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1.
Medicine (Baltimore) ; 99(28): e21113, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664134

RESUMO

RATIONALE: Emphysematous osteomyelitis is a rare disease caused by gas-forming bacteria. But only 45 cases have been reported in the literature since then. PATIENT CONCERNS: A 72-year-old female presented to our hospital with severe lower back pain that aggravated 4 days ago. DIAGNOSES: Computed tomography (CT) revealed intraosseous mottled air in the T12 and L1 vertebral bodies and epidural space. The enhanced T1 and T2 magnetic resonance imaging scans showed heterogeneous signal intensity of vertebral bodies, suggestive of emphysematous osteomyelitis. INTERVENTIONS: Surgery was performed to identify culture strains and to remove emphysematous lesions of the vertebral body using extensive transpedicular irrigation. OUTCOMES: Escherichia coli (E coli) was identified in the surgical specimen, and intravenous antibiotic therapy was continued with cefotaxime. The patient had a significant decrease in lower back pain after the surgery and the final CT scan before discharge revealed significantly decreased air at T12 and L1 vertebral bodies and no air density in the epidural space. LESSONS: We present a patient diagnosed with emphysematous osteomyelitis in vertebral bodies caused by E coli and successfully treated with surgical intervention.


Assuntos
Enfisema/diagnóstico , Infecções por Escherichia coli/diagnóstico , Vértebras Lombares , Osteomielite/diagnóstico , Doenças da Coluna Vertebral/diagnóstico , Vértebras Torácicas , Idoso , Enfisema/etiologia , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Osteomielite/complicações , Doenças Raras , Doenças da Coluna Vertebral/complicações , Tomografia Computadorizada por Raios X
3.
Am J Med Sci ; 359(6): 334-338, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32317168

RESUMO

BACKGROUND: Emphysematous pancreatitis (EP) is an unusual medical emergency that presents with intraparenchymal pancreatic air in the setting of necrotizing infection. We aimed to determine the differences in the epidemiology, etiology, clinical presentation, symptoms and outcome of EP between elderly and nonelderly patients. MATERIALS AND METHODS: A PubMed search was performed using the keywords "emphysematous pancreatitis," "gas-forming pancreatitis" and "pancreatitis and pneumoperitoneum" from March 1959 to February 2019. Forty-two EP articles with 58 patients were enrolled in our study. We divided the patients into ≥65 (elderly, n = 25) and <65-year age groups (non-elderly, n = 33). Data on patient age, sex, comorbidities, symptoms, clinical findings, etiologies, laboratory results, treatments, outcomes and mortality were collected and analyzed using the Student's t test and chi-square test using IBM SPSS 20. P values < 0.05 (2-tailed) indicated statistical significance. RESULTS: Alcohol- and biliary pancreatitis-related EP were 4.95- and 4-fold, respectively, more frequent in the elderly than in the nonelderly (36% versus [vs.] 9.1%, P < 0.05). Fever was more frequent in the nonelderly than in the elderly (69.7% vs. 36%, P < 0.05). The elderly presented with more severe shock status (68% vs. 33.3%, P < 0.05) and received more surgical interventions than the nonelderly (60% vs. 30.3%, P < 0.05). CONCLUSIONS: Biliary pancreatitis is the most common type of EP in the elderly and has an atypical presentation with less fever, more severe shock, and more surgical interventions. In treating elderly patients with pancreatitis, immediate administration of adequate antibiotics, assisted drainage and early surgical intervention are needed to prevent shock.


Assuntos
Enfisema/diagnóstico , Enfisema/cirurgia , Pâncreas/microbiologia , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/cirurgia , Dor Abdominal , Adulto , Idoso , Idoso de 80 Anos ou mais , Enfisema/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/mortalidade , Choque/complicações
7.
Occup Environ Med ; 77(6): 386-392, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32132182

RESUMO

OBJECTIVES: Four machine manufacturing facility workers had a novel occupational lung disease of uncertain aetiology characterised by lymphocytic bronchiolitis, alveolar ductitis and emphysema (BADE). We aimed to evaluate current workers' respiratory health in relation to job category and relative exposure to endotoxin, which is aerosolised from in-use metalworking fluid. METHODS: We offered a questionnaire and spirometry at baseline and 3.5 year follow-up. Endotoxin exposures were quantified for 16 production and non-production job groups. Forced expiratory volume in one second (FEV1) decline ≥10% was considered excessive. We examined SMRs compared with US adults, adjusted prevalence ratios (aPRs) for health outcomes by endotoxin exposure tertiles and predictors of excessive FEV1 decline. RESULTS: Among 388 (89%) baseline participants, SMRs were elevated for wheeze (2.5 (95% CI 2.1 to 3.0)), but not obstruction (0.5 (95% CI 0.3 to 1.1)). Mean endotoxin exposures (range: 0.09-28.4 EU/m3) were highest for machine shop jobs. Higher exposure was associated with exertional dyspnea (aPR=2.8 (95% CI 1.4 to 5.7)), but not lung function. Of 250 (64%) follow-up participants, 11 (4%) had excessive FEV1 decline (range: 403-2074 mL); 10 worked in production. Wheeze (aPR=3.6 (95% CI 1.1 to 12.1)) and medium (1.3-7.5 EU/m3) endotoxin exposure (aPR=10.5 (95% CI 1.3 to 83.1)) at baseline were associated with excessive decline. One production worker with excessive decline had BADE on subsequent lung biopsy. CONCLUSIONS: Lung function loss and BADE were associated with production work. Relationships with relative endotoxin exposure indicate work-related adverse respiratory health outcomes beyond the sentinel disease cluster, including an incident BADE case. Until causative factors and effective preventive strategies for BADE are determined, exposure minimisation and medical surveillance of affected workforces are recommended.


Assuntos
Poluentes Ocupacionais do Ar/efeitos adversos , Bronquiolite/epidemiologia , Enfisema/epidemiologia , Endotoxinas/efeitos adversos , Doenças Profissionais/epidemiologia , Exposição Ocupacional/efeitos adversos , Adulto , Idoso , Poluentes Ocupacionais do Ar/análise , Bronquiolite/induzido quimicamente , Enfisema/induzido quimicamente , Endotoxinas/análise , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Instalações Industriais e de Manufatura , Pessoa de Meia-Idade , National Institute for Occupational Safety and Health, U.S. , Doenças Profissionais/induzido quimicamente , Exposição Ocupacional/análise , Alvéolos Pulmonares/patologia , Inquéritos e Questionários , Estados Unidos
9.
Niger Postgrad Med J ; 27(1): 59-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32003364

RESUMO

Emphysematous pyelonephritis (EPN) is a rare, severe necrotising infection of the renal parenchyma and surrounding tissues. It is usually life-threatening and should be promptly treated. Here, we report a clinical case of a 54-year-old male who presented with the left flank pains of 3-week duration. The flank pain was described as dull, constant with associated fever. He was diagnosed with diabetes mellitus (DM) while on admission. A clinical diagnosis of the left pyelonephritis was made. The abdominopelvic computed tomography scan confirmed bilateral EPN by showing a thin film of perinephric fluid (13.2 ml) in the left lower pole. He was managed conservatively with fluid therapy, adequate glycaemic control and intravenous antibiotics with no percutaneous drainage done. This highlights the importance of early initiation of appropriate medical treatment to avoid interventional urological procedures of nephrectomy. It also highlights the importance of clinical suspicion of EPN in patients presenting with symptoms of urinary tract infection and DM.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Enfisema , Pielonefrite , Complicações do Diabetes/diagnóstico , Enfisema/complicações , Enfisema/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Dor/etiologia , Pielonefrite/complicações , Pielonefrite/diagnóstico
10.
Am J Respir Cell Mol Biol ; 62(4): 466-478, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31922895

RESUMO

Surfactant protein (SP)-C deficiency is found in samples from patients with idiopathic pulmonary fibrosis, especially in familial forms of this disease. We hypothesized that SP-C may contribute to fibrotic remodeling in aging mice and alveolar lipid homeostasis. For this purpose, we analyzed lung function, alveolar dynamics, lung structure, collagen content, and expression of genes related to lipid and cholesterol metabolism of aging SP-C knockout mice. In addition, in vitro experiments with an alveolar macrophage cell line exposed to lipid vesicles with or without cholesterol and/or SP-C were performed. Alveolar dynamics showed progressive alveolar derecruitment with age and impaired oxygen saturation. Lung structure revealed that decreasing volume density of alveolar spaces was accompanied by increasing of the ductal counterparts. Simultaneously, septal wall thickness steadily increased, and fibrotic wounds appeared in lungs from the age of 50 weeks. This remarkable phenotype is unique to the 129Sv strain, which has an increased absorption of cholesterol, linking the accumulation of cholesterol and the absence of SP-C to a fibrotic remodeling process. The findings of this study suggest that overall loss of SP-C results in an age-dependent, complex, heterogeneous phenotype characterized by a combination of overdistended air spaces and fibrotic wounds that resembles combined emphysema and pulmonary fibrosis in patients with idiopathic pulmonary fibrosis. Addition of SP-C to cholesterol-laden lipid vesicles enhanced the expression of cholesterol metabolism and transport genes in an alveolar macrophage cell line, identifying a potential new lipid-protein axis involved in lung remodeling.


Assuntos
Remodelação das Vias Aéreas/fisiologia , Colesterol/metabolismo , Fibrose Pulmonar Idiopática/metabolismo , Proteína C/metabolismo , Surfactantes Pulmonares/metabolismo , Idoso , Animais , Enfisema/metabolismo , Humanos , Metabolismo dos Lipídeos/fisiologia , Pulmão/metabolismo , Macrófagos Alveolares/metabolismo , Masculino , Camundongos , Camundongos Knockout , Alvéolos Pulmonares/metabolismo
12.
Zhonghua Yi Xue Za Zhi ; 100(2): 104-109, 2020 Jan 14.
Artigo em Chinês | MEDLINE | ID: mdl-31937048

RESUMO

Objective: To investigate differential genes (DEGs) between no/mild and severe emphysema by bioinformatics analysis. Methods: The microarray dataset GSE1650, of lung tissue in no/mild and severe emphysema, was downloaded from the GEO database, and DEGs were obtained by t test. Analysis of DEGs based on DAVID database was used to obtain gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) pathway. The protein-protein interaction network (PPI) was established using STRING database to identify hub genes. Results: A total of 76 DEGs were obtained, of which 62 genes were up-regulated and 14 genes were down-regulated in severe emphysema group. Gene ontology showed that the DEGs were mainly involved in neutrophil chemotaxis, cellular response to interleukin-1, extracellular matrix organization, immune response, and KEGG pathway involved cytokine-cytokine receptor interaction, ECM-receptor interaction, PI3K-Akt signaling pathway, platelet activation. Seventeen hub genes were recognized by PPI analysis, including CXCL8, RRAD, CLU, TIMP1, SEPP1, ISLR, BGN, COL1A1, COLIA2, ACTA2, ACTN1, FIGF, TPM1, TPM2, LUM, COL6A3 and TAGLN. Among them, fifteen genes (CLU, TIMP1, SEPP1, ISLR, BGN, COLIA2, COL1A1, ACTA2, ACTN1, FIGF, TPM1, TPM2, LUM, COL6A3, TAGLN) were up-regulated and two genes (CXCL8, RRAD) were down-regulated. Conclusion: Bioinformatics analysis based on GEO database showed that there were DEGs between non/mild and severe emphysema patients.


Assuntos
Biologia Computacional , Enfisema , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Fosfatidilinositol 3-Quinases , Proteínas ras
15.
Am J Respir Crit Care Med ; 201(8): 886-888, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31913692
20.
Pol Arch Intern Med ; 130(1): 17-24, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-31552916

RESUMO

INTRODUCTION: Chest low-dose computed tomography (LDCT) has recently been proved effective in lung cancer screening. OBJECTIVES: We aimed to assess the association between the occurrence of emphysema and solitary pulmonary nodules (SPNs) in first­round screening with LDCT. PATIENTS AND METHODS: A total of 601 asymptomatic volunteers with a smoking history underwent LDCT; 523 patients were assigned to one of the following groups: E, emphysema without nodules (n = 103); E + N, emphysema with coexisting nodules (n = 96); N, nodules without emphysema (n = 142); and NENN, no nodules and no emphysema (n = 182). The effect of emphysema and demographic factors on the profile of SPNs was assessed. RESULTS: Patients in the E + N group were older than those in the N group (median age, 65 vs 63 years; P = 0.001) and they smoked more (median pack­years, 37.8 vs 32; P = 0.01). Emphysema was detected in 199 of the 523 patients (38%), while nodules, in 238 (45.5%). The number of nodules in the E + N group was 390 (4.1 nodules per patient), and in the N group, 540 (3.8 nodules per patient). Multiple SPNs, of different size and morphology, constituted 93.3% of the nodules in the E + N group. Seven cases of cancer were detected among 238 patients with nodules, and their distribution was similar in the groups with and without emphysema (4.2 per 100 patients in the E + N group and 2.1 per 100 in the N group; P = 0.44). CONCLUSIONS: Emphysema was more frequently associated with multiple SPNs of different morphology among elderly patients with a higher number of smoking pack­years.


Assuntos
Enfisema , Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Idoso , Detecção Precoce de Câncer , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
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