Julio Chertcoff

Radiological versus histopathological diagnosis of usual interstitial pneumonia in the clinical practice: does it have any survival difference?

Background: Recent studies have shown that quantification of specific histopathologic features found in usual interstitial pneumonia (UIP) are useful in defining a prognosis, suggesting the need of biopsy in all patients. Objectives: This study examines whether UIP-associated mortality is different in patients diagnosed by high-resolution computed tomography (HRCT) features considered definite of UIP and in patients with no definite radiological diagnosis that required histological confirmation of diagnoses. Methods: Forty-five patients were included (30 males, mean age 65.3 ± 10.7 years). Two groups of patients were identified: those with HRCT findings of definite UIP (n = 26) and those whose radiological diagnosis was not definite and required a surgical biopsy to confirm the presence of UIP (n = 19). Forced vital capacity, forced expiratory volume in 1 s and diffusing capacity for carbon monoxide were measured in all patients. All data were obtained from medical records, and the survival status was obtained by telephone or personal interview. All clinical parameters and HRCTs were obtained within 1 month before surgical lung biopsy. Results: Median survival was not different across groups and was similar to that previously reported (35 months). Kaplan-Meier analysis did not show any difference in 5-year survival between both groups. Conclusions: In a clinical context in which the diagnosis of UIP can be obtained as a dynamic process that includes an integrated clinical, radiological and pathologic approach, a reliable diagnosis of UIP can be obtained based on a typical definite HRCT with no risk of including patients with a more benign disease and a more prolonged survival.

Analysis of Survival in 400 Surgically Resected Non-small Cell Lung Carcinomas: Towards a Redefinition of the T Factor

Introduction: The tumor, node, metastasis (TNM) system has been recognized internationally as the standard for staging disease extension, but despite the improvements of the 1997/2002 international staging system, there may be marked differences in postoperative 5-year survival rates within each stage. There is controversy about the impact of tumor size itself as a variable unrelated to stage. The objective of this study was to analyze the influence of tumor size on the survival in patients with surgically resected non-small cell lung carcinoma (NSCLC). Methods: Between August 1985 and January 2006, 400 patients underwent pulmonary resection with a curative intention for non-small cell lung carcinoma. Patients were excluded if they had received neoadjuvant chemotherapy. The clinicopathological records of each patient were examined for prognostic factors such as age, sex, right or left side cancer, histology, tumor location, tumor size, clinical nodal stage number, and distribution of metastatic nodes. Results: Operative mortality was 2.2% for lobectomy and 18% for pneumonectomy (p < 0.05). Adenocarcinoma was the most common type (n = 245, 61.2%). Surgery was considered a complete resection in 341 patients (85.2%). When only patients without neoplastic hilar or mediastinal metastases (pN0) were included, the difference in survival was significantly different in terms of tumor size (log rank 28.46, p < 0.0001). Univariate analysis for the group of pN0 patients showed survival was not significantly affected by age, sex, side, or adenocarcinoma histology. In the multivariate analysis, tumor size and the T factor were found to have maintained its independent prognostic effects on overall survival. Among patients with pN0 tumors smaller that 15 mm in diameter, 5-year survival was 95% whereas patients with tumors bigger than 16 mm in diameter had a 5-year survival of 65% (p < 0.0001). Conclusion: In conclusion, our data suggest that tumors over 15 mm are associated with shorter 5-year survival in all TNM stages. Current TNM categories are not sufficiently discriminatory and the T factor requires to be reevaluated in further revisions of the TNM classification.

Neumonía intersticial inducida por bloqueo androgénico máximo como tratamiento de cáncer de próstata avanzado: Report of one case

Maximum androgen blockade is the standard endocrine treatment for advanced prostate cancer. Interstitial lung disease in different degrees of severity, with low mortality and excellent response to treatment may appear with its use. We report a 77 years old patient with advanced prostate cancer who developed severe and progressive respiratory failure associated to bilateral pulmonary infiltrates, attributed to the direct effect of maximum androgen blockade. Despite the therapeutic efforts, the patient died. Lung pathology revealed Usual Interstitial Pneumonia.

Hepatopulmonary Syndrome and Portopulmonary Hypertension in the Same Patient

Abstract Introduction. Sensitizer-induced occupational asthma (OA) has significant health and socioeconomic outcomes in affected subjects. Objective. To evaluate clinical and functional outcomes of sensitizer-induced OA in bakers and cotton workers three to five years after cessation of exposure to the offending workplace agent.Background: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of supraphysiologic ovarian stimulation but infrequently has been described in spontaneous pregnancy.Introduction: Sympathetic nervous system activity is increased in patients with systemic hypertension. Angiotensin converting enzyme inhibitors can effectively control hypertension without a reflex sympathetic stimulation. However, limited data are available about the role of sympathetic dysfunction in the pathophysiology of diastolic dysfunction among patients with controlled hypertension receiving angiotensin converting enzyme inhibitors.

Hantavirus Cardiopulmonary Syndrome

Hantavirus cardiopulmonary syndrome is a potentially fatal illness initially described in the Southwestern United States in 1993. Since then, 249 cases have been identified in the United States and the infection has been found in almost all other countries on the American continent. Mortality is extremely high (30%–60%) if the diagnosis is not made at an early stage, and it should be distinguished from other causes, viral or otherwise, of severe community-acquired pneumonia. Transmission of the disease occurs via inhalation of the virus from material contaminated with the urine or feces of rodents or from rodent bites, and there have also been isolated reports of person-to-person transmission. The disease typically presents with three stages: prodromic, cardiopulmonary, and convalescence. Treatment is supportive, with close monitoring of the administration of fluids, electrolytes, and inotropic drugs and adequate ventilator support, invasive or otherwise, as required. Ribavirin has been approved for treatment and the use of oxygenation with an extracorporeal membrane may be effective.