Purpose
The aim of this prospective observational study was to evaluate the relationship between changes in pulmonary artery systolic pressure (ΔPASP) and both severity of community‐acquired ...pneumonia (CAP) and changes in peripheral blood oxygen partial pressure (PaO2).
Materials and Methods
Seventy‐five consecutive adult patients hospitalized for treatment of CAP were recruited in this single‐center cohort study. Doppler echocardiographic measurement of PASP was performed by 2 staff cardiologists. Follow‐up assessment was performed within 2 to 4 weeks of ending antibiotic treatment at radiographic resolution of CAP. Fifteen patients were excluded during follow‐up due to confirmation of chronic obstructive pulmonary disease.
Results
Pneumonia was unilateral in 40 (66.7%) and bilateral in 20 (33.3%) patients. Radiographic extent of pneumonia involved 2 pulmonary segments in 31 patients (51.7%), 3 to 5 pulmonary segments in 25 (41.7%), and 6 pulmonary segments in 4 patients (6.6%). ΔPASP between hospital admission and follow‐up correlated with the number of pulmonary segments involved (Rho = 0.953; P < .001) and PaO2 (Rho = −0.667; P < .001). The maximum PASP was greater during pneumonia than after resolution (34.82 ± 3.96 vs. 22.67 ± 4.04, P < .001).
Conclusions
Changes in PASP strongly correlated with radiological severity of CAP and PaO2. During pneumonia, PASP appeared increased without significant change in left ventricular filling pressures. This suggests that disease‐related changes in lung tissue caused by pneumonia may easily and reproducibly be assessed using conventional noninvasive bedside diagnostics such as echocardiography and arterial blood gas analysis.
Waldenström's macroglobulinemia is a distinct clinicopathologic entity defined as a B-cell neoplasm characterized by lymphoplasmacytic infiltrate in the bone marrow, with an associated immunoglobulin ...(Ig) M paraprotein. Clinical manifestations are due to deposition of IgM in the liver, spleen, and/or lymph nodes, so it presents with anemia, hyperviscosity, lymphadenopathy, hepatomegaly, splenomegaly and neurologic symptoms. The main diagnostic criteria are a typical peak on serum protein electrophoresis and malignant cells in bone marrow biopsy samples. There is no standard therapy for the treatment of symptomatic Waldenstrom's macroglobulinemia and no agents have been specifically approved for this disease, but initial treatment usually starts with the monoclonal anti-CD20 antibody rituximab, either alone or in combination with other agents, rather than chemotherapy alone. This article confirms that, despite the existence of more modern imaging methods, ultrasonography still has a significant diagnostic role.
Invasive ductal carcinoma is the most common type of breast cancer and accounts for about 70-85% of all invasive breast carcinomas. It primarily metastasizes to the bone, lungs, regional lymph nodes, ...liver and brain. Most of breast cancer recurrence occurs within the first 5 years of diagnosis, particularly for ER negative disease. Gastrointestinal tract involvement is very rare and is detected in only 10% of all the cases, and it usually derives from lobular breast cancer rather than the much more common cell type of ductal breast cancer. Early diagnosis is very important because it enables prompt and adequate choice of treatment and improves patient’s long-term prognosis. In this report we describe an unusual case of obstructive jaundice caused by metastases from invasive ductal breast cancer to the lymph nodes of the hepatoduodenal ligament with extramural compression of the distal common bile duct and tumor invasion to the lumen of the duct. Our goal is to emphasize possible diagnostic pitfalls and increase the clinical awareness and the importance of intensive follow-up in patients with breast cancer, even years after the initial diagnosis.
Waldenströmova makroglobulinemija je specifičan kliničkopatološki entitet definiran kao B stanična neoplazma obilježena limfoplazmatskim infiltratima u koštanoj srži udruženim s paraproteinom ...imunoglobulinom (Ig) M. Kliničke manifestacije nastaju kao posljedica taloženja IgM u jetri, slezeni i/ili limfnim čvorovima, tako da se bolest manifestira anemijom, hiperviskozitetom, limfadenopatijom, hepatomegalijom, splenomegalijom i neurološkim simptomima. Glavni dijagnostički kriteriji su tipični vršak u elektroforezi serumskih proteina te maligne stanice u uzorcima biopsije koštane srži. Ne postoji standardna terapija za liječenje simptomatske Waldenströmove makroglobulinemije i nema lijekova specifično odobrenih za ovu bolest, no liječenje najčešće ne započinje kemoterapijom, nego monoklonskim anti-CD 20 antitijelom rituksimabom kao monoterapijom ili u kombinaciji s drugim lijekovima. Ovaj članak potvrđuje da unatoč postojanju modernih metoda prikazivanja ultrazvuk i dalje ima značajnu dijagnostičku ulogu.
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