Pagrindinis baigiamojo darbo tikslas buvo nustatyti kaip dažnai katės serga pleuritu, kokie yra pagrindiniai klinikiniai simptomai, nustatyti ir įvertinti rizikos veiksnius , išanalizuoti, kurie diagnostikos ir gydymo metodai yra efektyviausi. Norint pasiekti šį tikslą buvo suformuluoti darbo uždaviniai ir pasirinkta tyrimo atlikimo vieta. Tyrimas buvo atliekamas smulkių gyvūnų veterinarijos klinikoje " X" Kauno mieste nuo 2011 metų sausio 1 dienos iki 2013 metų sausio 1 dienos. Per šį laikotarpį kiekviena katė serganti kvėpavimo takų ligomis buvo registruojama klinikos duomenų bazėje. Kiekvienai katei buvo atliktas klinikinis tyrimas ir jei buvo įtariamas pleuritas, buvo atlikti kiti tyrimo metodai kaip rentgeninis ar ultragarsinis tyrimas. Torakocentezė buvo atliekama diagnostiniu ir gydomuoju pagrindu prieš ar po rentgeninio tyrimo. Torakocentezės metu buvo paimti mėginiai citologiniam ir bakteriologiniam tyrimams. Pagrindiniai taikyti gydymo metodai pleurito metu buvo pleuros ertmės drenažas ir antimikrobinė terapija. Atlikus tyrimą nustatyta,kad kvėpavimo takų ligomis sirgo 130 katės. Pleuritas buvo diagnozuota 19 proc. pacientų. Pastebėta, kad katės tarp 1 ir 5 metų amžiaus sirgo pleuritu dažniau(50 proc.). Dažniau sirgo mišrios veislės katės (67 proc.). Nustatyta, kad patelės dažniau sirgo nei patinai (67 proc). Sergant pleuritu pacientams dažniausiai pasireiškė anoreksija (100 proc.), dyspnėja (66,7 proc.) ir letargija (50 proc.). Atlikus kraujo morfologinius... [toliau žr. visą tekstą] / The main goal of this thesis was to determine how often cats suffer from pleural effusion and what are the main clinical symptoms, determine and evaluate the risk factors, analyze which diagnostic and treatment methods are most effective. To achieve this goal was formulated work tasks and choose the location and period of research. Research was carried out in a small animal veterinary clinic “X” in Kaunas from 1st January 2011 to 1st January 2013. Every cat who had the respiratory system disease was brought to the clinic during this period was registred in the clinic database. The clinical exam was carried out to all cats and if pleural effusion was suspected, further diagnostic methods as x-ray or ultrasound was performed. Thoracocentesis was performed as a diagnostic and therapeutic technique, before or after radiographic confirmation of pleural effusion. To confirm inflammatory conditions of pleura were taken samples of liquid for cytology and bacteriology analysis. The mainstay of pyothorax management was thoracic drainage and appropriate antibiotic therapy. During research period, respiratory system disease was diagnosed to 130 cats. Pleuritis was diagnosed to 19 % of patient. The largest number of pleuritis was observed in cats that were between the age of 1 to 5 years (50%). 67 % of the cats diagnosed with pleuritis were mixed bread. Females more frequently than males suffer from pleural effusion (67%). The most expressed clinical symptoms for patients with pleuritis... [to full text]

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı, 2006. / Bibliyografya var.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Os métodos convencionais para o diagnóstico da tuberculose (TB) pleural possuem várias limitações, assim métodos mais sensíveis e específicos são necessários. O objetivo deste estudo foi avaliar uma metodologia de hibridização em microplaca e uma técnica de reação em cadeia da polimerase (PCR) em tempo real para a detecção de DNA de Mycobacterium tuberculosis em amostras de líquido pleural, fragmento de pleura e soro. Adicionalmente, foi avaliada a utilidade da PCR em tempo real em paralelo com a cultura do líquido pleural para o diagnóstico de TB pleural. Foram avaliados 161 pacientes com derrame pleural e submetidos à toracocentese e biópsia pleural. O padrão-ouro para definição de um caso de TB pleural baseou-se na combinação de baciloscopia, cultura, exame histopatológico e critérios clínicos. Cento e sete dos 161 pacientes com derrame pleural receberam diagnóstico de TB pleural. Os resultados da metodologia de hibridização em microplaca não foram satisfatórios, assim foi desenvolvida uma técnica de PCR em tempo real. Nas amostras de líquido pleural, a PCR em tempo real mostrou uma sensibilidade de 46% (IC 95%, 36%-56%) com especificidade de 100%, enquanto a cultura obteve uma sensibilidade de 29% (IC 95%, 20%- 38%). A PCR em tempo real realizada em associação com a cultura no líquido pleural apresentou uma sensibilidade de 60% (IC 95%, 50%-70%). Para as amostras de fragmento pleural, a PCR em tempo real mostrou uma sensibilidade de 42% (IC 95%, 26%-59%) e especificidade de 100%, para este tipo de amostra o exame histopatológico apresentou a maior sensibilidade (90% - IC 95%, 84%- 96%). Nas amostras de soro a PCR em tempo real foi positiva em apenas dois pacientes, os quais também apresentaram resultado positivo nos outros tipos de amostras. Estes resultados indicam que a PCR em tempo real realizada no líquido pleural pode ser uma forma útil para obter um diagnóstico de TB pleural mais rápido, específico e com um procedimento menos invasivo para coleta das amostras. / Conventional tests for pleural tuberculosis (TB) have several limitations and more sensitive and specific methods are needed. The aim of this study was to evaluate microwell hybridization and real-time PCR (polimerase chain reaction) for detection of Mycobacterium tuberculosis DNA in pleural fluid, pleural tissue and serum. Additionally, the utility of real-time PCR in parallel with culture in pleural fluid for the diagnosis of pleural TB was assessed. One hundred sixty one patients with a pleural effusion submitted to a thoracentesis and pleural biopsy were evaluated. The gold-standard for case definition of pleural TB were the combination of acid-fast bacilli, culture, histopathologic examination and clinical parameters. One hundred seven of the 161 patients with pleural effusion received diagnosis of pleural TB. Results of microwell hybridization were not satisfactory, thus we developed a real-time PCR assay. In pleural fluid specimens, real-time PCR showed a sensitivity of 46% (CI 95%, 36%-56%) with specificity of 100%, while the sensitivity of culture was 29% (CI 95%, 20%-38%). The combination of real time PCR and culture in pleural fluid showed a sensitivity of 60% (CI 95%, 50%-70%). For the pleural tissue, real-time PCR showed a sensitivity of 42% (CI 95%, 26%-59%) with specificity of 100%, for this specimen histopathologic examination had the highest sensitivity (90% - CI 95%, 84%-96%). In the serum real-time PCR was positive in only two patients, which also had positive results in other specimens. Our results indicate that the real-time PCR is a useful approach to achieve a more rapid and specific diagnosis for pleural TB with a less invasive procedure for specimen collection.

Os métodos convencionais para o diagnóstico da tuberculose (TB) pleural possuem várias limitações, assim métodos mais sensíveis e específicos são necessários. O objetivo deste estudo foi avaliar uma metodologia de hibridização em microplaca e uma técnica de reação em cadeia da polimerase (PCR) em tempo real para a detecção de DNA de Mycobacterium tuberculosis em amostras de líquido pleural, fragmento de pleura e soro. Adicionalmente, foi avaliada a utilidade da PCR em tempo real em paralelo com a cultura do líquido pleural para o diagnóstico de TB pleural. Foram avaliados 161 pacientes com derrame pleural e submetidos à toracocentese e biópsia pleural. O padrão-ouro para definição de um caso de TB pleural baseou-se na combinação de baciloscopia, cultura, exame histopatológico e critérios clínicos. Cento e sete dos 161 pacientes com derrame pleural receberam diagnóstico de TB pleural. Os resultados da metodologia de hibridização em microplaca não foram satisfatórios, assim foi desenvolvida uma técnica de PCR em tempo real. Nas amostras de líquido pleural, a PCR em tempo real mostrou uma sensibilidade de 46% (IC 95%, 36%-56%) com especificidade de 100%, enquanto a cultura obteve uma sensibilidade de 29% (IC 95%, 20%- 38%). A PCR em tempo real realizada em associação com a cultura no líquido pleural apresentou uma sensibilidade de 60% (IC 95%, 50%-70%). Para as amostras de fragmento pleural, a PCR em tempo real mostrou uma sensibilidade de 42% (IC 95%, 26%-59%) e especificidade de 100%, para este tipo de amostra o exame histopatológico apresentou a maior sensibilidade (90% - IC 95%, 84%- 96%). Nas amostras de soro a PCR em tempo real foi positiva em apenas dois pacientes, os quais também apresentaram resultado positivo nos outros tipos de amostras. Estes resultados indicam que a PCR em tempo real realizada no líquido pleural pode ser uma forma útil para obter um diagnóstico de TB pleural mais rápido, específico e com um procedimento menos invasivo para coleta das amostras. / Conventional tests for pleural tuberculosis (TB) have several limitations and more sensitive and specific methods are needed. The aim of this study was to evaluate microwell hybridization and real-time PCR (polimerase chain reaction) for detection of Mycobacterium tuberculosis DNA in pleural fluid, pleural tissue and serum. Additionally, the utility of real-time PCR in parallel with culture in pleural fluid for the diagnosis of pleural TB was assessed. One hundred sixty one patients with a pleural effusion submitted to a thoracentesis and pleural biopsy were evaluated. The gold-standard for case definition of pleural TB were the combination of acid-fast bacilli, culture, histopathologic examination and clinical parameters. One hundred seven of the 161 patients with pleural effusion received diagnosis of pleural TB. Results of microwell hybridization were not satisfactory, thus we developed a real-time PCR assay. In pleural fluid specimens, real-time PCR showed a sensitivity of 46% (CI 95%, 36%-56%) with specificity of 100%, while the sensitivity of culture was 29% (CI 95%, 20%-38%). The combination of real time PCR and culture in pleural fluid showed a sensitivity of 60% (CI 95%, 50%-70%). For the pleural tissue, real-time PCR showed a sensitivity of 42% (CI 95%, 26%-59%) with specificity of 100%, for this specimen histopathologic examination had the highest sensitivity (90% - CI 95%, 84%-96%). In the serum real-time PCR was positive in only two patients, which also had positive results in other specimens. Our results indicate that the real-time PCR is a useful approach to achieve a more rapid and specific diagnosis for pleural TB with a less invasive procedure for specimen collection.

Resumo: Na rotina hospitalar, são numerosos os casos clínicos em que se faz necessária a intervenção cirúrgica da cavidade abdominal em eqüinos, seja por meio da realização de laparotomias ou de laparoscopias, a qual vem se intensificando com o passar dos anos, na tentativa de serem minimizados os riscos e o trauma cirúrgicos. Desta forma, torna-se importante o conhecimento das alterações causadas pela entrada de ar na cavidade abdominal sobre a mecânica respiratória. Com o estudo objetivou-se avaliar a influência do pneumoperitôneo sobre a pressão pleural (Ppl), parâmetros cardiovasculares e hemogasométricos em oito eqüinos, averiguar a relação entre a pressão gástrica (Pga) e a pressão abdominal (Pab) e estimar os valores da pressão transdiafragmática (PTr) para esta espécie. Não houve alteração (p>0,05) da Ppl, parâmetros hemogasométricos, da FC, FR, PAS e PVC após a instauração do pneumoperitôneo passivo com ar atmosférico. Houve variação (p 0,05) dos valores da PAD e PAM e da temperatura retal (To) após instauração do discreto pneumoperitôneo e o aumento da To pareceu estar mais relacionado à fatores estressantes do que ao aumento da pressão abdominal. A pressão transdiafragmática (PTr) foi calculada com base na fórmula Ptr = Pab - Ppl. Com base nos resultados obtidos pode ser concluído que o pneumoperitôneo passivo não altera a Ppl, os parâmetros cardiovasculares e hemogasométricos em eqüinos. Não foi observada relação entre os valores da pressão gástrica (Pga) e da pressão abdominal (Pab), portanto o método de aferição indireta da pressão abdominal é ineficaz para estimar os valores reais da Pab e a pressão transdiafragmática apresenta valores negativos para a espécie eqüina. / Abstract: In the hospital routine there are a large number of clinical cases in which surgical intervention of the abdominal cavity is needed in horses, or by laparotomy, or by laparoscopy, which has increased its used by the past few years, as an effort to minimize the risks and surgical trauma. In that way it is important to understand the mechanical changes caused by the air entrance into the abdominal cavity. The objectives of study were to evaluate the influence of the pneumoperitoneum on pleural pressure (Ppl); cardiovascular and hemogasometric parameters in eight horses, investigate the relationship between the gastric pressure (Pga) and the abdominal pressure (Pab) and to estimate the transdiaphragmatic pressure (PTr) values for this species. There were no changes (p>0,05) in the Ppl, hemogasometric parameters, FC, FR, PAS and PVC after the instauration of the passive pneumoperitoneum with atmospheric air. There were changes (p>0,05) in PAD, PAM and body temperature (To) values after instauration of the de discrete pneumoperitoneum, and the changes in To seemed to be more related with the stressful conditions than with the increase in abdominal pressure. The transdiaphragmatic pressure (PTr) was calculated using the formula Ptr = Pab - Ppl. Based in the results obtained the passive pneumoperitoneum did not change Ppl, the cardiovascular and hemogasometric parameters in horses. There was no relationship between the gastric pressure (Pga) and abdominal pressure (Pab) so the indirect method for the abdominal pressure measurement is not capable of estimating the real values of the Pab, and the transdiaphragmatic pressure values are negative in horses. / Orientador: Carlos Augusto Araújo Valadão / Coorientador: César Augusto Melo e Silva / Banca: Luis Cláudio Lopes Correia da Silva / Banca: Juliana Regina Peiró / Mestre

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objectives: Diagnosis of pleural tuberculosis (PT) is still a challenge, particularly in resource-constrained settings. Alternative diagnostic tools are needed. We aimed at evaluating the utility of Clinical Prediction Rules (CPRs) for diagnosis of pleural tuberculosis in Peru. Methods: We identified CPRs for diagnosis of PT through a structured literature search. CPRs using high-complexity tests, as defined by the FDA, were excluded. We applied the identified CPRs to patients with pleural exudates attending two third-level hospitals in Lima, Peru, a setting with high incidence of tuberculosis. Besides pleural fluid analysis, patients underwent closed pleural biopsy for reaching a final diagnosis through combining microbiological and histopathological criteria. We evaluated the performance of the CPRs against this composite reference standard using classic indicators of diagnostic test validity. Results: We found 15 eligible CPRs, of which 12 could be validated. Most included ADA, age, lymphocyte proportion and protein in pleural fluid as predictive findings. A total of 259 patients were included for their validation, of which 176 (67%) had PT and 50 (19%) malignant pleural effusion. The overall accuracy of the CPRs varied from 41% to 86%. Two had a positive likelihood ratio (LR) above 10, but none a negative LR below 0.1. ADA alone at a cut-off of ≥40 IU attained 87% diagnostic accuracy and had a positive LR of 6.6 and a negative LR of 0.2. Conclusion: Many CPRs for PT are available. In addition to ADA alone, none of them contributes significantly to diagnosis of PT.

Introduction. L’efficacité de la chimiothérapie intracavitaire dépend de la pénétration du produit au sein du péritoine (CHIP) ou de la plèvre. L’hyperthermie et l’hyperpression peuvent augmenter cette pénétration. Ce travail étudie leur effet intrapéritonéal, puis établit la méthode optimale pour les délivrer. L’étude de la faisabilité et de la tolérance d’une hyperpression intrapleurale est essentielle pour transposer ces bénéfices à la cavité thoracique. Méthodes. Quatre groupes de porcs ont reçu une CHIP ouverte avec de l’oxaliplatine à une concentration constante (150 mg/l) pendant 30 minutes en normothermie ou hyperthermie (42-43°C) ; et en pression atmosphérique ou hyperpression (25 cmH2O). Deux groupes ont reçu une procédure fermée en hyperthermie et hyperpression ou forte hyperpression (40 cmH2O). L’absorption systémique et tissulaire d’oxaliplatine a été étudiée. La tolérance d’une perfusion pleurale a été étudiée chez 21 porcs avec ou sans résection associée, avec ou sans chimiothérapie (cisplatine + gemcitabine), à divers niveaux de pression de 15 à 25 cmH2O. Résultats. L’hyperthermie augmente les concentrations de platine dans les surfaces viscérales (p=0.0014), alors que l’hyperpression l’augmente dans les surfaces viscérales et pariétales (respectivement p= 0.0058 et p= 0.0044). L’association des deux facteurs permet d’obtenir les concentrations les plus importantes dans le péritoine viscéral (p= 0.00001) et pariétal (p= 0.0003). Les concentrations obtenues lors des procédures fermées sont inférieures à celles obtenues en ouvert, même lorsque la pression atteint 40 cmH2O. Une chimiothérapie intrapleurale à 20 cmH2O sans résection associée est le niveau maximal toléré durant 60 minutes. Conclusion. Au cours d’une CHIP, l’hyperthermie augmente la pénétration d’oxaliplatine dans le péritoine viscéral, alors que l’hyperpression est efficace dans le péritoine viscéral et pariétal. Leur association est synergique et la procédure ouverte semble la meilleure pour la délivrer. Une chimiothérapie intrapleurale est faisable à 20 cmH2O dans ce modèle. / Introduction. In order to achieve a good effect, chemotherapy drugs need to penetrate into the peritoneal (HIPEC) or pleural tissue. Hyperthermia and high-pressure may enhance this penetration. The aim of this study was to evaluate their peritoneal effect and to establish the best technique to it. A feasibility study of an intrapleural high-pressure was an essential step to export these effects to the thoracic space. Methods. Four groups of pigs underwent an open HIPEC with a constant concentration (150 mg/l) of oxaliplatin during 30 minutes either in normothermia, or in hyperthermia (42-43°C); and either with atmospheric pressure or with high-pressure (25 cmH2O). Two more groups underwent a closed procedure with hyperthermia and either high-pressure or very high-pressure (40 cmH2O). The systemic and tissue absorption of oxaliplatin were studied. The haemodynamic and respiratory tolerance of a pleural infusion was also tested in 21 pigs with and without associated resection; with and without chemotherapy infusion (cisplatin + gemcitabin) and at various levels of pressure (from 15 to 25 cmH2O). Results. Hyperthermia enhances the concentrations of platinum in visceral surfaces (p=0.0014), whereas high-pressure enhances it both in visceral and in parietal surfaces (p= 0.0058 and p= 0.0044, respectively). Their association obtains the highest concentrations both in the visceral (p= 0.00001) and the parietal peritoneum (p= 0.0003). The concentrations obtained during closed procedure are lower than those achieved with the open technique, even with 40 cmH2O of pressure. A 60-minutes intrapleural chemotherapy perfusion with 20 cmH2O of pressure without any lung resection was the maximal tolerated level. Conclusion. During HIPEC, hyperthermia improves the penetration of oxaliplatin in the visceral peritoneum, whereas high-pressure is effective in both peritoneal surfaces. Their association is synergic and the open technique seems to be the best one to deliver it. An intrapleural chemotherapy with a 20 cmH2O pressure is feasible in this model.

京都大学 / 0048 / 新制・論文博士 / 博士(社会健康医学) / 乙第13292号 / 論社医博第13号 / 新制||社医||10(附属図書館) / (主査)教授 川上 浩司, 教授 平井 豊博, 教授 伊達 洋至 / 学位規則第4条第2項該当 / Doctor of Public Health / Kyoto University / DFAM

Chronic myeloid leukemia is characterized by a unique reciprocal translocation between chromosomes 9 and 22 resulting in deregulated tyrosine kinase activity. Tyrosine kinase inhibitors, such as imatinib, dasatinib, and nilotinib have revolutionized treatment of Chronic myeloid leukemia. However, tyrosine kinase inhibitors? use has presented new challenges in managing both acute and chronic toxicities, particularly ?off-target? toxicities like pleural effusion. Pleural effusions are seen less often with imatinib and very rarely with nilotinib. A 66-year-old male presented to emergency department with complaints of mild chest pain and dyspnea of 3 days duration with progressive worsening, including dyspnea at rest. Patient was currently taking nilotinib after failing imatinib for chronic myeloid leukemia. Nilotinib was put on hold. After exclusion of cardiac and pulmonary etiologies patient was treated for community acquired pneumonia with minimal improvement. Despite the very low incidence of pleural effusion with nilotinib (<1%), he was started on 20?mg of prednisone PO for 3 days. Patient had a dramatic improvement within 48?h after beginning prednisone. This treatment approach suggests that pleural effusions associated with nilotinib can be successfully treated in the same way as pleural effusions associated with dasatinib.