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1.
J. bras. pneumol ; 45(6): e20180132, 2019. tab
Article in English | LILACS | ID: biblio-1040290

ABSTRACT

ABSTRACT Objective: Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. Methods: We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. Results: There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). Conclusions: Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.


RESUMO Objetivos: A avaliação funcional pré-operatória é fundamental para otimizar a seleção dos pacientes para cirurgia torácica para tratamento do CPCNP. Uma alta inclinação VE/VCO2 se mostrou um preditor de complicações cirúrgicas e de aumento da mortalidade. Programas de reabilitação pulmonar (PRP) demonstraram aumentar os parâmetros funcionais e os desfechos de curto prazo em pacientes com DPOC submetidos à ressecção pulmonar. O impacto dos PRP na inclinação VE/VCO2 não foi totalmente investigado. Métodos: Avaliamos retrospectivamente 25 pacientes com DPOC consecutivos submetidos aos efeitos de um programa de reabilitação pulmonar de alta intensidade (PRP) na inclinação VE/VCO2. Resultados: Não foram observadas variações significativas nos principais parâmetros espirométricos após o programa de reabilitação de três semanas (pré-reabilitação VEF1 versus pós-reabilitação VEF1 %prev: 61,5 ± 22,0% para 62,0 ± 21,1%, ns; pré-reabilitação DLCO para pós-reabilitação DLCO %prev: 67,2 ± 18,1% para 67,5 ± 13,2%, ns). Por outro lado, o pico de VO2 e a inclinação VE/VCO2 melhoraram significativamente após PRP (pico de VO2 pré-reabilitação para pico de VO2 pós-reabilitação: 14,7 ± 2,5 para 18,2 ± 2,7 mL/kg/min, p < 0,0000001; inclinação pré-reabilitação VE/VCO2 para pós-reabilitação inclinação VE/VCO2: 32,0 ± 2,8 para 30,1 ± 4,0, p<0,01). Conclusão: Documentamos o benefício no desempenho físico de um treinamento de três semanas em um grupo de pacientes com DPOC com um comprometimento funcional notável em parâmetros de esforço. Dados adicionais e mais abrangentes são necessários para esclarecer os mecanismos fisiológicos.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Carcinoma, Non-Small-Cell Lung/rehabilitation , Pulmonary Disease, Chronic Obstructive/rehabilitation , Exercise Therapy/methods , Lung Neoplasms/rehabilitation , Oxygen Consumption/physiology , Reference Values , Spirometry , Time Factors , Carbon Dioxide/metabolism , Vital Capacity/physiology , Forced Expiratory Volume/physiology , Retrospective Studies , Treatment Outcome , Carcinoma, Non-Small-Cell Lung/surgery , Carcinoma, Non-Small-Cell Lung/physiopathology , Pulmonary Disease, Chronic Obstructive/physiopathology , Exercise Test , Lung Neoplasms/surgery , Lung Neoplasms/physiopathology
2.
J. bras. pneumol ; 45(4): e20170458, 2019. tab
Article in English | LILACS | ID: biblio-1012567

ABSTRACT

ABSTRACT Objective: To translate the European Organisation for Research and Treatment of Cancer (EORTC) 29-item Quality of Life Questionnaire-Lung Cancer Module (QLQ-LC29, developed for the assessment of quality of life in patients with lung cancer) to Portuguese, conducting a pilot study of the Portuguese-language version and adapting it for use in Brazil. Methods: For the translation, cultural adaptation, and pilot testing of the QLQ-LC29, we followed the guidelines established by the EORTC. The translation (English → Portuguese) and back-translation (Portuguese → English) were both carried out by translators, working independently, who were native speakers of one language and fluent in the other. After review, a draft version was created for pilot testing in lung cancer patients in Brazil. Results: A total of 15 patients diagnosed with lung cancer completed the Portuguese-language version of the questionnaire. At the end of the process, we conducted a structured interview to identify any patient difficulty in understanding any of the questions. The final versions were sent to the EORTC and were approved. Conclusions: The Portuguese-language version of the EORTC QLQ-LC29 appears to be a useful, important, reliable questionnaire that is a valid tool for assessing quality of life in patients with lung cancer in Brazil.


RESUMO Objetivo: O objetivo deste estudo foi traduzir, adaptar culturalmente e realizar um ensaio piloto para criar a versão em português do Brasil do questionário da European Organisation for Research and Treatment of Cancer (EORTC) denominado Quality of Life Questionnaire-Lung Cancer (QLQ-LC29, lung module), desenvolvido para a avaliação da qualidade de vida em doentes com câncer de pulmão. Métodos: Foram seguidas as orientações da EORTC para a tradução, a adaptação cultural e a realização de um ensaio piloto do QLQ-LC29. Foi realizado o processo de tradução (inglês → português) e tradução reversa (português → inglês) por tradutores independentes nativos em um dos idiomas e fluentes no outro idioma. Após revisão, uma versão preliminar for criada para o ensaio piloto com pacientes no Brasil. Resultados: No total, 15 pacientes com diagnóstico de câncer de pulmão preencheram a versão em português do Brasil do questionário. No final, foi conduzida uma entrevista estruturada para identificar qualquer dificuldade em alguma das perguntas. As versões finais foram enviadas para a EORTC e aprovadas. Conclusões: A versão em português do Brasil do EORTC QLQ-LC29 (lung module) é uma ferramenta útil, importante, fidedigna e válida para a aferição da qualidade de vida relacionada à saúde em pacientes com neoplasia pulmonar.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Quality of Life , Translations , Surveys and Questionnaires/standards , Lung Neoplasms/physiopathology , Reference Values , Brazil , Pilot Projects , Cross-Cultural Comparison , Reproducibility of Results , Language , Lung Neoplasms/therapy
3.
São Paulo; s.n; s.n; 2019. 136 p. graf, tab, ilus.
Thesis in Portuguese | LILACS | ID: biblio-995079

ABSTRACT

Os nanocristais são partículas de fármacos cristalinos, com tamanho médio na faixa de submicrons, geralmente entre 200 e 500 nm, estabilizados por agentes estéricos ou eletrostáticos adsorvidos na superfície das partículas do fármaco. Sua dimensão reduzida proporciona propriedades especiais, como a adesividade às mucosas e o aumento de área superficial e da solubilidade de saturação, o que melhora significativamente a biodisponibilidade de fármacos pouco solúveis em água. Outra aplicação emergente dos nanocristais é na melhoria da entrega e da retenção de fármacos em tecidos e células tumorais. Estudos demonstraram que o flubendazol é um fármaco capaz de induzir a morte celular em tumores malignos e retardar o seu crescimento, por meio da alteração que provoca na estrutura dos microtúbulos e pela inibição da polimerização da tubulina. Foi demonstrada sua atividade antiproliferativa em linhagens de leucemia, mieloma, câncer intestinal, câncer de mama e neuroblastoma. O flubendazol é também um fármaco eficaz contra os helmintos, demonstrando atividade superior na eliminação dos vermes adultos, quando comparado com a dietilcarbamazina. Embora o flubendazol pareça ser uma molécula promissora, é um fármaco praticamente insolúvel em água (0,005 mg/mL). Para atingir o efeito terapêutico desejado, é necessário o desenvolvimento de uma formulação com melhores solubilidade e biodisponibilidade. Nesse sentido, o presente trabalho apresenta o preparo e a caracterização físico-química de nanocristais de flubendazol por meio da microfluidização. Foram realizados ensaios exploratórios para avaliar a performance de diferentes agentes estabilizantes nas suspensões: o polissorbato 80, o polaxamer 188 e o D-α tocoferol polietilenoglicol 1.000 succinato (TPGS). A avaliação da distribuição do tamanho de partícula foi realizada por espalhamento de luz laser (LLS), espalhamento de luz dinâmica (DLS), análise de rastreamento de nanopartículas (NTA) e microscopia eletrônica de varredura (MEV). A utilização do TPGS favoreceu a obtenção de uma nanossuspensão com o menor diâmetro hidrodinâmico médio das partículas, de 253,9 ± 3,0 nm. Nos estudos exploratórios, também foram determinados os parâmetros ótimos de moagem do microfluidizador, sendo estabelecidos: 35.000 psi de pressão, temperatura do produto de 30°C (± 5°C) e tempo de recirculação de 2 horas/100 gramas. Objetivando alcançar o menor diâmetro hidrodinâmico médio dos nanocristais, executou-se um planejamento estatístico no qual foi avaliada a influência da concentração de flubendazol (% p/p) e de TPGS (% p/p) na formulação. A análise revelou a significativa influência da concentração do TPGS na redução do tamanho de partícula e na estabilidade físico-química da nanossuspensão. Ensaios complementares de solubilidade demonstraram que o nanocristal proporcionou incremento na solubilidade de 2,3 e 3,2 e 5,2 vezes em HCl 0,1 N, tampão fosfato pH 6,8 e tampão fosfato salino pH 7,4, respectivamente. No ensaio de dissolução conduzido em HCl 0,1 N e 0,1% TPGS, observou-se significativo incremento, de 41% de fármaco dissolvido após 60 minutos, quando comparado com o flubendazol micronizado. As características do estado sólido do nanocristal foram avaliadas por meio de análise térmica (calorimetria exploratória diferencial e termogravimetria) e difratometria de raios X, não sendo observadas significativas alterações da estrutura cristalina. O presente trabalho também avaliou a efetividade dos nanocristais de flubendazol em tumores de pulmão, demonstrando sua expressiva capacidade de retardar o crescimento e diminuir o tamanho desses tumores em camundongos xenotransplantados


Os nanocristais são partículas de fármacos cristalinos, com tamanho médio na faixa de submicrons, geralmente entre 200 e 500 nm, estabilizados por agentes estéricos ou eletrostáticos adsorvidos na superfície das partículas do fármaco. Sua dimensão reduzida proporciona propriedades especiais, como a adesividade às mucosas e o aumento de área superficial e da solubilidade de saturação, o que melhora significativamente a biodisponibilidade de fármacos pouco solúveis em água. Outra aplicação emergente dos nanocristais é na melhoria da entrega e da retenção de fármacos em tecidos e células tumorais. Estudos demonstraram que o flubendazol é um fármaco capaz de induzir a morte celular em tumores malignos e retardar o seu crescimento, por meio da alteração que provoca na estrutura dos microtúbulos e pela inibição da polimerização da tubulina. Foi demonstrada sua atividade antiproliferativa em linhagens de leucemia, mieloma, câncer intestinal, câncer de mama e neuroblastoma. O flubendazol é também um fármaco eficaz contra os helmintos, demonstrando atividade superior na eliminação dos vermes adultos, quando comparado com a dietilcarbamazina. Embora o flubendazol pareça ser uma molécula promissora, é um fármaco praticamente insolúvel em água (0,005 mg/mL). Para atingir o efeito terapêutico desejado, é necessário o desenvolvimento de uma formulação com melhores solubilidade e biodisponibilidade. Nesse sentido, o presente trabalho apresenta o preparo e a caracterização físico-química de nanocristais de flubendazol por meio da microfluidização. Foram realizados ensaios exploratórios para avaliar a performance de diferentes agentes estabilizantes nas suspensões: o polissorbato 80, o polaxamer 188 e o D-α tocoferol polietilenoglicol 1.000 succinato (TPGS). A avaliação da distribuição do tamanho de partícula foi realizada por espalhamento de luz laser (LLS), espalhamento de luz dinâmica (DLS), análise de rastreamento de nanopartículas (NTA) e microscopia eletrônica de varredura (MEV). A utilização do TPGS favoreceu a obtenção de uma nanossuspensão com o menor diâmetro hidrodinâmico médio das partículas, de 253,9 ± 3,0 nm. Nos estudos exploratórios, também foram determinados os parâmetros ótimos de moagem do microfluidizador, sendo estabelecidos: 35.000 psi de pressão, temperatura do produto de 30°C (± 5°C) e tempo de recirculação de 2 horas/100 gramas. Objetivando alcançar o menor diâmetro hidrodinâmico médio dos nanocristais, executou-se um planejamento estatístico no qual foi avaliada a influência da concentração de flubendazol (% p/p) e de TPGS (% p/p) na formulação. A análise revelou a significativa influência da concentração do TPGS na redução do tamanho de partícula e na estabilidade físico-química da nanossuspensão. Ensaios complementares de solubilidade demonstraram que o nanocristal proporcionou incremento na solubilidade de 2,3 e 3,2 e 5,2 vezes em HCl 0,1 N, tampão fosfato pH 6,8 e tampão fosfato salino pH 7,4, respectivamente. No ensaio de dissolução conduzido em HCl 0,1 N e 0,1% TPGS, observou-se significativo incremento, de 41% de fármaco dissolvido após 60 minutos, quando comparado com o flubendazol micronizado. As características do estado sólido do nanocristal foram avaliadas por meio de análise térmica (calorimetria exploratória diferencial e termogravimetria) e difratometria de raios X, não sendo observadas significativas alterações da estrutura cristalina. O presente trabalho também avaliou a efetividade dos nanocristais de flubendazol em tumores de pulmão, demonstrando sua expressiva capacidade de retardar o crescimento e diminuir o tamanho desses tumores em camundongos xenotransplantados


Subject(s)
Animals , Male , Mice , Drug Screening Assays, Antitumor , Nanoparticles/metabolism , Antimetabolites, Antineoplastic/classification , Nanotechnology/classification , Lung Neoplasms/physiopathology
4.
Medisan ; 22(9)nov.-dic. 2018. tab
Article in Spanish | LILACS | ID: biblio-976169

ABSTRACT

Se realizó un estudio observacional, descriptivo y transversal de 61 pacientes con diagnóstico confirmado de cáncer de pulmón, atendidos en el Servicio de Radiología del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante 2015, con vistas a caracterizarles según variables de interés. Los resultados se organizaron en distribuciones de frecuencias y se confeccionaron tablas de una y dos entradas para establecer algunas relaciones entre variables. En la serie predominaron el sexo masculino (55,7 por ciento), el grupo etario de 60-69 años (39,3 por ciento), el antecedente de bronquitis crónica en ambos sexos (75,4 por ciento), la tos como síntoma principal (63,9 por ciento), la localización periférica (78,7 por ciento) y el adenocarcinoma como tipo histológico (57,4 por ciento), entre otros. Al momento del diagnóstico el mayor número de afectados se encontraba en etapas avanzadas de la enfermedad, por lo que se recomienda implementar estudios a todos aquellos con riesgo de padecerla.


An observational, descriptive and cross-sectional study of 61 patients with confirmed diagnosis of lung cancer, assisted in the Radiology Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba was carried out during 2015, with the aim of characterizing them according to variables of interest. The results were organized in distributions of frequencies and charts of one and two entrances were made to establish some relationships among variables. In the series, the male sex (55.7 percent), the age group 60-69 years (39.3 percent), history of chronic bronchitis in both sexes (75.4 percent), cough as main symptom (63.9 percent), outlying localization (78.7 percent) and the adenocarcinoma as histological type (57.4 percent) prevailed, among others. At the moment of the diagnosis the greatest number affected patients was in advanced stages of the disease, so that it is recommended to implement studies to all those with risk of suffering it.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Lung Neoplasms/physiopathology , Lung Neoplasms/epidemiology , Lung Neoplasms/diagnostic imaging , Tomography, Spiral Computed/methods , Lung Neoplasms
5.
J. bras. pneumol ; 43(3): 169-175, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-893837

ABSTRACT

ABSTRACT Objective: To evaluate the properties of the Identity-Consequence Fatigue Scale (ICFS) in patients with lung cancer (LC), assessing the intensity of fatigue and associated factors. Methods: This was a cross-sectional study involving LC patients, treated at a teaching hospital in Brazil, who completed the ICFS. Patients with chronic heart disease (CHD) and healthy controls, matched for age and gender, also completed the scale. Initially, a Brazilian Portuguese-language version of the ICFS was administered to 50 LC patients by two independent interviewers; to test for reproducibility, it was readministered to those same patients. At baseline, the LC patients were submitted to spirometry and the six-minute walk test, as well as completing the Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), and Fatigue Severity Scale (FSS). Inflammatory status was assessed by blood C-reactive protein (CRP) levels. To validate the ICFS, we assessed the correlations of its scores with those variables. Results: The sample comprised 50 patients in each group (LC, CHD, and control). In the LC group, the intraclass correlation coefficients for intra-rater and inter-rater reliability regarding ICFS summary variables ranged from 0.94 to 0.76 and from 0.94 to 0.79, respectively. The ICFS presented excellent internal consistency, and Bland-Altman plots showed good test-retest reliability. The ICFS correlated significantly with FSS, HADS, and SF-36 scores, as well as with CRP levels. Mean ICFS scores in the LC group differed significantly from those in the CHD and control groups. Conclusions: The ICFS is a valid, reliable instrument for evaluating LC patients, in whom depression, quality of life, and CRP levels seem to be significantly associated with fatigue.


RESUMO Objetivo: Avaliar as propriedades da Escala de Identificação e Consequências da Fadiga (EICF) em pacientes com câncer de pulmão (CP), analisando a intensidade da fadiga e fatores associados. Métodos: Estudo transversal com pacientes com CP, atendidos em um hospital-escola no Brasil, que preencheram a EICF. Pacientes com doenças cardíacas crônicas (DCC) e controles saudáveis, pareados por idade e sexo, também preencheram a escala. Inicialmente, uma versão brasileira da escala foi aplicada a 50 pacientes com CP por dois entrevistadores independentes; para testar a reprodutibilidade, ela foi reaplicada aos mesmos pacientes. No momento basal, os pacientes com CP realizaram espirometria e teste de caminhada de seis minutos, bem como preencheram a Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e Fatigue Severity Scale (FSS). O estado inflamatório foi avaliado pelos níveis de proteína C reativa (PCR) no sangue. Para validar a EICF, avaliamos as correlações entre as pontuações na mesma e essas variáveis. Resultados: A amostra foi composta por 50 pacientes em cada grupo (CP, DCC e controle). No grupo CP, os coeficientes de correlação intraclasse para confiabilidade intra e interobservador para as variáveis resumidas da EICF variaram de 0,94 a 0,76 e de 0,94 a 0,79, respectivamente. A EICF apresentou excelente consistência interna, e as disposições gráficas de Bland-Altman demonstraram boa confiabilidade teste-reteste. A EICF apresentou correlações significativas com as pontuações na FSS, HADS e SF-36, bem como com os níveis de PCR. As médias das pontuações na EICF do grupo CP diferiram significativamente das dos grupos DCC e controle. Conclusões: A EICF é um instrumento válido e confiável para a avaliação de pacientes com CP, nos quais depressão, qualidade de vida e níveis de PCR parecem estar significativamente associados à fadiga.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Fatigue/diagnosis , Fatigue/physiopathology , Lung Neoplasms/physiopathology , Self Report/standards , Brazil , C-Reactive Protein/analysis , Case-Control Studies , Chronic Disease , Cross-Sectional Studies , Fatigue/psychology , Heart Diseases/physiopathology , Lung Neoplasms/pathology , Lung Neoplasms/psychology , Psychiatric Status Rating Scales , Quality of Life/psychology , Reproducibility of Results , Severity of Illness Index , Spirometry , Statistics, Nonparametric , Time Factors , Translations , Walk Test
6.
Article in English | IMSEAR | ID: sea-156806

ABSTRACT

Pulmonary capillary haemangiomatosis (PCH) is a rare disorder of unknown aetiology, characterised by proliferating capillaries that invade the pulmonary interstitium, alveolar septae and the pulmonary vasculature. It is often mis-diagnosed as primary pulmonary hypertension and pulmonary veno-occlusive disease. Pulmonary capillary haemangiomatosis is a locally aggressive benign vascular neoplasm of the lung. We report the case of a 19-year-old female who was referred to us in the early post-partum period with severe pulmonary artery hypertension, which was diagnosed as PCH by open lung biopsy.


Subject(s)
Biopsy , Diagnosis, Differential , Female , Hemangioma, Capillary/diagnosis , Hemangioma, Capillary/physiopathology , Hemangioma, Capillary/therapy , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/therapy , Lung/pathology , Lung/diagnostic imaging , Lung Neoplasms/diagnosis , Lung Neoplasms/physiopathology , Lung Neoplasms/therapy , Oxygen Inhalation Therapy/methods , Thoracic Surgery, Video-Assisted/methods , Young Adult
7.
Article in English | IMSEAR | ID: sea-154382

ABSTRACT

A 3-year-old girl presented with a history of intermittent fever of six months duration associated with respiratory symptoms consisting of recurrent cough, fever, wheeze and a suspected history of contact with tuberculosis (TB). Chest radiograph revealed pulmonary infiltrates mimicking miliary TB. She was started on anti-tuberculous treatment, but in view of clinical deterioration, a further work-up including a lung biopsy revealed non-Hodgkin’s lymphoma (NHL). This case documents the extremely rare occurrence of pulmonary involvement and miliary infiltrates on the chest radiograph in NHL.


Subject(s)
Antineoplastic Agents/administration & dosage , Antitubercular Agents/administration & dosage , Antitubercular Agents/adverse effects , Biopsy , Child, Preschool , Cyclophosphamide/administration & dosage , Diagnosis, Differential , Female , Humans , Lung/pathology , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Lung Neoplasms/physiopathology , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/pathology , Lymphoma, Large B-Cell, Diffuse/physiopathology , Prednisolone/administration & dosage , Symptom Assessment/methods , Treatment Outcome , Tuberculosis, Miliary/diagnosis , Tuberculosis, Miliary/drug therapy , Vincristine/administration & dosage
8.
Rev. ANACEM (Impresa) ; 7(2): 80-83, ago. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-716571

ABSTRACT

INTRODUCCIÓN: En el taponamiento cardiaco existe restricción del llenado del corazón debido a un incremento de la presión de la cavidad pericárdica secundario a derrame pericárdico. Este aumento puede alcanzar valores que lleguen a superar las presiones fisiológicas de las cavidades derechas, comprometiendo así el llene de éstas, afectando secundariamente la precarga del ventrículo izquierdo. PRESENTACIÓN DEL CASO: Paciente de 52 años, sexo masculino, con antecedentes de tabaquismo y diabetes mellitus tipo 2, que consultó al servicio de urgencias del centro asistencial Víctor Ríos Ruiz de Los Ángeles por cuadro caracterizado por dolor cólico epigástrico, asociado a nauseas, vómitos, distensión abdominal, coluria, oliguria, anorexia, constipación, astenia, adinamia y malestar general. Es hospitalizado en el servicio de cirugía por sospecha de colecistitis aguda, se realiza ecografía abdominal donde se pesquizó líquido libre perihepático y periesplénico, y aumento del calibre de la vena cava inferior con derrame pleural bilateral. Comenzó con hipotensión, pulso paradojal e ingurgitación yugular, por lo que es trasladado a UCI donde la ecocardiografía confirmó taponamiento cardiaco. Se realizó pericardiocentésis y estudio del líquido, que muestra células de aspecto neoplásico. Se realizó tomografía axial computarizada (TAC) encontrándose lesión sólida en lóbulo pulmonar inferior izquierdo, nódulo en lóbulo medio y múltiples adenopatías mediastínicas e hiliares bilaterales. DISCUSIÓN: El derrame pericárdico maligno suele presentarse como taponamiento cardiaco, siendo la causa más frecuente el cáncer de pulmón. El pronóstico de un derrame pericárdico en contexto de cáncer pulmonar es más bien ominoso, llegando a ser menor a los 3 meses de vida.


INTRODUCTION: In cardiac tamponade, there is a filling restriction of the heart due to increased pressure of the pericardial cavity secondary to pericardial effusion. Pressure can reach values greater than that of the right heart cavities, compromising their filling, and, secondarily, affecting the preload of the left ventricle. CASE REPORT: A 52-year old male, with type 2 diabetes mellitus, consulted to the emergency department of Víctor Ríos Ruiz Hospital of Los Angeles, Chile for epigastric colic pain, nausea, vomiting, abdominal distention, choluria, oliguria, anorexia, constipation, asthenia, adynamia and malaise. He is admitted to the surgery ward on the suspicion of acute cholecystitis. Abdominal ultrasound showed perihepatic and perisplenic free fluid and increased caliber of the inferior vena cava, associated with bilateral pleural effusion. Hypotension, paradoxical pulse and jugular engorgement developed, so he is transferred to the ICU where echocardiography confirmed cardiac tamponade. Pericardiocentesis was performed, which showed malignant cells on microscopy. A computerized tomography (CT scan) showed a solid mass in the left inferior lung lobe, a nodule in the middle lobe and multiple mediastinal and hiliar bilateral lymphoadenopaties. DISCUSSION: Malignant pericardial effusion commonly presents as cardiac tamponade, being the lung cancer its main etiology. The prognosis of pericardial effusion in lung cancer is rather ominous, with an overall survival of less than 3 months.


Subject(s)
Humans , Female , Middle Aged , Pericardial Effusion/diagnosis , Lung Neoplasms/diagnosis , Cardiac Tamponade/diagnosis , Pleural Effusion, Malignant/diagnosis , Fatal Outcome , Lung Neoplasms/physiopathology , Palliative Care , Cardiac Tamponade/physiopathology
9.
Braz. j. med. biol. res ; 46(1): 21-31, 11/jan. 2013. tab, graf
Article in English | LILACS | ID: lil-665792

ABSTRACT

Among the most common features of highly invasive tumors, such as lung adenocarcinomas (AD) and squamous cell carcinomas (SqCC), is the massive degradation of the extracellular matrix. The remarkable qualitative and quantitative modifications of hyaluronidases (HAases), hyaluronan synthases (HAS), E-cadherin adhesion molecules, and the transforming growth factor β (TGF-β) may favor invasion, cellular motility, and proliferation. We examined HAase proteins (Hyal), HAS, E-cadherin, and TGF-β profiles in lung AD subtypes and SqCC obtained from smokers and non-smokers. Fifty-six patients, median age 64 years, who underwent lobectomy for AD (N = 31) and SqCC (N = 25) were included in the study. HAS-1, -2 and -3, and Hyal-1 and -3 were significantly more expressed by tumor cells than normal and stroma cells (P < 0.01). When stratified according to histologic types, HAS-3 and Hyal-1 immunoreactivity was significantly increased in tumor cells of AD (P = 0.01) and stroma of SqCC (P = 0.002), respectively. Tobacco history in patients with AD was significantly associated with increased HAS-3 immunoreactivity in tumor cells (P < 0.01). Stroma cells of SqCC from non-smokers presented a significant association with HAS-3 (P < 0.01). Hyal, HAS, E-cadherin, and TGF-β modulate a different tumor-induced invasive pathway in lung AD subgroups and SqCC. HAases in resected AD and SqCC were strongly related to the prognosis. Therefore, our findings suggest that strategies aimed at preventing high HAS-3 and Hyal-1 synthesis, or local responses to low TGF-β and E-cadherin, may have a greater impact in lung cancer prognosis.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma/pathology , Carcinoma, Squamous Cell/pathology , Extracellular Matrix/pathology , Lung Neoplasms/pathology , Adenocarcinoma/metabolism , Adenocarcinoma/physiopathology , Cadherins/analysis , Carcinoma, Squamous Cell/metabolism , Carcinoma, Squamous Cell/physiopathology , Cell Adhesion Molecules/analysis , Extracellular Matrix/metabolism , Glucuronosyltransferase/analysis , Lung Neoplasms/metabolism , Lung Neoplasms/physiopathology , Neoplasm Staging , Neoplasm Invasiveness/prevention & control
10.
Rev. colomb. biotecnol ; 12(2): 41-54, dic. 2010. ilus
Article in Spanish | LILACS | ID: lil-590773

ABSTRACT

En México, la mortalidad debido a enfermedades bronco-respiratorias se ubica en el sexto lugar según datos estadísticos dados por el Instituto Nacional de Enfermedades Respiratorias (INER). Esto genera la necesidad de incrementar la eficiencia en la aplicación de los tratamientos usados para este tipo de patología. Algunos de los métodos utilizados con mayor frecuencia para el tratamiento de estas dolencias hacen uso de micro dispositivos, también conocidos como válvulas endobronquiales. Este es un sistema alternativo que evita cirugías invasivas y logra prolongar e incrementar la calidad de vida de los pacientes. En este trabajo se presenta el análisis del desempeño de la válvula IBV®. Para el desarrollo del estudio numérico se determinaron las dimensiones y propiedades mecánicas del modelo a partir de catálogos del fabricante. Se desarrolló un modelo para el cual se consideraron las propiedades del Nitinol® y Silastic®. Asimismo, se propusieron dos condiciones de operación para la válvula, una anclada en el bronquio y la otra en la condición en la que se encuentra plegada dentro del broncoscopio. Se utilizó el Método del elemento finito (MEF) para simular las condiciones de trabajo de la válvula. Los resultados encontrados muestran el funcionamiento estructural y el nivel de los esfuerzos generados en el implante durante el ciclo de respiración forzada del individuo. Además, se proporcionan las bases para generar un nuevo dispositivo que pueda emular el funcionamiento de este tipo de implantes y aumente la eficiencia del tratamiento de dicha patología.


In Mexico, the mortality rate due to bronchial respiratory sickness is placed in the sixth position, according to statistics from the National Institute of Breathing Sickness (INER), so it is convenient to increment the efficiency of treatments for those pathologies. The intrabronchial valve is a recommended alternative method; being it main objective to avoid invasive surgery and increase the time and quality of patient´s life. Within this work a biomechanical analysis of an IBV® valve is carried out. Regarding the numerical analysis, the dimensions and mechanical properties of the valve were proposed based on catalogues published by the manufacturer as more reliable information was not available in the open literature. As a result, a new model was developed in which both materials Nitinol® and Silastic® are considered as the main valve materials. The proposed working conditions assume that the valve is implanted in folded form at the bronchus and then anchored when it is unfolded. Finite Element Method (FEM) was used to simulate the proposed working conditions. Results obtained show the structural performance and the level of stress generated in the implant during the breathing cycle. In addition, it provides the knowledge to generate a new device that could emulate the performance of these implants and develop a more efficient treatment this disease.


Subject(s)
Lung Neoplasms/surgery , Lung Neoplasms/diagnosis , Lung Neoplasms/nursing , Lung Neoplasms/epidemiology , Lung Neoplasms/physiopathology , Lung Neoplasms/chemically induced , Lung Neoplasms/pathology , Lung Neoplasms/chemistry , Lung Neoplasms/drug therapy , Heart Valves/abnormalities , Heart Valves/physiology , Heart Valves/immunology , Heart Valves/pathology , Heart Valves/chemistry
11.
J. bras. pneumol ; 36(5): 588-594, set.-out. 2010. tab
Article in Portuguese | LILACS | ID: lil-564201

ABSTRACT

OBJETIVO: Avaliar o efeito da quimioterapia sobre a condição física de pacientes com câncer de pulmão avançado. MÉTODOS: Foram avaliados 50 pacientes com câncer de pulmão não pequenas células nos estágios IIIB e IV e com status de performance segundo a escala do Eastern Cooperative Oncology Group (ECOG) entre zero e dois. Todos receberam quimioterapia com as drogas paclitaxel e derivados da platina e foram avaliados em três momentos (pré-quimioterapia, pós-quimioterapia e seis meses após o início do tratamento), nos quais a escala ECOG, o índice de massa corpórea (IMC) e a Distância percorrida no Teste de Caminhada de Seis minutos (DTC6) foram avaliados. RESULTADOS: Dos 50 pacientes incluídos, 14 foram a óbito, 5 foram excluídos do estudo por apresentar piora do status de performance, e 31 concluíram o seguimento de seis meses. Não houve diferença estatisticamente significativa para o IMC (p = 1,00, pré-quimioterapia vs. pós-quimioterapia; e p = 0,218, pré-quimioterapia vs. seis meses após) ou para a DTC6 entre os momentos de avaliação. O status de performance melhorou, principalmente com o aumento do número de pacientes assintomáticos após seis meses de acompanhamento (p = 0,031). CONCLUSÕES: O uso de quimioterapia teve um efeito benéfico no status de performance dos pacientes. Não houve alterações no IMC ou na DTC6 durante o período do estudo, o que pode sugerir a manutenção da condição física dos pacientes.


OBJECTIVE: To evaluate the effect of chemotherapy on the physical condition of patients with advanced lung cancer. METHODS: We evaluated 50 patients with non-small cell lung cancer (in stages IIIB and IV) and Eastern Cooperative Oncology Group (ECOG) performance status scale scores between zero and two. All patients underwent chemotherapy using paclitaxel and platinum derivatives and were evaluated at three time points (prechemotherapy, postchemotherapy and six months after starting the treatment), at which the ECOG scale, the body mass index (BMI) and the six-minute walk distance (6MWD) were assessed. RESULTS: Of the 50 patients included in the study, 14 died, 5 were excluded due to the worsening of their performance status, and 31 completed the six-month follow-up. There was no statistically significant difference between the time points of assessment for BMI (prechemotherapy vs. postchemotherapy, p = 1.00; and prechemotherapy vs. six months later, p = 0.218) or for 6MWD. Performance status improved, and this was especially due to the increase in the number of asymptomatic patients after the six-month follow-up (p = 0.031). CONCLUSIONS: Chemotherapy had a beneficial effect on the performance status of the patients. No significant changes in BMI or 6MWD were found during the study period, which might suggest the maintenance of the physical condition of the patients.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma/drug therapy , Body Mass Index , Carcinoma, Non-Small-Cell Lung/drug therapy , Exercise Tolerance/physiology , Lung Neoplasms/drug therapy , Walking/physiology , Adenocarcinoma/physiopathology , Antineoplastic Agents, Phytogenic/therapeutic use , Carcinoma, Non-Small-Cell Lung/physiopathology , Exercise Tolerance/drug effects , Lung Neoplasms/physiopathology , Paclitaxel/therapeutic use , Platinum Compounds/therapeutic use
12.
Indian J Cancer ; 2010 Jul-Sept; 47(3): 328-331
Article in English | IMSEAR | ID: sea-144360

ABSTRACT

Context: The pattern of nodal spread in oral cancers is largely predictable and treatment of neck can be tailored with this knowledge. Most studies available on the pattern are from the western world and for early cancers of the tongue and floor of the mouth. Aims: The present study was aimed to evaluate the prevalence and pattern of nodal metastasis in patients with pathologic T4 (pT4) buccal/alveolar cancers. Settings and Design: Medical records of the patients with pT4 primary buccal and alveolar squamous cell carcinomas treated by single-stage resection of primary tumor and neck dissection at Gujarat Cancer and Research Institute (GCRI), Ahmedabad, a regional cancer center in India, during September 2004 to August 2006, were analyzed for nodal involvement. Materials and Methods: The study included 127 patients with pT4 buccal/alveolar cancer. Data pertaining to clinical nodal status, histologic grade, pT and pN status (TNM classification of malignant tumors, UICC, 6th edition, 2002), total number of nodes removed, and those involved by tumor, and levels of nodal involvement were recorded. Statistical analysis was performed using the Chi-square test. Results: Fifty percent of the patients did not have nodal metastasis on final histopathology. Occult metastasis rate was 23%. All of these occurred in levels I to III. Among those with clinically palpable nodes, level V involvement was seen only in 4% of the patients with pT4 buccal cancer and 3% of the patients with alveolar cancer. Conclusions: Elective treatment of the neck in the form of selective neck dissection of levels I to III is needed for T4 cancers of gingivobuccal complex due to a high rate of occult metastasis. Selected patients with clinically involved nodes could be well served by a selective neck dissection incorporating levels I to III or IV.


Subject(s)
Adenocarcinoma, Bronchiolo-Alveolar/pathology , Adenocarcinoma, Bronchiolo-Alveolar/physiopathology , Adenocarcinoma, Bronchiolo-Alveolar/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , India , Lung Neoplasms/epidemiology , Lung Neoplasms/pathology , Lung Neoplasms/physiopathology , Lung Neoplasms/surgery , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymphatic Metastasis , Male , Middle Aged , Mouth Neoplasms/epidemiology , Mouth Neoplasms/pathology , Mouth Neoplasms/physiopathology , Mouth Neoplasms/surgery , Neck Dissection , Neoplasm Staging , Neoplasms, Squamous Cell/epidemiology , Neoplasms, Squamous Cell/pathology , Neoplasms, Squamous Cell/physiopathology , Neoplasms, Squamous Cell/surgery , Prevalence
13.
J Cancer Res Ther ; 2009 Jan-Mar; 5(1): 31-5
Article in English | IMSEAR | ID: sea-111545

ABSTRACT

OBJECTIVE: This study was undertaken to explore the clinicopathological profile of bronchogenic carcinoma in young patients. MATERIALS AND METHODS: The present study was conducted on 799 consecutive histopathologically proven cases of bronchogenic carcinoma that were referred from different parts of Uttar Pradesh. RESULTS: Out of 799 patients, 73 patients (9.1%; 59 males and 14 females) were < or = 40 years of age and were classified as 'young' patients. The mean ages of the subjects in the younger and older patient groups were 36 and 58 years, respectively. Among the older patients, 590 (81.3%) were smokers, and there were 53 (72.6%) smokers among the younger patients. Squamous cell carcinoma was the commonest histological subtype in both the groups, but squamous cell carcinoma was more frequently diagnosed in older patients than in younger patients. CONCLUSION: This study suggests that, regardless of age or sex, lung cancer must be ruled out in all patients who have persistent signs of pulmonary disease and a history of heavy smoking.


Subject(s)
Adult , Carcinoma, Bronchogenic/etiology , Carcinoma, Bronchogenic/pathology , Carcinoma, Bronchogenic/physiopathology , Carcinoma, Squamous Cell/etiology , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/physiopathology , Female , Humans , Lung Neoplasms/etiology , Lung Neoplasms/pathology , Lung Neoplasms/physiopathology , Male , Middle Aged , Neoplasm Staging , Smoking/adverse effects
14.
Tanaffos. 2009; 8 (2): 17-23
in English | IMEMR | ID: emr-92917

ABSTRACT

Despite the advances in diagnosis and treatment of lung cancer, its survival rate has only improved in those with early stages of disease. Telomerase is a tumor marker that has been focused on recently as a novel tool for early diagnosis of lung cancer. This study aimed to compare telomerase activity in cases with malignant and benign pleural effusions. Telomerase activity was assessed in 28 consecutive cases of pleural effusions [19 cases with malignant and 9 cases with benign histopathologic diagnosis] with telomeric repeat amplification protocol [TRAP] between Apr. 2006 and Sep. 2007. Data analysis was performed by using Chi-square test and t-test. Twenty [71.4%] out of 28 cases with pleural effusions were positive for telomerase activity. Telomerase activity was positive in all 19 malignant effusions, while only one case with effusion due to a benign condition [TB] had positive telomerase activity [p < 0.0001]. The sensitivity, specificity and diagnostic accuracy of telomerase activity for detecting malignant pleural effusions were 100%, 88.9% and 96.4%, respectively. Positive and negative predictive values of telomerase activity were 95% and 100%, respectively. Mean relative telomerase activity was not significantly different in malignant and benign effusions [24.3 +/- 5.2% vs. 15.05%; p>0.05] Telomerase activity is a highly sensitive and specific diagnostic biomarker for malignancy and may be used as an adjunct to other diagnostic tools such as cytology for malignant pleural effusions


Subject(s)
Humans , Male , Female , Lung Neoplasms/diagnosis , Biomarkers, Tumor , Pleural Effusion, Malignant , Sensitivity and Specificity , Predictive Value of Tests , Lung Neoplasms/physiopathology
15.
Article in English | WPRIM | ID: wpr-225674

ABSTRACT

OBJECTIVE: To estimate a new technique for quantifying regional lung motion using 3D-MRI in healthy volunteers and to apply the technique in patients with intra- or extrapulmonary tumors. MATERIALS AND METHODS: Intraparenchymal lung motion during a whole breathing cycle was quantified in 30 healthy volunteers using 3D-dynamic MRI (FLASH [fast low angle shot] 3D, TRICKS [time-resolved interpolated contrast kinetics]). Qualitative and quantitative vector color maps and cumulative histograms were performed using an introduced semiautomatic algorithm. An analysis of lung motion was performed and correlated with an established 2D-MRI technique for verification. As a proof of concept, the technique was applied in five patients with non-small cell lung cancer (NSCLC) and 5 patients with malignant pleural mesothelioma (MPM). RESULTS: The correlation between intraparenchymal lung motion of the basal lung parts and the 2D-MRI technique was significant (r = 0.89, p < 0.05). Also, the vector color maps quantitatively illustrated regional lung motion in all healthy volunteers. No differences were observed between both hemithoraces, which was verified by cumulative histograms. The patients with NSCLC showed a local lack of lung motion in the area of the tumor. In the patients with MPM, there was global diminished motion of the tumor bearing hemithorax, which improved siginificantly after chemotherapy (CHT) (assessed by the 2D- and 3D-techniques) (p < 0.01). Using global spirometry, an improvement could also be shown (vital capacity 2.9 +/- 0.5 versus 3.4 L +/- 0.6, FEV1 0.9 +/- 0.2 versus 1.4 +/- 0.2 L) after CHT, but this improvement was not significant. CONCLUSION: A 3D-dynamic MRI is able to quantify intraparenchymal lung motion. Local and global parenchymal pathologies can be precisely located and might be a new tool used to quantify even slight changes in lung motion (e.g. in therapy monitoring, follow-up studies or even benign lung diseases).


Subject(s)
Carcinoma, Non-Small-Cell Lung/physiopathology , Case-Control Studies , Female , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Lung Neoplasms/physiopathology , Magnetic Resonance Imaging/methods , Male , Mesothelioma/physiopathology , Middle Aged , Movement/physiology
16.
J. bras. pneumol ; 34(6): 387-393, jun. 2008. ilus, tab
Article in Portuguese | LILACS | ID: lil-485899

ABSTRACT

OBJETIVO: Avaliar a qualidade de vida de pacientes com câncer de pulmão e compará-la com a qualidade de vida de indivíduos sem câncer. MÉTODOS: O questionário Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) foi aplicado em 57 pacientes com diagnóstico de câncer de pulmão provenientes do Ambulatório de Oncopneumologia do Hospital São Paulo e em um grupo controle de 57 indivíduos participantes do Grupo de Ginástica Extra Penha. O teste de Mann-Whitney foi utilizado para comparar cada domínio entre os grupos. O primeiro modelo de regressão logística foi ajustado para sexo masculino, tratamento não cirúrgico, índice de Karnofsky e tabagismo, que foram incluídos como preditores. O segundo modelo foi ajustado para cada domínio do SF-36 para identificar aumento na proporção de estádios IIIB e IV. RESULTADOS: O grupo com câncer de pulmão e o grupo controle apresentaram, respectivamente, as seguintes pontuações médias para os domínios do SF-36: aspectos físicos, 29,39 ± 36,94 e 82,89 ± 28,80; aspectos emocionais, 42,78 ± 44,78 e 86,55 ± 28,77; capacidade funcional, 56,49 ± 28,39 e 89,00 ± 13,80; vitalidade, 61,61 ± 23,82 e 79,12 ± 17,68; dor, 62,72 ± 28,72 e 81,54 ± 19,07; estado geral de saúde, 62,51 ± 25,57 e 84,47 ± 13,47; saúde mental, 68,28 ± 23,46 e 82,63 ± 17,44; e aspectos sociais, 72,87 ± 29,20 e 91,67 ± 17,44. O modelo de regressão logística demonstrou que aspectos físicos, capacidade funcional e saúde mental foram preditores de estádios IIIB e IV. CONCLUSÕES: Os pacientes com câncer de pulmão apresentaram pior qualidade de vida em relação ao grupo controle, principalmente em relação aos aspectos físicos.


OBJECTIVE: To assess the quality of life of patients with lung cancer and to compare it with that of individuals without cancer. METHODS: The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) was administered to 57 patients diagnosed with lung cancer, treated at the Lung Cancer Outpatient Clinic of the Hospital São Paulo, and to a control group of 57 individuals recruited from the Extra Penha workout group. The Mann-Whitney test was used to compare the groups, domain by domain. The first model of logistic regression was adjusted for male gender, nonsurgical treatment, Karnofsky performance status and smoking, which were included as predictors. The second model was adjusted for each SF-36 domain in order to identify increases in the proportions of patients in stage IIIB or IV. RESULTS: The lung cancer group and the control group presented the following mean scores, respectively, for the SF-36 domains: role limitations due to physical health problems, 29.39 ± 36.94 and 82.89 ± 28.80; role limitations due to emotional problems, 42.78 ± 44.78 and 86.55 ± 28.77; physical function, 56.49 ± 28.39 and 89.00 ± 13.80; vitality, 61.61 ± 23.82 and 79.12 ± 17.68; bodily pain, 62.72 ± 28.72 and 81.54 ± 19.07; general health, 62.51 ± 25.57 and 84.47 ± 13.47; emotional well-being, 68.28 ± 23.46 and 82.63 ± 17.44; and social functioning, 72.87 ± 29.20 and 91.67 ± 17.44. The logistic regression model showed that role limitations due to physical health problems, physical function and emotional well-being were predictors of stages IIIB and IV. CONCLUSIONS: The patients with lung cancer had a poorer quality of life, especially regarding physical aspects, than did the control subjects.


Subject(s)
Female , Humans , Male , Middle Aged , Adenocarcinoma/psychology , Carcinoma, Squamous Cell/psychology , Lung Neoplasms/psychology , Quality of Life/psychology , Adenocarcinoma/physiopathology , Carcinoma, Squamous Cell/physiopathology , Epidemiologic Methods , Health Status , Lung Neoplasms/physiopathology
17.
J. bras. pneumol ; 34(5): 312-322, maio 2008. ilus
Article in English, Portuguese | LILACS | ID: lil-484213

ABSTRACT

A relação entre câncer e alteração na coagulação já havia sido sugerida há quase 150 anos por Trousseau e, subseqüentemente, ficou claro o maior risco que os pacientes oncológicos têm de desenvolverem fenômenos tromboembólicos. Isto pode ser conseqüência da ativação do sistema de coagulação pelas células neoplásicas ou pelas terapias empregadas (quimioterapias e cirurgias). Tais fenômenos podem, ainda, ser a primeira manifestação do câncer e a sua recorrência, mesmo com anticoagulação adequada, foi descrita. O sistema de coagulação é ativado, normalmente, com finalidade reparativa. Na presença de neoplasias, este complexo sistema está atuante frente a variados estímulos e parece contribuir para a progressão tumoral. Este efeito é mais importante para os focos metastáticos que para o próprio tumor primário. Contudo, a maior parte das vítimas de neoplasias morre das complicações das metástases, revelando a importância deste tema. Nesta área, vários mecanismos já são conhecidos e geram interessantes perspectivas para tratamentos futuros. Atualmente, o sucesso obtido com as heparinas de baixo peso molecular no carcinoma de pequenas células de pulmão é animador. Embora o conhecimento sobre esses mecanismos sejam relativamente recentes, os campos de pesquisa e tratamento estão amplamente abertos.


The relationship between cancer and coagulopathy was suggested by Trousseau nearly 150 years ago. Later, it became more evident that oncologic patients are at a higher risk of experiencing thromboembolic events. This can be due to activation of the coagulation system either by neoplastic cells or by prescribed therapies (chemotherapy or surgical procedures). In fact, these events can constitute the first manifestation of cancer, and their recurrence, despite efficient anticoagulation, has been described. The coagulation system is normally activated in order to provide healing. In the presence of neoplasms, this complex system is activated as a response to multiple stimuli and seems to contribute to cancer progression. Activation of the coagulation system has a greater effect on metastatic foci than on the primary tumor. However, most cancer victims die from complications caused by metastasis, which underscores the importance of this theme. In this area, various mechanisms have been described, creating promising perspectives for future treatments. The current success in using low-molecular-weight heparins against small cell lung cancer is encouraging. Although the knowledge of those mechanisms is relatively incipient, many basic research and clinical studies are underway.


Subject(s)
Humans , Lung Neoplasms/complications , Thrombophilia/etiology , Anticoagulants/therapeutic use , Blood Coagulation/drug effects , Blood Coagulation/physiology , Fibrinolysis/physiology , Heparin, Low-Molecular-Weight/therapeutic use , Lung Neoplasms/drug therapy , Lung Neoplasms/physiopathology , Thrombophilia/prevention & control
18.
Radiol. bras ; 40(1): 13-16, jan.-fev. 2007. tab
Article in Portuguese | LILACS | ID: lil-443799

ABSTRACT

OBJETIVO: Avaliar o rendimento da tomografia computadorizada torácica, em relação à mediastinoscopia, na detecção de metástases ganglionares mediastinais em pacientes portadores de carcinoma brônquico analisando o rendimento dessa e identificando as regiões mais problemáticas. MATERIAIS E MÉTODOS: Analisamos 195 pacientes portadores de carcinoma brônquico, buscando-se comparar os achados entre tomografia computadorizada torácica e mediastinoscopia com biópsia. RESULTADOS: Em relação às metástases nodais mediastinais, 33,9 por cento tinham doença metastática ganglionar peribrônquica e/ou hilar ipsilateral, 46,1 por cento possuíam metástases mediastinais ipsilaterais e/ou subcarinais e 20 por cento apresentavam doença metastática mediastinal e/ou hilar contralateral, escalênica ou supraclavicular. As regiões com melhores valores de sensibilidade foram traqueobrônquica direita, paratraqueal direita alta e paratraqueal esquerda alta. As regiões nodais com melhores resultados de especificidade foram paratraqueal esquerda alta, paratraqueal direita alta e regiões traqueobrônquicas. CONCLUSÃO: A tomografia computadorizada torácica mostrou-se importante ferramenta diagnóstica na detecção de anormalidades em gânglios mediastinais; entretanto, a natureza neoplásica desses gânglios deve ser conferida por mediastinoscopia, ou até mesmo por toracotomia, a fim de que a correta decisão quanto ao tratamento possa ser tomada.


OBJECTIVE: To evaluate the yielding of chest computed tomography in comparison with mediastinoscopy for detection of mediastinal nodal metastases in patients with bronchial carcinoma, and identifying the most problematic regions. MATERIALS AND METHODS: We have analyzed 195 patients with bronchial carcinoma, comparing the findings of chest computed tomography and mediastinoscopy with biopsy. RESULTS: As regards mediastinal nodal metastasis, 33.9 percent of patients presented peribronchial and/or ipsilateral hilar nodal metastases, 46.1 percent ipsilateral and/or subcarinal mediastinal metastases, and 20 percent contralateral mediastinal and/or hilar, scalenic or supraclavicular metastatic disease. Higher sensitivity values were found in the following regions: right tracheobronchial, right upper paratracheal, and left upper paratracheal. Higher specificity values were found in the following nodal regions: left upper paratracheal, right upper paratracheal and tracheobronchial. CONCLUSION: Chest computed tomography has shown to be an important diagnostic tool for detection of mediastinal lymph nodes abnormalities. However, the neoplastic nature of such mediastinal nodes should be confirmed by means of mediastinoscopy or even thoracotomy, aiming at making the correct decision regarding the treatment of patients with non-small cell lung cancer.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/diagnosis , Lung Neoplasms , Mediastinoscopy/methods , Lung Neoplasms/diagnosis , Lung Neoplasms/physiopathology , Sensitivity and Specificity , Tomography, X-Ray Computed/methods
19.
Acta méd. costarric ; 48(2): 84-87, abr.-jun. 2006. ilus
Article in Spanish | LILACS | ID: lil-432819

ABSTRACT

Justificación y objetivo: El cáncer de pulmón ha aumentado en los últimos años y ha llegado a ocupar, tanto en hombres como en mujeres, el noveno lugar de incidencia en América Latina. En Costa Rica constituye la tercera causa de muerte por tumores malignos en hombres de la sexta en mujeres. El objetivo del presente estudio es determinar las causas más frecuentes del nódulo pulmonar solitario y entre ellas, el sitio que ocupa el cáncer pulmonar. Método: Se estudiaron 49 pacientes que ingresaron con el diangóstico de nódulo pulmonar solitario, o se les descubrió 1 durante su internamiento y cumplieron con los criterios de inclusión. Todos fueron referidos al servicio de Cirugía de Tórax y Cardiovascular del Hospital Dr. Rafael A. Calderón Guardia, en el periodo comprendido entre entre enero de 1996 y diciembre de 2001. La información de siguientes variables: sexo, edad, y clasificación histológica de las biopsias, obtuvo a partir de los expedientes clínicos. Resultados: De los 49 pacientes, 26 eran mujeres (53 por ciento). La edad más frecuente estuvo en el grupo de 50 años o más. Predominaron las entidades benignas y dentro de ellas, el histoplasmoma ocupó el primer lugar. En la patología maligna predominó el tumor carcinoide. El cáncer de pulmón y el linfoma se ubicaron en el segundo lugar. Conclusiones: En esta muestra se encontró como causa más frecuente de nódulo pulmonar solitario, una de carácter benigno, hubo un bajo porcentaje de nódulos de carácter maligno. Descriptores: nódulo pulmonar solitario, histoplamoma, tumor carcinoide, histología.


Subject(s)
Male , Adult , Humans , Female , Adolescent , Middle Aged , Lung Neoplasms/diagnosis , Lung Neoplasms/etiology , Lung Neoplasms/physiopathology , Solitary Pulmonary Nodule , Costa Rica
20.
Indian J Cancer ; 2005 Jul-Sep; 42(3): 125-32
Article in English | IMSEAR | ID: sea-51141

ABSTRACT

Lung cancer is one of the leading causes of cancer death worldwide. Survival has not improved significantly in spite of newer therapies. In view of the high-symptom burden and severe morbidity, evaluation of quality of life (QOL) becomes important in these patients. Several instruments are now available for this purpose, and have demonstrated good correlation with performance status, symptoms, and survival. Quality of life assessments also help in comparing different therapeutic regimes, thus allowing selection of the appropriate modality. Problems of inconsistent interpretability and high-patient dropout rate poses a challenging problem that needs to be tackled. In spite of these drawbacks, QOL is now considered to be an essential component of lung cancer management and should be performed routinely. Such a practice will help the physician plan appropriate treatment strategies and set practical therapeutic goals.


Subject(s)
Attitude to Health , Humans , Lung Neoplasms/physiopathology , Prognosis , Psychometrics/instrumentation , Quality of Life , Surveys and Questionnaires , Risk Assessment , Sickness Impact Profile
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