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1.
J Infect Chemother ; 27(1): 99-102, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33023821

RESUMO

We present three patients affected by pulmonary squamous cell carcinoma, metastatic esophageal cancer and advanced non-Hodgkin lymphoma, who incurred in coronavirus 2019 (COVID-19) infection during the early phase of epidemic wave in Italy. All patients presented with fever. Social contact with subject positive for COVID-19 was declared in only one of the three cases. In all cases, laboratory findings showed lymphopenia and elevated C-reactive protein (CRP). Chest x-ray and computed tomography showed bilateral ground-glass opacities, shadowing, interstitial abnormalities, and "crazy paving" pattern which evolved with superimposition of consolidations in one patient. All patients received antiviral therapy based on ritonavir and lopinavir, associated with hydroxychloroquine. Despite treatment, two patients with advanced cancers died after 39 and 17 days of hospitalization, while the patient with lung cancer was dismissed at home, in good conditions.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Hidroxicloroquina/uso terapêutico , Lopinavir/uso terapêutico , Neoplasias/complicações , Pneumonia Viral/tratamento farmacológico , Ritonavir/uso terapêutico , Idoso , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/tratamento farmacológico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Quimioterapia Combinada , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/tratamento farmacológico , Evolução Fatal , Humanos , Itália , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Kyobu Geka ; 73(10): 840-844, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130776

RESUMO

Interstitial lung diseases (ILDs) are associated with an increased risk of lung cancer, and pulmonary resection is well known to be associated with high postoperative morbidity and mortality in lung cancer patients. Postoperative mortality rate of acute exacerbation( AE) was reported 33.3~100%. Sex, CRP, KL-6, %vital capacity( VC), forced expiratory volume in 1 second( FEV1.0), history of AE, preoperative steroid use, and surgical procedures were identified as possible risk factors of AE in the univariate analyses by the data obtained from patients with non-small cell lung cancer who had undergone pulmonary resection and presented with a clinical diagnosis of ILD between January 2000 and December 2009 at 64 institutions throughout Japan. Multivariate analysis using these factors identified surgical procedures except for wedge resection, history of AE, KL-6, %VC, and male sex as independent risk factors. A score by risk prediction for AE was 5 X (history of AE)+4 X (CT:UIP pattern)+3 X (gender:male)+3 X (preoperative steroid use)+2 X (KL-6>1,000 U/ml)+1 X (VC≤80%). The predicted probability of risk score 15~22 is>0.25, and risk score 11~14 is 0.1~0.25. We can use a simple risk scoring system comprising seven parameters to identify high risk patients for AE, and provide essential information to support fair and objective clinical decision-making by thoracic surgeons.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Doenças Pulmonares Intersticiais , Neoplasias Pulmonares , Progressão da Doença , Humanos , Japão , Doenças Pulmonares Intersticiais/complicações , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Masculino , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
3.
Kyobu Geka ; 73(10): 845-850, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130777

RESUMO

Pulmonary dysfunction with lung cancer has been shown a major postoperative risk factor in patients undergoing thoracic surgery. Preoperative physiological assessment according to guideline by American College of Chest Physicians (ACCP) or European Respiratory Society( ERS)/European Society of Thoracic Surgeons (ESTS) is important to select patients due to evaluate the risk of lung resection for a lung cancer patient. Moreover, for lung cancer patients undergoing thoracic surgery with pulmonary dysfunction, circulatory function evaluation is important in addition to preoperative respiratory management and rehabilitation. Thoracic surgery for patients with pulmonary dyfunction should be selected to assess preoperative pulmonary function and to predict postoperative complications.


Assuntos
Neoplasias Pulmonares , Procedimentos Cirúrgicos Pulmonares , Cirurgia Torácica , Humanos , Pulmão , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Fatores de Risco
5.
J Thorac Cardiovasc Surg ; 159(2): 691-702.e5, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-33003262

RESUMO

OBJECTIVE: We sought to identify whether chronic opioid users are at increased risk for complications or hospital readmission following lobectomy for non-small cell lung cancer. METHODS: The National Cancer Institute Surveillance, Epidemiology, and End Results-Medicare database was queried to identify patients older than age 65 years who received a lobectomy for non-small cell lung cancer. Chronic opioid users were identified through Medicare Part D records and were defined as those with >120 cumulative days of opioid supply for the year before surgery. A systematic 1:2 propensity matching was performed among chronic opioid users. RESULTS: Six thousand four hundred thirty-seven patients were identified, among whom 3627 (56%) were opioid naïve, 1866 (29%) were intermittent opioid users, and 944 (15%) were chronic opioid users. After propensity matching, 30-day mortality and 90-day mortality were nearly 2-fold higher among chronic opioid users compared with nonchronic users. In addition, length of stay and hospital charges were increased among chronic opioid users (median, 6 vs 7 days and mean increase, $12,526, respectively). Multivariable analysis revealed that intermittent opioid users and chronic opioid users were associated with an increased risk of 90-day hospital readmission compared with opioid-naïve patients (odds ratio, 1.35; 95% confidence interval, 1.07-1.71 and odds ratio, 1.72; 95% confidence interval, 1.40-2.12, respectively), predominantly burdened by infectious, renal, and pulmonary causes. CONCLUSIONS: Patients who chronically use opioids before lobectomy represent high-risk patients. The risk of 30- and 90-day mortality, length of stay, hospital charges, and 90-day readmission after lobectomy among chronic opioid users are substantially elevated.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Transtornos Relacionados ao Uso de Opioides/complicações , Pneumonectomia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Pulmão/cirurgia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/cirurgia , Masculino , Readmissão do Paciente/estatística & dados numéricos , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 99(44): e23030, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126392

RESUMO

RATIONALE: Extramedullary invasion of chronic myelomonocytic leukemia (CMML) usually occurs in the liver, spleen, and lymph nodes, while the pleural infiltration of CMML is rare. The presence of pleural effusion is usually associated with uncontrolled leukocytosis and increased monocytes. PATIENT CONCERNS: Here we reported a rare case of CMML-0 with pleural effusion as the first manifestation in a 44-year-old woman. The pleural effusion was caused by blasts infiltration confirmed by the flow cytometer and the pleural biopsy. DIAGNOSES: CMML with pleural invasion. INTERVENTIONS: The patient was treated with azacitidine 75 mg/m d for 2 cycles, followed by daily oral intake of hydroxyurea (500 mg/d). OUTCOMES: Pleural effusion was resolved and chest pain was relieved. LESSONS: The current case indicated that leukemic infiltration into pleura could occur despite mild leukocytes, while demethylation may be an effective therapy.


Assuntos
Leucemia Mielomonocítica Crônica/diagnóstico , Neoplasias Pulmonares/diagnóstico , Adulto , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Azacitidina/administração & dosagem , Azacitidina/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Humanos , Hidroxiureia/administração & dosagem , Hidroxiureia/uso terapêutico , Leucemia Mielomonocítica Crônica/complicações , Leucemia Mielomonocítica Crônica/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Derrame Pleural/etiologia , Tomografia Computadorizada por Raios X
8.
J Stroke Cerebrovasc Dis ; 29(10): 105164, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912544

RESUMO

INTRODUCTION: The incidence of lung cancer and acute ischemic stroke remains high in recent years, both of which occur mostly in people over 60 years old. In the present study, we aimed to further clarify the pathogenesis of lung cancer-associated acute ischemic stroke (LCA-AIS) by comparing and analyzing clinical characteristics of stroke patients with or without lung cancer. METHODS: A total of 51 patients with lung cancer were selected as the case group (LCSG), and 78 patients without cancer history were adopted as the control group (SG). The data collected in this study included sex, age, traditional cerebrovascular disease risk factors (TCDRFs), blood test index, imaging findings, etiological typing, and prognosis evaluation. SPSS21.0 software was used for statistical analysis. Normally distributed data were analyzed by t-test, and count data were analyzed by chi-square test or exact probability method. P < 0.05 was considered statistically significant. RESULTS: In the case group, the levels of plasma D-dimer, fibrinogen degradation products (FDPs) and NIHSS, as well as the mRS score and mortality of patients, were higher, while the levels of RBC, Hb and Hcy were lower compared with the control group. Imaging findings showed that multivessel involvement was more common in the case group, and the infarcts were more likely to be multiple and involved in both the anterior and posterior circulations. The TOAST classification of LCSG was dominated by stroke of undetermined etiology (SUE) and stroke of other determined etiology (SOE). Statistical analysis showed that the patients were more likely to suffer from acute ischemic stroke within 1 year after the diagnosis of lung cancer (41 cases, 80.39%). CONCLUSIONS: Hypercoagulability and acute multiple brain infarcts were more common in patients with LCA-AIS, and hypoproteinemia and hyponatremia were more likely to occur in these patients, leading to worse prognosis. Patients were most likely to have a stroke within 1 year after the diagnosis of lung cancer.


Assuntos
Infarto Encefálico/etiologia , Neoplasias Pulmonares/complicações , Tromboembolia/etiologia , Trombofilia/etiologia , Idoso , Biomarcadores/sangue , Infarto Encefálico/diagnóstico , Infarto Encefálico/mortalidade , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Hipoproteinemia/diagnóstico , Hipoproteinemia/etiologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/mortalidade , Trombofilia/diagnóstico , Trombofilia/mortalidade , Fatores de Tempo
10.
Med Clin (Barc) ; 155(9): 411-413, 2020 11 13.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32883512
11.
Am J Clin Oncol ; 43(9): 636-639, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889833

RESUMO

OBJECTIVES: Cancer patients are using medical cannabis (MC) to address symptoms; however, little data exist to guide clinicians when counseling patients. We seek to define the patterns of MC use among cancer patients, as well as efficacy and safety of MC. MATERIALS AND METHODS: Cancer patients attending oncology office visits at Beaumont Hospital, Michigan from July to December 2018 were anonymously surveyed. The survey included data regarding demographics, diagnosis, treatment, symptom burden, and MC use. Patients who reported MC use since their cancer diagnosis completed a section on patterns of use, efficacy, and safety. RESULTS: The response rate was 188 of 327 (57.5%). MC use was reported by 46 of 188 (24.5%). A median composite baseline symptom score ranging from 8 (best) to 32 (worst) was higher in patients using MC versus nonusers; 17.5 versus 14.4 (P<0.001). Pain was the symptom with the highest frequency of improvement 34/42 (81%), followed by appetite 34/44 (77.3%), and anxiety 32/44 (73%). MC improved the ability to tolerate treatment in 24/44 (54.5%). Cloudy thinking is the symptom that worsened the most 7/42 (16.7%), with decreased energy being experienced by 4/41 (9.8%) of the users. CONCLUSIONS: MC was utilized by a significant portion of cancer patients in this sample, across age, diagnosis, stage, and treatment. Patients with a higher severity of baseline symptoms were more likely to use MC and report a favorable efficacy profile of MC. Minimal toxicity was reported in this cohort. Prospective studies are needed to define the efficacy and safety of MC.


Assuntos
Maconha Medicinal/uso terapêutico , Neoplasias/complicações , Neoplasias/terapia , Fitoterapia , Preparações de Plantas/uso terapêutico , Adolescente , Adulto , Idoso , Anorexia/tratamento farmacológico , Anorexia/etiologia , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Neoplasias da Mama/complicações , Neoplasias da Mama/terapia , Dor do Câncer/tratamento farmacológico , Cannabis , Feminino , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/terapia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/terapia , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Masculino , Maconha Medicinal/efeitos adversos , Pessoa de Meia-Idade , Náusea/tratamento farmacológico , Preparações de Plantas/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/etiologia , Inquéritos e Questionários , Adulto Jovem
12.
Zhonghua Zhong Liu Za Zhi ; 42(8): 665-669, 2020 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-32867459

RESUMO

Objective: To investigate the CT features and dynamic changes of new developed lung cancer in patients with connective tissue disease-related interstitial lung disease (CTD-ILD). Methods: A series of chest CT images of 58 CTD-ILD patients during follow-up were collected. The CT features of interstitial lung disease, the initial appearance time of lung cancer, the time of diagnosis of lung cancer, the morphological characteristics (location, shape, size) of lung cancer lesions and the dynamic changes of CT features were analyzed. Results: Among 58 patients, rheumatoid arthritis was the most common (31 cases). Chest CT images showed coexistence of two or more interstitial CT signs. During the follow-up, a total of 59 lung cancer lesions were found. The median time of lung cancer lesion occurred was 289 days. The median delay in diagnosis was 43 days. There were 44 cases of non-small cell lung cancer (including 23 cases of squamous cell carcinoma and 19 cases of adenocarcinoma), 12 cases of small cell lung cancer. Forty-three (72.9%) lesions were located in the lower lobes and 41 (69.5%) lesions were located in the area of pulmonary interstitial fibrosis. According to CT morphological characteristics of lung cancer, nodular type (37 cases), inflammatory consolidation (12 cases) and intra-honeycomb type (10 cases) were identified. Conclusions: The chest CT features of patients with CTD-ILD are complex. New developed lung cancer is easily missed or misdiagnosed in the early stage. Pay attention to the special CT characteristics of CTD-ILD with lung cancer is helpful for early diagnosis.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Doenças do Tecido Conjuntivo/complicações , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Neoplasias Pulmonares/complicações , Tomografia Computadorizada por Raios X/métodos , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem
13.
J Immunother Cancer ; 8(2)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32895296

RESUMO

BACKGROUND: Individualized prediction of mortality risk can inform the treatment strategy for patients with COVID-19 and solid tumors and potentially improve patient outcomes. We aimed to develop a nomogram for predicting in-hospital mortality of patients with COVID-19 with solid tumors. METHODS: We enrolled patients with COVID-19 with solid tumors admitted to 32 hospitals in China between December 17, 2020, and March 18, 2020. A multivariate logistic regression model was constructed via stepwise regression analysis, and a nomogram was subsequently developed based on the fitted multivariate logistic regression model. Discrimination and calibration of the nomogram were evaluated by estimating the area under the receiver operator characteristic curve (AUC) for the model and by bootstrap resampling, a Hosmer-Lemeshow test, and visual inspection of the calibration curve. RESULTS: There were 216 patients with COVID-19 with solid tumors included in the present study, of whom 37 (17%) died and the other 179 all recovered from COVID-19 and were discharged. The median age of the enrolled patients was 63.0 years and 113 (52.3%) were men. Multivariate logistic regression revealed that increasing age (OR=1.08, 95% CI 1.00 to 1.16), receipt of antitumor treatment within 3 months before COVID-19 (OR=28.65, 95% CI 3.54 to 231.97), peripheral white blood cell (WBC) count ≥6.93 ×109/L (OR=14.52, 95% CI 2.45 to 86.14), derived neutrophil-to-lymphocyte ratio (dNLR; neutrophil count/(WBC count minus neutrophil count)) ≥4.19 (OR=18.99, 95% CI 3.58 to 100.65), and dyspnea on admission (OR=20.38, 95% CI 3.55 to 117.02) were associated with elevated mortality risk. The performance of the established nomogram was satisfactory, with an AUC of 0.953 (95% CI 0.908 to 0.997) for the model, non-significant findings on the Hosmer-Lemeshow test, and rough agreement between predicted and observed probabilities as suggested in calibration curves. The sensitivity and specificity of the model were 86.4% and 92.5%. CONCLUSION: Increasing age, receipt of antitumor treatment within 3 months before COVID-19 diagnosis, elevated WBC count and dNLR, and having dyspnea on admission were independent risk factors for mortality among patients with COVID-19 and solid tumors. The nomogram based on these factors accurately predicted mortality risk for individual patients.


Assuntos
Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Neoplasias/terapia , Nomogramas , Pneumonia Viral/mortalidade , Fatores Etários , Idoso , Área Sob a Curva , Betacoronavirus , China/epidemiologia , Estudos de Coortes , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Dispneia/fisiopatologia , Fadiga/fisiopatologia , Feminino , Frequência Cardíaca , Humanos , Contagem de Leucócitos , Modelos Logísticos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Neoplasias/complicações , Neoplasias/patologia , Neutrófilos , Pandemias , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/complicações , Curva ROC , Estudos Retrospectivos , Medição de Risco
14.
Medicine (Baltimore) ; 99(37): e22087, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925748

RESUMO

RATIONALE: Anti-gamma-aminobutyric-acid B receptor (anti-GABAB R) encephalitis is clinically characterized by seizures, cognitive disorders, and behavioral changes. Most patients are diagnosed with small-cell lung carcinoma. PATIENT CONCERNS: The patient suffered from a repeated grand mal seizure lasting for 10 minutes, intermittent speech vagueness, manic at night, and mental disorder. DIAGNOSIS: The patient was diagnosed with autoimmune encephalitis. The gamma-aminobutyric-acid B(GABAB) receptor antibody test result was positive. After a bronchoscopic biopsy, the patient was diagnosed with small-cell lung carcinoma. INTERVENTIONS: The patient was administered with intravenous immunoglobulin and Methylprednisolone. Etoposide was used after the small-cell lung carcinoma was diagnosed. OUTCOMES: After immunotherapy, following the 4 months of Etoposide and antiseizure treatment, the neurology examination revealed a remarkable improvement. MRS score reduced from 5 to 1. Electroencephalogram (EEG) recovered to normal from an extreme delta brush (EDB) electroencephalographic-pattern. CONCLUSION: Immunotherapy and Etoposide can improve the outcome of severe anti-γ-aminobutyric acid B receptor encephalitis with small-cell lung carcinoma. After immunotherapy and antineoplastic therapy, Electroencephalogram (EEG) can be recovered to normal from an extreme delta brush.


Assuntos
Anti-Inflamatórios/uso terapêutico , Eletroencefalografia , Encefalite/diagnóstico , Encefalite/tratamento farmacológico , Etoposídeo/uso terapêutico , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/tratamento farmacológico , Metilprednisolona/uso terapêutico , Inibidores da Topoisomerase II/uso terapêutico , Autoanticorpos/sangue , Autoanticorpos/líquido cefalorraquidiano , Encefalite/complicações , Encefalite/imunologia , Doença de Hashimoto/complicações , Doença de Hashimoto/imunologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Receptores de GABA-B/imunologia , Carcinoma de Pequenas Células do Pulmão/complicações , Carcinoma de Pequenas Células do Pulmão/diagnóstico , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico
15.
Cancer Control ; 27(1): 1073274820960467, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32938231

RESUMO

Patients with lung cancer are presumed to be at high risk from COVID-19 infection due to underlying malignancy. A total of 31 COVID-19 patients with pre-diagnosed lung cancer and 186 age and sex matched COVID-19 patients without cancer in 6 hospitals in Wuhan, China were identified in our study. There was a significantly higher level of IL-6 in lung cancer group showed by multifactorial analysis. The restricted mean survival time in 10, 20, and 53 days in COVID-19 patients with lung cancer were ealier than non-cancer COVID-19 patients in the same observation time (all P values < 0.05). Our results indicated that pre-diagnosed lung cancer was associated with higher morbidity and mortality in COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias Pulmonares/complicações , Pandemias , Pneumonia Viral/epidemiologia , China/epidemiologia , Infecções por Coronavirus/complicações , Feminino , Hospitalização/tendências , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
16.
Eur J Cancer ; 138: 109-112, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32871524
17.
BMC Pulm Med ; 20(1): 242, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917179

RESUMO

BACKGROUND: Lung cancer is a frequent comorbidity of chronic obstructive pulmonary disease (COPD). However, the local risk of developing lung cancer related to regional emphysema distribution and clinical outcome has not been investigated. Our aim was to evaluate the impact of regional emphysema score (RES) on tumor location and prognosis in non-small cell lung cancer (NSCLC) patients. METHODS: We enrolled 457 patients who underwent curative surgery for NSCLC at seven hospitals at The Catholic University of Korea from 2014 to 2018. Emphysema was visually assessed for each lobe, with the lingula as a separate lobe. Semi-quantitative emphysema scoring was classified as follows: 0 = none, 0.5 = 1 to 10%, 1 = 11 to 25%, 2 = 26 to 50%, 3 = 51 to 75%, and 4 = 76 to 100%. An RES was given to each of the six lung zone: the upper, middle, and lower lobes in the right and left lungs. RESULTS: There were 145 patients in the high RES (≥ 3) group and 312 in the low RES (< 3) group. The mean RES in each lobe with cancer was significantly higher than that in other lobes without cancer (0.51 vs. 0.37, P <  0.001). This group showed significantly shorter disease-free survival (P <  0.001), in addition, presence of COPD, low diffusing capacity of the lung for carbon monoxide (< 80), smoking status, and poor differentiation were more frequent in this group. Also, cancer in a lobe with a higher RES (odds ratio (OR) = 1.56; 95% confidence interval (CI:1.01-2.42; P = 0.04), pathologic stage ≥ III (OR = 2.23; 95% CI: 1.28-3.89; P <  0.001), and poor differentiation (OR = 1.99; 95% CI: 1.22-3.21; P <  0.001) were independent factors for tumor recurrence. CONCLUSIONS: The regional severity of emphysema by visual qualification was associated with the location of lung cancer, and was an independently poor prognostic factor for tumor recurrence in completely resected NSCLC patients.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/complicações , Neoplasias Pulmonares/complicações , Enfisema Pulmonar/complicações , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença
19.
Medicine (Baltimore) ; 99(32): e21521, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769890

RESUMO

RATIONALE: The establishment of lung isolation is often particularly challenging for the anesthesiologist in patients with difficult airway. Usually, orotracheal intubation with double lumen tube is the commonly used technique for achieving 1 lung anesthesia. Whereas, in patients with limited mouth opening and restricted cervical mobility, this technique becomes extremely difficult and hazardous. We report a case in which bronchial blocker placement was succeeded via both nostrils in a difficult airway due to restricted mouth opening. PATIENT CONCERNS: A 50-year-old, non-smoking female with a painless mass in the left upper lobe. She had a 10-year history of ankylosing spondylitis and squamous cell carcinoma of the floor of the mouth after 5 operations 4 years previously. DIAGNOSES: Left upper lobe adenocarcinoma, ankylosing spondylitis and oral squamous cell carcinoma. INTERVENTIONS: To achieve 1 lung anesthesia, both nostrils were used for extraluminal bronchial blocker placement. OUTCOMES: Initially, oral intubation was selected for establishing a patent airway but failed. Then switched to nasal canal for insertion, after several attempts, a conventional nasal intubation tube (internal diameter 6.0 mm) was placed via 1 nostril under topical anesthesia, with the aid of a flexible fiberoptic bronchoscope, and a bronchial blocker was advanced to the desired position via the other nostril. LESSONS: In difficult airway with limited mouth opening and restricted cervical mobility, multidisciplinary experts participated discussion is a prerequisite for contemplating a scientific plan. Preoperative computed tomography scan and 3-dimensional computed tomography reconstruction would be helpful in detecting the narrowest part of airway conduit and determining a safe, reliable, and feasible airway program.


Assuntos
Adenocarcinoma de Pulmão/terapia , Obstrução das Vias Respiratórias/terapia , Intubação/métodos , Neoplasias Pulmonares/terapia , Nariz , Ventilação Monopulmonar/métodos , Adenocarcinoma de Pulmão/complicações , Obstrução das Vias Respiratórias/complicações , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/terapia , Feminino , Humanos , Neoplasias Pulmonares/complicações , Pessoa de Meia-Idade , Boca/patologia , Neoplasias Bucais/complicações , Neoplasias Bucais/terapia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/terapia
20.
Rinsho Shinkeigaku ; 60(9): 597-602, 2020 Sep 29.
Artigo em Japonês | MEDLINE | ID: mdl-32779594

RESUMO

An 82-year-old man with advanced lung cancer who had declined aggressive therapy was transferred to our hospital due to sudden-onset consciousness disturbance, global aphasia, and right hemiplegia. An electrocardiogram showed atrial fibrillation, and brain MRI and MRA revealed acute ischemic lesions of the left hemisphere and occlusion of the left internal carotid artery (ICA), respectively. We diagnosed acute ischemic stroke due to left ICA occlusion and performed endovascular thrombectomy, which resulted in complete recanalization of the left ICA after retrieval of the culprit embolus. Pathological examination of the retrieved thrombus revealed the presence of tumor tissue, as well as fibrin or red blood cells. Treatment was continued after admission, but the patient died of respiratory failure on day 40 of hospitalization. Autopsy revealed invasion of the tumor in the pulmonary vein, but not in the wall of the left atrium where thrombi were present. However, pathological examination of these thrombi in the left atrium revealed tumor tissue, along with fibrin or red blood cells. These findings suggest that the wall of the left atrium, in which lung cancer had not invaded, may be an incubator of a mixed embolus containing tumor tissue and thrombi in a case of cerebral embolism associated with both lung cancer and atrial fibrillation.


Assuntos
Fibrilação Atrial/complicações , Embolia Intracraniana/etiologia , Embolia Intracraniana/patologia , Neoplasias Pulmonares/complicações , Células Neoplásicas Circulantes , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Autopsia , Artéria Carótida Interna , Evolução Fatal , Átrios do Coração , Humanos , Embolia Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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