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1.
Medicine (Baltimore) ; 99(4): e18589, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977850

RESUMO

To date, there is no clear agreement regarding which is the best method to detect a connective tissue disease (CTD) during the initial diagnosis of interstitial lung diseases (ILD). The aim of our study was to explore the impact of a systematic diagnostic strategy to detect CTD-associated ILD (CTD-ILD) in clinical practice, and to clarify the significance of interstitial pneumonia with autoimmune features (IPAF) diagnosis in ILD patients.Consecutive patients evaluated in an ILD Diagnostic Program were divided in 3 groups: IPAF, CTD-ILD, and other ILD forms. Clinical characteristics, exhaustive serologic testing, high resolution computed tomography (HRCT) images, lung biopsy specimens, and follow-up were prospectively collected and analyzed.Among 139 patients with ILD, CTD was present in 21 (15.1%), 24 (17.3%) fulfilled IPAF criteria, and 94 (67.6%) were classified as other ILD forms. Specific systemic autoimmune symptoms such as Raynaud phenomenon (19%), inflammatory arthropathy (66.7%), and skin manifestations (38.1%) were more frequent in CTD-ILD patients than in the other groups (all P < .001). Among autoantibodies, antinuclear antibody was the most frequently found in IPAF (42%), and CTD-ILD (40%) (P = .04). Nonspecific interstitial pneumonia, detected by HRCT scan, was the most frequently seen pattern in patients with IPAF (63.5%), or CTD-ILD (57.1%) (P < .001). In multivariate analysis, a suggestive radiological pattern by HRCT scan (odds ratio [OR] 15.1, 95% confidence interval [CI] 4.7-48.3, P < .001) was the strongest independent predictor of CTD-ILD or IPAF, followed by the presence of clinical features (OR 14.6, 95% CI 4.3-49.5, P < .001), and serological features (OR 12.4, 95% CI 3.5-44.0, P < .001).This systematic diagnostic strategy was useful in discriminating an underlying CTD in patients with ILD. The defined criteria for IPAF are fulfilled by a considerable proportion of patients referred for ILD.


Assuntos
Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/diagnóstico , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Autoanticorpos/imunologia , Biópsia , Doenças do Tecido Conjuntivo/patologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
4.
Arch. bronconeumol. (Ed. impr.) ; 51(6): 261-267, jun. 2015. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-139504

RESUMO

Introducción: En los pacientes con enfermedad pulmonar intersticial difusa (EPID) que presentan datos clínicos y radiológicos inconsistentes es recomendable la realización de una biopsia pulmonar quirúrgica (BPQ). La criobiopsia es una técnica endoscópica reciente menos invasiva que la BPQ que podría jugar un papel relevante en el diagnóstico de las EPID. El objetivo del presente estudio es analizar la rentabilidad diagnóstica, las complicaciones y los costes económicos derivados del uso de la criobiopsia en el diagnóstico de las EPID. Métodos: Estudio observacional retrospectivo en el que se incluyeron pacientes afectados de EPID tributarios de biopsia pulmonar, a los que se les practicaron criobiopsias desde enero de 2011 a enero de 2014. El procedimiento se realizó mediante videobroncoscopio, bajo anestesia general y ventilación mecánica. Se analizó la rentabilidad diagnóstica, las complicaciones producidas y los costes económicos derivados de esta técnica. Resultados: Se analizaron las muestras de criobiopsia de un total de 33 pacientes. Se obtuvo un diagnóstico específico en 26, lo que representa una rentabilidad diagnóstica del 79%. Cinco pacientes hubieran requerido BPQ para confirmación histológica, aunque en 4 de ellos no pudo realizarse por presentar comorbilidades graves. Las complicaciones más frecuentes fueron el neumotórax (12%) y el sangrado moderado (21%). No hubo complicaciones graves. Considerando que a los pacientes con diagnóstico específico se les evitó unaBPQ, la criobiopsia representó unahorro económico estimado dehasta 59.846 €. Conclusiones: La criobiopsia es una técnica segura y potencialmente útil en el diagnóstico de las EPID que permite, además, un ahorro económico considerable


Background: Assessment of patients with suspected interstitial lung disease (ILD) includes surgical lung biopsy (SLB) when clinical and radiological data are inconclusive. However, cryobiopsy is acquiring an important role in the ILD diagnostic process. The objective of this study was to evaluate the diagnostic yield, safety and economic costs of the systematic use of cryobiopsy in the assessment of patients with suspected ILD. Methods: This was a retrospective observational study of patients who had undergone transbronchial cryobiopsy for evaluation of ILD from January 2011 to January 2014. The procedures were performed with a video bronchoscope using a cryoprobe for the collection of lung parenchyma specimens, which were analyzed by pathologists. Diagnostic yield, complications and economic costs ofthis technique were analyzed Results: Criobiopsy specimens from a total of 33 patients were included. A specific diagnosis was obtained in 26, producing a diagnostic yield of 79%. In 5 patients, SLB was required for a histopathological confirmation of disease, but the procedure could not be performed in 4, due to severe comorbidities. The most frequent complications were pneumothorax (12%) and grade i (9%) or grade ii (21%) bleeding. There were no life-threatening complications. The systematic use of cryobiopsy saved up to €59,846. Conclusion: Cryobiopsy is a safe and potentially useful technique in the diagnostic assessment


Assuntos
Feminino , Humanos , Masculino , Biópsia/mortalidade , Biópsia/enfermagem , Anestesia/mortalidade , Anestesia/enfermagem , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Espirometria/métodos , Espirometria , Estudo Observacional , Biópsia/instrumentação , Biópsia/métodos , Pneumopatias/complicações , Pneumopatias/diagnóstico , Anestesia , Anestesia/métodos , Respiração Artificial/enfermagem , Espirometria/enfermagem , Epidemiologia Descritiva
5.
Arch Bronconeumol ; 51(6): 261-7, 2015 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25454902

RESUMO

BACKGROUND: Assessment of patients with suspected interstitial lung disease (ILD) includes surgical lung biopsy (SLB) when clinical and radiological data are inconclusive. However, cryobiopsy is acquiring an important role in the ILD diagnostic process. The objective of this study was to evaluate the diagnostic yield, safety and economic costs of the systematic use of cryobiopsy in the assessment of patients with suspected ILD. METHODS: This was a retrospective observational study of patients who had undergone transbronchial cryobiopsy for evaluation of ILD from January 2011 to January 2014. The procedures were performed with a video bronchoscope using a cryoprobe for the collection of lung parenchyma specimens, which were analyzed by pathologists. Diagnostic yield, complications and economic costs of this technique were analyzed. RESULTS: Criobiopsy specimens from a total of 33 patients were included. A specific diagnosis was obtained in 26, producing a diagnostic yield of 79%. In 5 patients, SLB was required for a histopathological confirmation of disease, but the procedure could not be performed in 4, due to severe comorbidities. The most frequent complications were pneumothorax (12%) and gradei (9%) or gradeii (21%) bleeding. There were no life-threatening complications. The systematic use of cryobiopsy saved up to €59,846. CONCLUSION: Cryobiopsy is a safe and potentially useful technique in the diagnostic assessment of patients with ILD. Furthermore, the systematic use of cryobiopsy has an important economic impact.


Assuntos
Broncoscopia/métodos , Criocirurgia/métodos , Biópsia Guiada por Imagem/métodos , Doenças Pulmonares Intersticiais/patologia , Cirurgia Vídeoassistida/métodos , Adulto , Idoso , Algoritmos , Líquido da Lavagem Broncoalveolar , Broncoscopia/efeitos adversos , Broncoscopia/economia , Criocirurgia/efeitos adversos , Criocirurgia/economia , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/economia , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Hemorragia Pós-Operatória/etiologia , Radiografia Intervencionista/economia , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Cirurgia Vídeoassistida/efeitos adversos
6.
Respirology ; 18(2): 263-71, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23134361

RESUMO

BACKGROUND AND OBJECTIVE: Although the benefits of systemic corticosteroids in community-acquired pneumonia (CAP) are not clear, their use is frequent in clinical practice. We described the frequency of this practice, patients' characteristics and its clinical impact. METHODS: We investigated all adult CAP patients visited between June 1997 and January 2008 (n = 3257). RESULTS: Two hundred and sixty patients received systemic corticosteroids (8%) with a mean daily dose of 45 (33) mg (median, 36 mg/day). Patients receiving corticosteroids were older (74 (13) vs 65 (19) years), had more comorbidities (respiratory, 59% vs 38%, cardiac, 29% vs 16%, etc.), higher Pneumonia Severity Index (Fine IV-V, 76% vs 50%) and had received inhaled corticosteroids (36% vs 15%) and previous antibiotics (31% vs 23%) more frequently (P < 0.01, each). Significant predictors of corticosteroid administration were: chronic obstructive pulmonary disease (odds ratio (OR), 1.91), fever (OR, 0.59), expectoration (OR, 1.59), creatinine (+1 mg/dL, OR, 0.92), SaO(2) ≥ 92% (OR, 0.46), C-reactive protein (+5 mg/dL; OR, 0.92) and cardiac failure (OR, 1.76). Mortality (6% vs 7%; P = 0.43) and time to clinical stability (4 (3-6) vs 5 (3-7) days; P = 0.11) did not differ between the two groups, while length of hospital stay was longer for the steroid group (9 (6-14) vs 6 (3-9) days; P < 0.01). CONCLUSIONS: The main reasons for administering systemic steroids were the presence of chronic respiratory comorbidity or severe clinical presentation, but therapy did not influence mortality or clinical stability; by contrast, steroid administration was associated with prolonged length of stay. Nevertheless the steroid group did not show an increased mortality as it was expected according to the initial Pneumonia Severity Index score. Influence of steroids on outcomes of CAP need to be further investigated through randomized clinical trial.


Assuntos
Corticosteroides/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/mortalidade , Relação Dose-Resposta a Droga , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
7.
Chest ; 142(5): 1334-1336, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23131942

RESUMO

A 51-year-old woman was given a diagnosis of primary retroperitoneal synovial sarcoma, which was surgically removed, and she was subsequently treated with chemotherapy and radiotherapy. Five years later, the patient was readmitted with a 1-month history of progressive dyspnea and was initially given a diagnosis of bilateral pulmonary embolism. Angiography performed some time later revealed progression of the previous filling defects and the appearance of two new nodular endovascular images. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed, and the cytologic analysis of the cell aspirate was compatible with endovascular metastatic sarcoma. In conclusion, EBUS-TBNA in the appropriate setting is an effective method for sampling endovascular lesions, adding pathologic information and allowing for early and accurate diagnosis.


Assuntos
Biópsia por Agulha , Endossonografia/métodos , Neoplasias Pulmonares/patologia , Embolia Pulmonar/patologia , Neoplasias Retroperitoneais/patologia , Sarcoma Sinovial/secundário , Ultrassonografia de Intervenção/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
8.
Crit Care Med ; 40(8): 2385-9, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22622402

RESUMO

OBJECTIVE: To evaluate the effects of systemic treatment with linezolid compared with vancomycin on biofilm formation in mechanically ventilated pigs with severe methicillin-resistant Staphylococcus aureus-induced pneumonia. DESIGN: Prospective randomized animal study. SETTING: Departments of Pneumology, Microbiology, and Pharmacy of the Hospital Clínic, Barcelona, and Scientific and Technological Services of the University of Barcelona. SUBJECTS: We prospectively analyzed 70 endotracheal tube samples. Endotracheal tubes were obtained from pigs either untreated (controls, n=20), or treated with vancomycin (n=32) or linezolid (n=18). INTERVENTIONS: The endotracheal tubes were obtained from a previous randomized study in tracheally intubated pigs with methicillin-resistant Staphylococcus aureus severe pneumonia, and mechanically ventilated for 69±16 hrs. MEASUREMENTS AND MAIN RESULTS: Distal and medial hemisections of the endotracheal tube were assessed to quantify methicillin-resistant Staphylococcus aureus burden, antibiotic biofilm concentration by high-performance liquid chromatography or bioassay, and biofilm thickness through scanning electron microscopy. We found a trend toward a significant variation in biofilm methicillin-resistant Staphylococcus aureus burden (log colony-forming unit/mL) among groups (p=.057), and the lowest bacterial burden was found in endotracheal tubes treated with linezolid (1.98±1.68) in comparison with untreated endotracheal tubes (3.72±2.20, p=.045) or those treated with vancomycin (2.97±2.43, p=.286). Biofilm linezolid concentration was 19-fold above the linezolid minimum inhibitory concentration, whereas biofilm vancomycin concentration (1.60±0.91 µg/mL) was consistently below or close to the vancomycin minimum inhibitory concentration. Biofilm was thicker in the vancomycin group (p=.077). CONCLUSIONS: Systemic treatment with linezolid limits endotracheal tube biofilm development and methicillin-resistant Staphylococcus aureus burden. The potential clinical usefulness of linezolid in decreasing the risk of biofilm-related respiratory infections during prolonged tracheal intubation requires further investigation.


Assuntos
Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Biofilmes/efeitos dos fármacos , Intubação Intratraqueal/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Oxazolidinonas/uso terapêutico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Animais , Linezolida , Microscopia Eletrônica de Varredura , Pneumonia Estafilocócica/tratamento farmacológico , Suínos , Vancomicina/uso terapêutico
9.
Eur Respir J ; 40(6): 1344-53, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22523352

RESUMO

In patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) needing hospitalisation, sputum purulence is associated with bacteria in the lower respiratory tract. We performed a prospective non-randomised interventional pilot study applying a sputum purulence-guided strategy of antibiotic treatment and investigating the relationship between sputum purulence and biomarkers. In hospitalised patients with acute exacerbation of COPD antibiotics were restricted to those with purulent sputum. The primary end-point was rate of therapeutic failure during hospitalisation. Secondary end-points were parameters reflecting short- and long-term outcomes. We included 73 patients, 34 with non-purulent sputum. No differences were observed on therapeutic failure criteria (9% non-purulent versus 10% purulent (p=0.51)). Serum C-reactive protein (CRP) was significantly increased in the purulent group at admission (11.6 versus 5.3, p=0.006) and at day 3 (2.7 versus 1.2, p=0.01). Serum procalcitonin (PCT) was similar between the groups. No differences were found in short-term outcomes. The exacerbation rate at 180 days was higher in the purulent group. These results support the hypothesis of performing a randomised trial using a sputum purulence-guided antibiotic treatment strategy in patients with acute exacerbations of COPD. CRP, but not PCT, may be a useful parameter to increase confidence of the absence of bacterial bronchial infection.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Escarro/efeitos dos fármacos , Idoso , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Biomarcadores/sangue , Biomarcadores/metabolismo , Proteína C-Reativa/metabolismo , Calcitonina/metabolismo , Peptídeo Relacionado com Gene de Calcitonina , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Precursores de Proteínas/metabolismo , Doença Pulmonar Obstrutiva Crônica/microbiologia , Sistema Respiratório/microbiologia , Escarro/metabolismo , Fatores de Tempo , Resultado do Tratamento
10.
Eur Respir J ; 39(6): 1334-42, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22282552

RESUMO

The Endobronchial Valve for Emphysema Palliation Trial (VENT) was a multi-centre, prospective, randomised, controlled trial conducted to evaluate the safety and effectiveness of unilateral endobronchial valve (EBV) treatment. The purpose of this analysis was to assess outcomes in the previously unreported European VENT study cohort. Patients with advanced emphysema were randomly assigned (2:1) to receive Zephyr® (Pulmonx Inc., Redwood City, CA, USA) EBV treatment (n = 111) or medical management (n = 60). At 6 months, EBV patients demonstrated a significant improvement compared with the controls for mean ± SD change in forced expiratory volume in 1 s (7 ± 20% versus 0.5 ± 19%; p = 0.067), cycle ergometry (2 ± 14 W versus -3 ± 10 W; p = 0.04) and St George's Respiratory Questionnaire (-5 ± 14 points versus 0.3 ± 13 points; p = 0.047). At 12 months, the magnitude of the difference between groups for change from baseline was of similar magnitude to the differences seen at 6 months. Rates for complications did not differ significantly. EBV patients with computed tomography (CT) scans suggestive of complete fissure and lobar occlusion had a mean ± SD lobar volume reduction of -80 ± 30% and >50% met minimal clinical difference thresholds. The degree of emphysema heterogeneity did not preclude excellent outcomes. Unilateral lobar volume reduction using EBV treatment is safe and superior clinical results correlated with CT suggestive of complete fissures and successful lobar occlusion. Emphysema heterogeneity was not critical for determining positive outcomes.


Assuntos
Pneumonectomia/métodos , Enfisema Pulmonar/cirurgia , Idoso , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Enfisema Pulmonar/diagnóstico por imagem , Qualidade de Vida , Testes de Função Respiratória , Índice de Gravidade de Doença , Inquéritos e Questionários , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Crit Care Med ; 40(1): 162-8, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21926613

RESUMO

OBJECTIVE: To assess the efficacy of linezolid compared with vancomycin in an experimental model of pneumonia induced by methicillin-resistant Staphylococcus aureus (MRSA) in ventilated pigs. METHODS: Forty pigs (30 kg) were intubated and challenged via bronchoscopy with a suspension of 106 colony forming units of MRSA into every lobe. Afterwards, pigs were ventilated up to 96 hours. Twelve hours after bacterial inoculation, the animals were randomized into 4 groups of treatment: group 1, control; group 2, vancomycin twice daily; group 3, continuous infusion of vancomycin; and group 4, linezolid. Clinical and laboratory parameters were monitored throughout the study. Bacterial cultures of bronchoalveolar lavage fluid and lung tissue samples were performed at the end of the study. Measurements of histopathology derangements of lung samples and studies of intrapulmonary drug penetration were performed. RESULTS: A total of 34 animals completed the study. No differences in clinical and laboratory parameters were observed. The percentage of bronchoalveolar lavage fluid and lung tissue samples with positive cultures for MRSA in controls and groups 2, 3, and 4 was respectively 75%, 11%, 11%, and 0% (p < .01); 52%, 9%, 24%, and 2.5% (p < .01). Histopathology studies demonstrated signs of pneumonia in 95%, 69%, 58%, and 57% and signs of severe pneumonia in 48%, 29%, 22%, and 0% of controls and groups 2, 3, and 4, respectively (p < .01). In addition, pharmacokinetics/pharmacodynamics profile in serum and lung tissue showed better results for linezolid compared with both vancomycin treatments. CONCLUSIONS: In this animal model of MRSA pneumonia, linezolid showed a better efficacy than vancomycin showed because of a better pharmacokinetics/pharmacodynamics index.


Assuntos
Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Oxazolidinonas/uso terapêutico , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Vancomicina/uso terapêutico , Animais , Líquido da Lavagem Broncoalveolar/química , Modelos Animais de Doenças , Interleucina-6/análise , Interleucina-6/sangue , Interleucina-8/análise , Interleucina-8/sangue , Linezolida , Pulmão/patologia , Pneumonia Estafilocócica/microbiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Respiração Artificial/efeitos adversos , Suínos , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/sangue
12.
Arch. bronconeumol. (Ed. impr.) ; 47(12): 584-589, dic. 2011. graf
Artigo em Espanhol | IBECS | ID: ibc-92385

RESUMO

IntroducciónLa ciclooxigenasa 2 (COX-2) está aumentada en la inflamación y en el cáncer. En este estudio se evaluó la expresión de la COX-2 en el pulmón y en el cáncer bronquial de pacientes con EPOC.MétodosSe estudiaron 44 pacientes varones con cáncer bronquial (27 escamosos y 17 adenocarcinomas). Se obtuvieron muestras del parénquima pulmonar, de la mucosa bronquial adyacente al tumor y del tumor mismo. El tejido pulmonar de 14 pacientes con neumotórax se empleó como control. El ARNm y la proteína de la COX-1 y de la COX-2 se midieron mediante RT-PCR y western blot, respectivamente.ResultadosLos niveles de ARNm de la COX-1 y de la COX -2 en el parénquima de los pacientes con EPOC fueron superiores a los de los controles. Los niveles del ARNm de la COX-2 en pacientes con EPOC fueron más altos en el parénquima pulmonar que en las vías aéreas y los tumores. No hubo diferencias en los niveles del ARNm de la COX-2 entre escamosos y adenocarcinomas. En contraste, la proteína de COX-2 mostró niveles más altos en los tumores que en el parénquima y las vías aéreas. Los niveles de la proteína de COX-2 fueron más altos en los adenocarcinomas que en los carcinomas escamosos.ConclusiónEste estudio muestra que en la EPOC la vía de la ciclooxigenasa está activada y asociada a un aumento en la expresión de la COX-2 en los tumores. Cabe la posibilidad de que la COX-2 esté involucrada en la asociación de EPOC y cáncer(AU)


IntroductionThe expression of cyclooxygenase 2 (COX-2) is usually increased in inflammation and cancer. This study examines the expression of COX-2 in the lung of chronic obstructive pulmonary disease (COPD) patients with lung cancer.MethodsWe studied 44 male patients with bronchial cancer (27 squamous carcinoma and 17 adenocarcinoma). Samples were obtained from the pulmonary parenchyma, from the bronchial mucosa adjacent to the tumor and from the tumor itself. Lung tissue specimens from 14 patients with pneumothorax were used as control. The mRNA and the COX-1 and COX-2 proteins were assessed by RT-PCR and Western blot, respectively.ResultsCOX-1 and COX-2 mRNA levels were significantly higher in the lung parenchyma of COPD patients than in the control subjects. COX-2 mRNA levels were also higher in the lung parenchyma than in both tumor and airway tissue samples procured from COPD patients. There were no differences in the COX-2 mRNA levels between squamous carcinoma and adenocarcinoma. In contrast, COX-2 protein levels were significantly higher in tumors than in lung parenchyma and airways. COX-2 protein levels were higher in adenocarcinoma compared with squamous carcinoma.ConclusionThis study shows that in COPD, the pathway of cyclooxygenase is activated and associated with an increase in the expression of COX-2 in lung tumors. These observations suggest that COX-2 is possibly involved in the association between COPD and cancer(AU)


Assuntos
Humanos , Masculino , Ciclo-Oxigenase 2 , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Neoplasias Pulmonares/fisiopatologia , Fumar/efeitos adversos , Pneumonectomia
13.
Arch Bronconeumol ; 47(12): 584-9, 2011 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-21798652

RESUMO

INTRODUCTION: The expression of cyclooxygenase 2 (COX-2) is usually increased in inflammation and cancer. This study examines the expression of COX-2 in the lung of chronic obstructive pulmonary disease (COPD) patients with lung cancer. METHODS: We studied 44 male patients with bronchial cancer (27 squamous carcinoma and 17 adenocarcinoma). Samples were obtained from the pulmonary parenchyma, from the bronchial mucosa adjacent to the tumor and from the tumor itself. Lung tissue specimens from 14 patients with pneumothorax were used as control. The mRNA and the COX-1 and COX-2 proteins were assessed by RT-PCR and Western blot, respectively. RESULTS: COX-1 and COX-2 mRNA levels were significantly higher in the lung parenchyma of COPD patients than in the control subjects. COX-2 mRNA levels were also higher in the lung parenchyma than in both tumor and airway tissue samples procured from COPD patients. There were no differences in the COX-2 mRNA levels between squamous carcinoma and adenocarcinoma. In contrast, COX-2 protein levels were significantly higher in tumors than in lung parenchyma and airways. COX-2 protein levels were higher in adenocarcinoma compared with squamous carcinoma. CONCLUSION: This study shows that in COPD, the pathway of cyclooxygenase is activated and associated with an increase in the expression of COX-2 in lung tumors. These observations suggest that COX-2 is possibly involved in the association between COPD and cancer.


Assuntos
Adenocarcinoma/enzimologia , Neoplasias Brônquicas/enzimologia , Carcinoma de Células Escamosas/enzimologia , Ciclo-Oxigenase 2/análise , Pulmão/enzimologia , Proteínas de Neoplasias/análise , Doença Pulmonar Obstrutiva Crônica/enzimologia , Adenocarcinoma/etiologia , Idoso , Neoplasias Brônquicas/etiologia , Carcinoma de Células Escamosas/etiologia , Cocarcinogênese , Ciclo-Oxigenase 1/análise , Ciclo-Oxigenase 1/genética , Ciclo-Oxigenase 2/genética , Dinoprostona/metabolismo , Indução Enzimática , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Proteínas de Neoplasias/genética , Pneumotórax/enzimologia , Doença Pulmonar Obstrutiva Crônica/complicações , RNA Mensageiro/análise , RNA Neoplásico/análise , Fumar/efeitos adversos
14.
Diagn Microbiol Infect Dis ; 68(1): 60-5, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20727472

RESUMO

The objective of this study was to determine whether the prevalence of Pneumocystis jirovecii dihydropteroate synthase (DHPS) gene mutations has changed since the introduction of combined antiretroviral therapy (cART) and whether the mutations are associated with poor outcome in Spanish HIV-1-infected patients with Pneumocystis pneumonia (PcP). We studied 167 PcP episodes in HIV-1-infected patients diagnosed during the pre-cART (1989-1995) and cART (2001-2004) periods. Molecular genotyping of DHPS was successfully performed in 98 patients (43 pre-cART and 55 cART). Seventeen patients (17/98, 17%; 95% confidence interval [CI], 10-25%) had mutations in the DHPS gene: 14 patients (14/43, 33%; 95% CI, 19-49%) from the pre-cART period and 3 patients (3/55, 5.5%; 95% CI, 1.3-16%) from the cART period (P < 0.01). In the multivariate analysis, the pre-cART period, previous PcP prophylaxis with sulfa drugs, and homosexuality as an HIV risk factor were found to be associated with a higher risk of presenting DHPS mutations. Overall, 95% of patients were treated with trimethoprim and sulfamethoxazole (TMP-SMX). In-hospital mortality was similar in patients with (out) mutations (6% versus 11%, P = 0.84). DHPS gene mutations were more common during the pre-cART period and were associated with previous sulfa exposure and homosexuality. However, their presence did not worsen prognosis of PcP. The response to TMP-SMX with therapeutic doses was successful in most cases.


Assuntos
Di-Hidropteroato Sintase/genética , Infecções por HIV/complicações , HIV-1/efeitos dos fármacos , Mutação , Pneumocystis carinii/enzimologia , Pneumonia por Pneumocystis/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Fármacos Anti-HIV/uso terapêutico , Anti-Infecciosos/uso terapêutico , Genótipo , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Mortalidade Hospitalar , Humanos , Pneumocystis carinii/genética , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/microbiologia , Prevalência , Espanha , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
15.
Am J Emerg Med ; 28(4): 454-9, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20466225

RESUMO

INTRODUCTION: HIV-1-infected patients have higher incidence of community-acquired pneumonia (CAP) and risk of complications. Bacteremia has been associated with a higher risk of complications in such patients. We investigated factors associated with bacteremia in HIV-1-infected patients with CAP presenting at the emergency department. METHODS: We included HIV-1-infected patients with CAP for 3 years (March 2005-February 2008). Only patients in whom blood cultures were performed were finally included. Clinical data (age; sex; CD4(+) count; serum HIV viral load; previous or current intravenous drug use and antiretroviral treatment; systolic blood pressure; and cardiac and respiratory rates), analytical data (leukocyte count, arterial oxygen content, C-reactive protein value, and urgent Streptococcus pneumoniae and Legionella spp antigen urine detection), and APACHE-II (Acute Physiology and Chronic Health Evaluation) score were compiled. The need for intensive care unit admission, mechanical ventilation, mortality, and for patients finally discharged, duration of admission were retrospectively obtained from the clinical history. A multivariate analysis using logistic regression was performed to find independent predictors of bacteremia. RESULTS: We diagnosed 129 HIV-1-infected patients with CAP. Blood cultures were performed in 118 cases (91%). Bacteremia was present in 28 (24%). Independent predictors of bacteremia were the detection of S pneumoniae antigen in urine (odds ratio, 9.0; 95% confidence interval, 1.9-42.0) and the absence of current antiretroviral treatment (odds ratio, 7.1; 95% confidence interval, 1.4-33.3). In-hospital mortality was higher in patients with bacteremia (15% vs 0%). CONCLUSION: HIV-1-infected patients with CAP who are not on current antiretroviral therapy and have positive S pneumoniae antigenuria are at increased risk of having bacteremia. Bacteremic patients have a poor outcome.


Assuntos
Bacteriemia/diagnóstico , Infecções por HIV/complicações , Pneumonia Bacteriana/diagnóstico , APACHE , Adulto , Fármacos Anti-HIV/uso terapêutico , Antígenos de Bactérias/sangue , Bacteriemia/etiologia , Bacteriemia/microbiologia , Proteína C-Reativa/análise , Contagem de Linfócito CD4 , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/microbiologia , Serviço Hospitalar de Emergência , Feminino , HIV-1 , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/etiologia , Haemophilus influenzae/imunologia , Humanos , Contagem de Leucócitos , Masculino , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/etiologia , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/microbiologia , Fatores de Risco , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/etiologia , Streptococcus pneumoniae/imunologia , Streptococcus pyogenes/imunologia , Resultado do Tratamento
16.
Oncology ; 76(3): 162-9, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19209007

RESUMO

BACKGROUND/AIMS: MicroRNAs (miRNAs) play a role during mouse embryonic development and are also important in carcinogenesis. In order to investigate whether there are similar patterns of miRNA expression levels in pseudoglandular human embryonic lung and in human lung tumors, we have analyzed 18 miRNAs (the let-7 family, the miR-17-92 cluster, miR-221 and miR-222) in human embryonic lung samples and in paired lung tumor and normal lung tissue samples and correlated the results with clinicopathological characteristics. METHODS: RNA was obtained from 12 human embryonic lung samples, 33 lung tumor samples and 33 paired normal lung samples. miRNAs were assessed by quantitative real-time PCR. RESULTS: Members of the let-7 family were downregulated and members of the miR-17-92 cluster and miR-221 were overexpressed both in embryonic lung tissue and in lung tumors. Low levels of let-7c were associated with absence of metastases (p = 0.015), early-stage non-small cell lung cancer (NSCLC, p = 0.05), and smokers (p = 0.009). High levels of miR-106a were associated with small-cell lung cancer (p = 0.031), and high levels of miR-19a with advanced NSCLC (p = 0.008). CONCLUSION: Our study lends support to the model of cancer as an alteration of normal development, as many miRNAs were similarly expressed in early human lung development and stage I-II of lung cancer development.


Assuntos
Neoplasias Pulmonares/genética , Pulmão/embriologia , MicroRNAs/análise , Idoso , Feminino , Perfilação da Expressão Gênica , Humanos , Pulmão/metabolismo , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase
17.
Arch Bronconeumol ; 44(6): 290-4, 2008 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-18559217

RESUMO

OBJECTIVE: The role of different techniques for mediastinal staging in patients with suspected lung cancer is a subject of debate. The aim of this study was to analyze the diagnostic yield and cost-effectiveness of transbronchial needle aspiration in the mediastinal staging of lung cancer in patients being evaluated in a tertiary hospital. PATIENTS AND METHODS: This was a retrospective, observational study of the results of transbronchial needle aspiration in patients with suspected lung cancer and mediastinal lymph node involvement. A cost-effectiveness analysis of the systematic use of this technique was also performed. RESULTS: One-hundred ninety-four patients (85% men, 15% women) were evaluated. The diagnosis of lung cancer was confirmed in 157 (81%). Cytology samples obtained by transbronchial needle aspiration were adequate in 147 (76%) of the 194 cases. When only the adequate samples were included in the analysis, transbronchial needle aspiration showed a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, negative predictive value of 64%, and efficiency of 90%. Mediastinoscopy was avoided in 44 (34%) of the 127 patients with localized non-small cell lung cancer, with an estimated saving of euro 119,456. CONCLUSIONS: Transbronchial needle aspiration has a high diagnostic yield and obviates the need for mediastinoscopy in a significant percentage of cases. This finding is of diagnostic and economic significance.


Assuntos
Biópsia por Agulha/economia , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Biópsia por Agulha/métodos , Brônquios , Análise Custo-Benefício , Feminino , Humanos , Metástase Linfática , Masculino , Mediastino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Arch. bronconeumol. (Ed. impr.) ; 44(6): 290-294, jun. 2008. tab
Artigo em Espanhol | IBECS | ID: ibc-65358

RESUMO

OBJETIVO: Existe controversia sobre el papel de las diferentes técnicas diagnósticas en la estadificación del mediastino en pacientes con sospecha de cáncer de pulmón. El objetivo del estudio ha sido analizar la rentabilidad diagnóstica y el coste-beneficio de la punción transbronquial aspirativa (PTA) en la estadificación mediastínica del cáncer de pulmón, en pacientes evaluados en un hospital de tercer nivel. PACIENTES Y MÉTODOS: Se ha realizado un estudio observacional retrospectivo, en el que se han analizado los resultados de las PTA practicadas a pacientes con sospecha de cáncer de pulmón y adenopatías mediastínicas patológicas. También se ha evaluado el coste-beneficio de la aplicación sistemática de esta técnica. RESULTADOS: Se evaluó a 194 pacientes (un 85% varones y un 15% mujeres), en 157 de los cuales (81%) se confirmó el diagnóstico de cáncer de pulmón. La muestra citológica que se obtuvo de la PTA fue adecuada en 147 de los 194 casos (76%). Cuando se analizaron las muestras adecuadas, la sensibilidad de la PTA fue del 88%, la especificidad del 100%, el valor predictivo positivo del 100%, el valor predictivo negativo del 64% y el valor global del 90%. En 44 de los 127 casos (34%) con cáncer de pulmón no microcítico localizado se evitó la realización de una mediastinoscopia, lo que representó un ahorro económico estimado de 119.456 ¿. CONCLUSIONES: La PTA es una técnica con una elevada rentabilidad diagnóstica que puede evitar la realización de una mediastinoscopia en un porcentaje significativo de pacientes, con las consiguientes implicaciones terapéuticas y económicas que ello conlleva


OBJECTIVE: The role of different techniques for mediastinal staging in patients with suspected lung cancer is a subject of debate. The aim of this study was to analyze the diagnostic yield and cost-effectiveness of transbronchial needle aspiration in the mediastinal staging of lung cancer in patients being evaluated in a tertiary hospital. PATIENTS AND METHODS: This was a retrospective, observational study of the results of transbronchial needle aspiration in patients with suspected lung cancer and mediastinal lymph node involvement. A cost-effectiveness analysis of the systematic use of this technique was also performed. RESULTS: One-hundred ninety-four patients (85% men, 15% women) were evaluated. The diagnosis of lung cancer was confirmed in 157 (81%). Cytology samples obtained by transbronchial needle aspiration were adequate in 147 (76%) of the 194 cases. When only the adequate samples were included in the analysis, transbronchial needle aspiration showed a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, negative predictive value of 64%, and efficiency of 90%. Mediastinoscopy was avoided in 44 (34%) of the 127 patients with localized non-small cell lung cancer, with an estimated saving of ¿119 456. CONCLUSIONS: Transbronchial needle aspiration has a high diagnostic yield and obviates the need for mediastinoscopy in a significant percentage of cases. This finding is of diagnostic and economic significance


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Biópsia por Agulha , Doenças do Mediastino/diagnóstico , Estadiamento de Neoplasias/métodos , Valor Preditivo dos Testes , Mediastinoscopia , Broncoscopia/métodos , Sensibilidade e Especificidade , Análise Custo-Benefício/estatística & dados numéricos , Análise Custo-Benefício , Mediastino/microbiologia , Mediastino/patologia , Mediastino/cirurgia , Estudos Retrospectivos , Sinais e Sintomas , Pulmão/anatomia & histologia , Pulmão/patologia , Mediastinoscopia/métodos
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