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1.
Nephrol Dial Transplant ; 33(4): 709-716, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29346631

RESUMO

Background: In kidney transplant recipients, anticardiolipin (ACL) antibodies without antiphospholipid syndrome (APS) are found in up to 38% of patients and could be associated with thrombotic events (TEs). However, the prognostic role of ACL regarding kidney transplant and patients outcomes have still not been well defined. Methods: We conducted an observational, monocentric, retrospective cohort study including 446 kidney transplant recipients and standardized follow-up: 36-month allograft and patient survival, 12-month estimated glomerular filtration rate (eGFR) and 3- and 12-month screening biopsies. Results: ACL tests were run on 247 patients, 101 were positive (ACL+ group, 41%) and 146 were negative (ACL- group, 59%). Allografts and patient survival within 36 months as TE were similar between both groups [hazard ratio (HR) = 1.18 and HR = 0.98, respectively]. The 12-month eGFR was significantly lower in the ACL+ group [median (95% confidence interval) 48.5 (35.1-60.3) versus 51.9 (39.1-65.0) mL/min/1.73 m2, P= 0.042]. ACL+ was independently associated with eGFR decrease (P = 0.04). In 12-month screening biopsies, tubular atrophy was significantly more severe in the ACL+ group compared with the ACL- group (P = 0.02). Conclusions: ACL without APS before kidney transplantation is an independent risk factor of eGFR decline within the first year post-transplant without over-incidence of TEs. Specific immunosuppressive therapy including mammalian target of rapamycin inhibitors should be discussed in the future.


Assuntos
Anticorpos Anticardiolipina/efeitos adversos , Taxa de Filtração Glomerular , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Nefropatias/cirurgia , Transplante de Rim/efeitos adversos , Adulto , Anticorpos Anticardiolipina/sangue , Anticorpos Anticardiolipina/imunologia , Feminino , Rejeição de Enxerto/sangue , Rejeição de Enxerto/patologia , Humanos , Nefropatias/sangue , Nefropatias/imunologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Transplantados
2.
Transpl Int ; 31(4): 377-385, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28945291

RESUMO

Solid organ transplantation societies recommend a relative contraindication of transplantation for people with bipolar or psychotic disorders. Very few data are available on the outcome of kidney transplantation and the increased risk of kidney disease in those patients. We conducted a retrospective multicenter cohort study (1979-2014) including kidney allograft recipients with either bipolar (BD) or psychotic disorders prior to transplant. Objectives were kidney allograft and patient outcomes compared to a matched control group without psychiatric disorders and the evolution of psychiatric disorder at 60 months after transplantation. Forty-seven patients including 25 women were identified, 34 with BD and 13 with psychotic disorder. Patients' overall cumulative death rates at 60 months were not significantly different in both groups [12.2%; 95% confidence interval: (4.5-24.1) in the group with psychiatric disorder versus 5.2%; (1.7-11.7) in control group P = 0.11] as for cumulative allograft loss rates [11.7% (3.5-25.2) vs. 9.4% (4.4-16.8) in control group (P = 0.91)]. Twenty-three patients (16 with BD and seven with psychotic disorder) experienced at least one psychiatric relapse [incidence rate: 1.8/100 persons- months; 95% CI; (1.2-2.7)] totaling 13 hospitalizations within 60 months of follow-up. Four patients stopped immunosuppressive therapy leading to allograft loss in three. Our study suggests that patients with BD or psychotic disorders have to be considered for renal transplantation with close psychiatric follow-up after transplant.


Assuntos
Transtorno Bipolar/complicações , Falência Renal Crônica/complicações , Transplante de Rim/mortalidade , Complicações Pós-Operatórias/epidemiologia , Transtornos Psicóticos/complicações , Adulto , Feminino , França/epidemiologia , Sobrevivência de Enxerto , Humanos , Falência Renal Crônica/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
3.
Transpl Int ; 30(3): 277-287, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27992962

RESUMO

After kidney transplantation, C4d is an incomplete marker of acute antibody-mediated rejection (AMR) and C1q-binding donor-specific antibodies (DSA) have been associated with allograft survival. However, the impact on allograft survival of C1q+ DSA after clinical AMR has not been studied yet. We analysed retrospectively in clinical AMR C4d staining and C1q-binding impact on allograft survival. We compared clinical, histological and serological features of C4d- and C4d+ AMR, C1q+ and C1q- DSA AMR and analysed C4d and C1q-binding impact on allograft survival. Among 500 for-cause kidney allograft biopsies, 48 fulfilled AMR criteria. C4d+ AMR [N = 18 (37.5%)] have significantly higher number class I DSA (P = 0.02), higher microvascular score (P = 0.02) and more transplant glomerulopathy (P = 0.04). C1q+ AMR [N = 20 (44%)] presented with significantly more class I and class II DSA (P = 0.005 and 0.04) and C4d+ staining (P = 0.01). Graft losses were significantly higher in the C4d+ group (P = 0.04) but similar in C1q groups. C4d+ but not C1q+ binding was an independent risk factor for graft loss [HR = 2.65; (1.11-6.34); P = 0.028]. In our cohort of clinical AMR, C4d+ staining but not C1q+ binding is an independent risk factor for graft loss. Allograft loss and patient survival were similar in C1q+ and C1q- AMR.


Assuntos
Complemento C1q/metabolismo , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/imunologia , Isoanticorpos/metabolismo , Transplante de Rim/efeitos adversos , Adulto , Estudos de Coortes , Complemento C4b/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/metabolismo , Estudos Retrospectivos , Fatores de Risco , Doadores de Tecidos
4.
J Am Soc Nephrol ; 27(8): 2520-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26701979

RESUMO

FSGS is a common glomerular disorder that has a high propensity for recurrence after kidney transplant. The pathophysiology of FSGS is unknown, but podocytes seem to be the target of one or several circulating factors that lead to cytoskeleton reorganization and proteinuria. Research on podocytes has identified B7-1 as an important factor in podocyte biology and a new therapeutic target in renal disease. Indeed, in four patients with recurrent FSGS after transplant, treatment with the B7-1 blocker abatacept was associated with proteinuria remission. Here, we prospectively treated nine patients with recurrent FSGS after transplant using either abatacept or belatacept, a B7-1 blocker with higher affinity, and did not induce proteinuria remission. Furthermore, we did not detect B7-1 expression by immunofluorescence in podocytes of biopsy specimens from these or other kidney grafts or podocytes of native kidney biopsy specimens. In conclusion, B7-1 blockade did not induce FSGS remission after transplant in our study.


Assuntos
Abatacepte/farmacologia , Abatacepte/uso terapêutico , Antígeno B7-1/antagonistas & inibidores , Glomerulosclerose Segmentar e Focal/complicações , Imunossupressores/farmacologia , Imunossupressores/uso terapêutico , Transplante de Rim , Síndrome Nefrótica/etiologia , Síndrome Nefrótica/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Falha de Tratamento , Adulto Jovem
5.
Br J Haematol ; 174(1): 148-52, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26992059

RESUMO

We performed a retrospective study to assess the changes in clinical, biological and heart echocardiographic parameters in 32 sickle cell disease (SCD) patients beginning haemodialysis. Acute SCD-related complications were similar at 6 months before and 6 months after the initiation of haemodialysis. Median haemoglobin level did not change significantly, but the need for blood transfusions increased (P < 0·001). The 5-year incidence of death was higher in SCD patients (P < 0·0001). The 5-year likelihood of receiving a renal graft was lower in SCD patients (P = 0·022). Our findings suggest that SCD patients have poorer survival and a lower likelihood of receiving a renal graft.


Assuntos
Anemia Falciforme/complicações , Adulto , Anemia Falciforme/mortalidade , Anemia Falciforme/terapia , Transfusão de Sangue/estatística & dados numéricos , Estudos de Coortes , Feminino , Hemoglobinas/análise , Humanos , Transplante de Rim/estatística & dados numéricos , Masculino , Morbidade , Mortalidade , Diálise Renal , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos , Adulto Jovem
7.
Am J Kidney Dis ; 63(5): 816-9, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24518129

RESUMO

We report an occurrence of progressive loss of transplant function and ultimately transplant failure after living related kidney transplantation involving monozygotic twin brothers of Afro-Caribbean origin who were both heterozygous for the G1 and G2 kidney disease risk alleles in the APOL1 gene, which encodes apolipoprotein L-I. A 21-year-old man with end-stage kidney disease of unknown cause received a kidney from his brother, who was confirmed as a monozygotic twin by microsatellite analysis. Thirty months after transplantation, the patient presented with proteinuria and decreased estimated glomerular filtration rate; a biopsy of the transplant showed typical focal segmental glomerulosclerosis lesions. He received steroid therapy, but progressed to kidney failure 5 years later. The twin brother had normal kidney function without proteinuria at the time of transplantation; however, 7 years later, he was found to have decreased estimated glomerular filtration rate (40mL/min/1.73m(2)) and proteinuria (protein excretion of 2.5g/d). APOL1 genotyping revealed that both donor and recipient were heterozygous for the G1 and G2 alleles. This case is in stark contrast to the expected course of kidney transplantation in identical twins and suggests a role for APOL1 polymorphisms in both the donor and recipient.


Assuntos
Apolipoproteínas/genética , Doenças em Gêmeos , Transplante de Rim/efeitos adversos , Lipoproteínas HDL/genética , Doadores Vivos , Polimorfismo Genético , Insuficiência Renal Crônica/genética , Gêmeos Monozigóticos/genética , Apolipoproteína L1 , Apolipoproteínas/metabolismo , Biópsia , Seguimentos , Predisposição Genética para Doença , Genótipo , Humanos , Rim/patologia , Lipoproteínas HDL/metabolismo , Masculino , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/cirurgia , Adulto Jovem
8.
Transpl Int ; 25(8): 812-24, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22507183

RESUMO

Glomerulonephritis is the primary cause of end-stage renal failure in 30-50% of kidney transplant recipients and recurrence of the initial disease is an important determinant of long-term graft outcome after transplantation. Although renal transplantation remains the best treatment option for patients with end stage renal diseases in most cases, diagnosis and management of recurrences of glomerulopathies are critical for the optimization and improvement of long-term kidney transplant graft survival and provide a unique opportunity to explore the pathogenesis of native kidney disease. This review aims to update knowledge for a large panel of recurrent primary and secondary glomerulonephritis after kidney transplantation, excluding diabetic nephropathy including primary focal and segmental glomerulosclerosis, membranous nephropathy, IgA nephropathy, membranoproliferative glomerulonephritis, lupus, vasculitis but also less usual secondary nephropathy related to sarcoidosis, AA and AL amyloidosis, monoclonal immunoglobulin deposition disease, and fibrillary glomerulonephritis.


Assuntos
Glomerulonefrite/complicações , Falência Renal Crônica/etiologia , Transplante de Rim/efeitos adversos , Adulto , Amiloidose/complicações , Doença Antimembrana Basal Glomerular/complicações , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações , Síndrome Antifosfolipídica/complicações , Criança , Glomerulonefrite por IGA/complicações , Glomerulonefrite Membranoproliferativa/complicações , Glomerulonefrite Membranosa/complicações , Glomerulosclerose Segmentar e Focal/fisiopatologia , Sobrevivência de Enxerto , Humanos , Vasculite por IgA/complicações , Nefropatias/complicações , Lúpus Eritematoso Sistêmico/complicações , Recidiva
9.
Clin Kidney J ; 15(2): 262-268, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35140935

RESUMO

BACKGROUND: Maintenance haemodialysis (MHD) patients have a high risk of initial mortality from coronavirus disease 2019 (COVID-19). However, long-term consequences of this disease in the MHD population are poorly described. We report the clinical presentation, outcome and long-term follow-up of MHD patients affected by COVID-19 in a multicentric cohort from the Paris, France area. METHODS: We conducted a retrospective analysis of clinical presentation and long-term follow-up of MHD patients affected by COVID-19 in 19 MHD centres in the Paris, France area. RESULTS: In this cohort of 248 patients with an initial mortality rate of 18%, age, comorbidities, dyspnoea and previous immunosuppressive treatment were associated with death at <30 days. Among the 203 surviving patients following the acute phase, long-term follow-up (median 180 days) was available for 189 (93%) patients. Major adverse events occurred in 30 (16%) patients during follow-up, including 12 deaths (6%) after a median of 78 days from onset of symptoms. Overall, cardiovascular events, infections and gastrointestinal bleeding were the main major adverse events. Post-COVID-19 cachexia was observed in 25/189 (13%) patients. Lower initial albuminaemia was significantly associated with this cachexia. No reinfection with severe acute respiratory syndrome coronavirus 2 was observed. CONCLUSIONS: This work demonstrates the long-term consequences of COVID-19 in MHD patients, highlighting both initial and long-term severity of the disease, including severe cachexia.

10.
Nephrol Ther ; 14(3): 179-188, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29706414

RESUMO

Recurrence of glomerular disease after renal transplantation is a frequent cause of graft loss. Incidence, risk factors and outcome of recurrence are widely due to the underlying glomerular disease. Graft biopsy analysis is required to confirm the definitive diagnosis of recurrence and to start an appropriate therapy that, in some cases, remains challenging to prevent graft failure. Increased use of protocol biopsy and recent advances in our understanding of the pathogenesis of some glomerular diseases with the identification of some relevant biomarkers provide a unique opportunity to initiate kidney-protective therapy at early stages of recurrence on the graft. This review summarizes our current knowledge on the management of many recurrent primary and secondary glomerulonephritis after kidney transplantation.


Assuntos
Glomerulonefrite/terapia , Transplante de Rim/efeitos adversos , Rim/patologia , Glomerulonefrite/etiologia , Sobrevivência de Enxerto , Humanos , Prognóstico , Recidiva , Fatores de Risco
11.
PLoS One ; 12(6): e0178572, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28654684

RESUMO

BACKGROUND: Approximately 25% of kidney transplant recipients develop de novo anti-HLA donor-specific antibodies (dnDSA) leading to acute antibody-mediated rejection (ABMR) in 30% of patients. Preemptive therapeutic strategies are not available. METHODS: We conducted a prospective observational study including 11 kidney transplant recipients. Inclusion criteria were dnDSA occurring within the first year after transplant and normal allograft biopsy. All patients were treated with high-dose IVIG (2 g/kg 0, 1 and 2 months post-dnDSA). The primary efficacy outcome was incidence of clinical and subclinical acute ABMR within 12 months after dnDSA detection as compared to a historical control group (IVIG-). RESULTS: Acute ABMR occurred in 2 or 11 patients in the IVIG+ group and in 1 of 9 patients in the IVIG- group. IVIG treatment did not affect either class I or class II DSA, as observed at the end of the follow-up. IVIG treatment significantly decreased FcγRIIA mRNA expression in circulating leukocytes, but did not affect the expression of any other markers of B cell activation. CONCLUSIONS: In this first pilot study including kidney allograft recipients with early dnDSA, preemptive treatment with high-dose IVIG alone did not prevent acute ABMR and had minimal effects on DSA outcome and B cell phenotype.


Assuntos
Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Imunoglobulinas Intravenosas/uso terapêutico , Isoanticorpos/imunologia , Transplante de Rim , Adulto , Idoso , Feminino , Rejeição de Enxerto/tratamento farmacológico , Rejeição de Enxerto/imunologia , Antígenos HLA/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Transplantados , Resultado do Tratamento , Adulto Jovem
12.
Medicine (Baltimore) ; 95(6): e2768, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26871829

RESUMO

Calciphylaxis is a small vessel vasculopathy, characterized by medial wall calcification that develops in a few patients with chronic renal failure. The prognosis of skin calciphylaxis has improved considerably since the introduction of sodium thiosulfate (STS), but it remains unclear whether this therapy is effective against organ lesions related to calciphylaxis. Pulmonary calciphylaxis is a usually fatal medical condition that may occur in association with skin involvement in patients with end-stage renal disease.We report here the case of a 49-year-old woman homozygous sickle cell disease patient on chronic hemodialysis with biopsy-proven systemic calciphylaxis involving the lungs and skin. On admission, ulcerative skin lesions on the lower limbs and bilateral pulmonary infiltrates on chest computerized tomography scan were the main clinical and radiological findings. Skin and bronchial biopsies demonstrated calciphylaxis lesions. The intravenous administration of STS in association with cinacalcet for 8 consecutive months led to a clear improvement in skin lesions and thoracic lesions on chest computerized tomography scan.This case suggests for the first time that organ lesions related to calciphylaxis, and particularly lung injury, are potentially reversible. This improvement probably resulted from the combination of 3 interventions (more frequent dialysis, cinacalcet, and STS), rather than the administration of STS alone.


Assuntos
Antioxidantes/uso terapêutico , Calciofilaxia/tratamento farmacológico , Pneumopatias/tratamento farmacológico , Tiossulfatos/uso terapêutico , Anemia Falciforme/complicações , Calciofilaxia/complicações , Feminino , Humanos , Pneumopatias/complicações , Pessoa de Meia-Idade , Indução de Remissão
13.
Medicine (Baltimore) ; 94(30): e1243, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26222864

RESUMO

The association between membranous nephropathy (MN) and immunological disorder-related liver disease has not been extensively investigated, and the specific features of this uncommon association, if any, remain to be determined.We retrospectively identified 10 patients with this association. We aimed to describe the clinical, biological, and pathological characteristics of these patients and their therapeutic management. The possible involvement of the phospholipase A2 receptor (PLA2R) in these apparent secondary forms of MN was assessed by immunohistochemistry with renal and liver biopsy specimens.The mean delay between MN and liver disease diagnoses was 3.9 years and the interval between the diagnosis of the glomerular and liver diseases was <1.5 years in 5 patients. MN was associated with a broad spectrum of liver diseases including primary biliary cirrhosis (PBC), autoimmune hepatitis (AIH), and primary sclerosing cholangitis (PSC). AIH whether isolated (n = 3) or associated with PBC (n = 2) or PSC (n = 2) was the most frequent autoimmune liver disease. Circulating PLA2R antibodies were detected in 4 out of 9 patients but the test was performed under specific immunosuppressive treatment in 3 out of 9 patients. Seven of the 9 patients with available renal tissue specimens displayed enhanced expression of PLA2R in glomeruli whereas PLA2R was not expressed in liver parenchyma from these patients or in normal liver tissue. The study of immunoglobulin (Ig) subclasses of deposits in glomeruli revealed that the most frequent pattern was the coexistence of IgG1 and IgG4 immune deposits with IgG4 predominating.Detection of PLA2R antibodies in glomeruli but not in liver parenchyma is a common finding in patients with MN associated with autoimmune liver disease, suggesting that these autoantibodies are not exclusively detected in idiopathic MN.


Assuntos
Autoanticorpos/imunologia , Doenças Autoimunes/complicações , Colangite Esclerosante/complicações , Glomerulonefrite Membranosa/etiologia , Fígado/patologia , Adulto , Idoso , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Biópsia , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/imunologia , Feminino , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/imunologia , Humanos , Rim/imunologia , Rim/patologia , Fígado/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Medicine (Baltimore) ; 93(24): 350-358, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25500704

RESUMO

Few studies have examined the occurrence of minimal change nephrotic syndrome (MCNS) in patients with non-Hodgkin lymphoma (NHL). We report here a series of 18 patients with MCNS occurring among 13,992 new cases of NHL. We analyzed the clinical and pathologic characteristics of this association, along with the response of patients to treatment, to determine if this association relies on a particular disorder. The most frequent NHLs associated with MCNS were Waldenström macroglobulinemia (33.3%), marginal zone B-cell lymphoma (27.8%), and chronic lymphocytic leukemia (22.2%). Other lymphoproliferative disorders included multiple myeloma, mantle cell lymphoma, and peripheral T-cell lymphoma. In 4 patients MCNS occurred before NHL (mean delay, 15 mo), in 10 patients the disorders occurred simultaneously, and in 4 patients MCNS was diagnosed after NHL (mean delay, 25 mo). Circulating monoclonal immunoglobulins were present in 11 patients. A nontumoral interstitial infiltrate was present in renal biopsy specimens from 3 patients without significant renal impairment. Acute kidney injury resulting from tubular lesions or renal hypoperfusion was present in 6 patients. MCNS relapse occurred more frequently in patients treated exclusively by steroid therapy (77.8%) than in those receiving steroids associated with chemotherapy (25%). In conclusion, MCNS occurs preferentially in NHL originating from B cells and requires an aggressive therapeutic approach to reduce the risk of MCNS relapse.


Assuntos
Linfoma não Hodgkin/complicações , Nefrose Lipoide/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Leucemia Linfocítica Crônica de Células B/complicações , Linfoma de Células B/complicações , Linfoma não Hodgkin/patologia , Masculino , Pessoa de Meia-Idade , Nefrose Lipoide/patologia , Estudos Retrospectivos , Fatores de Tempo , Macroglobulinemia de Waldenstrom/complicações
16.
J Travel Med ; 19(1): 22-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22221808

RESUMO

BACKGROUND: Although acute respiratory tract infections (RTI) have been recognized as a significant cause of illness in returning travelers, few studies have specifically evaluated the etiologies of RTI in this population. METHODS: This prospective investigation evaluated travelers returning from countries with endemic influenza A(H1N1) 2009, and who were seen in our department at the onset of the outbreak (April-July 2009). Patients were included if they presented with signs of RTI that occurred during travel or less than 7 days after return from overseas travel. Patients were evaluated for microbial agents with RespiFinder plus assay, and throat culture according to clinical presentation. RESULTS: A total of 113 travelers (M/F ratio 1.2:1; mean age 39 y) were included. They were mainly tourists (n = 50; 44.2%) mostly returning from North America (n = 65; 58%) and Mexico (n = 21; 18.5%). The median duration of travel was 23 days (range 2-540 d). The median lag time between return and onset of illness was 0.2 days (range 10 d prior to 7 d after). The main clinical presentation of RTI was influenza-like illness (n = 76; 67.3%). Among the 99 microbiologically evaluated patients, a pathogen was found by polymerase chain reaction (PCR) or throat culture in 65 patients (65.6%). The main etiological agents were influenza A(H1N1) 2009 (18%), influenza viruses (14%), and rhinovirus (20%). A univariate analysis was unable to show variables associated with influenza A(H1N1) 2009, whereas rhinorrhea was associated with viruses other than influenza (p = 0.04). CONCLUSION: Despite the A(H1N1) 2009 influenza pandemic, rhinovirus and other influenza viruses were also frequent causes of RTI in overseas travelers. Real-time reverse transcription-PCR and nasopharyngeal swab cultures are useful diagnostic tools for evaluating travelers with RTI.


Assuntos
Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Orthomyxoviridae/isolamento & purificação , Pandemias , Infecções Respiratórias/microbiologia , Rhinovirus/isolamento & purificação , Viagem , Adulto , Feminino , Humanos , Influenza Humana/diagnóstico , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Estudos Prospectivos , Infecções Respiratórias/epidemiologia , Adulto Jovem
17.
Chest ; 138(3): 648-55, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20382717

RESUMO

BACKGROUND: Pleural ultrasonography (PU) is more sensitive than chest radiograph (CXR) for diagnosing pneumothorax and could be useful for detecting resolution of pneumothorax after drainage. The aim of this prospective double-blind observational study was to assess PU accuracy during pneumothorax follow-up after drainage. METHODS: All patients hospitalized with pneumothorax requiring drainage were eligible. After drainage, residual pneumothorax was assessed by CXR and PU (1) 24 h after bubbling in the aspiration device had stopped, (2) 6 h after clamping the pleural catheter, and (3) 6 h after removing the pleural catheter. Pneumothorax indicated by PU but not CXR was confirmed by CT scan or by aspiration of > 10 mL of air. RESULTS: Forty-four unilateral pneumothoraces were studied (primary spontaneous: 70.5%), and 162 pairs of examinations (CXR and PU) were performed. Twenty residual pneumothoraces were detected by both CXR and PU. Furthermore, PU suspected 14 pneumothoraces that were not identified by CXR; 13 were confirmed. All of these pneumothoraces resulted in therapeutic intervention. Thus, 39% (13/33) of the confirmed residual pneumothoraces were missed by CXR. In patients with primary spontaneous pneumothorax, the positive predictive value of PU for residual pneumothorax diagnosis was 100%; for other pneumothoraces, this value ranged from 90% in the absence of a lung point to 100% when a lung point was observed. PU results were obtained faster than results from CXR (35 +/- 34 min vs 71 +/- 56 min, P < .0001). CONCLUSIONS: The accuracy of PU is excellent for detecting residual pneumothorax during pneumothorax follow-up after drainage.


Assuntos
Drenagem , Cavidade Pleural/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Pneumotórax/terapia , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
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