Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.759
Filtrar
1.
Curr Med Sci ; 39(5): 778-783, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612396

RESUMO

Laparoscopic hepatectomy (LH) is a newly developed technique associated with advantages as open surgery, but the study on outcome of liver function recovery was scarce. This preliminary report was aimed to comparatively assess the short-term outcomes between LH and open hepatectomy (OH) for primary hepatocellular carcinoma (PHC). This study retrospectively analyzed the demographic data and short-term outcomes of 81 patients who underwent LH or OH for the primary treatment of PHC between Oct. 2017 and May 2018 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (China). A total of 81 PHC patients who received major liver resection were enrolled. There were 38 (47%) patients in the LH group and 43 (53%) patients in the OH group. The operative time was significantly longer (373.53±173.38 vs. 225.43±55.08, P<0.01), and hospital stay (17.34±5.93 vs. 21.70±6.89, P=0.003), exhaust time (2.32±0.62 vs. 3.07±0.59, P<0.01) and defecation time (2.92±0.78 vs. 3.63±0.58, P<0.01) were significantly shorter in LH group than in OH group. The recovery of liver function was significantly faster in LH group, including higher serum albumin (P=0.002), higher ratio of albumin/globulin (P=0.029) and lower direct bilirubin (P=0.001) than in OH group. It is suggested that LH can serve as a fast recovery and cheap surgical procedure in the treatment of PHC, which is safe and feasible.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Adulto , Ascite/diagnóstico , Ascite/etiologia , Ascite/patologia , Bilirrubina/sangue , Carcinoma Hepatocelular/patologia , Feminino , Hepatectomia/instrumentação , Humanos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Albumina Sérica/metabolismo , Soroglobulinas/metabolismo , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/patologia , Fatores de Tempo , Resultado do Tratamento
2.
Int J Mol Sci ; 20(20)2019 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-31614900

RESUMO

Thrombin is an essential procoagulant and profibrotic mediator. However, its implication in tuberculous pleural effusion (TBPE) remains unknown. The effusion thrombin and plasminogen activator inhibitor-1 (PAI-1) levels were measured among transudative pleural effusion (TPE, n = 22) and TBPE (n = 24) patients. Pleural fibrosis, identified as radiological residual pleural thickening (RPT) and shadowing, was measured at 12-month follow-up. Moreover, in vivo and in vitro effects of thrombin on PAI-1 expression and mesothelial-mesenchymal transition (MMT) were assessed. We demonstrated the effusion thrombin levels were significantly higher in TBPE than TPE, especially greater in TBPE patients with RPT > 10mm than those without, and correlated positively with PAI-1 and pleural fibrosis area. In carbon black/bleomycin-treated mice, knockdown of protease-activated receptor-1 (PAR-1) markedly downregulated α-smooth muscle actin (α-SMA) and fibronectin, and attenuated pleural fibrosis. In pleural mesothelial cells (PMCs), thrombin concentration-dependently increased PAI-1, α-SMA, and collagen I expression. Specifically, Mycobacterium tuberculosis H37Ra (MTBRa) induced thrombin production by PMCs via upregulating tissue factor and prothrombin, and PAR-1 silencing considerably abrogated MTBRa-stimulated PAI-1 expression and MMT. Consistently, prothrombin/PAR-1 expression was evident in the pleural mesothelium of TBPE patients. Conclusively, thrombin upregulates PAI-1 and MMT and may contribute to tuberculous pleural fibrosis. Thrombin/PAR-1 inhibition may confer potential therapy for pleural fibrosis.


Assuntos
Inibidor 1 de Ativador de Plasminogênio/metabolismo , Pleura/patologia , Receptor PAR-1/metabolismo , Trombina/metabolismo , Tuberculose/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Modelos Animais de Doenças , Exsudatos e Transudatos/metabolismo , Feminino , Fibrose , Seguimentos , Humanos , Masculino , Mesoderma/efeitos dos fármacos , Mesoderma/crescimento & desenvolvimento , Camundongos , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade , Mycobacterium tuberculosis/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Derrame Pleural/metabolismo , Derrame Pleural/patologia , Transdução de Sinais , Tuberculose/patologia , Adulto Jovem
3.
BMC Immunol ; 20(1): 36, 2019 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623558

RESUMO

BACKGROUND: A previous study demonstrated pleural fluid (PF) IgA immunodominance for the fused MT10.3:MPT64 protein in pleural tuberculosis (PLTB) cases. However, no clue on the role of IgA and IgG against this and other antigens in PF and serum concerning improved diagnosis is available. Thus, the aim of the present study was to validate PF IgA-MT10.3:MPT64 and evaluate PF and serum IgA and IgG reactivity against this protein, its peptides (F2) and single MPT64, MT10.3 and the PPE59 mycobacterial specific antigens. IgA and IgG ELISA were measured against the antigen in PLTB (n = 29) and other non-TB pleurisy (n = 39) patient samples. RESULTS: The immunodominance of PF IgA-MT10.3:MPT64 was confirmed in PLTB (86.2%) followed by PPE59 (62%), while serum IgA-F2 exhibited 51.7% sensitivity. PF and serum IgG-MT10.3:MPT64 led to 65.5 and 51.7% sensitivity, respectively. However, MT10.3 and MPT64 displayed overall lower sensitivity (≤34.5) for both antibodies. All results at 95% fixed specificity. Combinatory results indicated 93.1% sensitivity for PF IgA-MT10.3:MPT64/-PPE59 and IgA/IgG-MT10.3:MPT64 at 92.3% specificity, followed by IgA-MT10.3:MPT64/-MPT64 or /-F2 (89.6%) without jeopardizing specificity (94.9%). The combinatory results of the PF adenosine deaminase test (ADA) and IgA-MT10.3:MPT64/-F2 demonstrated the highest sensitivity (96.6%), with a specificity of 92.3%. CONCLUSIONS: The PF IgA-MT10:MPT64 immune dominance was validated in PLTB, and its combinatory results with PPE59 or MPT64 or F2 antigens as well as with IgG, are reported herein for the first time, improving their potential to assist diagnosis. Combining PF-ADA and IgA-MT10.3:MPT64/-F2 results achieved better accuracy. Moreover, serum IgG, although less accurate, displays potential beyond microbiological tests.


Assuntos
Anticorpos Antibacterianos/imunologia , Antígenos de Bactérias/imunologia , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Mycobacterium tuberculosis/imunologia , Derrame Pleural/imunologia , Tuberculose Pleural/imunologia , Biomarcadores , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Derrame Pleural/patologia , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tuberculose Pleural/sangue , Tuberculose Pleural/diagnóstico
4.
Chirurgia (Bucur) ; 114(4): 506-511, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511140

RESUMO

We present the case of a 49 years-old female treated 10 years ago for a breast cancer (mastectomy followed by radio- and chemotherapy), referred to our unit for a recurrent pleural effusion with no response to medical treatment (pleural liquid - total proteins 4,1 g%, glucose 100 mg%, LDH 493 U/l, abundant cellularity with 30% eosinophils but no obvious neoplastic cells). The CT examination showed a loculated pleural effusion and a thickened irregular pleura, raising the suspicion of malignancy. Intraoperatively we found a loculated effusion - Fraser Gourd decortication and 7 subpleural pulmonary tumors with a diameter between 0,5 and 5 cm which we considered to be pulmonary metastases and performed non-anatomical resections with pulmonary reconstruction. The postoperative course was favourable, with discharge on postoperative day 16.The pathologic examination showed an inflammatory infiltrated pleura with no atypia and pulmonary infarction in all the 7 pulmonary resection specimens. Standard coagulation tests were normal but a detailed analysis of the coagulation status was not available, while postoperative cardiac and peripheric venous ultrasound did not show any abnormality explaining the pulmonary infarction. After the definitive diagnosis, the patient was treated with antiaggregants and dicumarinic oral anticoagulation, the later being abandoned due to poor compliance. At the 26 months follow-up the patient showed no signs of recurrence but she died at 32 months after surgery due to a stroke. The case is interesting due to the illustration of the diagnostic difficulties encountered in the oncological patients with pleural effusions; considering this case as "inoperable" would have resulted in anuseless chemotherapy and progression towards a more severe pleuro-pulmonary suppuration.


Assuntos
Neoplasias da Mama/terapia , Derrame Pleural/patologia , Infarto Pulmonar/terapia , Neoplasias da Mama/complicações , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Derrame Pleural/etiologia , Derrame Pleural/terapia , Infarto Pulmonar/etiologia , Resultado do Tratamento
5.
Anticancer Res ; 39(9): 4891-4896, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519592

RESUMO

BACKGROUND/AIM: Epithelioid haemangioendothelioma (EHE) is a rare tumor with a wide spectrum of clinical behavior. There is no consensus on the role of local therapy in symptomatic, multi-focal disease. PATIENTS AND METHODS: A retrospective review of patients presenting to the Royal Marsden Hospital between January 2000 and December 2017 was conducted. RESULTS: Fifty-three patients with EHE were identified, of which 18 patients (34.0%) received local therapy, and 11 patients (20.8%) underwent active surveillance. A variety of local treatment modalities were used with few toxicities, and local recurrence was managed with other local treatments or systemic therapy. Distal disease progression was infrequent (n=4, 7.5%). Patients who developed pleural effusion (n=5, 9.4%) had poor outcome irrespective of treatment. CONCLUSION: Local therapy has a role in a selected patient group managed in a multidisciplinary setting, including patients with indolent disease, and patients with a solitary area of progression/symptomatic disease.


Assuntos
Hemangioendotelioma Epitelioide/patologia , Hemangioendotelioma Epitelioide/terapia , Adolescente , Adulto , Idoso , Terapia Combinada , Gerenciamento Clínico , Feminino , Hemangioendotelioma Epitelioide/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Derrame Pleural/patologia , Prognóstico , Conduta Expectante , Adulto Jovem
6.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414757

RESUMO

BACKGROUND: Detection of carcinoembryonic Antigen (CEA) in pleural effusion has good clinical application value in differentiating benign and malignant pleural effusion, but sometimes CEA provides limited help. We report a case of a patient with left lung neoplasms combined with bilateral pleural effusion with increased CEA in the pleural effusion whose thoracoscopy pleural biopsy pathology was negative, mimicking lung carcinoma and ultimately confirmed as pulmonary sarcomatoid carcinoma by CT-guided percutaneous lung biopsy. METHODS: The chest computed tomography (CT) scan, thoracoscopy pleural biopsy, and CT-guided percutaneous lung biopsy were arranged to explore the etiology of pleural effusion. RESULTS: The chest CT scan showed bilateral pleural effusion with left lung neoplasms, pulmonary atelectasis, and left hilar enlargement. Pathology of thoracoscopy biopsy showed pleural inflammation with infiltration of inflammatory cells. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary sarcomatoid carcinoma. CONCLUSIONS: Elevated pleural effusion CEA is not a specific index of lung cancer. CT-guided percutaneous lung biopsy is appropriate for patients presenting with pleural diseases with lung neoplasms, especially when thoracoscopy pleural biopsy result was negative.


Assuntos
Antígeno Carcinoembrionário/metabolismo , Carcinoma/diagnóstico , Erros de Diagnóstico , Neoplasias Pulmonares/diagnóstico , Pleura/metabolismo , Derrame Pleural/diagnóstico , Idoso , Biópsia , Carcinoma/diagnóstico por imagem , Carcinoma/metabolismo , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pleura/diagnóstico por imagem , Pleura/patologia , Derrame Pleural/metabolismo , Derrame Pleural/patologia , Toracoscopia/métodos , Tomógrafos Computadorizados
7.
Am J Med Sci ; 358(2): 115-120, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31331448

RESUMO

BACKGROUND: Malignant pleural effusion (MPE) occasionally demonstrates neutrophilic predominance, commonly found in parapneumonic pleural effusion (PPE). In comparison with lymphocytic MPE, neutrophilic MPE may have different characteristics associated with a more intense inflammatory response and poor prognosis. These characteristics of neutrophilic MPE may lead to inappropriate management and delayed diagnosis. Moreover, the limited diagnostic yield of microbiologic and cytologic tests makes early differential diagnosis between neutrophilic MPE and PPE more challenging. This study investigated objective laboratory findings to help distinguish neutrophilic MPE from PPE. MATERIALS AND METHODS: A retrospective study was conducted on patients with neutrophilic MPE and PPE. Routine blood and pleural fluid data of the 2 groups were compared, and the diagnostic performances of predictors for neutrophilic MPE were assessed using receiver-operating characteristic curves. RESULTS: Forty-one and 140 patients with neutrophilic MPE and PPE, respectively, were included. In final analysis, serum C-reactive protein, pleural fluid neutrophil-to-lymphocyte ratio, and pleural fluid carcinoembryonic antigen were significantly different between the 2 groups. With cut-off values of C-reactive protein <6.0 mg/dL, neutrophil-to-lymphocyte ratio <3.0 and carcinoembryonic antigen >8.0 ng/mL, the presence of any 2 or more parameters provided an area under the curve of 0.928 (95% CI, 0.851-0.999), yielding a sensitivity of 88%, specificity of 98%, positive predictive value of 92% and negative predictive value of 96% for identifying MPE. CONCLUSIONS: MPE should be considered even in patients with neutrophilic exudative effusion, especially if at least 1 predictor for neutrophilic MPE is present. Our results may help guide differentiation of neutrophilic MPE from PPE.


Assuntos
Líquidos Corporais , Neutrófilos , Derrame Pleural Maligno/sangue , Derrame Pleural/sangue , Idoso , Líquidos Corporais/citologia , Antígeno Carcinoembrionário/análise , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Análise Multivariada , Neutrófilos/química , Neutrófilos/citologia , Derrame Pleural/patologia , Derrame Pleural Maligno/patologia , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
MEDICC Rev ; 21(1): 26-29, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31242149

RESUMO

Pleural effusion is a common condition in critically ill patients (both clinical and surgical). Its diagnosis and classification are important for followup of patients with cardiorespiratory difficulty. Lung ultrasound is used for this purpose, but no reports have been published on its use in Cuba with critically ill patients in intensive care units. We performed lung ultrasound on 144 such patients with cardiorespiratory illnesses, average age 54 years, predominantly men (66%; 95/144), with average APACHE II score 13.6, and 22.1% mortality risk. Patients were divided into two groups: clinical (bronchopneumonia and cardiac insufficiency) and surgical (postoperative liver and kidney transplant or vascular and cardiovascular surgery) to diagnose and classify pleural effusion according to locus (right, left and bilateral) and structural pattern (I, II A, II B, III and IV). Pleural effusions were diagnosed in 81.2% (117/144) of patients (clinical 44.4%, 52/117; surgical 55.6%, 65/117). Bilateral location was the most common (68.4%, 80/117), followed by right (23.9%, 28/117) and then left (7.7%, 9/117). Structural pattern I (anechoic appearance) was observed in 61.5% of cases (72/117); 21.4% (25/117) were II A, 12.8% (15/117) II B, 3.4% (4/117) III, and 0.9% (1/117) were IV. We found no association between pleural effusion localization and ultrasound structural pattern in clinical patients (Fisher exact test 4.2 p = 0.9). In surgical patients, however, complex ultrasound patterns (II A, II B and III) were significantly more common in bilateral forms (Fisher exact test 14.1; p = 0.009). Further studies of this type in Cuba will help provide useful data for prompt treatment and followup of these patients.


Assuntos
Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , APACHE , Estado Terminal , Cuba , Feminino , Humanos , Unidades de Terapia Intensiva , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/classificação , Derrame Pleural/diagnóstico , Derrame Pleural/patologia , Ultrassonografia
9.
Arq. bras. med. vet. zootec. (Online) ; 71(3): 869-877, May-June 2019. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1011305

RESUMO

The objective of this study was to determine the frequency of different categories of specific and general classification in canine cavitary effusions (CE), as well as their association with the underlying etiologies. The laboratorial and clinical data from 304 cases of canine CE were retrospectively assessed. In 32.9% (100 cases), at least one of the specific classification categories was established, with a subtotal predominance of neoplasia (42%), bacterial serositis (24%) and hemorrhage (16%). Neoplasia was confirmed by effusion cytology in 57.5% of the cases with histopathological confirmation. From the cases in which the specific classification was not obtained, 35.8% were classified as modified transudate, 30.4% as pure transudate, 21.1% % as exudate and 12.7% was not included in any general category. The most common causes of effusion among these cases were hypoproteinemia and/or hipoalbuminemia (HPHA) (25.8%), hepatopathy (22.5%), cardiac insufficiency (15.5%) and cytologically undetected cases of neoplasia (12.4%). In conclusion, HPHA, hepatopathy and neoplasia represents important etiologies for canine CE development. Classification of effusions, solely based on [TP] and TNCC, might be an inaccurate diagnostic tool of effusions. New laboratorial classification methods for canine CE should be researched.(AU)


O objetivo deste estudo foi determinar a frequência de diferentes categorias de classificação específica e geral em efusões cavitárias (EC) caninas, bem como sua associação com as etiologias subjacentes. Os dados laboratoriais e clínicos de 304 casos de EC canina foram avaliados retrospectivamente. Em 32,9% (100 casos), pelo menos uma das categorias específicas de classificação foi estabelecida, com predomínio subtotal de neoplasia (42%), serosite bacteriana (24%) e hemorragia (16%). A neoplasia foi confirmada pela citologia da efusão em 57,5% dos casos com confirmação histopatológica. Dos casos em que a classificação específica não foi obtida (204 casos), 35,8% foram classificados como transudato modificado, 30,4% como transudato puro, 21,1% como exsudato e 12,7% não foram incluídos em nenhuma categoria geral. As causas mais comuns de efusão nestes casos foram hipoproteinemia e/ou hipoalbuminemia (HPHA) (25,8%), hepatopatia (22,5%), insuficiência cardíaca (15,5%) e casos de neoplasia citologicamente não detectados (12,4%). Em conclusão, HPHA, hepatopatia e neoplasia representam importantes etiologias para o desenvolvimento da EC canina. A classificação geral de efusões, baseada exclusivamente em proteína e celularidade, pode ser uma ferramenta diagnóstica imprecisa. Novos métodos de classificação laboratorial para ECs caninas devem ser pesquisados.(AU)


Assuntos
Animais , Cães , Derrame Pericárdico/patologia , Derrame Pericárdico/veterinária , Derrame Pleural/patologia , Derrame Pleural/veterinária , Líquido Ascítico/patologia , Doenças do Cão , Exsudatos e Transudatos
10.
J Forensic Leg Med ; 65: 61-67, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31103925

RESUMO

Often, pleural effusion is noted at autopsy when the cause of death is drowning or diseases such as heart, renal and liver failure. Several studies have established a correlation between the concentrations of electrolytes in pleural effusion and the post-mortem interval (PMI) or those concentrations and drowning site. The present study aims to investigate the relationship between the amount of pleural effusion, concentrations of electrolytes and total protein in pleural effusion, by integrated interpretation using various factors such as the deceased's gender, age, cause of death, drowning site, PMI and body temperature. We included 40 cadavers (26 male, 14 female) with >20-mL pleural effusion, which were categorised into four groups as follows: freshwater drowning; brackish water drowning; seawater drowning (drowning group); and not drowning. An equation derived to assess the lung weight revealed that the drowning site affected the lung weight. An equation for the amount of pleural effusion in the drowning group for the first time revealed that the amount of pleural effusion was directly proportional to the PMI. Using an equation to assess the PMI, we could estimate the PMI within 13.0-13.2 h in cases with >20-mL pleural effusion. Despite a small number of cases in the present study, we attained exciting results from the integrated statistical analysis.


Assuntos
Afogamento/diagnóstico , Modelos Estatísticos , Derrame Pleural/metabolismo , Derrame Pleural/patologia , Mudanças Depois da Morte , Cloretos/metabolismo , Feminino , Patologia Legal/métodos , Água Doce , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Potássio/metabolismo , Águas Salinas , Sódio/metabolismo
12.
Diagn Cytopathol ; 47(8): 776-782, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31091023

RESUMO

BACKGROUND: Malignant lymphomas (ML) are often complicated by serous effusions. The present study is an attempt to cytologically assess a large series of serous effusions associated with ML, identify the immunoreactivity of cells and to evaluate the role of various ancillary methods in confirming and subtyping these cases. METHODS: A cross-sectional study of 4612 serous effusions was undertaken at the Department of Cytology, Gujarat Cancer and Research Institute by retrieving data from the year 2015 to 2017. Total 169 cases of ML, clinically suspicious, were included. All cerebrospinal fluids, serous effusions involved by myeloid neoplasms, and cases of primary effusion lymphomas were excluded from our study. Pap stained smears of all these serous effusions were examined. Ancillary methods such as immunohistochemistry were used to further subtype the positive cases using the WHO classification of hematopoietic and lymphoid neoplasms (2016). RESULTS: Out of total 169 clinically suspicious cases, 109 cases were cytologically positive for ML which included 73 (66.9%) pleural effusions, 34 (31.1%) ascitic fluids, and 2 (1.8%) pericardial effusions. T-lymphoblastic lymphoma (36.9%) and Burkitt's lymphoma (38.2%) were the most common ML involving the pleural and ascitic fluids respectively. Non-Hodgkin's lymphoma (NHL) more frequently involved the serous cavities than Hodgkin's lymphoma. (P value <.0001). Among the NHL, T-cell lymphomas more commonly lead to serous effusions than B-cell lymphomas (P value <.0048). CONCLUSION: Cytological examination of serous effusions is an accurate, prompt, affordable technique having diagnostic and therapeutic implications. With the help of ancillary methods, we can identify the phenotype of cells, classify as well as confirm our diagnosis.


Assuntos
Líquido Ascítico/patologia , Citodiagnóstico/métodos , Linfoma/diagnóstico , Linfoma/patologia , Derrame Pleural/patologia , Centros de Atenção Terciária , Adolescente , Linfoma de Burkitt/patologia , Forma Celular , Tamanho Celular , Criança , Feminino , Humanos , Masculino , Adulto Jovem
13.
Forensic Sci Int ; 300: e24-e30, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31023496

RESUMO

Realgar (arsenic sulfide) is widely used in combination with other herbs as Chinese patent medicine to treat a variety of diseases in China. As a mineral arsenic, its mild toxicity was also well known. Longtime over-dose usage or wrongly oral intake of realgar can cause chronic arsenic poisoning and/or death, but acute fatal arsenic poisoning resulted from short-term dermal use of realgar-containing medicine was very rare. Here, we present the case of a 35-year-old Chinese man, who was diagnosed with severe psoriasis and died of fatal acute arsenic poisoning after he applied a local folk prescription ointment containing mainly the realgar to the affected skin for about 4 days. The autopsy showed multiple punctate hemorrhages over the limbs, pleural effusion, edematous lungs with consolidation, mild myocardial hypertrophy and normal-looking kidneys. The histopathological examination of renal tissue showed severe degeneration, necrosis and desquamation of renal tubular epithelial cells, presence of protein cast and a widened edematous interstitium with interstitial fibrosis. The presence of arsenic in large amount in the ointment (about 6%), in blood (1.76 µg/mL), and in skin (4.71 µg/g), were confirmed analytically. We also provide the clinical records of the deceased and briefly reviewed 7 similar cases in literature (6 in Chinese and 1 in English) in the past 30 years in China.


Assuntos
Intoxicação por Arsênico/etiologia , Medicina Tradicional Chinesa/efeitos adversos , Sulfetos/envenenamento , Administração Tópica , Adulto , Intoxicação por Arsênico/patologia , Arsenicais/administração & dosagem , Arsenicais/análise , China , Hemorragia/patologia , Humanos , Rim/patologia , Pulmão/patologia , Masculino , Pomadas , Derrame Pleural/patologia , Pele/química , Sulfetos/administração & dosagem , Sulfetos/análise
14.
Forensic Sci Med Pathol ; 15(3): 470-473, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31011986

RESUMO

Total parenteral nutrition (TPN) using a central line is an invasive and widely used procedure associated with several complications. Pleural effusion secondary to the leakage of alimentation into the pleural cavity is a rare but encountered complication of central-line TPN administration. This case study focuses on a postmortem examination of an 84-year-old woman, hospitalized due to malnutrition and dysphagia. The left internal jugular vein was cannulated, with no post-procedural x-ray check-up of the catheter tip position. An autopsy revealed 800 ml of milky-white fluid in the left pleural cavity, raising the issue of whether the pleural effusion was of chylous or TPN origin. The aim of this case study was to describe the postmortem diagnostic approach of the fluid analysis. Suspecting chylothorax, we first analyzed the triglyceride (TG) levels in the fluid, which, according to the literature, is the best parameter to detect chyle when lipoprotein electrophoresis (chylomicron %) is unavailable. Biochemistry showed increased levels of TG, which can be found in both chylous and TPN fluid. We then added glucose and potassium to the biochemical analysis, again showing increased levels at 46 mmol/L and 22 mmol/L, respectively. We had no information about the given TPN, and thus, comparing the final chemical results with the TPN composition was impossible. The presence of increased levels of triglycerides, glucose, and potassium in the white fluid more strongly resembled a standard TPN than chyle. Hence, by using these three measurements, we concluded that the milky-white fluid was a leakage of TPN.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Nutrição Parenteral Total/efeitos adversos , Derrame Pleural/patologia , Idoso de 80 Anos ou mais , Quilotórax , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Veias Jugulares , Derrame Pleural/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
Pathology ; 51(4): 405-411, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31014824

RESUMO

A pleural biopsy without granulomatous inflammation or tumour cells is interpreted as 'non-specific pleuritis' (NSP), a diagnosis without any specificity, often frustrating for physicians. However, varying histological features are found in NSPs with unknown significance. The aim of this study was to describe the detailed microscopic features of NSP and correlate them with the underlying aetiology. One hundred patients diagnosed with NSP after pleural biopsy were retrospectively evaluated. A benign cause of pleural effusion was attributed. Histological features evaluated were inflammation, fibrosis, vascular proliferation, haemorrhage, fibrin, oedema and mesothelial hyperplasia. A semi-quantitative scoring was applied. Bacterial-caused and autoimmune disease-associated NSPs showed a higher score followed by viral and drug-induced conditions, while pneumothorax and cardiac-induced NSPs showed a lower score (p<0.0001). The degree of fibrosis was higher in bacterial NSP, and the type of fibrosis was cellular in this group (p=0.006). Vascular proliferation differed between groups (p<0.0001), and was higher in bacterial NSP. Histological findings differ significantly between the varying aetiologies of NSP, and this may be used to suggest the cause of the effusion.


Assuntos
Hiperplasia/patologia , Inflamação/patologia , Pleurisia/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Epitélio/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Derrame Pleural/patologia , Estudos Retrospectivos , Toracoscopia , Adulto Jovem
16.
J Clin Lab Anal ; 33(6): e22901, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30985967

RESUMO

OBJECTIVE: Thymidine kinase 1 (TK1) is a key enzyme in the pyrimidine salvage pathway. Increased TK1 concentration correlates with cell division. TK1 is an emerging biomarker in cancer diagnosis; however, its effectiveness in diagnosis and management for malignant pleural effusion (MPE) is unclear. We evaluated the diagnostic efficiency and prognostic value of pleural effusion TK1 (pTK1) concentration for MPE. METHODS: From 2013 to 2017, 210 pleural effusion samples were collected from 160 patients diagnosed with MPE and 50 patients diagnosed with benign pleural effusion (BPE). TK1 concentrations in pleural effusion were measured by chemiluminescence dot blot assays. The median follow-up was 12 months. We constructed a receiver-operating characteristic (ROC) curve to find the optimal cutoff value for MPE diagnosis. The hazard ratios were estimated using a multivariable Cox proportional hazard model. A nomogram was drawn to illustrate the prognostic characteristics of MPE. RESULTS: The TK1 concentration in pleural effusion was significantly higher in MPE than BPE (P < 0.001), and patients with MPE could be distinguished by an optimal cutoff value of 3.10 pmol/L with a sensitivity of 0.894 and a specificity of 0.800. The multivariate analysis suggested that pTK1 concentration was an independent predictor of survival in patients with MPE. CONCLUSIONS: The diagnostic and prognostic prediction of MPE may be improved by measuring pTK1 concentration and utilizing a multivariate nomogram.


Assuntos
Biomarcadores Tumorais/análise , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/mortalidade , Derrame Pleural/enzimologia , Timidina Quinase/análise , Idoso , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Nomogramas , Derrame Pleural/patologia , Derrame Pleural Maligno/enzimologia , Derrame Pleural Maligno/patologia , Reprodutibilidade dos Testes , Timidina Quinase/metabolismo
17.
Medicine (Baltimore) ; 98(14): e14979, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946324

RESUMO

BACKGROUND: Soluble mesothelin-related peptide (SMRP) is a widely studied tumor marker for diagnosing malignant pleural mesothelioma (MPM). This study discussed the diagnostic value of SMRPs in pleural effusion (PE) for MPM. METHODS: Medline, Embase, Web of Science, and Cochrane library system were systematically searched on the data of SMRPs in PE for MPM diagnosis. Pooled diagnostic sensitivity, specificity, and symmetric receiver operating characteristic curve were calculated. RESULTS: Thirteen studies fulfilled the inclusion criteria and a total of 3359 cases including 759 MPM cases, 1061 non-MM (malignant mesothelioma) malignant PE, and 1539 benign PE were brought into this meta-analysis. The pooled results of SMRPs in PE for diagnosing MPM were as follows: sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.68 (95% confidence interval [CI]: 0.64-0.72), 0.91 (95% CI: 0.86-0.94), 7.8 (95% CI: 5.0-12.0), 0.35 (95% CI: 0.31-0.40), and 22 (95% CI: 14-35), respectively. The area under the summary receiver operating characteristic curves (AUC) was 0.75 (95% CI: 0.72-0.80). Subgroup analyzes revealed that the AUC of cohort group using histological diagnosis could be improved to 0.86 (95% CI: 0.83, 0.89). The Deek's funnel plot asymmetry test showed no publication bias. CONCLUSION: Although the sensitivity of SMRPs was low, PE-SMRPs can be a good indicator of the existence of MPM.


Assuntos
Proteínas Ligadas por GPI/metabolismo , Neoplasias Pulmonares/metabolismo , Mesotelioma/metabolismo , Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Derrame Pleural/metabolismo , Biomarcadores Tumorais/metabolismo , Exsudatos e Transudatos/metabolismo , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Mesotelioma/diagnóstico , Mesotelioma/patologia , Derrame Pleural/diagnóstico , Derrame Pleural/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/metabolismo , Derrame Pleural Maligno/patologia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/metabolismo , Neoplasias Pleurais/patologia , Sensibilidade e Especificidade
18.
Vet Clin Pathol ; 48(1): 67-70, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30924544

RESUMO

A 4-year-old, spayed female French Bulldog was presented for respiratory distress and suspected aspiration pneumonia after oral administration of activated charcoal for possible ingestion of a suspected toxic dose of trazodone. The patient had a moderate volume of pleural effusion, which contained free and intracellular black particulate matter consistent with charcoal. Due to presumed charcoal aspiration with subsequent lung rupture, the right middle and right caudal lung lobes were surgically removed. Histology revealed abundant black debris consistent with charcoal and severe granulomatous inflammation. Based on the clinical, gross, and histologic findings, a diagnosis of severe, chronic, locally extensive, aspiration pneumonia and lung rupture with secondary pleuritis and mediastinitis due to charcoal aspiration was made. Aspiration pneumonia is the main complication of activated charcoal administration, which can incite extensive, granulomatous inflammation in the respiratory tract. To the authors' knowledge, this is the first report describing the cytologic and histologic findings associated with inadvertent charcoal aspiration in a veterinary species.


Assuntos
Carvão Vegetal/efeitos adversos , Doenças do Cão/patologia , Lesão Pulmonar/veterinária , Pneumonia Aspirativa/veterinária , Animais , Carvão Vegetal/uso terapêutico , Doenças do Cão/cirurgia , Cães , Feminino , Granuloma/patologia , Granuloma/veterinária , Pulmão/patologia , Pulmão/cirurgia , Lesão Pulmonar/cirurgia , Derrame Pleural/patologia , Derrame Pleural/veterinária , Pneumonia Aspirativa/diagnóstico , Pneumonia Aspirativa/patologia , Trazodona/envenenamento
19.
Vet Clin Pathol ; 48(1): 50-60, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30865320

RESUMO

BACKGROUND: Cell blocks and immunohistochemistry (IHC) are increasingly recognized as being complementary tools for cytologic diagnostics, especially for neoplastic diseases. OBJECTIVES: The study aimed to evaluate the utility of cell tube block (CTB) IHC for refining the diagnosis of effusions in dogs and cats. METHODS: Cavitary effusions (n = 25) from dogs and cats classified by cytology as reactive, neoplastic, borderline (suspicious of neoplasia), and chylous were studied. CTB sections were stained with H&E, and immunostained with PAX-5, CD3, pancytokeratin (CK), vimentin, and Wilms tumor 1 protein (WT1) antibodies, according to the cytologic diagnoses. A histologic case series of confirmed normal, reactive, and neoplastic mesothelium and several different carcinomas were included to test the utility of WT1 as a marker of mesothelial cells. RESULTS: CTBs had a layered appearance with reduced background staining. CD3 and PAX5 immunolabeling allowed immunophenotype assessment in all of the lymphoma cases. In carcinomatous effusions, neoplastic cells were CK-positive, WT1-negative, and vimentin-negative (except for two cases). Wilms tumor 1 protein was positive in the nuclei of normal, reactive, and neoplastic mesothelial cells, and ovarian carcinomatous cells. Other carcinomas and lymphomas were negative. CONCLUSIONS: CTBs are valuable tools to assist in making a diagnosis of cavitary effusions in dogs and cats, and WT1 is a promising marker to differentiate mesothelial from carcinomatous cells.


Assuntos
Líquido Ascítico/citologia , Doenças do Gato/diagnóstico , Doenças do Cão/diagnóstico , Técnicas de Preparação Histocitológica/veterinária , Derrame Pericárdico/veterinária , Derrame Pleural/veterinária , Animais , Líquido Ascítico/patologia , Doenças do Gato/patologia , Gatos , Doenças do Cão/patologia , Cães , Técnicas de Preparação Histocitológica/métodos , Imuno-Histoquímica/veterinária , Neoplasias Renais/diagnóstico , Neoplasias Renais/patologia , Neoplasias Renais/veterinária , Derrame Pericárdico/citologia , Derrame Pericárdico/patologia , Derrame Pleural/patologia , Tumor de Wilms/diagnóstico , Tumor de Wilms/patologia , Tumor de Wilms/veterinária
20.
Diagn Cytopathol ; 47(6): 599-602, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30829462

RESUMO

A 54-year-old woman presented with a left breast mass, discovered 4 years ago but was static until 2 months before presentation, when it showed a rapid increase in size and became painful. Mammography showed a large lobulated mass with internal cystic components (BI-RADS 4B). A biopsy was performed, followed by modified radical mastectomy. The histologic diagnosis was malignant phyllodes tumor (PT). The patient developed local recurrence 4 months later while on adjuvant radiotherapy and she had a salvage resection. Two months later, she developed massive left pleural effusion. Pleural fluid cytology showed single discohesive markedly atypical cells with hyperchromatic and enlarged nuclei, irregular nuclear membrane, and distinct macronucleoli. Multinucleated forms were also seen. The mononuclear and multinucleated tumor cells cytomorphologically resembled that of the recurrent tumor, indicative of recurrence. Positron emission tomography/computed tomography confirmed recurrence at the left pleura. The patient opted for palliative care and succumbed 1 month later. The current case demonstrated a rare clinical presentation of recurrent malignant PT as massive unilateral malignant pleural effusion. Correlation with previous histologic and cytologic specimens may be useful as similar cytologic features could be identified in subsequent recurrent tumors.


Assuntos
Neoplasias da Mama/diagnóstico , Citodiagnóstico , Tumor Filoide/diagnóstico , Derrame Pleural/diagnóstico , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Tumor Filoide/complicações , Tumor Filoide/diagnóstico por imagem , Tumor Filoide/patologia , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA