Subject(s)
Bronchogenic Cyst/complications , Bronchogenic Cyst/diagnosis , Bronchopulmonary Sequestration/complications , Bronchopulmonary Sequestration/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Bronchogenic Cyst/pathology , Bronchogenic Cyst/surgery , Bronchopulmonary Sequestration/pathology , Bronchopulmonary Sequestration/surgery , Diagnosis, Differential , Humans , Lung/pathology , Lung/surgery , Male , Middle Aged , ThoracotomyABSTRACT
MRI of the whole spine and radionuclide bone scan were performed prospectively on 50 consecutive patients with newly diagnosed non small-cell lung carcinoma. The final diagnosis of vertebral metastasis was made by means of follow-up studies. The prevalence of vertebral metastasis was 24% (12/50 patients). The sensitivity of MR imaging (92%) was superior to that of radionuclide bone scan (67%) in the detection of vertebral involvement, the specificity was the same (94%). MRI of the spine was not useful as a screening procedure before treatment, but offered advantages over radionuclide bone scan in patients with symptoms and when bone scintigraphy detected abnormal foci, including identification of additional vertebral metastatic foci and better analysis of the extent of metastatic involvement within vertebrae.
Subject(s)
Carcinoma, Non-Small-Cell Lung/secondary , Lung Neoplasms/pathology , Magnetic Resonance Imaging , Spinal Neoplasms/secondary , Adult , Aged , Aged, 80 and over , Bone and Bones/diagnostic imaging , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Radionuclide Imaging , Sensitivity and Specificity , Spinal Neoplasms/diagnosis , Spinal Neoplasms/diagnostic imaging , Time FactorsABSTRACT
BACKGROUND: Pulmonary manifestations in leptospirosis are considered a major complication and are related to a poor prognosis. We present a large series of patients with pulmonary involvement using a practical approach based on the presence of acute respiratory failure (ARF). METHODS: A retrospective study of patients with confirmed leptospirosis. RESULTS: One hundred and sixty-nine patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. One hundred and thirty-four patients (36.7±14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of ARF. Univariate analysis found the following factors related to severe pulmonary leptospirosis: dyspnoea (OR=10.14, p<0.0001), pulmonary crepitations (OR=4.8, p<0.0004), abnormal chest X-ray (OR=9.88, p<0.007) with alveolar shadowing (OR=8.12, p<0.0001), oliguria/anuria (OR=5.48, p<0.0001), hepatomegaly (OR=7.11, p< 0.0001), shock (OR=8.38, p< 0.0001), ICU admission (OR=60.08, p< 0.0001), dialysis (OR=4.87, p< 0.001), mechanical ventilation (OR=216, p< 0.0001) and development of nosocomial infection (OR=21.5, p< 0.0001). The mortality rate was significantly different between severe (40%) and non-severe (5.3%) pulmonary forms (OR=11.87, p< 0.0001). Multivariate analysis found two independent factors related to severe pulmonary involvement: dyspnoea (OR=10.18, p< 0.0001) and oliguria/anuria (OR=4.87, p< 0.0009). We performed a multivariate analysis to assess independent factors related to mortality and found: mechanical ventilation requirement (OR=27.85, p< 0.0001) and AST greater than 150 IU/L (OR=4.57, p< 0.02). Haemoptysis was associated with survival (OR=0.2, p< 0.02). CONCLUSIONS: Severe pulmonary involvement in leptospirosis is associated with extensive disease involving other organs. The association of multiple factors is associated with severe forms of the disease and a high mortality rate.
Subject(s)
Leptospirosis/complications , Lung Diseases/complications , Adult , Animals , Cause of Death , Female , Hospitalization/statistics & numerical data , Humans , Leptospirosis/diagnosis , Leptospirosis/epidemiology , Leptospirosis/mortality , Lung Diseases/diagnosis , Lung Diseases/epidemiology , Lung Diseases/mortality , Male , Middle Aged , Prognosis , Rats , Retrospective Studies , Severity of Illness Index , Survival Analysis , Zoonoses/epidemiologySubject(s)
Cholecystitis/complications , Cholecystitis/diagnostic imaging , Hematocele/complications , Hematocele/diagnostic imaging , Hemoperitoneum/etiology , Abdominal Pain/etiology , Aged , Cholecystitis/surgery , Diagnosis, Differential , Hematocele/surgery , Humans , Male , Rupture, Spontaneous , Shock, Hemorrhagic/etiology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Pulmonary manifestations in leptospirosis are considered a major complication, and are related to a poor prognosis. We present a large series of patients with pulmonary involvement using a practical approach based on the presence of acute respiratory failure (ARF). METHODS: A retrospective study of patients with confirmed leptospirosis. RESULTS: 169 patients with a laboratory-confirmed diagnosis of leptospirosis were investigated. 134 patients (36.7 + or - 14 years of age) had pulmonary involvement. Severe pulmonary involvement was defined by evidence of acute respiratory failure. Univariate analysis found the following factors related to severe pulmonary leptospirosis: dyspnoea (OR 10.14, p<0.0001), pulmonary crepitations (OR 4.8, p<0.0004), abnormal chest X Ray (OR 9.88, p<0.007) with alveolar shadowing (OR 8.12, p<0.0001), oliguria/anuria (OR 5.48, p<0.0001), hepatomegaly (OR 7.11, p<0.0001), shock (OR 8.38, p<0.0001), ICU admission (OR 60.08, p<0.0001), dialysis (OR 4.87, p<0.001), mechanical ventilation (OR 216, p<0.0001) and development of nosocomial infection (OR 21.5, p<0.0001). The mortality rate was significantly different between severe (40%) and non-severe (5.3%) pulmonary forms (OR 11.87, p<0.0001). Multivariate analysis found 2 independent factors related to severe pulmonary involvement: dyspnoea (OR 10.18, p<0.0001), and oliguria/anuria (OR 4.87, p<0.0009). We performed a multivariate analysis to assess independent factors related to mortality and found: Mechanical ventilation requirement (OR 27.85, p<0.0001) and ASAT>150 UI/L (OR 4.57, p<0.02). Haemoptysis was associated with survival (OR 0.2, p<0.02). CONCLUSION: Severe pulmonary involvement in leptospirosis is associated with extensive disease involving other organs. The association of multiples factors is associated with severe forms of the disease and a high mortality rate.