9 research outputs found
Surgical management of pulmonary inflammatory pseudotumors: A single center experience
<p>Abstract</p> <p>Background</p> <p>The pulmonary inflammatory pseudotumor (PIP) is a rare disease. It is still debated whether it represents an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. PIP is characterized by a cellular polymorphism.</p> <p>Methods</p> <p>We retrospectively analyzed 8 patients with PIP treated by surgery between 2001 and 2009. Preoperative thoracic computed tomography (CT) scan was performed in all cases. All patients underwent preoperative bronchoscopy with washing and brushing and/or transbronchial biopsy and preoperative cytology examination</p> <p>Results</p> <p>There were 5 men and 3 women, aged between 38 and 69 years (mean of 58 years). 3 patients (37%) were asymptomatic. The others had symptoms characterized by chest pain, shortness of breath and persistent cough or hemoptysis. 5 patients had neutrophilic leucocytosis. CT scan demonstrated solitary nodules (maximum diameter <3 cm) in 5 patients (62%) and lung masses (maximum diameter >3 cm) in 3 patients (37%). In 2 patients there were signs of pleural infiltration. Distant lesions were excluded in all cases. A preoperative histology examination failed to reach a definitive diagnosis in all patients. At surgery, we performed two lobectomies, one segmentectomy and five wedge resections, these being performed with videothoracoscopy (VATS), except for one patient where open surgery was used. Complete tumor resection was obtained in all patients. According to the Matsubara classification, there were 2 cases of organizing pneumonia, 5 cases of fibrous histiocytoma and one case of lymphoplasmacytoma. All patients were discharged alive from hospital between 4 and 7 days after surgery. At follow-up CT scan performed annually (range 11 to 112 months) (mean 58 months), there were no residual lesions, neither local nor distant recurrences.</p> <p>Conclusions</p> <p>PIP is a rare disease. Many synonyms have been used for this disease, usually in relation to the most represented cell type. The true incidence is unclear. Preoperative diagnosis is difficult to reach, despite performing a bronchoscopy or a transparietal needle aspiration. Different classifications have been proposed for PIP. Either medical, radiation or surgical therapy has been used for PIP. Whenever possible, surgery should be considered the standard treatment. Complete surgical resection is advocated to prevent recurrence.</p
Congenital hip dysplasia treated by total hip arthroplasty using cementless tapered stem in patients younger than 50 years old: results after 12-years follow-up
Background
Congenital hip dysplasia may lead to severe acetabular and femoral abnormalities that can make total hip arthroplasty a challenging procedure. We assessed a series of patients affected by developmental hip dysplasia treated with total hip arthroplasty using cementless tapered stem and here we report the outcomes at long-term follow-up.
Materials and methods
Twenty-eight patients (24 women and 4 men) aged between 44 and 50 years (mean 47 years) were observed. Clinical evaluation was rated with the Harris Hip Score. Radiographic evaluation consisted in standard anteroposterior and axial view radiographs of the hip. According to Crowe’s classification, 16 hips presented dysplasia grade 1, 14 grade 2, and 4 grade 3. All patients were treated with total hip arthroplasty using a cementless tapered stem (Wagner Cone Prosthesis). Six patients were operated bilaterally, with a totally of 34 hips operated. After surgery, the patients were clinically and radiographically checked at 3, 6, and 12 months and yearly thereafter until an average follow-up of 12 years (range 10–14 years).
Results
Average Harris Hip Score was 56 ± 9 (range 45–69) preoperatively, 90 ± 9 (range 81–100) 12 months after surgery, and 91 ± 8 (range 83–100) at last follow-up. Radiographic evaluation demonstrated excellent osteointegration of the implants. Signs of bone resorption were present in 6 hips, nevertheless no evidence of loosening was observed and none of the implants has been revised.
Conclusions
Even in dysplasic femur, the tapered stem allowed adequate stability and orientation of the implant. We consider tapered stem a suitable option for total hip arthroplasty in developmental hip dysplasia, also in case of young patients, thanks to the favourable long-term results
Supporting the Support Network: The Value of Family Peer Work in Youth Mental Health Care
Comparative Analysis of the Treatment of Chronic Antipsychotic Drugs on Epileptic Susceptibility in Genetically Epilepsy-prone Rats
Prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial fibrillation: implications for risk and therapy.
To the Editor:
Nonvalvular atrial fibrillation (NVAF) is the most common sustained arrhythmia encountered in clinical practice and is associated with a 5-fold increased risk for stroke (1).
Moreover, patients with NVAF often suffer from atherosclerotic complications such as acute myocardial infarction (AMI) (2). Peripheral artery disease (PAD) is an established marker of systemic atherosclerosis but its prevalence in NVAF is still unclear. We reasoned that inclusion of ankle-brachial index (ABI), which is an established tool for diagnosis of PAD (3), in the CHA2DS2-VASc (4) score would better define the prevalence of vascular disease.
To address this issue, the Italian Society of Internal Medicine (SIMI) established an Italian registry documenting ABI in NVAF patients.
The Atrial Fibrillation Registry for the ARAPACIS (Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study) study is an independent research project involving all Regional Councils of SIMI. The first objective of the study was to estimate the prevalence of ABI 640.90 in NVAF patients.
Consecutive patients with NVAF referred to internal medicine wards were eligible for the enrollment. Enrollment started in October 2010 and continued until October 30, 2012. Patients were enrolled if they were 18 years or older and had a diagnosis of NVAF, recording during the qualifying admission/consultation or in the preceding 12 months, and if it was possible to obtain the ABI measurement. Exclusion criteria included the following: acquired or congenital valvular AF, active cancer, disease with life expectancy <3 years, hyperthyroidism and pregnancy.
We initially planned to include 3,000 patients. The Data and Safety Monitoring Board (Online Appendix) decided to perform an interim analysis to assess the prevalence of ABI in the enrolled populations\u2014as a higher than expected prevalence of low ABI was detected\u2014and decided to interrupt the patients' enrollment. The sample size was amended as follows: a sample of 2,027 patients leads to the expected prevalence of 21% with a 95% confidence interval width of 3.5% (StataCorp LP, College Station, Texas).
Among the 2,027 NVAF patients included in the study, hypertension was detected in 83%, diabetes mellitus in 23%, dyslipidemia in 39%, metabolic syndrome in 29%, and smoking in 15%. At least 1 atherosclerotic risk factor was detected in 90% of patients.
The NVAF population was at high risk for stroke, with only 18% having a CHA2DS2-VASc score of 0 to 1, while 82% had a risk 652. Despite this, 16% were untreated with any antithrombotic drug, 19% were treated with antiplatelet drugs (APs), and 61% with oral anticoagulants (OAC); 4% of patients were treated with both APs and OAC.
Among the AF population, 428 patients (21%) had ABI 640.90 compared with 1,381 patients, who had an ABI of 0.91 to 1.39 (69%); 204 patients (10%) had ABI 651.40 (Fig. 1). ABI recorded only in 1 leg was excluded from the analysis (n = 14). ABI 640.90 progressively increased from paroxysmal to permanent NVAF (18%, 21%, 24%; p = 0.0315).
Figure 1.
ABI Distribution of Any Category and CHA2DS2-VASc Score Including ABI 640.90
C = congestive heart failure (or left ventricular systolic dysfunction) (Points: 1), H = hypertension (Points: 1), A2 = Age 6575 years (Points: 2), D = diabetes mellitus (Points: 1), S2 = prior stroke or transient ischemic attack or thromboembolism (Points: 2); V = vascular disease (previous acute myocardial infarction, peripheral arterial disease, or aortic plaque) (Points: 1); A = age 65 to 74 years (Points: 1); Sc = sex category (female) (Points: 1). ABI = ankle brachial index.
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NVAF patients with ABI 640.90 were more likely to be hypertensive (88% vs. 82%; p = 0.032), diabetic (34% vs. 20%; p 0.90 (93% vs. 82%; p < 0.0001).
Logistic regression analysis demonstrated that ABI 640.90 was significantly associated with a smoking habit (odds ratio [OR]: 1.99; 95% confidence interval [CI]: 1.48 to 2.66; p < 0.0001), diabetes (OR: 1.93; 95% CI: 1.51 to 2.46; p < 0.0001), age class 65 to 74 years (OR: 2.05; 95% CI: 1.40 to 3.07; p < 0.0001), age class 6575 years (OR: 3.12; 95% CI: 2.16 to 4.61; p < 0.0001), and history of previous transient ischemic attack/stroke (OR: 1.64; 95% CI: 1.20 to 2.24; p = 0.002).
Vascular disease, as assessed by the history elements of CHA2DS2VASc score, was recorded in 17.3% of patients; inclusion of ABI 640.90 in the definition of vascular disease yielded a total prevalence of 33%. A higher prevalence of vascular disease was detected if ABI 640.90 was included in the CHA2DS2VASc score (Fig. 1). CHA2DS2VASc including ABI 640.90 was more associated with previous stroke (43%; OR: 1.85; 95% CI: 1.41 to 2.44; p < 0.0001) compared to CHA2DS2VASc with ABI 0.91 to 1.39 (23%; OR: 1.52; 95% CI: 1.10 to 2.11; p = 0.0117).
To the best of our knowledge, there is no large-scale study that specifically examined the prevalence of ABI 640.90 in NVAF. In our population, 21% had ABI 640.90 indicating that NVAF is often associated with systemic atherosclerosis.
The CHADS2 has been recently refined with the CHA2DS2-VASc score, which includes vascular disease as documented by a history of AMI, symptomatic PAD, or detection of atherosclerotic plaque in the aortic arch (4).
Comparison of vascular prevalence as assessed by CHA2DS2-VASc score and/or ABI 640.90 is of interest to define the potentially positive impact of measuring ABI in the management of NVAF patients. Inclusion of ABI 640.90 in the definition of vascular disease greatly increased the prevalence of vascular disease, which increased from 17.3% (based on history alone) to 33% (based on ABI) in the entire population. If ABI 640.90 was encompassed in the definition of vascular disease of CHA2DS2-VASc score the prevalence of vascular disease increased in every risk class.
Inclusion of ABI 640.90 in the CHA2DS2-VASc score allowed us to better define the risk profile of NVAF patients with an up-grading of the risk score in each CHA2DS2-VASc score category. This may have important therapeutic implications if the new score could be tested prospectively, as a higher number of NVAF patients would potentially be candidates for an anticoagulant treatment by measuring ABI. A prospective study is, therefore, necessary to validate the risk score of this new definition of vascular disease.
In conclusion, this study provides the first evidence that one-fifth of NVAF patients had an ABI 640.90, indicating that it may represent a simple and cheap method to better define the prevalence of vascular disease in NVAF
Prevalence of peripheral artery disease by abnormal ankle-brachial index in atrial fibrillation: Implications for risk and therapy
To the Editor: Nonvalvular atrial fibrillation (NVAF) is the most
common sustained arrhythmia encountered in clinical practice and
is associated with a 5-fold increased risk for stroke (1).
Moreover, patients with NVAF often suffer from atherosclerotic
complications such as acute myocardial infarction (AMI) (2).
Peripheral artery disease (PAD) is an established marker of systemic
atherosclerosis but its prevalence in NVAF is still unclear. We
reasoned that inclusion of ankle-brachial index (ABI), which is an
established tool for diagnosis of PAD (3), in the CHA2DS2-VASc
(4) score would better define the prevalence of vascular disease.
Toaddress this issue, the ItalianSociety of InternalMedicine (SIMI)
established an Italian registry documenting ABI inNVAF patients.
The Atrial Fibrillation Registry for the ARAPACIS (Ankle-
brachial Index Prevalence Assessment: Collaborative Italian Study)
study is an independent research project involving all Regional
Councils of SIMI. The first objective of the study was to estimate
the prevalence of ABI 0.90 in NVAF patients.
Consecutive patients with NVAF referred to internal medicine
wards were eligible for the enrollment. Enrollment started in
October 2010 and continued until October 30, 2012. Patients were
enrolled if they were 18 years or older and had a diagnosis of
NVAF, recording during the qualifying admission/consultation or
in the preceding 12 months, and if it was possible to obtain the
ABI measurement. Exclusion criteria included the following:
acquired or congenital valvular AF, active cancer, disease with life
expectancy <3 years, hyperthyroidism and pregnancy.
We initially planned to include 3,000 patients. The Data and
Safety Monitoring Board (Online Appendix) decided to perform an
interim analysis to assess the prevalence of ABI in the enrolled
populationsdas a higher than expected prevalence of low ABI was
detecteddand decided to interrupt the patients’ enrollment. The
sample size was amended as follows: a sample of 2,027 patients leads
to the expected prevalence of 21% with a 95% confidence interval
width of 3.5% (StataCorp LP, College Station, Texas).
Among the 2,027 NVAF patients included in the study, hyper-
tension was detected in 83%, diabetes mellitus in 23%, dyslipidemia
in 39%, metabolic syndrome in 29%, and smoking in 15%. At least 1
atherosclerotic risk factor was detected in 90% of patients.
The NVAF population was at high risk for stroke, with only
18% having a CHA2DS2-VASc score of 0 to 1, while 82% had
a risk 2. Despite this, 16% were untreated with any antith-
rombotic drug, 19% were treated with antiplatelet drugs (APs), and
61% with oral anticoagulants (OAC); 4% of patients were treated
with both APs and OAC.
Among the AF population, 428 patients (21%) had ABI 0.90
(69%); 204 patients (10%) had ABI 1.40 (Fig. 1). ABI recorded
only in 1 leg was excluded from the analysis (n ¼ 14). ABI 0.90
progressively increased from paroxysmal to permanent NVAF (18%,
tensive (88% vs. 82%; p ¼ 0.032), diabetic (34% vs. 20%; p <
0.0001), or smokers (20% vs. 14%; p ¼ 0.0008), or to have experi-
enced transient ischemic attack or stroke (17% vs. 10%; p < 0.001).
21%, 24%; p ¼ 0.0315).
NVAF patients with ABI 0.90 were more likely to be hyper-
NVAF patients with ABI 0.90 had a higher percentage of
CHA2DS2-VASc score 2 compared with those with ABI >0.90
(93% vs. 82%; p < 0.0001).
significantly associated with a smoking habit (odds ratio [OR]:
1.99; 95% confidence interval [CI]: 1.48 to 2.66; p < 0.0001),
diabetes (OR: 1.93; 95% CI: 1.51 to 2.46; p < 0.0001), age class 65
to 74 years (OR: 2.05; 95% CI: 1.40 to 3.07; p < 0.0001), age
Logistic regression analysis demonstrated that ABI 0.90 was
class 75 years (OR: 3.12; 95% CI: 2.16 to 4.61; p < 0.0001),
and history of previous transient ischemic attack/stroke (OR: 1.64;
95% CI: 1.20 to 2.24; p ¼ 0.002).
Vascular disease, as assessed by the history elements of
CHA2DS2VASc score, was recorded in 17.3% of patients; inclu-
sion of ABI 0.90 in the definition of vascular disease yielded
a total prevalence of 33%. A higher prevalence of vascular disease
was detected if ABI 0.90 was included in the CHA2DS2VASc
score (Fig. 1). CHA2DS2VASc including ABI 0.90 was more
associated with previous stroke (43%; OR: 1.85; 95% CI: 1.41 to
2.44; p < 0.0001) compared to CHA2DS2VASc with ABI 0.91 to
1.39 (23%; OR: 1.52; 95% CI: 1.10 to 2.11; p ¼ 0.0117).
To the best of our knowledge, there is no large-scale study that
specifically examined the prevalence of ABI 0.90 in NVAF. In
our population, 21% had ABI 0.90 indicating that NVAF is
often associated with systemic atherosclerosis.
The CHADS2 has been recently refined with the CHA2DS2-
VASc score, which includes vascular disease as documented by
a history of AMI, symptomatic PAD, or detection of atheroscle-
rotic plaque in the aortic arch (4).
Comparison of vascular prevalence as assessed by CHA2DS2-
NVAF patients. Inclusion of ABI 0.90 in the definition of
vascular disease greatly increased the prevalence of vascular disease,
which increased from 17.3% (based on history alone) to 33% (based
compared with 1,381 patients, who had an ABI of 0.91 to 1.39
to better define the risk profile ofNVAFpatients with an up-grading
of the risk score in each CHA2DS2-VASc score category. This may
have important therapeutic implications if the new score could be
tested prospectively, as a higher number of NVAF patients would
on ABI) in the entire population. If ABI 0.90 was encompassed
in the definition of vascular disease of CHA2DS2-VASc score the
prevalence of vascular disease increased in every risk class.
Inclusion of ABI0.90 in theCHA2DS2-VASc score allowed us
VASc score and/or ABI 0.90 is of interest to define the poten-
tially positive impact of measuring ABI in the management of potentially be candidates for an anticoagulant treatment by
measuring ABI. A prospective study is, therefore, necessary to
validate the risk score of this new definition of vascular disease.
In conclusion, this study provides the first evidence that one-fifth
of NVAF patients had an ABI 0.90, indicating that it may
represent a simple and cheap method to better define the prevalence
of vascular disease in NVAF