Sandbox:Prince: Difference between revisions
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incidence and ivsestg. | |||
One hundred ninety cases of PPE were diagnosed. The annual incidence of PPE in the population under 18 years of age increased from 19.9 cases per 100,000 in 2004 to 35.2 per 100,000 in 2006. S. pneumoniae was the main causal agent identified: 82.9% of the 21.6% patients with positive culture. Non-vaccine serotypes (NVS) predominated (81.5%), and serotype 1 was responsible for 38.5% of cases. The use of polymerase chain reaction (PCR) test to detect S. pneumoniae increased etiological diagnosis from 21.6% to 42.1%. Antigen assays used to detect pneumococcus in pleural fluid demonstrated 87.9% sensitivity and 100% specificity when PCR was used as the gold standard. There has been an increase in the incidence of PPE that parallels the increase in CAP. S. pneumoniae remains the principal causal agent, and NVS clearly predominate. The use of PCR to detect S. pneumoniae substantially increases etiologic diagnosis. The use of antigen assays to detect pneumococcus in pleural fluid is a quick and sensitive diagnostic method, and thus a valid alternative to PCR. 19911359 | |||
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whereas 37 +/- 27% considered that exploratory thoracentesis was likely to determine the cause of the effusion, and 17.36 +/- 16% considered that its results were likely to result in a change in their therapeutic attitude.11689765 | whereas 37 +/- 27% considered that exploratory thoracentesis was likely to determine the cause of the effusion, and 17.36 +/- 16% considered that its results were likely to result in a change in their therapeutic attitude.11689765 | ||
Only complicated parapneumonic effusions need to be drained. Therapeutic evacuation modalities include repeated therapeutic thoracentesis, chest tube drainage or thoracic surgery. The choice of the first-line evacuation treatment is still controversial and there are few prospective controlled studies. The effectiveness of fibrinolytic agents is not established except when they are combined with DNase. Antibiotics are mandatory; they should be initiated as quickly as possible and should be active against anaerobic bacteria except for in the context of pneumococcal infections. There are few data on the use of chest physiotherapy, which remains widely used. Mortality is still high and is influenced by underlying comorbidities.25595878 | |||
dx | dx | ||
The diagnosis of PE in children is based on chest radiographs, thoracentesis and pleural fluid analysis 12457598 | The diagnosis of PE in children is based on chest radiographs, thoracentesis and pleural fluid analysis 12457598 | ||
more often on the right side, and the tuberculin test is negative in one third of cases.24721286 | |||
The combination of adenosine deaminase 27135844 and lymphocyte percentage may be useful in this respect. Treatment is the same as for any TB. The addition of corticosteroids is not advisable, and chest drainage could help to improve symptoms more rapidly in large effusions.24721286 | The combination of adenosine deaminase 27135844 and lymphocyte percentage may be useful in this respect. Treatment is the same as for any TB. The addition of corticosteroids is not advisable, and chest drainage could help to improve symptoms more rapidly in large effusions.24721286 | ||
Revision as of 20:37, 14 October 2016
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prognosis.22982649
The probability of MPE was higher in patients with larger tumors, mediastinal lymph node involvement, and adenocarcinoma, NSCLC not otherwise specified, or large-cell histology. In patients with stage M1b, median overall survival (3 months versus 5 months), estimated 1-year survival (12.6% versus 24.8%), and 2-year survival (5.4% versus 11.3%) were significantly lower in patients with MPE compared with those without MPE
incidence and ivsestg.
One hundred ninety cases of PPE were diagnosed. The annual incidence of PPE in the population under 18 years of age increased from 19.9 cases per 100,000 in 2004 to 35.2 per 100,000 in 2006. S. pneumoniae was the main causal agent identified: 82.9% of the 21.6% patients with positive culture. Non-vaccine serotypes (NVS) predominated (81.5%), and serotype 1 was responsible for 38.5% of cases. The use of polymerase chain reaction (PCR) test to detect S. pneumoniae increased etiological diagnosis from 21.6% to 42.1%. Antigen assays used to detect pneumococcus in pleural fluid demonstrated 87.9% sensitivity and 100% specificity when PCR was used as the gold standard. There has been an increase in the incidence of PPE that parallels the increase in CAP. S. pneumoniae remains the principal causal agent, and NVS clearly predominate. The use of PCR to detect S. pneumoniae substantially increases etiologic diagnosis. The use of antigen assays to detect pneumococcus in pleural fluid is a quick and sensitive diagnostic method, and thus a valid alternative to PCR. 19911359
The during 7 years 258 patients with malignant effusion (ME) of different ethiology were treated in clinic, that composed 13.8% among all patients with pleural effusion. It was discovered the increase of this complication frequence in 1.6 time. The main reasons of ME were lung cancer--in 42.6% of observations, pleural mezothelioma--in 19.3%, mammary glands cancer--in 6.9%, real reason of ME was not found in 13.9%. Aged patients (oldest 60 years) are risk group for discovering of ME, for pleural mezothelioma the next ages are risk 30-40 and oldest 60 years.15560580
Studies with data on incidence and serotypes were included; reviews, case reports, and conference abstracts were excluded. Of 152 papers, 84 fitted the inclusion criteria. A few pneumococcal serotypes were predominant causes of CPP, particularly serotypes 1, 19A, 3, 14, and 7F. CPP was a more common manifestation of pneumococcal disease among older (>2 years old) than younger children. The data support increases in both reported incidence rates and proportions of CPP in children and adults during the period 1990-2012; specific increases varied by geographic region. The proportions of serotype 3 and, particularly in Asia, serotype 19A CPP have increased, whereas most studies show declines in serotype 14. Serotype 1 has been a predominant cause of CPP since 1990, while antibiotic resistance was infrequent among serotype 1 isolates. The reported incidence and proportions of CPP among pneumonia cases steadily increased from 1990 to 2012. Several factors might account for these increases, including enhanced disease detection due to a higher index of suspicion, more sophisticated diagnostic assays, and changes in the prevalence of serotypes with capacity to invade the pleural space that were not targeted by the 7-valent pneumococcal conjugate vaccine (PCV7). 24563274
txt
whereas 37 +/- 27% considered that exploratory thoracentesis was likely to determine the cause of the effusion, and 17.36 +/- 16% considered that its results were likely to result in a change in their therapeutic attitude.11689765
Only complicated parapneumonic effusions need to be drained. Therapeutic evacuation modalities include repeated therapeutic thoracentesis, chest tube drainage or thoracic surgery. The choice of the first-line evacuation treatment is still controversial and there are few prospective controlled studies. The effectiveness of fibrinolytic agents is not established except when they are combined with DNase. Antibiotics are mandatory; they should be initiated as quickly as possible and should be active against anaerobic bacteria except for in the context of pneumococcal infections. There are few data on the use of chest physiotherapy, which remains widely used. Mortality is still high and is influenced by underlying comorbidities.25595878
dx
The diagnosis of PE in children is based on chest radiographs, thoracentesis and pleural fluid analysis 12457598
more often on the right side, and the tuberculin test is negative in one third of cases.24721286
The combination of adenosine deaminase 27135844 and lymphocyte percentage may be useful in this respect. Treatment is the same as for any TB. The addition of corticosteroids is not advisable, and chest drainage could help to improve symptoms more rapidly in large effusions.24721286
1[1]
References
- ↑ Howe, BE Jr. (1988). Emergency War Surgery, Second United States Revision of the Emergency War Surgery NATO. U. S. Government Printing Office. ISBN 9780160014932.