Risk factors for exacerbations and pneumonia in patients with chronic obstructive pulmonary disease: a pooled analysis.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear. METHODS: This post-hoc, pooled analysis included studies of COPD patients treated with inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combinations and comparator arms of ICS, LABA, and/or placebo. Backward elimination via Cox's proportional hazards regression modelling evaluated which combination of risk factors best predicts time to first (a) pneumonia, and (b) moderate/severe COPD exacerbation. RESULTS: Five studies contributed: NCT01009463, NCT01017952, NCT00144911, NCT00115492, and NCT00268216. Low body mass index (BMI), exacerbation history, worsening lung function (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage), and ICS treatment were identified as factors increasing pneumonia risk. BMI was the only pneumonia risk factor influenced by ICS treatment, with ICS further increasing risk for those with BMI <25 kg/m2. The modelled probability of pneumonia varied between 3 and 12% during the first year. Higher exacerbation risk was associated with a history of exacerbations, poorer lung function (GOLD stage), female sex and absence of ICS treatment. The influence of the other exacerbation risk factors was not modified by ICS treatment. Modelled probabilities of an exacerbation varied between 31 and 82% during the first year. CONCLUSIONS: The probability of an exacerbation was considerably higher than for pneumonia. ICS reduced exacerbations but did not influence the effect of risks associated with prior exacerbation history, GOLD stage, or female sex. The only identified risk factor for ICS-induced pneumonia was BMI <25 kg/m2. Analyses of this type may help the development of COPD risk equations

Computed tomography and magnetic resonance imaging of desmoplastic fibroma with simultaneous manifestation in two unusual locations: a case report

<p>Abstract</p> <p>Introduction</p> <p>Desmoplastic fibroma is an extremely rare primary benign bone tumor. It occurs most often in the mandible, followed by the femur and pelvis. To the best of our knowledge, fewer than 200 cases have been described in the published literature. Furthermore, this case is the first report of desmoplastic fibroma with simultaneous presentation in two different locations.</p> <p>Case presentation</p> <p>We present an unusual case of desmoplastic fibroma in a 56-year-old Caucasian man, who presented to our hospital with lumbar pain. Computed tomography and magnetic resonance imaging were performed, demonstrating two lytic expansile lesions affecting both his left iliac bone and his left sacral wing. Curettage and cortical-cancellous grafting was performed, followed by postoperative computed tomography and magnetic resonance imaging.</p> <p>Conclusion</p> <p>Desmoplastic fibroma with unusual and simultaneous manifestations in two different locations has never been reported previously to the best of our knowledge. The purpose of this case report is to present the computed tomography and magnetic resonance imaging features of this rare tumor before and after the surgical treatment. Furthermore, the radiological findings with the description of the characteristics and the clinical presentation of this rare tumor, contribute to the wide spectrum of manifestations of this tumor, in order to recognize it and to have the appropriate management.</p