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Actinomicose Cervicofacial/diagnóstico , Edema/diagnóstico , Pescoço/patologia , Infecções por Pasteurellaceae/diagnóstico , Redução de Peso , Actinomicose Cervicofacial/complicações , Aggregatibacter actinomycetemcomitans/isolamento & purificação , Transtornos Relacionados ao Uso de Cocaína/complicações , Diagnóstico Diferencial , Edema/patologia , Hepatite C/complicações , Dependência de Heroína/complicações , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Masculino , Pessoa de Meia-Idade , Infecções por Pasteurellaceae/complicações , Doenças Torácicas/complicações , Doenças Torácicas/diagnóstico , Doenças Torácicas/microbiologia , Tabagismo/complicaçõesRESUMO
INTRODUCTION: Schwannomas are a form of rare tumor, arising from neural tissue and representing 2 % of mediastinal tumors. They are usually located in the posterior mediastinum, most often in the paravertebral gutters and typically appended to intercostal nerves. CASE REPORTS: We report two cases of unusual mediastinal schwannomas, appended to the vagus nerve. The schwannoma was located in the subcarinal region in the first case and in the right para-tracheal region in the second case. The lesions were thought to be bronchogenic cysts preoperatively in both cases because of a cystic appearance on preoperative CT scan and endobronchial ultrasonography. A surgical approach was adopted to remove the tumors. Video-assisted thoracoscopy was used in one case and robotic-assisted surgery in the second case, without any complication, allowing for complete resection and to establish a certain pathological diagnosis. CONCLUSION: Despite this location and cystic presentation being unusual, schwannoma should be considered as a possible cause of cystic lesions in the mediastinum. Minimally invasive surgery allows for complete resection and definitive pathological diagnosis.
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Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias do Mediastino/diagnóstico , Neurilemoma/diagnóstico , Doenças do Nervo Vago/diagnóstico , Nervo Vago/patologia , Idoso , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Feminino , Humanos , Masculino , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Mediastino/patologia , Mediastino/cirurgia , Pessoa de Meia-Idade , Neurilemoma/patologia , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Robóticos , Nervo Vago/cirurgia , Doenças do Nervo Vago/cirurgiaRESUMO
Tissue-type plasminogen activator (tPA) is a pleiotropic serine protease of the central nervous system (CNS) with reported neurotrophic and neurotoxic functions. Produced and released under its single chain form (sc), the sc-tPA can be cleaved by plasmin or kallikrein in a two chain form, tc-tPA. Although both sc-tPA and tc-tPA display a similar fibrinolytic activity, we postulated here that these two conformations of tPA (sc-tPA and tc-tPA) could differentially control the effects of tPA on neuronal survival. Using primary cultures of mouse cortical neurons, our present study reveals that sc-tPA is the only one capable to promote N-methyl-D-aspartate receptor (NMDAR)-induced calcium influx and subsequent excitotoxicity. In contrast, both sc-tPA and tc-tPA are capable to activate epidermal growth factor receptors (EGFRs), a mechanism mediating the antiapoptotic effects of tPA. Interestingly, we revealed a tPA dependent crosstalk between EGFR and NMDAR in which a tPA-dependent activation of EGFRs leads to downregulation of NMDAR signaling and to subsequent neurotrophic effects.
Assuntos
Receptores ErbB/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo , Ativador de Plasminogênio Tecidual/fisiologia , Apoptose , Sinalização do Cálcio , Sobrevivência Celular , Feminino , Humanos , Conformação Proteica , Receptor Cross-Talk , Ativador de Plasminogênio Tecidual/químicaRESUMO
INTRODUCTION: Spontaneous regression of an epithelial thymic tumour has been reported but seems extremely rare. Its mechanism is unknown. CASE REPORT: We report two cases of epithelial thymic tumour, either histologically proven or highly suspected on imaging, that regressed spontaneously (partially in one patient and totally in the other). CONCLUSION: Spontaneous regression of an epithelial thymic tumour is very rare but this possibility could lead to clinical and radiological monitoring rather than surgery in selected patients.
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Neoplasias Epiteliais e Glandulares/patologia , Neoplasias do Timo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Radiografia , Remissão Espontânea , Neoplasias do Timo/diagnóstico por imagemRESUMO
Congenital bronchial atresia is a rare congenital obliteration of a segmental or lobar bronchus resulting in distension of the corresponding parenchyma. It is seldom diagnosed in the adult. It may lead to infectious complications and, in the long term, to damage to the adjacent lung parenchyma. A surgical resection is necessary and it can be achieved by thoracoscopy. We report a recent series of six patients.
Assuntos
Brônquios/anormalidades , Anormalidades Múltiplas , Adulto , Brônquios/cirurgia , Broncoscopia , Diagnóstico Tardio , Suscetibilidade a Doenças , Feminino , Tórax em Funil , Hemoptise/etiologia , Humanos , Pulmão/anormalidades , Pulmão/cirurgia , Abscesso Pulmonar/complicações , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumotórax/etiologia , Embolia Pulmonar/complicações , Enfisema Pulmonar/complicações , Toracoscopia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Multidetector row computed tomography (MDCT) is the imaging modality of reference for the diagnosis of bronchiectasis. MDCT may also detect a focal stenosis, a tumor or multiple morphologic abnormalities of the bronchial tree. It may orient the endoscopist towards the abnormal bronchi, and in all cases assess the extent of the bronchial lesions. The CT findings of bronchial abnormalities include anomalies of bronchial division and origin, bronchial stenosis, bronchial wall thickening, lumen dilatation, and mucoid impaction. The main CT features of bronchiectasis are increased bronchoarterial ratio, lack of bronchial tapering, and visibility of peripheral airways. Other bronchial abnormalities include excessive bronchial collapse at expiration, outpouchings and diverticula, dehiscence, fistulas, and calcifications.
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Broncopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/secundário , Bronquiectasia/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Broncogênico/diagnóstico por imagem , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/imunologia , Diagnóstico Diferencial , Proteínas ELAV/imunologia , Hamartoma/diagnóstico por imagem , Humanos , MasculinoRESUMO
Renal angiomyolipomas are renal hamartomas. They are usually found incidentally, presenting as well-defined echogenic masses on sonography and fat containing tumors on CT and MRI. We report a case of angiomyolipoma with sonographic and CT evidence of extension to the renal vein and inferior vena cava.
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Angiomiolipoma/diagnóstico , Neoplasias Renais/diagnóstico , Veias Renais , Neoplasias Vasculares/diagnóstico , Veia Cava Inferior , Idoso , Feminino , HumanosRESUMO
Multidetector CT and MRI are the most efficient non invasive techniques in the assessment of pancreatic diseases. As with MRI, multidetector CT has now become an all in one examination using 2 D and 3 D multiplanar reformations with the ability to perform with high accuracy: a) vascular assessment using MIP reconstruction and b) biliary and pancreatic ducts assessment using minIP reconstruction. This review compares and illustrates the respective advantages of MRI and multidetector CT in the assessment of pancreatic diseases.
Assuntos
Imageamento por Ressonância Magnética/métodos , Pancreatopatias/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adenocarcinoma/diagnóstico , Idoso , Colangiocarcinoma/diagnóstico , Doença Crônica , Cistadenocarcinoma Seroso/diagnóstico , Humanos , Imageamento Tridimensional/métodos , Imageamento Tridimensional/normas , Imageamento por Ressonância Magnética/normas , Masculino , Cisto Pancreático/diagnóstico , Pancreatite/diagnóstico , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/normasRESUMO
Gemcitabine is a therapeutic agent that has been recently employed in the treatment of various cancers. Pulmonary toxicity has rarely been described. We report a case of a patient treated with Gemcitabine who developed acute respiratory symptoms related to a hypersensitivity pneumonia. Despite a severe clinical and radiological presentation, the outcome was favorable with corticosteroid treatment. In the event of respiratory symptoms in patients receiving Gemcitabine further investigations (chest X-ray, thorax CT-scan, bronchoalveolar lavage) are indicated. In view of the severity of pulmonary toxicity that can be caused by Gemcitabine, re-introduction of treatment is not recommended. We compare our case with other published cases of Gemcitabine-induced pulmonary toxicity.
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Antimetabólitos Antineoplásicos/efeitos adversos , Desoxicitidina/análogos & derivados , Desoxicitidina/efeitos adversos , Hipersensibilidade Respiratória/induzido quimicamente , Insuficiência Respiratória/induzido quimicamente , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , GencitabinaRESUMO
CONTEXT: The ethical issues surrounding end-of-life decision making for infants with adverse prognoses are controversial. Little empirical evidence is available on the attitudes and values that underlie such decisions in different countries and cultures. OBJECTIVE: To explore the variability of neonatal physicians' attitudes among 10 European countries and the relationship between such attitudes and self-reported practice of end-of-life decisions. DESIGN AND SETTING: Survey conducted during 1996-1997 in 10 European countries (France, Germany, Italy, the Netherlands, Spain, Sweden, the United Kingdom, Estonia, Hungary, and Lithuania). PARTICIPANTS: A total of 1391 physicians (response rate, 89%) regularly employed in 142 neonatal intensive care units (NICUs). MAIN OUTCOME MEASURES: Scores on an attitude scale, which measured views regarding absolute value of life (score of 0) vs value of quality of life (score of 10); self-report of having ever set limits to intensive neonatal interventions in cases of poor neurological prognosis. RESULTS: Physicians more likely to agree with statements consistent with preserving life at any cost were from Hungary (mean attitude scores, 5.2 [95% confidence interval ¿CI¿, 4.9-5.5]), Estonia (4.9 [95% CI, 4.3-5.5]), Lithuania (5.5 [95% CI, 4.8-6.1]), and Italy (5.7 [95% CI, 5.3-6.0]), while physicians more likely to agree with the idea that quality of life must be taken into account were from the United Kingdom (attitude scores, 7.4 [95% CI, 7.1-7.7]), the Netherlands (7. 3 [95% CI, 7.1-7.5]), and Sweden (6.8 [95% CI, 6.4-7.3]). Other factors associated with having a pro-quality-of-life view were being female, having had no children, being Protestant or having no religious background, considering religion as not important, and working in an NICU with a high number of very low-birth-weight newborns. Physicians with scores reflecting a more quality-of-life view were more likely to report that in their practice, they had set limits to intensive interventions in cases of poor neurological prognosis, with an adjusted odds ratio of 1.5 (95% CI, 1.3-1.7) per unit change in attitude score. CONCLUSIONS: In our study, physicians' likelihood of reporting setting limits to intensive neonatal interventions in cases of poor neurological prognosis is related to their attitudes. After adjusting for potential confounders, country remained the most important predictor of physicians' attitudes and practices. JAMA. 2000;284:2451-2459.
Assuntos
Atitude Frente a Morte , Tomada de Decisões , Neonatologia , Cuidados Paliativos , Padrões de Prática Médica , Assistência Terminal , Adulto , Coleta de Dados , Ética Médica , Europa (Continente) , Análise Fatorial , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/terapia , Internacionalidade , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de VidaAssuntos
Carcinoma de Células Acinares/complicações , Carcinoma de Células Acinares/diagnóstico , Doenças do Colo/etiologia , Fístula Intestinal/etiologia , Pancreatopatias/etiologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Idoso , Aneurisma/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Artéria EsplênicaRESUMO
OBJECTIVE: To evaluate outcome of triplets pregnancies. METHODS: A retrospective study about children of 45 triplet pregnancies which occurred spontaneously or after assisted reproductive technologies. All were managed by the same obstetrical and pediatric team. RESULTS: Mean birth weight was 1800 g and 26% of children were very low birth weights (< 1500 g). There was no difference in the mean Apgar score of pH between first, second and third infant. Neonatal and perinatal mortality rate were respectively 60 and 75%. Incidence of respiratory distress syndrome was 29%, hyaline membrane disease 11%, intraventricular hemorrhage (grade 4) 1.3%, necrotizing enterocolitis 10.5% and bronchopulmonary dysplasia 4%. Only 10% of the infants were not hospitalized and were kept by their mother. 38% of the newborns had to be hospitalized in a Neonatal Intensive Care Unit, with a mean stay of 6 days. At birth, 34% of the babies required intubation for artificial ventilation. CONCLUSIONS: The main problem of triplet pregnancies is high prematurity.
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Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Resultado da Gravidez , Trigêmeos , Índice de Apgar , Peso ao Nascer , Feminino , Humanos , Mortalidade Infantil , Recém-Nascido , Terapia Intensiva Neonatal , Tempo de Internação , Morbidade , Gravidez , Estudos RetrospectivosRESUMO
PURPOSE: To compare thin-section computed tomography (CT) and helical CT in the detection and assessment of the extent of bronchiectasis. MATERIALS AND METHODS: Both thin-section and helical CT scans were obtained in 50 consecutive patients with clinical symptoms suggestive of bronchiectasis. Thin-section CT was performed with 1.5-mm collimation and 10-mm intervals, and helical CT was performed with 3-mm collimation and a pitch of 1.6 during a 24-second breath hold. Three observers evaluated 593 segments on CT scans both independently and in consensus. Radiation dose was measured for both techniques. RESULTS: Bronchiectasis was noted in 77 segments (22 patients) on thin-section CT scans compared with 90 segments (26 patients) on helical CT scans. No findings were positive for bronchiectasis on only thin-section CT scans. Interobserver agreement was statistically significantly better (P < .05) in identification of segments that were positive for bronchiectasis on helical CT scans (kappa = 0.87) than on thin-section CT scans (kappa = 0.71). Total skin dose of radiation delivered with helical CT was 3.4 times greater than that delivered with thin-section CT. CONCLUSION: Helical scanning can improve CT depiction of bronchiectasis but with an increase in radiation exposure to the patient. It should be used in patients considered for surgery or for thin-section CT scans that are difficult to interpret.
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Bronquiectasia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Doses de Radiação , Recidiva , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/estatística & dados numéricosRESUMO
BACKGROUND: There is now good evidence that the clinical course of infants with respiratory distress syndrome can be improved by treatment with exogenous surfactant. However, optimal methods of giving such a treatment are still debated. POPULATION AND METHODS: The arterial blood gases and the arterial/alveolar oxygen tension ratio (a/A) were recorded during the 24 hours following artificial surfactant (Exosurf) treatment in 400 newborns aged 25 to 42 gestational weeks. A positive response was defined by an a/A ratio > 0.22 or an increase in a/A ratio up to 25%. RESULTS: After administration of the first dose, a positive response was obtained in 63% of cases during the first 6 hours and 11% during the 6 following hours. The response after the second dose was favourable in 75% of cases. At 24 hours after treatment, 36% of the infants had obtained an a/A ratio > 0.22. CONCLUSION: Because of the 18% of infants who responded positively only after the second dose, administration of this dose seems justifiable even in case of non-response to the first dose. The quality of the response is related to the severity of the pulmonary illness but is independent of the gestational age.
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Gasometria , Álcoois Graxos/farmacologia , Fosforilcolina , Polietilenoglicóis/farmacologia , Surfactantes Pulmonares/farmacologia , Análise de Variância , Gasometria/estatística & dados numéricos , Estudos de Coortes , Combinação de Medicamentos , Álcoois Graxos/administração & dosagem , Álcoois Graxos/uso terapêutico , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/uso terapêutico , Surfactantes Pulmonares/administração & dosagem , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Fatores de TempoRESUMO
The purpose of the study was to evaluate the CT abnormalities of airways and lung parenchyma in asthmatic patients and to assess inter- and intraobserver variability for these abnormalities. The CT scans of 50 asthmatic patients and 10 healthy volunteers were assessed independently by four independent chest radiologists who were masked with respect to the clinical information. Bronchiectasis involving mostly subsegmental and distal bronchi was noted in 28.5% of the asthmatic subjects and none of the non-asthmatics. Bronchial wall thickening, small centrilobular opacities and decreased lung attenuation were observed in 82%, 21% and 31% of asthmatic patients respectively, compared with 7%, 5% and 7% of healthy subjects. The intra- and inter-observer agreements for these four CT abnormalities were measured by the kappa statistic and ranged from 0.60 to 0.79 and from 0.40 to 0.64, respectively. It is concluded that asthmatic patients may exhibit bronchial wall thickening, bronchiectasis and morphological abnormalities suggestive of distal airways disease that can be assessed on CT scans with a clinically acceptable observer variability.
Assuntos
Asma/diagnóstico por imagem , Broncografia , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/classificação , Asma/fisiopatologia , Brônquios , Bronquiectasia/diagnóstico por imagem , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Muco , Variações Dependentes do Observador , Alvéolos Pulmonares/diagnóstico por imagem , Método Simples-CegoRESUMO
BACKGROUND: Data concerning neonates with acute respiratory distress syndrome (RDS) are still scarce. The characteristics and follow-up of a French cohort which has participated in an international trial concerning the efficacy of artificial surfactant have been studied. POPULATION AND METHODS: One thousand one hundred and fifty-seven neonates admitted from October 1990 to December 1991 in 27 French intensive care units because of RDS due to hyaline membrane disease were included in the study, whatever their birthweight and gestational age (GA). RESULTS: Three hundred and sixteen neonates (27.3%) were born from twin or multiple pregnancies. Fourty-five (5.5%) of the mothers had been given corticosteroids for the week preceding delivery. 55.5% were delivered by cesarean section. Mean GA was 31.0 +/- 2.9 weeks and mean birth-weight was 1,603 +/- 625 g. Two hundred and sixty-six neonates (23%) were small for GA. Two hundred and twenty-three died after a mean survival of 4.2 days (63% before the end of the first week and 80% before the end of the third week). Fifty percent of these deaths were due to respiratory distress, 28% to severe brain disorders and 9% to infections. The bronchopulmonary dysplasia rate was 21.7%. Early ultrasound scan of the brain showed major injuries in 19.5% of cases; the second scan performed in 822 infants was normal in 84.3%. CONCLUSIONS: Taking into account GA, mortality and morbidity rates were similar to those of the other non-French participating centres.
Assuntos
Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Peso ao Nascer , Estudos de Coortes , França , Idade Gestacional , Humanos , Recém-Nascido , Pneumopatias/etiologia , Doenças do Sistema Nervoso/etiologia , Razão de Chances , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidadeRESUMO
Standard radiography of the chest shows pulmonary infiltration and is determinant for the diagnosis of chronic diffuse infiltrative lung diseases. Since lung biopsy is an invasive exploratory technique, using computed tomography (CT) in the diagnostic approach is perfectly justified as a direct prolongation of plain radiography. CT identifies patients who, in spite of normal chest X-ray films, do have pulmonary infiltration. It is superior to radiography in suggesting the correct aetiological diagnosis, as it provides signs that are more discriminant than the radiographic signs. It also gives a better approach to the localization of lesions, thereby helping in guiding lung biopsies. Finally, once the diagnosis has been made CT remains useful in evaluating the effects of treatment of pulmonary lesions and in detecting possible complications.
Assuntos
Fibrose Pulmonar/diagnóstico por imagem , Humanos , Fibrose Pulmonar/etiologia , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
The diagnostic value of chest radiography and high-resolution computed tomography (CT) in chronic diffuse interstitial lung disease (CDILD) was assessed in 140 consecutive patients with diffuse infiltration of the lung visible at radiography. Radiographs and CT scans were separately read by three independent observers without knowledge of clinical and pathologic data. The observers listed the three most likely diagnoses and recorded the degree of confidence they had in their choice on a 0%-100% probability scale. Findings at radiography and high-resolution CT were recorded by each observer and were used for a stepwise discriminant analysis between diagnoses. First-choice diagnoses of all three observers that were made with a high level of confidence (probability, greater than or equal to 75%) were more accurate with CT than with radiography (P less than .001). The superiority of high-resolution CT over radiography was most obvious for histiocytosis X and sarcoidosis; in cases of pulmonary fibrosis, CT was not significantly different from radiography. The interobserver agreement for the proposed diagnosis was significantly better with high-resolution CT (P less than .001). Twenty-one of 26 radiographic findings and 21 of 25 CT findings were discriminant. Stepwise discriminant analysis revealed the superiority of CT over radiography, since the ranking of all findings showed that the four most discriminant findings, and eight of the first 12 findings, were revealed with CT.