Role of Computed Tomography-guided Fine-needle Aspiration Cytology/Biopsy in Management of Lung Lesions: Experience of a Tertiary Care Oncology Hospital

Background: Fine-needle aspiration cytology (FNAC) and biopsy are routinely used methods for the diagnosis of lung lesions. In sampling of lung lesions, computed tomography (CT) is used to provide direction to the needle. The procedure is related with few complications. Methods: In this retrospective study, records of 247 patients who underwent CT-guided FNAC and/or biopsy at our tertiary care oncology-specific hospital during a calendar year (2015) were analyzed. The pretest coagulation profiles, predisposing emphysematous conditions on CT, and patient demographics were recorded. Lesion demographics included site, size, and depth. Postprocedure complications and diagnosis on cytology, histopathology, and immunohistochemistry (IHC) were tabulated. Results: Out of 247 patients, 160 (64.8%) were males. Most patients belonged to 51� years age group. Adenocarcinoma was the most common primary tumor of lung whereas carcinoma breast was the most common secondary diagnosed. Thirty (12.1%) patients developed complications after the procedure, with 29 of these having pneumothorax. Conclusions: Computed tomography-guided FNAC and/or biopsy is a safe and reliable tool to diagnose lung lesions.

Detection of COVID-19 Lung Lesions in Computed Tomography Images Using Deep Learning / Detección de lesiones pulmonares por COVID-19 en imágenes de tomografía computarizada mediante aprendizaje profundo

ABSTRACT The novel coronavirus (COVID-19) is a disease that mainly affects the lung tissue. The detection of lesions caused by this disease can help to provide an adequate treatment and monitoring its evolution. This research focuses on the bi- nary classification of lung lesions caused by COVID-19 in images of computed tomography (CT) using deep learning. The database used in the experiments comes from two independent repositories, which contains tomographic scans of patients with a positive diagnosis of COVID-19. The output layers of four pre-trained convolutional networks were adapted to the proposed task and re-trained using the fine-tuning technique. The models were validated with test images from the two database's repositories. The model VGG19, considering one of the repositories, showed the best performance with 88% and 90.2% of accuracy and recall, respectively. The model combination using the soft voting technique presented the highest accuracy (84.4%), with a recall of 94.4% employing the data from the other repository. The area under the receiver operating characteristic curve was 0.92 at best. The proposed method based on deep learning represents a valuable tool to automatically classify COVID-19 lesions on CT images and could also be used to assess the extent of lung infection.

Effect of parity segregation on Mycoplasma hyopneumoniae infection dynamics and pneumonic lesions in pigs / Efeito da ordem de parto segregada sobre a dinâmica de infecção de Mycoplasma hyopneumoniae e lesões pulmonares ao abate

Gilts represent a group risk for Mycoplasma hyopneumoniae vertical transmission in swine herds. Therefore, parity segregation can be an alternative to control M. hyopneumoniae infections. The study evaluated the effect of parity segregation on M. hyopneumoniae infection dynamics and occurrence and severity of lung lesions at slaughter. For that, three multiple site herds were included in the study. Herd A consisted of the farm where gilts would have their first farrowing (parity order (PO) 1). After the first farrowing PO 1 sows were transferred to herd B (PO2-6). Herd C was a conventional herd with gilt replacement (PO1-6). Piglets born in each herd were raised in separated nursery and finishing units. Sows (n = 33 (A), 37 (B), 34 (C)) in all herds were sampled prior to farrowing and piglets (n = 54 (A), 71 (B), 66 (C)) were sampled longitudinally at 21, 63, 100, 140 days of age and at slaughter for M. hyopneumoniae detection by PCR and lung lesions scoring. M. hyopneumoniae prevalence in sows did not differ among herds. Prevalence of positive piglets was higher at weaning in the PO1 herd (A) (P < 0.05). However, prevalence of positive pigs from 100 days of age to slaughter age was higher in the PO2-6 herd (B) (P < 0.05). Lung lesion occurrence and severity were higher in herd B. The authors suggested that the lack of a proper gilt acclimation might have influenced the results, leading to sows being detected positive at farrowing, regardless of the parity.

As leitoas consistem em um grupo de risco na transmissão vertical de Mycoplasma hyopneumoniae dentro do sistema de produção de suínos. Dessa forma, a segregação de partos poderia ser utilizada como alternativa para controlar as infecções por M. hyopneumoniae. O objetivo deste estudo foi avaliar o efeito da segregação de partos sobre a dinâmica de infecção de M. hyopneumoniae e a ocorrência e severidade das lesões pulmonares ao abate. Para isso três sistemas de produção de suínos com três sítios cada foram incluídos no estudo. A granja A consistia da unidade onde as leitoas tem o primeiro parto, ou seja, alojava somente de fêmeas de ordem de parto 1 (Granja OP1). Após o primeiro parto as fêmeas OP1 foram transferidas para a granja B (Granja OP2-6), ou seja, consistia de fêmeas de ordem de parto 2 a 6, e a granja C consistiu em uma granja convencional com reposição de leitoas (Granja OP1-6), com fêmeas de ordem de parto 1 a 6. Os leitões nascidos de cada granja foram transferidos e criados em creches e terminações segregadas. As matrizes (n = 33 (A), 37 (B), 34 (C)) de todas as granjas do estudo foram amostradas previamente ao parto e os leitões (n = 54 (A), 71 (B), 66 (C)) foram amostrados longitudinalmente aos 21, 63, 100 e 140 dias de idade e ao abate. Em todos os momentos de coleta, as amostras foram avaliadas por PCR para detecção de M. hyopneumoniae. As lesões pulmonares foram avaliadas e escores de lesão foram atribuídos ao abate. A prevalência de matrizes positivas para M. hyopneumoniae não diferiu entre as granjas (P > 0,05). A prevalência ao desmame foi maior na granja A (OP1) (P < 0,05). No entanto, dos 100 dias de idade até o abate a prevalência de leitões positivos para M. hyopneumoniae foi maior na granja B (OP2-6) (P < 0,05). A ocorrência e severidade de lesões pulmonares foram maiores na granja B. Os autores sugerem que a falta de uma aclimatação adequada das leitoas pode ter influenciado nos resultados, levando à detecção de matrizes positivas ao parto, independente da ordem de parto.

Clinical Application of Electromagnetic Navigation Bronchoscopy on the Diagnosis of Peripheral Lung Lesions / 中国肺癌杂志

BACKGROUND@#Electromagnetic navigation bronchoscopy is a tool that can accurately navigation peripheral lung lesions. Because of electromagnetic navigation bronchoscopy (ENB) is too expensive, it has not been widely used in China. It is urgent for us to summarize experience in clinical application, especially in the diagnosis of pulmonary nodules.@*METHODS@#The clinical data of patients with pulmonary peripheral lesions (PPLs) in our department undergoing ENB biopsy between July 2017 and December 2018 were retrospectively analyzed.@*RESULTS@#There were 18 patients with 21 PPLs (10 males and 8 females). Among them, 11 patients got the final pathological diagnosis, 8 cases were diagnosed with adenocarcinoma lung cancer, 1 case was diagnosed with tuberculosis and 2 cases were diagnosed with small cell lung cancer. The positive rate of diagnosis was 61.1%. The sensitivity was 73.3%. The positive diagnosis rate is related to the size of the lesion, the positive diagnosis rate for lesions >2 cm is 100.0% (P=0.04).@*CONCLUSIONS@#Electromagnetic navigation bronchoscope is safe and effective in clinic. It has a high positive rate for the diagnosis of peripheral lung lesions larger than 2 cm, ENB has broad clinical application prospects.

Gross and Histopathological Findings in Fatalities Caused by Pulmonary Disease: An Autopsy Study

Respiratory pathologies are some of the common causes of deaths and it has been reported that in almost 1/3rd cases of sudden deaths the primary pathology may be attributable to pulmonary pathology. One of the important aspect of respiratory pathologies is that they can progress rapidly over a short period of time and in many cases these pathologies may prove to be fatal. In such cases gross and histopathological examination of lung tissue can give valuable insights into the cause of death. We conducted this prospective study to study the pathological findings in the lungs of such cases. Methods: The present study was conducted in the department of forensic medicine and toxicology of a tertiary care medical college situated in an urban area. The duration of study was 2 years. All cases of natural deaths brought for medico-legal autopsy were included in this study on the basis of a predefined inclusion and exclusion criteria. Virchow’s technique for dissection was followed in all the cases. The demographic details, gross and histopathological examination of lungs was done and findings were noted. Statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: The study consisted of a total 54 patients out of which there were 34 males and 20 females with a M:F ratio of 1:0.58. The most common affected age group was found to be between 30-40 years (22.22%). The mean age of males and females were found to be comparable with no statistically significant difference (P>0.05). Most people died within 3-7 days from time of admission (25.92%). Pneumonia was found to be leading cause of deaths in lung pathology which contributed to 74.7% cases. On gross pathology consolidation and pulmonary edema were most common findings whereas on gross as well as histopathological examination. Conclusion: Gross and histopathological examination of lung tissue in individuals dying due to natural causes can give valuable insights into the cause of death.

Lung lesions of slaughtered horses in southern Brazil / Lesões pulmonares de equinos de matadouro-frigorífico no Sul do Brasil

Respiratory diseases cause significant veterinary costs, reduce performance and require withdrawal of horses. Yet, studies of the causes of pneumonia in horses are scant. This study aimed to describe the pathological and microbiological features of lung lesions in slaughtered horses in southern Brazil. In this study, 84 samples of lungs were examined, and a conclusive diagnosis was obtained in 74 cases. These were composed of bronchopneumonia in 50 cases, followed by granulomatous eosinophilic pneumonia (9/74), recurrent airway obstruction (7/74), lung fibrosis (4/74), lung hemorrhage (3/74) and pulmonary pythiosis (1/74). Bronchopneumonia had grossly firm focally extensive yellow to dark-red areas, which consisted microscopically of multifocal to coalescing infiltrate of degenerate neutrophils. Streptococcus equi subsp. zooepidemicus was identified in 21 of the 50 cases. Granulomatous eosinophilic pneumonia had multifocal pinpoint firm-hard yellow areas, which microscopically were composed of granulomas with a mineralized center surrounded by collagen fibers and severe infiltrate of eosinophils. Recurrent airway obstruction had mild multifocal pinpoint firm white areas that consisted microscopically of large amounts of mucus inside bronchi and bronchiole. Lung fibrosis had two patterns: focally extensive areas of consolidation and firm nodular areas. Microscopically, the first pattern had interstitial to peribronchial fibrosis, while the second had, in addition to the interstitial fibrosis, a severe pneumocyte hyperplasia and an alveolar infiltrate of neutrophils and macrophages with rare intranuclear inclusion bodies (equine herpesvirus 5, EHV-5). Pulmonary pythiosis presented a focal firm nodular area, with multiple kunkers observed in the cut surface, which corresponded microscopically to areas of necrosis surrounded by a mixed inflammatory infiltrate. At the periphery of the necrotic areas, multiple negatively stained hyphae were observed, which were evidenced through Grocott's stain and immunohistochemistry anti-Pythium insidiosum.(AU)

Doenças respiratórias causam em equinos custos significativos com tratamento veterinário, redução de performance e descarte de animais. No entanto, estudos que abordem as causas de pneumonia em equinos são escassos. O objetivo deste estudo foi descrever os aspectos patológicos e microbiológicos de lesões pulmonares em equinos abatidos em matadouro-frigorífico no Sul do Brasil. Neste estudo, 84 amostras de pulmões foram examinadas, e o diagnóstico conclusivo das condições foi obtido em 74 casos. Esses foram compostos por broncopneumonia em 50 casos, seguido por pneumonia granulomatosa eosinofílica (9/74), obstrução aérea recorrente (7/74), fibrose pulmonar (4/74), hemorragia pulmonar (3/74) e pitiose pulmonar (1/74). A broncopneumonia era caracterizada macroscopicamente por áreas focalmente extensas firmes de coloração amarelada a vermelho-escuras, as quais consistiam microscopicamente em infiltrado multifocal a coalescente de neutrófilos degenerados. Streptococcus equi subsp. zooepidemicus foi identificado em 21 dos 50 casos. A pneumonia eosinofílica granulomatosa era caracterizada por áreas multifocais puntiformes firmes a duras e amareladas, que microscopicamente eram compostas por granulomas com área central mineralizada circundados por fibras de colágeno e infiltrado acentuado de eosinófilos. A obstrução aérea recorrente era caracterizada por discretas áreas puntiformes firmes e brancacentas que consistiam microscopicamente em grande quantidade de muco no interior de brônquios e bronquíolos. A fibrose pulmonar exibia dois padrões: áreas de consolidação focalmente extensas e áreas nodulares firmes. Microscopicamente, o primeiro padrão exibia fibrose intersticial a peribronquial, enquanto no segundo padrão havia, além da fibrose intersticial, intensa hiperplasia de pneumócitos e infiltrado alveolar de neutrófilos e macrófagos com raros corpúsculos de inclusão intranucleares (herpesvírus equino 5, EHV-5). A pitiose pulmonar exibia uma área nodular firme focal com múltiplos kunkers ao corte, os quais correspondiam microscopicamente a áreas de necrose circundadas por infiltrado inflamatório misto. À periferia das áreas necróticas, múltiplas imagens negativas de hifas eram observadas, as quais foram evidenciadas através da coloração de Grocott e imuno-histoquímica anti-Pythium insidiosum.(AU)

Secuestro pulmonar en adultos: reporte de tres casos y revisión de la literatura / Adult bronchopulmonary sequestration: report of three cases and review of the literature

Resumen El secuestro pulmonar es una enfermedad congénita infrecuente caracterizada por la presencia de una porción de parénquima pulmonar que recibe vascularización independiente de la circulación sistémica. Se presentan tres casos de secuestro pulmonar intralobares, de presentación tardía, uno de ellos asociado a una malformación adenomatosa quística y en los cuales el manejo se completó por videotoracoscopia: dos de ellos con lobectomía total y uno con lobectomía sublobar. Se trata de una enfermedad de presentación clínica variable y cuyo tratamiento es, en la mayoría de los casos, quirúrgico, requiriéndose usualmente resecciones lobares, las cuales pueden llevarse a cabo de manera eficaz y segura por videotoracoscopia.

Abstract Pulmonary sequestration is an infrequent congenital disease characterized by the presence of a portion of pulmonary parenchyma that receives vascularization independent of the systemic circulation. We present three cases of intralobar pulmonary sequestration of late presentation, one of them associated with a cystic adenomatous malformation and in which the management was completed by videothoracoscopy: two of them with total lobectomy and the other with sublobar lobectomy. It is a disease of variable clinical presentation and whose treatment is, in most cases, surgical, usually requiring lobar resections, which can be carried out effectively and safely by video-assisted thoracoscopy.

Genome-wide copy number variations in congenital cystic lung disease / 临床儿科杂志

Objective To explore the potentially relevant copy number variations (CNVs) in congenital cystic lung diseases (CCLD). Methods Clinical data of 16 patients diagnosed with CCLD and CNVs results were retrospectively analyzed. Results Of 16 cases, 12 were males and 4 were females aged between 2 months and 12 years and 6 months. Of 16 cases, 10 cases were bronchogenic cyst, 4 cases were pulmonary sequestration, 2 cases were congenital cystic adenomatoid malformation, 1 case was congenital lobar emphysema and one case was not classified. These cases presented mainly with fever, cough, and sputum without specificity. Six CNVs with unknown clinical significance were found in two patients. Abnormal amplification of HDAC8 gene was found in 4 patients diagnosed with BC.Conclusions CCLD is less likely to be associated with the CNVs;HDAC8 gene may be related to bronchogenic cyst.

Role of ultrasound guided transthoracic fine needle aspiration cytology in diagnosing various lung lesions

Background: Transthoracic Fine Needle Aspiration Cytology is regarded as the most effective of the cytological methods for diagnosing lung cancer, in particular peripherally-located lesions. Aim: To evaluate the role of sonography in percutaneous Fine needle aspiration Cytology of peripheral pulmonary lesions. Materials and methods: This was the prospective study done in peripheral pulmonary lesions. Total number of patients in the study was 81. Results: 61 patients (75.3%) were Males, while 20 (24.6%) were Female. The Male: Female ratio was 3:1. The mean age of patients in this study was 48. The youngest patient was aged 26 years and oldest was aged 71 years giving an age range of 26 to 71 years. 54(66%) patients of this study were smokers. Only 3 female patients were smokers. The most common symptom was cough and sign was anemia. Left side and Left Upper Zone of lung was most involved area in lung. Squamous cell carcinoma was the commonest cytological type noted accounting for 60% followed by adenocarcinoma. In nonmalignant lesions tuberculosis was most commonly observed in total 81 Complications of needle biopsy were 2 cases (2.4%) were with Hemoptysis and 3 cases (3.7%) were with Pneumothorax. Conclusion: It is concluded that Ultrasound Guided Transthoracic Fine Needle Aspiration cytology of peripheral pulmonary lesions abutting the chest wall is Acceptable, Simple, Safe, Quick, Accurate and Useful.

Approach to the patient with IgG4-related disease manifested as central diabetes insipidus and lung lesions / 中华内分泌代谢杂志

A 39-year-old female with central diabetes insipidus complained of polydipsia and polyuria and was found to be accompanied by lung lesions. The diagnosis of IgG4-related disease was confirmed by laboratory and pathological results. It should be alert to consider the possibility of IgG4-related disease in a patient with central diabetes insipidus coexisting with the signs of multisystem lesions such as lung disease.

Application value of CT-guided percutaneous lung biopsy in lung disease / 实用放射学杂志

Objective To investigate the efficiency and application value of CT-guided percutaneous puncture biopsy in the diagnosis of lung disease.Methods The clinical and imaging data of 60 patients with CT-guided percutaneous lung biopsy were analyzed retrospectively.Results Among all the 60 patients, 57 had finally to be proved by pathological diagnosis, including 47 primary lung cancer (21 squamous cell carcinoma, 18 adenocarcinoma, 3 small cell lung cancer and 5 bronchioloalveolar carcinoma), 7 metastatic lung cancer and 3 tuberculosis.In addition, 3 cases were chronic inflammation and did not make a definite diagnosis, in which 2 were proved to be caseous pneumonia and 1 was proved to be fungus infection by postoperative pathology.The successful rate of punctures,the diagnostic accuracy and the total complications rate of lung puncture biopsy in 60 cases was 100%, 95.0% and 21.7% [11.7% pneumothorax (7/60), 8.3% hemoptysis (5/60) and 1.7% needle bleeding(1/60)].Conclusion CT-guided percutaneous puncture biopsy is a safe, accurate and significant clinical method in the diagnosis and differential diagnosis of lung lesions.

Role of Fiberoptic Bronchoscopy in Histopathological Analysis of Lung Lesions.

Introduction: Bronchogenic lesions are undoubtedly one of the most common diseases worldwide. Pulmonary cytology and biopsy are simple and resourceful methods of early diagnosis of respiratory diseases. The use of bronchoscope has increased the variety of diagnostic specimen obtainable and extended the scope of cyto-pathology. Fiberoptic bronchoscopy has an excellent result in diagnosis of lung diseases when combined with brushing cytology and biopsy. The present study aims to ascertain the yield of diagnostic bronchoscopic procedures in lung lesions and to calculate the incidence of various types of malignancies. Materials and methods: This hospital based observational study was carried out in the Pathology department of Geetanjali Hospital. A total of 110 patients of clinically suspected lung lesion were included and bronchoscopy was carried out in all patients. Various samples such as bronchial brushing, bronchial biopsy and bronchial washing were taken as and when required and samples were given to pathology and microbiology department for reporting. Data was analysed by SPSS ver. 21. Results: Out of 110 biopsies 61 were found to be malignant, 20 were inflammatory lesions, 16 were non-malignant, 11 were inadequate material and 2 were inconclusive. Overall diagnostic yield of bronchial biopsy was 88.2%.The most common type of malignant was Squamous cell carcinoma (34.5%) Adenocarcinoma (9%) and Small cell carcinoma (7.2%). Conclusion: Bronchial biopsy is a valuable tool and helps in the diagnosis of lung lesions.

Evaluation of Ultrasound Guided Fine Needle Aspiration Cytology for Diagnosing Lung Lesions – A 3-Year Study

Fine needle aspiration cytology (FNAC) especially ultrasound guided has a very important role in diagnosing pulmonary lesions. The present study was undertaken to evaluate the diagnostic efficacy of image-guided percutaneous fine needle aspiration cytology in various lung lesions. This is a three-year retrospective study from August 2010 to July 2013. A total of 322 cases were included in the study. The clinical, radiological and cytological data of all 322 cases who underwent ultrasound guided FNAC were studied. Of the 322 cases in our study, malignancy was the predominant lesion found in 192 cases (59.62%) followed by inflammatory pathology 23 cases (7.1%). Among the malignant lesions, adenocarcinoma was the most common malignancy (26.56%) in females and males followed by squamous cell carcinoma (23.95%). Over the three-year period of the study, 92 cases were grouped under non-specific lesions/inadequate for interpretation. Percutaneous ultrasound-guided FNAC is a relatively safe and accurate procedure in the diagnosis of lung lesion especially peripheral lung lesions.

Differential diagnosis of the peripheral lung lesions with new microvascular pattern of contrast-enhanced ultrasound / 中华超声影像学杂志

Objective To investigate the value of new microvascular pattern of contrast-enhanced ultrasonography (CEUS) in the diagnosis of peripheral lung lesion.Methods A total of 72 peripheral lung lesions which had been proved by clinical and pathology results underwent conventional ultrasound,CEUS and new microvascular pattern examination.Two independent readers (Reader 1 and Reader 2) blindly and retrospectively analysised and classified the characteristic of microvascular patterns respectively,and Kappa test was used for evaluating the concordance between the two readers.The diagnosis accuracy of CEUS was calculated,and the CEUS diagnostic scores were compared with conventional ultrasound.Results 16 benign lesions and 56 malignant lesions were enrolled in this study.The microvascular patterns in benign lesions included branch enhancement(43.8 ％,31.3％),point and patchy enhancement (18.8％,25.0％) and rim-like enhancement (18.8％,18.8％).The microvascular patterns in malignant lesions included vascular enhancement (46.4％,57.1％),cotton enhancement (26.8％,25.0％) and dead wood enhancement (19.6％,8.9％).There was significant difference between benign and malignant lesions.Kappa result showed that the two readers had a good diagnosis concordance(Kappa=0.759,P =0.000).According to the different types of microvascular pattern,the diagnostic accuracy,sensitivity,and specificity rates of two readers were 92.9％,91.1％;81.3％,75.0％ and 90.3％,87.5％,respectively.Before CEUS,59.7％ and 68.1％ of lesions were diagnosed as 3 by two readers respectively,while only 1.4％ and 6.9％ of lesions were diagnosed as 3 after CEUS.Further analysis demonstrated that there was significant difference in the microvascular pattern between squamous carcinoma and adenocarcinoma,and also between squamous carcinoma and small cell lung carcinoma.Conclusions Contrast-enhanced ultrasound could significantly increase the differential diagnosis of peripheral lung lesions.New microvascular pattern helped to display patterns of vascular perfusion.of peripheral lung lesions,and provide new diagnostic clue for differential diagnosis.

Clinical value of 18 F-FDG PET-CT in aiding CT-guided percutaneous lung biopsy / 实用放射学杂志

Objective To investigate the clinical value of PET-CT in aiding CT guided percutaneous puncture biopsy for lung mas-ses.Methods The retrospective data were analyzed including 5 7 patients with lung masses who underwent CT guided percutaneous puncture biopsy combined with PET-CT (regarded as a research group)and other 75 similar patients with single CT-guided biopsy (control group).In two groups,it was divided with malignant,suspicious malignant,can not be diagnosed,inflammatory,benign by pathological findings,and was contrasted with the surgical pathology or final clinical results.To calculate sensitivity,specificity and accuracy of diagnosis for cancer through two puncture method.Recorded complication for pneumothorax and bleeding in two groups .Be compared analysis using the 2 test.Results In study group,it was higher for the diagnosis of malignancy sensitivity, specificity,accuracy.There were 96.3% (52/54),100.0%(3/3)and 96.5%(55/57)in research group,while those were 88.4%(61/69),83.3% (5/6)and 88.0% (66/75)in the control group,respectively.And no statistically significant.Between research and the control group,there was a significantly statistical difference in the rate of twice punctures in one mass (χ2= 10.122,P=0.001).Between the two groups,there was no statistically significant difference in the pneumothorax rate and the hemorrhage rate. Conclusion PET-CT in aiding CT-guided lung biopsy improves the sensitivity,specificity and accuracy of diagnosis.

Trema micrantha como causa de pneumopatia tóxica em ovinos: reprodução experimental / Trema micrantha as cause of toxic pneumopathy in sheep: experimental reproduction

A intoxicação experimental por Trema micrantha em cinco ovinos é descrita. Quatro ovinos apresentaram sinais clínicos respiratórios acentuados e morte após ingestão da terceira dose de folhas da planta. As manifestações clínicas mais frequentes nesses casos foram taquipneia, dispneia, retração ritmada das narinas, mucosas cianóticas, corrimento nasal mucoso, hipertermia, aumento de volume abdominal bilateral e na região parotídea, incluindo crepitação à palpação, membros lateralmente afastados ao caminhar e decúbito esternal. T. micrantha mostrou-se tóxica para ovinos na dose de 20-50g/kg de peso animal. Na necropsia desses ovinos foram observados, além das mucosas cianóticas, enfisema subcutâneo em região cervical ventral ou porção mediastinal dorsal, pulmões não colabados, pesados, com impressão das costelas na superfície e conteúdo espumoso vermelho em traqueia e brônquios, além de múltiplas petéquias subpleurais. Na avaliação histológica predominaram alterações pulmonares, com espessamento de septos alveolares por proliferação difusa de pneumócitos tipo II, conferindo aspecto adenomatoso a algumas áreas. Os pneumócitos apresentavam núcleo volumoso, hipercromático, ora bizarro ou eram multinucleados, com nucléolos evidentes e, em algumas áreas, os pneumócitos estavam descamados para a luz alveolar, ora formando sincícios. Havia também proliferação do epitélio bronquiolar, com formação de mais de uma camada celular, núcleos hipercromáticos e volumosos e redução na quantidade de cílios. As alterações proliferativas dos pneumócitos e do epitélio bronquiolar foram evidenciadas pela imunomarcação anti-citoqueratina e anti-Ki-67 e, para a diferenciação entre pneumócitos e macrófagos alveolares, foi empregada imuno-histoquímica anti-mieloide/histiócitos (MAC387). Um ovino apresentou quadro clinico-patológico de insuficiência hepática aguda, com necrose hepatocelular acentuada após ingestão de 25g/kg de T. micrantha. A intoxicação experimental por ...

This paper describes the experimental Trema micrantha poisoning in sheep. Four from five sheep showed marked respiratory distress and death after ingestion of the third dose of plant leaves. The most frequent clinical findings were tachypnea, dyspnea, rhythmic contraction of the nostrils, cyanotic mucous membranes, mucous nasal discharge, hyperthermia, abdominal distension, increased volume and crepitation of parotid region, walking with the legs kept away laterally and sternal recumbency. T. micrantha proved to be toxic to sheep at 20 to 50g/kg bodyweight. At necropsy, we observed cyanotic mucous membranes, subcutaneous emphysema in the ventral area of cervical region or dorsal mediastinum, heavy and collapsed lungs with rib markings, red frothy fluid in the lumen of the trachea and primary bronchi, and several subpleural petechiae. Microscopic examination of lung tissue sections revealed that the tissue was characterized by thickening of the alveolar septa by diffuse type II pneumocytes proliferation, conferring an adenomatous appearance to some areas. These pneumocytes had large and hyperchromatic, sometimes bizarre nucleus or were multinucleate, with evident nucleoli. In some areas desquamated pneumocytes were found in the alveolar lumen, sometimes forming syncytia. There also was bronchiolar epithelium proliferation, conferring to the mucosa more than one epithelial cell layer, these cells had large and hyperchromatic nuclei and reduction in the amount of cilia. The proliferative changes of pneumocytes and bronchiolar epithelium were evaluated by anti-cytokeratin and anti-Ki-67 immunostaining. In order to differentiate pneumocytes and alveolar macrophages, we used anti-monocyte marker (MAC387). One sheep showed clinicopathological findings of acute liver failure with hepatocellular necrosis after ingestion of 25g/kg T. micrantha. The experimental poisoning by T. micrantha in sheep resulted in predominantly respiratory clinicopathological ...

Congenital cystic lung lesions in 52 children / 中华实用儿科临床杂志

Objective To investigate the diagnosis,operation and outcomes of congenital cystic lung lesions in children.Methods Fifty-two children with congenital cystic lung lesions were collected.The clinical data s were analyzed including manifestations,lesion characteristics,imaging,histopathology,diagnosis,surgical treatment methods and short-term pulmonary functions.Results There were 33 male and 19 female,aged from 1 day to 159 months,their median age was 3.67 months.Five cases were neonates.There were 42 cases of bronchogenic cyst,6 cases of pulmonary sequestration,3 cases of congenital lobar emphysema and 1 case of congenital cystic adenomatoid malformation.The cases commonly manifested by lung infections.Of 52 cases,61.5％ were diagnosed after the first onset of lung infection,21.1％ for repeated lung infections and 17.3％ with no symptom.Right lower lung was the most common lesion site and the cases accounted about for 36.5％.Multiple gas cysts were the most common imaging findings accounting about for 42.3％.The pathologic examination of all cases showed bronchogenic cysts.The missed diagnosis rate was 17.3％.The misdiagnosis rate was 24.9％,which of bronchogenic cyst cases was 19.2％.All cases received the lobectomy without death.Conclusions The preoperative diagnosis of congenital cystic lung lesions is mostly based on imaging findings.Clinical manifestations are useful for identifying early the lesions.The preoperative diagnosis may be easily missed or incorrectly done.Pathological findings contribute to make a definite diagnosis.The surgery effect is satisfactory and the outcome is good.

Monitoramento da presença de Mycoplasma hyopneumoniae em granjas de suínos durante a implementação de programas de erradicação / Monitoring the presence of Mycoplasma hyopneumoniae in swine farms during the implementation of eradication programs

O objetivo deste estudo foi monitorar a presença de M. hyopneumoniae em granjas suínas durante a implementação de programas de erradicação utilizando diferentes técnicas de diagnóstico focalizando no PCR. Trabalhou-se com uma empresa que possuía três granjas, uma parto-terminação (390 matrizes), uma múltiplo-sítio (4100 matrizes) e uma nova granja que povoava suas novas instalações. Nas duas primeiras, foi desenvolvido um programa de despovoamento parcial para erradicar a pneumonia enzoótica suína, a última foi povoada pelos suínos dos anteriores após a erradicação. Nos três rebanhos, os suínos foram monitorados por: sorologia (ELISA), PCR, lesões pulmonares macro e microscópicas e a presença de tosse não produtiva. A ausência de tosse, a baixa porcentagem de suínos soropositivos na fase de terminação e a baixa proporção de lesões pulmonares no abate sugerem que a pneumonia enzoótica suína foi erradicada, mas não o agente causativo -M. hyopneumoniae- cujo DNA foi detectado pela PCR, mostrando diferentes comportamentos de acordo com o rebanho.

The aim of this study was to monitor the presence of M. hyopneumoniae in pig farms during the implementation of eradication programs using different diagnostic techniques focusing on PCR. They worked with a company owner of three farms, a farrow-to-finish (390 sows), a multiple-site (4100 sows) and a new one that was populated its new facility. In the first two were developed a partial depopulation program to eradicate swine enzootic pneumonia, the latter one was populated with pigs after the previous eradication. In the three farms, the pigs were monitored by: serology (ELISA), PCR, macroscopic and microscopic lung lesions and the presence of non-productive cough. The absence of cough, low percentage of seropositive pigs in the finishing stage and the low proportion of lung lesions at slaughter suggest that swine enzootic pneumonia was eradicated, but not the causative agent -M. hyopneumoniae- whose DNA was detected by PCR showing different behaviors according to the herd.

Collateral Ventilation to Congenital Hyperlucent Lung Lesions Assessed on Xenon-Enhanced Dynamic Dual-Energy CT: an Initial Experience

OBJECTIVE: We wanted to evaluate the resistance to collateral ventilation in congenital hyperlucent lung lesions and to correlate that with the anatomic findings on xenon-enhanced dynamic dual-energy CT. MATERIALS AND METHODS: Xenon-enhanced dynamic dual-energy CT was successfully and safely performed in eight children (median age: 5.5 years, 4 boys and 4 girls) with congenital hyperlucent lung lesions. Functional assessment of the lung lesions on the xenon map was done, including performing a time-xenon value curve analysis and assessing the amplitude of xenon enhancement (A) value, the rate of xenon enhancement (K) value and the time of arrival value. Based on the A value, the lung lesions were categorized into high or low (A value > 10 Hounsfield unit [HU]) resistance to collateral ventilation. In addition, the morphologic CT findings of the lung lesions, including cyst, mucocele and an accessory or incomplete fissure, were assessed on the weighted-average CT images. The xenon-enhanced CT radiation dose was estimated. RESULTS: Five of the eight lung lesions were categorized into the high resistance group and three lesions were categorized into the low resistance group. The A and K values in the normal lung were higher than those in the low resistance group. The time of arrival values were delayed in the low resistance group. Cysts were identified in five lesions, mucocele in four, accessory fissure in three and incomplete fissure in two. Either cyst or an accessory fissure was seen in four of the five lesions showing high resistance to collateral ventilation. The xenon-enhanced CT radiation dose was 2.3 +/- 0.6 mSv. CONCLUSION: Xenon-enhanced dynamic dual-energy CT can help visualize and quantitate various degrees of collateral ventilation to congenital hyperlucent lung lesions in addition to assessing the anatomic details of the lung.

Congenital cystic lung lesions / 临床儿科杂志

Congenital cystic lung lesions are a group of congenital lung diseases with low incidence. These include congenital cystic adenomatoid malformation,bronchogenic cyst,congenital lobar emphysema and pulmonary sequestration. These malformations occur during the period of lung development stimulated by various factors. Manifestations of the diseases are very similar,but the pathogenesis and pathology are very different. Congenital cystic adenomatoid malformations are thought to be the results of the cessation of bronchiolar maturation with overgrowth of mesenchymal elements and without development of alveoli. There are 5 pathological types of congenital cystic adenomatoid malformations. Bronchogenic cysts are the results of abnormal budding from a segment of the tracheobronchial tree during embryo development,and the buds with no communication with normal tracheobronchial tree. Congenital lobar emphysema is a term reserved for hyperinflation of alveoli from idiopathic reasons or extrinsic compression,as well as pathological changes of the bronchial wall. Pulmonary sequestrations account for parts of nonfunctioning lung tissue that mostly do not communicate with normal bronchoalveolar tree and vascularized by a systemic artery,two types(intralobar and extralobar sequestration)are described.