RESUMEN
BACKGROUND: Thoracocentesis of pleural effusion is a simple technique for pleural fluid examination through cytology. In addition to cytological examination to assess the nature of pleural fluid content, we can also perform more detailed examinations through cytoblocks of residual fluid. These paraffin-embedded cytoblock samples are important because we can perform examinations as in other bioptic samples. In these samples, immunohistochemical and molecular analyses can be performed. METHODS: Two hundred fifty-five cytological samples from patients with pleural effusion were examined. In cases in which the presence of malignant cells was identified in the cytological examination, as well as cases that were suspicious but not definitive for the presence of a malignant effusion, a cytoblock was prepared. Histological examination and immunohistochemical analysis were performed. RESULTS: Among 255 cases with pleural effusion, 152 had the presence of malignant cells and 6 cases were suspicious, but uncertain for the presence of malignant cells, while 86 cases had inflammatory pleural effusion or other pathologies but were not malignant. After histological analysis of the cytoblock and immunohistochemical analysis, we identified 82 malignant tumors of the lung, 8 malignant tumors of the gastrointestinal tract, 15 malignant tumors of the breast, and 6 malignant tumors of the female genital tract, as well as 24 tumors of undetermined origin. CONCLUSIONS: Cytoblocks are important for the diagnosis of the primary nature of malignant pleural effusions. The highest importance is primary lung tumors, as well as those tumors in which the primary site of the tumor cannot be determined clinically.
Asunto(s)
Neoplasias Pulmonares , Derrame Pleural Maligno , Derrame Pleural , Humanos , Femenino , Derrame Pleural/diagnóstico , Derrame Pleural/patología , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Exudados y Transudados , Citodiagnóstico/métodosRESUMEN
BACKGROUND: The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional capacity assessed by 6 min walk test (6-MWT) in patients with heart failure (HF), irrespective of ejection fraction (EF). METHODS: In 147 HF patients (mean age 61 ± 11 years, 50.3% male), a 6-MWT and an echo-Doppler study were performed in the same day. Global LV dyssynchrony was indirectly assessed by total isovolumic time - t-IVT [in s/min; calculated as: 60 - (total ejection time + total filling time)], and Tei index (t-IVT/ejection time). Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m), and also in two groups according to EF (Group A: LVEF ≥ 45% and Group B: LVEF < 45%). RESULTS: In the cohort of patients as a whole, the 6-MWT correlated with t-IVT (r = -0.49, p < 0.001) and Tei index (r = -0.43, p < 0.001) but not with any of the other clinical or echocardiographic parameters. Group I had lower hemoglobin level (p = 0.02), lower EF (p = 0.003), larger left atrium (p = 0.02), thicker interventricular septum (p = 0.02), lower A wave (p = 0.01) and lateral wall late diastolic myocardial velocity a' (p = 0.047), longer isovolumic relaxation time (r = 0.003) and longer t-IVT (p = 0.03), compared with Group II. In the patients cohort as a whole, only t-IVT ratio [1.257 (1.071-1.476), p = 0.005], LV EF [0.947 (0.903-0.993), p = 0.02], and E/A ratio [0.553 (0.315-0.972), p = 0.04] independently predicted poor 6-MWT performance (<300 m) in multivariate analysis. None of the echocardiographic measurements predicted exercise tolerance in HFpEF. CONCLUSION: In patients with HF, the limited exercise capacity, assessed by 6-MWT, is related mostly to severity of global LV dyssynchrony, more than EF or raised filling pressures. The lack of exercise predictors in HFpEF reflects its multifactorial pathophysiology.
Asunto(s)
Tolerancia al Ejercicio , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Índice de Severidad de la Enfermedad , Volumen Sistólico , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/epidemiología , Estudios de Cohortes , Comorbilidad , Ecocardiografía/estadística & datos numéricos , Prueba de Esfuerzo/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/fisiopatología , Humanos , Incidencia , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Disfunción Ventricular Izquierda/fisiopatología , Yugoslavia/epidemiologíaRESUMEN
PURPOSE: The current study examined the prevalence and correlates of somatic distress (SD) in the aftermath of war, and the role of a process hypothesized to contribute to posttraumatic stress: experiential avoidance. METHODS: Civilian war survivors (n = 163) from Kosovo were assessed in structured interviews, reporting on average more than ten types of traumatic war exposure. RESULTS: One in eight (12.9%) of the participants meet criteria for SD, which was associated with greater psychological distress, experiential avoidance, and lower quality of life after accounting for the effects of war-related variables, demographic variables, as well as posttraumatic stress disorder and major depressive episode. Experiential avoidance partially mediated the association between SD and psychological distress and quality of life. CONCLUSIONS: The results indicate that SD is prevalent among war-exposed civilians and that experiential avoidance may be a significant factor in understanding and treating traumatized people who are experiencing SD.