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1.
BMC Infect Dis ; 21(1): 4, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397312

RESUMO

BACKGROUND: Tuberculous pleural effusion (TPE) is the most common extrapulmonary manifestation and may have lasting effect on lung function. However conventional diagnostic tests for TPE register multiple limitations. This study estimates diagnostic efficacy of the interferon gamma release assay (IGRA: T-SPOT.TB) in TPE patients of different characteristics. METHODS: We performed a prospective, single-centre study including all suspected pleural effusion patients consecutively enrolled from June 2015 to October 2018. Through receiver operating characteristic (ROC) curves, technical cut-offs and the utility of T-SPOT on pleural fluid (PF) were determined and analysed. Logistic regression analysis was performed to obtain the independent risk factors for TPE, and evaluated the performance of the T-SPOT assay stratified by risk factors in comparison to ADA. RESULTS: A total of 601 individuals were consecutively recruited. The maximum spot-forming cells (SFCs) of early secretory antigenic target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) in the PF T-SPOT assay had the best diagnostic efficiency in our study, which was equal to ADA (0.885 vs 0.887, P = 0.957) and superior to peripheral blood (PB), with a sensitivity of 83.0% and a specificity of 83.1% (The cut-off value was 466 SFCs/106 mononuclear cells). Among the TPE patients with low ADA (< 40 IU/L), the sensitivity and specificity of PF T-SPOT were still 87.9 and 90.5%, respectively. The utility of ADA was negatively related to increasing age, but the PF T-SPOT test had a steady performance at all ages. Age (< 45 yrs.; odds ratio (OR) = 5.61, 95% confidence interval (CI) 3.59-8.78; P < 0.001), gender (male; OR = 2.68, 95% CI 1.75-2.88; P < 0.001) and body mass index (BMI) (< 22; OR = 1.93, 95% CI 1.30-2.88; P = 0.001) were independently associated with the risk of TB by multivariate logistic regression analysis. Notably, when stratified by risk factor, the sensitivity of PF T-SPOT was superior to the sensitivity for ADA (76.5% vs. 23.5%, P = 0.016) and had noninferior specificity (84.4% vs. 96.9%, P = 0.370). CONCLUSIONS: In conclusion, the PF T-SPOT assay can effectively discriminate TPE patients whose ADA is lower than 40 IU/L and is superior to ADA in unconventional TPE patients (age ≥ 45 yrs., female or BMI ≥ 22). The PF T-SPOT assay is an excellent choice to supplement ADA to diagnose TPE.


Assuntos
Adenosina Desaminase/análise , Testes Diagnósticos de Rotina/métodos , Testes de Liberação de Interferon-gama/métodos , Mycobacterium tuberculosis/genética , Derrame Pleural/diagnóstico , Derrame Pleural/epidemiologia , Tuberculose Pleural/diagnóstico , Tuberculose Pleural/epidemiologia , Adenosina Desaminase/sangue , Adulto , Idoso , Pequim/epidemiologia , Exsudatos e Transudatos/química , Exsudatos e Transudatos/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Derrame Pleural/microbiologia , Prevalência , Estudos Prospectivos , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade , Escarro/química , Escarro/microbiologia , Tuberculose Pleural/microbiologia
2.
Khirurgiia (Mosk) ; (1): 22-26, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395508

RESUMO

OBJECTIVE: To compare the efficacy of chemical pleurodesis with talc and trichloroacetic acid during thoracoscopy. MATERIAL AND METHODS: Thoracoscopy with pleural biopsy was performed in 355 (83.5%) out of 424 patients with pleural effusion. Pleurodesis was ensured by intraoperative insufflation of talc powder (n=135) and application of 33% trichloroacetic acid solution to parietal and visceral pleura (n=19) in patients with malignant (125), inflammatory (6), post-traumatic (4), tuberculous (3), pancreatogenic (8) and hepatogenic (8) effusions. Drainage tubes were removed if daily drainage output volume was less than 100 ml or complete lung inflation was observed. RESULTS: Post-pleurodesis drainage took 7.1±5.4 days. Two patients developed bumpy rashes that were initially interpreted as carcinomatosis. However, these rashes were later identified as tuberculosis. Retrospectively, these patients were not good candidates for pleurodesis. Pleurodesis with talc suppressed exudation in 89.6% of cases. Complications developed in 4 cases (3%): pneumonia (1) and pleural empyema (3). These complications were associated with a violation of technical procedure of pleurodesis, i.e. procedure in rigid lung, atelectasis (1) and bronchopleural fistula (2). Mean duration of drainage after trichloroacetic acid-induced pleurodesis was 7.9±6.7 days. This procedure was effective in 84.2% of cases, and there were no complications. There are no previous reports on the use of this pleurodesis technique in the literature. Mean duration of drainage after talc-induced pleurodesis was decreased up to 6.9±5.4 days in patients with malignant pleural effusion (p<0.05), after trichloroacetic acid-induced pleurodesis - up to 7.5±8.1 days (p>0.05) compared to patients without pleurodesis (9.1±11.2 days). CONCLUSION: Pleurodesis with talc or trichloroacetic acid during thoracoscopy is effective for pleural effusions following malignancies, liver, kidney and cardiac diseases with decompensation. Essential requirements are adequate lung inflation, no atelectasis and bronchopleural fistula.


Assuntos
Derrame Pleural , Pleurisia , Pleurodese/métodos , Soluções Esclerosantes , Talco , Ácido Tricloroacético , Administração Tópica , Exsudatos e Transudatos , Humanos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/terapia , Pleurisia/etiologia , Pleurisia/terapia , Estudos Retrospectivos , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/efeitos adversos , Talco/administração & dosagem , Talco/efeitos adversos , Toracoscopia , Ácido Tricloroacético/administração & dosagem , Ácido Tricloroacético/efeitos adversos
3.
BMJ Case Rep ; 13(12)2020 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-33376090

RESUMO

Autoimmune hepatitis (AIH) is an autoimmune liver disease characterised by the presence of autoantibodies including antinuclear antibodies, anti-smooth muscle antibody and hypergammaglobulinaemia. Systemic lupus erythematosus (SLE) is a systemic disease that can affect multiple organs. Coexistence of AIH and SLE as an overlap syndrome occurs in about 1%-2.6% of the AIH cases. Since both conditions share common autoimmune features, their coexistence can pose a diagnostic dilemma which can result in a delay in treatment. We present here a challenging case of a middle-aged woman with AIH in remission who later developed new-onset fatigue, pleural effusion and splenomegaly.


Assuntos
Autoanticorpos/sangue , Hepatite Autoimune , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico , Derrame Pleural , Esplenomegalia , Biópsia/métodos , Comorbidade , Diagnóstico Diferencial , Progressão da Doença , Feminino , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/epidemiologia , Hepatite Autoimune/imunologia , Hepatite Autoimune/terapia , Humanos , Fígado/patologia , Testes de Função Hepática/métodos , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/terapia , Linfadenopatia/diagnóstico , Linfadenopatia/etiologia , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Esplenomegalia/diagnóstico por imagem , Esplenomegalia/etiologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Khirurgiia (Mosk) ; (12): 59-63, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33301255

RESUMO

OBJECTIVE: To analyze the mechanisms and severity of endothelial dysfunction in patients with pleural effusion of various origins using skin thermometry. MATERIAL AND METHODS: We studied microcirculation in 135 patients with pleural effusions of various origins. Local skin thermometry and computer wavelet analysis were performed in 3-5 days after thoracoscopy with pleural biopsy using Microtest-100WF device with a temperature measuring resolution of 0.001°C. We estimated endothelial, myogenic and neurogenic indices using spectral analysis of skin temperature fluctuations in a range 0.0095-2 Hz. The control group comprised 40 healthy participants aged 23-36 years. RESULTS: Three groups of patients were distinguished depending on the cause of effusion: malignant pleural effusions (n=65, 48.1%); inflammatory pleural effusions (para-pneumonic, post-traumatic, pancreatogenic, tuberculous) (n=58, 43%); transudates (hepatogenic, cardiogenic, and nephrogenic) (n=12, 8.9%). There were no significant differences in vascular tone in response to local heating of the second finger of the hand up to 40°C. Measurements were carried out within 10 min in all groups. Patients with diabetes mellitus and cardiovascular diseases (n=48, 35.6%) had significant decrease of thermal vasodilation index in endothelial range up to 2.93±1.77, in the control group - up to 4.21±2.40 (p=0.041). CONCLUSION: Endothelial dysfunction is a universal non-specific aspect in pathogenesis of various diseases. This process is essential in pleural effusion. Local thermometry and computer wavelet analysis revealed no significant differences between patients with malignant, inflammatory and transudative pleural effusions. Pleural effusions in the context of cardiovascular pathology and/or diabetes mellitus occur due to impaired vasodilatation mechanisms in endothelial range.


Assuntos
Endotélio Vascular/fisiopatologia , Derrame Pleural , Pele/irrigação sanguínea , Termometria , Doenças Vasculares/diagnóstico , Adulto , Biópsia , Humanos , Microcirculação/fisiologia , Pleura/irrigação sanguínea , Pleura/patologia , Pleura/cirurgia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Toracoscopia , Doenças Vasculares/fisiopatologia , Adulto Jovem
5.
Pan Afr Med J ; 37: 43, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33209170

RESUMO

The occurrence of haemorrhagic pleurisy in patients with myeloma is most often related to a non-specific cause. Pleural myeloma is rare but this diagnosis should be excluded. We here report a rare case of haemorrhagic pleurisy due to the loosening of an osteosynthesis screw. The study involved a 55-year-old female patient who had been followed up for multiple myeloma since 2012. Diagnosis was confirmed by the presence of haemorrhagic pleural effusion, by chest computerized tomography scan which showed the loosening of left-sided osteosynthesis screw with tip located in the prevertebral region at the level of the pleural effusion and by negative etiological assesment.


Assuntos
Parafusos Ósseos , Mieloma Múltiplo/diagnóstico , Derrame Pleural/diagnóstico , Pleurisia/diagnóstico , Falha de Equipamento , Feminino , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Pleurisia/etiologia , Tomografia Computadorizada por Raios X
6.
BMC Infect Dis ; 20(1): 840, 2020 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-33183269

RESUMO

BACKGROUND: Etiological diagnosis of tuberculous pleuritis is challenging, owing to a paucity of Mycobacterium tuberculosis (MTB) in the affected region. Moreover, currently available methods, such as the detection of acid-fast bacilli and microbiological culture, are not always conducive to timely diagnosis and treatment. In this study, we evaluated the performance of Xpert® MTB/RIF assay (hereinafter referred to as "Xpert") in detecting MTB in difficult-to-diagnose patients using suspensions of pleural biopsy tissue specimens obtained under direct thoracoscopic guidance. METHODS: One hundred and sixty patients with an unexplained pleural effusion were included from the Shenyang Tenth People's Hospital and Shenyang Chest Hospital, China, between 2017 and 2018. The included patients underwent thoracoscopy under local anesthesia, with an intercostal incision of approximately 1.0 cm for biopsy. The biopsy specimens were used for pathological and etiological examinations. The Xpert test was evaluated for its sensitivity and specificity, as well as positive and negative predictive values (PPV and NPV, respectively), against data obtained using standards: the BACTEC™ MGIT™ 960 liquid culture system and a composite reference standard (CRS). RESULTS: The sensitivity and specificity of Xpert were 68.8 and 64.6%, respectively, against the MGIT 960 culture data. The PPV and NPV of Xpert were 56.4 and 75.6%, respectively. The sensitivity of Xpert was 69.0% against the CRS data, which was significantly higher than that of MGIT 960 culture (56.6%). The PPV and NPV of Xpert against the CRS data were 100.0 and 57.3%, respectively. CONCLUSIONS: Xpert is a good rule-in test but has limited value as a rule-out test for the diagnosis of tuberculosis pleuritis.


Assuntos
Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico/métodos , Cavidade Pleural/patologia , Pleurisia/diagnóstico , Toracoscopia/métodos , Tuberculose Pleural/diagnóstico , Adolescente , Adulto , Idoso , Biópsia , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/microbiologia , Pleurisia/epidemiologia , Pleurisia/microbiologia , Sensibilidade e Especificidade , Tuberculose Pleural/epidemiologia , Tuberculose Pleural/microbiologia , Adulto Jovem
7.
Sarcoidosis Vasc Diffuse Lung Dis ; 37(2): 225-230, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33093787

RESUMO

Objective: Immunoglobulin G4-related disease (IgG4-RD) is a recently described systemic disorder. Pleural effusion is considered an uncommon manifestation of the disease. We describe a case series of patients with IgG4-RD and clinically significant pleural effusions. Methods: A retrospective analysis of patients with histologically proven IgG4-RD treated for pleural effusion in our clinic. Results: We identified 4 male patients with pleural effusion caused by IgG4-RD. The effusions were lymphocytic exudates, with especially high protein concentrations. All patients had hyperglobulinemia, elevated serum immunoglobulin G (IgG) levels and elevated levels subclasses IgG1 and IgG4. In two patients, levels of adenosine deaminase (ADA) were measured in the effusion and were elevated (309 and 108 IU/L). Tuberculosis was excluded in both cases by pleural biopsy. Involvement of other organs by IgG4-RD was the rule, especially thoracic lymphadenopathy which was prominent in all patients. In all cases, effusion responded to corticosteroids therapy. One patient developed radiological findings compatible with rounded atelectasis during remission. Conclusions: IgG4-RD may cause an ADA-positive, lymphocytic exudate with a high protein concentration, characteristics resembling tuberculous effusion. Thoracic lymphadenopathy, hyperglobulinemia, and an increased total IgG, IgG1, IgG4 may suggest the diagnosis. Not previously described, IgG4-RD pleural inflammation may result in rounded atelectasis. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 225-230).


Assuntos
Adenosina Desaminase/metabolismo , Doença Relacionada a Imunoglobulina G4/enzimologia , Linfócitos/enzimologia , Derrame Pleural/enzimologia , Corticosteroides/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Biópsia , Diagnóstico Diferencial , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Doença Relacionada a Imunoglobulina G4/imunologia , Contagem de Linfócitos , Linfócitos/efeitos dos fármacos , Linfócitos/imunologia , Masculino , Derrame Pleural/diagnóstico , Derrame Pleural/tratamento farmacológico , Derrame Pleural/imunologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Ann Palliat Med ; 9(5): 3710-3715, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33065808

RESUMO

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified strain of coronavirus in the human body and was reported in Wuhan at the end of 2019. So far, the epidemic is continuing and very serious, with the number of infections and deaths increasing. Despite active investigations around the world to better understand the dynamics of transmission and the scope of clinical disease, COVID-19 continues to spread rapidly from person to person. The common signs and symptoms of SARS-CoV-2 infection include fever, fatigue, dry cough, and dyspnea; in severe cases, patients may have acute respiratory distress syndrome, septic shock, metabolic acidosis difficult to treat and coagulation disorder. However, some patients who test positive for SARS-CoV-2 in their respiratory tract may not have such clinical signs and symptoms. This report presents a case study analysis of a patient admitted in the Fourth Taiyuan People's Hospital, who had suffered traumatic injuries from a car accident and survived COVID-19, with pleural effusion as the initial symptom. We report a case of 2019-NCOV with pleural effusion as the first symptom. Describe in detail the differential diagnosis, diagnosis, clinical management, and cure of this case. In order to combat the novel CoronaviruscoVID-19 in the process to provide lessons and help.


Assuntos
Acidentes de Trânsito , Infecções por Coronavirus/diagnóstico , Traumatismo Múltiplo/diagnóstico , Derrame Pleural/diagnóstico , Pneumonia Viral/diagnóstico , Adulto , Betacoronavirus , Otorreia de Líquido Cefalorraquidiano/complicações , Otorreia de Líquido Cefalorraquidiano/diagnóstico , Infecções por Coronavirus/complicações , Progressão da Doença , Sinusite Etmoidal/complicações , Sinusite Etmoidal/diagnóstico , Feminino , Traumatismos do Pé/complicações , Traumatismos do Pé/diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Fraturas Maxilares/complicações , Fraturas Maxilares/diagnóstico , Seio Maxilar/lesões , Traumatismo Múltiplo/complicações , Fraturas Orbitárias/complicações , Pandemias , Derrame Pleural/etiologia , Pneumonia Viral/complicações , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico , Falanges dos Dedos do Pé/lesões , Tomografia Computadorizada por Raios X , Fraturas da Ulna/complicações , Fraturas da Ulna/diagnóstico
11.
Sci Rep ; 10(1): 15222, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938981

RESUMO

Pleural effusion is very common, but an etiologic diagnosis is often difficult. We used three unconventional diagnostic techniques (voltammetric analysis, protein electrophoresis and pH measurement) performed on pleural effusion to do a preliminary distinction between a neoplastic and a non-neoplastic origin. Pleural fluid samples were collected through thoracentesis, thoracoscopy, or post-surgery pleural drainage of 116 patients admitted to acute care wards. Samples were analyzed with the three unconventional techniques: voltammetric analysis using the BIONOTE system, capillary electrophoresis and pH measurement using a potentiometric method. The BIONOTE system is an innovative system that performs a cyclic voltammetric analysis of a biological liquid sample. The final output of the electrochemical analysis is an electrical pattern that represents a fingerprint of the analyzed sample and each sample has a different fingerprint. Data from the three unconventional diagnostic techniques were analyzed using partial least squares discriminant analysis to discriminate neoplastic from non-neoplastic effusions; we also evaluated sensitivity, specificity and percentage of correct classification. The mean age was 68 years (SD: 12); 78 (67.24%) participants were men. Results obtained from all the unconventional techniques employed showed that neoplastic and non-neoplastic pleural effusions were correctly classified in 80.2% of cases, with a sensitivity of 77% and specificity of 83%. The combined use of voltammetric analysis, protein electrophoresis and pH measurement of pleural fluid can easily and quickly distinguish a neoplastic from a non-neoplastic pleural effusion with reliable accuracy and represents an innovative diagnostic approach. In fact, this protocol can be executed in just few minutes directly in the patient's bed and it holds great promise to improve the prognosis and therapeutic chances.


Assuntos
Derrame Pleural/diagnóstico , Proteínas/metabolismo , Toracentese/métodos , Toracoscopia/métodos , Idoso , Idoso de 80 Anos ou mais , Drenagem , Eletroforese , Feminino , Humanos , Concentração de Íons de Hidrogênio , Análise dos Mínimos Quadrados , Masculino , Pessoa de Meia-Idade , Derrame Pleural/metabolismo , Derrame Pleural/patologia , Derrame Pleural/cirurgia , Estudo de Prova de Conceito , Estudos Prospectivos , Sensibilidade e Especificidade
12.
Asian Cardiovasc Thorac Ann ; 28(9): 560-565, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32741198

RESUMO

BACKGROUND: Differentiation between benign and malignant exudative pleural effusion remains a clinical challenge. Recently, several markers have been reported to increase the diagnostic accuracy of malignant pleural effusion, with controversial results. METHODS: Patients with exudative pleural effusion were divided into 2 groups: a malignant pleural effusion group (39 patients) diagnosed by malignant cells in pleural fluid cytology or by malignant infiltration of the pleura on pleural biopsy, and a benign pleural effusion group (51 patients) with neither malignant cells in pleural fluid cytology nor malignant infiltration of the pleura on pleural biopsy. Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 were determined in both serum and pleural fluid samples, using commercially available enzyme-linked immunosorbent assay kits. RESULTS: The etiology of malignant pleural effusion in the malignant group was breast cancer in 43.6% and bronchogenic carcinoma in 25.6%. There was a statistically significant difference between the 2 groups regarding sex, with more males in the benign group. There was no significant difference between groups regarding age. The median levels of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 were higher in the malignant group than in the benign group, and the differences were highly significant in both pleural fluid (p < 0.001) and serum (p < 0.001). CONCLUSION: Matrix metaloproteinase-9 and tissue inhibitor of metalloproteinase-1 in serum and pleural fluid samples might be valuable markers for differentiating benign from malignant pleural effusions.


Assuntos
L-Lactato Desidrogenase/sangue , Metaloproteinase 9 da Matriz/sangue , Derrame Pleural Maligno/diagnóstico , Derrame Pleural/diagnóstico , Inibidor Tecidual de Metaloproteinase-1/sangue , Adulto , Biomarcadores/sangue , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/sangue , Derrame Pleural Maligno/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Toracentese
13.
Sci Rep ; 10(1): 11856, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32678248

RESUMO

Dengue induces a spectrum of severity in humans from the milder dengue fever to severe disease, or dengue hemorrhagic fever (DHF). Chymase is a candidate biomarker that may aid dengue prognosis. This prospective study aimed to identify whether warning signs of severe dengue, including hypovolemia and fluid accumulation, were associated with elevated chymase. Serum chymase levels were quantified prospectively and longitudinally in hospitalized pediatric dengue patients in Sri Lanka. Warning signs were determined based on daily clinical assessments, laboratory tests and ultrasound findings. Chymase was significantly elevated during the acute phase of disease in DHF or Severe dengue, defined by either the 1997 or 2009 WHO diagnosis guidelines, and persisted longer in the most severe patients. Chymase levels were higher in patients with narrow pulse pressure and clinical warning signs such as severe leakage, fluid accumulation, pleural effusion, gall-bladder wall thickening and rapid haematocrit rise concurrent with thrombocytopenia. No association between chymase and liver enlargement was observed. This study confirms that serum chymase levels are associated with DHF/Severe dengue disease in hospitalized pediatric patients. Chymase levels correlate with warning signs of vascular dysfunction highlighting the possible functional role of chymase in vascular leakage during dengue.


Assuntos
Quimases/sangue , Vírus da Dengue/patogenicidade , Hipovolemia/diagnóstico , Derrame Pleural/diagnóstico , RNA Viral/sangue , Dengue Grave/diagnóstico , Trombocitopenia/diagnóstico , Biomarcadores/sangue , Criança , Pré-Escolar , Vírus da Dengue/genética , Vírus da Dengue/isolamento & purificação , Feminino , Hospitalização , Humanos , Hipovolemia/sangue , Hipovolemia/patologia , Hipovolemia/virologia , Estudos Longitudinais , Masculino , Derrame Pleural/sangue , Derrame Pleural/patologia , Derrame Pleural/virologia , Prognóstico , Estudos Prospectivos , Dengue Grave/sangue , Dengue Grave/patologia , Dengue Grave/virologia , Índice de Gravidade de Doença , Sri Lanka , Trombocitopenia/sangue , Trombocitopenia/patologia , Trombocitopenia/virologia , Carga Viral
14.
Medicine (Baltimore) ; 99(24): e20684, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541516

RESUMO

RATIONALE: Late presenting congenital diaphragmatic hernia (CDH) that develops after the neonatal period has various clinical manifestations and can often be misdiagnosed as pleural effusion, pneumonia, or pneumothorax. We report an adolescent case who was transferred to our hospital after iatrogenic gastric perforation during chest tube thoracotomy caused by misdiagnosis of pleural effusion. PATIENT CONCERNS: A 13-year-old boy with no medical history of conditions relevant to CDH and traumatic events visited a community hospital complaining of left upper quadrant abdominal pain and vomiting over the previous 3 days. The initial chest x-ray looked like pleural effusion at a cursory glance, so a chest tube thoracotomy was performed, upon insertion food-like materials drained through the tube. DIAGNOSIS: CDH and iatrogenic gastric perforation by chest tube were diagnosed by chest computed tomography scan. INTERVENTIONS: The patient was transferred to our hospital immediately, and emergent operation was performed. There was a large hernial defect on the left posterolateral side of the diaphragm and various intra-abdominal organs, including the stomach, had been displaced into the thoracic cavity. After manual reduction, stomach perforation by chest tube was identified. Wedge resection of the gastric perforation site was performed and the hernial defect in the diaphragm was closed with Gore-Tex mesh and nonabsorbable sutures. OUTCOMES: The patient was discharged without complication on the postoperative 15th day. LESSONS: Late presenting CDH can be misdiagnosed as pleural effusion on chest x-ray, so special attention should be given to a differential diagnosis to avoid any serious complications.


Assuntos
Erros de Diagnóstico , Hérnias Diafragmáticas Congênitas/diagnóstico , Derrame Pleural/diagnóstico , Adolescente , Fatores Etários , Humanos , Masculino
15.
CEN Case Rep ; 9(4): 404-408, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32557209

RESUMO

On 31 December 2019, cases of pneumonia whose cause was later identified as SARS-CoV-2 were detected in Wuhan City, Hubei Province of China, and now COVID-19 has spread worldwide. On March 1, 2020, a 69-year-old Japanese man who had been on hemodialysis for 3 years was diagnosed as having COVID-19 pneumonia and hospitalized at our Medical Center. Pulmonary CT revealed bilateral multiple consolidation with bilateral pleural effusion. Aggressive weight reduction was needed to improve the patient's respiratory condition. Hemodialysis therapy was performed in isolation with hydroxychloroquine administration, but the formation of a dialysis membrane clot forced the withdrawal of dialysis therapy. Changing the dialysis membrane material and anticoagulant enabled the resumption of dialysis therapy, allowing the body weight to correct downward. On the 5th hospitalization day, the patient's fever dropped and he showed improved oxygenation and chest X-ray. He was eventually discharged. The hydroxychloroquine and appropriate fluid management may have contributed to the patient's recovery. Clinicians should pay close attention to avoid dialysis-related problems when treating a patient with COVID-19.


Assuntos
Infecções por Coronavirus , Hidroxicloroquina/administração & dosagem , Falência Renal Crônica , Pandemias , Derrame Pleural , Pneumonia Viral , Diálise Renal , Idoso , Anti-Infecciosos/administração & dosagem , Anticoagulantes/uso terapêutico , Terapia Combinada , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Pulmão/diagnóstico por imagem , Masculino , Membranas Artificiais , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Diálise Renal/instrumentação , Diálise Renal/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
16.
Clin Med (Lond) ; 20(4): e62-e65, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32398268

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a highly contagious illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pneumonia and acute respiratory distress syndrome (ARDS) are the most common severe complications. There is growing evidence regarding the imaging findings of COVID-19 in chest X-rays and computed tomography (CT); however, their availability to clinical staff in this pandemic outbreak might be compromised. At this moment, the role of lung ultrasound (LUS) has yet to be explored. The purpose of this case report is to describe the natural course of the disease in mild infection managed at home. CASE REPORT: We report a 35-year-old man with recently diagnosed COVID-19 infection. Clinical examination was unremarkable. The diagnosis of mild disease was made clinically which was later reaffirmed by LUS after identifying a bilateral small pleural effusion and a thickened pleural line. During follow up, subpleural consolidations appeared before symptoms slightly aggravated (cough, tiredness and fever). The patient's condition improved after adjustment of therapy at home. CONCLUSION: LUS is an excellent tool in the characterisation of COVID-19 infection and is more available than CT or X-ray. We emphasise the utility and the opportunity that LUS presents in some clinical scenarios, like this COVID-19 pandemic, and how it may serve as a monitoring and therapy guide.


Assuntos
Infecções por Coronavirus , Serviços de Assistência Domiciliar/organização & administração , Pulmão/diagnóstico por imagem , Pandemias , Derrame Pleural , Pneumonia Viral , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/métodos , Adulto , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Acesso aos Serviços de Saúde , Humanos , Masculino , Monitorização Fisiológica/métodos , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Índice de Gravidade de Doença , Avaliação de Sintomas/métodos , Resultado do Tratamento
17.
Am J Med Sci ; 360(3): 236-242, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32423747

RESUMO

BACKGROUND: The etiology of pleural effusions often remained unknown notwithstanding surgical pleural biopsy and further clinical observation. A better understanding of clinical characteristics of patients with idiopathic pleural effusion (IPE) may improve the ability to differentiate between IPEs and cytology-negative malignant pleural effusions (MPEs) and facilitate the identification of patients requiring invasive investigation. However, little is known about the clinical factors that can help distinguish patients with IPE from those with cytology-negative MPE. MATERIALS AND METHODS: Patients who were diagnosed with IPE or cytology-negative MPE between 2010 and 2017 were enrolled in this retrospective study. Clinical, laboratory and radiologic characteristics were compared between patients with IPE and cytology-negative MPE. Diagnostic performances of predictors for IPE were assessed using receiver operating characteristic curves. RESULTS: Of 146 patients undergoing pleural biopsy owing to cytology-negative pleural effusion of uncertain cause, MPE was confirmed in 54 patients. IPE was ultimately diagnosed in 22 patients. Multivariate analysis demonstrated that a minimal amount of pleural effusion (odds ratio [OR] = 12.41, P = 0.039), presence of pleural nodularity (OR = 0.01, P < 0.001) and pleural fluid carcinoembryonic antigen levels less than 14 ng/mL (OR = 87.59, P = 0.002) were independent factors for distinguishing IPEs from cytology-negative MPEs. A combination of the absence of pleural nodularity with pleural fluid carcinoembryonic antigen levels less than 14 ng/mL yielded an area under the curve of 0.94 (sensitivity = 91% and specificity = 96%). CONCLUSIONS: Using these readily available parameters to identify IPE in patients with cytology-negative exudative effusion of unknown cause can help guide decision-making when choosing to perform an invasive pleural biopsy or to take a conservative approach.


Assuntos
Derrame Pleural Maligno/diagnóstico , Derrame Pleural/diagnóstico , Idoso , Biópsia , Antígeno Carcinoembrionário/análise , Diagnóstico Diferencial , Exsudatos e Transudatos/química , Exsudatos e Transudatos/citologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/patologia , Derrame Pleural Maligno/patologia , Curva ROC , Radiografia Torácica , Estudos Retrospectivos , Toracentese , Toracoscopia , Tomografia Computadorizada por Raios X
18.
Medicine (Baltimore) ; 99(14): e19625, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243388

RESUMO

Patients with both serous effusion and eosinophilia are rarely reported and geographically distributed; their early diagnosis is difficult.According to the ultimate diagnosis, patients (≤14 years) in West China Second hospital with serous effusion and eosinophilia were divided into two groups including a parasitic group and a non-parasitic group. Clinical data were collected and analyzed between the two groups. Subsequently, significant measurement indicators were evaluated by receiver operating characteristic (ROC) curve to explore the optimal cut-off points for the most appropriate sensitivity and specificity.A total of 884 patients were diagnosed with serous effusion and 61 of them displayed co-morbidity with eosinophilia during enrolled time. Among 61 patients, 34 patients had parasitic infection and 27 had non-parasitic diseases. There were statistical difference in effusion position, the levels of white blood cell count (WBC), eosinophil (EOS), EOS%, C-reactive protein (CRP) between parasitic group and non-parasitic group. ROC curve demonstrated that the areas under the curve of EOS count and EOS% were >80%, and the corresponding optimal cut-off values were 1.71 × 10/L and 25.6% for distinguishing between parasitic and non-parasitic infections in our patients.This study provided a quantified index for potentially quick and convenient indicators of pediatric patients presenting with both eosinophilia and effusion. Eosinophils were helpful to improve the initial diagnosis with awareness of parasitic diseases. For the cases with EOS > 1.71 × 10/L or EOS% > 25.6%, parasitic infection should be considered and serological tests are recommended in our region.


Assuntos
Doenças Parasitárias/diagnóstico , Derrame Pleural/diagnóstico , Eosinofilia Pulmonar/diagnóstico , Proteína C-Reativa/análise , Criança , Pré-Escolar , China , Diagnóstico Diferencial , Diagnóstico Precoce , Eosinófilos/metabolismo , Feminino , Humanos , Pacientes Internados , Contagem de Leucócitos , Masculino , Doenças Parasitárias/sangue , Doenças Parasitárias/complicações , Derrame Pleural/sangue , Derrame Pleural/parasitologia , Eosinofilia Pulmonar/sangue , Eosinofilia Pulmonar/parasitologia , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
19.
Am J Case Rep ; 21: e922195, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32307403

RESUMO

BACKGROUND Pancreaticopleural fistula is a rare complication of chronic pancreatitis. Its formation is associated with local disruption of the pancreatic duct or pseudocyst communicating with the ductal system. Rarely, other intrathoracic complications may develop such as mediastinitis, pericarditis, hemothorax, and pleural empyema. The combination of pancreaticopleural fistula with lung abscesses is extremely rare. CASE REPORT A 37-year-old male patient, a long-term alcohol abuser, was admitted with complaints on left thoracic and upper abdominal pain, fever with a body temperature of 39.1°C, and a severe cough with purulent sputum. Left-sided pneumonia with pleural effusion was diagnosed. Thoracentesis and then a pleural drainage were performed. However, the symptoms persisted. Pleural effusion amylase was very high - more than 60 000 IU/L. Computed tomography and magnetic resonance imaging revealed cystic changes in the pancreatic head, pseudocyst in the pancreatic body, dilation of the Wirsung duct, and pancreaticopleural fistula with several left lung abscesses. Step by step, the patient underwent drainage of lung abscesses, external drainage of the pancreatic pseudocyst, and external-internal stenting of the pancreatic duct under ultrasound guidance. After fistula resolution, the patient was readmitted and successfully underwent the Bern variant of the Beger procedure. Six months later, he had no complaints and returned to work. In a follow-up examination, there was no fistula, no ductal hypertension, and only small pulmonary residual changes. CONCLUSIONS A very rare case of chronic pancreatitis complicated by pancreaticopleural fistula with lung abscesses is presented. The clinical outcome was good due to the staged character of treatment and participation of a multidisciplinary specialist team.


Assuntos
Abscesso Pulmonar/diagnóstico , Fístula Pancreática/diagnóstico , Pancreatite Crônica/complicações , Derrame Pleural/diagnóstico , Adulto , Drenagem , Humanos , Abscesso Pulmonar/terapia , Masculino , Pâncreas/cirurgia , Ductos Pancreáticos/cirurgia , Fístula Pancreática/cirurgia , Pancreatite Crônica/cirurgia , Derrame Pleural/terapia
20.
Sci Rep ; 10(1): 5679, 2020 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-32231227

RESUMO

Discriminating between malignant pleural effusion (MPE) and benign pleural effusion (BPE) remains difficult. Thus, novel and efficient biomarkers are required for the diagnosis of pleural effusion (PE). The aim of this study was to validate calprotectin as a diagnostic biomarker of PE in clinical settings. A total of 425 patients were recruited, and the pleural fluid samples collected had BPE in 223 cases (53.7%) or MPE in 137 patients (33%). The samples were all analysed following the same previously validated clinical laboratory protocols and methodology. Calprotectin levels ranged from 772.48 to 3,163.8 ng/mL (median: 1,939 ng/mL) in MPE, and 3,216-24,000 ng/mL in BPE (median: 9,209 ng/mL; p < 0.01), with an area under the curve of 0.848 [95% CI: 0.810-0.886]. For a cut-off value of ≤ 6,233.2 ng/mL, we found 96% sensitivity and 60% specificity, with a negative and positive predictive value, and negative and positive likelihood ratios of 96%, 57%, 0.06, and 2.4, respectively. Multivariate analysis showed that low calprotectin levels was a better discriminator of PE than any other variable [OR 28.76 (p < 0.0001)]. Our results confirm that calprotectin is a new and useful diagnostic biomarker in patients with PE of uncertain aetiology which has potential applications in clinical practice because it may be a good complement to cytological methods.


Assuntos
Complexo Antígeno L1 Leucocitário/análise , Derrame Pleural Maligno/diagnóstico , Derrame Pleural/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores Tumorais/análise , Diagnóstico Diferencial , Feminino , Humanos , Complexo Antígeno L1 Leucocitário/metabolismo , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espanha/epidemiologia
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