RESUMO
BACKGROUND: In patients with palpable hepatomegaly and space occupying lesions demonstrated by imaging techniques, blind fine needle aspiration puncture (FNAP) at the patient's bedside is feasible. OBJECTIVE: To compare the diagnostic yield of the fine needle aspiration puncture (FNAP) performed blindly or under radiological control in patients with hepatomegaly and multiple solid space occupying lesions in the liver, demonstrated by ultrasonography. METHODS: A retrospective study was made of 169 consecutive FNAPs of liver tumors performed either blindly at the bedside by an internist (55 patients) or imaged-guided by a radiologist (114 patients). RESULTS: The diagnostic yield of the technique performed blindly to demonstrate malignancy was 78% (95% confidence interval [CI]: 66-87%) versus 83% (95% CI: 75-89%, P=.42) obtained in the image-guided FNAPs. The diagnostic yield did not vary based on type of tumor invading the liver. CONCLUSION: Blind FNAP procedures in patients with palpable enlarged liver due to solid space occupying lesions is as effective as those performed under radiological control.
Assuntos
Biópsia por Agulha Fina , Fígado , Humanos , Estudos RetrospectivosRESUMO
OBJECTIVE: To assess the usefulness of repeat cytological examination of pleural fluid (PF) for diagnosing malignancy as well as the influence of time length between analyses, effusion's size and pleural fluid biochemistries on the diagnostic yield of cytology. METHODS: Retrospective analysis of 1,427 patients with pleural effusion (PE), including 466 patients with malignant PE. In this latter group, the time length between cytological analysis, the size of the PE, and the biochemical characteristics of PF were recorded. RESULTS: The first cytological analysis had a sensitivity of 48.5%. If this was negative, a second PF specimen was diagnostic in 28.6% of cases, whereas submission of a third PF specimen allowed 10.3% of additional diagnosis. The incidence of positive results depended on the primary tumor (e.g. 66.5% in adenocarcinomas, 30.8% in mesotheliomas), but neither on the time length between cytological analyses nor on the effusion's size. A multivariate analysis showed that a PF to serum glucose ratio = 0.75 was associated with a higher diagnostic yield of cytology (74 vs. 47%, p < 0.001). CONCLUSION: At least a second PF specimen should be submitted immediately for cytologic analyis in all PE of unknown cause, when the first analysis is not contributory. To delay this second analysis does not increase diagnostic yield. The percentage of cases in which cytologic study of the PF established the diagnosis of malignant PE depends on the tumor type and on certain PF biochemical characteristics such as the PF to serum glucose ratio.
Assuntos
Derrame Pleural Maligno/patologia , Idoso , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
Hypokalemia is generally associated to neuromuscular symtoms, acid-base disorders and even to rhabdomyolysis. However, chronic hypokalemia can induce chronic renal failure through a characteristic tubulointerstitial damage consisting on vacuolization of epithelial tubular cells and interstitial fibrosis. This entity is called hypokalemic nephropathy, quite unusual and probably little know in our speciality. We present a clinical report of a patient admitted to our hospital with a severe hypokalemia secondary to an aldosterone producing adrenal adenoma that was diagnosed during admission. Besides hypokalemia the patient presented renal failure. Renal biopsy proved characteristic tubulointerstitial damage as described in hypokaliemic nephropathy. In summary, we report a Conn syndrome presenting as a hypokalemic nephropathy.
Assuntos
Hiperaldosteronismo/complicações , Hipopotassemia/etiologia , Nefropatias/etiologia , Humanos , Hiperaldosteronismo/diagnóstico , Hipopotassemia/complicações , Nefropatias/complicações , Masculino , Pessoa de Meia-IdadeAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Leishmaniose/diagnóstico , Doenças da Língua/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Antiprotozoários/administração & dosagem , Antiprotozoários/uso terapêutico , Diagnóstico Diferencial , Humanos , Leishmaniose/tratamento farmacológico , Masculino , Meglumina/administração & dosagem , Meglumina/uso terapêutico , Antimoniato de Meglumina , Compostos Organometálicos/administração & dosagem , Compostos Organometálicos/uso terapêutico , Fatores de Tempo , Doenças da Língua/tratamento farmacológico , Resultado do TratamentoAssuntos
Vasculite/classificação , Vasculite/patologia , Idoso , Idoso de 80 Anos ou mais , Doença Antimembrana Basal Glomerular/patologia , Anti-Infecciosos/efeitos adversos , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/patologia , Glomerulonefrite/complicações , Glomerulonefrite/patologia , Humanos , Rim/patologia , Masculino , Nefrite Intersticial/induzido quimicamente , Nefrite Intersticial/patologia , Norfloxacino/efeitos adversosAssuntos
Crioglobulinemia/complicações , Glomerulonefrite/etiologia , Glomerulonefrite/patologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/patologia , Idoso , Crioglobulinemia/patologia , Crioglobulinas/análise , Evolução Fatal , Imunofluorescência , Glomerulonefrite/metabolismo , Humanos , Técnicas Imunoenzimáticas , Imunoglobulina M/análise , Glomérulos Renais/química , Glomérulos Renais/patologia , MasculinoRESUMO
Renal actinomycosis is rarely suspected and is difficult to diagnose, limited to a few cases in any series. A 56-year-old man with renal actinomycosis and Rendu-Osler disease is described. Long-term therapy with penicillin resulted in a clinical cures. A case report is presented.
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Abscesso/diagnóstico , Actinomicose/diagnóstico , Nefropatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 37 year-old woman presented with type D2 familial dysplastic nevus syndrome with melanoma. A melanoma was excised of her back and more than one hundred pigmented lesions, four of which presented histologic characteristics of dysplastic nevus were observed. Several relatives of her presented multiple nevi and a sister of her mother and a brother of the patient had been diagnosed of melanoma. It is well established that such kind of nevi are precursor for melanomas, particularly familial forms. The clinical identification of such lesions is very simple and facilitates the diagnosis and early treatment of melanoma.
Assuntos
Síndrome do Nevo Displásico/patologia , Neoplasias Cutâneas/patologia , Adulto , Síndrome do Nevo Displásico/genética , Feminino , Humanos , Linhagem , Fatores de Risco , Neoplasias Cutâneas/genéticaRESUMO
Regional distribution of glycoconjugates in normal and neoplastic colonic mucosa was studied by means of eight lectins: Dolichos biflorus (DBA), Glycine max (SBA), Triticum vulgare (WGA), Arachis hypogaea (PNA), Griffonia simplicifolia-I (GS-I), Canavalia ensiformis (Con A), Limax flavus (LFA), and Ulex europaeus-I (UEA-I). The lectin binding patterns were examined in 40 normal colonic mucosa (NM) (12 proximal (P) and 28 distal (D], 38 carcinomas (15 P and 23 D), and 31 transitional mucosa (TM) (9 P and 22 D). Sections of NM located 5 cm and 10 cm distant from the tumour and sections from the resection margins (more than 10 cm from the tumour) of the surgical specimens were also studied in 19 cases (6 P and 13 D). In NM, regional differences between the proximal and distal colon were detected with most lectins. DBA, SBA and LFA bound mainly to the goblet cell mucin of the distal colon, while GS-I and UEA-I labelling predominated in proximal colonic mucosa. The lectin reactivity in carcinomas was: DBA 26%, SBA 63%, PNA 95%, GS-I 66%, UEA-I 76%, WGA 100%, Con A 92% and LFA 42%. No regional differences were observed in the lectin patterns of proximal and distal colonic carcinomas nor was any relationship detected between lectin reactivities and Dukes stage, size or histological type of tumours. Transitional mucosa of both the proximal and distal colon showed an increase in PNA-binding and loss of DBA and SBA. LFA and UEA-I reactivity in proximal TM was similar to that observed in proximal NM. Distal TM showed a decrease in LFA labelling and the appearance of UEA-I reactivity in goblet cell mucin in 5 cases (23%). The reactivity of the other lectins was as with NM. The only change in normal mucosa distant from tumours was a focal increase in PNA reactivity in 4 cases. These findings suggest that carcinomas from different colonic regions have a more uniform distribution of carbohydrates than the respective NM.