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PubMed1983

Canine mammary epithelial neoplasms: biologic implications of morphologic characteristics assessed in 232 dogs.

We studied 232 dogs that underwent mastectomy for mammary epithelial neoplasms. The mastectomy specimens were evaluated according to structural parameters found to be prognostically significant in human mammary neoplasms, such as grade of atypia in non-invasive proliferations of duct epithelium, extent of malignant disease, and nuclear differentiation in malignant neoplasms. In this study, the biologic behavior of mammary lesions was assessed according to the frequency of development of de novo or recurrent invasive carcinoma within two years. Our data indicate that we can recognize structural variables which permit classification of mammary neoplasms into categories with distinct patterns of biologic behavior. In addition to normotypic proliferative lesions and invasive malignant neoplasms, we were able to identify precancerous atypic and non-invasive malignant neoplasms that are considered precursor lesions in women. Also, as in women, nuclear differentiation was found to be a prognostically significant variable. Lymphoid cellular reactions, considered to be structural correlates of host-tumor immune responses in women, were noted in 35% of dogs with precancerous or malignant neoplasms. Application of the described parameters should facilitate comparative studies of canine and human mammary carcinogenesis and use of the dog as a model for the development of new therapeutic modalities and immunoprophylaxis of human mammary cancer.

Animals↗
PubMed1985

Thyrotropin receptor-adenylate cyclase system in Hurthle cell neoplasms.

Hurthle cell neoplasms are though to arise from the follicular cells of the thyroid gland, although some studies suggest that they originate from the parafollicular cells. We studied tissue from five patients (three men and two women, aged 33-72 yr) with Hurthle cell neoplasms (four adenomas and one carcinoma) to determine whether Hurthle cell neoplasms have an intact TSH receptor-adenylate cyclase (AC) system and, if so, whether it differs in benign and malignant Hurthle cell and neoplasms. Binding of [125I]bovine (b) TSH and an AC response to TSH occurred in all four Hurthle cell adenomas. In three of these tumors, there was good binding and a relatively good correlation between the concentration of bTSH producing half-maximal inhibition of [125I]bTSH binding (4.8 mU/ml) and the TSH concentration causing half-maximal stimulation of AC (2.2 mU/ml). There was also a 2- to 5-fold increase in AC activity in response to bTSH (300 mU/ml), a value comparable to that which occurs in follicular thyroid neoplasms and differentiated thyroid cancers. In the fourth Hurthle cell adenoma, however, binding was low, the apparent Kd (170 mU/ml) and Km (20 mU/ml) were high, and there was only a 1.4-fold increase in AC activity in response to bTSH (300 mU/ml). In the one metastatic Hurthle cell carcinoma, there was no high affinity TSH binding or AC response to TSH. Thus, Hurthle cell neoplasms are of follicular cell origin, since benign Hurthle cell tumors have an intact TSH receptor-AC system. Malignant Hurthle cell neoplasms, like undifferentiated and medullary thyroid cancer, lack a functional TSH receptor.

Adenoma↗
PubMed2000

Fine-needle aspiration of secondary neoplasms involving the salivary glands. A report of 36 cases.

Metastases or secondary deposits account for 16% of the malignant neoplasms involving the major salivary glands. A correct diagnosis of a secondary neoplasm is important to avoid unnecessary radical surgery and to guide further therapy. Fine-needle aspiration biopsy (FNAB) is an excellent noninvasive diagnostic tool for evaluating salivary gland lesions. We reviewed 36 secondary malignant salivary gland neoplasms evaluated by FNAB. Ancillary studies were performed in selected cases. Follow-up included clinical correlation and review of histologic material. For 4 adenocarcinomas, 4 squamous cell carcinomas, 1 undifferentiated carcinoma, 1 cutaneous basal cell carcinoma, 10 cutaneous melanomas including 1 desmoplastic variant, 3 osteosarcomas, 11 non-Hodgkin lymphomas, and 2 multiple myelomas, there was 1 false-negative FNAB result. The desmoplastic melanoma was interpreted as reactive lymphoid hyperplasia. A malignant diagnosis was given in all remaining cases except the secondary basal cell carcinoma, which was diagnosed as a neoplasm with basal cell features. FNAB is a reliable tool to differentiate hematologic malignant neoplasms and melanomas from other salivary gland neoplasms. A complete knowledge of the clinical history, review of previous pathologic materials, and, in some instances, the use of ancillary studies are crucial for recognizing solid malignant neoplasms secondarily involving the salivary glands.

Adult↗
PubMed2006

[Cardiac transplantation and neoplasms: experiences at Escola Paulista de Medicina of the Federal University of São Paulo].

OBJECTIVE: To study the occurrence and types of neoplasms developed by patients who underwent an orthotopic cardiac transplantation under the Program of Cardiac Transplantation of Escola Paulista de Medicina, Federal University of São Paulo. METHODS: This is an observational study of 106 patients who underwent orthotopic cardiac transplantation from November 1986 to September 2002 and survived at least thirty days following the procedure. The triple immunosuppressive regimen given included cyclosporin A, azathioprine and a corticosteroid agent. Only two patients received OKT3 in addition to the regimen established. Mean follow-up was 61.4 months (ranging from two months to 192 months). RESULTS: Twenty-three patients (21.3%) developed neoplasms--56.5% of these were skin neoplasm, 30.1%, solid tumors, and 13.4% of post-transplant lymphoproliferative disease (PTLD). Mean interval between transplantation and diagnosis of neoplasm was: 54.9 months for skin neoplasm; 24.8 months for solid tumors and 70.3 months for PTLD. CONCLUSION: Malignant neoplasms are relatively common in the population studied. Skin cancer was the most common type compared to the other types of neoplasms. Solid tumors were more frequently diagnosed than the lymphoproliferative diseases in the population examined.

Adolescent↗
PubMedDate not supplied

[Neoplasm mortality in women in reproductive age (15 to 49 years) in the State of São Paulo, Brazil, from 1991 to 1995].

OBJECTIVE: To describe the mortality owing to neoplasms in women of reproductive age (15 to 49 years) in the State of São Paulo, Brazil, from 1991 to 1995. METHODS: A list of all deaths and their underlying causes, coded according to the International Classification of Diseases, 9 th revision, and estimates of the female population according to age groups were provided by the SEADE Foundation. Specific coefficients for 100 thousand women for each year as well as the medians of the coefficients related to 5 years, and the percentage of underlying causes of death by subgroups were calculated. RESULTS: In young women (15 to 29 years) highest rates were found for the subgroup "Malignant neoplasm of lymphatic and hematopoiethic tissues", followed by the subgroup "Malignant neoplasm of bones, connective tissue, skin and breast". In women aged 30 to 49 years, the leading underlying causes of death were those included in the last subgroup, followed by the subgroups "Malignant neoplasm of genitourinary organs", "Malignant neoplasm of digestive organs and peritoneum", and "Malignant neoplasm of lymphatic and hematopoietic tissues". The highest specific rates of underlying causes of death for women aged 15-29 were myeloid and lymphoid leukemias, and for women aged 30-49 were in decreasing rank," breast cancer"; "uterine cervix cancer" and "not specified uterine part cancer"; "stomach cancer"; "tracheal, bronchial and lung cancer" and "ovarian and other uterine annexes". CONCLUSION: Preventive measures to eliminate or lower the risk factors exposure and to promote early diagnosis and prompt treatment of these neoplasms should be enhanced in order to avoid possible future pregnancy complications and to prolong survival of women of reproductive age.

Adolescent↗
PubMed1998

[TP53 gene aberrations in chondromatous neoplasms: correlation with immunohistochemical p53 accumulation and MDM2 expression].

Histological differentiation between chondroma and chondrosarcoma is a common problem in surgical pathology. In a former study (3) we were able to show, that immuno-histochemical p53-accumulation in chondromatous neoplasias might be an additional hint for malignancy. Now we tried to find out, whether p53-accumulation is caused by TP53-aberrations or functional inactivation of p53-wildtype protein by MDM2. For this purpose, paraffin-embedded material of 80 chondromatous neoplasms (18 chondromas, 18 chondromatous neoplasms of uncertain dignity (i.e. cytologically suspicious but without definite invasive growth), and 44 chondrosarcomas (24 GI, 13 GII, 7 GIII)) were screened for TP53 gene-aberrations by means of DGGE (denaturing gradient gel electrophoresis; exons 5-8). The results were correlated with immunohistochemical p53-accumulation (DO-7, DAKO) and MDM2-expression (AB-1, Oncogene). A total of 43% of all chondromatous neoplasms showed TP53-aberrations in DGGE-analysis, i.e. 27% of chondromas, 50% of chondromatous neoplasms of uncertain dignity, 46% of GI-, 46% of GII- and 71% of GIII-chondrosarcomas. Exon 6 (58% of all cases with aberrations) and exon 8 (47%) were affected most frequently. No significant correlation between TP53-aberration and either p53-accumulation or MDM2-expression was present. A statistically significant correlation could be found between p53-accumulation and MDM2-expression (p < 0.0001). Regarding histological tumor-classification, p53-accumulation and MDM2-expression discriminated between chondromas/chondromatous neoplasms of uncertain dignity and well differentiated chondrosarcomas in a statistically significant manner. In the subgroup of p53-positive and MDM2-negative cases significantly more TP53-aberrations were detected by DGGE-analysis than in the other groups. Interestingly, the subgroup of p53- and MDM2-negative cases showed the second highest rate of TP53-DGGE-aberrations. Nearly 50% of these aberrations, however, were localized in exon 8, a mutation that is known to cause no p53-protein-accumulation. In conclusion, TP53-aberrations occur frequently in chondromatous neoplasms and show no significant association to either immunohistochemical p53-accumulation or MDM2-expression. Functional inactivation of p53 wildtype protein by MDM2-expression seems to be the major cause of p53-accumulation in chondromatous neoplasms and emphasizes the role of these parameters as additional hint for malignancy.

Bone Neoplasms↗
PubMed1999

Primary thymic epithelial neoplasms: spectrum of differentiation and histological features.

Primary thymic epithelial neoplasms have been the source of much controversy over the years because of difficulties in their histopathologic classification and prognostication of clinical behavior. Despite recent advances in our understanding of the immunopathology and molecular pathology of these neoplasms, no universally accepted system of classification is yet available for these tumors. A variety of classification schemes have been proposed in the past based on either morphological, histogenetic, or immunophenotypic considerations. For the most part, the majority of such classifications have been merely descriptive with little value for prognostication, or have proven cumbersome and difficult to apply in clinical practice. Recent studies have shown that primary thymic epithelial neoplasms, rather than representing several discrete, separate entities constitute part of a continuous spectrum of differentiation ranging from well-differentiated neoplasms to poorly-differentiated neoplasms. Based on these observations, a novel classification of primary thymic epithelial neoplasms has been proposed that divides these tumors into three easily reproducible diagnostic categories based on their degrees of differentiation: thymoma, atypical thymoma, and thymic carcinoma (corresponding to well-differentiated, moderately-differentiated, and poorly-differentiated neoplasms, respectively). The histopathologic features and diagnostic criteria for these tumors is the subject of this review.

Cell Differentiation↗
PubMed2000

Composite dendritic cell neoplasm (NOS) and small lymphocytic lymphoma.

This report describes a composite (or "collision") of a dendritic cell neoplasm and small lymphocytic lymphoma. It represents the seventh example of dendritic cell neoplasia occurring in the setting of low-grade B-cell malignancy and the third example of a composite tumor, in which both neoplasms were present within the same lymph node. The small lymphocytic lymphoma component exhibited a typical CD20+, CD5+, and CD23+ immunophenotype. The dendritic cell neoplasm exhibited reactivity with CNA-42, but nonreactivity for CD21, CD35, smooth muscle actin, desmin, and epithelial membrane antigen (EMA). Equivocal cytoplasmic staining was seen for S100p, CD68, and Factor XIIIa. Ultrastructurally, the dendritic cell neoplasm exhibited desmosomes, rough endoplasmic reticulum, cytoplasmic intermediate filaments, and intercellular collagen. Because the immunophenotype and ultrastructure did not correspond to one of the five recognizable dendritic cell subtypes, the neoplasm was designated dendritic cell neoplasm, not otherwise specified (NOS). Polymerase chain reaction (PCR) analysis for immunoglobulin heavy chain gene rearrangements performed on individual components of the composite tumor demonstrated rearrangement within the small lymphocytic lymphoma component, but none in the dendritic cell component. The lack of an immunoglobulin heavy chain gene rearrangement within the dendritic cell component argues against a transformational event and supports the concept that these separate neoplasms represent a true "collision" or composite lesion.

Aged↗
PubMed1998

[Significance of resistance index and pulsatility index in differential diagnosis of breast neoplasm].

OBJECTIVE: To investigate the significance of the resistance index (RI) and pulsatility index (PI) in differential diagnosis between the benign and malignant breast neoplasms. METHODS: Forty-seven cases of malignant breast tumors, sixty-nine cases of fibroadenomas, seven cases of inflammatory masses and twenty-two cases of mammiplasia were demonstrated on color Doppler flow imaging (CDFI). The measurements of RI and PI of the four groups were recorded respectively and the comparison between benign and malignant neoplasms was made by applying Doppler quantitative analysis. RESULTS: The color flow was detected in 59.4% of benign breast neoplasms and in 89% of malignant ones respectively (chi 2-test, P < 0.001). There were significant difference between benign and malignant neoplasms on the RI and PI. The malignant neoplasms were characteristic of higher RI (> or = 0.70) and PI (> or = 1.30), which were of satisfactory value for differential diagnosis, amounting to 95.5% of accuracy. CONCLUSIONS: Combination of both color Doppler analysis and 2D-US might remarkably increase the sensitivity and specificity of differential diagnosis of breast neoplasms. Our results confirmed the significance of color Doppler flow imaging and Doppler quantitative analysis on the differential diagnosis of breast neoplasms.

Adult↗
PubMed2002

[Central nervous system neoplasms in clinical data from the Neurology Clinic KCU in Sarajevo 1990-1999].

The Neoplasms are the second leading cause of the mortality of the adult according to WHO. The last decade is the decade of the increase of all the epidemiologic parameters of the neoplasms in general, so also the neoplasms of the central nervous system. The goal of the work was to realize the frequency of the appearance of the neoplasms of the CNS on the clinical material of the Neurologic clinic CC University of Sarajevo with the special accent on the influence of the war as the specific stressor and the factor sui generis at the epidemiologic parameters of the neoplasms of the CNS. The study is retrospective: it is comprehended the period from the 1st January 1990 till 31st December 1999 year. The patients have been analyzed according to years, according the kind of the neoplastic processes and according to the time periods. At the analyzed period was treated 10,329 patients per year, according to the kind of the neoplastic processes and according to the time periods we evidenced the mild decrease from 1991-1999 year (3.03%-2.44%). According to the sex we register 167 males (60%) and 116 females (40%). The most frequent occurrence is in the age period from 55 to 69 years (55% patients). Of the primary neoplastic processes we had in 178 patients (64), with metastases 105 patients (36%). We analyzed the time periods: the prewar period (1st January 1990-5th April 1992), the war period (6th April 1992 till 14th February 1955), and the postwar period (15th December 1995 till 31st December 1999 year). The primary neoplasms in the postwar period we had in 70 patients (40%), in the course og est 35 patients (20%) and after war 69 patients (40%). The metastatic processes are in the evident increase during the war and after the war: before the war 19 patients (18%), during the war 32 patients (31%) and after the war 54 patients (51%). In the collected material during the war and after the war was evidenced the increase of the primary neoplastic processes at the lungs and other organs which have methastized at the nervous system. On the basis of our examination we can conclude that the total clinical material was present the mild percentage decrease of the neoplasms in the relation to all other admitted patients. The primary neoplastic process have been equally present in the patient material before and after the war with certain decrease during the war (probably because of the war and the reduced diagnostics). It is noticed the significant increase of the metastatic processes of the nervous system during the war and after the war. We are of opinion that the increase of the metastatic processes during the war and after the war is more many fold conditioned: the conditions of life of people during the war, shellings, fright from death and wounding, mourning for the killed and the wounded members of the most narrow family, the weak and inadequate nutrition, the increased smoking of the cigarettes, decrease of the total immune forces of an organism and others.

Aged↗
PubMed1999

[Expression and significance of basic fibroblast growth factor in ovarian epithelial neoplasm].

OBJECTIVE: To determine the effect of basic fibroblast growth factor (bFGF) on the biological behaviour of ovarian epithelial neoplasm. METHODS: Ten cases of normal ovarian tissues and eighty cases of ovarian epithelial tumor tissues were detected by immunohistochemical methods. Mias-2000 Picture Analysis System was used to study the relationship of bFGF expression intensity and microvessel count, FIGO stage, pathological grade and classification of ovarian epithelial neoplasm. RESULTS: 1. Expression of bFGF was mainly in cytoplasm and nucleus in several cells of borderline and malignant tumor. 2. The expression intensity of bFGF was closely related to the malignant degree of ovarian epithelial neoplasm. The density of bFGF expression was (3.35 +/- 3.52)% in normal ovarian epithelium, (19.25 +/- 21.73)% in benign tumor, (33.78 +/- 10.86)% in borderline tumor and (48.18 +/- 12.93)% in malignant tumor. The results indicated that bFGF might play an important role in carcinogenesis of ovarian epithelial neoplasm. 3. The expression intensity of bFGF was increased with the FIGO stage of ovarian tumor. 4. The expression intensity of bFGF was increased accompanying with the decrease of differentiation degree in ovian neoplasm. 5. In borderline tumor, expression intensity of bFGF in serous cystadenoma was significantly higher than in mucinous cystadenoma, which indicated bFGF might be an important factor in canceration of ovarian epithelial neoplasm. CONCLUSION: bFGF may play important roles in carcinogenesis, development, invasion and metastasis of ovarian epithelial neoplasm.

Cystadenoma, Mucinous↗
PubMedDate not supplied

Radical surgical treatment for cystic neoplasms of the pancreas: personal experience.

BACKGROUND: Cystic neoplasms comprise 1-10% of all pancreatic neoplasms. Most authors recommend resection due to the difficulties in differentiating benign from malignant tumors prior to operation. We performed an analysis on the radical surgical handling of patients with cystic neoplasms of the pancreas. PATIENTS AND METHODS: We analyzed data of all patients with pancreatic neoplasms who were treated by potentially curative surgical treatment by a single surgeon (A.D.C.). Postoperative survival and complications were recorded. RESULTS: Between August 1983 and November 2003, the aforementioned surgeon performed 77 pancreatic resections for pancreatic tumors. Nine of those operations were performed for cystic neoplasms of the pancreas. All patients submitted to partial pancreatic resections were discharged in good health. The patient that underwent a total pancreatectomy died nine days after the procedure. At a mean follow up of 44 months, there has been one local recurrence with death. CONCLUSIONS: Cystic tumors of the pancreas accounted for 11.7 % of the neoplasms studied in our series. Resection of those neoplasms attained by distal pancreatectomy is a safe procedure. PD is a risky procedure and should be viewed cautiously. Total pancreatectomy remains as a high-risk procedure and should be avoided.

Adolescent↗
PubMed2006

[Values of color Doppler flow imaging and imaging changes of breast fascia and ligament in differential diagnosis of small breast neoplasms].

BACKGROUND & OBJECTIVE: Color Doppler flow imaging (CDFI) has been widely applied to the diagnosis of breast neoplasms. But combined use of CDFI and imaging changes of breast fascia and ligament (superficial and deep fascia, and Cooper's ligament) on the differential diagnosis of small breast neoplasms (< or =2 cm) has rarely been reported. This study was to explore the value of combined use of CDFI and imaging changes of breast fascia and ligament in differential diagnosis of small breast neoplasms. METHODS: CDFI was performed on 110 patients with small breast neoplasms. Among them, 52 cases were diagnosed to be benign by pathologic examination after surgery, while the rest 58 were malignant. The blood flow and Doppler image inside and around the breast lesions were analyzed. Four grades were classified according to blood flow imaging. The infiltration of breast fascia and ligament was also considered. The CDFI result was compared with that of pathologic examination. RESULTS: The correct diagnosis rates of CDFI in diagnosing benign and malignant small breast neoplasms were 90.4% and 84.5%, respectively. The false-positive and false-negative rates of CDFI were 9.6% and 15.5%, respectively. There were obvious differences in blood flow grading, systolic maximum velocity (V(max)), resistance index (RI), and imaging changes of superficial, deep fascia and Cooper's ligament between benign and malignant small breast neoplasms. CONCLUSION: Combination of CDFI with imaging changes of breast fascia and ligament is valuable in clinical diagnosis and differential diagnosis of small breast neoplasms.

Adolescent↗
PubMed1989

Molecular genetic analysis of three AIDS-associated neoplasms of uncertain lineage demonstrates their B-cell derivation and the possible pathogenetic role of the Epstein-Barr virus.

Each of three individuals with acquired immunodeficiency syndrome (AIDS) developed a pleomorphic malignant neoplasm in which a precise histopathologic diagnosis could not be rendered. In each case, the tumor cells expressed leukocyte common antigen and a variable constellation of antigens associated with B- and T-cell activation (HLA-DR, T9, T10, BL2, BL3, Ki-24, BLAST-2). They lacked all B cell, T cell, myeloid, and monocyte lineage-restricted antigens, resulting in their classification as hematopoietic neoplasms of uncertain lineage. However, antigen receptor gene rearrangement analysis demonstrated that each of these three neoplasms exhibited clonal immunoglobulin heavy chain and kappa light chain gene rearrangements and lacked T-cell receptor beta chain gene rearrangements and therefore were B cell-derived non-Hodgkin's lymphomas (NHL) representative of an equivalent, relatively mature stage of B-cell differentiation. In contrast with most AIDS-associated NHLs, each of these three neoplasms lacked c-myc gene rearrangements and contained Epstein-Barr virus (EBV) proteins and/or sequences. These studies demonstrate that these three AIDS-associated neoplasms of uncertain lineage exhibit a strikingly similar constellation of distinctly uncommon morphologic, immunophenotypic, and molecular genetic characteristics that distinguishes them substantially from the vast majority of NHLs that have been reported to occur in association with AIDS. The consistent presence of EBV proteins and/or DNA sequences suggests that the Epstein-Barr virus played a pathogenetic role in the development of these three AIDS-associated neoplasms. Finally, these studies further illustrate the utility of antigen receptor gene rearrangement analysis in the diagnosis and classification of hematopoietic neoplasms of uncertain lineage.

Acquired Immunodeficiency Syndrome↗
PubMed1980

Spontaneous endomyometrial neoplasms in aging Chinese hamsters.

Twenty-one endomyometrial neoplasms among 93 nulliparous noninbred Chinese hamsters were evaluated. The median survival time of the 93 females was 1,040 days. The median age of hamsters with endomyometrial neoplasms was 1,200 days. Neoplasms were classified as carcinoma or malignant mixed müllerian tumors of the endometrium and benign or malignant myometrial neoplasms. There were 13 endometrial adenocarcinomas. Three tumors were mixed adenosquamous carcinomas, which occurred in significantly older Chinese hamsters than did adenocarcinomas. Three malignant mixed müllerian tumors consisted of 2 carcinosarcomas and 1 mixed mesodermal tumor. The 2 myometrial neoplasms were a leiomyoma and a leiomyosarcoma. The classification and relative frequency of these neoplasms were similar to endomyometrial neoplasms of women, which makes Chinese hamsters useful subjects for studies of spontaneous endomyometrial cancers.

Adenocarcinoma↗
PubMed1994

Increased incidence of second neoplasms in patients treated with interferon alpha 2b for hairy cell leukemia: a clinicopathologic assessment.

We report that there is an unexpectedly high incidence of second neoplasms in patients after treatment of hairy cell leukemia (HCL) with interferon alpha 2b (IFN). In a cohort of 69 patients with HCL entered in a protocol using IFN as the primary treatment, and followed thereafter for a median of 91 months (range, 0.2 to 109 months), 13 patients (19%) developed a second neoplasm. Six neoplasms were of hematopoietic origin, whereas the remaining seven were adenocarcinomas. The expected number of second tumors in this cohort is three (based on calculations from the National Cancer Institute's SEER data), so the excess frequency (observed:expected) is 4.33. However, the excess frequency is even greater for the hematopoietic neoplasms; the expected frequency is 0.15, whereas six hematopoietic tumors occurred, for an observed:expected ratio of 40. In general, the second neoplasms have behaved aggressively, and the median survival after diagnosis of the second neoplasm was only 8.8 months. Although we cannot entirely exclude the possibility that IFN therapy has some direct oncogenic effect, we suspect that increased frequency of second tumors is related to prolonged survival of patients who are immunocompromised because of HCL and thus prone to develop second tumors. If so, the frequency of second neoplasms in patients with HCL may be even greater in the future with continued improvements in therapy.

Adult↗
PubMed1993

[Inadequate hospital admissions and inactive days of hospital stay in patients with chronic obstructive pulmonary disease and lung neoplasms].

BACKGROUND: This study was carried out to evaluate the hypothesis that the proportion of inadequate hospital admissions and days is greater in patients with pulmonary neoplasm than in patients with chronic obstructive pulmonary disease (COPD) given the therapeutic and diagnostic features of both diseases and to establish the applicability of the Appropriateness Evaluation Protocol (AEP). METHODS: A retrospective review was performed of the medical records of patients admitted for COPD and pulmonary neoplasm. Two external physicians reviewed the clinical histories using the AEP. Admissions and hospital days considered as potentially inadequate by the reviewers were supervised by a clinical epidemiological panel which confirmed and identified the causes for inadequacy. One hundred sixty-six patients admitted with COPD and 79 with pulmonary neoplasm selected by a systematic sample of admissions whose principal diagnosis was COPD or pulmonary neoplasm were studied over one year in a tertiary level teaching hospital in Barcelona. RESULTS: It was found that 4.8% of the admissions with COPD and 15.5% of the days of hospital stay were inappropriate while in patients with pulmonary neoplasm 14% of the admissions and 40% of the days of hospital stay were inappropriate. The main causes of inadequacy were: social (33.3% in patients with COPD); patients inadequately admitted but who remained in hospital to undergo diagnostic tests which could have been performed on an out patients basis (46% in patients with pulmonary neoplasm). CONCLUSIONS: Inappropriateness was greater in admissions and in hospital days with greater diagnostic components (pulmonary neoplasm) than in fundamentally therapeutic cases (COPD). The Appropriateness Evaluation Protocol was valid in this hospital with the supervising panel being very useful in the judgement of cases not clearly established in the protocol. The level of inadequacy was found to be similar to that of other studies although the results are not directly comparable.

Aged↗
PubMed1996

[Diagnostic approach to neoplasms at an internal medicine service].

BACKGROUND: The aim of this study was to investigate the diagnostic behavior of different members of a department of internal medicine towards some neoplasms, analyzing the study times, reasons for suspicion and the number of tests performed and their results. PATIENTS AND METHODS: A retrospective review of the clinical histories of the patients admitted from January 1, 1992 to June 30, 1994 whose diagnosis was a new neoplasm of the digestive tract, lung cancer, cancer of unknown origin or lymphoma was carried out. The total diagnostic study time and the different partial times were measured and confirmed. The causes leading to suspicion of the neoplasms were also analyzed by groups, and finally the efficacy of the different diagnostic tests; either non invasive, oriented at the decision of the definitive test, or invasive (biopsies and fine needle aspiration puncture). RESULTS: The median total study time was 13 days with no differences between the groups. The median time until clinical suspicion was 0 days (interquartile range 0-2), being significantly greater in the digestive neoplasms. Less than half of the total study time corresponded to the clinical work itself (5 vs. 8 days). Suspicion of neoplasms in 49% of the cases arose from radiographic alteration and in 30% from clinical alterations. With regards to diagnostic tests, the value of thorax X-ray as the first exploration, mainly in the lung neoplasms (82.5% of the radiographies showed alterations), the elevated efficacy of computerized tomography, among the non invasive tests and fine needle aspiration puncture among the invasive tests were of note. Definitive diagnosis was achieved in 62% of the cases by biopsy and in 31% by fine needle aspiration puncture. CONCLUSIONS: Not all the time spent in achieving diagnosis of neoplasms is attributable to clinical work, although this may be shortened. To do so, a faster and more adequate use of the tests of greater performance (thorax X-ray, computerized tomography and fine needle aspiration puncture) should be used and performed with greater coordination and cooperation among the clinical technicians and physicians of the different departments.

Adult↗