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Size-selected dianionic lead clusters Pb_{n}^{2-}, n=34-56, are stored in a Penning trap and studied with respect to their decay products upon photoexcitation. Contrary to the decay of other dianionic metal clusters, these lead clusters show a variety of decay channels. The mass spectra of the fragments are compared to the corresponding spectra of the monoanionic precursors. This comparison leads to the conclusion that, in the cluster size region below about n=48, the fission reaction Pb_{n}^{2-}âPb_{n-10}^{-}+Pb_{10}^{-} is the major decay process. Its disappearance at larger cluster sizes may be an indication of a nonmetal to metal transition. Recently, the pair of Pb_{10}^{-} and Pb_{n-10}^{-} were observed as pronounced fragments in electron-attachment studies [S. König et al., Int. J. Mass Spectrom. 421, 129 (2017)IMSPF81387-380610.1016/j.ijms.2017.06.009]. The present findings suggest that this combination is the fingerprint of the decay of doubly charged lead clusters. With this assumption, the dianion clusters have been traced down to Pb_{21}^{2-}, whereas the smallest size for the direct observation was as high as n=28.
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OBJECTIVE: To assess the effect of two different additives (propylene glycol (PG) and polyethylene glycol 400 (PEG 400)) on release and in vitro skin retention of quercetin and chrysin from semisolid bases (amphiphilic creams and acidic carbomer gels). METHODS: For obtaining semisolid formulations, flavonoids were pre-dissolved in the liquid (PG or PEG 400) or directly suspended in the semisolid base. Three chrysin formulations ('cream 0', 'PG-cream' and 'PEG 400-cream') and five quercetin formulations ('cream 0', 'PG cream', 'PEG 400 cream', 'gel 0' and 'PG gel') were prepared. The release studies were carried out in Franz diffusion cells by means of a cellulose membrane. The porcine ear skin was used in in vitro skin retention studies. RESULTS: The dissolution was a prerequisite to increase the release rates of tested flavonoids from obtained semisolid formulations. The cumulative amount of chrysin released after 6 h from 'PEG 400 cream' containing partly dissolved form of that flavonoid was higher than that from 'cream 0' or 'PG cream' containing its suspended form. The formulations containing quercetin dissolved in PG ('PG cream', 'PG gel') or PEG 400 ('PEG 400 cream') exhibited higher release rates of that flavonoid than corresponding semisolid suspensions ('cream 0' or 'gel 0'). The effects of both liquid additives (PG and PEG 400) on the cumulative amount of quercetin released after 6 h were comparable. However, there was no correlation between the release rate and the skin retention. The amounts of the flavonoids found in the skin were strongly affected by the type of the used solvent. While PG increased the skin retention of both flavonoids, PEG 400 had no effect on chrysin skin retention and delayed quercetin skin absorption. CONCLUSION: The proper choice of the solvent added to the semisolid base is crucial for enhanced skin delivery of the tested flavonoids. PG is more efficient absorption promoter than PEG 400 of both chrysin and quercetin.
Assuntos
Flavonoides/administração & dosagem , Pele/metabolismo , Animais , Cromatografia Líquida de Alta Pressão , Emulsões , Flavonoides/metabolismo , Géis , Técnicas In Vitro , Espectrofotometria Ultravioleta , SuínosRESUMO
OBJECTIVES: To investigate inter-reader agreement for the detection of pleural and parenchymal abnormalities using CT in a large cross-sectional study comprising information on individual cumulative exposure to asbestos. METHODS: The project was approved by the hospital ethics committee, and all patients received information on the study and gave their written informed consent. In 5511 CT scans performed in a cohort of retired workers previously exposed to asbestos and volunteering to participate in a multiregional survey programme (Asbestos Related Diseases Cohort, ARDCO), double randomised standardised readings, triple in case of disagreement, were performed by seven trained expert radiologists specialised in thoracic imaging and blind to the initial interpretation. Inter-reader agreement was evaluated by calculating the κ-weighted coefficient between pairs of expert readers and results of routine practice and final diagnosis after expert reading. RESULTS: κ-Weighted coefficients between trained experts ranged from 0.28 to 0.52 (fair to good), 0.59 to 0.86 (good to excellent) and 0.11 to 0.66 (poor to good) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. κ-Weighted coefficients between results of routine practice and final diagnosis after expert reading were 0.13 (poor), 0.53 (moderate) and 0.11 (poor) for the diagnosis of asbestosis, pleural plaques and fibrosis of the visceral pleura, respectively. CONCLUSIONS: Interpretation of benign asbestos-related thoracic abnormalities requires standardisation of the reading and trained readers, particularly for participants asking for compensation, and with a view to the longitudinal survey of asbestos-exposed workers.
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Amianto/efeitos adversos , Asbestose/diagnóstico , Erros de Diagnóstico/prevenção & controle , Exposição Ocupacional/efeitos adversos , Pleura/diagnóstico por imagem , Doenças Pleurais/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Idoso , Asbestose/diagnóstico por imagem , Estudos Transversais , Fibrose , Pessoal de Saúde/normas , Humanos , Pessoa de Meia-Idade , Doenças Pleurais/diagnóstico por imagemRESUMO
BACKGROUND: The mechanism of aspirin sensitivity in patients with asthma and rhinosinusitis has been attributed to arachidonic acid metabolism abnormalities. OBJECTIVE: We aimed to test whether aspirin-triggered generation of 15-hydroxyeicosatetraenoic acid (15-HETE) in nasal polyp dispersed cells (NPDCs) from aspirin-sensitive patients is associated with activation of inflammatory cells. METHODS: Polyps were obtained from 11 aspirin-sensitive and 19 aspirin-tolerant patients with chronic rhinosinusitis. NPDCs were stimulated by aspirin or calcium ionophore. Levels of 15-HETE, leukotriene (LT) C4, eosinophil cationic protein (ECP), and tryptase were measured in NPDC supernatant. RESULTS: NPDCs from aspirin-sensitive patients contained more eosinophils (14% vs 9%, P < .05) and released 2.4-fold more ECP (P < .01) at baseline. Stimulation with aspirin (200 microM) resulted in a significant increase in 15-HETE generation only in tissue from aspirin-sensitive patients (mean increase, 82%) but did not induce any increase in the release of LTC4, ECP, or tryptase. Preincubation with calcium ionophore resulted in significantly enhanced generation of 15-HETE, ECP, tryptase, and LTC4 in patients from both groups. Incubation of NPDCs with misoprostol inhibited aspirin-induced 15-HETE generation in aspirin-sensitive patients and calcium ionophore-induced 15-HETE, ECP, and tryptase release in both aspirin-sensitive and aspirin-tolerant patients. CONCLUSION: Our study demonstrated that aspirin-induced 15-HETE generation in nasal polyps from aspirin-sensitive patients is not associated with activation of mast cells and eosinophils. Misoprostol has a potent inhibitory effect on the activation of cells derived from the site of nasal mucosal inflammation, regardless of sensitivity to aspirin.
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Aspirina/efeitos adversos , Hipersensibilidade a Drogas/metabolismo , Eosinófilos/efeitos dos fármacos , Ácidos Hidroxieicosatetraenoicos/metabolismo , Mastócitos/efeitos dos fármacos , Pólipos Nasais/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Araquidonato 15-Lipoxigenase/fisiologia , Ionóforos de Cálcio/farmacologia , Eosinófilos/fisiologia , Feminino , Humanos , Masculino , Mastócitos/fisiologia , Pessoa de Meia-Idade , Misoprostol/farmacologiaRESUMO
Mutations at the natural resistance-associated macrophage protein 1 (Nramp1) locus cause susceptibility to infection with antigenically unrelated intracellular pathogens. Nramp1 codes for an integral membrane protein expressed in the lysosomal compartment of macrophages, and is recruited to the membrane of phagosomes soon after the completion of phagocytosis. To define whether Nramp1 functions as a transporter at the phagosomal membrane, a divalent cation-sensitive fluorescent probe was designed and covalently attached to a porous particle. The resulting conjugate, zymosan-FF6, was ingested by macrophages and its fluorescence emission was recorded in situ after phagocytosis, using digital imaging. Quenching of the probe by Mn(2+) was used to monitor the flux of divalent cations across the phagosomal membrane in peritoneal macrophages obtained from Nramp1-expressing (+/+) and Nramp1-deficient (-/-) macrophages. Phagosomes from Nramp1(+/+) mice extrude Mn(2+) faster than their Nramp(-/-) counterparts. The difference in the rate of transport is eliminated when acidification of the phagosomal lumen is dissipated, suggesting that divalent metal transport through Nramp1 is H(+) dependent. These studies suggest that Nramp1 contributes to defense against infection by extrusion of divalent cations from the phagosomal space. Such cations are likely essential for microbial function and their removal from the phagosomal microenvironment impairs pathogenesis, resulting in enhanced bacteriostasis or bactericidal activity.
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Proteínas de Transporte/metabolismo , Proteínas de Transporte de Cátions , Membranas Intracelulares/metabolismo , Proteínas de Ligação ao Ferro , Macrófagos Peritoneais/metabolismo , Manganês/metabolismo , Proteínas de Membrana/metabolismo , Fagossomos/imunologia , Fagossomos/metabolismo , Animais , Transporte Biológico/efeitos dos fármacos , Cátions Bivalentes/metabolismo , Etilenodiaminas/farmacologia , Corantes Fluorescentes/síntese química , Corantes Fluorescentes/metabolismo , Fura-2/metabolismo , Concentração de Íons de Hidrogênio , Membranas Intracelulares/efeitos dos fármacos , Macrófagos Peritoneais/citologia , Macrófagos Peritoneais/efeitos dos fármacos , Macrófagos Peritoneais/imunologia , Camundongos , Camundongos Knockout , Microscopia de Fluorescência , Mutação , Espectrometria de Fluorescência , Tapsigargina/farmacologia , Zimosan/análogos & derivados , Zimosan/síntese química , Zimosan/metabolismoRESUMO
Tumors of the trachea and central bronchi can be benign or malignant. Clinical presentation may be confusing, particularly in benign tumors that can be misdiagnosed as asthma or chronic bronchitis. Chest radiography has many limitations and is often considered unremarkable in patients with tumors of the central airways; therefore, multidetector CT (MDCT) has become the most useful noninvasive method for diagnosing and assessing the central airways. The purpose of this article is to provide a review of imaging of the tumors of the trachea and central bronchi. We emphasize the crucial role of MDCT and postprocessing techniques in assessing neoplasms of the central airways.
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Tumors of the trachea and central bronchi can be benign or malignant. Clinical presentation may be confusing, particularly in benign tumors that can be misdiagnosed as asthma or chronic bronchitis. Chest radiography has many limitations and is often considered unremarkable in patients with tumors of the central airways; therefore, multidetector CT (MDCT) has become the most useful noninvasive method for diagnosing and assessing the central airways. The purpose of this article is to provide a review of imaging of the tumors of the trachea and central bronchi. We emphasize the crucial role of MDCT and postprocessing techniques in assessing neoplasms of the central airways.
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Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias da Traqueia/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
Postoperative complications after pneumonectomy, lobectomy, or wedge resection are relatively frequent and potentially significant. Chest radiographs and CT have a crucial role in the early detection and prompt management of these complications. The purpose of this paper is to illustrate the most frequent or severe complications, based on the timing of occurrence. Early complications include bronchopleural fistula, empyema, atelectasis, pneumonia, hemothorax, chylothorax, pulmonary edema, lobar torsion, cardiac hernia, gossypiboma and esophagopleural fistula. Late complications include bronchopleural fistula, esophagopleural fistula, postpneumonectomy syndrome, chest wall arteriovenous fistula and local tumor recurrence.
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Pneumonectomia , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Quilotórax/diagnóstico por imagem , Feminino , Seguimentos , Hemotórax/diagnóstico por imagem , Humanos , Pulmão/patologia , Pneumopatias/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Estadiamento de Neoplasias , Doenças Pleurais/diagnóstico por imagem , Pneumonectomia/efeitos adversos , Pneumonia Estafilocócica/diagnóstico por imagem , Fatores de TempoRESUMO
Localized ground-glass opacities (GGOs) have been recently individualized and account for between 2.9% and 19% of all pulmonary nodules detected in high-risk patients included in CT screening series for lung cancer. These opacities, nodular, lobular or flat, correspond to benign lesions (localised infectious and inflammatory diseases, focal interstitial fibrosis, and atypical alveolar hyperplasia) or malignant lesions (bronchioloalveolar carcinoma, early-stage adenocarcinoma and sometimes metastases). Localized GGOs are more likely to be malignant than solid nodules and prognosis is related to the percentage of the ground-glass component. However, doubling time of pure localized malignant GGOs is longer than mixed localized malignant GGOs and even longer than the doubling time of solid malignant nodules. Therefore, localized GGOs warrant a dedicated diagnostic workup.
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Adenocarcinoma Bronquioloalveolar/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Radiografia Torácica/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/classificação , Adenocarcinoma/patologia , Algoritmos , Biópsia , Ensaios Clínicos como Assunto , Diagnóstico Diferencial , Feminino , Humanos , Hiperplasia , Pulmão/patologia , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Alvéolos Pulmonares/patologia , Fatores de Risco , Fumar/efeitos adversos , Nódulo Pulmonar Solitário/etiologia , Nódulo Pulmonar Solitário/patologiaRESUMO
Lung cancer is one of the most frequently occurring cancer in the world. Imaging plays a critical role for screening, diagnosing, staging, and following patients. Although morphologic imaging such as chest X-ray and CT are still useful for these purpose, major limitations occur in the proper evaluation of diagnosing and staging. Metabolic imaging using PET significantly increases the accuracy of staging. This paper will review the role of imaging in patients suspected or diagnosed with lung cancer.
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Neoplasias Pulmonares/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Idoso , Humanos , MasculinoRESUMO
PURPOSE: The purpose of this study was to evaluate the usefulness of computed tomography-texture analysis (CTTA) in differentiating between in-situ and minimally-invasive from invasive adenocarcinomas in subsolid lung nodules (SSLNs). MATERIAL AND METHODS: Two radiologists retrospectively reviewed 49 SSLNs in 44 patients. There were 27 men and 17 women with a mean age of 63±7 (SD) years (range: 47-78years). For each SSLN, type (pure ground-glass or part-solid) was assessed by consensus and CTTA was conducted independently by each observer using a filtration-histogram technique. Different filters were used before histogram quantification: no filtration, fine, medium and coarse, followed by histogram quantification using mean intensity, standard deviation (SD), entropy, mean positive pixels (MPP), skewness and kurtosis. RESULTS: We analyzed 13 pure ground-glass and 36 part-solid nodules corresponding to 16 adenocarcinomas in-situ (AIS), 5 minimally invasive adenocarcinomas (MIA) and 28 invasive adenocarcinomas (IVA). At uni- and multivariate analysis CTTA allowed discriminating between IVAs and AIS/MIA (P<0.05 and P=0.025, respectively) with the following histogram parameters: skewness using fine textures and kurtosis using coarse filtration for pure ground-glass nodules, and SD without filtration for part-solid nodules. CONCLUSION: CTTA has the potential to differentiate AIS and MIA from IVA among SSLNs. However, our results require further validation on a larger cohort.
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Adenocarcinoma in Situ/diagnóstico por imagem , Adenocarcinoma in Situ/patologia , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Tomografia Computadorizada por Raios X , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Estudos RetrospectivosRESUMO
Deep dermal partial-thickness scalds remain one of the most common types of injuries in childhood. Local treatment of those wounds, alternatively described as IIb degree, is still very controversial. Some authors advise conservative treatment of such wounds, pointing to their ability to self-reepithelialise, which is possible but significantly prolonged. Other investigators postulate operative treatment, i.e., tangential necrectomy and split-thickness autologous skin grafting, which may shorten the time of wound healing. Arguments call for contra-arguments, and the problem still seems to be unresolved. There is indeed a lack of acceptable standardisation of the local treatment for deep dermal partial-thickness scalds in the paediatric population. The results of both conservative and operative treatment of 114 children aged between 3 months and 17 years, treated for deep dermal partial-thickness scalds from 1997 to 2004 are presented. The treatment of five groups of patients, divided into groups based on the extent of their burn wounds, is evaluated. The patients were treated by tangential necrectomy and skin grafting, mechanical dermabrasion, Granuflex(R) (Convatec) hydrocolloid dressings, Iruxol Mono(R) (Knoll) enzymatic dressings, or Aquacel Ag(R) (Convatec) hydrofibre dressings with silver ions. A number of parameters of wound healing were analysed. The results of this paper encouraged us to present and discuss a proposition for the standardisation of local treatment of deep dermal partial-thickness burn wounds in the paediatric population, according to the extent of injury.
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Queimaduras/terapia , Carboximetilcelulose Sódica/administração & dosagem , Cloranfenicol/administração & dosagem , Dermabrasão/métodos , Derme/lesões , Colagenase Microbiana/administração & dosagem , Curativos Oclusivos , Transplante de Pele/métodos , Administração Tópica , Adolescente , Queimaduras/patologia , Criança , Pré-Escolar , Desbridamento/métodos , Derme/patologia , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Transplante Autólogo , Índices de Gravidade do Trauma , Resultado do Tratamento , CicatrizaçãoRESUMO
Lemierre syndrome is a septic thrombosis of the internal jugular vein with pulmonary abscesses secondary to untreated pharyngotonsillitis due to anaerobic bacteria. It occurs in young, previously healthy patients and leads to life-threatening consequences if not treated. We illustrate the value of imaging and particularly cervical and thoracic CT in a report of three recent cases.
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Infecções por Fusobacterium/diagnóstico por imagem , Veias Jugulares , Tromboflebite/diagnóstico por imagem , Tromboflebite/microbiologia , Tomografia Computadorizada por Raios X , Adulto , Humanos , Masculino , SíndromeRESUMO
INTRODUCTION: Stenting is accepted in managing patients with inoperable obstruction of the upper airways. The choice of the type as well as the dimensions of stents are crucial as it impacts on the success of the procedure and potential complications which must be diagnosed non-invasively. STATE OF THE ART: The goal of this review is to present our multidisciplinary experience using multidetector CT as a minimally invasive technique for detecting airway obstructions, for evaluating preoperatively local anatomic conditions useful to determinate the type and size of metallic stents to be used, and following non-invasively the stent in order to detect various complications. CONCLUSIONS: MDCT acquisition should use thin slices as multiplanar reformations and 3D reconstructions play an essential complementary role to axial images in pre- and post-stent placement settings.
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Obstrução das Vias Respiratórias/cirurgia , Stents , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Obstrução das Vias Respiratórias/diagnóstico por imagem , HumanosRESUMO
Authors present a case of a female patient surgically treated for chronic otitis media (radical middle ear surgery) in which basing on postoperative pathology report a specific inflammatory process (tuberculosis) has been diagnosed. It is pointed out that in this patient there is a history of malignant neoplastic process (rhabdomyosarcoma embryonal) treated previously at the contralateral middle ear.
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Neoplasias da Orelha , Orelha Média/cirurgia , Otite Média/cirurgia , Rabdomiossarcoma Embrionário , Tuberculose/cirurgia , Neoplasias da Orelha/diagnóstico , Neoplasias da Orelha/terapia , Orelha Média/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Otite Média/microbiologia , Rabdomiossarcoma Embrionário/diagnóstico , Rabdomiossarcoma Embrionário/terapia , Resultado do Tratamento , Tuberculose/microbiologiaRESUMO
Common variable immunodeficiency (CVID) is the most frequent primary immunodeficiency syndrome in adults with equal sex prevalence. The syndrome typically presents as recurrent infections, with onset in childhood or young adulthood (between 20 and 30 years). CVID patients also have a higher prevalence of autoimmune diseases. A 38-year-old woman presented to the Rheumatology Department with polyarthralgia and fever of 39 degrees C of several months' duration. She had recurrent respiratory and gastrointestinal tract infections and pernicious anemia. Immunological studies showed decreased levels of IgG, IgM, complete IgA deficiency, increased percentage of CD8 lymphocytes, and a reduced CD4:CD8 ratio. HLA-DR typing was performed and we identified HLA-DRB1*01. Adequate intravenous immune globulin substitution as well as antibiotic and anti-inflammatory treatment resulted in the remission of arthritis. Hand radiograms repeated after 12 months showed narrowing of the intra-articular space in the right metacarpophalangeal and radiocarpal joints with multiple bone cysts and erosions. Erosions were found in both humeral heads as well. This prompted the diagnosis of rheumatoid arthritis. Arthritis can be a presenting symptom of primary immunodeficiency in adults, especially when accompanied by recurrent infections or autoimmune diseases. These patients require more advanced diagnostic procedures and therapeutic cooperation of different specialists.
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Artrite Reumatoide/imunologia , Imunodeficiência de Variável Comum/imunologia , Hospedeiro Imunocomprometido , Adulto , Antibacterianos/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/patologia , Artrite Reumatoide/terapia , Imunodeficiência de Variável Comum/patologia , Imunodeficiência de Variável Comum/terapia , Diagnóstico Diferencial , Feminino , Teste de Histocompatibilidade , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Valores de Referência , Resultado do TratamentoRESUMO
Adenocarcinoma is the most common histologic type of lung cancer. Recent lung adenocarcinoma classifications from the International Association for the Study of Lung cancer, the American Thoracic Society and the European Respiratory Society (IASLC/ETS/ERS, 2011) and World Health Organization (WHO, 2015) define a wide range of adenocarcinoma types and subtypes featuring different prognosis and management. This spectrum of lesions translates into various CT presentations and features, which generally show good correlation with histopathology, stressing the key role of the radiologist in the diagnosis and management of those patients. This review aims at helping radiologists to understand the basics of the up-to-date adenocarcinoma pathological classifications, radio-pathological correlations and how to use them in the clinical setting, as well as other imaging-related correlations (radiogenomics, quantitative analysis, PET-CT).
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Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada por Raios X/métodos , Adenocarcinoma/classificação , Diagnóstico Diferencial , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/classificação , Sensibilidade e Especificidade , Nódulo Pulmonar Solitário/classificação , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia , Estatística como AssuntoRESUMO
INTRODUCTION: In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible. CASE REPORT: A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe. CONCLUSION: The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine.
Assuntos
Broncoscopia , Pulmão/cirurgia , Pneumonectomia/métodos , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/cirurgia , Broncoscopia/métodos , Feminino , Humanos , Pulmão/patologia , Pessoa de Meia-Idade , Tamanho do Órgão , Prognóstico , Enfisema Pulmonar/patologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Lung cancer is the leading cause of deaths due to cancer in France. More than half of lung cancers are discovered at an advanced-stage. New anticancer treatment strategies (i.e., the so-called personalized or targeted therapy) have recently been introduced and validated for non-small-cell lung cancer (NSCLC), in addition to or in association with standard chemotherapy. Personalized therapy includes tyrosine kinase inhibitors (TKIs), antiangiogenic treatments and immunotherapy. Because these treatments may be responsible for atypical thoracic adverse effects and responses as compared to standard chemotherapy, RECIST 1.1 criteria may be inadequate to evaluate the responses to these agents. The goal of this article was to review personalized treatment strategies for NSCLC, to consider the therapy-specific responses and thoracic complications induced by these new therapeutic agents and finally to discuss future directions for the personalized assessment of tumor response.
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Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Medicina de Precisão , Radiologia , Humanos , Imunoterapia , Neoplasias Pulmonares/genética , Proteínas Tirosina Quinases/antagonistas & inibidoresRESUMO
The authors report a case of adrenal ganglioneuroma diagnosed in a young woman with melanoma. This benign hormone silent tumor arises from neural crest tissue. The imaging features at US, CT and MRI are described. Diagnosis was confirmed at CT guided biopsy.