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1.
BMJ Case Rep ; 12(10)2019 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-31611227

RESUMO

Specific vesiculobullous skin lesions in lupus erythematosus (LE) are rare and must be differentiated from toxic epidermal necrolysis (TEN), TEN-like dermatoses and other vesiculobullous conditions. We report a patient with typical subacute cutaneous lupus erythematous that progressed with large sheet-like areas of epidermal detachment and Nikolsky sign resembling TEN. She had a serological profile suggestive of underlying connective tissue disease, histological findings of interface dermatitis with a lymphocytic infiltrate, positive direct immunofluorescence, resolution with immunomodulation and lack of a culprit drug, features observed in TEN-like cutaneous lupus erythematous. Furthermore, she was diagnosed with lung carcinoma, an association that has been previously reported. Differentiating a bullous eruption in the context of pre-existing LE remains difficult requiring a thorough analysis of clinical and histopathological data.


Assuntos
Carcinoma Broncogênico/etiologia , Neoplasias Pulmonares/etiologia , Lúpus Eritematoso Cutâneo/complicações , Síndrome de Stevens-Johnson/complicações , Idoso de 80 Anos ou mais , Feminino , Humanos
2.
Arch Bronconeumol ; 53(8): 437-442, 2017 Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28279517

RESUMO

Asbestos is the term used for a set of mineral silicates that tend to break up into fibers. Its use has been associated with numerous diseases affecting the lung and pleura in particular, all of which are characterized by their long period of latency. Asbestos, moreover, has been recognized by the WHO as a Group IA carcinogen since 1987 and its use was banned in Spain in 2002. The publication in 2013 of the 3rd edition of the specific asbestos health monitoring protocol, together with the development of new diagnostic techniques, prompted the SEPAR EROM group to sponsor publication of guidelines, which review the clinical, radiological and functional aspects of the different asbestos-related diseases. Recommendations have also been made for the diagnosis and follow-up of exposed patients. These recommendations were drawn up in accordance with the GRADE classification system.


Assuntos
Asbestose/diagnóstico , Asbestose/terapia , Asbestos/classificação , Asbestos/toxicidade , Asbestose/diagnóstico por imagem , Asbestose/prevenção & controle , Biomarcadores Tumorais , Carcinoma Broncogênico/diagnóstico , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/terapia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/terapia , Programas de Rastreamento , Mesotelioma/diagnóstico , Mesotelioma/etiologia , Mesotelioma/terapia , Fibras Minerais/análise , Fibras Minerais/toxicidade , Exposição Ocupacional , Saúde do Trabalhador/legislação & jurisprudência , Doenças Pleurais/diagnóstico , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/terapia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/etiologia , Neoplasias Pleurais/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Testes de Função Respiratória , Fumar/epidemiologia , Espanha
4.
Respir Med ; 109(3): 427-33, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25616348

RESUMO

BACKGROUND: Lung transplant is the only available therapy for patients with advanced lung disease. The goal of this study was to examine the prevalence, origin, management and outcome of lung cancer in recipients of lung transplant at our institution. METHODS: After institutional review board approval, we conducted a retrospective chart review of all lung transplantations in our institution from January 1990 until June 2012. RESULTS: The prevalence of lung cancer in the explanted lung was 6 (1.2%) of 462 and all cases were in subjects with lung fibrosis. All 4 subjects with lymph node involvement died of causes related to the malignancy. Nine (1.9%) of 462 patients were found to have bronchogenic carcinoma after lung transplant. The most common location was in the native lung in recipients of a single lung transplant (6 out of 9 patients). In one case, the tumor originated in the allograft and was potentially donor related. The median time to diagnosis after lung transplant was 28 months with a range from 9 months to 10 years. Median survival was 8 months, with tumors involving lymph nodes or distant metastases associated with a markedly worse prognosis (median survival 7 months) than stage I disease (median survival 27 months). CONCLUSIONS: The prevalence of lung cancer in lung transplant recipients is low. Using accepted donor screening criteria, donor derived malignancy is exceptionally rare. While stage I disease is associated with improved survival in this cohort, survival is still not comparable to that of the general population, likely influenced by the need for aggressive immune suppression.


Assuntos
Carcinoma Broncogênico/epidemiologia , Carcinoma Broncogênico/etiologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/etiologia , Transplante de Pulmão/efeitos adversos , Adulto , Carcinoma Broncogênico/mortalidade , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Taxa de Sobrevida , Estados Unidos/epidemiologia
5.
Rev Mal Respir ; 31(6): 488-98, 2014 Jun.
Artigo em Francês | MEDLINE | ID: mdl-25012035

RESUMO

Cannabis is the most commonly smoked illicit substance in the world. It can be smoked alone in plant form (marijuana) but it is mainly smoked mixed with tobacco. The combined smoking of cannabis and tobacco is a common-place phenomenon in our society. However, its use is responsible for severe pulmonary consequences. The specific impact of smoking cannabis is difficult to assess precisely and to distinguish from the effect of tobacco. Marijuana smoke contains polycyclic aromatic hydrocarbons and carcinogens at higher concentration than tobacco smoke. Cellular, tissue, animal and human studies, and also epidemiological studies, show that marijuana smoke is a risk factor for lung cancer. Cannabis exposure doubles the risk of developing lung cancer. This should encourage clinicians to identify cannabis use and to offer patients support in quitting.


Assuntos
Carcinoma Broncogênico/etiologia , Neoplasias Pulmonares/etiologia , Fumar Maconha/efeitos adversos , Animais , Carcinoma Broncogênico/epidemiologia , Humanos , Neoplasias Pulmonares/epidemiologia , Fumar Maconha/epidemiologia , Fatores de Risco , Fumaça/efeitos adversos , Fumar/efeitos adversos , Fumar/epidemiologia , Tabaco
6.
Ann Thorac Surg ; 98(1): 362-71, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24856793

RESUMO

Risk factors for lung cancer in lung transplant recipients are a history of smoking and immunosuppression, to which adds increasing use of lungs from donors with a smoking history. The three typical presentations are incidental diagnosis on the explanted lung, concerning less than 2%; lung cancer developing on the lung graft, accounting for less than 1%; and incidence of lung cancer on the native lung, estimated at 9%. Treatment along available guidelines may be hampered by decreased lung function owing to chronic rejection or adverse effects of immunosuppression. Prognosis is comparable to a general population in resected stage I cancer and is less favorable in advanced stages.


Assuntos
Carcinoma Broncogênico/etiologia , Rejeição de Enxerto/complicações , Tolerância Imunológica , Imunossupressão/efeitos adversos , Neoplasias Pulmonares/etiologia , Transplante de Pulmão/efeitos adversos , Doadores de Tecidos , Rejeição de Enxerto/imunologia , Humanos , Prognóstico , Fatores de Risco
7.
Asian Cardiovasc Thorac Ann ; 22(3): 315-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24585908

RESUMO

BACKGROUND: Tobacco smoke contains many carcinogens that may mediate susceptibility to lung cancer. Cytochrome P450 isoenzyme 1A1 activity and expression increases several fold in lung cancer due to smoking. Finding the role of cytochrome P450 1A1 in susceptibility to tobacco-related lung cancer may be important to predict the outcome in early stage cancer, and may result in an improved survival rate. PATIENTS AND METHODS: This study was carried on 2 groups of patients: group A was 20 patients with operable smoking-related lung cancer, who underwent surgery at the time of diagnosis; group B was 20 nonsmokers without lung cancer who underwent chest exploration following road traffic accidents. Specimens were obtained from tumor tissue and surrounding healthy tissue in group A patients, and from healthy lung tissue in group B patients. These specimens were sent for measurement of protein content and cytochrome P450 1A1 activity. RESULTS: There was significantly greater tissue cytochrome P450 1A1 activity in group A compared to group B. Patients with stage II cancer showed significantly higher levels of tissue cytochrome P450 1A1 activity than those with stage I. There was also a significant difference in tissue cytochrome P450 1A1 activity between the tumor tissue and the tissue surrounding the tumor. CONCLUSION: Carcinogens in smoke increase cytochrome P450 1A1 activity, which might be considered to play a role in cigarette smoking-induced lung cancer.


Assuntos
Carcinoma Broncogênico/etiologia , Citocromo P-450 CYP1A1/biossíntese , Neoplasias Pulmonares/etiologia , Fumar/efeitos adversos , Adulto , Idoso , Carcinoma Broncogênico/enzimologia , Carcinoma Broncogênico/patologia , Carcinoma Broncogênico/cirurgia , Estudos de Casos e Controles , Suscetibilidade a Doenças , Indução Enzimática , Feminino , Humanos , Neoplasias Pulmonares/enzimologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pneumonectomia , Medição de Risco , Fatores de Risco , Fumar/metabolismo
9.
Rev Mal Respir ; 29(9): 1127-31, 2012 Nov.
Artigo em Francês | MEDLINE | ID: mdl-23200587

RESUMO

A diagnosis of asbestosis, lung fibrosis due to asbestos exposure, was proposed in 2003 in a 64-year-old woman on the basis of the history, computed tomography appearances, lung function studies, and biometric data. This diagnosis was confirmed by the pathological examination of a lung lobe resected surgically for bronchial carcinoma in 2010. The diagnosis of asbestosis is now rarely made as a result of a substantial decrease in dust exposure over the past decades and mainly because of the interdiction of asbestos use in western countries. Currently, the most frequent thoracic manifestations of asbestos exposure are benign pleural lesions and mesothelioma. It has also become exceptional to have pathological confirmation of the diagnosis, obtained in this woman thanks to the surgical treatment of another complication of her occupational exposure.


Assuntos
Asbestose/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Amianto Amosita/efeitos adversos , Amianto Amosita/análise , Asbestose/complicações , Asbestose/diagnóstico por imagem , Asbestose/patologia , Asbestose/cirurgia , Líquido da Lavagem Broncoalveolar/química , Carcinoma Broncogênico/tratamento farmacológico , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/patologia , Carcinoma Broncogênico/cirurgia , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Terapia Combinada , Feminino , Humanos , Achados Incidentais , Indústrias , Pulmão/patologia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Fibras Minerais/efeitos adversos , Fibras Minerais/análise , Exposição Ocupacional , Pleura/patologia , Aspergilose Pulmonar/etiologia , Testes de Função Respiratória , Tomografia Computadorizada por Raios X , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos , Vimblastina/análogos & derivados , Vinorelbina
10.
Rev Mal Respir ; 29(4): 545-56, 2012 Apr.
Artigo em Francês | MEDLINE | ID: mdl-22542412

RESUMO

Lung cancer and chronic obstructive lung disease (COPD) are two common fatal diseases. Apart from their common link to tobacco, these two diseases are usually considered to be the result of separate distinct mechanisms. In the past 15 years, numerous studies have produced arguments in favour of a relationship between these two pathologies that goes beyond a simple addition of risk factors. At the epidemiological level, there are data that demonstrate an increased incidence of bronchial carcinoma in patients with COPD. The links between these two pathologies are still unexplained but there are numerous arguments supporting a common physiopathology. Common genetic and epigenetic abnormalities, mechanical factors and signalisation pathways have been quoted. COPD and lung cancer appear to be two diseases possessing a genetic basis that creates a predisposition to environmental or toxic assaults, resulting in a different clinical manifestation in each disease. Consequently, improvements in the management of these two diseases will involve a more intensive investigation of their physiopathology, and require a closer collaboration between research centres and clinical units.


Assuntos
Carcinoma Broncogênico/epidemiologia , Carcinoma Broncogênico/etiologia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/etiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/etiologia , Carcinoma Broncogênico/complicações , Carcinoma Broncogênico/genética , Predisposição Genética para Doença , Humanos , Inflamação/complicações , Inflamação/epidemiologia , Inflamação/genética , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/genética , Modelos Biológicos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/genética , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/genética , Estresse Mecânico
11.
Arch. bronconeumol. (Ed. impr.) ; 48(3): 99-101, mar. 2012. ilus
Artigo em Espanhol | IBECS | ID: ibc-101586

RESUMO

Hombre de 45 años de edad, fumador, que fue derivado para la valoración de un esputo hemoptoico (estrías hemáticas) y una lesión quística extensa localizada en el lóbulo pulmonar inferior izquierdo (LII). En la tomografía computarizada (TC) torácica se observó la presencia de atrapamiento aéreo en LII. Antes de completar la evaluación diagnóstica, el paciente se perdió para el seguimiento. Al regresar después de un intervalo de 2 meses, se observó la «desaparición» del quiste junto con el colapso completo del LII. La broncoscopia de fibra óptica reveló la presencia de un tumor que ocluía por completo el bronquio principal del LII y la biopsia confirmó la presencia de un carcinoma pulmonar de células escamosas. El perfil clínico-radiológico temporal sugirió un mecanismo de válvula como consecuencia de la obstrucción endobronquial como causa primaria de la formación del quiste. Entre grandes fumadores que se presentan con quistes pulmonares solitarios, sintomáticos, el caso descrito destaca la necesidad de considerar la obstrucción endobronquial maligna como la etiología probable(AU)


A 45-year-old smoker was referred for evaluation of recent onset streaky hemoptysis and a large cystic lesion in the left lower lobe (LLL). Presence of air trapping in LLL was observed on computed tomography scan of thorax. Prior to completion of diagnostic evaluation, the patient was lost to follow up. On return after a two-month gap, ‘disappearance’ of the cyst was observed along with complete collapse of LLL. A fibreoptic bronchoscopy revealed presence of a tumor completely occluding the LLL main bronchus and biopsy confirmed presence of squamous cell carcinoma of lung. The temporal clinico-radiological profile suggested a check-valve mechanism resulting from endobronchial obstruction as the primary mechanism for cyst formation. This case highlights the need to consider malignant endobronchial obstruction as the likely etiology among heavy smokers presenting with symptomatic solitary lung cysts(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Cistos/complicações , Carcinoma Broncogênico/complicações , Carcinoma Broncogênico/diagnóstico , Obstrução das Vias Respiratórias/complicações , Broncoscopia/métodos , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico , /métodos , Radiografia Torácica/tendências , Radiografia Torácica , Fotomicrografia/instrumentação , Fotomicrografia/métodos
12.
Rev Mal Respir ; 28(8): 1048-58, 2011 Oct.
Artigo em Francês | MEDLINE | ID: mdl-22099410

RESUMO

Lung cancer is the most common cause of cancer-related mortality throughout the world representing around 18% of the total. There is still a male predominance but this is becoming less pronounced and in the US, lung cancer is now the most common cause of cancer-related mortality in women. In France, it had risen to second place in women in 2005 after having been in 6th place in 1975. Median age at diagnosis differs according to countries and health system and is around 70 years in the US and around 65 years in France. The distribution of histological subtypes has changed considerably during recent decades with an increasing frequency of adenocarcinoma at the expense of squamous cell carcinoma. The main risk factor for lung cancer remains active tobacco smoking but the attributable risk of smoking varies from one country to another and according to gender. In Japan, the great majority of lung cancer in women is not attributable to active tobacco smoking. Environmental tobacco smoke exposure has a less important role than active tobacco smoking although it is not negligible. The specific impact of smoking cannabis is difficult to assess precisely as, in most cases, it is mixed with tobacco. However, despite important differences with tobacco smoke, cannabis exposure doubles the risk of developing lung cancer. Occupational risk factors have for a long time been neglected and thus occupational lung cancers have been under-reported. Finally, lung cancer in never-smokers is driving considerable interest as it represents by itself the 7th largest cause of mortality due to cancer. Risk factors involved might be air pollution (indoors and outdoors) but also hormone replacement therapy in women.


Assuntos
Carcinoma Broncogênico/epidemiologia , Projetos de Pesquisa Epidemiológica , Neoplasias Pulmonares/epidemiologia , Oncologia/tendências , Carcinoma Broncogênico/etiologia , Feminino , Humanos , Neoplasias Pulmonares/etiologia , Masculino , Fumar Maconha/efeitos adversos , Fumar Maconha/epidemiologia , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Fumar/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/estatística & dados numéricos
13.
Clin Chest Med ; 32(2): 343-55, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21511094

RESUMO

Malignancy is an important complication of thoracic organ transplantation and is associated with significant morbidity and mortality. Lung transplant recipients are at greater risk for cancer than immunocompetent persons, with cancer-specific incidence rates up to 60-fold higher than the general population. The increased risk for cancer is attributed to neoplastic properties of immunosuppressive medications, oncogenic viruses, and cancer-specific risk factors. This article addresses the epidemiology, presentation, and treatment of the most common malignancies after lung transplantation, including skin cancer, posttransplant lymphoproliferative disorder, and bronchogenic carcinoma.


Assuntos
Neoplasias Pulmonares/etiologia , Transplante de Pulmão , Transtornos Linfoproliferativos/etiologia , Complicações Pós-Operatórias , Neoplasias Cutâneas/etiologia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/etiologia , Carcinoma Basocelular/terapia , Carcinoma Broncogênico/diagnóstico , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/terapia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Fatores de Risco , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia
14.
Cancer ; 117(19): 4381-9, 2011 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-21412758

RESUMO

BACKGROUND: Cushing syndrome (CS) secondary to ectopic adrenocorticotropic hormone (ACTH) secretion (EAS) has been described in association with a variety of tumors. The current experience with this syndrome was based on a few case series and individual case reports. Limited data were available about the tumors associated with CS-EAS in a cancer center setting. In this report, the authors have described their experience with CS-EAS at The University of Texas MD Anderson Cancer Center to further enhance the current understanding and management of this syndrome. METHODS: This was a retrospective review of 43 patients with CS-EAS who were diagnosed between 1979 and 2009 at The University of Texas MD Anderson Cancer Center. RESULTS: Different neuroendocrine tumors were associated with CS-EAS. Twenty-one patients (48.9%) had tumors located in the chest cavity, with bronchial carcinoid and small cell lung cancer representing the 2 most common causes. The ACTH source remained occult in 4 patients (9.3%) despite extensive workup. Clinical presentation varied, and the classic features of CS were not evident in some patients. Death occurred in 27 patients (62.8%), and the median overall survival was 32.2 months. Major morbidities included new-onset or worsening hyperglycemia (77%), symptomatic venous thromboembolism (14%), and infections (23%). CONCLUSIONS: In patients with CS-EAS who attended a comprehensive cancer center, tumors originating in the chest cavity were the leading tumors associated with this syndrome. The authors suspect that CS-EAS is under reported because of the atypical presentation in some patients. Thus, they suggest careful evaluation of patients with neuroendocrine tumors to avoid missing coexisting CS-EAS.


Assuntos
Síndrome de ACTH Ectópico/etiologia , Hormônio Adrenocorticotrópico/metabolismo , Síndrome de Cushing/complicações , Neoplasias Pulmonares/etiologia , Tumores Neuroendócrinos/etiologia , Carcinoma de Pequenas Células do Pulmão/etiologia , Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico/metabolismo , Adulto , Idoso , Carcinoma Broncogênico/diagnóstico , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/metabolismo , Comorbidade , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/metabolismo , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/metabolismo , Prognóstico , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Carcinoma de Pequenas Células do Pulmão/metabolismo , Taxa de Sobrevida , Adulto Jovem
15.
Zhongguo Fei Ai Za Zhi ; 14(1): 75-8, 2011 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-21219838

RESUMO

BACKGROUND AND OBJECTIVE: Lung transplantation is an efficient therapeutic option for patients with end-stage pulmonary diseases, but less is known about lung cancer after lung transplantation. The aim of this study is to improve the awareness, diagnosis and treatment of bronchogenic carcinoma after lung transplantation with a case report and related literatures. METHODS: We reported a 65-year-old male with idiopathic pulmonary fibrosis (IPF) who underwent right lung transplantation under extracorporeal membrane oxygenation (ECMO) support in May 2007 in our hospital. The patient recovered smoothly and discharged from the hospital 46 days after the procedure with regular follow-up. Immunosuppression therapy was triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids. RESULTS: Small cell lung cancer in the left lung with multiple osseous metastases was found 13 months after the lung transplantation. Symptoms were relieved a bit by administering chemotherapeutics (etoposide and cisplatin) for 4 cycles. However, the patient was succumbed to his illness within 11 months after the diagnosis of lung cancer. CONCLUSIONS: Lung cancer after lung transplantation has been suggested as one of causes of late mortality with the risk factors such as chronic obstructive pulmonary disease (COPD), IPF, cigarette smoking history and immunosuppression etc. Early diagnosis and treatment are very important to improve the prognosis.


Assuntos
Carcinoma Broncogênico/etiologia , Fibrose Pulmonar Idiopática/terapia , Neoplasias Pulmonares/etiologia , Transplante de Pulmão/efeitos adversos , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Broncogênico/tratamento farmacológico , Carcinoma Broncogênico/mortalidade , Evolução Fatal , Humanos , Fibrose Pulmonar Idiopática/cirurgia , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Masculino
16.
Respir Med ; 104(11): 1691-9, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20483577

RESUMO

BACKGROUND: The leading comorbidities and causes of death in patients with chronic obstructive pulmonary disease (COPD) are lung cancer and cardiovascular disease. The aim of this study was to establish the incidence of lung cancer, myocardial infarction and heart failure in patients with COPD in UK primary care. METHODS: The General Practice Research Database (GPRD) was used to identify a cohort of 1927 patients with a first recorded diagnosis of COPD. This cohort was followed for up to 5 years to identify new diagnoses of lung cancer, myocardial infarction and heart failure. Mortality was also assessed. The relative risk (RR) of each outcome in the COPD cohort was compared with that in a control cohort with no diagnosis of COPD. RESULTS: The risk of lung cancer was significantly increased in individuals with a diagnosis of COPD compared with those with no COPD diagnosis (RR: 3.33; 95% confidence interval [CI]: 2.33-4.75; adjusted for age, sex and smoking status). A diagnosis of COPD was also associated with a significant increase in the risk of heart failure (age- and sex-adjusted RR: 2.94; 95% CI: 2.46-3.51) and death (age- and sex-adjusted RR: 2.76; 95% CI: 2.45-3.12), but not myocardial infarction (age- and sex-adjusted RR: 1.18; 95% CI: 0.81-1.71). CONCLUSIONS: Patients with a diagnosis of COPD are at significantly increased risk of lung cancer, heart failure and death compared with the general population. They do not appear to be at increased risk of myocardial infarction.


Assuntos
Carcinoma Broncogênico/epidemiologia , Insuficiência Cardíaca/epidemiologia , Neoplasias Pulmonares/epidemiologia , Infarto do Miocárdio/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/mortalidade , Comorbidade , Bases de Dados Factuais , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Humanos , Incidência , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Fatores de Risco , Reino Unido/epidemiologia
17.
Clin Cancer Res ; 16(2): 398-409, 2010 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-20068077

RESUMO

PURPOSE: Some 85% of lung cancers are smoking related. Here, we investigate the role of serine protease HtrA3 in smoking-related lung cancer. EXPERIMENTAL DESIGN: We assess HtrA3 methylation and its corresponding expression in the human bronchial cell line BEAS-2B following cigarette smoke carcinogen treatment, in lung cancer cell lines and in primary lung tumors from light, moderate, and heavy smokers. We also show the effects of HtrA3 downregulation on MTT reduction and clonogenic survival with etoposide and cisplatin treatment and the corresponding effects of HtrA3 re-expression during treatment. RESULTS: We show for the first time that HtrA3 expression is reduced or completely lost in over 50% of lung cancer cell lines and primary lung tumors from heavy smokers. Treatment of HtrA3-deficient cell lines with 5-aza-2'-deoxycytidine resulted in a dose-dependent increase in HtrA3 transcription. Further, sequence analysis of bisulfite-modified DNA from lung cancer cell lines and from primary lung tumors showed an increased frequency of methylation within the first exon of HtrA3 with a corresponding loss of HtrA3 expression, particularly in tumors from smokers. In BEAS-2B, treatment with the cigarette smoke carcinogen 4-(methylnitrosamino)-I-(3-pyridyl)-1-butanone resulted in HtrA3 downregulation with a corresponding increase in methylation. Additional studies indicate resistance to etoposide and cisplatin cytotoxicity as a functional consequence of HtrA3 loss. Finally, immunohistochemical analysis of primary lung tumors revealed a strong correlation between low HtrA3 expression and heavy smoking history. CONCLUSIONS: Collectively, these results suggest that cigarette smoke-induced methylation of HtrA3 could contribute to the etiology of chemoresistant disease in smoking-related lung cancer.


Assuntos
Carcinoma Broncogênico/etiologia , Metilação de DNA/fisiologia , Inativação Gênica , Neoplasias Pulmonares/etiologia , Serina Endopeptidases/genética , Fumar/efeitos adversos , Adenocarcinoma/etiologia , Adenocarcinoma/genética , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Broncogênico/tratamento farmacológico , Carcinoma Broncogênico/genética , Carcinoma de Células Grandes/etiologia , Carcinoma de Células Grandes/genética , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/genética , Linhagem Celular Tumoral , Células Cultivadas , Cisplatino/administração & dosagem , Resistencia a Medicamentos Antineoplásicos/genética , Etoposídeo/administração & dosagem , Inativação Gênica/fisiologia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/genética , Camundongos , Camundongos Endogâmicos BALB C , Nitrosaminas/efeitos adversos , Serina Endopeptidases/metabolismo
18.
Radiologe ; 50(1): 53-60, 2010 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-19882335

RESUMO

How to deal with solitary pulmonary nodules (SPN) which are incidentally detected by computed tomography (CT) is an increasingly important task in the era of modern multislice CT. This paper reviews the morphological and functional characteristics and their value for discrimination between benign and malignant SPNs. In particular, the importance of nodule size, growth rate, margin morphology, density, calcifications or fatty components within the nodules, the significance of cavitations or aerobronchograms, enhancement patterns at dynamic contrast-enhanced CT and findings on positron emission tomography (PET) are discussed. The Bayesian analysis to calculate the probability of malignancy is presented. Finally, flow charts demonstrate the national and international recommendations for nodule management.


Assuntos
Aumento da Imagem , Processamento de Imagem Assistida por Computador , Achados Incidentais , Tomografia por Emissão de Pósitrons , Nódulo Pulmonar Solitário/diagnóstico , Tomografia Computadorizada Espiral , Tomografia Computadorizada por Raios X , Adulto , Idoso , Teorema de Bayes , Biópsia , Carcinoma Broncogênico/diagnóstico , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/patologia , Meios de Contraste/administração & dosagem , Árvores de Decisões , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Programas de Rastreamento , Pessoa de Meia-Idade , Fatores de Risco , Nódulo Pulmonar Solitário/etiologia , Nódulo Pulmonar Solitário/patologia , Carga Tumoral , Adulto Jovem
19.
Cardiovasc Intervent Radiol ; 33(1): 209-12, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19214626

RESUMO

A 72-year-old man was referred to our department with an incidentally diagnosed bronchogenic carcinoma of the right upper lobe. Positron emission tomography (PET) combined with computed tomography (PET-CT) revealed an unexpected hot spot in the ventral wall of the infrarenal segment of the inferior vena cava (IVC). Diagnostic biopsy of this lesion was performed under CT guidance with semiautomated 20G fine-needle aspiration (FNA) through a 19G coaxial needle. Cytology revealed few carcinoma cells, which led to the remarkable diagnosis of a distant metastasis to the IVC wall. Both the immediate postinterventional CT control and the further surveillance period of the patient were unremarkable; in particular, no signs of bleeding complications were detected. We conclude that coaxial FNA of an IVC wall lesion is technically feasible and may even help diagnose distant metastasis.


Assuntos
Biópsia por Agulha Fina/métodos , Carcinoma Broncogênico/diagnóstico , Carcinoma Broncogênico/secundário , Neoplasias Pulmonares/patologia , Neoplasias Vasculares/patologia , Neoplasias Vasculares/secundário , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Idoso , Carcinoma Broncogênico/etiologia , Carcinoma Broncogênico/patologia , Humanos , Achados Incidentais , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/etiologia , Masculino , Escleroderma Sistêmico/complicações , Tomografia Computadorizada por Raios X , Neoplasias Vasculares/etiologia
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