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3.
Medicina (B Aires) ; 79(5): 415-418, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671396

RESUMO

We present the case of a 62-year-old woman who consulted for fever (38°), stabbing thoracic pain (on one side), and pruritic skin lesions. She underwent peripheral blood tests, chest X-rays and CT. Her symptoms were interpreted as severe communityacquired pneumonia. After a treatment with antibiotics, her skin lesions persisted, and other symptoms were only partially relieved. A skin biopsy was performed, which revealed Treponema pallidum. Such finding was confirmed through positive serum VDRL and FTA-ABS tests. The patient received 4 doses of benzathine penicillin G with favorable evolution of skin lesions and improvement of radiological images.


Assuntos
Pneumopatias/microbiologia , Sífilis/complicações , Biópsia , Dermatite/microbiologia , Dermatite/patologia , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Pessoa de Meia-Idade , Radiografia Torácica , Sífilis/microbiologia , Tomografia Computadorizada por Raios X , Treponema pallidum/isolamento & purificação
4.
Nat Med ; 25(11): 1691-1698, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31700187

RESUMO

Millions of people worldwide with incurable end-stage lung disease die because of inadequate treatment options and limited availability of donor organs for lung transplantation1. Current bioengineering strategies to regenerate the lung have not been able to replicate its extraordinary cellular diversity and complex three-dimensional arrangement, which are indispensable for life-sustaining gas exchange2,3. Here we report the successful generation of functional lungs in mice through a conditional blastocyst complementation (CBC) approach that vacates a specific niche in chimeric hosts and allows for initiation of organogenesis by donor mouse pluripotent stem cells (PSCs). We show that wild-type donor PSCs rescued lung formation in genetically defective recipient mouse embryos unable to specify (due to Ctnnb1cnull mutation) or expand (due to Fgfr2cnull mutation) early respiratory endodermal progenitors. Rescued neonates survived into adulthood and had lungs functionally indistinguishable from those of wild-type littermates. Efficient chimera formation and lung complementation required newly developed culture conditions that maintained the developmental potential of the donor PSCs and were associated with global DNA hypomethylation and increased H4 histone acetylation. These results pave the way for the development of new strategies for generating lungs in large animals to enable modeling of human lung disease as well as cell-based therapeutic interventions4-6.


Assuntos
Pneumopatias/terapia , Pulmão/crescimento & desenvolvimento , Células-Tronco Pluripotentes/metabolismo , Regeneração/genética , Acilação/genética , Animais , Blastocisto/metabolismo , Diferenciação Celular/genética , Metilação de DNA/genética , Modelos Animais de Doenças , Histonas/genética , Humanos , Pulmão/patologia , Pneumopatias/patologia , Camundongos , Organogênese/genética , Células-Tronco Pluripotentes/transplante , Receptor Tipo 2 de Fator de Crescimento de Fibroblastos/genética , beta Catenina/genética
5.
Medicine (Baltimore) ; 98(43): e17349, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651839

RESUMO

RATIONALE: Diffuse pulmonary lymphangiomatos (DPL) is a rare aggressive lymphatic disorder characterized by proliferation of anastomozing lymphatic vessels and extremely rare in adult patients. PATIENT CONCERNS: We report a case of diffuse pulmonary lymphangiomatosis in 59-year-old man presented with cough and sputum for 2 months. DIAGNOSES: Combining clinical manifestations with results of radiological, bronchoscopy, and surgical lung biopsy, it was consistent with the diagnosis of DPL. INTERVENTIONS: After bronchoalveolar lavage and biopsy, symptom of cough got worse suddenly accompanied by excessive chyloptysis. The patient received an emergency surgical intervention and low fat medium chain fat treatment. OUTCOMES: The patient was discharged with a much better health condition. LESSONS: This case report is the oldest patient reported in the English literature, to the best of our knowledge. Serious complications of bronchoscopy should be considered, especially in DPL patients with severely enlarged mediastinum or with thin-walled translucent vesicles under endoscopy.


Assuntos
Tosse/patologia , Pneumopatias/congênito , Linfangiectasia/congênito , Biópsia , Broncoscopia , Tosse/etiologia , Humanos , Pulmão/patologia , Pneumopatias/complicações , Pneumopatias/patologia , Linfangiectasia/complicações , Linfangiectasia/patologia , Masculino , Pessoa de Meia-Idade , Doenças Raras/patologia , Escarro
7.
Med. clín (Ed. impr.) ; 153(8): 305-311, oct. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185414

RESUMO

Objectives: The aim of this study is to identify the clinical characteristics of primary Sjögren's syndrome (PSS) patients with pulmonary involvement and the associated factors for pulmonary involvement in PSS. Methods: We retrospectively reviewed clinical features, laboratory examinations, imaging tests, pathological results and therapeutic strategy of 367 PSS patients. Comparisons were made between two subgroups: PSS with pulmonary involvement and those without. Correlation between the pathology of minor salivary gland biopsy (MSGB) and diverse features with pulmonary involvement were detected by Pearson correlation analysis and associated factors were selected by multivariate logistic regression analysis. Results: The lung involved PSS patients had significantly higher level of inflammatory associated indexes (p<0.05). There is no significant correlation between pathology of MSGB and lung involvements. Age, elevated neutrophils level and hypoproteinemia are significantly associated with lung disease with in PSS cohort (p<0.05). As for therapeutic strategy, moderate dose prednisone (15-40mg/d) and cyclophosphamide (CTX) are mainly different between two subgroups. Conclusions: PSS patients with pulmonary involvements show enhanced inflammation. Age, elevated neutrophils level and hypoproteinemia are independent associated with pulmonary involvements in PSS patients. For those PSS with pulmonary involvement moderate dose of prednisone and CTX were still the mainstream


Objetivos: El objetivo de este estudio es identificar las características clínicas de los pacientes con afectación pulmonar en el síndrome de Sjögren primario (SSp), y los factores relacionados con la afectación pulmonar en el SSp. Métodos: Hemos revisado retrospectivamente las características clínicas, los análisis de laboratorio, las pruebas de imagen, los resultados patológicos y la estrategia terapéutica de 367 pacientes con SSp. Se realizaron comparaciones entre 2 subgrupos: SSp con afectación pulmonar y SSp sin afectación pulmonar. La correlación entre la patología de la biopsia de la glándula salival menor (BGSM) y diversas características con afectación pulmonar se detectó mediante el análisis de correlación de Pearson, y los factores asociados se seleccionaron mediante un análisis de regresión logística multivariable. Resultados: Los pacientes con afectación pulmonar en el SSp tenían niveles significativamente más altos de índices inflamatorios asociados (p<0,05). No encontramos una correlación significativa entre la patología de la BGSM y la afectación pulmonar. La edad, el nivel elevado de neutrófilos y la hipoproteinemia se asociaron de manera independiente con la enfermedad pulmonar en la cohorte de SSp (p<0,05). En cuanto a la estrategia terapéutica: prednisona en dosis moderada (15-40mg/d) y ciclofosfamida (CTX) fueron los principales medicamentos entre los 2 subgrupos. Conclusiones: Los pacientes con afectación pulmonar en el SSp tenían una inflamación más elevada que el grupo de pacientes con SSp sin afectación pulmonar. La edad, el nivel elevado de neutrófilos y la hipoproteinemia se asocian de manera independiente con la afectación pulmonar en pacientes con el SSp. Para aquellos pacientes con afectación pulmonar en el SSp, el tratamiento más común fue una dosis moderada de prednisona y CTX


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/complicações , Estudos de Coortes , Pneumopatias/patologia , Estudos Retrospectivos , Modelos Logísticos , Glândulas Salivares Menores/patologia , Biópsia , Hipoproteinemia/complicações , Pneumopatias/diagnóstico , Pneumopatias/tratamento farmacológico , Prednisona/administração & dosagem , Análise Multivariada
9.
Infect Immun ; 87(12)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31548321

RESUMO

Leptospirosis caused by pathogenic Leptospira is one of the most common zoonoses in the world. It is believed that humans become infected with it mainly through their skin and mucous membranes by contact with water or soil that is contaminated with urine excreted from infected animals. Recently, outbreaks have frequently occurred in the tropics, especially after flooding, but how leptospires cause mass infection remains poorly understood. In this study, we injected leptospires into the tracheas of hamsters under direct view and prove for the first time that leptospires can infect through the respiratory tract. We determined that a 50% lethal dose (LD50) of the Leptospira interrogans strain UP-MMC-SM (L495) for hamsters in transtracheal infection was 3.2 × 102 cells. The results of culture, macroscopic findings, and histopathological analysis suggested that intratracheally injected leptospires invaded the lung tissue, proliferated in the collagen-rich stroma adjacent to the bronchus and blood vessels, and then spread throughout the body via the bloodstream. In the lung, leptospires continuously infiltrated the alveolar wall without inflammatory cell infiltration, spread throughout the lung, and finally caused pulmonary hemorrhage. Our results revealed that the respiratory tract might be a portal of entry for leptospires. We speculate that some cases of leptospirosis might be caused by transbronchial infection from inhaling infectious aerosols containing leptospires during floods. Leptospira was also confirmed to be a unique pathogen that invades through the bronchus, proliferates in the collagen-rich lung stroma, and spreads through the alveolar interstitium throughout the lung without causing pneumonia.


Assuntos
Leptospira interrogans/patogenicidade , Leptospirose/patologia , Leptospirose/transmissão , Pneumopatias/patologia , Infecções Respiratórias/transmissão , Animais , Líquido da Lavagem Broncoalveolar/microbiologia , Cricetinae , Modelos Animais de Doenças , Leptospirose/microbiologia , Pulmão/patologia , Pneumopatias/microbiologia , Infecções Respiratórias/microbiologia , Infecções Respiratórias/patologia
10.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401574

RESUMO

Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory syndrome characterised by unregulated macrophage and T-lymphocyte activation, resulting in cytokine overproduction and subsequent histiocytic phagocytosis. Here we report a case of pulmonary cryptococcosis, in a 59-year-old diabetic patient, with no other risk factors whose clinical course was complicated by secondary hemophagocytosis. Even after addressing the primary underlying illness (pulmonary cryptococcosis), his clinical condition continued to worsen. After excluding the other causes of HLH and possible reasons of his clinical worsening, glucocorticoids were added following which the patient experienced a remarkable improvement in his clinical and laboratory parameters. To our knowledge, this is the first case report of HLH being caused by pulmonary cryptococcosis and only second case report of cryptococcosis being complicated with HLH (previous report being associated with meningoencephalitic cryptococcosis).


Assuntos
Criptococose/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Antifúngicos/administração & dosagem , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Cryptococcus neoformans/isolamento & purificação , Dexametasona/administração & dosagem , Fluconazol/administração & dosagem , Glucocorticoides/administração & dosagem , Humanos , Pneumopatias/diagnóstico por imagem , Pneumopatias/patologia , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
11.
Molecules ; 24(16)2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31426440

RESUMO

Matrix metalloproteinases (MMPs) are a family of zinc- and calcium-dependent endopeptidases which are secreted or anchored in the cell membrane and are capable of degrading the multiple components of the extracellular matrix (ECM). MMPs are frequently overexpressed or highly activated in numerous human diseases. Owing to the important role of MMPs in human diseases, many MMP inhibitors (MMPIs) have been developed as novel therapeutics, and some of them have entered clinical trials. However, so far, only one MMPI (doxycycline) has been approved by the FDA. Therefore, the evaluation of the activity of a specific subset of MMPs in human diseases using clinically relevant imaging techniques would be a powerful tool for the early diagnosis and assessment of the efficacy of therapy. In recent years, numerous MMPIs labeled imaging agents have emerged. This article begins by providing an overview of the MMP subfamily and its structure and function. The latest advances in the design of subtype selective MMPIs and their biological evaluation are then summarized. Subsequently, the potential use of MMPI-labeled diagnostic agents in clinical imaging techniques are discussed, including positron emission tomography (PET), single-photon emission computed tomography (SPECT) and optical imaging (OI). Finally, this article concludes with future perspectives and clinical utility.


Assuntos
Aterosclerose/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Inibidores de Metaloproteinases de Matriz/farmacocinética , Metaloproteinases da Matriz/química , Sondas Moleculares/farmacocinética , Neoplasias/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Animais , Aterosclerose/metabolismo , Aterosclerose/patologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/patologia , Domínio Catalítico/genética , Modelos Animais de Doenças , Encefalomielite Autoimune Experimental/diagnóstico por imagem , Encefalomielite Autoimune Experimental/metabolismo , Encefalomielite Autoimune Experimental/patologia , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Humanos , Pneumopatias/metabolismo , Pneumopatias/patologia , Inibidores de Metaloproteinases de Matriz/síntese química , Metaloproteinases da Matriz/genética , Metaloproteinases da Matriz/metabolismo , Imagem Molecular/métodos , Sondas Moleculares/síntese química , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/metabolismo , Esclerose Múltipla/patologia , Neoplasias/metabolismo , Neoplasias/patologia , Osteoartrite/metabolismo , Osteoartrite/patologia , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos
12.
Nat Commun ; 10(1): 3841, 2019 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451696

RESUMO

Human lung tissue-resident NK cells (trNK cells) are likely to play an important role in host responses towards viral infections, inflammatory conditions and cancer. However, detailed insights into these cells are still largely lacking. Here we show, using RNA sequencing and flow cytometry-based analyses, that subsets of human lung CD69+CD16- NK cells display hallmarks of tissue-residency, including high expression of CD49a, CD103, and ZNF683, and reduced expression of SELL, S1PR5, and KLF2/3. CD49a+CD16- NK cells are functionally competent, and produce IFN-γ, TNF, MIP-1ß, and GM-CSF. After stimulation with IL-15, they upregulate perforin, granzyme B, and Ki67 to a similar degree as CD49a-CD16- NK cells. Comparing datasets from trNK cells in human lung and bone marrow with tissue-resident memory CD8+ T cells identifies core genes co-regulated either by tissue-residency, cell-type or location. Together, our data indicate that human lung trNK cells have distinct features, likely regulating their function in barrier immunity.


Assuntos
Imunidade nas Mucosas , Células Matadoras Naturais/metabolismo , Pneumopatias/imunologia , Pulmão/citologia , Transcriptoma/imunologia , Idoso , Idoso de 80 Anos ou mais , Células da Medula Óssea/imunologia , Células da Medula Óssea/metabolismo , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Conjuntos de Dados como Assunto , Feminino , Humanos , Células Matadoras Naturais/imunologia , Pulmão/imunologia , Pulmão/cirurgia , Pneumopatias/patologia , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Mucosa Respiratória/citologia , Mucosa Respiratória/imunologia , Mucosa Respiratória/metabolismo
13.
Vet Parasitol ; 273: 1-4, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31442886

RESUMO

Pulmonary endarteritis caused by Dirofilaria immitis and pulmonary hypertension (PH) are closely linked and the determination of PH could be validated to assess the severity and chronicity of the vascular damage, i.e. by the use of the Right Pulmonary Artery Distensibility (RPAD) Index. The aim was to evaluate the RPAD Index in dogs 10 months after the last dose of adulticide. The study included 23 client-owned dogs with heartworm brought for adulticide treatment. Echocardiographic exam was carried out to estimate worm burden, RPAD Index as well as other routine echocardiographic values on day 0 (diagnosis), day 120 (discharge), and 10 months after the last dose of adulticide. No significant differences were observed in the RPAD Index over time, neither when microfilaremic status and parasite burden were evaluated. An RPAD Index <29% was found in 52.2% of the dogs on day 0, day 120, and 10 months after the last dose of adulticide. Regarding other echocardiographic parameters, only significant differences were observed on tricuspid annular plane systolic excursion (TAPSE) values between day 0:day 120 (p = 0.008), and day 0:end of the study (p = 0.037). There was not significant improvement in pulmonary damage 10 months after the elimination of the parasites (p = 0.296), suggesting that, once the endarteritis has developed, the vascular changes are chronic and may not be reversible. The modifications of the TAPSE value suggest an improvement in the systolic function of the right ventricle after the disappearance of the worms, independently of the presence of PH. The endarteritis causes a decrease in the elasticity in the pulmonary vasculature and an increase in the resistance that, chronically, and depending on the severity, will cause the development of PH and later right heart failure. This complication of the disease is one of the most damaging and frequent, so it is necessary to adequately monitor PH in dogs undergoing adulticide treatment. Furthermore, knowing the pulmonary status could provide valuable information to help provide an objective prognosis and help assess the need to add additional treatments, once the worms have been eliminated.


Assuntos
Dirofilaria immitis , Dirofilariose/patologia , Doenças do Cão/patologia , Endarterite/veterinária , Pneumopatias/veterinária , Animais , Antiparasitários/uso terapêutico , Dirofilariose/complicações , Dirofilariose/tratamento farmacológico , Doenças do Cão/diagnóstico , Doenças do Cão/tratamento farmacológico , Cães , Endarterite/complicações , Endarterite/diagnóstico , Endarterite/patologia , Concentração de Íons de Hidrogênio , Pneumopatias/complicações , Pneumopatias/diagnóstico , Pneumopatias/patologia , Fatores de Tempo
14.
Life Sci ; 233: 116711, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31374233

RESUMO

AIMS: Insulin is a central peptide hormone required for carbohydrate metabolism; however, its role in diabetes-associated pulmonary disease is unknown. Here, we investigated the preventative effect of insulin against hyperglycemia-induced pulmonary vascular leakage and its molecular mechanism of action in the lungs of diabetic mice. MAIN METHODS: Vascular endothelial growth factor (VEGF) activated transglutaminase 2 (TGase2) by sequentially elevating intracellular Ca2+ and reactive oxygen species (ROS) levels in primary human pulmonary microvascular endothelial cells (HPMVECs). KEY FINDINGS: Insulin inhibited VEGF-induced TGase2 activation, but did not affect intracellular Ca2+ elevation and ROS generation. Insulin prevented VEGF-induced vascular leakage by inhibiting TGase2-mediated c-Src phosphorylation, disassembly of VE-cadherin and ß-catenin, and stress fiber formation. Insulin replacement therapy prevented hyperglycemia-induced TGase2 activation, but not ROS generation, in the lungs of diabetic mice. Insulin also prevented vascular leakage and cancer metastasis in the diabetic lung. Notably, vascular leakage was not detectable in the lungs of TGase2-null (Tgm2-/-) diabetic mice. SIGNIFICANCE: These findings demonstrate that insulin prevents hyperglycemia-induced pulmonary vascular leakage in diabetic mice by inhibiting VEGF-induced TGase2 activation rather than ROS generation.


Assuntos
Diabetes Mellitus Experimental/fisiopatologia , Proteínas de Ligação ao GTP/antagonistas & inibidores , Hemorragia/prevenção & controle , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Pneumopatias/prevenção & controle , Transglutaminases/antagonistas & inibidores , Animais , Proteínas de Ligação ao GTP/fisiologia , Hemorragia/etiologia , Hemorragia/patologia , Humanos , Pneumopatias/etiologia , Pneumopatias/patologia , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/prevenção & controle , Neoplasias Pulmonares/secundário , Masculino , Melanoma Experimental/metabolismo , Melanoma Experimental/patologia , Melanoma Experimental/prevenção & controle , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Transglutaminases/fisiologia , Células Tumorais Cultivadas
15.
J Med Case Rep ; 13(1): 232, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31315682

RESUMO

BACKGROUND: Intercostal lung herniation is a rare condition that may be congenital (20%) or acquired (80%). The isolated congenital form is exceptional, with one case reported in the literature. CASE PRESENTATION: We report a case of a 10-year-old French boy of Algeria origin, born with intermittent swelling of his right hemithorax. The swelling and pain gradually increased with age. A clinical examination revealed a localized swelling of his right hemithorax at the level of the midclavicular line and the fifth intercostal space. The swelling increased in size during respiratory movements and enlarged with Valsalva maneuvers. The intercostal lung hernia was treated by thoracoscopy. CONCLUSIONS: This is the second case of isolated congenital intercostal pulmonary hernia reported in the French and English literature. It is the first to be treated by thoracoscopy. Based on this case we performed a review of the diagnosis and therapeutic aspect of pulmonary hernias.


Assuntos
Hérnia/congênito , Pneumopatias/congênito , Toracoscopia/métodos , Criança , Hérnia/diagnóstico , Hérnia/patologia , Hérnia/terapia , Herniorrafia/métodos , Humanos , Pneumopatias/diagnóstico , Pneumopatias/patologia , Masculino
17.
Reumatismo ; 71(2): 103-104, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31309783

RESUMO

Pulmonary involvement, mainly originating from vasculitis, is one of the features of Behçet's syndrome (BS). We describe, for the first time in literature, computerised tomography images of a male BS patient with multiple pulmonary cystic lesions possibly originated from vasculitis or bronchiolar stenosis.


Assuntos
Síndrome de Behçet/complicações , Cistos/etiologia , Pneumopatias/etiologia , Adulto , Cistos/patologia , Humanos , Pneumopatias/patologia , Masculino
18.
J Korean Acad Nurs ; 49(3): 329-339, 2019 Jun.
Artigo em Coreano | MEDLINE | ID: mdl-31266929

RESUMO

PURPOSE: The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease. METHODS: This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients' demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment. RESULTS: The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment. CONCLUSION: This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.


Assuntos
Tomada de Decisões , Cardiopatias/patologia , Pneumopatias/patologia , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar , Doença Crônica , Feminino , Cardiopatias/terapia , Humanos , Pneumopatias/terapia , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Assistência Terminal
20.
BMJ Case Rep ; 12(6)2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31239319

RESUMO

Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) is a rare pulmonary disorder characterised by classic radiological findings and symptoms of obstructive lung disease. DIPNECH is considered a precursor to carcinoid tumours in the lungs. In this case, we describe a patient with years of unexplained dry cough presenting with 2 weeks of progressive nausea and vomiting, and found to have massive hepatomegaly on examination. By CT-PE, she was diagnosed with DIPNECH, and abdominal MRI revealed metastatic carcinoid tumours. Despite its non-specific presentation, DIPNECH has characteristic radiological findings of mosaic attenuation with numerous pulmonary nodules. DIPNECH requires early identification and close surveillance to prevent progression to carcinoid tumours. Thus, it is critical for frontline providers to consider this diagnosis as part of their differential when other common causes of obstructive lung disease have been ruled out.


Assuntos
Hepatopatias/patologia , Pneumopatias/patologia , Células Neuroendócrinas/patologia , Lesões Pré-Cancerosas/patologia , Humanos , Hiperplasia , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Pneumopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos
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