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4.
N Engl J Med ; 381(10): 923-932, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31483963

RESUMO

BACKGROUND: Pulmonary alveolar proteinosis is a disease characterized by abnormal accumulation of surfactant in the alveoli. Most cases are autoimmune and are associated with an autoantibody against granulocyte-macrophage colony-stimulating factor (GM-CSF) that prevents clearing of pulmonary surfactant by alveolar macrophages. An open-label, phase 2 study showed some therapeutic efficacy of inhaled recombinant human GM-CSF in patients with severe pulmonary alveolar proteinosis; however, the efficacy in patients with mild-to-moderate disease remains unclear. METHODS: We conducted a double-blind, placebo-controlled trial of daily inhaled recombinant human GM-CSF (sargramostim), at a dose of 125 µg twice daily for 7 days, every other week for 24 weeks, or placebo in 64 patients with autoimmune pulmonary alveolar proteinosis who had a partial pressure of arterial oxygen (Pao2) while breathing ambient air of less than 70 mm Hg (or <75 mm Hg in symptomatic patients). Patients with severe pulmonary alveolar proteinosis (Pao2 <50 mm Hg) were excluded to avoid possible exacerbation of the disease in patients who were assigned to receive placebo. The primary end point was the change in the alveolar-arterial oxygen gradient between baseline and week 25. RESULTS: The change in the mean (±SD) alveolar-arterial oxygen gradient was significantly better in the GM-CSF group (33 patients) than in the placebo group (30 patients) (mean change from baseline, -4.50±9.03 mm Hg vs. 0.17±10.50 mm Hg; P = 0.02). The change between baseline and week 25 in the density of the lung field on computed tomography was also better in the GM-CSF group (between-group difference, -36.08 Hounsfield units; 95% confidence interval, -61.58 to -6.99, calculated with the use of the Mann-Whitney U test and the Hodges-Lehmann estimate of confidence intervals for pseudo-medians). Serious adverse events developed in 6 patients in the GM-CSF group and in 3 patients in the placebo group. CONCLUSIONS: In this randomized, controlled trial, inhaled recombinant human GM-CSF was associated with a modest salutary effect on the laboratory outcome of arterial oxygen tension, and no clinical benefits were noted. (Funded by the Japan Agency for Medical Research and Development and the Ministry of Health, Labor, and Welfare of Japan; PAGE ClinicalTrials.gov number, NCT02835742; Japan Medical Association Center for Clinical Trials number, JMA-IIA00205.).


Assuntos
Doenças Autoimunes/tratamento farmacológico , Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Fatores Imunológicos/uso terapêutico , Proteinose Alveolar Pulmonar/tratamento farmacológico , Administração por Inalação , Adulto , Idoso , Autoanticorpos/sangue , Doenças Autoimunes/diagnóstico por imagem , Método Duplo-Cego , Esquema de Medicação , Feminino , Fator Estimulador de Colônias de Granulócitos e Macrófagos/administração & dosagem , Fator Estimulador de Colônias de Granulócitos e Macrófagos/efeitos adversos , Fator Estimulador de Colônias de Granulócitos e Macrófagos/imunologia , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/efeitos adversos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Proteinose Alveolar Pulmonar/imunologia , Capacidade de Difusão Pulmonar , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Fumar/efeitos adversos , Tomografia Computadorizada por Raios X , Teste de Caminhada
5.
Medicine (Baltimore) ; 98(33): e16606, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415352

RESUMO

OBJECTIVE: The aim of this study was to determine optimal window settings for conventional polyenergetic and virtual monoenergetic images derived from computed tomography pulmonary angiogram (CTPA) examinations of a novel dual-layer spectral detector computed tomography system (DLCT). METHODS: Monoenergetic (40 keV) and polyenergetic images of 50 CTPA examinations were calculated and the best individual window width and level (W/L) values were manually assessed. Optimized values were obtained afterwards based on regression analysis. Diameters of standardized pulmonary artery segments and subjective image quality parameters were evaluated and compared. RESULTS: Attenuation and contrast-to-noise values were higher in monoenergetic than in polyenergetic images (P≤.001). Averaged best individual W/L for polyenergetic and monoenergetic were 1020/170 and 2070/480 HU, respectively.All adjusted W/L-settings varied significantly compared to standard settings (700/100 HU) and obtained higher subjective image quality scores. A systematic overestimation of artery diameters for standard window settings in monoenergetic images was observed. CONCLUSIONS: Appropriate W/L-settings are required to assess polyenergetic and monoenergetic CTPA images of a novel DLCT. W/L-settings of 1020/170 HU and 2070/480 HU were found to be the best averaged values for polyenergetic and monoenergetic CTPA images, respectively.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Processamento de Imagem Assistida por Computador/métodos , Pulmão/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Humanos , Pneumologia/métodos , Razão Sinal-Ruído
6.
JAMA ; 322(6): 546-556, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31408135

RESUMO

Importance: While air pollutants at historical levels have been associated with cardiovascular and respiratory diseases, it is not known whether exposure to contemporary air pollutant concentrations is associated with progression of emphysema. Objective: To assess the longitudinal association of ambient ozone (O3), fine particulate matter (PM2.5), oxides of nitrogen (NOx), and black carbon exposure with change in percent emphysema assessed via computed tomographic (CT) imaging and lung function. Design, Setting, and Participants: This cohort study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Air and Lung Studies conducted in 6 metropolitan regions of the United States, which included 6814 adults aged 45 to 84 years recruited between July 2000 and August 2002, and an additional 257 participants recruited from February 2005 to May 2007, with follow-up through November 2018. Exposures: Residence-specific air pollutant concentrations (O3, PM2.5, NOx, and black carbon) were estimated by validated spatiotemporal models incorporating cohort-specific monitoring, determined from 1999 through the end of follow-up. Main Outcomes and Measures: Percent emphysema, defined as the percent of lung pixels less than -950 Hounsfield units, was assessed up to 5 times per participant via cardiac CT scan (2000-2007) and equivalent regions on lung CT scans (2010-2018). Spirometry was performed up to 3 times per participant (2004-2018). Results: Among 7071 study participants (mean [range] age at recruitment, 60 [45-84] years; 3330 [47.1%] were men), 5780 were assigned outdoor residential air pollution concentrations in the year of their baseline examination and during the follow-up period and had at least 1 follow-up CT scan, and 2772 had at least 1 follow-up spirometric assessment, over a median of 10 years. Median percent emphysema was 3% at baseline and increased a mean of 0.58 percentage points per 10 years. Mean ambient concentrations of PM2.5 and NOx, but not O3, decreased substantially during follow-up. Ambient concentrations of O3, PM2.5, NOx, and black carbon at study baseline were significantly associated with greater increases in percent emphysema per 10 years (O3: 0.13 per 3 parts per billion [95% CI, 0.03-0.24]; PM2.5: 0.11 per 2 µg/m3 [95% CI, 0.03-0.19]; NOx: 0.06 per 10 parts per billion [95% CI, 0.01-0.12]; black carbon: 0.10 per 0.2 µg/m3 [95% CI, 0.01-0.18]). Ambient O3 and NOx concentrations, but not PM2.5 concentrations, during follow-up were also significantly associated with greater increases in percent emphysema. Ambient O3 concentrations, but not other pollutants, at baseline and during follow-up were significantly associated with a greater decline in forced expiratory volume in 1 second per 10 years (baseline: 13.41 mL per 3 parts per billion [95% CI, 0.7-26.1]; follow-up: 18.15 mL per 3 parts per billion [95% CI, 1.59-34.71]). Conclusions and Relevance: In this cohort study conducted between 2000 and 2018 in 6 US metropolitan regions, long-term exposure to ambient air pollutants was significantly associated with increasing emphysema assessed quantitatively using CT imaging and lung function.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Pulmão/fisiologia , Enfisema Pulmonar , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Carbono/efeitos adversos , Carbono/análise , Estudos de Coortes , Progressão da Doença , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Óxidos de Nitrogênio/efeitos adversos , Óxidos de Nitrogênio/análise , Ozônio/efeitos adversos , Ozônio/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Enfisema Pulmonar/epidemiologia , Enfisema Pulmonar/fisiopatologia , Testes de Função Respiratória , Tomografia Computadorizada por Raios X , Estados Unidos/epidemiologia
7.
Surg Clin North Am ; 99(5): 921-939, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446918

RESUMO

This article reviews a few surgical palliative care procedures that can be performed by surgeons and interventional radiologists using image-guided techniques. Treatment of recurrent pleural effusions, gastrostomy feeding tube maintenance, percutaneous cholecystostomy, and transjugular intrahepatic portosystemic shunts (TIPS) with embolotherapy of bleeding stomal varices is discussed.


Assuntos
Cuidados Paliativos/métodos , Sistema Biliar/diagnóstico por imagem , Colecistostomia/métodos , Drenagem/métodos , Embolização Terapêutica/métodos , Nutrição Enteral/métodos , Varizes Esofágicas e Gástricas/terapia , Vesícula Biliar/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/terapia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Radiografia , Toracentese/métodos , Ultrassonografia
8.
Medicine (Baltimore) ; 98(34): e16932, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441883

RESUMO

INTRODUCTION: Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of mature peripheral T-cell lymphoma and accounts for approximately 1% to 2% of non-Hodgkin lymphomas. Although the B symptoms with generalized lymphadenopathy are the most frequent manifestations of AITL, its diagnosis remains a challenge as clinical manifestations and pathological features are frequently misleading. PATIENT CONCERNS: We report herein the case of a 70-year-old man with intermittent fever, pulmonary infection, and skin rash developed for 1 month before admission. Previously, he had undergone thyroidectomy for thyroid papillary carcinoma. Fever occurred on the day of discharge and occurred again during the next month. Symptoms worsened despite treatment with antibiotics and papular rash appeared. The local hospital diagnosed it as drug fever and stopped all antibiotics. Fever and rash were controlled temporarily; however, both relapsed 2 days before admission. On the night of admission, the patient developed fever again. Blood culture showed Staphylococcus epidermidis and Staphylococcus haemolyticus infection. INTERVENTIONS: Taking into account the recent history of surgery, the patient was diagnosed with septicemia and was treated with anti-infective treatment. On 13th day after admission, the patient developed fever again accompanied by generalized lymphadenopathy. However, multiple blood cultures were negative and bone marrow aspiration cytology, biopsy, immunohistochemistry, and gene rearrangement results were normal. DIAGNOSIS: The patient was finally subjected to cervical lymph node biopsy and was diagnosed with AITL. OUTCOMES: The patient was transferred to the Department of Hematology for further treatment. CONCLUSION: This case highlights the complex diagnostic challenges of AITL. AITL accompanied by thyroid carcinoma may not be a mere coincidence and administration of antibiotics may be a rare cause of AITL.


Assuntos
Linfonodos/patologia , Linfoma de Células T Periférico/diagnóstico , Linfoma de Células T Periférico/patologia , Idoso , Diagnóstico Diferencial , Exantema/etiologia , Febre/etiologia , Humanos , Pulmão/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Masculino , Infecções Estafilocócicas/diagnóstico , Tireoidectomia/efeitos adversos
9.
Medicine (Baltimore) ; 98(26): e16086, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261523

RESUMO

Pleuroparenchymal fibroelastosis (PPFE) is a rare new interstitial lung disease (ILD) characterized by the fibrotic thickening of the visceral pleura and subadjacent parenchymal areas of the upper lobes This study reveals that patients with ILD-SSc associated with chest HRCT evidence of PPFE require close and recurrent follow-up with periodic evaluation of lung function parameters, DLCO and chest HRCT. Rheumatologists should be aware of this new radiological finding which is accompanied by a negative prognosis, especially when associated with a progressive course. Patients with this radiological pattern need to be monitored with particular attention.


Assuntos
Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pleurais/complicações , Doenças Pleurais/diagnóstico por imagem , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico por imagem , Idoso , Feminino , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/terapia , Masculino , Doenças Pleurais/terapia , Prognóstico , Fibrose Pulmonar/complicações , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/terapia , Estudos Retrospectivos , Reumatologistas , Escleroderma Sistêmico/terapia
10.
Ann Hematol ; 98(9): 2187-2195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31273420

RESUMO

Organizing pneumonia (OP) is a poorly understood complication of hematopoietic stem cell transplant (HSCT). We identified 15 patients diagnosed with OP following HSCT and described their clinical course. CT chest findings were remarkable for multifocal infiltrates that were predominantly consolidating or ground glass opacities. Bronchoalveolar lavage (BAL) was performed on 14 patients with five having lymphocytosis (> 25% lymphocytes), three with eosinophilia (> 5% eosinophils), three with neutrophilia (> 30% neutrophils), and three with normal cell counts. Flow cytometry was analyzed on BAL fluid in 13 patients with 11 having a CD4/CD8 of < 0.9. Initial treatment with 0.3-1.0 mg/kg prednisone resulted in improvement in symptoms, in radiographic findings, and in pulmonary function testing for the majority of patients. Six patients had recurrence of OP after completing treatment. Eleven patients had evidence of extra-pulmonary graft-versus-host disease prior to diagnosis of OP, and seven patients were diagnosed with an upper respiratory tract infection (URI) within 8 weeks of OP diagnosis. Most patients respond well to prednisone with significant improvement in pulmonary function, but risk of recurrence is high after cessation of steroid treatment. Risk factors for the development of OP may include prior URI.


Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Pulmão , Pneumonia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Líquido da Lavagem Broncoalveolar , Eosinofilia/diagnóstico por imagem , Eosinofilia/tratamento farmacológico , Eosinofilia/fisiopatologia , Eosinófilos , Feminino , Doença Enxerto-Hospedeiro/diagnóstico por imagem , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/fisiopatologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neutrófilos , Pneumonia/diagnóstico por imagem , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , Pneumonia/fisiopatologia , Testes de Função Respiratória
12.
Medicine (Baltimore) ; 98(28): e16350, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305425

RESUMO

Most of the recent studies have used fixed tube current while few investigators use automatic current selection (ACS) with iterative reconstruction (IR) techniques to reduce effective dose (ED) to < 1 mSv in low-dose chest computed tomography (LDCCT). We investigated whether image quality of lungs as produced by a fixed tube current (FTC) of 35 mAs can be maintained with ED < 1 mSv produced by ACS with IR techniques in LDCCT. A total of 32 participants were included. The LDCCT was performed by a FTC 35 mAs (with a kilovoltage peak of 120 kVp) in 16 participants (Group A), and by a DoseRight ACS in 16 participants (Group B). Their images were improved by IR technique. The ED was estimated by multiplying the individual dose length product (DLP) by the dose conversion factor. The image quality was assessed by the CT number, noise levels, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the regions of interest in the apex, upper lobe, and lower lobe of lung regions in the CT images. A t-test was used to evaluate the LDCCT image quality between the groups. The ED was significantly 49.2% lower in Group B than in Group A (0.71 ±â€Š0.05 mSv vs 1.40 ±â€Š0.02 mSv, P < .001). However, noise level, SNR, and CNR were not significantly different between Groups A and B, indicating the image quality was similar between two groups, or our setting parameters for DoseRight ACS with IR technique can achieve the image quality as good as obtained on the FTC 35 mAs with IR techniques. Our results suggest that the DoseRight ACS with IR technique reduces ED to lower than 1 mSv (averagely 0.71 mSv) yet maintains an image quality as good as produced by FTC 35 mAs with IR technique in normal BMI persons. The ACS setup thus is more preferable than the FTC to achieve the ALARA (as low as reasonably achievable) principle.


Assuntos
Pulmão/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Automação/métodos , Índice de Massa Corporal , Eletricidade , Feminino , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 98(28): e16364, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305433

RESUMO

RATIONALE: Esophageal duplication cyst (EDC) is a rare developmental aberration originated from the embryonic foregut. It may remain asymptomatic but produce local mass effect on surrounding organs if rapid enlarges. EDC may sometimes accompany with other congenital malformations. Congenital pulmonary airway malformation (CPAM) is a congenital lung malformation with an unknown chance of developing symptoms. Here we report a rare case of esophageal duplication cyst with type 2 congenital pulmonary airway malformation (CPAM). PATIENT CONCERNS: A 16-month old boy with a prenatal diagnosis of type 2 CPAM presented progressive stridor and respiratory distress and was admitted to our hospital under the diagnosis of pneumonia. The patient responded poorly to antibiotics. A chest Xray (CXR) showed consolidation over the left upper lobe with trachea deviated to right side. A chest computed tomography (CT) revealed a cystic lesion sized 3.3 × 3.3 cm in the superior mediastinum. DIAGNOSES: Post-operative pathological report confirmed the diagnosis of esophageal duplication cyst. INTERVENTIONS: We pre-medicated the patient with steroids and inhaled bronchodilators for airway maintenance. Then the patient received tumor resection via median sternotomy. OUTCOMES: The patient recovered without complication and discharged smoothly 4 days after the surgery. LESSONS: EDC is a rare but potentially life-threatening disease owning to compression of large airways. Chest CT scan could detect the lesion non-invasively and should be considered in patients with persistent stridor, as well as CXR findings of the trachea deviated by a mass lesion in mediastinum, especially for those with CPAM.


Assuntos
Anormalidades Congênitas , Cisto Esofágico/complicações , Esôfago/anormalidades , Laringe/anormalidades , Pulmão/anormalidades , Sons Respiratórios , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/terapia , Diagnóstico Diferencial , Cisto Esofágico/diagnóstico , Cisto Esofágico/terapia , Esôfago/diagnóstico por imagem , Esôfago/cirurgia , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Sons Respiratórios/diagnóstico
14.
Br J Radiol ; 92(1101): 20190184, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31287737

RESUMO

OBJECTIVES: In non-small cell lung cancer (NSCLC) patients, to establish whether the fractional volumes of irradiated anatomic or perfused lung differed between those with and without deteriorating lung function or radiation associated lung injury (RALI). METHODS: 48 patients undergoing radical radiotherapy for NSCLC had a radiotherapy-planning CT scan and single photon emission CT lung perfusion imaging (99mTc-labelled macroaggregate albumin). CT defined the anatomic and the single photon emission CT scan (co-registered with CT) identified the perfused (threshold 20 % of maximum) lung volumes. Fractional volumes of anatomic and perfused lung receiving more than 5, 10, 13, 20, 30, 40, 50 Gy were compared between patients with deteriorating (>median decline) vs stable (30, 40, 50 Gy). Fractional volumes of anatomic and perfused lung receiving > 10 Gy best predicted decline in FEV1 (Area under receiver operating characteristic curve (Az = 0.77 and 0.76 respectively); sensitivity/specificity 75%/81 and 80%/71%) for a 32.7% anatomic and 33.5% perfused volume cut-off. Irradiating an anatomic fractional volume of 4.7% to > 50 Gy had a sensitivity/specificity of 83%/89 % for indicating RALI (Az = 0.83). CONCLUSION: A 10-20 Gy radiation dose to anatomic or perfused lung results in decline in FEV1. A fractional anatomic volume of >5% receiving >50 Gy influences development of RALI. ADVANCES IN KNOWLEDGE: Extent of low-dose radiation to normal lung influences functional respiratory decline.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Lesões por Radiação/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/efeitos da radiação , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Dosagem Radioterapêutica , Tomografia Computadorizada de Emissão de Fóton Único/métodos
15.
Neumol. pediátr. (En línea) ; 14(2): 95-99, jul. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1015014

RESUMO

The diagnosis of primary ciliary dyskinesia (PCD) is complex and requires high clinical suspicion. The findings in the diagnostic images are nonspecific and can be seen in other conditions of the airway. In this review, we will describe the findings of PCD in chest radiography and computed tomography, with emphasis on some of the characteristics that differentiate it from cystic fibrosis and we will review the role of CT in the monitoring of changes of the PCD, since the CT findings correlate very well with the structural changes that occur in the course of PCD, especially bronchiectasis. However, using serial CTs should be decided on a case-by-case basis to avoid unnecessary radiation because they are pediatric patients.


El diagnóstico de la Discinesia ciliar primaria (DCP) es complejo y requiere alta sospecha clínica. Los hallazgos en la imágenes diagnósticas son inespecíficos y se pueden ver en otras afecciones de la vía aérea. En esta revisión describiremos los hallazgos de la DCP en Radiología simple y en Tomografía computada (TC), con énfasis en algunas de las características que permiten diferenciarla de la Fibrosis quística (FQ) y revisaremos el rol de la TC en la monitorización de la DCP ya que los hallazgos en la TC se correlacionan muy bien con los cambios estructurales que ocurren en el curso de la DCP, en especial las bronquiectasias. Sin embargo usar TC seriadas se debe decidir caso por caso para evitar la radiación innecesaria por ser pacientes pediátricos.


Assuntos
Humanos , Criança , Sistema Respiratório/metabolismo , Síndrome de Kartagener/fisiopatologia , Pulmão/diagnóstico por imagem , Sistema Respiratório/fisiopatologia , Sistema Respiratório/patologia , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X/métodos , Síndrome de Kartagener/metabolismo , Síndrome de Kartagener/microbiologia , Pulmão/metabolismo , Pulmão/patologia
16.
Clin Nucl Med ; 44(8): 674-675, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274621

RESUMO

A 30-year-old woman with a recent episode of dyspnea was presented. The lung perfusion scan using Tc-MAA (macro-aggregated albumin) initially revealed an acceptable lung-to-background activity ratio implying a proper radiopharmaceutical preparation and radiolabeling efficiency. Unexpectedly, later during the scan, rapidly increasing concentration of activity was observed in salivary glands, thyroid and stomach. Rapid breakdown of Tc-MAA complexes was considered as a likely explanation for the increase in the circulatory level of the free pertechnetate.


Assuntos
Pulmão/diagnóstico por imagem , Compostos Radiofarmacêuticos/farmacocinética , Agregado de Albumina Marcado com Tecnécio Tc 99m/farmacocinética , Cintilografia de Ventilação/Perfusão , Adulto , Feminino , Humanos , Glândulas Salivares/diagnóstico por imagem , Estômago/diagnóstico por imagem , Glândula Tireoide/diagnóstico por imagem
17.
Emerg Med Clin North Am ; 37(3): 409-430, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262412

RESUMO

Resuscitative ultrasound describes point-of-care applications that provide diagnostic information, physiologic monitoring, and procedural guidance in critically ill patients. This article reviews the evaluation of ventricular function, identification of pericardial effusion and tamponade, evaluation of preload and fluid responsiveness, and hemodynamic monitoring, as some of the main applications where this modality can help emergency physicians during resuscitation of critically ill patients.


Assuntos
Ecocardiografia Transesofagiana , Ventrículos do Coração/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Ressuscitação , Velocidade do Fluxo Sanguíneo , Tamponamento Cardíaco/diagnóstico por imagem , Estado Terminal , Medicina de Emergência , Serviço Hospitalar de Emergência , Hemodinâmica , Humanos , Monitorização Fisiológica , Derrame Pericárdico/diagnóstico por imagem , Ultrassonografia , Ultrassonografia Doppler , Veia Cava Inferior/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Direita/diagnóstico por imagem
18.
Nat Commun ; 10(1): 2781, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31273194

RESUMO

Recent advances in optical clearing and light-sheet microscopy have provided unprecedented access to structural and molecular information from intact tissues. However, current light-sheet microscopes have imposed constraints on the size, shape, number of specimens, and compatibility with various clearing protocols. Here we present a multi-immersion open-top light-sheet microscope that enables simple mounting of multiple specimens processed with a variety of clearing protocols, which will facilitate wide adoption by preclinical researchers and clinical laboratories. In particular, the open-top geometry provides unsurpassed versatility to interface with a wide range of accessory technologies in the future.


Assuntos
Microscopia de Fluorescência/métodos , Animais , Encéfalo/diagnóstico por imagem , Desenho de Equipamento , Humanos , Imagem Tridimensional/instrumentação , Imagem Tridimensional/métodos , Pulmão/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Masculino , Camundongos , Microscopia de Fluorescência/instrumentação , Próstata/diagnóstico por imagem
19.
N Engl J Med ; 381(4): 328-337, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31259488

RESUMO

BACKGROUND: Whether early placement of an inferior vena cava filter reduces the risk of pulmonary embolism or death in severely injured patients who have a contraindication to prophylactic anticoagulation is not known. METHODS: In this multicenter, randomized, controlled trial, we assigned 240 severely injured patients (Injury Severity Score >15 [scores range from 0 to 75, with higher scores indicating more severe injury]) who had a contraindication to anticoagulant agents to have a vena cava filter placed within the first 72 hours after admission for the injury or to have no filter placed. The primary end point was a composite of symptomatic pulmonary embolism or death from any cause at 90 days after enrollment; a secondary end point was symptomatic pulmonary embolism between day 8 and day 90 in the subgroup of patients who survived at least 7 days and did not receive prophylactic anticoagulation within 7 days after injury. All patients underwent ultrasonography of the legs at 2 weeks; patients also underwent mandatory computed tomographic pulmonary angiography when prespecified criteria were met. RESULTS: The median age of the patients was 39 years, and the median Injury Severity Score was 27. Early placement of a vena cava filter did not result in a significantly lower incidence of symptomatic pulmonary embolism or death than no placement of a filter (13.9% in the vena cava filter group and 14.4% in the control group; hazard ratio, 0.99; 95% confidence interval [CI], 0.51 to 1.94; P = 0.98). Among the 46 patients in the vena cava filter group and the 34 patients in the control group who did not receive prophylactic anticoagulation within 7 days after injury, pulmonary embolism developed in none of those in the vena cava filter group and in 5 (14.7%) in the control group, including 1 patient who died (relative risk of pulmonary embolism, 0; 95% CI, 0.00 to 0.55). An entrapped thrombus was found in the filter in 6 patients. CONCLUSIONS: Early prophylactic placement of a vena cava filter after major trauma did not result in a lower incidence of symptomatic pulmonary embolism or death at 90 days than no placement of a filter. (Funded by the Medical Research Foundation of Royal Perth Hospital and others; Australian New Zealand Clinical Trials Registry number, ACTRN12614000963628.).


Assuntos
Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Ferimentos e Lesões/terapia , Adulto , Angiografia por Tomografia Computadorizada , Humanos , Incidência , Escala de Gravidade do Ferimento , Estimativa de Kaplan-Meier , Perna (Membro)/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/mortalidade , Risco , Falha de Tratamento , Ultrassonografia , Trombose Venosa/diagnóstico por imagem , Ferimentos e Lesões/mortalidade
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(6): 704-708, 2019 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-31315727

RESUMO

OBJECTIVE: To investigate the clinical correlations between mechanical power (MP) and lung ultrasound score (LUS), and analyze their evaluation value of prognosis in patients with acute respiratory distress syndrome (ARDS). METHODS: Patients with moderate to severe ARDS, who underwent invasive mechanical ventilation admitted to intensive care unit (ICU) of the Lianyungang Affiliated Hospital of Xuzhou Medical University from January 2017 to March 2019 were enrolled. The MP and LUS were recorded 0, 24, 48 and 72 hours after ICU admission. The patients were divided into death group and survival group according to the 28-day prognosis. The trends of MP and LUS in the two groups and their differences between groups were analyzed. Then the MP and LUS were analyzed by bivariate correlation analysis, and their correlations with acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), oxygenation index (PaO2/FiO2), and blood lactate (Lac) were also analyzed. The predictive value of MP and LUS 0 hour and 72 hours in ICU for 28-day mortality in patients with moderate to severe ARDS was analyzed by receiver operating characteristic (ROC) curve. RESULTS: At the end, 83 patients were enrolled, with 32 died and 51 survived in 28-day. The Lac level, APACHE II and SOFA in the death group were significantly higher than those in the survival group, while PaO2/FiO2 was significantly lower than the survival group, and the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the MP and LUS of the survival group showed a significant decrease trend, while the death group showed a significant upward trend. The MP and LUS of the death group 0, 24, 48, 72 hours after ICU admission were significantly higher than those of the survival group [MP (J/min): 20.97±3.34 vs. 17.20±4.71, 21.56±3.48 vs. 16.87±3.85, 22.72±2.97 vs. 16.13±3.52, 25.81±3.46 vs. 15.24±3.78; LUS: 19.17±3.31 vs. 16.27±4.28, 20.28±3.65 vs. 15.27±3.23, 21.53±4.32 vs. 13.63±3.71, 23.94±3.82 vs. 12.53±2.94, all P < 0.05]. There was a significant positive correlation between MP and LUS 0, 24, 48, 72 hours after ICU admission (r value was 0.547, 0.577, 0.754, and 0.783, respectively, all P < 0.01). The MP and LUS at 0 hour of ICU admission were significantly positively correlated with SOFA and PaO2/FiO2 (r value was 0.421, 0.450, and 0.409, 0.536, respectively, all P < 0.01), but no correlation with Lac and APACHE II was found. The ROC curve analysis showed that the MP and LUS at 0 hour and 72 hours had predictive value for the 28-day mortality [the area under the ROC curve (AUC) of MP was 0.836, 0.867; and the AUC of LUS was 0.820, 0.891, all P < 0.01]. CONCLUSIONS: There was a significant correlation between MP and LUS in patients with moderate to severe ARDS. The MP and LUS could be used early to evaluate the 28-day prognosis of patients with moderate to severe ARDS.


Assuntos
Pulmão/diagnóstico por imagem , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/terapia , APACHE , Humanos , Unidades de Terapia Intensiva , Prognóstico , Curva ROC , Ultrassonografia
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