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1.
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
2.
Artigo em Chinês | MEDLINE | ID: mdl-31594131

RESUMO

Objective: To investigate the situation where pneumoconiosis patients who should be in hospital are not hospitalized, to analyze the main reasons and influencing factors for their restricted use of hospitalization medical services, and to provide a reference for relevant policy making. Methods: Subjects were sampled in nine provinces, including Zhejiang, Jiangsu, Shandong, and Hebei, using a method that combined stratified sampling and typical sampling, from March 2017 to January 2018. These subjects were patients occupationally diagnosed with pneumoconiosis and patients clinically diagnosed with pneumoconiosis. The questionnaire The health seeking behaviors of pneumoconiosis patients and their influencing factors was used as the survey tool to investigate their health seeking behaviors such as going to the outpatient clinic and being hospitalized. Andersen's Behavioral Model of Health Services Use was used as the analysis model; The χ2 test was used for univariate analysis, and the multivariate logistic regression model was used for multivariate analysis. Results: A total of 1 037 patients with pneumoconiosis were surveyed, with a mean age of 55.9±11.2 years and 67.5% (700/1 037) living in rural areas for a long time. Occupational injury insurance and medical insurance for urban and rural residents were the main insurances used, accounting for 40.9% (424/1 037) and 59.4% (616/1 037) of the cases, respectively. A total of 177 (17.1%) patients were once advised by the doctors to be hospitalized because of pneumoconiosis, while they did not. The proportion of patients who should be in hospital but did not do so among rural patients was significantly higher than that in urban patients (20.1% (141/700) vs 10.7% (36/337) , P<0.05) . Financial difficulties (12.0%, 124/1 037) and self-rated mild symptoms (3.2%, 33/1 037) were the main reasons for not being hospitalized. Model analysis showed that the propensity factor, ability factor, health needs, health seeking behaviors, and self-rated health factor in the Anderson model were all statistically significant (P<0.05) . The main features of high proportion of patients who should be in hospital but did not do so were as follows: personal monthly income below 1 000 RMB (odds ratio[OR]of no income=2.92, 95% confidence interval[CI]: 1.14-7.48; OR of less than 1 000 RMB=3.55, 95%CI: 1.35-9.35) , no occupational injury insurance (OR=2.05, 95%CI: 1.16-3.43) , and concurrent emphysema (OR= 1.98, 95%CI: 1.12-3.50) . Conclusion: Low income, no occupational injury insurance, and concurrent emphy-sema are the main constraining factors for hospitalization services use in pneumoconiosis patients.


Assuntos
Hospitalização/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumoconiose , Adulto , Idoso , China , Enfisema/complicações , Humanos , Renda , Seguro Saúde , Modelos Logísticos , Pessoa de Meia-Idade , População Rural , Inquéritos e Questionários , População Urbana
3.
Jpn J Radiol ; 37(12): 808-816, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541398

RESUMO

PURPOSE: This study evaluated whether or not patterns of emphysema and their qualitative and quantitative severity can predict the risk of complications with post-computed tomography (CT)-guided transthoracic lung biopsy (TTLB). MATERIALS AND METHODS: Three hundred and ninety-seven patients who underwent CT-guided TTLB in 2010-2018 were retrospectively reviewed. The severity of emphysema and presence of perilesional emphysema were assessed visually using the Fleischner Society classification. Ninety seven of the 397 patients underwent quantitative analysis of emphysema. Complications, including pneumothorax, chest tube insertion, and hemorrhage, were assessed by post-TTLB CT and radiographic imaging. The grade of hemorrhage was categorized into three groups. Independent risk factors for pneumothorax and hemorrhage were assessed by univariate and multivariate logistic regression analyses. RESULTS: Pneumothorax occurred in 48.6% of cases and hemorrhage in 70.5%. Perilesional emphysema was significantly associated with pneumothorax (odds ratio 6.720; 95% confidence interval 3.265-13.831, p < 0.001) and hemorrhage (odds ratio 3.877; 95% confidence interval 1.796-8.367; p = 0.001). The severity of visual and quantitative emphysema was not a significant risk factor for pneumothorax or hemorrhage (p > 0.05). Perilesional emphysema was significantly associated with the grade of hemorrhage (p < 0.001). CONCLUSION: Perilesional emphysema can estimate the risk of iatrogenic complications from CT-guided TTLB.


Assuntos
Enfisema/complicações , Hemorragia/etiologia , Pulmão/patologia , Pneumotórax/etiologia , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
4.
BMJ Case Rep ; 12(8)2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31473637

RESUMO

Gallstone ileus and small bowel diverticulosis are uncommon pathologies. However, the simultaneous presentation of both in this patient provided a diagnostic puzzle for the surgical and radiological teams at our institution. The imaging also demonstrated several typical features for the pathologies in question. Ultimately the management of the patient was not compromised by the diagnostic dilemma, but the imaging findings represent a useful learning opportunity for all radiologists and general surgeons.


Assuntos
Dor Abdominal/diagnóstico , Cálculos Biliares/diagnóstico , Hérnia Inguinal/diagnóstico , Íleus/diagnóstico , Enteropatias/diagnóstico , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Enfisema/complicações , Enfisema/diagnóstico , Cálculos Biliares/complicações , Hérnia Inguinal/complicações , Humanos , Íleus/complicações , Enteropatias/complicações , Masculino
6.
Int Urol Nephrol ; 51(10): 1709-1713, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31309391

RESUMO

PURPOSE: In view of the differences in early and late management experiences based on Huang and Tseng CT classification of emphysematous pyelonephritis (EP), our study included 34 patients aimed to re-correlate the current management plans with CT classification. METHODS: A retrospective review from January 2009 to December 2018, in patients with primary or final diagnosis of EP. Data included; patients' demographics, routine laboratory and imaging work-up. CT was performed for all, and images were classified based on Huang and Tseng classification. The CT classification was correlated to the laboratory parameters and the final treatment plans. Data were collected and analyzed using SPSS®. RESULTS: Complete data for 34 patients were analyzed. The majority (70%) had positive urine culture, and Carbapenems and Ureidopenicillin were the most commonly used antibiotics. Based on CT classification, 75% (26/34) of the patients were in class I and II, 6 cases with class IIIa, and only two with class IIIb, with no cases of class IV. All patients in class I and II responded well to the medical therapy, and eight required PCN/DJ. Four required nephrectomy in class III, with zero mortality. CONCLUSION: Patients in class I and II comprise the majority of EP patients, and respond well to medical treatment with excellent outcome. Insertion of PCN and DJ are not required routinely, but with urinary obstruction requiring drainage, and a few cases who required nephrectomy-all with class III. Our data show improvement in the overall survival in patients for EP.


Assuntos
Enfisema/classificação , Enfisema/terapia , Pielonefrite/classificação , Pielonefrite/terapia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Correlação de Dados , Enfisema/complicações , Enfisema/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Pielonefrite/complicações , Pielonefrite/diagnóstico por imagem , Estudos Retrospectivos
7.
Biomed Pharmacother ; 117: 109053, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176169

RESUMO

Chronic obstructive pulmonary disease (COPD) often causes diaphragm dysfunction, which is the main contributor to neuro-muscular respiratory failure and associated with the prognosis of COPD. However, the morphological changes in diaphragm during the development of COPD are complicated and underlying mechanisms have not been absolutely elucidated. Considering smoking is one of the most leading and important risk factors for development of COPD, we set out to investigate the effects of smoking on muscle fibre remodeling and underlying mechanisms in diaphragms. Rats were randomly exposed to cigarette smoke (CS) for one of three durations of 4, 8, and 12 weeks. CS exposure resulted in increased percentage of type I muscle fibres, enhanced apoptosis index, endoplasmic reticulum (ER) dilation, elevated expression of glucose-regulated protein 78, C/EBP homologous protein, caspase-12, peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α), cytochrome c oxidase 4, Sdhb, p53 and a reduction in fibre diameters in rat diaphragms. The results indicated that CS exposure induced a shift to muscle fibres with aerobic metabolism in predominance in rat diaphragms, which may be dependent on the regulation of PGC-1α and p53. Additionally, ER stress (ERS) associated apoptosis may contribute to the pathogenesis of diaphragmatic muscle atrophy induced by CS exposure.


Assuntos
Diafragma/patologia , Fibras Musculares Esqueléticas/patologia , Fumar/efeitos adversos , Animais , Apoptose , Inibidor de Quinase Dependente de Ciclina p21/metabolismo , Enfisema/complicações , Enfisema/patologia , Retículo Endoplasmático/ultraestrutura , Estresse do Retículo Endoplasmático , Feminino , Mitocôndrias/metabolismo , Atrofia Muscular/patologia , Miosinas/metabolismo , Oxirredução , Pneumonia/complicações , Pneumonia/patologia , Ratos Sprague-Dawley , Fatores de Tempo , Proteína Supressora de Tumor p53/metabolismo
8.
J Infect Chemother ; 25(10): 791-796, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31103341

RESUMO

OBJECTIVES: To study risk factors for sepsis and mortality evaluating the role of platelet to leucocytic count ratio (PLR) as a marker for urosepsis and clinical outcomes in cases of emphysematous pyelonephritis (EPN). MATERIALS: Patients with EPN were retrospectively reviewed. Patients' age, sex, diabetes mellitus (DM), Body Mass Index (BMI), hydronephrosis, types of EPN, air locules volume, serum creatinine, leucocytic count, and platelet count, PLR, albumin, INR and the line of treatment were analyzed as risk factors of sepsis. Correlation between PLR and other variables was done using Pearson correlation coefficient. Univariate and multivariate analyses for sepsis and mortality were performed. RESULTS: Of fifty four patients, 38 patients had SIRS ≥2 criteria on admission. Twenty patients developed sepsis requiring ICU admission. In univariate analysis, male gender, lower BMI, higher INR, higher WBCs count and lower PLR were associated with sepsis (P = 0.0001, 0.009, 0.04, 0.003 and 0.001, respectively). In multivariate analysis, PLR ≤18.4, male sex and BMI ≤24.2 were independent risk factors. Lower PLR directly correlated with serum albumin (P = 0.01) and inversely correlated with serum creatinine and random blood glucose level and Klebsiella infection (P = 0.001, 0.007 and 0.005, respectively). Also, it was correlated with a higher total score of qSOFA and SOFA (P = 0.02 and 0.04). Lower PLR was independent risk factors for death in EPN patients with (P = 0.003). CONCLUSION: EPN is associated with sepsis development. Lower PLR is an independent simple predictor for sepsis and mortality in patients with EPN.


Assuntos
Enfisema/sangue , Pielonefrite/sangue , Choque Séptico/diagnóstico , Adulto , Enfisema/complicações , Enfisema/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Rim/patologia , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Prognóstico , Pielonefrite/complicações , Pielonefrite/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Choque Séptico/etiologia , Choque Séptico/mortalidade
9.
Stroke ; 50(4): 992-994, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30885079

RESUMO

Background and Purpose- Protease/antiprotease imbalance is implicated in the pathogenesis of emphysema and may also lead to vessel wall weakening, aneurysm development, and rupture. However, it is unclear whether emphysema is associated with cerebral and aortic aneurysm rupture. Methods- We performed a retrospective cohort study using outpatient and inpatient claims data from 2008 to 2014 from a nationally representative sample of Medicare beneficiaries ≥66 years of age. Our predictor variable was emphysema, and our outcome was hospitalization for either aneurysmal subarachnoid hemorrhage or a ruptured aortic aneurysm. All predictors and outcomes were defined using previously reported International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithms. Survival statistics and Cox regression were used to compare risk between patients with and without emphysema. Results- We identified 1 670 915 patients, of whom 133 972 had a diagnosis of emphysema. During a mean follow-up period of 4.3 (±1.9) years, we identified 4835 cases of aneurysm rupture, 433 of which occurred in patients with emphysema. The annual incidence of aneurysm rupture was 6.5 (95% CI, 6.4-6.8) per 10 000 in patients without emphysema and 14.6 (95% CI, 13.3-16.0) per 10 000 in patients with emphysema. After adjustment for demographics and known risk factors for aneurysmal disease, emphysema was independently associated with aneurysm rupture (hazard ratio, 1.7; 95% CI, 1.5-1.9). Emphysema was associated with both aneurysmal subarachnoid hemorrhage (hazard ratio, 1.5; 95% CI, 1.3-1.7) and ruptured aortic aneurysm (hazard ratio, 2.3; 95% CI, 1.9-2.8). Conclusions- Patients with emphysema face an increased risk of developing subarachnoid hemorrhage and aortic aneurysm rupture, potentially consistent with shared pathways in pathogenesis.


Assuntos
Ruptura Aórtica/epidemiologia , Enfisema/complicações , Hemorragia Subaracnóidea/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Ruptura Aórtica/etiologia , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/etiologia
12.
Pediatr Emerg Care ; 35(8): e152-e153, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28617713

RESUMO

The radiographic finding of gastric emphysema with portal venous gas is classically an ominous finding, associated with a high rate of mortality. Although classically the case, this imaging finding must be quickly correlated with the overall clinical picture, allowing for the essential differentiation between the highly lethal emphysematous gastritis and the much more benign gastric emphysema, each of which has drastically different management strategies. We report a case of gastric emphysema with portal venous gas likely attributable to a gastric outlet obstruction and gastric mucosal defect in a 17-year-old girl with a chief complaint of syncope that was diagnosed in the emergency department and treated conservatively.


Assuntos
Enfisema/complicações , Gastropatias/diagnóstico por imagem , Síncope/etiologia , Adolescente , Tratamento Conservador , Constrição Patológica , Duodenite/diagnóstico por imagem , Duodenite/patologia , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Piloro/patologia , Gastropatias/patologia , Úlcera Gástrica/diagnóstico por imagem , Úlcera Gástrica/patologia , Síncope/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Vômito/diagnóstico , Vômito/etiologia
13.
Respir Investig ; 57(2): 140-149, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30472091

RESUMO

BACKGROUND: This study aimed to determine the radiologic predictors and clarify the clinical features related to survival in patients with combined pulmonary fibrosis and emphysema (CPFE) and lung cancer. METHODS: We retrospectively reviewed the medical chart data and high-resolution computed tomography (HRCT) findings for 81 consecutive patients with CPFE and 92 primary lung cancers (70 men, 11 women; mean age, 70.9 years). We selected 8 axial HRCT images per patient, and visually determined the normal lung, modified Goddard, and fibrosis scores. Multivariate analysis was performed using the Cox proportional hazards regression model. RESULTS: The major clinical features were a high smoking index of 54.8 pack-years and idiopathic pulmonary fibrosis (n = 44). The major lung cancer profile was a peripherally located squamous cell carcinoma (n = 40) or adenocarcinoma (n = 31) adjacent to emphysema in the upper/middle lobe (n = 27) or fibrosis in the lower lobe (n = 26). The median total normal lung, modified Goddard, and fibrosis scores were 10, 8, and 8, respectively. TNM Classification of malignant tumors (TNM) stage I, II, III, and IV was noted in 37, 7, 26, and 22 patients, respectively. Acute exacerbation occurred in 20 patients. Multivariate analysis showed that a higher normal lung score and TNM stage were independent radiologic and clinical predictors of poor survival at the time of diagnosis of lung cancer. CONCLUSIONS: A markedly reduced area of normal lung on HRCT was a relevant radiologic predictor of survival.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/mortalidade , Enfisema/complicações , Enfisema/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/mortalidade , Pulmão/diagnóstico por imagem , Fibrose Pulmonar/complicações , Fibrose Pulmonar/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X , Idoso , Carcinoma de Células Escamosas/patologia , Progressão da Doença , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida
14.
Turk J Med Sci ; 48(5): 945-951, 2018 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-30384558

RESUMO

Background/aim: This study performed typing of chronic obstructive pulmonary disease (COPD) using high-resolution computed tomography (HRCT) to determine the association with smoking, matrix metalloproteinases, and common comorbidities. Materials and methods: The study enrolled 94 hospitalized patients. Participants were divided into a group of 69 current and former smokers (group A) and a group of 25 that had never smoked (group B). Patients were also divided into 3 categories according to the degree of emphysema and bronchial wall thickness using HRCT to determine the association with levels of matrix metalloproteinase 9 (MMP-9) and TIMP-1, as well as associated comorbidities. These three categories were: type A - no or mild emphysema, with or without bronchial wall thickening; type E - emphysema without bronchial wall thickening; and type M - both emphysema and bronchial wall thickening. Results: The low attenuation area (LAA) scores in group A patients were higher than those in group B (t = 2.86, P < 0.01); correlation analysis showed that smoking was associated with a decline of the forced expiratory volume in 1 s and forced vital capacity ratio (FEV1/ FVC%) and higher LAA scores in patients with COPD (F = 4.46, F = 8.20, P < 0.05). The levels of MMP-9 in group A were higher than those in group B (t = 3.65, P < 0.01). Among COPD patients with more than 3 comorbidities, there were statistically significant differences in both the smoking group and the nonsmoking group (chi-square = 12.08, P < 0.01). When compared to type A patients, who had coincident cardiovascular diseases in the smoking group, patients of type M and E showed statistically significant differences (F = 2.42 and 2.12, P < 0.05). Conclusion: Emphysema was more severe in smokers. Metalloproteinase levels in smokers were higher than those in nonsmokers. Moreover, comorbidities were more severe in smokers.


Assuntos
Pneumonia , Doença Pulmonar Obstrutiva Crônica , Fumar/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Bronquite Crônica/complicações , Bronquite Crônica/epidemiologia , Estudos de Coortes , Comorbidade , Enfisema/complicações , Enfisema/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/classificação , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Radiografia Torácica
15.
J Vet Emerg Crit Care (San Antonio) ; 28(6): 596-602, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30302906

RESUMO

OBJECTIVE: To describe the presentation, diagnosis, treatment, and outcome of a case of emphysematous gastritis (EG) in a cat. CASE SERIES SUMMARY: A 15-year-old female neutered domestic short-hair cat presented for a 4-month history of weight loss and intermittent vomiting. Clinicopathologic and imaging findings suggested an underlying primary gastrointestinal (GI) disease, as well as possible hepatobiliary disease. Two days following exploratory laparotomy to obtain GI and liver biopsies, the patient became septic and intracellular bacteria were present on cytology of peritoneal effusion. On radiographs, the stomach was markedly distended with fluid and contained a thin gas opacity surrounding the stomach wall. The patient was taken back to surgery to identify a source of sepsis. At surgery, the patient's stomach was firm and emphysematous on palpation but grossly appeared normal. There were no signs of dehiscence of the previous biopsy sites. Stomach biopsy confirmed the presence of intralesional Gram-positive rods, consistent with microbial EG, and a light growth of a Clostridium sp. was cultured from abdominal fluid, consistent with clostridial peritonitis. During a third surgery for suspected septic peritonitis, a jejunostomy tube was placed for postgastric enteral feeding. The patient ultimately survived to discharge and is clinically stable 10 months later. NEW/UNIQUE INFORMATION PROVIDED: EG is a rare but potentially fatal clinical entity in the human and veterinary literature with only 1 other case reported in cats. Though clostridial organisms have been reported in EG in people, this is the first implication of EG secondary to a Clostridium sp. in the cat. This is also the first report to document the use of a jejunostomy tube for postgastric enteral nutrition to treat EG in the veterinary literature.


Assuntos
Doenças do Gato/diagnóstico , Enfisema/veterinária , Gastrite/veterinária , Sepse/veterinária , Animais , Antibacterianos/uso terapêutico , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/tratamento farmacológico , Gatos , Diagnóstico Diferencial , Enfisema/complicações , Enfisema/diagnóstico , Feminino , Gastrite/complicações , Gastrite/diagnóstico , Radiografia/veterinária , Sepse/complicações , Sepse/diagnóstico , Streptococcus bovis/isolamento & purificação , Vômito/etiologia , Vômito/veterinária
17.
BMJ Case Rep ; 20182018 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209146

RESUMO

Emphysematous pyelonephritis (EPN) is a rare, necrotising infection of the renal parenchyma, predominantly associated with Escherichia coli infection and unless promptly recognised and dealt with, it carries a poor prognosis. The current treatment is one of antimicrobial therapies together with nephrectomy in a majority of patients. We report an elderly man with multiple comorbidities with a diagnosis of EPN whose condition improved with antimicrobial and supportive therapy, and no surgical intervention was required.


Assuntos
Tratamento Conservador/métodos , Enfisema/terapia , Pielonefrite/terapia , Idoso , Antibacterianos/uso terapêutico , Enfisema/complicações , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/terapia , Humanos , Masculino , Pielonefrite/complicações , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Tokai J Exp Clin Med ; 43(3): 106-110, 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30191545

RESUMO

We report the case of a 62-year-old man who used approximately one can of waterproofing spray in an enclosed room and, then, smoked a cigarette. He developed a fever of 39°C with respiratory distress and was transported by ambulance to his usual doctor. Since his respiratory state was very severe, he was transferred to our hospital. The patient had a smoking habit of 20 cigarettes per day for approximately 42 years. Chest computed tomography (CT) on arrival showed ground glass opacity (GGO) in the bilateral lungs with emphysematous change. We diagnosed the patient with acute respiratory distress syndrome (ARDS) because of severe hypoxemia. Based on the symptoms' progress, the cause of ARDS was thought to be lung injury due to waterproofing spray inhalation, and treatment was accordingly initiated. Several reports have described lung injury caused by waterproofing spray inhalation; however, severe cases that progress to ARDS are rare. We believe that the aggravation was caused by smoking after inhaling the waterproofing spray and pre-existing pulmonary lesions, such as emphysema. Education regarding the precautions to be taken when using waterproofing spray is necessary.


Assuntos
Lesão Pulmonar Aguda/etiologia , Polímeros de Fluorcarboneto/efeitos adversos , Exposição por Inalação/efeitos adversos , Síndrome do Desconforto Respiratório do Adulto/etiologia , Fumar/efeitos adversos , Lesão Pulmonar Aguda/diagnóstico por imagem , Aerossóis , Enfisema/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Surfactantes Pulmonares/efeitos adversos , Radiografia Torácica , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
19.
Echocardiography ; 35(9): 1482-1483, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30079519

RESUMO

We presented a case with massive hepatic portovenous gas (HPVG) and gastric emphysema, probably due to increased intraluminal pressure in the stomach after bagging and noninvasive ventilation. There are multiple microbubbles in the inferior vena cava, right atrium and right ventricle. There has been only one case report ever published showing the similar features of the "aquarium sign" in the right heart in a patient with intussusception. We believe our case is a good illustration of this extremely rare entity in echocardiography.


Assuntos
Ecocardiografia/métodos , Enfisema/complicações , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Intussuscepção/complicações , Gastropatias/complicações , Corticosteroides/uso terapêutico , Idoso , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Enfisema/diagnóstico por imagem , Enfisema/tratamento farmacológico , Átrios do Coração/diagnóstico por imagem , Cardiopatias/tratamento farmacológico , Ventrículos do Coração/diagnóstico por imagem , Humanos , Intussuscepção/diagnóstico por imagem , Intussuscepção/tratamento farmacológico , Masculino , Microbolhas , Estômago/diagnóstico por imagem , Gastropatias/diagnóstico por imagem , Gastropatias/tratamento farmacológico , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagem
20.
Hum Mol Genet ; 27(10): 1785-1793, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-29538751

RESUMO

The most common genotype associated with severe α-1-antitrypsin deficiency (AATD) is the Z homozygote. The Z variant (Glu342Lys) of α-1-antitrypsin (AAT) undergoes a conformational change and is retained within the endoplasmic reticulum (ER) of hepatocytes leading to the formation of ordered polymeric chains and inclusion bodies. Accumulation of mutated protein predisposes to cirrhosis whilst plasma AAT deficiency leads to emphysema. Increased risk of liver and lung disease has also been reported in heterozygous subjects who carry Z in association with the milder S allele (Glu264Val) or even with wild-type M. However, it is unknown whether Z AAT can co-polymerize with other AAT variants in vivo. We co-expressed two AAT variants, each modified by a different tag, in cell models that replicate AAT deficiency. We used pull-down assays to investigate interactions between co-expressed variants and showed that Z AAT forms heteropolymers with S and with the rare Mmalton (Phe52del) and Mwurzburg (Pro369Ser) mutants, and to a lesser extent with the wild-type protein. Heteropolymers were recognized by the 2C1 mAb that binds to Z polymers in vivo. There was increased intracellular accumulation of AAT variants when co-expressed with Z AAT, suggesting a dominant negative effect of the Z allele. The molecular interactions between S and Z AAT were confirmed by confocal microscopy showing their colocalization within dilated ER cisternae and by positivity in Proximity Ligation Assays. These results provide the first evidence of intracellular co-polymerization of AAT mutants and contribute to understanding the risk of liver disease in SZ and MZ heterozygotes.


Assuntos
Enfisema/genética , Cirrose Hepática/genética , Deficiência de alfa 1-Antitripsina/genética , alfa 1-Antitripsina/genética , Alelos , Enfisema/sangue , Enfisema/complicações , Enfisema/fisiopatologia , Retículo Endoplasmático/genética , Retículo Endoplasmático/patologia , Regulação da Expressão Gênica/genética , Genótipo , Células HEK293 , Hepatócitos/metabolismo , Hepatócitos/patologia , Heterozigoto , Humanos , Fígado , Cirrose Hepática/complicações , Cirrose Hepática/fisiopatologia , Agregados Proteicos/genética , Conformação Proteica , Multimerização Proteica/genética , alfa 1-Antitripsina/sangue , alfa 1-Antitripsina/química , Deficiência de alfa 1-Antitripsina/complicações , Deficiência de alfa 1-Antitripsina/fisiopatologia
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