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1.
JAMA ; 326(14): 1452, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34636861
4.
JAMA ; 325(22): 2322, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34100869
5.
JAMA ; 2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34137786
9.
JAMA ; 324(11): 1116, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32930760
11.
Respir Med Case Rep ; 14: 49-52, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26029579

RESUMO

Giant cell interstitial pneumonia (GIP) is a rare form of chronic interstitial pneumonia typically associated with hard metal exposure. Only two cases of GIP induced by nitrofurantoin have been reported in the medical literature. We are reporting a case of recurrent nitrofurantoin-induced GIP. Although extremely rare, GIP needs to be included in the differential diagnosis in patients with chronic nitrofurantoin use who present with respiratory illness.

12.
Crit Care Med ; 36(2): 414-20, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18091539

RESUMO

OBJECTIVE: To determine how medical intensive care unit (MICU) admission decisions are made at U.S. academic MICUs and to learn how these practices compare with the recommendations of the Society of Critical Care Medicine and the American Thoracic Society. DESIGN: A 22-question Web-based survey. SETTING: University health sciences centers. SUBJECTS: MICU directors at academic U.S. medical centers offering fellowship programs in pulmonary/critical care or critical care medicine. INTERVENTIONS: The survey was sent by E-mail to 146 academic MICU directors. MEASUREMENTS AND MAIN RESULTS: Survey response rate was 83% (121/146). MICU attendings were the primary decision-maker for patient admission to the intensive care unit (ICU) in 40% of the MICUs during daytime hours, in 36% on weekends, and in 27% overnight. Critical care fellows and resident house staff were often responsible for making MICU admission decisions, particularly overnight and on weekends. Of the MICUs surveyed, 88% had written admission guidelines, although only 25% used them on a regular basis. Written restriction guidelines were present in only 21% of these ICUs, although 53% of MICU directors believed that MICUs should have standardized criteria for restricting admission to the ICU. Finally, 29% of MICUs surveyed did not authorize MICU attendings to deny ICU admission on a case-by-case basis for futile or inadvisable care, thereby maintaining an open door policy for ICU admission. CONCLUSIONS: Significant practice variability exists across U.S. academic MICUs regarding how decisions are made to admit patients to the ICU. The majority of academic MICUs in the United States do not strictly employ ICU admission and restriction guidelines, as recommended by the Society of Critical Care Medicine and the American Thoracic Society.


Assuntos
Centros Médicos Acadêmicos , Unidades de Terapia Intensiva/organização & administração , Admissão do Paciente , Diretores Médicos/psicologia , Tomada de Decisões , Fidelidade a Diretrizes , Pesquisas sobre Serviços de Saúde , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Estados Unidos
13.
Cancer ; 101(7): 1632-8, 2004 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-15378500

RESUMO

BACKGROUND: Recently, the authors identified molecular signatures and pathways associated with nonsmall cell lung carcinoma histology and lung development. They hypothesized that genetic classifiers of histology would provide insight into lung tumorigenesis and would be associated with clinical outcome when evaluated in a broader set of specimens. METHODS: Associations between patient survival and immunostaining for 11 representative histologic classifiers (epidermal growth factor receptor [EGFR], CDK4, syndecan-1, singed-like, TTF-1, keratin 5, HDAC2, docking protein 1, integrin alpha3, P63, and cyclin D1) were examined using a tissue microarray constructed from nonsmall cell lung carcinoma specimens. RESULTS: Sixty-three tumors were examined, including 43 adenocarcinomas, 11 large cell carcinomas, and 9 squamous cell carcinomas. Sixty-three percent of tumors were clinical Stage I lesions, and 37% were Stage II-III lesions. In a multivariate analysis that controlled for age, gender, and race, syndecan-1 expression was found to be associated with a significant reduction in the risk of death (hazard ratio, 0.31 [95% confidence interval, 0.18-0.87]; P < 0.05). Multivariate analysis also indicated that EGFR expression was associated with a significant reduced risk of death. CONCLUSIONS: The authors demonstrated that expression of either of the nonsmall cell lung carcinoma subtype classifiers syndecan-1 and EGFR was associated with a 30% reduction in the risk of death, with this reduction being independent of histology and other confounders. The results of the current study suggest that loss of expression of these histologic classifiers is associated with biologic aggressiveness in lung tumors and with poor outcome for patients with such tumors. If their significance can be validated prospectively, these biomarkers may be used to guide therapeutic planning for patients with nonsmall cell lung carcinoma.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/mortalidade , Receptores ErbB/análise , Neoplasias Pulmonares/mortalidade , Glicoproteínas de Membrana/análise , Proteoglicanas/análise , Adenocarcinoma/mortalidade , Idoso , Carcinoma de Células Grandes/mortalidade , Carcinoma de Células Escamosas/mortalidade , Ciclina D1/análise , Quinase 4 Dependente de Ciclina , Quinases Ciclina-Dependentes/análise , Feminino , Histona Desacetilase 2 , Histona Desacetilases/análise , Humanos , Imuno-Histoquímica , Cadeias alfa de Integrinas/análise , Queratina-5 , Queratinas/análise , Masculino , Proteínas de Membrana/análise , Análise Multivariada , Proteínas Nucleares/análise , Proteínas Proto-Oncogênicas/análise , Proteínas Repressoras/análise , Sindecana-1 , Sindecanas , Fator Nuclear 1 de Tireoide , Fatores de Transcrição/análise
14.
Am Surg ; 70(8): 706-9, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15328805

RESUMO

Malignancies of the appendix are uncommon; a small subset of these lesions are actually metastatic cancers. In some rare cases, these lesions can cause obstruction, appendicitis, and perforation. M.K. is a 54-year-old man who presented to our institution with a 1-day history of right lower quadrant pain and a past medical history significant only for a 75-pack-year smoking history. CT scan revealed a perforated appendix, and the patient was taken to the operating room where a gangrenous appendix was removed uneventfully. Two days post-procedure, the patient was found to have acute mental status changes, requiring intubation and transfer to the surgical intensive care unit. As part of a workup, a CT scan of the head revealed multiple lesions compatible with metastatic disease. At that point, the pathology from the appendix came back as small cell lung cancer. Chest CT revealed hilar adenopathy and a hilar mass. The patient received emergent whole-brain irradiation therapy with improvement in his mental status, allowing him to be extubated and discharged from the hospital within 10 days of admission. Surgeons should remember that an underlying oncologic process may be the etiology of appendicitis in a small but important subgroup of patients.


Assuntos
Apendicectomia , Neoplasias do Apêndice/secundário , Apendicite/cirurgia , Neoplasias Encefálicas/secundário , Carcinoma de Células Pequenas/secundário , Perfuração Intestinal/cirurgia , Neoplasias Pulmonares/patologia , Doença Aguda , Neoplasias do Apêndice/diagnóstico por imagem , Neoplasias do Apêndice/cirurgia , Apendicite/diagnóstico por imagem , Apendicite/patologia , Neoplasias Encefálicas/diagnóstico por imagem , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/cirurgia , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
17.
Am J Respir Crit Care Med ; 170(2): 167-74, 2004 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-15087295

RESUMO

Gene expression profiles of resected tumors may predict treatment response and outcome. We hypothesized that profiles derived from lung tumor biopsies would discriminate tumor-specific gene signatures and provide predictive information about outcome. Lung carcinoma specimens were obtained from 23 patients undergoing computed tomography-guided transthoracic biopsy or endobronchial brushing for undiagnosed nodules. Excess tissue was processed for gene profiling. We built class prediction models for lung cancer histology and for cancer outcome. The histology model used an F test to identify 99 genes that were differentially expressed among lung cancer subtypes. The histology validation set class prediction accuracy rate was 86%. The outcome model used the maximum difference subset algorithm to identify 42 genes associated with high risk for cancer death. The outcome training set class prediction accuracy rate was 87%. In conclusion, gene expression profiles of biopsy specimens of lung cancers identify unique tumoral signatures that provide information about tissue morphology and prognosis. The use of specimens acquired from lung biopsy procedures to identify biomarkers of clinical outcome may have application in the management of patients with lung cancer. The procedures are safe and feasible; the efficacy and utility of this strategy will ultimately be determined by prospective clinical trials.


Assuntos
Biomarcadores Tumorais/genética , Perfilação da Expressão Gênica/métodos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Pulmão/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/imunologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco/métodos , Análise de Sobrevida
18.
Am J Pathol ; 163(5): 1949-60, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14578194

RESUMO

Current paradigms hold that lung carcinomas arise from pleuripotent stem cells capable of differentiation into one or several histological types. These paradigms suggest lung tumor cell ontogeny is determined by consequences of gene expression that recapitulate events important in embryonic lung development. Using oligonucleotide microarrays, we acquired gene profiles from 32 microdissected non-small-cell lung tumors. We determined the 100 top-ranked marker genes for adenocarcinoma, squamous cell, large cell, and carcinoid using nearest neighbor analysis. Results were validated by immunostaining for 11 selected proteins using a tissue microarray representing 80 tumors. Gene expression data of lung development were accessed from a publicly available dataset generated with the murine Mu11k genome microarray. Self-organized mapping identified two temporally distinct clusters of murine orthologues. Supervised clustering of lung development data showed large-cell carcinoma gene orthologues were in a cluster expressed in pseudoglandular and canalicular stages whereas adenocarcinoma homologues were predominantly in a cluster expressed later in the terminal sac and alveolar stages of murine lung development. Representative large-cell genes (E2F3, MYBL2, HDAC2, CDK4, PCNA) are expressed in the nucleus and are associated with cell cycle and proliferation. In contrast, adenocarcinoma genes are associated with lung-specific transcription pathways (SFTPB, TTF-1), cell adhesion, and signal transduction. In sum, non-small-cell lung tumors histology gene profiles suggest mechanisms relevant to ontogeny and clinical course. Adenocarcinoma genes are associated with differentiation and glandular formation whereas large-cell genes are associated with proliferation and differentiation arrest. The identification of developmentally regulated pathways active in tumorigenesis provides insights into lung carcinogenesis and suggests early steps may differ according to the eventual tumor morphology.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/genética , Regulação Neoplásica da Expressão Gênica , Neoplasias Pulmonares/genética , Pulmão/crescimento & desenvolvimento , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Carcinoma Pulmonar de Células não Pequenas/patologia , Linhagem da Célula , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica no Desenvolvimento , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/patologia , Masculino , Camundongos , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos
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