RESUMO
SETTING: Patients with cavitary pulmonary tuberculosis (TB) on baseline chest radiograph (CXR) who remain culture-positive after 8 weeks of treatment are at high risk of relapse. The role of end-of-treatment (EOT) CXR in predicting relapse is unclear. OBJECTIVE: To determine whether EOT CXR independently predicts TB relapse. DESIGN: We conducted a secondary analysis of a randomized trial of intermittent treatment using rifapentine in the continuation phase of TB treatment among 1004 human immunodeficiency virus seronegative adults with culture-proven pulmonary TB. RESULTS: Relapse occurred in 17.3% of subjects with persistent cavity on EOT CXR, in 7.6% of subjects with a cavity that resolved by EOT, and 2.5% (P=0.002 for trend) of subjects who never had a cavity. In multivariable analysis, patients with persistent cavity on EOT CXR were significantly more likely to relapse than patients with no cavity on baseline or 2-month CXR (hazard ratio [HR] 4.22, 95%CI 2.00-8.91), and were more likely to relapse than subjects whose early cavity had resolved by EOT CXR (HR 1.92, 95%CI 1.09-3.39). CONCLUSION: A persistent cavity after 6 months of TB treatment was independently associated with disease relapse after controlling for other variables. EOT CXR may help predict those likely to relapse.
Assuntos
Antibióticos Antituberculose/uso terapêutico , Radiografia Pulmonar de Massa/estatística & dados numéricos , Rifampina/análogos & derivados , Tuberculose Pulmonar/diagnóstico por imagem , Adulto , Feminino , Soronegatividade para HIV , Humanos , Masculino , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Rifampina/uso terapêutico , Fatores de Risco , Sensibilidade e Especificidade , Resultado do Tratamento , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/patologiaRESUMO
We present a patient with a symptomatic pleural effusion resulting from papillary carcinoma of the thyroid metastatic to the pleura. Distinctive features include clinically evident pleural metastasis and the presence of psammoma bodies in the pleural fluid, which are characteristic (albeit not pathognomonic) of papillary carcinoma of the thyroid.
Assuntos
Carcinoma Papilar/secundário , Derrame Pleural Maligno/etiologia , Neoplasias Pleurais/secundário , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/complicações , Carcinoma Papilar/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Pleurais/complicações , Neoplasias Pleurais/patologiaRESUMO
Disc agar diffusion tests were performed on 1340 clinical isolates (six common pathogens) to determine if the site of infection influenced antimicrobial susceptibility results for a given organism. There were several mathematically significant differences among sites and organisms, however the most important included cefoperazone (wound), piperacillin (sputum and urine) and tobramycin (sputum) against P. aeruginosa. Of these, only piperacillin was significantly less susceptible against P. aeruginosa lower respiratory tract isolates at our hospital. The impact of this on treatment (empiric) efficacy is unknown.
