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Abstract:Introduction:Tuberculosis (TB) has been one of the health problems in the world.Diagnosis of pulmonary tuberculosis based on finding of AFB in thesputum has several limitations and mycobacterial culture is timeconsuming. So we decided to evaluate biomarker like AdenosineDeaminase (ADA) activity in Bronchoalvolar Lavage(BAL) fluid .Objectives: To study level of BAL ADA in sputum negative suspectedcases of pulmonary tuberculosis and correlate it with BAL GenXpert(Cartridge Based Nucleic Acid Amplification) result.Method: We have enrolled suspected sputum negative pulmonary TBand suspected lung malignancy patients (as control). Total 33 patients -17 suspected sputum negative pulmonary TB, 16 suspected lungmalignancy were enrolled in study and subjected to bronchoscopy andBAL fluid was submitted for ADA level and GenXpert for TB.Result: Increased BAL ADA level was found in suspected sputumnegative pulmonary TB as compare to suspected malignancy. IncreasedBAL level was well correlared with GenXpert positivity in suspected TBgroup.Conclusion: BAL fluid ADA can be useful tool for early diagnosis ofsuspected sputum negative pulmonary TB.
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Background@#The etiology of pleural effusion remains unclear in nearly 20% of cases. One way to diagnose malignancy is by doing pleural fluid cytology. There are factors that influence the yield of pleural fluid cytology and one of them is appropriate and timely fixation of samples. Currently, there is no local consensus regarding the timing with which the specimen should be fixed.@*Objective@#The study aims to compare the yield of malignancy between early fixation versus usual fixation of pleural fluid samples, meaning there is no set time for fixation to be done.@*Methodology@#The study employed a prospective cross-sectional research design. All patients with pleural effusion who fulfilled the criteria set by the study were included. Two sets of pleural fluid samples were collected amounting to 20cc each. First sample was assigned as Bottle #1 and placed immediately with fixative while the second sample was assigned as Bottle #2. Bottle #2 underwent routine fixation which follows no fixed or standard time of fixation. The time difference between the fixation of two sample groups greatly varied with Bottle #1 fixed immediately right after collection while Bottle#2 depends on the time it will be processed by the laboratory personnel. Both samples were submitted for cell block and cell cytology reading.@*Results@#Characteristics of the 55 patients included in the study showed age group range from 41 to 65 years of age, with 27 male and 28 female patients. Only one third had history of smoking. There were 21.82% who had family history of cancer and with and suspicious mass on chest radiograph. Out of 55 patients, 29 patients had history of previous diagnosis of cancer, 23 had recurrent pleural effusion, and 28 had chest radiograph with suspicious nodules. Based on gross appearance, there were 20 serous and 21 sanguineous pleural fluid noted. Mean cell count was high (1,115.50 ± 741.02) with lymphocytic predominance (82.56 ± 24.46). Elevated protein concentration (5,388.25 ± 8,230.46) and LDH (484.17 ± 248.72) were noted. Glucose (8.78 ± 6.68 mmol/L) was low. There were 21 patients who had high WBC, 24 with high protein and 16 with elevated LDH. There were 3 patients who were positive for AFB and none for KOH. Comparative analysis showed that the pleural fluid samples assigned to the routinely fixed group which were handed to the nurse after thoracentesis, then forwarded to the laboratory through a ward laboratory aide or patient watcherfor fixation with with 95% alcoholby thelaboratory personnel significantly had a longer duration of 406.62 minutes as compared to immediately fixed at 12.27 minutes (P<0.01). For diagnosis of malignancy, significantly more cases were diagnosed in the immediately fixed group with 36.36% cases versus 18.18% (p=0.016).@*Conclusion@#Among patients with suspected malignant pleural effusions, early fixation of pleural fluid samples resulted in higher histopathology yields as compared to those fixed after going through the routine fixation.
Subject(s)
Pleural Effusion, MalignantABSTRACT
Remitting seronegative symmetrical synovitis with pitting edema(RS3PE),the inflammatory arthritis attacking mainly elderly males,is characterized by symmetrical synovitis with pitting edema of the dorsum of hands and feet and the absence of rheumatoid factor.RS3PE commonly accompanies malignant tumor,infections and other diseases.Here we report a case of RS3PE associated with lung malignancy and review other six cases to summarize the clinical features,treatment and prognosis.
Subject(s)
Aged , Humans , Male , Edema/etiology , Lung Neoplasms/complications , Syndrome , Synovitis/drug therapyABSTRACT
Introduction - Les facteurs influençant la qualité de vie (QDV) des patients tunisiens atteints d'un cancer du poumon (CDP) sont méconnus.L'objectif de cette étude est d'identifier les facteurs influençant la QDV des patients tunisiens atteints d'un CDP. Méthodes - Un questionnaire médical a évalué les caractéristiques générales et spécifiques de 100 patients dont 90 hommes, et les questionnaires QLQ-C30 et QLQLC13 ont évalué la QDV. Résultats - Les femmes, les sujets âgés, les mariés et les analphabètes avaient une mauvaise QDV. Comparativement aux patients indemnes de comorbidités, ceux ayant une à deux comorbidités avaient des scores d'activités physiques et professionnelles/loisirs plus bas. Comparativement aux patients ayant un cancer datant de moins d'un an, ceux dont le cancer datait de plus d'un an avaient des scores de santé globale et d'activité physique plus bas, et des scores de nausées/vomissements, d'insomnie et d'anorexie plus élevés. Les patients en stade avancé avaient une mauvaise QDV en termes d'activités physique et émotionnelle, d'insomnie et de constipation. Les patients ayant des métastases avaient une mauvaise QDV en termes de score global, d'activité physique, de fatigue, d'insomnie, d'anorexie et de diarrhée. Le type histologique et le type de traitement n'influençaient pas la QDV. Le sexe n'influençait pas les scores du QLQ-LC13. Comparativement aux patients traités par chimiothérapie, ceux traités par la combinaison chimiothérapie et chirurgie avaient des scores de dyspnée et de neuropathie périphérique plus élevés. Conclusion - Les facteurs suivants influencent la QDV des Tunisiens atteints d'un CDP: le sexe, l'âge, l'état civil, le niveau de scolarisation, les comorbidités, le stade et la durée d'évolution du cancer, et les métastases. Comparativement aux patients traités par chimiothérapie, ceux traités par chimiothérapie et chirurgie avaient des scores de dyspnée et de neuropathie périphérique plus élevés
Introduction - No previous study has established the factors that influence the quality of life (QOL) of tunisian patients with lung cancer (LC).This study aims to identify the factors that influence QOL of tunisian patients with LC. Methods. A medical questionnaire assessed the general and specific characteristics of 100 patients (90 men), and structured questionnaires (QLQ-C30 and QLQ-LC13) assessed QOL. Results -Women, elderly, married and illiterate patients had poor QOL. Compared to patients free from comorbidity, those with one to two comorbidities had lower scores of physical and life-role activities. Compared to patients with cancer discovered less than one year ago, those who's cancer appeared more than one year ago had lower scores of global health, physical activity, nausea/vomiting, and higher scores of insomnia and anorexia. Patients with advanced cancer had poor QOL in terms of physical and emotional activities, and insomnia and constipation items. Patients with metastases had a poor QOL in terms of global health, physical activity, fatigue symptom, insomnia, anorexia, and diarrhea. The histological and treatment types did not influence QOL. The QLQ-LC13 scores were not influenced by sex. However, compared to patients treated with chemotherapy, those treated with chemotherapy and surgery had higher scores of dyspnea and peripheral neuropathy. Conclusion - The following factors influenced QOL of Tunisian patients with LC: sex, age, civil status, schooling level, comorbidities, LC stage and duration, metastases. Compared to patients treated with chemotherapy, those treated with chemotherapy and surgery had higher scores of dyspnea and peripheral neuropathy
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Physics , Quality of Life , Global Health , Disease Management , Leisure Activities , Lung Neoplasms , Socioeconomic Factors , Therapeutics , ExerciseABSTRACT
Background: Delays that postpone the evaluation and management of malignancy may lead to considerable morbidity. The primary objective of this study was to assess the time required to diagnose and treat lung cancer at an Indian public referral center that predominantly serves lower-income patients. Methods: A review of patients diagnosed with lung cancer between January 2008 and December 2016 was completed. We computed the median time intervals and inter-quartile ranges between symptom onset, definitive diagnostic investigation, confirmed histologic diagnosis, and chemotherapy initiation. Median intervals were correlated with baseline demographics and disease characteristics using Kruskal-Wallis test. Results: One thousand, three hundred and-seventy patients were selected. A majority (94.5%) with non-small cell lung cancer were diagnosed with advanced disease. After developing symptoms, patients required 101 [56168] days to undergo a definitive diagnostic study, 107 [60173] days to confirm a diagnosis, and 126 [85196.8] days to initiate treatment. Patients who were previously treated for tuberculosis required more time to receive chemotherapy compared to those who were not (187 [134261.5] days vs. 113 [75180] days, p < 0.0001). A specialty Lung Cancer Clinic was implemented in 2012, and the mean referrals per month increased nearly four-fold (p < 0.0001), but the time required to administer treatment was not shortened. Conclusion: Among lower-income Indian patients, the most prominent delays occur prior to diagnosis. Efforts should be directed toward encouraging physicians to maintain a high index of clinical suspicion and educating patients to report concerning symptoms as early as possible.
Subject(s)
Humans , Adult , Lung Neoplasms/diagnosis , Lung Neoplasms/therapy , IndiaABSTRACT
Pulmonary actinomycosis is a rare yet important and challenging diagnosis to make. It is commonly confused with other lung diseases, such as tuberculosis and bronchogenic carcinoma, leading to delay diagnosis or misdiagnosis. A 49-year-old man presented with a chronic cough, hemoptysis, and pleuritic chest pain. His initial imaging studies including computed tomography (CT) was suggestive of bronchogenic carcinoma. A subsequent CTguided biopsy was consistent with pulmonary actinomycosis and excluded the possibility of bronchogenic carcinoma. He was treated with antibiotic therapy and achieved remission with complete radiological resolution upon follow-up.
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Objective To discuss the clinical effect of artificial pneumothorax combined with intercostal nerve block in alleviating chest pain occurring during and after percutaneous microwave ablation (MWA) for subpleural lung malignancy.Methods A total of 30 patients with subpleural lung malignancy were randomly and equally divided into group A (n=10),group B (n=10) and group C (n=10).The patients in group A received both artificial pneumothorax and intercostal nerve block before MWA.The patients in group B only received artificial pneumothorax before MWA,and the patients in group C only received intercostal nerve block before MWA.The degree of pain was evaluated by visual analogue scale (VAS) score during MWA,immediately after MWA and at 6 h,12 h and 24 h after WMA.The side effects after MWA were recorded.Results During MWA,no statistically significant differences in VAS scores existed between each other among the three groups (P=0.885).The VAS scores determined at 6 h,12 h and 24 h after MWA in group C were significantly increased (P=0.014,P=0.006 and P=0.006 respectively).No patient in group A and group B developed symptoms of chest tightness after artificial pneumothorax was performed.After treatment,a small amount of asymptomatic residual pneumothorax was still observed in 6 patients of group A and group B,which disappeared spontaneously in about one week.Another patient still showed massive pneumothorax even after thoracic gas suction,and the patient recovered after thoracic closed drainage for three days.No other serious complications related to artificial pneumothorax occurred.Conclusion Artificial pneumothorax combined with intercostal nerve block can effectively relieve the chest pain occurring during and after MWA in patients with subpleural lung malignancy,and clinically this technique is quite safe.(J Intervent Radiol,2017,26:269-273)
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Sarcomatoid carcinomas of the lung are rare malignant biphasic tumors, which contain both a malignant epithelial component and a sarcomatoid component. The majority of patients are men and the mean age of onset is 60 years at the time of diagnosis. A metastasis to the regional lymph nodes and to distant organs is common. The clinical course of patients with this neoplasm is aggressive, with an overall 5-year survival rate approximating 20%. A sarcomatoid carcinoma of the lung is often observed in the large bronchi and peripheral lung field than in the trachea, and the clinical manifestations are related to their specific location. We report a case of sarcomatoid carcinoma of the lung in a 79-year-old man who presented with dyspnea on exertion.