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INTRODUCTION: Tuberculosis (TB) remains one of the most dangerous infections with the high mortality in the whole world. The leading problems in the modern course of TB are both long-term therapy and appearance of multiplying and wide resistant forms, as well as the rise of comorbid pathology (e.g. AIDS-associated TB). Nonefficient antibiotic therapy forces the search of alternative ways of treatment. Prospective among existent ones is "target therapy" aimed on key links in a host organism. The aim of our study was to determine the morphofunctional characteristics of VEGF-A dependent angiogenesis in patients with fibrous-cavernous pulmonary tuberculosis, depending on the activity of dischargein order to justify the use of angiogenesis blockers. METHODS: Material for research were the fragments of the cavities' wall and pericavernous lung tissue of deceased or operated patients about fibro-cavernous tuberculosis with active bacillation (nâ¯=â¯89) and with clinical abacillation (nâ¯=â¯74). To assess the activity of VEGF-A-dependent angiogenesis, we used an immunohistochemical study with markers CD68, VEGF-A, CD34 and CollagenIV, followed by determination of the vascular perfusion index. RESULTS: Hyperactivation of VEGF-A dependent angiogenesis in the foci of specific inflammation leads to the dysregulation of the formation in functionally complete vessels and the creation of the most comfortable conditions for the persistence of M. tuberculosis in the form of sufficient aeration in the area of specific granulations, while reducing the vascular permeability of the fibrous layer vessels, providing inefficient recruitment of cells of the immune system and targeted delivery of drugs. In the pericavernous zone and intact pulmonary tissue, hyperexpression of VEGF-A leads to aggravation of local pulmonary hypertension, increase of tissue hypoxia, fibrous remodeling of the aero-hematic barrier and the formation of the alveolar-capillary block, which is a morphofunctional indicator of respiratory failure. CONCLUSIONS: Taking into account the absolute prevalence of proangiogenic factors in FCT in all patients, the use of targeted therapy aimed at VEGF-A blockade is pathogenetically justified.
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OBJECTIVES: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG PET/CT) scanning has been proposed as a new tool to assess disease activity in Takayasu Arteritis (TA). We investigated whether F-18 FDG PET/CT findings were consistent with current clinical disease status in patients with TA. METHODS: In this cross-sectional study, 22 patients with TA were enrolled. Clinical disease activity was assessed by the combination of National Institutes of Health (NIH) criteria, Disease Extent Index-Takayasu (DEI-Tak) score, physician global assessment and F-18 FDG PET/CT scans. RESULTS: At the time F-18 FDG PET/CT scans were taken, the majority of the patients (17/22) were using immunosuppressive (IS) drugs, and only four patients had clinically active disease. F-18 FDG PET/CT scans confirmed the presence of active vasculitic lesions in those four patients. In 16 out of 18 patients who were accepted to be in clinical remission, F-18 FDG PET/CT scans were also normal. There were only two patients with discordant results, i.e. active F-18 FDG PET/CT findings despite the lack of clinical activity. Interestingly, clinical exacerbation occurred four weeks later in one of them. Overall sensitivity and specificity of F-18 FDG PET/CT findings for clinical activity were 100% and 88.9%, respectively. CONCLUSIONS: We found that F-18 FDG PET/CT findings were generally consistent with clinical disease status in TA. Although use of IS drugs certainly impairs diagnostic accuracy of F-18 FDG PET/CT in TA, this imaging method may still have a potential for confirming remission or detecting disease activity in patients with TA receiving treatment.
Asunto(s)
Fluorodesoxiglucosa F18 , Imagen Multimodal , Tomografía de Emisión de Positrones , Radiofármacos , Arteritis de Takayasu/diagnóstico por imagen , Adolescente , Adulto , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recurrencia , Inducción de Remisión , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Arteritis de Takayasu/tratamiento farmacológico , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
Two cases of primary cutaneous meningioma are described. A male and a female patient, aged 56 and 61 years, respectively, presented each with a solitary subepidermal nodule. The initial diagnosis was established in both patients by application of FNA biopsy. The subsequent histologic examination confirmed the cytologic diagnosis. Extensive investigation of the patients by computed tomography (CT) and nuclear magnetic resonance imaging (MRI) scans failed to reveal any primary meningioma of the neuraxis. Neurologic examination and routine laboratory test results were all normal. The microscopic features, immunocytological study and histology, which all gave a similar pattern to that seen in intracranial meningiomas, are discussed. Distinction from other cutaneous lesions that may be considered in the differential diagnosis is made. A brief review of the literature is also presented.