Treatment of stage I lung cancer detected by computed tomography screening

INTRODUCTION: Reducing lung cancer deaths through early detection by computed tomography (CT) screening requires delivery of effective treatment. We performed this retrospective study to determine the types of treatment used for screen-detected stage I lung cancer at our academic center and to compare the demographic and clinical characteristics of patients by type of treatment. METHODS: All persons screened in the lung cancer screening program at our institution through June 16, 2021, were included. Those with screening CT findings needing follow-up were managed through a thoracic surgery clinic. Demographic and clinical characteristics of patients diagnosed with having stage I lung cancer through June 16, 2021, were compared by type of treatment, with follow-up through December 31, 2021. RESULTS: Stage I NSCLC was diagnosed in 54 of 2203 persons screened (2.5%), on the basis of biopsy in 37 and on imaging findings in 17 patients in whom a tissue diagnosis could not be obtained. Treatment was by lobectomy in 18, sublobar resection in 14, and stereotactic body radiation therapy (SBRT) in 22. Patients treated with SBRT had lower forced expiratory volume in 1 second ( CONCLUSIONS: Many patients with screen-detected stage I lung cancer are medically unfit for lobectomy, and a variety of treatments are being used. Assessment of treatment-based outcomes will be critical for ensuring an optimal balance of the risks and benefits of CT screening in a medically diverse population

Czynniki ryzyka sercowo-naczyniowego w grupie 100 pacjentów z zatorem tętnic siatkówki — rejestr jednoośrodkowy

Introduction. The aim of the study was to evaluate cardiovascular risk factors in patients after retinal artery occlusion (RAO). Additionally, our findings were compared with the results of epidemiological studies on the prevalence of cardiovascular risk factors in the Polish population. Material and methods. We conducted a retrospective study which involved a group of 100 patients admitted to the ophthalmology service due to RAO in 2004–2014. Results. In our study group, hypertension was found in 78% of patients, hypercholesterolemia in 67% of patients, ischemic heart disease in 53% of patients, previous myocardial infarction in 20% of patients, heart failure in 17% of patients, diabetes type 2 in 16% of patients, atrial fibrillation in 14% of patients, and kidney dysfunction in 11% of patients. Twelve percent of patients had a history of stroke, and 31% were smokers. Doppler ultrasonography (USG) showed carotid atherosclerotic plaques in 78% of patients and ≥ 70% carotid artery stenosis in 33% of patients. Transthoracic echocardiography revealed aortic valve calcifications in 63% of patients. Conclusions. Cardiovascular risk factors are present in a large majority of patients with RAO. Compared to the general population, patients with RAO often suffer from hypertension, hypercholesterolemia, type 2 diabetes and renal dysfunction. Due to an association between RAO and cardiovascular risk factors, appropriate diagnostic work-up is of major importance in these patients. Basic investigations in patients after a RAO event should include carotid artery Doppler ultrasound, echocardiography, electrocardiography, blood pressure measurement, and laboratory tests  Wstęp. Celem pracy była ocena obecności czynników ryzyka sercowo-naczyniowego w grupie pacjentów po epizodzie zamknięcia naczynia tętniczego siatkówki (RAO). Cel dodatkowy stanowiło porównanie wyników badań epidemiologicznych dotyczących rozpowszechnienia czynników ryzyka sercowo-naczyniowego wśród ludności Polski z wynikami przeprowadzonego badania. Materiał i metody. Przeprowadzono badanie retrospektywne, które objęło grupę 100 pacjentów hospitalizowanych na oddziale okulistyki w latach 2004–2014 z powodu RAO. Wyniki. W badanej grupie nadciśnienie tętnicze stwierdzono u 78% pacjentów, hipercholesterolemię u 67% pacjentów, chorobę niedokrwienną serca u 53% pacjentów, zawał serca u 20% pacjentów, niewydolność krążenia u 17% pacjentów, cukrzycę typu 2 u 16% pacjentów, migotanie przedsionków u 14% pacjentów, upośledzoną funkcję nerek u 11% pacjentów. Dwanaście procent pacjentów było po udarze mózgu. Nikotynizm stwierdzono u 31% pacjentów. Blaszkę miażdżycową w wykonanych badaniach ultrasonografii (USG) metodą Dopplera uwidoczniono u 78% pacjentów, zwężenie tętnicy szyjnej równe lub większe 70% dotyczyło 33% pacjentów. W wykonanych badaniach echokardiograficznych stwierdzono obecność zwapnień na płatkach zastawki aortalnej u 63% pacjentów. Wnioski. Znamienna większość pacjentów z rozpoznanym RAO jest obciążona czynnikami ryzyka sercowo-naczyniowego. Pacjenci ci, w porównaniu z populacją ogólną, częściej chorują na nadciśnienie tętnicze, hipercholesterolemię, cukrzycę typu 2, częściej też stwierdza się u nich dysfunkcję nerek. Ze względu na związek między RAO a czynnikami ryzyka sercowo-naczyniowego niezwykle istotna jest odpowiednia diagnostyka. Wśród podstawowych badań u pacjentów po epizodzie RAO powinny się znaleźć badanie USG tętnic szyjnych z oceną doplerowską, badanie echokardiograficzne i elektrokardiograficzne, pomiar ciśnienia tętniczego a także badania laboratoryjne.  

Volumetric Measurements of Lung Nodules with Multi-Detector Row CT: Effect of Changes in Lung Volume

OBJECTIVE: To evaluate how changes in lung volume affect volumetric measurements of lung nodules using a multi-detector row CT. MATERIALS AND METHODS: Ten subjects with asthma or chronic bronchitis who had one or more lung nodules were included. For each subject, two sets of CT images were obtained at inspiration and at expiration. A total of 33 nodules (23 nodules > or =3 mm) were identified and their volume measured using a semiautomatic volume measurement program. Differences between nodule volume on inspiration and expiration were compared using the paired t-test. Percent differences, between on inspiration and expiration, in nodule attenuation, total lung volume, whole lung attenuation, and regional lung attenuation, were computed and compared with percent difference in nodule volume determined by linear correlation analysis. RESULTS: The difference in nodule volume observed between inspiration and expiration was significant (p or =3 mm. The volume of nodules was measured to be larger on expiration CT than on inspiration CT (28 out of 33 nodules; 19 out of 23 nodules > or =3 mm). A statistically significant correlation was found between the percent difference of lung nodule volume and lung volume or regional lung attenuation (p or =3 mm. CONCLUSION: Volumetric measurements of pulmonary nodules were significantly affected by changes in lung volume. The variability in this respiration-related measurement should be considered to determine whether growth has occurred in a lung nodule.Supported by in part NIH NHLBI, RO1 HL 69149 and by a grant from Electronics and Telecommunications Research Institute

3D diffusion-weighted (129) Xe MRI for whole lung morphometry

PURPOSE: To obtain whole lung morphometry measurements from (129) Xe in a single breath-hold with 3D multiple b-value (129) Xe diffusion-weighted MRI (DW-MRI) with an empirically optimized diffusion time and compressed sensing for scan acceleration. METHODS: Prospective three-fold undersampled 3D multiple b-value hyperpolarized (129) Xe DW-MRI datasets were acquired, and the diffusion time (Δ) was iterated so as to provide diffusive length scale (LmD ) estimates from the stretched exponential model (SEM) that are comparable to those from (3) He. The empirically optimized (129) Xe diffusion time was then implemented with a four-fold undersampling scheme and was prospectively benchmarked against (3) He measurements in a cohort of five healthy volunteers, six ex-smokers, and two chronic obstructive pulmonary disease patients using both SEM-derived LmD and cylinder model (CM)-derived mean chord length (Lm). RESULTS: Good agreement between the mean (129) Xe and (3) He LmD (mean difference, 2.2%) and Lm (mean difference, 1.1%) values was obtained in all subjects at an empirically optimized (129) Xe Δ = 8.5 ms. CONCLUSION: Compressed sensing has facilitated single-breath 3D multiple b-value (129) Xe DW-MRI acquisitions, and results at (129) Xe Δ = 8.5 ms indicate that (129) Xe provides a viable alternative to (3) He for whole lung morphometry mapping with either the SEM or CM. Magn Reson Med, 2017. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited

A thoracic surgery clinic dedicated to indeterminate pulmonary nodules: Too many scans and too little pathology?

ObjectiveWidespread application of computed tomographic scans has increased detection of asymptomatic pulmonary nodules. A dedicated clinic was established to encourage referral and manage large numbers of patients with such nodules.MethodsPatients were evaluated periodically by a nurse practitioner with surgeon oversight, and follow-up imaging was centralized. Patients were rescanned at intervals on the basis of radiologist recommendation.ResultsA total of 414 patients, 189 male and 225 female with a median age of 60.2 years (20.7–84.1 years), were evaluated since April 2000. Median follow-up was 1.51 years (0–6.65 years). Thirty-seven percent (153/414) were older than 60 years with at least 10 pack-years of tobacco use, whereas 30% (123/414) had never smoked. A total of 286 patients completed at least 2 years of follow-up computed tomographic evaluation. After 2 years, 24.2% (69/286) were deemed in stable condition and were discharged from further follow-up, whereas 22.4% (64/286) of patients were followed up longer than 2 years owing to the development of new nodules. Forty-five percent (127/286) of patients did not complete their recommended follow-up at our clinic. Overall, 3% (13/414) of our patients have been shown to have a malignant tumor. Only 5 patients underwent curative resection of a primary lung cancer.ConclusionIn a population of patients with indeterminate nodules in routine clinical practice, few patients required intervention and few cancers were detected. Although the benefits of a “nodule” clinic may include patient reassurance and convenience to referring physicians, a significant number of patients did not complete their follow-up in our clinic

Choroby układu sercowo-naczyniowego u pacjenta z zatorem tętnicy siatkówki

Zator tętnicy siatkówki może być pierwszym objawem chorób układu sercowo-naczyniowego. Do najczęstszych przyczyn zatoru tętnicy siatkówki należą miażdżyca tętnic szyjnych i patologie zastawek serca. Zator tętnicy siatkówki może być również pierwszym objawem infekcyjnego zapalenia wsierdzia, śluzaka przedsionka, migotania przedsionków czy olbrzymiokomórkowego zapalenia tętnic. Pacjenci po incydencie zatoru tętnicy siatkówki mają krótszą przewidywaną długość życia, większe ryzyko udaru mózgu czy ostrego zespołu wieńcowego. W pracy opisano przyczyny sercowo-naczyniowe zatoru tętnicy siatkówki, szczególną uwagę poświęcono odpowiedniej diagnostyce, dzięki której możliwa jest identyfikacja chorób układu sercowo-naczyniowego i ich właściwe leczenie, co wiążę się z poprawą rokowania w aspekcie przeżycia w tej grupie chorych

Dynamic magnetic resonance imaging in assessing lung function in adolescent idiopathic scoliosis: a pilot study of comparison before and after posterior spinal fusion

<p>Abstract</p> <p>Background</p> <p>Restrictive impairment is the commonest reported pulmonary deficit in AIS, which improves following surgical operation. However, exact mechanism of how improvement is brought about is unknown. Dynamic fast breath-hold (BH)-MR imaging is a recent advance which provides direct quantitative visual assessment of pulmonary function. By using above technique, change in lung volume, chest wall and diaphragmatic motion in AIS patients before and six months after posterior spinal fusion surgery were measured.</p> <p>Methods</p> <p>16 patients with severe right-sided predominant thoracic scoliosis (standing Cobb's angle 50° -82°, mean 60°) received posterior spinal fusion without thoracoplasty were recruited into this study. BH-MR sequences were used to obtain coronal images of the whole chest during full inspiration and expiration. The following measurements were assessed: (1) inspiratory, expiratory and change in lung volume; (2) change in anteroposterior (AP) and transverse (TS) diameter of the chest wall at two levels: carina and apex (3) change in diaphragmatic heights. The changes in parameters before and after operation were compared using Wilcoxon signed ranks test. Patients were also asked to score their breathing effort before and after operation using a scale of 1–9 with ascending order of effort. The degree of spinal surgical correction at three planes was also assessed by reformatted MR images and correction rate of Cobb's angle was calculated.</p> <p>Results</p> <p>The individual or total inspiratory and expiratory volume showed slight but insignificant increase after operation. There was significantly increase in bilateral TS chest wall movement at carina level and increase in bilateral diaphragmatic movements between inspiration and expiration. The AP chest wall movements, however, did not significantly change.</p> <p>The median breathing effort after operation was lower than that before operation (p < 0.05).</p> <p>There was significant reduction in coronal Cobb's angle after operation but the change in sagittal and axial angle at scoliosis apex was not significant.</p> <p>Conclusion</p> <p>There is improvement of lateral chest wall and diaphragmatic motions in AIS patients six months after posterior spinal fusion, associated with subjective symptomatic improvement. Lung volumes however, do not significantly change after operation. BH-MR is novel non-invasive method for long term post operative assessment of pulmonary function in AIS patients.</p