ABSTRACT
BACKGROUND: It is important how to evaluate chronic cervical lymphadenopathies and when to perform excisional biopsy in children. We tried to analyze the usefulness of clinical and ultrasonographic findings in order to differentiate malign lymphadenopathies from benign ones. METHODS: This prospective study included 100 children who had cervical lymphadenopathies, larger than 1. 5 cm for 4 weeks duration at least. Children were between 2 and 14 years old, the mean age was 6.88±3.38 years. They were examined by clinical symptoms and ultrasonographic appearances. Persistent lymphadenopathies were evaluated by excisional biopsy. RESULTS: Cervical lymhadenopathies of 80 children with well clinical symptoms decreased and resolved within 10 weeks durations. Their ultrasonographic findings revealed regular margins, ovoid shapes and getting smaller than 1. 5 cm. The remaining 20 children persisting longer than 10 weeks at the same size, with worrisome clinical symptoms and susceptible ultrasonographic findings (round shapes, irregular margins) underwent excisional biopsy. According to the biopsy results, five had tubercular lymphadenopathies, three had Hodgkin'slenfoma, two had acute lymphoblastic leukemia. CONCLUSIONS: Chronic cervical lymphadenopathies can persist up to 10 weeks, althoughthey are reactive and benign.
Subject(s)
Lymphadenopathy/diagnosis , Adolescent , Biopsy , Child , Child, Preschool , Chronic Disease , Diagnosis, Differential , Female , Hodgkin Disease/diagnosis , Humans , Lymph Nodes/pathology , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/pathology , Male , Neck , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Prospective Studies , Time Factors , Tuberculosis, Lymph Node/diagnosis , Ultrasonography/methodsABSTRACT
OBJECTIVES: We sought to compare the short-term impact of three different phosphodiesterase-5 (PDE5) inhibitors on pulmonary and systemic hemodynamics and gas exchange parameters in patients with pulmonary arterial hypertension (PAH). BACKGROUND: The PDE5 inhibitor sildenafil has been reported to cause pulmonary vasodilation in patients with PAH. Vardenafil and tadalafil are new PDE5 inhibitors, recently being approved for the treatment of erectile dysfunction. METHODS: Sixty consecutive PAH patients (New York Heart Association functional class II to IV) who underwent right heart catheterization received short-term nitric oxide (NO) inhalation and were subsequently assigned to oral intake of 50 mg sildenafil (n = 19), 10 mg (n = 7) or 20 mg (n = 9) vardenafil, or 20 mg (n = 9), 40 mg (n = 8), or 60 mg (n = 8) tadalafil. Hemodynamics and changes in oxygenation were assessed over a subsequent 120-min observation period. RESULTS: All three PDE5 inhibitors caused significant pulmonary vasorelaxation, with maximum effects being obtained after 40 to 45 min (vardenafil), 60 min (sildenafil), and 75 to 90 min (tadalafil). Sildenafil and tadalafil, but not vardenafil, caused a significant reduction in the pulmonary to systemic vascular resistance ratio. Significant improvement in arterial oxygenation (equally to NO inhalation) was only noted with sildenafil. CONCLUSIONS: In PAH patients, the three PDE5 inhibitors differ markedly in their kinetics of pulmonary vasorelaxation (most rapid effect by vardenafil), their selectivity for the pulmonary circulation (sildenafil and tadalafil, but not vardenafil), and their impact on arterial oxygenation (improvement with sildenafil only). Careful evaluation of each new PDE5 inhibitor, when being considered for PAH treatment, has to be undertaken, despite common classification as PDE5 inhibitors.
