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1.
Surg Innov ; 31(2): 185-194, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38403897

RESUMO

BACKGROUND: To date, several chest drainage systems are available, such as digital drainage systems (DDS) and traditional systems with continuous suction or water seal. However, none of these systems were yet shown to be favorable in the treatment of complex situations such as persistent air leaks or residual spaces. We present in-vitro as well as clinical data of a novel hybrid drainage system consisting of an optimized digital drainage system (ODDS) and an underwater seal drainage system (UWSD). METHODS: For in-vitro analysis, a DDS and an ODDS were connected to a pleural cavity simulator. Different air leaks were produced and data on intrapleural pressure and air flow were analyzed. Furthermore, we tested the hybrid drainage system in 10 patients with potential air leaks after pulmonary surgery. RESULTS: In in-vitro analysis, we could show, that with advanced pump technology, pressure fluctuations caused by the drainage system when trying to maintain a set pressure level in patients with airleaks were much smaller when using an ODDS and could even be eliminated when using a fluid collection canister with sufficient buffer capacity. This minimized air leak boosts caused by the drainage system. Optimizing the auto-pressure regulation algorithms also led to a reduced airflow through the fistula and promoted rest. Switching to a passive UWSD also reduced the amount of airflow. Clinical application of the hybrid drainage system yielded promising results. CONCLUSION: The novel hybrid drainage system shows promising results in the treatment of patients with complex clinical situations such as persistent air leaks.


Assuntos
Drenagem , Pulmão , Humanos , Pulmão/cirurgia , Sucção , Drenagem/métodos , Cavidade Pleural , Algoritmos , Tubos Torácicos , Pneumonectomia
2.
Khirurgiia (Mosk) ; (1): 102-109, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38258696

RESUMO

A 19-year-old patient after previous wedge resection of the right upper pulmonary lobe a year ago urgently admitted with recurrent right-sided spontaneous pneumothorax. According to standard management of spontaneous pneumothorax, we performed diagnostic thoracoscopy and drainage of the right pleural cavity with regular X-ray examinations. However, these measures were ineffective. The patient was scheduled for surgery, and we intraoperatively observed an unusual cause of pneumothorax. Thus, we present spontaneous pneumothorax following right upper lobe pulmonary sequestration. The uniqueness of this case is associated with unusual manifestation and non-standard localization of rare lesion. A few cases of pneumothorax in similar patients are described in the world literature. The key limiting factor in diagnosis of such defects (identification of aberrant vessel supplying abnormal lung parenchyma) is the lack of routine CT angiography in patients diagnosed with pneumothorax. That is why CT changes were interpreted as postoperative ones, and the true cause was established only during redo surgery. A thorough inspection of the pleural cavity and alertness regarding unusual appearance of the right upper pulmonary lobe made it possible to suggest a non-standard diagnosis, avoid complications (bleeding from afferent vessel) and perform adequate lung resection.


Assuntos
Sequestro Broncopulmonar , Pneumotórax , Humanos , Adulto Jovem , Sequestro Broncopulmonar/complicações , Sequestro Broncopulmonar/diagnóstico , Sequestro Broncopulmonar/cirurgia , Angiografia por Tomografia Computadorizada , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Cavidade Pleural , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pneumotórax/cirurgia
4.
Respirar (Ciudad Autón. B. Aires) ; 15(4): 279-284, Diciembre 2023.
Artigo em Espanhol | LILACS, UNISALUD, BINACIS | ID: biblio-1518697

RESUMO

Introducción: El biliotórax es una condición infrecuente definida por la presencia de bilis en el espacio pleural. Actualmente, hay alrededor de 70 casos descritos en la litera-tura. Sigue siendo relativamente desconocido, por lo tanto, poco sospechado. Esta entidad suele ser el resultado de una lesión iatrogénica, a menudo secundaria a cirugías o traumatismos del tracto biliar, que conduce a la formación de una fístula pleurobiliar.


Introduction: Bilothorax is a rare condition defined by the presence of bile in the pleural space. Currently, there are around 70 cases described in the literature. It remains relatively unknown and, therefore, little suspected. This entity is usually the result of an iatrogenic injury, often secondary to surgery or trauma to the biliary tract, leading to the formation of a pleurobiliary fistula


Assuntos
Humanos , Masculino , Idoso , Derrame Pleural/complicações , Bile , Empiema Pleural/tratamento farmacológico , Neoplasias Hepáticas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Procedimentos Cirúrgicos Operatórios , Sistema Biliar , Biópsia , Tomografia , Cavidade Pleural , Metástase Neoplásica/diagnóstico
5.
Sci Rep ; 13(1): 14135, 2023 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-37644125

RESUMO

Computed Tomography (CT) imaging is routinely used for imaging of the lungs. Deep learning can effectively automate complex and laborious tasks in medical imaging. In this work, a deep learning technique is utilized to assess lobar fissure completeness (also known as fissure integrity) from pulmonary CT images. The human lungs are divided into five separate lobes, divided by the lobar fissures. Fissure integrity assessment is important to endobronchial valve treatment screening. Fissure integrity is known to be a biomarker of collateral ventilation between lobes impacting the efficacy of valves designed to block airflow to diseased lung regions. Fissure integrity is also likely to impact lobar sliding which has recently been shown to affect lung biomechanics. Further widescale study of fissure integrity's impact on disease susceptibility and progression requires rapid, reproducible, and noninvasive fissure integrity assessment. In this paper we describe IntegrityNet, an attention U-Net based automatic fissure integrity analysis tool. IntegrityNet is able to predict fissure integrity with an accuracy of 95.8%, 96.1%, and 89.8% for left oblique, right oblique, and right horizontal fissures, compared to manual analysis on a dataset of 82 subjects. We also show that our method is robust to COPD severity and reproducible across subject scans acquired at different time points.


Assuntos
Trabalho de Parto , Tomografia Computadorizada por Raios X , Humanos , Gravidez , Feminino , Fenômenos Biomecânicos , Cavidade Pleural , Pulmão/diagnóstico por imagem
6.
Front Immunol ; 14: 1191357, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37435066

RESUMO

Background: Tuberculosis (TB) is caused by Mycobacterium tuberculosis (Mtb) and remains a major health threat worldwide. However, a detailed understanding of the immune cells and inflammatory mediators in Mtb-infected tissues is still lacking. Tuberculous pleural effusion (TPE), which is characterized by an influx of immune cells to the pleural space, is thus a suitable platform for dissecting complex tissue responses to Mtb infection. Methods: We employed singe-cell RNA sequencing to 10 pleural fluid (PF) samples from 6 patients with TPE and 4 non-TPEs including 2 samples from patients with TSPE (transudative pleural effusion) and 2 samples with MPE (malignant pleural effusion). Result: Compared to TSPE and MPE, TPE displayed obvious difference in the abundance of major cell types (e.g., NK, CD4+T, Macrophages), which showed notable associations with disease type. Further analyses revealed that the CD4 lymphocyte population in TPE favored a Th1 and Th17 response. Tumor necrosis factors (TNF)-, and XIAP related factor 1 (XAF1)-pathways induced T cell apoptosis in patients with TPE. Immune exhaustion in NK cells was an important feature in TPE. Myeloid cells in TPE displayed stronger functional capacity for phagocytosis, antigen presentation and IFN-γ response, than TSPE and MPE. Systemic elevation of inflammatory response genes and pro-inflammatory cytokines were mainly driven by macrophages in patients with TPE. Conclusion: We provide a tissue immune landscape of PF immune cells, and revealed a distinct local immune response in TPE and non-TPE (TSPE and MPE). These findings will improve our understanding of local TB immunopathogenesis and provide potential targets for TB therapy.


Assuntos
Mycobacterium tuberculosis , Derrame Pleural , Tuberculose , Humanos , Apresentação de Antígeno , Cavidade Pleural
7.
Gen Thorac Cardiovasc Surg ; 71(8): 487-490, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37165288

RESUMO

A 70-year-old man was incidentally diagnosed with left pneumothorax. Primary surgery via the caudal thoracic cavity found severe pleural adhesions causing narrowing of the tunnel leading to the lung apex. The point of air leakage was located at the lung apex beyond the tunnel. To stop the air leakage, fibrin glue was injected to the apex via the tunnel; however, leakage reoccurred postoperatively. Considering the lung injury, a novel approach for lung apex without adhesion dissection was chosen for secondary surgery. An axillary skin incision was made at the 2nd intercostal space, and extrapleural dissection proceeded toward the apex. After the pleural space was confirmed by the movement of pleural effusion, the parietal pleura was incised, and a bulla was exposed and resected. The presented procedure to reach the apex of the lung without adhesion dissection could be an option in cases with dense and extensive pleural adhesions.


Assuntos
Doenças Pleurais , Pneumotórax , Masculino , Humanos , Idoso , Doenças Pleurais/diagnóstico , Doenças Pleurais/etiologia , Doenças Pleurais/cirurgia , Pulmão , Pneumotórax/etiologia , Pneumotórax/cirurgia , Pleura/cirurgia , Cavidade Pleural
8.
Chest ; 164(3): 796-805, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37187435

RESUMO

Pressure-dependent pneumothorax is a common clinical event, often occurring after pleural drainage in patients with visceral pleural restriction, partial lung resection, or lobar atelectasis from bronchoscopic lung volume reduction or an endobronchial obstruction. This type of pneumothorax and air leak is clinically inconsequential. Failure to appreciate the benign nature of such air leaks may result in unnecessary pleural procedures or prolonged hospital stay. This review suggests that identification of pressure-dependent pneumothorax is clinically important because the air leak that results is not related to a lung injury that requires repair but rather to a physiological consequence of a pressure gradient. A pressure-dependent pneumothorax occurs during pleural drainage in patients with lung-thoracic cavity shape/size mismatch. It is caused by an air leak related to a pressure gradient between the subpleural lung parenchyma and the pleural space. Pressure-dependent pneumothorax and air leak do not need any further pleural interventions.


Assuntos
Pneumotórax , Procedimentos Cirúrgicos Torácicos , Humanos , Pneumotórax/diagnóstico , Pneumotórax/etiologia , Pneumotórax/cirurgia , Pneumonectomia/efeitos adversos , Cavidade Pleural , Pleura
9.
Hum Pathol ; 136: 105-113, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37023867

RESUMO

Liposarcoma rarely occurs in the pleura or thoracic cavity, and few reports appear in the literature. We hypothesized that combining clinicopathologic, immunohistochemical, and fluorescence in situ hybridization methods would allow definite diagnoses. Using formalin-fixed, paraffin-embedded blocks, we examined 6 atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDLPS), 5 dedifferentiated liposarcomas (DDLPSs), 2 pleomorphic liposarcomas, and 1 myxoid liposarcoma (MLPS). We used the Kaplan-Meier method and the Wilcoxon test for survival analysis for prognostic factor evaluation. Histologically, ALT/WDLPS was composed of a relatively mature adipocytic proliferation, accompanied by some lipoblasts. DDLPS exhibited round-to-oval tumor cells with a high nucleus-to-cytoplasm ratio that had proliferated in nests, accompanied in case 10 by some giant cells but no fatty cells. The pleomorphic type contained a varying proportion of pleomorphic lipoblasts. MLPS displayed uniform round- to oval-shaped cells and small signet-ring lipoblasts in a myxoid stroma. Immunohistochemically, 11 (79%), 11 (79%), and 10 (71%) of 14 cases were positive for S-100, p16, and CDK4, respectively. Six of the 14 cases (43%) were positive for MDM2 and adipophilin. One case of ALT/WDLPS and 3 cases of DDLPS exhibited MDM2 amplification by fluorescence in situ hybridization (Vysis LSI MDM2 SpectrumGreen Probe plus Vysis CEP 12 SpectrumOrange probe). ALT/WDLPS was the most favorable type for survival, while adipophilin tended to be a negative prognostic factor for pleural liposarcoma. For a firm diagnosis of liposarcoma in the pleura, immunohistochemistry for CDK4, MDM2, and adipophilin together with MDM2 gene amplification by fluorescence in situ hybridization may be an important diagnostic tool.


Assuntos
Lipoma , Lipossarcoma , Adulto , Humanos , Cavidade Pleural/química , Cavidade Pleural/metabolismo , Cavidade Pleural/patologia , Hibridização in Situ Fluorescente/métodos , Perilipina-2 , Lipossarcoma/patologia , Lipoma/diagnóstico , Proteínas S100 , Proteínas Proto-Oncogênicas c-mdm2/análise , Amplificação de Genes , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/análise
10.
Asian Cardiovasc Thorac Ann ; 31(4): 357-359, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37093739

RESUMO

Implantable cardioverter defibrillators are implanted in children to prevent sudden death due to life-threatening ventricular arrhythmias. Transvenous electrode placement is difficult for children because of the small vessel size. Especially, defibrillator electrode placement requires other innovative techniques. We successfully implanted a defibrillator electrode in the pleural cavity using a thoracoscopic approach for a 4-year-old child with sodium channelopathy.


Assuntos
Morte Súbita Cardíaca , Desfibriladores Implantáveis , Humanos , Pré-Escolar , Morte Súbita Cardíaca/prevenção & controle , Cavidade Pleural , Arritmias Cardíacas
11.
Immunity ; 56(5): 1064-1081.e10, 2023 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-36948193

RESUMO

The recent revolution in tissue-resident macrophage biology has resulted largely from murine studies performed in C57BL/6 mice. Here, using both C57BL/6 and BALB/c mice, we analyze immune cells in the pleural cavity. Unlike C57BL/6 mice, naive tissue-resident large-cavity macrophages (LCMs) of BALB/c mice failed to fully implement the tissue-residency program. Following infection with a pleural-dwelling nematode, these pre-existing differences were accentuated with LCM expansion occurring in C57BL/6, but not in BALB/c mice. While infection drove monocyte recruitment in both strains, only in C57BL/6 mice were monocytes able to efficiently integrate into the resident pool. Monocyte-to-macrophage conversion required both T cells and interleukin-4 receptor alpha (IL-4Rα) signaling. The transition to tissue residency altered macrophage function, and GATA6+ tissue-resident macrophages were required for host resistance to nematode infection. Therefore, during tissue nematode infection, T helper 2 (Th2) cells control the differentiation pathway of resident macrophages, which determines infection outcome.


Assuntos
Filariose , Filarioidea , Infecções por Nematoides , Camundongos , Animais , Filarioidea/fisiologia , Células Th2 , Monócitos , Cavidade Pleural , Camundongos Endogâmicos C57BL , Macrófagos/fisiologia , Diferenciação Celular , Camundongos Endogâmicos BALB C
12.
Surg Innov ; 30(5): 661-663, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36796368

RESUMO

BACKGROUND/NEED: Pleural empyemas carry a high morbidity and mortality. Some can be managed with medical treatment but most require some form of surgery with the goals to remove the infected material from the pleural space and to help re-expand the collapsed lung. Keyhole surgery by Video Assisted Thoracoscopy Surgery (VATS) is rapidly becoming a common approach to deal with early stage empyemas to avoid larger, more painful thoracotomies that hinder recovery. However, the ability to achieve those aforementioned goals is often hindered by VATS surgery due to the instruments available. METHODOLOGY AND DEVICE DESCRIPTION: We have developed a simple instrument called the "VATS Pleural Debrider" to achieve those goals in empyema surgery that can be used in keyhole surgery. PRELIMINARY RESULTS: We have used this device in over 90 patients with no peri-operative mortality and a low re-operation rate. CURRENT STATUS: Used in routine urgent/emergency pleural empyema surgery across 2 cardiothoracic surgery centres.


Assuntos
Empiema Pleural , Pneumotórax , Humanos , Cirurgia Torácica Vídeoassistida , Empiema Pleural/cirurgia , Pneumotórax/cirurgia , Toracotomia , Cavidade Pleural/cirurgia , Estudos Retrospectivos
14.
Online braz. j. nurs. (Online) ; 22(supl.1): e20236616, 03 fev 2023. ilus
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1416550

RESUMO

OBJETIVO: mapear os cuidados de enfermagem empregados aos pacientes adultos com drenagem torácica internados em terapia intensiva. MÉTODO: scoping review a ser conduzida conforme o Joanna Briggs Institute, com a seguinte questão de pesquisa: "quais são os cuidados de enfermagem indicados aos pacientes adultos com drenagem torácica internados em terapia intensiva?". A busca será desenvolvida em cinco bases de dados: Pubmed, Scopus, Embase, BVS e Web of Science, e os achados serão geridos com o auxílio do software Rayyan. Serão incluídos estudos quantitativos e qualitativos, artigos de revisão, dissertações, teses, diretrizes clínicas e protocolos terapêuticos sobre a temática, incluindo a literatura cinzenta. Será descrito o número total de fontes de evidência encontradas e selecionadas. Através de uma narrativa, será detalhado o processo de decisão da inclusão dos estudos. Os principais achados deverão estar descritos em consonância com o objetivo e os resultados relacionados à questão de pesquisa.


OBJECTIVE: to map nursing care employed to adult patients with chest drainage admitted to intensive care. METHOD: scoping review to be conducted according to the Joanna Briggs Institute, with the following research question: "What are the nursing cares indicated to adult patients with chest drainage admitted to intensive care?". The search will be developed in five databases: Pubmed, Scopus, Embase, BVS and Web of Science, and the findings will be managed with the support of Rayyan software. Quantitative and qualitative studies, review articles, dissertations, theses, clinical guidelines and therapeutic protocols on the subject will be included, including gray literature. The total number of sources of evidence found and selected will be described. Through a narrative, the decision-making process of the inclusion of the studies will be detailed. The main findings must be described in line with the objective and the results related to the research question.


Assuntos
Humanos , Adulto , Drenagem/enfermagem , Procedimentos Cirúrgicos Torácicos , Cavidade Pleural , Unidades de Terapia Intensiva , Cuidados de Enfermagem
15.
Esophagus ; 20(1): 89-98, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35900684

RESUMO

BACKGROUND: Anastomotic mediastinal/pleural cavity leak (AMPCL) is a life-threatening postoperative complication after esophagectomy. The objective of this study was to find a safe and effective surgical method to reduce the incidence of AMPCL. METHODS: A total of 223 patients who underwent surgery in Fujian Medical University Union Hospital from May 2020 to October 2021 were enrolled in this study. Data for preoperative and postoperative test indices, postoperative complications, perioperative treatment were collected. After using 1:1 propensity score matching (PSM) to match two cohort (caliper = 0.1), the relationship between various factors and the incidence of AMPCL were analyzed. RESULTS: 209 patients were included for further analysis in the end. There were 95 patients in the sternocleidomastoid muscle flap embedding group (intervention group) and 114 in the routine operation group (control group). There was a significant difference in mean age between two groups. Gender, age, body mass index, diabetes, American society of anesthesiologists score, preoperative neoadjuvant therapy, pathological stage were included in performing 1:1 PSM, and there were no significant differences between two groups. Median operative time was significantly less in intervention group. Anastomotic leak (AL) did not present significant difference between two groups (8 [8.6] vs. 13 [14.0], p = 0.247), however, the AMPCL in intervention group was significantly lower than control group (0 [0] vs. 6 [6.5], p = 0.029). CONCLUSIONS: The sternocleidomastoid muscle flap embedding could significantly reduce the incidence of AMPCL. This additional procedure is safe, and effective without increase in the occurrence of postoperative complications and hospital expenses.


Assuntos
Fístula Anastomótica , Neoplasias Esofágicas , Humanos , Fístula Anastomótica/etiologia , Cavidade Pleural , Neoplasias Esofágicas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Músculos
16.
Am Surg ; 89(6): 2813-2815, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34775803

RESUMO

Urinothorax, defined as urine within the pleural space, is an uncommon finding in published trauma literature. To date, there are less than ten recorded cases of non-iatrogenic trauma-induced urinothorax, most resulting from blunt traumatic injuries from motor vehicle collisions. Given the rarity of the condition, the diagnosis is often missed or delayed. Once the diagnosis is suspected, the most reliable finding is a pleural fluid to serum creatinine ratio of >1. A confirmed diagnosis of urinothorax then requires drainage of pleural fluid and management of distal ureteral obstruction. Unfortunately, the added complexity of the poly-trauma patient obscures this difficult diagnosis often leading to a delay in treatment and prolonged hospital stay. No current published literature exists on penetrating trauma as a cause of urinothorax. Here, we describe a unique case of urinothorax in a 32-year-old male as a result of penetrating trauma.


Assuntos
Derrame Pleural , Obstrução Ureteral , Ferimentos Penetrantes , Masculino , Humanos , Adulto , Derrame Pleural/etiologia , Cavidade Pleural , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Creatinina
17.
J Bronchology Interv Pulmonol ; 30(3): 244-251, 2023 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35867004

RESUMO

BACKGROUND: Indwelling pleural catheters (IPCs) reduce dyspnea and improve quality of life in patients with malignant pleural effusions (MPEs). Data on outcomes of MPEs secondary to metastatic melanoma managed with IPCs are scarce. We aimed to evaluate outcomes of patients receiving IPCs for MPEs secondary to melanoma compared with other malignancies. METHODS: We identified patients from our prospectively collected database of all patients who had an IPC insertion for MPEs at our tertiary care center for melanoma between May 2006 and November 2018 and for nonmelanoma between May 2006 and June 2013. Chart reviews were conducted to obtain patient demographics, catheter complications, time of IPC removal or death, x-ray imaging, and pleural fluid characteristics. RESULTS: We identified 27 MPEs because of melanoma and 1114 because of nonmelanoma malignancies treated with IPC. The most frequent complication was pleural fluid loculation requiring fibrinolytics which was significantly higher in the melanoma (14.8%) compared with the nonmelanoma group (3.8%; P =0.02). Cumulative incidence functions for catheter removal ( P =0.8) or death with catheter in situ ( P =0.3) were not significant between melanoma and nonmelanoma groups in competing risk analysis. Baseline radiographic pleural effusion scores were similar, but became significantly higher (increased pleural opacity) in the melanoma group at time points following IPC insertion ( P <0.05). CONCLUSION: MPEs because of melanoma had a higher rate of loculations requiring fibrinolytics and less radiographic improvement after IPC insertion suggesting this patient subgroup has a more complicated pleural space which may be less responsive to drainage.


Assuntos
Melanoma , Derrame Pleural Maligno , Humanos , Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/terapia , Qualidade de Vida , Cateteres de Demora/efeitos adversos , Cavidade Pleural , Melanoma/complicações , Drenagem/efeitos adversos , Drenagem/métodos , Pleurodese/métodos
18.
Ann Diagn Pathol ; 63: 152084, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36577188

RESUMO

Primary effusion lymphoma (PEL) is a rare neoplasm that arises in the context of severe immunosuppression. Acquired immunodeficiency syndrome (AIDS) as a result of human immunodeficiency virus (HIV) infection is the most common cause of immunodeficiency in patients who develop PEL. These neoplasms usually involve one or more body cavities, so-called classic PEL. The pleural cavity is most often involved, followed by the peritoneal and pericardial cavities. Involvement of the cerebrospinal fluid (CSF) and meninges is rare. A subset of patients can present with a tissue-based mass, known as the extracavitary variant. We encountered a patient with HIV infection and severe immunosuppression who presented initially with mediastinal, retroperitoneal mass and bilateral pleural effusions. He subsequently developed CSF involvement. Despite therapy, the patient relapsed with chest wall disease 6 months later and died shortly thereafter. Our literature review yielded about 400 cases of PEL reported previously. About 65 % of PEL patients have had AIDS, but a subset of patients had immunosuppression attributable to organ transplantation or physiological immunosenescence. CSF involvement has been reported in ~2 % of patients, and about 10 % of patients had both body cavity and extracavitary disease. The pathologic findings in this case were typical of extracavitary PEL. The neoplastic cells had features of plasmablasts and were positive for HHV-8, Epstein-Barr virus encoded RNA (EBER) and plasma cell associated markers, and were negative for B-cell antigens. The prognosis of patients with PEL is usually poor with a median survival less than one year in most studies. We use this patient's case as an illustration of PEL and we review the clinicopathologic findings and differential diagnosis of PEL.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por Vírus Epstein-Barr , Infecções por HIV , Herpesvirus Humano 8 , Linfoma de Efusão Primária , Masculino , Humanos , Linfoma de Efusão Primária/diagnóstico , Cavidade Pleural/patologia , Herpesvirus Humano 4
19.
PLoS One ; 17(12): e0276978, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454800

RESUMO

Pleural mesothelial cells are the predominant cell type in the pleural cavity, but their role in the pathogenesis of pleural diseases needs to be further elucidated. 3D organotypic models are an encouraging approach for an in vivo understanding of molecular disease development. The aim of the present study was to develop a 3D organotypic model of the pleural mesothelium. Specimens of human pleura parietalis were obtained from patients undergoing surgery at the University Hospital Leipzig, Germany. 3D co-culture model of pleura was established from human pleural mesothelial cells and fibroblasts. The model was compared to human pleura tissue by phase-contrast and light microscopy, immunochemistry and -fluorescence as well as solute permeation test. Histological assessment of the 3D co-culture model displayed the presence of both cell types mimicking the morphology of the human pleura. Vimentin and Cytokeratin, PHD1 showed a similar expression pattern in pleural biopsies and 3D model. Expression of Ki-67 indicates the presence of proliferating cells. Tight junctional marker ZO-1 was found localized at contact zones between mesothelial cells. Each of these markers were expressed in both the 3D co-culture model and human biopsies. Permeability of 3D organotypic co-culture model of pleura was found to be higher for 70 kDa-Dextran and no significant difference was seen in the permeability for small dextran (4 kDa). In summary, the presented 3D organoid of pleura functions as a robust assay for pleural research serving as a precise reproduction of the in vivo morphology and microenvironment.


Assuntos
Pleura , Doenças Pleurais , Humanos , Técnicas de Cocultura , Dextranos , Cavidade Pleural
20.
Tunis Med ; 100(8-9): 642-646, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36571732

RESUMO

INTRODUCTION: Lung ultrasound (LUS) has been recommended by the British Thoracic Society as a standard of care before performing pleural procedures since 2010. Indeed, the choice of the puncture site based only on physical examination and chest x-ray can lead to complications. The aim of this study was to compare the accuracy of pleural puncture sites using LUS as opposed to clinical examination. METHODS: An evaluative prospective study including 43 patients hospitalized in the pneumology department at the Military Hospital of Tunis was conducted between January and November 2021.Pleural puncture sites were proposed by two groups involving 'senior' and 'junior' physicians, classified according to their experience and grades, based on the clinical examination and the chest x-ray findings. The accuracy of the proposed sites was then verified by an ultrasound-qualified "expert" using LUS. RESULTS: The mean age was 60 ± 17 years. LUS revealed the presence of pleural effusion in 88% of the cases (n=38). Differential diagnosis was therefore excluded in 12% of the cases (n=5), including pleural thickening (5%, n=2) and atelectasis (7%, n=3). Compared to LUS, clinical examination and chest x-ray had lower sensitivities, estimated at 74% and 83%, respectively. The clinical identification error rate was significantly higher in junior (77%) compared to senior physicians (49%) (p<0.05). LUS prevented possible accidental organ puncture in 36% of the cases (n=31). The risk factors associated with inaccurate clinical site selection included right-sided effusion and minimal pleural effusion on chest radiography, with an estimated relative risk (RR) of 1.44 [CI95%:0.56-3.72] and 1.82 [CI95%:0.52-6.40], respectively. The experience of the senior physicians influenced the choice of the clinical sites with moderate agreement (Kappa index: 0.4-0.6). CONCLUSION: Compared to the ACPA- group, the ACPA+ one had more lung-hyperinflation and OVI, and comparative percentages of RVI, MVI, and NSVI. CONCLUSION: LUS significantly improves the accuracy of pleural puncture sites, thus minimizing the risk of complications regardless of the operator's level of clinical experience.


Assuntos
Pulmão , Cavidade Pleural , Derrame Pleural , Punções , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico , Estudos Prospectivos , Punções/efeitos adversos , Radiografia Torácica , Ultrassonografia/métodos , Cavidade Pleural/diagnóstico por imagem
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