RESUMEN
BACKGROUND: Mycobacterium avium complex (MAC) pulmonary disease (PD) is often difficult and complicated to diagnose or to discriminate from follicular bronchitis, bronchiectasis, or other conditions associated with rheumatoid arthritis (RA) lung in the clinical setting. OBJECTIVE: We investigated whether a serologic test for anti-glycopeptidolipid (GPL) antibody was useful for distinguishing MAC-PD from RA lung in diagnosis. METHODS: Serum IgA antibody to MAC-specific GPL core antigen was measured by an enzyme immunoassay. Antibody levels were measured in sera from 14 RA patients with MAC-PD (RA + MAC), 20 RA patients with bronchial or bronchiolar lesions without MAC-PD (RA w/o MAC), 20 RA patients without pulmonary lesions (RA only), and 25 healthy volunteers (HV). RESULTS: The levels of serum anti-GPL antibodies were higher in the RA + MAC group than in the RA w/o MAC, RA-only, and HV groups (2.87 ± 2.83 vs. 0.50 ± 0.45, 0.31 ± 0.24, and 0.38 ± 0.10 U/ml, respectively; p < 0.001). With the cutoff point in receiver-operating characteristic analysis set at 0.7 U/ml, the serologic test differentiated RA + MAC from RA w/o MAC with a sensitivity of 100% and specificity of 90%. CONCLUSIONS: This serologic test for anti-GPL antibody is useful for diagnosing MAC-PD in RA.
Asunto(s)
Artritis Reumatoide/diagnóstico , Enfermedades Pulmonares/diagnóstico , Infección por Mycobacterium avium-intracellulare/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Pruebas SerológicasRESUMEN
BACKGROUND: The purpose of this study was to evaluate the feasibility and compliance of adjuvant chemotherapy of S-1 plus carboplatin for patients with completely resected non-small cell lung cancer (NSCLC) of pathological stage IB-IIIB. METHODS: S-1 was given orally at a dose of 80 mg/m²/day for 2 weeks, followed by a 2-week period of no treatment. Carboplatin was given intravenously on day 8 at an area under the curve of 6. This regimen was repeated for four to six 28-day courses. RESULTS: Seventeen patients were enrolled in this study. Fourteen of them completed at least 4 cycles of chemotherapy. Nine patients had grade 2 and three patients had grade 3 thrombocytopenia, respectively. Severe nonhematologic toxicities were uncommon. Treatment was delayed in a few patients because of prolonged thrombocytopenia. CONCLUSION: We concluded that the regimen was feasible and tolerable for patients with completely resected NSCLC as adjuvant chemotherapy.
Asunto(s)
Antineoplásicos/uso terapéutico , Carboplatino/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Ácido Oxónico/uso terapéutico , Tegafur/uso terapéutico , Anciano , Antineoplásicos/efectos adversos , Área Bajo la Curva , Carboplatino/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Quimioterapia Adyuvante , Combinación de Medicamentos , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Ácido Oxónico/efectos adversos , Curva ROC , Tegafur/efectos adversos , Trombocitopenia/etiología , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: Immunoglobulin G4 (IgG4)-related disease is a multi-organ disorder that can include the lungs. IgG4-related lung disease can present in various forms; the clinical, radiological and pathological features of patients with this disease have been assessed. METHODS: Forty-eight patients suspected of having IgG4-related lung disease, with a high serum concentration of IgG4 and abundant IgG4-positive plasma cell infiltration into the intrathoracic organs, were retrospectively evaluated. Their clinical features, chest imaging findings and pathological findings were examined, with final diagnoses made by an open panel conference. RESULTS: Of the 48 patients, 18 with extrathoracic manifestations were diagnosed as having IgG4-related lung disease. Most of these patients were middle-aged to elderly men. IgG4-related lung disease was characterized by high serum concentrations of IgG and IgG4, normal white blood cell count and serum C-reactive protein concentration and a good response to corticosteroids. Common radiological findings included mediastinal lymphadenopathy and thickening of the perilymphatic interstitium, with or without subpleural and/or peribronchovascular consolidation. Pathological examination showed massive lymphoplasmacytic infiltration with fibrosis in and around the lymphatic routes, with distribution well correlated with radiological manifestations. CONCLUSIONS: The findings suggest that the intrathoracic manifestations of IgG4-related lung disease develop through lymphatic routes of the lungs and show various clinical characteristics. Because some lymphoproliferative disorders show similar findings, the correlation of clinicoradiological and pathological characteristics is crucial for the diagnosis of IgG4-related lung disease.
Asunto(s)
Inmunoglobulina G/inmunología , Enfermedades Pulmonares/inmunología , Pulmón/diagnóstico por imagen , Pulmón/patología , Paraproteinemias/inmunología , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Broncoscopía , Femenino , Humanos , Inmunoglobulina G/sangre , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/metabolismo , Masculino , Persona de Mediana Edad , Paraproteinemias/diagnóstico , Paraproteinemias/metabolismo , Células Plasmáticas/inmunología , Células Plasmáticas/patología , Estudios RetrospectivosRESUMEN
Out of 77 patients who were admitted to our hospital because of pulmonary tuberculosis from January 2007 to October 2009, 3 patients (3.9%) suffered from pulmonary thrombotic embolism (PTE) and/or deep venous thrombosis (DVT). Case 1: An 80-year-old male with elevated D-dimer was diagnosed with PTE on the basis of an enhanced chest CT showing filling defects in the bilateral pulmonary arteries. Case 2: A 39-year-old male presented with prolonged high-grade fever even after administration of anti-tuberculosis drugs and complained of weakness. His D-dimer was high on admission and became still higher; then, edema was found on his left lower limb, and he was diagnosed with DVT on the basis of lower limb ultrasonography showing isoechoic thrombosis from the IVC to the left popliteal vein. An IVC filter was needed to treat his lesion. Case 3: A 69-year-old female with elevated D-dimer and edema on the right lower limb was diagnosed with PTE and DVT on the basis of chest CT findings. Since anti-coagulation therapy could not be continued due to intestinal bleeding, an IVC filter was placed. All 3 cases presented with no dyspnea and two of the three cases showed no hypoxemia. Even in cases of pulmonary tuberculosis without dyspnea, D-dimer seems to be useful for the early diagnosis of thromboembolism.
Asunto(s)
Embolia Pulmonar/etiología , Tuberculosis Pulmonar/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , MasculinoRESUMEN
We encountered a case of primary racemose hemangioma treatment with successful bronchial artery embolism for massive hemoptysis. A 56-year-old woman with massive hemoptysis was transported to our hospital. The source of the massive hemoptysis was observed to be from around a non-pulsatile polyp covered by normal mucosa occluding the truncus intermedius by fiberoptic bronchoscopy. We stopped the bleeding temporarily using differential lung ventilation, and then bronchial artery angiography was performed. The main right bronchial artery was enlarged, and enlarged and convoluted right peripheral bronchial vessels were also observed. We diagnosed the massive bleeding to be due to racemose hemangioma. A successful bronchial artery embolization (BAE) was performed with gelforms and metallic coils for the treatment of racemose hemangioma. There has been no recurrence of hemoptysis for one year after BAE. There have been many reports on massive hemoptysis as in this patient who were treated by lobectomy, nevertheless we would like to state BAE should be considered as a suitable treatments for primary racemose hemangioma with hemoptysis if there is no recognizable shunt artery.