Assuntos
Brônquios/patologia , Tosse/etiologia , Sarcoma Mieloide/diagnóstico , Traqueia/patologia , Idoso , Medula Óssea/patologia , Broncoscopia/métodos , Tosse/diagnóstico , Progressão da Doença , Evolução Fatal , Feminino , Células Precursoras de Granulócitos/patologia , Humanos , Recidiva Local de Neoplasia , Cuidados Paliativos , Sarcoma Mieloide/metabolismo , Sarcoma Mieloide/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Bronquiolite Obliterante/induzido quimicamente , Bronquiolite Obliterante/complicações , Bronquiolite Obliterante , Sulfassalazina/efeitos adversos , Espirometria/métodos , Diagnóstico Precoce , Prednisona/uso terapêutico , Broncodilatadores/uso terapêutico , Corticosteroides/uso terapêutico , Dispneia/complicações , Dispneia/etiologia , Tosse/complicações , Tomografia Computadorizada de Emissão/métodos , Tomografia Computadorizada de Emissão , Eosinofilia/sangue , Eosinofilia/complicações , Tórax/patologia , TóraxRESUMO
Actinomycosis is a rare and slowly progressive infectious disease that can affect a variety of organ systems including the lung. It is caused by filamentous Gram-positive anaerobic bacteria of the genus Actinomyces. Despite its rarity, pulmonary actinomycosis can involve lung parenchyma, bronchial structures, and chest wall. The disease can mimic lung malignancy given its nonspecific clinical and radiological presentation, thus posing a diagnostic dilemma to the attending physician. In this paper, we describe two patients with pulmonary actinomycosis mimicking bronchogenic carcinoma; the former presented with peripheral infiltrate and associated hilar/mediastinal lymphadenopathy and the latter presented with a foreign body-induced endobronchial mass. Clinical, imaging, diagnostic, and therapeutical aspects of the disease are discussed, demonstrating the paramount importance of the histological examination of lung tissue specimens in the confirmation of the infection given either its low culture yield or the limited use of new molecular diagnostic tools in routine clinical practice.
RESUMO
Bronchoscopic drainage of a pyogenic lung abscess is an established therapeutic approach in selected patients in whom conventional antibiotic therapy fails. This intervention has also been undertaken in patients with abscess owing to underlying lung cancer and prior combined radiochemotherapy. However, this procedure has rarely been performed in cavitary lesions of advanced tumor origin before initiating any chemotherapy/radiotherapy scheme. Herein, we describe a case of a 68-year-old woman with lung adenocarcinoma stage IIIB, who underwent bronchoscopic drainage of necrotizing tumor lesion, thus improving her initial poor clinical condition and rendering other treatment modalities, such as radiotherapy, more effective and beneficial. Bronchoscopic drainage of a symptomatic cancerous lung abscess should be considered as an alternative and palliative treatment approach in patients with advanced inoperable non-small cell lung cancer.
Assuntos
Adenocarcinoma/cirurgia , Abscesso Pulmonar/cirurgia , Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Adenocarcinoma de Pulmão , Idoso , Broncoscopia , Drenagem , Feminino , Humanos , Pulmão/patologia , Abscesso Pulmonar/etiologia , Abscesso Pulmonar/patologia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , NecroseRESUMO
Cryptogenic organizing pneumonia (COP), previously called bronchiolitis obliterans organizing pneumonia (BOOP) is a clinicopathological disorder of unknown aetiology but increasingly reported. It usually presents with symptoms of dyspnea, cough, fever, weight loss accompanied by the presence of alveolar opacities on chest radiograph. Haemoptysis, described as blood streaking has only rarely been reported as primary presentation of COP. Herein, we report a case of COP in which submassive haemoptysis was the main clinical manifestation. The clinical, radiological, pathological, and therapeutic aspects of the disease are briefly discussed. Cryptogenic organizing pneumonia should be taken into consideration in the differential diagnosis of severe haemoptysis.
Assuntos
Pneumonia em Organização Criptogênica/complicações , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Hemoptise/etiologia , Tosse/etiologia , Pneumonia em Organização Criptogênica/tratamento farmacológico , Diagnóstico Diferencial , Dispneia/etiologia , Febre/etiologia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Resultado do Tratamento , Redução de PesoAssuntos
Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Bevacizumab , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Adenocarcinoma Bronquioloalveolar/complicações , Tosse/etiologia , Neoplasias Pulmonares/complicações , Escarro , Adenocarcinoma Bronquioloalveolar/diagnóstico por imagem , Adenocarcinoma Bronquioloalveolar/patologia , Idoso , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Radiografia TorácicaAssuntos
Síndrome de Horner/diagnóstico , Síndrome de Horner/microbiologia , Pneumopatias Fúngicas/diagnóstico , Mucormicose/diagnóstico , Adulto , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Broncoscopia , Feminino , Tecnologia de Fibra Óptica , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/cirurgia , Imageamento por Ressonância Magnética , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Tomografia Computadorizada EspiralRESUMO
OBJECTIVE: To evaluate the levels of hydrogen peroxide (H(2)O(2)) and 8-isoprostane in the expired breath condensate (EBC) of patients with COPD, and to assess the relationship between the above markers of oxidative stress and parameters expressing inflammatory process and disease severity. SETTING: Inpatient respiratory unit and outpatient clinic in tertiary care hospital. DESIGN: Cross-sectional study. PATIENTS: Thirty stable COPD patients (all smokers) with disease severity ranging from mild to severe. Ten subjects who were smokers with stage 0 disease (ie, at risk for COPD; mean [+/- SD] FEV(1), 88 +/- 5% predicted) were studied as a control group. METHODS: H(2)O(2) and 8-isoprostane levels were measured in EBC, and the values were correlated with variables expressing COPD severity (ie, FEV(1) percent predicted, dyspnea severity score (ie, Medical Research Council scale) and airway inflammation (ie, differential cell counts from induced sputum). RESULTS: The mean concentration of H(2)O(2) was significantly elevated in COPD patients compared to control subjects (mean, 0.66 micromol/L [95% confidence interval (CI), 0.54 to 0.68 micro mol/L) vs 0.31 micro mol/L [95% CI, 0.26 to 0.35 micromol/L], respectively; p < 0.0001). The difference was primarily due to the elevation of H(2)O(2) in patients with severe and moderate COPD, whose expired breath H(2)O(2) levels were significantly higher than those of patients with mild disease (mean, 0.96 micromol/L [95% CI, 0.79 to 1.13 micromol/L], 0.68 micromol/L [95% CI, 0.55 to 0.81 micromol/L], and 0.33 micromol/L [95% CI, 0.24 to 0.43 micromol/L], respectively, p < 0.0001). The mean concentration of 8-isoprostane was significantly elevated in patients with COPD compared to that of the control group (47 pg/mL [95% CI, 41 to 53 pg/mL] vs 29 pg/mL [95% CI, 25 to 33 pg/mL], respectively; p < 0.0001) but did not differ significantly among the different stages of the disease (p = 0.43). Repeatability and stability data within measurements showed that H(2)O(2) has a better repeatability and stability than 8-isoprostane. Furthermore, we observed significant correlations of H(2)O(2) with FEV(1), neutrophil count, and dyspnea score. Those correlations existed only in patients with moderate and severe disease. No correlations were found between levels of 8-isoprostane and the above parameters. CONCLUSIONS: We conclude that levels of H(2)O(2) and 8-isoprostane are elevated in the EBC of patients with COPD, but that H(2)O(2) seems to be a more repeatable and a more sensitive index of the inflammatory process and the severity of the disease.
Assuntos
Estresse Oxidativo , Doença Pulmonar Obstrutiva Crônica/metabolismo , Adulto , Idoso , Androstadienos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Testes Respiratórios , Broncodilatadores/uso terapêutico , Expiração , Fluticasona , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/imunologia , Teofilina/uso terapêuticoRESUMO
Endogenous airway acidification, as assessed by pH in expired breath condensate, has been implicated in asthma pathophysiology. We measured pH in breath condensate of patients with inflammatory airway diseases in stable condition and examined its relationship with the inflammatory process (as assessed by differential cell counts in induced sputum), oxidative stress (as assessed by H(2)O(2) and 8-isoprostane), and nitric oxide metabolism (as assessed by total nitrate/nitrite). We studied 40 patients with bronchial asthma (20 with moderate disease, forced expiratory volume in 1 second 60 [10]% SD predicted), 20 patients with bronchiectasis, 20 patients with chronic obstructive pulmonary disease (COPD), and 10 normal subjects. Mean (95% confidence intervals) pH values were significantly lower in patients with COPD and bronchiectasis compared with patients with asthma and control subjects (7.16, 7.09-7.23 and 7.11, 7.04-7.19 versus 7.43, 7.35-7.52 and 7.57, 7.51-7.64, respectively, p < 0.0001). Patients with moderate asthma had significantly lower values compared with mild and control subjects. In patients with COPD and bronchiectasis, the values of pH were significantly correlated with both sputum neutrophilia and oxidative stress. Respectively, in patients with moderate asthma, a significant correlation was observed between pH and sputum eosinophilia, total nitrate/nitrite, and oxidative stress. The pH of the expired breath condensate might be a simple, noninvasive, inexpensive, and easily repeatable procedure for the evaluation of the inflammatory process in airway diseases.