The presence of bronchiectasis in patients with asthma varies in different reports, while a clear aetiological relation has not been precisely established.To investigate the presence of bronchiectasis in patients with severe uncontrolled asthma and examine whether they contribute to the severity of asthma.Patients with severe asthma were prospectively recruited. HRCT of the chest was performed to identify and grade bronchiectasis using the 'Smith' radiology scale. Investigation of the underlying cause was carried out for patients with bronchiectasis in order to exclude aetiologies other than asthma. The Statistical Package for the Social Sciences (SPSS), version 21, was used.Forty patients were studied, 28 women, mean age (±SD) 57.9 years (±12.4). Mean ACT score was 14.2(±4.9). Main symptoms were: wheezing (95%), cough (92%), dysponea (92%) and sputum production (72%). Mean duration of asthma was 16.5(±11.5) years, exacerbations: 4.4(±2.7)/year. In 27 patients (67.5%) bronchiectasis was diagnosed. In nine patients (22.5%) pathogens were cultured in sputum (mainly Pseudomonas aeruginosa, Haemophilus influenzae). Patients with sputum production and pathogens in sputum cultures had a higher Smith score compared to those without expectoration and without pathogens, respectively (P = .005, P < .0001). No correlation was found between the extent of bronchiectasis and lung function. The radiological severity of bronchiectasis was correlated with the antibiotic courses/year (P = .002).Bronchiectasis is common in patients with severe asthma. Sputum production and pathogen isolation in sputum may indicate the presence of bronchiectasis which seems to contribute to the severity of asthma.
To evaluate the efficacy and complications of computed tomography (CT)-guided radiofrequency ablation (RFA) of unresectable hepatocellular carcinoma (HCC).A retrospective study of 282 patients (231 males, 51 females, age range: 44-76 years, mean age: 62 years) with HCC (322 lesions) who had been treated by CT-guided RFA over a period of 5 years, was performed. The diameter of the tumors ranged from 1.5 to 5 cm. The tumors were considered as ablated completely, if no viability was found on dual-phase dynamic contrast enhanced CT at 1 month after RFA. The follow-up period ranged from 6 to 68 months (mean 29 months) and included a dual-phase dynamic contrast enhanced CT at 1, 3 and 6 months post-RFA and every 6 months afterwards. Patient outcome was evaluated and the survival and recurrence rates were assessed. Each case was reviewed for short-term and long-term complications.The ablation success rate was 87.3% (281/322 HCC nodules), while 41 (12.7%) lesions were managed with repeated RFA because of tumor residue. The survival rates at 1, 2, 3, 4 and 5 years were 94.8%, 86.6%, 73.1%, 64.2% and 51.1%, respectively. A total number of 9 (2.8% per procedure) minor complications occurred. No major complications were observed. During the follow-up period, the local tumour progression rate was 22%, while the recurrence rate of new intrahepatic nodules was 48%.The results of this study support that RFA is an effective and safe technique for the treatment of unresectable HCC.
To evaluate the efficacy and safety of computed tomography (CT)-guided radiofrequency thermal ablation (RFA) of liver tumors (hepatocellular carcinoma and liver metastases) > 3 mm in diameter that were in contact with blood vessels.During a 3-year period RFA was performed in 28 patients (age range, 36-83 years; male/female ratio, 17:11) with liver tumors (primary and metastatic) that were in contact with blood vessels > 3 mm in diameter. Tumor diameter ranged from 1.7 to 5.1 cm. To evaluate the immediate response, dual-phase dynamic CT images were obtained after intravenous contrast material administration. Imaging follow-up was at 1, 3, 6, and 12 months post-RFA, and every year thereafter.All of 28 patients were treated with a total of 36 sessions. In 22 (79%) of the patients, complete ablation of the tumor was achieved. The remaining 6 (21%) patients showed irregular peripheral enhancement and underwent a second session. At 1-year follow-up 2 of the tumors showed a recurrent lesion and a new ablation was performed. The local tumor progression rate at 1-year follow-up was 8.7% and disease-free survival was achieved in 82.1% of the patients. Complications occurred in 4 patients (14.3%); 2 patients presented with a small sub-capsular hematoma, and 2 patients had a partial liver infarction.RFA is a safe and effective method, even with high-risk tumors adjacent to large blood vessels, which can lead to good results with minimal complications and a low rate of tumor progression.
Percutaneous image-guided ablation with the use of radiofrequency has recently received much attention as a minimally invasive technique for the treatment of solid malignancies. Renal cell carcinomas (RCCs) were among the first extrahepatic tumours to be targeted with radiofrequency ablation (RFA). The aim of this study is to present the efficacy of RFA in RCC and the factors that have an impact on the attained necrosis with regards to the histological findings.
Background: Diagnostic work-up of pulmonary embolism (PE) remains a challenge. Methods: We retrospectively studied all patients referred for computed tomography pulmonary angiography (CTPA) with suspicion of PE during a 12-month period (2018). The diagnostic accuracy of different D-dimer (Dd) cutoff thresholds for ruling out PE was evaluated. Furthermore, the association of Dd and red cell distribution width (RDW) with embolus location, CTPA findings, and patient outcome was recorded. Results: One thousand seventeen (n = 1017) patients were finally analyzed (mean age: 64.6 years (SD = 11.8), males: 549 (54%)). PE incidence was 18.7%. Central and bilateral embolism was present in 44.7% and 59.5%, respectively. Sensitivity and specificity for conventional and age-adjusted Dd cutoff was 98.2%, 7.9%, and 98.2%, 13.1%, respectively. A cutoff threshold (2.1 mg/L) with the best (64.4%) specificity was identified based on Receiver Operating Characteristics analysis. Moreover, a novel proposed Dd cutoff (0.74 mg/L) emerged with increased specificity (20.5%) and equal sensitivity (97%) compared to 0.5 mg/L, characterized by concurrent reduction (17.2%) in the number of performed CTPAs. Consolidation/atelectasis and unilateral pleural effusion were significantly associated with PE (p < 0.05, respectively). Patients with consolidation/atelectasis or intrapulmonary nodule(s)/mass on CTPA exhibited significantly greater median Dd values compared to patients without the aforementioned findings (2.34, (IQR 1.29−4.22) vs. 1.59, (IQR 0.81−2.96), and 2.39, (IQR 1.45−4.45) vs. 1.66, (IQR 0.84−3.12), p < 0.001, respectively). RDW was significantly greater in patients who died during hospitalization (p = 0.012). Conclusions: Age-adjusted Dd increased diagnostic accuracy of Dd testing without significantly decreasing the need for imaging. The proposed Dd value (0.74 mg/L) showed promise towards reducing considerably the need of CTPA. Multiple radiographic findings have been associated with increased Dd values in our study.
