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1.
Int J Surg Case Rep ; 87: 106480, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34628335

RESUMO

INTRODUCTION: Shoulder manipulation under ultrasound-guided cervical nerve root block (MUC) gives good clinical results in patients with frozen shoulder 1 week after the procedure. However, some patients are refractory to MUC. The present study was performed to investigate the prognostic factors of MUC for frozen shoulder. METHODS: We evaluated 73 frozen shoulders (70 patients) to investigate the prognostic factors of MUC. The patients' mean age was 56.6 years, and 60% were female. The mean duration of symptoms before MUC was 8.6 months. We assessed pain using a numeric rating scale (NRS), range of motion (ROM), and the American Shoulder and Elbow Surgeons (ASES) score before and 1 year after MUC. We compared patients with an ASES score of <80 (defined as a poor clinical result) with those with an ASES score of ≥80 (good clinical result). To identify the risk factors for a poor clinical result, multiple logistic regression analysis was performed using the following variables: age, sex, duration of symptoms before MUC, diabetes mellitus (DM), initial NRS score, and initial ROM. RESULTS: The initial NRS score and the prevalence of DM were significantly greater in the poor clinical results group. Multiple logistic regression analysis revealed that DM was the only independent risk factor for a poor clinical result after MUC (odds ratio, 51; 95% confidence interval, 10.9-237; p = .01). CONCLUSIONS: DM is a negative prognostic factor of MUC for frozen shoulder, and patients with DM should be informed of this before they undergo treatment for frozen shoulder.

2.
Int J Surg Case Rep ; 87: 106391, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34583261

RESUMO

INTRODUCTION AND IMPORTANCE: Shoulder stiffness in postoperative breast cancer causes a decrease in their quality of life. However, the underlying pathology is not fully understood, and no study has investigated the dynamic magnetic resonance imaging (MRI) findings in these patients. Therefore, the current preliminary study aimed to investigate the dynamic MRI findings in patients with shoulder stiffness occurring after breast cancer surgery. METHODS: We retrospectively analyzed the electronic medical records of postoperative breast cancer patients with shoulder stiffness, dated from January 2015 to December 2020. The baseline characteristics, breast cancer treatment methods, range of active shoulder motion, and location of the abnormal enhancement on dynamic MRI were assessed. RESULTS: The mean age of the patients was 57.8 ± 6.1 years (range, 47-63 years) and the mean duration of shoulder symptoms was 5.6 ± 3.6 months (range, 2-12 months). An abnormal enhancement of the rotator interval and axillary pouch was observed on dynamic MRI of all the included patients. CONCLUSION: This study presents the first case reports of the dynamic MRI findings in postoperative breast cancer patients with shoulder stiffness. All patients had abnormal enhancement of the rotator interval and axillary pouch.

3.
Thorac Cancer ; 12(18): 2508-2512, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34378333

RESUMO

Of the 80 solid tumor cases in which liquid biopsy (LB) was performed using Guardant360 in the PROFILE study, nine were lung cancer cases. Here, we review three cases in which LB was useful in diagnosing ALK fusion-positive lung cancer, selecting sequential ALK-tyrosine kinase inhibitors, confirming uncommon EGFR mutations, and receiving biomarker-compatible therapy.

5.
Sci Rep ; 11(1): 10727, 2021 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-34021229

RESUMO

Corticosteroids use in coronavirus disease 2019 (COVID-19) is controversial, especially in mild to severe patients who do not require invasive/noninvasive ventilation. Moreover, many factors remain unclear regarding the appropriate use of corticosteroids for COVID-19. In this context, this multicenter, retrospective, propensity score-matched study was launched to evaluate the efficacy of systemic corticosteroid administration for hospitalized patients with COVID-19 ranging in the degree of severity from mild to critically-ill disease. This multicenter, retrospective study enrolled consecutive hospitalized COVID-19 patients diagnosed January-April 2020 across 30 institutions in Japan. Clinical outcomes were compared for COVID-19 patients who received or did not receive corticosteroids, after adjusting for propensity scores. The primary endpoint was the odds ratio (OR) for improvement on a 7-point ordinal score on Day 15. Of 1092 COVID-19 patients analyzed, 118 patients were assigned to either the corticosteroid and non-corticosteroid group, after propensity score matching. At baseline, most patients did not require invasive/noninvasive ventilation (85.6% corticosteroid group vs. 89.8% non-corticosteroid group). The odds of improvement in a 7-point ordinal score on Day 15 was significantly lower for the corticosteroid versus non-corticosteroid group (OR, 0.611; 95% confidence interval [CI], 0.388-0.962; p = 0.034). The time to improvement in radiological findings was significantly shorter in the corticosteroid versus non-corticosteroid group (hazard ratio [HR], 1.758; 95% CI, 1.323-2.337; p < 0.001), regardless of baseline clinical status. The duration of invasive mechanical ventilation was shorter in corticosteroid versus non-corticosteroid group (HR, 1.466; 95% CI, 0.841-2.554; p = 0.177). Of the 106 patients who received methylprednisolone, the duration of invasive mechanical ventilation was significantly shorter in the pulse/semi-pulse versus standard dose group (HR, 2.831; 95% CI, 1.347-5.950; p = 0.006). In conclusion, corticosteroids for hospitalized patients with COVID-19 did not improve clinical status on Day 15, but reduced the time to improvement in radiological findings for all patients regardless of disease severity and also reduced the duration of invasive mechanical ventilation in patients who required intubation.Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry on April 21, 2020 (ID: UMIN000040211).


Assuntos
Corticosteroides/administração & dosagem , COVID-19/terapia , Hospitalização , Respiração Artificial , SARS-CoV-2 , COVID-19/diagnóstico por imagem , COVID-19/patologia , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
J Infect Chemother ; 27(6): 857-863, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33676842

RESUMO

BACKGROUND: There are few agents that have been proven effective for COVID-19. Predicting clinical improvement as well as mortality or severity is very important. OBJECTIVES: This study aimed to investigate the factors associated with the clinical improvement of COVID-19. METHODS: Overall, 74 patients receiving treatment for COVID-19 at Tokyo Medical and Dental University Hospital from April 6th to May 15th, 2020 were included in this study. Clinical improvement was evaluated, which defined as the decline of two levels on a six-point ordinal scale of clinical status or discharge alive from the hospital within 28 days after admission. The clinical courses were particularly investigated and the factors related to time to clinical improvement were analyzed with the log-rank test and the Cox proportional hazard model. RESULTS: Forty-nine patients required oxygen support during hospitalization, 22 patients required invasive mechanical ventilation, and 5 patients required extracorporeal membrane oxygenation. A total of 83% of cases reached clinical improvement. Longer period of time from onset to admission (≥10 days) (HR, 1.057; 95% CI, 1.002-1.114), no hypertension (HR, 2.077; 95% CI, 1.006-4.287), and low D-dimer levels (<1 µg/ml) (HR, 2.372; 95% CI, 1.229-4.576) were confirmed to be significant predictive factors for time to clinical improvement. Furthermore, a lower SARS-CoV-2 RNA copy number was also a predictive factor for clinical improvement. CONCLUSIONS: Several predictors for the clinical improvement of COVID-19 pneumonia were identified. These results may be important for the management of COVID-19 pneumonia.


Assuntos
COVID-19/terapia , Adulto , Idoso , COVID-19/diagnóstico , Oxigenação por Membrana Extracorpórea , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , RNA Viral/isolamento & purificação , Respiração Artificial , Tóquio
8.
J Infect Chemother ; 27(2): 284-290, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33129694

RESUMO

BACKGROUND: The prediction of COVID-19 disease behavior in the early phase of infection is challenging but urgently needed. MuLBSTA score is a scoring system that predicts the mortality of viral pneumonia induced by a variety of viruses, including coronavirus, but the scoring system has not been verified in novel coronavirus pneumonia. The aim of this study was to validate this scoring system for estimating the risk of disease worsening in patients with COVID-19. METHODS: This study included the patients who were treated between April 1 st and March 13 th , 2020. The patients were classified into mild, moderate, and severe groups according to the extent of respiratory failure. MuLBSTA score was applied to estimate the risk of disease worsening in each severity group and we validated the utility of the scoring system. RESULTS: A total of 72 patients were analyzed. Among the 46 patients with mild disease, 17 showed disease progression to moderate or severe disease after admission. The model showed a sensitivity of 100% and a specificity of only 34.5% with a cut-off value of 5 points. Among the 55 patients with mild or moderate disease, 6 deteriorated to severe disease, and the model showed a sensitivity of 83.3% and a specificity of 71.4% with a cut-off value of 11 points. CONCLUSIONS: This study showed that MuLBSTA score is a potentially useful tool for predicting COVID-19 disease behavior. This scoring system may be used as one of the criteria to identify high-risk patients worsening to life-threatening status.


Assuntos
COVID-19/diagnóstico , COVID-19/patologia , Progressão da Doença , Adulto , Fatores Etários , Idoso , Infecções Bacterianas/epidemiologia , COVID-19/epidemiologia , Técnicas e Procedimentos Diagnósticos/normas , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Contagem de Linfócitos/normas , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Insuficiência Respiratória/epidemiologia , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Fumar/epidemiologia
9.
BMC Pulm Med ; 20(1): 288, 2020 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-33160347

RESUMO

BACKGROUND: The number of reports on sarcoidosis complicated by hypersensitivity pneumonitis (HP) is limited, and most describe cases complicated by chronic bird-related HP. Here, we present for the first time a case with Propionibacterium acnes-associated sarcoidosis complicated by acute bird-related HP. CASE PRESENTATION: A 62-year-old man with a past medical history of sarcoidosis was admitted to our department, and chest computed tomography showed diffuse ground-glass opacities, which appeared as he rapidly increased the number of pigeons he kept for a competition. Random transbronchial lung biopsy revealed well-formed non-caseating epithelioid granulomas, which contained positively stained substances on immunohistochemistry using the PAB antibody, a specific monoclonal antibody against P. acnes lipoteichoic acid. Poorly formed non-caseating granulomas without positively stained substances were also detected. CONCLUSION: We describe the successful identification of this exceptionally rare case of sarcoidosis complicated by acute bird-related HP in which two morphologically and immunohistologically different types of granulomas were present in the same lung.


Assuntos
Pulmão dos Criadores de Aves/etiologia , Columbidae/imunologia , Granuloma/microbiologia , Propionibacterium acnes/isolamento & purificação , Sarcoidose/microbiologia , Doença Aguda , Animais , Anticorpos Antibacterianos/sangue , Biópsia , Pulmão dos Criadores de Aves/patologia , Granuloma/patologia , Humanos , Imuno-Histoquímica , Pulmão/microbiologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Sarcoidose/patologia , Tomografia Computadorizada por Raios X
10.
Am J Sports Med ; 48(12): 3057-3065, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32941055

RESUMO

BACKGROUND: Osteochondral autograft transplant (OAT), a surgical treatment for capitellar osteochondritis dissecans (OCD), has favorable rates of elbow recovery and return to sports in adolescents. However, few reports have investigated how long patients continue to play baseball after OAT and their satisfaction with their treatment outcome. PURPOSE: To evaluate the rate of boys who played baseball and received OAT for OCD in junior high school or earlier (age <15 years) and continued to play baseball in high school and the players' satisfaction with their elbow function during play. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 32 elbows of boys who played baseball and received OAT at age ≤15 years (mean, 14.1 years) were examined and divided into pitcher (n = 11) and nonpitcher (n = 21) groups according to their player position before surgery. The clinical Timmerman-Andrews score at the end of their high school baseball, participation percentage of players who continued to play baseball, and satisfaction level during play (on a scale of 0-10 during pitching and batting and in a 4-choice format) were compared between the 2 groups. RESULTS: The Timmerman-Andrews scores significantly improved after surgery in both groups, with no significant difference between the groups. Of the 32 players, 30 (93.8%) continued to play baseball throughout high school, including all players in the pitcher group and 19 (90.5%) of those in the nonpitcher group. The percentage of players who continued to pitch was 55.6% (6/11) in the pitcher group. Satisfaction with elbow joint function at the time of pitching was significantly lower in the pitcher group. Further, 5 players reported being "a little unsatisfied" because of elbow pain during pitching. All of the players indicated satisfaction with elbow function during batting. CONCLUSION: The percentage of players who received OAT for OCD in junior high school and continued to play baseball in high school was favorable. However, satisfaction with elbow function during throwing was lower in pitchers than in nonpitchers. CLINICAL RELEVANCE: Before surgery, consent should be obtained from patients who are pitchers after it is explained that satisfaction with elbow joint function during pitching could be decreased after OAT.


Assuntos
Beisebol , Transplante Ósseo , Cartilagem Articular/transplante , Articulação do Cotovelo , Osteocondrite Dissecante , Adolescente , Autoenxertos , Estudos de Coortes , Cotovelo/cirurgia , Articulação do Cotovelo/cirurgia , Humanos , Masculino , Osteocondrite Dissecante/cirurgia , Satisfação do Paciente , Volta ao Esporte , Instituições Acadêmicas
11.
JSES Int ; 4(3): 555-558, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32939485

RESUMO

Background: The symptoms of chronic calcifying tendinitis consist of shoulder contracture and impingement sign. However, there have been no reports about the use of imaging studies to differentiate these 2 clinical symptoms. A "burning sign" caused by abnormal blood flow was previously reported in the shoulder joint in patients with frozen shoulder by dynamic magnetic resonance imaging. This burning sign was related to pain. The purpose of this study was to investigate the dynamic magnetic resonance imaging findings in patients with symptomatic chronic calcifying tendinitis and to examine the relationship between the location of the burning sign and the physical findings. Methods: We retrospectively analyzed data for 6 patients with symptomatic chronic calcifying tendinitis (mean age, 55.5 ± 9.3 years; 4 women). The range of shoulder motion, impingement sign, and location of the burning sign were assessed. Results: Four patients had an impingement sign without shoulder contracture, and the other 2 patients had shoulder contracture. All the patients with an impingement sign also had a burning sign around the calcium deposit and no enhancement in the rotator interval and axillary pouch. Conversely, all the patients with contracture had a burning sign in the rotator interval and axillary pouch and no enhancement around the calcium deposit. Conclusions: Dynamic magnetic resonance imaging identified 2 types of findings in patients with symptomatic chronic calcifying tendinitis: a burning sign in the rotator interval and axillary pouch or around the calcium deposit. The former pattern may be related to shoulder contracture, whereas the latter may be related to impingement sign.

12.
Immunotherapy ; 12(8): 563-569, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32363992

RESUMO

SMARCA4-deficient thoracic sarcoma is a rare tumor typically presenting as a mediastinal mass. The prognosis is estimated to be poor, and no effective treatment has been established. We present a case of a 76-year-old man who was diagnosed with SMARCA4-deficient thoracic sarcoma. The provisional diagnosis was carcinoma of unknown primary but subsequently corrected to SMARCA4-deficient thoracic sarcoma based on the panel-based cancer gene screening and immunohistochemistry. Cytotoxic chemotherapy as the first- and second-line did not reveal enough therapeutic effects but third-line therapy using nivolumab showed marked tumor regression, which was sustained. This is the first case report of SMARCA4-deficient thoracic sarcoma showing a good response to nivolumab. Immune checkpoint inhibitor might be therapeutic candidates for this type of tumor.

13.
Cancer Genet ; 241: 51-56, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31917104

RESUMO

INTRODUCTION: Next-generation sequencing (NGS) of multiple metastases in an advanced cancer patient reveals the evolutional history of the tumor. The evolutionary model is clinically valuable because it reflects the future course of the tumorigenic process and prognosis of the patient. MATERIALS AND METHODS: We experienced two lung cancer patients whose clinical courses were abruptly deteriorating resulting in very poor prognosis. To investigate the evolutionary model of these patients, we performed targeted sequencing covering whole exons of 53 significantly mutated genes associated with lung cancer of multiple metastases by autopsy. We conducted PyClone analysis to infer subclonal archtecture of multi-lesional samples. RESULTS: The NGS analysis revealed both patients harboring multiple clonal driver mutations. In Case.1, KRAS Q61H, KEAP1 G333C, STK11 K312*, RBM10 Q320* and MGA I1429V and in Case.2, TP53 R337L, TP53 Q192*, PTEN W274C, RB1 P29fs and CREBBP P696L with high allele fraction were detected in all lesions. These mutations were clustered and occupied major population across multi-lesional tumor samples. Our data suggested their lung cancers progressed with punctuated and big bang evolutional model. CONCLUSION: We should pay attention to clinical course of lung cancer patients harboring multiple clonal driver mutations in their primary lesions. Their punctuated and big bang evolutionary process could develop systemic clinically undetectable metastases with an unexpected speed.


Assuntos
Adenocarcinoma de Pulmão/genética , Biomarcadores Tumorais/genética , Evolução Clonal , Neoplasias Hepáticas/genética , Neoplasias Pulmonares/genética , Taxa de Mutação , Adenocarcinoma de Pulmão/mortalidade , Adenocarcinoma de Pulmão/secundário , Adenocarcinoma de Pulmão/terapia , Idoso , Análise Mutacional de DNA , Progressão da Doença , Evolução Fatal , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/genética , Metástase Linfática/patologia , Masculino , Fatores de Tempo , Sequenciamento Completo do Exoma
14.
Intern Med ; 59(3): 425-428, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31645530

RESUMO

A 61-year-old man was referred to our hospital with dyspnea and an abnormal lung shadow. His occupational history, pathological findings, and an elemental analysis led to a definitive diagnosis of pneumoconiosis induced by titanium grindings. The patient experienced gradual improvement solely by avoiding titanium grindings. Titanium-induced lung disease is very rare, and most of these cases are caused by inhalation of titanium dioxide (TiO2), which is included in a wide range of commercially available products, such as paints, pigments, and cosmetics. However, industrial workers can also develop lung diseases due to the inhalation of metallic titanium materials during metal grinding.


Assuntos
Exposição por Inalação/efeitos adversos , Exposição Ocupacional/efeitos adversos , Pneumoconiose/diagnóstico , Pneumoconiose/etiologia , Pneumoconiose/terapia , Titânio/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Cartilage ; : 1947603519862318, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31327238

RESUMO

Statins have demonstrated to be effective for treating chondrodysplasia and its effects were believed to be associated with the fibroblast growth factor receptor 3 (FGFR3). Statins promoted the degradation of FGFR3 in studies using disease-specific induced pluripotent stem cells and model mice, however, recent studies using normal chondrocytes reported that statins did not degrade FGFR3. In order to further investigate the effects of statins in endochondral ossification, this study examined the influence of statins on Indian hedgehog (Ihh), another important component of endochondral ossification, and its related pathways. The chondrocyte cell line ATDC5 was used to investigate changes in cell proliferation, mRNA, and protein expression levels. In addition, an organ culture of a mouse metatarsal bone was performed followed by hematoxylin-eosin staining and fluorescent immunostaining. Results indicated that expression level of Ihh increased with the addition of statins, which activated the Ihh pathway and altered the localization of Ihh. Changes in cholesterol modification may have affected Ihh diffusibility; however, further experiments are necessary. A reactive increase in parathyroid hormone-related protein (PTHrP) was observed in addition to changes in the Wnt pathway through secreted-related protein 2/3 and low-density lipoprotein 5/6. This led to the promotion of cell proliferation, increase of the hypertrophic chondrocyte layer, inhibition of apoptosis, and decrease in mineralization. This study demonstrated that statins had an influence on Ihh, and that the hyperfunction of Ihh may prevent premature cell death caused by FGFR3-related chondrodysplasia through an indirect increase in the expression of PTHrP.

17.
J Shoulder Elbow Surg ; 28(8): 1562-1567, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31327395

RESUMO

BACKGROUND: Fatty degeneration of the rotator cuff muscles is reported to be associated with retear after rotator cuff repair. The purpose of this study was to assess the relationship between retear and preoperative fatty degeneration, as quantified by T2 mapping. METHODS: This prospective cohort study included 83 large and 24 massive rotator cuff tears (average age, 67 years; range, 46-82 years). All patients preoperatively underwent T2 mapping magnetic resonance imaging, and T2 values of the supraspinatus and infraspinatus muscles were quantified. Cuff integrity was evaluated with magnetic resonance imaging 1 year postoperatively. Preoperative T2 values were compared between the retear and intact groups. The preoperative Goutallier stage, Constant score, and the shoulder score of the University of California at Los Angeles were also compared between the 2 groups. RESULTS: Retear was found in 32 shoulders (30%). Postoperative Constant and University of California at Los Angeles scores were significantly higher in intact shoulders than in retear shoulders (P < .001 for both). Mean preoperative T2 values of supraspinatus and infraspinatus were 77.4 ± 13.2 ms and 73.2 ± 15.3 ms in retear shoulders and 66.5 ± 11.1 ms and 58.6 ± 11.7 ms in intact shoulders, respectively; the differences were significant in both muscles (P < .001). Cutoff values for prediction of retear were 71.8 ms in supraspinatus and 63.1 ms in infraspinatus. There were no significant differences in the preoperative Goutallier stages of supraspinatus and infraspinatus between the 2 groups. CONCLUSIONS: Retear shoulders demonstrated significantly higher preoperative T2 values than intact shoulders. T2 mapping can be a useful tool for predicting postoperative retears.


Assuntos
Tecido Adiposo/patologia , Artroscopia/métodos , Imageamento por Ressonância Magnética/métodos , Complicações Pós-Operatórias/etiologia , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Recidiva , Manguito Rotador/patologia , Lesões do Manguito Rotador/diagnóstico , Lesões do Manguito Rotador/etiologia , Ruptura , Resultado do Tratamento
18.
JSES Open Access ; 3(1): 21-24, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30976731

RESUMO

Background: In our previous study, iatrogenic capsular tears, bone bruises of the humeral head, and labral tears were detected on magnetic resonance imaging (MRI) performed 1 week after manipulation following ultrasound-guided cervical nerve root block in patients with frozen shoulder 6 months after manipulation. Methods: We studied 25 patients with frozen shoulder. MRI was performed before, 1 week after, and 6 months after manipulation. On the basis of the course of MRI findings over a period of 6 months, the patients were divided into 2 groups: those with MRI findings of bone bruises, capsular tears, and/or labral tears (19 patients) and those with no MRI findings (6 patients). The clinical outcomes of the 2 groups at 6 months after manipulation were compared using the Wilcoxon matched-pairs test, the Mann-Whitney test, and the Fisher exact probability test for statistical analysis. Results: At 1 week after manipulation, 96% of patients had capsular tears, 40% had bone bruises, and 20% had labral tears; these percentages had decreased at 6 months after manipulation to 4%, 20%, and 8%, respectively. No significant differences in clinical outcomes were noted between patients with residual MRI findings 6 months after manipulation and those without any MRI findings. Conclusion: Most of the iatrogenic capsular tears, bone bruises, and labral tears detected 1 week after manipulation had disappeared 6 months later. Residual MRI findings 6 months after manipulation had no significant correlation with clinical symptoms.

19.
Respir Investig ; 57(4): 354-360, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30760407

RESUMO

BACKGROUND: The impact of dementia on the survival of patients with pulmonary tuberculosis (TB) remains unclear. This study sought to describe the risk factors influencing in-hospital mortality in patients with pulmonary TB and comorbid dementia. METHODS: A 9-y, medical record-based retrospective study of hospitalized adult patients with newly diagnosed, smear-positive, non-multidrug-resistant pulmonary TB without human immunodeficiency virus infection was performed. Clinical presentations, biochemical tests, radiographic findings, and clinical outcomes were collected. Variables were compared between groups. Statistically significant (p-value < 0.05) variables were entered into a multivariate stepwise logistic regression model. Survival analysis was performed using the Kaplan-Meier method, and groups were compared by log-rank test. RESULTS: Of the 279 enrolled patients (178 men; median age, 76 y), the mortality rate was 12.2% (34/279). Univariate analysis showed a higher frequency of dementia in patients who died in hospital than that in surviving patients. Multivariate stepwise logistic analysis showed that dementia was significantly associated with higher rates of in-hospital mortality (odds ratio, 3.20; 95% confidence interval, 1.15-8.88, p = 0.026). In addition, subgroup survival curves showed that dementia was associated with reduced survival rates, even after adjusting for age (log-rank test, p = 0.0007). CONCLUSIONS: The comorbidity of dementia with pulmonary TB was associated with patient in-hospital mortality. Medical practitioners should be aware of dementia in patients with smear-positive pulmonary TB to identify high-mortality groups.


Assuntos
Demência/epidemiologia , Demência/mortalidade , Mortalidade Hospitalar , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Tuberculose Pulmonar/microbiologia , Adulto Jovem
20.
Medicine (Baltimore) ; 97(43): e12430, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30412059

RESUMO

RATIONAL: Granulomatous polyangiitis (GPA) is a type of vasculitis involving medium and small arteries, typically affecting the upper and lower respiratory tract with coexisting glomerulonephritis. GPA is also characterized by necrotizing granulomatous inflammation and the presence of antineutrophil cytoplasm antibodies (ANCA). So far, various infections have lead to elevation of titers of serum ANCA, making it difficult to diagnose. PATIENT CONCERNS: We report a 50-year-old woman who was diagnosed as tuberculous lymphadenitis. During the treatment by anti-tuberculosis (TB) drugs, rapidly progressive renal failure and pleurisy had appeared with elevated titer of PR3-ANCA. Renal biopsy revealed crescentic glomerulonephritis. DIAGNOSIS: Renal biopsy revealed crescentic glomerulonephritis and diagnosis of GPA was made. INTERVENTIONS: Steroid therapy had been started with continuation of anti-TB drugs. OUTCOMES: Renal dysfunction had gradually recovered and pleurisy had disappeared with decreasing titer of PR3-ANCA. LESSONS: This is the first report of GPA complicated by TB infection. When we encounter a case with rapidly progressive renal failure during the TB infection, complication of GPA should be suspected as 1 of the different diagnosis.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/análise , Granulomatose com Poliangiite/complicações , Tuberculose dos Linfonodos/etiologia , Anticorpos Antibacterianos/análise , Biópsia , Diagnóstico Diferencial , Feminino , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/imunologia , Humanos , Pessoa de Meia-Idade , Mycobacterium tuberculosis/imunologia , Tomografia Computadorizada por Raios X , Tuberculose dos Linfonodos/diagnóstico , Tuberculose dos Linfonodos/imunologia
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