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1.
Eur J Cancer ; 84: 55-59, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28783541

RESUMO

BACKGROUND: Never-smokers with lung cancer often present late as there are no established aetiological risk factors. The aim of the study is to define the frequency over time and characterise clinical features of never-smokers presenting sufficiently early to determine if it is possible to identify patients at risk. METHODS: We retrospectively analysed data from a prospectively collected database of patients who underwent surgery. The frequency was defined as number of never-smokers versus current and ex-smokers by year. Clinical features at presentation were collated as frequency. RESULTS: A total of 2170 patients underwent resection for lung cancer from March 2008 to November 2014. The annual frequency of developing lung cancer in never-smokers increased from 13% to 28%, attributable to an absolute increase in numbers and not simply a change in the ratio of never-smokers to current and ex-smokers. A total of 436 (20%) patients were never-smokers. The mean age was 60 (16 SD) years and 67% were female. Presenting features were non-specific consisting of cough in 34%, chest infections in 18% and haemoptysis in 11%. A total of 14% were detected on incidental chest film, 30% on computed tomography, 7% on positron-emission tomography/computed tomography and 1% on MRI. CONCLUSIONS: We observed more than a double of the annual frequency of never-smokers in the last 7 years. Patients present with non-specific symptoms and majority were detected on incidental imaging, a modality that is likely to play an increasingly important role for early detection in this cohort that does not have any observable clinical risk factors.


Assuntos
Neoplasias Pulmonares/epidemiologia , Prevenção do Hábito de Fumar , Centros de Atenção Terciária , Adulto , Idoso , Bases de Dados Factuais , Detecção Precoce de Câncer , Feminino , Humanos , Achados Incidentais , Londres/epidemiologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Valor Preditivo dos Testes , Radiografia Torácica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores de Tempo
2.
J Thorac Oncol ; 5(10): 1544-50, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20802350

RESUMO

INTRODUCTION: To investigate prognostic factors for patient survival after surgical palliation of malignant pleural effusion (MPE). METHOD: We reviewed 278 consecutive nonoverseas patients (108 men, median age: 60 years [range 26-89]) undergoing 310 surgical procedures for palliation of MPE over a 72-month period. There were 195 thoracoscopic talc pleurodesis, 39 pleuroperitoneal shunts, 38 pleurodesis by an intercostal drain, 29 pleural biopsies alone, and nine long-term drains. Referring physicians provided survival data. The significance of prognostic factors was examined with the log-rank test (Kaplan-Meier), those significant entered a Cox logistic multivariate regression analysis. RESULTS: Follow-up was complete until death (following 264 procedures) and for a median 648 days (range 173-2135) for surviving patients. Overall median postoperative survival was 211 days (95% confidence interval: 169-253). Survival was not significantly different for tumor type or method of palliation. In univarate analysis, preoperative leucocytosis, hypoxemia, raised alanine transaminase, body mass index below 18 and hypoalbuminemia were associated with a significantly reduced postoperative survival. In multivariate analysis, leucocytosis (p < 0.0001), hypoxemia (p = 0.014), and hypoalbuminemia (p < 0.0001) maintained significance. CONCLUSIONS: The survival reported demonstrates the necessity of an active approach to palliation of MPE. The identification of prognostic factors will assist the choice of palliative technique. In addition, an appreciation of the influence of selection on survival after surgical palliation of malignant pleural mesothelioma, especially that of unforeseen prognostic factors, is useful when evaluating the results of aggressive treatment such as chemoradiotherapy and radical surgery for these diseases.


Assuntos
Neoplasias/mortalidade , Cuidados Paliativos , Derrame Pleural Maligno/mortalidade , Derrame Pleural Maligno/cirurgia , Neoplasias Pleurais/mortalidade , Pleurodese/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Neoplasias Pleurais/cirurgia , Prognóstico , Taxa de Sobrevida
3.
Arch Pathol Lab Med ; 131(4): 582-7, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17425388

RESUMO

CONTEXT: Intraoperative distinction between primary and metastatic carcinomas in the lung at frozen section remains problematic. OBJECTIVE: To assess the value and practicality of immunohistochemistry for thyroid transcription factor 1 at the time of intraoperative frozen section. DESIGN: Thirty-three patients presented with either a solitary pulmonary mass or 2 pulmonary masses and a history of carcinoma in a different organ. In addition to routine frozen section for assessment of tumor type, we looked for expression of thyroid transcription factor 1, using the EnVision system with abridged methodology. RESULTS: Ten cases were positive for thyroid transcription factor 1, which was confirmed on subsequent paraffin sections. Nine of these were confirmed as primary pulmonary adenocarcinomas, but 1 case proved to be a rare false-positive metastatic colonic carcinoma. Twenty-three cases were negative on frozen section and reported as favoring metastatic disease. In all cases, additional immunohistochemical data increased diagnostic confidence, but particularly in cases of positive primary pulmonary tumors and in cases with disease metastatic from sites other than the large bowel. The average time in addition to that of the basic frozen section was 24 minutes per test with a cost of 32 pounds sterling (US$57). CONCLUSIONS: Frozen section immunohistochemistry for thyroid transcription factor 1 shows specificity and sensitivity similar to those seen for formalin-fixed tissues and is feasible within the time frame of a thoracotomy. Diagnostic confidence is increased, especially with positive primary pulmonary tumors. However, its practice should be properly planned within an operative procedure as liberal usage will likely have significant staff and cost implications.


Assuntos
Secções Congeladas , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Metástase Neoplásica/diagnóstico , Proteínas Nucleares/metabolismo , Fatores de Transcrição/metabolismo , Biomarcadores Tumorais/análise , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Período Intraoperatório , Masculino , Sensibilidade e Especificidade , Fator Nuclear 1 de Tireoide
4.
Blood Coagul Fibrinolysis ; 16(5): 365-7, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15970721

RESUMO

A 64-year-old woman was transferred for investigation of a mediastinal mass, biopsy of which showed a diffuse large B-cell lymphoma. She was also found to have an antiphospholipid antibody. The pre-operative coagulation screen showed a prolonged activated partial thromboplastin time, 71.3 s (normal range, 26-36 s), which was not corrected by the addition of normal plasma. The dilute Russell's viper venom time was positive. Anti-cardiolipin assay was strongly positive, immunoglobulin M was 153 AU; immunoglobulin G was normal, 3.1 AU. Assays of factors VIII, IX and XI showed higher concentrations with increasing dilutions in one-stage factor assays from 1: 10 to 1: 80 suggestive of an inhibitor. Factor XII was 9 U/dl and results were unaffected by increasing dilution, suggesting specific antibodies to factor XII. The factor XII antigen was 40 U/dl. The patient had immunoglobulin M auto-antibodies to factor XII.


Assuntos
Autoanticorpos/sangue , Fator XII/imunologia , Linfoma de Células B/imunologia , Linfoma Difuso de Grandes Células B/imunologia , Testes de Coagulação Sanguínea , Feminino , Humanos , Pessoa de Meia-Idade
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