Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy

Our objective was to evaluate the efficacy of a standardised work-up in the diagnosis of pleural tuberculosis (TB) that included fibreoptic bronchoscopy and medical thoracoscopy. A consecutive series of 52 pleural TB patients observed during the period 2001-2015 was evaluated retrospectively. 20 females, mean (range) age 39.7 (18-74) years, and 32 males, mean (range) age 45.75 (21-83) years, were included (28 non-EU citizens (53.8%)). The diagnosis of TB infections was established by identification (using stains, culture or molecular tests) of Mycobacterium tuberculosis in the pleura, sputum and/or bronchial specimens, or by evidence of caseous granulomas on pleural biopsies. Patients with and without lung lesions were considered separately. The diagnostic yield of the microbiological tests on pleural fluid was 17.3% (nine out of 52 patients). Among the 18 patients with lung lesions, bronchial samples (washing, lavage or biopsy) were positive in 50% of cases (nine patients). Cultures of pleural biopsies were positive in 63% of cases (29 out of 46 patients); pleural histology was relevant in all patients. Without pleural biopsy, a diagnosis would have been reached in 15 out of 52 patients (28.6%) and in four of them only following culture at 30-40 days. An integrated diagnostic work-up that includes all the diagnostic methods of interventional pulmonology is required for a diagnosis of pleural TB. In the majority of patients, a diagnosis can be reached only with pleural biopsy

Neoplasie del polmone in Neoplasie del Distretto Toracico

none13noIl volume vuole essere funzionale alla pratica quotidiana con particolare riguardo a: identificazione del paziente al quale somministrare, con elevate possibilità di successo, un determinato trattamento farmacologico realmente mirato ("medicina personalizzata" o, meglio ancora, "medicina di precisione"); stimolo a un effettivo approccio multidisciplinare al malato neoplastico, con una ottimale integrazione tra oncologo medico, chirurgo d'organo o di apparato, radioterapista e altri professionisti coinvolti nella diagnosi e cura dei tumori, il tutto nell'ambito dell'applicazione rigorosa dei percorsi diagnostici terapeutici assistenziali (PDTA); realizzazione di una costante continuità di cura che veda anche la collaborazione puntuale con gli esperti di cure palliative, non solo nelle terapie di fine vita ma anche nella sempre più irrinunciabile simultaneous care; presa in carico a tutto tondo del paziente oncologico, con attenzione agli aspetti non solo clinici ma anche psicologici e sociali; razionale impiego delle limitate risorse disponibili, nel segno dell'appropriatezza e della sostenibilità e nel rispetto delle linee guida nazionali, regionali e internazionali.noneAndrea Ardizzoni; Marcello Tiseo; Maria Michiara; Enrico Maria Silini; Luca Ampollini; Paolo Carbognani; Michele Rusca; Maria Majori; Angelo Gianni Casalini; Nicola Sverzellati; Livia Ruffini; Cristina Dell’Anna; Pier Luigi LosardoAndrea Ardizzoni; Marcello Tiseo; Maria Michiara; Enrico Maria Silini; Luca Ampollini; Paolo Carbognani; Michele Rusca; Maria Majori; Angelo Gianni Casalini; Nicola Sverzellati; Livia Ruffini; Cristina Dell’Anna; Pier Luigi Losard

Prosafe: a european endeavor to improve quality of critical care medicine in seven countries

BACKGROUND: long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present ProsaFe, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. the project involved 343 icUs in seven countries. all patients admitted to the icU were eligible for data collection. MetHoDs: the ProsaFe network collected data using the same electronic case report form translated into the corresponding languages. a complex, multidimensional validation system was implemented to ensure maximum data quality. individual and aggregate reports by country, region, and icU type were prepared annually. a web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. conversely, icU equipment differed, and patient outcomes showed wide variations among countries. coNclUsioNs: ProsaFe is a permanent, stable, open access, multilingual database for clinical benchmarking, icU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor