patients (82%). The most common infection was pneumonia (72%), followed by intraabdominal infections (18%) and bacteremia (5%). In patients without infection, the median PCT concentration was 0.57 ng/ml (range 0.28 to 1.14) versus 2.99 (1.31 to 9.4) in those with infection (p<.001). Diagnostic capacity was maintained in patients with intraabdominal infections. The diagnostic cutoff point was set at 0.8 ng/ml (sensitivity 83%, specificity 75%, AUC 0.82 [0.702-0.93]). CONCLUSIONS: In patients with liver cirrhosis, PCT is useful for identifying bacterial infections, including intraabdominal processes.
Assuntos
Infecções Bacterianas/diagnóstico , Calcitonina/sangue , Cirrose Hepática/complicações , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Estudos RetrospectivosRESUMO
We define a journal club as a group of people who meet to critically read and discuss scientific articles. In medicine, journal clubs are a very important part of training during residency programs. In 2013, the Spanish Society of Medical Radiology's (SERAM) journal club was established with the aim of promoting the acquisition of non-interpretative skills and training in scientific journalism during residency. After nearly 10 years, more than 137 reviewers at 54 hospitals have formed part of the SERAM's journal club. In this time period, the number of reviewers, publications, and visits to our website have increased progressively. The SERAM's journal club currently employs a structured workflow that is organized into quarterly groups and supported by a peer-review system. In the future, the SERAM's journal club aims to internationalize its content beyond the Spanish-speaking community, increase its presence in social networks, and incorporate audiovisual content.
Assuntos
Internato e Residência , Radiologia , Humanos , Educação de Pós-Graduação em MedicinaRESUMO
OBJECTIVES: To analyze the biologic behavior and etiologic mechanism of upper-tract involvement in patients with bladder cancer in situ (Tis) and its impact on management of these patients. METHODS: One hundred thirty-eight patients with bladder Tis, 786 with superficial bladder cancer, and 179 patients with invasive bladder cancer treated by cystectomy were studied: 34 (24.6%), 18 (2.3%), and 7 (3.9%) developed upper-tract involvement in each group, respectively. Sixty-three patients with primary urothelial upper-tract tumors were also studied. Taking progression-free survival as an end point, univariate and multivariate analyses were performed. RESULTS: The upper-tract recurrence rate was significantly higher in patients with bladder Tis than in patients with superficial bladder tumors (P <0.001); it was also significantly higher in patients treated with cystectomy because of bladder Tis compared with those treated because of invasive tumors (P <0.01). Patients with bladder Tis and upper-tract involvement showed high rates of upper-tract bilaterality (32.3%) and prostate involvement (67.4%). On pathologic examination, the upper tract showed predominantly superficial (Ta-T1-Tis) tumors (67.4%) and distal ureter location as the only finding (47%). In patients with bladder Tis, upper-tract involvement alone does not have a negative impact on the survival rate according to univariate and multivariate analysis (P = NS). CONCLUSIONS: In patients with bladder Tis, upper-tract involvement represents a diffuse process; therefore, a close evaluation of both the prostate and the upper tract is recommended. Upper-tract involvement has no impact on bladder-preservation strategy. Many of these patients could also be offered a conservative management for the involved upper tract.
Assuntos
Carcinoma in Situ/secundário , Neoplasias Renais/secundário , Neoplasias Ureterais/secundário , Neoplasias da Bexiga Urinária/patologia , Idoso , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/terapia , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/terapia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Ureterais/epidemiologia , Neoplasias Ureterais/terapia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/terapiaRESUMO
Eight malignant fibrous histiocytomas (MFH) of bone were studied with immunohistochemistry and electron microscopy. Ultrastructurally, fibroblasts and myofibroblasts were the main tumor cells in four cases and abundant in two other cases; these cells showed immunohistochemical positivity to alpha 1-antitrypsin, vimentin and anti-muscle antigen (HHF 35). Moreover, histiocytic-like tumor cells were electron-microscopically detected in four cases, being the main tumor cell type in two of the cases; immunohistochemically these cells expressed positivity to alpha-1-antichymotrypsin (A1ACT), alpha-1-antitrypsin (A1AT) and vimentin. Present results confirm the cellular heterogeneity of MFH of bone, in which fibroblasts and myofibroblasts transformed cells play a histogenetical role, suggesting the existence of close links with classic fibrosarcoma of bone.
Assuntos
Neoplasias Ósseas/patologia , Fibroblastos/patologia , Histiocitoma Fibroso Benigno/patologia , Músculos/patologia , Actinas/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/ultraestrutura , Transformação Celular Neoplásica/patologia , Feminino , Fibroblastos/metabolismo , Fibroblastos/ultraestrutura , Histiocitoma Fibroso Benigno/metabolismo , Histiocitoma Fibroso Benigno/ultraestrutura , Humanos , Imuno-Histoquímica , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Músculos/metabolismo , Músculos/ultraestrutura , Vimentina/metabolismo , alfa 1-Antiquimotripsina/metabolismo , alfa 1-Antitripsina/metabolismoRESUMO
New compounds showing hypoglycaemic activity have been designed through a computer aided method based on quantitative structure-activity relationship (QSAR) and molecular connectivity. After calculation of topological indices for a set of 89 compounds including active and inactive with regards to hypoglycaemic action, linear discriminant analysis was performed so that a useful model to predict such an activity was achieved. Later on, the discriminant model was applied on a huge database so that fourteen compounds were selected as potential new hypoglycaemics. From them, just five were finally selected for experimental test on expected hypoglycaemic activity. Among the selected compounds, l-arabitol, Acid blue 161, 1,4-butanediol diglycidil ether and Acid red 151 stand out, which are comparable in potency to standard drugs such as tolbutamide. Acid blue has a glycaemia profile similar to that of tolbutamide but does not lead to a severe hypoglycaemic condition, while the profile of the other agents is near normality.
Assuntos
Hipoglicemiantes/química , Relação Quantitativa Estrutura-Atividade , Desenho de Fármacos , Estrutura MolecularRESUMO
Although acine cell neoplasms have for a long time been regarded as benign tumors, they are presently considered to represent the carcinomas. These rare tumors mainly affect the parotid glands, and only exceptionally involve other salivary glands. Clinically, acic cell carcinoma present as isolated tumors simulating a pleomorphic adenoma. The diagnosis is histopathological, and complete surgical removal of the tumor is the treatment of choice, with cervical lymphatic voiding and/or postoperative radiotherapy in selected cases. A prolonged patient follow-up is required, for the tumor may recur many years after surgery. We report a case of acinic cell carcinoma in submaxillary gland.
Assuntos
Carcinoma de Células Acinares/patologia , Neoplasias da Glândula Submandibular/patologia , Adulto , Biópsia por Agulha , Carcinoma de Células Acinares/cirurgia , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias da Glândula Submandibular/cirurgiaRESUMO
Angiocentric lymphomas are very infrequent neoplasms in our geographical setting. They tend to develop in the oronasal region in the form of necrotic lesions--specifically in the midfacial zone--with a rapid course and poor prognosis. Immunohistochemically, the malignant cells have been shown to correspond to T lymphocytes. In addition, recent research supports the possible role of Epstein-Barr virus as a possible etiological factor. We present the case of a 67 year old man with an ulcerated palatinal lesion of recent appearance that was diagnosed as angiocentric lymphoma by histopathological and immunohistochemical study. Following diagnosis, treatment was provided in the form of 3 cycles of CHOP type chemotherapy and radiotherapy.
Assuntos
Linfoma não Hodgkin/patologia , Neoplasias Palatinas/patologia , Idoso , Humanos , MasculinoRESUMO
As aves silvestres podem ser reservatório de bactérias patogênicas e atuar como veiculadoras desses microrganismos para o ambiente, os animais domésticos e o homem. Portanto, o objetivo deste trabalho foi verificar a ocorrência de Campylobacter spp., Yersinia enterocolitica e Salmonella enterica em aves silvestres capturadas nas áreas próximas de aviários e em frangos de corte alojados nesses estabelecimentos, além de verificar a presença dos genes cdtA, cdtB e cdtC nos isolados de Campylobacter e identificar os sorotipos de Salmonella encontrados. Amostras de fezes de 189 aves silvestres capturadas com redes de neblina nas áreas próximas de 10 aviários e de 200 frangos de corte foram processadas para pesquisa de Campylobacter spp., S. enterica e Y. enterocolitica. Duas espécies de aves silvestres, Sicalis flaveola (canário-da-terra) e Zonotrichia capensis (tico-tico), foram positivas para Salmonella e Campylobacter, respectivamente. Foram isolados Campylobacter spp., S. enterica e Y. enterocolitica de frangos. Todos os isolados de Campylobacter analisados apresentaram os genes cdt. Em dois aviários, Campylobacter foi isolado tanto de frangos como de aves silvestres, entretanto a contaminação mútua entre essas aves não foi comprovada. Este foi o primeiro relato de isolamento de Campylobacter de Z. capensis e de Salmonella do sorotipo Derby de S. flaveola.(AU)
Wild birds can be reservoirs of pathogenic bacteria and act as carriers of these microorganisms to the environment, domestic animals, and humans. Therefore, this study had as objective to verify the occurrence of Campylobacter spp., Yersinia enterocolitica and Salmonella enterica in wild birds captured in the surroundings of the aviaries and in the broilers housed in these establishments. The presence of the cdtA, cdtB and cdtC genes in Campylobacter isolates was also investigated and Salmonella serotypes were identified. Stool samples from 189 wild birds captured with mist nets in around 10 aviaries and from 200 broilers were processed for Campylobacter spp., S. enterica and Y. enterocolitica research. Two species of wild birds, Sicalis flaveola (Saffron Finch) and Zonotrichia capensis (Rufous-collared Sparrow) were positive for Salmonella and Campylobacter, respectively. Campylobacter spp., S. enterica and Y. enterocolitica were isolated from broilers. The cdt genes were found in all Campylobacter isolates. In two aviaries, Campylobacter was isolated from both broilers and wild birds, however the mutual contamination among these birds has not been shown. This was the first report of Campylobacter isolation from Z. capensis and of Derby Salmonella serotype isolation from S. flaveola.(AU)
Assuntos
Aves/microbiologia , Campylobacter/patogenicidade , Enterobacteriaceae/patogenicidadeRESUMO
Doenças infecciosas são as maiores responsáveis por falhas reprodutivas (FR) em cadelas, causando aborto, morte fetal e natimortalidade. Este estudo teve como objetivo investigar a associação entre agentes infecciosos, FR inexplicáveis e anemia em cadelas. Todas as amostras maternas e fetais foram negativas para a presença dos principais agentes infecciosos causadores de FR: herpes vírus canino 1, Neospora caninum, Brucella spp. e B. canis, enquanto agentes como o de Leishmania spp., parvovírus canino, Ehrlichia canis e Anaplasma platys foram encontrados em sangue materno. Coinfecções de A. platys/E. canis e A. platys/Leishmania spp. foram diagnosticadas. Os resultados indicam que os animais com anemia causadas por doenças transmitidas por vetores podem ser mais suscetíveis a sofrerem FR do que animais com valores hematológicos normais.(AU)
Assuntos
Animais , Feminino , Gravidez , Cães , Aborto Animal/etiologia , Infecções por Anaplasmataceae/complicações , Anemia/veterinária , Morte Fetal , Ehrlichia , Leishmaniose/complicaçõesRESUMO
PURPOSE: We prospectively validated the association of local tumor stage and grade as a predictive factor for occult lymph node micrometastasis in patients with penile carcinoma and clinically negative lymph nodes. MATERIALS AND METHODS: In a retrospective study of 66 patients we demonstrated the predictive value of the association of local tumor stage and grade for occult micrometastasis, identifying 3 risk groups. A therapy strategy was designed according to these risk groups. A total of 37 consecutive patients were included in a prospective study in which the same criteria for risk group allocation and the same therapeutic recommendations were used as in the retrospective study. RESULTS: In the prospective study we noted positive lymph nodes in 11% of stage T1, 63% of stages T2-3, 15% of grade 1, 67% of grade 2 and 75% of grade 3 cases. The incidence of positive nodes was 0% in the low, 83.3% in the high and 33.3% in the intermediate risk group. These rates were similar to those in the retrospective study with no significant difference. CONCLUSIONS: The predictive value of the association of local tumor stage and grade for occult lymph node micrometastasis was validated in a prospective study. This factor allows the differentiation of 3 risk groups of patients with high reliability in the low and high risk groups. However, other prognostic factors are needed in the intermediate risk group to improve the prediction of lymph node involvement.
Assuntos
Carcinoma/patologia , Linfonodos/patologia , Neoplasias Penianas/patologia , Adulto , Idoso , Virilha , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: We analyzed the long-term results of radical transurethral resection for the treatment of a large series of patients with muscle infiltrating bladder cancer entered into a prospective study to determine progression predictive factors. MATERIALS AND METHODS: The study included 133 patients with invasive bladder cancer treated by radical transurethral resection who had negative biopsies of the muscle layer of the tumor bed. Followup was more than 5 years for all subjects and more than 10 years in 59 (44.4%). A comparative nonrandomized study was performed of a control group of 76 patients with invasive pathological stage pT2-3a, N0-3 bladder cancer treated by cystectomy. In those patients treated by radical transurethral resection univariate and multivariate analyses were performed to establish clinical progression predictive factors. RESULTS: At 5 and 10 years of followup cause specific survival rates were 80.5 and 74.5%, and bladder preservation rates were 82.7 and 79.6%, respectively. No significant difference was noted in terms of cause specific survival, with respect to the control group. The initial presence of associated bladder carcinoma in situ was the only independent progression predictive factor. CONCLUSIONS: For patients with invasive bladder cancer radical transurethral resection is justified when the tumor is clinically limited to the muscular layer and when all biopsies of the periphery and depth of the tumor bed show muscular tissue negative for tumor cells. Patients with initial associated bladder carcinoma in situ should not be excluded from this treatment but endovesical bacillus Calmette-Guerin immunotherapy should be administered and a closer followup is recommended.
Assuntos
Neoplasias da Bexiga Urinária/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Progressão da Doença , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/patologia , Neoplasias Musculares/cirurgia , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Prospectivos , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologiaRESUMO
Of the 101 patients with penile cancer, we have analyzed 66 from whom we had enough information: 42 (63.3%) patients with corpora cavernosa invasion (T2-3) and 24 (36.6%) without (T1). With respect to the tumor grade, in 36 (54.3%) patients it was well differentiated (G I), in 23 (34.8%) moderately (G II) and in 7 (10.6%) poorly differentiated (G III). We also analyzed the inguinal lymph node condition. Of the 66 patients, 28 (42.4%) developed nodal metastases, and 38 (57.6%) were considered free of nodal metastases and disease with an average follow-up of 76.2 months (range 38-192). The presence of metastatic nodes was influenced by both tumor stage and grade with significant differences between T2-3 and T1 (p = 0.001) and between G II-III and G I (p < 0.01), but each of them alone was not a sufficiently reliable predictive factor. In order to associate local stages and tumor grades in relation to the presence of metastatic nodes, we checked that none of the patients with T1, G I (group 1) developed nodal metastases, and therefore, 'wait and see' should be the suitable approach. Twenty (80%) of the patients with T2-3, G II-III (group 2) developed metastatic lymph nodes, thus, in this group, an early lymphadenectomy should be performed. In the remaining 22 patients with T1, G II-III and T2, G I (group 3), 8 (36.4%) showed metastatic lymph nodes; in this group, other factors such as age, cultural level and obesity should be taken into account when deciding on lymphadenectomy.
Assuntos
Neoplasias Penianas/patologia , Adulto , Idoso , Seguimentos , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Penianas/cirurgia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To determine the relationship between oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), and to evaluate possible differences between those carcinomas with and without associated leukoplakia. MATERIAL AND METHODS: A total of 138 patients were studied at the Stomatology Service of the University General Hospital, Valencia, Spain. These patients were divided into two groups: group 1, patients with oral cancer and leukoplakia, and group 2, patients with OSCC but with no associated premalignant lesions. The relationship between this precancerous lesion and the OSCC was evaluated, as well as the possible clinical and histological differences between the tumours of the two groups. RESULTS: Leukoplakia was detected in 27 (19.56%) patients with OSCC. No differences were found between the two groups regarding age and tumour location. However, statistically significant differences were observed with respect to the form, tumour stage and the presence of adenopathies in the cancers with and without leukoplakia; in that the tumours associated with leukoplakia were diagnosed as being at a more initial stage. CONCLUSIONS: Those patients with OL associated with oral cancer presented with tumours at a less advanced stage than those where no associated leukoplakia existed.
Assuntos
Carcinoma de Células Escamosas/complicações , Leucoplasia Oral/complicações , Neoplasias Bucais/complicações , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
The biological behaviour of initially untreated carcinoma in situ of the bladder was studied in 20 patients. A 35.4-month follow-up revealed a heterogeneous behaviour of this disease entity. Diffuse tumors were clearly distinct from focal tumors. The evolution of the former appeared to be more aggressive: no spontaneous remission was observed, 58.3% remained as such while 41.6% progressed to muscle layer infiltration. Focal tumors evolved more favourably: only 1 (12.5%) developed into diffuse carcinoma in situ, 2 (25%) continued to be positive for cytology, while 4 (50%) remitted spontaneously. We therefore consider that both patient groups must be treated upon diagnosis. Intravesical treatment, which achieves a high rate of complete response, is advocated.
Assuntos
Carcinoma in Situ/patologia , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Primárias Múltiplas/patologia , Remissão EspontâneaRESUMO
Of our 276 patients with superficial bladder carcinoma, 242 were male, and 36 of these had recurrence in prostatic urethra, 26 with macroscopic tumors, and 10 with tumors in situ (TIS). These recurrences represent an incidence of 13.3%, with an average follow-up of 34.3 months. When the urethral tumor was limited to the mucosa, we chose conservative therapy, and the patients entered a random program with Mitomycin or Adriamycin administered endovesically. With this program, we could control the disease in 59.3% of the patients. However, 22.2% of them had recurrence with prostatic stromal infiltration, so that we performed a more exhaustive exploration of the prostate, taking biopsies not only at the 5 and 7 o'clock positions, but also making a wider resection in order to find the incipient infiltration of the prostatic stroma, and trying to avoid a possible understaging. When the urethral tumor had infiltrated the prostatic stroma, we performed cystoprostatourethrectomy, getting a survival rate free of disease of 40%. An association with vesical TIS was detected in 61.1% of these patients, with terminal ureteral tumor in 8.3% and with the anterior urethra in 11.1%, showing the diffuse pattern of the disease. We conclude that when recurrence of prostatic urethra is present, it is necessary to monitor the whole urothelium during follow-up.
Assuntos
Recidiva Local de Neoplasia/terapia , Neoplasias da Próstata/terapia , Neoplasias Uretrais/terapia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Carcinoma in Situ/terapia , Terapia Combinada , Doxorrubicina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Mitomicina , Mitomicinas/uso terapêutico , Taxa de SobrevidaRESUMO
In a sample of 306 patients with superficial bladder tumors (Ta, Tl), 48 were affected by associated carcinoma in situ (TIS). We included 40 of them in a random program with Mitomycin C or Adriamycin, administered endovesically. We found that those patients with associated TIS whose progression rate had increased to 37.1% compared to 8.8% in the original series (p less than 0.01), had a worse prognosis. Besides, 10 of them required radical cystectomy. With this chemotherapy program, we achieved a high rate of complete response (70%), but its duration was limited by a recurrence rate of 42.9%, with a time free of disease of 26.2 months. In the whole group, the survival rate free of disease was 77.5%, with an average follow-up of 37.3 months. On the other hand, we found extravesical recurrences not only in the prostatic urethra (13; 32.5%) but also at the end of the ureter (3; 7.5%).