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1.
Arch. argent. pediatr ; 119(3): e264-e268, Junio 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1248231

ABSTRACT

La linfangiomatosis pulmonar difusa es una enfermedad rara caracterizada por una marcada proliferación y dilatación de los vasos linfáticos en los pulmones, la pleura y el mediastino. Se desconoce la prevalencia, y la etiología no se comprende completamente.Una niña de 22 meses ingresó por poliserositis, con derrame pericárdico y pleural. Requirió pericardiocentesis y avenamiento pleural, y presentó drenaje de quilo (1,5-4 litros/día) sin respuesta al tratamiento médico (ayuno, nutrición parenteral y octreotide). Se realizó biopsia pulmonar. La anatomía patológica mostró hallazgos compatibles con linfangiomatosis difusa pulmonar. Comenzó tratamiento con sirolimus y propanolol, que disminuyeron las pérdidas por el drenaje pleural a la semana. Presentó buena evolución; suspendió aporte de oxígeno y se retiró el drenaje pleural. Se externó al cuarto mes de internación. El diagnóstico temprano de la linfangiomatosis pulmonar difusa es difícil de lograr, pero permite aplicar terapéuticas que evitan la progresión de enfermedad y disminuir la morbimortalida


Diffuse pulmonary lymphangiomatosis is a rare disease characterized by marked proliferation and dilation of lymphatic vessels in the lungs, pleura, and mediastinum. The prevalence is unknown and the etiology is not fully understood.A 22-month-old girl was admitted for polyserositis, with pericardial and pleural effusion. She required pericardiocentesis and pleural drainage, presenting chyle drainage (1.5-4 liters/day) without response to medical treatment (fasting, parenteral nutrition and octreotide). A lung biopsy was performed. The pathological anatomy showed findings compatible with diffuse pulmonary lymphangiomatosis. Treatment with sirolimus and propanolol began, decreasing losses due to pleural drainage one week after treatment. She progressed well, discontinued oxygen supply and pleural drainage was removed, leaving the patient after the fourth month of hospitalization.Early diagnosis of diffuse pulmonary lymphangiomatosis is difficult to achieve, but it allows the application of therapies that prevent disease progression, reducing morbidity and mortality.


Subject(s)
Humans , Female , Infant , Lung Diseases/congenital , Lymphangiectasis/congenital , Pleural Effusion , Propranolol/therapeutic use , Biopsy , Sirolimus/therapeutic use , Lung Diseases/pathology , Lung Diseases/diagnostic imaging , Lymphangiectasis/pathology , Lymphangiectasis/diagnostic imaging
2.
Rev. chil. enferm. respir ; 36(1): 18-25, mar. 2020. tab
Article in Spanish | LILACS | ID: biblio-1115458

ABSTRACT

Las enfermedades granulomatosas incluyen una amplia gama de enfermedades. Sin embargo, en la práctica clínica, muchos casos de enfermedad granulomatosa permanecen sin etiología después del examen histológico. Nuestro objetivo fue determinar, a partir de las biopsias de pulmón, pleura y ganglios linfáticos mediastínicos, en los que se informaron granulomas, las características clínicas y los diagnósticos de estos pacientes. Así también la mortalidad a un año de seguimiento. Metodología: Analizamos retrospectivamente biopsias de pulmón, pleura y/o ganglios linfáticos mediastínicos con granulomas de 75 pacientes del Instituto Nacional del Tórax (2012-2016), sus características clínicas y de laboratorio. La información se obtuvo de los registros médicos. Los datos de mortalidad se obtuvieron del registro civil. Resultados: Se determinó una etiología en todos los casos, excepto en 3 (4%). Los diagnósticos más frecuentes fueron tuberculosis (n = 37; 49%) y sarcoidosis (n = 18; 24%). Otras causas fueron silicosis (5,3%), vasculitis (4%) y neumonitis por hipersensibilidad (2,7%). Los pacientes con tuberculosis (TB) tenían parámetros inflamatorios más altos, como velocidad de eritrosedimentación y proteína C reactiva. Además, sólo se encontraron granulomas con necrosis caseosa en pacientes con tuberculosis. En cambio, los pacientes con sarcoidosis tenían lesiones cutáneas y una mayor frecuencia de linfadenopatías. Cuatro (5.3%) pacientes fallecieron a un año de seguimiento: dos debido a neumonía, uno por hipersensibilidad crónica y uno por TB. Conclusión: La tuberculosis y la sarcoidosis fueron las causas más frecuentes de granulomas respiratorios en este estudio retrospectivo. Se logró determinar una etiología en el 96% de los casos, considerando variables clínicas, de laboratorio e histopatológicas para un diagnóstico diferencial correcto.


Granulomatous diseases comprise a wide range of pathologies. However, in clinical practice, many pulmonary granulomas remain without etiology after the histologic examination. Our aim was to determine from the biopsies of the lung, pleura and mediastinal lymph nodes in which granulomas were reported, the clinical characteristics and diagnoses of the patients. Methodology: We analyzed retrospectively biopsies of the lung, pleura and mediastinal lymph nodes with granulomas from 75 patients handled at our institution (2012-2016), as well as their clinical and laboratory data. The information was obtained from medical records. A one-year mortality date was obtained from the civil registry. Main results: A cause was determined in all the cases, except in three of them (4%). The most frequent diagnoses were tuberculosis (n =37; 49%) and sarcoidosis (n =18; 24%). Other causes were silicosis (5.3%), vasculitis (4%) and hypersensitivity pneumonitis (2.7%). Patients with tuberculosis (TB) had higher inflammatory parameters such as erythrocyte sedimentation rate and C-reactive protein. Besides granulomas with caseous necrosis were only found in TB patients. Instead, patients with sarcoidosis had skin lesions and a higher frequency of lymphadenopathy. Four patients (5.3%) died in a one-year of follow-up: two of them because of pneumonia and the other two patients because of chronic hypersensitivity and TB respectively. Conclusion: Tuberculosis and sarcoidosis were the most common causes of respiratory granulomas in this retrospective study. A specific cause was determined in 96% of cases, considering clinical, laboratory and histopathological variables to do a right differential diagnosis.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Granuloma/diagnosis , Granuloma/pathology , Lung Diseases/diagnosis , Lung Diseases/pathology , Sarcoidosis/diagnosis , Sarcoidosis/pathology , Tuberculosis/diagnosis , Tuberculosis/pathology , Biopsy , Retrospective Studies , Follow-Up Studies , Diagnosis, Differential
3.
Autops. Case Rep ; 10(1): 2019133, Jan.-Mar. 2020. ilus
Article in English | LILACS | ID: biblio-1052963

ABSTRACT

Pulmonary alveolar microlithiasis (PAM) is a rare entity, presenting mostly as an incidental finding. This disease has an autosomal recessive inheritance with inactivating mutations in the gene "solute carrier family 34 member 2". The present study was conducted to bring attention to this rare though preventable disease. The study was a cross-sectional descriptive study, conducted at the Department of Pathology, of a tertiary care hospital in New Dehli-India. PAMs were incidentally seen in two patients diagnosed with micronodular hepatic cirrhosis leading to reanalysis of 212 autopsies, retrospectively. Statistical analysis was done using Stata 14.0. We observed three forms (Type A, B and C) of round hyaline bodies measuring in diameter with thin delicate, radiating fibrils. These bodies were PAS positive, showed black discolouration of the pigment with von Kossa stain and birefringence on polarized microscopy using Congo red stain, however the refringence was light green as compared to apple green birefringence seen with amyloid deposition. PAM has a slow progressive course leading to a high rate of incidental detection. Drugs known to inhibit the micro-crystal growth of hydroxyapatite may slow the disease progression. The family members of patients with PAM may also be kept on follow up with regular imaging. Key messages: It is important to bring out the incidental finding as, seemingly innocuous observations may provide valuable insight into incurable diseases, especially rare diseases.


Subject(s)
Humans , Male , Adult , Middle Aged , Incidental Findings , Lung Diseases/pathology , Autopsy , Calcification, Physiologic , Rare Diseases
4.
Medicina (B.Aires) ; 79(5): 415-418, oct. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1056743

ABSTRACT

La sífilis es una enfermedad de transmisión sexual causada por una espiroqueta, Treponema palidum. Presentamos el caso de una mujer de 62 años de edad, que consultó por fiebre de 38°, dolor torácico en puntada de costado y lesiones pruriginosas en piel. Se realizó examen de laboratorio de sangre periférica, radiografía y tomografía de tórax. Recibió tratamiento antibiótico y fue diagnosticada como neumonía aguda de la comunidad. Debido a la respuesta parcial de los síntomas y persistencia de lesiones pruriginosas se realizó biopsia de piel que informó Treponema palidum, el cual fue confirmado con test serológico VDRL y FtA-abs positivo. La paciente recibió 4 dosis de penicilina G benzatínica con favorable evolución de las lesiones en piel y mejoría de las imágenes radiológicas.


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


Subject(s)
Humans , Female , Middle Aged , Syphilis/complications , Lung Diseases/microbiology , Treponema pallidum/isolation & purification , Biopsy , Radiography, Thoracic , Syphilis/microbiology , Tomography, X-Ray Computed , Dermatitis/microbiology , Dermatitis/pathology , Lung Diseases/pathology , Lung Diseases/diagnostic imaging
5.
Rev. Asoc. Méd. Argent ; 132(1): 7-19, Mar. 2019. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1009926

ABSTRACT

Se presenta el caso clínico de un lactante fallecido a los siete meses de edad con cuadro intersticial persistente. Objetivos: describir detalladamente el camino diagnóstico; alertar sobre posibles confusiones en recién nacidos con diagnósticos más frecuentes; detallar los hallazgos clínicos, radiológicos y de anatomía patológica (consultas en el exterior). Metodología: sumatoria de estudios complejos para descartar causas más frecuentes de patología intersticial en el lactante; consultas radiológicas, de anatomía patológica y genética en el exterior del país. Resultado: con diagnóstico de PAP (proteinosis alveolar pulmonar) se encontró una duplicación de material genético a nivel de cromosoma X, correspondiente al gen CSF2RA (colony stimulating factor 2-subunidad a). Este gen codifica al receptor CSF2 cuya citoquina controla la producción, diferenciación y función de granulocitos/macrófagos. (AU)


A clinical case of a deceased seven month old infant presenting persistent interstitial lung compromise is presented. Objectives. Detailed description of the diagnostic pathway used; to alert about possible confusion with other ­ more frequent ­ pathologies in the new borninfant age; to present clinical, radiological, genetic and pathology findings (consultations abroad). Methodology. A complete description of complex studies to rule out other more frequent pathologies is presented together with radiological, pathological and genetic results from consultations abroad. Results. A diagnosis of PAP (pulmonary alveolar proteinosis) was confirmed with duplication of genetic material at CSF2RA gene (colony stimulating factor 2-subunit a). This gene codifies the CSF2 receptor whose cytokine controls production, differentiation and function of granulocytes/macrophages. (AU)


Subject(s)
Humans , Male , Infant, Newborn , Infant , Lung Diseases, Interstitial/diagnosis , Lung Diseases/diagnosis , Lung Diseases/genetics , Lung Diseases/pathology , Lung Diseases/diagnostic imaging , Sex Chromosome Aberrations , Pulmonary Surfactants , Tomography, X-Ray Computed , Follow-Up Studies , Genetic Techniques , Lung Diseases, Interstitial/genetics , Diagnosis, Differential , Lung/pathology , Mutation/genetics
7.
J. bras. pneumol ; 44(2): 93-98, Mar.-Apr. 2018. tab
Article in English | LILACS | ID: biblio-893912

ABSTRACT

ABSTRACT Objective: To describe the clinical manifestations of patients with pulmonary infection caused by mycobacteria of the Mycobacterium abscessus complex (MABSC), and to compare these manifestations with those of patients infected with other nontuberculous mycobacteria (NTM). Methods: This was a retrospective cohort study involving 43 patients divided into two groups: the MABSC group, consisting of patients with pulmonary infection caused by MABSC (n = 17); and the NTM group, consisting of patients with pulmonary infection caused by NTM other than MABSC (n = 26). Patients were previously treated with a regimen of rifampin, isoniazid, pyrazinamide, and ethambutol before the diagnosis of NTM was confirmed by two culture-positive sputum samples. The nucleotide sequences of the hsp65, 16S rRNA, and/or rpoB genes were analyzed to identify the mycobacteria. Data were collected on demographic, clinical, and radiological characteristics, as well as on treatment responses and outcomes. Results: Loss of appetite was the only clinical manifestation that was significantly more common in the MABSC group than in the NTM group (p = 0.0306). The chance of having to use a second treatment regimen was almost 12 times higher in the MABSC group than in the NTM group. Treatment success was significantly higher in the NTM group than in the MABSC group (83.2% vs. 17.6%; p < 0.0001). The chance of recurrence was approximately 37 times higher in the MABSC group than in the NTM group. Conclusions: In the study sample, treatment response of pulmonary disease caused by MABSC was less favorable than that of pulmonary disease caused by other NTM.


RESUMO Objetivo: Descrever as manifestações clínicas de pacientes com infecção pulmonar por micobactérias do complexo Mycobacterium abscessus (CMA) e compará-las com as daqueles infectados com outras micobactérias não tuberculosas (MNT). Métodos: Estudo de coorte retrospectivo envolvendo 43 pacientes divididos em dois grupos: grupo CMA, com pacientes com infecção pulmonar por CMA (n = 17); e grupo MNT, com pacientes com infecção pulmonar por MNT que não CMA (n = 26). Os pacientes foram previamente tratados com o esquema rifampicina, isoniazida, pirazinamida e etambutol antes de o diagnóstico de MNT ser confirmado com culturas positivas em duas amostras de escarro diferentes. As sequências nucleotídicas dos genes hsp65, RNAr 16S e/ou rpoB foram analisadas para a identificação das micobactérias. Foram coletadas características demográficas, clínicas e radiológicas, assim como respostas terapêuticas e desfechos. Resultados: A única manifestação clínica significativamente mais frequente no grupo CMA que no grupo MNT foi hiporexia (p = 0,0306). A chance de haver a necessidade de utilização de um segundo esquema terapêutico foi quase 12 vezes maior no grupo CMA que no grupo MNT. O sucesso terapêutico foi significativamente maior no grupo MNT que no grupo CMA (83,2% vs. 17,6%; p < 0,0001). A chance de recidiva no grupo CMA foi aproximadamente 37 vezes maior que no grupo MNT. Conclusões: Na amostra estudada, a resposta terapêutica da doença pulmonar causada por CMA evoluiu de forma menos favorável do que naquela causada pelas demais MNT.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Mycobacterium abscessus/isolation & purification , Lung Diseases/microbiology , Mycobacterium Infections, Nontuberculous/microbiology , Brazil , Comorbidity , Retrospective Studies , Treatment Outcome , Life Style , Lung Diseases/pathology , Lung Diseases/drug therapy , Nontuberculous Mycobacteria/isolation & purification , Mycobacterium Infections, Nontuberculous/pathology , Mycobacterium Infections, Nontuberculous/drug therapy , Antitubercular Agents/therapeutic use
8.
Rev. chil. cir ; 69(3): 207-210, jun. 2017. ilus
Article in Spanish | LILACS | ID: biblio-844361

ABSTRACT

Introducción: En los últimos 30 años las técnicas quirúrgicas mínimamente invasivas en patología torácica modificaron el paradigma. Cada día más procedimientos son efectuados por esta vía desde el advenimiento de la cirugía videotoracoscópica. Objetivo: Demostrar el uso de la videotoracoscopia subxifoidea para biopsia pulmonar y bullectomía. Material y métodos: Vía subxifoidea por videotoracoscopia en 6 casos. Resultados: Se obtuvo diagnóstico histológico en 5 casos y resección de bullas subpleurales en uno sin complicaciones por el acceso subxifoideo. Conclusiones: Es la primera experiencia en un hospital universitario de Argentina con este acceso quirúrgico sin complicaciones, con rendimiento diagnóstico histológico y resultado terapéutico.


Introduction: In the last 30 years minimally invasive surgical techniques for thoracic pathology was changed the paradigm. Every day more procedures are performed in this way since the advent of videothorascopic surgery. Objective: Demonstrate the use of the subxiphoid videothorascopy for lung biopsy and pulmonary wedge resection for bulla. Material and methods: Subxiphoid access by videothorascopy in 6 clinic cases. Results: Histologic diagnosis in 5 cases and pulmonary wedge resection for bulla in another case without complications with subxiphoid access were obtained. Conclusions: Is the first experience in an Argentinian university hospital with this surgery access without complications and with performance histological diagnosis and therapeutic result.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Lung Diseases/pathology , Pneumonectomy/methods , Thoracic Surgery, Video-Assisted , Thoracoscopy , Lung Diseases/surgery , Xiphoid Bone
10.
J. bras. pneumol ; 41(5): 410-414, tab, graf
Article in English | LILACS | ID: lil-764562

ABSTRACT

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new method for the diagnosis and staging of lung disease, and its use is increasing worldwide. It has been used as a means of diagnosing lung cancer in its initial stages, and there are data supporting its use for the diagnosis of benign lung disease. The aim of this study was to share our experience with EBUS-TBNA and discuss its diagnostic value.Methods: We retrospectively analyzed the results related to 159 patients who underwent EBUS-TBNA at our pulmonary medicine clinic between 2010 and 2013. We recorded the location and size of lymph nodes seen during EBUS. Lymph nodes that appeared to be affected on EBUS were sampled at least twice. We recorded the diagnostic results of EBUS-TBNA and (for cases in which EBUS-TBNA yielded an inconclusive diagnosis) the final diagnoses after further investigation and follow-up.Results: We evaluated 159 patients, of whom 89 (56%) were male and 70 (44%) were female. The mean age was 54.6 ± 14.2 years among the male patients and 51.9 ± 11.3 years among the female patients. Of the 159 patients evaluated, 115 (84%) were correctly diagnosed by EBUS. The diagnostic accuracy of EBUS-TBNA was 83% for benign granulomatous diseases and 77% for malignant diseases.Conclusions: The diagnostic value of EBUS-TBNA is also high for benign pathologies, such as sarcoidosis and tuberculosis. In patients with mediastinal disorders, the use of EBUS-TBNA should be encouraged, primarily because it markedly reduces the need for mediastinoscopy.


Objetivo: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA, punção aspirativa por agulha guiada por ultrassom endobrônquico) é um novo método para o diagnóstico e estadiamento das doenças pulmonares e seu uso está aumentando em todo o mundo. Ela tem sido utilizada como um método diagnóstico de câncer de pulmão em estágios iniciais, e há dados que apoiam sua utilização para o diagnóstico de doenças pulmonares benignas. O objetivo deste estudo foi compartilhar a nossa experiência com EBUS-TBNA e discutir seu valor diagnóstico.Métodos: Analisamos, retrospectivamente, os resultados relacionados a 159 pacientes submetidos a EBUS-TBNA em nossa clínica de medicina pulmonar entre 2010 e 2013. Registramos a localização e o tamanho dos linfonodos visualizados durante EBUS. Os linfonodos suspeitos durante o procedimento foram puncionados ao menos duas vezes. Foram registrados os resultados diagnósticos por EBUS-TBNA e, para os casos com diagnóstico indefinido após EBUS-TBNA, os diagnósticos finais após investigação aprofundada e acompanhamento.Resultados: Avaliamos 159 pacientes, dos quais 89 (56%) eram homens e 70 (44%) eram mulheres. As médias de idade foram de 54,6 ± 14,2 anos nos homens e de 51,9 ± 11,3 anos nas mulheres. Dos 159 pacientes avaliados, 115 (84%) foram diagnosticados corretamente por EBUS. A acurácia diagnóstica de EBUS-TBNA foi de 83% para doenças granulomatosas benignas e de 77% para doenças malignas.Conclusões: O valor diagnóstico de EBUS-TBNA também é alto para patologias benignas, como sarcoidose e tuberculose. Em pacientes com alterações no mediastino, o uso de EBUS-TBNA deve ser incentivado, principalmente devido à redução significativa da necessidade de mediastinoscopia.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Biopsy, Needle/methods , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Lung Diseases/pathology , Bronchoscopy/methods , Lung Diseases , Lung Neoplasms/pathology , Lymph Nodes/pathology , Neoplasm Staging , Reference Values , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Sarcoidosis/pathology
11.
Int. braz. j. urol ; 41(2): 353-359, Mar-Apr/2015. tab, graf
Article in English | LILACS | ID: lil-748310

ABSTRACT

Purpose To evaluate the clinical outcome of a cohort of localized prostate cancer patients treate with 125-I permanent brachytherapy at the São José Hospital – CHLC, Lisbon. Materials and Methods A retrospective analysis was carried out on 429 patients with low and intermediate-risk of prostate adenocarcinoma, according to the recommendations of the EORTC, who underwent 125I brachytherapies in intraoperative dosimetry “real-time” system between September 2003 and September 2013. Results The mean follow-up was 71.98 months. Biochemical relapse of disease by rising PSA (Phoenix criterion) was observed in 18 patients (4.2%). Through the application of Kaplan-Meier survival curves in this sample, the rate of survival at 6 years without biochemical relapse was higher than 95%. By Iog rank test comparing biochemical relapse with initial PSA (15-10 and <10) and Gleason values (7 and <7), there was no statistical difference (P=0.830) of the initial PSA in the probability of developing biochemical relapse. In relation to Gleason score, it was noted a statistical difference (P<0.05), demonstrating that patients with Gleason 7 are more likely to develop biochemical relapse. Conclusions Brachytherapy as monotherapy is at present an effective choice in the treatment of localized prostate adenocarcinoma. Biochemical relapses are minimal. The initial PSA showed no statistically difference in the rate of relapses, unlike the value Gleason, where it was demonstrated that patients with Gleason 7 have a higher probability of biochemical relapse. Cases with PSA bounce should be controlled before starting a salvage treatment. .


Subject(s)
Humans , Genome, Human , Genome-Wide Association Study , Genetic Loci/genetics , Lung Diseases/genetics , Vital Capacity/genetics , Cohort Studies , Databases, Genetic , Follow-Up Studies , Forced Expiratory Volume , Genetic Predisposition to Disease , Lung Diseases/pathology , Meta-Analysis as Topic , Prognosis , Polymorphism, Single Nucleotide/genetics , Quantitative Trait Loci/genetics , Respiratory Function Tests , Spirometry
12.
Clinics ; 69(5): 335-340, 2014. tab
Article in English | LILACS | ID: lil-709608

ABSTRACT

OBJECTIVES: To evaluate the performance of fine and cutting needles in computed tomography guided-biopsy of lung lesions suspicious for malignancy and to determine which technique is the best option for a specific diagnosis. METHODS: This retrospective study reviewed the data from 362 (71.6%) patients who underwent fine-needle aspiration biopsy and from 97 (19.7%) patients who underwent cutting-needle biopsy between January 2006 and December 2011. The data concerning demographic and lesion characteristics, procedures, biopsy sample adequacy, specific diagnoses, and complications were collected. The success and complication rates of both biopsy techniques were calculated. RESULTS: Cutting-needle biopsy yielded significantly higher percentages of adequate biopsy samples and specific diagnoses than did fine-needle aspiration biopsy (p<0.05). The sensitivity, specificity, and accuracy of cutting-needle biopsy were 93.8%, 97.3%, and 95.2%, respectively; those of fine-needle aspiration biopsy were 82.6%, 81.3%, and 81.8%, respectively (all p<0.05). The incidence of pneumothorax was higher for fine-needle aspiration biopsy, and that of hematoma was higher for cutting-needle biopsy (both p<0.05). CONCLUSIONS: Our experience using these two techniques for computed tomography-guided percutaneous biopsy showed that cutting-needle biopsy yielded better results than did fine-needle aspiration biopsy and that there was no significant increase in complication rates to indicate the best option for specific diagnoses. .


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Biopsy, Fine-Needle/instrumentation , Lung Diseases/pathology , Lung/pathology , Biopsy , Incidence , Lung Diseases , Lung , Pneumothorax/complications , Retrospective Studies , Radiography, Interventional/methods , Sensitivity and Specificity , Tomography, X-Ray Computed
13.
J. bras. pneumol ; 39(5): 539-546, Sep-Oct/2013. tab
Article in English | LILACS | ID: lil-695182

ABSTRACT

OBJECTIVE: To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil. METHODS: We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months) and delayed (≥ 6 months)-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment). RESULTS: We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14). In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010), as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024), misdiagnosis with and treatment for tuberculosis (≥ 3 months) also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively). CONCLUSIONS: The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis. .


OBJETIVO: Avaliar a frequência do diagnóstico tardio de sarcoidose no Brasil e os fatores relacionados a esse atraso. MÉTODOS: Avaliamos pacientes com diagnóstico de sarcoidose confirmado por biópsia utilizando um questionário que abordava o tempo entre o início dos sintomas e a data da primeira consulta médica; e o número e especialidades dos médicos consultados. Sintomas sistêmicos e pulmonares, envolvimento extratorácico, dados espirométricos, estadiamento radiológico, escolaridade, renda individual e diagnóstico/tratamento de tuberculose foram comparados entre os pacientes com diagnóstico precoce (< 6 meses até o diagnóstico) e tardio (≥ 6 meses). RESULTADOS: Foram incluídos 100 pacientes. A mediana do número de médicos consultados foi 3 (variação: 1-14). O diagnóstico de sarcoidose foi feito na primeira consulta em 11 casos. Um clínico geral foi inicialmente consultado em 54 casos. O diagnóstico de sarcoidose foi precoce em 41 casos e tardio em 59. Não houve diferença entre os grupos no tocante ao gênero, raça, tipo de seguro saúde, escolaridade, renda, sintomas sistêmicos e respiratórios, envolvimento extratorácico e estadiamento radiológico. Os pacientes com diagnóstico tardio apresentavam menor CVF (80,3 ± 20,4% vs. 90,5 ± 17,1%; p = 0,010) e VEF1 (77,3 ± 19,9% vs. 86,4 ± 19,5%; p = 0,024), além de mais frequentemente receberem diagnóstico de tuberculose (24% vs. 7%; p = 0,032) e tratamento para tuberculose (≥ 3 meses; 20% vs. 0%; p = 0,002). CONCLUSÕES: O diagnóstico de sarcoidose é tardio em muitos casos, mesmo quando há achados de imagem sugestivos. O diagnóstico tardio está associado a menor função pulmonar na época do diagnóstico. Vários ...


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Delayed Diagnosis/statistics & numerical data , Lung Diseases/pathology , Lung/pathology , Sarcoidosis/pathology , Age Factors , Brazil/epidemiology , Chi-Square Distribution , Diagnostic Errors , Educational Status , Socioeconomic Factors , Surveys and Questionnaires , Sarcoidosis/epidemiology , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/pathology
14.
Rev. méd. Chile ; 141(4): 449-456, abr. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-680467

ABSTRACT

Background: CT guided percutaneous biopsy of pulmonary lesions is a widely used technique. Aim: To evaluate the yield and complication rate of CT-guided percutaneous core biopsy of pulmonary lesions. Material and Methods: A retrospective study of 153 consecutive lung biopsies performed in a 7-yearperiod was undertaken. Patients and lesions characteristics were reviewed. The yield for the diagnosis of malignant and benign lesions and the complication rate were calculated. Lesion size and depth from the pleural surface were analyzed as potential predictive variables for occurrence of a false-negative diagnosis of malignancy. The final diagnosis was established by surgical biopsy of the lesion or clinical and imaging follow up. Results: The mean age of patients was 66 ± 14 years and 55% were mole. The final diagnosis of the lesion was malignant in 139 and benign in 14 cases (prevalence of malignancy 90.8%). For the diagnosis of malignancy, the overall yield ofthe biopsy was 91.5%o with a sensitivity of 90.6%>. A specific diagnosis of benign lesions was obtained in 5 out ofl4 biopsies (35%). We did not identify an association between the lesion size or depth and the rate of false-negative diagnosis of malignancy. The pneumothorax rate was 13.7%o (n = 21) and eight (38%) required drainage. The average lesion depth of patients that had a pneumothorax was significant greater than the cases without the complication. No major bleeding complications occurred. Conclusions: Percutaneous CT-guided cutting needle biopsies of pulmonary lesions have an excellent diagnostic accuracy for malignant pulmonary lesions, at a low complication rate.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Biopsy, Needle/methods , Lung Diseases/pathology , Lung/pathology , Tomography, X-Ray Computed/methods , Biopsy, Needle/adverse effects , Lung Diseases , Lung Neoplasms/pathology , Lung Neoplasms , Lung , Predictive Value of Tests , Retrospective Studies , Radiography, Interventional/methods , Sensitivity and Specificity , Tomography, X-Ray Computed/adverse effects
15.
Med. interna (Caracas) ; 29(2): 119-126, 2013. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-753314

ABSTRACT

La infección por el Virus de Inmunodeficiencia Humana es un importante problema de salud pública a pesar del advenimiento de la terapia antiretroviral. Describir los patógenos pulmonares más frecuentes en pacientes VIH+ en la era del uso de terapia antirretroviral de gran actividad (TARGA). Se evaluaron 35 pacientes VIH+ que acudieron al Servicio de Neumonología y Cirugía de Tórax del Instituto Autónomo Hospital Universitario de Los Andes (Mérida, Venezuela). Se realizó evaluación clínica y fibrobroncoscopia con la finalidad de obtener muestras para cultivos cuantitativos bacteriológicos, micológicos y estudio anatomopatológico. Todos los pacientes mostraron síntomas respiratorios; sólo la disnea fue más frecuente en pacientes sin TARGA. Las alteraciones radiológicas no fueron significativamente diferentes entre ambos grupos de pacientes; sin embargo, el engrosamiento septal evidenciado en la TCAR (tomografía de alta resolución) de Tórax y la neumonía intersticial en las muestras histopatológicas fueron más frecuentes en pacientes que no recibían TARGA. El 72% de los pacientes tuvo cultivos bacteriológicos positivos, asociados con niveles bajos de CD4+ (p=0.02). El 37% mostró cultivos micológicos positivos, pero ningún paciente presentó serología positiva para los hongos cultivados del LBA. El 57% presentó evidencias histopatológicas de infección por P. jirovecci, generalmente asociada a coinfección con C. albicans y/o H. capsulatum. A pesar del uso de terapia antiretroviral, las patologías pulmonares infecciosas siguen siendo causa frecuente de morbilidad en pacientes infectados con el VIH en Venezuela.


HIV infection is an important public health problem despite the use of antiretroviral therapy. To determine the pathogens in a group of HIV+ patients with lung infections in the era of current high activity anti-retroviral therapy (HAART). Thirty five patients who consulted to the Pulmonary and Thoracic Surgery Department of the University Hospital of Los Andes (Mérida, Mérida state, Venezuela) were evaluated. Clinical evaluation and flexible bronchoscopy were done to obtain samples for quantitative bacterial culture, mycological culture and anatomopathologic evaluation. All patients showed respiratory symptoms, but dyspnea was more frequent in patients not receiving HAART. Radiologic findings were not different between the two groups of patients although septal thickening in High Resolution Computed Thoracic Tomography (HRCT) and interstitial pneumonia in histopathologic samples were more often found in patients not receiving HAART. 72% of had positive bacterial cultures and these were associated with low CD4+ count (p = 0.02). 37% of patients showed positive my cological culture, although none of them showed positive serology for any of the fungi cultured from bronchoalveolar lavage. 57% of patients showed histopathologic evidence of P. jirovecci infection, generally associated with confection by C. albicans and/or H. capsulatum. Despite the use of antiretroviral therapy, pulmonary infectious diseases continue to be a major cause of morbidity among HIV infected patients in Venezuela.


Subject(s)
Humans , Male , Female , Anti-Retroviral Agents/therapeutic use , Lung Diseases/complications , Lung Diseases/pathology , Communicable Diseases/mortality , Communicable Diseases/pathology , HIV , Microbiological Phenomena/immunology , Allergy and Immunology , Internal Medicine , Pulmonary Medicine
16.
Article in English | WPRIM | ID: wpr-184178

ABSTRACT

Placental transmogrification is a very rare lung disease, where the alveoli resemble the chorionic villi of placenta, and this change is a characteristic finding. A 31-year-old female patient presented with cough and dyspnea that had begun 2 weeks prior to admission. Along with giant bulla found in the left upper lung field, subsegmental consolidation was also identified in the lingular segment on plain chest radiograph and CT scan. Wedge resection was performed to remove the bulla. Pathologic examination of the resected bulla revealed destruction of the normal structures and characteristic villous and papillary changes. These changes led to a diagnosis of placental transmogrification. We made an encounter of an unusual placental transmogrification which had different image findings from other reported transmogrification cases. Thus, we report an atypical placental transmogrification case where both consolidation and giant bulla coexist.


Subject(s)
Adult , Chorionic Villi/pathology , Diagnosis, Differential , Female , Humans , Lung/pathology , Lung Diseases/pathology , Pneumonectomy , Tomography, X-Ray Computed/methods
18.
Article in English | WPRIM | ID: wpr-93089

ABSTRACT

BACKGROUND/AIMS: Real-time, convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used for the staging of malignant mediastinal lymph nodes. We evaluated the diagnostic efficacy and safety of EBUS-TBNA when used as an initial diagnostic tool. METHODS: We retrospectively studied 56 patients who underwent EBUS-TBNA as an initial diagnostic tool between August 2010 and December 2011. Procedure purpose were classified into four categories: 1) intrathoracic masses adjacent to the central airway; 2) enlarged lymph nodes for concurrent diagnosis and staging in suspected malignancy; 3) enlarged lymph nodes in suspected malignancy cases with inability to perform percutaneous core needle biopsy (PCNB); and 4) solely mediastinal masses/lymph nodes in lieu of mediastinoscopy. RESULTS: The diagnostic accuracy of EBUS-TBNA regardless of procedure purpose was calculated to be 83.9%. Furthermore, the diagnostic accuracy of malignant disease was significantly higher than benign disease (93.9% vs. 70.6%, p < 0.001). The diagnostic accuracy of EBUS-TBNA for each disease is as follows: tuberculosis, 50%; sarcoidosis, 60%; aspergillosis, 100%; lung abscess, 100%; lung cancer, 93%; and lymphoma, 100%. There were minor complications in seven patients during the EBUS-TBNA procedure. The complications included mild hypoxia and bleeding. CONCLUSIONS: In conclusion, EBUS-TBNA is a useful initial diagnostic tool for both benign and malignant diseases. EBUS-TBAN is also a very safe procedure and less invasive compared to mediastinoscopy or PCNB.


Subject(s)
Adult , Aged , Aged, 80 and over , Biopsy, Large-Core Needle , Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects , Female , Humans , Lung Diseases/pathology , Lung Neoplasms/pathology , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Mediastinoscopy , Middle Aged , Neoplasm Staging , Predictive Value of Tests , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed , Young Adult
19.
J. Health Sci. Inst ; 30(3)jul.-set. 2012. graf, tab
Article in Portuguese | LILACS | ID: lil-670574

ABSTRACT

Objetivo - Avaliar e comparar a distância percorrida pelos diferentes distúrbios pulmonares com a predita por Enright-Sherrill, assim como a velocidade média durante o teste de caminhada de seis minutos (TC6). Além de verificar se a idade, o índice de massa corporal (IMC), os índices espirométricos e a velocidade média poderiam influenciar na resposta do TC6. Métodos - Participaram 124 indivíduos com diagnóstico de doenças pulmonares, que foram divididos a partir da espirometria em três grupos: obstrutivo, restritivo e misto. Foram avaliados os dados antropométricos e pessoais destes, e depois encaminhados para realizar o TC6 segundo a ATS. Resultados - Observou-se diferença estatística (p<0,001) entre a distância percorrida pelos três grupos durante o TC6 com a predita por Enright-Sherrill. No entanto, quando avaliada a distância entre os grupos não foi observada diferença estatística (p>0,05). Em relação à velocidade média não houve diferença entre os grupos (p=0,666). Contudo, observou-se que esta variável é influenciada pelo tempo (p<0,001). Também se observou correlação entre a idade (r=-0,29) e a velocidade média (r=0,93) com a distância percorrida. Já a distância predita, apresentou correlação com o IMC (r=-0,84), idade (r=-0,36) e velocidade média (r=0,37). Conclusões - Quanto ao distúbioo pulmonar, não houve interferência deste sobre a distância percorrida e predita no TC6, e sobre a velocidade média. No entanto, observou-se que a idade, o IMC e a velocidade média são os responsáveis pela resposta do TC6.


Objective -To evaluate and compare the six-minute walking distance (6MWD) in different lung disorders with the predicted by Enright-Sherrill; as well as the average speed during the six-minute walk test (6MWT). Beyond this, check if age, body-mass index, lung function and average speed can influence the response of 6MWT. Methods - This study included 124 subjects with lung diseases, which have been divided from the lung functions results in three groups: obstructive, restrictive and mixed. The anthropometrics and personal data was evaluated, and then, they were sent to perform the 6MWT, according to ATS. Results - We observed statistical difference (p<0.001) between the 6MWD obtained by the groups and the predicted by Enright-Sherrill. However, we didn't observed statistical difference among the groups, when we evaluate the 6MWD. In relation to average speed, we didn't find difference among groups (p=0.666). However, we observed that the time influenced this variable (p<0.001). Also, we observed correlation between the age (r=-0.29) and average speed (r=0.93) with the 6MWD. Already, the predicted 6MWD had correlation with body-mass index (r=-0.84), age (r=-0.36) and average speed (r=0.37). Conclusions - As to lung disorders, there was no interference about six-minute walk distance and predicted 6MWD, as well as about average speed. However, has been observed that age, body-mass index and average speed are the responsible for the response of 6MWT.


Subject(s)
Humans , Male , Female , Spirometry/statistics & numerical data , Spirometry , Pulmonary Disease, Chronic Obstructive , Pulmonary Fibrosis , Lung Diseases/diagnosis , Lung Diseases/pathology , Lung Diseases/prevention & control , Exercise Test/instrumentation , Exercise Test/methods
20.
Rev. med. (Säo Paulo) ; 91(2): 69-82, abr.-jun. 2012. tab
Article in Portuguese | LILACS | ID: lil-747349

ABSTRACT

Introdução: Tromboembolismo pulmonar (TEP) é uma das mais graves complicações dentre pacientes hospitalizados e permanece subdiagnosticado. Ainda hoje, sua fisiopatologia não está completamente elucidada. Objetivos: Correlacionar comorbidades, neoplasias, cirurgias e achados histológicos às manifestações clínicas associadas ao TEP. Métodos: Entre 2001 a 2008, foram revisadas 291 autópsias de pacientes cuja causa de morte foi TEP. Os seguintes dados foram obtidos: idade, sexo, manifestações clínicas, achados histológicos e principais doenças de base/comorbidades, neoplasias e cirurgias da última internação. Os achados histológicos foram categorizados em: dano alveolar difuso (DAD), edema agudo de pulmão (EAP), hemorragia intra alveolar (HIA) e pneumonia intersticial linfo-plasmocítica (PILP). Odds ratios foram obtidas por regressão logística e foram consideradas significativas quando p < 0,05. Resultados: A mediana de idade foi 64 anos. Cerca de 64% dos pacientes apresentava doenças cardiovasculares. O achado pulmonar mais prevalente foi EAP. Apenas 13% dos casos apresentaram suspeita clínica. Insuficiência respiratória esteve associada a EAP, HIA e DAD; assim como instabilidade hemodinâmica a HIA e DAD. Conclusões: Foram encontradas importantes associações entre achados clínicos e histológicos em pacientes com TEP. A compreensão dos mecanismos fisiopatológicos envolvidos com cada doença associada a TEP pode auxiliar no diagnóstico e no tratamento da doença.


Introduction: Pulmonary thromboembolism (PTE) is one of the most fatal complications among hospitalized patients and remains undiagnosed. Its physiopathology and its epidemiology aren’t widely known in literature. Objectives: To correlate underlying diseases, different cancers and surgeries to histological findings and in-vivo manifestations associated to fatal PTE from autopsy reports. Methods: From 2,001 to 2,008, were reviewed 291 autopsies of patients whose cause of death was PTE. The following data were obtained: age, sex, clinical invivo manifestations, post-mortem pathological patterns and mainassociated underlying diseases, cancers and surgeries performed in last hospitalization. The pulmonary histopathological changes were categorized in: diffuse alveolar damage (DAD), pulmonary edema (PE), alveolar hemorrhage (AH) and lympho/plasmacytic interstitial pneumonia (LPIP). Odds ratios of positive relations were obtained by logistic regression and were considered significative when p < 0.05. Results: The median age was 64 years. 64% ofpatients presented cardiovascular illness associated to PTE. The most prevalent pulmonary finding was PE. Only 13% of cases had clinical suspect. Acute respiratory failure was positively related to PE, AH and DAD; as well hemodynamic instability to AH and DAD. Conclusions: We found important relations between clinical data and histological findings of fatal PTE patients. The understanding of pulmonary physiopathological mechanism involved with eachPTE-associated disease can improve diagnosis in order to offer prompt treatment and reduce mortality.


Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Middle Aged , Aged, 80 and over , Autopsy/statistics & numerical data , Pulmonary Heart Disease/complications , Pulmonary Heart Disease/diagnosis , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Diagnostic Techniques, Respiratory System/mortality , Pulmonary Edema/pathology , Pulmonary Embolism/physiopathology , Lung Diseases/pathology
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