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Sample records for symptomatic radiation pneumonitis

  1. Risk Factors Associated With Symptomatic Radiation Pneumonitis After Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer.

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    Shi, Shiming; Zeng, Zhaochong; Ye, Luxi; Huang, Yan; He, Jian

    2017-06-01

    Radiation pneumonitis is the most frequent acute pulmonary toxicity following stereotactic body radiation therapy for lung cancer. Here, we investigate clinical and dosimetric factors associated with symptomatic radiation pneumonitis in patients with stage I non-small cell lung cancer treated with stereotactic body radiation therapy. A total of 67 patients with stage I non-small cell lung cancer who received stereotactic body radiation therapy at our institution were enrolled, and their clinicopathological parameters and dosimetric parameters were recorded and analyzed. The median follow-up period was 26.4 months (range: 7-48 months). In univariate analysis, tumor size ( P = .041), mean lung dose ( P = .028), V2.5 ( P = .024), V5 ( P = .014), V10 ( P = .004), V20 ( P = .024), V30 ( P = .020), V40 ( P = .040), and V50 ( P = 0.040) were associated with symptomatic radiation pneumonitis. In multivariable logistic regression analysis, V10 ( P = .049) was significantly associated with symptomatic radiation pneumonitis. In conclusion, this study found that tumor size, mean lung dose, and V2.5 to V50 were risk factors markedly associated with symptomatic radiation pneumonitis. Our data suggested that lung V10 was the most significant factor, and optimizing lung V10 may reduce the risk of symptomatic radiation pneumonitis. For both central and peripheral stage I lung cancer, rate of radiation pneumonitis ≥grade 2 was low after stereotactic body radiation therapy with appropriate fraction dose.

  2. Risk Factors Associated With Symptomatic Radiation Pneumonitis After Stereotactic Body Radiation Therapy for Stage I Non–Small Cell Lung Cancer

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    Shi, Shiming; Zeng, Zhaochong; Ye, Luxi; Huang, Yan; He, Jian

    2016-01-01

    Radiation pneumonitis is the most frequent acute pulmonary toxicity following stereotactic body radiation therapy for lung cancer. Here, we investigate clinical and dosimetric factors associated with symptomatic radiation pneumonitis in patients with stage I non–small cell lung cancer treated with stereotactic body radiation therapy. A total of 67 patients with stage I non–small cell lung cancer who received stereotactic body radiation therapy at our institution were enrolled, and their clini...

  3. Developing Multivariable Normal Tissue Complication Probability Model to Predict the Incidence of Symptomatic Radiation Pneumonitis among Breast Cancer Patients.

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    Lee, Tsair-Fwu; Chao, Pei-Ju; Chang, Liyun; Ting, Hui-Min; Huang, Yu-Jie

    2015-01-01

    Symptomatic radiation pneumonitis (SRP), which decreases quality of life (QoL), is the most common pulmonary complication in patients receiving breast irradiation. If it occurs, acute SRP usually develops 4-12 weeks after completion of radiotherapy and presents as a dry cough, dyspnea and low-grade fever. If the incidence of SRP is reduced, not only the QoL but also the compliance of breast cancer patients may be improved. Therefore, we investigated the incidence SRP in breast cancer patients after hybrid intensity modulated radiotherapy (IMRT) to find the risk factors, which may have important effects on the risk of radiation-induced complications. In total, 93 patients with breast cancer were evaluated. The final endpoint for acute SRP was defined as those who had density changes together with symptoms, as measured using computed tomography. The risk factors for a multivariate normal tissue complication probability model of SRP were determined using the least absolute shrinkage and selection operator (LASSO) technique. Five risk factors were selected using LASSO: the percentage of the ipsilateral lung volume that received more than 20-Gy (IV20), energy, age, body mass index (BMI) and T stage. Positive associations were demonstrated among the incidence of SRP, IV20, and patient age. Energy, BMI and T stage showed a negative association with the incidence of SRP. Our analyses indicate that the risk of SPR following hybrid IMRT in elderly or low-BMI breast cancer patients is increased once the percentage of the ipsilateral lung volume receiving more than 20-Gy is controlled below a limitation. We suggest to define a dose-volume percentage constraint of IV20radiation therapy treatment planning to maintain the incidence of SPR below 20%, and pay attention to the sequelae especially in elderly or low-BMI breast cancer patients. (AIV20: the absolute ipsilateral lung volume that received more than 20 Gy (cc).

  4. Developing Multivariable Normal Tissue Complication Probability Model to Predict the Incidence of Symptomatic Radiation Pneumonitis among Breast Cancer Patients.

    Directory of Open Access Journals (Sweden)

    Tsair-Fwu Lee

    Full Text Available Symptomatic radiation pneumonitis (SRP, which decreases quality of life (QoL, is the most common pulmonary complication in patients receiving breast irradiation. If it occurs, acute SRP usually develops 4-12 weeks after completion of radiotherapy and presents as a dry cough, dyspnea and low-grade fever. If the incidence of SRP is reduced, not only the QoL but also the compliance of breast cancer patients may be improved. Therefore, we investigated the incidence SRP in breast cancer patients after hybrid intensity modulated radiotherapy (IMRT to find the risk factors, which may have important effects on the risk of radiation-induced complications.In total, 93 patients with breast cancer were evaluated. The final endpoint for acute SRP was defined as those who had density changes together with symptoms, as measured using computed tomography. The risk factors for a multivariate normal tissue complication probability model of SRP were determined using the least absolute shrinkage and selection operator (LASSO technique.Five risk factors were selected using LASSO: the percentage of the ipsilateral lung volume that received more than 20-Gy (IV20, energy, age, body mass index (BMI and T stage. Positive associations were demonstrated among the incidence of SRP, IV20, and patient age. Energy, BMI and T stage showed a negative association with the incidence of SRP. Our analyses indicate that the risk of SPR following hybrid IMRT in elderly or low-BMI breast cancer patients is increased once the percentage of the ipsilateral lung volume receiving more than 20-Gy is controlled below a limitation.We suggest to define a dose-volume percentage constraint of IV20< 37% (or AIV20< 310cc for the irradiated ipsilateral lung in radiation therapy treatment planning to maintain the incidence of SPR below 20%, and pay attention to the sequelae especially in elderly or low-BMI breast cancer patients. (AIV20: the absolute ipsilateral lung volume that received more than

  5. Predictive markers of radiation pneumonitis.

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    Provatopoulou, X; Athanasiou, E; Gounaris, A

    2008-01-01

    Radiation pneumonitis is an acute-phase response to radiation therapy and a common complication that affects a patient's quality of life. Under the need to reduce the incidence and severity of radiation-induced pulmonary complications as well as to identify patients at risk, several investigations on potential predictive markers of radiation pneumonitis have been conducted. The present study reviews the currently available knowledge on biomolecules of potential predictive value for radiation pneumonitis.

  6. Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy – a single-centre experience

    International Nuclear Information System (INIS)

    Henkenberens, C.; Janssen, S.; Lavae-Mokhtari, M.; Leni, K.; Meyer, A.; Christiansen, H.; Bremer, M.; Dickgreber, N.

    2016-01-01

    To assess efficacy of our single-centre experience with inhalative steroids (IS) in lung cancer patients with symptomatic radiation pneumonitis (RP) grade II. Between 05/09 and 07/10, 24 patients (female, n = 8; male, n = 16) with lung cancer (non-small cell lung carcinoma [NSCLC]: n = 19; small cell lung cancer [SCLC]: n = 3; unknown histology: n = 2) and good performance status (ECOG ≤1) received definitive radiotherapy to the primary tumour site and involved lymph nodes with concurrent chemotherapy (n = 18), sequential chemotherapy (n = 2) or radiation only (n = 4) and developed symptomatic RP grade II during follow-up. No patient presented with oxygen requiring RP grade III. The mean age at diagnosis was 66 years (range: 50–82 years). Nine patients suffered from chronic obstructive pulmonary disease (COPD) before treatment, and 18 patients had a smoking history (median pack years: 48). The mean lung dose was 15.5 Gy (range: 3.0–23.1 Gy). All patients were treated with IS. If a patient’s clinical symptoms did not significantly improve within two weeks of IS therapy initiation, their treatment was switched to oral prednisolone. All 24 patients were initially treated with a high dose IS (budesonide 800 μg 1-0-1) for 14 days. Of the patients, 18 showed a significant improvement of clinical symptoms and 6 patients did not show significant improvement of clinical symptoms and were classified as non-responders to IS. Their treatment was switched to oral steroids after two weeks (starting with oral prednisolone, 0.5 mg/kg bodyweight; at least 50 mg per day). All of these patients responded to the prednisolone. None of non-responders presented with increased symptoms of RP and required oxygen and / or hospitalization (RP grade III). The median follow-up after IS treatment initiation was 18 months (range: 4–66 months). The median duration of IS treatment and prednisolone treatment was 8.2 months (range: 3.0–48.3 months) and 11.4 months (range: 5.0–44

  7. Radiation pneumonitis in breast cancer

    International Nuclear Information System (INIS)

    Ferrino, R.; Carvalho, H.A.; Gomes, H.C.; Kuang, L.F.; Aguilar, P.B.; Lederman, M.V.

    1987-01-01

    Forty-nine observations of patients with breast cancer frm 1980 to 1985 were reviewed. All of them received radiotherapy. In 44.9% radiologic findings of radiation pneumonitis were detected and only 9% presented mild or moderate respiratory symptoms. (M.A.C.) [pt

  8. Do Angiotensin-Converting Enzyme Inhibitors Reduce the Risk of Symptomatic Radiation Pneumonitis in Patients With Non-Small Cell Lung Cancer After Definitive Radiation Therapy? Analysis of a Single-Institution Database

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    Wang, Hongmei [Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, P.R. of China (China); Liao, Zhongxing, E-mail: zliao@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zhuang, Yan; Xu, Ting; Nguyen, Quynh-Nhu; Levy, Lawrence B.; O' Reilly, Michael [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gold, Kathryn A. [Department of Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gomez, Daniel R. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-12-01

    Purpose: Preclinical studies have suggested that angiotensin-converting enzyme inhibitors (ACEIs) can mitigate radiation-induced lung injury. We sought here to investigate possible associations between ACEI use and the risk of symptomatic radiation pneumonitis (RP) among patients undergoing radiation therapy (RT) for non–small cell lung cancer (NSCLC). Methods and Materials: We retrospectively identified patients who received definitive radiation therapy for stages I to III NSCLC between 2004 and 2010 at a single tertiary cancer center. Patients must have received a radiation dose of at least 60 Gy for a single primary lung tumor and have had imaging and dosimetric data available for analysis. RP was quantified according to Common Terminology Criteria for Adverse Events, version 3.0. A Cox proportional hazard model was used to assess potential associations between ACEI use and risk of symptomatic RP. Results: Of 413 patients analyzed, 65 were using ACEIs during RT. In univariate analysis, the rate of RP grade ≥2 seemed lower in ACEI users than in nonusers (34% vs 46%), but this apparent difference was not statistically significant (P=.06). In multivariate analysis of all patients, ACEI use was not associated with the risk of symptomatic RP (hazard ratio [HR] = 0.66; P=.07) after adjustment for sex, smoking status, mean lung dose (MLD), and concurrent carboplatin and paclitaxel chemotherapy. Subgroup analysis showed that ACEI use did have a protective effect from RP grade ≥2 among patients who received a low (≤20-Gy) MLD (P<.01) or were male (P=.04). Conclusions: A trend toward reduction in symptomatic RP among patients taking ACEIs during RT for NSCLC was not statistically significant on univariate or multivariate analyses, although certain subgroups may benefit from use (ie, male patients and those receiving low MLD). The evidence at this point is insufficient to establish whether the use of ACEIs does or does not reduce the risk of RP.

  9. Radiation Pneumonitis after Radiotherapy of Neck Lymphoma

    Directory of Open Access Journals (Sweden)

    Min Wei

    2014-01-01

    Full Text Available Radiotherapy is still one of the effective means for treatment of malignant tumors up to now. Particularly, it is an indispensable effective measure for treatment of some lymphoma patients. In routine work, radiation pneumonitis (RP is the most significant complication of acute treatment-related toxicities in lung cancer; however, serious radioactive pneumonia is rare for the radiotherapy of neck lymphoma because the volume of the lungs affected by radiation dose was very small. We report a lymphoma case, where the patient had undergone radiotherapy for the bilateral neck and bilateral supraclavicular/infraclavicular area. Following completion of radiotherapy, the patient developed severe radiation pneumonitis.

  10. Radiation pneumonitis after radiotherapy of neck lymphoma.

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    Wei, Min; Cai, Jun; Tong, Tao; Yu, Shihua; Yang, Yonghua; Zhang, Weijia; Yang, Jiyuan

    2014-01-01

    Radiotherapy is still one of the effective means for treatment of malignant tumors up to now. Particularly, it is an indispensable effective measure for treatment of some lymphoma patients. In routine work, radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer; however, serious radioactive pneumonia is rare for the radiotherapy of neck lymphoma because the volume of the lungs affected by radiation dose was very small. We report a lymphoma case, where the patient had undergone radiotherapy for the bilateral neck and bilateral supraclavicular/infraclavicular area. Following completion of radiotherapy, the patient developed severe radiation pneumonitis.

  11. [Predictive factors for acute radiation pneumonitis].

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    Arpin, D; Mahé, M-A; Servois, V; Claude, L

    2009-06-01

    Thoracic irradiation is a major weapon in the treatment of nonmetastatic primary lung cancer, in particular in patients presenting a locally advanced disease of the mediastinium. Acute radiation pneumonitis (ARP) is one of the main limiting toxicities. The purpose of this work is to sum up the current state of knowledge of the factors of risk of developing ARP. The incidence after conventional irradiation, in patients with non small cell lung cancer (NSCLC) is about 7 to 10% in the moderate although symptomatic forms of ARP and about 1 to 3% in the severe forms. The factors related to the patient, the tumour or treatments prior to the irradiation do not determine any specific risk of ARP besides an age of over 65 years that remains debatable. The validated predictive factors of ARP are mainly related to the irradiation factors (healthy lung volumes irradiated, average dose of irradiation, etc.). Nevertheless, in spite of the adjustment of these parameters, the individual susceptibility to the toxicity of thoracic radiotherapy remains significant, directing current research to the biological markers intrinsic to the patient. In particular, the involvement of early variations of certain cytokines (IL-6, IL-10, TGF-ss) in the occurrence of ARP during irradiation has been suggested and studies are under way to confirm their involvement and determine their role.

  12. Radiation Pneumonitis after Radiotherapy of Neck Lymphoma

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    Wei, Min; Cai, Jun; Tong, Tao; Yu, Shihua; Yang, Yonghua; Zhang, Weijia; Yang, Jiyuan

    2014-01-01

    Radiotherapy is still one of the effective means for treatment of malignant tumors up to now. Particularly, it is an indispensable effective measure for treatment of some lymphoma patients. In routine work, radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer; however, serious radioactive pneumonia is rare for the radiotherapy of neck lymphoma because the volume of the lungs affected by radiation dose was very small. We report a ...

  13. The measurements of plasma cytokines in radiation-induced pneumonitis in lung cancer patients

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    Hur, Won Joo; Youn, Seon Min; Lee, Hyung Sik; Yang, Kwang Mo; Sin, Geun Ho; Son, Choon Hee; Han, Jin Yeong; Lee, Ki Nam; Jeong, Min Ho [College of Medicine, Donga Univ., Pusan (Korea, Republic of)

    2000-12-01

    To investigate whether changes in plasma concentrations of transforming growth factor-{beta} 1(TGF-{beta} 1), tumor necrosis factor-alpha (TNF-{alpha}) and interleukin-6 (lL -6) could be used to identify the development of radiation-induced pneumonitis in the lung cancer patients. Seventeen patients with lung cancer (11 NSCLC. 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation-induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent: 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-{beta}1, TNF--{alpha} and IL -6 were obtained in all patients before, weekly during radiotherapy and at each follow-up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow-up visits after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. Thirteen patients eventually developed signs and symptoms of clinical pneumonitis while four patients did not. TGF- P 1 levels were elevated in - all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2-4 weeks after completion of radiotherapy). The levels of TNF--{alpha} and IL -6 were also elevated in the group of patients who developed pneumonitis but the pattern was not characteristic. Changes in plasma TGF{beta}-1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF--{alpha} and IL-6 shows no meaningful changes in association with radiation pneumonitis.

  14. A literature-based meta-analysis of clinical risk factors for development of radiation induced pneumonitis

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    Vogelius, Ivan R; Bentzen, Søren M

    2012-01-01

    Abstract Introduction. The risk of developing side effects after radiotherapy is not only dependent on radiation dose, but may also be affected by patient-related risk factors. Here we perform a literature-based meta-analysis to estimate the effect of various clinical risk factors on the incidence...... of symptomatic radiation pneumonitis (RP). Material and methods. A systematic review of English language articles in the Pubmed, Embase and Cochrane controlled trials registers. Studies with the mesh term "radiation pneumonitis" or the search term "radiation pneumonitis" were included. Additional studies were...... identified by manual searching of the references. Studies reporting crude incidence or odds ratios (OR) for radiation pneumonitis vs. age, disease location, smoking status, chemotherapy schedule or comorbidity were included. A systematic overview (meta-analysis) was conducted to synthesize data across...

  15. Challenges scoring radiation pneumonitis in patients irradiated for lung cancer.

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    Yirmibesoglu, Eda; Higginson, Daniel S; Fayda, Merdan; Rivera, M Patricia; Halle, Jan; Rosenman, Julian; Xie, Liyi; Marks, Lawrence B

    2012-06-01

    To quantify uncertainties in scoring radiation pneumonitis. Records of 434 patients irradiated for lung cancer from 2000 to 2010 were retrospectively reviewed; IRB-approved study. From these, 121 received ≥ 60 Gy for non-small cell lung cancer (NSCLC) with ≥ 6 months follow-up. Patients where the physicians were uncertain of the diagnosis due to confounding factors were deemed "hard to score". Subgroups were defined based on lung dosimetric parameters, and frequencies in different subgroups were compared via Fisher's exact test. 21/121 of patients were considered to have pneumonitis; median follow 17 months. Of these, 10/21 were "hard to score"; reasons including acute COPD exacerbation, infection, and tumor progression. "Hard to score" pneumonitis was slightly more common in patients with a COPD history (15%) vs. without COPD (4%) (p=0.05); and with a pre-RT FEV1pneumonitis trended to be non-significantly slightly higher in patients higher mean lung doses, V5, and V30. Radiation pneumonitis occurred in 17% of patients undergoing RT for NSCLC; with diagnostic uncertainty in 48% of these. Poor pre-RT pulmonary function increases the rate of "hard to score" pneumonitis. Dosimetric parameters are slightly better related to "unambiguous" than "hard to score" pneumonitis, as expected. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  16. Lung Size and the Risk of Radiation Pneumonitis

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    Briere, Tina Marie, E-mail: tmbriere@mdanderson.org [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Krafft, Shane [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Martel, Mary K. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2016-02-01

    Purpose: The purpose of this study was to identify patient populations treated for non-small cell lung cancer (NSCLC) who may be more at risk of radiation pneumonitis. Methods and Materials: A total of 579 patients receiving fractionated 3D conformal or intensity modulated radiation therapy (IMRT) for NSCLC were included in the study. Statistical analysis was performed to search for cohorts of patients with higher incidences of radiation pneumonitis. In addition to conventional risk factors, total and spared lung volumes were analyzed. The Lyman-Kutcher-Burman (LKB) and cure models were then used to fit the incidence of radiation pneumonitis as a function of lung dose and other factors. Results: Total lung volumes with a sparing of less than 1854 cc at 40 Gy were associated with a significantly higher incidence of radiation pneumonitis at 6 months (38% vs 12% for patients with larger volumes, P<.001). This patient cohort was overwhelmingly female and represented 22% of the total female population of patients and nearly 30% of the cases of radiation pneumonitis. An LKB fit to normal tissue complication probability (NTCP) including volume as a dose modifying factor resulted in a dose that results in a 50% probability of complication for the smaller spared volume cohort that was 9 Gy lower than the fit to all mean lung dose data and improved the ability to predict radiation pneumonitis (P<.001). Using an effective dose parameter of n=0.42 instead of mean lung dose further improved the LKB fit. Fits to the data using the cure model produced similar results. Conclusions: Spared lung volume should be considered when treating NSCLC patients. Separate dose constraints based on smaller spared lung volume should be considered. Smaller spared lung volume patients should be followed closely for signs of radiation pneumonitis.

  17. Acute radiation dermatitis and pneumonitis in Japanese breast cancer patients with whole breast hypofractionated radiotherapy compared to conventional radiotherapy.

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    Osako, Tomo; Oguchi, Masahiko; Kumada, Madoka; Nemoto, Keiko; Iwase, Takuji; Yamashita, Takashi

    2008-05-01

    To evaluate acute morbidity, radiation dermatitis and pneumonitis, of Japanese patients treated with whole breast hypofractionated radiotherapy (RT) after breast-conserving surgery (BCS), compared to conventional RT. Japanese patients who received whole breast RT after BCS between October 2003 and September 2006 were retrospectively reviewed. Patients who had selected the conventional or hypofractionated schedule received whole breast irradiation of 50 Gy in 25 fractions plus boost or 40 Gy in 16 fractions plus boost. Radiation dermatitis and symptomatic pneumonitis were graded according to the Common Terminology Criteria for Adverse Events version 3.0. Of 443 consecutive patients, 377 (85%) received the conventional schedule and 66 (15%) received the hypofractionated schedule. Of patients treated with the conventional schedule, Grade 0, 1, 2 and 3 radiation dermatitis were observed in 16 (4%), 278 (74%), 77 (20%) and 6 (2%), respectively. Of patients treated with the hypofractionated schedule, Grade 0, 1, 2 and 3 dermatitis were observed in 11 (17%), 49 (74%), 5 (8%) and 1 (1%), respectively. Grade 2-3 dermatitis by the hypofractionated schedule (9%) was observed less frequently than that by the conventional schedule (22%) (chi-square test; P = 0.016). Moreover, of patients treated with the conventional schedule, 4 (1%) had Grade 2 radiation pneumonitis. No patient treated with the hypofractionated schedule had symptomatic pneumonitis. Radiation dermatitis and pneumonitis in Japanese patients treated with the hypofractionated schedule is acceptable. Especially, radiation dermatitis by the hypofractionated schedule is milder than that by the conventional schedule.

  18. Radiation Recall Pneumonitis During Systemic Treatment With Everolimus.

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    Clark, Douglas; Gauchan, Dron; Ramaekers, Ryan; Norvell, Max; Copur, Mehmet Sitki

    2014-01-01

    Radiation recall syndrome is an acute inflammatory reaction developing at anatomical sites of previously irradiated tissue, weeks to months after the completion of radiation therapy. The distribution pattern of inflammation typically involves, and remains limited to, the boundaries of prior radiation treatment fields. Several classical chemotherapy drugs have been reported to have the potential for causing radiation recall syndrome. With the increasing availability and expanding use of novel biologic and targeted therapy anticancer drugs, isolated reports of radiation recall syndrome secondary to this class of agents are starting to appear in the literature. We describe a case of everolimus-induced radiation recall pneumonitis in a patient with metastatic renal cell cancer.

  19. Radiation pneumonitis in non.small.cell lung cancer patients treated ...

    African Journals Online (AJOL)

    Radiation pneumonitis in non.small.cell lung cancer patients treated with helical tomotherapy. B Yao, YD Wang, QZ Liu. Abstract. Objective: In this study, we investigated the incidence of radiation pneumonitis (RP) in non.small.cell lung cancer (NSCLC) patients undergoing helical tomotherapy (HT) and the clinical and ...

  20. Framework for radiation pneumonitis risk stratification based on anatomic and perfused lung dosimetry

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    Dhami, Gurleen; Zeng, Jing; Patel, Shilpen A.; Rengan, Ramesh [University of Washington School of Medicine, Department of Radiation Oncology, Seattle, WA (United States); Vesselle, Hubert J.; Kinahan, Paul E.; Miyaoka, Robert S. [University of Washington School of Medicine, Department of Radiology, Seattle, WA (United States); Bowen, Stephen R. [University of Washington School of Medicine, Department of Radiation Oncology, Seattle, WA (United States); University of Washington School of Medicine, Department of Radiology, Seattle, WA (United States)

    2017-05-15

    To design and apply a framework for predicting symptomatic radiation pneumonitis in patients undergoing thoracic radiation, using both pretreatment anatomic and perfused lung dose-volume parameters. Radiation treatment planning CT scans were coregistered with pretreatment [{sup 99m}Tc]MAA perfusion SPECT/CT scans of 20 patients who underwent definitive thoracic radiation. Clinical radiation pneumonitis was defined as grade ≥ 2 (CTCAE v4 grading system). Anatomic lung dose-volume parameters were collected from the treatment planning scans. Perfusion dose-volume parameters were calculated from pretreatment SPECT/CT scans. Equivalent doses in 2 Gy per fraction were calculated in the lung to account for differences in treatment regimens and spatial variations in lung dose (EQD2{sub lung}). Anatomic lung dosimetric parameters (MLD) and functional lung dosimetric parameters (pMLD{sub 70%}) were identified as candidate predictors of grade ≥ 2 radiation pneumonitis (AUC > 0.93, p < 0.01). Pairing of an anatomic and functional dosimetric parameter (e.g., MLD and pMLD{sub 70%}) may further improve prediction accuracy. Not all individuals with high anatomic lung dose (MLD > 13.6 GyEQD2{sub lung}, 19.3 Gy for patients receiving 60 Gy in 30 fractions) developed radiation pneumonitis, but all individuals who also had high mean dose to perfused lung (pMLD{sub 70%} > 13.3 GyEQD2) developed radiation pneumonitis. The preliminary application of this framework revealed differences between anatomic and perfused lung dosimetry in this limited patient cohort. The addition of perfused lung parameters may help risk stratify patients for radiation pneumonitis, especially in treatment plans with high anatomic mean lung dose. Further investigations are warranted. (orig.) [German] Erstellung und Anwendung eines Rahmenwerks zur Vorhersage symptomatischer Strahlenpneumonitis bei Patienten mit einer Thorax-Bestrahlung anhand anatomischer und perfundierter Lungendosis-Volumen-Parameter in der

  1. Pre-radiotherapy FDG PET predicts radiation pneumonitis in lung cancer

    International Nuclear Information System (INIS)

    Castillo, Richard; Guerrero, Thomas; Pham, Ngoc; Ansari, Sobiya; Meshkov, Dmitriy; Castillo, Sarah; Li, Min; Olanrewaju, Adenike; Hobbs, Brian; Castillo, Edward

    2014-01-01

    A retrospective analysis is performed to determine if pre-treatment [ 18 F]-2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (FDG PET/CT) image derived parameters can predict radiation pneumonitis (RP) clinical symptoms in lung cancer patients. We retrospectively studied 100 non-small cell lung cancer (NSCLC) patients who underwent FDG PET/CT imaging before initiation of radiotherapy (RT). Pneumonitis symptoms were evaluated using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4) from the consensus of 5 clinicians. Using the cumulative distribution of pre-treatment standard uptake values (SUV) within the lungs, the 80th to 95th percentile SUV values (SUV 80 to SUV 95 ) were determined. The effect of pre-RT FDG uptake, dose, patient and treatment characteristics on pulmonary toxicity was studied using multiple logistic regression. The study subjects were treated with 3D conformal RT (n = 23), intensity modulated RT (n = 64), and proton therapy (n = 13). Multiple logistic regression analysis demonstrated that elevated pre-RT lung FDG uptake on staging FDG PET was related to development of RP symptoms after RT. A patient of average age and V 30 with SUV 95 = 1.5 was an estimated 6.9 times more likely to develop grade ≥ 2 radiation pneumonitis when compared to a patient with SUV 95 = 0.5 of the same age and identical V 30 . Receiver operating characteristic curve analysis showed the area under the curve was 0.78 (95% CI = 0.69 – 0.87). The CT imaging and dosimetry parameters were found to be poor predictors of RP symptoms. The pretreatment pulmonary FDG uptake, as quantified by the SUV 95 , predicted symptoms of RP in this study. Elevation in this pre-treatment biomarker identifies a patient group at high risk for post-treatment symptomatic RP

  2. [Radiotherapy Techniques and Radiation Pneumonitis: A Lot To A Little Or A Little To A Lot?].

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    Yu, Bingqi; Wang, Jin; Xu, Yujin; Su, Feng; Shan, Guoping; Chen, Ming

    2015-12-01

    Radiotherapy is one of the main treatment for patients with lung cancer. Three-dimensional conformal radiation therapy (3D-CRT) and intensity modulated radiation therapy (IMRT) are widely used to deliver radiation. Here, we focus on the correlations between dose distribution in lung and radiation pneumonitis according to the analysis about radiotherapy for lung cancer: A lot to a little or a little to a lot, which is the main cause of radiation pneumonitis?

  3. 311 Pathogenesis of Radiation-induced Pneumonitis in Patients with Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Politi, Ekaterini; Tolia, Maria; Makrilia, Nektaria; Psarros, Fotis; Dannos, Ioannis; Syrigos, Kostas N.; Syrigou, Ekaterini

    2012-01-01

    Background Chest radiation is a common therapeutic approach in the management of lung cancer, as well as in other malignancies, rendering radiation-induced pneumonitis a rather commonly reported adverse event. A large proportion of patients undergoing radiation have underlying chronic obstructive pulmonary disease (COPD). We aim to elucidate the pathogenetic pathways implicated in radiation-induced pneumonitis particularly in this subgroup of patients. Methods A literature search was performe...

  4. [Effects of thymosin alpha-1 on radiation-induced pneumonitis].

    Science.gov (United States)

    Yu, Rong; Sun, Yu; Cai, Qing; Li, Yongheng; Zhu, Guangying

    2011-03-01

    Radiation-induced lung injure is one of the major factors of limitation in radiotherapy for lung cancer. Whether the use of thymosin and radiotherapy simultaneously would increase the radiation-induced lung injure is unclear. The aim of this study is to evaluate the effects of thymosin alpha-1 on radiation induced pneumonitis in mice. Three groups of mice, control (C), radiation alone (RT), thymosin alpha-1 plus radiation (T+RT), were entered into the study. The weight and mortality of mice, pleural effusion, quantity of protein and cell count in the bronchoalvealar lavage (BAL) and pulmonary fibrosis score were evaluated as the outcome measures. The mortality ratio of the T+RT and RT groups were 3/14, 2/10, respectively. The time of death were all in the 23-24 weeks after radiotherapy. There was no pleural effusion in the T+RT group other than 2/2 occurred in RT group. The quantity of protein, cell number and neutrophil number in the BAL and lung coefficient in mice of T+RT group were remarkably lower than that of RT group, but the BALF macrophages number was remarkably higher than that in RT group in the 8 weeks. The quantity of protein, cell number, neutrophil number and macrophages number in the BAL, lung coefficient, the scores of lung fibrosis in mice of T+RT group were significantly lower than that of RT group in the 24 weeks. All test data were lowest in mice of C group. And there was no obvious pulmonary fibrosis in the mice of C group. Thymosin alpha-1 could relieve radiation-induced acute and late pulmonary injuries.

  5. Effects of Thymosin Alpha-1 on Radiation-induced Pneumonitis

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    Rong YU

    2011-03-01

    Full Text Available Background and objective Radiation-induced lung injure is one of the major factors of limitation in radiotherapy for lung cancer. Whether the use of thymosin and radiotherapy simultaneously would increase the radiationinduced lung injure is unclear. The aim of this study is to evaluate the effects of thymosin alpha-1 on radiation induced pneumonitis in mice. Methods Three groups of mice, control (C, radiation alone (RT, thymosin alpha-1 plus radiation (T+RT, were entered into the study. The weight and mortality of mice, pleural effusion, quantity of protein and cell count in the bronchoalvealar lavage (BAL and pulmonary fibrosis score were evaluated as the outcome measures. Results The mortality ratio of the T+RT and RT groups were 3/14, 2/10, respectively. The time of death were all in the 23-24 weeks after radiotherapy. There was no pleural effusion in the T+RT group other than 2/2 occured in RT group. The quantity of protein, cell number and neutrophil number in the BAL and lung coefficient in mice of T+RT group were remarkably lower than that of RT group, but the BALF macrophages number was remarkably higher than that in RT group in the 8 weeks. The quantity of protein, cell number, neutrophil number and macrophages number in the BAL, lung coefficient, the scores of lung fibrosis in mice of T+RT group were significantly lower than that of RT group in the 24 weeks. All test data were lowest in mice of C group. And there was no obvious pulmonary fibrosis in the mice of C group. Conclusion Thymosin alpha-1 could relieve radiation-induced acute and late pulmonary injuries.

  6. Age factor relevant to the development of radiation pneumonitis in radiotherapy of lung cancer

    International Nuclear Information System (INIS)

    Koga, K.; Kusumoto, S.; Watanabe, K.; Nishikawa, K.; Harada, K.; Ebihara, H.

    1988-01-01

    The significance of age factor for the development of radiation pneumonitis is evaluated in 62 patients with lung cancer between 1977 and 1985. The younger group consists of those less than 70 years old and the elderly group of those 70 years old or more. Radiation doses ranged from 1.5 to 2 Gy, 3 to 5 times per week, therefore the delivered doses were converted to nominal single doses (rets dose). Severe radiation pneumonitis was more often observed in the elderly than in the younger regardless of radiation field size and chemotherapy (n.s.). The onset of radiation pneumonitis occurred earlier in a field size of 90 sq cm or more than in that of less than 90 sq cm in both age groups; there was no significant difference between the two age groups in each field size. The pneumonitis was more frequently noted with increasing rets dose in both age groups (n.s.) regardless of field size and chemotherapy. It is concluded that there is no significant difference in the development of radiation pneumonitis between the younger group and the elderly group, but the pneumonitis is inclined to be more severe in the latter

  7. Heart irradiation as a risk factor for radiation pneumonitis

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    Huang, Ellen X.; El Naqa, Issam; Deasy, Joseph O.; Bradley, Jeffrey D.; Hope, Andrew J.; Lindsay, Patricia E.; Trovo, Marco

    2011-01-01

    Purpose. To investigate the potential role of incidental heart irradiation on the risk of radiation pneumonitis (RP) for patients receiving definitive radiation therapy for non-small-cell lung cancer (NSCLC). Material and methods. Two hundred and nine patient datasets were available for this study. Heart and lung dose-volume parameters were extracted for modeling, based on Monte Carlo-based heterogeneity corrected dose distributions. Clinical variables tested included age, gender, chemotherapy, pre-treatment weight-loss, performance status, and smoking history. The risk of RP was modeled using logistic regression. Results. The most significant univariate variables were heart related, such as heart heart V65 (percent volume receiving at least 65 Gy) (Spearman Rs = 0.245, p < 0.001). The best-performing logistic regression model included heart D10 (minimum dose to the hottest 10% of the heart), lung D35, and maximum lung dose (Spearman Rs 0.268, p < 0.0001). When classified by predicted risk, the RP incidence ratio between the most and least risky 1/3 of treatments was 4.8. The improvement in risk modeling using lung and heart variables was better than using lung variables alone. Conclusions. These results suggest a previously unsuspected role of heart irradiation in many cases of RP

  8. Radiation pneumonitis and fibrosis: mechanisms underlying its pathogenesis and implications for future research.

    Science.gov (United States)

    Tsoutsou, Pelagia G; Koukourakis, Michael I

    2006-12-01

    Radiation pneumonitis and subsequent radiation pulmonary fibrosis are the two main dose-limiting factors when irradiating the thorax that can have severe implications for patients' quality of life. In this article, the current concepts about the pathogenetic mechanisms underlying radiation pneumonitis and fibrosis are presented. The clinical course of fibrosis, a postulated acute inflammatory stage, and a late fibrotic and irreversible stage are discussed. The interplay of cells and the wide variety of molecules orchestrating the immunologic response to radiation, their interactions with specific receptors, and the cascade of events they trigger are elucidated. Finally, the implications of this knowledge with respect to the therapeutic interventions are critically presented.

  9. [Efficacy of Liangxue Jiedu Huoxue Decoction in prevention of radiation pneumonitis: a randomized controlled trial].

    Science.gov (United States)

    Xiao, Chun; Ding, Hui-Juan; Feng, Lin-Chun; Qu, Bao-Lin; Dou, Yong-Qi

    2010-07-01

    Radiation pneumonitis is one of the most common complications during radiotherapy of thoracic tumors. It impacts the quality of life of the patients and has life-threatening danger. However, there is a lack of drugs for prevention and treatment of this disease. To evaluate the efficacy of Liangxue Jiedu Huoxue Decoction, a compound traditional Chinese herbal medicine, in prevention of radiation pneumonitis. A prospective randomized clinical study was conducted. A total of 100 patients diagnosed with lung cancer from Department of Radiotherapy, Chinese PLA General Hospital, who were planning to receive radiotherapy, were randomly assigned into treatment group and control group, with 50 patients in each group. In the treatment group 3 cases were lost to follow-up and one case was excluded, while in the control group 6 cases were lost to follow-up and 2 cases were excluded. Patients in the treatment group were treated with Liangxue Jiedu Huoxue Decoction in addition to radiotherapy, while patients in the control group were treated with radiotherapy alone. The incidence rates of radiation pneumonitis in the two groups were calculated. Acute radiation injury scoring criteria by Radiation Therapy Oncology Group (RTOG), clinical-radiographic-physiologic (CRP) score system, and Karnofsky Performance Status Scale (KPS) were used to evaluate the status of the patients. The incidence rate of radiation pneumonitis was lower in the treatment group than in the control group (13.04% versus 33.33%, Pradiation pneumonitis, reduce the extent of the lung injury, alleviate the symptoms of radiation pneumonitis, and improve life quality of the patients.

  10. Usefulness of serum KL-6 and SP-D in the diagnosis of radiation pneumonitis

    International Nuclear Information System (INIS)

    Saika, Yoshinori; Doi, Kenji; Misaki, Toshimasa; Tatsumi, Tomoaki; Komori, Tsuyoshi; Narabayashi, Isamu

    2004-01-01

    The objective of this study was to investigate the usefulness of serum KL-6 and SP-D in the diagnosis of radiation pneumonitis. We measured serum KL-6 and SP-D in patients undergoing radiation therapy of the chest, primarily for lung cancer, in the Department of Radiology, Osaka Medical College and compared the results with the findings on plain chest X-ray films and thoracic computed tomography conducted at the same time. The sensitivity of serum KL-6 and SP-D for diagnosing radiation pneumonitis were 68.2% and 70.0%, respectively, the specificity were 86.6% and 80.0%, and the accuracy were 82.0% and 77.8%. Examination of the relationship between lesion extent and activity and serum KL-6 showed that serum KL-6 values were higher when the lesion extended beyond the irradiation field than when the lesion was confined to within the irradiation field and that the value tended to be lower for old lesions than for active lesions. In patients with radiation pneumonitis in whom serum KL-6 and SP-D could be measured over time, KL-6 tended to increase after the lesion was discovered by imaging, whereas SP-D increased prior to this in many cases. Examination of the comparison between before radiotherapy and just after radiotherapy in the patients with radiation pneumonitis showed that SP-D had a consistent tendency to increase. Both serum KL-6 and SP-D had a satisfactory degree of sensitivity and specificity for diagnosing radiation pneumonitis. Serum KL-6 correlated with the extent and activity of the lesions. The results suggested that serum SP-D may be helpful for the early detection of radiation pneumonitis. (author)

  11. Predictors of Radiation Pneumonitis in Patients Receiving Intensity-Modulated Radiation Therapy for Hodgkin and Non-Hodgkin Lymphoma

    Science.gov (United States)

    Pinnix, Chelsea C.; Smith, Grace L.; Milgrom, Sarah; Osborne, Eleanor M.; Reddy, Jay P.; Akhtari, Mani; Reed, Valerie; Arzu, Isidora; Allen, Pamela K.; Wogan, Christine F.; Fanale, Michele A.; Oki, Yasuhiro; Turturro, Francesco; Romaguera, Jorge; Fayad, Luis; Fowler, Nathan; Westin, Jason; Nastoupil, Loretta; Hagemeister, Fredrick B.; Rodriguez, Alma; Ahmed, Sairah; Nieto, Yago; Dabaja, Bouthaina

    2015-01-01

    Purpose Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. Methods We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP per the Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ2 test and logistic multivariate regression. Results Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grade 1–3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation (10%, P=0.019). Several dosimetric parameters predicted RP, including mean lung dose (MLD) >13.5 Gy, V20 >30%, V15 >35%, V10 >40% and V5>55%. The likelihood ratio (LR) χ2 value was highest for V5mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed or refractory lymphoma who received salvage chemotherapy and hematopoietic stem cell transplantation were at higher risk for symptomatic RP

  12. Predictors of Radiation Pneumonitis in Patients Receiving Intensity Modulated Radiation Therapy for Hodgkin and Non-Hodgkin Lymphoma

    International Nuclear Information System (INIS)

    Pinnix, Chelsea C.; Smith, Grace L.; Milgrom, Sarah; Osborne, Eleanor M.; Reddy, Jay P.; Akhtari, Mani; Reed, Valerie; Arzu, Isidora; Allen, Pamela K.; Wogan, Christine F.; Fanale, Michele A.; Oki, Yasuhiro; Turturro, Francesco; Romaguera, Jorge; Fayad, Luis; Fowler, Nathan; Westin, Jason; Nastoupil, Loretta; Hagemeister, Fredrick B.; Rodriguez, M. Alma

    2015-01-01

    Purpose: Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. Methods and Materials: We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ 2 test and logistic multivariate regression. Results: Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V 20 of >30%, V 15 of >35%, V 10 of >40%, and V 5 of >55%. The likelihood ratio χ 2 value was highest for V 5 >55% (χ 2  = 19.37). Conclusions: In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed or refractory lymphoma who received

  13. Predictors of radiation pneumonitis in patients receiving intensity modulated radiation therapy for Hodgkin and non-Hodgkin lymphoma.

    Science.gov (United States)

    Pinnix, Chelsea C; Smith, Grace L; Milgrom, Sarah; Osborne, Eleanor M; Reddy, Jay P; Akhtari, Mani; Reed, Valerie; Arzu, Isidora; Allen, Pamela K; Wogan, Christine F; Fanale, Michele A; Oki, Yasuhiro; Turturro, Francesco; Romaguera, Jorge; Fayad, Luis; Fowler, Nathan; Westin, Jason; Nastoupil, Loretta; Hagemeister, Fredrick B; Rodriguez, M Alma; Ahmed, Sairah; Nieto, Yago; Dabaja, Bouthaina

    2015-05-01

    Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ(2) test and logistic multivariate regression. Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V20 of >30%, V15 of >35%, V10 of >40%, and V5 of >55%. The likelihood ratio χ(2) value was highest for V5 >55% (χ(2) = 19.37). In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed or refractory lymphoma who received salvage chemotherapy and hematopoietic stem cell transplantation

  14. Relationship between radiation pneumonitis and prognosis in patients with primary lung cancer treated by radiotherapy.

    Science.gov (United States)

    Yamano, Mototsugu; Ogino, Hiroyuki; Shibamoto, Yuta; Horii, Naotoshi

    2007-01-01

    Relationship between the grade of radiation pneumonitis (RP) and treatment outcome in lung cancer patients has not been clarified yet. The purpose of this study was to retrospectively evaluate the relationship in patients with primary lung cancer treated by radiotherapy. One hundred thirty-five patients who underwent definitive radiotherapy with known grade of RP were analyzed. RP was scored by using the Radiation Therapy Oncology Group (RTOG) acute radiation morbidity scoring criteria. Survival and local control data were analyzed in relation to the grade of RP. RP was grade 0 in 5 patients, grade 1 in 71, grade 2 in 39, grade 3 in 15 (11%), grade 4 in 0 and grade 5 in 5 (3.7%). There were no significant correlations between patient or tumor characteristics and grade of RP. Excluding 5 patients with grade 5 pneumonitis, survival rates were similar between those with grade 0 or 1 pneumonitis and those with grade 2 or 3. Also, there was no difference in survival between patients with grade 0-2 pneumonitis and those with grade 3. Local control rates were similar between the two groups. Grade of RP did not appear to be associated with prognosis when patients with grade 5 pneumonitis were excluded from analysis.

  15. Effects of some nonsteroidal anti-inflammatory agents on experimental radiation pneumonitis

    International Nuclear Information System (INIS)

    Gross, N.J.; Holloway, N.O.; Narine, K.R.

    1991-01-01

    Corticosteroids have previously been found to be protective against the mortality of radiation pneumonitis in mice, even when given well after lethal lung irradiation. The authors explored the possibility that this effect was due to their well-known anti-inflammatory actions by giving various nonsteroidal inhibitors of arachidonate metabolism to groups of mice that had received 19 Gy to the thorax (bilaterally). Treatments of four cyclooxygenase inhibitors, one lipoxygenase inhibitor, and one leukotriene receptor antagonist, given by various routes in various doses, were commenced 10 weeks after irradiation or sham irradiation and continued throughout the period when death from radiation pneumonitis occurs, 11-26 weeks after irradiation. Each of the treatments had the appropriate effect on arachidonate metabolism in the lungs as assessed by LTB4 and PGE2 levels in lung lavage fluid. The principal end point was mortality. The 5-lipoxygenase inhibitor diethylcarbamazine and the LTD4/LTE4 receptor antagonist LY 171883 markedly reduced mortality in dose-response fashion. The effects of cyclooxygenase inhibitors were divergent; piroxicam and ibuprofen were marginally protective, indomethacin in all doses accelerated mortality, and aspirin reduced mortality in a dose-response fashion. These results suggest that the protective effect of corticosteroids in radiation pneumonitis can be tentatively attributed to their anti-inflammatory actions, and that nonsteroidal anti-inflammatory agents, particularly those that affect lipoxygenase products, may offer equal or better protection than corticosteroids against mortality due to radiation pneumonitis

  16. Effects of some nonsteroidal anti-inflammatory agents on experimental radiation pneumonitis

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    Gross, N.J.; Holloway, N.O.; Narine, K.R. (Medical Radiology Service, Hines VA Hospital, Maywood, IL (United States))

    1991-09-01

    Corticosteroids have previously been found to be protective against the mortality of radiation pneumonitis in mice, even when given well after lethal lung irradiation. The authors explored the possibility that this effect was due to their well-known anti-inflammatory actions by giving various nonsteroidal inhibitors of arachidonate metabolism to groups of mice that had received 19 Gy to the thorax (bilaterally). Treatments of four cyclooxygenase inhibitors, one lipoxygenase inhibitor, and one leukotriene receptor antagonist, given by various routes in various doses, were commenced 10 weeks after irradiation or sham irradiation and continued throughout the period when death from radiation pneumonitis occurs, 11-26 weeks after irradiation. Each of the treatments had the appropriate effect on arachidonate metabolism in the lungs as assessed by LTB4 and PGE2 levels in lung lavage fluid. The principal end point was mortality. The 5-lipoxygenase inhibitor diethylcarbamazine and the LTD4/LTE4 receptor antagonist LY 171883 markedly reduced mortality in dose-response fashion. The effects of cyclooxygenase inhibitors were divergent; piroxicam and ibuprofen were marginally protective, indomethacin in all doses accelerated mortality, and aspirin reduced mortality in a dose-response fashion. These results suggest that the protective effect of corticosteroids in radiation pneumonitis can be tentatively attributed to their anti-inflammatory actions, and that nonsteroidal anti-inflammatory agents, particularly those that affect lipoxygenase products, may offer equal or better protection than corticosteroids against mortality due to radiation pneumonitis.

  17. [Non-small cell lung cancer: risk factors of radiation pneumonitis].

    Science.gov (United States)

    Giroux Leprieur, E; Fernandez, D; Chatellier, G; Klotz, S; Giraud, P; Durdux, C

    2012-01-01

    To evaluate the predictors of acute radiation pneumonitis after conformal thoracic radiotherapy in the treatment of locally advanced non-small cell lung cancer. Forty-seven consecutive patients were treated with conformal thoracic irradiation for locally advanced non-small cell lung cancer and retrospectively analysed. The mean total dose of radiotherapy was 65 Gy with respiratory gating in 19 cases. Neoadjuvant and concomitant chemotherapy was performed in 33 patients (70%) and 41 patients (87%) respectively. Eleven patients (23%) had an acute radiation pneumonitis, resulting in death for one patient. In univariate analysis, age, sex, pretherapeutic value of forced expiratory volume, non-gated radiotherapy and type of concomitant chemotherapy did not appear as contributing factors in contrast to the administration of neoadjuvant gemcitabine (P=0.03). The occurrence of acute radiation pneumonitis was significantly associated with non-tumour lung volumes irradiated to 13 Gy (V13, P=0.04), 20 Gy (V20, P=0.02) and 25 Gy (V25, P=0.006), the mean lung dose (P=0.008) and lung normal tissue complication probability (P=0.004). In multivariate logistic regression analysis, the occurrence of acute radiation pneumonitis was significantly associated with age above 75 years (odds ratio [OR]=16.72 ; P=0.02) and with administration of neoadjuvant gemcitabine (OR=18.08, P=0.04). Acute radiation pneumonitis is a common acute side effect of the conformal thoracic radiotherapy of locally advanced non-small cell lung cancer, requiring close post-treatment follow-up, particularly for elderly patients. The use of gemcitabine before radiation should be avoided. The benefits and risks of conformal thoracic radiotherapy must be carefully analyzed in view of the dosimetric parameters obtained. Copyright © 2012. Published by Elsevier SAS.

  18. Imaging radiation pneumonitis in a rat model of a radiological terrorism incident

    Science.gov (United States)

    Molthen, Robert; Wu, QingPing; Krenz, Gary; Medhora, Meetha; Jacobs, Elizabeth; Moulder, John E.

    2009-02-01

    We have developed a rat model of single, sub-lethal thoracic irradiation. Our irradiation protocol is considered representative of exposures near the detonation site of a dirty bomb or small nuclear device. The model is being used to investigate techniques for identifying, triaging and treating possible victims. In addition to physiological markers of right ventricular hypertrophy, pulmonary vascular resistance, and arterial distensibility, we present two methods for quantifying microvascular density. We used methods including microfocal X-ray imaging to investigate changes in lung structure/function resulting from radiation exposure. Radiation pneumonitis is a complication in subjects receiving thoracic irradiation. A radiographic hallmark of acute radiation pneumonitis is a diffuse infiltrate corresponding to the radiation treatment field. We describe two methods for quantifying small artery dropout that occurs in the model at the same time-period. Rats were examined 3-days, 2-weeks, 1-month (m), 2-m, 5-m, and 12-m post-irradiation and compared with aged-matched controls. Right ventricular hypertrophy and increases in pulmonary vascular resistance were present during the pneumonitis phase. Vascular injury was dependent on dose and post-irradiation duration. Rats irradiated with 5 Gy had few detectable changes, whereas 10 Gy resulted in a significant decrease in both microvascular density and arterial distensibility around 2- m, the decrease in each lessening, but extending through 12-m. In conclusion, rats irradiated with a 10 Gy dose had changes in vascular structure concurrent with the onset of radiation pneumonitis that were detectable with our imaging techniques and these structural changes persist after resolution of the pneumonitis.

  19. A selenocysteine derivative therapy affects radiation-induced pneumonitis in the mouse.

    Science.gov (United States)

    Kunwar, Amit; Jain, V K; Priyadarsini, K I; Haston, Christina K

    2013-10-01

    The mechanism leading to the radiation-induced lung response of pneumonitis is largely unknown. Here we investigated whether treatment with 3,3'-diselenodipropionic acid (DSePA), which reduces radiation-induced oxidative stress in acute response models, decreases the lung response to irradiation. Mice of the C3H/HeJ (alveolitis/pneumonitis-responding) strain received 18 Gy whole-thorax irradiation, and a subset of these mice was treated with DSePA (2 mg/kg) three times per week, beginning at 2 hours after radiation treatment, and continuing in the postirradiation period until death because of respiratory distress symptoms. DSePA treatment increased the postirradiation survival time of mice by an average of 32 days (P = 0.0002). Radiation-treated and DSePA-treated mice presented lower levels of lipid peroxidation and augmented glutathione peroxidase in the lungs, compared with those levels measured in mice receiving radiation only, when mice receiving radiation only were killed because of distress symptoms, whereas catalase and superoxide dismutase levels did not show consistent differences among treatment groups. DSePA treatment decreased pneumonitis and the numbers of mast cells, neutrophils, and lymphocytes in the lungs and bronchoalveolar lavage, respectively, of irradiated mice relative to mice exposed to radiation alone. DSePA treatment also decreased the radiation-induced increase in granulocyte colony-stimulating factor levels in the bronchoalveolar lavage and lung-tissue expression of intercellular adhesion molecule-1 and E-selectin, while increasing the expression of glutathione peroxidase-4. We conclude that DSePA treatment reduces radiation-induced pneumonitis in mice by delaying oxidative damage and the inflammatory cell influx.

  20. Bronchiolitis obliterans organizing pneumonia after tangential beam irradiation to the breast. Discrimination from radiation pneumonitis

    International Nuclear Information System (INIS)

    Nambu, Atsushi; Ozawa, Katsura; Kanazawa, Masaki; Miyata, Kazuyuki; Araki, Tsutomu; Ohki, Zennosuke

    2002-01-01

    We report a case of bronchiolitis obliterans organizing pneumonia (BOOP) secondary to tangential beam irradiation to the breast, which occurred seven months after the completion of radiotherapy. Although radiation pneumonitis is an alternative consideration, BOOP could be differentiated from it by its relatively late onset and extensive distribution, which did not respect the radiation field. This disease should always be kept in mind in patients with a history of tangential beam irradiation to the breast. (author)

  1. A Combination of Podophyllotoxin and Rutin Alleviates Radiation-Induced Pneumonitis and Fibrosis through Modulation of Lung Inflammation in Mice

    Directory of Open Access Journals (Sweden)

    Savita Verma

    2017-06-01

    Full Text Available Pneumonitis and pulmonary fibrosis are predominant consequences of radiation exposure, whether planned or accidental. The present study, demonstrates radioprotective potential of a formulation, prepared by combining podophyllotoxin and rutin (G-003M, in mice exposed to 11 Gy thoracic gamma radiation (TGR. Treated mice were observed for survival and other symptomatic features. Formation of reactive oxygen species (ROS/nitric oxide (NO was measured in bronchoalveolar lavage cells. DNA damage and cell death were assessed in alveolar cells by terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. Total protein (TP, lactate dehydrogenase (LDH, and alkaline phosphatase (ALP were measured in bronchoalveolar lavage fluid (BALF/serum of mice to assess lung vascular permeability. Interleukin-6 (IL-6, tumor necrosis factor-α (TNF-α, transforming growth factor-β1 (TGF-β1, cluster of differentiation 45, inducible nitric oxide synthase (iNOS, and nitrotyrosine were also estimated in lungs/BALF of differentially treated mice. Our observations revealed 100% survival in G-003M-pretreated mice against 66.50% in 11 Gy TGR exposed. Other symptoms like reduction in graying of hair, weight loss, and breathing rate were also observed in pretreated groups. Significant decline in ROS/NO and cell death in formulation pretreated mice were also observed. Decreased level of TP, LDH, and ALP in BALF/serum samples revealed G-003M-induced inhibition in lung permeability. Level of IL-6, TNF-α, and TGF-β1 in the lungs of these mice was found corresponding to control group at 8 weeks posttreatment. On the contrary, these cytokines raised significantly in 11 Gy TGR-exposed mice. Lung pneumonitis and fibrosis were found significantly countered in these mice. The observations revealed that G-003M could regulate immune system by curtailing radiation-induced oxidative and inflammatory stress, which has helped in minimizing radiation-inflicted pneumonitis and

  2. Predictors of Radiation Pneumonitis in Patients Receiving Intensity Modulated Radiation Therapy for Hodgkin and Non-Hodgkin Lymphoma

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    Pinnix, Chelsea C., E-mail: ccpinnix@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Smith, Grace L.; Milgrom, Sarah; Osborne, Eleanor M.; Reddy, Jay P.; Akhtari, Mani; Reed, Valerie; Arzu, Isidora; Allen, Pamela K.; Wogan, Christine F. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Fanale, Michele A.; Oki, Yasuhiro; Turturro, Francesco; Romaguera, Jorge; Fayad, Luis; Fowler, Nathan; Westin, Jason; Nastoupil, Loretta; Hagemeister, Fredrick B.; Rodriguez, M. Alma [Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); and others

    2015-05-01

    Purpose: Few studies to date have evaluated factors associated with the development of radiation pneumonitis (RP) in patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL), especially in patients treated with contemporary radiation techniques. These patients represent a unique group owing to the often large radiation target volumes within the mediastinum and to the potential to receive several lines of chemotherapy that add to pulmonary toxicity for relapsed or refractory disease. Our objective was to determine the incidence and clinical and dosimetric risk factors associated with RP in lymphoma patients treated with intensity modulated radiation therapy (IMRT) at a single institution. Methods and Materials: We retrospectively reviewed clinical charts and radiation records of 150 consecutive patients who received mediastinal IMRT for HL and NHL from 2009 through 2013. Clinical and dosimetric predictors associated with RP according to Radiation Therapy Oncology Group (RTOG) acute toxicity criteria were identified in univariate analysis using the Pearson χ{sup 2} test and logistic multivariate regression. Results: Mediastinal radiation was administered as consolidation therapy in 110 patients with newly diagnosed HL or NHL and in 40 patients with relapsed or refractory disease. The overall incidence of RP (RTOG grades 1-3) was 14% in the entire cohort. Risk of RP was increased for patients who received radiation for relapsed or refractory disease (25%) versus those who received consolidation therapy (10%, P=.019). Several dosimetric parameters predicted RP, including mean lung dose of >13.5 Gy, V{sub 20} of >30%, V{sub 15} of >35%, V{sub 10} of >40%, and V{sub 5} of >55%. The likelihood ratio χ{sup 2} value was highest for V{sub 5} >55% (χ{sup 2} = 19.37). Conclusions: In using IMRT to treat mediastinal lymphoma, all dosimetric parameters predicted RP, although small doses to large volumes of lung had the greatest influence. Patients with relapsed

  3. Impact of Preexisting Interstitial Lung Disease on Acute, Extensive Radiation Pneumonitis: Retrospective Analysis of Patients with Lung Cancer.

    Science.gov (United States)

    Ozawa, Yuichi; Abe, Takefumi; Omae, Minako; Matsui, Takashi; Kato, Masato; Hasegawa, Hirotsugu; Enomoto, Yasunori; Ishihara, Takeaki; Inui, Naoki; Yamada, Kazunari; Yokomura, Koshi; Suda, Takafumi

    2015-01-01

    This study investigated the clinical characteristics and predictive factors for developing acute extended radiation pneumonitis with a focus on the presence and radiological characteristics of preexisting interstitial lung disease. Of 1429 irradiations for lung cancer from May 2006 to August 2013, we reviewed 651 irradiations involving the lung field. The presence, compatibility with usual interstitial pneumonia, and occupying area of preexisting interstitial lung disease were retrospectively evaluated by pretreatment computed tomography. Cases of non-infectious, non-cardiogenic, acute respiratory failure with an extended bilateral shadow developing within 30 days after the last irradiation were defined as acute extended radiation pneumonitis. Nine (1.4%) patients developed acute extended radiation pneumonitis a mean of 6.7 days after the last irradiation. Although preexisting interstitial lung disease was found in 13% of patients (84 patients), 78% of patients (7 patients) with acute extended radiation pneumonitis cases had preexisting interstitial lung disease, which resulted in incidences of acute extended radiation pneumonitis of 0.35 and 8.3% in patients without and with preexisting interstitial lung disease, respectively. Multivariate logistic analysis indicated that the presence of preexisting interstitial lung disease (odds ratio = 22.6; 95% confidence interval = 5.29-155; p acute extended radiation pneumonitis (odds ratio = 6.14; 95% confidence interval = 1.0-37.4); p = 0.038). Pretreatment computed tomography evaluations of the presence of and area size occupied by preexisting interstitial lung disease should be assessed for safer irradiation of areas involving the lung field.

  4. Experimental treatment of radiation pneumonitis with human umbilical cord mesenchymal stem cells.

    Science.gov (United States)

    Wang, Rui; Zhu, Chang-zheng; Qiao, Ping; Liu, Jian; Zhao, Qiang; Wang, Kui-jie; Zhao, Ting-bao

    2014-04-01

    To evaluate of the curative effect of human umbilical cord mesenchymal stem cells (hUC-MSCs) on rat acute radiation pneumonitis. Fourty rats were randomly divided into control group, radiation group, stem cell prevention group, stem cell treatment group and prednisone treatment group. All rats except those in the control group were radiated with X ray to establish the acute radiation pneumonitis damage model. The hUC-MSCs cultured in vitro was administrated to the rats of the prevention group via tail vein (1×10(6) cells/kg BW) 24 h before the radiation, while the same administration was performed in the rats of the treatment group 24 h after the radiation. After 24 h post the radiation, the rats in the radiation group were given 0.4 mL physiological saline, and those in the prednisone group were given 1 mg/kg prednisone. All rats were observed and executed 72 h after the radiation to detect lung histological changes. After the administration of hUC-MSCs, the survival status of the rats in the prevention group and treatment group was obviously better than that in the control group. As shown by the histological staining, the morphology, proliferation activity and bronchial state of lung tissues were better in the prevention group and treatment group than in the control group. The hUC-MSCs have definite therapeutic effects on acute radiation pneumonitis in rats. Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  5. Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer

    OpenAIRE

    Zhao, Yaqin; Chen, Lu; Zhang, Shu; Wu, Qiang; Jiang, Xiaoqin; Zhu, Hong; Wang, Jin; Li, Zhiping; Xu, Yong; Zhang, Ying Jie; Bai, Sen; Xu, Feng

    2015-01-01

    Background Radiation pneumonitis (RP) is a common side reaction in radiotherapy for esophageal cancer. There are few reports about RP in esophageal cancer patients receiving postoperative intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). This study aims to analyze clinical or dosimetric factors associated with RP, and provides data for radiotherapy planning. Methods We reviewed 68 postoperative esophageal cancer patients who were treated with radiothera...

  6. Predictive factors for acute radiation pneumonitis in postoperative intensity modulated radiation therapy and volumetric modulated arc therapy of esophageal cancer.

    Science.gov (United States)

    Zhao, Yaqin; Chen, Lu; Zhang, Shu; Wu, Qiang; Jiang, Xiaoqin; Zhu, Hong; Wang, Jin; Li, Zhiping; Xu, Yong; Zhang, Ying Jie; Bai, Sen; Xu, Feng

    2015-01-01

    Radiation pneumonitis (RP) is a common side reaction in radiotherapy for esophageal cancer. There are few reports about RP in esophageal cancer patients receiving postoperative intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). This study aims to analyze clinical or dosimetric factors associated with RP, and provides data for radiotherapy planning. We reviewed 68 postoperative esophageal cancer patients who were treated with radiotherapy at the West China Hospital from October 2010 to November 2012 to identify any correlation between the clinical or dosimetric parameters and acute radiation pneumonitis (ARP) or severe acute radiation pneumonitis (SARP) by t-test, chi-square test, and logistic regression analysis. Of the 68 patients, 33 patients (48.5%) developed ARP, 13 of which (19.1%) developed SARP. Of these 33 patients, 8 (11.8%), 12 (17.6%), 11 (16.2%), and 2 (2.9%) patients were grade 1, 2, 3, and 4 ARP, respectively. Univariate analysis showed that lung infection during radiotherapy, use of VMAT, mean lung dose (MLD), and dosimetric parameters (e.g. V20, V30) are significantly correlated with RP. Multivariate analysis found that lung infection during radiotherapy, MLD ≥ 12 Gy, and V30 ≥ 13% are significantly correlated with an increased risk of RP. Lung infection during radiotherapy and low radiation dose volume distribution were predictive factors associated with RP and should be accounted for during radiation planning.

  7. Decreased Risk of Radiation Pneumonitis With Incidental Concurrent Use of Angiotensin-Converting Enzyme Inhibitors and Thoracic Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kharofa, Jordan [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Cohen, Eric P. [Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI (United States); Tomic, Rade [Department of Medicine, Division of Pulmonology, Medical College of Wisconsin, Milwaukee, WI (United States); Xiang Qun [Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI (United States); Gore, Elizabeth, E-mail: Egore@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)

    2012-09-01

    Purpose: Angiotensin-converting enzyme (ACE) inhibitors have been shown to mitigate radiation-induced lung injury in preclinical models. The aim of this study was to evaluate whether ACE inhibitors decrease the risk of radiation pneumonitis in lung cancer patients receiving thoracic irradiation. Methods and Materials: Patients with Stage I through III small-cell and non-small-cell lung cancer treated definitively with radiation from 2004-2009 at the Clement J. Zablocki Veterans Affairs Medical Center were retrospectively reviewed. Acute pulmonary toxicity was quantified within 6 months of completion of treatment according to the Common Terminology Criteria for Adverse Events version 4. The use of ACE inhibitors, nonsteroidal anti-inflammatory drugs, inhaled glucocorticosteroids, statins, and angiotensin receptor blockers; dose-volume histogram parameters; and patient factors were assessed for association with Grade 2 or higher pneumonitis. Results: A total of 162 patients met the criteria for inclusion. The majority of patients had Stage III disease (64%) and received concurrent chemotherapy (61%). Sixty-two patients were identified as ACE inhibitor users (38%). All patients had acceptable radiation plans based on dose-volume histogram constraints (V20 [volume of lung receiving at least 20 Gy] {<=}37% and mean lung dose {<=}20 Gy) with the exception of 2 patients who did not meet both criteria. Grade 2 or higher pulmonary toxicity occurred in 12 patients (7.4%). The rate of Grade 2 or higher pneumonitis was lower in ACE inhibitor users vs. nonusers (2% vs. 11%, p = 0.032). Rates of Grade 2 or higher pneumonitis were significantly increased in patients aged greater than 70 years (16% vs. 2%, p = 0.005) or in whom V5 (volume of lung receiving at least 5 Gy) was 50% or greater (13% vs. 4%, p = 0.04). V10 (volume of lung receiving at least 10 Gy), V20, V30 (volume of lung receiving at least 30 Gy), and mean lung dose were not independently associated with Grade 2 or

  8. Decreased risk of radiation pneumonitis with incidental concurrent use of angiotensin-converting enzyme inhibitors and thoracic radiation therapy.

    Science.gov (United States)

    Kharofa, Jordan; Cohen, Eric P; Tomic, Rade; Xiang, Qun; Gore, Elizabeth

    2012-09-01

    Angiotensin-converting enzyme (ACE) inhibitors have been shown to mitigate radiation-induced lung injury in preclinical models. The aim of this study was to evaluate whether ACE inhibitors decrease the risk of radiation pneumonitis in lung cancer patients receiving thoracic irradiation. Patients with Stage I through III small-cell and non-small-cell lung cancer treated definitively with radiation from 2004-2009 at the Clement J. Zablocki Veterans Affairs Medical Center were retrospectively reviewed. Acute pulmonary toxicity was quantified within 6 months of completion of treatment according to the Common Terminology Criteria for Adverse Events version 4. The use of ACE inhibitors, nonsteroidal anti-inflammatory drugs, inhaled glucocorticosteroids, statins, and angiotensin receptor blockers; dose-volume histogram parameters; and patient factors were assessed for association with Grade 2 or higher pneumonitis. A total of 162 patients met the criteria for inclusion. The majority of patients had Stage III disease (64%) and received concurrent chemotherapy (61%). Sixty-two patients were identified as ACE inhibitor users (38%). All patients had acceptable radiation plans based on dose-volume histogram constraints (V20 [volume of lung receiving at least 20 Gy] ≤37% and mean lung dose ≤20 Gy) with the exception of 2 patients who did not meet both criteria. Grade 2 or higher pulmonary toxicity occurred in 12 patients (7.4%). The rate of Grade 2 or higher pneumonitis was lower in ACE inhibitor users vs. nonusers (2% vs. 11%, p = 0.032). Rates of Grade 2 or higher pneumonitis were significantly increased in patients aged greater than 70 years (16% vs. 2%, p = 0.005) or in whom V5 (volume of lung receiving at least 5 Gy) was 50% or greater (13% vs. 4%, p = 0.04). V10 (volume of lung receiving at least 10 Gy), V20, V30 (volume of lung receiving at least 30 Gy), and mean lung dose were not independently associated with Grade 2 or higher pneumonitis. ACE inhibitors may

  9. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma

    International Nuclear Information System (INIS)

    Allen, Aaron M.; Czerminska, Maria; Jaenne, Pasi A.; Sugarbaker, David J.; Bueno, Raphael; Harris, Jay R.; Court, Laurence; Baldini, Elizabeth H.

    2006-01-01

    Purpose: To describe the initial experience at Dana-Farber Cancer Institute/Brigham and Women's Hospital with intensity-modulated radiation therapy (IMRT) as adjuvant therapy after extrapleural pneumonectomy (EPP) and adjuvant chemotherapy. Methods and Materials: The medical records of patients treated with IMRT after EPP and adjuvant chemotherapy were retrospectively reviewed. IMRT was given to a dose of 54 Gy to the clinical target volume in 1.8 Gy daily fractions. Treatment was delivered with a dynamic multileaf collimator using a sliding window technique. Eleven of 13 patients received heated intraoperative cisplatin chemotherapy (225 mg/m 2 ). Two patients received neoadjuvant intravenous cisplatin/pemetrexed, and 10 patients received adjuvant cisplatin/pemetrexed chemotherapy after EPP but before radiation therapy. All patients received at least 2 cycles of intravenous chemotherapy. The contralateral lung was limited to a V20 (volume of lung receiving 20 Gy or more) of 20% and a mean lung dose (MLD) of 15 Gy. All patients underwent fluorodeoxyglucose positron emission tomography (FDG-PET) for staging, and any FDG-avid areas in the hemithorax were given a simultaneous boost of radiotherapy to 60 Gy. Statistical comparisons were done using two-sided t test. Results: Thirteen patients were treated with IMRT from December 2004 to September 2005. Six patients developed fatal pneumonitis after treatment. The median time from completion of IMRT to the onset of radiation pneumonitis was 30 days (range 5-57 days). Thirty percent of patients (4 of 13) developed acute Grade 3 nausea and vomiting. One patient developed acute Grade 3 thrombocytopenia. The median V20, MLD, and V5 (volume of lung receiving 5 Gy or more) for the patients who developed pneumonitis was 17.6% (range, 15.3-22.3%), 15.2 Gy (range, 13.3-17 Gy), and 98.6% (range, 81-100%), respectively, as compared with 10.9% (range, 5.5-24.7%) (p = 0.08), 12.9 Gy (range, 8.7-16.9 Gy) (p = 0.07), and 90% (range, 66

  10. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma.

    Science.gov (United States)

    Allen, Aaron M; Czerminska, Maria; Jänne, Pasi A; Sugarbaker, David J; Bueno, Raphael; Harris, Jay R; Court, Laurence; Baldini, Elizabeth H

    2006-07-01

    To describe the initial experience at Dana-Farber Cancer Institute/Brigham and Women's Hospital with intensity-modulated radiation therapy (IMRT) as adjuvant therapy after extrapleural pneumonectomy (EPP) and adjuvant chemotherapy. The medical records of patients treated with IMRT after EPP and adjuvant chemotherapy were retrospectively reviewed. IMRT was given to a dose of 54 Gy to the clinical target volume in 1.8 Gy daily fractions. Treatment was delivered with a dynamic multileaf collimator using a sliding window technique. Eleven of 13 patients received heated intraoperative cisplatin chemotherapy (225 mg/m(2)). Two patients received neoadjuvant intravenous cisplatin/pemetrexed, and 10 patients received adjuvant cisplatin/pemetrexed chemotherapy after EPP but before radiation therapy. All patients received at least 2 cycles of intravenous chemotherapy. The contralateral lung was limited to a V20 (volume of lung receiving 20 Gy or more) of 20% and a mean lung dose (MLD) of 15 Gy. All patients underwent fluorodeoxyglucose positron emission tomography (FDG-PET) for staging, and any FDG-avid areas in the hemithorax were given a simultaneous boost of radiotherapy to 60 Gy. Statistical comparisons were done using two-sided t test. Thirteen patients were treated with IMRT from December 2004 to September 2005. Six patients developed fatal pneumonitis after treatment. The median time from completion of IMRT to the onset of radiation pneumonitis was 30 days (range 5-57 days). Thirty percent of patients (4 of 13) developed acute Grade 3 nausea and vomiting. One patient developed acute Grade 3 thrombocytopenia. The median V20, MLD, and V5 (volume of lung receiving 5 Gy or more) for the patients who developed pneumonitis was 17.6% (range, 15.3-22.3%), 15.2 Gy (range, 13.3-17 Gy), and 98.6% (range, 81-100%), respectively, as compared with 10.9% (range, 5.5-24.7%) (p = 0.08), 12.9 Gy (range, 8.7-16.9 Gy) (p = 0.07), and 90% (range, 66-98.3%) (p = 0.20), respectively, for the

  11. Radiation therapy-related toxicity (including pneumonitis and fibrosis).

    Science.gov (United States)

    Chopra, Rahul R; Bogart, Jeffrey A

    2009-05-01

    In the modern age of cancer therapy, advances in the multidisciplinary management of cancer have resulted in increased rates of survivorship. Radiation therapy (RT) toxicity must be tempered with the desire to achieve dose escalation to provide the best chance of long-term cure. This article is designed to acquaint emergency medicine physicians with common, expected, and potential acute and late complications of RT.

  12. Radiation recall pneumonitis induced by erlotinib after palliative thoracic radiotherapy for lung cancer: Case report and literature review.

    Science.gov (United States)

    Awad, Raef; Nott, Louise

    2016-03-01

    Radiation lung injury usually develops 1-6 months after cessation of radiation therapy to the lung. Acute change in the previously irradiated lung after administration of antineoplastic agent is known as radiation recall pneumonitis. Erlotinib is a reversible epidemal growth factor receptor tyrosine kinase inhibitor, which is effective for patients with advanced lung cancer with epidermal growth factor receptor mutations. Here we report a rare case of radiation recall pneumonitis following treatment with erlotinib 4 months after palliative radiotherapy to the lung. A 76-year-old man with non-small cell lung cancer was treated with polychemotherapy, palliative thoracic irradiation (30 Gy in 12 fractions) and erlotinib thereafter. Two months after administration of erlotinib he developed of severe dyspnea, cough, anorexia and lack of energy. CT chest revealed extensive radiation pneumonitis. Erlotinib was ceased and high-dose steroids were started. The symptoms ultimately resolved and erlotinib was resumed cautiously after 11 weeks. On dosimetric analysis, lung V20 and the mean lung dose were 20.33% and 10.7 Gy, respectively, and hence, the risk of radiation pneumonitis is very low. These data indicate that systemic administration of erlotinib after low-dose palliative radiation therapy can be associated with unexpected toxicity when visceral organs are within the radiation field. © 2016 John Wiley & Sons Australia, Ltd.

  13. Lyman-Kutcher-Burman NTCP model parameters for radiation pneumonitis and xerostomia based on combined analysis of published clinical data.

    Science.gov (United States)

    Semenenko, V A; Li, X A

    2008-02-07

    Knowledge of accurate parameter estimates is essential for incorporating normal tissue complication probability (NTCP) models into biologically based treatment planning. The purpose of this work is to derive parameter estimates for the Lyman-Kutcher-Burman (LKB) NTCP model using a combined analysis of multi-institutional toxicity data for the lung (radiation pneumonitis) and parotid gland (xerostomia). A series of published clinical datasets describing dose response for radiation pneumonitis (RP) and xerostomia were identified for this analysis. The data support the notion of large volume effect for the lung and parotid gland with the estimates of the n parameter being close to unity. Assuming that n = 1, the m and TD(50) parameters of the LKB model were estimated by the maximum likelihood method from plots of complication rate as a function of mean organ dose. Ninety five percent confidence intervals for parameter estimates were obtained by the profile likelihood method. If daily fractions other than 2 Gy had been used in a published report, mean organ doses were converted to 2 Gy/fraction-equivalent doses using the linear-quadratic (LQ) formula with alpha/beta = 3 Gy. The following parameter estimates were obtained for the endpoint of symptomatic RP when the lung is considered a paired organ: m = 0.41 (95% CI 0.38, 0.45) and TD(50) = 29.9 Gy (95% CI 28.2, 31.8). When RP incidence was evaluated as a function of dose to the ipsilateral lung rather than total lung, estimates were m = 0.35 (95% CI 0.29, 0.43) and TD(50) = 37.6 Gy (95% CI 34.6, 41.4). For xerostomia expressed as reduction in stimulated salivary flow below 25% within six months after radiotherapy, the following values were obtained: m = 0.53 (95% CI 0.45, 0.65) and TD(50) = 31.4 Gy (95% CI 29.1, 34.0). Although a large number of parameter estimates for different NTCP models and critical structures exist and continue to appear in the literature, it is hard to justify the use of any single parameter set

  14. Impact of Preexisting Interstitial Lung Disease on Acute, Extensive Radiation Pneumonitis: Retrospective Analysis of Patients with Lung Cancer.

    Directory of Open Access Journals (Sweden)

    Yuichi Ozawa

    Full Text Available This study investigated the clinical characteristics and predictive factors for developing acute extended radiation pneumonitis with a focus on the presence and radiological characteristics of preexisting interstitial lung disease.Of 1429 irradiations for lung cancer from May 2006 to August 2013, we reviewed 651 irradiations involving the lung field. The presence, compatibility with usual interstitial pneumonia, and occupying area of preexisting interstitial lung disease were retrospectively evaluated by pretreatment computed tomography. Cases of non-infectious, non-cardiogenic, acute respiratory failure with an extended bilateral shadow developing within 30 days after the last irradiation were defined as acute extended radiation pneumonitis.Nine (1.4% patients developed acute extended radiation pneumonitis a mean of 6.7 days after the last irradiation. Although preexisting interstitial lung disease was found in 13% of patients (84 patients, 78% of patients (7 patients with acute extended radiation pneumonitis cases had preexisting interstitial lung disease, which resulted in incidences of acute extended radiation pneumonitis of 0.35 and 8.3% in patients without and with preexisting interstitial lung disease, respectively. Multivariate logistic analysis indicated that the presence of preexisting interstitial lung disease (odds ratio = 22.6; 95% confidence interval = 5.29-155; p < 0.001 and performance status (≥2; odds ratio = 4.22; 95% confidence interval = 1.06-20.8; p = 0.049 were significant predictive factors. Further analysis of the 84 patients with preexisting interstitial lung disease revealed that involvement of more than 10% of the lung field was the only independent predictive factor associated with the risk of acute extended radiation pneumonitis (odds ratio = 6.14; 95% confidence interval = 1.0-37.4; p = 0.038.Pretreatment computed tomography evaluations of the presence of and area size occupied by preexisting interstitial lung

  15. Prevention of radiation pneumonitis from inhaled 144Ce by lung lavage in beagle dogs

    International Nuclear Information System (INIS)

    Muggenburg, B.A.; Mauderly, J.L.; Boecker, B.B.; Hahn, F.F.; McClellan, R.O.

    1975-01-01

    This study was performed to evaluate bronchopulmonary lavage and chelation therapy as a treatment method to prevent the development of radiation pneumonitis after inhalation of a radioactive aerosol. Twelve beagle dogs were exposed to an aerosol of cerium-144 in fused clay particles resulting in initial lung burdens from 47 to 64 μCi of 144 Ce per kg of body weight. Eight of the dogs were treated with a series of 10 bronchopulmonary lavages and 10 intravenous injections of calcium diethylenetriamine pentaacetate acid during the first 56 days after exposure to remove the deposited 144 Ce; the remaining 4 exposed dogs received no treatment. An additional 4 dogs were exposed to stable cerium and were given the course of treatment as an additional control group. Three of the 4 untreated dogs and 2 of the 8 treated dogs died 171 to 246 days after exposure with radiation pneumonitis or pulmonary fibrosis, or both. All but one of the remaining dogs were alive and apparently in good clinical health 550 days after exposure; the one dog had radiographic indications of pulmonary fibrosis by 365 days after exposure. The relative distribution of 144 Ce in the lungs and other major organs was similar in the treated and untreated dogs that died

  16. Combining multiple models to generate consensus: Application to radiation-induced pneumonitis prediction

    International Nuclear Information System (INIS)

    Das, Shiva K.; Chen Shifeng; Deasy, Joseph O.; Zhou Sumin; Yin Fangfang; Marks, Lawrence B.

    2008-01-01

    The fusion of predictions from disparate models has been used in several fields to obtain a more realistic and robust estimate of the ''ground truth'' by allowing the models to reinforce each other when consensus exists, or, conversely, negate each other when there is no consensus. Fusion has been shown to be most effective when the models have some complementary strengths arising from different approaches. In this work, we fuse the results from four common but methodologically different nonlinear multivariate models (Decision Trees, Neural Networks, Support Vector Machines, Self-Organizing Maps) that were trained to predict radiation-induced pneumonitis risk on a database of 219 lung cancer patients treated with radiotherapy (34 with Grade 2+ postradiotherapy pneumonitis). Each model independently incorporated a small number of features from the available set of dose and nondose patient variables to predict pneumonitis; no two models had all features in common. Fusion was achieved by simple averaging of the predictions for each patient from all four models. Since a model's prediction for a patient can be dependent on the patient training set used to build the model, the average of several different predictions from each model was used in the fusion (predictions were made by repeatedly testing each patient with a model built from different cross-validation training sets that excluded the patient being tested). The area under the receiver operating characteristics curve for the fused cross-validated results was 0.79, with lower variance than the individual component models. From the fusion, five features were extracted as the consensus among all four models in predicting radiation pneumonitis. Arranged in order of importance, the features are (1) chemotherapy; (2) equivalent uniform dose (EUD) for exponent a=1.2 to 3; (3) EUD for a=0.5 to 1.2, lung volume receiving >20-30 Gy; (4) female sex; and (5) squamous cell histology. To facilitate ease of interpretation and

  17. Effects of tobacco-smoke on radiation-induced pneumonitis in rats

    International Nuclear Information System (INIS)

    Nilsson, K.; Henriksson, R.; Cai, Y.-Q.; Hellstroem, S.; Bjermer, L.; Hoernqvist Bylunds, S.

    1992-01-01

    To investigate the effect of exposure to tobacco smoke (TS) on the development of irradiation-induced pneumonitis in rats, five groups of animals were investigated including controls (C), tobacco smoke exposed (S), irradiated (RNS) and irradiated and tobacco smoke exposed (RS). An additional group (RS/NS) was exposed to tobacco before irradiation but not afterwards. Results indicate that smoking suppresses the radiation-induced inflammation but to a lesser degree affects the radiation-induced increase in membrane permeability as reflected by increased protein levels in BAL. Moreover, the marked effects on the numbers of mast cells and neutrophils in the RS group may indicate that these cells play an important role in the mechanism by which tobacco smoke modulates the effects of irradiation. When exposure to tobacco smoke was terminated immediately after irradiation (RS/NS), the inflammatory response was unaffected. (author)

  18. Pathogenesis and symptomatics of the acute radiation syndrome

    International Nuclear Information System (INIS)

    Fliedner, T.M.; Haen, M.; Carbonell, F.

    1980-01-01

    The pathogenesis and symptomatics of the acute radiation syndrome are discussed. Diagnosis and therapy would be impossible without detailed knowledge in these fields. The concept of acute radiation syndrome is explained, and a pathophysiological analysis of the various forms of radiation syndrome - haematological, intestinal and affecting the central nervous system is attempted. The developments in the diagnosis and therapy of acute radiation syndrome since its first description - 35 years ago - are reviewed. Today, whole-body doses of 100 rd and more can be treated by radiotherapy. (orig./MG) [de

  19. Updated assessment of the six-minute walk test as predictor of acute radiation-induced pneumonitis.

    Science.gov (United States)

    Mao, Jingfang; Zhang, Junan; Zhou, Sumin; Das, Shiva; Hollis, Donna R; Folz, Rodney J; Wong, Terence Z; Marks, Lawrence B

    2007-03-01

    To assess the utility of the 6-minute walk test (6MWT) as a predictor of symptomatic radiation-induced pneumonitis (RP). As part of a prospective trial to study radiation-induced lung injury, 53 patients receiving thoracic radiotherapy (RT) underwent a pre-RT 6MWT, pulmonary function tests (PFTs), and had >or=3-month follow-up for prospective assessment of Grade 2 or worse RP (requiring medications or worse). Dosimetric parameters (e.g., the percentage of lung receiving >or=30 Gy) were extracted from the lung dose-volume histogram. The correlations between the 6MWT and PFT results were assessed using Pearson's correlation. The receiver operating characteristic technique was used in patient subgroups to evaluate the predictive capacities for RP of the dosimetric parameters, 6MWT results, and PFT results, or the combination (using discriminant analysis) of all three metrics. ROCKIT software was used to compare the receiver operating characteristic areas between each predictive model. The association of the decline in 6MWT with the development of RP was evaluated using Fisher's exact test. The pre-RT PFT and 6MWT results correlated weakly (r = 0.44-0.57, p or=30 Gy, receiver operating characteristic area 0.73, p = 0.03). Including the PFT or 6MWT results with the percentage of lung receiving >or=30 Gy did not improve the predictions. The predictive abilities of dosimetric-based models improved when the analysis was restricted to those patients whose tumors were not causing regional lung dysfunction. No correlation was found between the decline in the 6MWT result and the RP rate (p = 0.6). Although the PFTs and 6MWT are related to each other, the correlation coefficients were weak, suggesting that they could be measuring different physiologic functions. In the present data set, the addition of the PFTs or 6MWT did not increase the ability of the dosimetric parameters to predict for acute symptomatic RP. Additional work is needed to better understand the interaction

  20. Early Graphical Appearance of Radiation Pneumonitis Correlates With the Severity of Radiation Pneumonitis After Stereotactic Body Radiotherapy (SBRT) in Patients With Lung Tumors

    International Nuclear Information System (INIS)

    Takeda, Atsuya; Ohashi, Toshio; Kunieda, Etsuo

    2010-01-01

    Purpose: To investigate factors associated with Grade ≥3 radiation pneumonitis (RP) in patients with lung tumors treated with stereotactic body radiotherapy (SBRT). Methods and Materials: We retrospectively analyzed 128 patients with 133 lung tumors treated with SBRT. RP was graded according to the Common Terminology Criteria for Adverse Events version 3.0. Univariate analyses were used to identify predictive factors for RP. Results: The median follow-up period after SBRT was 12 months (range, 5-45 months). Incidences of Grades 0, 1, 2, and 3 RP were 27%, 52%, 16%, and 5%, respectively. No patients suffered Grade 4 or 5 RP. For all patients with Grade 2 or 3, symptoms occurred either simultaneously with or subsequent to graphical appearances. The latent period was the only significant factor associated with Grade ≥3 RP (p < 0.01). A latent period of 1 or 2 months indicated a 40% (6/15) risk for Grade 3. However, the risk for Grade 3 was 1.2% (1/82) 3 months after SBRT. No pretreatment clinical or dosimetric factors were significantly associated with Grade ≥3 RP. However, 4 of 7 patients with Grade 3 RP had severe pulmonary comorbidities. Conclusion: Only the latency period was a significant factor in the development of RP. No pretreatment clinical or dosimetric factors were significantly associated with Grade ≥3 RP. Patients, especially those with severe pulmonary comorbidities, should be carefully observed for the graphical appearance of RP within a few months during the follow-up period after SBRT.

  1. Involvement of p38-βTrCP-Tristetraprolin-TNFα axis in radiation pneumonitis.

    Science.gov (United States)

    Krishnamurthy, Pranathi Meda; Shukla, Shirish; Ray, Paramita; Mehra, Rohit; Nyati, Mukesh K; Lawrence, Theodore S; Ray, Dipankar

    2017-07-18

    Early release of tumor necrosis factor-alpha (TNF-α) during radiotherapy of thoracic cancers plays an important role in radiation pneumonitis, whose inhibition may provide lung radioprotection. We previously reported radiation inactivates Tristetraprolin (TTP), a negative regulator of TNF-α synthesis, which correlated with increased TNF-α release. However, the molecular events involved in radiation-induced TTP inactivation remain unclear. To determine if eliminating Ttp in mice resulted in a phenotypic response to radiation, Ttp-null mice lungs were exposed to a single dose of 15 Gy, and TNF-α release and lung inflammation were analyzed at different time points post-irradiation. Ttp-/- mice with elevated (9.5±0.6 fold) basal TNF-α showed further increase (12.2±0.9 fold, pacute lung inflammation within a week post-irradiation. Further studies using mouse lung macrophage (MH-S), human lung fibroblast (MRC-5), and exogenous human TTP overexpressing U2OS and HEK293 cells upon irradiation (a single dose of 4 Gy) promoted p38-mediated TTP phosphorylation at the serine 186 position, which primed it to be recognized by an ubiquitin ligase (E3), beta transducing repeat containing protein (β-TrCP), to promote polyubiquitination-mediated proteasomal degradation. Consequently, a serine 186 to alanine (SA) mutant of TTP was resistant to radiation-induced degradation. Similarly, either a p38 kinase inhibitor (SB203580), or siRNA-mediated β-TrCP knockdown, or overexpression of dominant negative Cullin1 mutants protected TTP from radiation-induced degradation. Consequently, SB203580 pretreatment blocked radiation-induced TNF-α release and radioprotected macrophages. Together, these data establish the involvement of the p38-βTrCP-TTP-TNFα signaling axis in radiation-induced lung inflammation and identified p38 inhibition as a possible lung radioprotection strategy.

  2. [18F]2-fluoro-2-deoxyglucose positron emission tomography/computed tomography in predicting radiation pneumonitis.

    Science.gov (United States)

    Song, Hao; Yu, Jin-ming; Kong, Feng-ming; Lu, Jie; Bai, Tong; Ma, Li; Fu, Zheng

    2009-06-05

    Prevention is presently the only available method to limit radiation-induced lung morbidity. A good predictor is the key point of prevention. This study aimed to investigate if [(18)F]2-fluoro-2-deoxyglucose (FDG) uptake changes in the lung after radiotherapy could be used as a new predictor for acute radiation pneumonitis (RP). Forty-one patients with lung cancer underwent FDG positron emission tomography/computed tomography (FDG-PET/CT) imaging before and after radiotherapy. The mean standardized uptake value (SUV) was measured for the isodose regions of 0 - 9 Gy, 10 - 19 Gy, 20 - 29 Gy, 30 - 39 Gy, 40 - 49 Gy. The mean SUV of these regions after radiotherapy was compared with baseline. The mean SUV in patients who developed RP was also compared with that in those who did not. The statistical difference was determined by matched pair t test. The Radiation Therapy Oncology Group (RTOG) criteria were used for diagnosis and grading of RP. With a median follow-up of 12 months, 11 (26.8%) of the 41 patients developed grade 2 and above acute RP. The mean SUV of regions (10 - 19 Gy, 20 - 29 Gy, 30 - 39 Gy, 40 - 49 Gy) increased after radiation therapy in all 41 patients. The mean SUVs after radiation therapy were 0.54, 0.68, 1.31, 1.74 and 2.27 for 0 - 9 Gy, 10 - 19 Gy, 20 - 29 Gy, 30 - 39 Gy and 40 - 49 Gy, respectively. Before the radiation therapy, the mean SUV in each region was 0.53, 0.52, 0.52, 0.53 and 0.54, respectively. These patients had significantly higher FDG activities in regions receiving 10 Gy or more (P acute RP subsequently. The mean SUV of the lung tissue may be a useful predictor for the acute RP. FDG-PET/CT may play a new role in the study of the radiation damage of the lung.

  3. Predictive Factors for Radiation Pneumonitis in Hodgkin Lymphoma Patients Receiving Combined-Modality Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fox, Amy M. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, MA (United States); 21st Century Oncology, Fort Myers, FL (United States); Dosoretz, Arie P. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, MA (United States); Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States); Mauch, Peter M. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, MA (United States); Chen, Yu-Hui [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (United States); Fisher, David C.; LaCasce, Ann S.; Freedman, Arnold S. [Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Silver, Barbara [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, MA (United States); Ng, Andrea K., E-mail: ang@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, MA (United States)

    2012-05-01

    Purpose: This study sought to quantify the risk of radiation pneumonitis (RP) in Hodgkin lymphoma (HL) patients receiving mediastinal radiation therapy (RT) and to identify predictive factors for RP. Methods and Materials: We identified 75 patients with newly diagnosed HL treated with mediastinal RT and 17 patients with relapsed/refractory HL treated with mediastinal RT before or after transplant. Lung dose-volumetric parameters including mean lung dose and percentage of lungs receiving 20 Gy were calculated. Factors associated with RP were explored by use of the Fisher exact test. Results: RP developed in 7 patients (10%) who received mediastinal RT as part of initial therapy (Radiation Therapy Oncology Group Grade 1 in 6 cases). A mean lung dose of 13.5 Gy or greater (p = 0.04) and percentage of lungs receiving 20 Gy of 33.5% or greater (p = 0.009) significantly predicted for RP. RP developed in 6 patients (35%) with relapsed/refractory HL treated with peri-transplant mediastinal RT (Grade 3 in 4 cases). Pre-transplant mediastinal RT, compared with post-transplant mediastinal RT, significantly predicted for Grade 3 RP (57% vs. 0%, p = 0.015). Conclusions: We identified threshold lung metrics predicting for RP in HL patients receiving mediastinal RT as part of initial therapy, with the majority of cases being of mild severity. The risk of RP is significantly higher with peri-transplant mediastinal RT, especially among those who receive pre-transplant RT.

  4. Predictive Factors for Radiation Pneumonitis in Hodgkin Lymphoma Patients Receiving Combined-Modality Therapy

    International Nuclear Information System (INIS)

    Fox, Amy M.; Dosoretz, Arie P.; Mauch, Peter M.; Chen, Yu-Hui; Fisher, David C.; LaCasce, Ann S.; Freedman, Arnold S.; Silver, Barbara; Ng, Andrea K.

    2012-01-01

    Purpose: This study sought to quantify the risk of radiation pneumonitis (RP) in Hodgkin lymphoma (HL) patients receiving mediastinal radiation therapy (RT) and to identify predictive factors for RP. Methods and Materials: We identified 75 patients with newly diagnosed HL treated with mediastinal RT and 17 patients with relapsed/refractory HL treated with mediastinal RT before or after transplant. Lung dose–volumetric parameters including mean lung dose and percentage of lungs receiving 20 Gy were calculated. Factors associated with RP were explored by use of the Fisher exact test. Results: RP developed in 7 patients (10%) who received mediastinal RT as part of initial therapy (Radiation Therapy Oncology Group Grade 1 in 6 cases). A mean lung dose of 13.5 Gy or greater (p = 0.04) and percentage of lungs receiving 20 Gy of 33.5% or greater (p = 0.009) significantly predicted for RP. RP developed in 6 patients (35%) with relapsed/refractory HL treated with peri-transplant mediastinal RT (Grade 3 in 4 cases). Pre-transplant mediastinal RT, compared with post-transplant mediastinal RT, significantly predicted for Grade 3 RP (57% vs. 0%, p = 0.015). Conclusions: We identified threshold lung metrics predicting for RP in HL patients receiving mediastinal RT as part of initial therapy, with the majority of cases being of mild severity. The risk of RP is significantly higher with peri-transplant mediastinal RT, especially among those who receive pre-transplant RT.

  5. Predictive factors for radiation pneumonitis in Hodgkin lymphoma patients receiving combined-modality therapy.

    Science.gov (United States)

    Fox, Amy M; Dosoretz, Arie P; Mauch, Peter M; Chen, Yu-Hui; Fisher, David C; LaCasce, Ann S; Freedman, Arnold S; Silver, Barbara; Ng, Andrea K

    2012-05-01

    This study sought to quantify the risk of radiation pneumonitis (RP) in Hodgkin lymphoma (HL) patients receiving mediastinal radiation therapy (RT) and to identify predictive factors for RP. We identified 75 patients with newly diagnosed HL treated with mediastinal RT and 17 patients with relapsed/refractory HL treated with mediastinal RT before or after transplant. Lung dose-volumetric parameters including mean lung dose and percentage of lungs receiving 20 Gy were calculated. Factors associated with RP were explored by use of the Fisher exact test. RP developed in 7 patients (10%) who received mediastinal RT as part of initial therapy (Radiation Therapy Oncology Group Grade 1 in 6 cases). A mean lung dose of 13.5 Gy or greater (p = 0.04) and percentage of lungs receiving 20 Gy of 33.5% or greater (p = 0.009) significantly predicted for RP. RP developed in 6 patients (35%) with relapsed/refractory HL treated with peri-transplant mediastinal RT (Grade 3 in 4 cases). Pre-transplant mediastinal RT, compared with post-transplant mediastinal RT, significantly predicted for Grade 3 RP (57% vs. 0%, p = 0.015). We identified threshold lung metrics predicting for RP in HL patients receiving mediastinal RT as part of initial therapy, with the majority of cases being of mild severity. The risk of RP is significantly higher with peri-transplant mediastinal RT, especially among those who receive pre-transplant RT. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. [Five cases of severe radiation pneumonitis after chemoradiotherapy for esophageal cancer].

    Science.gov (United States)

    Sakurai, Katsunobu; Kubo, Naoshi; Shibutani, Masatsune; Yamazoe, Sadaaki; Kimura, Kenjiro; Nagahara, Hisashi; Toyokawa, Takahiro; Amano, Ryosuke; Tanaka, Hiroaki; Muguruma, Kazuya; Ohtani, Hiroshi; Yashiro, Masakazu; Maeda, Kiyoshi; Ohira, Masaichi; Hirakawa, Kosei

    2013-11-01

    Chemoradiotherapy( CRT) for esophageal cancer is a useful modality for both locally advanced and resectable cases. Among adverse events related to CRT, radiation pneumonitis( RP) requires special attention because it has been shown to be occasionally associated with a worse acute prognosis. We report 5 cases of severe RP after CRT. All patients were male, and their mean age was 72 years (range: 66-76 years). The clinical stage of esophageal cancer was I in 1 case, II in 2 cases, and IVa in 2 cases. The mean total radiation dose was 51.8 Gy (range: 43.4-61.4). Initial symptoms and first abnormal findings were a high fever in 4 cases and elevated serum C-reactive protein( CRP) levels in 1 case. No patients presented with respiratory symptoms, including dyspnea and coughing, as initial symptoms. All cases were diagnosed as RP by chest computed tomography examination, an average of 6.8 days after the completion of RT. Four patients required intensive care and were put on ventilator support. All patients received steroid pulse therapy. Two patients recovered from RP; however, 3 died( 1 attributable to multi-organ failure and 2 to respiratory failure). It is important to consider RP caused by CRT when patients present with high fever or elevated CRP levels after the completion of RT for esophageal cancer.

  7. Impact of Preexisting Interstitial Lung Disease on Acute, Extensive Radiation Pneumonitis: Retrospective Analysis of Patients with Lung Cancer

    OpenAIRE

    Ozawa, Yuichi; Abe, Takefumi; Omae, Minako; Matsui, Takashi; Kato, Masato; Hasegawa, Hirotsugu; Enomoto, Yasunori; Ishihara, Takeaki; Inui, Naoki; Yamada, Kazunari; Yokomura, Koshi; Suda, Takafumi

    2015-01-01

    Introduction This study investigated the clinical characteristics and predictive factors for developing acute extended radiation pneumonitis with a focus on the presence and radiological characteristics of preexisting interstitial lung disease. Methods Of 1429 irradiations for lung cancer from May 2006 to August 2013, we reviewed 651 irradiations involving the lung field. The presence, compatibility with usual interstitial pneumonia, and occupying area of preexisting interstitial lung disease...

  8. Risk of radiation-induced pneumonitis after helical and static-port tomotherapy in lung cancer patients and experimental rats

    International Nuclear Information System (INIS)

    Zhang, Xianglan; Shin, You Keun; Zheng, Zhenlong; Zhu, Lianhua; Lee, Ik Jae

    2015-01-01

    Radiotherapy (RT) is one of the major non-operative treatment modalities for treating lung cancer. Tomotherapy is an advanced type of intensity-modulated radiotherapy (IMRT) in which radiation may be delivered in a helical fashion. However, unexpected pneumonitis may occur in patients treated with tomotherapy, especially in combination with chemotherapy, as a result of extensive low-dose radiation of large lung volumes. The aim of our study was to investigate the risk of radiation-induced pneumonitis after helical-mode and static-mode tomotherapy in patients with lung cancer and in an animal model. A total of 63 patients with primary lung cancer who were treated with static or helical tomotherapy with or without concurrent chemoradiotherapy (CCRT) were analyzed. Additionally, rats with radiation-induced pulmonary toxicity, which was induced by the application of helical or static tomography with or without CCRT, were evaluated. Helical-mode tomotherapy resulted in a significantly higher rate of late radiation pneumonitis in lung cancer patients than static-mode tomotherapy when evaluated by the Radiation Therapy Oncology Group (RTOG) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) scoring system. In the animal model, helical tomotherapy alone induced significantly higher expression of interleukin (IL)-1α, IL-1β, IL-6, and transforming growth factor (TGF)-β in lung specimens, especially on the untreated side, compared to static tomotherapy alone. Additionally, rats treated with helical tomotherapy and CCRT demonstrated significantly higher expression of inflammatory cytokines compared to those treated with static tomotherapy and CCRT. Rat models treated with tomotherapy with or without CCRT could present similar patterns of pulmonary toxicity to those shown in lung cancer patients. The models can be used in further investigations of radiation induced pulmonary toxicity

  9. Radiation pneumonitis following treatment of non-small-cell lung cancer with continuous hyperfractionated accelerated radiotherapy (CHART).

    Science.gov (United States)

    Jenkins, Peter; D'Amico, Karen; Benstead, Kim; Elyan, Sean

    2003-06-01

    To determine whether partial volume lung irradiation influences the risk of developing acute radiation pneumonitis after the treatment of non-small-cell lung cancer with continuous hyperfractionated accelerated radiotherapy (CHART). We conducted an analysis of 32 patients treated with CHART at the Gloucestershire Oncology Center. Twelve patients were treated using conventional two-dimensional treatment techniques and received elective nodal irradiation (ENI). Their treatment plans were subsequently recapitulated using a three-dimensional treatment planning system. Twenty patients were planned using this system from the outset. For these patients, elective nodal irradiation was omitted. Dose-volume histograms (DVH) were constructed and several parameters analyzed for their ability to predict for the development of pneumonitis. Univariate analysis revealed that the percentage lung volume receiving more than 20 Gy (V20) and the mean lung dose are of predictive value for the development of pneumonitis after CHART. There is a strong correlation between these two parameters. Importantly, partial volume lung irradiation using CHART appears to be better tolerated than conventionally fractionated radiotherapy. The omission of ENI considerably reduces V20. Using a commonly employed 3-beam technique it was also noted that the shape of the planning target volume (PTV) in the transverse plane (expressed as an elliptical index) affects the conformity of the V20 isodose to the PTV. This influences the scope for dose escalation with irregularly shaped tumors. In relation to acute radiation pneumonitis, CHART appears to have a superior therapeutic index than conventionally fractionated radiotherapy. V20 and mean lung dose are useful factors for predicting the risk of this complication. The use of these parameters will aid the selection of optimal treatment plans and provides a basis for future dose escalation studies.

  10. Does Bleomycin Lung Toxicity Increase the Risk of Radiation Pneumonitis in Hodgkin Lymphoma?

    International Nuclear Information System (INIS)

    Abou Yehia, Zeinab; Mikhaeel, George N.; Smith, Grace; Pinnix, Chelsea C.; Milgrom, Sarah A.; Tang, Chad; Jiang, Wen; Fanale, Michelle A.; Oki, Yasuhiro; Shank, JoAnn H.; Horace, Trisha; Reddy, Jay; Akhtari, Mani; Gunther, Jillian R.; Suki, Tina; Allen, Pamela K.; Turner, Shryll; Mawlawi, Osama; Dabaja, Bouthaina S.

    2016-01-01

    Purpose: Bleomycin pulmonary toxicity (BPT) is a well-known complication of treatment in patients with Hodgkin lymphoma (HL). We undertook the present study to investigate the risk of radiation pneumonitis (RP) in the setting of BPT and to determine the need for delay or omission of radiation therapy (RT) in these patients. Methods and Materials: We identified 123 HL patients treated with ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine) followed by RT to the chest from January 2009 to December 2014. The medical records were reviewed for clinical, pathologic, and treatment information and toxicities. Our primary outcome was RP of any grade. Univariate and multivariate analyses were used to assess the association of BPT, baseline patient characteristics, and treatment variables with the incidence of RP. Results: A total of 123 patients were included, of whom 99 (80%) received consolidation intensity modulated RT after ABVD treatment. We identified 31 patients (25.2%) with BPT after frontline ABVD. Seventeen patients (13.8%) developed RP a median of 8 weeks (range 1-39) after RT completion. BPT did not correlate with the risk of developing RP (P=.36). We evaluated the RP outcomes with respect to the bleomycin to RT interval (≤6 weeks vs >6 weeks), and we found that this interval did not predict for RP risk (P=.60). Dosimetric parameters such as the volume covered by 5 Gy and the mean lung dose were analyzed. A volume covered by 5 Gy of >55% and mean lung dose >13.5 Gy increased the risk of RP by 1.14-fold (P=.002) and 4.24-fold (P=.007), respectively. Conclusions: The results of our study suggest that BPT does not increase the risk of developing RP. Furthermore, RT initiation does not need to be delayed after chemotherapy, except to allow for the completion of steroid therapy or clinical recovery from BPT.

  11. Does Bleomycin Lung Toxicity Increase the Risk of Radiation Pneumonitis in Hodgkin Lymphoma?

    Energy Technology Data Exchange (ETDEWEB)

    Abou Yehia, Zeinab [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mikhaeel, George N. [Department of Clinical Oncology, Guy' s & St Thomas' Hospital, London (United Kingdom); Smith, Grace; Pinnix, Chelsea C.; Milgrom, Sarah A.; Tang, Chad; Jiang, Wen [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Fanale, Michelle A.; Oki, Yasuhiro [Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Shank, JoAnn H.; Horace, Trisha; Reddy, Jay [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Akhtari, Mani [Department of Radiation Oncology, The University of Texas Medical Branch Hospitals, Galveston, Texas (United States); Gunther, Jillian R. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Suki, Tina [The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Allen, Pamela K.; Turner, Shryll [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mawlawi, Osama [Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dabaja, Bouthaina S., E-mail: bdabaja@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2016-12-01

    Purpose: Bleomycin pulmonary toxicity (BPT) is a well-known complication of treatment in patients with Hodgkin lymphoma (HL). We undertook the present study to investigate the risk of radiation pneumonitis (RP) in the setting of BPT and to determine the need for delay or omission of radiation therapy (RT) in these patients. Methods and Materials: We identified 123 HL patients treated with ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine) followed by RT to the chest from January 2009 to December 2014. The medical records were reviewed for clinical, pathologic, and treatment information and toxicities. Our primary outcome was RP of any grade. Univariate and multivariate analyses were used to assess the association of BPT, baseline patient characteristics, and treatment variables with the incidence of RP. Results: A total of 123 patients were included, of whom 99 (80%) received consolidation intensity modulated RT after ABVD treatment. We identified 31 patients (25.2%) with BPT after frontline ABVD. Seventeen patients (13.8%) developed RP a median of 8 weeks (range 1-39) after RT completion. BPT did not correlate with the risk of developing RP (P=.36). We evaluated the RP outcomes with respect to the bleomycin to RT interval (≤6 weeks vs >6 weeks), and we found that this interval did not predict for RP risk (P=.60). Dosimetric parameters such as the volume covered by 5 Gy and the mean lung dose were analyzed. A volume covered by 5 Gy of >55% and mean lung dose >13.5 Gy increased the risk of RP by 1.14-fold (P=.002) and 4.24-fold (P=.007), respectively. Conclusions: The results of our study suggest that BPT does not increase the risk of developing RP. Furthermore, RT initiation does not need to be delayed after chemotherapy, except to allow for the completion of steroid therapy or clinical recovery from BPT.

  12. The impact of radiation dose and fractionation on the risk factor of radiation pneumonitis on four radiation therapy oncology group (RTOG) lung cancer trials

    International Nuclear Information System (INIS)

    Roach, Mack; Pajak, Thomas F; Byhardt, Roger; Graham, Mary L; Asbell, Sucha O; Russell, Anthony H; Fu, Karen K; Urtasun, Raul C; Herskovic, Arnold M; Cox, James D

    1997-01-01

    Purpose/Objective: To assess the relationship between total dose of radiation delivered, the fractionation scheme used, age, and Karnofsky Performance Status (KPS) on the risk of moderate to severe (≥ Grade 2) radiation pneumonitis in patients treated with radiotherapy alone for lung cancer on four RTOG Trials. Materials and Methods: Between February of 1984 and April of 1989, 1701 patients with clinically localized (I-IIIb) lung cancer were entered on clinical trials employing radiotherapy alone. Twelve hundred and forty-seven patients were entered on RTOG 8311 or 8407 (phase I/II trials) and 454 patients were entered on RTOG 8321 or 8403 (phase III trials). RTOG 8403 and 8321 patients received once-a-day irradiation to 60 Gy. Patients treated on RTOG 8407 were treated with a concomitant boost technique in a non-randomized fashion to 64.8, 69.6, 74.4 or 79.2 Gy. Patients treated on RTOG 8407 were treated with a concomitant boost technique in a non-randomized fashion to 63 Gy or 70.2 Gy. All patients were assessed for the incidence of Grade 2-5, radiation pneumonitis. One hundred and seven (6%) of patients were either ineligible or canceled (n=60), or were excluded because of incomplete data (n=47). The factors evaluated included total dose of radiation, the fractionation scheme, age and pre-treatment KPS. Patients treated to doses ≥ 72 Gy were considered to have received high doses (72.0 - 81.6 Gy), while the remaining patients treated to doses < 72 Gy (57.6 - 71.9 Gy) were considered to have received standard dose radiation. For the this analysis, information regarding field size and baseline pulmonary function was not available. Results: Age, sex, stage distribution, and the percentage of patients with a KPS ≥90 were similar among the patients treated on these four studies. Patients receiving hyperfractionated radiotherapy to doses ≥ 72 Gy experienced a higher incidence of radiation pneumonitis ≥ Grade 2, than patients treated with standard doses < 72

  13. Analysis of dose-volume parameters predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-conformal radiation therapy or IMRT.

    Science.gov (United States)

    Kumar, Gaurav; Rawat, Sheh; Puri, Abhishek; Sharma, Manoj Kumar; Chadha, Pranav; Babu, Anand Giri; Yadav, Girigesh

    2012-01-01

    Multimodality therapy for esophageal cancer can cause various kinds of treatment-related sequelae, especially pulmonary toxicities. This prospective study aims to investigate the clinical and dosimetric parameters predicting lung injury in patients undergoing radiation therapy for esophageal cancer. Forty-five esophageal cancer patients were prospectively analyzed. The pulmonary toxicities (or sequelae) were evaluated by comparing chest X-ray films, pulmonary function tests and symptoms caused by pulmonary damage before and after treatment. All patients were treated with either three-dimensional radiotherapy (3DCRT) or with intensity-modulated radiotherapy (IMRT). The planning dose volume histogram was used to compute the lung volumes receiving more than 5, 10, 20 and 30 Gy (V5, V10, V20, V30) and mean lung dose. V20 was larger in the IMRT group than in the 3DCRT group (p = 0.002). V20 (>15%) and V30 (>20%) resulted in a statistically significant increase in the occurrence of chronic pneumonitis (p = 0.03) and acute pneumonitis (p = 0.007), respectively. The study signifies that a larger volume of lung receives lower doses because of multiple beam arrangement and a smaller volume of lung receives higher doses because of better dose conformity in IMRT plans. Acute pneumonitis correlates more with V30 values, whereas chronic pneumonitis was predominantly seen in patients with higher V20 values.

  14. Clinical validation of the LKB model and parameter sets for predicting radiation-induced pneumonitis from breast cancer radiotherapy

    International Nuclear Information System (INIS)

    Tsougos, Ioannis; Mavroidis, Panayiotis; Theodorou, Kyriaki; Rajala, J; Pitkaenen, M A; Holli, K; Ojala, A T; Hyoedynmaa, S; Jaervenpaeae, Ritva; Lind, Bengt K; Kappas, Constantin

    2006-01-01

    The choice of the appropriate model and parameter set in determining the relation between the incidence of radiation pneumonitis and dose distribution in the lung is of great importance, especially in the case of breast radiotherapy where the observed incidence is fairly low. From our previous study based on 150 breast cancer patients, where the fits of dose-volume models to clinical data were estimated (Tsougos et al 2005 Evaluation of dose-response models and parameters predicting radiation induced pneumonitis using clinical data from breast cancer radiotherapy Phys. Med. Biol. 50 3535-54), one could get the impression that the relative seriality is significantly better than the LKB NTCP model. However, the estimation of the different NTCP models was based on their goodness-of-fit on clinical data, using various sets of published parameters from other groups, and this fact may provisionally justify the results. Hence, we sought to investigate further the LKB model, by applying different published parameter sets for the very same group of patients, in order to be able to compare the results. It was shown that, depending on the parameter set applied, the LKB model is able to predict the incidence of radiation pneumonitis with acceptable accuracy, especially when implemented on a sub-group of patients (120) receiving D-bar-bar vertical bar EUD higher than 8 Gy. In conclusion, the goodness-of-fit of a certain radiobiological model on a given clinical case is closely related to the selection of the proper scoring criteria and parameter set as well as to the compatibility of the clinical case from which the data were derived. (letter to the editor)

  15. Estimated radiation pneumonitis risk after photon versus proton therapy alone or combined with chemotherapy for lung cancer

    DEFF Research Database (Denmark)

    Vogelius, Ivan R.; Westerly, David C; Aznar, Marianne Camille

    2011-01-01

    Background. Traditionally, radiation therapy plans are optimized without consideration of chemotherapy. Here, we model the risk of radiation pneumonitis (RP) in the presence of a possible interaction between chemotherapy and radiation dose distribution. Material and methods. Three alternative......-radiation combinations could be an interesting indication for selecting patients for proton therapy. It is likely that the IMRT plans would perform better if the CERD was accounted for during optimization, but more clinical data is required to facilitate evidence-based plan optimization in the multi-modality setting....... treatment plans are compared in 18 non-small cell lung cancer patients previously treated with helical tomotherapy; the tomotherapy plan, an intensity modulated proton therapy plan (IMPT) and a three dimensional conformal radiotherapy (3D-CRT) plan. All plans are optimized without consideration...

  16. [Correlation study of physical and biologic parameters to acute radiation pneumonitis].

    Science.gov (United States)

    Zhao, Yan-hai; Li, Zhi-ping; Chen, Xiao-mei; Liu, Xiao-jing; Wu, Wen-chao; Xu, Yong; Li, Ping; Zhang, Jin-tao; Zeng, Hui

    2008-09-01

    To study the relationship between the level of plasma transform growth factor-betal (TGF-betal), interleukin-6 (IL-6), thrombomodulin (TM) dose-volume factors and acute radiation pneumonitis (ARP). Three dimensional conformal radiation therapy and chemotherapy were applied to 27 lung cancer patients, 15 esophageal carcinoma, and 1 thymoma patients. 19 patients received adjuvant radiochemotherapy, and 25 patients received concurrent radio-chemotherapy. Enzyme-linked immunosorbent assay (ELISA) was applied to detect the serum IL-6, TGF-betal and TM levels of patients before radiotherapy (B-RT) and at 30 Gy(M-RT). ARP was graded according to NCI common toxicity criteria (CTCAE v 3.0), Grade 2 or more ARP was taken as the main end point. The relationship between the levels of serum TGF-betal, IL-6, TM, parameters of lung function and dose-volume factors, and the incidence rate of ARP were analyzed. Mean lung dose (MLD) and the Vx were considered as the dose-volume factors. Among 44 patients, 15 of them had ARP. 9 got grade 2 ARP and 6 had grade 3. After received a dose of 30 Gy, TGF-betal value in M-RT was (396 +/- 338) and (866 +/- 270) pg/mL in non-ARP and ARP group (P = 0.000). The ARP incidence rate in or =60 age group were 46.15% (12/26) and 16.67% (3/18) (P = 0.042), and 45.45% (15/33), 0% (0/11) (P = 0.017) in had smoking history and nonsmoking history group, respectively. 1 out of 13 patients (7.69%) who had increased M-RT TM value suffered of ARP, while 14 out of 31 patients (45.16%) whose M-RT TM value lower than pr-RT suffered of ARP (P = 0.044). The results of multivariate analysis implied that the MLD and the value of TGF-betal in M-RT were associated with severe ARP. TGF-beta1 and MLD are significant indicators of ARP. FEV1 actual value/predicted value% might have predicting effect for the severity of ARP.

  17. Radiation therapy for symptomatic hepatomegaly in myelofibrosis with myeloid metaplasia

    Energy Technology Data Exchange (ETDEWEB)

    Tefferi, A.; Jimenez, T.; Gray, L.A.; Mesa, R.A. [Division of Hematology and Internal Medicine, Rochester, MN (United States); Chen, M.G. [Division of Radiation Oncology, Mayo Clinic and Mayo Foundation, MN (United States)

    2001-07-01

    Objective: To describe the experience with liver irradiation in advanced cases of myelofibrosis with myeloid metaplasia (MMM). Methods: Over a 20-yr period, 14 patients with MMM were treated with a total of 25 courses of liver, abdominal, or abdominal and pelvic irradiation for symptomatic hepatomegaly with (5 patients) or without (9 patients) ascites. All 14 patients had advanced disease and 11 (79%) had previous splenectomy. The median radiation therapy (RT) dose per course was 150 cGy (range 50-1000) administered at a median of six fractions. Four patients received two to six courses. Results. Twelve of the 14 patients (86%) had a transient (median 3 months) subjective response from RT. However, in only 35% of these was there a transient (median 3 months) decrease in palpable liver size. Four of the five patients with ascites experienced a short-term response from RT. Eight of the 13 patients suitable for evaluation (62%) had treatment-associated cytopenia, often in the form of anemia and/or thrombocytopenia. At last follow-up, 10 patients (71%) had died after a median of 7 months (range 0.1-23) and 4 were alive at 3, 20, 33, and 57 months after RT. Conclusions: Low-dose abdominal RT for symptomatic hepatomegaly or ascites associated with advanced-stage MMM is myelosuppressive and provides only temporary and mainly subjective and short-lived relief. (au)

  18. Influence of radiation dose rate and lung dose on interstitial pneumonitis after fractionated total body irradiation: acute parotitis may predict interstitial pneumonitis.

    Science.gov (United States)

    Oya, Natsuo; Sasai, Keisuke; Tachiiri, Seiji; Sakamoto, Takashi; Nagata, Yasushi; Okada, Takashi; Yano, Shinsuke; Ishikawa, Takayuki; Uchiyama, Takashi; Hiraoka, Masahiro

    2006-01-01

    This study evaluated patients for the influence of the dose rate and lung dose of fractionated total body irradiation (TBI) in preparation for allogeneic bone marrow transplantation (BMT) on the subsequent development of interstitial pneumonitis (IP). Sixty-six patients at our institute were treated with TBI followed by BMT. All of the patients received a total TBI dose of 12 Gy given in 6 fractions over 3 days and were divided into 3 groups according to the radiation dose rate and lung dose: group A, lung dose of 8 Gy (n = 18); group B, lung dose of 12 Gy at 8 cGy/min (n = 25); and group C, lung dose of 12 Gy at 19 cGy/min (n = 23). The overall survival rate, the cumulative incidence of relapse, and the cumulative incidence of IP were evaluated in relation to various potential indicators of future IP. There were no significant differences in survival and relapse rates between patient group A and combined groups B and C. Clinically significant IP occurred in 13 patients. The cumulative incidence of IP was significantly higher in patients who developed acute parotitis as indicated by either an elevation in the serum amylase level or parotid pain of grade 1 to 2. There was no difference in IP incidence among groups A, B, and C. There was no significant difference in IP incidence between lung dose values of 8 Gy (with lung shielding) and 12 Gy (without lung shielding) and between dose rate values of 8 cGy/min and 19 cGy/ min, at least when TBI was given in 6 fractions. The presence of acute parotitis during or just after TBI may be a predictor of IP.

  19. Chemical pneumonitis

    Science.gov (United States)

    ... chemical pneumonitis. Symptoms Acute symptoms may include: Air hunger (feeling that you cannot get enough air) Breathing ... must be authorized in writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get ...

  20. Hypersensitivity Pneumonitis

    Science.gov (United States)

    ... may increase the risk of developing hypersensitivity pneumonitis. Sex or gender Men and women can have hypersensitivity ... opioids can lead to physical dependence and possibly addiction. Lung transplants If your condition is not adequately ...

  1. Bayesian network ensemble as a multivariate strategy to predict radiation pneumonitis risk

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sangkyu, E-mail: sangkyu.lee@mail.mcgill.ca; Ybarra, Norma; Jeyaseelan, Krishinima; Seuntjens, Jan; El Naqa, Issam [Medical Physics Unit, McGill University, Montreal, Quebec H3G1A4 (Canada); Faria, Sergio; Kopek, Neil; Brisebois, Pascale [Department of Radiation Oncology, Montreal General Hospital, Montreal, H3G1A4 (Canada); Bradley, Jeffrey D.; Robinson, Clifford [Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110 (United States)

    2015-05-15

    Purpose: Prediction of radiation pneumonitis (RP) has been shown to be challenging due to the involvement of a variety of factors including dose–volume metrics and radiosensitivity biomarkers. Some of these factors are highly correlated and might affect prediction results when combined. Bayesian network (BN) provides a probabilistic framework to represent variable dependencies in a directed acyclic graph. The aim of this study is to integrate the BN framework and a systems’ biology approach to detect possible interactions among RP risk factors and exploit these relationships to enhance both the understanding and prediction of RP. Methods: The authors studied 54 nonsmall-cell lung cancer patients who received curative 3D-conformal radiotherapy. Nineteen RP events were observed (common toxicity criteria for adverse events grade 2 or higher). Serum concentration of the following four candidate biomarkers were measured at baseline and midtreatment: alpha-2-macroglobulin, angiotensin converting enzyme (ACE), transforming growth factor, interleukin-6. Dose-volumetric and clinical parameters were also included as covariates. Feature selection was performed using a Markov blanket approach based on the Koller–Sahami filter. The Markov chain Monte Carlo technique estimated the posterior distribution of BN graphs built from the observed data of the selected variables and causality constraints. RP probability was estimated using a limited number of high posterior graphs (ensemble) and was averaged for the final RP estimate using Bayes’ rule. A resampling method based on bootstrapping was applied to model training and validation in order to control under- and overfit pitfalls. Results: RP prediction power of the BN ensemble approach reached its optimum at a size of 200. The optimized performance of the BN model recorded an area under the receiver operating characteristic curve (AUC) of 0.83, which was significantly higher than multivariate logistic regression (0

  2. Dose-volume histogram parameters for predicting radiation pneumonitis using receiver operating characteristic curve

    International Nuclear Information System (INIS)

    Wang Dongqing; Zhang Jian; Li Baosheng; Sun Hongfu

    2012-01-01

    Objective: To assess the accuracy (ACC), sensitivity (SEN), and specificity (SPE) of dose-volume histogram (DVH) parameters in predicting the radiation pneumonitis (RP) using receiver operating characteristic (ROC) curve. Methods: Complete clinical data of 118 non-small cell lung cancer patients treated with three-dimensional conformal and intensity-modulated radiotherapy plus chemotherapy were included. Chi-square and logistic regression were retrospectively applied to analyze the correlations between DVH parameters [relative lung volume received ≥ 5 Gy (V 5 ), 10 Gy (V 10 ), 13 Gy (V 13 ), 20 Gy (V 20 ) and 30 Gy (V 30 ) and mean lung dose (MLD)] and grade 2 (and above) RP defined by the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0. ROC curve was adopted to investigate the predictive ACC, SEN and SPE of potential DVH parameters associated with RP. Results: Total lungs V 5 , V 10 , V 13 , V 20 and MLD were all correlated to the development of RP (χ 2 =4.786, 5.771, 6.366, 7.367 and 6.945, P<0.05) according to univariate analysis. However, total lungs V 30 , patient characteristics (age, sex, KPS, tumor location, pathology) and treatment factors (prescription dose, radiotherapy technique, chemotherapy method and timing) were not contributors to RP. Logistic regression showed that V 20 of both lungs remains tight by associated with RP (χ 2 =10.96, OR=4.16, 95% CI 1.40 ∼ 12.36, P<0.05), although significant colinearity was found between V 20 and other DVH parameters (r=0.767-0.902, P<0.05). ROC curve confirmed that V 20 of both lungs could act as a predictor for RP (Z=2.038, P<0.05). The predictive ACC, SEN, and SPE were 0.645 (95% CI 0.498-0.793), 0.650 (95% CI 0.408-0.864), and 0.674 (95% CI 0.571-0.765), respectively. However, the positive predictive value was only 28.9%. Conclusions: V 20 of both lungs was correlated to the development of RP. It could act as a predictor for RP though the predictability is limited

  3. ATM Polymorphisms Predict Severe Radiation Pneumonitis in Patients With Non-Small Cell Lung Cancer Treated With Definitive Radiation Therapy

    International Nuclear Information System (INIS)

    Xiong, Huihua; Liao, Zhongxing; Liu, Zhensheng; Xu, Ting; Wang, Qiming; Liu, Hongliang; Komaki, Ritsuko; Gomez, Daniel; Wang, Li-E; Wei, Qingyi

    2013-01-01

    Purpose: The ataxia telangiectasia mutated (ATM) gene mediates detection and repair of DNA damage. We investigated associations between ATM polymorphisms and severe radiation-induced pneumonitis (RP). Methods and Materials: We genotyped 3 potentially functional single nucleotide polymorphisms (SNPs) of ATM (rs1801516 [D1853N/5557G>A], rs189037 [-111G>A] and rs228590) in 362 patients with non-small cell lung cancer (NSCLC), who received definitive (chemo)radiation therapy. The cumulative severe RP probabilities by genotypes were evaluated using the Kaplan-Meier analysis. The associations between severe RP risk and genotypes were assessed by both logistic regression analysis and Cox proportional hazard model with time to event considered. Results: Of 362 patients (72.4% of non-Hispanic whites), 56 (15.5%) experienced grade ≥3 RP. Patients carrying ATM rs189037 AG/GG or rs228590 TT/CT genotypes or rs189037G/rs228590T/rs1801516G (G-T-G) haplotype had a lower risk of severe RP (rs189037: GG/AG vs AA, adjusted hazard ratio [HR] = 0.49, 95% confidence interval [CI], 0.29-0.83, P=.009; rs228590: TT/CT vs CC, HR=0.57, 95% CI, 0.33-0.97, P=.036; haplotype: G-T-G vs A-C-G, HR=0.52, 95% CI, 0.35-0.79, P=.002). Such positive findings remained in non-Hispanic whites. Conclusions: ATM polymorphisms may serve as biomarkers for susceptibility to severe RP in non-Hispanic whites. Large prospective studies are required to confirm our findings

  4. ATM Polymorphisms Predict Severe Radiation Pneumonitis in Patients With Non-Small Cell Lung Cancer Treated With Definitive Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Xiong, Huihua [Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan (China); Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liao, Zhongxing, E-mail: zliao@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Liu, Zhensheng [Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Xu, Ting [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wang, Qiming; Liu, Hongliang [Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Komaki, Ritsuko; Gomez, Daniel [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wang, Li-E [Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Qingyi, E-mail: qwei@mdanderson.org [Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-03-15

    Purpose: The ataxia telangiectasia mutated (ATM) gene mediates detection and repair of DNA damage. We investigated associations between ATM polymorphisms and severe radiation-induced pneumonitis (RP). Methods and Materials: We genotyped 3 potentially functional single nucleotide polymorphisms (SNPs) of ATM (rs1801516 [D1853N/5557G>A], rs189037 [-111G>A] and rs228590) in 362 patients with non-small cell lung cancer (NSCLC), who received definitive (chemo)radiation therapy. The cumulative severe RP probabilities by genotypes were evaluated using the Kaplan-Meier analysis. The associations between severe RP risk and genotypes were assessed by both logistic regression analysis and Cox proportional hazard model with time to event considered. Results: Of 362 patients (72.4% of non-Hispanic whites), 56 (15.5%) experienced grade ≥3 RP. Patients carrying ATM rs189037 AG/GG or rs228590 TT/CT genotypes or rs189037G/rs228590T/rs1801516G (G-T-G) haplotype had a lower risk of severe RP (rs189037: GG/AG vs AA, adjusted hazard ratio [HR] = 0.49, 95% confidence interval [CI], 0.29-0.83, P=.009; rs228590: TT/CT vs CC, HR=0.57, 95% CI, 0.33-0.97, P=.036; haplotype: G-T-G vs A-C-G, HR=0.52, 95% CI, 0.35-0.79, P=.002). Such positive findings remained in non-Hispanic whites. Conclusions: ATM polymorphisms may serve as biomarkers for susceptibility to severe RP in non-Hispanic whites. Large prospective studies are required to confirm our findings.

  5. Ipsilateral lung dose volume parameters predict radiation pneumonitis in addition to classical dose volume parameters in locally advanced NSCLC treated with combined modality therapy

    Directory of Open Access Journals (Sweden)

    Sushma Agrawal

    2014-01-01

    Full Text Available Purpose: The purpose was to determine the correlation of clinical factors and lung dose volume parameters with significant radiation pneumonitis (RP in non-small cell lung cancer patients treated with combined modality therapy. Materials and Methods: Between January 2008 and December 2010, 52 patients of non-small cell lung cancer were treated with combined modality therapy with radical intent. Radiation pneumonitis was correlated with ipsilateral (V 20 ipsi, V 5 ipsi and MLD ipsi and whole lung (V 20 , V 5 , and MLD dose volume parameters. Clinical factors like pulmonary function tests (PFT, site of tumor, planning target volume, and type of treatment were also correlated with incidence of significant pneumonitis. Results: Out of 52 patients, 35.3% developed grade 2 or more pneumonitis. On univariate analysis, factors significantly correlating with radiation pneumonitis were V 5 (P = 0.002, V 5 ipsi (P = 0.000, V 20 (P = 0.019, V 20 ipsi (P = 0.004, MLD (P = 0.008 and MLD ipsi (P = 0.008. On multivariate analysis, V 5 ipsi was retained as the most significant factor. Concurrent chemoradiation caused significantly more RP than neoadjuvant chemoradiation (P = 0.004. A cutoff of 65% for V 5 ipsi had a sensitivity of 65% and a specificity of 91%. Conclusion: The correlation between pneumonitis and dosimetric constraints has been validated. Adding ipsilateral V 20 , V 5 , and MLD to the classical total lung constraints identifies patients likely to develop pulmonary toxicity in patients undergoing chemoradiation.

  6. Adding Ipsilateral V20 and V30 to Conventional Dosimetric Constraints Predicts Radiation Pneumonitis in Stage IIIA-B NSCLC Treated With Combined-Modality Therapy

    International Nuclear Information System (INIS)

    Ramella, Sara; Trodella, Lucio; Mineo, Tommaso Claudio; Pompeo, Eugenio; Stimato, Gerardina; Gaudino, Diego; Valentini, Vincenzo; Cellini, Francesco; Ciresa, Marzia; Fiore, Michele; Piermattei, Angelo; Russo, Patrizia; Cesario, Alfredo; D'Angelillo, Rolando M.

    2010-01-01

    Purpose: To determine lung dosimetric constraints that correlate with radiation pneumonitis in non-small-cell lung cancer patients treated with three-dimensional radiation therapy and concurrent chemotherapy. Methods and Materials: Between June 2002 and December 2006, 97 patients with locally advanced non-small-cell lung cancer were treated with concomitant radiochemotherapy. All patients underwent complete three-dimensional treatment planning (including dose-volume histograms), and patients were treated only if the percentage of total lung volume exceeding 20 Gy (V 20 ) and 30 Gy (V 30 ), and mean lung dose (MLD) had not exceeded the constraints of 31%, 18%, and 20 Gy, respectively. The total and ipsilateral lung dose-volume histogram parameters, planning target volume, and total dose delivered were analyzed and correlated with pneumonitis incidence. Results: If dose constraints to the total lung were respected, the most statistically significant factors predicting pneumonitis were the percentage of ipsilateral lung volume exceeding 20 Gy (V 20 ipsi), percentage of ipsilateral lung volume exceeding 30 Gy (V 30 ipsi), and planning target volume. These parameters divided the patients into low- and high-risk groups: if V 20 ipsi was 52% or lower, the risk of pneumonitis was 9%, and if V 20 ipsi was greater than 52%, the risk of pneumonitis was 46%; if V 30 ipsi was 39% or lower, the risk of pneumonitis was 8%, and if V 30 ipsi was greater than 39%, the risk of pneumonitis was 38%. Actuarial curves of the development of pneumonitis of Grade 2 or higher stratified by V 20 ipsi and V 30 ipsi were created. Conclusions: The correlation between pneumonitis and dosimetric constraints has been validated. Adding V 20 ipsi and V 30 ipsi to the classical total lung constraints could reduce pulmonary toxicity in concurrent chemoradiation treatment. V 20 ipsi and V 30 ipsi are important if the V 20 to the total lung, V 30 to the total lung, and mean lung dose have not exceeded

  7. NTCP modelling and pulmonary function tests evaluation for the prediction of radiation induced pneumonitis in non-small-cell lung cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Tsougos, Ioannis [Department of Medical Physics, Medical School, University of Thessaly, Larissa (Greece); Nilsson, Per [Department of Radiation Physics, Lund University Hospital, Lund (Sweden); Theodorou, Kiki [Department of Medical Physics, Medical School, University of Thessaly, Larissa (Greece); Kjellen, Elisabeth [Department of Oncology, Lund University Hospital, Lund (Sweden); Ewers, Sven-Boerje [Department of Oncology, Lund University Hospital, Lund (Sweden); Jarlman, Olof [Department of Diagnostic Radiology, Lund University Hospital, Lund (Sweden); Lind, Bengt K [Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University (Sweden); Kappas, Constantin [Department of Medical Physics, Medical School, University of Thessaly, Larissa (Greece); Mavroidis, Panayiotis [Department of Medical Physics, University Hospital of Larissa, Larissa (Greece)

    2007-02-21

    This work aims to evaluate the predictive strength of the relative seriality, parallel and Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP) models regarding the incidence of radiation pneumonitis (RP), in a group of patients following lung cancer radiotherapy and also to examine their correlation with pulmonary function tests (PFTs). The study was based on 47 patients who received radiation therapy for stage III non-small-cell lung cancer. For each patient, lung dose volume histograms (DVHs) and the clinical treatment outcome were available. Clinical symptoms, radiological findings and pulmonary function tests incorporated in a post-treatment follow-up period of 18 months were used to assess the manifestation of radiation induced complications. Thirteen of the 47 patients were scored as having radiation induced pneumonitis, with RTOG criteria grade {>=} 3 and 28 of the 47 with RTOG criteria grade {>=} 2. Using this material, different methods of estimating the likelihood of radiation effects were evaluated, by analysing patient data based on their full dose distributions and associating the calculated complication rates with the clinical follow-up records. Lungs were evaluated as a paired organ as well as individual lungs. Of the NTCP models examined in the overall group considering the dose distribution in the ipsilateral lung, all models were able to predict radiation induced pneumonitis only in the case of grade 2 radiation pneumonitis score, with the LKB model giving the best results ({chi}{sup 2}-test: probability of agreement between the observed and predicted results P{sub {chi}}({chi}{sup 2}) = 0.524 using the 0.05 significance level). The NTCP modelling considering lungs as a paired organ did not give statistically acceptable results. In the case of lung cancer radiotherapy, the application of different published radiobiological parameters alters the NTCP results, but not excessively as in the case of breast cancer radiotherapy. In

  8. Correlation of the acute oxidative stress markers with radiation induced late lung disease response of pneumonitis and/or fibrosis

    International Nuclear Information System (INIS)

    Kunwar, Amit

    2016-01-01

    Biomarkers which predict for the occurrence of radiation-induced lung responses of pneumonitis and/or fibrosis are largely unknown. Herein, we investigated whether markers of oxidative stress and intracellular antioxidants, measured within days of radiation exposure, correlated with the lung tissue injury response occurring weeks later. Inbred strains of mice (KK/HIJ, C57BL/6J, 129S1/SvImJ, C3H/HeJ, A/J, AKR/J, CBA/J, NZW/LacJ) known to differ in their susceptibility to radiation induced pulmonary fibrosis, and to vary in time to onset of respiratory distress post thoracic irradiation (from 10-23 weeks) were studied. Mice were unirradiated (controls) or received whole thorax irradiation (18 Gy) and were euthanized at 6h, 1d, 7d, 8w and upon presentation of respiratory distress. Pulmonary levels of antioxidants superoxide dismutase, catalase, glutathione peroxidase (GPx) and glutathione, and of oxidative damage (reactive oxygen species (ROS), 8-hydroxydeoxyguanosine (8-OHdG) and numbers of γH2AX foci), were assessed

  9. Open label multicenter trial of subcutaneous amifostine (Ethyol) in the prevention of radiation induced esophagitis and pneumonitis in patients with measurable, unresectable non-small cell lung cancer.

    Science.gov (United States)

    Mehta, Vivek

    2004-12-01

    While concurrent delivery of chemotherapy and radiotherapy (RT) has a synergistic effect on tumor control and improves the median and overall survival in patients with locally advanced non-small cell lung cancer, appreciable acute and late morbidity occur to the esophagus and the lung during treatment (ie, acute radiation esophagitis, pulmonary toxicity). Emerging evidence suggests that the volume of normal lung exposed to certain threshold doses of RT might predict for the incidence of pneumonitis. Clinical data also indicate that amifostine (Ethyol; Medimmune Inc, Gaithersburg, MD), an organic thiophosphate, acts as a selective cytoprotective agent for normal tissues against the toxicities of chemotherapy and RT. Moreover, preclinical and clinical data suggest that subcutaneous administration of amifostine may be better tolerated with similar efficacy to that of the intravenous route. We are conducting an open-label trial that is accruing patients with locally advanced non-small cell lung cancer, who will receive concurrent chemoradiotherapy (cisplatin/etoposide or carboplatin/paclitaxel plus RT delivered using 3-dimensional conformal radiotherapy treatment planning) and amifostine 500 mg before RT. Incidence and severity of acute radiation esophagitis, acute radiation pneumonitis, chronic radiation pneumonitis, and changes in pulmonary function will be recorded, as will elements of the RT treatment planning (eg, dose volume histogram data for the lung and esophagus). Pre- and post-therapy pulmonary function is a primary endpoint, and others include general safety assessments of subcutaneous amifostine administration.

  10. Histomorphologic change of radiation pneumonitis in rat lungs: captopril reduces rat lung injury induced by irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee [College of Medicine, Keimhyung Univ., Taegu (Korea, Republic of)

    1999-09-01

    To assess the histomorphologic changes in the rat lung injury induced by radiation, to determine whether captopril reduces the rat lung injury and to evaluate change in TNF-{alpha} and TGF {beta} and rat lung damage by radiation and captopril. Right lungs in male Sprague-Dawley rats were divided irradiation alone (10, 20, 30 Gy) or radiation (same dose with radiation alone group) with captopril (500 mg/L). Radiation alone group were sacrificed at twelve hours and eleven weeks after radiation and radiation with captopril group (captopril group) were sacrificed at eleven weeks after radiation with captopril. We examined the light microscope and electron microscopic features in the groups. In radiation alone group, there were patch parenchymal collapse and consolidation at twelve hours after radiation. The increase of radiation dose shows more prominent the severity and broader the affected areas. Eleven weeks after radiation, the severity and areas of fibrosis had increased in proportion to radiation dose given in the radiation alone group. There was notable decrease of lung fibrosis in captopril group than in radiation alone group. The number of mast cells rapidly increased with increase of radiation dose in radiation alone group and the degree of increase of mast cell number and severity of collagen accumulation more decreased in captopril group than in radiation alone group. In radiation alone group expression of TNF-{alpha} and TGF-{beta}] increased according to increase of radiation dose at twelve hours after radiation in both group. At eleven weeks after radiation, expression of TGF- P increased according to increase of radiation dose in radiation group but somewhat decreased in captopril group. In the captopril group the collagen deposition increased but less dense than those of radiation alone group. The severity of perivascular thickening, capillary change, the number and degranulation of mast cells more decreased in the captopril group than in the radiation

  11. Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer: clinical, dosimetric, and associated-treatment risk factors.

    Science.gov (United States)

    Leprieur, Etienne Giroux; Fernandez, Diego; Chatellier, Gilles; Klotz, Sylvain; Giraud, Philippe; Durdux, Catherine

    2013-01-01

    Conformational thoracic radiotherapy (CTR) is a key-treatment in locally advanced nonsmall cell lung cancer (LA-NSCLC). Acute radiation pneumonitis (ARP) is one of the major complications. To evaluate the predictors of ARP after CTR in the treatment of LA-NSCLC. A total of 47 consecutive patients (pts) were treated with CTR for LA-NSCLC and retrospectively analyzed. The mean total dose of radiation therapy (RT) was 65 Gy, with respiratory gating (RG) in 19 cases. Induction and concomitant chemotherapy was performed in 33 pts (70%) and 41 pts (87%), respectively. Eleven pts (23%) had an ARP resulting in death for one pt. In univariate analysis, age, sex, pretherapeutic value of forced expiratory volume (FEV), not-gated radiotherapy and type of concomitant chemotherapy did not appear as contributing factors in contrast to the administration of induction gemcitabine ( p = 0.03). The occurrence of ARP was significantly associated with nontumor lung volumes irradiated to 13 Gy (V13, p = 0.04), 20 Gy (V20, p = 0.02), and 25 Gy (V25, p = 0.006), the mean lung dose ( p = 0.008) and lung normal tissue complication probability (NTCP) ( p = 0.004). In multivariate logistic regression analysis, the occurrence of ARP was significantly associated with age >75 years (odds ratio (OR) = 16.72, confidence interval (CI) 95% 1.77-157.87) and administration of induction gemcitabine (OR = 18.08, CI 95% 1.09-300.08). ARP is a common acute complication, requiring close posttreatment follow-up, particularly for elderly patients. The use of gemcitabine before radiation should be avoided. The benefits and risks of CTR must be carefully analyzed, according to the dosimetric parameters.

  12. Acute radiation pneumonitis after conformational radiotherapy for nonsmall cell lung cancer: Clinical, dosimetric, and associated-treatment risk factors

    Directory of Open Access Journals (Sweden)

    Etienne Giroux Leprieur

    2013-01-01

    Full Text Available Background: Conformational thoracic radiotherapy (CTR is a key-treatment in locally advanced nonsmall cell lung cancer (LA-NSCLC. Acute radiation pneumonitis (ARP is one of the major complications. Aims: To evaluate the predictors of ARP after CTR in the treatment of LA-NSCLC. Materials and methods: A total of 47 consecutive patients (pts were treated with CTR for LA-NSCLC and retrospectively analyzed. The mean total dose of radiation therapy (RT was 65 Gy, with respiratory gating (RG in 19 cases. Induction and concomitant chemotherapy was performed in 33 pts (70% and 41 pts (87%, respectively. Results: Eleven pts (23% had an ARP resulting in death for one pt. In univariate analysis, age, sex, pretherapeutic value of forced expiratory volume (FEV, not-gated radiotherapy and type of concomitant chemotherapy did not appear as contributing factors in contrast to the administration of induction gemcitabine ( p = 0.03. The occurrence of ARP was significantly associated with nontumor lung volumes irradiated to 13 Gy (V13, p = 0.04, 20 Gy (V20, p = 0.02, and 25 Gy (V25, p = 0.006, the mean lung dose ( p = 0.008 and lung normal tissue complication probability (NTCP ( p = 0.004. In multivariate logistic regression analysis, the occurrence of ARP was significantly associated with age >75 years (odds ratio (OR = 16.72, confidence interval (CI 95% 1.77-157.87 and administration of induction gemcitabine (OR = 18.08, CI 95% 1.09-300.08. Conclusion: ARP is a common acute complication, requiring close posttreatment follow-up, particularly for elderly patients. The use of gemcitabine before radiation should be avoided. The benefits and risks of CTR must be carefully analyzed, according to the dosimetric parameters.

  13. Genistein alleviates radiation-induced pneumonitis by depressing Ape1/Ref-1 expression to down-regulate inflammatory cytokines.

    Science.gov (United States)

    Liu, Guo-Dong; Xia, Lei; Zhu, Jian-Wu; Ou, Shan; Li, Meng-Xia; He, Yong; Luo, Wei; Li, Juan; Zhou, Qian; Yang, Xue-Qin; Shan, Jin-Lu; Wang, Ge; Wang, Dong; Yang, Zhen-Zhou

    2014-07-01

    The aim of the study was to investigate the role of genistein in alleviating radiation-induced pneumonitis(RIP) through down-regulating levels of the inflammatory cytokines by inhibiting the expression of apurinic/apyrimidinic endonuclease 1/redox factor-1 (Ape1/Ref-1). Fifty female C57BL/6J mice (8 weeks old) were randomly divided into a control group, a pure irradiation (IR) group and a genistein + IR group. At the four time points after IR, hematoxylin, and Masson’s trichrome stainings were used to examine the pathological changes and collagen fiber deposition. Flow cytometry was used to detect reactive oxygen system (ROS) changes, EMSA was used to estimate the nuclear factor kappa B (NF-κB) transcriptional activities and an ELISA assay was used to measure the levels of TGF-β1, IL-1β, TNF-α, and IL-6 in the serum and bronchoalveolar lavage fluid (BALF) 2 weeks after IR.The pathological detection results showed acute inflammatory/fibrinoid exudation of the thoracic tissue after IR,which was significantly alleviated with genistein. The IR inducedan APE1 protein expression increase and NF-jB was effectively suppressed by genistein (P < 0.05). The induction of the inflammatory cytokines TGF-β1, IL-1β,TNF-α, and IL-6 by IR were in turn inhibited in the serum and BALF of the genistein-pretreated mice (P < 0.05). In addition, the ROS production was significantly boosted in the A549 cells after IR, which could be down-regulated by the pretreatment of genistein. The results demonstrate that genistein alleviates RIP by attenuating the inflammatory response in the initiation of RIP. A possible target of genistein is the Ape1/ref-1, which regulates key inflammatory cytokines by activating the NF-κB.

  14. Feasibility and potential utility of multicomponent exhaled breath analysis for predicting development of radiation pneumonitis after stereotactic ablative radiotherapy.

    Science.gov (United States)

    Moré, Jayaji M; Eclov, Neville C W; Chung, Melody P; Wynne, Jacob F; Shorter, Joanne H; Nelson, David D; Hanlon, Alexandra L; Burmeister, Robert; Banos, Peter; Maxim, Peter G; Loo, Billy W; Diehn, Maximilian

    2014-07-01

    In this prospective pilot study, we evaluated the feasibility and potential utility of measuring multiple exhaled gases as biomarkers of radiation pneumonitis (RP) in patients receiving stereotactic ablative radiotherapy (SABR) for lung tumors. Breath analysis was performed for 26 patients receiving SABR for lung tumors. Concentrations of exhaled nitric oxide (eNO), carbon monoxide (eCO), nitrous oxide (eN2O), and carbon dioxide (eCO2) were measured before and immediately after each fraction using real-time, infrared laser spectroscopy. RP development (CTCAE grade ≥2) was correlated with baseline gas concentrations, acute changes in gas concentrations after each SABR fraction, and dosimetric parameters. Exhaled breath analysis was successfully completed in 77% of patients. Five of 20 evaluable patients developed RP at a mean of 5.4 months after SABR. Acute changes in eNO and eCO concentrations, defined as percent changes between each pre-fraction and post-fraction measurement, were significantly smaller in RP versus non-RP cases (p = 0.022 and 0.015, respectively). In an exploratory analysis, a combined predictor of baseline eNO greater than 24 parts per billion and acute decrease in eCO less than 5.5% strongly correlated with RP incidence (p =0.0099). Neither eN2O nor eCO2 concentrations were significantly associated with RP development. Although generally higher in patients destined to develop RP, dosimetric parameters were not significantly associated with RP development. The majority of SABR patients in this pilot study were able to complete exhaled breath analysis. Baseline concentrations and acute changes in concentrations of exhaled breath components were associated with RP development after SABR. If our findings are validated, exhaled breath analysis may become a useful approach for noninvasive identification of patients at highest risk for developing RP after SABR.

  15. Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC): Predictors for radiation pneumonitis and fibrosis

    International Nuclear Information System (INIS)

    Kong, F.-M.; Hayman, James A.; Griffith, Kent A.; Kalemkerian, Gregory P.; Arenberg, Douglas; Lyons, Susan; Turrisi, Andrew; Lichter, Allen; Fraass, Benedick; Eisbruch, Avraham; Lawrence, Theodore S.; Haken, Randall K. ten

    2006-01-01

    Purpose: We aimed to report the final toxicity results on a radiation-dose escalation trial designed to test a hypothesis that very high doses of radiation could be safely administered to patients with non-small-cell lung cancer (NSCLC) by quantifying the dose-volume toxicity relationship of the lung. Methods and Materials: A total of 109 patients with unresectable or medically inoperable NSCLC were enrolled and treated with radiation-dose escalation (on the basis of predicted normal-lung toxicity) either alone or with neoadjuvant chemotherapy by use of 3D conformal techniques. Eighty-four patients (77%) received more than 69 Gy, the trial was stopped after the dose reached 103 Gy. Estimated median follow-up was 110 months. Results: There were 17 (14.6%) Grade 2 to 3 pneumonitis and 15 (13.8%) Grade 2 to 3 fibrosis and no Grade 4 to 5 lung toxicity. Multivariate analyses showed them to be (1) not associated with the dose prescribed to the tumor, and (2) significantly (p < 0.001) associated with lung-dosimetric parameters such as the mean lung dose (MLD), volume of lung that received at least 20 Gy (V20), and the normal-tissue complication probability (NTCP) of the lung. If cutoffs are 30% for V20, 20 Gy for MLD, and 10% for NTCP, these factors have positive predictive values of 50% to 71% and negative predictive value of 85% to 89%. Conclusions: With long-term follow-up for toxicity, we have demonstrated that much higher doses of radiation than are traditionally administered can be safely delivered to a majority of patients with NSCLC. Quantitative lung dose-volume toxicity-based dose escalation can form the basis for individualized high-dose radiation treatment to maximize the therapeutic ratio in these patients

  16. A prospective study on radiation pneumonitis following conformal radiation therapy in non-small-cell lung cancer: clinical and dosimetric factors analysis.

    Science.gov (United States)

    Claude, Line; Pérol, David; Ginestet, Chantal; Falchero, Lionel; Arpin, Dominique; Vincent, Michel; Martel, Isabelle; Hominal, Stéphane; Cordier, Jean-François; Carrie, Christian

    2004-05-01

    Clinical and dosimetric prognostic factors for radiation pneumonitis (RP) have been reported after three-dimensional conformal radiotherapy (3D-CRT) in patients with non-small cell lung cancer (NSCLC). Ninety-six patients who received 3D-CRT for stage IA to IIIB NSCLC were evaluated prospectively. Surgery was performed before radiation in 51% of the patients (n = 49). RP was diagnosed six-eight weeks after 3D-CRT using the Lent-Soma classification. Factors evaluated included treatment factors such as total mean lung dose (MLD), and dose-volume histogram (DVH) thresholds for several radiation dose steps. These thresholds were originally determined from the median of the irradiated lung volume at each step. Six patients could not be evaluated for RP six weeks after 3D-CRT. Of the 90 remaining patients, 40 (44%) had RP (i.e. grade > or =1) at 6 weeks, including 7 patients (7.8%) with severe RP (grade > or =2). Regarding the whole toxicity (grade > or =1), age (> or =60 years), MLD, V20 and V30 were significantly related to RP. DVH thresholds determined for radiation doses from 20 to 40 Gy were also predictive of RP. Considering only severe RP (grade > or =2), only MLD, V20 and V30 remained associated with increased acute pulmonary toxicity. In this study, dosimetric factors (MLD, V20, V30) and age (> or =60 years) were predictive of RP regarding the whole pulmonary toxicity (grade > or =1). In addition, thresholds from 20 to 40 Gy, based on a stratification according to the median of the percentage of irradiated lung volume, were also predictive factors. They may, therefore, help discriminate patients at high and low risk for RP. However, only MLD, V20 and V30 remained associated with severe RP (grade > or =2), probably due to the small number of severe events in our series.

  17. [Low dose volume histogram analysis of the lungs in prediction of acute radiation pneumonitis in patients with esophageal cancer treated with three-dimensional conformal radiotherapy].

    Science.gov (United States)

    Shen, Wen-bin; Zhu, Shu-chai; Gao, Hong-mei; Li, You-mei; Liu, Zhi-kun; Li, Juan; Su, Jing-wei; Wan, Jun

    2013-01-01

    To investigate the predictive value of low dose volume of the lung on acute radiation pneumonitis (RP) in patients with esophageal cancer treated with three-dimensional conformal radiotherapy (3D-CRT) only, and to analyze the relation of comprehensive parameters of the dose-volume V5, V20 and mean lung dose (MLD) with acute RP. Two hundred and twenty-two patients with esophageal cancer treated by 3D-CRT have been followed up. The V5-V30 and MLD were calculated from the dose-volume histogram system. The clinical factors and treatment parameters were collected and analyzed. The acute RP was evaluated according to the RTOG toxicity criteria. The acute RP of grade 1, 2, 3 and 4 were observed in 68 (30.6%), 40 (18.0%), 8 (3.6%) and 1 (0.5%) cases, respectively. The univariate analysis of measurement data:The primary tumor length, radiation fields, MLD and lung V5-V30 had a significant relationship with the acute RP. The magnitude of the number of radiation fields, the volume of GTV, MLD and Lung V5-V30 had a significant difference in whether the ≥ grade 1 and ≥ grade 2 acute RP developed or not. Binary logistic regression analysis showed that MLD, Lung V5, V20 and V25 were independent risk factors of ≥ grade 1 acute RP, and the radiation fields, MLD and Lung V5 were independent risk factors of ≥ grade 2 acute RP. The ≥ grade 1 and ≥ grade 2 acute RP were significantly decreased when MLD less than 14 Gy, V5 and V20 were less than 60% and 28%,respectively. When the V20 ≤ 28%, the acute RP was significantly decreased in V5 ≤ 60% group. When the MLD was ≤ 14 Gy, the ≥ 1 grade acute RP was significantly decreased in the V5 ≤ 60% group. When the MLD was >14 Gy, the ≥ grade 2 acute RP was significantly decreased in the V5 ≤ 60% group. The low dose volume of the lung is effective in predicting radiation pneumonitis in patients with esophageal cancer treated with 3D-CRT only. The comprehensive parameters combined with V5, V20 and MLD may increase the

  18. SU-D-16A-03: A Radiation Pneumonitis Dose-Response Model Incorporating Non- Local Radiation-Induced Bystander Effect

    Energy Technology Data Exchange (ETDEWEB)

    Gordon, J; Snyder, K; Zhong, H; Chetty, I [Henry Ford Health System, Dept. Radiation Oncology, Detroit, MI (United States)

    2014-06-01

    Purpose: Dose-response models that can reliably predict radiation pneumonitis (RP) to guide radiation therapy (RT) for lung cancer presently do not exist. A model is proposed that incorporates non-local radiationinduced bystander effect (RIBE). Methods: A single sigmoid response function, derived from published data for whole lung irradiation, relates RP probability to cumulative lung damage, regardless of fractionation scheme. Lung damage is assumed to be caused by direct local radiation damage, quantified via the linear-quadratic (LQ) model, and RIBE. Based on published data, RIBE is assumed to be activated when per-fraction dose rises above ∼0.6 Gy, but is constant with dose above that threshold. Integral RIBE damage is assumed proportional to lung volume irradiated above ∼0.6 Gy per fraction. Key model parameters include LQ α and β, and two RIBE parameters: the single-fraction probability δ of damage, and a proportionality parameter κ that relates the potential for RIBE damage to irradiated lung volume. All parameters are tentatively fitted from published data, the RIBE parameters from published RP rates for conventionally fractionated RT (CFRT) and stereotactic body RT (SBRT). Results: The model predicts dose-response curves that are consistent with clinical experience. It provides a tentative explanation for why V20 (33 fractions), V13 (20 fractions) and V5 (<10 fractions) are observed to be correlated with RP. It also provides a plausible explanation for the success of SBRT — RIBE damage increases with the number of fractions, so penalizes CFRT relative to SBRT. Conclusion: The proposed model is relatively simple, extrapolates from published data, plausibly explains several clinical observations, and produces dose-response curves that are consistent with clinical experience. While capable of elaboration, its ability to explain doseresponse experience with different fractionation schemes using a small number of assumptions and parameters is an

  19. SU-D-16A-03: A Radiation Pneumonitis Dose-Response Model Incorporating Non- Local Radiation-Induced Bystander Effect

    International Nuclear Information System (INIS)

    Gordon, J; Snyder, K; Zhong, H; Chetty, I

    2014-01-01

    Purpose: Dose-response models that can reliably predict radiation pneumonitis (RP) to guide radiation therapy (RT) for lung cancer presently do not exist. A model is proposed that incorporates non-local radiationinduced bystander effect (RIBE). Methods: A single sigmoid response function, derived from published data for whole lung irradiation, relates RP probability to cumulative lung damage, regardless of fractionation scheme. Lung damage is assumed to be caused by direct local radiation damage, quantified via the linear-quadratic (LQ) model, and RIBE. Based on published data, RIBE is assumed to be activated when per-fraction dose rises above ∼0.6 Gy, but is constant with dose above that threshold. Integral RIBE damage is assumed proportional to lung volume irradiated above ∼0.6 Gy per fraction. Key model parameters include LQ α and β, and two RIBE parameters: the single-fraction probability δ of damage, and a proportionality parameter κ that relates the potential for RIBE damage to irradiated lung volume. All parameters are tentatively fitted from published data, the RIBE parameters from published RP rates for conventionally fractionated RT (CFRT) and stereotactic body RT (SBRT). Results: The model predicts dose-response curves that are consistent with clinical experience. It provides a tentative explanation for why V20 (33 fractions), V13 (20 fractions) and V5 (<10 fractions) are observed to be correlated with RP. It also provides a plausible explanation for the success of SBRT — RIBE damage increases with the number of fractions, so penalizes CFRT relative to SBRT. Conclusion: The proposed model is relatively simple, extrapolates from published data, plausibly explains several clinical observations, and produces dose-response curves that are consistent with clinical experience. While capable of elaboration, its ability to explain doseresponse experience with different fractionation schemes using a small number of assumptions and parameters is an

  20. Lung function evaluation in acute postradiation pneumonitis

    International Nuclear Information System (INIS)

    Jassem, E.; Zandwijk, N. van; Jassem, J.; Badzio, A.

    1997-01-01

    The aim of this study was pulmonary function evaluation in patients with radiation pneumonitis (rp). Study group included 18 patients with symptomatic rp (8 with breast cancer, 6 with Hodgkin's disease and 4 with lung cancer) treated at the Netherland s Cancer inst. In Amsterdam between 1988 and 1994. The lung function tests were performed at the time of rp presentation and monthly thereafter and consisted of a standard spirometry: forced expiratory volume in 1 sec. (FEV1), vital capacity (VC) and diffusing capacity for carbon monoxide (DLCO) performed with the use of a single breath technique. The mean values of DLCO, VC, FEV1 and TLC at the time of rp presentation were 72.2%, 91.0% and 85.8% of predicted value (pv), respectively. The results of the a bone tests at the last examination (66.4%, 85.6%, 77.2% and 76.2% of pv), respectively, were lower than those registered at the time of rp presentation. The highest degree of functional deterioration included diffusion capacity; the mean of the lowest values of DLCO was 56.4% of pv. Usually the lowest value of DLCO accompanied the exacerbation of clinical symptoms. The results of this study demonstrated pulmonary function deterioration in patients with rp. (author)

  1. Reduction of treatment breaks and radiation-induced esophagitis and pneumonitis using amifostine in unresectable non-small cell lung cancer patients receiving definitive concurrent chemotherapy and radiation therapy: a prospective community-based clinical trial.

    Science.gov (United States)

    Wynn, Raymond B; Mehta, Vivek

    2005-04-01

    Concurrent chemotherapy with daily thoracic radiation therapy is a common regimen used in patients with non-small cell lung cancer resulting in excellent response rates but with appreciable morbidity. Radiation-induced toxicities may increase the number of treatment breaks and then may limit the use of this aggressive treatment approach for some patients. We are conducting an open-label, multicenter trial determining the incidence of radiation treatment breaks and severity of treatment-related toxicities with the concurrent use of a cytoprotective agent. Approximately 15 to 20 sites in the United States will participate with a total of 200 patients. Patients will receive one of two chemotherapy regimens and daily radiation (1.8 to 2.0 Gy daily; total dose, 60 to 70 Gy) and amifostine 500 mg subcutaneously or intravenous push daily over a 6- to 7-week period. Patients will receive amifostine (Ethyol; MedImmune Inc, Gaithersburg, MD) 500 mg daily. The route of amifostine administration chosen at the time of patient registration must be adhered to throughout the study. In addition, all patients may receive consolidation chemotherapy consisting of intravenous docetaxel 75 mg/m 2 once every 3 weeks for three courses, starting more than 30 but less than 60 days after the last dose of amifostine or thoracic radiation therapy, whichever is the last therapy discontinued. The objectives of this study are to determine the incidence of radiation treatment breaks and evaluate acute radiation esophagitis, acute radiation pneumonitis, chronic radiation pneumonitis, and pulmonary function in patients with measurable, medically inoperable non-small cell lung cancer stage II, unresectable stage IIIA, or IIIB disease receiving combined modality therapy and amifostine.

  2. BIO 300, a nanosuspension of genistein, mitigates pneumonitis/fibrosis following high-dose radiation exposure in the C57L/J murine model.

    Science.gov (United States)

    Jackson, Isabel L; Zodda, Andrew; Gurung, Ganga; Pavlovic, Radmila; Kaytor, Michael D; Kuskowski, Michael A; Vujaskovic, Zeljko

    2017-12-01

    BIO 300 nanosuspension (Humanetics Corporation) is being developed as a medical countermeasure (MCM) for the mitigation of the delayed effects of acute radiation exposure, specifically pneumonitis and fibrosis of the lung. The objective of this study was to determine the best dose and treatment duration of BIO 300 to mitigate lung injury and improve the likelihood for survival in C57L/J mice exposed to whole thorax lung irradiation (WTLI). Age- and sex-matched C57L/J mice received a single dose of 11.0 or 12.5 Gy WTLI. BIO 300 (200 or 400 mg·kg -1 , oral gavage) was administered daily starting 24 h post-exposure for a duration of 2, 4, 6 or, in some cases, 10 weeks. Non-treated controls were included for comparison in both sexes. Animals were observed daily for signs of major morbidity. Respiratory function was assessed biweekly. Lungs were collected, weighed and paraffin embedded for histological evaluation post mortem. BIO 300 administered at an oral dose of 400 mg·kg -1 for 4 to 6 weeks starting 24 h post-WTLI reduced morbidity associated with WTLI. The improvement in survival correlated with reduced respiratory frequency and enhanced pause. The irradiated lungs of mice treated with BIO 300 (400 mg·kg -1 ) for 4 to 6 weeks displayed less morphological damage and airway loss due to oedema, congestion and fibrotic scarring than the untreated, irradiated controls. BIO 300 is a promising MCM candidate to mitigate pneumonitis/fibrosis when administered daily for 4-6 weeks starting 24 h post-exposure. © 2017 The British Pharmacological Society.

  3. Symptomatic hypothalamic-pituitary dysfunction in nasopharyngeal carcinoma patients following radiation therapy: a retrospective study

    International Nuclear Information System (INIS)

    Lam, K.S.; Ho, J.H.; Lee, A.W.; Tse, V.K.; Chan, P.K.; Wang, C.; Ma, J.T.; Yeung, R.T.

    1987-01-01

    Endocrine assessment was performed in 32 relapse-free southern Chinese patients 5-17 years following radiation therapy (RT) alone for early nasopharyngeal carcinoma (NPC). Initial screening was done using questionnaires emphasizing impaired sexual function and menstrual disturbance plus measurement of serum levels of thyroxine, free thyroxine index, thyrotropic hormone, prolactin, and additionally testosterone for males only. Those showing abnormalities were subjected to detailed pituitary function tests. Hypothalamic-pituitary dysfunction was found in 7 female patients and only 1 male patient. A delayed TSH response to thyrotropin releasing hormone suggesting a hypothalamic disorder was seen in 6 of the affected female patients, and hyperprolactinaemia in also 6. None of the patients had evidence of diabetes insipidus. Hypopituitarism became symptomatic 2-5 years after RT with a mean latent interval of 3.8 years. A practical protocol for regular endocrine assessment for NPC patients after RT has been proposed. Multiple linear regression analysis of the radiotherapeutic data from the 11 female patients indicates that the likelihood of late occurrence of symptomatic hypothalamic-pituitary dysfunction following RT is dependent on the TDF of the target dose to the nasopharyngeal region and the height of the upper margin of the opposed lateral facial fields above the diaphragma sellae (coefficient of multiple correlation = 0.9025). Except when the sphenoid sinus or the middle cranial fossa is involved, it is advisable to set the height of the upper margin of the lateral facial field at a level no higher than the diaphragma sellae. The hypothalamus and possibly the pituitary stalk as well may sustain permanent damage by doses of radiation within the conventional radiotherapeutic range for carcinomas

  4. Factors Predictive of Symptomatic Radiation Injury After Linear Accelerator-Based Stereotactic Radiosurgery for Intracerebral Arteriovenous Malformations

    Energy Technology Data Exchange (ETDEWEB)

    Herbert, Christopher, E-mail: cherbert@bccancer.bc.ca [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC (Canada); Moiseenko, Vitali [Department of Medical Physics, British Columbia Cancer Agency, Vancouver, BC (Canada); McKenzie, Michael [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC (Canada); Redekop, Gary [Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC (Canada); Hsu, Fred [Department of Radiation Oncology, British Columbia Cancer Agency, Abbotsford, BC (Canada); Gete, Ermias; Gill, Brad; Lee, Richard; Luchka, Kurt [Department of Medical Physics, British Columbia Cancer Agency, Vancouver, BC (Canada); Haw, Charles [Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC (Canada); Lee, Andrew [Department of Neurosurgery, Royal Columbian Hospital, New Westminster, BC (Canada); Toyota, Brian [Division of Neurosurgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC (Canada); Martin, Montgomery [Department of Medical Imaging, British Columbia Cancer Agency, Vancouver, BC (Canada)

    2012-07-01

    Purpose: To investigate predictive factors in the development of symptomatic radiation injury after treatment with linear accelerator-based stereotactic radiosurgery for intracerebral arteriovenous malformations and relate the findings to the conclusions drawn by Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC). Methods and Materials: Archived plans for 73 patients who were treated at the British Columbia Cancer Agency were studied. Actuarial estimates of freedom from radiation injury were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of radiation injury. Log-rank test was used to search for dosimetric parameters associated with freedom from radiation injury. Results: Symptomatic radiation injury was exhibited by 14 of 73 patients (19.2%). Actuarial rate of symptomatic radiation injury was 23.0% at 4 years. Most patients (78.5%) had mild to moderate deficits according to Common Terminology Criteria for Adverse Events, version 4.0. On univariate analysis, lesion volume and diameter, dose to isocenter, and a V{sub x} for doses {>=}8 Gy showed statistical significance. Only lesion diameter showed statistical significance (p < 0.05) in a multivariate model. According to the log-rank test, AVM volumes >5 cm{sup 3} and diameters >30 mm were significantly associated with the risk of radiation injury (p < 0.01). The V{sub 12} also showed strong association with the incidence of radiation injury. Actuarial incidence of radiation injury was 16.8% if V{sub 12} was <28 cm{sup 3} and 53.2% if >28 cm{sup 3} (log-rank test, p = 0.001). Conclusions: This study confirms that the risk of developing symptomatic radiation injury after radiosurgery is related to lesion diameter and volume and irradiated volume. Results suggest a higher tolerance than proposed by QUANTEC. The widely differing findings reported in the literature, however, raise considerable uncertainties.

  5. An autopsied case of human chorionic gonadotropin (HCG)-producing lung cancer accompanied by bilateral radiation pneumonitis due to small doses of irradiation

    International Nuclear Information System (INIS)

    Tano, Yoshihiko; Adachi, Michifumi; Kimura, Makoto; Matsushima, Toshiharu; Torii, Takashi

    1990-01-01

    An autopsied case of human chorionic gonadotropin (HCG)-producing lung cancer accompanied by bilateral radiation pneumonitis is reported. A 68 year-old male was admitted to our hospital because of an abnormal shadow in his chest x-ray. Lung cancer was diagnosed and treated with radiotherapy. The radiotherapy (1,200 cGy) was discontinued, however because his general condition deteriorated. Chest x-rays then showed a pneumonia-like shadow in the projected field of irradiation. The same shadow was observed in the contralateral lung field one month later. Gynecomastia and an elevated level of serum HCG were noticed during hospitalization. The patient died and an autopsy was performed. Histopathological examination upon autopsy confirmed a large cell carcinoma of the lung which stained positively for HCG with an immunoenzyme labelling technique using the PAP method. Marked fibrosis and thickening of the alveolar septae were histologically demonstrated in the projected field of irradiation and the contralateral field where chest x-rays showed the pneumonia-like shadow. (author)

  6. An autopsied case of human chorionic gonadotropin (HCG)-producing lung cancer accompanied by bilateral radiation pneumonitis due to small doses of irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Tano, Yoshihiko; Adachi, Michifumi; Kimura, Makoto; Matsushima, Toshiharu; Torii, Takashi (Kawasaki Medical School, Kawasaki Hospital, Okayama (Japan))

    1990-07-01

    An autopsied case of human chorionic gonadotropin (HCG)-producing lung cancer accompanied by bilateral radiation pneumonitis is reported. A 68 year-old male was admitted to our hospital because of an abnormal shadow in his chest x-ray. Lung cancer was diagnosed and treated with radiotherapy. The radiotherapy (1,200 cGy) was discontinued, however because his general condition deteriorated. Chest x-rays then showed a pneumonia-like shadow in the projected field of irradiation. The same shadow was observed in the contralateral lung field one month later. Gynecomastia and an elevated level of serum HCG were noticed during hospitalization. The patient died and an autopsy was performed. Histopathological examination upon autopsy confirmed a large cell carcinoma of the lung which stained positively for HCG with an immunoenzyme labelling technique using the PAP method. Marked fibrosis and thickening of the alveolar septae were histologically demonstrated in the projected field of irradiation and the contralateral field where chest x-rays showed the pneumonia-like shadow. (author).

  7. Propensity-score-matched evaluation of the incidence of radiation pneumonitis and secondary cancer risk for breast cancer patients treated with IMRT/VMAT.

    Science.gov (United States)

    Chao, Pei-Ju; Lee, Hsiao-Fei; Lan, Jen-Hong; Guo, Shih-Sian; Ting, Hui-Min; Huang, Yu-Jie; Chen, Hui-Chun; Lee, Tsair-Fwu

    2017-10-23

    Propensity score matching evaluates the treatment incidence of radiation-induced pneumonitis (RP) and secondary cancer risk (SCR) after intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for breast cancer patients. Of 32 patients treated with IMRT and 58 who received VMAT were propensity matched in a 1:1 ratio. RP and SCR were evaluated as the endpoints of acute and chronic toxicity, respectively. Self-fitted normal tissue complication probability (NTCP) parameter values were used to analyze the risk of RP. SCRs were evaluated using the preferred Schneider's parameterization risk models. The dosimetric parameter of the ipsilateral lung volume receiving 40 Gy (IV 40 ) was selected as the dominant risk factor for the RP NTCP model. The results showed that the risks of RP and NTCP, as well as that of SCR of the ipsilateral lung, were slightly lower than the values in patients treated with VMAT versus IMRT (p ≤ 0.01). However, the organ equivalent dose and excess absolute risk values in the contralateral lung and breast were slightly higher with VMAT than with IMRT (p ≤ 0.05). When compared to IMRT, VMAT is a rational radiotherapy option for breast cancer patients, based on its reduced potential for inducing secondary malignancies and RP complications.

  8. Predictors of grade {>=}2 and grade {>=}3 radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with three-dimensional conformal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dang, Jun; Li, Guang; Ma, Lianghua; Han, Chong; Zhang, Shuo; Yao, Lei [Dept. of Radiation Oncology, The First Hospital of China Medical Univ., Shenyang (China)], e-mail: gl1963516@yahoo.cn; Diao, Rao [Dept. of Experimental Technology Center, China Medical Univ., Shenyang (China); Zang, Shuang [Dept. of Nursing, China Medical Univ., Shenyang (China)

    2013-08-15

    Grade {>=}3 radiation pneumonitis (RP) is generally severe and life-threatening. Predictors of grade {>=}2 are usually used for grade {>=}3 RP prediction, but it is unclear whether these predictors are appropriate. In this study, predictors of grade {>=}2 and grade {>=}3 RP were investigated separately. The increased risk of severe RP in elderly patients compared with younger patients was also evaluated. Material and methods: A total of 176 consecutive patients with locally advanced non-small cell lung cancer were followed up prospectively after three-dimensional conformal radiotherapy. RP was graded according to Common Terminology Criteria for Adverse Events version 3.0. Results: Mean lung dose (MLD), mean heart dose, ratio of planning target volume to total lung volume (PTV/Lung), and dose-volume histogram comprehensive value of both heart and lung were associated with both grade {>=}2 and grade {>=}3 RP in univariate analysis. In multivariate logistic regression analysis, age and MLD were predictors of both grade {>=}2 RP and grade {>=}3 RP; receipt of chemotherapy predicted grade {>=}3 RP only; and sex and PTV/Lung predicted grade {>=}2 RP only. Among patients who developed high-grade RP, MLD and PTV/Lung were significantly lower in patients aged {>=}70 years than in younger patients (p<0.05 for both comparisons). Conclusions: The predictors were not completely consistent between grade {>=}2 RP and grade {>=}3 RP. Elderly patients had a higher risk of severe RP than younger patients did, possibly due to lower tolerance of radiation to the lung.

  9. Comments on 'Reconsidering the definition of a dose-volume histogram'--dose-mass histogram (DMH) versus dose-volume histogram (DVH) for predicting radiation-induced pneumonitis.

    Science.gov (United States)

    Mavroidis, Panayiotis; Plataniotis, Georgios A; Górka, Magdalena Adamus; Lind, Bengt K

    2006-12-21

    In a recently published paper (Nioutsikou et al 2005 Phys. Med. Biol. 50 L17) the authors showed that the use of the dose-mass histogram (DMH) concept is a more accurate descriptor of the dose delivered to lung than the traditionally used dose-volume histogram (DVH) concept. Furthermore, they state that if a functional imaging modality could also be registered to the anatomical imaging modality providing a functional weighting across the organ (functional mass) then the more general and realistic concept of the dose-functioning mass histogram (D[F]MH) could be an even more appropriate descriptor. The comments of the present letter to the editor are in line with the basic arguments of that work since their general conclusions appear to be supported by the comparison of the DMH and DVH concepts using radiobiological measures. In this study, it is examined whether the dose-mass histogram (DMH) concept deviated significantly from the widely used dose-volume histogram (DVH) concept regarding the expected lung complications and if there are clinical indications supporting these results. The problem was investigated theoretically by applying two hypothetical dose distributions (Gaussian and semi-Gaussian shaped) on two lungs of uniform and varying densities. The influence of the deviation between DVHs and DMHs on the treatment outcome was estimated by using the relative seriality and LKB models using the Gagliardi et al (2000 Int. J. Radiat. Oncol. Biol. Phys. 46 373) and Seppenwoolde et al (2003 Int. J. Radiat. Oncol. Biol. Phys. 55 724) parameter sets for radiation pneumonitis, respectively. Furthermore, the biological equivalent of their difference was estimated by the biologically effective uniform dose (D) and equivalent uniform dose (EUD) concepts, respectively. It is shown that the relation between the DVHs and DMHs varies depending on the underlying cell density distribution and the applied dose distribution. However, the range of their deviation in terms of the

  10. Bleomycin-induced pneumonitis

    NARCIS (Netherlands)

    S. Sleijfer (Stefan)

    2001-01-01

    textabstractThe cytotoxic agent bleomycin is feared for its induction of sometimes fatal pulmonary toxicity, also known as bleomycin-induced pneumonitis (BIP). The central event in the development of BIP is endothelial damage of the lung vasculature due to bleomycin-induced

  11. Adenovirus-mediated Foxp3 expression in lung epithelial cells ameliorates acute radiation-induced pneumonitis in mice.

    Science.gov (United States)

    Shin, D; Lee, G; Lee, S; Park, S; Jung, K-H; Lee, J H; Lee, J M; Kim, J-Y; Cho, J; Bae, H

    2017-02-01

    Forkhead transcription factor 3 (Foxp3) has a critical role in regulatory T cells (Treg). There are an increasing number of researches concerning the functions of Foxp3 in other cells, including lung epithelial cells besides Treg. However, the roles of Foxp3 in lung epithelial cells remain poorly understood. To examine the potential therapeutic benefits of Foxp3 for lung inflammation, this study investigates the effect of adenovirus-mediated Foxp3 overexpression in a radiation-induced lung damage model. Foxp3-EGFP expressing adenovirus was administered by intratracheal injection three times over 14 days after focal X-ray irradiation. To evaluate effects of Foxp3 overexpression in radiation-induced lung inflammation, immune cell profiles of bronchoalveolar lavage (BAL) fluid were analyzed. Foxp3 gene-delivered mice showed significant inhibition of immune cell infiltration, such as eosinophils, lymphocytes, macrophages and neutrophils in BAL fluid. Histopathological analysis also showed that Foxp3 overexpression inhibits inflammatory cell recruitment and collagen deposition in lung tissues. In addition, expression of inflammatory and fibrosis-related genes was decreased in the Foxp3 expression adenovirus-infected group. These results suggest that Foxp3 expression in lungs holds considerable therapeutic potential for attenuating inflammation and fibrosis in radiation-induced lung injury.

  12. Unraveling biophysical interactions of radiation pneumonitis in non-small-cell lung cancer via Bayesian network analysis.

    Science.gov (United States)

    Luo, Yi; El Naqa, Issam; McShan, Daniel L; Ray, Dipankar; Lohse, Ines; Matuszak, Martha M; Owen, Dawn; Jolly, Shruti; Lawrence, Theodore S; Kong, Feng-Ming Spring; Ten Haken, Randall K

    2017-04-01

    In non-small-cell lung cancer radiotherapy, radiation pneumonitis≥grade 2 (RP2) depends on patients' dosimetric, clinical, biological and genomic characteristics. We developed a Bayesian network (BN) approach to explore its potential for interpreting biophysical signaling pathways influencing RP2 from a heterogeneous dataset including single nucleotide polymorphisms, micro RNAs, cytokines, clinical data, and radiation treatment plans before and during the course of radiotherapy. Model building utilized 79 patients (21 with RP2) with complete data, and model testing used 50 additional patients with incomplete data. A developed large-scale Markov blanket approach selected relevant predictors. Resampling by k-fold cross-validation determined the optimal BN structure. Area under the receiver-operating characteristics curve (AUC) measured performance. Pre- and during-treatment BNs identified biophysical signaling pathways from the patients' relevant variables to RP2 risk. Internal cross-validation for the pre-BN yielded an AUC=0.82 which improved to 0.87 by incorporating during treatment changes. In the testing dataset, the pre- and during AUCs were 0.78 and 0.82, respectively. Our developed BN approach successfully handled a high number of heterogeneous variables in a small dataset, demonstrating potential for unraveling relevant biophysical features that could enhance prediction of RP2, although the current observations would require further independent validation. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Dose-volume analysis of lung complications in the radiation treatment of malignant thymoma: a retrospective review

    International Nuclear Information System (INIS)

    Moiseenko, Vitali; Craig, Tim; Bezjak, Andrea; Dyk, Jake van

    2003-01-01

    Background and purpose: Radiation pneumonitis and fibrosis are limiting factors in radiation treatment (RT) of thoracic tumors. The objectives of this study were to quantify the influence of irradiated lung volume and dose on lung response, and to evaluate the influence of other prognostic factors. Material and methods: Treatment histories of 55 thymoma patients were evaluated retrospectively for radiation pneumonitis and fibrosis. Complications were scored as pneumonitis if observed within 6 months of completion of RT, and as fibrosis if observed after 6 months. Complications were classified as 'all pneumonitis' and 'all fibrosis' if a patient either showed symptoms (such as chronic cough and dyspnea) or radiographic changes in lung. The second group scored as 'symptomatic pneumonitis' and 'symptomatic fibrosis' consisted of patients that exhibited clinical symptoms. Dose-volume data were estimated using representative anatomies combined with available individual dose data. The Lyman NTCP model was used to assess the dependence of lung complication incidence on dose and volume. Results: The derived values of the parameters governing dose-volume dependence for symptomatic complications agreed with currently accepted and recently published values within the margins of error. Dose-response curves for complications that included radiographic changes were less steep than for symptomatic complications. The volume dependence for symptomatic fibrosis was more pronounced compared to all fibrosis. A strong correlation was observed between developing pneumonitis and developing fibrosis. Conclusions: The long survival allowed the assessment of lung complication data in thymoma patients for both acute and late response. Mean dose in lung strongly correlated with lung complications that manifest clinically. The determination of the dose-volume dependence is affected by the choice of endpoints (i.e. whether complications are scored based on clinical symptoms or radiographic

  14. Prediction of PET/CT to alleviate radiation pneumonitis in patients with non-small cell lung cancer for 3-dimentional conformal radiotherapy

    International Nuclear Information System (INIS)

    Gong Heyi; Yu Jinming; Li Jianbin; Li Baosheng; Fu Zheng; Liu Tonghai

    2005-01-01

    Objective: To investigate the impact of PET/CT on clinical staging of non-small cell lung cancer (NSCLC), delineation of target volume, and prediction to alleviate radiation pneumonitis (RP) from 3-dimentional conformal radiotherapy (3D-CRT) planning. Methods: From October 2002 to June 2004, 34 patients diagnosed cytologically or pathologically with NSCLC, who were candidates for radical radiotherapy or surgery, received PET/CT scanning. Both images were transmitted into treatment planning system (TPS) workstations respectively and were fused and reconstructed. All patients were staged according to the 1997 World Health Organization (WHO) staging system. The impact of PET/CT on the clinical staging of all the patients was determined. The gross tumor volume (GTV) was delineated on the CT imaging and PET/CTfused imaging respectively. Based on the two images, 3D- CRT planning was made respectively at the TPS workstation with Topslane software, the planning target volumes (PTV) being defined with a 15 mm margin around GTV of primary lumps (PTV 1 ) and 7 mm for involved lymph nodes (PTV 2 ). Evaluating indexes including V PTV (volume of PTV, V PTV = V PTV1 + V PTV2 ), V 20 (percentage of the total lung volume receiving more than 20 Gy), MLD (mean lung dose) , TCP (tumor control probability) , NTCP (normal tissue complication probability) , and Ds (dose to spinal cord) were selected to be paralleled to compare the quality of the two plans and the impact of PET/CT on RP was further analyzed. Results: In 13 of 34 (38.2%) cases, PET/CT information changed the clinical staging, 8 of which were upstaged and 5 downstaged. For 10 of 34 (29.4%) cases, PET/CT results modified their management decisions. Among 16 patients performed by surgery, 14 had consistent PET/CT staging with pathologic staging. The sensitivity of PET/CT was 93.3% and accuracy 87.5%. Difference of indexes including V PTV , V 20 and MLD between the two radiation planning was statistically significant, but Ds

  15. Using generalized equivalent uniform dose atlases to combine and analyze prospective dosimetric and radiation pneumonitis data from 2 non-small cell lung cancer dose escalation protocols.

    Science.gov (United States)

    Liu, Fan; Yorke, Ellen D; Belderbos, José S A; Borst, Gerben R; Rosenzweig, Kenneth E; Lebesque, Joos V; Jackson, Andrew

    2013-01-01

    To demonstrate the use of generalized equivalent uniform dose (gEUD) atlas for data pooling in radiation pneumonitis (RP) modeling, to determine the dependence of RP on gEUD, to study the consistency between data sets, and to verify the increased statistical power of the combination. Patients enrolled in prospective phase I/II dose escalation studies of radiation therapy of non-small cell lung cancer at Memorial Sloan-Kettering Cancer Center (MSKCC) (78 pts) and the Netherlands Cancer Institute (NKI) (86 pts) were included; 10 (13%) and 14 (17%) experienced RP requiring steroids (RPS) within 6 months after treatment. gEUD was calculated from dose-volume histograms. Atlases for each data set were created using 1-Gy steps from exact gEUDs and RPS data. The Lyman-Kutcher-Burman model was fit to the atlas and exact gEUD data. Heterogeneity and inconsistency statistics for the fitted parameters were computed. gEUD maps of the probability of RPS rate≥20% were plotted. The 2 data sets were homogeneous and consistent. The best fit values of the volume effect parameter a were small, with upper 95% confidence limit around 1.0 in the joint data. The likelihood profiles around the best fit a values were flat in all cases, making determination of the best fit a weak. All confidence intervals (CIs) were narrower in the joint than in the individual data sets. The minimum P value for correlations of gEUD with RPS in the joint data was .002, compared with P=.01 and .05 for MSKCC and NKI data sets, respectively. gEUD maps showed that at small a, RPS risk increases with gEUD. The atlas can be used to combine gEUD and RPS information from different institutions and model gEUD dependence of RPS. RPS has a large volume effect with the mean dose model barely included in the 95% CI. Data pooling increased statistical power. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Using Generalized Equivalent Uniform Dose Atlases to Combine and Analyze Prospective Dosimetric and Radiation Pneumonitis Data From 2 Non-Small Cell Lung Cancer Dose Escalation Protocols

    Energy Technology Data Exchange (ETDEWEB)

    Liu Fan; Yorke, Ellen D. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Belderbos, Jose S.A.; Borst, Gerben R. [The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam (Netherlands); Rosenzweig, Kenneth E. [Mount Sinai School of Medicine, New York, New York (United States); Lebesque, Joos V. [The Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam (Netherlands); Jackson, Andrew, E-mail: jacksona@mskcc.org [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2013-01-01

    Purpose: To demonstrate the use of generalized equivalent uniform dose (gEUD) atlas for data pooling in radiation pneumonitis (RP) modeling, to determine the dependence of RP on gEUD, to study the consistency between data sets, and to verify the increased statistical power of the combination. Methods and Materials: Patients enrolled in prospective phase I/II dose escalation studies of radiation therapy of non-small cell lung cancer at Memorial Sloan-Kettering Cancer Center (MSKCC) (78 pts) and the Netherlands Cancer Institute (NKI) (86 pts) were included; 10 (13%) and 14 (17%) experienced RP requiring steroids (RPS) within 6 months after treatment. gEUD was calculated from dose-volume histograms. Atlases for each data set were created using 1-Gy steps from exact gEUDs and RPS data. The Lyman-Kutcher-Burman model was fit to the atlas and exact gEUD data. Heterogeneity and inconsistency statistics for the fitted parameters were computed. gEUD maps of the probability of RPS rate {>=}20% were plotted. Results: The 2 data sets were homogeneous and consistent. The best fit values of the volume effect parameter a were small, with upper 95% confidence limit around 1.0 in the joint data. The likelihood profiles around the best fit a values were flat in all cases, making determination of the best fit a weak. All confidence intervals (CIs) were narrower in the joint than in the individual data sets. The minimum P value for correlations of gEUD with RPS in the joint data was .002, compared with P=.01 and .05 for MSKCC and NKI data sets, respectively. gEUD maps showed that at small a, RPS risk increases with gEUD. Conclusions: The atlas can be used to combine gEUD and RPS information from different institutions and model gEUD dependence of RPS. RPS has a large volume effect with the mean dose model barely included in the 95% CI. Data pooling increased statistical power.

  17. SU-E-J-251: Incorporation of Pre-Therapy 18F-FDG Uptake with CT Texture Features in a Predictive Model for Radiation Pneumonitis Development

    Energy Technology Data Exchange (ETDEWEB)

    Anthony, G; Cunliffe, A; Armato, S; Al-Hallaq, H [The University of Chicago, Chicago, IL (United States); Castillo, R [Univ Texas Medical Branch of Galveston, Pearland, TX (United States); Pham, N [Baylor College of Medicine, Houston, TX (United States); Guerrero, T [Beaumont Health System, Royal Oak, MI (United States)

    2015-06-15

    Purpose: To determine whether the addition of standardized uptake value (SUV) statistical variables to CT lung texture features can improve a predictive model of radiation pneumonitis (RP) development in patients undergoing radiation therapy. Methods: Anonymized data from 96 esophageal cancer patients (18 RP-positive cases of Grade ≥ 2) were retrospectively collected including pre-therapy PET/CT scans, pre-/posttherapy diagnostic CT scans and RP status. Twenty texture features (firstorder, fractal, Laws’ filter and gray-level co-occurrence matrix) were calculated from diagnostic CT scans and compared in anatomically matched regions of the lung. The mean, maximum, standard deviation, and 50th–95th percentiles of the SUV values for all lung voxels in the corresponding PET scans were acquired. For each texture feature, a logistic regression-based classifier consisting of (1) the average change in that texture feature value between the pre- and post-therapy CT scans and (2) the pre-therapy SUV standard deviation (SUV{sub SD}) was created. The RP-classification performance of each logistic regression model was compared to the performance of its texture feature alone by computing areas under the receiver operating characteristic curves (AUCs). T-tests were performed to determine whether the mean AUC across texture features changed significantly when SUV{sub SD} was added to the classifier. Results: The AUC for single-texturefeature classifiers ranged from 0.58–0.81 in high-dose (≥ 30 Gy) regions of the lungs and from 0.53–0.71 in low-dose (< 10 Gy) regions. Adding SUVSD in a logistic regression model using a 50/50 data partition for training and testing significantly increased the mean AUC by 0.08, 0.06 and 0.04 in the low-, medium- and high-dose regions, respectively. Conclusion: Addition of SUVSD from a pre-therapy PET scan to a single CT-based texture feature improves RP-classification performance on average. These findings demonstrate the potential for

  18. Loss of lung function after chemo-radiotherapy for NSCLC measured by perfusion SPECT/CT: Correlation with radiation dose and clinical morbidity

    DEFF Research Database (Denmark)

    Farr, Katherina P; Møller, Ditte S; Khalil, Azza A

    2015-01-01

    BACKGROUND: The purpose of the study was to assess dose and time dependence of radiotherapy (RT)-induced changes in regional lung function measured with single photon emission computed tomography (SPECT) of the lung and relate these changes to the symptomatic endpoint of radiation pneumonitis (RP...

  19. Chronic hypersensitivity pneumonitis.

    Science.gov (United States)

    Pereira, Carlos Ac; Gimenez, Andréa; Kuranishi, Lilian; Storrer, Karin

    2016-01-01

    Hypersensitivity pneumonitis (HSP) is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary.

  20. A case of recurrent breast cancer with intramedullary spinal cord metastasis and symptomatic improvement by Radiation Therapy

    International Nuclear Information System (INIS)

    Wakahara, Makoto; Hosoya, Keiko; Hirooka, Yumi

    2017-01-01

    A 65-year-old woman underwent surgery for right breast cancer (TIN1aM0) in December 2005. In March 2011, the breast cancer recurred with multiple lung and lymph node metastases. In February 2013, because of multiple brain metastases whole-brain radiation therapy was performed. In January 2014, she developed paralysis of the left leg. Spinal cord magnetic resonance imaging revealed a mass lesion (Th12 to L1 level) in the spinal cord, and she was diagnosed with intramedullary spinal cord metastasis (ISCM) from the breast cancer. Spinal cord irradiation reduced the metastasis and improved her paralysis. Although pharmacotherapy was continued, her metastases, with the exception of ISCM, progressed and she died of the disease in November 2014. It is necessary to diagnose ISCM at the time of its onset. Additionally immediate therapeutic intervention can significantly reduce the volume of ISCM, resulting in symptomatic relief from neurological deficit; in this case, radiation therapy was effective. (author)

  1. Chronic hypersensitivity pneumonitis

    Directory of Open Access Journals (Sweden)

    Pereira CA

    2016-09-01

    Full Text Available Carlos AC Pereira,1 Andréa Gimenez,2 Lilian Kuranishi,2 Karin Storrer 2 1Interstitial Lung Diseases Program, 2Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil Abstract: Hypersensitivity pneumonitis (HSP is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary. Keywords: interstitial lung diseases, extrinsic allergic alveolitis, diffuse lung disease, lung immune response, HRCT, farmers lung

  2. The role of palliative radiation therapy in symptomatic locally advanced gastric cancer

    International Nuclear Information System (INIS)

    Tey, Jeremy; Back, Michael F.; Shakespeare, Thomas P.; Mukherjee, Rahul K.; Lu, Jiade J.; Lee, Khai Mun; Wong, Lea Choung; Leong, Cheng Nang; Zhu Ming

    2007-01-01

    Purpose: To review the outcome of palliative radiotherapy (RT) alone in patients with symptomatic locally advanced or recurrent gastric cancer. Methods and Materials: Patients with symptomatic locally advanced or recurrent gastric cancer who were managed palliatively with RT at Cancer Institute, Singapore were retrospectively reviewed. Study end points included symptom response, median survival, and treatment toxicity (retrospectively scored using the Common Toxicity Criteria v3.0 [CTC]). Results: Between November 1999 and December 2004, 33 patients with locally advanced or recurrent gastric cancer were managed with palliative intent using RT alone. Median age was 76 years (range, 38-90 years). Twenty-one (64%) patients had known distant metastatic disease at time of treatment. Key index symptoms were bleeding (24 patients), obstruction (8 patients), and pain (8 patients). The majority of patients received 30 Gy/10 fractions (17 patients). Dose fractionation regimen ranged from an 8-Gy single fraction to 40 Gy in 16 fractions. Median survival was 145 days, actuarial 12-month survival 8%. A total of 54.3% of patients (13/24) with bleeding responded (median duration of response of 140 days), 25% of patients (2/8) with obstruction responded (median duration of response of 102 days), and 25% of patients (2/8) with pain responded (median duration of response of 105 days). No obvious dose-response was evident. One Grade 3 CTC equivalent toxicity was recorded. Conclusion: External beam RT alone is an effective and well tolerated modality in the local palliation of gastric cancer, with palliation lasting the majority of patients' lives

  3. A haemodynamic study of pulmonary hypertension in chronic hypersensitivity pneumonitis.

    Science.gov (United States)

    Oliveira, Rudolf K F; Pereira, Carlos A C; Ramos, Roberta P; Ferreira, Eloara V M; Messina, Carolina M S; Kuranishi, Lilian T; Gimenez, Andrea; Campos, Orlando; Silva, Célia M C; Ota-Arakaki, Jaquelina S

    2014-08-01

    Chronic hypersensitivity pneumonitis is a common fibrotic interstitial lung disease. The prevalence of pulmonary hypertension diagnosed by right heart catheterisation and its cardiopulmonary function findings in patients with chronic hypersensitivity pneumonitis are unknown. Consecutive symptomatic patients with chronic hypersensitivity pneumonitis were prospectively evaluated. All patients were submitted to right heart catheterisation, pulmonary function testing, a 6-min walk test, echocardiography, blood gas determination and N-terminal pro-brain natriuretic peptide analyses. Nonhypoxaemic patients also underwent incremental cardiopulmonary exercise testing. 50 patients underwent right heart catheterisation; 25 (50%) of these had pulmonary hypertension and 22 (44%) had a pre-capillary haemodynamic pattern. The patients with pre-capillary pulmonary hypertension had lower forced vital capacity (mean ± sd 50 ± 17% versus 69 ± 22% predicted, p<0.01), carbon monoxide diffusing capacity (37 ± 12% versus 47 ± 14% predicted, p<0.01), arterial oxygen tension (median (interquartile range) 59.0 (47.8-69.3) versus 73.0 (62.2-78.5) mmHg, p<0.01) and saturation after the 6-min walk test (78 ± 8% versus 86 ± 7%, p<0.01). In pre-capillary pulmonary hypertension, oxygen uptake was also lower at the anaerobic threshold (41 ± 11% versus 50 ± 8% predicted, p=0.04) and at peak exercise (12.8 ± 1.6 versus 15.0 ± 2.5 mL · kg(-1) · min(-1), p=0.02). Pre-capillary pulmonary hypertension is common in symptomatic chronic hypersensitivity pneumonitis and is related to interstitial lung disease severity. Additionally, pulmonary hypertension is more prevalent in hypoxaemic patients with impaired lung function and exercise capacity. ©ERS 2014.

  4. Risk of Symptomatic Stroke After Radiation Therapy for Childhood Cancer: A Long-Term Follow-Up Cohort Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Dijk, Irma W.E.M. van, E-mail: i.w.vandijk@amc.uva.nl [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands); Pal, Helena J.H. van der [Department of Medical Oncology, Academic Medical Center, Amsterdam (Netherlands); Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Os, Rob M. van [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands); Roos, Yvo B.W.E.M. [Department of Neurology, Academic Medical Center, Amsterdam (Netherlands); Sieswerda, Elske [Department of Medical Oncology, Academic Medical Center, Amsterdam (Netherlands); Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Dalen, Elvira C. van; Ronckers, Cécile M. [Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Oldenburger, Foppe [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands); Leeuwen, Flora E. van [Department of Epidemiology, Netherlands Cancer Institute, Academic Medical Center, Amsterdam (Netherlands); Caron, Huib N. [Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Koning, Caro C.E. [Department of Radiation Oncology, Academic Medical Center, Amsterdam (Netherlands); Kremer, Leontien C.M. [Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands)

    2016-11-01

    Purpose: Long-term childhood cancer survivors are at high risk of late adverse effects, including stroke. We aimed to determine the cumulative incidence of clinically validated symptomatic stroke (transient ischemic attack [TIA], cerebral infarction, and intracerebral hemorrhage [ICH]) and to quantify dose-effect relationships for cranial radiation therapy (CRT) and supradiaphragmatic radiation therapy (SDRT). Methods and Materials: Our single-center study cohort included 1362 survivors of childhood cancer that were diagnosed between 1966 and 1996. Prescribed CRT and SDRT doses were converted into the equivalent dose in 2-Gy fractions (EQD{sub 2}). Multivariate Cox regression models were used to analyze the relationship between the EQD{sub 2} and stroke. Results: After a median latency time of 24.9 years and at a median age of 31.2 years, 28 survivors had experienced a first stroke: TIA (n=5), infarction (n=13), and ICH (n=10). At an attained age of 45 years, the estimated cumulative incidences, with death as competing risk, among survivors treated with CRT only, SDRT only, both CRT and SDRT, and neither CRT nor SDRT were, respectively, 10.0% (95% confidence interval [CI], 2.5%-17.0%), 5.4% (95% CI, 0%-17.0%), 12.5% (95% CI, 5.5%-18.9%), and 0.1% (95% CI, 0%-0.4%). Radiation at both locations significantly increased the risk of stroke in a dose-dependent manner (hazard ratios: HR{sub CRT} 1.02 Gy{sup −1}; 95% CI, 1.01-1.03, and HR{sub SDRT} 1.04 Gy{sup −1}; 95% CI, 1.02-1.05). Conclusions: Childhood cancer survivors treated with CRT, SDRT, or both have a high stroke risk. One in 8 survivors treated at both locations will have experienced a symptomatic stroke at an attained age of 45 years. Further research on the pathophysiologic processes involved in stroke in this specific group of patients is needed to enable the development of tailored secondary prevention strategies.

  5. Risk of Symptomatic Stroke After Radiation Therapy for Childhood Cancer: A Long-Term Follow-Up Cohort Analysis

    International Nuclear Information System (INIS)

    Dijk, Irma W.E.M. van; Pal, Helena J.H. van der; Os, Rob M. van; Roos, Yvo B.W.E.M.; Sieswerda, Elske; Dalen, Elvira C. van; Ronckers, Cécile M.; Oldenburger, Foppe; Leeuwen, Flora E. van; Caron, Huib N.; Koning, Caro C.E.; Kremer, Leontien C.M.

    2016-01-01

    Purpose: Long-term childhood cancer survivors are at high risk of late adverse effects, including stroke. We aimed to determine the cumulative incidence of clinically validated symptomatic stroke (transient ischemic attack [TIA], cerebral infarction, and intracerebral hemorrhage [ICH]) and to quantify dose-effect relationships for cranial radiation therapy (CRT) and supradiaphragmatic radiation therapy (SDRT). Methods and Materials: Our single-center study cohort included 1362 survivors of childhood cancer that were diagnosed between 1966 and 1996. Prescribed CRT and SDRT doses were converted into the equivalent dose in 2-Gy fractions (EQD 2 ). Multivariate Cox regression models were used to analyze the relationship between the EQD 2 and stroke. Results: After a median latency time of 24.9 years and at a median age of 31.2 years, 28 survivors had experienced a first stroke: TIA (n=5), infarction (n=13), and ICH (n=10). At an attained age of 45 years, the estimated cumulative incidences, with death as competing risk, among survivors treated with CRT only, SDRT only, both CRT and SDRT, and neither CRT nor SDRT were, respectively, 10.0% (95% confidence interval [CI], 2.5%-17.0%), 5.4% (95% CI, 0%-17.0%), 12.5% (95% CI, 5.5%-18.9%), and 0.1% (95% CI, 0%-0.4%). Radiation at both locations significantly increased the risk of stroke in a dose-dependent manner (hazard ratios: HR CRT 1.02 Gy −1 ; 95% CI, 1.01-1.03, and HR SDRT 1.04 Gy −1 ; 95% CI, 1.02-1.05). Conclusions: Childhood cancer survivors treated with CRT, SDRT, or both have a high stroke risk. One in 8 survivors treated at both locations will have experienced a symptomatic stroke at an attained age of 45 years. Further research on the pathophysiologic processes involved in stroke in this specific group of patients is needed to enable the development of tailored secondary prevention strategies.

  6. Chapter 19: Hypersensitivity pneumonitis.

    Science.gov (United States)

    Blatman, Karen Hsu; Grammer, Leslie C

    2012-01-01

    Hypersensitivity pneumonitis (HP), also referred to as extrinsic allergic alveolitis, is characterized by non-IgE-mediated inflammation of the parenchyma, alveoli, and terminal airways of the lung initiated by inhaled antigens in a susceptible host. Etiologic agents of HP are either organic high molecular weight compounds such as bacteria, fungi, amoebae, plant, and animal proteins or inorganic low molecular weight haptens such as isocyanate and drugs including amiodarone, nitrofurantoin, and minocycline. Six significant predictors have been identified that provide ∼95% diagnostic accuracy. These six predictors are (1) exposure to a known offending allergen, (2) positive precipitating antibodies to the offending antigen, (3) recurrent episodes of symptoms, (4) inspiratory crackles on lung auscultation, (5) symptoms occurring 4-8 hours after exposure, and (6) weight loss. HP is staged into acute, subacute, and chronic. In the acute stage after direct exposure to the antigen, there is fever, chills, nonproductive cough, dyspnea, malaise, and myalgias, all resembling influenza. However, if obtained, a chest radiograph shows nodular infiltrates, and pulmonary function testing is restrictive (unless the cause is avian in which obstruction or obstruction with restriction is present). In the chronic stage, fever and chills are absent, but weight loss can occur. The immunologic response includes activated macrophages and CD8(+) cytotoxic lymphocytes, and bronchoalveolar lavage fluid reveals marked lymphocytosis with a ratio of CD4(+) cells to CD8(+) cells <1. Activated macrophages have increased expression of CD80/CD86, and T cells have increased expression of its counter-ligand CD28, evidence for heightened antigen presentation.

  7. Symptomatic radiation-induced cardiac disease in long-term survivors of esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Iwahashi, Noriaki; Kosuge, Masami; Kimura, Kazuo [Division of Cardiology, Yokohama City University Medical Center, Yokohama (Japan); Sakamaki, Kentaro [Department of Biostatistics, Yokohama City University Medical Center, Yokohama (Japan); Kunisaki, Chikara [Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama (Japan); Ogino, Ichiro; Watanabe, Shigenobu

    2016-06-15

    To evaluate clinical and dosimetric factors retrospectively affecting the risk of symptomatic cardiac disease (SCD) in esophageal cancer patients treated with radiotherapy. A total of 343 patients with newly diagnosed esophageal cancer were managed with concurrent chemoradiotherapy or radiotherapy alone. Of these, 58 patients were followed at our hospital for at least 4 years. Median clinical follow-up was 79 months. Cardiac toxicity was determined by Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0. The maximum and mean doses to the heart and percentage of the volume were calculated from the dose-volume histograms. SCD manifested in 11 patients. The heart diseases included three pericardial effusions, one pericardial effusion with valvular disease and paroxysmal atrial tachycardia, three atrial fibrillations, one sinus tachycardia, one coronary artery disease, one chest pain with strongly suspected coronary artery disease, and one congestive heart failure. The actual incidence of SCD was 13.8 % at 5 years. Univariate and multivariate analyses of continuous variables revealed that the risk of developing an SCD depended on the volume of the heart receiving a dose greater than 45 Gy (V45), 50 Gy (V50), and 55 Gy (V55). No other clinical factors were found to influence the risk of SCD. For V45, V50, and V55, the lowest significant cutoff values were 15, 10, and 5 %, respectively. High-dose and large-volume irradiation of the heart increased the risk of SCD in long-term survivors. Using modern radiotherapy techniques, it is important to minimize the heart dose-volume parameters without reducing the tumor dose. (orig.) [German] Beurteilung von klinischen und dosimetrischen Faktoren, die mit Risiken eines retrospektiven Auftretens von symptomatischen Herzerkrankungen (SCD) bei Patienten zusammenhaengen, die aufgrund eines Oesophaguskarzinoms strahlentherapeutisch behandelt wurden. Insgesamt 343 Patienten mit neu diagnostiziertem Oesophaguskarzinom wurden mit

  8. Influenza SIRS with Minimal Pneumonitis.

    Science.gov (United States)

    Erramilli, Shruti; Mannam, Praveen; Manthous, Constantine A

    2016-01-01

    Although systemic inflammatory response syndrome (SIRS) is a known complication of severe influenza pneumonia, it has been reported very rarely in patients with minimal parenchymal lung disease. We here report a case of severe SIRS, anasarca, and marked vascular phenomena with minimal or no pneumonitis. This case highlights that viruses, including influenza, may cause vascular dysregulation causing SIRS, even without substantial visceral organ involvement.

  9. Influenza SIRS with Minimal Pneumonitis

    OpenAIRE

    Erramilli, Shruti; Mannam, Praveen; Manthous, Constantine A.

    2016-01-01

    Although systemic inflammatory response syndrome (SIRS) is a known complication of severe influenza pneumonia, it has been reported very rarely in patients with minimal parenchymal lung disease. We here report a case of severe SIRS, anasarca, and marked vascular phenomena with minimal or no pneumonitis. This case highlights that viruses, including influenza, may cause vascular dysregulation causing SIRS, even without substantial visceral organ involvement.

  10. Fatal pneumonitis associated with postoperative intensity-modulated radiotherapy in lung cancer: Case report and review

    OpenAIRE

    HU, YAN; LI, JINGJING; SU, XIAOYAN

    2012-01-01

    Radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer. Intensity-modulated radiotherapy (IMRT) with inverse planning enables us to achieve the desired dose distribution. However, there are many high-risk procedures associated with lung irradiation, including chemotherapy and surgery. We report a case of fatal treatment-related pneumonitis, where the patient had undergone postoperative IMRT for lung cancer. Following completion of ...

  11. Analysis of clinical and dosimetric factors associated with severe acute radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent chemotherapy and intensity-modulated radiotherapy.

    Science.gov (United States)

    Shi, Anhui; Zhu, Guangying; Wu, Hao; Yu, Rong; Li, Fuhai; Xu, Bo

    2010-05-12

    To evaluate the association between the clinical, dosimetric factors and severe acute radiation pneumonitis (SARP) in patients with locally advanced non-small cell lung cancer (LANSCLC) treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT). We analyzed 94 LANSCLC patients treated with concurrent chemotherapy and IMRT between May 2005 and September 2006. SARP was defined as greater than or equal 3 side effects and graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. The clinical and dosimetric factors were analyzed. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between clinical, dosimetric factors and SARP. Median follow-up was 10.5 months (range 6.5-24). Of 94 patients, 11 (11.7%) developed SARP. Univariate analyses showed that the normal tissue complication probability (NTCP), mean lung dose (MLD), relative volumes of lung receiving more than a threshold dose of 5-60 Gy at increments of 5 Gy (V5-V60), chronic obstructive pulmonary disease (COPD) and Forced Expiratory Volume in the first second (FEV1) were associated with SARP (p 4.2% and NTCP 50% were 5.7% and 29.2%, respectively (p < 0.01). NTCP value and V10 are the useful indicators for predicting SARP in NSCLC patients treated with concurrent chemotherapy and IMRT.

  12. Impact of Toxicity Grade and Scoring System on the Relationship Between Mean Lung Dose and Risk of Radiation Pneumonitis in a Large Cohort of Patients With Non-Small Cell Lung Cancer

    International Nuclear Information System (INIS)

    Tucker, Susan L.; Jin Hekun; Wei Xiong

    2010-01-01

    Purpose: To compute the risk of radiation pneumonitis (RP) as a function of mean lung dose (MLD), with RP scored using three grading systems and analyzed at four threshold levels of toxicity in a large cohort of patients with non-small cell lung cancer (NSCLC) treated with definitive radiotherapy (RT). Methods and Materials: On the basis of medical records and radiographic images, RP was scored retrospectively in 442 patients with NSCLC who had ≥6 months of follow-up after the end of RT. The severity of RP was scored for each patient using the National Cancer Institute (NCI) Common Toxicity Criteria, version 2.0 (CTC2.0); the NCI Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE3.0); and the grading system of the Radiation Therapy Oncology Group (RTOG). For each grading system and for each of four levels of toxicity (Grade ≥1, ≥2, ≥3, ≥4), the Lyman, logistic, and log-logistic normal tissue complication probability (NTCP) models were fitted to the data as functions of MLD. The parameter estimates from the model fits are listed in table form, and the RP risk estimates are presented graphically for the Lyman and log-logistic NTCP models. Results: The results presented here illustrate the impact of scoring system and level of toxicity on the relationship between MLD and RP risk. Conclusions: These results facilitate quantitative comparisons between our data and studies of RP risk reported by others, and several examples of such comparisons are provided.

  13. Influenza SIRS with minimal pneumonitis

    Directory of Open Access Journals (Sweden)

    Shruti Erramilli

    2016-08-01

    Full Text Available While systemic inflammatory response syndrome (SIRS, is a known complication of severe influenza pneumonia, it has been reported very rarely in patients with minimal parenchymal lung disease. We here report a case of severe SIRS, anasarca and marked vascular phenomena with minimal or no pneumonitis. This case highlights that viruses, including influenza, may cause vascular dysregulation causing SIRS, even without substantial visceral organ involvement.

  14. Analysis of clinical and dosimetric factors associated with severe acute radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent chemotherapy and intensity-modulated radiotherapy

    Directory of Open Access Journals (Sweden)

    Xu Bo

    2010-05-01

    Full Text Available Abstract Background To evaluate the association between the clinical, dosimetric factors and severe acute radiation pneumonitis (SARP in patients with locally advanced non-small cell lung cancer (LANSCLC treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT. Methods We analyzed 94 LANSCLC patients treated with concurrent chemotherapy and IMRT between May 2005 and September 2006. SARP was defined as greater than or equal 3 side effects and graded according to Common Terminology Criteria for Adverse Events (CTCAE version 3.0. The clinical and dosimetric factors were analyzed. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between clinical, dosimetric factors and SARP. Results Median follow-up was 10.5 months (range 6.5-24. Of 94 patients, 11 (11.7% developed SARP. Univariate analyses showed that the normal tissue complication probability (NTCP, mean lung dose (MLD, relative volumes of lung receiving more than a threshold dose of 5-60 Gy at increments of 5 Gy (V5-V60, chronic obstructive pulmonary disease (COPD and Forced Expiratory Volume in the first second (FEV1 were associated with SARP (p p = 0.001 and V10 (p = 0.015 were the most significant factors associated with SARP. The incidences of SARP in the group with NTCP > 4.2% and NTCP ≤4.2% were 43.5% and 1.4%, respectively (p 50% were 5.7% and 29.2%, respectively (p Conclusions NTCP value and V10 are the useful indicators for predicting SARP in NSCLC patients treated with concurrent chemotherapy and IMRT.

  15. The interstitial pneumonitis induced by cytostatics

    International Nuclear Information System (INIS)

    Dubrava, M.; Markova, I.; Mistina, L.

    1998-01-01

    The author presents a cause of 9-year old boy with ALL-F2B in the stage of the prevention treatment where in the its course the induced interstitial pneumonitis by cytostatics was developed. The bacterial, virus, mycological and parasitic causes of the interstitial pneumonitis on the basis of the bronchoscopy, BAL, CT, scintigraphy, laboratory and by cultivation were excluded. (authors)

  16. Fatal pneumonitis associated with postoperative intensity-modulated radiotherapy in lung cancer: Case report and review.

    Science.gov (United States)

    Hu, Yan; Li, Jingjing; Su, Xiaoyan

    2013-02-01

    Radiation pneumonitis (RP) is the most significant complication of acute treatment-related toxicities in lung cancer. Intensity-modulated radiotherapy (IMRT) with inverse planning enables us to achieve the desired dose distribution. However, there are many high-risk procedures associated with lung irradiation, including chemotherapy and surgery. We report a case of fatal treatment-related pneumonitis, where the patient had undergone postoperative IMRT for lung cancer. Following completion of radiotherapy, the patient developed progressive dyspnea. A chest computed tomography (CT) scan revealed the presence of diffuse reticular interstitial processes and honeycombing in both lungs. The fibrotic change in both lungs in a transverse view was compatible with low-dose irradiation of non-target organs at risk. Acute radiation pneumonitis was diagnosed. For patients receiving postoperative IMRT, low-dose irradiation volumes should be considered for lungs, as well as strict dose-volume histogram (DVH) parameters.

  17. WE-AB-207B-02: A Bayesian Network Approach for Joint Prediction of Tumor Control and Radiation Pneumonitis (RP) in Non-Small-Cell Lung Cancer (NSCLC)

    International Nuclear Information System (INIS)

    Luo, Y; McShan, D; Matuszak, M; Hobson, S; Jolly, S; Ten Haken, R; El Naqa, I

    2016-01-01

    Purpose: NSCLC radiotherapy treatment is a trade-off between controlling the tumor while limiting radiation-induced toxicities. Here we identify hierarchical biophysical relationships that could simultaneously influence both local control (LC) and RP by using an integrated Bayesian Networks (BN) approach. Methods: We studied 79 NSCLC patients treated on prospective protocol with 56 cases of LC and 21 events of RP. Beyond dosimetric information, each patient had 193 features including 12 clinical factors, 60 circulating blood cytokines before and during radiotherapy, 62 microRNAs, and 59 single-nucleotide polymorphisms (SNPs). The most relevant biophysical predictors for both LC and RP were identified using a Markov blanket local discovery algorithm and the corresponding BN was constructed using a score-learning algorithm. The area under the free-response receiver operating characteristics (AU-FROC) was used for performance evaluation. Cross-validation was employed to guard against overfitting pitfalls. Results: A BN revealing the biophysical interrelationships jointly in terms of LC and RP was developed and evaluated. The integrated BN included two SNPs, one microRNA, one clinical factor, three pre-treatment cytokines, relative changes of two cytokines between pre and during-treatment, and gEUDs of the GTV (a=-20) and lung (a=1). On cross-validation, the AUC prediction of independent LC was 0.85 (95% CI: 0.75–0.95) and RP was 0.83 (0.73–0.92). The AU-FROC of the integrated BN to predict both LC/RP was 0.81 (0.71–0.90) based on 2000 stratified bootstrap, indicating minimal loss in joint prediction power. Conclusions: We developed a new approach for multiple outcome utility application in radiotherapy based on integrated BN techniques. The BN developed from large-scale retrospective data is able to simultaneously predict LC and RP in NSCLC treatments based on individual patient characteristics. The joint prediction is only slightly compromised compared to

  18. Symptomatic Outcomes in Relation to Tumor Expansion After Fractionated Stereotactic Radiation Therapy for Vestibular Schwannomas: Single-Institutional Long-Term Experience

    Energy Technology Data Exchange (ETDEWEB)

    Aoyama, Hidefumi, E-mail: h-aoyama@med.niigata-u.ac.jp [Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Department of Radiology, Division of Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata (Japan); Onodera, Shunsuke [Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Takeichi, Norihito [Department of Otolaryngology, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Onimaru, Rikiya [Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Terasaka, Shunsuke; Sawamura, Yutaka [Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo (Japan); Shirato, Hiroki [Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo (Japan)

    2013-02-01

    Purpose: The effect of transient tumor expansion after conventionally fractionated stereotactic radiation therapy (SRT) on the symptomatic outcomes is not well-known. Methods and Materials: This study enrolled 201 consecutive patients who received SRT for vestibular schwannoma. A conventional fractionation schedule was applied in 194 patients (97%), and 142 (71%) received a total dose of 50 Gy. The median follow-up time was 72 months. Results: The maximum diameter was 9 mm or less in 13 patients, 10-19 mm in 79 patients, 20-29 mm in 87 patients, and 30 mm or greater in 22 patients. At presentation, tumor size of 20 mm or greater was significantly associated with loss of serviceable hearing and trigeminal neuropathy. After SRT, tumor expansion was observed in 42 patients (21%). By tumor size, tumor expansion was observed in 0%, 11.4%, 25.6%, and 50% of patients with tumors of 9 mm or less, 10-19 mm, 20-29 mm, and 30 mm or greater, respectively, in diameter. The tumor expansion was significantly associated with an increased risk of hydrocephalus requiring shunt placement (P=.004), loss of serviceable hearing (P=.0064), and worsening of facial (P<.0001) and trigeminal nerve (P<.0001) functions. Spontaneous tumor shrinkage was observed in 29 of those 42 patients, mostly within 2 years after the expansion, and the majority of the worsened symptoms except for hearing resolved once the tumor had shrunk. As a result, salvage surgical resection for symptomatic relief was required in only 5% of patients. Conclusions: Fractionated SRT could be safely applied even for medium- to large-sized ({>=}20 mm) tumors. However, greater knowledge of the risks and consequences, including transient symptomatic worsening, and the time span of expansion will be required for the follow-up of patients after SRT to avoid unnecessary surgical intervention.

  19. Fractionated half body irradiation for palliation of multiple symptomatic bone metastases from solid tumors

    Energy Technology Data Exchange (ETDEWEB)

    Sekiguchi, Kenji; Hayashi, Shinya; Sunagawa, Yoshimitsu; Sougawa, Mitsuharu; Nakazawa, Masanori; Yamashita, Takashi (Japanese Foundation for Cancer Research, Tokyo (Japan). Hospital)

    1992-06-01

    This was a phase I-II nonrandomized study that explored the toxicity and response of fractionated half-body irradiation (F-HBI) in patients with multiple symptomatic osseous metastases. The patients had no premedication and received 10 Gy in 5 fractions with a dose rate of 15 cGy/min. At the Cancer Institute Hospital, 9 patients were treated by this technique (1 upper and lower F-HBI, 6 upper F-HBI, 2 lower F-HBI). All patients were female and had adenocarcinomas (8 breast and 1 lung). Adverse effects were myelosuppression, vomiting and partial alopecia. But hematologic toxicity was treated with blood transfusion or G-CSF. All toxicity was transient, and no pneumonitis nor radiation-related deaths occurred. When given as palliation, F-HBI was found to relieve pain in 80% of the patients. In 10% of the patients the pain relief was complete. The mean time to achieve pain relief in responders after F-HBI was 9 days. The pain relief was long-lasting and continued without need of reirradiation for 40% of the remaining patient's life. This treatment modality appears to be well tolerated and effective in patients with multiple symptomatic osseous metastases. The optimal indications, dose and fractionation for F-HBI should be further explored in randomized trials. (author).

  20. Volumetric index of Tl-201 uptake in symptomatic patients after high - dose radiation treatment for high-grade gliomas

    Energy Technology Data Exchange (ETDEWEB)

    Carvalho, P.A.; Garada, B.M.; Loeffler, J.S. [Brigham and Womens Hospital, Boston, MA (United States)]|[Harvard Medical School, Boston, MA (United States)] [and others

    1995-05-01

    To verify the utility of a volumetric estimation of Tl-201 uptake in the context of possible astrocytoma recurrence after surgery, radiotherapy plus stereotactic boost (radiosurgery/brachitherapy), we analyzed sequential Tl-201/Tc99m-HMPAO brain SPECT studies of 28 patients (18 m/10 f). These were categorized as having tumor mass recurrence (TM), infiltrating tumor cells but no definite tumor mass (IT), or radiation changes and necrosis (RCN) after stereotactic biopsy and/or craniotomy. SPECT studies were obtained with a high-resolution dedicated gamma camera (CERASPECT, Digital Scinitgraphics, Inc.) and image acquisition was performed after intravenous Tl-201 (18.5 MBq) and Tc-99m HMPAO (740 MBq). In order to include relevant information about tumor burden, a volumetric index of Tl-201 uptake was expressed in cm{sup 3} related to voxel size (4.6 x 10{sup -3} cc) within an elliptical ROI that included the tumor area. Only voxels with a threshold {ge} 2 in relation to the average scalp Tl-201 uptake were included and this total number of voxels expressed in cc was compared to previously established maximal tumor/scalp Tl-201 uptake ratios (T/S) and histopathology. Results are presented as the median (min-max) and differences were considered significant for p<0.05. Differences were significant between all groups for both ratios and volume indices and correlation between the two variables was 0.90. In conclusion, the volumetric index of Tl-201 is similar to the maximal Tl-201 T/S ratios in discriminating tumor recurrence and radiation necrosis, suggesting a future role for the volumetric index estimation in the evaluation of treatment efficacy and patient follow-up.

  1. Pneumonic Plague Transmission, Moramanga, Madagascar, 2015.

    Science.gov (United States)

    Ramasindrazana, Beza; Andrianaivoarimanana, Voahangy; Rakotondramanga, Jean Marius; Birdsell, Dawn N; Ratsitorahina, Maherisoa; Rajerison, Minoarisoa

    2017-03-01

    During a pneumonic plague outbreak in Moramanga, Madagascar, we identified 4 confirmed, 1 presumptive, and 9 suspected plague case-patients. Human-to-human transmission among close contacts was high (reproductive number 1.44) and the case fatality rate was 71%. Phylogenetic analysis showed that the Yersinia pestis isolates belonged to group q3, different from the previous outbreak.

  2. Radiation tolerance of the cervical spinal cord: incidence and dose-volume relationship of symptomatic and asymptomatic late effects following high dose irradiation of paraspinal tumors

    International Nuclear Information System (INIS)

    Liu, Mitchell C.C.; Munzenrider, John E.; Finkelstein, Dianne; Liebsch, Norbert; Adams, Judy; Hug, Eugen B.

    1997-01-01

    changes was between 2 and 8.5 months after radiation therapy. Two risk factors appeared to have significant impact when all incidences were considered: proton portion of tumor dose > 55 CGE (p=.023), and spinal cord surface dose ≥ 60 CGE (p=.045). For patients receiving 55 CGE to >1.5cc of spinal cord, the risk of developing imaging changes was significantly higher (p=.0074). Age < 40 years was found to be correlated with higher incidence of Lhermitt's syndrome (p=.002). No variable was significant for predicting incidence of sensory or motor deficits. Conclusions: For chordomas and chondrosarcomas of the cervical spine, requiring high radiation doses, the guidelines of limiting maximum spinal cord surface dose to ≤ 64 CGE and maximum spinal cord center dose to ≤ 53 CGE appears safe. For the patients who had been treated within the above tolerance dose, none of them had developed motor deficits. Both a significant dose response relationship as well as volume effect for symptomatic or asymptomatic spinal cord changes were observed. The incidence of 1 patient, who developed motor damage after higher radiation doses to the spinal cord than generally allowed, emphasizes the importance of strict guidelines for critical, normal tissues in high dose, conformal radiation treatment

  3. Inhalational Gentamicin Treatment Is Effective Against Pneumonic Plague in a Mouse Model

    Directory of Open Access Journals (Sweden)

    David Gur

    2018-04-01

    Full Text Available Pneumonic plague is an infectious disease characterized by rapid and fulminant development of acute pneumonia and septicemia that results in death within days of exposure. The causative agent of pneumonic plague, Yersinia pestis (Y. pestis, is a Tier-1 bio-threat agent. Parenteral antibiotic treatment is effective when given within a narrow therapeutic window after symptom onset. However, the non-specific “flu-like” symptoms often lead to delayed diagnosis and therapy. In this study, we evaluated inhalational gentamicin therapy in an infected mouse model as a means to improve antibiotic treatment efficacy. Inhalation is an attractive route for treating lung infections. The advantages include directly dosing the main infection site, the relative accessibility for administration and the lack of extensive enzymatic drug degradation machinery. In this study, we show that inhalational gentamicin treatment administered 24 h post-infection, prior to the appearance of symptoms, protected against lethal intranasal challenge with the fully virulent Y. pestis Kimberley53 strain (Kim53. Similarly, a high survival rate was demonstrated in mice treated by inhalation with another aminoglycoside, tobramycin, for which an FDA-approved inhaled formulation is clinically available for cystic fibrosis patients. Inhalational treatment with gentamicin 48 h post-infection (to symptomatic mice was also successful against a Y. pestis challenge dose of 10 i.n.LD50. Whole-body imaging using IVIS technology demonstrated that adding inhalational gentamicin to parenteral therapy accelerated the clearance of Y. pestis from the lungs of infected animals. This may reduce disease severity and the risk of secondary infections. In conclusion, our data suggest that inhalational therapy with aerosolized gentamicin may be an effective prophylactic treatment against pneumonic plague. We also demonstrate the benefit of combining this treatment with a conventional parenteral

  4. Radiation dose and cancer risk to out-of-field and partially in-field organs from radiotherapy for symptomatic vertebral hemangiomas

    Energy Technology Data Exchange (ETDEWEB)

    Mazonakis, Michalis, E-mail: mazonak@med.uoc.gr; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, Crete 71003 (Greece); Tzedakis, Antonis [Department of Medical Physics, University Hospital of Iraklion, Iraklion, Crete 71110 (Greece); Lyraraki, Efrossyni [Department of Radiotherapy and Oncology, University Hospital of Iraklion, Iraklion, Crete 71110 (Greece)

    2016-04-15

    Purpose: Vertebral hemangiomas (VHs) are the most common benign tumors of the spine that may cause bone resorption. Megavoltage irradiation is usually the treatment of choice for the management of symptomatic VHs. The current study was conducted to estimate the risk for carcinogenesis from radiotherapy of this benign disease on the basis of the calculated radiation doses to healthy organs. Methods: The Monte Carlo N-particle transport code was employed to simulate the irradiation with 6 MV x-rays of a VH presented in the cervical, upper thoracic, lower thoracic, and lumbar spine. The average radiation dose (D{sub av}) received by each critical organ located outside the primarily irradiated area was calculated. Three-dimensional treatment plans were also generated for the VHs occurring at the four different sites of the spinal cord based on patients’ computed tomography data. The organ equivalent dose (OED) to each radiosensitive structure, which was partly encompassed by the applied treatment fields, was calculated with the aid of differential dose–volume histograms. The D{sub av} and the OED values were combined with a linear-no-threshold model and a nonlinear mechanistic model, respectively, to estimate the organ-, age-, and gender-specific lifetime attributable risks (LARs) for cancer development. The estimated risks were compared with the respective nominal lifetime intrinsic risks (LIRs) for the unexposed population. Results: For a standard target dose of 34 Gy, the OED varied from 0.39–5.15 Gy by the organ of interest and the irradiation site. The D{sub av} range for the out-of-field organs was 4.9 × 10{sup −4} to 0.56 Gy. The LAR for the appearance of malignancies in the partially in-field organs after radiotherapy of male and female patients was (0.08%–1.8%) and (0.09%–1.9%), respectively. These risk values were 1.5–15.5 times lower when compared to the respective LIRs. The lifetime probability for out-of-field cancer induction in irradiated

  5. Investigation of the relationship between gross tumor volume location and pneumonitis rates using a large clinical database of non-small-cell lung cancer patients.

    Science.gov (United States)

    Vinogradskiy, Yevgeniy; Tucker, Susan L; Liao, Zhongxing; Martel, Mary K

    2012-04-01

    Studies have suggested that function may vary throughout the lung, and that patients who have tumors located in the base of the lung are more susceptible to radiation pneumonitis. The purpose of our study was to investigate the relationship between gross tumor volume (GTV) location and pneumonitis rates using a large clinical database of 547 patients with non-small-cell lung cancer. The GTV centroids of all patients were mapped onto one common coordinate system, in which the boundaries of the coordinate system were defined by the extreme points of each individual patient lung. The data were qualitatively analyzed by graphing all centroids and displaying the data according to the presence of severe pneumonitis, tumor stage, and smoking status. The centroids were grouped according to superior-inferior segments, and the pneumonitis rates were analyzed. In addition, we incorporated the GTV centroid information into a Lyman-Kutcher-Burman normal tissue complication probability model and tested whether adding spatial information significantly improved the fit of the model. Of the 547 patients analyzed, 111 (20.3%) experienced severe radiation pneumonitis. The pneumonitis incidence rates were 16%, 23%, and 21% for the superior, middle, and inferior thirds of the lung, respectively. Qualitatively, the GTV centroids of nonsmokers were notably absent from the superior portion of the lung. In addition, the GTV centroids of patients who had Stage III and IV clinical staging were concentrated toward the medial edge of the lung. The comparison between the GTV centroid model and the conventional dose-volume model did not yield a statistically significant difference in model fit. Lower pneumonitis rates were noted for the superior portion of the lung; however the differences were not statistically significant. For our patient cohort, incorporating GTV centroid information did not lead to a statistically significant improvement in the fit of the pneumonitis model. Copyright

  6. Investigation of the Relationship Between Gross Tumor Volume Location and Pneumonitis Rates Using a Large Clinical Database of Non-Small-Cell Lung Cancer Patients

    International Nuclear Information System (INIS)

    Vinogradskiy, Yevgeniy; Tucker, Susan L.; Liao Zhongxing; Martel, Mary K.

    2012-01-01

    Purpose: Studies have suggested that function may vary throughout the lung, and that patients who have tumors located in the base of the lung are more susceptible to radiation pneumonitis. The purpose of our study was to investigate the relationship between gross tumor volume (GTV) location and pneumonitis rates using a large clinical database of 547 patients with non–small-cell lung cancer. Methods and Materials: The GTV centroids of all patients were mapped onto one common coordinate system, in which the boundaries of the coordinate system were defined by the extreme points of each individual patient lung. The data were qualitatively analyzed by graphing all centroids and displaying the data according to the presence of severe pneumonitis, tumor stage, and smoking status. The centroids were grouped according to superior–inferior segments, and the pneumonitis rates were analyzed. In addition, we incorporated the GTV centroid information into a Lyman–Kutcher–Burman normal tissue complication probability model and tested whether adding spatial information significantly improved the fit of the model. Results: Of the 547 patients analyzed, 111 (20.3%) experienced severe radiation pneumonitis. The pneumonitis incidence rates were 16%, 23%, and 21% for the superior, middle, and inferior thirds of the lung, respectively. Qualitatively, the GTV centroids of nonsmokers were notably absent from the superior portion of the lung. In addition, the GTV centroids of patients who had Stage III and IV clinical staging were concentrated toward the medial edge of the lung. The comparison between the GTV centroid model and the conventional dose–volume model did not yield a statistically significant difference in model fit. Conclusions: Lower pneumonitis rates were noted for the superior portion of the lung; however the differences were not statistically significant. For our patient cohort, incorporating GTV centroid information did not lead to a statistically significant

  7. Pneumonic Plague: The Darker Side of Yersinia pestis.

    Science.gov (United States)

    Pechous, Roger D; Sivaraman, Vijay; Stasulli, Nikolas M; Goldman, William E

    2016-03-01

    Inhalation of the bacterium Yersinia pestis results in primary pneumonic plague. Pneumonic plague is the most severe manifestation of plague, with mortality rates approaching 100% in the absence of treatment. Its rapid disease progression, lethality, and ability to be transmitted via aerosol have compounded fears of the intentional release of Y. pestis as a biological weapon. Importantly, recent epidemics of plague have highlighted a significant role for pneumonic plague during outbreaks of Y. pestis infections. In this review we describe the characteristics of pneumonic plague, focusing on its disease progression and pathogenesis. The rapid time-course, severity, and difficulty of treating pneumonic plague highlight how differences in the route of disease transmission can enhance the lethality of an already deadly pathogen. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Nontuberculous mycobacterial hypersensitivity pneumonitis related to a home shower: treatment and secondary prevention.

    Science.gov (United States)

    Hankwitz, Paul E; Cervia, Joseph Steven; Thomas, Charles F; Fink, Jordan N; Marras, Ted; Tomic, Rade

    2011-07-28

    A 57-year-old physician with increasing dyspnoea and hypoxaemia had a high-resolution CT scan of the chest, which disclosed diffuse pulmonary ground glass opacities, more pronounced in the upper lobes with minimal mediastinal lymphadenopathy. Transbronchial biopsy of the right middle and lower lobes was performed, demonstrating varying degrees of well circumscribed organising granulomatous pneumonitis thought to be most consistent with hypersensitivity to nontuberculous mycobacteria. Cultures of water obtained from the patient's home shower were positive for Mycobacterium avium complex. The patient began substituting baths for showers, experiencing some gradual improvement of his symptoms. Subsequently, he installed point-of-use 0.2 micron membrane filters on his shower, and resumed regular showering after installation with continued symptomatic improvement. CT scans at 3 and 18 months revealed improvement and resolution, respectively. Four years later, he continues to shower in filtered home shower water and remains clinically well.

  9. Symptomatic epilepsy in children

    OpenAIRE

    Еlaginykh E.S.

    2014-01-01

    Research goals were to evaluate the etiological structure of symptomatic epilepsy in children, age structure of period of disease manifestation, average length of latent period among children with different characters of lesions, dependence between frequency of seizures and character of lesion. Material and methods. A total of 180 case-records of patients with symptomatic epilepsy were analyzed by the next criteria: anamnesis, materials of electroencephalogram and neurovisualization. Results....

  10. Acute chemical pneumonitis caused by nitric acid inhalation: case report

    International Nuclear Information System (INIS)

    Choe, Hyung Shim; Lee, In Jae; Ko, Eun Young; Lee, Jae Young; Kim, Hyun Beom; Hwang, Dae Hyun; Lee, Kwan Seop; Lee, Yul; Bae, Sang Hoon

    2003-01-01

    Chemical pneumonitis induced by nitric acid inhalation is a rare clinical condition. The previously reported radiologic findings of this disease include acute permeability pulmonary edema, delayed bronchiolitis obliterans, and bronchiectasis. In very few published rare radiologic reports has this disease manifested as acute alveolar injury; we report a case of acute chemical pneumonitis induced by nitric acid inhalation which at radiography manifested as bilateral perihilar consolidation and ground-glass attenuation, suggesting acute alveolar injury

  11. Acute chemical pneumonitis caused by nitric acid inhalation: case report

    Energy Technology Data Exchange (ETDEWEB)

    Choe, Hyung Shim; Lee, In Jae; Ko, Eun Young; Lee, Jae Young; Kim, Hyun Beom; Hwang, Dae Hyun; Lee, Kwan Seop; Lee, Yul; Bae, Sang Hoon [Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2003-06-01

    Chemical pneumonitis induced by nitric acid inhalation is a rare clinical condition. The previously reported radiologic findings of this disease include acute permeability pulmonary edema, delayed bronchiolitis obliterans, and bronchiectasis. In very few published rare radiologic reports has this disease manifested as acute alveolar injury; we report a case of acute chemical pneumonitis induced by nitric acid inhalation which at radiography manifested as bilateral perihilar consolidation and ground-glass attenuation, suggesting acute alveolar injury.

  12. Hazards of the 'hard cash': hypersensitivity pneumonitis.

    Science.gov (United States)

    Kupeli, Elif; Karnak, Demet; Sak, Serpil Dizbay; Kayacan, Oya

    2010-01-01

    Hypersensitivity pneumonitis (HP) is a nonimmunoglobulin E-related immune-mediated parenchymal lung disease. A 45-year-old woman who was a lifelong nonsmoker with a six-month history of frequent episodes of cough and dyspnea was admitted to hospital. She had been working as a money counter for 20 years at a central bank. Bibasilar crackles on lung auscultation, ground-glass opacities and a mosaic pattern on high-resolution computed tomography, restrictive abnormality on pulmonary function tests and mild hypoxemia were the prominent findings. Bronchoalveolar lavage fluid analysis revealed a predominance of CD4-positive T cells, and she tested positive on her natural challenge test. She was diagnosed with subacute HP based on established criteria. She was advised to discontinue counting fresh banknotes. Prednisolone was commenced, then tapered to discontinue in the ensuing six months. Clinical and radiological improvement was achieved within two months. To the authors' knowledge, the present report is the first to describe 'hard cash HP', possibly caused by chipping dust or printing dye.

  13. Pneumonic vs nonpneumonic acute exacerbations of COPD.

    Science.gov (United States)

    Lieberman, David; Lieberman, Devora; Gelfer, Yevgenia; Varshavsky, Raiesa; Dvoskin, Bella; Leinonen, Maija; Friedman, Maureen G

    2002-10-01

    To describe and compare the background, clinical manifestations, disease course, and infectious etiologies of pneumonic acute exacerbations (PNAE) vs nonpneumonic acute exacerbations (NPAE) of COPD. A prospective, observational study. A tertiary university medical center in southern Israel. Twenty-three hospitalizations for PNAE and 217 hospitalizations for NPAE were included in the study. Paired sera were obtained for each of the hospitalizations and were tested serologically for 12 pathogens. Only a significant change in antibody titers or levels was considered diagnostic. No significant differences were found between the two groups for any of the parameters related to COPD or comorbidity. The clinical type of the exacerbation was not significantly different between the groups. Compared to NPAE, patients with PNAE had lower PO(2) values at hospital admission (p = 0.004) but higher rates of abrupt onset (p = 0.005), ICU admissions (p = 0.006), invasive mechanical ventilation (p = 0.01), mortality (p = 0.007), and longer hospital stay (p = 0.001). In 22 PNAE hospitalizations (96%) and in 153 NPAE hospitalizations (71%), at least one infectious etiology was identified (p = 0.001). Mixed infection was found in 13 patients with PNAE (59%) and in 59 patients with NPAE (39%; not significant [NS]). Viral etiology was identified in 18 patients with PNAE (78%) compared with 99 patients with NPAE (46%; p = 0.003). Pneumococcal etiology was found in 10 patients with PNAE (43%) and in 38 patients with NPAE (18%; p = 0.006). An atypical etiology was identified in 8 patients with PNAE (35%) and 64 patients with NPAE (30%; NS). Community-acquired pneumonia is common among patients hospitalized for an acute exacerbation of COPD and is generally manifested by more severe clinical and laboratory parameters. In PNAE, compared to NPAE, viral and pneumococcal etiologies are more common, but the rate of atypical pathogens is similar. The therapeutic significance of these findings

  14. Caffeic acid phenethyl ester decreases acute pneumonitis after irradiation in vitro and in vivo

    Directory of Open Access Journals (Sweden)

    Yang Cheng-Ta

    2005-12-01

    Full Text Available Abstract Background Lung cancer is relatively resistant to radiation treatment and radiation pneumonitis is a major obstacle to increasing the radiation dose. We previously showed that Caffeic acid phenethyl ester (CAPE induces apoptosis and increases radiosensitivity in lung cancer. To determine whether CAPE, an antioxidant and an inhibitor of NF-kappa B, could be a useful adjuvant agent for lung cancer treatment, we examine the effects of CAPE on irradiated normal lung tissue in this study. Methods We compared the effects of CAPE on cytotoxicity and intracellular oxidative stress in normal lung fibroblast and a lung cancer cell line. For in vivo analysis, whole thorax radiation (single dose 10 Gy and 20 Gy was delivered to BALB/c male mice with or without CAPE pretreatment. NF- kappaB activation and the expression levels of acute inflammatory cytokines were evaluated in mice after irradiation. Results The in vitro studies showed that CAPE cause no significant cytotoxicity in normal lung as compared to lung cancer cells. This is probably due to the differential effect on the expression of NF-kappa B between normal and malignant lung cells. The results from in vivo study showed that CAPE treatment decreased the expression of inflammatory cytokines including IL-1 alpha and beta, IL-6, TNF-alpha and TGF- beta, after irradiation. Moreover, histological and immunochemical data revealed that CAPE decreased radiation- induced interstitial pneumonitis and TGF-beta expression. Conclusion This study suggests that CAPE decreases the cascade of inflammatory responses induced by thoracic irradiation without causing toxicity in normal lung tissue. This provides a rationale for combining CAPE and thoracic radiotherapy for lung cancer treatment in further clinical studies.

  15. Caffeic acid phenethyl ester decreases acute pneumonitis after irradiation in vitro and in vivo.

    Science.gov (United States)

    Chen, Miao-Fen; Keng, Peter C; Lin, Paul-Yang; Yang, Cheng-Ta; Liao, Shuen-Kuei; Chen, Wen-Cheng

    2005-12-09

    Lung cancer is relatively resistant to radiation treatment and radiation pneumonitis is a major obstacle to increasing the radiation dose. We previously showed that Caffeic acid phenethyl ester (CAPE) induces apoptosis and increases radiosensitivity in lung cancer. To determine whether CAPE, an antioxidant and an inhibitor of NF-kappa B, could be a useful adjuvant agent for lung cancer treatment, we examine the effects of CAPE on irradiated normal lung tissue in this study. We compared the effects of CAPE on cytotoxicity and intracellular oxidative stress in normal lung fibroblast and a lung cancer cell line. For in vivo analysis, whole thorax radiation (single dose 10 Gy and 20 Gy) was delivered to BALB/c male mice with or without CAPE pretreatment. NF- kappaB activation and the expression levels of acute inflammatory cytokines were evaluated in mice after irradiation. The in vitro studies showed that CAPE cause no significant cytotoxicity in normal lung as compared to lung cancer cells. This is probably due to the differential effect on the expression of NF-kappa B between normal and malignant lung cells. The results from in vivo study showed that CAPE treatment decreased the expression of inflammatory cytokines including IL-1 alpha and beta, IL-6, TNF-alpha and TGF- beta, after irradiation. Moreover, histological and immunochemical data revealed that CAPE decreased radiation- induced interstitial pneumonitis and TGF-beta expression. This study suggests that CAPE decreases the cascade of inflammatory responses induced by thoracic irradiation without causing toxicity in normal lung tissue. This provides a rationale for combining CAPE and thoracic radiotherapy for lung cancer treatment in further clinical studies.

  16. Radiation dose-volume effects in the lung

    DEFF Research Database (Denmark)

    Marks, Lawrence B; Bentzen, Soren M; Deasy, Joseph O

    2010-01-01

    The three-dimensional dose, volume, and outcome data for lung are reviewed in detail. The rate of symptomatic pneumonitis is related to many dosimetric parameters, and there are no evident threshold "tolerance dose-volume" levels. There are strong volume and fractionation effects.......The three-dimensional dose, volume, and outcome data for lung are reviewed in detail. The rate of symptomatic pneumonitis is related to many dosimetric parameters, and there are no evident threshold "tolerance dose-volume" levels. There are strong volume and fractionation effects....

  17. Symptomatic pneumocephalus occurring years after transphenoidal surgery and radiation therapy for an invasive pituitary tumor: a case report and review of the literature.

    Science.gov (United States)

    Rao, Ganesh; Apfelbaum, Ronald I

    2003-01-01

    We present the unusual case of a patient who experienced a CSF leak and subsequent pneumocephalus several years after transphenoidal surgery and radiation treatment for an ACTH secreting pituitary tumor. This patient underwent aggressive management including placement of a lumbar drain, and reoperation to stop her leak. Despite these efforts, her leak persisted resulting in significant tension pneumocephalus. Pneumocephalus is a rare but important potential complication of transphenoidal surgery. Here we discuss our management of this patient's condition, and review the existing literature.

  18. Interstitial pneumonitis after acetylene welding: a case report.

    Science.gov (United States)

    Brvar, Miran

    2014-01-01

    Acetylene is a colorless gas commonly used for welding. It acts mainly as a simple asphyxiant. In this paper, however, we present a patient who developed a severe interstitial pneumonitis after acetylene exposure during aluminum welding. A 44-year old man was welding with acetylene, argon and aluminum electrode sticks in a non-ventilated aluminum tank for 2 h. Four hours after welding dyspnea appeared and 22 h later he was admitted at the Emergency Department due to severe respiratory insufficiency with pO2 = 6.7 kPa. Chest X-ray showed diffuse interstitial infiltration. Pulmonary function and gas diffusion tests revealed a severe restriction (55% of predictive volume) and impaired diffusion capacity (47% of predicted capacity). Toxic interstitial pneumonitis was diagnosed and high-dose systemic corticosteroid methylprednisolone and inhalatory corticosteroid fluticasone therapy was started. Computed Tomography (CT) of the lungs showed a diffuse patchy ground-glass opacity with no signs of small airway disease associated with interstitial pneumonitis. Corticosteroid therapy was continued for the next 8 weeks gradually reducing the doses. The patient's follow-up did not show any deterioration of respiratory function. In conclusion, acetylene welding might result in severe toxic interstitial pneumonitis that improves after an early systemic and inhalatory corticosteroid therapy.

  19. Bronchoalveolar lavage in HIV infected patients with interstitial pneumonitis.

    Science.gov (United States)

    de Blic, J; Blanche, S; Danel, C; Le Bourgeois, M; Caniglia, M; Scheinmann, P

    1989-01-01

    The value of taking microbiological and cytological specimens by flexible bronchoscopy and bronchoalveolar lavage under local anaesthesia was assessed on 43 occasions in 35 HIV infected children, aged 3 months to 16 years, with interstitial pneumonitis. In acute interstitial pneumonitis (n = 22, 26 specimens from bronchoalveolar lavages) the microbiological yield was 73%, Pneumocystis carinii being the commonest infective agent (n = 14). P carinii pneumonia was found only in children with deficient antigen induced lymphocyte proliferative responses who had not been treated with long term prophylactic co-trimoxazole. In contrast, in 13 children with chronic interstitial pneumonitis that was consistent with a diagnosis of pulmonary lymphoid hyperplasia who underwent bronchoalveolar lavage on 17 occasions, there were two isolates of cytomegalovirus and one of adenovirus, but P carinii was not found. Ten of the 13 children had normal antigen induced lymphocyte proliferative responses. Useful cytological data were also gleaned from bronchoalveolar lavage specimens. Lymphocytosis was significantly higher in pulmonary lymphoid hyperplasia (36(SD 11)%) than in P carinii pneumonia (24(19)%) whereas the percentage of polymorphonuclear neutrophils was significantly lower (3(2)% compared with 12(13)%). Flexible bronchoscopy with bronchoalveolar lavage is safe even in young infants and should reduce the necessity for open lung biopsy in the management of HIV infected children with interstitial pneumonitis. PMID:2817943

  20. Frequency, treatment, and functional outcome in children with hypersensitivity pneumonitis

    DEFF Research Database (Denmark)

    Buchvald, Frederik; Petersen, Bodil Laub; Pedersen, Karen Damgaard

    2011-01-01

    Hypersensitivity pneumonitis is a rare interstitial lung disease and very few data regarding frequency, treatment and outcome exist for children. Children identified with hypersensitivity pneumonia from a Danish national cohort with diffuse interstitial lung disease form the basis of this study f...

  1. [Sirolimus associated pneumonitis in a hematopoietic stem cell transplant patient].

    Science.gov (United States)

    García, Estefanía; Buenasmañanas, Diana; Martín, Carmen; Rojas, Rafael

    2015-07-06

    Sirolimus (SR) is a lipophilic macrocytic lactone with immunosuppressive properties (mTOR inhibitor) commonly used in solid organ transplantation and recently introduced in the prophylaxis and treatment of graft-versus-host disease. Its numerous side effects include: hyperlipidemia, arthralgias, noncardiac peripheral edema, thrombotic microangiopathy and interstitial pneumonitis. SR-associated pneumonitis is a rare but potentially serious complication due to its increasing utilization in transplant patients. We report the case of a patient undergoing hematopoietic stem cell transplantation with severe respiratory distress and SR therapy. Microbiological tests were all negative and other complications related to transplantation were discarded. The chest computed tomography of high-resolution showed pneumonitis. The SR therapy was interrupted and treatment was started with steroids with resolution of symptoms. SR associated pneumonitis is a potentially fatal side effect. In patients treated with SR and respiratory failure, we must suspect this complication because early recognition along with drug discontinuation and steroid treatment is essential to reverse this complication. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  2. Interstitial pneumonitis after acetylene welding: A case report

    Directory of Open Access Journals (Sweden)

    Miran Brvar

    2014-02-01

    Full Text Available Acetylene is a colorless gas commonly used for welding. It acts mainly as a simple asphyxiant. In this paper, however, we present a patient who developed a severe interstitial pneumonitis after acetylene exposure during aluminum welding. A 44-year old man was welding with acetylene, argon and aluminum electrode sticks in a non-ventilated aluminum tank for 2 h. Four hours after welding dyspnea appeared and 22 h later he was admitted at the Emergency Department due to severe respiratory insufficiency with pO2 = 6.7 kPa. Chest X-ray showed diffuse interstitial infiltration. Pulmonary function and gas diffusion tests revealed a severe restriction (55% of predictive volume and impaired diffusion capacity (47% of predicted capacity. Toxic interstitial pneumonitis was diagnosed and high-dose systemic corticosteroid methylprednisolone and inhalatory corticosteroid fluticasone therapy was started. Computed Tomography (CT of the lungs showed a diffuse patchy ground-glass opacity with no signs of small airway disease associated with interstitial pneumonitis. Corticosteroid therapy was continued for the next 8 weeks gradually reducing the doses. The patient's follow-up did not show any deterioration of respiratory function. In conclusion, acetylene welding might result in severe toxic interstitial pneumonitis that improves after an early systemic and inhalatory corticosteroid therapy.

  3. Radiation therapy in the management of symptomatic bone metastases: the effect of total dose and histology on pain relief and response duration

    International Nuclear Information System (INIS)

    Arcangeli, Giorgio; Giovinazzo, Giuseppe; Saracino, Biancamaria; D'Angelo, Luciano; Giannarelli, Diana; Arcangeli, Giancarlo; Micheli, Adriana

    1998-01-01

    Purpose: In order to better define variables and factors that may influence the pain response to radiation, and to look for a radiation regimen that can assure the highest percentage and the longest duration of pain relief, we performed a prospective, although not randomized, study on patients with bone metastases from various primary sites. Methods and Materials: From December 1988 to March 1994, 205 patients with a total of 255 solitary or multiple bone metastases from several primary tumors were treated in our radiotherapy center with palliative intent. Irradiation fields were treated with three main fractionation schedules: (1) Conventional fractionation: 40-46 Gy/20-23 fractions in 5-5.5 weeks; (2) Short course: 30-36 Gy/10-12 fractions in 2-2.3 weeks; (3) Fast course: 8-28 Gy/1-4 consecutive fractions. Pain intensity was self-assessed by patients using a visual analogic scale graduated from 0 (no pain) to 10 (the strongest pain one can experience). Analgesic requirement was assessed by using a five-point scale, scoring both analgesic strength and frequency (0 = no drug or occasional nonopioids; 1 = Nonopioids once daily; 2 = Nonopioids more than once daily; 3 = Mild opioids (oral codeine, pentazocine, etc.), once daily; 4 = Mild opioids more than once daily; 5 = Strong opioids (morphine, meperidine, etc.). Complete pain relief meant the achievement of a score ≤ 2 in the pain scale or 0 in the analgesic requirement scale. Partial pain relief indicated a score of 3 to 4 or of 1 to 2 on the former and latter scale, respectively. Results: Total pain relief (complete + partial) was observed in 195 (76%) sites, in 158 of which (62%) a complete response was obtained. Metastases from NSC lung tumors appeared to be the least responsive among all primary tumors, with 46% complete pain relief in comparison to 65% and 83% complete relief in breast (p = 0.04) and in prostate metastases (p 0.002), respectively. A significant difference in pain relief was detected among

  4. Pathology of radiation induced lung damage

    International Nuclear Information System (INIS)

    Kawabata, Yoshinori; Murata, Yoshihiko; Ogata, Hideo; Katagiri, Shiro; Sugita, Hironobu; Iwai, Kazuo; Sakurai, Isamu.

    1985-01-01

    We examined pathological findings of radiation induced lung damage. Twenty-three cases are chosen from our hospital autopsy cases for 9 years, which fulfil strict criteria of radiation lung damage. Lung damage could be classified into 3 groups : 1) interstitial pneumonia type (9 cases), 2) intermediate pneumonia type (8 cases), and 3) alveolar pneumonia type (6 cases), according to the degree of intra-luminal exudation. These classification is well correlated with clinical findings. Pathological alveolar pneumonia type corresponds to symptomatic, radiologic ground glass pneumonic shadow. And pathologic interstitial type corresponds to clinical asymptomatic, radiologic reticulo-nodular shadow. From the clinico-pathological view point these classification is reasonable one. Radiation affects many lung structures and showed characteristic feature of repair. Elastofibrosis of the alveolar wall is observed in every cases, obstructive bronchiolitis are observed in 5 cases, and obstructive bronchiolitis in 9 cases. They are remarkable additional findings. Thickening of the interlobular septum, broncho-vascular connective tissue, and pleural layer are observed in every cases together with vascular lesions. (author)

  5. [Long-term effects of radiation on the spine - Results of a cohort of symptomatic survivors of childhood and review of the literature].

    Science.gov (United States)

    Escalas, Cécile; Bourdet, Christopher; Fayech, Chiraz; Demoor-Goldschmidt, Charlotte

    2015-01-01

    The objective of the present retrospective study was to describe the clinical, radiological and bone characteristics of long-term survivors who have received radiotherapy involving some part of the vertebral column for certain childhood tumors. Monocentric descriptive study of a cohort of patients followed at Gustave-Roussy in the framework of long-term monitoring treated for a solid tumor in childhood with radiotherapy on part of the spine and having back pain and/or spinal deformity have been addressed in the Service of Musculoskeletal Rehabilitation at the Cochin Hospital. For each patient, were performed standardized radiographs of the entire spine and spinal MRI. Eighteen patients were evaluated (average age of 35.4 ± 6.9 years; mean age at radiation therapy: 3.6 ± 2.8 years). Original tumors were nephroblastoma (9 cases), neuroblastoma (4 cases) and medulloblastoma (3 cases). Of the 15 patients analyzed by X-rays of the entire spine, 67% (10/15) patients had scoliosis (2 with a Cobb angle > 20°), 73% (11/15) had an abnormal thoracic kyphosis, 67% (10/15) had abnormal lumbar lordosis. Of the 16 patients analyzed by MRI, 75% (12/16) had discopathies or anomalies of the discal plate, 63% (10/16) had mild abnormalities of bone marrow. Muscle abnormalities were common (81%, 13/16). The main risk factors of spinal deformities are intraductal tumor, spinal surgery, spinal radiotherapy and a young age at the time of the cancer. These cured children require dedicated monitoring. Currently, this risk is reduced with the actual techniques of radiotherapy. Copyright © 2015 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  6. Bilateral acute lupus pneumonitis in a case of rhupus syndrome

    Directory of Open Access Journals (Sweden)

    Supriya Sarkar

    2012-01-01

    Full Text Available Rhupus syndrome, the overlap of rheumatoid arthritis (RA and systemic lupus erythematosus (SLE, is an extremely uncommon condition. Organ damages found due to SLE are usually mild in rhupus. Lupus pneumonitis in rhupus syndrome has not been reported worldwide. We are reporting a 23-year-old female with bilateral symmetric erosive arthritis, oral ulcer, alopecia, polyserositis, anemia, leucopenia, positive RA-factor, anti nuclear antibody (ANA and anti ds-DNA. She presented with acute onset dyspnea, high fever, chest pain, tachycardia, tachypnea, hypoxia and respiratory alkalosis. High resolution computed tomography (HRCT-thorax showed bilateral, basal consolidation with air bronchogram. Repeated sputum and single broncho alveolar lavage (BAL fluid examination revealed no organism or Hemosiderin-laden macrophage. The diagnosis of rhupus was confirmed by combined manifestations of RA and SLE, and the diagnosis of acute lupus pneumonitis was established by clinico-radiological picture and by excluding other possibilities.

  7. Acute biological effects of simulating the whole-body radiation dose distribution from a solar particle event using a porcine model.

    Science.gov (United States)

    Wilson, Jolaine M; Sanzari, Jenine K; Diffenderfer, Eric S; Yee, Stephanie S; Seykora, John T; Maks, Casey; Ware, Jeffrey H; Litt, Harold I; Reetz, Jennifer A; McDonough, James; Weissman, Drew; Kennedy, Ann R; Cengel, Keith A

    2011-11-01

    In a solar particle event (SPE), an unshielded astronaut would receive proton radiation with an energy profile that produces a highly inhomogeneous dose distribution (skin receiving a greater dose than internal organs). The novel concept of using megavoltage electron-beam radiation to more accurately reproduce both the total dose and the dose distribution of SPE protons and make meaningful RBE comparisons between protons and conventional radiation has been described previously. Here, Yucatan minipigs were used to determine the effects of a superficial, SPE-like proton dose distribution using megavoltage electrons. In these experiments, dose-dependent increases in skin pigmentation, ulceration, keratinocyte necrosis and pigment incontinence were observed. Five of 18 animals (one each exposed to 7.5 Gy and 12.5 Gy radiation and three exposed to 25 Gy radiation) developed symptomatic, radiation-associated pneumonopathy approximately 90 days postirradiation. The three animals from the highest dose group showed evidence of mycoplasmal pneumonia along with radiation pneumonitis. Moreover, delayed-type hypersensitivity was found to be altered, suggesting that superficial irradiation of the skin with ionizing radiation might cause immune dysfunction or dysregulation. In conclusion, using total doses, patterns of dose distribution, and dose rates that are compatible with potential astronaut exposure to SPE radiation, animals experienced significant toxicities that were qualitatively different from toxicities previously reported in pigs for homogeneously delivered radiation at similar doses.

  8. Chronic pneumonitis of infancy: high-resolution CT findings

    International Nuclear Information System (INIS)

    Olsen, Oeystein E.; Owens, Catherine M.; Sebire, Neil J.; Jaffe, Adam

    2004-01-01

    Chronic pneumonitis of infancy (CPI) is a very rare entity. We report the chest radiography and high-resolution CT (HRCT) findings in an infant with histopathologically confirmed CPI. The child was admitted for intensive care 18 h after birth and died at 39 days of age. On HRCT there was diffuse ground-glass change, interlobular septal thickening and discrete centrilobular nodules. An accurate diagnosis is crucial for correct management; however, several entities with the same HRCT findings are recognized. (orig.)

  9. A Case of Occupational Hypersensitivity Pneumonitis Associated with Trichloroethylene

    OpenAIRE

    Kim, Young Jae; Hwang, Eu Dong; Leem, Ah Young; Kang, Beo Deul; Chang, Soo Yun; Kim, Ho Keun; Park, In Kyu; Kim, Song Yee; Kim, Eun Young; Jung, Ji Ye; Kang, Young Ae; Park, Moo Suk; Kim, Young Sam; Kim, Se Kyu; Chang, Joon

    2014-01-01

    Trichloroethylene (TCE) is a toxic chemical commonly used as a degreasing agent, and it is usually found in a colorless or blue liquid form. TCE has a sweet, chloroform-like odor, and this volatile chlorinated organic chemical can cause toxic hepatitis, neurophysiological disorders, skin disorders, and hypersensitivity syndromes. However, the hypersensitivity pneumonitis (HP) attributed to TCE has rarely been reported. We hereby describe a case of HP associated with TCE in a 29-year-old man w...

  10. Symptomatic mesodiverticular bands in children

    African Journals Online (AJOL)

    Materials and methods A computer-assisted (PubMed) search of the literature to identify all cases of symptomatic. MDB reported in English with patients' age ranging from. 0 to 14 years was performed. Results Eight cases of symptomatic MBD in pediatric age. (0–14 years) were found in the literature in the last. 50 years.

  11. CT findings associated with survival in chronic hypersensitivity pneumonitis

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Jonathan H.; Montner, Steven M. [University of Chicago Medical Center, Department of Radiology, Chicago, IL (United States); Adegunsoye, Ayodeji; Vij, Rekha; Noth, Imre; Strek, Mary E. [University of Chicago Medical Center, Section of Pulmonary/Critical Care, Department of Medicine, Chicago, IL (United States); Oldham, Justin M. [University of California at Davis, Section of Pulmonary/Critical Care, Department of Medicine, Sacramento, CA (United States); Husain, Aliya N. [University of Chicago Medical Center, Department of Pathology, Chicago, IL (United States)

    2017-12-15

    To identify CT findings in chronic hypersensitivity pneumonitis (cHP) associated with survival. Two thoracic radiologists assessed CT scans for specific imaging findings and patterns in 132 subjects with cHP. Survival analyses were performed. The majority of subjects had an inconsistent with usual interstitial pneumonitis pattern on CT (55.3%,73/132). Hypersensitivity pneumonitis (HP) diagnosis on CT was less common in those with fibrosis (66.1%, 74/112) than those without fibrosis (85%,17/20). Smoking was associated with a lower prevalence of HP on CT (p=0.04). CT features of pulmonary fibrosis, especially traction bronchiectasis (HR 8.34, 95% CI 1.98-35.21) and increased pulmonary artery (PA)/aorta ratio (HR 2.49, 95% CI 1.27-4.89) were associated with worse survival, while ground-glass opacity (HR 0.31, 95% CI 0.12-0.79) was associated with improved survival. Survival association with imaging was less pronounced after adjustment for gender, age and physiology score. A substantial proportion of cHP cases have a non-HP-like appearance. Ground-glass opacity, pulmonary fibrosis features and elevated PA/aorta ratio on CT likely reflect varying degrees of disease severity in cHP and may inform future clinical prediction models. (orig.)

  12. Pneumonitis and pneumonitis-related death in cancer patients treated with programmed cell death-1 inhibitors: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Cui P

    2017-09-01

    Full Text Available Peng-Fei Cui,1–3,* Jun-Xun Ma,1,* Fei-Xue Wang,1,* Jing Zhang,1 Hai-Tao Tao,1 Yi Hu1 1First Department of Medical Oncology, 2Department of Graduate Administration, Chinese PLA General Hospital, Beijing, 3Health Bureau of the 75709 Army, Central Theater of the Chinese PLA, Wuhan, China *These authors contributed equally to this work Purpose: We conducted a meta-analysis of published clinical trials to determine the relationship between the risks of pneumonitis and pneumonitis-related death and programmed cell death-1 (PD-1 inhibitor treatment in patients with cancer.Materials and methods: We examined clinical trials from the Medline and Google Scholar databases. Data from original studies and review articles were also cross-referenced and evaluated. Randomized Phase II and Phase III trials of pembrolizumab and nivolumab treatment in patients with cancer were eligible for the analysis. Information about the participants, all-grade and high-grade pneumonitis, and pneumonitis-related death was extracted from each study and analyzed.Results: After the exclusion of ineligible studies, 12 clinical trials were included in the analysis. The odds ratio (OR for all-grade pneumonitis after PD-1 inhibitor treatment was 4.59 (95% confidence interval [CI]: 2.51–8.37; P<0.00001, and the OR for high-grade pneumonitis after PD-1 inhibitor treatment was 3.83 (95% CI: 1.54–9.48; P=0.004. The OR for pneumonitis-related death after PD-1 inhibitor treatment was 2.47 (95% CI: 0.41–14.81; P=0.32. Moreover, the OR for all-grade pneumonitis after nivolumab/ipilimumab combination therapy versus nivolumab monotherapy was 3.54 (95% CI: 1.52–8.23; P=0.003, and that for high-grade pneumonitis after nivolumab/ipilimumab combination therapy versus nivolumab monotherapy was 2.35 (95% CI: 0.45–12.13; P=0.31. Treated cancer appeared to have no effect on the risk of pneumonitis.Conclusion: Our data showed that PD-1 inhibitors were associated with increased risks of all

  13. Predicting Lung Radiotherapy-Induced Pneumonitis Using a Model Combining Parametric Lyman Probit With Nonparametric Decision Trees

    International Nuclear Information System (INIS)

    Das, Shiva K.; Zhou Sumin; Zhang, Junan; Yin, F.-F.; Dewhirst, Mark W.; Marks, Lawrence B.

    2007-01-01

    Purpose: To develop and test a model to predict for lung radiation-induced Grade 2+ pneumonitis. Methods and Materials: The model was built from a database of 234 lung cancer patients treated with radiotherapy (RT), of whom 43 were diagnosed with pneumonitis. The model augmented the predictive capability of the parametric dose-based Lyman normal tissue complication probability (LNTCP) metric by combining it with weighted nonparametric decision trees that use dose and nondose inputs. The decision trees were sequentially added to the model using a 'boosting' process that enhances the accuracy of prediction. The model's predictive capability was estimated by 10-fold cross-validation. To facilitate dissemination, the cross-validation result was used to extract a simplified approximation to the complicated model architecture created by boosting. Application of the simplified model is demonstrated in two example cases. Results: The area under the model receiver operating characteristics curve for cross-validation was 0.72, a significant improvement over the LNTCP area of 0.63 (p = 0.005). The simplified model used the following variables to output a measure of injury: LNTCP, gender, histologic type, chemotherapy schedule, and treatment schedule. For a given patient RT plan, injury prediction was highest for the combination of pre-RT chemotherapy, once-daily treatment, female gender and lowest for the combination of no pre-RT chemotherapy and nonsquamous cell histologic type. Application of the simplified model to the example cases revealed that injury prediction for a given treatment plan can range from very low to very high, depending on the settings of the nondose variables. Conclusions: Radiation pneumonitis prediction was significantly enhanced by decision trees that added the influence of nondose factors to the LNTCP formulation

  14. Predicting lung radiotherapy-induced pneumonitis using a model combining parametric Lyman probit with nonparametric decision trees.

    Science.gov (United States)

    Das, Shiva K; Zhou, Sumin; Zhang, Junan; Yin, Fang-Fang; Dewhirst, Mark W; Marks, Lawrence B

    2007-07-15

    To develop and test a model to predict for lung radiation-induced Grade 2+ pneumonitis. The model was built from a database of 234 lung cancer patients treated with radiotherapy (RT), of whom 43 were diagnosed with pneumonitis. The model augmented the predictive capability of the parametric dose-based Lyman normal tissue complication probability (LNTCP) metric by combining it with weighted nonparametric decision trees that use dose and nondose inputs. The decision trees were sequentially added to the model using a "boosting" process that enhances the accuracy of prediction. The model's predictive capability was estimated by 10-fold cross-validation. To facilitate dissemination, the cross-validation result was used to extract a simplified approximation to the complicated model architecture created by boosting. Application of the simplified model is demonstrated in two example cases. The area under the model receiver operating characteristics curve for cross-validation was 0.72, a significant improvement over the LNTCP area of 0.63 (p = 0.005). The simplified model used the following variables to output a measure of injury: LNTCP, gender, histologic type, chemotherapy schedule, and treatment schedule. For a given patient RT plan, injury prediction was highest for the combination of pre-RT chemotherapy, once-daily treatment, female gender and lowest for the combination of no pre-RT chemotherapy and nonsquamous cell histologic type. Application of the simplified model to the example cases revealed that injury prediction for a given treatment plan can range from very low to very high, depending on the settings of the nondose variables. Radiation pneumonitis prediction was significantly enhanced by decision trees that added the influence of nondose factors to the LNTCP formulation.

  15. Palliative radiotherapy for symptomatic osseous metastases

    International Nuclear Information System (INIS)

    Shigematsu, Naoyuki; Ito, Hisao; Toya, Kazuhito; Ko, Weijey; Kutsuki, Shouji; Tsukamoto, Nobuhiro; Kubo, Atsushi; Dokiya, Takushi; Yorozu, Atsunori.

    1995-01-01

    Bone matastases are one of the most common and serious conditions requiring radiotherapy, but there is still a considerable lack of agreement on optimal radiation schedule. We analyzed patients with symptomatic osseous matastases from lung (72 patients) and breast (63 patients) carcinoma treated by palliative radiotherapy between 1983 and 1992. In this series, the incidences of symptomatic bone metastases appearing within 2 years after the first diagnosis of the primary lesion were 96% and 36% for lung and breast carcinomas, respectively. Thirty percent of bone metastases from breast carcinoma were diagnosed more than 5 years after the first diagnosis. Thus careful follow-up must be carried out for a prolonged period. Pain relief was achieved at almost the same rate for bone metastases from lung and breast carcinomas (81% and 85%, respectively), an the rapid onset of pain relief (15 Gy or less) was obtained in about half the patients for both diseases. The rapid onset of pain relief and the lack of association between the onset of pain relief and primary tumor argued against the conventional theory that tumor shrinkage is a component of the initial response. In contrast to the fact that almost all lung carcinoma patients had very poor prognoses, one third of the breast carcinoma patients were alive more than 2 years after palliative radiotherapy. Thust, the late effects of radiation, such as radiation myelopathy, must be always considered especially in breast carcinoma patients even when it is 'just' palliative radiotherapy for bone metastases. (author)

  16. Aspiration pneumonitis primes the host for an exaggerated inflammatory response during pneumonia

    NARCIS (Netherlands)

    van Westerloo, David J.; Knapp, Sylvia; van't Veer, Cornelis; Buurman, Wim A.; de Vos, Alex F.; Florquin, Sandrine; van der Poll, Tom

    2005-01-01

    Objective. Nosocomial pneumonia is a feared complication in the critically ill patient. Aspiration pneumonitis is frequently complicated by infections. The objective of this study was to determine the influence of aspiration pneumonitis on the host response to a common nosocomial respiratory

  17. Everolimus-induced pneumonitis associates with favourable outcome in patients with metastatic renal cell carcinoma

    DEFF Research Database (Denmark)

    Penttilä, P; Donskov, F; Rautiola, J

    2017-01-01

    BACKGROUND: Mammalian target of rapamycin inhibitors may induce pneumonitis. We analysed the association of pneumonitis with outcomes in everolimus treated metastatic renal cell carcinoma (mRCC) patients. PATIENTS AND METHODS: Eighty-five mRCC patients received everolimus at Helsinki University...

  18. CONSERVATIVE TREATMENT OF POST-PNEUMONIC THORACIC EMPYEMA IN CHILDREN

    Directory of Open Access Journals (Sweden)

    N. G. Nilesh Nagdeve

    2016-11-01

    Full Text Available BACKGROUND The aim of the study is to retrospectively review data of the outcome of post-pneumonic empyema in children managed in our institute over last seven years. MATERIALS AND METHODS The medical records of children below 12 years of age admitted over last seven years in Government Medical College, Nagpur, with the diagnosis of post-pneumonic thoracic were reviewed. Patients with empyema due to tuberculosis, patients with chest tube drainage or any surgical intervention done before admission were excluded from analysis. The data regarding age, duration of pre-hospital illness, complaints, blood and pleural fluid analyses, radiological evaluations, microbiological studies, modes of treatment, duration of chest tube drainage and length of hospital stay was noted and analysed. RESULTS A total of 105 patients (65 males, 45 females diagnosed as post-pneumonic empyema were evaluated. The peak incidence was in the 3-6-year-old group with male preponderance. A mean duration between onset of symptoms and hospitalisation was 9.32±1.68 days. The WBC counts were >15,000 in 71.12% of the patients. Examination of pleural fluid revealed frank pus in 84.38%. Bacterial growth was observed in only 27.6% patients. Radiologically, 60% patients presented in fibropurulent stage without loculations while 40% patients had loculations. 64% showed clinical improvement after the start of antibiotics and insertion of chest tube while 36% patients required the second line antibiotics after five days of admission. Chest tubes were left in place for a mean period of 8.9±5.8 days. The length of hospitalisation was 12.3±6.0 days. Twelve patients with bronchopleural fistula had hospital stay of 26±7.36 days. Three patients needed thoracotomy and decortication for continued pleural pathology even after 5 days of second line antibiotics. The relationship between presence of loculations and need for surgical intervention was not statistically significant (p<0.05. All

  19. Temporal Progression of Pneumonic Plague in Blood of Nonhuman Primate: A Transcriptomic Analysis.

    Directory of Open Access Journals (Sweden)

    Rasha Hammamieh

    Full Text Available Early identification of impending illness during widespread exposure to a pathogenic agent offers a potential means to initiate treatment during a timeframe when it would be most likely to be effective and has the potential to identify novel therapeutic strategies. The latter could be critical, especially as antibiotic resistance is becoming widespread. In order to examine pre-symptomatic illness, African green monkeys were challenged intranasally with aerosolized Yersinia pestis strain CO92 and blood samples were collected in short intervals from 45 m till 42 h post-exposure. Presenting one of the first genomic investigations of a NHP model challenged by pneumonic plague, whole genome analysis was annotated in silico and validated by qPCR assay. Transcriptomic profiles of blood showed early perturbation with the number of differentially expressed genes increasing until 24 h. By then, Y. pestis had paralyzed the host defense, as suggested by the functional analyses. Early activation of the apoptotic networks possibly facilitated the pathogen to overwhelm the defense mechanisms, despite the activation of the pro-inflammatory mechanism, toll-like receptors and microtubules at the port-of-entry. The overexpressed transcripts encoding an early pro-inflammatory response particularly manifested in active lymphocytes and ubiquitin networks were a potential deviation from the rodent models, which needs further verification. In summary, the present study recognized a pattern of Y. pestis pathogenesis potentially more applicable to the human system. Independent validation using the complementary omics approach with comprehensive evaluation of the organs, such as lungs which showed early bacterial infection, is essential.

  20. Delayed Paclitaxel-Trastuzumab-Induced Interstitial Pneumonitis in Breast Cancer

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    Omalkhair Abulkhair

    2011-04-01

    Full Text Available Pneumonitis is a rare but serious complication associated with paclitaxel and/or trastuzumab treatment. We report a 51-year-old female patient with locally advanced breast cancer who presented with shortness of breath, fever, dry cough and pulmonary infiltrates. She had been treated without complications for 10 weeks with paclitaxel (Taxol® and trastuzumab (Herceptin® as neoadjuvant therapy, with complete clinical and pathological response. Infections and cardiomyopathy were excluded as causes of her symptoms. Bronchoscopy and biopsy were performed and a diagnosis of drug-induced interstitial pneumonitis was made. After treatment with steroids, the patient showed a significant response in less than 24 h; she was discharged home without the need for oxygen less than 48 h after therapy initiation. Although no causative association could be found between either trastuzumab or paclitaxel and this patient’s pulmonary syndrome, the potential for such toxicity should be considered, especially as paclitaxel/trastuzumab is a vey common combination therapy for breast cancer.

  1. Pulmonary epithelial permeability in rats with bleomycin-induced pneumonitis

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    Anazawa, Yoshiki; Isawa, Toyoharu; Teshima, Takeo; Miki, Makoto; Motomiya, Masakichi (Tohoku Univ., Sendai (Japan). Research Inst. for Tuberculosis and Cancer)

    1992-07-01

    This study was performed to investigate the mechanism by which [sup 99m]Tc-DTPA molecules pass through the pulmonary epithelium following inhalation of [sup 99m]Tc-DTPA aerosol. Interstitial pneumonitis was induced in 6-week-old male rats by instilling 1 mg/kg of bleomycin into the trachea. Disappearance of radioactivity from the lungs was measured with a gamma camera every 2 weeks to estimate pulmonary epithelial permeability, and light- and electron-microscopic histopathologic examinations were performed at the same intervals. There was a statistically significant increase in the pulmonary epithelial permeability at 2 weeks after the instillation of bleomycin. However, subsecquent changes in pulmonary epithelial permeability were not uniform; some animals showed recovery and some showed further increase and/or partial recovery. Microscopically, increase in the capillary bed, round cell infiltration, and widening of the interstitial space were observed in addition to the presence of macrophages in the alveolar spaces at 2 weeks. Electron microscopic examination revealed vacuolization, thinning and detachment of the alveolar epithelium, and denudation of the basement membrane. Prominent fibrosis, honeycombing, thinning of the pulmonary epithelium, and increase in collagen fibers were observed after 18 weeks. We consider that vacuolization, thinning, and detachment of the pulmonary epithelium and denudation of the basement membrane are related to the increase in pulmonary epithelial permeability in bleomycin-induced interstitial pneumonitis. (author).

  2. Treatment of symptomatic splenomegaly with low doses of radiotherapy: Retrospective analysis and review of the literature

    Directory of Open Access Journals (Sweden)

    Carolina de la Pinta

    2017-09-01

    Conclusion: Low doses of radiation therapy for treatment of symptomatic splenomegaly were effective, with a low rate of side effects. Splenic pain and abdominal discomfort completely improved and cytopenias rised to secure levels.

  3. Nonspecific interstitial pneumonitis: a common cause of pulmonary disease in the acquired immunodeficiency syndrome

    International Nuclear Information System (INIS)

    Suffredini, A.F.; Ognibene, F.P.; Lack, E.E.

    1987-01-01

    During a 4.4-year period, nonspecific interstitial pneumonitis was seen in 41 of 110 (38%) patients with the acquired immunodeficiency syndrome and accounted for 32% (48/152) of all episodes of clinical pneumonitis. Diffuse alveolar damage was typically a feature of nonspecific interstitial pneumonitis, but neither lung biopsy nor bronchoalveolar lavage detected a pathogen. Of these 41 patients, 13 had no associated pulmonary tumor and had not been exposed to pulmonary toxins, whereas 28 patients had either concurrent pulmonary Kaposi sarcoma, previous experimental therapies, or a history of pneumocystis pneumonia or drug abuse. Of these 41, 23 had normal chest radiographs. The clinical features of patients with nonspecific interstitial pneumonitis were similar to those of patients with pneumocystis pneumonia, although histologic findings showed less severe alveolar damage in patients with nonspecific interstitial pneumonitis (p less than 0.001). Pathologic evaluation and clinical follow-up suggest that many clinical episodes of pneumonitis in patients with the acquired immunodeficiency syndrome are due to nonspecific interstitial pneumonitis of unknown cause

  4. Combined pulmonary fibrosis and emphysema in hypersensitivity pneumonitis.

    Science.gov (United States)

    Soumagne, Thibaud; Pana-Katatali, Héloïse; Degano, Bruno; Dalphin, Jean-Charles

    2015-12-21

    Combined pulmonary fibrosis and emphysema is a distinct syndrome reported in patients who smoke. A 72-year-old, never-smoking female dairy farmer was referred for progressive dyspnoea on exertion, basal crackles on auscultation, normal spirometry and normal lung volumes but decreased diffusing capacity of the lung for carbon monoxide, centrilobular emphysema in the upper zones of the lungs and diffuse infiltrative lung disease in the lower zones on high-resolution CT scan. Bronchoalveolar lavage differential cell count showed 35% lymphocytosis, and precipitating antibodies for Wallemia sebi, Trichoderma species and Cladosporium sphaerospermum were identified. The diagnosis of farmer's lung disease with combined pulmonary fibrosis and emphysema was retained. This case highlights for the first time that hypersensitivity pneumonitis should be suspected in the setting of combined pulmonary fibrosis and emphysema in non-smoking patients. 2015 BMJ Publishing Group Ltd.

  5. Severe nivolumab-induced pneumonitis preceding durable clinical remission in a patient with refractory, metastatic lung squamous cell cancer: a case report

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    Hong Li

    2017-02-01

    Full Text Available Abstract Background Programmed cell death 1 (PD-1 and its ligand 1 (PD-L1 inhibitors have quickly become standard of care for patients with advanced non-small cell lung cancer and increasing numbers of other cancer types. In this report, we discuss the clinical history, pathological evaluation, and genomic findings in a patient with metastatic lung squamous cell cancer (SCC who developed severe nivolumab-induced pneumonitis preceding durable clinical remission after three doses of nivolumab. Case presentation A patient with chemotherapy-refractory, metastatic lung SCC developed symptomatic pneumonitis by week 4 after nivolumab treatment, concurrently with onset of a potent antitumor response. Despite discontinuation of nivolumab after three doses and the use of high dose oral corticosteroids for grade 3 pneumonitis, continued tumor response to a complete remission by 3 months was evident by radiographic assessment. At the time of this submission, the patient has remained in clinical remission for 14 months. High PD-L1 expression by immunohistochemistry staining was seen in intra-alveolar macrophages and viable tumor cells in the pneumonitis and recurrent tumor specimens, respectively. Tumor genomic profiling by FoundationOne targeted exome sequencing revealed a very high tumor mutation burden (TMB corresponding to 95–96 percentile in lung SCC, i.e., 87.4–91.0 and 82.9 mut/Mb, respectively, in pre- and post-nivolumab tumor specimens. Except for one, the 13 functional genomic alterations remained the same in the diagnostic, recurrent, and post-treatment, relapsed tumor specimens, suggesting that nivolumab reset the patient’s immune system against one or more preexisting tumor-associated antigens (TAAs. One potential TAA candidate is telomerase reverse transcriptase (TERT in which an oncogenic promoter -146C>T mutation was detected. Human leukocyte antigen (HLA typing revealed HLA-A*0201 homozygosity, which is the prevalent HLA class I

  6. Simultaneous interstitial pneumonitis and cardiomyopathy induced by venlafaxine

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    Pedro Gonçalo Ferreira

    2014-06-01

    Full Text Available Venlafaxine is a serotonin-norepinephrine reuptake inhibitor used as an antidepressant. Interindividual variability and herb-drug interactions can lead to drug-induced toxicity. We report the case of a 35-year-old female patient diagnosed with synchronous pneumonitis and acute cardiomyopathy attributed to venlafaxine. The patient sought medical attention due to dyspnea and dry cough that started three months after initiating treatment with venlafaxine for depression. The patient was concomitantly taking Centella asiatica and Fucus vesiculosus as phytotherapeutic agents. Chest CT angiography and chest X-ray revealed parenchymal lung disease (diffuse micronodules and focal ground-glass opacities and simultaneous dilated cardiomyopathy. Ecocardiography revealed a left ventricular ejection fraction (LVEF of 21%. A thorough investigation was carried out, including BAL, imaging studies, autoimmune testing, right heart catheterization, and myocardial biopsy. After excluding other etiologies and applying the Naranjo Adverse Drug Reaction Probability Scale, a diagnosis of synchronous pneumonitis/cardiomyopathy associated with venlafaxine was assumed. The herbal supplements taken by the patient have a known potential to inhibit cytochrome P450 enzyme complex, which is responsible for the metabolization of venlafaxine. After venlafaxine discontinuation, there was rapid improvement, with regression of the radiological abnormalities and normalization of the LVEF. This was an important case of drug-induced cardiopulmonary toxicity. The circumstantial intake of inhibitors of the CYP2D6 isoenzyme and the presence of a CYP2D6 slow metabolism phenotype might have resulted in the toxic accumulation of venlafaxine and the subsequent clinical manifestations. Here, we also discuss why macrophage-dominant phospholipidosis was the most likely mechanism of toxicity in this case.

  7. Epidemiology of Hypersensitivity Pneumonitis among an Insured Population in the United States: A Claims-Based Cohort Analysis.

    Science.gov (United States)

    Fernández Pérez, Evans R; Kong, Amanda M; Raimundo, Karina; Koelsch, Tilman L; Kulkarni, Rucha; Cole, Ashley L

    2017-12-13

    Hypersensitivity pneumonitis is a complex lung disease resulting from repeated inhalation of a variety of antigens. Limited data exist regarding its epidemiology. To describe the trends in the annual incidence and prevalence of hypersensitivity pneumonitis in the US. We developed novel claims-based coding algorithms to identify hypersensitivity pneumonitis, chronic hypersensitivity pneumonitis, and fibrotic hypersensitivity pneumonitis cases using the 2004-2013 MarketScan Commercial and Medicare Supplemental healthcare claims databases. Algorithm validity and reliability were assessed with clinical data from National Jewish Health. We calculated yearly cumulative incidence and prevalence overall and by age. For the subgroup with vital status, Kaplan-Meier methods were used to analyze survival stratified by evidence of fibrosis. We identified 7,498 cases that met our hypersensitivity pneumonitis definition over the 10-year study period, including 3,902 with chronic hypersensitivity pneumonitis and 1,852 with fibrotic hypersensitivity pneumonitis. Based on the clinical-radiological adjudication of the validation sample, 38 (95%) cases were confirmed as hypersensitivity pneumonitis. The mean age was 52 years and 58% were women. The one-year prevalence rates for hypersensitivity pneumonitis ranged from 1.67 to 2.71 per 100,000 persons, and 1-year cumulative incidence rates ranged from 1.28 to 1.94 per 100,000 persons. The prevalence increased with age, ranging from 0.95 per 100,000 among 0-9 year-olds to 11.2 per 100,000 among those aged 65+. Between 56% and 68% of hypersensitivity pneumonitis cases in each year were classified as chronic hypersensitivity pneumonitis (prevalence: 0.91 to 1.70 per 100,000 persons; cumulative incidence: 0.63 to 1.08 per 100,000 persons). Fewer had fibrotic hypersensitivity pneumonitis (prevalence: 0.41 to 0.80 per 100,000 persons; cumulative incidence: 0.29 to 0.43 per 100,000 persons). Most cases (74%) were classified as unspecified

  8. Combining Physical and Biologic Parameters to Predict Radiation-Induced Lung Toxicity in Patients With Non-Small-Cell Lung Cancer Treated With Definitive Radiation Therapy

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    Stenmark, Matthew H. [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Cai Xuwei [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Radiation Oncology, Shanghai Cancer Hospital, Fudan University, Shanghai (China); Shedden, Kerby [Department of Biostatistics, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Hayman, James A. [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Yuan Shuanghu [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Radiation Oncology, Shangdong Cancer Hospital, Jinan (China); Ritter, Timothy [Veterans Affairs Medical Center, Ann Arbor, Michigan (United States); Ten Haken, Randall K.; Lawrence, Theodore S. [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Kong Fengming, E-mail: fengkong@med.umich.edu [Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan (United States); Veterans Affairs Medical Center, Ann Arbor, Michigan (United States)

    2012-10-01

    Purpose: To investigate the plasma dynamics of 5 proinflammatory/fibrogenic cytokines, including interleukin-1beta (IL-1{beta}), IL-6, IL-8, tumor necrosis factor alpha (TNF-{alpha}), and transforming growth factor beta1 (TGF-{beta}1) to ascertain their value in predicting radiation-induced lung toxicity (RILT), both individually and in combination with physical dosimetric parameters. Methods and Materials: Treatments of patients receiving definitive conventionally fractionated radiation therapy (RT) on clinical trial for inoperable stages I-III lung cancer were prospectively evaluated. Circulating cytokine levels were measured prior to and at weeks 2 and 4 during RT. The primary endpoint was symptomatic RILT, defined as grade 2 and higher radiation pneumonitis or symptomatic pulmonary fibrosis. Minimum follow-up was 18 months. Results: Of 58 eligible patients, 10 (17.2%) patients developed RILT. Lower pretreatment IL-8 levels were significantly correlated with development of RILT, while radiation-induced elevations of TGF-ss1 were weakly correlated with RILT. Significant correlations were not found for any of the remaining 3 cytokines or for any clinical or dosimetric parameters. Using receiver operator characteristic curves for predictive risk assessment modeling, we found both individual cytokines and dosimetric parameters were poor independent predictors of RILT. However, combining IL-8, TGF-ss1, and mean lung dose into a single model yielded an improved predictive ability (P<.001) compared to either variable alone. Conclusions: Combining inflammatory cytokines with physical dosimetric factors may provide a more accurate model for RILT prediction. Future study with a larger number of cases and events is needed to validate such findings.

  9. Interstitial pneumonitis is a frequent complication in liver transplant recipients treated with sirolimus.

    LENUS (Irish Health Repository)

    Morcos, A

    2012-06-01

    Sirolimus is a powerful immunosuppressive drug which is being used increasingly after liver transplantation because of its renal sparing and anti-tumour effects. It has been associated with uncommon, but potentially fatal, interstitial pneumonitis.

  10. Radiation

    International Nuclear Information System (INIS)

    2013-01-01

    The chapter one presents the composition of matter and atomic theory; matter structure; transitions; origin of radiation; radioactivity; nuclear radiation; interactions in decay processes; radiation produced by the interaction of radiation with matter

  11. Lung dose depending on exact patient positioning during total body irradiation (TBI) - isoeffective considerations to assess the risk of interstitial pneumonitis after TBI; Lungendosis in Abhaengigkeit von der Lagerungsgenauigkeit bei Ganzkoerperbestrahlungen (TBI). Isoeffektivitaetsueberlegungen zur Einschaetzung des Risikos einer interstitiellen Pneumonitis nach Ganzkoerperbestrahlung

    Energy Technology Data Exchange (ETDEWEB)

    Piroth, M.D.; Zierhut, D.; Sroka-Perez, G.; Wannenmacher, M. [Radiologische Klinik der Univ. Heidelberg (Germany). Abt. fuer Klinische Radiologie; Kampen, M. van [Krankenhaus Nord-West, Frankfurt am Main (Germany). Radioonkologische Klinik

    2002-01-01

    Purpose: In this case report, we studied the effect of patient's movements on total lung dose during total body irradiation (TBI). The dose-effect relationship regarding the development of interstitial pneumonitis and the problem of defining a threshold value are discussed. Based on considerations about the isoeffects we calculated the pneumonitis risk in dependence of increasing lung dose. Patient and Method: We calculated dose-volume histograms of the lung for defined lateral deviations (0-3 cm) from the isocenter. Total dose was 12 Gy, given in six fractions over 3 days. Lung shields were used after a total dose of 9 Gy. Lung shields were transferred into the Helax-TMS trademark planning system to quantify the influence of lateral deviation to lung dose. Results: The child's lateral deviation amounted up to 3 cm. Median dose of the whole lung amounted up to 11.64 Gy depending on lateral deviation. Discussion: In TBI, the lung limits the total dose. To estimate the risk of radiation pneumonitis, we calculated the isoeffective lung dose of our TBI regime for a fractionation scheme of 2 Gy daily using a formalism of van Dyk. The increase of median lung dose from 9.76 to 11.64 Gy would isoeffectively correspond to the increase from 19 Gy (no deviation) to 20.9 Gy (3 cm lateral deviation) with conventional fractionation. According to Burman, a pneumonitis risk of approximately 20% could be expected. Conclusion: With an estimated pneumonitis risk of approximately 20%, an indication for irradiation in general anesthesia seems to be reasonable. This is practicable in cooperation with radiation oncologists, anesthesists and pediatricians and should be included into therapeutic concepts. (orig.) [German] Hintergrund: An einem Fallbeispiel werden die Auswirkungen von Lagerungsungenauigkeiten auf die Gesamtlungendosis bei Ganzkoerperbestrahlung eines Kindes erlaeutert. Die Dosis-Wirkungs-Beziehung bezueglich der Entstehung einer interstitiellen Pneumonitis nach

  12. Evaluation and Monitoring of a Child With Hydrocarbon Pneumonitis Using Point-of-Care Lung Ultrasound in the Pediatric Emergency Department.

    Science.gov (United States)

    Vazquez, Michelle; Paul, Audrey Z; Tay, Ee Tein; Tsung, James W

    2016-09-01

    A well-appearing 3-year-old boy presented to the pediatric emergency department 2 hours after a presumed hydrocarbon ingestion. He was referred to the emergency department by his pediatrician after consultation with the local poison control center after possibly ingesting ylang ylang (Cananga odorata) fragrance oil. The child was asymptomatic with a normal physical examination. Point-of-care lung ultrasound identified focal hydrocarbon pneumonitis in the right lung and demonstrated resolution of these findings. Utilization of point-of-care ultrasound resulted in a shorter emergency department length of stay and the avoidance of radiation exposure from serial chest x-rays.

  13. MR Imaging in symptomatic osteochondromas

    International Nuclear Information System (INIS)

    Kim, Soo Young; Kim, Jee Young; Kim, Sang Heum; Chun, Kyung Ah; Park, Young Ha

    1998-01-01

    The purpose of this study is to assess the MR findings of symptomatic osteochondromas. We evaluated 31 patients who between July, 1994 and May, 1997 underwent MR imaging for symptomatic osteochondroma. Fourteen were males and 17 were females, and their ages ranged from 8 to 49 (mean, 23) years. Using T1WI, T2WI and gadolinium-DTPA-enhanced T1WI, images were analysed according to signal intensity in the osseous component of the osteochondroma, thickness of the cartilage cap, and associated change in surrounding soft tissue. Clinical manifestation included a palpable mass or tendency to grow (n=22) and pain on movement (n=9). Complications were of three types : that which followed change in the osseous component of the tumor, associated change in surrounding soft tissue, and malignant transformation. In the osseous component, bone marrow edema or contusion was seen in 21 cases (67.7%), and in two (65%), fracture was observed. In surrounding soft tissue, muscle impingement was seen in 21 cases (67.7%), bursitis was in 7 cases (22.6 %), tenosynovitis in seven (22.6 %), and vascular compression in five (16.1 %). In three cases (9.7%), transformation to chondrosarcoma had occurred; two of these were derived from osteochondromatosis and one from a single osteochondroma. The thickness of the cartilage cap was as follow : 10 mm (n=3). In patients with symptomatic osteochondroma, MR imaging is useful for detecting both complications and malignant transformation. (author). 21 refs., 1 tab., 6 figs

  14. Radiation-induced lung injury

    International Nuclear Information System (INIS)

    Rosiello, R.A.; Merrill, W.W.

    1990-01-01

    The use of radiation therapy is limited by the occurrence of the potentially fatal clinical syndromes of radiation pneumonitis and fibrosis. Radiation pneumonitis usually becomes clinically apparent from 2 to 6 months after completion of radiation therapy. It is characterized by fever, cough, dyspnea, and alveolar infiltrates on chest roentgenogram and may be difficult to differentiate from infection or recurrent malignancy. The pathogenesis is uncertain, but appears to involve both direct lung tissue toxicity and an inflammatory response. The syndrome may resolve spontaneously or may progress to respiratory failure. Corticosteroids may be effective therapy if started early in the course of the disease. The time course for the development of radiation fibrosis is later than that for radiation pneumonitis. It is usually present by 1 year following irradiation, but may not become clinically apparent until 2 years after radiation therapy. It is characterized by the insidious onset of dyspnea on exertion. It most often is mild, but can progress to chronic respiratory failure. There is no known successful treatment for this condition. 51 references

  15. The analysis of prognostic factors affecting post-radiation acute reaction after conformal radiotherapy for non-small cell lung cancer.

    Science.gov (United States)

    Spych, Michał; Gottwald, Leszek; Klonowicz, Małgorzata; Biegała, Michał; Bibik, Robert; Fijuth, Jacek

    2010-10-01

    The aim was to evaluate the risk of acute side effects in the lung after 3-dimensional conformal radiotherapy (3D-CRT) in patients treated for non-small cell lung cancer (NSCLC). An attempt was made to single out clinical factors and factors related to treatment technique which may induce acute post-radiation pneumonitis. The analysis concerned 34 consecutive patients who underwent radical radiation therapy for NSCLC. Intensity of early toxicity was evaluated using modified RTOG/EORTC toxicity score. The endpoint for this analysis was the occurrence of radiation pneumonitis of grade 2 or higher. Factors related to treatment techniques were included in the statistical analysis. Fifty-three percent of patients included in the study suffered from acute post-radiation pneumonitis. The results of the study revealed the existence of lung tissue sensitivity to low doses of ionizing radiation. The multivariate analysis showed that total lung volume receiving a low dose of 10 Gy increased the risk of post-radiation pneumonitis (p = 0.01). Acute post-radiation pneumonitis was a relevant clinical problem in patients who underwent radical radiotherapy for non-small cell lung cancer. The lung volume receiving a dose of 10 Gy was the most important dosimetric factor which influenced the post-radiation acute pneumonitis.

  16. Radiation effects in the lung

    International Nuclear Information System (INIS)

    Coggle, J.E.; Lambert, B.E.; Moores, S.R.

    1986-01-01

    This article outlines the principles of radiobiology that can explain the time of onset, duration, and severity of the complex reactions of the lung to ionizing radiation. These reactions have been assayed biochemically, cell kinetically, physiologically, and pathologically. Clinical and experimental data are used to describe the acute and late reactions of the lung to both external and internal radiation including pneumonitis, fibrosis and carcinogenesis. Acute radiation pneumonitis, which can be fatal, develops in both humans and animals within 6 months of exposure to doses greater than or equal to 8 Gy of low LET radiation. It is divisible into a latent period lasting up to 4 weeks; an exudative phase (3-8 weeks) and with an acute pneumonitic phase between 2 and 6 months. There is much evidence to suggest that pneumonitis is an epithelial reaction and some evidence to suggest that this early damage may not be predictive of late fibrosis. However, despite detailed work on collagen metabolism, the pathogenesis of radiation fibrosis remains unknown. The data on radiation-induced pulmonary cancer, both in man and experimental animals from both external and internal irradiation following the inhalation of both soluble and insoluble alpha and beta emitting radionuclides are reviewed. 312 references. (Abstract Truncated)

  17. MR Imaging in symptomatic osteochondromas

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Soo Young; Kim, Jee Young; Kim, Sang Heum; Chun, Kyung Ah; Park, Young Ha [Catholic University of Korea, Seoul (Korea, Republic of)

    1998-06-01

    The purpose of this study is to assess the MR findings of symptomatic osteochondromas. We evaluated 31 patients who between July, 1994 and May, 1997 underwent MR imaging for symptomatic osteochondroma. Fourteen were males and 17 were females, and their ages ranged from 8 to 49 (mean, 23) years. Using T1WI, T2WI and gadolinium-DTPA-enhanced T1WI, images were analysed according to signal intensity in the osseous component of the osteochondroma, thickness of the cartilage cap, and associated change in surrounding soft tissue. Clinical manifestation included a palpable mass or tendency to grow (n=22) and pain on movement (n=9). Complications were of three types : that which followed change in the osseous component of the tumor, associated change in surrounding soft tissue, and malignant transformation. In the osseous component, bone marrow edema or contusion was seen in 21 cases (67.7%), and in two (65%), fracture was observed. In surrounding soft tissue, muscle impingement was seen in 21 cases (67.7%), bursitis was in 7 cases (22.6 %), tenosynovitis in seven (22.6 %), and vascular compression in five (16.1 %). In three cases (9.7%), transformation to chondrosarcoma had occurred; two of these were derived from osteochondromatosis and one from a single osteochondroma. The thickness of the cartilage cap was as follow : < 5 mm (n=16), 5-10 mm (n=12), and > 10 mm (n=3). In patients with symptomatic osteochondroma, MR imaging is useful for detecting both complications and malignant transformation. (author). 21 refs., 1 tab., 6 figs.

  18. Symptomatic management in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Pushkar Shah

    2015-01-01

    Full Text Available Multiple sclerosis (MS is the commonest cause of disability in young adults. While there is increasing choice and better treatments available for delaying disease progression, there are still, very few, effective symptomatic treatments. For many patients such as those with primary progressive MS (PPMS and those that inevitably become secondary progressive, symptom management is the only treatment available. MS related symptoms are complex, interrelated, and can be interdependent. It requires good understanding of the condition, a holistic multidisciplinary approach, and above all, patient education and empowerment.

  19. Hypersensitivity pneumonitis with Mycobacterium avium complex among spa workers.

    Science.gov (United States)

    Moraga-McHaley, Stephanie Ann; Landen, Michael; Krapfl, Heidi; Sewell, C Mack

    2013-01-01

    The New Mexico Department of Health (NMDOH) investigated the cause of two cases of hypersensitivity pneumonitis (HP) in spa maintenance workers with laboratory confirmed Mycobacterium avium complex (MAC). The investigation occurred in tandem with worker protection and swimming pool regulatory investigations by the New Mexico Environment Department at the spa where the workers were employed. The investigation was conducted in order to identify unreported cases, exposure source(s), and to prevent further worker exposure. NMDOH surveyed 57 spa employees about symptoms and exposures, categorized jobs according to self-reported exposure to water, and computed odds ratios for symptom reporting by exposure category. Environmental isolates from spa water and filter swabs were cultured and compared to patient isolates by the Environmental and Applied Microbiology Team, Centers for Disease Control and Prevention (CDC). Workers with the highest exposure reported more HP-like symptoms (OR = 9.6), as did intermediate exposure workers (OR = 6.5), compared to workers with no aerosolized water exposure. Two of 13 environmental isolates were closely related to one of the patient isolates. Workers were likely exposed during spray cleaning of cartridge filters in a poorly ventilated work space. Recommendations include inhibiting organism growth in spa systems, assuring the use of respiratory protection, and adequately ventilating work spaces where filters and equipment are cleaned.

  20. Sirolimus-associated interstitial pneumonitis in a liver transplant recipient

    International Nuclear Information System (INIS)

    Claire Berrouet, Marie; Aristizabal, Julian Miguel; Restrepo, Juan Carlos; Correa, Gonzalo

    2005-01-01

    Sirolimus is an immunosuppressive drug that has been used during the past few years. Sirolimus is indicated in rescue therapies and to reduce the secondary toxic effects of calcineurin inhibitors. This drug has been associated with infrequent but severe pulmonary toxicity. Cases of interstitial pneumonitis, bronchiolitis obliterans with organizing pneumonia, and alveolar proteinosis have been described. We describe a case of pulmonary toxicity associated with the use of sirolimus in a 59-yr-old liver transplant recipient. We also review all reported cases of sirolimus-associated lung toxicity among liver transplantation recipients, with the intention of understanding the risk factors, the clinical picture and the outcomes of this complication. Five cases have been reported since January 2000, including the present case. Clinical presentation is similar, with fever, dyspnoea, fatigue, cough, and hemoptysis. Discontinuation of the drug led to resolution of clinical and radiographic findings. Sirolimus-induced pulmonary toxicity is a serious condition and should be considered in the differential diagnosis of liver recipients presenting with respiratory findings. Discontinuation of the drug is associated with resolution of the pulmonary compromise

  1. Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis

    Directory of Open Access Journals (Sweden)

    Ayodeji Adegunsoye

    2017-08-01

    Full Text Available In chronic hypersensitivity pneumonitis (CHP, lack of improvement or declining lung function may prompt use of immunosuppressive therapy. We hypothesised that use of azathioprine or mycophenolate mofetil with prednisone reduces adverse events and lung function decline, and improves transplant-free survival. Patients with CHP were identified. Demographic features, pulmonary function tests, incidence of treatment-emergent adverse events (TEAEs and transplant-free survival were characterised, compared and analysed between patients stratified by immunosuppressive therapy. A multicentre comparison was performed across four independent tertiary medical centres. Among 131 CHP patients at the University of Chicago medical centre (Chicago, IL, USA, 93 (71% received immunosuppressive therapy, and had worse baseline forced vital capacity (FVC and diffusing capacity, and increased mortality compared with those who did not. Compared to patients treated with prednisone alone, TEAEs were 54% less frequent with azathioprine therapy (p=0.04 and 66% less frequent with mycophenolate mofetil (p=0.002. FVC decline and survival were similar between treatment groups. Analyses of datasets from four external tertiary medical centres confirmed these findings. CHP patients who did not receive immunosuppressive therapy had better survival than those who did. Use of mycophenolate mofetil or azathioprine was associated with a decreased incidence of TEAEs, and no difference in lung function decline or survival when compared with prednisone alone. Early transition to mycophenolate mofetil or azathioprine may be an appropriate therapeutic approach in CHP, but more studies are needed.

  2. Prevalence of mycoplasmas in the respiratory tracts of pneumonic calves.

    Science.gov (United States)

    ter Laak, E A; Noordergraaf, J H; Dieltjes, R P

    1992-10-01

    The prevalence of mycoplasmas in the respiratory tracts of 148 pneumonic calves originating from 25 herds in the Netherlands is reported. Four types of culture media were used to isolate mycoplasmas: solid modified Edward medium, 2 types of Friis media, and A7B differential agar medium. Mycoplasmas were isolated both from nasal swab specimens and lung lavage fluids collected from live calves and from nasal mucosa and lung tissue specimens collected post mortem. All of the mycoplasma strains isolated could be identified as either Ureaplasma diversum (isolated from 80% of 25 herds), Mycoplasma dispar (92%), M. bovirhinis (88%), M. bovis (20%), M. bovigenitalium (4%), M. arginini (16%), or M. canis (12%). Isolation rates of M. dispar and U. diversum were considerably higher from lung lavage fluids than from nasal swab specimens. M. bovis was detected only in fattening herds and not in dairy herds. The respiratory tracts of 75% of the calves examined contained at least 2 mycoplasma species. In total, 25 different combinations of mycoplasma species were detected in specimens collected from noses and lungs. The pathogenic species U. diversum and M. dispar had not been isolated before in the Netherlands.

  3. A case of occupational hypersensitivity pneumonitis associated with trichloroethylene.

    Science.gov (United States)

    Kim, Young Jae; Hwang, Eu Dong; Leem, Ah Young; Kang, Beo Deul; Chang, Soo Yun; Kim, Ho Keun; Park, In Kyu; Kim, Song Yee; Kim, Eun Young; Jung, Ji Ye; Kang, Young Ae; Park, Moo Suk; Kim, Young Sam; Kim, Se Kyu; Chang, Joon; Chung, Kyung Soo

    2014-02-01

    Trichloroethylene (TCE) is a toxic chemical commonly used as a degreasing agent, and it is usually found in a colorless or blue liquid form. TCE has a sweet, chloroform-like odor, and this volatile chlorinated organic chemical can cause toxic hepatitis, neurophysiological disorders, skin disorders, and hypersensitivity syndromes. However, the hypersensitivity pneumonitis (HP) attributed to TCE has rarely been reported. We hereby describe a case of HP associated with TCE in a 29-year-old man who was employed as a lead welder at a computer repair center. He was installing the capacitors on computer chip boards and had been wiped down with TCE. He was admitted to our hospital with complaints of dry coughs, night sweats, and weight losses for the past two months. HP due to TCE exposure was being suspected due to his occupational history, and the results of a video-associated thoracoscopic biopsy confirmed the suspicions. Symptoms have resolved after the steroid pulse therapy and his occupational change. TCE should be taken into consideration as a potential trigger of HP. Early recognition and avoidance of the TCE exposure in the future is important for the treatment of TCE induced HP.

  4. Change in FVC and survival in chronic fibrotic hypersensitivity pneumonitis.

    Science.gov (United States)

    Gimenez, Andrea; Storrer, Karin; Kuranishi, Lilian; Soares, Maria Raquel; Ferreira, Rimarcs Gomes; Pereira, Carlos A C

    2018-04-01

    The predictive value of the decline in FVC by ≥10% on survival in patients with fibrotic hypersensitivity pneumonitis is unknown. Of 112 patients included, 66 (59%) had surgical lung biopsies. Patients with ≥10% decline in predicted FVC after 6-12 months had a significantly increased risk of all-cause mortality (median survival 53 months, 95% CI 37 to 69 vs 139 months, 95% CI 66 to 212 months, p=0.007). On multivariate analysis remained associated with increasing mortality: decline in FVC by ≥10% (HR 4.13, 95% CI 1.96 to 8.70, p=0.005), lower FVC% (HR 1.03, 95% CI 1.01 to 1.05, p=0.003) and with decreasing mortality improvement with antigen avoidance (HR 0.18, 95% CI 0.04 to 0.77, p=0.021). © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Hazards of the ‘Hard Cash’: Hypersensitivity Pneumonitis

    Directory of Open Access Journals (Sweden)

    Elif Kupeli

    2010-01-01

    Full Text Available Hypersensitivity pneumonitis (HP is a nonimmunoglobulin E-related immune-mediated parenchymal lung disease. A 45-year-old woman who was a lifelong nonsmoker with a six-month history of frequent episodes of cough and dyspnea was admitted to hospital. She had been working as a money counter for 20 years at a central bank. Bibasilar crackles on lung auscultation, ground-glass opacities and a mosaic pattern on high-resolution computed tomography, restrictive abnormality on pulmonary function tests and mild hypoxemia were the prominent findings. Bronchoalveolar lavage fluid analysis revealed a predominance of CD4-positive T cells, and she tested positive on her natural challenge test. She was diagnosed with subacute HP based on established criteria. She was advised to discontinue counting fresh banknotes. Prednisolone was commenced, then tapered to discontinue in the ensuing six months. Clinical and radiological improvement was achieved within two months. To the authors’ knowledge, the present report is the first to describe ‘hard cash HP’, possibly caused by chipping dust or printing dye.

  6. Evaluation of oxidative stress in caprine bronchoalveolar lavage fluid of pneumonic and normal lungs

    Directory of Open Access Journals (Sweden)

    T.A. Jarikre

    2017-12-01

    Full Text Available Research in the area of oxidative stress in pneumonic pathology still requires attention in small ruminants especially with the use of bronchoalveolar lavage (BAL which may be a more sensitive indicator of respiratory diseases than blood. This investigation evaluates the role of oxidative stress in the pathogenesis of caprine pneumonia using BAL fluid (BALf from healthy and pneumonic goats. A BALf from 192 goats (whose pneumonic histopathology had been characterized using standard techniques was biochemically assayed for anti-oxidants and pro-oxidants. Malondialdehyde (MDA, hydrogen peroxide generation (H2O2, myeloperoxidase (MPO and reduced glutathione (GSH contents were measured to assess free radical activity in the BALf. Superoxide dismutase (SOD, Glutathione transferase (GST and Glutathione peroxidase (GPx activity were also determined colourimetrically. There were significant increases in the BALf supernatant of MDA, H2O2 and MPO with decreases in GSH level and SOD activity in the pneumonic goats (P < 0.05. There was also significant correlation of BALf oxidative assay to the type and severity of pneumonia. The levels of MDA, H2O2, and MPO increased significantly (P < 0.05 in bronchopneumonia and bronchointerstitial pneumonia than other pneumonic conditions and normal lungs. The management of caprine pneumonia should often incorporate antioxidant supplementation to correct the imbalance in pro-oxidant and anti-oxidant levels. Keywords: Anti-oxidants, Pro-oxidants, Pneumonia, Myeloperoxidase, Malondialdehyde, Glutathione transferase

  7. High-resolution computed tomography and histopathological findings in hypersensitivity pneumonitis: a pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Torres, Pedro Paulo Teixeira e Silva; Moreira, Marise Amaral Reboucas; Silva, Daniela Graner Schuwartz Tannus; Moreira, Maria Auxiliadora do Carmo [Universidade Federal de Goias (UFG), Goiania, GO (Brazil); Gama, Roberta Rodrigues Monteiro da [Hospital do Cancer de Barretos, Barretos, SP (Brazil); Sugita, Denis Masashi, E-mail: pedroptstorres@yahoo.com.br [Anapolis Unievangelica, Anapolis, GO (Brazil)

    2016-03-15

    Hypersensitivity pneumonitis is a diffuse interstitial and granulomatous lung disease caused by the inhalation of any one of a number of antigens. The objective of this study was to illustrate the spectrum of abnormalities in high-resolution computed tomography and histopathological findings related to hypersensitivity pneumonitis. We retrospectively evaluated patients who had been diagnosed with hypersensitivity pneumonitis (on the basis of clinical-radiological or clinical-radiological-pathological correlations) and had undergone lung biopsy. Hypersensitivity pneumonitis is clinically divided into acute, subacute, and chronic forms; high-resolution computed tomography findings correlate with the time of exposure; and the two occasionally overlap. In the subacute form, centrilobular micronodules, ground glass opacities, and air trapping are characteristic high-resolution computed tomography findings, whereas histopathology shows lymphocytic inflammatory infiltrates, bronchiolitis, variable degrees of organizing pneumonia, and giant cells. In the chronic form, high-resolution computed tomography shows traction bronchiectasis, honeycombing, and lung fibrosis, the last also being seen in the biopsy sample. A definitive diagnosis of hypersensitivity pneumonitis can be made only through a multidisciplinary approach, by correlating clinical findings, exposure history, high-resolution computed tomography findings, and lung biopsy findings. (author)

  8. Radiation induced lung injury: prediction, assessment and management.

    Science.gov (United States)

    Giridhar, Prashanth; Mallick, Supriya; Rath, Goura Kishore; Julka, Pramod Kumar

    2015-01-01

    Radiation induced lung injury has long been considered a treatment limiting factor for patients requiring thoracic radiation. This radiation induced lung injury happens early as well as late. Radiation induced lung injury can occur in two phases viz. early (radiation pneumonitis and late (>6 months) when it is called radiation induced lung fibrosis. There are multiple factors that can be patient, disease or treatment related that predict the incidence and severity of radiation pneumonitis. Radiation induced damage to the type I pneumocytes is the triggering factor to initiate such reactions. Over the years, radiation therapy has witnessed a paradigm shift in radiation planning and delivery and successfully reduced the incidence of lung injury. Radiation pneumonitis is usually a diagnosis of exclusion. Steroids, ACE inhibitors and pentoxyphylline constitute the cornerstone of therapy. Radiation induced lung fibrosis is another challenging aspect. The pathophysiology of radiation fibrosis includes continuing inflammation and microvascular changes due to pro-angiogenic and pro- fibrogenic stimuli resembling those in adult bronchiectasis. General supportive management, mobilization of airway secretions, anti-inflammatory therapy and management of acute exacerbations remains the treatment option. Radiation induced lung injury is an inevitable accompaniment of thoracic radiation.

  9. Blast cells transfer experimental hypersensitivity pneumonitis in guinea pigs

    International Nuclear Information System (INIS)

    Schuyler, M.; Cook, C.; Listrom, M.; Fengolio-Preiser, C.

    1988-01-01

    We previously demonstrated that experimental hypersensitivity pneumonitis (HP) can be transferred by lymph node cells (LNC) cultured in vitro with antigen. The purpose of this study was to identify the cells responsible for transfer and to determine if pulmonary cells can transfer HP. We cultured LNC from sensitized Strain 2 guinea pigs with a soluble extract of Micropolyspora faeni for 72 h, separated lymphoblasts from small lymphocytes, and transferred both subpopulations intravenously to syngeneic recipients. We also transferred irradiated lymphoblasts (1,500 rads), macrophage-depleted, lymphoblast-enriched populations, and pulmonary cells either without culture or after culture with M. faeni. Control animals received an equal volume of medium. All recipient animals were challenged intratracheally (i.t.) with M. faeni 48 h after the cell transfer, and they were killed 4 days after i.t. challenge. Randomly selected microscopic fields of the lung (250/animal) were judged to be normal or abnormal without knowledge of treatment. This measurement was reproducible (r = 0.95 for duplicate measurements, n = 55). All guinea pigs were maintained in HEPA-filtered air. There was a low level of pulmonary response to an i.t. challenge of M. faeni in animals that received medium. Animals that received pulmonary cells, either cultured or noncultured, did not differ from those in the control group. There was a substantial increase (p less than 0.01) in the extent of pulmonary abnormalities in the recipients of the lymphoblast population, with significant correlation (r = 0.87, p less than 0.01) between the number of lymphoblasts transferred and the extent of pulmonary abnormalities

  10. Intrasellar Symptomatic Salivary Gland Rest

    Directory of Open Access Journals (Sweden)

    Chih-Hao Chen

    2007-05-01

    Full Text Available Ectopic salivary gland tissue in sellar turcica is frequently observed in microscopic examination at autopsy. This tissue is considered clinically silent. Only 2 symptomatic cases have been previously reported. Here we report a 28-year-old woman presenting with galactorrhea and hyperprolactinemia. Magnetic resonance imaging revealed a 6×5-mm nodule in the posterior aspect of the pituitary gland. This nodule showed isointensity on T1- and T2-weighted images and less enhancement on post-contrast T1-weighted images. Transsphenoidal exploration revealed a cystic lesion within the pituitary gland, which consisted of a grayish gelatinous content. The pathologic examination confirmed the diagnosis of salivary gland rest.

  11. Desired Diversity and Symptomatic Anxiety

    DEFF Research Database (Denmark)

    Friis Christensen, Jannick; Muhr, Sara Louise

    2018-01-01

    This paper conceptualises organisational diversity as constituted by psychoanalytic lack. Empirically, we show how diversity as Lacanian lack is understood as nothing in or of itself, but as an empty signifier with no signified. The lack of diversity becomes a catalyst for desiring particular ideas...... of diversity that, however, constantly change due to the empty form of diversity. Anxiety manifests itself in the obsession of unobtainable idealised forms of diversity as well as in the uncertainty associated with the traumatic experience of always falling short of what is desired in an object...... – the experience of failed diversity. Conclusively, we discuss the productive potential of the power of lack. The impossibility of diversity is what, at once, conditions the possibility of diversity. We therefore suggest that the symptomatic anxiety provoked by the lack should be enjoyed in order to engage...

  12. Pathological study about two autopsy cases of bilateral irradiation pneumonitis induced by unilateral irradiation

    International Nuclear Information System (INIS)

    Yamauchi, Noriko; Tajima, Yo; Iio, Masaaki; Oshima, Takeo; Iino, Koichi.

    1978-01-01

    The first case is a 73-year-old man with left lung cancer. Seven days after completion of radiotherapy 7,000 rad, a chest roentgenogram showed diffuse bilateral pneumonia. The second case is a 61-year-old woman with right lung cancer and about one month after completion of radiotherapy 2,600 rad, a chest roentgenogram showed bilateral pneumonia. Pathological findings, all lobes of both lungs of these cases showed acute interstitial pneumonitis. The pathogenesis of irradiation pneumonitis is poorly understood. Several investigators thought that the pathogenesis of irradiation pneumonitis was caused by autoimmune mechanism, they carried out sero-pathological studies and demonstrated the bilateral pneumonia caused by unilateral irradiation. (author)

  13. Two Cases of Nivolumab Re-Administration after Pneumonitis as Immune-Related Adverse Events

    Directory of Open Access Journals (Sweden)

    Keisuke Imafuku

    2017-04-01

    Full Text Available Nivolumab is a recently approved medication for the treatment of unresectable malignant melanoma. Many immune-related adverse events (irAEs associated with nivolumab have been reported, such as pneumonitis, hepatitis, dermatitis, and thyroiditis. Prednisolone can effectively treat irAEs. However, it is unclear how or if nivolumab should be administered to patients after they have experienced an irAE. Herein, we show 2 patients who underwent pneumonitis as irAE. Case 1 demonstrated a cryptogenic organizing pneumonia pattern in the CT scan and case 2 had a diffuse alveolar damage (DAD pattern. Oral corticosteroids improved chest shadow of CT scan in both cases. However, when nivolumab was re-administrated, case 1 demonstrated no symptoms, but case 2 demonstrated pneumonia again. From our cases, it is difficult to re-administrate nivolumab for the patients with pneumonitis which shows a DAD pattern in CT, even if oral corticosteroids improve their symptoms.

  14. Symptomatic outcome after laparoscopic cholecystectomy.

    Science.gov (United States)

    Niranjan, B; Chumber, S; Kriplani, A K

    2000-01-01

    Patients with gallstones often present with multiple complaints. We wanted to study the major complaints of our patients undergoing laparoscopic cholecystectomy and the symptomatic relief afforded by the operation. We studied 113 patients with symptomatic gallstone disease who underwent laparoscopic cholecystectomy in a single surgical unit. Patients with proven common bile duct stones, obstructive jaundice, cholangitis, present or past associated abdominal pathology or cholecystoenteric fistula were excluded from the study. The mean follow up period was 18 months (range 10-22 months). A detailed account of the symptoms of gallstones, length of post-operative stay, persistence of symptoms, development of fresh symptoms and resumption of fat containing diet were assessed. The male to female ratio was 1:4. Common presenting symptoms were abdominal pain (96%), flatulence or feeling of fullness of abdomen (85%), heartburn (66%), belching (62%), sour eructation (52%), vomiting (48%) and nausea (45%). Mean postoperative hospital stay was 28 hours (range 9-68 hours). Biliary pain was relieved in 99% of patients after laparoscopic cholecystectomy (p cholecystectomy. Fresh symptoms that developed after laparoscopic cholecystectomy were heart-burn (6%), belching (3.5%), sour eructation (1%) and vomiting (0.5%). Post-cholecystectomy post-prandial diarrhoea occurred in 20% of the patients. The patients' appreciation of a satisfactory cosmetic result of operation scars was 100 percent. Fifteen female patients (13.5%) complained of increased weight gain of more than 5 kg after laparoscopic cholecystectomy [(p > 0.05; not significant (NS)]. Laparoscopic cholecystectomy significantly relieved symptoms of gall stone disease. Biliary pain, nausea, vomiting and sour eructations had better outcome compared to belching, flatulence and heartburn, which are also relieved in majority. Postcholecystectomy post-prandial diarrhea was a significant new symptom after cholecystectomy. Pre

  15. A method to adjust radiation dose-response relationships for clinical risk factors

    DEFF Research Database (Denmark)

    Appelt, Ane Lindegaard; Vogelius, Ivan R

    2012-01-01

    Several clinical risk factors for radiation induced toxicity have been identified in the literature. Here, we present a method to quantify the effect of clinical risk factors on radiation dose-response curves and apply the method to adjust the dose-response for radiation pneumonitis for patients...

  16. CT Scan Findings of Probable Usual Interstitial Pneumonitis Have a High Predictive Value for Histologic Usual Interstitial Pneumonitis

    Science.gov (United States)

    Chawla, Ashish; Peljto, Anna L.; Cool, Carlyne D.; Groshong, Steve D.; Talbert, Janet L.; McKean, David F.; Brown, Kevin K.; Fingerlin, Tasha E.; Schwarz, Marvin I.; Schwartz, David A.; Lynch, David A.

    2015-01-01

    BACKGROUND: The current usual interstitial pneumonitis (UIP)/idiopathic pulmonary fibrosis CT scan classification system excludes probable UIP as a diagnostic category. We sought to determine the predictive effect of probable UIP on CT scan on histology and the effect of the promoter polymorphism in MUC5B (rs35705950) on histologic and CT scan UIP diagnosis. METHODS: The cohort included 201 subjects with pulmonary fibrosis who had lung tissue samples obtained within 1 year of chest CT scan. UIP diagnosis on CT scan was categorized as inconsistent with, indeterminate, probable, or definite UIP by two to three pulmonary radiologists. Tissue slides were scored by two expert pulmonary pathologists. All subjects with available DNA (N = 200) were genotyped for rs35705950. RESULTS: The proportion of CT scan diagnoses were as follows: inconsistent with (69 of 201, 34.3%), indeterminate (72 of 201, 35.8%), probable (34 of 201, 16.9%), and definite (26 of 201, 12.9%) UIP. Subjects with probable UIP on CT scan were more likely to have histologic probable/definite UIP than subjects with indeterminate UIP on CT scan (82.4% [28 of 34] vs 54.2% [39 of 72]; P = .01). CT scan and microscopic honeycombing were not associated with each other (P = .76). The minor (T) allele of the MUC5B polymorphism was associated with concordant CT scan and histologic UIP diagnosis (P = .03). CONCLUSIONS: Probable UIP on CT scan is associated with a higher rate of histologic UIP than indeterminate UIP on CT scan suggesting that they are distinct groups and should not be combined into a single CT scan category as currently recommended by guidelines. CT scan and microscopic honeycombing may be dissimilar entities. The T allele at rs35705950 predicts a UIP diagnosis by both chest CT scan and histology. PMID:25317858

  17. Prevalence of Cyclospora cayetanensis among symptomatic and ...

    African Journals Online (AJOL)

    Naguib M. Massoud

    2012-04-24

    Apr 24, 2012 ... There was no sig- nificant difference between symptomatic Cyclospora infected and noninfected cases as regards the duration of diarrhea and clinical presentations. Conclusion: Cyclospora infection in immune-competent symptomatic and asymptomatic children in Alexandria is common. Physicians should ...

  18. Symptomatic mesodiverticular bands in children | Bertozzi | Annals ...

    African Journals Online (AJOL)

    Symptomatic mesodiverticular bands in children. ... Abstract. Objective: The aim of this study was to review the English literature about a rare condition such as symptomatic mesodiverticular bands (MDBs) in children. Background: The MDB is an ... All cases reported an intestinal occlusion as clinical picture. Internal hernia ...

  19. Symptomatic splenomegaly and palliative radiotherapy

    International Nuclear Information System (INIS)

    Yaneva, M.; Vlaikova, M.

    2005-01-01

    We analysed the effect of irradiation of an enlarged spleen in some hematologic diseases: chronic myelaemia, osteomyelophybrosis and chronic lymphadenosis, where splenectomy had been contraindicated and where pain has been a leading symptom and also the discomfort because of an enlarged spleen. For 20 years in the Clinic of Radiotherapy have been treated 23 patients with the above mentioned diseases. We have irradiated all patients using X-ray and later- Co-60. To reach a palliative effect we have irradiated patients with single doses from 50 cGy to 100 cGy with an interval of 2-3 days between each fraction, but the total doses have been different- from 400 cGy to 1500 cGy. The enlarged spleen has reached the pelvis in 3 cm to 17 cm below the costal margin, and in some patients has crossed the median line of the body going in some centimetres on the other side. The reduction of splenic size and volume is as follows: full reduction in 6 patients (26.1%) and partial in 17 (73.9%). All patients resulted in decreases in pain and tension in abdomen and the total discomfort. No serious side haematologic effects were encountered. Our experience indicates that cautious splenic irradiation can be a safe and useful therapeutic alternative. The symptomatic palliation in patients, where splenectomy is not an option, is effective and is an additional alternative for an improvement of their general condition

  20. Lupus pneumonitis presenting with high titre of anti-Ro antibody.

    Science.gov (United States)

    Chen, Mei-Chuan; Wu, Yueh-Lin; Lee, Kai-Ling; Lai, Kevin S; Chung, Chi-Li

    2018-01-01

    Lupus pneumonitis carries high mortality and is a rare manifestation of systemic lupus erythematosus (SLE). However, it is difficult to diagnose and is often mistaken as pneumonia, alveolar haemorrhage, or organizing pneumonia. Previous studies demonstrated that serum anti-Ro antibodies are elevated more frequently in SLE patients with pneumonitis than in those without. We report a 21-year-old female who was newly diagnosed as having SLE with nephritis and who suddenly developed right lung opacity and rapidly progressed to severe hypoxaemia despite the use of broad-spectrum antibiotics. The serum titre of anti-Ro antibody was greater than 240 U/mL. She underwent lung biopsy and lupus pneumonitis was confirmed by the pathological findings. Subsequently, she showed a favourable response to plasma exchange, steroid pulse therapy, and mycophenolate mofetil (MMF) treatment. For SLE patients with pulmonary infiltrates, high degree of clinical suspicion of lupus pneumonitis is required and measurement of serum anti-Ro antibody may help to make the diagnosis.

  1. [Primary pneumonic plague with nosocomial transmission in La Libertad, Peru 2010].

    Science.gov (United States)

    Donaires, Luis F; Céspedes, Manuel; Valencia, Pedro; Salas, Juan Carlos; Luna, María E; Castañeda, Alex; Peralta, Víctor; Cabezas, César; Pachas, Paul E

    2010-09-01

    Pneumonic plague is one of the clinical forms of plague, of low frequency and high mortality, transmitted by direct inhalation of Yersinia pestis coming from an animal or from person to person. To describe the clinical and epidemiological characteristics of the cases of primary pneumonic plague in an outbreak in the north of Peru. The clinical records of the confirmed cases of primary pneumonic plague presenting in an outbreak occurring in La Libertad, in July 2010, were reviewed, also the search and contact investigation was performed. The index case was identified, as well as three additional cases, out of these, two were nosocomial infections related to the index case. The initial clinical presentation was characterized by sudden onset of fever, chills, myalgia and chest pain, which in less than 24 hours evolved to hypotension and cyanosis. The initiation of specific treatment varied from 2 to 12 days, and cases with prompt initiation of treatment had a better clinical outcome. The lethality was 50% (2/4). Nosocomial transmission of pneumonic plague in Peru is evidenced, with severe clinical manifestations and high lethality.

  2. First case of severe pneumonic tularemia in an immunocompetent patient in the Netherlands

    NARCIS (Netherlands)

    Sigaloff, K.C.E.; Chung, P.K.; Koopmans, J.; Notermans, D.W.; Rijckevorsel, Van G.G.C.; Koene, M.; Sprengers, R.W.; Gooskens, J.; Stalenhoef, J.E.

    2017-01-01

    Tularemia is a zoonosis caused by different subspecies of the Gram-negative bacterium Francisella tularensis. We report the first case in the Netherlands of pneumonic tularemia caused by the F. tularensis subspecies holarctica after probable occupational inhalation of contaminated aerosols.

  3. Poor Baseline Pulmonary Function May Not Increase the Risk of Radiation-Induced Lung Toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jingbo [Department of Radiation Oncology, University of Michigan/Ann Arbor Veterans Health System, Ann Arbor, Michigan (United States); Department of Radiation Oncology, Cancer Hospital, Chinese Academic Medical Sciences and Peking Union Medical College, Beijing (China); Cao, Jianzhong [Department of Radiation Oncology, Cancer Hospital, Chinese Academic Medical Sciences and Peking Union Medical College, Beijing (China); Yuan, Shuanghu [Department of Radiation Oncology, University of Michigan/Ann Arbor Veterans Health System, Ann Arbor, Michigan (United States); Ji, Wei [Department of Radiation Oncology, Cancer Hospital, Chinese Academic Medical Sciences and Peking Union Medical College, Beijing (China); Arenberg, Douglas [Department of Internal Medicine, University of Michigan/Ann Arbor Veterans Health System, Ann Arbor, Michigan (United States); Dai, Jianrong [Department of Radiation Oncology, Cancer Hospital, Chinese Academic Medical Sciences and Peking Union Medical College, Beijing (China); Stanton, Paul; Tatro, Daniel; Ten Haken, Randall K. [Department of Radiation Oncology, University of Michigan/Ann Arbor Veterans Health System, Ann Arbor, Michigan (United States); Wang, Luhua, E-mail: wlhwq@yahoo.com [Department of Radiation Oncology, Cancer Hospital, Chinese Academic Medical Sciences and Peking Union Medical College, Beijing (China); Kong, Feng-Ming, E-mail: fengkong@med.umich.edu [Department of Radiation Oncology, University of Michigan/Ann Arbor Veterans Health System, Ann Arbor, Michigan (United States)

    2013-03-01

    Purpose: Poor pulmonary function (PF) is often considered a contraindication to definitive radiation therapy for lung cancer. This study investigated whether baseline PF was associated with radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC) receiving conformal radiation therapy (CRT). Methods and Materials: NSCLC patients treated with CRT and tested for PF at baseline were eligible. Baseline predicted values of forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), and diffusion capacity of lung for carbon monoxide (DLCO) were analyzed. Additional factors included age, gender, smoking status, Karnofsky performance status, coexisting chronic obstructive pulmonary disease (COPD), tumor location, histology, concurrent chemotherapy, radiation dose, and mean lung dose (MLD) were evaluated for RILT. The primary endpoint was symptomatic RILT (SRILT), including grade ≥2 radiation pneumonitis and fibrosis. Results: There was a total of 260 patients, and SRILT occurred in 58 (22.3%) of them. Mean FEV1 values for SRILT and non-SRILT patients were 71.7% and 65.9% (P=.077). Under univariate analysis, risk of SRILT increased with MLD (P=.008), the absence of COPD (P=.047), and FEV1 (P=.077). Age (65 split) and MLD were significantly associated with SRILT in multivariate analysis. The addition of FEV1 and age with the MLD-based model slightly improved the predictability of SRILT (area under curve from 0.63-0.70, P=.088). Conclusions: Poor baseline PF does not increase the risk of SRILT, and combining FEV1, age, and MLD may improve the predictive ability.

  4. Poor Baseline Pulmonary Function May Not Increase the Risk of Radiation-Induced Lung Toxicity

    International Nuclear Information System (INIS)

    Wang, Jingbo; Cao, Jianzhong; Yuan, Shuanghu; Ji, Wei; Arenberg, Douglas; Dai, Jianrong; Stanton, Paul; Tatro, Daniel; Ten Haken, Randall K.; Wang, Luhua; Kong, Feng-Ming

    2013-01-01

    Purpose: Poor pulmonary function (PF) is often considered a contraindication to definitive radiation therapy for lung cancer. This study investigated whether baseline PF was associated with radiation-induced lung toxicity (RILT) in patients with non-small cell lung cancer (NSCLC) receiving conformal radiation therapy (CRT). Methods and Materials: NSCLC patients treated with CRT and tested for PF at baseline were eligible. Baseline predicted values of forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), and diffusion capacity of lung for carbon monoxide (DLCO) were analyzed. Additional factors included age, gender, smoking status, Karnofsky performance status, coexisting chronic obstructive pulmonary disease (COPD), tumor location, histology, concurrent chemotherapy, radiation dose, and mean lung dose (MLD) were evaluated for RILT. The primary endpoint was symptomatic RILT (SRILT), including grade ≥2 radiation pneumonitis and fibrosis. Results: There was a total of 260 patients, and SRILT occurred in 58 (22.3%) of them. Mean FEV1 values for SRILT and non-SRILT patients were 71.7% and 65.9% (P=.077). Under univariate analysis, risk of SRILT increased with MLD (P=.008), the absence of COPD (P=.047), and FEV1 (P=.077). Age (65 split) and MLD were significantly associated with SRILT in multivariate analysis. The addition of FEV1 and age with the MLD-based model slightly improved the predictability of SRILT (area under curve from 0.63-0.70, P=.088). Conclusions: Poor baseline PF does not increase the risk of SRILT, and combining FEV1, age, and MLD may improve the predictive ability

  5. Successful pulpal anesthesia for symptomatic irreversible pulpitis.

    Science.gov (United States)

    Drum, Melissa; Reader, Al; Nusstein, John; Fowler, Sara

    2017-04-01

    Profound pulpal anesthesia after a successful inferior alveolar nerve block can be difficult to achieve when the clinical condition is a pulpal diagnosis of symptomatic irreversible pulpitis. The authors reviewed the literature as it relates to the anesthesia necessary for endodontic therapy of patients with painful, vital, mandibular teeth diagnosed with symptomatic irreversible pulpitis. Supplemental anesthetic techniques and medications are available that can be used to improve pulpal anesthesia for patients with the clinical condition of symptomatic irreversible pulpitis. The authors identified treatment recommendations for anesthesia in the case of symptomatic irreversible pulpitis based on a review of the available evidence. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

  6. Symptomatic pericardial cyst: a case series.

    Science.gov (United States)

    Najib, Mohammad Q; Chaliki, Hari P; Raizada, Amol; Ganji, Jhansi L; Panse, Prasad M; Click, Roger L

    2011-11-01

    Pericardial cysts are most commonly located at the cardiophrenic angle or, rarely, in the posterior or anterior superior mediastinum. The majority of pericardial cysts are asymptomatic and are found incidentally. Symptomatic pericardial cysts present with dyspnoea, chest pain, or persistent cough. We describe four patients with symptomatic pericardial cysts who were treated with either echocardiographically guided percutaneous aspiration or video-assisted thoracoscopic surgery, or both; thoracotomy; or conservative therapy.

  7. Radiation

    International Nuclear Information System (INIS)

    Davidson, J.H.

    1986-01-01

    The basic facts about radiation are explained, along with some simple and natural ways of combating its ill-effects, based on ancient healing wisdom as well as the latest biochemical and technological research. Details are also given of the diet that saved thousands of lives in Nagasaki after the Atomic bomb attack. Special comment is made on the use of radiation for food processing. (U.K.)

  8. Radiographic resolution of lymphocytic interstitial pneumonitis (LIP) in children with human immunodeficiency virus (HIV): not a sign of clinical deterioration.

    NARCIS (Netherlands)

    Lynch, J.L.; Blickman, J.G.; Meulen, D.C. ter; Babl, F.E.; Moloney, C.H.; Pelton, S.I.

    2001-01-01

    BACKGROUND: The literature and anecdotal evidence associate the resolution of radiographic findings of lymphocytic interstitial pneumonitis (LIP) with a decline in immune and clinical status of human immunodeficiency virus (HIV) infected children. OBJECTIVE: As our clinical impression was the

  9. Hypersensitivity pneumonitis caused by the broom grass (Calluna vulgaris

    Directory of Open Access Journals (Sweden)

    Yusuf Aydemir

    2015-01-01

    Full Text Available Hypersensitivity pneumonitis (HP, is an inflammatory disease that represents one possible response of the interstitial and parenchymal tissue to the intensive and repeated inhalation of organic dusts or reactive chemicals substances. In this case report, for the first time in the literature as we know, acute hypersensitivity pneumonitis in a patient who working in broom grass manufacturing were presented. Broom manufacturer employee 35 years old female patient was admitted with dyspnea, fever and cough, beginning the three months before. Physical examination, there were bilateral basal crackles. On Thorax CT bilateral diffuse ground-glass opacity and mosaic perfusion were observed. Patient was hospitalized, IV prednisolone therapy was started. Almost complete clinical improvement was achieved. We would like to emphasize that detailed occupational history should be questioned; because; diagnosis of acute HP, due to the mixing with the viral infection or atypical pneumonia, easily skipped.

  10. Early host cell targets of Yersinia pestis during primary pneumonic plague.

    Directory of Open Access Journals (Sweden)

    Roger D Pechous

    Full Text Available Inhalation of Yersinia pestis causes primary pneumonic plague, a highly lethal syndrome with mortality rates approaching 100%. Pneumonic plague progression is biphasic, with an initial pre-inflammatory phase facilitating bacterial growth in the absence of host inflammation, followed by a pro-inflammatory phase marked by extensive neutrophil influx, an inflammatory cytokine storm, and severe tissue destruction. Using a FRET-based probe to quantitate injection of effector proteins by the Y. pestis type III secretion system, we show that these bacteria target alveolar macrophages early during infection of mice, followed by a switch in host cell preference to neutrophils. We also demonstrate that neutrophil influx is unable to limit bacterial growth in the lung and is ultimately responsible for the severe inflammation during the lethal pro-inflammatory phase.

  11. A clinical score, including biohumoral parameters, is a useful pretest index to discriminate pulmonary infections from radiation damage in chemoradiation-treated lung cancer patients.

    Science.gov (United States)

    Ramella, Sara; Spoto, Silvia; Fiore, Michele; Grasso, Giovanna; Campanale, Roberto Erasmo; Ippolito, Edy; Greco, Carlo; Iurato, Aurelia; Trodella, Luca Eolo; Cortigiani, Marco; Trodella, Lucio; D'Angelillo, Rolando Maria; Costantino, Sebastiano

    2014-05-01

    To obtain an easy and prompt differential diagnosis between lower airways infections and acute radiation pneumonitis in chemoradiation lung cancer patients. From 303 patients treated, only patients with severe pulmonary symptoms were hospitalized. Clinical and radiation scores were calculated evaluating clinical, biohumoral, dosimetric parameters. Out of 36 patients hospitalized, infections and acute radiation pneumonitis were reported in 66.7% and 33.3%, respectively. Patients with clinical score ≥ 2 had an Odds Ratio of 3.4 (1.4-8.3; p = .006) to have infectious pneumonia, while radiation score was not predictive.

  12. Differentiation between endobronchial tuberculosis and bronchogenic carcinoma associated with atelectasis or obstructive pneumonitis: CT evaluation

    International Nuclear Information System (INIS)

    Chung, Hwan Hoon; Oh, Yu Whan; Kim, Kyeong Ah; Kim, Jung Hyuk

    1995-01-01

    Endobronchial tuberculosis and bronchogenic cancer are common causes of atelectasis or obstructive pneumonitis in Korea. Differentiation between endobronchial tuberculosis and bronchogenic carcinoma is important for the treatment and prognosis but it is sometimes difficult to differentiate these two lesions with radiologic examinations. The purpose of this study was to find the differential points between endobronchial tuberculosis and bronchogenic carcinoma associated with atelectasis or obstructive pneumonitis. Forty patients in whom atelectasis or obstructive pneumonitis was detected on chest radiographs comprised the study. A definite mass opacity was not observed on chest radiographs in all patients. In these patients, the causes of obstruction were endobronchial tuberculosis (n = 20) and bronchogenic cancer (n = 20) which were microbiologically or pathologically confirmed. Double obstructive lesions were more frequently found in endobronchial tuberculosis (8/20) than in bronchogenic cancer (1/20). Multiple calcification along the bronchial wall and severe distortion of bronchi were observed only in endobronchial tuberculosis (4/20) and associated low density mass at obstruction site was only observed in bronchogenic cancer (6/20). Bronchial dilatation (11/20) and parenchymal calcifications (14/20) distal to obstruction site, air containing bronchogram at post obstructive bronchus (14/20) were more frequently found in endobronchial tuberculosis. Contour bulging at obstruction site (14/20), and only mucus bronchogram at post obstructive bronchus (14/20) were more frequently found in bronchogenic carcinoma. In patients with atelectasis or obstructive pneumonitis, endobronchial tuberculosis is characterized by double obstructive lesion, multiple calcifications at the bronchial wall, and severe distortion of the bronchi. Endobronchial carcinoma is characterized by a low density mass at the obstructive site

  13. An encapsulated Yersinia pseudotuberculosis is a highly efficient vaccine against pneumonic plague.

    Directory of Open Access Journals (Sweden)

    Anne Derbise

    Full Text Available BACKGROUND: Plague is still a public health problem in the world and is re-emerging, but no efficient vaccine is available. We previously reported that oral inoculation of a live attenuated Yersinia pseudotuberculosis, the recent ancestor of Yersinia pestis, provided protection against bubonic plague. However, the strain poorly protected against pneumonic plague, the most deadly and contagious form of the disease, and was not genetically defined. METHODOLOGY AND PRINCIPAL FINDINGS: The sequenced Y. pseudotuberculosis IP32953 has been irreversibly attenuated by deletion of genes encoding three essential virulence factors. An encapsulated Y. pseudotuberculosis was generated by cloning the Y. pestis F1-encoding caf operon and expressing it in the attenuated strain. The new V674pF1 strain produced the F1 capsule in vitro and in vivo. Oral inoculation of V674pF1 allowed the colonization of the gut without lesions to Peyer's patches and the spleen. Vaccination induced both humoral and cellular components of immunity, at the systemic (IgG and Th1 cells and the mucosal levels (IgA and Th17 cells. A single oral dose conferred 100% protection against a lethal pneumonic plague challenge (33×LD(50 of the fully virulent Y. pestis CO92 strain and 94% against a high challenge dose (3,300×LD(50. Both F1 and other Yersinia antigens were recognized and V674pF1 efficiently protected against a F1-negative Y. pestis. CONCLUSIONS AND SIGNIFICANCE: The encapsulated Y. pseudotuberculosis V674pF1 is an efficient live oral vaccine against pneumonic plague, and could be developed for mass vaccination in tropical endemic areas to control pneumonic plague transmission and mortality.

  14. Demyelinating polyneuropathy, dermatomyositis, and interstitial pneumonitis associated with autoantibody against melanoma differentiation-associated gene 5

    Directory of Open Access Journals (Sweden)

    Yu-Hsiang Chiu

    2017-01-01

    Full Text Available Patients with serum anti-melanoma differentiation-associated gene 5 autoantibodies (anti-MDA5 are related to amyopathic dermatomyositis, especially in Asians. Here, we present a 46-year-old woman who was diagnosed with anti-MDA5-mediated demyelinating polyneuropathy clinically mimicking dermatomyositis. She had rapid progression of interstitial pneumonitis complicated with Pneumocystis jirovecii and Aspergillus pneumonia with septic shock. It is rare that patients with anti-MDA5-positive dermatomyositis present as demyelinating polyneuropathy.

  15. Clinical management of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat: A case report

    OpenAIRE

    Faez Firdaus Abdullah Jesse; Eric Lim Teik Chung; Yusuf Abba; Asinamai Athliamai Bitrus; Idris Umar Hambali; Mohd Azmi Mohd Lila; Abd Wahid Haron

    2017-01-01

    Objective: This clinical case reports the occurrence of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat. Materials and methods: A 2-year-old Jamnapari goat weighing 25 Kg was presented to the Universiti Veterinary Hospital, Universiti Putra Malaysia with primary complain of eye problem and inappetence. Results: Upon clinical examination, the most prominent abnormality observed was corneal opacity of the right eye with presence of ulceration on the corneal surface a...

  16. High-resolution CT findings in cytomegalovirus pneumonitis after bone marrow transplantation

    International Nuclear Information System (INIS)

    Abe, Katsumi; Suzuki, Kenzo; Kamata, Noriko

    1998-01-01

    In order to explore the high-resolution CT (HRCT) findings of cytomegalovirus (CMV) pneumonitis after bone marrow transplantation, we retrospectively reviewed the HRCT findings in nine patients with CMV pneumonitis cytologically proven by bronchoalveolar lavege. In 67% of cases, HRCT showed ground-glass attenuation. Consolidation and bronchial wall thickening were demonstrated in 33%, pleural effusion in 22%, and micro centrilobular nodules, bronchiectasis, and reticulation in 11%, respectively. Lymphadenopathy and masses were not seen. The areas of ground-glass attenuation were distributed bilaterally in all cases, diffusely in 67%, centrilobularly in 50%, and panlobularly in 50%. Subpleural lung regions were spared in 83%. The areas of consolidation were bilateral in 67%, nonsegmental in 67%, and involved the lower lobe in all cases. A total of 25 follow-up HRCT were performed in six patients. Small centrilobular ground-glass opacities disappeared after treatment in one patient. Micro centrilobular nodules vanished after treatment in one patient. Small centrilobular ground-glass opacities developed into consolidation and resolved after treatment in one patient. In one patient, diffuse ground-glass opacities progressed to consolidation, and the patient died due to respiratory failure. No abnormal findings were observed in two patients. It may be considered that in the early phase of CMV pneumonitis HRCT shows small or micro centrilobular ground-glass opacities and nodules and that in the advanced phase these lesions progress to dense alveolar opacities as CMV infection advances, although a variety of HRCT appearances is observed in the course of CMV pneumonitis. (author)

  17. Complete Protection against Pneumonic and Bubonic Plague after a Single Oral Vaccination.

    Directory of Open Access Journals (Sweden)

    Anne Derbise

    Full Text Available No efficient vaccine against plague is currently available. We previously showed that a genetically attenuated Yersinia pseudotuberculosis producing the Yersinia pestis F1 antigen was an efficient live oral vaccine against pneumonic plague. This candidate vaccine however failed to confer full protection against bubonic plague and did not produce F1 stably.The caf operon encoding F1 was inserted into the chromosome of a genetically attenuated Y. pseudotuberculosis, yielding the VTnF1 strain, which stably produced the F1 capsule. Given orally to mice, VTnF1 persisted two weeks in the mouse gut and induced a high humoral response targeting both F1 and other Y. pestis antigens. The strong cellular response elicited was directed mostly against targets other than F1, but also against F1. It involved cells with a Th1-Th17 effector profile, producing IFNγ, IL-17, and IL-10. A single oral dose (108 CFU of VTnF1 conferred 100% protection against pneumonic plague using a high-dose challenge (3,300 LD50 caused by the fully virulent Y. pestis CO92. Moreover, vaccination protected 100% of mice from bubonic plague caused by a challenge with 100 LD50 Y. pestis and 93% against a high-dose infection (10,000 LD50. Protection involved fast-acting mechanisms controlling Y. pestis spread out of the injection site, and the protection provided was long-lasting, with 93% and 50% of mice surviving bubonic and pneumonic plague respectively, six months after vaccination. Vaccinated mice also survived bubonic and pneumonic plague caused by a high-dose of non-encapsulated (F1- Y. pestis.VTnF1 is an easy-to-produce, genetically stable plague vaccine candidate, providing a highly efficient and long-lasting protection against both bubonic and pneumonic plague caused by wild type or un-encapsulated (F1-negative Y. pestis. To our knowledge, VTnF1 is the only plague vaccine ever reported that could provide high and durable protection against the two forms of plague after a single

  18. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

    The intention of this study is to share the experience of the author in the occurrence, possible causative factors, and treatment of surgically symptomatic prolapsed lumbar and sacral intervertebral discs in females, and to compare this experience in Switzerland, Nigeria, and Jamaica using surgery records for a period of over ...

  19. Endovascular treatment of symptomatic intracranial atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Syed I Hussain

    2011-02-01

    Full Text Available Abstract: Symptomatic intracranial atherosclerotic disease (ICAD is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis greater than 70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and or stenting is a safe, suitable and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and or stenting of symptomatic intracranial atherosclerotic disease.

  20. Prevalence of Cyclospora cayetanensis among symptomatic and ...

    African Journals Online (AJOL)

    Microsporidia, Giardia lamblia and Hymenolepis nana were also detected in the symptomatic group. There was no significant difference as regards age and residency of Cyclospora positive and negative cases in both groups. In asymptomatic group, Cyclospora infected cases were males while in negative cases, 50% were ...

  1. Prevalence and incidence of symmetrical symptomatic peripheral ...

    African Journals Online (AJOL)

    Background. Symptomatic symmetrical peripheral neuropathy (SSPN) is common in patients with HIV infection. It is also a common adverse event associated with both tuberculosis (TB) treatment and antiretroviral therapy (ART), particularly stavudine. While tenofovir is the one of recommended first-line nucleotide reverse ...

  2. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.

    Science.gov (United States)

    Wald, Arnold

    2003-03-01

    Constipation, diarrhea, and symptomatic hemorrhoids are disorders common in the general population, particularly in women. These conditions, if mild, often are self-treated with various home remedies or nonprescription preparations. Few of these patients, moreover, are referred to gastroenterologists, as primary care providers generally are confident managing these conditions, unless they are severe, refractory to conventional management, or require additional diagnostic studies.

  3. Accelerated hypofractionated three-dimensional conformal radiation therapy (3 Gy/fraction) combined with concurrent chemotherapy for patients with unresectable stage III non-small cell lung cancer: preliminary results of an early terminated phase II trial.

    Science.gov (United States)

    Ren, Xiao-Cang; Wang, Quan-Yu; Zhang, Rui; Chen, Xue-Ji; Wang, Na; Liu, Yue-E; Zong, Jie; Guo, Zhi-Jun; Wang, Dong-Ying; Lin, Qiang

    2016-04-23

    Increasing the biological effective dose (BED) of radiotherapy for non-small cell lung cancer (NSCLC) can increase local control rates and improve overall survival. Compared with conventional fractionated radiotherapy, accelerated hypofractionated radiotherapy can yield higher BED, shorten the total treatment time, and theoretically obtain better efficacy. However, currently, there is no optimal hypofractionated radiotherapy regimen. Based on phase I trial results, we performed this phase II trial to further evaluate the safety and preliminary efficacy of accelerated hypofractionated three-dimensional conformal radiation therapy(3-DCRT) combined with concurrent chemotherapy for patients with unresectable stage III NSCLC. Patients with previously untreated unresectable stage III NSCLC received 3-DCRT with a total dose of 69 Gy, delivered at 3 Gy per fraction, once daily, five fractions per week, completed within 4.6 weeks. At the same time, platinum doublet chemotherapy was applied. After 12 patients were enrolled in the group, the trial was terminated early. There were five cases of grade III radiation esophagitis, of which four cases completed the radiation doses of 51 Gy, 51 Gy, 54 Gy, and 66 Gy, and one case had 16 days of radiation interruption. The incidence of grade III acute esophagitis in patients receiving an irradiation dose per fraction ≥2.7 Gy on the esophagus was 83.3% (5/6). The incidence of symptomatic grade III radiation pneumonitis among the seven patients who completed 69 Gy according to the plan was 28.6% (2/7). The median local control (LC) and overall survival (OS) were not achieved; the 1-year LC rate was 59.3%, and the 1-year OS rate was 78.6%. For unresectable stage III NSCLC, the accelerated hypofractionated radiotherapy with a total dose of 69 Gy (3 Gy/f) combined with concurrent chemotherapy might result in severe radiation esophagitis and pneumonitis to severely affect the completion of the radiotherapy. Therefore, we considered that

  4. Reduction of radiation pneumonitis by V20-constraints in breast cancer

    Directory of Open Access Journals (Sweden)

    Svane Gunilla

    2010-10-01

    Full Text Available Abstract Introduction Adjuvant local-regional radiotherapy (LRRT is routinely recommended for breast cancer patients. It is well known being related to pulmonary side-effects. We studied post-RT radiological changes on X-ray and CT, and correlated the findings with Quality of Life (QoL, common dosimetric factors and co-variates. The results were compared with a previously reported cohort of 137 irradiated women. Methods 88 women underwent chest X-ray and CT pre-and 4-5 months after 3-D planned LRRT, minimizing the dose to the ipsilateral lung to V20 13, V20, V30 and mean dose were calculated and QoL was assessed before and 4 months after RT. Results The use of dose-volume constraints significally reduced moderate-severe radiological changes on chest X-ray compared with our earlier study (Chi square trend test: p 13 correlated independently with radiological changes on CT (logistic regression: p = 0.04; ROC area: 0.7. The Co-variates smoking habits, age, chemotherapy, endocrine or trastuzumab therapy did not influence the outcome on multivariate analysis. QoL changes in physical function, i.e. fatigue, dyspnoea were not detected but there was a trend for a worse recovery after chemotherapy in patients with high V13 (Spearman Rank Correlation: p Conclusions The use of dose-volume constraints significantly reduced post-RT radiological changes on chest X-ray in LRRT for BC. The lung changes on CT were also generally limited when we used this strategy and was not always picked up on chest X-ray. Variation in V13 alone was correlated with occurrence of lung changes on CT.

  5. Radiation pneumonitis in non‑small‑cell lung cancer patients treated ...

    African Journals Online (AJOL)

    scanned every day using megavoltage CT imaging enabled for HT before treatment, and the patients were positioned using the integrated registration with the planning CT for both bony and soft tissue anatomy. Patients were examined in a supine position with their arms above their heads and secured in an immobilization.

  6. Radiation-induced Pulmonary Damage in Lung Cancer Patients

    International Nuclear Information System (INIS)

    Chung, Su Mi; Choi, Ihl Bohng; Kang, Mi Mun; Kim, In Ah; Shinn, Kyung Sub

    1993-01-01

    Purpose: A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. Method and Materials: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinoma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years(range: 33-80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range of 2 to 150 days (median 40 days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose(ED) model, ED=D·N-0.377·T-0.058 was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined. Result: In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic charges consistent with radiation pneumonitis were seen in 100% of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced charge between the group with radiation

  7. Spatially distinct neutrophil responses within the inflammatory lesions of pneumonic plague.

    Science.gov (United States)

    Stasulli, Nikolas M; Eichelberger, Kara R; Price, Paul A; Pechous, Roger D; Montgomery, Stephanie A; Parker, Joel S; Goldman, William E

    2015-10-13

    During pneumonic plague, the bacterium Yersinia pestis elicits the development of inflammatory lung lesions that continue to expand throughout infection. This lesion development and persistence are poorly understood. Here, we examine spatially distinct regions of lung lesions using laser capture microdissection and transcriptome sequencing (RNA-seq) analysis to identify transcriptional differences between lesion microenvironments. We show that cellular pathways involved in leukocyte migration and apoptosis are downregulated in the center of lung lesions compared to the periphery. Probing for the bacterial factor(s) important for the alteration in neutrophil survival, we show both in vitro and in vivo that Y. pestis increases neutrophil survival in a manner that is dependent on the type III secretion system effector YopM. This research explores the complexity of spatially distinct host-microbe interactions and emphasizes the importance of cell relevance in assays in order to fully understand Y. pestis virulence. Yersinia pestis is a high-priority pathogen and continues to cause outbreaks worldwide. The ability of Y. pestis to be transmitted via respiratory droplets and its history of weaponization has led to its classification as a select agent most likely to be used as a biological weapon. Unrestricted bacterial growth during the initial preinflammatory phase primes patients to be infectious once disease symptoms begin in the proinflammatory phase, and the rapid disease progression can lead to death before Y. pestis infection can be diagnosed and treated. Using in vivo analyses and focusing on relevant cell types during pneumonic plague infection, we can identify host pathways that may be manipulated to extend the treatment window for pneumonic plague patients. Copyright © 2015 Stasulli et al.

  8. No effect of pirfenidone treatment in fulminant bleomycin-induced pneumonitis

    Directory of Open Access Journals (Sweden)

    Elisabeth Bendstrup

    2014-01-01

    Full Text Available Bleomycin-induced pneumonitis (BIP is a serious and potentially fatal adverse effect of bleomycin. Currently, BIP is treated on an empirical basis with high dose steroid. Pirfenidone is a new antifibrotic drug, which has been proven beneficial in idiopathic pulmonary fibrosis and is able to inhibit or reverse BIP in animal models. Here, the first two cases of human BIP treated with pirfenidone in addition to steroid therapy are presented. Unfortunately, both patients died, which may be explained by the initiation of therapy at a late stage. Therefore, studies of early or prophylactic treatment with pirfenidone in relation to bleomycin-containing chemotherapy regimens are needed.

  9. The incidence of interstitial pneumonitis: Comparison of total body irradiation schedules for allogenic bone marrow transplantation

    International Nuclear Information System (INIS)

    Bamberg, M.; Molls, M.; Beelen, D.W.; Mahmoud, H.K.; Schaefer, U.W.

    1986-01-01

    Interstitial pneumonitis (IP) is one of the major causes of death following bone marrow transplantation (BMT). This report deals with a comparison between data compiled from six centers concerning the essential factors responsible for the development of IP. Special concern has been paid to the idiopathic form of disease where TBI is thought to be the most important factor in its pathogenesis. Our own experience using different TBI modalities shows that the instantaneous dose rate seems to be an important factor in the development of IIP. Comparing the data from various centers it is not possible at the present time to recommend one optimal modality. (orig.) [de

  10. Applications of Machine Learning for Radiation Therapy.

    Science.gov (United States)

    Arimura, Hidetaka; Nakamoto, Takahiro

    2016-01-01

    Radiation therapy has been highly advanced as image guided radiation therapy (IGRT) by making advantage of image engineering technologies. Recently, novel frameworks based on image engineering technologies as well as machine learning technologies have been studied for sophisticating the radiation therapy. In this review paper, the author introduces several researches of applications of machine learning for radiation therapy. For examples, a method to determine the threshold values for standardized uptake value (SUV) for estimation of gross tumor volume (GTV) in positron emission tomography (PET) images, an approach to estimate the multileaf collimator (MLC) position errors between treatment plans and radiation delivery time, and prediction frameworks for esophageal stenosis and radiation pneumonitis risk after radiation therapy are described. Finally, the author introduces seven issues that one should consider when applying machine learning models to radiation therapy.

  11. Clinical management of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat: A case report

    Directory of Open Access Journals (Sweden)

    Faez Firdaus Abdullah Jesse

    2017-12-01

    Full Text Available Objective: This clinical case reports the occurrence of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat. Materials and methods: A 2-year-old Jamnapari goat weighing 25 Kg was presented to the Universiti Veterinary Hospital, Universiti Putra Malaysia with primary complain of eye problem and inappetence. Results: Upon clinical examination, the most prominent abnormality observed was corneal opacity of the right eye with presence of ulceration on the corneal surface and chemosis of the right conjunctiva with excessive lacrimation. On auscultation, there was the presence of crackle lung sounds with bilateral mucopurulent nasal discharges. Samples from the ocular swab yielded a positive growth for Mycoplasma spp., while the nasal swab yielded a positive growth for Mannheimia haemolytica. The goat was diagnosed with stage I pinkeye with concurrent pneumonic pasteurellosis infection. Treatment was instituted with 400 mL of 0.9% NaCl administered intravenously once for rehydration. Flunixin meglumine 2.2 mg/kg bwt was given intramuscularly twice daily for three days as anti-inflammatory and analgesic. Oxytetracycline 20 mg/kg bwt was injected once intramuscularly as long acting broad spectrum antibiotic for treatment of pinkeye and pasteurellosis infections. Furthermore, terramycin eye ointment containing oxytetracycline HCl was also administered intraocularly twice daily for seven days as treatment for the Mycoplasma spp. Conclusion: The prognosis for this case was good as the goat were treated promptly and effectively. [J Adv Vet Anim Res 2017; 4(4.000: 390-393

  12. The diagnostic accuracy of acute phase proteins and proinflammatory cytokines in sheep with pneumonic pasteurellosis

    Directory of Open Access Journals (Sweden)

    Wael M. El-Deeb

    2016-07-01

    Full Text Available The goal of this study was to assess the diagnostic accuracy of acute phase proteins and proinflammatory cytokines in sheep with pneumonic pasteurellosis. Blood samples were collected from 56 sheep (36 naturally infected with Pasteurella multocida and 20 healthy controls belonging to one farm in Eastern region, Saudi Arabia. Serum samples were evaluated for acute phase proteins (Haptoglobin (Hp, serum amyloid A (SAA and fibrinogen (Fb, and the proinflammatory cytokines (interleukins (IL-1α, IL-1β, and IL-6, tumor necrosis factor-alpha (TNF-α, and interferon-gamma (IFN-ϒ. Additionally, nasopharyngeal swabs and bronchoalveolar lavages were collected from all animals for bacteriological examinations. Receiver operating characteristic curve was used to assess the diagnostic performance of each parameter. All parameters showed moderate to high degree of positive correlation with case-control status. There was no significant difference in the area under the curve (AUC among acute phase proteins; however, both Hp and SAA showed better sensitivity and specificity than Fb. The proinflammatory cytokines (IL1-α, IL1-β, and IL6 showed similar and highly accurate diagnostic performance (AUC > 0.9, whereas IFN-ϒ was moderately accurate (AUC = 0.79. In conclusion, this study confirms the value of acute phase proteins and cytokines as diagnostic biomarkers of naturally occuring pneumonic pasteurellosis in sheep.

  13. Hepatitis and pneumonitis during adalimumab therapy in Crohn disease: mind the histoplasmosis!

    Science.gov (United States)

    Pinheiro, Bruno do Valle; Delgado, Aureo de Almeida; Chebli, Julio Maria Fonseca

    2014-01-01

    Tumor necrosis factor-alpha (TNF-α) inhibitor therapy plays a pivotal role in the management of moderate to severe inflammatory bowel disease. Because of the role of TNF-α in the host defenses, anti-TNF therapy has been associated with an increase the risks of granulomatous infections. To report the first case of adalimumab-associated invasive histoplasmosis presenting as an acute hepatitis-like syndrome and febrile pneumonitis in a patient with Crohn's disease. Case report of a patient with progressive histoplasmosis confirmed by percutaneous fine needle aspiration biopsy lung and urine Histoplasma antigen. We present the case of a young man with CD who developed pneumonia and acute hepatitis-like features caused by Histoplasma capsulatum infection during adalimumab therapy. To the best of our knowledge, this acute hepatitis-like manifestation has never been reported as a presentation of the histoplasmosis in patients with Crohn's disease. This case underscores the potential risk for serious infection that may arise in this setting and should alert clinicians to the need to consider the histoplasmosis diagnosis in patients presenting with acute hepatitis-like syndrome associated with prolonged febrile illness or pneumonitis during therapy with anti-TNF-α antibodies.

  14. HEPATITIS AND PNEUMONITIS DURIN ADALIMUMAB THERAPY IN CROHN? DISEASE: mind the histoplasmosis!

    Directory of Open Access Journals (Sweden)

    Bruno do Valle PINHEIRO

    2014-03-01

    Full Text Available Context Tumor necrosis factor-alpha (TNF-α inhibitor therapy plays a pivotal role in the management of moderate to severe inflammatory bowel disease. Because of the role of TNF-α in the host defenses, anti-TNF therapy has been associated with an increase the risks of granulomatous infections. Objective To report the first case of adalimumab-associated invasive histoplasmosis presenting as an acute hepatitis-like syndrome and febrile pneumonitis in a patient with Crohn’s disease. Method Case report of a patient with progressive histoplasmosis confirmed by percutaneous fine needle aspiration biopsy lung and urine Histoplasma antigen. Results We present the case of a young man with CD who developed pneumonia and acute hepatitis-like features caused by Histoplasma capsulatum infection during adalimumab therapy. To the best of our knowledge, this acute hepatitis-like manifestation has never been reported as a presentation of the histoplasmosis in patients with Crohn’s disease. Conclusions This case underscores the potential risk for serious infection that may arise in this setting and should alert clinicians to the need to consider the histoplasmosis diagnosis in patients presenting with acute hepatitis-like syndrome associated with prolonged febrile illness or pneumonitis during therapy with anti-TNF-α antibodies.

  15. [Environmental causes of the distal airways disease. Hypersensitivity pneumonitis and rare causes].

    Science.gov (United States)

    Dalphin, J-C; Didier, A

    2013-10-01

    Hypersensitivity pneumonitis is one of the most frequent causes of distal airways disease. It is associated with inflammation of the bronchioles, predominantly by lymphocytic infiltrates, and with granuloma formation causing bronchial obstruction. This inflammation explains the clinical manifestations and the airways obstruction seen on pulmonary function tests, most often in the distal airways but proximal in almost 20%. CT scan abnormalities reflect the lymphocytic infiltrates and air trapping and, in some cases, the presence of emphysema. Bronchiolitis induced by chronic inhalation of mineral particles or acute inhalation of toxic gases (such as NO2) are other examples of small airways damage due to environmental exposure. The pathophysiological mechanisms are different and bronchiolar damage is either exclusive or predominant. Bronchiolitis induced by tobacco smoke exposure, usually classified as interstitial pneumonitis, is easily diagnosed thanks to broncho-alveolar lavage. Its prognosis is linked to the other consequences of tobacco smoke exposure including respiratory insufficiency. Finally, the complex lung exposure observed in some rare cases (such as the World Trade Center fire or during wars) may lead to a less characteristic pattern of small airways disease. Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  16. [Human plague and pneumonic plague : pathogenicity, epidemiology, clinical presentations and therapy].

    Science.gov (United States)

    Riehm, Julia M; Löscher, Thomas

    2015-07-01

    Yersinia pestis is a highly pathogenic gram-negative bacterium and the causative agent of human plague. In the last 1500 years and during three dreaded pandemics, millions of people became victims of Justinian's plague, the Black Death, or modern plague. Today, Y. pestis is endemic in natural foci of Asian, African and American countries. Due to its broad dissemination in mammal species and fleas, eradication of the pathogen will not be possible in the near future. In fact, plague is currently classified as a "re-emerging disease". Infection may occur after the bite of an infected flea, but also after oral ingestion or inhalation of the pathogen. The clinical presentations comprise the bubonic and pneumonic form, septicemia, rarely pharyngitis, and meningitis. Most human cases can successfully be treated with antibiotics. However, the high transmission rate and lethality of pneumonic plague require international and mandatory case notification and quarantine of patients. Rapid diagnosis, therapy and barrier nursing are not only crucial for the individual patient but also for the prevention of further spread of the pathogen or of epidemics. Therefore, WHO emergency schedules demand the isolation of cases, identification and surveillance of contacts as well as control of zoonotic reservoir animals and vectors. These sanctions and effective antibiotic treatment usually allow a rapid containment of outbreaks. However, multiple antibiotic resistant strains of Y. pestis have been isolated from patients in the past. So far, no outbreaks with such strains have been reported.

  17. Controlling Ebola: what we can learn from China's 1911 battle against the pneumonic plague in Manchuria

    Directory of Open Access Journals (Sweden)

    He Liu

    2015-04-01

    Full Text Available The pneumonic plague, which spread across Northeast China during the winter of 1910 and spring of 1911, caused numerous deaths and brought about severe social turmoil. After compulsory quarantine and other epidemic prevention measures were enforced by Dr Wu Lien-teh, the epidemic was brought to an end within 4 months. This article reviews the ways in which the plague was dealt with from a historical perspective, based on factors such as clinical manifestations, duration of illness, case fatality rate, degree of transmissibility, poverty, inadequate healthcare infrastructure, and the region's recent strife-filled history. Similarities were sought between the pneumonic plague in Northeast China in the twentieth century and the Ebola virus outbreak that is currently ravaging Africa, and an effort made to summarize the ways in which specific measures were applied successfully to fight the earlier epidemic. Our efforts highlight valuable experiences that are of potential benefit in helping to fight the current rampant Ebola epidemic in West Africa.

  18. Diagnostic value of serum precipitins to mould antigens in active hypersensitivity pneumonitis.

    Science.gov (United States)

    Fenoglio, C-M; Reboux, G; Sudre, B; Mercier, M; Roussel, S; Cordier, J-F; Piarroux, R; Dalphin, J-C

    2007-04-01

    Serum precipitins have a controversial diagnostic value in hypersensitivity pneumonitis (HP). The present authors' objective was to assess their diagnostic value by developing scores from a panel of specific antigens tested by two techniques (electrosyneresis and double diffusion) to discriminate active HP from other interstitial lung diseases. Consecutive patients presenting with a condition for which HP was considered in the differential diagnosis were included in the study. All patients underwent the same standardised diagnostic procedure, including precipitin tests performed in routine conditions. Clinical manifestations, bronchoalveolar lavage and high-resolution computed tomography defined the presence or absence of HP. Receiver-operating characteristic curves and logistic regression were used to develop the serological scores. A total of 122 patients (including 31 cases of HP) were included in the study. Five antigens from the panel were selected for the serological scores (Absidia corymbifera, Eurotium amstelodami, Wallemia sebi, Saccharopolyspora rectivirgula and mesophilic Streptomyces sp.). Electrosyneresis was more discriminative than the double-diffusion technique. Predictive negative values varied 81-88% and predictive positive values varied 71-75% for prevalence of HP 20-35%. In conclusion, serological scores using a panel of relevant antigens may guide both biological and clinical practice in areas of high prevalence of hypersensitivity pneumonitis.

  19. Chronic hypersensitivity pneumonitis: high resolution computed tomography patterns and pulmonary function indices as prognostic determinants

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, Simon L.F.; Devaraj, Anand; Hansell, David M. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Sverzellati, Nicola [University of Parma, Department of Clinical Sciences, Section of Radiology, Parma (Italy); Wells, Athol U. [Royal Brompton Hospital, Interstitial Lung Diseases Unit, London (United Kingdom)

    2012-08-15

    To investigate high resolution computed tomography (HRCT) and pulmonary function indices (PFTs) for determining prognosis in patients with chronic fibrotic hypersensitivity pneumonitis (CHP). Case records, PFTs (FEV{sub 1}, FVC and DLco) and HRCTs of ninety-two patients with chronic hypersensitivity pneumonitis were evaluated. HRCT studies were scored by two observers for total disease extent, ground-glass opacification, fine and coarse reticulation, microcystic and macrocystic honeycombing, centrilobular emphysema and consolidation. Traction bronchiectasis within each pattern was graded. Using Cox proportional hazards regression models the prognostic strength of individual HRCT patterns and pulmonary function test variables were determined. There were forty two deaths during the study period. Increasing severity of traction bronchiectasis was the strongest predictor of mortality (HR 1.10, P < 0.001, 95%CI 1.04-1.16). Increasing global interstitial disease extent (HR 1.02, P = 0.02, 95%CI 1.00-1.03), microcystic honeycombing (HR 1.09, P = 0.019, 95%CI 1.01-1.17) and macrocystic honeycombing (HR 1.06, P < 0.01, 95%CI 1.01-1.10) were also independent predictors of mortality. In contrast, no individual PFT variable was predictive of mortality once HRCT patterns were accounted for. HRCT patterns, in particular, severity of traction bronchiectasis and extent of honeycombing are superior to pulmonary function tests for predicting mortality in patients with CHP. (orig.)

  20. Local radiotherapy for palliation in multiple myeloma patients with symptomatic bone lesions

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Won; Lee, Jeong Eun [Dept. of Radiation Oncology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2016-03-15

    To evaluate the clinical outcomes of symptomatic bone lesions in patients with multiple myeloma (MM) who received local radiotherapy (LRT). Fifty-one patients with 87 symptomatic bone lesions treated via LRT were analyzed. LRT was delivered at a median total dose of 21 Gy (range, 12 to 40 Gy) in a median of 7 fractions (range, 4 to 20 fractions). The clinical outcomes of LRT and the factors affecting treatment response were assessed. After a median follow-up time of 66.7 weeks, symptom relief was achieved for 85 of 87 lesions (97.7%). The median time to symptom relief was 7 days from the start of LRT (range, 1 to 67 days). The duration of in-field failure-free survival ranged from 1.1 to 450.9 weeks (median, 66.7 weeks). The radiation dose or use of previous and concurrent chemotherapy was not significantly associated with in-field failure for LRT (p = 0.354, 0.758, and 0.758, respectively). Symptomatic bone lesions in patients with MM can be successfully treated with LRT. A higher radiation dose or the use of concurrent chemotherapy may not influence the in-field disease control. A relatively low radiation dose could achieve remission of symptoms in patients with MM.

  1. [Therapy of polyneuropathies. Causal and symptomatic].

    Science.gov (United States)

    Müller-Felber, W

    2001-05-28

    In the first instance, polyneuropathies are treated causally. The most common underlying cause is diabetes mellitus or alcohol abuse. In a large number of patients with polyneuropathy, however, the underlying cause cannot be definitively identified. For these--but equally for patients with etiologically clear polyneuropathy--a stock-taking of clinical symptoms should be carried out and, where indicated, symptomatic treatment initiated. In addition to medication aimed at combating pain, muscular spasm, autonomic functional disorders, and for the prevention of thrombosis, physical measures (physiotherapy, foot care, orthopedic shoes) are of primary importance.

  2. Occupational Hypersensitivity Pneumonitis Reported to the Czech National Registry of Occupational Diseases in the Period 1992-2005

    Czech Academy of Sciences Publication Activity Database

    Fenclová, Z.; Pelclová, D.; Urban, P.; Navrátil, Tomáš; Klusáčková, P.; Lebedová, J.

    2009-01-01

    Roč. 47, č. 4 (2009), s. 443-448 ISSN 0019-8366 Institutional research plan: CEZ:AV0Z40400503 Keywords : Hypersensitivity pneumonitis * Incidence * Branch of economic activity * Occupation Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 1.215, year: 2009

  3. A comprehensive study on the role of the Yersinia pestis virulence markers in an animal model of pneumonic plague

    NARCIS (Netherlands)

    W.E. Kaman (Wendy); S. Hawkey; D. van der Kleij (Desiree); M.P. Broekhuijsen; N.J. Silman; F.J. Bikker (Floris)

    2011-01-01

    textabstractWe determined the role of Yersinia pestis virulence markers in an animal model of pneumonic plague. Eleven strains of Y. pestis were characterized using PCR assays to detect the presence of known virulence genes both encoded by the three plasmids as well as chromosomal markers. The

  4. A comprehensive study on the role of the Yersinia pestis virulence markers in an animal model of pneumonic plague

    NARCIS (Netherlands)

    Kaman, W.E.; Hawkey, S.; Kleij, D. van der; Broekhuijsen, M.P.; Silman, N.J.; Bikker, F.J.

    2011-01-01

    We determined the role of Yersinia pestis virulence markers in an animal model of pneumonic plague. Eleven strains of Y. pestis were characterized using PCR assays to detect the presence of known virulence genes both encoded by the three plasmids as well as chromosomal markers. The virulence of all

  5. Symptomatic and asymptomatic candidiasis in a pediatric intensive care unit.

    Science.gov (United States)

    Arslankoylu, Ali Ertug; Kuyucu, Necdet; Yilmaz, Berna Seker; Erdogan, Semra

    2011-11-21

    This study aimed to examine the incidence, epidemiology, and clinical characteristics of symptomatic and asymptomatic candidiasis in a pediatric intensive care unit (PICU), and to determine the risk factors associated with symptomatic candidiasis. This retrospective study included 67 patients from a 7-bed PICU in a tertiary care hospital that had Candida-positive cultures between April 2007 and July 2009. Demographic and clinical characteristics of the patients, Candida isolates, antimicrobial and antifungal treatments, and previously identified risk factors for symptomatic candidiasis were recorded, and symptomatic and asymptomatic patients were compared. In all, 36 (53.7%) of the patients with Candida-positive cultures had asymptomatic candidiasis and 31 (46.3%) had symptomatic candidiasis. Candida albicans was the most common Candida sp. in the asymptomatic patients (n = 20, 55.6%), versus Candida parapsilosis in the symptomatic patients (n = 15, 48.4%). The incidence of central venous catheter indwelling, blood transfusion, parenteral nutrition, and surgery was higher in the symptomatic patient group than in the asymptomatic patient group (P candidiasis according to forward stepwise multivariate logistic regression analysis (OR: 6.1; 95% CI: 1.798-20.692). Surgery was the only risk factor significantly associated with symptomatic candidiasis and non-albicans Candida species were more common among the patients with symptomatic candidiasis. While treating symptomatic candidiasis in any PICU an increase in the incidence of non-albicans candidiasis should be considered.

  6. Selection of symptomatic patients with Crohn's disease for abdominopelvic computed tomography: role of serum C-reactive protein.

    LENUS (Irish Health Repository)

    Desmond, Alan N

    2012-11-01

    Results of previous studies have shown that repeated abdominopelvic computed tomography (CT) examinations can lead to substantial cumulative diagnostic radiation exposure in patients with Crohn\\'s disease (CD). Improved selection of patients referred for CT will reduce unnecessary radiation exposure. This study examines if serum C-reactive protein (CRP) concentration predicts which symptomatic patients with CD are likely to have significant disease activity or disease complications (such as abscess) detected on abdominopelvic CT.

  7. Radiological features of a symptomatic splenic hamartoma

    International Nuclear Information System (INIS)

    Thompson, S.E.; Walsh, E.A.; Cramer, B.C.; Pushpanathan, C.C.; Hollett, P.; Ingram, L.; Price, D.

    1996-01-01

    Symptomatic splenic hamartomas are rare in the pediatric age group, with only four previous reports in the literature. Splenic hamartoma has been reported as a solid homogeneous mass without calcification on CT and ultrasound (US), and only one previous report of the findings on MRI has been published. We report a case of a large symptomatic splenic hamartoma in a 14-year-old girl who presented with splenomegaly, pancytopenia and growth retardation. A solid mass with multiple punctate foci resembling calcifications was seen on US. The mass was heterogeneous and better demarcated on enhanced CT. Radiocolloid scintigraphy demonstrated uptake within the lesion, but less than that of normal spleen. The mass was isointense relative to normal splenic tissue on T1-weighted MRI (0.5 T) and of increased intensity with T2 weighting. At splenectomy, a red pulp hamartoma was identified, which contained nodules of hyalinization and necrosis thought to account for the punctate foci seen on US. (orig.). With 4 figs

  8. Review of acute symptomatic urolithiasis in Auckland.

    Science.gov (United States)

    Loeff, Stephanie; Saluja, Manmeet; Rice, Michael

    2018-02-02

    To evaluate the incidence of acute symptomatic urolithiasis in the Auckland region. Associated epidemiological factors and stone characteristics were also studied and compared to previous research conducted in order to analyse trends. All patients that presented acutely with symptomatic urolithiasis to the Auckland District Health Board (AHDB) between July 2014 and June 2015 were studied. Clinical data was obtained from medical records and population data was based on estimates provided by the Ministry of Health. Two-tailed tests and the Pearson Chi-Square tests were used for analysis. Overall, 1,125 patients (1,328 events) presented with an incidence of 85 per 100,000 per year, which was lower than that reported in 2006. The highest incidence was found among the Middle Eastern ethnic subgroup (0.130 %), followed by Māori (0.102%), Asian (0.087%), European (0.084%) and Pacific (0.041%) ethnicity. Males were more likely to be affected than females. Urolithiasis was most common in the fifth decade of life (25%). Forty-seven percent of the study population presented with multiple stones and 64% had recurrent urolithiasis or were 'high risk' stone formers. Distal ureteric stones Auckland. This deviation could be attributed to the large influx of Asian immigrants observed in this period of time. A caucasian male, between 40-49 years, with a calculus <5mm in the distal ureter with a history of a previous urolithiasis has the highest chance to present with renal colic.

  9. Radiological features of a symptomatic splenic hamartoma

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, S.E. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Walsh, E.A. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Cramer, B.C. [Department of Radiology, Janeway Child Health Centre and Memorial University of Newfoundland, Janeway Place, St. John`s, NF A1A 1R8 (Canada); Pushpanathan, C.C. [Department of Pathology, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Hollett, P. [Department of Nuclear Medicine, Health Sciences Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Ingram, L. [Department of Pediatrics, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada); Price, D. [Department of Surgery, Janeway Child Health Centre and Memorial University of Newfoundland, St. John`s, NF (Canada)

    1996-09-01

    Symptomatic splenic hamartomas are rare in the pediatric age group, with only four previous reports in the literature. Splenic hamartoma has been reported as a solid homogeneous mass without calcification on CT and ultrasound (US), and only one previous report of the findings on MRI has been published. We report a case of a large symptomatic splenic hamartoma in a 14-year-old girl who presented with splenomegaly, pancytopenia and growth retardation. A solid mass with multiple punctate foci resembling calcifications was seen on US. The mass was heterogeneous and better demarcated on enhanced CT. Radiocolloid scintigraphy demonstrated uptake within the lesion, but less than that of normal spleen. The mass was isointense relative to normal splenic tissue on T1-weighted MRI (0.5 T) and of increased intensity with T2 weighting. At splenectomy, a red pulp hamartoma was identified, which contained nodules of hyalinization and necrosis thought to account for the punctate foci seen on US. (orig.). With 4 figs.

  10. Pneumonic Plague

    Science.gov (United States)

    ... Poisoning Methyl isocyanate Case Definition: Methyl Isocyanate Poisoning Mustard gas (H) (sulfur mustard) Facts About Sulfur Mustard Case ... About Strychnine Case Definition: Strychnine Sulfur mustard (H) (mustard gas) Facts About Sulfur Mustard Case Definition: Vesicant (Mustards, ...

  11. Dileclion of pathogenic bacteria and mycoplasmas from pneumonic lungs of pigs and histopalhological finding

    Directory of Open Access Journals (Sweden)

    Siti Chotiah

    1996-03-01

    Full Text Available A total of 104 pig's lung samples with pneumonic lesions were collected from Kapuk abattoir in West Jakarta and piggeries in Tangerang, West Java. Isolation and identification of pathogenic bacteria and mycoplasmas of the lung were carried out and Mycoplarma sp . was isolated from 9 (8.7% samples, Pacteurella multocida from 5 (4.8%samples, and Bordetella brornrhiseptica from 2 (1 .9% samples while the test of the samples were negative . Histopathological examination were also carried out and the lesions were found on 30 (28.8% samples for Bordetella sp., 6 (5 .8% samples for Mycoplarma sp ., 16 (15.4% samples for Mycoplarma sp . in combination with Bordetella sp ., 25 (24.0% samples for Mycoplavma sp . in combination with Pacteurella sp. and 27 (26.0 % samples were judged to be normal . All microorganisms were found 68 .7% and 72.7% from apical lobes of the lung by bacteriological and histopathological examinations respectively .

  12. Epidemiologic investigation of an oil-associated pneumonic paralytic eosinophilic syndrome in Spain.

    Science.gov (United States)

    Rigau-Pérez, J G; Pérez-Alvarez, L; Dueñas-Castro, S; Choi, K; Thacker, S B; Germain, J L; González-de-Andrés, G; Cañada-Royo, L; Pérez-Gallardo, F

    1984-02-01

    From May 1 to December 26, 1981, a previously undescribed illness caused 277 deaths and the hospitalization of 12,656 persons in Spain. The disease was characterized by pneumonitis, eosinophilia, and marked loss of muscle mass and function. A succession of case-control studies was done in the town of Las Navas del Marqués (province of Avila) located 47 miles northeast of Madrid and with a population of 4009 people. The studies confirmed the association between illness and consumption of an illegally sold cooking oil. Other risk factors identified in the linear logistic regression analysis included involvement in various kitchen activities, increased average time spent inside the house, and the purchase of cooking oil from a specific street vendor. Although the oil was found to be a mixture of vegetable and animal fats contaminated with aniline and anilide-oil complexes, the specific etiologic mechanism of the disease has not been determined.

  13. Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis.

    Science.gov (United States)

    Lascarrou, Jean Baptiste; Lissonde, Floriane; Le Thuaut, Aurélie; Bachoumas, Konstantinos; Colin, Gwenhael; Henry Lagarrigue, Matthieu; Vinatier, Isabelle; Fiancette, Maud; Lacherade, Jean Claude; Yehia, Aihem; Joret, Aurélie; Lebert, Christine; Bourdon, Sandra; Martin Lefèvre, Laurent; Reignier, Jean

    2017-08-01

    To determine the proportion of patients with documented bacterial aspiration pneumonia among comatose ICU patients with symptoms suggesting either bacterial aspiration pneumonia or non-bacterial aspiration pneumonitis. Prospective observational study. University-affiliated 30-bed ICU. Prospective cohort of 250 patients admitted to the ICU with coma (Glasgow Coma Scale score ≤ 8) and treated with invasive mechanical ventilation. None. The primary outcome was the proportion of patients with microbiologically documented bacterial aspiration pneumonia. Patients meeting predefined criteria for aspiration syndrome routinely underwent telescopic plugged catheter sampling during bronchoscopy before starting probabilistic antibiotic treatment. When cultures were negative, the antibiotic treatment was stopped. Of 250 included patients, 98 (39.2%) had aspiration syndrome, including 92 before mechanical ventilation discontinuation. Telescopic plugged catheter in these 92 patients showed bacterial aspiration pneumonia in 43 patients (46.7%). Among the remaining 49 patients, 16 continued to receive antibiotics, usually for infections other than pneumonia; of the 33 patients whose antibiotics were discontinued, only two subsequently showed signs of lung infection. In the six patients with aspiration syndrome after mechanical ventilation, and therefore without telescopic plugged catheter, antibiotic treatment was continued for 7 days. Mechanical ventilation duration, ICU length of stay, and mortality did not differ between the 43 patients with bacterial aspiration pneumonia and the 49 patients with non-bacterial aspiration pneumonitis. The 152 patients without aspiration syndrome did not receive antibiotics. Among comatose patients receiving mechanical ventilation, those without clinical, laboratory, or radiologic evidence of bacterial aspiration pneumonia did not require antibiotics. In those with suspected bacterial aspiration pneumonia, stopping empirical antibiotic therapy

  14. Circumventing Y. pestis Virulence by Early Recruitment of Neutrophils to the Lungs during Pneumonic Plague.

    Directory of Open Access Journals (Sweden)

    Yaron Vagima

    2015-05-01

    Full Text Available Pneumonic plague is a fatal disease caused by Yersinia pestis that is associated with a delayed immune response in the lungs. Because neutrophils are the first immune cells recruited to sites of infection, we investigated the mechanisms responsible for their delayed homing to the lung. During the first 24 hr after pulmonary infection with a fully virulent Y. pestis strain, no significant changes were observed in the lungs in the levels of neutrophils infiltrate, expression of adhesion molecules, or the expression of the major neutrophil chemoattractants keratinocyte cell-derived chemokine (KC, macrophage inflammatory protein 2 (MIP-2 and granulocyte colony stimulating factor (G-CSF. In contrast, early induction of chemokines, rapid neutrophil infiltration and a reduced bacterial burden were observed in the lungs of mice infected with an avirulent Y. pestis strain. In vitro infection of lung-derived cell-lines with a YopJ mutant revealed the involvement of YopJ in the inhibition of chemoattractants expression. However, the recruitment of neutrophils to the lungs of mice infected with the mutant was still delayed and associated with rapid bacterial propagation and mortality. Interestingly, whereas KC, MIP-2 and G-CSF mRNA levels in the lungs were up-regulated early after infection with the mutant, their protein levels remained constant, suggesting that Y. pestis may employ additional mechanisms to suppress early chemoattractants induction in the lung. It therefore seems that prevention of the early influx of neutrophils to the lungs is of major importance for Y. pestis virulence. Indeed, pulmonary instillation of KC and MIP-2 to G-CSF-treated mice infected with Y. pestis led to rapid homing of neutrophils to the lung followed by a reduction in bacterial counts at 24 hr post-infection and improved survival rates. These observations shed new light on the virulence mechanisms of Y. pestis during pneumonic plague, and have implications for the

  15. Interleukin-17A and Neutrophils in a Murine Model of Bird-Related Hypersensitivity Pneumonitis.

    Directory of Open Access Journals (Sweden)

    Masahiro Ishizuka

    Full Text Available Hypersensitivity pneumonitis (HP is an immune mediated lung disease induced by the repeated inhalation of a wide variety of antigens. Bird-related hypersensitivity pneumonitis (BRHP is one of the most common forms of HP in human and results from the inhalation of avian antigens. The findings of a recent clinical analysis suggest that in addition to Th1 factors, the levels of interleukin(IL-17 and IL-17-associated transcripts are increased in the setting of HP, and that both IL-17A and neutrophils are crucial for the development of pulmonary inflammation in murine models of HP. Our objectives were to investigate the roles of IL-17A and neutrophils in granuloma-forming inflammation in an acute HP model. We developed a mouse model of acute BRHP using pigeon dropping extract. We evaluated the process of granuloma formation and the roles of both IL-17A and neutrophils in a model. We found that the neutralization of IL-17A by the antibody attenuated granuloma formation and the recruitment of neutrophils, and also decreased the expression level of chemokine(C-X-C motif ligand 5 (CXCL5 in the acute HP model. We confirmed that most of the neutrophils in the acute HP model exhibited immunoreactivity to the anti-IL-17 antibody. We have identified the central roles of both IL-17A and neutrophils in the pathogenesis of granuloma formation in acute HP. We have also assumed that neutrophils are an important source of IL-17A in an acute HP model, and that the IL-17A-CXCL5 pathway may be responsible for the recruitment of neutrophils.

  16. [Cutaneous lesions during hot-tub hypersensitivity pneumonitis: Pseudomonas folliculitis ?

    Science.gov (United States)

    Sokolowsky, N; Rolland, L; Vandenhende, M-A; Colin, J-Y; Laurent, F; Morlat, P; Bonnet, F; Beylot-Barry, M

    2017-04-01

    Interstitial lung disease, cutaneous rash and elevated serum angiotensin converting enzyme (ACE) may suggest diagnoses other than sarcoidosis. A 58-year-old man had presented dyspnoea for 2 years with increased angiotensin-converting enzyme, as well as an interstitial syndrome and micronodules. The possibility of sarcoidosis was raised. Systemic corticosteroids resulted in improvement of the dyspnoea although it recurred on dose reduction. We noted fluctuating eczematous macules of the limbs with a histology of aspecific folliculitis. The identification of Mycobacterium avium complex (MAC) in the bronchoalveolar wash prompted us to initiate antimycobacterial therapy, but this was to no avail. Review of the CT-scan and questioning of the patient (daily use of a Jacuzzi for 7 years) resulted in diagnosis of hypersensitivity pneumonitis due to MAC. The cutaneous lesions were taken to indicate "hot tub folliculitis". Discontinuation of hot-tub use and a short course of oral corticosteroids resulted in healing within 4 months, with no recurrence at 2 years. HTL is a form of hypersensitivity pneumonitis due to the presence of MAC in the water of Jacuzzis. This condition regresses spontaneously without treatment on discontinuation of Jacuzzi use. Hot-tub folliculitis due to Pseudomonas aeruginosa (PA) presents as macules and papules on covered skin areas (swimsuit) within 48hours of bathing and often declines within 2 weeks. Our case is original as regards the concomitant lung and cutaneous involvement associated with Jacuzzi use, with an immunoallergic mechanism for the MAC and probably an infectious mechanism for the PA. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. [Laparoscopic cleavage in splenic symptomatic cyst].

    Science.gov (United States)

    Fernández-López, Antonio-José; Candel-Arenas, Marifé; González-Valverde, Francisco-Miguel; Luján-Martínez, Delia; Medina-Manuel, Esther; Albarracín Marín-Blázquez, Antonio

    2017-12-01

    Splenic cysts are rare diseases that are diagnosed incidentally during imaging studies. When cysts are recognized, surgical treatment is recommended adapted to the particular case, depending on the size and location of the cyst and the age of the patient in order to avoid dangerous complications such as spleen rupture or cyst infection with abscess. We report 2patients with symptomatic splenic epidermoid cyst treated by laparoscopic cleavage. Laparoscopic cleavage is a surgical option for splenic cyst, with the goal of reducing postoperative complications while preserving splenic function. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  18. 25-Hydroxyvitamin D and symptomatic ischemic stroke

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Nordestgaard, Børge G; Schnohr, Peter

    2013-01-01

    OBJECTIVE: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population. METHODS: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen...... City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events. RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations...... were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D...

  19. Symptom management during the radiation oncology treatment course: a practical guide for the oncology clinician.

    Science.gov (United States)

    Fogh, Shannon; Yom, Sue S

    2014-12-01

    Symptom management during radiation therapy is critical to providing high-quality care for patients receiving treatment. Symptoms are varied and dependent on the site irradiated. Common symptoms associated with radiation therapy include dermatitis, xerostomia, mucositis, and pneumonitis. Treatment strategies include prevention, anticipation, and development of clinical practice enabling rapid identification and management of emerging symptoms. Understanding the spectrum of symptomatology affecting irradiated patients is integral to improved quality of life and treatment efficacy. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Radiation-induced lung damage: Etiopathogenesis, clinical features, imaging findings and treatment

    OpenAIRE

    Vasić Ljiljana; Đurđević Predrag

    2012-01-01

    Introduction. This review is related to the mechanism of development of radiation induced pneumonitis, its pathological, clinical and radiological features and therapy. The team treating cancer patients consists of radiation oncologists and oncologists, as well as general practitioners, pulmologists and radiologists for monitoring effects of therapy. Therefore, a different number of specialists should be familiar with the importance of diagnosis in order to avoid differential diagnostic...

  1. [Medical prevention and treatment of radiation-induced pulmonary complications].

    Science.gov (United States)

    Vallard, A; Rancoule, C; Le Floch, H; Guy, J-B; Espenel, S; Le Péchoux, C; Deutsch, É; Magné, N; Chargari, C

    2017-08-01

    Radiation-induced lung injuries mainly include the (acute or sub-acute) radiation pneumonitis, the lung fibrosis and the bronchiolitis obliterans organizing pneumonia (BOOP). The present review aims at describing the diagnostic process, the current physiopathological knowledge, and the available (non dosimetric) preventive and curative treatments. Radiation-induced lung injury is a diagnosis of exclusion, since clinical, radiological, or biological pathognomonic evidences do not exist. Investigations should necessarily include a thoracic high resolution CT-scan and lung function tests with a diffusing capacity of the lung for carbon monoxide. No treatment ever really showed efficacy to prevent acute radiation-induced lung injury, or to treat radiation-induced lung fibrosis. The most promising drugs in order to prevent radiation-induced lung injury are amifostine, angiotensin-converting-enzyme inhibitors and pentoxifylline. Inhibitors of collagen synthesis are currently tested at a pre-clinical stage to limit the radiation-induced lung fibrosis. Regarding available treatments of radiation-induced pneumonitis, corticoids can be considered the cornerstone. However, no standardized program or guidelines concerning the initial dose and the gradual tapering have been scientifically established. Alternative treatments can be prescribed, based on clinical cases reporting on the efficacy of immunosuppressive drugs. Such data highlight the major role of the lung dosimetric protection in order to efficiently prevent radiation-induced lung injury. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  2. Symptomatic relapse of HIV-associated cryptococcal meningitis in ...

    African Journals Online (AJOL)

    Objectives. Cryptococcal meningitis is the most common cause of adult meningitis in southern Africa. Much of this disease burden is thought to be due to symptomatic relapse of previously treated infection. We studied the contribution of inadequate secondary fluconazole prophylaxis to symptomatic relapses of cryptococcal ...

  3. Symptomatic unruptured cerebral aneurysms. Features and surgical outcome

    International Nuclear Information System (INIS)

    Date, Isao

    2010-01-01

    Development of less invasive imaging studies, such as magnetic resonance angiography, has increased the chances that unruptured cerebral aneurysms are found. The rupture risk of 'symptomatic' aneurysms is higher than for 'asymptomatic' aneurysms; so 'symptomatic' aneurysms are more often surgically treated. Many reviews examine 'asymptomatic' unruptured cerebral aneurysms, but few evaluate 'symptomatic' aneurysms. The author has treated many patients with symptomatic unruptured cerebral aneurysms and found that improved cranial nerve signs can be expected if the surgical treatment is performed before the symptoms become irreversible; the critical period is approximately 3 months. It is important to suppress the pulsation of the aneurysms compressing the cranial nerves; both a clipping procedure and endovascular coiling are effective. Cranial nerve signs are more commonly the symptoms of unruptured cerebral aneurysms, but large to giant aneurysms can also be the causes of hemiparesis, hydrocephalus, epilepsy, or even cerebral infarction. This review summarizes the features and surgical outcome of symptomatic unruptured cerebral aneurysms. (author)

  4. Value of bronchoalveolar lavage in the management of severe acute pneumonia and interstitial pneumonitis in the immunocompromised child.

    Science.gov (United States)

    de Blic, J; McKelvie, P; Le Bourgeois, M; Blanche, S; Benoist, M R; Scheinmann, P

    1987-01-01

    The diagnostic value of 73 bronchoalveolar lavages was assessed in 67 immunocompromised children (aged 3 months to 16 years) with pulmonary infiltrates. Thirty one children had primary and 19 secondary immune deficiency, 14 acquired immunodeficiency syndrome (AIDS), and three AIDS related complex. Bronchoalveolar lavage was performed during fibreoptic bronchoscopy, under local anaesthesia in all but two. One or more infective agents was found in eight of 11 patients with severe acute pneumonia and in 26 of 62 patients with interstitial pneumonitis. In interstitial pneumonitis, the most frequently encountered agents were Pneumocystis carinii (12), cytomegalovirus (8), and Aspergillus fumigatus (3). The yield was related to the severity of interstitial pneumonitis. The mean cellular count and cytological profile in lavage returns from patients with varying infective agents or underlying pathological conditions showed no significant difference, except in those children with AIDS and AIDS related complex who had appreciable lymphocytosis (mean percentage of lymphocytes 28 (SD 17]. In children with AIDS and chronic interstitial pneumonitis lymphocytosis without pneumocystis infection was observed in eight of nine bronchoalveolar lavage returns and was suggestive of pulmonary lymphoid hyperplasia. Finally, bronchoalveolar lavage produced a specific diagnosis from the microbiological or cytological findings in 44 instances (60%). Transient exacerbation of tachypnoea was observed in the most severely ill children but there was no case of respiratory decompensation attributable to the bronchoscopy. Bronchoalveolar lavage is a safe and rapid examination for the investigation of pulmonary infiltrates in immunocompromised children. It should be performed as a first line investigation and should reduce the use of open lung biopsy techniques. PMID:2827334

  5. Diagnostic challenges of symptomatic uncomplicated diverticular disease.

    Science.gov (United States)

    Cremon, Cesare; Bellacosa, Lara; Barbaro, Maria R; Cogliandro, Rosanna F; Stanghellini, Vincenzo; Barbara, Giovanni

    2017-06-01

    Colonic diverticulosis is a common condition in Western industrialized countries occurring in up to 65% of people over the age of 60 years. Only a minority of these subjects (about 10-25%) experience symptoms, fulfilling Rome III Diagnostic Criteria for irritable bowel syndrome (IBS) diagnosis (IBS-like symptoms) in 10% to 66% of cases. Symptomatic uncomplicated diverticular disease (SUDD) is a syndrome characterized by recurrent abdominal symptoms attributed to diverticula in the absence of macroscopically evident alterations other than the presence of diverticula. Due to the different peak of incidence, the overlap between SUDD and IBS is predominantly present in middle-aged or older patients. In these cases, it is very complex to establish if the symptoms are related to the presence of diverticula or due to an overlapping IBS. In fact, the link between gastrointestinal symptoms and diverticula is unclear, and the mechanism by which diverticula may induce the development of IBS-like symptoms remains to be elucidated. Currently, the etiology and pathophysiology of SUDD, particularly when IBS-like symptoms are present, are not completely understood, and thus these two entities remain a diagnostic challenge not only for the general practitioner but also for the gastroenterologist. Although many issues remain open and unresolved, some minimize the importance of a distinction of these two entities as dietary and pharmacological management may be largely overlapping.

  6. [Laparoscopic management of symptomatic urachal anomalies].

    Science.gov (United States)

    Sánchez-Ismayel, Alexis; Cruz-González, Germán; Sánchez, Renata; Sánchez-Salas, Rodolfo; Rodríguez, Omaira; Sanabria, Erasmo; Sotelo, Rene; Sánchez-Salas, Rafael E

    2009-03-01

    Acquired urachal anomalies are a rare pathology. Gold-standard treatment for this clinical situation remains the resection of the urachus in its entire tract with or without partial resection of the bladder. Our aim is to up-date authors's experience in the minimally invasive surgical treatment of acquired urachal disease. From 2001 to 2007, 14 patients were operated for acquired urachal disease at our institution. A three portal technique previously described by the authors was employed. The diagnosis of acquired uracal disease was confirmed in all cases and the resection of the urachus in its entire tract performed in cephalocaudal direction onto the bladder. Operative and demographic data was prospectively collected and analysis retrospectively performed. Mean operative time was 63 minutes (45,110), minimal blood loss, and no conversions to open surgery or perioperative complications were verified. The majority of the patients were discharged in the first 24 hours. At a follow-up of 22 months no recurrences of urachal pathology recurrences have been verified. Laparoscopy plays a significant role in the management of symptomatic urachus anomalies. It allows objective confirmation of clinical diagnosis and adequate resection of the urachus in a safe and efficient fashion, while providing the well-known advantages of minimally acces surgery. Preoperative evaluation work-up has minimal impact of therapeutical decision.

  7. Acute symptomatic hyponatremia in a flight attendant.

    Science.gov (United States)

    Madero, Magdalena; Monares, Enrique; Domínguez, Aurelio Méndez; Ayus, Juan Carlos

    2015-08-01

    Acute symptomatic hyponatremia after thiazide diuretic initiation is a medical emergency. Here we describe the case of a flight attendant who developed acute hyponatremia during a flight and the potential risk factors for developing this condition. A 57-year-old flight attendant with history of essential hypertension was recently started on a thiazide diuretic. As she did routinely when working, she increased her water intake during a flight from London to Mexico City. She complained of nausea and headache during the flight. Upon arrival, she developed severe disorientation and presented to the hospital emergency room (ER) with a Glasgow scale of 12, hypoxia, and a generalized tonic clonic seizure. Her laboratory results on arrival were consistent with severe hyponatremia (serum Na 116 mEql/L) and severe cerebral edema by CT scan. She was treated with hypertonic saline, with complete resolution of the neurologic symptoms. We describe high water intake and hypoxia related to decreased partial pressure of oxygen in the cabin as the two main risk factors for thiazide-induced acute hyponatremia in this case.

  8. Neonatal management of symptomatic transplacental cryoglobulinaemia.

    Science.gov (United States)

    Laugel, V; Goetz, J; Wolff, S; Beladdale, J; Sibilia, J; Messer, J

    2004-04-01

    This study reports the first case of symptomatic placental transfer of cryoglobulins and discusses the potential pathogenic processes and the basic guidelines for neonatal management. A 32-y-old woman was affected by essential type I cryoglobulinaemia and displayed the cold-triggered cutaneous symptoms of the disease due to a monoclonal immunoglobulin G (IgG) cryoglobulin. She gave birth to healthy dizygotic twins who were placed in incubators immediately after birth and did not show any cutaneous or visceral lesion in the first 2 d. Cyanotic macules appeared on the hand and foot of one of the newborns when they were removed from the incubators. The same monoclonal IgG-lambda cryoglobulin was identified in the two newborns' cord blood and in the mother's serum. The skin lesions disappeared within 1 wk as both twins were transiently replaced in incubators. No recurrence of skin lesions was observed even at room temperature and, 6 mo later, both twins were healthy and their clinical examination was normal. To the authors' knowledge, this is the first report of placental transfer of cryoglobulins and the first description of any neonatal effect. Neonates born to mothers suffering from IgG cryoglobulinaemia should be protected against cold to avoid precipitation of the pathogenic cryoglobulins, until spontaneous resolution.

  9. Hypersensitivity pneumonitis due to metal working fluids: Sporadic or under reported?

    Science.gov (United States)

    Gupta, Amit; Rosenman, Kenneth D

    2006-06-01

    Occupational exposure to metal working fluids (MWF) is common with over 1.2 million workers in the United States involved in machine finishing, machine tooling, and other metalworking operations. MWF is a known cause of hypersensitivity pneumonitis (HP). Recent reports of outbreaks of hypersensitivity HP secondary to exposure to MWF are reported. Cases were identified through the Occupational Disease surveillance system in the State of Michigan and from referrals for evaluation to the Division of Occupational and Environmental Medicine at Michigan State University (MSU). Each patient underwent a clinical examination including an occupational history, lung function studies, radiographic imaging, and in some cases lung biopsies. Following the diagnosis of definite HP, an industrial hygiene investigation was carried out, which included a plant walk-through, and review of the "Injury and Illness" log. Air monitoring and microbial sampling results were reviewed. As part of Michigan's mandatory surveillance system for occupational illnesses, seven cases of suspected HP were identified in 2003-2004 from three facilities manufacturing automobile parts in Michigan. Each plant used semi-synthetic MWFs, and conducted a MWF management program including biocide additions. Two facilities had recently changed the MWF before the cases arose. Growth of mycobacteria was found in these two MWFs. Breathing zone samples for particulates of two employees in plant A (two cases) ranged from 0.48 to 0.56 mg/m3. In plant B (four cases), two employees' sampling results ranged from 0.10 to 0.14 mg/m3. No air sampling data were available from plant C. Hypersensitivity pneumonitis due to exposure to MWFs is under-recognized by health care providers, and current surveillance systems are inadequate to provide a true estimate of its occurrence. HP arose from environments with exposures well below the Occupational Safety and Health Administration (OSHA) permissible exposure limit (PEL) for MWF, and

  10. Breast conserving operation and radiation therapy in early breast cancer: interim analysis

    International Nuclear Information System (INIS)

    Kim, Jin Hee; Kim, Ok Bae; Kim, You Sah

    2001-01-01

    To evaluate interim results in terms of failure, cosmetic results and survival after breast conserving operation and radiation therapy in early breast cancer. From January 1992 through December 1997, seventy two patients with early stage 0, I and II breast cancer were treated with conservative surgery plus radiotherapy at Keimyung University Dongsan Medical Center. Age distribution was 25 to 77 years old with median age of 43. Ac cording to TNM stage, five patients had stage 0, thirty three were stage I, twenty five were lIa, and nine were llb. Most patients underwent excision of all gross tumor and ipsilateral axillary dissection. Breast was irradiated through medial and lateral tangential fields of 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks. We delivered a boost irradiation dose of 10 to 16 Gy in 1 to 2 weeks to excision site. Adjuvant chemotherapy was administered in forty one patients with CMF (cyclophosphamide, methotrexate, 5fluorouracil) regimens of 6 cycles concurrently or before radiation. Cosmetic results were assessed by questionnaire to patients grading of excellent, good, fair, poor. Follow-up periods were 22 to 91 months with median 40 months. Five year disease free survival rate (5YDFS) was 95.8%. According to stage, 5YDFS was 100%, 96.9%, 96% and 88.9% in stage 0, I, lIa and llb, respectively. Two patients had distant metastasis and one had local and distant failure. One patient with distant failure had bone and liver metastasis at 14 months after treatment and the other had lung and both supraclavicular metastasis at 21 months after treatment. Patient with local and distant failure had local recurrence on other quadrant in same breast and then salvaged with total mastectomy and chemotherapy but she died due to brain metastasis at 55 months. Complications were radiation pneumonitis in five patients (four patients of asymptomatic, one patient of symptomatic) and hand or arm edema(4 patients). Fifty nine patients answered our cosmetic

  11. Vegetarian diet as a risk factor for symptomatic gallstone disease.

    Science.gov (United States)

    McConnell, T J; Appleby, P N; Key, T J

    2017-06-01

    Previous small studies have shown either no difference or a lower risk of symptomatic gallstone disease in vegetarians than in non-vegetarians. This study examined the incidence of symptomatic gallstone disease in a cohort of British vegetarians and non-vegetarians, and investigated the associations between nutrient intake and risk of symptomatic gallstone disease. The data were analysed from 49 652 adults enroled in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, one-third of whom were vegetarian. The linked databases of hospital records were used to identify incident cases. Risk by diet group was estimated using Cox proportional hazards models. Further analysis quantified risk by intakes of selected macronutrients. There were 1182 cases of symptomatic gallstone disease during 687 822 person-years of follow-up (mean=13.85 years). There was a large significant association between increasing body mass index (BMI) and risk of developing symptomatic gallstone disease (overall trend Pvegetarians had a moderately increased risk compared with non-vegetarians (HR: 1.22; 95% CI: 1.06-1.41; P=0.006). Although starch consumption was positively associated with gallstones risk (P=0.002 for trend), it did not explain the increased risk in vegetarians. There is a highly significant association of increased BMI with risk of symptomatic gallstone disease. After adjusting for BMI, there is a small but statistically significant positive association between vegetarian diet and symptomatic gallstone disease.

  12. Massive symptomatic subependymoma of the lateral ventricles: case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Rath, T.J.; Sundgren, P.C.; Gebarski, S.S. [University of Michigan Health Systems, Department of Radiology, Ann Arbor, MI (United States); Brahma, B.; Chandler, W.F. [University of Michigan Health Systems, Department of Neurosurgery, Ann Arbor, MI (United States); Lieberman, A.P. [University of Michigan Health Systems, Department of Pathology, Ann Arbor, MI (United States)

    2005-03-01

    Subependymomas are benign intraventricular tumors with an indolent growth pattern, which are usually asymptomatic, and most commonly occur in the fourth and lateral ventricles. When symptomatic, subependymomas often obstruct critical portions of the cerebrospinal fluid (CSF) pathway, causing hydrocephalus, and range from 3 cm to 5 cm in size. We report a case of an unusually massive subependymoma of the lateral ventricles treated with subtotal resection, ventriculoperitoneal shunt, and post-surgical radiation. The clinical course, radiographic and pathologic characteristics of this massive intraventricular subependymoma are discussed, as well as the differential diagnosis of lateral ventricular masses and a review of the literature concerning subependymomas. (orig.)

  13. Pediatric intracerebral hemorrhage: acute symptomatic seizures and epilepsy.

    Science.gov (United States)

    Beslow, Lauren A; Abend, Nicholas S; Gindville, Melissa C; Bastian, Rachel A; Licht, Daniel J; Smith, Sabrina E; Hillis, Argye E; Ichord, Rebecca N; Jordan, Lori C

    2013-04-01

    Seizures are believed to be common presenting symptoms in neonates and children with spontaneous intracerebral hemorrhage (ICH). However, few data are available on the epidemiology of acute symptomatic seizures or the risk for later epilepsy. To define the incidence of and explore risk factors for seizures and epilepsy in children with spontaneous ICH. Our a priori hypotheses were that younger age at presentation, cortical involvement of ICH, acute symptomatic seizures after presentation, ICH due to vascular malformation, and elevated intracranial pressure requiring urgent intervention would predict remote symptomatic seizures and epilepsy. Prospective cohort study conducted between March 1, 2007, and January 1, 2012. Three tertiary care pediatric hospitals. Seventy-three pediatric subjects with spontaneous ICH including 20 perinatal (≥37 weeks' gestation to 28 days) and 53 childhood subjects (>28 days to Acute symptomatic seizures (clinically evident and electrographic-only seizures within 7 days), remote symptomatic seizures, and epilepsy. Acute symptomatic seizures occurred in 35 subjects (48%). Acute symptomatic seizures as a presenting symptom of ICH occurred in 12 perinatal (60%) and 19 childhood (36%) subjects (P = .07). Acute symptomatic seizures after presentation occurred in 7 children. Electrographic-only seizures were present in 9 of 32 subjects (28%) with continuous electroencephalogram monitoring. One-year and 2-year remote symptomatic seizure-free survival rates were 82% (95% CI, 68-90) and 67% (95% CI, 46-82), respectively. One-year and 2-year epilepsy-free survival rates were 96% (95% CI, 83-99) and 87% (95% CI, 65-95), respectively. Elevated intracranial pressure requiring acute intervention was a risk factor for seizures after presentation (P = .01; Fisher exact test), remote symptomatic seizures, and epilepsy (P = .03, and P = .04, respectively; log-rank test). Presenting seizures are common in perinatal and childhood ICH. Continuous

  14. [Treating Radiation Peumonitis by Zlyin Huoxue Granule Combined Glucocorticoids and Antibiotics: a Clinical Observation].

    Science.gov (United States)

    Liu, Li-hua; Chen, Shao-shui; Ning, Fang-ling

    2015-10-01

    To observe the clinical effect of Ziyin Huoxue Granule (ZHG) combined glucocorticoids and antibiotics in treatment of radiation pneumonitis. Totally 70 radiation pneumonitis patients were assigned to the treatment group and the control group according to random digit table, 35 in each group. All patients received glucocorticoids and antibiotics. Patients in the treatment group additionally took ZHG, one dose per day for 4 successive weeks. Watters clinical-radiologic-physiologic (CRP) score, Karnofsky Performance Status Scale (KPS) , and acute radiation injury classification [set by Radiation Therapy Oncology Group (RTOG)] were observed in the two groups before and after treatment. The application time for antibiotics and glucocorticoids was compared between the two groups. All patients completed this trial, and nobody dropped out or died. There was no statistical difference in Watters-CRP scores, KPS, or RTOG between the two groups before treatment (P > 0.05). Compared with before treatment in the same group, RTOG classification was obviously improved in the two groups (P glucocorticoids was reduced (P 0.05). ZHG combined glucocorticoids and antibiotics was superior in treating radiation pneumonitis to using glucocorticoids or antibiotics alone in elevating Watters-CRP scores, shortening the application time for glucocorticoids and antibiotics, and improving patients' physical conditions.

  15. Isolation of different bacteria from pneumonic lungs of cows slaughtered in Tabriz (IRAN abattoir

    Directory of Open Access Journals (Sweden)

    amirparviz Rezaie Saber

    2014-08-01

    Full Text Available In this investigation, bacterial agents involved in pneumonia of slaughtered cross-bred cows in Tabriz abattoir were studied due to importance of bacterial pneumonia among Tabriz cattles. For doing so, we referred to Tabriz slaughter house every season and fifty healthy and fifty unhealthy lungs were sampled and transferred to the microbiology laboratory of Tabriz veterinary faculty, they were cultured then colonies were studied and finally the family and species of bacteria were recognized by using differential culture media. The separated bacteria from pneumonic lungs in four seasons involved 20 Streptococcus pneumoniae, 23 Escherichia coli, 18 Staphylococcus Aureus, 1 Staphylococcus epidermidis, 9 Corynebacterium pyogenes, 11 Pseudomonas aeruginosa, 48 Pasteurella haemolytica, 8 Erysipelothrix inscidiosa, 23 Rodococcus equi, 4 Nocardia farcinica, 2 Moraxella bovis, 1 Bordetella bronchiseptica, 2 Brucella bovis and 2 Haemophilus influenza. In four unhealthy lungs in fall, Pasteurella heamolytica with Bordetella bronchiseptica and from three lesioned lungs in fall, Brucella bovis with Haemophilus influenza and in three lesioned lungs in winter, Pasteurella heamolytica with Brodetella bronchiseptica were separated. The Bacteria isolated from healthy lungs consisted of 3 Staphylococcus epidermidis, 2 Pasteurella multocida, 6 Escherichia coli and 1 Nocardia farcinica. From 200 healthy lungs which were studied, 2 cases in spring, 4 cases in summer, 4 cases in fall and 2 cases in winter were isolated. It should be noted that, no bacteria was removed from primary culture of healthy and lesioned lungs in anaerobic conditions and mycoplasma culture.

  16. The value of family history in the diagnosis of hypersensitivity pneumonitis in children

    Directory of Open Access Journals (Sweden)

    Joana Cardoso

    2014-04-01

    Full Text Available Hypersensitivity pneumonitis (HP, or extrinsic allergic alveolitis, is an immunologically mediated disease resulting from the inhalation of organic substances that trigger an inflammatory response in the alveolar wall, bronchioles, and interstitium in susceptible individuals. Although HP is predominantly an occupational disease, seen in adulthood, cases in children have been described. The diagnosis of HP requires a high degree of suspicion. The treatment consists in avoiding contact with the antigen, and, in some cases, systemic corticosteroids might be necessary in order to prevent its progression to pulmonary fibrosis. We report the clinical cases of three children with a history of contact with birds and a family history of HP. All three patients presented with cough and dyspnea on exertion. The disease was diagnosed on the basis of the clinical history and ancillary diagnostic test results consistent with the diagnosis, including a predominance of lymphocytes (> 60%, CD8+ T lymphocytes in particular in bronchoalveolar lavage fluid and a ground-glass pattern seen on HRCT of the chest. Early diagnosis is crucial in order to prevent HP from progressing to pulmonary fibrosis. Hereditary factors seem to influence the onset of the disease.

  17. Chest radiographic features of lymphocytic interstitial pneumonitis in HIV-infected children

    International Nuclear Information System (INIS)

    Pitcher, R.D.; Beningfield, S.J.; Zar, H.J.

    2010-01-01

    Aim: To review the radiological features of biopsy-proven lymphocytic interstitial pneumonitis (LIP) in human immunodeficiency virus (HIV)-infected children and establish whether these are based on systematic radiological analysis, and to investigate whether more specific radiological diagnostic criteria can be developed. Materials and methods: A Medline search of English-language articles on the radiological features of biopsy-proven LIP in HIV-infected children was conducted for the period 1982 to 2007 inclusive. Radiological findings were compared with the Centers for Disease Control and Prevention (CDC) criteria for a presumptive diagnosis of LIP. Results: Pulmonary pathology was recorded as 'diffuse' and 'bilateral' in 125 (97.6%) of 128 reported cases of LIP. Twenty-five different terms were used to describe the pulmonary parenchyma. In 96 (75%), the terminology was consistent with CDC diagnostic criteria. Radiological evolution was documented in 43 (33.5%). Persistent focal opacification superimposed on diffuse pulmonary nodularity was demonstrated in 10 (7.8%). The method of radiological evaluation was described in six (4.6%). In no instance was the terminology defined. Conclusion: The radiological features of LIP have not been systematically analysed. However, CDC criteria remain reliable, allowing diagnosis of at least 75% of cases. The sensitivity of these criteria may be increased by including cases with persistent focal pulmonary opacification superimposed on diffuse nodularity. Longitudinal studies utilizing standardized radiographic analysis are needed to elucidate the natural history of LIP.

  18. Automated computer-based CT stratification as a predictor of outcome in hypersensitivity pneumonitis

    Energy Technology Data Exchange (ETDEWEB)

    Jacob, Joseph; Mak, S.M.; Mok, W.; Hansell, D.M. [Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, Royal Brompton Hospital, London (United Kingdom); Bartholmai, B.J. [Mayo Clinic Rochester, Division of Radiology, Rochester, MN (United States); Rajagopalan, S.; Karwoski, R. [Mayo Clinic Rochester, Biomedical Imaging Resource, Rochester, MN (United States); Della Casa, G. [Universita degli Studi di Modena e Reggio Emilia, Modena, Emilia-Romagna (Italy); Sugino, K. [Toho University Omori Medical Centre, Tokyo (Japan); Walsh, S.L.F. [Kings College Hospital, London (United Kingdom); Wells, A.U. [Royal Brompton and Harefield NHS Foundation Trust, Interstitial Lung Disease Unit, Royal Brompton Hospital, London (United Kingdom)

    2017-09-15

    Hypersensitivity pneumonitis (HP) has a variable clinical course. Modelling of quantitative CALIPER-derived CT data can identify distinct disease phenotypes. Mortality prediction using CALIPER analysis was compared to the interstitial lung disease gender, age, physiology (ILD-GAP) outcome model. CALIPER CT analysis of parenchymal patterns in 98 consecutive HP patients was compared to visual CT scoring by two radiologists. Functional indices including forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLco) in univariate and multivariate Cox mortality models. Automated stratification of CALIPER scores was evaluated against outcome models. Univariate predictors of mortality included visual and CALIPER CT fibrotic patterns, and all functional indices. Multivariate analyses identified only two independent predictors of mortality: CALIPER reticular pattern (p = 0.001) and DLco (p < 0.0001). Automated stratification distinguished three distinct HP groups (log-rank test p < 0.0001). Substitution of automated stratified groups for FVC and DLco in the ILD-GAP model demonstrated no loss of model strength (C-Index = 0.73 for both models). Model strength improved when automated stratified groups were combined with the ILD-GAP model (C-Index = 0.77). CALIPER-derived variables are the strongest CT predictors of mortality in HP. Automated CT stratification is equivalent to functional indices in the ILD-GAP model for predicting outcome in HP. (orig.)

  19. Fungal peptides from pneumonitis hypersensitivity etiologic agents are able to induce specific cellular immune response.

    Science.gov (United States)

    Bellanger, Anne-Pauline; Lignon, Thibaud; Godet, Yann; Rognon, Bénédicte; Reboux, Gabriel; Gbaguidi-Haore, Houssein; Borg, Christophe; Millon, Laurence

    2017-01-01

    Hypersensitivity pneumonitis (HP) is an immunoallergic disease due to chronic exposure to high quantities of different microorganisms such as Mycobacterium immunogenum (Mi), a mycobacterium, and Lichtheimia corymbifera (Lc), a filamentous fungus. It has recently been demonstrated that the protein DLDH (dihydrolipoyl dehydrogenase), is common to these microorganisms. This study aimed to investigate the immune potential of overlapping peptide pools covering the MiDLDH and LcDLDH. A selection of 34 peptides, from the MiDLDH and LcDLDH, able to interact with Major Histocompatibility Complex (MHC) 1 and MHC 2, was obtained using three different epitope prediction websites. By means of ELISPOT assays, we compared the frequency of Interferon gamma (IFNγ) secreting peripheral blood mononuclear cells (PBMC) after stimulation with overlapping peptide pools. Tests were performed using cells from 35 healthy blood donors. One peptide pool containing five peptides from MiDLDH and able to interact with MHC 2 induced a marked IFNγ specific immune response (Pool F, ptest). This study demonstrated that peptides from microorganisms involved in HP were able to induce a high IFNγ specific immune response after stimulation of PBMCs from healthy blood donors which could be useful to develop an effective prevention strategy. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Primary Sjogren’s Syndrome Presenting as Acute Interstitial Pneumonitis/Hamman-Rich Syndrome

    Directory of Open Access Journals (Sweden)

    Abidullah Khan

    2016-01-01

    Full Text Available A previously well, 45-year-old Pakistani lady was admitted to the medical unit on-call of Khyber Teaching Hospital (KTH Peshawar with a 5-day history of fever, productive cough with copious mucoid sputum, dyspnea, and pleuritic chest pain. She also complained of dry eyes, mouth, and vagina. Her chest X-ray showed diffuse alveolar shadowing and arterial gas analysis confirmed type 1 respiratory failure. Over the next few days, she deteriorated rapidly making an urgent transfer to the medical intensive care unit (MICU necessary, where she was mechanically ventilated. An HRCT followed by bronchoscopic biopsies made a diagnosis of acute interstitial pneumonitis (AIP, formerly known as Hamman-Rich syndrome. She also turned out to be positive for both anti-SS-A/Ro and anti-SS-B/La antibodies along with a positive Schirmer’s test and lower lip biopsy. She received intravenous steroids and supportive care. The patient had a complete recovery after approximately three weeks’ stay in the hospital with lung function returning back to normal. This is most probably the first ever case of primary Sjogren syndrome (pSjS presenting as AIP, recovering completely in less than a month time.

  1. Automated computer-based CT stratification as a predictor of outcome in hypersensitivity pneumonitis

    International Nuclear Information System (INIS)

    Jacob, Joseph; Mak, S.M.; Mok, W.; Hansell, D.M.; Bartholmai, B.J.; Rajagopalan, S.; Karwoski, R.; Della Casa, G.; Sugino, K.; Walsh, S.L.F.; Wells, A.U.

    2017-01-01

    Hypersensitivity pneumonitis (HP) has a variable clinical course. Modelling of quantitative CALIPER-derived CT data can identify distinct disease phenotypes. Mortality prediction using CALIPER analysis was compared to the interstitial lung disease gender, age, physiology (ILD-GAP) outcome model. CALIPER CT analysis of parenchymal patterns in 98 consecutive HP patients was compared to visual CT scoring by two radiologists. Functional indices including forced vital capacity (FVC) and diffusion capacity for carbon monoxide (DLco) in univariate and multivariate Cox mortality models. Automated stratification of CALIPER scores was evaluated against outcome models. Univariate predictors of mortality included visual and CALIPER CT fibrotic patterns, and all functional indices. Multivariate analyses identified only two independent predictors of mortality: CALIPER reticular pattern (p = 0.001) and DLco (p < 0.0001). Automated stratification distinguished three distinct HP groups (log-rank test p < 0.0001). Substitution of automated stratified groups for FVC and DLco in the ILD-GAP model demonstrated no loss of model strength (C-Index = 0.73 for both models). Model strength improved when automated stratified groups were combined with the ILD-GAP model (C-Index = 0.77). CALIPER-derived variables are the strongest CT predictors of mortality in HP. Automated CT stratification is equivalent to functional indices in the ILD-GAP model for predicting outcome in HP. (orig.)

  2. An onion farmer with a case of hypersensitivity pneumonitis caused by Aspergillus niger.

    Science.gov (United States)

    Sakamoto, Tomohiro; Yamasaki, Akira; Funaki, Yoshihiro; Harada, Tomoya; Okazaki, Ryota; Hasegawa, Yasuyuki; Sueda, Yuriko; Fukushima, Takehito; Morita, Masahito; Yamamoto, Akihiro; Kodani, Masahiro; Shimizu, Eiji

    2018-01-01

    A 62-year old man was admitted to our hospital with a 2-week complaint of a dry cough, general fatigue, and dyspnea on effort. He has been an onion farmer for several years and developed these symptoms after cleaning up onion peels with air compressors. A chest roentgenogram and computed tomography showed a ground glass shadow in the bilateral upper lung field. Cellular analysis of the bronchoalveolar lavage fluid showed elevated total cell numbers and lymphocytes. Transbronchial lung biopsies revealed a non-caseating granuloma with both epithelioid cells and Langhans giant cells. After the admission, these symptoms and radiological findings gradually improved without any treatment. Then, a returning-home provocation test was positive only when he worked cleaning up onion peels with air compressors. A. niger was cultured from his workplace and black mold from the onion peels. The precipitation antibody and the antigen were both positive for Aspergillus . Therefore, we diagnosed this case as hypersensitivity pneumonitis caused by inhalation of A. niger . Although hypersensitivity pneumonia caused by A. niger is rare, physicians should aware the possibility of this condition in farmers because A niger is ubiquitously present in several vegetables and fruits.

  3. Chronic interstitial pneumonitis in dogs naturally infected with Leishmania (Leishmania chagasi: a histopathological and morphometric study

    Directory of Open Access Journals (Sweden)

    Gonçalves Ricardo

    2003-01-01

    Full Text Available Eighteen mongrel dogs of unknown age and naturally infected with Leishmania (Leishmania chagasi, were obtained from the City Hall of Belo Horizonte, Brazil. Four dogs were used as control. Lung samples were obtained and immediately fixed in formalin. The histopathological picture of all lung tissue sections was a chronic and diffuse interstitial pneumonitis. The thickened inter-alveolar septa were characterized by the cellular exudate (mostly macrophages, lymphocytes and plasmocytes associated with collagen deposition. Morphometric analysis showed greater septal thickness in the infected animals than in controls. In fact, the morphometric study of collagen stained with ammoniac silver confirmed a larger deposition of collagen in the infected animals. The parasitologic method was carried out during the study of the lesions on the slides. However, we did not observe any correlation between the histopathologic and morphometric data and the clinical status of the animals. We conclude that the pulmonary lesions observed in all naturally infected dogs were correlated with the disease and that the morphometric method used was satisfactory for the analysis of septal thickness and of increased collagen deposition, confirming the presence of fibrosis.

  4. Chronic interstitial pneumonitis in dogs naturally infected with Leishmania (Leishmania) chagasi: a histopathological and morphometric study.

    Science.gov (United States)

    Gonçalves, Ricardo; Tafuri, Washington Luiz; Melo, Maria Norma de; Raso, Pedro; Tafuri, Wagner Luiz

    2003-01-01

    Eighteen mongrel dogs of unknown age and naturally infected with Leishmania (Leishmania) chagasi, were obtained from the City Hall of Belo Horizonte, Brazil. Four dogs were used as control. Lung samples were obtained and immediately fixed in formalin. The histopathological picture of all lung tissue sections was a chronic and diffuse interstitial pneumonitis. The thickened inter-alveolar septa were characterized by the cellular exudate (mostly macrophages, lymphocytes and plasmocytes) associated with collagen deposition. Morphometric analysis showed greater septal thickness in the infected animals than in controls. In fact, the morphometric study of collagen stained with ammoniac silver confirmed a larger deposition of collagen in the infected animals. The parasitologic method was carried out during the study of the lesions on the slides. However, we did not observe any correlation between the histopathologic and morphometric data and the clinical status of the animals. We conclude that the pulmonary lesions observed in all naturally infected dogs were correlated with the disease and that the morphometric method used was satisfactory for the analysis of septal thickness and of increased collagen deposition, confirming the presence of fibrosis.

  5. Placental histopathology lesions and pregnancy outcome in pregnancies complicated with symptomatic vs. non-symptomatic placenta previa.

    Science.gov (United States)

    Weiner, Eran; Miremberg, Hadas; Grinstein, Ehud; Schreiber, Letizia; Ginath, Shimon; Bar, Jacob; Kovo, Michal

    2016-10-01

    The mechanisms involved in bleeding in cases of placenta previa (PP) and the effect on pregnancy outcome is unclear. We aimed to compare pregnancy outcome and placental histopathology in pregnancies complicated with symptomatic (bleeding) vs. non-symptomatic PP, and to study the effects of the co-existence of histopathological retro-placental hemorrhage (RPH) in cases of symptomatic PP on neonatal and maternal outcomes. Labor and maternal characteristics, neonatal outcome and placental histopathology lesions of pregnancies with PP, delivered between 24 and 42weeks, during 2009-2015, were reviewed. Results were compared between PP who had elective cesarean delivery (CD) (previa group) and PP with bleeding necessitating emergent CD (symptomatic previa group). Placental lesions were classified to lesions consistent with maternal malperfusion or fetal thrombo-occlusive disease (vascular and villous changes), and inflammatory lesions. Compared to the previa group (n=63), the symptomatic previa group (n=74) was characterized by older patients (pPlacentas within the symptomatic previa group were smaller, with higher rates of weightplacenta previa is associated with increased placental malperfusion lesions suggesting an association of maternal malperfusion with abnormal placental separation. The coexisting finding of RPH with symptomatic placenta previa can be seen as a marker for more extensive/severe placental separation, hence the association with maternal transfusion requirements and poorer fetal outcome. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease

    OpenAIRE

    Liu, Chia-Yuan; Chang, Wen-Hsiung; Lin, Shee-Chan; Chu, Cheng-Hsin; Wang, Tsang-En; Shih, Shou-Chuan

    2005-01-01

    AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.

  7. Surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis

    NARCIS (Netherlands)

    Keus, F.; Broeders, I. A. M. J.; van Laarhoven, C. J. H. M.

    2006-01-01

    Indications for cholecystectomy are limited to clearly symptomatic gallstones. Relatively high failure rates of pain relief are probably caused by incorrect selection of patients for the operation. Contraindications for (laparoscopic) cholecystectomy are related to anaesthesiological considerations.

  8. ACUTE NEUROINFECTIONS AND SYMPTOMATIC EPILEPSY IN CHILDREN: CAUSAL RELATIONSHIP (review

    Directory of Open Access Journals (Sweden)

    E. Yu. Gorelik

    2017-01-01

    Full Text Available Convulsions in case of acute neuroinfections can both complicate the disease course and transfer to symptomatic epilepsy which is one of the most important medical and social problems. The review article presents the data on epidemiology of convulsive disorder and symptomatic epilepsy in case of neuroinfections in children. There are considered the current immune and biochemical aspects of epileptogenesis in case of infectious pathology. There is given the information on neurophysiological and radial features of symptomatic epilepsy developed in case of neuroinfections of different etiology. There is underlined the practical significance of timely complex etio-pathogenetic therapy for neuroinfections complicated by convulsion that allows to reduce the frequency of symptomatic epilepsy development. There are presented the data on the results of transcranial magnetic stimulation in case of refractory epilepsy.

  9. Urinary nitrite in symptomatic and asymptomatic urinary infection.

    OpenAIRE

    Powell, H R; McCredie, D A; Ritchie, M A

    1987-01-01

    The dipstrip test for urinary nitrite is fairly unreliable in symptomatic urinary infections and only 104 (52%) of 200 symptomatic children with urinary infection attending an emergency department had a positive result. The test yielded positive results, however, in 83 of 100 outpatients with largely asymptomatic urinary infection attending a follow up clinic because of known predisposition to urinary infection. This difference was highly significant. The finding of urinary nitrite is highly ...

  10. The incidence of symptomatic malrotation post gastroschisis repair.

    LENUS (Irish Health Repository)

    Abdelhafeez, A

    2011-12-01

    Gastroschisis is known to be associated with abnormal bowel rotation. Currently, the broadly accepted practice is not to perform Ladd\\'s procedure routinely at the time of closure of gastroschisis defects. However the incidence of symptomatic malrotation and volvulus post gastroschisis repair is unknown; this incidence is important in view of the current practice of bedside gastroschisis closure. This study examined the incidence of symptomatic malrotation and volvulus following gastroschisis repair.

  11. Mechanisms of symptomatic spinal cord ischemia after TEVAR

    DEFF Research Database (Denmark)

    Czerny, Martin; Eggebrecht, Holger; Sodeck, Gottfried

    2012-01-01

    To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR).......To test the hypothesis that simultaneous closure of at least 2 independent vascular territories supplying the spinal cord and/or prolonged hypotension may be associated with symptomatic spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR)....

  12. Symptomatic Diverticulosis Is Characterized By Loose Stools.

    Science.gov (United States)

    Järbrink-Sehgal, M Ellionore; Andreasson, Anna; Talley, Nicholas J; Agréus, Lars; Song, Jeong-Yeop; Schmidt, Peter T

    2016-12-01

    Symptomatic uncomplicated diverticular disease is considered to be a discreet clinical entity distinct from irritable bowel syndrome (IBS), but population-based data are unavailable. We aimed to investigate the prevalence and location of diverticulosis in the general population, and its association with colonic symptoms and mental health. We propose that individuals with diverticulosis would report more constipation and IBS. We performed a population-based study of randomly selected adults born in Sweden (age, 18-70 y; 57.2% women); 745 received a gastroenterology consultation, completed validated abdominal symptom and mental health questionnaires, and were examined by colonoscopy. Logistic regression was used to calculate the associations between diverticulosis and age, sex, gastrointestinal symptoms, anxiety, depression, and self-rated health. Among the 742 participants (54.6% women), 130 (17.5%) had diverticulosis. Age was the strongest predictor of diverticulosis (P diverticulosis was rare in participants younger than 40 years (0.7%). All participants with diverticulosis had sigmoid involvement. Participants with diverticulosis were more likely to report loose stools (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.20-2.96), urgency (OR, 1.64; 95% CI, 1.02-2.63), passing mucus (OR, 2.26; 95% CI, 1.08-4.72), and a high stool frequency (OR, 2.02; 95% CI, 1.11-3.65). Diverticulosis was associated with abdominal pain (OR, 2.10; 95% CI, 1.01-4.36; P = .047) and diarrhea-predominant IBS (OR, 9.55; 95% CI, 1.08-84.08; P = .04) in participants older than 60 years. The presence of anxiety and depression and self-rated health were similar in participants with and without diverticulosis. The prevalence of diverticulosis is age-dependent. Diverticulosis is associated with diarrhea in subjects across all age ranges. In subjects older than age 60, diverticulosis is associated with abdominal pain and diarrhea-predominant IBS. Copyright © 2016 AGA Institute

  13. Radiation-induced pulmonary toxicity following adjuvant radiotherapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Sung Ho; Kim, Tae Jung; Eom, Keun Young; Kim, Jee Hyun; Kim, Sung Won; Kim, Jae Sung; Kim, In Ah [Seoul National University College of Medicine, Seongnam (Korea, Republic of)

    2007-06-15

    To evaluate the incidences and potential predictive factors for symptomatic radiation pneumonitis (SRP) and radiographic pulmonary toxicity (RPT) following adjuvant radiotherapy (RT) for patients with breast cancer. A particular focus was made to correlate RPT with the dose volume histogram (DVH) parameters based on three-dimensional RT planning (3D-RTP) data. From September 2003 through February 2006, 171 patients with breast cancer were treated with adjuvant RT following breast surgery. A radiation dose of 50.4 Gy was delivered with tangential photon fields on the whole breast or chest wall. A single anterior oblique photon field for supraclavicular (SCL) nodes was added if indicated. Serial follow-up chest radiographs were reviewed by a chest radiologist. Radiation Therapy Oncology Group (RTOG) toxicity criteria were used for grading SRP and a modified World Health Organization (WHO) grading system was used to evaluate RPT. The overall percentage of the ipsilateral lung volume that received {>=} 15 Gy (V{sub 15}), 20 Gy (V{sub 20}), and 30 Gy (V{sub 30}) and the mean lung dose (MLD) were calculated. We divided the ipsilateral lung into two territories, and defined separate DVH parameters, i.e., V{sub 15} {sub TNGT}, V{sub 20} {sub TNGT}, V{sub 30} {sub TNGT}, MLD {sub TNGT}, and V{sub 15} {sub SCL}, V{sub 20} {sub SCL} V {sub 30SCL}, MLD {sub SCL} to assess the relationship between these parameters and RPT. Four patients (2.1%) developed SRP (three with grade 3 and one with grade 2, respectively). There was no significant association of SRP with clinical parameters such as, age, pre-existing lung disease, smoking, chemotherapy, hormonal therapy and regional RT. When 137 patients treated with 3D-RTP were evaluated, 13.9% developed RPT in the tangent (TNGT) territory and 49.2% of 59 patients with regional RT developed RPT in the SCL territory. Regional RT ({rho} < 0.001) and age ({rho} = 0.039) was significantly correlated with RPT. All DVH parameters except for V

  14. Dose-modifying factor for captopril for mitigation of radiation injury to normal lung

    Science.gov (United States)

    Medhora, Meetha; Gao, Feng; Fish, Brian L.; Jacobs, Elizabeth R.; Moulder, John E.; Szabo, Aniko

    2012-01-01

    Our goal is to develop countermeasures for pulmonary injury following unpredictable events such as radiological terrorism or nuclear accidents. We have previously demonstrated that captopril, an angiotensin converting enzyme (ACE) inhibitor, is more effective than losartan, an angiotensin type-1 receptor blocker, in mitigating radiation-pneumopathy in a relevant rodent model. In the current study we determined the dose modifying factors (DMFs) of captopril for mitigation of parameters of radiation pneumonitis. We used a whole animal model, irradiating 9–10-week-old female rats derived from a Wistar strain (WAG/RijCmcr) with a single dose of irradiation to the thorax of 11, 12, 13, 14 or 15 Gy. Our study develops methodology to measure DMFs for morbidity (survival) as well as physiological endpoints such as lung function, taking into account attrition due to lethal radiation-induced pneumonitis. Captopril delivered in drinking water (140–180 mg/m2/day, comparable with that given clinically) and started one week after irradiation has a DMF of 1.07–1.17 for morbidity up to 80 days (survival) and 1.21–1.35 for tachypnea at 42 days (at the peak of pneumonitis) after a single dose of ionizing radiation (X-rays). These encouraging results advance our goals, since DMF measurements are essential for drug labeling and comparison with other mitigators. PMID:22843631

  15. Predictive factors of late radiation fibrosis: a prospective study in non-small cell lung cancer.

    Science.gov (United States)

    Mazeron, Renaud; Etienne-Mastroianni, Bénédicte; Pérol, David; Arpin, Dominique; Vincent, Michel; Falchero, Lionel; Martel-Lafay, Isabelle; Carrie, Christian; Claude, Line

    2010-05-01

    To determine predictive factors of late radiation fibrosis (RF) after conformal radiotherapy (3D-RT) in non-small cell lung cancer (NSCLC). Ninety-six patients with Stage IA-IIIB NSCLC were included in a prospective trial. Clinical evaluation, chest X-ray, and pulmonary functional tests including diffusion parameters were performed before and 6 months after radiotherapy. An independent panel of experts prospectively analyzed RF, using Late Effects in Normal Tissues-Subjective, Objective, Management and Analytic scales classification. Logistic regression analysis was performed to identify relationships between clinical, functional, or treatment parameters and incidence of RF. Variations of circulating serum levels of pro-inflammatory (interleukin-6, tumor necrosis factor alpha, tumor growth factor beta1) and anti-inflammatory (interleukin-10) cytokines during 3D-RT were examined to identify correlations with RF. Of the 96 patients included, 72 were evaluable for RF at 6 months. Thirty-seven (51.4%) developed RF (Grade >or=1), including six severe RF (Grades 2-3; 8.3%). In univariate analysis, only poor Karnofsky Performance Status and previous acute radiation pneumonitis were associated with RF (p acute radiation pneumonitis and dosimetric parameters were significantly correlated with RF occurrence. It was not significantly correlated either with cytokines at baseline or with their variation during 3D-RT. This study confirms the importance of dosimetric parameters to limit the risk of RF. Contrary to acute radiation pneumonitis, RF was not correlated to cytokine variations during 3D-RT.

  16. Altered distribution of Pneumocystis carinii pneumonia during radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, H.H.; Park, S.H. [Department of Diagnostic Radiology, Kangnam St. Mary`s Hospital, College of Medicine, Seoul (Korea, Republic of); Kim, S.C. [Department of Internal Medicine, Kangnam St. Mary`s Hospital, College of Medicine, Catholic University of Korea, Seoul (Korea, Republic of); Kim, Y.S. [Department of Therapeutic Radiology, Kangnam St. Mary`s Hospital, College of Medicine, Catholic University of Korea, Seoul (Korea, Republic of)

    1999-10-01

    The radiographic findings of Pneumocystis carinii pneumonia (PCP) are various. The typical findings are diffuse, bilateral, symmetric, finely granular, or reticular infiltrates. In patients taking aerosol pentamidine, atypical findings may be the first manifestation. One interesting radiologic finding of PCP is that the pneumonia may spare the irradiated lung. We report PCP developed in a patient undergoing irradiation for lung cancer. High-resolution CT revealed diffuse, bilateral, and symmetric ground-glass opacities with septal thickening in both lungs; however, the radiation port was spared and appeared as the ``photographic negative of post-radiation pneumonia.`` The distribution of the pneumonic infiltrates was altered by radiotherapy. (orig.) With 1 fig., 6 refs.

  17. Altered distribution of Pneumocystis carinii pneumonia during radiation therapy

    International Nuclear Information System (INIS)

    Kim, H.H.; Park, S.H.; Kim, S.C.; Kim, Y.S.

    1999-01-01

    The radiographic findings of Pneumocystis carinii pneumonia (PCP) are various. The typical findings are diffuse, bilateral, symmetric, finely granular, or reticular infiltrates. In patients taking aerosol pentamidine, atypical findings may be the first manifestation. One interesting radiologic finding of PCP is that the pneumonia may spare the irradiated lung. We report PCP developed in a patient undergoing irradiation for lung cancer. High-resolution CT revealed diffuse, bilateral, and symmetric ground-glass opacities with septal thickening in both lungs; however, the radiation port was spared and appeared as the ''photographic negative of post-radiation pneumonia.'' The distribution of the pneumonic infiltrates was altered by radiotherapy. (orig.)

  18. Radiation exposure and lung disease in today's nuclear world.

    Science.gov (United States)

    Deas, Steven D; Huprikar, Nikhil; Skabelund, Andrew

    2017-03-01

    Ionizing radiation poses important health risks. The per capita annual dose rate has increased in the United States and there is increasing concern for the risks posed by low-dose occupational exposure among workers in nuclear industries and healthcare. Recent nuclear accidents and concern for terrorism have heightened concern for catastrophic, high-dose ionizing radiation exposure. This review will highlight recent research into the risks to lung health posed by ionizing radiation exposure and into potential treatments. Angiotensin-converting enzyme inhibitors and some antioxidants have shown promise as mitigators, to decrease pneumonitis and fibrosis when given after exposure. Studies of survivors of nuclear catastrophes have shown increased risk for lung cancer, especially in nonsmokers. There is evidence for increased lung cancer risk in industrial radiation workers, especially those who process plutonium and may inhale radioactive particles. There does not seem to be an increased risk of lung cancer in healthcare workers who perform fluoroscopic procedures. High-dose ionizing radiation exposure causes pneumonitis and fibrosis, and more research is needed to develop mitigators to improve outcomes in nuclear catastrophes. Long-term, low-dose occupational radiation may increase lung cancer risk. More research to better define this risk could lead to improved safety protocols and screening programs.

  19. Early immunopathological events in acute model of mycobacterial hypersensitivity pneumonitis in mice.

    Science.gov (United States)

    Johansson, Elisabet; Boivin, Gregory P; Yadav, Jagjit S

    2017-12-01

    Prolonged exposure to antigens of non-tuberculous mycobacteria species colonizing industrial metalworking fluid (MWF), particularly Mycobacterium immunogenum (MI), has been implicated in chronic forms of hypersensitivity pneumonitis (HP) in machinists based on epidemiology studies and long-term exposure of mouse models. However, a role of short-term acute exposure to these antigens has not been described in the context of acute forms of HP. This study investigated short-term acute exposure of mice to MI cell lysate (or live cell suspension) via oropharyngeal aspiration. The results showed there was a dose- and time-dependent increase (peaking at 2 h post-instillation) in lung immunological responses in terms of the pro- (TNFα, IL-6, IL-1β) and anti-inflammatory (IL-10) cytokines. Bronchoalveolar lavage and histology showed neutrophils as the predominant infiltrating cell type, with lymphocytes mice led to a transient early immunopathologic response, with little adaptive immunity, which is consistent with events associated with human acute forms of HP. Screening of MWF-originated mycobacterial genotypes/variants (six of MI, four of M. chelonae, two of M. abscessus) showed both inter- and intra-species differences, with MI genotype MJY10 being the most immunogenic. In conclusion, this study characterized the first short-term mycobacterial exposure mouse model that mimics acute HP in machinists; this could serve as a potentially useful model for rapid screening of field MWF-associated mycobacteria for routine and timely occupational risk assessment and for investigating early biomarkers and mechanisms of this understudied immune lung disease.

  20. Age influence on hypersensitivity pneumonitis induced in mice by exposure to Pantoea agglomerans.

    Science.gov (United States)

    Lemieszek, Marta Kinga; Chilosi, Marco; Golec, Marcin; Skórska, Czesława; Dinnyes, Andras; Mashayekhi, Kaveh; Vierlinger, Klemens; Huaux, Francois; Wielscher, Matthias; Hofner, Manuela; Yakoub, Yousof; Pastena, Chiara; Daniele, Isabella; Cholewa, Grażyna; Sitkowska, Jolanta; Lisowska, Wiesława; Zwoliński, Jacek; Milanowski, Janusz; Mackiewicz, Barbara; Góra-Florek, Anna; Ziesche, Rolf; Dutkiewicz, Jacek

    2013-09-01

    Hypersensitivity pneumonitis (HP) represents the immunologically mediated lung disease induced by repeated inhalations of a wide variety of certain finely dispersed organic antigens. In susceptible subjects, these inhalations provoke a hypersensitivity reaction characterized by intense inflammation of the terminal bronchioles, the interstitium and the alveolar tree. The inflammation often organizes into granulomas and may progress to pulmonary fibrosis. Our previous work indicated that cell extract of gram-negative bacteria Pantoea agglomerans (SE-PA) causes, in young C57BL/6J mice, pulmonary changes that are very similar to the clinical manifestations of HP in men. The purpose of presented studies was to describe the response of mice immune system while exposed to SE-PA. Particular attention was paid to examine the age influence on SE-PA induced inflammation and fibrosis in lung tissue. We used 3- and 18-month-old C57BL/6J mice. Lung samples were collected from untreated mice and animals exposed to harmful agent for 7 and 28 days. HP development was monitored by histological and biochemical evaluation. Using ELISA tests, we examined concentration of pro- and anti-inflammatory cytokines in lung homogenates. Our study demonstrated again that SE-PA provokes in mice changes typical for the clinical picture of HP, and that successive stages of disease (acute, subacute and chronic) might be obtained by modulation of time exposure. Furthermore, we found that animals' age at the time of sensitization influences the nature of observed changes (cytokine expression pattern) and the final outcome (reaction intensity and scale of fibrosis).

  1. Immunoglobulin free light chains are increased in hypersensitivity pneumonitis and idiopathic pulmonary fibrosis.

    Directory of Open Access Journals (Sweden)

    Tom Groot Kormelink

    Full Text Available BACKGROUND: Idiopathic pulmonary fibrosis (IPF, a devastating lung disorder of unknown aetiology, and chronic hypersensitivity pneumonitis (HP, a disease provoked by an immunopathologic reaction to inhaled antigens, are two common interstitial lung diseases with uncertain pathogenic mechanisms. Previously, we have shown in other upper and lower airway diseases that immunoglobulin free light chains (FLCs are increased and may be involved in initiating a local inflammation. In this study we explored if such a mechanism may also apply to HP and IPF. METHODS: In this study we examined the presence of FLC in serum and BAL fluid from 21 IPF and 22 HP patients and controls. IgG, IgE and tryptase concentrations were measured in BAL fluid only. The presence of FLCs, plasma cells, B cells and mast cells in lung tissue of 3 HP and 3 IPF patients and 1 control was analyzed using immunohistochemistry. RESULTS: FLC concentrations in serum and BAL fluid were increased in IPF and HP patients as compared to control subjects. IgG concentrations were only increased in HP patients, whereas IgE concentrations were comparable to controls in both patient groups. FLC-positive cells, B cells, plasma cells, and large numbers of activated mast cells were all detected in the lungs of HP and IPF patients, not in control lung. CONCLUSION: These results show that FLC concentrations are increased in serum and BAL fluid of IPF and HP patients and that FLCs are present within affected lung tissue. This suggests that FLCs may be involved in mediating pathology in both diseases.

  2. One-hour PTH after thyroidectomy predicts symptomatic hypocalcemia.

    Science.gov (United States)

    White, Michael G; James, Benjamin C; Nocon, Cheryl; Nagar, Sapna; Kaplan, Edwin L; Angelos, Peter; Grogan, Raymon H

    2016-04-01

    A major morbidity after total thyroidectomy is hypocalcemia. Although many clinical factors and laboratory studies have been correlated with both biochemical and symptomatic hypocalcemia, the ideal use and timing of these tests remain unclear. We hypothesize 1-h (PACU) parathyroid hormone (PTH) will identify patients at risk for symptomatic hypocalcemia. This prospective study evaluated 196 patients undergoing total thyroidectomy. Serum calcium and PTH levels were measured 1 h after surgery and on postoperative day 1 (POD1). Performance of a central compartment lymph node dissection, parathyroid autotransplantation, indication for procedure, pathology, and presence of parathyroid tissue in the pathology specimen were recorded. Of 196 patients, nine (4.6%) developed symptomatic hypocalcemia. Thirty four (17.3%) had a 1-h PACU PTH ≤10 pg/dL, whereas 31 (15.8%) had a POD1 PTH of ≤10. Five (56%) of the nine symptomatic patients underwent central compartment lymph node dissection, four (44%) had parathyroid autotransplantation, and four (44%) had a PACU PTH ≤10. PACU and POD1 PTH levels were correlated (R(2) = 0.682). Multivariate regression identified central compartment dissection, autotransplantation, and PACU or POD1 PTH correlated with symptomatic hypocalcemia. PACU PTH, POD1 PTH, PACU Ca, malignant final pathology, and age ≤45 y correlated with biochemical hypocalcemia. A 1-h postoperative PACU PTH is equivalent to POD1 PTH in predicting the development of symptomatic hypocalcemia. Biochemical hypocalcemia was not predictive of symptoms in the immediate postoperative period. Lymph node dissection and parathyroid autotransplantation correlated with symptomatic hypocalcemia and improve the sensitivity of biochemical screening alone. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Late toxicity and outcomes following radiation therapy for chest wall sarcomas in pediatric patients.

    Science.gov (United States)

    Lucas, John T; Fernandez-Pineda, Israel; Tinkle, Christopher L; Bishop, Michael W; Kaste, Sue C; Heda, Rajiv; Davidoff, Andrew M; Krasin, Matthew J

    To investigate the contribution of radiation therapy to acute and late toxicity in pediatric chest wall sarcoma patients and evaluate dosimetric correlates of higher incidence toxicities such as scoliosis and pneumonitis. The data from 23 consecutively treated pediatric patients with chest wall sarcomas of various histologies (desmoid, Ewing, rhabdomyosarcoma, nonrhabdomyosarcoma-soft tissue sarcomas) were reviewed to evaluate the relationship between end-organ radiation dose, clinical factors, and the risk of subsequent late effects (scoliosis, pneumonitis). Cobb angles were used to quantify the extent of scoliosis. Doses to the spine and lung were calculated from the radiation treatment plan. The range of scoliosis identified on follow-up imaging ranged from -47.6 to 64° (median, 2.95°). No relationship was identified between either radiation dose to the ipsilateral or contralateral vertebral body or tumor size and the degree or direction of scoliosis. The extent of surgical resection and number and location of resected ribs affected the extent of scoliosis. The dominant predictor of extent of scoliosis at long-term follow-up was the extent of scoliosis following surgical resection. Radiation pneumonitis was uncommon and was not correlated with mean dose or volume of lung receiving 24 Gy; however, 1 of 3 surviving patients who received whole pleural surface radiation therapy developed significant restrictive lung disease. Acute and late radiation therapy-associated toxicities in pediatric chest wall sarcoma patients are modest. The degree of scoliosis following resection is a function of the extent of resection and of the number and location of ribs resected, and the degree of scoliosis at the last follow-up visit is a function of the extent of scoliosis following surgery. Differential radiation therapy dose across the vertebral body does not increase the degree of scoliosis. Severe restrictive pulmonary disease is a late complication of survivors after whole

  4. Physical activity and exercise performance in symptomatic Cambodia veterans.

    Science.gov (United States)

    de Vries, M; Soetekouw, P M M B; Van Der Meer, J W M; Folgering, H; Bleijenberg, G

    2002-02-01

    Dutch (ex-)servicemen who encounter health problems since return from the 1992-3 peace operation UNTAC, commonly complain of reduced activity levels, decreases in physical fitness and aggravation of symptoms after strenuous exercise. To evaluate these symptoms. A prospective study of 26 symptomatic Cambodia veterans and 26 matched controls (healthy Cambodia veterans). Using an actometer and diaries, both groups were followed for a 12-day baseline period prior to an incremental maximal exercise test on a bicycle ergometer, followed by 7 days of post-ergometer data. During baseline, symptomatic Cambodia veterans reported more symptoms, had lower levels of physical activity and took longer periods of rest after high activity periods. Symptomatic veterans did not perceive the exercise test needing more exertion than healthy veterans did, although their physical fitness was decreased. Post-ergometer, daily observed symptoms did not aggravate in symptomatic veterans. Four days post-ergometer, actometer and daily observed activity scores were lowered in both groups. As compared to baseline, one day post-ergometer, levels of physical activity were changed in healthy veterans, but not in controls. Complaints about reduced activity levels and decreases in physical fitness in symptomatic Cambodia veterans were confirmed. Post-exertion malaise was not found. The observed post-exertion effects were traced back to weekday patterns.

  5. Functional Connectivity Networks in Asymptomatic and Symptomatic DYT1 Carriers.

    Science.gov (United States)

    Premi, Enrico; Diano, Matteo; Gazzina, Stefano; Cauda, Franco; Gualeni, Vera; Tinazzi, Michele; Fiorio, Mirta; Liberini, Paolo; Lazzarini, Clara; Archetti, Silvana; Biasiotto, Giorgio; Turla, Marinella; Bertasi, Valeria; Cotelli, Maria; Gasparotti, Roberto; Padovani, Alessandro; Borroni, Barbara

    2016-11-01

    DYT1 mutation is characterized by focal to generalized dystonia and incomplete penetrance. To explore the complex perturbations in the different neural networks and the mutual interactions among them, we studied symptomatic and asymptomatic DTY1 mutation carriers by resting-state functional MRI. A total of 7 symptomatic DYT1, 10 asymptomatic DYT1, and 26 healthy controls were considered. Resting-state functional MRI (Oxford Centre for Functional MRI of the Brain) [FMRIB] Software Library) (FSL) MELODIC, dual regression, (as a toolbox of FSL, with Nets is referred to "networks") (FSLNets) (http://fsl.fmrib.ox.ac.uk/fsl/fslwiki/FSLNets) was performed on 9 resting-state neural networks. DYT1 mutation signature (symptomatic DYT1 and asymptomatic DYT1) was characterized by increased connectivity in the dorsal attention network and in the left fronto-parietal network. Functional correlates of symptomatic DYT1 patients (symptomatic DYT1 vs healthy controls) showed increased connectivity in the sensorimotor network. This study argues that DYT1 dystonia is a network disorder, with crucial nodes in sensory-motor integration of posterior parietal structures. A better characterization of cortical networks involved in dystonia is crucial for possible neurophysiological therapeutic interventions. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  6. Inflammatory sequences in acute pulmonary radiation injury

    International Nuclear Information System (INIS)

    Slauson, D.O.; Hahn, F.F.; Benjamin, S.A.; Chiffelle, T.L.; Jones, R.K.

    1976-01-01

    The histopathologic events in the developing acute pulmonary inflammatory reaction to inhaled particles of Yttrium 90 are detailed. In animals that died or were sacrificed during the first year after inhalation exposure, microscopic findings of acute inflammation predominated and included vascular congestion; stasis; focal hemorrhage; edema; various inflammatory cell infiltrates; cytolysis and desquamation of bronchiolar and alveolar epithelium followed by regeneration; vascular injury and repair; and the eventual development of pulmonary fibrosis. Accumulation of alveolar fibrin deposits was an additional characteristic, though not a constant feature of the early stages of radiation pneumonitis. In addition to the direct effects of radiation on pulmonary cell populations, the histopathologic findings were suggestive of diverse activation of various cellular and humoral mediation systems in their pathogenesis. The potential interrelationships of systems responsible for increased vascular permeability, coagulation and fibrinolysis, chemotaxis, and direct cellular injury were discussed and related to the pathogenesis of the microscopic findings characteristic of early pulmonary radiation injury

  7. [A patient with acute hypersensitivity pneumonitis with a diagnosis of air-conditioner lung, who responded to therapy].

    Science.gov (United States)

    Ishikawa, Rie; Kamiya, Hiroyuki; Ikushima, Souichiro; Oristu, Masaru; Takemura, Tamiko

    2010-02-01

    The patient was a 48-year-old woman and current smoker. In May 2007, she moved to a new residence. In the middle of the following month, she developed acute respiratory distress and a fever (38 degrees C) after running her air conditioner continuously throughout the night. The chest X-ray film showed diffuse infiltrative shadows in the middle and lower lung fields. After hospital admission, her oxygenation improved without treatment and the infiltrates improved over the clinical course. As a consequence, we suspected hypersensitivity pneumonitis. The bronchoalveolar lavage showed predominant lymphocytes of 72.6%, with a low CD 4/8 ratio of 0.2. Transbronchial lung biopsy findings corresponded to acute hypersensitivity pneumonitis. The results of the environmental challenge test were positive only when her air conditioner was on, resulting, in a diagnosis of air-conditioner lung. Several microorganisms were detected in an environmental sample, but 20 kinds of serum precipitating antibodies were negative on a thorough screening, so no responsible antigen could be identified. The patient's symptoms did not recur after her air conditioner was replaced.

  8. Hypersensitivity pneumonitis-like reaction and occupational asthma associated with 1,3-bis(isocyanatomethyl) cyclohexane pre-polymer.

    Science.gov (United States)

    Simpson, C; Garabrant, D; Torrey, S; Robins, T; Franzblau, A

    1996-07-01

    Twenty-three of 34 workers who had worked in the injection molding operation making polyurethane foam parts at an automobile parts manufacturing plant developed respiratory symptoms and/or systemic symptoms over a 2-month period following the full production use of a new diisocyanate paint that contained 1,3-bis(isocyanatomethyl)cyclohexane pre-polymer (BIC)(CAS #75138-76-0, 38661-72-2). At 3 months, all subjects underwent an interview, physical examination, pre- and post-shift pulmonary function tests, and either methacholine challenge test or bronchodilator challenge at an occupational health clinic. The most frequently cited symptoms were dyspnea (65%), cough (61%), chest tightness (57%), chills (57%), wheezing (30%), and myalgias, arthralgias, and nausea (26%). Thirteen subjects had either a positive methacholine challenge test or a positive response to bronchodilator challenge, making the overall prevalence of airway hyperresponsiveness 38%. The overall prevalence of hypersensitivity pneumonitis-like reactions among line operators in the injection molding process was 27%. This disease outbreak suggests that 1,3-bis(isocyanatomethyl)cyclohexane pre-polymer may cause asthma and hypersensitivity pneumonitis-like reactions. The use of BIC was discontinued 6 months after the first workers developed symptoms.

  9. Sub-acute occupational hypersensitivity pneumonitis due to low-level exposure to diisocyanates in a secretary.

    Science.gov (United States)

    Schreiber, J; Knolle, J; Sennekamp, J; Schulz, K T; Hahn, J U; Hering, K G; Raulf-Heimsoth, M; Merget, R

    2008-09-01

    There is virtually no information in the literature about the exposure levels needed to induce hypersensitivity pneumonitis (HP) by diisocyanates. The present study reports a case of occupational HP due to diisocyanates after low-level exposure. A 53-yr-old female never-smoker developed progressive shortness of breath on exertion, cough, fatigue and flu-like symptoms shortly after she began work as a secretary of a car body repair shop. A diagnosis of HP was made 2 yrs later, based on a restrictive ventilatory defect, a reticulonodular and discrete ground-glass pattern on high-resolution computed tomography, lymphocytosis in bronchoalveolar lavage and specific immunoglobulin G antibodies to diisocyanate human serum albumin conjugates in the patient's serum. The diagnosis was confirmed by recovery after exposure cessation and deterioration after re-exposure. Ambient monitoring revealed air concentrations of different diisocyanate monomers below the detection limit in both the patient's work station and in front of the paint spray booths, with the exception of one measurement that showed 4,4-methylenediphenyl diisocyanate concentrations of 3 microg x m(-3) in front of one booth (corresponding to a total reactive isocyanate group concentration of 1 microg x m(-3)). The present authors conclude that concentrations of diisocyanates far below current exposure limits may induce hypersensitivity pneumonitis in susceptible subjects.

  10. Differentiation of bronchogenic carcinoma from secondary changes, obstructive pneumonitis and/or collapse by I-123 IMP lung imaging

    International Nuclear Information System (INIS)

    Nakajo, Masayuki; Uchiyama, Noriaki; Shimada, Jurio; Shinohara, Shinji; Iriki, Atsushi; Hirotsu, Yasunobu; Egawa, Katsushi; Fukunaga, Hidetomo; Norimatsu, Yoshimasa.

    1990-01-01

    Serial lung images with N-isopropyl-p-[I-123]-iodoamphetamine (I-123 IMP) were obtained to assess the imaging findings and to clarify the lesion to uptake relationships in 74 lesions in 73 patients with various histological types of bronchogenic carcinoma. A decreased uptake area was observed in all 74 lesions in the initial one or two-min I-123 IMP image. The initial image was analogous to a Tc-99m macroaggregated albumin (MAA) lung perfusion image in 70 patients in whom both lung imaging procedures were performed. The imaging findings changed following this initial phase. At 4 hr, the lesion was depicted as either areas of decreased uptake or increased uptake or a combination of the two. Comparison between the lesion findings in the 4-hr I-123 IMP images, radiograms and removed specimens revealed that areas of decreased uptake corresponded to the cancerous portions of the lung mass or pleural effusion and areas of increased uptake corresponded to inflammatory portions including obstructive pneumonitis and/or collapse. Thus, the 4-hr I-123 IMP lung images can be used to discriminate the cancerous portion from associated secondary changes, obstructive pneumonitis and/or collapse. (author)

  11. The analysis of prognostic factors affecting post-radiation acute reaction after conformal radiotherapy for non-small cell lung cancer

    OpenAIRE

    Spych, Michał; Gottwald, Leszek; Klonowicz, Małgorzata; Biegała, Michał; Bibik, Robert; Fijuth, Jacek

    2010-01-01

    Introduction The aim was to evaluate the risk of acute side effects in the lung after 3-dimensional conformal radiotherapy (3D-CRT) in patients treated for non-small cell lung cancer (NSCLC). An attempt was made to single out clinical factors and factors related to treatment technique which may induce acute post-radiation pneumonitis. Material and methods The analysis concerned 34 consecutive patients who underwent radical radiation therapy for NSCLC. Intensity of early toxicity was evaluated...

  12. Melioidosis: reactivation during radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jegasothy, B.V.; Goslen, J.B.; Salvatore, M.A.

    1980-05-01

    Melioidosis is caused by Pseudomonas pseudomallei, a gram-negative, motile bacillus which is a naturally occurring soil saprophyte. The organism is endemic in Southeast Asia, the Philippines, Australia, and parts of Central and South America. Most human disease occurs from infection acquired in these countries. Infection with P pseudomallei may produce no apparent clinical disease. Acute pneumonitis or septicemia may result from inhalation of the organism, and inoculation into sites of trauma may cause localized skin abscesses, or the disease may remain latent and be reactivated months or years later by trauma, burns, or pneumococcal pneumonia, diabetic ketoacidosis, influenza, or bronchogenic carcinoma. The last is probably the commonest form of melioidosis seen in the United States. We present the first case of reactivation of melioidosis after radiation therapy for carcinoma of the lung, again emphasizing the need to consider melioidosis in a septic patient with a history of travel, especially to Southeast Asia.

  13. Melioidosis: reactivation during radiation therapy

    International Nuclear Information System (INIS)

    Jegasothy, B.V.; Goslen, J.B.; Salvatore, M.A.

    1980-01-01

    Melioidosis is caused by Pseudomonas pseudomallei, a gram-negative, motile bacillus which is a naturally occurring soil saprophyte. The organism is endemic in Southeast Asia, the Philippines, Australia, and parts of Central and South America. Most human disease occurs from infection acquired in these countries. Infection with P pseudomallei may produce no apparent clinical disease. Acute pneumonitis or septicemia may result from inhalation of the organism, and inoculation into sites of trauma may cause localized skin abscesses, or the disease may remain latent and be reactivated months or years later by trauma, burns, or pneumococcal pneumonia, diabetic ketoacidosis, influenza, or bronchogenic carcinoma. The last is probably the commonest form of melioidosis seen in the United States. We present the first case of reactivation of melioidosis after radiation therapy for carcinoma of the lung, again emphasizing the need to consider melioidosis in a septic patient with a history of travel, especially to Southeast Asia

  14. Autoimmune Hypothyroidism As a Predictor of Mortality in Chronic Hypersensitivity Pneumonitis

    Directory of Open Access Journals (Sweden)

    Ayodeji Adegunsoye

    2017-10-01

    Full Text Available BackgroundChronic hypersensitivity pneumonitis (CHP is a fibrotic parenchymal lung disease that occurs when inhalation of environmental antigens leads to immune dysregulation. Autoimmune features have recently been identified as potentially important among patients with CHP. However, the relationship between hypothyroidism (HT and CHP is unknown. In this study, we investigate the prevalence and impact of HT among patients with CHP.MethodsWe conducted a retrospective, case–control analysis. We identified 121 patients at the University of Chicago Interstitial Lung Disease Center with a multidisciplinary diagnosis of CHP. These patients were matched 3:1 according to age, sex, and race to 363 control subjects with asthma from 2006 to 2015. We analyzed demographics, clinical characteristics, and survival between both groups and assessed the relationship of HT with CHP. Survival analysis was performed using Cox proportional hazards modeling.ResultsPatients with CHP had higher prevalence of HT (25.6%, n = 31 compared to controls (10.7%, n = 39; OR, 2.86; 95% CI, 1.62–4.99; P < 0.0001. Compared to CHP alone, patients with CHP/HT were more likely to be female (80.6 vs 51.1%, P = 0.004, have increased incidence of autoimmune disease (19.4 vs 3.3%, P = 0.009, antinuclear antibody seropositivity (80.6 vs 57.0%, P = 0.019, and higher TSH levels (4.0 vs 1.9 mIU/L, P < 0.0001. HT was a significant independent predictor of mortality among CHP patients with seropositive ANA (HR, 3.39; 95% CI, 1.31–8.80; P = 0.012.ConclusionHT is common in patients with CHP and may carry prognostic significance in patients with features of autoimmunity. Further research exploring common pathogenic pathways between autoimmune HT and CHP may illuminate the association of HT with survival.

  15. Symptomatic retention of the Agile® patency capsule.

    Science.gov (United States)

    Egea Valenzuela, Juan; Estrella Díez, Esther; Alberca de Las Parras, Fernando

    2017-06-01

    The Agile® capsule has shown to be useful when evaluating the patency of the small bowel in patients prior to capsule endoscopy studies. It is a safe tool and a low rate of complications have been reported, highlighting symptomatic retention, although references in literature are scarce and it is only observed in 1.2% of the procedures. We present the case of a symptomatic retention of this device in a patient with previously known colonic Crohn's disease in who a small bowel study was indicated and was sent for prior patency test.

  16. Occurrence of BOOP outside radiation field after radiation therapy for small cell lung cancer

    International Nuclear Information System (INIS)

    Hamanishi, Tohru; Oida, Kazukiyo; Morimatu, Takafumi

    2001-01-01

    We report a case of bronchiolitis obliterans organizing pneumonia (BOOP) that occurred outside the radiation field after radiation therapy for small cell lung cancer. A 74-year-old woman received chemotherapy and a total of 60 Gy of radiation therapy to the right hilum and mediastinum for small cell carcinoma of the suprahilar area of the right lung. Radiation pneumonitis developed within the radiation port 3 months after the completion of radiation therapy. She complained of cough and was admitted 7 months after completion of the radiation therapy. Chest radiography and computed tomography demonstrated peripheral alveolar opacities outside the radiation field on the side contralateral to that receiving the radiation therapy. Bronchoalveolar lavage showed that the total cell count was increased, with a markedly increased percentage of lymphocytes. Transbronchial lung biopsy revealed a histologic pattern consistent with BOOP. Treatment with corticosteroids resulted in rapid improvement of the symptoms and complete resolution of the radiographic abnormalities of the left lung. Although some cases of BOOP following radiation therapy for breast cancer have been reported, none of BOOP after radiation therapy for lung cancer have appeared in the literature. (author)

  17. [Symptoms and treatment of radiation-induced reactions].

    Science.gov (United States)

    Brzozowska, Anna; Idziak, Magdalena; Burdan, Franciszek; Mazurkiewicz, Maria

    2015-05-01

    Radiotherapy is one of the main methods of cancer treatment alone or in combination with chemotherapy. It is applied in about 60% of oncological patients. However, in spite of its clinical usefulness, radiotherapy is associated with a high risk of radiation-induced side effects, including dermatitis, enteritis, cystitis, pericarditis, pneumonia or depression, sexual function disorders, cardiomiopathy, coronary heart disease, anomalies of heart valves and development of second malignant tumor. The early diagnosis and proper treatment of radiation-induced side effects have a major impact on patients` quality of life and future prognosis. Radiation reactions can be categorized as acute or late, occurring before and after six months after radiotherapy. Among the most common acute reactions there were observed: skin rash, mucositis, nausea, vomiting, fever and radiation pneumonitis. Within reference to the late complications, we distinguish for instance fibrosis of organs, a radiation necrosis of bone, ulcers, fistulas, sexual dysfunction and the development of second malignant carcinomas. © 2015 MEDPRESS.

  18. Effect of Azithromycin plus Rifampin versus That of Azithromycin Alone on the Eradication of Chlamydia pneumoniae from Lung Tissue in Experimental Pneumonitis

    OpenAIRE

    Wolf, Katerina; Malinverni, Raffaele

    1999-01-01

    Azithromycin, doxycycline, and rifampin, alone or in combination, were tested in vitro against Chlamydia pneumoniae AR-39. The combination of azithromycin plus rifampin showed the strongest activity and produced higher rates of eradication of C. pneumoniae from lung tissues than azithromycin alone in experimental mouse pneumonitis.

  19. Vertebral metastases with high risk of symptomatic malignant spinal cord compression

    International Nuclear Information System (INIS)

    Hamamoto, Yasushi; Kataoka, Masaaki; Senba, Takatoshi

    2009-01-01

    To find vertebral metastases with high risk of symptomatic malignant spinal cord compression (MSCC), features of vertebral metastases caused motor deficits of the lower extremities were examined. From 2004 through 2006, 78 patients with metastases of the thoracic and/or the cervical spine were treated with radiation therapy (RT). Of these, 86 irradiated lesions in 73 patients were evaluable by magnetic resonance imaging and/or computed tomography at the initiation of RT and were reviewed retrospectively in this study. Twenty-eight patients (38%) had motor deficits at the initiation of RT. Assessed factors were age, sex, primary disease (lung, breast, digestive system and other cancer), lamina involvement, main level of tumor location and vertebral-body involvement. Incidence of motor deficits at the initiation of RT was 55% for lesions with lamina involvement and 5% for lesions without lamina involvement (P 0.9999, P=0.7798, P=0.1702 and P=0.366, respectively). Vertebral metastases with lamina involvement tended to cause symptomatic MSCC. Latent development of MSCC occurred more frequently in the MTS compared with other levels of the thoracic and the cervical spine. (author)

  20. Mammographic profiles of women with symptomatic breast diseases ...

    African Journals Online (AJOL)

    Methods: This was a prospective descriptive analytical study of women with symptomatic breast diseases who had mammography between January 2012 and December 2016 at our health facilities. Data sheet was developed to record the patients' biodata, indication for referral, and mammographic findings. Results: During ...

  1. Symptomatic Neuroma Following Initial Amputation for Traumatic Digital Amputation.

    Science.gov (United States)

    Vlot, Margot A; Wilkens, Suzanne C; Chen, Neal C; Eberlin, Kyle R

    2018-01-01

    We tested the null hypothesis that no factors are independently associated with the development of symptomatic neuroma after traumatic digital amputation. We performed a retrospective review of 1,083 patients who underwent revision amputation for traumatic digital amputation; we excluded those undergoing replantation or revascularization. Patients who developed a painful neuroma during follow-up were identified with a minimum follow-up of 1 week and a median of 3.3 months. We calculated the rate of developing a painful neuroma as a proportion of the total number of patients and performed multivariable logistic regression analysis to identify factors independently associated with its development. Of 1,083 patients, 71 (6.6%) developed a symptomatic neuroma. Mean time to diagnosis was 6.4 months. A total of 47 patients (66%) underwent surgery for painful neuroma. Mean time to surgical intervention was 11 months. Index finger injury and avulsion injury mechanism were significantly associated with a higher risk for symptomatic neuroma. Approximately 1 in 15 patients will develop a symptomatic neuroma after traumatic digital amputation and more than half of these patients will undergo revision surgery for neuroma, with a mean time to operative intervention of 11 months. Prognostic II. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  2. Evaluation of prognostic value of albumin and iron in symptomatic ...

    African Journals Online (AJOL)

    Background & objectives: This study was designed to assess the prognostic value of albumin and iron in symptomatic HIV subjects on ART with or without malaria infection. Methods: 150 participants (male, n=65, female, n=85) aged between 17 and 70 years were recruited for the study at the HIV clinic of Nnamdi Azikiwe ...

  3. Symptomatic rubella re-infection in early pregnancy and subsequent ...

    African Journals Online (AJOL)

    A case of serologically proven symptomatic rubella re-infection in early pregnancy in a healthy multigravida who had been successfully vaccinated is reported to illustrate that the risk to the fetus is considerably less than with primary infection. The infant was infected, as evidenced by specific IgM in cord blood, but had no ...

  4. Symptomatic Tarlov Cysts: Surgical Treatment by Subcutaneous Infusion Port.

    Science.gov (United States)

    Huang, Ying; Zhu, Tong; Lin, Hongyi; Li, Jing; Zeng, Tao; Lin, Jian

    2018-05-01

    The treatment of Tarlov cysts is challenging and difficult. The objective of our study was to describe the security and efficacy of the subcutaneous infusion port for drainage of symptomatic Tarlov cysts. The authors executed a retrospective review of data from 5 symptomatic Tarlov cysts patients who were treated using a subcutaneous infusion port from June 2014 to July 2017. Numerical Rating Scale scores and the Japanese Orthopedic Association scores of back pain were analyzed. Complications and adverse effects on postoperative days 1, 7, 14, and 28 were also analyzed. The mean follow-up was 12.6 months. Five adults (3 females and 2 males) who had been symptomatic received a subcutaneous infusion port. After treatment, all patients experienced pain relief and pain alleviation lasted from 1 day to 3 years without complications and adverse effects. A subcutaneous infusion port is a useful treatment option for symptomatic Tarlov cysts. When the patients' symptoms returned and the cysts repressurized, we quickly and simply drained the cysts by using the infusion port. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. Delayed treatment of symptomatic breast cancer: The experience ...

    African Journals Online (AJOL)

    Background. A cross-sectional study carried out at a teaching hospital in Kaduna, Nigeria, to investigate the extent and reasons for the delay between onset of symptoms and admission for treatment of symptomatic breast cancer. Methods. The patients had histologically proven breast cancer and had been admitted for ...

  6. urinary tract infections in symptomatic pregnant women attending

    African Journals Online (AJOL)

    Administrator

    cause urinary tract infections. Several factors are known to predispose an individual to developing urinary tract infections; one of the factors is pregnancy. Therefore, this research set out to determine the bacteriologic profile of urinary tract infection and the susceptibility pattern among symptomatic pregnant women in Abuja.

  7. Symptomatic Bochdalek Hernia in Pregnancy: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    Selçuk Yetkinel

    2017-01-01

    Full Text Available Introduction. Symptomatic Bochdalek hernia in pregnancy is quite rare. To the best of our knowledge, there are a total of 44 cases reported in the literature between 1959 and 2016 (Hernández-Aragon et al., 2015; Koca et al., 2016. Difficulty and delay in diagnosis may lead to life-threatening complications. Case Report. We report a case of Bochdalek hernia during the 30 gestational weeks’ pregnancy in whom pregnancy continued after surgical repair which resulted in term birth. Discussion. Bochdalek hernia is diagnosed with an incidence of 1 in 2200–12500 live births, while symptomatic diaphragm hernia is much less in adults. The actual incidence of diaphragmatic hernias during pregnancy is still unknown. Symptoms may include abdominal distension, recurrent abdominal pain, nausea, vomiting, inability to defecate, dyspnea, and chest pain. The patient with diaphragmatic hernia may be asymptomatic until the late weeks of gestation, as in our case, or herniation may occur during advanced gestational weeks with increased intraabdominal pressure. Conclusion. In conclusion, diagnosis of the diaphragm hernia during pregnancy is very rare. Diagnosis is rarer in symptomatic patients due to its rarity and the duration of diagnosis may, therefore, be delayed. Diaphragm hernia should be kept in mind in symptomatic patients due to its high maternal and fetal mortality rates.

  8. Symptomatic Non-parasitic benign hepatic cyst: Evaluation of ...

    African Journals Online (AJOL)

    Background/Purpose: Solitary non-parasitic cysts of the liver are commonly asymptomatic and do not require treatment. Rarely, however, the cysts become symptomatic and are then best treated surgically. The optimal surgical treatment is debatable. The aim of this study was to evaluate the role of deroofing as a safe and ...

  9. Symptomatic HIV infection in infancy - clinical and laboratory ...

    African Journals Online (AJOL)

    Objective. To investigate the usefulness of immunological tests in the diagnosis of HIV infection in young symptomatic children < 15 months of age). Design. Tests were evaluated in HIV-infected ... The test detected 16 of 19 infected infants (sensitivity 84%, negative predictive value 98%). With the exception of the finding of ...

  10. Symptomatic Raccoon Dogs and Sarcoptic Mange Along an Urban Gradient.

    Science.gov (United States)

    Saito, Masayuki U; Sonoda, Yoichi

    2017-06-01

    We quantitatively evaluated the effects of landscape factors on the distribution of symptomatic raccoon dogs with sarcoptic mange along an urban gradient. We used 246 camera traps (182 traps from April 2005 to December 2006; 64 traps from September 2009 to October 2010) to record the occurrence of asymptomatic and symptomatic raccoon dogs at 21 survey sites along an urban-rural gradient in the Tama Hills area of Tokyo. Each occurrence was explained in terms of the surrounding forest, agricultural, and grassland areas and additional factors (i.e., seasonal variations and survey methods) at various spatial scales using a generalized additive mixed model (GAMM). In our analysis, a 1000-m radius was identified as the important spatial scale for asymptomatic and symptomatic raccoon dog occurrence. The peak of the predicted occurrence probability of asymptomatic raccoon dogs appeared in the intermediate forest landscape as opposed to non-forest and forest landscapes. However, a high occurrence probability of symptomatic raccoon dogs was detected in non-forest and intermediate forest landscapes (i.e., urban and suburban) as opposed to a forest landscape, presumably because of animals occurring at much higher densities in more urbanized areas. Therefore, our results suggest that human-modified landscapes play an important role in the high occurrence of sarcoptic mange in raccoon dogs.

  11. Symptomatic Uterine Leiomyoma in a 65-year old Postmenopausal ...

    African Journals Online (AJOL)

    She presented with constipation suggestive of intestinal obstruction with no history of previous surgery, and investigations confirmed a calcified uterine leiomyoma. She had exploratory ... Symptomatic uterine leiomyoma in an elderly postmenopausal woman is rare, and its coexistence with CIN III in a virgin, is even rarer.

  12. Symptomatic pelvic organ prolapse: Experience at a tertiary ...

    African Journals Online (AJOL)

    To determine the demographic characteristics in patients presenting with symptomatic POP to a tertiary urogynaecology .... regarding their vaginal symptoms, namely: 1. Are you aware of a dragging pain in your lower abdomen? 2. Are you aware of soreness in your vagina? 3. ... for each question on a scale from 1 to 10.

  13. Plasmodium falciparum multiplicity correlates with anaemia in symptomatic malaria

    NARCIS (Netherlands)

    Mockenhaupt, Frank P.; Ehrhardt, Stephan; Eggelte, Teunis A.; Markert, Miriam; Anemana, Sylvester; Otchwemah, Rowland; Bienzle, Ulrich

    2003-01-01

    In 366 Ghanaian children with symptomatic Plasmodium falciparum malaria, low haemoglobin levels and severe anaemia were associated with a high multiplicity of infection (MOI) and with distinct merozoite surface protein alleles. High MOI not only reflects premunition but may also contribute to

  14. Symptomatic HIV infection in infancy - clinical and laboratory ...

    African Journals Online (AJOL)

    in infancy - clinical and laboratory markers of infection. M P Meyer, Z Latief, C Haworlh, 5 Salie,. A van Dyk. Objective. To investigate the usefulness of immunological tests in the diagnosis of HIV infection in young symptomatic children « 15 months of age). Design. Tests were evaluated in HIV-infected (HIV antibody- and ...

  15. Prevalence and associations of symptomatic renal papillary necrosis ...

    African Journals Online (AJOL)

    Aim: To assess the prevalence and associations of symptomatic renal papillary necrosis (RPN) in sickle cell anemia patients. Patients and Methods: The case notes of homozygous hemoglobin (Hb) S patients diagnosed with RPN were retrospectively assessed. Diagnosis was based on microscopic hematuria and positive ...

  16. Radiological and clinical pneumonitis after stereotactic lung radiotherapy: a matched analysis of three-dimensional conformal and volumetric-modulated arc therapy techniques.

    Science.gov (United States)

    Palma, David A; Senan, Suresh; Haasbeek, Cornelis J A; Verbakel, Wilko F A R; Vincent, Andrew; Lagerwaard, Frank

    2011-06-01

    Lung fibrosis is common after stereotactic body radiotherapy (SBRT) for lung tumors, but the influence of treatment technique on rates of clinical and radiological pneumonitis is not well described. After implementing volumetric modulated arc therapy (RapidArc [RA]; Varian Medical Systems, Palo Alto, CA) for SBRT, we scored the early pulmonary changes seen with arc and conventional three-dimensional SBRT (3D-CRT). Twenty-five SBRT patients treated with RA were matched 1:2 with 50 SBRT patients treated with 3D-CRT. Dose fractionations were based on a risk-adapted strategy. Clinical pneumonitis was scored using Common Terminology Criteria for Adverse Events version 3.0. Acute radiological changes 3 months posttreatment were scored by three blinded observers. Relationships among treatment type, baseline factors, and outcomes were assessed using Spearman's correlation, Cochran-Mantel-Haenszel tests, and logistic regression. The RA and 3D-CRT groups were well matched. Forty-three patients (57%) had radiological pneumonitis 3 months after treatment. Twenty-eight patients (37%) had computed tomography (CT) findings of patchy or diffuse consolidation, and 15 patients (20%) had ground-glass opacities only. Clinical pneumonitis was uncommon, and no differences were seen between 3D-CRT vs. RA patients in rates of grade 2/3 clinical pneumonitis (6% vs. 4%, respectively; p = 0.99), moderate/severe radiological changes (24% vs. 36%, respectively, p = 0.28), or patterns of CT changes (p = 0.47). Radiological severity scores were associated with larger planning target volumes (p = 0.09) and extended fractionation (p = 0.03). Radiological changes after lung SBRT are common with both approaches, but no differences in early clinical or radiological findings were observed after RA. Longer follow-up will be required to exclude late changes. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Relationship between longitudinal strain and symptomatic status in aortic stenosis.

    Science.gov (United States)

    Attias, David; Macron, Laurent; Dreyfus, Julien; Monin, Jean-Luc; Brochet, Eric; Lepage, Laurent; Hekimian, Guillaume; Iung, Bernard; Vahanian, Alec; Messika-Zeitoun, David

    2013-08-01

    Global longitudinal strain (GLS) and basal longitudinal strain (BLS) assessed using two-dimensional speckle-tracking imaging have been proposed as subtle markers of left ventricular (LV) systolic dysfunction with potential prognostic value in patients with aortic stenosis (AS). The aim of this study was to evaluate the relationship between longitudinal strain and symptomatic status in patients with AS. GLS and BLS were measured in 171 patients with pure, isolated, at least mild AS prospectively enrolled at two institutions. The population was divided into four groups: asymptomatic nonsevere AS (n = 55), asymptomatic severe AS with preserved LV ejection fraction (LVEF; ≥50%) (n = 37), symptomatic severe AS with preserved LVEF (n = 60), and severe AS with reduced LVEF (<50%) (n = 19). GLS was significantly different among the four groups (P < .0001), but the difference was due mainly to patients with reduced LVEFs. In addition, there was an important overlap among the groups, and in multivariate analysis, after adjustment for age, gender, AS severity, and LVEF, GLS was not an independent predictor of symptomatic status (P = .07). BLS was also significantly different among the four groups (P < .0001) but in contrast was independently associated with symptomatic status (P < .0001). However, as for GLS, there was an important overlap between groups and differences were close to intraobserver or interobserver variability (1.3 ± 1.1% and 2.0 ± 1.6%, respectively). In this prospective multicenter cohort of patients with wide ranges of AS severity, symptoms, and LVEFs, BLS but not GLS was independently associated with symptomatic status. However, there was an important overlap among groups, and differences were close to measurements' reproducibility, raising caution regarding the use of longitudinal strain, at least as a single criterion, in the decision-making process for patients with severe asymptomatic AS. Copyright © 2013. Published by Mosby, Inc.

  18. Outcome of endovascular treatment in symptomatic intracranial vascular stenosis

    International Nuclear Information System (INIS)

    Suh, Dae Chul; Kim, Sang Joon; Lee, Duk Hee; Kim, Won; Choi, Choong Gon; Lee, Jeong Hyun; Kwon, Sun Uck; Kim, Jong Sung; Kim, Hyun Jeong

    2005-01-01

    The outcome evaluation for the revascularization of intracranial vascular stenoses has not been fully described due to the highly technical nature of the procedure. We report here on the early and late clinical outcome of angioplasty and/or stenting of symptomatic severe intracranial vascular stenoses at a single institute. Since 1995, we have treated 35 patients with symptomatic intracranial vascular stenosis (more than 70% stenosis, mean stenosis: 78.6% ± 6.2%). Angioplasty (n = 19) was performed for the horizontal segment of the middle cerebral artery (M1) (n = 16) and the basilar artery (BA) (n = 1), the intradural vertebral artery (VA) (n = 1), and the cavernous internal carotid artery (ICA) (n = 1). Stenting (n = 16) was performed for the cavernous or petrous ICAs (n = 9), the intradural VA (n = 3), BA (n = 2), and M1 (n = 2) artery. We assessed the angiographic success (defined as residual stenosis < 50%) rate, the periprocedural complications during the 30-day periprocedural period, the symptomatic recurrence and restenosis during a mean 22-month follow-up (FU) period. The Kaplan-Meier estimate of the cumulative even-free rate of the major cerebrovascular events, i.e. death, stroke or restenosis, was also done. Angiographic success was achieved in 97% of our patients (34/35). There were four procedure-related complications (11%) including a death and a minor stroke. During the mean 22-month FU, the asymptomatic restenosis rate was 9% and the symptomatic restenosis rate was 6% in the target lesion and 9% in all the vascular territories. The Kaplan-Meier estimate was 70.6% (95% confidence interval = 46.5-94.7) after 33 month of FU. In addition to a high angiographic success rate and an acceptable periprocedural complication rate, intracranial angioplasty and/or stenting revealed a relatively low symptomatic recurrence rate. Hemorrhage is a rare, but the physician must aware that potentially fatal periprocedural complications can occur

  19. Does highly symptomatic class membership in the acute phase predict highly symptomatic classification in victims 6 months after traumatic exposure?

    Science.gov (United States)

    Hansen, Maj; Hyland, Philip; Armour, Cherie

    2016-05-01

    Recently studies have indicated the existence of both posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) subtypes but no studies have investigated their mutual association. Although ASD may not be a precursor of PTSD per se, there are potential benefits associated with early identification of victims at risk of developing PTSD subtypes. The present study investigates ASD and PTSD subtypes using latent class analysis (LCA) following bank robbery (N=371). Moreover, we assessed if highly symptomatic ASD and selected risk factors increased the probability of highly symptomatic PTSD. The results of LCA revealed a three class solution for ASD and a two class solution for PTSD. Negative cognitions about self (OR=1.08), neuroticism (OR=1.09) and membership of the 'High symptomatic ASD' class (OR=20.41) significantly increased the probability of 'symptomatic PTSD' class membership. Future studies are needed to investigate the existence of ASD and PTSD subtypes and their mutual relationship. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Myocardial Crypts: An incidental fi nding in a symptomatic patient with raised troponin

    Directory of Open Access Journals (Sweden)

    Ihab S Ramzy

    2014-01-01

    Full Text Available A 61 year old female of Asian origin presented with a two day history of intermittent sharp central chest pain radiating to the left shoulder, with each episode lasting a few seconds. Associated symptoms included exertional dyspnoea and limited exercise capacity to one fl ight of stairs. She denied any palpitations, pre-syncope or syncope. She had no orthopnoea, paroxysmal nocturnal dyspnoea or ankle swelling. She had stable pulmonary sarcoidosis, dual-chamber pacemaker insertion for symptomatic bradycardia 7 years ago, non-insulin dependent diabetes mellitus, hypertension, benign paroxysmal positional vertigo from the right ear, and hearing diffi culties. Drug history included Metformin 500 mg, Ramipril 10 mg, Bendrofl umethiazide 2.5 mg, Aspirin 75 mg and Simvastatin 20 mg. She had no known drug allergies.

  1. Neumonitis por hipersensibilidad en la ciudad de México Hypersensitivity pneumonitis in Mexico City

    Directory of Open Access Journals (Sweden)

    José G. Carrillo-Rodríguez

    2000-06-01

    Full Text Available OBJETIVO: Determinar la asociación entre la zona urbana de origen del paciente en la ciudad de México y la prevalencia de neumonitis por hipersensibilidad inducida por antígeno aviario. MATERIAL Y MÉTODOS: Se trata de un estudio de casos y controles realizado en el Instituto Nacional de Enfermedades Respiratorias, en la ciudad de México, en el año de 1999. Se estudiaron 109 casos con neumonitis por hipersensibilidad y 184 controles: de éstos, 39, con fibrosis pulmonar idiopática; 63, con tuberculosis pulmonar, y 82, con asma. La ciudad de México y las zonas conurbadas se dividieron en cinco zonas geográficas: centro, noreste, sureste, noroeste y el suroeste. Se calcularon las prevalencias de las diferentes enfermedades por zona urbana de los pacientes que participaron en el estudio; como medida de asociación, se estimó la razón de momios, con un intervalo de confianza al 95%. Asimismo, se realizó regresión logística múltiple ajustando por edad, sexo y estrato socioeconómico. RESULTADOS: Ochenta casos de neumonitis por hipersensibilidad se concentraron en el sur del noreste de las zonas conurbadas y la parte norte del sureste de la ciudad de México, 48 y 32, respectivamente (RM= 3.86, IC 95% 2.17-6.96. Treinta y seis controles de asma se localizaron en el suroeste de la ciudad de México, zona donde se ubica el Intituto Nacional de Enfermedades Respiratorias (pOBJECTIVE: To investigate the association between the urban area of origin of patients and the prevalence of hypersensitivity pneumonitis (HP, induced by avian antigens. MATERIAL AND METHODS: A case-control study was conducted in 1999 at the National Institute of Respiratory Diseases (NIRD. Cases were 109 consecutive HP patients and controls were 184 patients: 39 with idiopathic pulmonary fibrosis (IPF, 63 with pulmonary tuberculosis (PTB, and 82 with asthma. Mexico City and surrounding counties (SC were divided into 5 geographical areas: 1 Downtown; 2 North-East (NE; 3

  2. Are indoor concentrations of airborne mould spores in non-industrial environments sufficiently high to cause hypersensitivity pneumonitis?

    DEFF Research Database (Denmark)

    Kolstad, Henrik A; Skov, Simon; Malling, Tine Birgitte Halsen

    2014-01-01

    OBJECTIVES: Antigen exposure is the only diagnostic criteria specific for hypersensitivity pneumonitis (HP) compared with other interstitial lung diseases. Indoor mould exposure in non-industrial environments has been claimed to cause HP, but little is known about exposure levels. Our objective...... was to compare indoor concentrations of airborne mould spores for patients diagnosed with indoor HP with background levels and levels measured for patients diagnosed with farmers' lung and suberosis. METHOD: We included 8 patients diagnosed with HP based on characteristic clinical findings, signs of indoor mould...... growth at home or at their non-industrial work place, and increased levels of precipitating antibodies for moulds. We collected 110 air samples from all affected rooms, adjacent rooms, and outdoor. RESULTS: The average total spore concentrations varied between 22 000 and 36 000 spores per m(3...

  3. Role of lysosomal enzymes released by alveolar macrophages in the pathogenesis of the acute phase of hypersensitivity pneumonitis

    Directory of Open Access Journals (Sweden)

    J. L. Pérez-Arellano

    1995-01-01

    Full Text Available Hydrolytic enzymes are the major constituents of alveolar macrophages (AM and have been shown to be involved in many aspects of the inflammatory pulmonary response. The aim of this study was to evaluate the role of lysosomal enzymes in the acute phase of hypersensitivity pneumonitis (HPs. An experimental study on AM lysosomal enzymes of an HP-guinea-pig model was performed. The results obtained both in vivo and in vitro suggest that intracellular enzymatic activity decrease is, at least partly, due to release of lysosomal enzymes into the medium. A positive but slight correlation was found between extracellular lysosomal activity and four parameters of lung lesion (lung index, bronchoalveolar fluid total (BALF protein concentration, BALF LDH and BALF alkaline phosphatase activities. All the above findings suggest that the AM release of lysosomal enzymes during HP is a factor involved, although possibly not the only one, in the pulmonary lesions appearing in this disease.

  4. Positive fungal quantitative PCR and Th17 cytokine detection in bronchoalveolar lavage fluids: Complementary biomarkers of hypersensitivity pneumonitis?

    Science.gov (United States)

    Bellanger, Anne-Pauline; Gbaguidi-Haore, Houssein; Gondoin, Anne; Pallandre, Jean-Rene; Vacheyrou, Mallory; Valot, Benoit; Soumagne, Thibaud; Reboux, Gabriel; Dalphin, Jean-Charles; Millon, Laurence

    2016-07-01

    Interstitial lung disease (ILD) is a large group of diseases, including hypersensitivity pneumonitis (HP), idiopathic pulmonary fibrosis (IPF) and sarcoidosis. In this study, we aimed to identify bronchoalveolar lavage fluid (BALF) biomarkers which could be contributive for HP diagnosis. We analyzed 39 BALF samples from 12 ILD patients with sarcoidosis, 11 with IPF and 16 with HP. We determined the levels of 10 cytokines and carried out quantitative PCR for 10 microorganisms involved in farm-associated or domestic forms of HP. IL-8, IL-6, TNFα, IL-17 and IL-23 levels were significantly higher in BALF samples from HP patients (psebi were positively significantly more frequently for HP patients (p<0.05, one-way Kruskal-Wallis). The biomarkers identified here can be detected in BALF, which could be routinely obtained as complementary analysis in ILD diagnosis. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Yersinia pestis endowed with increased cytotoxicity is avirulent in a bubonic plague model and induces rapid protection against pneumonic plague.

    Directory of Open Access Journals (Sweden)

    Ayelet Zauberman

    Full Text Available An important virulence strategy evolved by bacterial pathogens to overcome host defenses is the modulation of host cell death. Previous observations have indicated that Yersinia pestis, the causative agent of plague disease, exhibits restricted capacity to induce cell death in macrophages due to ineffective translocation of the type III secretion effector YopJ, as opposed to the readily translocated YopP, the YopJ homologue of the enteropathogen Yersinia enterocolitica Oratio8. This led us to suggest that reduced cytotoxic potency may allow pathogen propagation within a shielded niche, leading to increased virulence. To test the relationship between cytotoxic potential and virulence, we replaced Y. pestis YopJ with YopP. The YopP-expressing Y. pestis strain exhibited high cytotoxic activity against macrophages in vitro. Following subcutaneous infection, this strain had reduced ability to colonize internal organs, was unable to induce septicemia and exhibited at least a 10(7-fold reduction in virulence. Yet, upon intravenous or intranasal infection, it was still as virulent as the wild-type strain. The subcutaneous administration of the cytotoxic Y. pestis strain appears to activate a rapid and potent systemic, CTL-independent, immunoprotective response, allowing the organism to overcome simultaneous coinfection with 10,000 LD(50 of virulent Y. pestis. Moreover, three days after subcutaneous administration of this strain, animals were also protected against septicemic or primary pneumonic plague. Our findings indicate that an inverse relationship exists between the cytotoxic potential of Y. pestis and its virulence following subcutaneous infection. This appears to be associated with the ability of the engineered cytotoxic Y. pestis strain to induce very rapid, effective and long-lasting protection against bubonic and pneumonic plague. These observations have novel implications for the development of vaccines/therapies against Y. pestis and shed

  6. Detection of radiation-induced lung injury using hyperpolarized (13)C magnetic resonance spectroscopy and imaging.

    Science.gov (United States)

    Thind, K; Chen, A; Friesen-Waldner, L; Ouriadov, A; Scholl, T J; Fox, M; Wong, E; VanDyk, J; Hope, A; Santyr, G

    2013-09-01

    Radiation-induced lung injury limits radiotherapy of thoracic cancers. Detection of radiation pneumonitis associated with early radiation-induced lung injury (2-4 weeks postirradiation) may provide an opportunity to adjust treatment, before the onset of acute pneumonitis and/or irreversible fibrosis. In this study, localized magnetic resonance (MR) spectroscopy and imaging of hyperpolarized (13)C-pyruvate (pyruvate) and (13)C-lactate (lactate) were performed in the thorax and kidney regions of rats 2 weeks following whole-thorax irradiation (14 Gy). Lactate-to-pyruvate signal ratio was observed to increase by 110% (P radiated rats compared with healthy age-matched rats. This was consistent with lung inflammation confirmed using cell micrographs of bronchioalveolar lavage specimens and decreases in arterial oxygen partial pressure (paO2), indicative of hypoxia. No statistically significant difference was observed in either lactate-to-pyruvate signal ratios in the kidney region (P = 0.50) between the healthy (0.215 ± 0.100) and radiated cohorts (0.215 ± 0.054) or in blood lactate levels (P = 0.69) in the healthy (1.255 ± 0.247 mmol/L) and the radiated cohorts (1.325 ± 0.214 mmol/L), confirming that the injury is localized to the thorax. This work demonstrates the feasibility of hyperpolarized (13)C metabolic MR spectroscopy and imaging for detection of early radiation-induced lung injury. Copyright © 2012 Wiley Periodicals, Inc.

  7. Urine sampling techniques in symptomatic primary-care patients

    DEFF Research Database (Denmark)

    Holm, Anne; Aabenhus, Rune

    2016-01-01

    in primary care. The aim of this study was to determine the accuracy of urine culture from different sampling-techniques in symptomatic non-pregnant women in primary care. Methods: A systematic review was conducted by searching Medline and Embase for clinical studies conducted in primary care using...... a randomized or paired design to compare the result of urine culture obtained with two or more collection techniques in adult, female, non-pregnant patients with symptoms of urinary tract infection. We evaluated quality of the studies and compared accuracy based on dichotomized outcomes. Results: We included...... seven studies investigating urine sampling technique in 1062 symptomatic patients in primary care. Mid-stream-clean-catch had a positive predictive value of 0.79 to 0.95 and a negative predictive value close to 1 compared to sterile techniques. Two randomized controlled trials found no difference...

  8. Prevalence of nutritional rickets among symptomatic children and ...

    African Journals Online (AJOL)

    Results: The prevalence of NR among symptomatic children aged 0-3 yearswas615 (95.35%). Males were 330 (53.7%), females were 285 (46.3%) with age ranging from 0 to three years. The prevalence of NR in the 6-12 months age group was 39.2% and 37.7% in the 1-1.5 year's age group. Exclusive breastfeeding rate at ...

  9. Plaque Characteristics of Patients with Symptomatic Mild Carotid Artery Stenosis.

    Science.gov (United States)

    Takai, Hiroki; Uemura, Juniti; Yagita, Yoshiki; Ogawa, Yukari; Kinoshita, Keita; Hirai, Satoshi; Ishihara, Manabu; Hara, Keijirou; Toi, Hiroyuki; Matsubara, Shunji; Nishimura, Hirotake; Uno, Masaaki

    2018-03-20

    Carotid revascularization may be considered for severe stenosis, but its use for symptomatic mild stenosis (<50%) with vulnerable plaque or ulcer remains uncertain. The characteristics of patients with symptomatic mild stenosis who underwent revascularization are reviewed. The subjects of this study were 18 patients with symptomatic mild stenosis (<50%) on angiography from among 175 patients who underwent revascularization in our department. The plaques were evaluated by black-blood magnetic resonance imaging (BB-MRI) and ultrasonography (US) and classified into 2 types: type 1 (n = 15), a lesion with an ulcer or mobile plaque or thrombosis on angiography or US; and type 2 (n = 3), a lesion without any of the above. Fourteen patients underwent carotid endarterectomy (CEA), and 4 patients underwent carotid artery stenting. The stenosis on angiography was 27.2% ± 10.7 (5%-41%), and the area carotid artery stenosis rate on US was 69.8 ± 14.5% (44.5%-97%). The stenosis rate of these 2 methods was not at all correlated. In type 1 plaque that underwent CEA, 10 of 11 patients had vulnerable plaque by histopathology, and 1 patient had thrombus on the plaque by operative findings. In type 2 plaque that underwent CEA, all patients had vulnerable plaque by histopathology. During the follow-up period, none of the patients had restenosis or stroke. The findings of US and BB-MRI in patients with symptomatic mild stenosis (<50%) on angiography are important for determining treatment. If BB-MRI or US shows the findings of vulnerable plaque in mild stenosis, surgical treatment may be considered for these patients. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  10. Quality Assurance Standards for Symptomatic Breast Disease Services

    OpenAIRE

    Department of Health (Ireland)

    2007-01-01

    Quality Assurance Standards for Symptomatic Breast Disease Services People in Ireland have a right to expect that medical care be of good quality. They expect that standards of care are consistently high. They expect that access to care is easy, speedy, effective and efficient. Society expects quality of care to measure up to international norms of good practice. Such assurance can be given by auditing the quality of activity. Click here to download PDF 606kb

  11. Percutaneous ultrasonic lithotripsy of symptomatic renal calculi in children

    Energy Technology Data Exchange (ETDEWEB)

    Papanicolaou, N.; Pfister, R.C.; Yoder, I.C.; Young, H.H. II; Herrin, J.T.

    1986-01-01

    Percutaneous ultrasonic lithotripsy of upper urinary tract lithiasis is a well-established procedure in adults. We successfully applied this technique to completely remove symptomatic renal calculi in two children with idiopathic hypercalciuria. The procedure was well tolerated and no complications occurred. Both patients were discharged within 4 days of the lithotripsy. This method is an alternative to surgery for the removal of large or impacted calculi from the upper urinary tracts of pediatric patients. (orig.).

  12. Percutaneous ultrasonic lithotripsy of symptomatic renal calculi in children

    International Nuclear Information System (INIS)

    Papanicolaou, N.; Pfister, R.C.; Yoder, I.C.; Young, H.H. II; Herrin, J.T.

    1986-01-01

    Percutaneous ultrasonic lithotripsy of upper urinary tract lithiasis is a well-established procedure in adults. We successfully applied this technique to completely remove symptomatic renal calculi in two children with idiopathic hypercalciuria. The procedure was well tolerated and no complications occurred. Both patients were discharged within 4 days of the lithotripsy. This method is an alternative to surgery for the removal of large or impacted calculi from the upper urinary tracts of pediatric patients. (orig.)

  13. Symptomatic Congenital Cytomegalovirus Infection Is Underdiagnosed in British Columbia.

    Science.gov (United States)

    Sorichetti, Brendan; Goshen, Oran; Pauwels, Julie; Kozak, Frederick K; Tilley, Peter; Krajden, Mel; Gantt, Soren

    2016-02-01

    Records were reviewed from all infants tested for congenital cytomegalovirus infection in British Columbia, Canada from 2006 to June 2014. Fourteen of 701 infants, or approximately 4.2 per 100,000 live births, had a positive test, indicating that >90% of expected symptomatic congenital cytomegalovirus infection cases were not diagnosed using clinician-initiated testing. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Arthroscopic Excision of a Symptomatic Meso-acromiale

    OpenAIRE

    Stetson, William B.; McIntyre, J. Alex; Mazza, Genevieve R.

    2017-01-01

    The surgical technique for the management of a symptomatic os acromiale remains unclear. Several operative techniques have been described including open excision, open reduction?internal fixation (ORIF), arthroscopic acromioplasty or subacromial decompression, and arthroscopic excision. There are 4 types of os acromiale, with the meso-acromion being the most common and difficult to treat. The excision of a pre-acromion arthroscopically or in an open manner usually produces satisfactory result...

  15. Symptomatic Congenital Cytomegalovirus Infection in Children of Seropositive Women

    OpenAIRE

    Ines Mack; Marie-Anne Burckhardt; Marie-Anne Burckhardt; Ulrich Heininger; Friederike Prüfer; Sven Schulzke; Sven Wellmann

    2017-01-01

    Cytomegalovirus (CMV) is the most frequent congenital virus infection worldwide. The risk of congenital CMV (cCMV) transmission is highest in seronegative women who acquire primary CMV infection during pregnancy. A growing body of evidence indicates that secondary CMV infections in pregnant women with preconceptual immunity (either through reactivation of latent virus or re-infection with a new strain of CMV) contribute to a much greater proportion of symptomatic cCMV than was previously thou...

  16. Clinical-pathomorphological correlation in patients with symptomatic dystonias

    Directory of Open Access Journals (Sweden)

    Ivanović Nataša

    2002-01-01

    Full Text Available Symptomatic dystonia can be the result of various metabolic, degenerative diseases, the consumption of certain medications or exposure to toxic agents. However, only symptomatic dystonia with focal structural lesion provides a significant "window" for, at least indirect, perception of aetiopa-thogenesis and pathomorphological substratum of idiopathic dystonia. Our study included 57 patients with symptomatic dystonia, which as a base had focal or multifocal lesions, of whom 7 patients had generalized dystonia, 18 hemidystonia, 6 segmental dystonia, 7 torticollis, 6 blepharospasm, 7 hand dystonia, 3 spasmodic dysphonia, and 3 had oromandibular dystonia. Stroke was highly statistically the most frequent cause of structural lesions (33/57 or 58%. Relevant pathomorphological changes were present in 50/57 (88% patients, of whom 25 (50% had lesion in the lenticular nucleus (including individual damage of the putamen and globus pallidus, 12/50 (24% had damage of the thalamus and 6/50 (12% had damage of the brainstem. Generalized dystonia was most frequently associated with bilateral lesion of the putamen, hemidystonia with lesion of contralateral putamen, torticollis with damage of the caudate nucleus, hand dystonia with lesion of the thalamus and blepharospasm with lesion of the upper brainstem.

  17. Sonographically determined clues to the symptomatic or silent cholelithiasis

    International Nuclear Information System (INIS)

    Saba, S.; Iqbal, Z.

    2007-01-01

    To determine an association between sonographically determined contractility with the symptomatic or silent nature of gallstone. Adult gallstone patients without (group I) and with biliary symptoms (group II) were compared with age and gender-matched controls. Demographic data, body mass index, risk factors, size, number and mobility of gallstone, gallbladder wall thickness (GBWT), volume and Ejection Fraction (EF) were determined on ultrasound before and after a standardized fatty meal (BFM and AFM). Demographic data, risk factors and gallstone characteristics were analyzed by Pearson Chi-square test and the gallbladder characteristics were analyzed by One-way ANOVA and Post Hoc tests by multiple comparisons on SPSS 11 with significance p=0.05. The gallbladder contractility as measured by changes in wall thickness and volume changes BFM and AFM, and ejection fraction was similar in controls and asymptomatic cholelithiasis groups and significantly reduced in symptomatic patients (p<.001). Multiparity (p=0.002), female gender (p=0.018), age less than 50 years (0.05), impacted calculi (p=0.001), multiple calculi (<.001) and calculi 5 mm (p<0.001) were associated with pain. A sluggishly emptying gallbladder was more significantly associated with symptomatic cholelithiasis compared to controls and asymptomatic cholelithiasis state in this series. Consideration of age, gender, impaction of calculi, number and size of calculi is important in causing symptom state and management options. (author)

  18. Factors that influence therapeutic outcomes in symptomatic gastroesophageal reflux disease.

    LENUS (Irish Health Repository)

    Quigley, Eamonn M M

    2012-02-03

    The term "symptomatic gastroesophageal reflux disease" (GERD) refers to those patients who present with the typical GERD symptoms of heartburn and regurgitation, yet do not have endoscopic evidence of esophagitis. The primary goals of managing symptomatic GERD are to control symptoms and improve quality of life. A clinical assessment of the GERD patient can identify important clinical features, such as atypical and extraesophageal symptoms for which acid-suppressive agents tend to be less effective. Performing an endoscopy can further identify the patient as having nonerosive reflux disease, erosive esophagitis, or Barrett\\'s esophagus-diagnoses which can help determine treatment but may not prove predictive of therapeutic response. Determining acid exposure through pH testing can predict therapeutic response, with those revealing an abnormal acid exposure time being more responsive to acid-suppressive therapy. However, the performance of an endoscopy and pH testing on each patient is clearly not practical. Whereas the natural history of symptomatic GERD is still largely undefined, acid-suppressive therapy appears to be the best approach available for both the short-term and long-term management of this disease.

  19. Symptomatic isolated middle cerebral artery dissection: High resolution MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Byon, Jung Hee; Kwak, Hyo Sung; Chung, Gyung Ho; Hwang, Seung Bae [Dept. of Radiology, Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2015-11-15

    To perform high-resolution magnetic resonance imaging (HRMRI) and determine clinical features of patients with acute symptomatic middle cerebral artery (MCA) dissection. Thirteen patients with acute symptomatic MCA dissection underwent HRMRI within 3 days after initial clinical onset. They also underwent routine brain MR imaging. HRMRI examinations included time-of-flight MR angiography (MRA), T2-weighted, T1-weighted, proton-density-weighted, and three-dimensional magnetization-prepared rapid acquisition gradient-echo (MPRAGE) sequences. Conventional angiography and MRA were used as reference standard to establish the diagnosis of MCA dissection. The angiographic findings and HRMRI findings such as intimal flap, double lumen, and intramural hematoma were analyzed in this study. All patients presented cerebral ischemia (median National Institutes of Health Stroke Scale score = 4, range = 0-18). String sign was seen on MRA in seven patients. However, double lumen was seen in all patients on HRMRI by intimal flap. High signal lesion on MPRAGE sequences around the dissection lumen due to intramural hematoma was seen in three patients. HRMRI can be used to easily detect the wall structure of MCA such as the intimal flap and double lumen in patients with acute symptomatic MCA dissection. MPRAGE can detect hemorrhage in false lumen of MCA dissection.

  20. Wingspan stent for symptomatic stenosis of middle cerebral artery

    International Nuclear Information System (INIS)

    Guo Xinbin; Zhang Jianning; Li Xudong; Huang Ying; Fan Yimu

    2010-01-01

    Objective: To evaluate the safety and feasibility of Wingspan stent for patients with symptomatic M1 stenosis of middle cerebral artery (MCA). Methods: Thirty-two cases with recurrent symptomatic MCA stenosis resistant to medical therapy treated by self-expanding stent were reviewed retrospectively [average (49 ± 19) years old, 13 women]. All patients underwent angioplasty and stenting with the Gateway balloon-Wingspan stent system. After 6 months, all patients were followed up by telephone or clinic, and advised followed up with DSA or TCD. Results: Thirty-two patients were successfully stented during the first treatment session. The mean degree of stenosis reduced from (76.5 ± 15.4)% to (19.3 ± 9.2)%. The number of complicating subarachnoid hemorrhage was one, and occlusion occurred on one patients related to balloon angioplasty. During a follow-up of 6 months, there was no recurrence of transient ischemic attack or stroke in 32 available patients. Cerebral hemodynamics using transcranial Doppler monitoring were normal in 19 follow-up patients. Six-month angiographic follow-up was obtained in 5 patients, demonstrating good patency in 5 stenting vessels. The other patients refused to perform TCD or DSA. Conclusions: Wingspan stent for symptomatic stenosis of middle cerebral artery appears to be a safe and feasible under strict control of periperformeral project. However further study is needed to evaluate the long-term effect. (authors)

  1. Symptomatic colonic polyps in childhood: not so benign.

    Science.gov (United States)

    Hoffenberg, E J; Sauaia, A; Maltzman, T; Knoll, K; Ahnen, D J

    1999-02-01

    The clinical spectrum of symptomatic polyps and the frequency of familial polyposis is not well defined in children. In the present study, a series of children with juvenile polyposis coli (JPC) and non-JPC polyps were studied. Children with symptomatic colonic polyps and negative family history of polyps were ascertained by review of endoscopic records. Juvenile polyposis coli was defined as 10 or more juvenile polyps or any juvenile polyp in a relative of an index case of JPC. Polyps were tested for Ki-ras mutations, p53 overexpression, and aneuploidy. Seventy-eight children (age range, 0.4-18 years) were identified, all evaluated for lower gastrointestinal bleeding. Nine (12%) had JPC, 66 (84%) had isolated juvenile polyps, and 3 (4%) had other types of polyps. The JPC and non-JPC groups were similar in age (p = 0.4) and symptom duration (p = 0.3). The JPC group had more polyps (p = 0.0001), and greater likelihood of anemia (p = 0.01), polyps with adenomatous change (p = 0.03), and right-colon polyps (p = 0.001). In three of eight JPC families, polyps were identified in asymptomatic first-degree relatives. No abnormalities in Ki-ras, p53, or aneuploidy were identified. Juvenile polyposis coli is common in children with symptomatic polyps, and is associated with anemia, right-colon polyps, and adenomas. The risk of polyps and of colorectal cancer in relatives of persons with JPC requires further study.

  2. Symptomatic Congenital Cytomegalovirus Infection in Children of Seropositive Women

    Directory of Open Access Journals (Sweden)

    Ines Mack

    2017-06-01

    Full Text Available Cytomegalovirus (CMV is the most frequent congenital virus infection worldwide. The risk of congenital CMV (cCMV transmission is highest in seronegative women who acquire primary CMV infection during pregnancy. A growing body of evidence indicates that secondary CMV infections in pregnant women with preconceptual immunity (either through reactivation of latent virus or re-infection with a new strain of CMV contribute to a much greater proportion of symptomatic cCMV than was previously thought. Here, we describe a case of symptomatic cCMV infection in the newborn of a woman with proven immunity prior to pregnancy. Diagnosis was confirmed by CMV PCR from amniotic fluid and fetal MR imaging. The newborn presented with typical cCMV symptoms including jaundice, hepatosplenomegaly, cholestasis, petechiae, small head circumference, and sensorineural hearing loss, the most common neurologic sequela. CMV was detected in infant blood and urine by PCR, and intravenous ganciclovir was initiated and continued orally for 6 weeks totally. Apart from persisting right-sided deafness, the child exhibited normal neurological development up through the last follow-up at 4.5 years. To date, the most effective strategy to prevent vertical CMV transmission is hygiene counseling for women of childbearing age, which, in our case, and in concordance with recent literature, applies to seronegative, as well as seropositive, women. Once an expecting mother shows seroconversion or signs of an active CMV infection, there are no established procedures to reduce the risk of transmission, or therapeutic options for the fetus with signs of infection. After birth, symptomatic infants can be treated with ganciclovir to inhibit viral replication and improve hearing ability and neurodevelopmental outcome. A comprehensive review of the literature, including our case study, reveals the most current and significant diagnostic and treatment options available. In conclusion, the triad

  3. The development of classically and alternatively activated macrophages has different effects on the varied stages of radiation-induced pulmonary injury in mice.

    Science.gov (United States)

    Zhang, Hui; Han, Guang; Liu, Hui; Chen, Ji; Ji, Xuemei; Zhou, Fuxiang; Zhou, Yunfeng; Xie, Conghua

    2011-01-01

    The classical and alternative activation of macrophages has been proposed to play a role in radiation-induced pneumonitis and fibrosis, respectively. To test this hypothesis, the thoraces of C57BL/6 mice were irradiated with 12 Gy X-rays, and irradiated and control mice were euthanized at 1, 8, 12, 24 and 72 hours, and 2, 4, 8, 16 and 24 weeks after irradiation. The expression of inducible nitric oxide synthase (iNOS) and arginase type 1 (Arg-1) was evaluated at the mRNA and protein levels at different stages post-irradiation. We demonstrated that the enhanced mRNA and protein expression of iNOS occurred within the pneumonic stage, whereas the high levels of Arg-1 expression occurred within the fibrotic phase. Immunohistochemistry revealed that iNOS and Arg-1 were mainly expressed in macrophages. The expression of iNOS and Arg-1 may be associated with acute radiation pneumonitis and the development of radiation fibrosis, respectively. Although the function of macrophages cannot explain the whole process of radiation-induced pulmonary injury development, it may play an important regulatory role during this process.

  4. The Case of a Zebra That Was Misdiagnosed as a Horse: Pulmonary Tumor Thrombotic Microangiopathy, a New Paraneoplastic Syndrome, Mimicking PD-1-Induced Pneumonitis

    Directory of Open Access Journals (Sweden)

    Corey A. Carter

    2016-01-01

    Full Text Available A case report of a 47-year-old woman with triple-negative breast cancer on a clinical trial called PRIMETIME (NCT02518958 who received the anti-PD-1 inhibitor nivolumab and the experimental anticancer agent RRx-001 is presented. Although initially diagnosed and treated for anti-PD-1-induced pneumonitis, clinical and radiological abnormalities triggered further investigation, leading to the diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM. This example highlights the importance of exercising due diligence in determining immune-related adverse events and suggests that PD-1-induced pneumonitis should be a diagnosis of exclusion rather than a diagnosis by default. A case history and review of the literature are presented for PTTM, which we propose to define as a paraneoplastic syndrome.

  5. Hypersensitivity pneumonitis (extrinsic allergic alveolitis): high-resolution computed tomography findings; Pneumonite por hipersensibilidade (alveolite alergica extrinseca): achados na tomografia computadorizada de alta resolucao

    Energy Technology Data Exchange (ETDEWEB)

    Almeida Junior, Jose Guiomar de; Marchiori, Edson [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Faculdade de Ciencias Medicas. Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br; Escuissato, Dante L. [Parana Univ., Curitiba, PR (Brazil). Dept. de Radiologia; Souza Junior, Arthur Soares [Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), SP (Brazil). Dept. de Radiologia; Gasparetto, Emerson L. [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas; Nobre, Luiz Felipe [Santa Catarina Univ., Florianopolis, SC (Brazil); Irion, Klaus L. [Santa Casa de Misericordia de Porto Alegre, RS (Brazil). Pavilhao Pereira Filho. Servico de Radiologia

    2003-12-01

    Hypersensitivity pneumonitis, or extrinsic allergic alveolitis, is an immunologic disease of the lungs caused by inhaled chemicals or organics allergens. A lymphocytic inflammatory response in the peripheral airways and surrounding interstitial tissue occurs. In this study the high-resolution computed tomography findings of 13 patients with hypersensitivity pneumonitis were analyzed and discussed. The most frequent high-resolution computed tomography findings were: ground-glass opacities (92.3%), centrilobular nodules (38.4%) and air trapping (38.4%). Other findings included bronchiectasis (23.1%), consolidation (23.1%), crazy paving (7.7%), parenchymal bands (15.4%), linear opacities (7.7%), architectural distortion (7.7%), tracheal dilatation (7.7%), intralobular reticulate (7.7%), honeycombing (7.7%), emphysema (7.7%) and atelectasis (7.7%). In two of the 13 patients there was fibrosis (architectural distortion and honeycombing), which represents the chronic phase of the disease. (author)

  6. Target cells in radiation pneumopathy

    International Nuclear Information System (INIS)

    Trott, Klaus Ruediger; Herrmann, Thomas; Kasper, Michael

    2004-01-01

    Radiation pneumopathy is the reaction of the organ lung to radiation effects in various target cells. It starts as an exudative inflammation, with the clinical picture of interstitial pneumonia 6-12 weeks after irradiation, and proceeds to a productive chronic inflammation lasting several months and terminating, as other chronic inflammations do, in scar formation, called lung fibrosis. Lung fibrosis is the common end point after lung damage from a wide range of damaging agents. The pathogenetic process leading to the signs and symptoms of radiation pneumopathy is an integrated response of the complex organization of lung tissue. Clinical and pathologic data in patients do not support the hypothesis that the early inflammatory phase of radiation 'pneumonitis' and late 'radiation fibrosis' are independent pathogenetic processes in the same way as acute radiodermatitis and subcutaneous fibrosis are separate pathologic entities. The target cell population that initiates the pathogenetic process in the lung is not known, and it has been suggested that no single identifiable target exists. The entire process is the result of complex functional alterations in endothelial cells, pneumocytes, macrophages, and other resident and transient cells. No evidence has been found for a role of stem cell sterilization, for impaired transit cell proliferation, or for hypoplasia, which is the hallmark of other acute inflammatory normal tissue damage (i.e., in the mucosa). The radiobiologic concepts developed in cellular radiobiology are not adequate for the quantitative analysis of radiation pneumopathy. A new analytical framework based on structurally defined intercellular interaction by signaling molecules and their activation needs to be developed. This would not be only an abstract radiobiologic paradigm but would be the key to the development of potential therapeutic interventions in irradiated patients

  7. New Insights into Autoinducer-2 Signaling as a Virulence Regulator in a Mouse Model of Pneumonic Plague

    Science.gov (United States)

    Fitts, Eric C.; Andersson, Jourdan A.; Kirtley, Michelle L.; Sha, Jian; Erova, Tatiana E.; Chauhan, Sadhana; Motin, Vladimir L.

    2016-01-01

    ABSTRACT The Enterobacteriaceae family members, including the infamous Yersinia pestis, the causative agent of plague, have a highly conserved interbacterial signaling system that is mediated by the autoinducer-2 (AI-2) quorum-sensing molecule. The AI-2 system is implicated in regulating various bacterial virulence genes in diverse environmental niches. Deletion of the gene encoding the synthetic enzyme for the AI-2 substrate, luxS, leads to either no significant change or, paradoxically, an increase in in vivo bacterial virulence. We showed that deletion of the rbsA and lsrA genes, components of ABC transport systems that interact with AI-2, synergistically disrupted AI-2 signaling patterns and resulted in a more-than-50-fold decrease in Y. pestis strain CO92 virulence in a stringent pneumonic plague mouse model. Deletion of luxS or lsrK (encoding AI-2 kinase) from the ΔrbsA ΔlsrA background strain or complementation of the ΔrbsA ΔlsrA mutant with the corresponding gene(s) reverted the virulence phenotype to that of the wild-type Y. pestis CO92. Furthermore, the administration of synthetic AI-2 in mice infected with the ΔrbsA ΔlsrA ΔluxS mutant strain attenuated this triple mutant to a virulence phenotype similar to that of the ΔrbsA ΔlsrA strain in a pneumonic plague model. Conversely, the administration of AI-2 to mice infected with the ΔrbsA ΔlsrA ΔluxS ΔlsrK mutant did not rescue animals from lethality, indicating the importance of the AI-2–LsrK axis in regulating bacterial virulence. By performing high-throughput RNA sequencing, the potential role of some AI-2-signaling-regulated genes that modulated bacterial virulence was determined. We anticipate that the characterization of AI-2 signaling in Y. pestis will lead to reexamination of AI-2 systems in other pathogens and that AI-2 signaling may represent a broad-spectrum therapeutic target to combat antibiotic-resistant bacteria, which represent a global crisis of the 21st century. IMPORTANCE

  8. Urinary Prothrombin Fragment 1+2 in relation to Development of Non-Symptomatic and Symptomatic Venous Thromboembolic Events following Total Knee Replacement

    DEFF Research Database (Denmark)

    Borris, Lars Carl; Breindahl, Morten; Rud-Lassen, Michael

    2011-01-01

    Prothrombin fragment 1+2 is excreted in urine (uF1+2) as a result of in vivo thrombin generation and can be a marker of coagulation status after an operative procedure. This study compared uF1+2 levels in patients with symptomatic and non-symptomatic venous thromboembolism (VTE) after total knee ...

  9. Treatment of symptomatic macromastia in a breast unit

    Directory of Open Access Journals (Sweden)

    Schneider José

    2010-11-01

    Full Text Available Abstract Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28% presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy

  10. Perinatal Outcomes with Tamsulosin Therapy for Symptomatic Urolithiasis.

    Science.gov (United States)

    Bailey, George; Vaughan, Lisa; Rose, Carl; Krambeck, Amy

    2016-01-01

    Medical expulsive therapy represents an effective adjunctive treatment for nonpregnant patients with symptomatic urolithiasis. Tamsulosin is classified by the FDA (Food and Drug Administration) as a category B medication. However, to our knowledge no published data exist for human pregnancy. We explored the safety and efficacy of tamsulosin therapy for symptomatic urolithiasis occurring during pregnancy. We retrospectively identified patients treated with tamsulosin for stone disease during pregnancy at the Mayo Clinic during 2000 to 2014. This medical expulsive therapy cohort was matched 2:1 to pregnant women with symptomatic urolithiasis during pregnancy who did not receive medical expulsive therapy. Groups were compared using linear mixed models for continuous variables and exact conditional logistic regression models for nominal variables to take into account correlation due to matching. A total of 27 patients receiving medical expulsive therapy comprised the study cohort. Median duration of antepartum tamsulosin exposure was 3 days (range 1 to 110), occurring during the first, second and third trimester in 3 (11%), 11 (40.7%) and 18 (67%) patients, respectively. Mean gestational age at delivery was 38.1 weeks (SD 2.4) and 6 (22%) infants were born preterm. All infant birthweights were considered appropriate for gestational age, and no cases of spontaneous abortion, intrauterine demise or neonatal congenital anomalies were encountered. Comparison between the medical expulsive therapy and control groups demonstrated no significant differences in maternal or infant outcomes for any of the examined variables. Tamsulosin medical expulsive therapy does not appear to be associated with adverse maternal or fetal outcomes and may be considered as adjunctive therapy for urolithiasis during pregnancy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Treatment of symptomatic macromastia in a breast unit

    Science.gov (United States)

    2010-01-01

    Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28%) presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy could bring clear advantages

  12. Predictors of acute symptomatic seizures after intracranial hemorrhage in infants.

    Science.gov (United States)

    Bansal, Seema; Kebede, Tewodros; Dean, Nathan P; Carpenter, Jessica L

    2014-10-01

    To determine the prevalence of acute symptomatic seizures in infants with supratentorial intracranial hemorrhage, to identify potential risk factors, and to determine the effect of acute seizures on long-term morbidity and mortality. Children less than 24 months with intracranial hemorrhage were identified from a neurocritical care database. All patients who received seizure prophylaxis beginning at admission were included in the study. Risk factors studied were gender, etiology, location of hemorrhage, seizure(s) on presentation, and the presence of parenchymal injury. Acute clinical and electrographic seizures were identified from hospital medical records. Subsequent development of late seizures was determined based on clinical information from patients' latest follow-up. Patients with idiopathic neonatal intracranial hemorrhage, premature infants, and those with prior history of seizures were excluded from analysis. Seventy-two infants met inclusion criteria. None. Forty percent of infants had acute symptomatic seizures. The prevalence was similar regardless of whether etiology of hemorrhage was traumatic or nontraumatic. Seizures on presentation and parenchymal injury were independent risk factors of acute seizures (p = 0.001 and p = 0.006, respectively). Younger children and women were also at higher risk (p Acute seizures were not predictive of mortality, but nearly twice as many patients with acute seizures developed late seizures when compared with those without. Electrographic seizures and parenchymal injury were also predictive of development of late seizures (p hemorrhage are at high risk for acute symptomatic seizures. This is regardless of the etiology of hemorrhage. Younger patients, women, patients with parenchymal injury, and patients presenting with seizure are most likely to develop acute seizures. Although the benefits of seizure prophylaxis have not been studied in this specific population, these results suggest that it is an important component

  13. Symptomatic portal vein occlusion: treated by interventional radiological techniques

    International Nuclear Information System (INIS)

    Wang Maoqiang; Gu Xiaofang; Guan Jun; Wang Zhongpu; Liu Fengyong; Wang Zhiqiang

    2004-01-01

    Objective: To evaluate the efficacy and safety of the interventional radiological techniques for management of symptomatic portal vein (PV) occlusion. Methods: Nine patients with PV trunk occlusion were treated using interventional procedures. Four patients presented with abdominal pain, distention, and malabsorption; five presented with portal hypertension and repeated bleeding from esophagogastric varices. The etiologic factors were identified in all 9 patients, including post-transplantation of the liver in 2, hepatocellular carcinoma (HCC) associated with PV tumor thrombus in 3, post abdominal operative state in 1, and PV thrombosis in 3 cases. The portal access was established via a percutaneous transhepatic route in 4, and via a transjugular intrahepatic portosystemic shunt ( TIPS) approach in 5 patients. The interventional procedures included stent placement in 4, balloon angioplasty in 6, and catheter directed pharmacologic and mechanical thrombolysis in 7 patients. Results: The technical success was achieved in all cases. No complications related to the procedure occurred. Portal flow was reestablished in all patients after the procedures. Clinical improvement was seen in 3 patients with symptomatic PV thrombosis, characterized by progressive reduction of abdominal pain, distention, and diarrhea. Follow-up time ranged from 4 to 36 months. One patient with HCC died of multiple organs metastases at 11 months after the treatment . One patient died of intraabdominal sepsis and multiple organs failure 12 days after the procedure even though the antegrade flow was re-established in the main trunk of the PV. Patency of the PV trunk was confirmed by follow-up color Doppler ultrasound scan in the rest 7 patients, without recurrence of variceal bleeding or PV thrombus. Conclusions: Interventional minimally invasive procedures, including balloon angioplasty, stent placement, catheter directed local pharmacologic and mechanical thrombolysis, are safe and effective in

  14. [Endovascular interventional treatment for symptomatic stenosis of middle cerebral artery].

    Science.gov (United States)

    Li, Sheng; Xiao, Li-ping; Li, Bao-min; Wang, Jun; Cao, Xiang-yu; Liu, Xin-feng; Ge, Ai-li; Zhang, A-lan

    2009-04-15

    To study the feasibility, security and validity of percutaneous angioplasty (PTA) or percutaneous angioplasty and stenting (PTAS) for symptomatic stenosis of middle cerebral artery. The results of treatment and follow-up of 39 cases with symptomatic stenosis of middle cerebral artery who had either recurrent transient ischemic attacks (TIAs) or resistant to medical therapy and were performed PTA or PTAS were studied retrospectively. Among the 39 cases with stenosis of middle cerebral artery (23 in left, 13 in right, 3 in bilateral side and 5 cases combining with stenosis of carotid artery) PTA were successfully performed in 9 cases and PTAS in 30 (whose post-operative residual stenosis were less than 10%). After operation the patients were administrated with antiplatelet drugs. The clinic symptom and sign of ischemia were improved obviously after operation. During the procedure the contrast could be seen outside the vessel in 2 cases, the patients had no obvious symptom of hemorrhage and got well rapidly. But in another case her consciousness changed 1 h after PTAS and the limbs could not move in right side. Emergency CT scan showed cerebral hemorrhage in left basic node area. The patient suffered language barrier and incomplete hemiplegy in right side. No complication was occurred in the others. During 5 to 60 months follow-up, the symptom of weakness in right arm reoccurred but lighter than before in only one case. TCD rechecked in 26 cases and demonstrated the blood beam speed was faster than normal in two case. DSA rechecked in 14 cases showed restenosis in-stent in the 2 cases and they were treated by medicine. PTA and PTAS is a feasible, safe and effective therapeutic method for the patients with symptomatic stenosis of middle cerebral artery. Further study in large number of patients is needed for long-term outcome.

  15. Tibial tuberosity excision for symptomatic Osgood-Schlatter disease.

    Science.gov (United States)

    Flowers, M J; Bhadreshwar, D R

    1995-01-01

    A modified Ferciot procedure was used to excise the tibial tubercle in patients with persistently symptomatic Osgood-Schlatter disease. Forty-two knees in 35 patients were reviewed at a mean follow-up of 5 years to assess outcome. The results revealed relief of pain in 95% of patients and reduction of prominence in 85.5% with minimal complication, in particular no evidence of genu recurvatum. The pathogenesis of the condition is outlined, and some of the theories and treatment modalities discussed. Tibial tubercle excision is recommended as the treatment of choice in those few cases that fail with conservative treatment.

  16. Symptomatic endometriosis of the colon - a case report

    International Nuclear Information System (INIS)

    Leutloff, U.C.; Roeren, T.; Feldmann, K.; Sillem, M.; Rabe, T.; Kauffmann, G.

    1996-01-01

    The intestinal endometriosis in need of treatment is a rare case in the surgical department. Preoperative diagnosis is very difficult and in any case must be based on histologic findings; endoscopy-guided biopsy very frequently yields negative results. Dual-contrast scanning of the colon still is a major examination method, but the findings make it difficult to rule out malignomas. Cyclic, recurrent abdominal complaints reported in the case history strongly indicate the possibility of endometriosis. Typing can be done in general only after surgery. The article reports the clinical and diagnostic parameters of a symptomatic endometriosis of the colon. (orig.) [de

  17. Case report of a symptomatic giant renal oncocytoma.

    LENUS (Irish Health Repository)

    Ahmad, Sarfraz

    2011-01-01

    Renal oncocytomas are benign tumours, often asymptomatic, and picked incidentally on radiological imaging. We present a case report of a symptomatic giant renal oncocytoma in a 61-year old man having lower back\\/right flank pain. A large right renal mass was identified on abdominal CT scan. Radiological features were not sufficient to differentiate this lesion from renal cancer. Right radical nephrectomy was performed. Typical features of oncocytoma, without evidence of malignancy, were seen on histological examination of the specimen. In this report, we discuss literature review of radiological, genetic, and pathological characteristics of renal oncocytoma.

  18. Pulmonary lymphatics and radiation

    International Nuclear Information System (INIS)

    Leeds, S.E.

    1976-01-01

    Knowledge of the anatomy and physiology of the respiratory system has been more difficult to acquire than that of other organ systems owing to the complexity of the respiratory function of the lungs and to the technical difficulties involved. This is especially true of the lymphatics of the lung and is illustrated by the fact that the first measurement of pulmonary lymph flow was in 1942 by Warren and Drinker. A review of the literature reveals that few experiments have been designed to study the pulmonary lymphatics per se in relation to the effects of external radiation or after the inhalation of radioactive particles. However, the documented involvement of hilar lymph nodes implies that the lung lymphatics have a role in transporting particles from the alveoli or malignant cells from the parenchyma. Information from clinical and experimental sources, though scattered, is fairly abundant and of value in assessing the role of the pulmonary lymphatics. Our method for collecting pulmonary lymph is presented. Studies on the pulmonary lymph flow in normal dogs and in dogs with experimental congestive heart failure are described. We irradiated (4000 to 5000 R) the medial one-third of both lungs of a series of dogs. The lymph flow of the lungs was measured immediately after the course of irradiation and after a period of about 5 months. Although lung biopsies showed characteristic radiation pneumonitis in many areas, alterations in the lung parenchyma were not quantitatively reflected in the pulmonary lymph flow either in the acute stage or after fibrosis had time to develop

  19. [Radiation-induced lung damage--etiopathogenesis, clinical features, imaging findings and treatment].

    Science.gov (United States)

    Vasić, Ljiljana; Durdević, Predrag

    2012-01-01

    This review is related to the mechanism of development of radiation induced pneumonitis, its pathological, clinical and radiological features and therapy. The team treating cancer patients consists of radiation oncologists and oncologists, as well as general practitioners, pulmologists and radiologists for monitoring effects of therapy. Therefore, a different number of specialists should be familiar with the importance of diagnosis in order to avoid differential diagnostic error in relation to infection, relapse or metastasis, chemotherapeutic adverse effects. Factors that influence the development of radiation pneumonitis are numerous: (1) the volume of irradiated parenchyma (2) the absorbed dose, (3) the number of fractions which divided the absorbed dose. (4) the size ofindividual doses per fraction, (5) radiation dose rate (the radiotherapy output device). Acute radioneumonitis is characterized by dyspnea, cough, and, rarely fever and chest pain. The timely treatment of the symptoms makes it easier for patients and reduces the likelihood of developing pulmonary fibrosis. There are no specific markers in serum or sputum that would definitely indicate the development of acute pneumnonitis. Changes in lung radiography and computed tomography may suggest its development; however, extra diagnostics information sometime needs to be obtained from magnetic resonance images and positron emission tomography to make diagnosis and choose the treatment. The longer survival results from new modalities of treatment applied in cancer patients, and the prevention of adverse effects of radiation therapy is getting more important since longlasting toxicity affects the life quality.

  20. Result of radiation therapy for non-resectable lung cancer

    International Nuclear Information System (INIS)

    Kataoka, Masaaki; Kawamura, Masashi; Kimura, Makoto; Mogami, Hiroshi; Kimura, Yoshiko; Hamamoto, Ken

    1988-01-01

    A total of 122 patients with non-resectable lung cancer, comprising 98 with non-small cell lung cancer (NSCLC) and 24 with small cell lung cancer (SCLC), who were treated from November 1976 through December 1985 with definitive radiation therapy (RT), were retrospectively analyzed for the outcome of RT. Overall, the 5-year survival rate was 6 %: it was 8 % for SCLC and 4 % for NSCLC. For NSCLC, survival was significantly better in stages I-III patients than stage IV patients (p < 0.01), although it was independent of histology, the combination of chemotherapy, and fractionation schedule. Local recurrence and distant metastasis were found to be the cause of death in 42 % and 13 %, respectively, in the stages I-II NSCLC group; and in 19 % and 52 %, respectively, in the SCLC group. The SCLC patients tended to have better survival when given chemotherapy before RT. Ten patients surviving for three years or more were characterized by having early stage of NSCLC, less than 100 cm of irradiated field, and a total dose of 60 Gy or more. Twelve patients (10 %) had severe radiation pneumonitis that resulted in death. Acute and fetal pneumonitis tended to be frequent when chemotherapy was combined with RT. (Namekawa, K.)

  1. Endoscopic Excision of Symptomatic Os Trigonum in Professional Dancers.

    Science.gov (United States)

    Morelli, Federico; Mazza, Daniele; Serlorenzi, Pierluigi; Guidi, Marco; Camerucci, Emanuela; Calderaro, Cosma; Iorio, Raffaele; Guzzini, Matteo; Ferretti, Andrea

    The present study reports the clinical results of excision of a symptomatic os trigonum using an endoscopic procedure in professional ballet dancers. The hypothesis was that posterior endoscopic excision of the os trigonum would be safe and effective in treating posterior ankle impingement syndrome related to the os trigonum. Twelve professional dancers underwent excision of a symptomatic os trigonum for PAIS using a posterior endoscopic technique after failure of conservative treatment. The patients were evaluated pre- and postoperatively according to the American Orthopaedic Foot and Ankle Society hindfoot scale score, the Tegner activity scale score, and the visual analog scale score. The surgical time, timing of a return to sports, patient satisfaction, and any complications related to the procedure were recorded. The average postoperative follow-up duration was 38.9 ± 20.6 (range 12 to 72) months. The mean Tegner activity scale score increased from 4.3 ± 0.8 (range 3 to 5) preoperatively to 9 ± 0.2 postoperatively (p os trigonum using a 2-portal technique after failure of conservative treatment is characterized by excellent results with low morbidity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Symptomatic fructose malabsorption in irritable bowel syndrome: A prospective study.

    Science.gov (United States)

    Melchior, Chloé; Gourcerol, Guillaume; Déchelotte, Pierre; Leroi, Anne-Marie; Ducrotté, Philippe

    2014-04-01

    Fructose can trigger or worsen symptoms in irritable bowel syndrome (IBS) patients. The aim of this study was to determine the prevalence of symptomatic fructose malabsorption in IBS patients and to test whether the patient's characteristics can help to detect a fructose malabsorption. Ninety Rome III IBS patients (predominant diarrhoea (IBS-D): 31%, predominant constipation (IBS-C): 18%, mixed type (IBS-M): 51%) were included prospectively. After exclusion of a small intestinal bacterial overgrowth by a glucose breath test, fructose malabsorption was assessed by a five-hour breath test, with symptom monitoring, after a 25 g load of fructose. An increase of more than 20 ppm of hydrogen (H2) or methane (CH4) levels in the exhaled air led to the diagnosis of malabsorption. Fructose test was abnormal in 20/90 patients among whom only 35% were intolerant, with a simultaneous rise of H2/CH4 levels and the onset of abdominal discomfort or diarrhoea. IBS characteristics were not predictive even if young (p = 0.031) and male IBS patients (p = 0.029) were at higher risk of malabsorption. At variance, 18 additional patients experienced intestinal symptoms during the test despite normal fructose absorption. After a 25 g fructose load, symptomatic fructose malabsorption and intolerance without malabsorption were detected in 22% and 28% of IBS patients respectively.

  3. Late spontaneous recanalization of symptomatic atheromatous internal carotid artery occlusion.

    Science.gov (United States)

    Delgado, Montserrat G; Vega, Pedro P; Lahoz, Carlos H; Calleja, Sergio

    2015-04-01

    Definitive treatment of symptomatic atheromatous internal carotid artery occlusion remains controversial, as far as in rare cases, late spontaneous recanalization has been seen. We consecutively studied 182 patients (January 2003 to August 2012) with an ischemic stroke in the internal carotid artery territory and diagnosis of atheromatous internal carotid artery occlusion during hospitalization. Seven patients presented a late spontaneous recanalization (>3 months) of the internal carotid artery. We described therapeutic attitude according to usual care in these patients. The authors attempt to highlight the unusual condition of recanalization after a symptomatic atheromatous chronic internal carotid artery occlusion. If these patients can be treated similar to patients with asymptomatic carotid pathology, then this needs to be clarified. However, due to the risk of ipsi- and contralateral ischemic strokes, revascularization techniques should be considered in certain cases. More studies are needed to establish the most appropriate therapeutical approach in order to avoid arbitrary treatment of these patients. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. Electrocardiographically and symptomatically silent myocardial ischemia during exercise testing

    International Nuclear Information System (INIS)

    Kurata, Chinori; Tawarahara, Kei; Sakata, Kazuyuki; Taguchi, Takahisa; Fukumoto, Yoshihiro; Kobayashi, Akira; Yamazaki, Noboru; Tanaka, Hiroshi

    1991-01-01

    Certain patients with coronary artery disease (CAD) may have neither ST depression nor chest pain during exercise despite the presence of myocardial ischemia. The frequency and characteristics of such electrocardiographically and symptomatically silent ischemia were studied in 171 patients with both angiographically documented CAD and scintigraphically documented ischemia. Fifty-six (33%) of 171 patients had neither ST depression nor chest pain (Group N), and 115 (67%) had ST depression and/or chest pain (Group P). The two groups were similar with respect to age, gender, the prevalence of prior infarction, and peak systolic blood pressure. Group N patients, however, had a higher mean peak heart rate and rate-pressure product, less severe scintigraphic ischemia, a lower lung thallium-201 uptake, and a smaller number of diseased vessels. Stepwise discriminant analysis showed a history of effort angina, lung thallium-201 uptake, and scintigraphic severity of ischemia to be significant discriminators between Groups N and P. In conclusion, electrocardiographically and symptomatically silent ischemia may be common during exercise in patients with CAD, and less severe ischemia may be one of important determinants. (author)

  5. Acute symptomatic neonatal seizures in preterm neonates: etiologies and treatments.

    Science.gov (United States)

    Pisani, Francesco; Spagnoli, Carlotta

    2017-12-15

    Acute symptomatic neonatal seizures in preterm newborns are a relevant clinical challenge due to the presence of many knowledge gaps. Etiology-wise, acute symptomatic seizures have an age-specific epidemiology, with intraventricular hemorrhage and its complications representing the first cause in extremely and very preterm neonates, whereas other etiologies have similar occurrence rates as in full-term infants. Specific treatment strategies for the premature neonates are not yet available. Studies suggest a similarly low response rate with even more unfavorable prognosis than in full-term infants. Pharmacodynamic and pharmacokinetic changes are likely under way during the preterm period, with the potential to affect both effectiveness and safety of antiepileptic drugs in these patients. However, due to the lack of clear evidence to guide prioritization of second-line drugs, off-label medications are frequently indicated by review papers and flow-charts, and are prescribed in clinical practice. We therefore conclude by exploring potential future lines of research. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Treatment of symptomatic pelvic varices by ovarian vein embolization

    International Nuclear Information System (INIS)

    Capasso, Patrizio; Simons, Christine; Trotteur, Genevieve; Dondelinger, Robert F.; Henroteaux, Denis; Gaspard, Ulysse

    1997-01-01

    Purpose. Pelvic congestion syndrome is a common cause of chronic pelvic pain in women and its association with venous congestion has been described in the literature. We evaluated the potential benefits of lumboovarian vein embolization in the treatment of lower abdominal pain in patients presenting with pelvic varicosities. Methods. Nineteen patients were treated. There were 13 unilateral embolizations, 6 initial bilateral treatments and 5 treated recurrences (a total of 30 procedures). All embolizations were performed with either enbucrilate and/or macrocoils, and there was an average clinical and Doppler duplex follow-up of 15.4 months. Results. The initial technical success rate was 96.7%. There were no immediate or long-term complications. Variable symptomatic relief was observed in 73.7% of cases with complete responses in 57.9%. All 8 patients who had partial or no pain relief complained of dyspareunia. The direct relationship between varices and chronic pelvic pain was difficult to ascertain in a significant number of clinical failures. Conclusion. Transcatheter embolization of lumboovarian varices is a safe technique offering symptomatic relief of pelvic pain in the majority of cases. The presence of dyspareunia seemed to be a poor prognostic factor, indicating that other causes of pelvic pain may coexist with pelvic varicosities

  7. The Benefit of Arthroscopy for Symptomatic Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Hsiu-Peng Teng

    2004-10-01

    Full Text Available Thirty-one knees with symptomatic total knee arthroplasty were diagnosed and treated arthroscopically. There were 18 knees with soft tissue impingement and 13 knees without. There were 16 knees with painful arthroplasty and range of motion (ROM greater than 90°. Hypertrophied synovitis with or without impingement was more easily found by arthroscopy in this group than in the other 15 knees with the chief complaint of limited ROM, where more remarkable fibrotic tissue with intra-articular adhesion was found. Overall, the average improvement in ROM was 43.1° immediately after arthroscopy, and 20° at the final follow-up. Symptoms improved in 90.3% of patients, and 58.1% were satisfied with the outcome of their surgery. Arthroscopy is helpful for intra-articular diagnosis, obtaining a specimen for histopathologic analysis, culture for subclinical infection, and better improvement in ROM. In our experience, arthros-copy for symptomatic knee arthroplasty is reliable, safe and effective.

  8. Symptomatic thoracic spinal cord herniation: case series and technical report.

    Science.gov (United States)

    Hawasli, Ammar H; Ray, Wilson Z; Wright, Neill M

    2014-09-01

    Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes. In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms. Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.

  9. A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Yoshinori Kadono

    2015-01-01

    Full Text Available Spinal epidural arachnoid cyst (EAC is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.

  10. Microbiology of bile in symptomatic uncomplicated gallstone disease

    International Nuclear Information System (INIS)

    Ahmad, M.; Akhtar, M.R.; Akhtar, M.R.

    2015-01-01

    To determine the microbiology of the bile culture and antimicrobial susceptibility in patients with symptomatic gallstone disease in our setup. Study Design: A descriptive study. Place and Duration of Study: Surgical Department Combined Military Hospital (CMH) Kharian from Oct, 2010 to Jun, 2011. Patients and Methods: A total of 106 patients underwent cholecystectomy due to symptomatic gallstones and their bile was cultured for aerobic and anaerobic bacteria and culture sensitivity was performed. Data was analysed by using statistical package for social sciences (SPSS) version 13. Results: Bile culture was negative in 81 patients (76.4%) and was positive in only 25 patients (23.6%). Escheria Coli was the most common cultured organism in 10 (40%) patients, Klebsiella in 5 (20%) patients, Pseudomonas in 5 (20%) patients, Proteus in 2 (8%) patients, Staphlococcus aureus in 2 (8%) patients and mixed organisms were cultured in 1 patient (4%). Cefoperazone with sulbactum and Amikacin were the most effective prophylactic antibiotics. Conclusion: Bile in majority of patients with symtomatic uncomplicated gallstone disease is sterile. E. coli is the most commonly cultured organism and cefoperazone with sulbactum and amikacin are the most appropriate antibiotics in our setup. (author)

  11. Uterine artery embolisation for symptomatic adenomyosis-Mid-term results

    International Nuclear Information System (INIS)

    Bratby, M.J.; Walker, W.J.

    2009-01-01

    Purpose: To evaluate the role of uterine artery embolisation (UAE) in the treatment of adenomyosis. Materials and methods: 27 women with symptomatic adenomyosis diagnosed on magnetic resonance imaging (MRI) underwent UAE between 1998 and 2004. Clinical evaluation using a standardised questionnaire was made at regular intervals after embolisation to assess patient outcome. Results: The diagnosis of adenomyosis was confirmed histologically by transvaginal biopsy in 5 women. There were 14 women with associated uterine fibroids. Diffuse adenomyosis was identified in 18 women. A focal adenomyoma was present in another 8 women. In 1 patient adenomyosis was not classified. All patients except one underwent bilateral uterine artery embolisation. There was an initial favourable clinical response, with improvement of menorrhagia in 79% (13/16) of patients at 12 months. Follow-up data was available on a total of 14 patients at 2 and 3 years after embolisation. 45.5% (5/11) reported a deterioration in menorrhagia symptoms at 2 years. Conclusion: UAE for symptomatic adenomyosis is effective in the short-term but there is a high rate of recurrence of clinical symptoms 2 year following treatment.

  12. Uterine artery embolisation for symptomatic adenomyosis-Mid-term results

    Energy Technology Data Exchange (ETDEWEB)

    Bratby, M.J. [Radiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX (United Kingdom); Walker, W.J. [Radiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX (United Kingdom)], E-mail: wjwalker@doctors.org.uk

    2009-04-15

    Purpose: To evaluate the role of uterine artery embolisation (UAE) in the treatment of adenomyosis. Materials and methods: 27 women with symptomatic adenomyosis diagnosed on magnetic resonance imaging (MRI) underwent UAE between 1998 and 2004. Clinical evaluation using a standardised questionnaire was made at regular intervals after embolisation to assess patient outcome. Results: The diagnosis of adenomyosis was confirmed histologically by transvaginal biopsy in 5 women. There were 14 women with associated uterine fibroids. Diffuse adenomyosis was identified in 18 women. A focal adenomyoma was present in another 8 women. In 1 patient adenomyosis was not classified. All patients except one underwent bilateral uterine artery embolisation. There was an initial favourable clinical response, with improvement of menorrhagia in 79% (13/16) of patients at 12 months. Follow-up data was available on a total of 14 patients at 2 and 3 years after embolisation. 45.5% (5/11) reported a deterioration in menorrhagia symptoms at 2 years. Conclusion: UAE for symptomatic adenomyosis is effective in the short-term but there is a high rate of recurrence of clinical symptoms 2 year following treatment.

  13. Clinical results of radiation therapy for thymoma

    Energy Technology Data Exchange (ETDEWEB)

    Masunaga, Shin-ichiro; Ono, Koji; Hiraoka, Masahiro; Sasai, Keisuke; Kitakabu, Yoshizumi; Abe, Mitsuyuki (Kyoto Univ. (Japan). Faculty of Medicine); Takahashi, Masaji; Tsutsui, Kazushige; Fushiki, Masato

    1992-05-01

    From August 1968 to December 1989, 58 patients with thymoma were treated by radiotherapy using cobalt-60 gamma ray. Eleven cases were treated by radiothrapy alone, 1 by preoperative radiotheapy, 43 by postoperative radiotherapy, and 3 in combination with intraoperative radiotherapy. The following points were clarified: (a) Postoperative and intraoperative radiotherapy were effective; (b) For postoperative radiotherapy, operability was the major factor influencing survival and local control, and Stage I and II tumors resected totally or subtotally as well as Stage III tumors resected totally were good indications for such therapy; (c) The patients with complicating myasthenia gravis had a longer survival time and better local control rate than those without it. Radiation pneumonitis was observed in 17 patients, and none of them died of this complication. In all cases in combination with intraoperative radiotherapy, dry desquamation was observed within the irradiated field. (author).

  14. Immediate versus delayed treatment for recently symptomatic carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    Vladimir Vasconcelos

    Full Text Available ABSTRACT BACKGROUND: The timing of surgery for recently symptomatic carotid artery stenosis remains controversial. Early cerebral revascularization may prevent a disabling or fatal ischemic recurrence, but it may also increase the risk of hemorrhagic transformation, or of dislodging a thrombus. This review examined the randomized controlled evidence that addressed whether the increased risk of recurrent events outweighed the increased benefit of an earlier intervention. OBJECTIVES: To assess the risks and benefits of performing very early cerebral revascularization (within two days compared with delayed treatment (after two days for people with recently symptomatic carotid artery stenosis. METHODS: Search methods: We searched the Cochrane Stroke Group Trials Register in January 2016, the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1, MEDLINE (1948 to 26 January 2016, EMBASE (1974 to 26 January 2016, LILACS (1982 to 26 January 2016, and trial registers (from inception to 26 January 2016. We also handsearched conference proceedings and journals, and searched reference lists. There were no language restrictions. We contacted colleagues and pharmaceutical companies to identify further studies and unpublished trials Selection criteria: All completed, truly randomized trials (RCT that compared very early cerebral revascularization (within two days with delayed treatment (after two days for people with recently symptomatic carotid artery stenosis. Data collection and analysis: We independently selected trials for inclusion according to the above criteria, assessed risk of bias for each trial, and performed data extraction. We utilized an intention-to-treat analysis strategy. MAIN RESULTS: We identified one RCT that involved 40 participants, and addressed the timing of surgery for people with recently symptomatic carotid artery stenosis. It compared very early surgery with surgery performed after 14 days of

  15. 4-(Nitrophenylsulfonyl)piperazines mitigate radiation damage to multiple tissues.

    Science.gov (United States)

    Micewicz, Ewa D; Kim, Kwanghee; Iwamoto, Keisuke S; Ratikan, Josephine A; Cheng, Genhong; Boxx, Gayle M; Damoiseaux, Robert D; Whitelegge, Julian P; Ruchala, Piotr; Nguyen, Christine; Purbey, Prabhat; Loo, Joseph; Deng, Gang; Jung, Michael E; Sayre, James W; Norris, Andrew J; Schaue, Dörthe; McBride, William H

    2017-01-01

    Our ability to use ionizing radiation as an energy source, as a therapeutic agent, and, unfortunately, as a weapon, has evolved tremendously over the past 120 years, yet our tool box to handle the consequences of accidental and unwanted radiation exposure remains very limited. We have identified a novel group of small molecule compounds with a 4-nitrophenylsulfonamide (NPS) backbone in common that dramatically decrease mortality from the hematopoietic acute radiation syndrome (hARS). The group emerged from an in vitro high throughput screen (HTS) for inhibitors of radiation-induced apoptosis. The lead compound also mitigates against death after local abdominal irradiation and after local thoracic irradiation (LTI) in models of subacute radiation pneumonitis and late radiation fibrosis. Mitigation of hARS is through activation of radiation-induced CD11b+Ly6G+Ly6C+ immature myeloid cells. This is consistent with the notion that myeloerythroid-restricted progenitors protect against WBI-induced lethality and extends the possible involvement of the myeloid lineage in radiation effects. The lead compound was active if given to mice before or after WBI and had some anti-tumor action, suggesting that these compounds may find broader applications to cancer radiation therapy.

  16. 4-(Nitrophenylsulfonylpiperazines mitigate radiation damage to multiple tissues.

    Directory of Open Access Journals (Sweden)

    Ewa D Micewicz

    Full Text Available Our ability to use ionizing radiation as an energy source, as a therapeutic agent, and, unfortunately, as a weapon, has evolved tremendously over the past 120 years, yet our tool box to handle the consequences of accidental and unwanted radiation exposure remains very limited. We have identified a novel group of small molecule compounds with a 4-nitrophenylsulfonamide (NPS backbone in common that dramatically decrease mortality from the hematopoietic acute radiation syndrome (hARS. The group emerged from an in vitro high throughput screen (HTS for inhibitors of radiation-induced apoptosis. The lead compound also mitigates against death after local abdominal irradiation and after local thoracic irradiation (LTI in models of subacute radiation pneumonitis and late radiation fibrosis. Mitigation of hARS is through activation of radiation-induced CD11b+Ly6G+Ly6C+ immature myeloid cells. This is consistent with the notion that myeloerythroid-restricted progenitors protect against WBI-induced lethality and extends the possible involvement of the myeloid lineage in radiation effects. The lead compound was active if given to mice before or after WBI and had some anti-tumor action, suggesting that these compounds may find broader applications to cancer radiation therapy.

  17. Symptomatic and asymptomatic accessory navicular bones: Findings of Tc-99m MDP bone scintigraphy

    International Nuclear Information System (INIS)

    Chiu, N.-T.; Jou, I.-M.; Lee, B.-F.; Yao, W.-J.; Tu, D.-G.; Wu, P.-S.

    2000-01-01

    AIM: The accuracy of bone scintigraphy in diagnosing symptomatic accessory navicular bones has not been well studied. We conducted a retrospective study to explore the results and use of scintigraphy in symptomatic and asymptomatic accessory navicular bones. MATERIALS AND METHODS: Thirteen patients with a total of 13 symptomatic and 10 asymptomatic accessory navicular bones were included in the study. We used a scoring system to grade the scintigraphic abnormalities. The patients' symptoms and scintigraphic findings were recorded. RESULTS: Though focally increased radiopharmaceutical uptake was observed in all symptomatic accessory naviculars, half of the asymptomatic accessory navicular bones had the same manifestations. The scoring system was of no value in differentiating symptomatic from asymptomatic accessory navicular bones. CONCLUSION: Bone scintigraphy is a sensitive but not a specific tool for diagnosing a symptomatic accessory navicular. Chiu, N.-T. (2000)

  18. The effect of ‘Candidatus Liberibacter asiaticus’ infection on the proteomic profiles and nutritional status of pre-symptomatic and symptomatic grapefruit (Citrus paradisi) plants

    Science.gov (United States)

    2013-01-01

    Background Huanglongbing (HLB) is a highly destructive citrus disease which threatens citrus production worldwide and ‘Candidatus Liberibacter asiaticus’ (Las), a non-culturable phloem-limited bacterium, is an associated causal agent of the disease. To better understand the physiological and molecular processes involved in host responses to Las, 2-DE and mass spectrometry analyses, as well as ICP spectroscopy analysis were employed to elucidate the global protein expression profiles and nutrient concentrations in leaves of Las-infected grapefruit plants at pre-symptomatic or symptomatic stages for HLB. Results This study identified 123 protein spots out of 191 spots that showed significant changes in the leaves of grapefruit plants in response to Las infection and all identified spots matched to 69 unique proteins/peptides. A down-regulation of 56 proteins including those associated with photosynthesis, protein synthesis, and metabolism was correlated with significant reductions in the concentrations of Ca, Mg, Fe, Zn, Mn, and Cu in leaves of grapefruit plants in response to Las infection, particularly in symptomatic plants. Oxygen-evolving enhancer (OEE) proteins, a PSI 9 kDa protein, and a Btf3-like protein were among a small group of proteins that were down-regulated in both pre-symptomatic and symptomatic plants in response to Las infection. Furthermore, a Las-mediated up-regulation of 13 grapefruit proteins was detected, which included Cu/Zn superoxide dismutase, chitinases, lectin-related proteins, miraculin-like proteins, peroxiredoxins and a CAP 160 protein. Interestingly, a Las-mediated up-regulation of granule-bound starch synthase was correlated with an increase in the K concentrations of pre-symptomatic and symptomatic plants. Conclusions This study constitutes the first attempt to characterize the interrelationships between protein expression and nutritional status of Las-infected pre-symptomatic or symptomatic grapefruit plants and sheds light on

  19. The effect of 'Candidatus Liberibacter asiaticus' infection on the proteomic profiles and nutritional status of pre-symptomatic and symptomatic grapefruit (Citrus paradisi) plants.

    Science.gov (United States)

    Nwugo, Chika C; Lin, Hong; Duan, Yongping; Civerolo, Edwin L

    2013-04-11

    Huanglongbing (HLB) is a highly destructive citrus disease which threatens citrus production worldwide and 'Candidatus Liberibacter asiaticus' (Las), a non-culturable phloem-limited bacterium, is an associated causal agent of the disease. To better understand the physiological and molecular processes involved in host responses to Las, 2-DE and mass spectrometry analyses, as well as ICP spectroscopy analysis were employed to elucidate the global protein expression profiles and nutrient concentrations in leaves of Las-infected grapefruit plants at pre-symptomatic or symptomatic stages for HLB. This study identified 123 protein spots out of 191 spots that showed significant changes in the leaves of grapefruit plants in response to Las infection and all identified spots matched to 69 unique proteins/peptides. A down-regulation of 56 proteins including those associated with photosynthesis, protein synthesis, and metabolism was correlated with significant reductions in the concentrations of Ca, Mg, Fe, Zn, Mn, and Cu in leaves of grapefruit plants in response to Las infection, particularly in symptomatic plants. Oxygen-evolving enhancer (OEE) proteins, a PSI 9 kDa protein, and a Btf3-like protein were among a small group of proteins that were down-regulated in both pre-symptomatic and symptomatic plants in response to Las infection. Furthermore, a Las-mediated up-regulation of 13 grapefruit proteins was detected, which included Cu/Zn superoxide dismutase, chitinases, lectin-related proteins, miraculin-like proteins, peroxiredoxins and a CAP 160 protein. Interestingly, a Las-mediated up-regulation of granule-bound starch synthase was correlated with an increase in the K concentrations of pre-symptomatic and symptomatic plants. This study constitutes the first attempt to characterize the interrelationships between protein expression and nutritional status of Las-infected pre-symptomatic or symptomatic grapefruit plants and sheds light on the physiological and molecular

  20. Symptomatic Adjacent Segment Pathology after Posterior Lumbar Interbody Fusion for Adult Low-Grade Isthmic Spondylolisthesis

    OpenAIRE

    Sakaura, Hironobu; Yamashita, Tomoya; Miwa, Toshitada; Ohzono, Kenji; Ohwada, Tetsuo

    2013-01-01

    The incidence of symptomatic adjacent segment pathology (ASP) after fusion surgery for adult low-grade isthmic spondylolisthesis (IS) has been reported to be relatively low compared with other lumbar disease entities. However, there has been no study of symptomatic ASP incidence using posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation. We investigated the incidence of symptomatic ASP after PLIF with pedicle screw instrumentation for adult low-grade IS and identified s...

  1. Characterization of symptomatic hip impingement in butterfly ice hockey goalies.

    Science.gov (United States)

    Ross, James R; Bedi, Asheesh; Stone, Rebecca M; Sibilsky Enselman, Elizabeth; Kelly, Bryan T; Larson, Christopher M

    2015-04-01

    This study aimed to characterize the radiographic deformity observed in a consecutive series of butterfly goalies with symptomatic mechanical hip pain and to use computer-based software analysis to identify the location of impingement and terminal range of motion. We also compared these analyses to a matched group of positional hockey players with symptomatic femoroacetabular impingement (FAI). A consecutive series of 68 hips in 44 butterfly-style hockey goalies and a matched group of 34 hips in 26 positional hockey players who underwent arthroscopic correction for symptomatic FAI were retrospectively analyzed. Each patient underwent preoperative anteroposterior (AP) and modified Dunn lateral radiographs and computed tomography (CT) of the affected hips. Common FAI measurements were assessed on plain radiographs. Patient-specific, CT-based 3-dimensional (3D) models of the hip joint were developed, and the femoral version, alpha angles at each radial clock face position, and femoral head coverage were calculated. Maximum hip flexion, abduction, internal rotation in 90° flexion (IRF), flexion/adduction/internal rotation (FADIR), and butterfly position were determined, and the areas of bony collision were defined. Butterfly goalies had an elevated mean alpha angle on both AP (61.3°) and lateral radiographs (63.4°) and a diminished beta angle (26.0°). The mean lateral center-edge angle (LCEA) measured 27.3° and acetabular inclination was 6.1°. A crossover sign was present in 59% of the hips. The maximum alpha angle on the radial reformatted computed tomographic scan was significantly higher among the butterfly goalies (80.9° v 68.6°; P hockey goalies have a high prevalence of FAI, characterized by a unique femoral cam-type deformity and noted by an elevated alpha angle and loss of offset, which is greater in magnitude and more lateral when compared with that in positional hockey players. Associated acetabular dysplasia is also common among hockey goalies. Level

  2. Treatment of symptomatic intracranial arterial stenosis with Wingspan stent system

    International Nuclear Information System (INIS)

    Luo Wangchi; Li Guifu; Li Tielin; Zhu Jixiang; You Jinsong; Ma Zhaohui; Huang Yan

    2011-01-01

    Objective: To discuss the safety of Gateway-Wingspan stent system in treating symptomatic intracranial atherosclerotic stenosis and its effect of preventing and treating cerebral ischemic events. Methods: Interventional treatment by using Gateway-Wingspan sent system was carried out in 36 patients with symptomatic intracranial atherosclerotic arterial stenosis (a total of 38 lesions) who had failed to response the medication. Of the 32 cases, elective surgery was performed in 32 and emergent surgery in 4. Of the total 38 stenotic sites, 22 were located at the posterior cerebral blood circulation region, while 16 at the anterior circulation region. Results: The average degree of stenosis before stenting procedure was 72.6%±12.6%, the residual stenosis degree after balloon dilatation and stenting was 33.8%±15.2% and 23.6%±13.9%, respectively. The successful rate of treatment was 97.4%. Perioperative complications occurred in 4 patients, two from 32 cases who received elective surgery and other two from 4 cases who received emergent stent implantation. In cases receiving elective surgery, one suffered from perforating arterial branch occlusion and one occurred cerebral bleeding due to the rupture of middle cerebral artery caused by guide-wire. In patients receiving emergent stent implantation, acute stent thrombosis occurred in 2 cases during the interventional management (n=1) or 24 hours after stent placement (n=1). The overall complication rate was 11.1% (4/36). The 30-day composite ipsilateral stroke rate was 5.5% and the frequency of ipsilateral stroke within 30 days or ipsilateral stroke between 30 days and 12 months was 11.1% (4/36) during a mean follow-up time of 9.6 months (ranged between 1-24 months). DSA check-up was conducted in 10 cases and restenosis at the middle cerebral artery was detected in 2 cases. Conclusion: It is quite safe to use Gateway-Wingspan stent system for the treatment of symptomatic intracranial stenosis and its short-term clinical

  3. Clinical analysis of 34 cases symptomatic epilepsy secondary to cerebrovascular disease

    International Nuclear Information System (INIS)

    Zeng Mingyu; Liu Chunfeng

    2000-01-01

    Objective: To investigate the relation between cerebrovascular disease and symptomatic epilepsy. Method: 786 patients suffered cerebrovascular disease were retrospectively analyzed. Result: The occurrence rate of Secondary to Cerebrovascular Disease symptomatic epilepsy Secondary to Cerebrovascular Disease was 4.3%. Those older than 60 are prone to develop Acrodynia symptomatic epilepsy. Generalized epileptic seizure were often seen. Secondary to Cerebrovascular Disease epilepsy die to cortical lesion are more easily seem than subcortical lesion. Early epilepsy is more than late epilepsy. Conclusion: The cause of symptomatic epilepsy after cerebrovascular disease is not same in different types and course of CVD. Those who developed epilepsy particularly epilepsy continua would have bad prognosis

  4. Genetic variants in inflammation-related genes are associated with radiation-induced toxicity following treatment for non-small cell lung cancer.

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    Michelle A T Hildebrandt

    2010-08-01

    Full Text Available Treatment of non-small cell lung cancer (NSCLC with radiotherapy or chemoradiotherapy is often accompanied by the development of esophagitis and pneumonitis. Identifying patients who might be at increased risk for normal tissue toxicity would help in determination of the optimal radiation dose to avoid these events. We profiled 59 single nucleotide polymorphisms (SNPs from 37 inflammation-related genes in 173 NSCLC patients with stage IIIA/IIIB (dry disease who were treated with definitive radiation or chemoradiation. For esophagitis risk, nine SNPs were associated with a 1.5- to 4-fold increase in risk, including three PTGS2 (COX2 variants: rs20417 (HR:1.93, 95% CI:1.10-3.39, rs5275 (HR:1.58, 95% CI:1.09-2.27, and rs689470 (HR:3.38, 95% CI:1.09-10.49. Significantly increased risk of pneumonitis was observed for patients with genetic variation in the proinflammatory genes IL1A, IL8, TNF, TNFRSF1B, and MIF. In contrast, NOS3:rs1799983 displayed a protective effect with a 45% reduction in pneumonitis risk (HR:0.55, 95% CI:0.31-0.96. Pneumonitis risk was also modulated by polymorphisms in anti-inflammatory genes, including genetic variation in IL13. rs20541 and rs180925 each resulted in increased risk (HR:2.95, 95% CI:1.14-7.63 and HR:3.23, 95% CI:1.03-10.18, respectively. The cumulative effect of these SNPs on risk was dose-dependent, as evidenced by a significantly increased risk of either toxicity with an increasing number of risk genotypes (P<0.001. These results suggest that genetic variations among inflammation pathway genes may modulate the development of radiation-induced toxicity and, ultimately, help in identifying patients who are at an increased likelihood for such events.

  5. Clinical evaluation of the partition model for estimating radiation doses from yttrium-90 microspheres in the treatment of hepatic cancer

    International Nuclear Information System (INIS)

    Ho, S.; Lau, W.Y.; Leung, T.W.T.; Chan, M.; Johnson, P.J.; Li, A.K.C.

    1997-01-01

    Radiation doses to the tumour and non-tumorous liver compartments from yttrium-90 microspheres in the treatment of hepatic cancer, as estimated by a partition model, have been verified by correlation with the actual doses measured with a beta probe at open surgery. The validity of the doses to the lungs, the tumour and non-tumours liver compartment as estimated by the partition model was further evaluated in clinical settings. On the basis of the observation that one of three patients who received more than 30 Gy from a single treatment and one of two patients who received more than 50 Gy from multiple treatments developed radiation pneumonitis, it was deduced that an estimated lung dose 30 Gy as estimated by the partition model and were predicted to develop radiation pneumonitis, did so despite the use of partial hepatic embolization to reduce the degree of lung shunting. Furthermore, a higher radiological response rate and prolonged survival were found in the group of patients who received higher tumour doses, as estimated by the partition model, than in the group with lower estimated tumour doses. Thus the radiation doses estimated by the partition model can be used to predict (a) complication rate, (b) response rate and (c) duration of survival in the same manner as the actual radiation doses measured with a beta probe at open surgery. The partition model has made selective internal radiation therapy using 90 Y microspheres safe and repeatable without laparotomy. (orig.)

  6. Symptomatic Primary (AL Amyloidosis of the Stomach and Duodenum

    Directory of Open Access Journals (Sweden)

    Reidar Fossmark

    2013-01-01

    Full Text Available Primary (AL amyloidosis of the gastrointestinal tract is relatively rare, and symptomatic amyloidosis of the stomach is even more seldom. We present the case of a patient who was referred to upper endoscopy because of weight loss, nausea, and vomiting. Large areas of intramucosal hemorrhages were seen, and biopsies resulted in profuse bleeding stopped with endoscopic clips. The biopsies showed amyloid depositions and further workup revealed that the patient also had cardiac and neuropathic involvements. The patient started treatment with dexamethasone, melphalan and bortezomib. After treatment was started the nausea and epigastric discomfort improved, and a reduction in the biochemical markers troponin T, NT-proBNP, and M-component was observed. Gastric amyloidosis is rarely seen at upper endoscopy in patients without a previously established diagnosis, but the unusual endoscopic findings and bleeding tendency after biopsy should be kept in mind by gastroenterologists.

  7. Pes anserine bursitis: incidence in symptomatic knees and clinical presentation

    International Nuclear Information System (INIS)

    Rennie, W.J.; Saifuddin, A.

    2005-01-01

    To determine the prevalence and associated clinical symptoms of pes anserine bursitis in symptomatic adult knees. A retrospective review was performed of the reports of 509 knee MRI studies obtained from July 1998 to June 2004 on 488 patients presenting to an orthopaedic clinic with knee pain suspected to be due to internal derangement. The MRI studies and case histories of all patients reported to have pes anserine bursitis were reviewed. The management of these patients was also noted. The prevalence of pes anserine bursitis as detected on MRI is 2.5%. The commonest clinical presentation was pain along the medial joint line mimicking a medial meniscal tear. We suggest that an accurate diagnosis of pes anserine bursitis on MRI will help prevent unnecessary arthroscopy and possibly initiate early treatment of the condition. Axial imaging is important in these cases to differentiate the bursa from other medial fluid collections. (orig.)

  8. Pes anserine bursitis: incidence in symptomatic knees and clinical presentation

    Energy Technology Data Exchange (ETDEWEB)

    Rennie, W.J. [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); Saifuddin, A. [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); University College London, Institute of Orthopaedics and Musculoskeletal Sciences (United Kingdom)

    2005-07-01

    To determine the prevalence and associated clinical symptoms of pes anserine bursitis in symptomatic adult knees. A retrospective review was performed of the reports of 509 knee MRI studies obtained from July 1998 to June 2004 on 488 patients presenting to an orthopaedic clinic with knee pain suspected to be due to internal derangement. The MRI studies and case histories of all patients reported to have pes anserine bursitis were reviewed. The management of these patients was also noted. The prevalence of pes anserine bursitis as detected on MRI is 2.5%. The commonest clinical presentation was pain along the medial joint line mimicking a medial meniscal tear. We suggest that an accurate diagnosis of pes anserine bursitis on MRI will help prevent unnecessary arthroscopy and possibly initiate early treatment of the condition. Axial imaging is important in these cases to differentiate the bursa from other medial fluid collections. (orig.)

  9. Memory in children with symptomatic temporal lobe epilepsy

    Directory of Open Access Journals (Sweden)

    Catarina A. Guimarães

    2014-03-01

    Full Text Available In children with temporal lobe epilepsy (TLE, memory deficit is not so well understood as it is in adults. The aim of this study was to identify and describe memory deficits in children with symptomatic TLE, and to verify the influence of epilepsy variables on memory. We evaluated 25 children with TLE diagnosed on clinical, EEG and MRI findings. Twenty-five normal children were compared with the patients. All children underwent a neuropsychological assessment to estimate intellectual level, attention, visual perception, handedness, and memory processes (verbal and visual: short-term memory, learning, and delayed recall. The results allowed us to conclude: besides memory deficits, other neuropsychological disturbances may be found in children with TLE such as attention, even in the absence of overall cognitive deficit; the earlier onset of epilepsy, the worse verbal stimuli storage; mesial lesions correlate with impairment in memory storage stage while neocortical temporal lesions correlate with retrieval deficits.

  10. Symptomatic splenic hamartoma with renal, cutaneous, and hematological abnormalities

    International Nuclear Information System (INIS)

    Kassarjian, A.; Patenaude, Y.G.; Bernard, C.; Bell, L.

    2001-01-01

    Background. There is a rare association between splenic hamartomas and hematological abnormalities with, to our knowledge, only 24 reported cases in the English literature. Patients and methods. We report a case of a splenic hamartoma in a 14-year-old boy associated with membranoproliferative glomerulonephritis, multiple lobular capillary hemangiomas of the skin, hypertension, and anemia. Following imaging with ultrasonography, MRI, and nuclear scans, a hamartoma was suspected, but malignancy could not be excluded. The lesion was removed by partial splenectomy, and pathological examination confirmed the presence of a red pulp splenic hamartoma. Results. The renal, hematological, and dermatological abnormalities resolved following removal of the splenic hamartoma. This is the first reported case of a splenic hamartoma associated with renal, cutaneous, and hematological abnormalities and only the second reported case of a symptomatic splenic hamartoma treated by partial splenectomy. (orig.)

  11. Extra colonic Findings on CT Colonography in Symptomatic Patients

    International Nuclear Information System (INIS)

    Drahovska, I.; Nigut, F.; Mach, P.; Lazurova, I.; Gombosova, L.

    2011-01-01

    The paper is an analysis of the consequences of the extra colonic findings identified on CT colonography examination of symptomatic patients and the validity of the intravenous application of contrast medium in this examination. The authors enrolled 252 patients, who underwent CT colonogprahy.128 extra colonic findings was identified in 80 patients (31.74%). The average age was 65.62 years (SD = 12.7, min. age was 29, max. age. 85 years). According the clinical significance the extra colonic findings have been divided into three groups – low, moderate and very important extra colonic findings. Low significant findings were 68 (53.12%), moderate 26 (20.31%) and very important extra colonic findings were 34 (26.56%), of which 30 were malignant nature. (author)

  12. Update on the risk stratification of acute symptomatic pulmonary thromboembolism.

    Science.gov (United States)

    Maestre Peiró, A; Gonzálvez Gasch, A; Monreal Bosch, M

    Early mortality in patients with pulmonary thromboembolism (PTE) varies from 2% in normotensive patients to 30% in patients with cardiogenic shock. The current risk stratification for symptomatic PTE includes 4 patient groups, and the recommended therapeutic strategies are based on this stratification. Patients who have haemodynamic instability are considered at high risk. Fibrinolytic treatment is recommended for these patients. In normotensive patients, risk stratification helps differentiate between those of low risk, intermediate-low risk and intermediate-high risk. There is currently insufficient evidence on the benefit of intensive monitoring and fibrinolytic treatment in patients with intermediate-high risk. For low-risk patients, standard anticoagulation is indicated. Early discharge with outpatient management may be considered, although its benefit has still not been firmly established. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. Symptomatic sinus bradycardia: A rare adverse effect of intravenous ondansetron

    Directory of Open Access Journals (Sweden)

    Md Shahnawaz Moazzam

    2011-01-01

    Full Text Available Ondansetron is a serotonin receptor antagonist which has been used frequently to reduce the incidence of post-operative nausea and vomiting in laparoscopic surgery. It has become very popular drug for the prevention of post-operative nausea and vomiting due to its superiority in-terms of efficacy as well as lack of side effects and drug interactions. Although cardiovascular adverse effects of this drug are rare, we found a case of symptomatic sinus bradycardia in a 43-year-old female patient, going for laparoscopic cholecystectomy, who developed the same after she was given intravenous ondansetron in operation theater during premedication. Hence, we report this case, as the rare possibility of encountering bradycardia effect after intravenous administration of ondansetron should be born in mind.

  14. Radiofrequency Ablation for Treatment of Symptomatic Uterine Fibroids

    Directory of Open Access Journals (Sweden)

    Siân Jones

    2012-01-01

    Full Text Available The use of thermal energy-based systems to treat uterine fibroids has resulted in a plethora of devices that are less invasive and potentially as effective in reducing symptoms as traditional options such as myomectomy. Most thermal ablation devices involve hyperthermia (heating of tissue, which entails the conversion of an external electromagnetic or ultrasound waves into intracellular mechanical energy, generating heat. What has emerged from two decades of peer-reviewed research is the concept that hyperthermic fibroid ablation, regardless of the thermal energy source, can create large areas of necrosis within fibroids resulting in reductions in fibroid volume, associated symptoms and the need for reintervention. When a greater percentage of a fibroid's volume is ablated, symptomatic relief is more pronounced, quality of life increases, and it is more likely that such improvements will be durable. We review radiofrequency ablation (RFA, one modality of hyperthermic fibroid ablation.

  15. Symptomatic Improvement of Gastroduodenal Crohn’s Disease with Omeprazole

    Directory of Open Access Journals (Sweden)

    K Woolfson

    1992-01-01

    Full Text Available Four patients with ileal Crohn’s disease presented with abdominal pain aggravated by food, a mean weight loss of 5.5 kg (range 4 to 7 and ulceration of the antrum and/or duodenum at gastroscnpy, without radiological features of mechanical obstruction . The endoscopic and histological appearance of the ulcers was consistent with Crohn's disease. Omeprazole 40 mg daily was administered, without other drugs, and after three days of therapy patients were asymptomatic. After eight weeks of omeprazole, a mean weight gain of 6 kg (range 3 to 10 had occurred and the drug was withdrawn. One patient remained well and three patients relapsed, but all responded to long term omeprazole for up to three years. Follow-up endoscopies have indicated healing in one patient, partial healing in two patients and no change in one patient. Omeprazole may be of value in the symptomatic management of patients with gastroduodenal Crohn’s disease.

  16. Symptomatic intraspinal synovial cysts: Opacification and treatment by percutaneous injection

    International Nuclear Information System (INIS)

    Bjorkengren, A.G.; Resnick, D.; Kurz, L.T.; Garfin, S.R.; Sartoris, D.J.

    1986-01-01

    Synovial cysts in an intraspinal location, associated with facet joint osteoarthritis, have been diagnosed using CT. Surgical removal of the cyst, when believed to be the cause of radiculopathy, has resulted in symptomatic relief. The authors have applied a nonoperative treatment method consisting of CT-guided needle placement in the facet joint adjacent to the cyst, followed by injection of contrast material and corticosteroids. Three patients were treated without complications and with complete relief of symptoms in two cases and partial relief in one, although no decrease in the size of the cysts was demonstrated on follow-up CT scans. The preliminary results indicate a possible role for this treatment technique in patients with intraspinal synovial cysts

  17. Symptomatic splenic hamartoma with renal, cutaneous, and hematological abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Kassarjian, A.; Patenaude, Y.G. [Dept. of Medical Imaging, Montreal Children' s Hospital, PQ (Canada); Bernard, C. [Dept. of Pathology, Montreal Children' s Hospital, PQ (Canada); Bell, L. [Dept. of Nephrology, Montreal Children' s Hospital, PQ (Canada)

    2001-02-01

    Background. There is a rare association between splenic hamartomas and hematological abnormalities with, to our knowledge, only 24 reported cases in the English literature. Patients and methods. We report a case of a splenic hamartoma in a 14-year-old boy associated with membranoproliferative glomerulonephritis, multiple lobular capillary hemangiomas of the skin, hypertension, and anemia. Following imaging with ultrasonography, MRI, and nuclear scans, a hamartoma was suspected, but malignancy could not be excluded. The lesion was removed by partial splenectomy, and pathological examination confirmed the presence of a red pulp splenic hamartoma. Results. The renal, hematological, and dermatological abnormalities resolved following removal of the splenic hamartoma. This is the first reported case of a splenic hamartoma associated with renal, cutaneous, and hematological abnormalities and only the second reported case of a symptomatic splenic hamartoma treated by partial splenectomy. (orig.)

  18. Broncho-pulmonary toxicity in stage III non small cell lung cancer patients treated with taxol containing chemotherapy and concurrent preoperative or definitive radiation therapy

    International Nuclear Information System (INIS)

    Sharma, M. Maddie; Gupta-Burt, Shalina; Recine, Diane C.; Faber, L. Penfield; Warren, William H.; LaFollette, Suzanne; Lincoln, Sarah T.; Bonomi, Philip D.

    1997-01-01

    Purpose/Objective: The objective of this trial was to test the feasibility of taxol containing combination chemotherapy and concurrent radiation as preoperative or definitive treatment for stage III non small cell lung cancer patients. Methods and Materials: Thirty-three patients were treated on this trial. The initial regimen was (Group 1 pts.): paraplatin (P) (AUC of 4) on day 2, etoposide (E) 50 mg po days 1-5 and 8-12, cisplatin (C) 50 mg/m2 on day 21 and taxol (T) 35 mg/m2 escalated to 45 mg/m2 on days 1 and 8, 24 hr. infusion. After treatment of 10 pts., the regimen was modified as follows (Group 2 pts.): P (AUC of 4) on day 1, E 40 mg/m2 IV daily and days 2-5, and T 80 mg/m2 escalated to 120 mg/m2 on day 1, 3 hr. infusion. After the next 16 pts., the regimen was modified again as follows (Group 3 pts.): P (AUC of 4) on day 1 and T 120 mg/m2 escalated to 140 mg/m2 on day 1, 3 hr. infusion. Seven patients were treated on the latest version of the regimen for a total of 33 pts. The radiation given was uniform throughout the 3 groups. A dose of 4000 cGy in 20 fxs was given in the surgical arm and 6000 cGy in 30 fxs in the non surgical arm. Treatments were given at 200 cGy/fx. once a day, on a 2 weeks on, 2 weeks off basis. The RTOG Acute Radiation Morbidity Scoring Criteria was used to grade pneumonitis. Post-operative complications were defined as occurring early (less than or equal to 30 days) or late (greater than 30 days) following surgery. Results: Sixteen of the 33 patients went to surgery. Grade 3 radiation pneumonitis developed in 4 of the 33 patients (12%). There were no episodes of Grade 4 pneumonitis. Grade 3 pneumonitis occured in: One patient in Group 1, (RT dose 5800 cGy), 2 pts in Group 2 (RT dose 4000 cGy and 6000 cGy, respectively), and 1 pt in Group 3 (RT dose 6000 cGy). Major post-operative complications occurred in 6 of the 16 patients (37.5%) who went to surgery. In Group 1, 1 pt. required oxygen supplementation secondary to a significant

  19. Acute symptomatic hypocalcemia from immune checkpoint therapy-induced hypoparathyroidism.

    Science.gov (United States)

    Win, Myint Aung; Thein, Kyaw Zin; Qdaisat, Aiham; Yeung, Sai-Ching Jim

    2017-07-01

    Ipilimumab (a monoclonal antibody against CTLA-4) and nivolumab (a humanized antibody against PD-1) target these immune checkpoint pathways and are used for treatment of melanoma and an increasing number of other cancers. However, they may cause immune-related adverse effects (IRAEs). Although many endocrinopathies are known to be IRAEs, primary hypoparathyroidism with severe hypocalcemia has never been reported. This is the first case of hypoparathyroidism as an IRAE presenting to an Emergency Department with acute hypocalcemia. A 73-year-old man with metastatic melanoma presented to the Emergency Department for the chief complaints of imbalance, general muscle weakness, abdominal pain and tingling in extremities. He had wide spread metastasis, and begun immunotherapy with concurrent ipilimumab and nivolumab 1.5months ago. At presentation, he had ataxia, paresthesia in the hands and feet, and abdominal cramping. Magnetic resonance imaging of the brain was unremarkable. He was found to be hypocalcemic with undetectable plasma parathyroid hormone. He was admitted for treatment of symptomatic hypocalcemia and was diagnosed with primary hypoparathyroidism. Shortly afterwards, he had thyrotoxicosis manifesting as tachycardia and anxiety, followed by development of primary hypothyroidism. At 4months after the Emergency Department visit, his parathyroid function and thyroid function had not recovered, and required continued thyroid hormone replacement and calcium and vitamin D treatment for hypocalcemia. Primary hypoparathyroidism caused by ipilimumab and nivolumab may acute manifest with severe symptomatic hypocalcemia. Emergency care providers should be aware of hypoparathyroidism as a new IRAE in this new era of immuno-oncology. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma.

    Science.gov (United States)

    Fader, Ryan R; Mitchell, Justin J; Chadayammuri, Vivek P; Hill, John; Wolcott, Michelle L

    2015-11-01

    Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms. Copyright 2015, SLACK Incorporated.

  1. Primary balloon angioplasty for symptomatic, high-grade intracranial stenosis.

    Science.gov (United States)

    Tomycz, Luke; Bansal, Neil K; Lockney, Tim; Strothers, Megan; Connors, John J; Shay, Scott; Singer, Robert J

    2013-01-01

    In light of recent controversy about the safety and efficacy of intracranial stenting, we sought to evaluate our experience with primary balloon angioplasty for symptomatic, high-grade intracranial stenosis. All intracranial angioplasty cases performed at Vanderbilt University Medical Center from 2006 to 2011 were retrospectively reviewed for degree of stenosis pre- and post-procedure. Immediate peri-procedural complications were evaluated as well as one-month and long-term outcomes. A total of 26 patients were included in the study with a mean age of 63.0 years and a mean follow-up of 350.2 days. The average pre-procedure stenosis was 71.2%. The immediate, average post-procedure stenosis was 46.6%, and the average post-procedure stenosis at last angiographic follow-up was 44.5%. Retreatment was required in only 3.8% of patients. The primary end-point of major stroke or death at 30 days was observed in 11.5%, and the overall intra-procedural complication rate was 7.7%. The incidence of stroke or death at last follow-up was 15.4%, which is comparable to the one-year stroke or death rate in the medical arm of the SAMPRISS trial. In this retrospective series, primary balloon angioplasty was found to be effective as a treatment option for symptomatic intracranial stenosis with the risk of stroke or death at 30 days higher than the medical arm of SAMPRIS but lower than the stenting arm. The one-year risk of stroke was comparable to that reported for the one-year outcomes in the SAMPRISS medical arm.

  2. Radiation therapy in leukemia (total body irradiation excluded)

    International Nuclear Information System (INIS)

    Peiffert, D.; Hoffstetter, S.

    1999-01-01

    Radiation techniques and indications in leukemias have been described in detail, yet prophylactic cranial irradiation in acute leukemia still has few indications. Cerebrospinal and testicular irradiation are reserved for relapsing disease. Radiation usually results in rapid functional improvement when used in neurologic emergencies and symptomatic neurologic or gross tumors relapses. Nevertheless, the improvements recently obtained by systemic chemotherapy have resulted in the reduction in the use of irradiation, especially in children, where it was considered deleterious with neuropsychological sequelae. Splenic irradiation remains useful for symptomatic myelo-proliferative syndrome. (authors)

  3. Prevalence and heritability of symptomatic syringomyelia in Cavalier King Charles Spaniels and long-term outcome in symptomatic and asymptomatic littermates

    DEFF Research Database (Denmark)

    Thøfner, Maria Søndergaard; Stougaard, C. L.; Westrup, Ulrik

    2015-01-01

    (P euthanasia in 20%. Dogs with syringes, which expressed no clinical signs at the age of 6, remained asymptomatic in 14/15 cases (93%). CONCLUSIONS AND CLINICAL IMPORTANCE: The prevalence of symptomatic SM is high...

  4. Distribution pattern of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs in males.

    Science.gov (United States)

    Nnamdi, Ibe Michael Onwuzuruike

    2013-09-01

    The pattern of distribution of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs has been published, though scantily, especially in males. We decided to look at our own series, compare and contrast ours with some of those published. We treated 88 locations of this lesion in 68 males. The clinical features were those of lower back pains, with or without radiation into the lower extremities, sensory loss and paresis of the limbs. There was a case of loss of urinary bladder and ano-rectal control. All lesions were confirmed through cauda-equinograms and treated under general anaesthesia in knee-chest position (MECCA position). The patients were followed up for 3-6 months post-operatively. There were 88 locations in 68 males of 21-70 years of age, with 29 prolapses occurring during the age range 31-40 years, while 54 locations were on the left and 48 at L4/5. The procedures were well tolerated by all patients and there were no post-operative complications. This lesion in our series occurred mostly on the left, at the L4/5 level and peaked at 31-40 years age range. The predictability of occurrence of this disease, using side, level and age is still not feasible in males from our series.

  5. Role of perfusion SPECT in prediction and measurement of pulmonary complications after radiotherapy for lung cancer

    DEFF Research Database (Denmark)

    Farr, Katherina P; Kramer, Stine; Khalil, Azza A

    2015-01-01

    PURPOSE: The purpose of the study was to evaluate the ability of baseline perfusion defect score (DS) on SPECT to predict the development of severe symptomatic radiation pneumonitis (RP) and to evaluate changes in perfusion on SPECT as a method of lung perfusion function assessment after curative...

  6. Human monocyte-derived dendritic cells exposed to microorganisms involved in hypersensitivity pneumonitis induce a Th1-polarized immune response.

    Science.gov (United States)

    Bellanger, Anne-Pauline; Pallandre, Jean-René; Borg, Christophe; Loeffert, Sophie; Gbaguidi-Haore, Houssein; Millon, Laurence

    2013-08-01

    Hypersensitivity pneumonitis (HP) is an immunoallergic disease characterized by a prominent interstitial infiltrate composed predominantly of lymphocytes secreting inflammatory cytokines. Dendritic cells (DCs) are known to play a pivotal role in the lymphocytic response. However, their cross talk with microorganisms that cause HP has yet to be elucidated. This study aimed to investigate the initial interactions between human monocyte-derived DCs (MoDCs) and four microorganisms that are different in nature (Saccharopolyspora rectivirgula [actinomycetes], Mycobacterium immunogenum [mycobacteria], and Wallemia sebi and Eurotium amstelodami [filamentous fungi]) and are involved in HP. Our objectives were to determine the cross talk between MoDCs and HP-causative agents and to determine whether the resulting immune response varied according to the microbial extract tested. The phenotypic activation of MoDCs was measured by the increased expression of costimulatory molecules and levels of cytokines in supernatants. The functional activation of MoDCs was measured by the ability of MoDCs to induce lymphocytic proliferation and differentiation in a mixed lymphocytic reaction (MLR). E. amstelodami-exposed (EA) MoDCs expressed higher percentages of costimulatory molecules than did W. sebi-exposed (WS), S. rectivirgula-exposed (SR), or M. immunogenum-exposed (MI) MoDCs (P < 0.05, Wilcoxon signed-rank test). EA-MoDCs, WS-MoDCs, SR-MoDCs, and MI-MoDCs induced CD4(+) T cell proliferation and a Th1-polarized immune response. The present study provides evidence that, although differences were initially observed between MoDCs exposed to filamentous fungi and MoDCs exposed to bacteria, a Th1 response was ultimately promoted by DCs regardless of the microbial extract tested.

  7. A non-invasive in vivo imaging system to study dissemination of bioluminescent Yersinia pestis CO92 in a mouse model of pneumonic plague.

    Science.gov (United States)

    Sha, Jian; Rosenzweig, Jason A; Kirtley, Michelle L; van Lier, Christina J; Fitts, Eric C; Kozlova, Elena V; Erova, Tatiana E; Tiner, Bethany L; Chopra, Ashok K

    2013-02-01

    The gold standard in microbiology for monitoring bacterial dissemination in infected animals has always been viable plate counts. This method, despite being quantitative, requires sacrificing the infected animals. Recently, however, an alternative method of in vivo imaging of bioluminescent bacteria (IVIBB) for monitoring microbial dissemination within the host has been employed. Yersinia pestis is a Gram-negative bacterium capable of causing bubonic, septicemic, and pneumonic plague. In this study, we compared the conventional counting of bacterial colony forming units (cfu) in the various infected tissues to IVIBB in monitoring Y. pestis dissemination in a mouse model of pneumonic plague. By using a transposon mutagenesis system harboring the luciferase (luc) gene, we screened approximately 4000 clones and obtained a fully virulent, luc-positive Y. pestis CO92 (Y. pestis-luc2) reporter strain in which transposition occurred within the largest pMT1 plasmid which possesses murine toxin and capsular antigen encoding genes. The aforementioned reporter strain and the wild-type CO92 exhibited similar growth curves, formed capsule based on immunofluorescence microscopy and flow cytometry, and had a similar LD(50). Intranasal infection of mice with 15 LD(50) of CO92-luc2 resulted in animal mortality by 72 h, and an increasing number of bioluminescent bacteria were observed in various mouse organs over a 24-72 h period when whole animals were imaged. However, following levofloxacin treatment (10 mg/kg/day) for 6 days 24 h post infection, no luminescence was observed after 72 h of infection, indicating that the tested antimicrobial killed bacteria preventing their detection in host peripheral tissues. Overall, we demonstrated that IVIBB is an effective and non-invasive way of monitoring bacterial dissemination in animals following pneumonic plague having strong correlation with cfu, and our reporter CO92-luc2 strain can be employed as a useful tool to monitor the efficacy

  8. The efficacy of prophylactic antibiotics in the management of children with kerosene-associated pneumonitis: a double-blind randomised controlled trial.

    Science.gov (United States)

    Balme, Kate H; Zar, Heather; Swift, Donne K; Mann, Michael D

    2015-01-01

    Hydrocarbons, especially kerosene (paraffin), are the most common agents causing childhood poisoning in low and middle income countries (LMICs). Aspiration of kerosene causes an inflammatory sterile chemical pneumonitis, which may increase susceptibility to secondary lower respiratory tract bacterial infection. This study aimed to assess the efficacy of prophylactic antibiotics in the management of kerosene-associated pneumonitis in children and to identify risk factors associated with severity or outcome. A double-blind placebo-controlled trial of prophylactic antibiotics in the management of kerosene-associated pneumonitis of children presenting to a referral hospital was performed from July 2010 to September 2011. Sequential children with a history of kerosene ingestion and mild respiratory illness were randomised to receive placebo or amoxicillin. Each child was followed-up at Day 3 and Day 5 post-ingestion. The primary outcome measure was the number of treatment failures in each group, defined as any child who deteriorated within this time, necessitating a change in treatment regimen. Secondary outcome measures were length of hospital stay and symptoms and signs at follow-up. Seventy-four patients were enrolled. Thirty-five (47%) received placebo and 39 (53%) active treatment. There was no significant difference in treatment failures between placebo (3/35, 9%; 95% CI, 3-22) and active (2/39, 5%; 95% CI, 1-17) groups (relative risk, 0.60; 95% CI, 0.11-3.37). The median length of hospital stay was identical (placebo 0.5 days; IQR, 0-1.0 and active 0.5 days; IQR, 0.5-1.0). Symptoms and signs at Days 3 and 5 post-ingestion were similar. The only significant risk factor for treatment failure was residence in formal housing. Clinical severity at presentation was similar for treatment successes and failures. Prophylactic antibiotics do not improve the outcome in children with mild respiratory illness after kerosene ingestion.

  9. Six psychotropics for pre-symptomatic & early Alzheimer's (MCI, Parkinson's, and Huntington's disease modification

    Directory of Open Access Journals (Sweden)

    Edward C Lauterbach

    2016-01-01

    Full Text Available The quest for neuroprotective drugs to slow the progression of neurodegenerative diseases (NDDs, including Alzheimer's disease (AD, Parkinson's disease (PD, and Huntington's disease (HD, has been largely unrewarding. Preclinical evidence suggests that repurposing quetiapine, lithium, valproate, fluoxetine, donepezil, and memantine for early and pre-symptomatic disease-modification in NDDs may be promising and can spare regulatory barriers. The literature of these psychotropics in early stage and pre-symptomatic AD, PD, and HD is reviewed and propitious findings follow. Mild cognitive impairment (MCI phase of AD: salutary human randomized controlled trial findings for low-dose lithium and, in selected patients, donepezil await replication. Pre-symptomatic AD: human epidemiological data indicate that lithium reduces AD risk. Animal model studies (AMS reveal encouraging results for quetiapine, lithium, donepezil, and memantine. Early PD: valproate AMS findings show promise. Pre-symptomatic PD: lithium and valproate AMS findings are encouraging. Early HD: uncontrolled clinical data indicate non-progression with lithium, fluoxetine, donepezil, and memantine. Pre-symptomatic HD: lithium and valproate are auspicious in AMS. Many other promising findings awaiting replication (valproate in MCI; lithium, valproate, fluoxetine in pre-symptomatic AD; lithium in early PD; lithium, valproate, fluoxetine in pre-symptomatic PD; donepezil in early HD; lithium, fluoxetine, memantine in pre-symptomatic HD are reviewed. Dose- and stage-dependent effects are considered. Suggestions for signal-enhancement in human trials are provided for each NDD stage.

  10. Deep-vein thrombosis and the incidence of subsequent symptomatic cancer

    NARCIS (Netherlands)

    Prandoni, P.; Lensing, A. W.; Büller, H. R.; Cogo, A.; Prins, M. H.; Cattelan, A. M.; Cuppini, S.; Noventa, F.; ten Cate, J. W.

    1992-01-01

    In contrast to the established relation between overt cancer and subsequent venous thromboembolism, it is unclear whether symptomatic deep-vein thrombosis is associated with a risk of subsequent overt malignant disease. Two hundred sixty consecutive patients with symptomatic, venographically proved

  11. Diagnosing symptomatic HIV infection and AIDS in adults.

    Science.gov (United States)

    1993-01-01

    The US Centers for Disease Control in 1982 listed conditions and infections then associated with AIDS. That case definition, used as a model for many countries, was designed primarily for epidemiologic surveillance and now includes more than 20 conditions. The definition, however, requires diagnostic and laboratory technologies which are not always available in developing countries. The World Health Organization (WHO) therefore published the Bangui definition in 1985 which uses clinical criteria alone. Many developing countries have adapted this definition to the types of pathogens they encounter domestically. According to the AIDS clinical definition, the presence of generalized Kaposi sarcoma or cryptococcal meningitis is sufficient for the diagnosis of AIDS. AIDS is also diagnosed if at least two major signs and one minor sign are present in the absence of known causes of immunosuppression such as malnutrition. Major signs are fever for more than one month, loss of more than 10% of body weight, and diarrhea for more than one month. Minor signs include cough for more than one month, generalized pruritic dermatitis, recurrent herpes zoster or shingles, oropharyngeal candidiasis or thrush, chronic or aggressive ulcerative herpes simplex, and persistent generalized lymphadenopathy. WHO has also developed criteria for diagnosing symptomatic HIV infection as an aid to individual case management. These criteria, however, are not intended to replace the Bangui AIDS case definitions developed for epidemiological purposes. The diagnosis of symptomatic HIV infection is made through physical examination and the taking of a very detailed case history. In so doing, there may be cardinal, characteristic, and/or associated findings. Cardinal findings of HIV infection are Kaposi sarcoma, oesophageal candidiasis, cytomegalovirus retinitis, Pneumocystis carinii pneumonia, and Toxoplasma encephalitis. Characteristic findings include oral thrush in a patient not taking antibiotics

  12. Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography

    Directory of Open Access Journals (Sweden)

    LaFramboise William A

    2012-12-01

    revascularization. Osteopontin (14 times and resistin (10 times were most frequently represented among these diagnostic signatures. The most efficacious protein signature in validation studies comprised osteopontin (OPN, resistin, matrix metalloproteinase 7 (MMP7 and interferon γ (IFNγ as a four-marker panel while the addition of either CRP or adiponectin (ACRP-30 yielded comparable results in five protein signatures. Conclusions Proteins in the serum of CAD patients predominantly reflected (1 a positive acute phase, inflammatory response and (2 alterations in lipid metabolism, transport, peroxidation and accumulation. There were surprisingly few indicators of growth factor activation or extracellular matrix remodeling in the serum of CAD patients except for elevated OPN. These data suggest that many symptomatic patients without significant CAD could be identified by a targeted multiplex serum protein test without cardiac catheterization thereby eliminating exposure to ionizing radiation and decreasing the economic burden of angiographic testing for these patients.

  13. Outcome of alcohol septal ablation in mildly symptomatic patients with hypertrophic obstructive cardiomyopathy

    DEFF Research Database (Denmark)

    Veselka, Josef; Faber, Lothar; Liebregts, Max

    2017-01-01

    Background- The long-term efficacy and safety of alcohol septal ablation (ASA) in patients with highly symptomatic hypertrophic obstructive cardiomyopathy has been demonstrated. The aim of this study was to evaluate the long-term outcomes of mildly symptomatic patients with hypertrophic obstructive......, and III at the last clinical checkup, respectively. Conclusions- Mildly symptomatic hypertrophic obstructive cardiomyopathy patients treated with ASA had sustained symptomatic and hemodynamic relief with a low risk of developing severe heart failure. Their survival is comparable to the general population....... cardiomyopathy treated with ASA. Methods and Results- We retrospectively evaluated consecutive patients enrolled in the Euro-ASA registry (1427 patients) and identified 161 patients (53±13 years; 27% women) who were mildly symptomatic (New York Heart Association [NYHA] class II) pre-ASA. The median...

  14. Safety and Efficacy of Stereotactic Body Radiation Therapy in the Treatment of Pulmonary Metastases from High Grade Sarcoma

    Directory of Open Access Journals (Sweden)

    Niraj Mehta

    2013-01-01

    Full Text Available Introduction. Patients with high-grade sarcoma (HGS frequently develop metastatic disease thus limiting their long-term survival. Lung metastases (LM have historically been treated with surgical resection (metastasectomy. A potential alternative for controlling LM could be stereotactic body radiation therapy (SBRT. We evaluated the outcomes from our institutional experience utilizing SBRT. Methods. Sixteen consecutive patients with LM from HGS were treated with SBRT between 2009 and 2011. Routine radiographic and clinical follow-up was performed. Local failure was defined as CT progression on 2 consecutive scans or growth after initial shrinkage. Radiation pneumonitis and radiation esophagitis were scored using Common Toxicity Criteria (CTC version 3.0. Results. All 16 patients received chemotherapy, and a subset (38% also underwent prior pulmonary metastasectomy. Median patient age was 56 (12–85, and median follow-up time was 20 months (range 3–43. A total of 25 lesions were treated and evaluable for this analysis. Most common histologies were leiomyosarcoma (28%, synovial sarcoma (20%, and osteosarcoma (16%. Median SBRT prescription dose was 54 Gy (36–54 in 3-4 fractions. At 43 months, local control was 94%. No patient experienced G2-4 radiation pneumonitis, and no patient experienced radiation esophagitis. Conclusions. Our retrospective experience suggests that SBRT for LM from HGS provides excellent local control and minimal toxicity.

  15. [Predictors of symptomatic improvement in eating disorders. Preliminary analysis].

    Science.gov (United States)

    Cygankiewicz, Patrycja; Solecka, Dorota; Pilecki, Maciej Wojciech; Józefik, Barbara

    2012-01-01

    The article discusses the preliminary results of a follow-up study carried out in 2009-2010 on former patients with a diagnosis of anorexia nervosa and bulimia nervosa, first seen in 2001-2004 at the Department of Child and Adolescent Psychiatry, the Jagiellonian University Medical College in Krakow. At that time they had been taking part in a research project, whose aim was to define the relationships among the psychopathological picture of eating disorders, self-image and family relations and also the influence of socio-cultural factors. The aim of the current study is to attempt to define factors influencing the course and prognosis of eating disorders in the studied group. Results from the Eating Disorder Inventory Questionnaire (EDI) and the Polish version of Family Assessment Measure (KOR) in the first study were juxtaposed with the clinical state and parameters of psychosocial functioning of the studied women assessed on the basis of the follow-up study. In the studied group, 13 girls suffered from anorexia nervosa--restricting type, 6 from anorexia nervosa binge-eating/purging type, and 6 from bulimia. In the studied group, there was complete symptomatic improvement in 12 persons (48%), subclinical symptoms continued to be observed in 9 persons (36%), and 4 persons (16%) met full diagnostic criteria for eating disorders. The most favourable course was observed in the group with a diagnosis of anorexia nervosa restricting type. The least favourable was observed in the group with a diagnosis of bulimia. Results. In the studied group, 13 girls suffered from anorexia nervosa - restricting type, 6 from anorexia nervosa binge-eating/purging type, and 6 from bulimia. In the studied group, there was complete symptomatic improvement in 12 persons (48%), subclinical symptoms continued to be observed in 9 persons (36%), and 4 persons (16%) met full diagnostic criteria for eating disorders. The most favourable course was observed in the group with a diagnosis of

  16. Management of symptomatic thrombocytopenia associated with dengue haemorrhagic fever

    International Nuclear Information System (INIS)

    Jameel, T.; Saleem, I.U.; Mehmood, K.; Tanvir, I.; Saadia, A.

    2010-01-01

    Introduction: Immune - mediated destruction of platelets is thought to be the mechanism of thrombocytopenia seen after the viraemic phase of dengue haemorrhagic fever (DHF). Immuno - suppressants such as steroids, immune globulin and Anti D immune globulin are effective in the treatment of this type of immune thrombocytopenic purpura. Objective: To evaluate the efficacy of oral Prednisolone in the rate of resolution of thrombocytopenia and monitoring of complications in patients recovering from Dengue haemorrhagic fever. Method: A controlled study was carried out on diagnosed cases Dengue haemorrhagic patients presenting with sever thrombocytopenia and symptoms like confluent ecchymosis, epistaxis and purpuric rashes. In study was conducted in Ittefaq hospital (trust) Lahore, during the period of October to December 2008. Treatment group received steroids in two forms i.e. first line therapy prednisolone (1 mg / kg) orally or as second line therapy of initial I/V high dose (prednisolone) in pulse doses i.e. 40 mg / bd for four days and later oral prednisolone as in first line therapy with omeprazole 20 mg / bd in addition to standard treatment. Control group received standard supportive care only. Results: A total of 341 suspected patients were admitted in hospital. Serological diagnosis was confirmed in 166 patients. CBC revealed platelet count . 100 x 109 / l in 106 patients. A group of symptomatic febrile patients have platelet count < 20 x 109 / l was selected for therapeutic intervention. first line therapy (oral prednisolone was stated in 43 patients. In Fourteen patients second line therapy (high dose dexamethasone pulse) therapy was instituted. Seven of them attained complete response whereas two patients achieved partial response. Four patients were shifted to Anti D therapy. Three deaths occurred during our study. Rest of all the patients improved and were discharged in due course of time. Conclusion: This small scale preliminary study shows promising

  17. Angiotensin converting enzyme inhibitors mitigate collagen synthesis induced by a single dose of radiation to the whole thorax.

    Science.gov (United States)

    Kma, Lakhan; Gao, Feng; Fish, Brian L; Moulder, John E; Jacobs, Elizabeth R; Medhora, Meetha

    2012-01-01

    Our long-term goal is to use angiotensin converting enzyme (ACE) inhibitors to mitigate the increase in lung collagen synthesis that is induced by irradiation to the lung, which could result from accidental exposure or radiological terrorism. Rats (WAG/RijCmcr) were given a single dose of 13 Gy (dose rate of 1.43 Gy/min) of X-irradiation to the thorax. Three structurally-different ACE inhibitors, captopril, enalapril and fosinopril were provided in drinking water beginning 1 week after irradiation. Rats that survived acute pneumonitis (at 6-12 weeks) were evaluated monthly for synthesis of lung collagen. Other endpoints included breathing rate, wet to dry lung weight ratio, and analysis of lung structure. Treatment with captopril (145-207 mg/m(2)/day) or enalapril (19-28 mg/m(2)/day), but not fosinopril (19-28 mg/m(2)/day), decreased morbidity from acute pneumonitis. Lung collagen in the surviving irradiated rats was increased over that of controls by 7 months after irradiation. This increase in collagen synthesis was not observed in rats treated with any of the three ACE inhibitors. Analysis of the lung morphology at 7 months supports the efficacy of ACE inhibitors against radiation-induced fibrosis. The effectiveness of fosinopril against fibrosis, but not against acute pneumonitis, suggests that pulmonary fibrosis may not be a simple consequence of injury during acute pneumonitis. In summary, three structurally-different ACE inhibitors mitigate the increase in collagen synthesis 7 months following irradiation of the whole thorax and do so, even when therapy is started one week after irradiation.

  18. Carnosine may reduce lung injury caused by radiation therapy.

    Science.gov (United States)

    Guney, Yildiz; Turkcu, Ummuhani Ozel; Hicsonmez, Ayse; Andrieu, Meltem Nalca; Guney, H Zafer; Bilgihan, Ayse; Kurtman, Cengiz

    2006-01-01

    Ionising radiation is known one of the most effective tools in the therapy of cancer but in many thoracic cancers, the total prescribed dose of radiation that can be safely administered to the target volume is limited by the risk of complications arising in the normal lung tissue. One of the major reasons for cellular injury after radiation is the formation of reactive oxygen species (ROS). Radiation pneumonitis is an acute phase side-effect which generally subsides after a few weeks and is followed by a chronic phase characterized by inflammation and fibrosis, that can develop months or years after irradiation. Carnosine is a dipeptide composed by the amino acids beta-histidine and l-alanine. The exact biological role of carnosine is not totally understood, but several studies have demonstrated that it possesses strong and specific antioxidant properties, protects against radiation damage,and promotes wound healing. The antioxidant mechanism of carnosine is attributed to its chelating effect against metal ions, superoxide dismutase (SOD)-like activity, ROS and free radicals scavenging ability . Either its antioxidant or anti-inflammatuar properties, we propose that carnosine ameliorates irradiation-induced lung injury. Thus, supplementing cancer patients to whom applied radiation therapy with carnosine, may provide an alleviation of the symptoms due to radiation-induced lung injury. This issue warrants further studies.

  19. Radiation protection

    International Nuclear Information System (INIS)

    Koelzer, W.

    1975-01-01

    Physical and radiological terms, quantities, and units. Basic principles of radiation protection (ICRP, IAEA, EURATOM, FRG). Biological effects of ionizing radiation. Objectives of practical radiation protection. (HP) [de

  20. Non degenerative disease in MRI cervical spine of symptomatic patients

    Directory of Open Access Journals (Sweden)

    Dan B Karki

    2016-01-01

    Full Text Available Background & Objectives: The most common etiology of neck pain is degenerative disc disease, however non-degenerative disease can be important cause of neck pain. This study aims to study the non-degenerative findings in cervical MRI in symptomatic patients with neck and radicular pain.Materials & Methods: The study was a institutional record based retrospective study performed for the duration of 3 years. MRI performed for patients with neck pain and/ or radiculopathy were reviewed. Patients with post operative findings were excluded from the study. Statistical analysis was done using SPSS 21.0.Results: A total of 721 MRI were performed for neck pain and radiculopathy, among which 91 (12.13% cases had non-degenerative changes. Most common non degenerative change was traumatic lesions followed by neoplastic lesions and syrinx. Traumatic lesions were more common in males as compared to females. Infection was more common in females as compared to males. C5 and C6 vertebrae were most common vertebra involved in trauma and infection. Some cases like signal change in spinal cord, and syrinx were also noted in our study.Conclusion: Non degenerative cause of neck pain were less common but important cause of neck pain. Traumatic lesions were the most common cause of non degenerative neck pain.Journal of College of Medical Sciences-Nepal, Vol.11(4 2015: 20-23

  1. Significance of Vertebral Endplate Failure in Symptomatic Lumbar Disc Herniation

    Science.gov (United States)

    Sahoo, Madan Mohan; Kaur, Sheetal; Sarangi, Jitendra; Mohapatra, Manoranjan

    2017-01-01

    Study Design: Prospective cohort study. Objective: Endplate lesions though have been implicated in the genesis of lumbar disc herniation (LDH), very little is known regarding their clinical course. Thus, the present study is aimed to investigate the incidence and types of endplate failure (EPF) in LDH and its correlation with the clinical symptoms and prognosis. Methods: Clinical and magnetic resonance imaging (MRI) features of 66 patients with isolated single level LDH were studied. Three-dimensional fast spoiled gradient (3D FSPGR) MRI and computed tomography scans were used to identify the bony and cartilaginous EPF. Twenty-five patients were operated on and 41 patients were treated conservatively. Changes in the pain score, function and neurology were noted at 3, 6, 12, 24, and 36 weeks. Results: Endplate lesions were observed in 64 patients (96.9%), including bony endplate failure (bony failure) in 47 patients (71.2%) and isolated cartilaginous endplate lesions in 17 patients (25.7%). Bony failure group had similar pain and functional scores but more severe neurological deficit at the initial evaluation. Clinical parameters improved in all groups, but the recovery was lesser in conservatively treated bony failure patients. Conclusion: Endplate lesions are commonly associated with symptomatic LDH. Presence of bony failure can increase neurological deficit and reduce the chance of recovery with conservative management. The 3D FSPGR sequence of MRI can be successfully used for detection of the endplate lesions in the herniated disc. PMID:28660105

  2. That's my STYLEoideum - Symptomatic os styloideum in an adolescent male.

    Science.gov (United States)

    Kaniewska, Malwina; Haefeli, Mathias; Laesser, Urs; Niemann, Tilo

    2017-07-01

    We present a 15-year-old male patient with persistent localized pain on the dorsal side of the left wrist between the base of the 2nd and 3rd metacarpal bones and over the third carpometacarpal joint. It was diagnosed as an accessory metacarpal bone -Os styloideum. This entity may be detected on plain radiographs and in ultrasound examination and is often asymptomatic. Symptomatic os styloideum occurs more frequently in the dominant hand and may be treated conservatively with corticosteroid infiltration. A palpable prominence on the dorsal side of the wrist and focal pain evoked anxiety of the adolescent patient who searched medical consultation. In the clinical examination, a bony protrusion was confirmed and different possible diagnoses have been considered. After treatment with a corticosteroid infiltration of the third carpometacarpal joint under fluoroscopy the pain resolved completely. We would like to draw attention of clinicians and radiologists to this rare anatomical variant that normally is asymptomatic, and therefore not immediately recognized. Acquaintance with this entity and its early detection may lead to conservative treatment instead of surgical excision. A comprehensive literature search, review and discussion about os styloideum are provided in the article.

  3. Optimal management of symptomatic os acromiale: current perspectives

    Directory of Open Access Journals (Sweden)

    Spiegl UJ

    2018-02-01

    Full Text Available Ulrich J Spiegl,1 Peter J Millett,2 Christoph Josten,1 Pierre Hepp1 1Department of Orthopedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany; 2The Steadman Clinic, Vail, CO, USA Abstract: The majority of os acromiale is asymptomatic and requires no treatment. In patients with shoulder pain, os acromiale is a possibility in the differential diagnosis and may imitate shoulder impingement. The diagnosis of symptomatic os acromiale can be proven by combining physical examination, conventional radiographs, magnetic resonance imaging, and selective injections. Surgical treatment is indicated in those patients with failed conservative therapy, in those with highly painful and unstable os acromiale, or in those with associated shoulder pathologies such as rotator cuff tears. Open or arthroscopic excision is indicated in patients with pre-type os acromiale. In meso-type acromiale, arthroscopic excision, acromioplasty, or open reduction and internal fixation have all been used, but fixation is usually preferred. Internal fixation should be done either with cannulated screws alone or in combination with tension band, which has biomechanical advantages. Keywords: os acromiale, nonoperative treatment, surgical treatment, open or arthroscopic excision, osteosynthesis techniques

  4. Cortical hypoexcitability persists beyond the symptomatic phase of a concussion.

    Science.gov (United States)

    Powers, Kaley C; Cinelli, Michael E; Kalmar, Jayne M

    2014-01-01

    The purpose of this research was to assess cortical excitability, voluntary activation of muscle and force sensation beyond the initial highly symptomatic period post-concussion (1-4 weeks post-injury). It was hypothesized that reduced excitability of the motor cortex may impair muscle activation and alter perceptions of force and effort. Eight concussed varsity football players were age- and position-matched with eight healthy teammates to control for training and body size. Healthy controls had not suffered a concussion in the previous 12 months. Paired-pulse transcranial magnetic stimulation was used to assess cortical excitability, voluntary activation was calculated using cortical twitch interpolation technique and sense of force was determined using constant-force sensation contractions. The concussed group had lower intra-cortical facilitation (p = 0.036), lower maximal voluntary muscle activation (p = 0.038) and greater perceptions of force (p < 0.05), likely due to compensatory increases in upstream drive, than their healthy matched teammates. Taken together, these findings suggest a state of hypoexcitability that persists beyond the immediate acute phase of a concussion and may result in neuromuscular impairments that would call to question the athlete's readiness to return to sport.

  5. Symptomatic Intraoral Submuscular Lipoma Located Nearby Mental Foramen.

    Science.gov (United States)

    Choi, Hwan Jun; Byeon, Je Yeon

    2016-07-01

    This report describes and discusses the clinical investigations available for the investigation of intraoral fatty tumors of the chin, with a focus on lipomas. Lipomas are relatively uncommon tumors in the oral cavity; only 1% to 4% of cases occur at this site. The presence of lipoma in the head and neck area may raise problems in surgical resection. Treatment of lipoma needs wide excision to reduce recurrence. But there are important structures on mental foramen, especially mental nerve. So careful dissection must be done to avoid nerve injury. Importantly, the development of sarcomatous change within the lipoma cannot be ruled out at imaging and requires a histologic specimen. Because of the histologic similarity between normal adipose tissue and lipoma, accurate clinical and surgical information is very important in making a definitive diagnosis. Thus, a clinician sending a surgical specimen for microscopic analysis must provide the oral pathologist with all available clinical and surgical information. The treatment of oral lipomas, including all the histologic variants, is simple surgical excision. No recurrence is observed. Although the growth of oral lipomas is usually limited, they can reach great dimensions, interfering with speech and mastication and reinforcing the need for excision. In this study, the authors describe the clinical and histopathologic features of symptomatic 2 patients of oral lipomas.

  6. Movement Pattern of Scapular Dyskinesis in Symptomatic Overhead Athletes.

    Science.gov (United States)

    Huang, Tsun-Shun; Lin, Jiu-Jenq; Ou, Hsiang-Ling; Chen, Yu-Ting

    2017-07-26

    This study investigated the characteristics of arm elevation via principal component analysis in symptomatic overhead athletes with scapular dyskinesis. One hundred-thirty-four overhead athletes with scapular dyskinesis [24: inferior angle prominence (pattern I); 46: medial border prominence (pattern II), 64: pattern I + II] were evaluated by three-dimensional electromagnetic motion and electromyography to record the scapular kinematics (upward rotation/posterior tipping/exterior rotation) and muscle activation (upper trapezius: UT; middle trapezius: MT; lower trapezius: LT; serratus anterior: SA) during lowering phase of arm elevation. The results showed: (1) for pattern I and II, the first 3 principal component (PCs) explained 41.4% and 42.6% of total variance of movement; (2) the first PCs were correlated with MT, LT activity (r = 0.41~0.61) and upward rotation, posterior tipping (r = -0.59~-0.33) in pattern I, and UT, MT, SA (r = 0.30~0.70) activity in pattern II; (3) contour plots of muscle activity demonstrated that muscle activities varied with dyskinesis patterns. In summary, for the pattern I, the major characteristics are coactivation of MT and LT and corresponding scapular posterior tipping and upward rotation. For the pattern II, the major characteristics are coactivation of UT, MT and SA without corresponding scapular external rotation.

  7. Rationale and evidences for treatment of symptomatic uncomplicated diverticular disease.

    Science.gov (United States)

    Cuomo, Rosario; Cargiolli, Martina; Andreozzi, Paolo; Zito, Francesco P; Sarnelli, Giovanni

    2017-06-01

    Symptomatic uncomplicated diverticular disease (SUDD) is one of the possible clinical manifestations of diverticular disease. It is a common disorder characterized by chronic abdominal symptoms ranging from lower left abdominal pain to alteration of bowel habit, that significantly reduce quality of life of subject affected. The present article aims to review the current data for medical management of SUDD. We analyzed the existing literature on the factors involved in the pathogenesis of SUDD and we highlighted the possible target for treatment. Treatment for SUDD should be direct to relieve chronic symptoms and prevent diverticulitis and its complications. In particular we focused on the role of probiotics, fiber-diet, mesalazine and rifaximin on these two aspects. In this setting, we conducted a PubMed search for guidelines, systematic reviews and meta-analyses and updated information to October 2016. Each topic was evaluated according to the best evidences available. Best results seemed to be obtained with combined therapies and in particular with rifaximin associated to high fiber-diet. This regimen seems to guarantee better symptoms control compared to fiber alone and it is more effective in preventing acute diverticulitis. On the contrary, no clear evidences about the efficacy of mesalazine and probiotics are available. The results of the studies available in literature are controversial and debatable, for this reason a clear and defined algorithm for treatment of SUDD has not yet been defined. Further randomized, double-blind, placebo controlled study are necessary.

  8. Comparative Analyses of Transcriptional Profiles in Mouse Organs Using a Pneumonic Plague Model after Infection with Wild-Type Yersinia pestis CO92 and Its Braun Lipoprotein Mutant

    Directory of Open Access Journals (Sweden)

    Cristi L. Galindo

    2009-01-01

    Full Text Available We employed Murine GeneChips to delineate the global transcriptional profiles of the livers, lungs, and spleens in a mouse pneumonic plague infection model with wild-type (WT Y. pestis CO92 and its Braun lipoprotein (Δlpp mutant with reduced virulence. These organs showed differential transcriptional responses to infection with WT Y. pestis, but the overall host functional processes affected were similar across all three tissues. Gene expression alterations were found in inflammation, cytokine signaling, and apoptotic cell death-associated genes. Comparison of WT and Δlpp mutant-infected mice indicated significant overlap in lipopolysaccharide- (LPS- associated gene expression, but the absence of Lpp perturbed host cell signaling at critical regulatory junctions resulting in altered immune response and possibly host cell apoptosis. We generated a putative signaling pathway including major inflammatory components that could account for the synergistic action of LPS and Lpp and provided the mechanistic basis of attenuation caused by deletion of the lpp gene from Y. pestis in a mouse model of pneumonic plague.