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1.
Anticancer Res ; 40(10): 5877-5881, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988918

RESUMO

BACKGROUND/AIM: Pleural effusion (PE) has a heterogeneous aetiology, and differential diagnosis between benign and malignant disease may require invasive procedures in up to 60% of cases. The sensitivity of pleural cytology is limited, and several strategies have been tested to reduce the need of invasive diagnostic approaches. The aim of this study was to evaluate the usefulness of pleural fluid cytology, compared to, and combined with, carcinoembryonic antigen (CEA), C reactive protein (CRP), and lactate dehydrogenase (LDH) assay of pleural fluid (PF) in patients with a history of cancer, exudative non-purulent PE, and suspicion of malignant PE on imaging studies. PATIENTS AND METHODS: The medical records of 40 patients with pulmonary metastases and malignant PE, and 57 controls with benign exudative PE were reviewed. All the patients underwent pleural cytology and CEA, CRP, and LDH assay before VATS-guided biopsy. RESULTS: The sensitivity and specificity were 55.0% and 98.2% (cytology), 35.0% and 98.2% (CEA), 92.5% and 71.9% (CRP), 70.0% and 54.4% (LDH). The multivariate analysis excluded LDH, and the final AUC (cytology+CEA+CRP) was 0.894. CONCLUSION: In all patients with a history of cancer and PE of uncertain origin, the combination of PF cytology plus pleural CEA and CRP assay together should be suggested to recognize malignant plural effusion (MPE), minimising the use of unnecessary invasive investigations.


Assuntos
Diagnóstico Diferencial , Neoplasias/diagnóstico , Pleura/metabolismo , Derrame Pleural Maligno/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Proteína C-Reativa/metabolismo , Antígeno Carcinoembrionário/metabolismo , Citodiagnóstico/métodos , Feminino , Humanos , L-Lactato Desidrogenase/metabolismo , Masculino , Pessoa de Meia-Idade , Neoplasias/metabolismo , Neoplasias/patologia , Pleura/patologia , Derrame Pleural Maligno/metabolismo , Derrame Pleural Maligno/patologia
2.
Intensive Care Med ; 46(10): 1873-1883, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32860069

RESUMO

PURPOSE: Information regarding the use of lung ultrasound (LUS) in patients with Coronavirus disease 2019 (COVID-19) is quickly accumulating, but its use for risk stratification and outcome prediction has yet to be described. We performed the first systematic and comprehensive LUS evaluation of consecutive patients hospitalized with COVID-19 infection, in order to describe LUS findings and their association with clinical course and outcome. METHODS: Between 21/03/2020 and 04/05/2020, 120 consecutive patients admitted to the Tel Aviv Medical Center due to COVID-19, underwent complete LUS within 24 h of admission. A second exam was performed in case of clinical deterioration. LUS score of 0 (best)-36 (worst) was assigned to each patient. LUS findings were compared with clinical data. RESULTS: The median baseline total LUS score was 15, IQR [7-20]. Baseline LUS score was 0-18 in 80 (67%) patients, and 19-36 in 40 (33%) patients. The majority had patchy pleural thickening (n = 100; 83%), or patchy subpleural consolidations (n = 93; 78%) in at least one zone. The prevalence of pleural thickening, subpleural consolidations and the total LUS score were all correlated with severity of illness on admission. Clinical deterioration was associated with increased follow-up LUS scores (p = 0.0009), mostly due to loss of aeration in anterior lung segments. The optimal cutoff point for LUS score was 18 (sensitivity = 62%, specificity = 74%). Both mortality and need for invasive mechanical ventilation were increased with baseline LUS score > 18 compared to baseline LUS score 0-18. Unadjusted hazard ratio of death for LUS score was 1.08 per point [1.02-1.16], p = 0.008; Unadjusted hazard ratio of the composite endpoint (death or need for invasive mechanical ventilation) for LUS score was 1.12 per point [1.05-1.2], p = 0.0008. CONCLUSION: Hospitalized patients with COVID-19, at all clinical grades, present with pathological LUS findings. Baseline LUS score strongly correlates with the eventual need for invasive mechanical ventilation and is a strong predictor of mortality. Routine use of LUS may guide patients' management strategies, as well as resource allocation in case of surge capacity.


Assuntos
Infecções por Coronavirus/patologia , Hospitalização , Pulmão/patologia , Pleura/patologia , Pneumonia Viral/patologia , Respiração Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Coronavirus , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Feminino , Hospitais , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Prognóstico , Valores de Referência , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Síndrome do Desconforto Respiratório do Adulto/patologia , Síndrome do Desconforto Respiratório do Adulto/virologia , Medição de Risco , Índice de Gravidade de Doença , Ultrassonografia
4.
Medicine (Baltimore) ; 99(28): e21046, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664116

RESUMO

RATIONALE: Although there have been several studies describing clinical and radiographic features about the novel coronavirus (COVID-19) infection, there is a lack of pathologic data conducted on biopsies or autopsies. PATIENT CONCERNS: A 56-year-old and a 70-year-old men with fever, cough, and respiratory fatigue were admitted to the intensive care unit and intubated for respiratory distress. DIAGNOSIS: The nasopharyngeal swab was positive for COVID-19 and the chest Computed Tomography (CT) scan showed the presence of peripheral and bilateral ground-glass opacities. INTERVENTIONS: Both patients developed pneumothoraces after intubation and was managed with chest tube. Due to persistent air leak, thoracoscopies with blebs resection and pleurectomies were performed on 23rd and 16th days from symptoms onset. OUTCOMES: The procedures were successful with no evidence of postoperative air-leak, with respiratory improvement. Pathological specimens were analyzed with evidence of diffuse alveolar septum disruption, interstitium thickness, and infiltration of inflammatory cells with diffuse endothelial dysfunction and hemorrhagic thrombosis. LESSONS: Despite well-known pulmonary damages induced by the COVID-19, the late-phase histological changes include diffused peripheral vessels endothelial hyperplasia, in toto muscular wall thickening, and intravascular hemorrhagic thrombosis.


Assuntos
Infecções por Coronavirus/patologia , Endotélio Vascular/patologia , Pulmão , Pandemias , Pleura , Pneumonia Viral/patologia , Trombose/patologia , Trombose/parasitologia , Idoso , Betacoronavirus/isolamento & purificação , Biópsia/métodos , Tubos Torácicos/efeitos adversos , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Pleura/cirurgia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pneumotórax/etiologia , Pneumotórax/terapia , Respiração Artificial/métodos , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Toracoscopia/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(29): e21239, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702901

RESUMO

To investigate the computed tomography (CT) imaging and pathological basis of the linear shadows connecting pulmonary segmental arteries to horizontal fissure (hereinafter referred to as "linear shadow") on thin-slice CT.Collect 127 clinical cases to analyze the display and morphology of linear shadows on the thin-slice CT and to measure their length, thickness, and angle. Collect 11 autopsy specimens of coal worker's pneumoconiosis to conduct an imaging and pathology basis control study for the linear shadows.There is no correlation between the linear shadow and gender, age, and smoking history. Linear shadows are observed in 54.33% of patients. 93.33% of those linear shadows are straight lines. Generally, the lengths are less than 10 mm, the thicknesses are around 1 mm, and the scopes of angles are wide, range from acute angles to obtuse angles. The linear shadow is a banded structure consisting of loose connective tissue, small blood vessels, and small lymphatic vessels due to the visceral pleura recessed and fused into the lung.Linear shadows are intrinsic to the lung. The linear shadows consist of loose connective tissue, small blood vessels, and small lymphatic vessels.


Assuntos
Antracose , Pneumopatias/diagnóstico por imagem , Pleura/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Adulto , Autopsia , Feminino , Humanos , Pneumopatias/patologia , Masculino , Pleura/patologia , Artéria Pulmonar/patologia , Tomografia Computadorizada por Raios X
6.
Infez Med ; 28(suppl 1): 104-110, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: covidwho-596660

RESUMO

PURPOSE: The aim of this study was to report the radiological features of chest CT scan of patients with coronavirus disease 2019 (COVID-19) living in a town in Southern Italy where a significant outbreak of the disease occurred. METHODS: We revised the CT scan of 62 patients (34 male, 28 female, mean age 71 +/- 14 years) with clinical and laboratory signs of COVID-19, as assessed by positive SARS-CoV-2 RT-PCR testing. All patients underwent chest CT at the time of admission to the hospital. A semi-quantitative scoring system was used to evaluate the extension of the disease. RESULTS: Out of the 62 patients the main radiological findings were reticular pattern (29%), ground-glass opacities (24%), crazy paving pattern (11%) and consolidation (35%). Most of the lesions were bilateral (97%), posterior (95%) and located near pleura (50%) or lung fissures (45%), mainly involving the lower right lobe (56%) and lower left lobe (23%). Pleural thickening was observed in 72.6% of patients and pleural effusion in 18%. Median value of the score was 7.0 and was significantly higher in male than female (8.5 vs 6.0, p=0.03) and in patients with pleural thickening compared to those without this finding (8.0 vs 5.0, p=0.03).


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pleura/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pleura/patologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Pneumonia Viral/complicações , Índice de Gravidade de Doença
7.
Infez Med ; 28(suppl 1): 104-110, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532946

RESUMO

PURPOSE: The aim of this study was to report the radiological features of chest CT scan of patients with coronavirus disease 2019 (COVID-19) living in a town in Southern Italy where a significant outbreak of the disease occurred. METHODS: We revised the CT scan of 62 patients (34 male, 28 female, mean age 71 +/- 14 years) with clinical and laboratory signs of COVID-19, as assessed by positive SARS-CoV-2 RT-PCR testing. All patients underwent chest CT at the time of admission to the hospital. A semi-quantitative scoring system was used to evaluate the extension of the disease. RESULTS: Out of the 62 patients the main radiological findings were reticular pattern (29%), ground-glass opacities (24%), crazy paving pattern (11%) and consolidation (35%). Most of the lesions were bilateral (97%), posterior (95%) and located near pleura (50%) or lung fissures (45%), mainly involving the lower right lobe (56%) and lower left lobe (23%). Pleural thickening was observed in 72.6% of patients and pleural effusion in 18%. Median value of the score was 7.0 and was significantly higher in male than female (8.5 vs 6.0, p=0.03) and in patients with pleural thickening compared to those without this finding (8.0 vs 5.0, p=0.03).


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pleura/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/complicações , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pleura/patologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Pneumonia Viral/complicações , Índice de Gravidade de Doença
8.
J Cancer Res Clin Oncol ; 146(9): 2231-2239, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32533405

RESUMO

BACKGROUND: Adjuvant chemotherapy could improve the prognosis of stage II-III non-small cell lung cancer (NSCLC). However, its influences on stage IB were controversial. The purpose of this study was to investigate whether patients with stage IB NSCLC could benefit from adjuvant chemotherapy. METHODS: Stage IB NSCLC in 2010-2015 was selected from the surveillance, epidemiology, and end result database. Chi square test was used to compare the clinical characteristics of patients with different adjuvant chemotherapy status. Kaplan-Meier survival curves were plotted by the log-rank test. Cox proportional hazard regression was used to perform multivariate analysis on overall survival (OS), and the life table method was employed to calculate 1-, 3-, and 5-year survival rates. RESULTS: A total of 2915 patients were included in this study, and the number of patients with visceral pleural invasion (VPI) was 1096 (37.6%), of which 145 (13.2%) received adjuvant chemotherapy. There was no statistical difference in OS among the total population with or without chemotherapy (p = 0.295), nor in patients with VPI (p = 0.216). In patients with VPI, the 1-, 3-, 5-year survival curves of patients who are receiving adjuvant chemotherapy showed an upward trend compared with patients who did not. Additionally, female, high differentiated, adenocarcinoma, and tumor size ≤ 3 cm were also independent prognostic factors for improving the prognosis of patients with VPI. CONCLUSION: In our study, stage IB NSCLC did not benefit from adjuvant chemotherapy, even in patients with VPI. However, the significance of adjuvant chemotherapy in patients with VPI is still worth further exploration.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Invasividade Neoplásica/patologia , Pleura/patologia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Quimioterapia Adjuvante/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias/métodos , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
9.
J Cardiothorac Surg ; 15(1): 110, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448399

RESUMO

BACKGROUND: The present study aimed to use an ex-vivo model to investigate whether a new method involving the use of fibrin glue and a polyglycolic acid (PGA) sheet under ventilation enhances the sealing effect after repair of the pleural defect. METHODS: Ex-vivo pig lungs were used in this study. We investigated the maximum pressure tolerance of pleural defects repaired using three methods: 1, directly spraying fibrin glue over a PGA sheet; 2, spreading fibrinogen on the site then sealing with a PGA sheet and spraying with fibrin glue; and 3, spreading fibrinogen while maintaining ventilation then sealing with a PGA sheet and spraying with fibrin glue. RESULTS: The maximum tolerable pressures were as follows (mean ± standard deviation, cmH2O): Method 1, 37.1 ± 13.6, Method 2, 71.4 ± 27.7, Method 3, 111.5 ± 8.8. Histological findings explained the difference in tolerable pressure at the repaired site between methods. Microscopic findings of lungs repaired using Method 3 indicated that the fibrinogen penetrated into deeper tissues to act as an anchor. CONCLUSIONS: Fibrin glue sealing under ventilation increases the anchoring effect of repairing air leakages due to pleural defect in an ex-vivo model. This method may have clinical application. For example, it may be useful to reduce severe air leakage in patients who undergo lung-sparing surgery for a pleural tumor.


Assuntos
Adesivo Tecidual de Fibrina/farmacologia , Pleura/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Animais , Modelos Animais de Doenças , Pleura/patologia , Complicações Pós-Operatórias/etiologia , Suínos , Adesivos Teciduais/farmacologia
10.
J Infect ; 81(1): e40-e44, 2020 07.
Artigo em Inglês | MEDLINE | ID: covidwho-45888

RESUMO

BACKGROUND: 2019 novel coronavirus disease (COVID-19) has become a worldwide pandemic. Under such circumstance pregnant women are also affected significantly. OBJECTIVE: This study aims to observe the clinical features and outcomes of pregnant women who have been confirmed with COVID-19. METHODS: The research objects were 55 cases of suspected COVID-19 pregnant women who gave a birth from Jan 20th 2020 to Mar 5th 2020 in our hospital-a big birth center delivering about 30,000 babies in the last 3 years. These cases were subjected to pulmonary CT scan and routine blood test, manifested symptoms of fever, cough, chest tightness or gastrointestinal symptoms. They were admitted to an isolated suite, with clinical features and newborn babies being carefully observed. Among the 55 cases, 13 patients were assigned into the confirmed COVID-19 group for being tested positive sever acute respiratory syndrome coronavirus 2(SARS-CoV-2) via maternal throat swab test, and the other 42 patients were assigned into the control group for being ruled out COVID-19 pneumonia based on new coronavirus pneumonia prevention and control program(the 7th edition). RESULTS: There were 2 fever patients during the prenatal period and 8 fever patients during the postpartum period in the confirmed COVID-19 group. In contrast, there were 11 prenatal fever patients and 20 postpartum fever patients in the control group (p>0.05). Among 55 cases, only 2 case had cough in the confirmed group. The imaging of pulmonary CT scan showed ground- glass opacity (46.2%, 6/13), patch-like shadows(38.5%, 5/13), fiber shadow(23.1%, 3/13), pleural effusion (38.5%, 5/13)and pleural thickening(7.7%, 1/13), and there was no statistical difference between the confirmed COVID-19 group and the control group (p>0.05). During the prenatal and postpartum period, there was no difference in the count of WBC, Neutrophils and Lymphocyte, the radio of Neutrophils and Lymphocyte and the level of CRP between the confirmed COVID-19 group and the control group(p<0.05). 20 babies (from confirmed mother and from normal mother) were subjected to SARS-CoV-2 examination by throat swab samples in 24 h after birth and no case was tested positive. CONCLUSION: The clinical symptoms and laboratory indicators are not obvious for asymptomatic and mild COVID-19 pregnant women. Pulmonary CT scan plus blood routine examination are more suitable for finding pregnancy women with asymptomatic or mild COVID-19 infection, and can be used screening COVID-19 pregnant women in the outbreak area of COVID-19 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Adulto , Betacoronavirus/isolamento & purificação , Estudos de Casos e Controles , China/epidemiologia , Tosse , Feminino , Febre , Humanos , Pulmão/diagnóstico por imagem , Contagem de Linfócitos , Pandemias , Pleura/diagnóstico por imagem , Pleura/patologia , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Tomografia Computadorizada por Raios X
11.
Trop Doct ; 50(3): 203-209, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32345149

RESUMO

The management of late-stage empyema thoracis requires surgical intervention. We performed a retrospective descriptive analysis of open pleural decortication for late stage empyema thoracis in 55 children (age ≤ 15 years; median age = 6 years; age range = 1-15 years; 40 [72.7%] boys) over 42 months. The median time to thoracotomy from the onset of symptoms was 24 days, and the median duration of hospital stay before and after surgery was 15 and 4 days, respectively. Three (5.5%) patients had necrotising pneumonia, requiring debridement; 4 (7.3%) patients had superficial surgical site infection; 12 (21.8%) patients had perioperative pus culture positive for bacteria; and 3 (5.5%) patients had tubercular aetiology. There was no operative mortality. At median follow-up of 18 months, all patients are in good general health. Open pleural decortication leads to rapid resolution of symptoms and reduces hospital stay in paediatric late-stage empyema thoracis.


Assuntos
Empiema Pleural/cirurgia , Pleura/cirurgia , Adolescente , Criança , Pré-Escolar , Empiema Pleural/etiologia , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Nepal/epidemiologia , Pleura/microbiologia , Pleura/patologia , Estudos Retrospectivos , Centros de Atenção Terciária , Toracotomia/métodos , Tempo para o Tratamento , Resultado do Tratamento
12.
J Infect ; 81(1): e40-e44, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32294503

RESUMO

BACKGROUND: 2019 novel coronavirus disease (COVID-19) has become a worldwide pandemic. Under such circumstance pregnant women are also affected significantly. OBJECTIVE: This study aims to observe the clinical features and outcomes of pregnant women who have been confirmed with COVID-19. METHODS: The research objects were 55 cases of suspected COVID-19 pregnant women who gave a birth from Jan 20th 2020 to Mar 5th 2020 in our hospital-a big birth center delivering about 30,000 babies in the last 3 years. These cases were subjected to pulmonary CT scan and routine blood test, manifested symptoms of fever, cough, chest tightness or gastrointestinal symptoms. They were admitted to an isolated suite, with clinical features and newborn babies being carefully observed. Among the 55 cases, 13 patients were assigned into the confirmed COVID-19 group for being tested positive sever acute respiratory syndrome coronavirus 2(SARS-CoV-2) via maternal throat swab test, and the other 42 patients were assigned into the control group for being ruled out COVID-19 pneumonia based on new coronavirus pneumonia prevention and control program(the 7th edition). RESULTS: There were 2 fever patients during the prenatal period and 8 fever patients during the postpartum period in the confirmed COVID-19 group. In contrast, there were 11 prenatal fever patients and 20 postpartum fever patients in the control group (p>0.05). Among 55 cases, only 2 case had cough in the confirmed group. The imaging of pulmonary CT scan showed ground- glass opacity (46.2%, 6/13), patch-like shadows(38.5%, 5/13), fiber shadow(23.1%, 3/13), pleural effusion (38.5%, 5/13)and pleural thickening(7.7%, 1/13), and there was no statistical difference between the confirmed COVID-19 group and the control group (p>0.05). During the prenatal and postpartum period, there was no difference in the count of WBC, Neutrophils and Lymphocyte, the radio of Neutrophils and Lymphocyte and the level of CRP between the confirmed COVID-19 group and the control group(p<0.05). 20 babies (from confirmed mother and from normal mother) were subjected to SARS-CoV-2 examination by throat swab samples in 24 h after birth and no case was tested positive. CONCLUSION: The clinical symptoms and laboratory indicators are not obvious for asymptomatic and mild COVID-19 pregnant women. Pulmonary CT scan plus blood routine examination are more suitable for finding pregnancy women with asymptomatic or mild COVID-19 infection, and can be used screening COVID-19 pregnant women in the outbreak area of COVID-19 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/virologia , Adulto , Betacoronavirus/isolamento & purificação , Estudos de Casos e Controles , China/epidemiologia , Tosse , Feminino , Febre , Humanos , Pulmão/diagnóstico por imagem , Contagem de Linfócitos , Pandemias , Pleura/diagnóstico por imagem , Pleura/patologia , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Tomografia Computadorizada por Raios X
14.
Dis Markers ; 2020: 6430459, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32089756

RESUMO

Introduction. Preoperative detection of pleural invasion in lung cancer patients is key to curative surgical treatment. We tried to predict pleural invasion in non-small-cell lung cancer patients with <100 ml pleural fluid. Methods: Patients admitted from August 1, 2011, to December 31, 2018, were retrospectively retrieved. Records of serum and imaging markers were analyzed. Results: Among 7004 patients who received surgery, 43 cases with <100 ml pleural fluid who had pleural invasion were included, and another 108 cases without pleural invasion were enrolled as controls. There were no differences in squamous cell carcinoma antigen (SCC) or neuron-specific enolase (NSE) values between the pleural invasion and noninvasion groups (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (p = 0.30 and 0.14, respectively), but there were significant differences in carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) values (. Conclusions: Serum CEA and CYFRA21-1, location of original lung cancer (right mid lobe), maximum diameter, CT-detectable pleural fluid, pleural sign by CT, and PET/CT-predicted pleural invasion were good markers for the prediction of pleural invasion in non-small-cell lung cancer patients.


Assuntos
Biomarcadores Tumorais/sangue , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pleura/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Idoso , Antígenos de Neoplasias/sangue , Antígeno Carcinoembrionário/sangue , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Feminino , Humanos , Queratina-19 , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fosfopiruvato Hidratase/sangue , Pleura/diagnóstico por imagem , Estudos Retrospectivos , Serpinas/sangue , Procedimentos Cirúrgicos Torácicos , Resultado do Tratamento
15.
Am J Surg Pathol ; 44(3): 347-356, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32045387

RESUMO

Nuclear grading systems for epithelioid malignant pleural mesothelioma (MPM) have been proposed but it remains uncertain if they could be applied in a biopsy-heavy setting. Using the proposed system, we conducted an independent, external validation study using 563 consecutive cases of epithelioid MPM diagnosed at our institution between 2003 and 2017, of which 87% of patients underwent biopsies only. The median number of sites sampled was 1, with a median maximum tissue dimension of 17 mm (biopsy) and 150 mm (resection). The median overall survival (OS) was 14.7 months. The frequencies of grade I, II, and III tumors were 31% (132/563), 52% (292/563), and 17% (94/563). Grade I tumors were associated with the most favorable median OS (24.7 mo) followed by grades II (12.7 mo) and III (7.2 mo). The 2-tier nuclear grade separated tumors into low grade (19.3 mo) and high grade (8.9 mo). In multivariate analysis, 3-tier nuclear grade, 2-tier nuclear grade, and mitosis-necrosis score predicted OS independent of age, procedural type, solid-predominant growth pattern, necrosis, and atypical mitosis (all P<0.001 except 2-tier nuclear grade, P=0.001). In the scenario of a single- site biopsy with tissue dimension ≤10 mm, none but age (P=0.002) were independently predictive. Our data also suggested sampling 3 sites or a maximum tissue dimension of at least 20 mm from a single site is optimal for nuclear grade assessment. In conclusion our study confirmed the utility of nuclear grade in epithelioid MPM using a biopsy-heavy cohort provided the tissue sample met minimum dimensional criteria.


Assuntos
Neoplasias Pulmonares/patologia , Mesotelioma/patologia , Pleura/patologia , Neoplasias Pleurais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Mesotelioma/diagnóstico , Mesotelioma/mortalidade , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/mortalidade , Estudos Retrospectivos , Análise de Sobrevida
16.
Medicine (Baltimore) ; 99(2): e18678, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914061

RESUMO

To investigate the correlation between the proliferating cell nuclear antigen Ki-67 and the multislice computed tomography (MSCT) signs in different subtypes of lung adenocarcinoma.Ninety-five patients with lung adenocarcinoma confirmed by surgical pathology and treated between January 2017 and December 2017 were included. MSCT was performed before the operation, and the characteristics of the high-resolution CT (HRCT) signs of the lesions were compared with the Ki-67 immunohistochemistry results.The levels of Ki-67 in the 95 lung adenocarcinoma specimens were positively correlated with the malignancy of lung adenocarcinoma. Spearman correlation coefficient was 0.615. The expression of Ki-67 was positively correlated with the nodules' diameter, density, and lobulated sign, with Spearman correlation coefficients of 0.58, 0.554, and 0.436. There was no significant correlation with spiculation and pleural retraction, with correlation coefficients of 0.319/0.381.These findings suggest that the MSCT signs of different types of lung adenocarcinoma might be associated with the expression of Ki-67. Without replacing biopsy, the imaging features of pulmonary nodules could be comprehensively analyzed to evaluate the proliferation potential of preoperative nodules, but additional studies are needed for confirmation.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/patologia , Antígeno Ki-67/biossíntese , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/patologia , Pleura/patologia , Estudos Retrospectivos
17.
Clin Imaging ; 60(2): 153-159, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31927170

RESUMO

OBJECTIVE: To analyze the computed tomography (CT) and clinical features of ectopic thymoma, and to be familiar with the CT diagnosis of this disease. MATERIALS AND METHODS: CT data, clinical data, and pathological data of eight cases of ectopic thymoma, confirmed by pathology from September 2013 to June 2019, were retrospectively analyzed. RESULTS: Eight cases of thymoma were diagnosed, which included three in mediastinum (one of B1 type, two of C type), two in pericardium (both of B3 type), one in lung (B1 type), one in pleura (AB type), and one in right atrium (B2 type). Among the eight cases, four were men and four were women, aged 36-70 years. The clinical manifestations were chest tightness, shortness of breath and cough, and one case of myasthenia gravis. Six of the 8 patients were misdiagnosed as lymphoma, solitary fibrous tumor, malignant teratoma by CT. CT showed the following: the long diameter of tumor was 4.2 cm-19.5 cm, the shape was elliptical or round, and one case of ectopic thymoma grew in the atrium. The density was homogeneous in two cases and heterogeneous in six cases. The boundary was clear in three cases and unclear in five cases. Among the eight cases, three showed pleural effusion, two showed pericardial effusion and three showed calcification. CONCLUSIONS: Ectopic thymoma is rare and often misdiagnosed due to abnormal position. However, CT findings of ectopic thymoma are similar to those of the anterior superior mediastinal thymoma.


Assuntos
Timoma/diagnóstico , Neoplasias do Timo/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Coristoma/diagnóstico , Coristoma/diagnóstico por imagem , Feminino , Átrios do Coração/patologia , Humanos , Pulmão/patologia , Linfoma/patologia , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Miastenia Gravis , Pericárdio/patologia , Pleura/patologia , Estudos Retrospectivos , Timoma/diagnóstico por imagem , Timoma/patologia , Timo , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia
18.
Cancer Res ; 80(4): 843-856, 2020 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-31911549

RESUMO

Among malignant mesotheliomas (MM), the sarcomatoid subtype is associated with higher chemoresistance and worst survival. Due to its low incidence, there has been little progress in the knowledge of the molecular mechanisms associated with sarcomatoid MM, which might help to define novel therapeutic targets. In this work, we show that loss of PTEN expression is frequent in human sarcomatoid MM and PTEN expression levels are lower in sarcomatoid MM than in the biphasic and epithelioid subtypes. Combined Pten and Trp53 deletion in mouse mesothelium led to nonepithelioid MM development. In Pten;Trp53-null mice developing MM, the Gαi2-coupled receptor subunit activated MEK/ERK and PI3K, resulting in aggressive, immune-suppressed tumors. Combined inhibition of MEK and p110ß/PI3K reduced mouse tumor cell growth in vitro. Therapeutic inhibition of MEK and p110ß/PI3K using selumetinib (AZD6244, ARRY-142886) and AZD8186, two drugs that are currently in clinical trials, increased the survival of Pten;Trp53-null mice without major toxicity. This drug combination effectively reduced the proliferation of primary cultures of human pleural (Pl) MM, implicating nonepithelioid histology and high vimentin, AKT1/2, and Gαi2 expression levels as predictive markers of response to combined MEK and p110ß/PI3K inhibition. Our findings provide a rationale for the use of selumetinib and AZD8186 in patients with MM with sarcomatoid features. This constitutes a novel targeted therapy for a poor prognosis and frequently chemoresistant group of patients with MM, for whom therapeutic options are currently lacking. SIGNIFICANCE: Mesothelioma is highly aggressive; its sarcomatoid variants have worse prognosis. Building on a genetic mouse model, a novel combination therapy is uncovered that is relevant to human tumors.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Classe I de Fosfatidilinositol 3-Quinases/antagonistas & inibidores , Neoplasias Pulmonares/tratamento farmacológico , Mesotelioma/tratamento farmacológico , Quinases de Proteína Quinase Ativadas por Mitógeno/antagonistas & inibidores , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Pleurais/tratamento farmacológico , Inibidores de Proteínas Quinases/farmacologia , Compostos de Anilina/farmacologia , Compostos de Anilina/uso terapêutico , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Benzimidazóis/farmacologia , Benzimidazóis/uso terapêutico , Proliferação de Células/efeitos dos fármacos , Cromonas/farmacologia , Cromonas/uso terapêutico , Classe I de Fosfatidilinositol 3-Quinases/metabolismo , Modelos Animais de Doenças , Epitélio/patologia , Feminino , Técnicas de Introdução de Genes , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Mesotelioma/genética , Mesotelioma/patologia , Camundongos , Camundongos Knockout , Quinases de Proteína Quinase Ativadas por Mitógeno/metabolismo , Terapia de Alvo Molecular/métodos , PTEN Fosfo-Hidrolase/genética , Neoplasias Peritoneais/genética , Neoplasias Peritoneais/patologia , Peritônio/patologia , Pleura/patologia , Neoplasias Pleurais/genética , Neoplasias Pleurais/patologia , Cultura Primária de Células , Prognóstico , Inibidores de Proteínas Quinases/uso terapêutico , Proteína Supressora de Tumor p53/genética
19.
Pediatr Pulmonol ; 55(3): E1-E4, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31944579

RESUMO

Pleuroparenchymal fibroelastosis (PPFE), which is primarily diagnosed in adults, is a progressive lung pathology associated with significant morbidity and mortality. PPFE is characterized by pleural and subpleural parenchymal disease causing dyspnea, cough, and recurrent pneumothoraces. PPFE can be precipitated by autoimmune disorders, recurrent respiratory infections, chemotherapy, and transplant. We describe the youngest recorded patient to develop PPFE, whose symptoms began several years after treatment for neuroblastoma. Her symptoms were initially mistaken for worsening asthma, and multiple comorbidities developed during the prolonged time to recognition of PPFE and she progressed to fatal lung disease before potentially curative lung transplantation could occur.


Assuntos
Doenças Pulmonares Intersticiais/diagnóstico , Tecido Parenquimatoso/patologia , Pleura/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Pré-Escolar , Tosse/etiologia , Dispneia/etiologia , Feminino , Fibrose , Humanos , Doenças Pulmonares Intersticiais/patologia , Neuroblastoma/diagnóstico por imagem , Neuroblastoma/tratamento farmacológico , Neuroblastoma/radioterapia , Tecido Parenquimatoso/diagnóstico por imagem , Pleura/diagnóstico por imagem
20.
BMJ Case Rep ; 12(11)2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31791991

RESUMO

We present an atypical presentation of Rosai-Dorfman disease (RDD). Due to its overlap with IgG4-related disease (IgG4-RD), this case proved to be a diagnostic dilemma. Our case is an example of the importance of having a broad-based differential and, ultimately, an in-depth histopathological review. Our patient presented with a constellation of symptoms suggestive of an underlying malignancy. He was provisionally diagnosed with peritoneal carcinomatosis of an unknown primary. His initial presentation triggered a series of investigations, surgery and biopsies. Omental biopsy specimens were suggestive of IgG4-RD. Despite appropriate treatment for IgG4-RD, his disease progressed, specifically in the lungs. Pleural biopsies were then collected and assessed alongside the omental biopsies. On review and reassessment, the patient was formally diagnosed with RDD.


Assuntos
Histiocitose Sinusal/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Histiocitose Sinusal/patologia , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Masculino , Mesentério/patologia , Pleura/patologia
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