RESUMO
A 55-year-old female had an abnormal shadow on chest radiograph. Computed tomography (CT) revealed a 26-mm tumor mass in the left upper lobe. No malignant findings were obtained by bronchoscopic cytology or histopathological diagnostics, but on positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) examination the maximum SUV was 9.01 in accordance with the tumor mass shadow on CT. Video-assisted thoracoscopic surgery was performed as clinically suspected of lung cancer, and the diagnosis was pulmonary mixed squamous cell and glandular papilloma (PMSGP). Primary PMSGP is extremely rare, and this is the first to describe the PET findings of this disease.
Assuntos
Fluordesoxiglucose F18 , Neoplasias Pulmonares/diagnóstico , Neoplasias Epiteliais e Glandulares/diagnóstico , Papiloma/diagnóstico , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Pessoa de Meia-Idade , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Papiloma/diagnóstico por imagemAssuntos
Acetatos , Adenocarcinoma/diagnóstico por imagem , Fluordesoxiglucose F18 , Hemangiossarcoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias do Colo do Útero/diagnóstico por imagem , Idoso , Radioisótopos de Carbono , Feminino , Humanos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Transsternal thymectomy is well established in the treatment of myasthenia gravis (MG). The objectives of this study were to evaluate the influence and prognostic factors of thymectomy as treatment for MG. PATIENTS AND METHODS: Surgical results of 54 patients with MG who underwent transsternal thymectomy were retrospectively reviewed. We investigated clinical outcomes of extended transsternal thymectomy in MG, and we analyzed the data to clarify the effect of prognostic factors on clinical outcome. RESULTS: A total of 54 patients, including 28 males and 26 females, were analyzed. At their last visit, 5 patients (9%) were in complete remission; 36 (67%) reported clinical improvement; and 18 (33%) had no change. There were no operative or late deaths. Clinical improvement was not detected by a patient's age, sex, presence or absence of thymoma, or acetylcholine receptor (AchR) antibodies titer. Patients in which the duration of illness before operation was equal to or less than 24 months (p = 0.018), and patients in the advanced Myasthenia Gravis Foundation of America (MGFA) stage (p = 0.014), showed a greater degree of clinical improvement. CONCLUSION: Transsternal thymectomy for MG is safe and effective. Those patients with severe symptoms and a shorter duration of illness showed more benefits from thymectomy.
Assuntos
Miastenia Gravis/cirurgia , Timectomia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Esternotomia , Timectomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: The early and late results of infective endocarditis (IE) with annular involvement were studied by focusing on surgical findings and operative procedures. MATERIALS AND METHODS: Fifteen adult patients with a mean age of 56 years were reviewed. Eight had native valve endocarditis (NVE), and 7 had prosthetic valve endocarditis (PVE). The diseased valve was mitral in 6 patients, aortic in 8, and mitral plus aortic in 1. Twelve patients were operated on during the active phase of IE. Enterococcus, Staphyrococcus, Streptococcus, and Stenotrophomonaus Maltophilia were predominant in bacterial examination. The mean follow-up period was 37 months. RESULTS: Active vegetation was observed in 63% of total patients. In NVE patients, valve replacement was performed in all 8 after complete debridement and annular patch reconstruction. One patient with hemodialysis died of heart failure. In PVE patients, valve deficiency was observed in all and active perivalvular abscess in 4. Conventional valve replacement was performed in 4 patients, and 3 of them died after surgery. Three patients who underwent aortic root translocation or Ross procedure survived. The hospital mortality of NVE and PVE surgery was 3% and 43%, respectively. There were no significant correlations between operative results and perioperative factors. During the follow-up period, late recurrent endocarditis did not occur, and one patient died of noncardiac diseases. CONCLUSION: For NVE, good operative results were obtained after complete resection of infected valve annulus and valve replacement. For PVE, new surgical treatments, such as the translocation method or Ross procedure, should be induced for further improvement of surgical results.
Assuntos
Valva Aórtica/cirurgia , Endocardite/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Adulto , Idoso , Valva Aórtica/microbiologia , Distribuição de Qui-Quadrado , Desbridamento , Endocardite/microbiologia , Endocardite/mortalidade , Feminino , Doenças das Valvas Cardíacas/microbiologia , Doenças das Valvas Cardíacas/mortalidade , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Reoperação , Medição de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: Maspin is a member of the serpin (serine protease inhibitor) family and has been shown to be a suppressor of tumor growth and metastasis in several types of tumors. The objective of this study was to evaluate whether maspin is a prognostic factor in patients with non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: We investigated maspin expression in 181 patients with curatively resected NSCLC by means of immunohistochemistry. We also determined whether expression of maspin correlates with the microvessel density (MVD) level. RESULTS: The incidence of strong maspin expression in patients with squamous cell carcinoma was significantly higher than that in patients with other histology (46 of 70 [65.7%]; P < .0001). There was no significant difference between maspin expression status and MVD. Prognosis was defined as progression-free survival (PFS) and overall survival (OS). There was no difference in PFS or OS between patients with strong and weak maspin expression among all patients. However, for squamous cell carcinoma, the PFS and OS rates for patients with strong maspin expression were significantly higher than those for patients with weak maspin expression (PFS, P = .004; OS, P = .001). In multivariate analysis on squamous cell carcinoma, strong maspin expression was an independent favorable prognostic indicator (PFS, P = .03; OS, P = .01). CONCLUSION: Strong maspin expression was an independent factor in predicting a favorable prognosis in squamous cell carcinoma of lung.