32 research outputs found
Outpatient Management of Malignant Pleural Effusion Using a Tunneled Pleural Catheter: Preliminary Experience
Inpatient management of malignant pleural effusion
includes the placement of a conventional thoracostomy tube
for drainage and talc slurry pleurodesis and/or a surgical
approach consisting of video-assisted thoracoscopic talc
insufflation. Both techniques require prolonged hospital
stays of up to 1 week. Unfortunately, life expectancy in
patients with this disease does not usually exceed 6 months,
and so the primary aim of any palliative intervention
intended to improve quality of life should be to avoid
hospital admissions and to relieve pain as far as possible.
Of the few outpatient alternatives to hospital management
the most frequently used is repeated thoracentesis. We
describe the outpatient management of malignant pleural
effusion by placement of a tunneled pleural catheter in a
patient with stage IIIB lung adenocarcinoma. In our
opinion, the use of this catheter offers a viable alternative to
conventional therapy and is better tolerated
Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients
Leptin is a powerful stimulant of ventilation in rodents. In humans, resistance
to leptin has been consistently associated with obesity. Raised leptin levels
have been reported in subjects with sleep apnoea or obesity-hypoventilation
syndrome. The aim of the present study was to assess, by multivariate analysis,
the possible association between respiratory centre impairment and levels of
serum leptin. In total, 364 obese subjects (body mass index >or=30 kg.m(-2))
underwent the following tests: sleep studies, respiratory function tests,
baseline and hypercapnic response (mouth occlusion pressure (P(0.1)), minute
ventilation), fasting leptin levels, body composition and anthropometric
measures. Subjects with airways obstruction on spirometry were excluded. Out of
the 346 subjects undergoing testing, 245 were included in the current analysis.
Lung volumes, age, log leptin levels, end-tidal carbon dioxide tension,
percentage body fat and minimal nocturnal saturation were predictors for baseline
P(0.1). The hypercapnic response test was performed by 186 subjects; log leptin
levels were predictors for hypercapnic response in males, but not in females.
Hyperleptinaemia is associated with a reduction in respiratory drive and
hypercapnic response, irrespective of the amount of body fat. These data suggest
the extension of leptin resistance to the respiratory centre
Emphysema presence, severity, and distribution has little impact on the clinical presentation of a cohort of patients with mild to moderate COPD
Phenotypic characterization of patients with COPD may have potential
prognostic and therapeutic implications. Available information on the
relationship between emphysema and the clinical presentation in patients with
COPD is limited to advanced stages of the disease. The objective of this study
was to describe emphysema presence, severity, and distribution and its impact on
clinical presentation of patients with mild to moderate COPD. METHODS: One
hundred fifteen patients with COPD underwent clinical and chest CT scan
evaluation for the presence, severity, and distribution of emphysema. Patients
with and without emphysema and with different forms of emphysema distribution
(upper/lower/core/peel) were compared. The impact of emphysema severity and
distribution on clinical presentation was determined. RESULTS: Fifty percent of
the patients had mild homogeneously distributed emphysema (1.84; 0.76%-4.77%).
Upper and core zones had the more severe degree of emphysema. Patients with
emphysema were older, more frequently men, and had lower FEV(1)%, higher total
lung capacity percentage, and lower diffusing capacity of the lung for carbon
monoxide. No differences were found between the clinical or physiologic
parameters of the different emphysema distributions. CONCLUSIONS: In patients
with mild to moderate COPD, although the presence of emphysema has an impact on
physiologic presentation, its severity and distribution seem to have little
impact on clinical presentation
Epicardial adipose tissue in patients with chronic obstructive pulmonary disease
EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular event
Trabecular bone score in active or former smokers with and without COPD
Background Smoking is a recognized risk factor for osteoporosis. Trabecular bone score (TBS) is a novel texture parameter to evaluate bone microarchitecture. TBS and their main determinants are unknown in active and former smokers. Objective To assess TBS in a population of active or former smokers with and without Chronic Obstructive Pulmonary Disease (COPD) and to determine its predictive factors. Methods Active and former smokers from a pulmonary clinic were invited to participate. Clinical features were recorded and bone turnover markers (BTMs) measured. Lung function, low dose chest Computed Tomography scans (LDCT), dual energy absorptiometry (DXA) scans were performed and TBS measured. Logistic regression analysis explored the relationship between measured parameters and TBS. Results One hundred and forty five patients were included in the analysis, 97 (67.8%) with COPD. TBS was lower in COPD patients (median 1.323; IQR: 0.13 vs 1.48; IQR: 0.16, p = 0.003). Regression analysis showed that a higher body mass index (BMI), younger age, less number of exacerbations and a higher forced expiratory volume-one second (FEV1%) was associated with better TBS (ÎČ = 0.005, 95% CI:0.000â0.011, p = 0.032; ÎČ = -0.003, 95% CI:-0.007(-)-0.000, p = 0.008; ÎČ = -0.019, 95% CI:-0.034(-)-0.004, p = 0.015; ÎČ = 0.001, 95% CI:0.000â0.002, p = 0.012 respectively). The same factors with similar results were found in COPD patients. Conclusions A significant proportion of active and former smokers with and without COPD have an affected TBS. BMI, age, number of exacerbations and the degree of airway obstruction predicts TBS values in smokers with and without COPD. This important information should be considered when evaluating smokers at risk of osteoporosis
Early lung cancer detection using spiral computed tomography and positron emission tomography
RATIONALE:
Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised.
OBJECTIVE:
To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET).
METHODS:
High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules.
RESULTS:
A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%.
CONCLUSION:
A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions
Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest.
Identification of risk factors for lung cancer can help in selecting
patients who may benefit the most from smoking cessation interventions, early
detection, or chemoprevention. OBJECTIVE: To evaluate whether the presence of
emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk
factor for lung cancer. METHODS: The study used data from a prospective cohort of
1,166 former and current smokers participating in a lung cancer screening study.
All individuals underwent a baseline LDCT and spirometry followed by yearly
repeat LDCT studies. The incidence density of lung cancer among patients with and
without emphysema on LDCT was estimated. Stratified and multiple regression
analyses were used to assess whether emphysema is an independent risk factor for
lung cancer after adjusting for age, gender, smoking history, and the presence of
airway obstruction on spirometry. RESULTS: On univariate analysis, the incidence
density of lung cancer among individuals with and without emphysema on LDCT was
25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk
ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also
associated with increased risk of lung cancer when the analysis was limited to
individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to
18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51;
95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79
to 5.58) was associated with increased risk of lung cancer after adjusting for
potential cofounders. CONCLUSIONS: Results suggest that the presence of emphysema
on LDCT is an independent risk factor for lung cancer
Obstructive sleep apnea severity is associated with left ventricular mass independent of other cardiovascular risk factors in morbid obesity
OBJECTIVE:
To evaluate the relation between obstructive sleep apnea (OSA) and left ventricular mass (LVM) in morbid obesity and the influence of gender, menopausal status, anthropometry, body composition, hypertension, and other cardiovascular risk factors in this relationship.
DESIGN:
Cross-sectional descriptive study.
METHODS:
Polysomnographic and echocardiographic studies were performed in a cohort of 242 patients (86 men, 100 premenopausal (PreM) and 56 postmenopausal (PostM) women), with grade II obesity and above (BMI: 43.7 ± 0.4 kg/m(2)) to investigate OSA and LVM respectively. Anthropometry, body composition, glucose tolerance, and blood pressure were also recorded.
RESULTS:
OSA to different degrees was diagnosed in 76.2% of the patients (n: 166), its prevalence being 90.9% (n: 70) for men, and 76% (n: 38) and 63.8% (n: 58) for PostM and PreM women, respectively (p < 0.01). LVM excess was greatest for PostM women (90.2%), followed by men (81.9%) and PreM females (69.6%) (p < 0.01). LVM values increased in accordance to OSA severity (absence, 193.7 ± 6.9 g; mild, 192.6 ± 7.8 g; moderate, 240.5 ± 12.5 g; severe, 273.6 ± 14.6 g; p < 0.01). LVM magnitude correlated with the menopausal state, age, central adiposity, hypertension (HT), type 2 diabetes (DM), desaturation index (DI), and apnea-hypopnea index (AHI) (r = 0.41; p < 0.01). The relationship between LVM and AHI persisted in the multivariate analysis (ÎČ = 0.25; p < 0.05) after adjusting for age, gender, menopausal state, BMI, waist circumference, neck circumference, DI, fasting plasma glucose, DM, and HT. But if tobacco habits are included, the statistical difference disappears (ÎČ = 0.22; p = 0.06).
CONCLUSIONS:
Morbid obesity is frequently associated with abnormal LVM, particularly in patients with OSA; this association is independent of HT, BMI, body composition, and other clinical factors, supporting a direct role of OSA on LVM in morbid obesity. This suggests that OSA and LVM might be taken as predictors of the cardiovascular risk in these patients.
KEYWORDS:
Sleep apnea; apnea-hypopnea index; left ventricular mass; morbid obesit
Smokers with CT detected emphysema and no airway obstruction have decreased plasma levels of EGF, IL-15, IL-8 and IL-1ra
Current or former smokers expressing a well-defined disease characteristic such as emphysema, has a specific plasma cytokine profile. This includes a decrease of cytokines mainly implicated in activation of apoptosis or decrease of immunosurveillance. This information should be taken into account when evaluated patients with tobacco respiratory diseases
Comparing algorithms for automated vessel segmentation in computed tomography scans of the lung: the VESSEL12 study
The VESSEL12 (VESsel SEgmentation in the Lung) challenge objectively compares the performance of different algorithms to identify vessels in thoracic computed tomography (CT) scans. Vessel segmentation is fundamental in computer aided processing of data generated by 3D imaging modalities. As manual vessel segmentation is prohibitively time consuming, any real world application requires some form of automation. Several approaches exist for automated vessel segmentation, but judging their relative merits is difficult due to a lack of standardized evaluation. We present an annotated reference dataset containing 20 CT scans and propose nine categories to perform a comprehensive evaluation of vessel segmentation algorithms from both academia and industry. Twenty algorithms participated in the VESSEL12 challenge, held at International Symposium on Biomedical Imaging (ISBI) 2012. All results have been published at the VESSEL12 website http://vessel12.grand-challenge.org. The challenge remains ongoing and open to new participants. Our three contributions are: (1) an annotated reference dataset available online for evaluation of new algorithms; (2) a quantitative scoring system for objective comparison of algorithms; and (3) performance analysis of the strengths and weaknesses of the various vessel segmentation methods in the presence of various lung diseases.Rudyanto, RD.; Kerkstra, S.; Van Rikxoort, EM.; Fetita, C.; Brillet, P.; Lefevre, C.; Xue, W.... (2014). Comparing algorithms for automated vessel segmentation in computed tomography scans of the lung: the VESSEL12 study. Medical Image Analysis. 18(7):1217-1232. doi:10.1016/j.media.2014.07.003S1217123218