Resolution Of Radiographic Abnormalities Research Articles

Characteristics of culture-negative subclinical pulmonarytuberculosis: a single-center observation.

Little is known about culture-negative subclinical pulmonary tuberculosis (TB), and its diagnosis remains challenging. Therefore, this study aimed to identify the characteristics and the extent of disease associated with culture-negative subclinical pulmonary TB. This retrospective cohort study was conducted on immunocompetent individuals with subclinical pulmonary TB at a university hospital in Thailand from January 2014 to December 2019. Subclinical pulmonary TB was diagnosed based on the presence of radiographic abnormalities consistent with TB in the absence of TB symptoms. All subjects demonstrated significant improvement or resolution of radiographic abnormalities following the completion of treatment. At least two negative sputum cultures were needed to fulfill the definition of culture-negative pulmonary TB. Data were analyzed using univariate and multiple logistic regression analyses to determine the characteristics of those with culture-negative subclinical pulmonary TB compared to culture-positive ones. Out of the 106 individuals identified with subclinical pulmonary TB, 84 met the criteria for inclusion in the analysis. The study found lower radiographic extent and increasing age were key attributes of culture-negative subclinical pulmonary TB. The odds ratios (95% confidence interval) were 7.18 (1.76 to 29.35) and 1.07 (1.01 to 1.13), respectively. They tend to have lower rates of bilateral involvement in both chest x-ray (8.5% vs. 32.0%, p=0.006) and computed tomography (15.4% vs. 42.9%, p=0.035). However, no other specific radiographic findings were identified. People with culture-negative subclinical pulmonary TB were likely to have less radiographic -severity, reflecting early disease. Nevertheless, no radiographic patterns, except for unilaterality, were related to culture-negative subclinical pulmonary TB.

Models of Resolution of Radiographic Abnormalities in Elderly Patients Hospitalized for Community Acquired Pneumonia

Models of Resolution of Radiographic Abnormalities in Elderly Patients Hospitalized for Community Acquired Pneumonia

Outcome of Active Surveillance and Endocrine Therapy Alone for DCIS.

Abstract Objective: There are currently no nonsurgical options offered to patients with DCIS. The purpose of this study was to assess clinical outcome in a cohort of women declining surgery for pathologically proven ductal carcinoma in situ (DCIS) who have opted for endocrine therapy and clinical/radiographic follow-up.Methods: Between 2003 and 2008, 52 women with ER-positive DCIS enrolled in an IRB-approved single-arm study of 3 months of neoadjuvant enodocrine therapy. The study design included definitive surgical excision. However, 9 women withdrew from the parent study at completion of 3 months and declined surgery, opting instead for a plan of active surveillance, with the intent to proceed with conventional therapy in the event of disease progression or radiographic suspicion for invasive disease. All women were amenable for follow up every 6 months with diagnostic mammography and breast MRI, and wished to continue endocrine therapy, despite unproven benefit in this setting. Endocrine treatment consisted of tamoxifen for premenopausal women or an aromatase inhibitor for postmenopausal women. Each patient was informed of the current treatment guidelines for DCIS, as well as the increased future probability for invasive cancer in the absence of standard treatment for DCIS.Results: The median age of the cohort was 48 years (41-60 years) at enrollment. Of these, 5 women were premenopausal on Tamoxifen, and 4 were post menopausal (3 on letrozole and 1 on arimidex). At the time of analysis, median follow up was 23 months (range 9-66 months). During follow up, 4 patients proceeded with surgery either electively (1 patient) or due to changes at imaging (3 patients). Two of these patients had node-negative invasive breast carcinoma identified at surgery, measuring 6 mm and 4 mm. Five patients have elected to continue surveillance (median follow up 34 months; range 10-66 months), and have had either stable disease or continued regression based on both mammographic and MRI criteria. Four patients remain on endocrine therapy. The patient with longest follow up has had almost complete resolution of radiographic abnormalities at 6 years of surveillance.Conclusion: In this pilot cohort, two-thirds of women who continued endocrine therapy and surveillance for ER-positive DCIS had radiographically stable disease or regression with short-term follow up. Women who initially declined surgery elected to undergo excision in the face of radiographic progression. Active surveillance with endocrine therapy for ER-positive DCIS is feasible, and a well-informed patient cohort is essential to minimize risk. The impact of such an approach on long-term morbidity is unknown, but requires further investigation. Ongoing efforts to improve the detection of invasive cancer in women with DCIS are expected to facilitate such an approach. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 954.

Pneumonia Recovery; Discrepancies in Perspectives of the Radiologist, Physician and Patient

BACKGROUNDChest radiographs are often used to diagnose community-acquired pneumonia (CAP), to monitor response to treatment and to ensure complete resolution of pneumonia. However, radiological exams may not reflect the actual clinical condition of the patient.OBJECTIVETo compare the radiographic resolution of mild to moderately severe CAP to resolution of clinical symptoms as assessed by the physician or rated by the patient.DESIGNProspective cohort study.PARTICIPANTSOne hundred nineteen patients admitted because of mild to moderately severe CAP with new pulmonary opacities.MAIN MEASURESRadiographic resolution and clinical cure of CAP were determined at day 10 and 28. Radiographic resolution was defined as the absence of infection-related abnormalities; clinical cure was rated by the physician and defined by improvement of signs and symptoms. In addition, the CAP score, a patient-based symptom score, was calculated.KEY RESULTSRadiographic resolution, clinical cure and normalization of the CAP score were observed in 30.8%, 93% and 32% of patients at day 10, and in 68.4%, 88.9% and 41.7% at day 28, respectively. More severe CAP (PSI score >90) was independently associated with delayed radiographic resolution at day 28 (OR 4.7, 95% CI 1.3–16.9). All 12 patients with deterioration of radiographic findings during follow-up had clinical evidence of treatment failure.CONCLUSIONSIn mild to moderately severe CAP, resolution of radiographic abnormalities and resolution of symptoms scored by the patient lag behind clinical cure assessed by physicians. Monitoring a favorable disease process by routine follow-up chest radiographs seems to have no additional value above following a patient's clinical course.

Invasive aspergillosis before allogeneic hematopoietic stem cell transplantation: 10-year experience at a single transplant center.

Hematopoietic stem cell transplantation (HCT) in patients with prior or active invasive aspergillosis (IA) is a frequent consideration. We reviewed outcomes of 2319 patients who underwent transplantation between 1992 and 2001 in our institution, among whom 45 patients (1.9%) had a known history of IA before HCT. Posttransplantation IA occurred in 13 of these 45 patients with a pretransplantation history (29%). Nine infections were considered recurrent by anatomic site and timing. Compared with all other patients who received allogeneic HCT during the same period, patients with histories of IA had lower overall survival (56% versus 77%; P =.0001) and higher transplant-related mortality (TRM; 38% versus 21%; P =.0001) 100 days after HCT, associated mainly with IA and other pulmonary complications. Among patients with prior IA, posttransplantation IA occurred more frequently in patients who received <1 month of antifungal therapy before HCT (4/6 versus 6/39; P =.001). The probability of posttransplantation IA and overall survival among patients who received >1 month of antifungal therapy and had resolution of radiographic abnormalities were not different from those of patients without prior IA. Patients with prior IA who received conditioning with total body irradiation (TBI) had higher TRM compared with those who received nonmyeloablative and non-total body irradiation-based regimens (16/31 versus 2/14; P =.024). Thus, the duration of antifungal therapy before transplantation, the resolution of radiographic abnormalities, and conditioning regimens are important variables to consider for minimizing the risk for IA recurrence and TRM after allogeneic HCT.

Resolution of radiographic abnormalities with ursodeoxycholic acid therapy of primary sclerosing cholangitis

Ursodeoxycholic acid therapy has shown encouraging results in relieving symptoms and decreasing liver biochemical abnormalities in patients with primary sclerosing cholangitis. However, established biliary strictures are generally considered irreversible. A case of primary sclerosing cholangitis with extensive intrahepatic biliary as well as pancreatic duct strictures that resolved to near normal on ursodeoxycholic acid therapy is reported. The implications of these findings are discussed.