RESUMO
BACKGROUND: The interferon (IFN)-γ release assay (IGRA) has recently been established as a method to evaluate the infection status of tuberculosis instead of the tuberculin skin test. However, indeterminate results can create challenges to interpretation. The IGRA has been available in Japan since 2005, including the recently launched QuantiFERON-TB Gold Plus (QFT-plus) assay. OBJECTIVES: The aim of this study was to investigate the clinical features and predictors of indeterminate results by the QFT-plus test in routine practice. METHODS: This was a cross-sectional study of 1258 patients. Multivariate logistic regression models were employed to investigate the clinical factors related to indeterminate results by the QFT-plus. RESULTS: Overall, 91.8% of results were found to be conclusive and 8.2% were indeterminate. The QFT-plus indeterminate results were predominantly due to a low level of IFN-γ production by mitogens. Multivariate analysis indicated that an indeterminate result was significantly associated with age, sex, corticosteroid use, autoimmune disease, and inpatient setting. CONCLUSION: Certain types of individuals are at higher risk of an indeterminate IGRA result. The QFT-plus test for hospitalized patients should be avoided as much as possible, and it is better to perform the test for those patients in outpatient settings.
Assuntos
Tuberculose Latente , Mycobacterium tuberculosis , Tuberculose , Estudos Transversais , Hospitais , Humanos , Testes de Liberação de Interferon-gama , Tuberculose Latente/diagnóstico , Teste TuberculínicoAssuntos
Embolização Terapêutica , Artéria Torácica Interna/lesões , Traumatismos Torácicos/terapia , Ferimentos não Penetrantes/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Traumatismos Torácicos/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
Uncomplicated Stanford type B acute aortic dissection, for which medical treatments are effective in most cases, is associated with a better prognosis than Stanford type A dissection. However, ruptured Stanford type B dissection still is associated with high mortality, because of the risks of open surgery and the complications of the disease. We report successful stent-graft placement in two patients with acute type B dissection with rupture, and discuss the advantages of stent-graft placement to treat ruptured acute type B dissection.
Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Aortografia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Stents , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A radiation accident occurred at a medical linear accelerator facility under construction in Japan. The radiation source was a 3- and 6-MV potential drop accelerator designed to produce X-rays for radiation therapy. This accelerator was also capable of producing a 5 to14-MV swept electron beam. During setting up, an operator turned on the accelerator to test the beam not knowing that a man was working on the ceiling above the accelerator. Thus, an X-ray beam was emitted against the ceiling and the man was exposed to 10-MV of X-ray irradiation. However, no obvious physical symptoms were noted. Dose estimation was made from reconstruction of the accident and clinical examinations including chromosome analysis. Mean dose of the whole body ranged from 70 to 180 mSv. Estimated dose from his right foot to hand was between180 to 900 mSv.
