Multidisciplinary virtual management of pulmonary nodules.

INTRODUCTION AND OBJECTIVES: Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines. MATERIALS AND METHODS: Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up. RESULTS: A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm). CONCLUSIONS: During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.

[Thymus carcinoid associated with type 1 multiple endocrine neoplasm syndrome]. / Carcinoide tímico asociado al síndrome de neoplasia endocrina múltiple tipo 1.

Thymus carcinoid tumors are unusual and can be differentiated from thymomas by clinical, histological and prognostic characteristics. The clinicopathological findings of a new case of carcinoid tumor of the thymus associated with type 1 multiple endocrine neoplasm, the presentation of which was conditioned by its metastasis, is herein presented.

[Cholelithiasis in children. Apropos of a case]. / Lithiase biliaire chez l'enfant. A propos d'un cas.

Ultrasounds provides the most useful information in pediatric gallbladder diseases. We present a case in which a 19-months old child was studied by ultrasonography demonstrating clearly lithiasis. The discovery was purely fortuitous, showing echogenic material with acoustic shadowing in the lumen of the gallbladder.

Diagnostic yield of fine-needle aspiration puncture for cytology of multifocal liver lesions: a comparison between image-guided and blind aspirations.

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.

Comparison of polymorphonuclear- and lymphocyte-rich tuberculous pleural effusions.

SETTING: Most patients with tuberculous pleural effusions (TPE) have more than 50% lymphocytes in the pleural fluid. Data on patients in whom polymorphonuclear leukocytes (PMNLs) are the predominant cell type are scarce. OBJECTIVE: To compare the clinical, biochemical, microbiological and radiological characteristics between patients with predominantly PMNL and those with lymphocytic TPE. DESIGN: Retrospective analysis of 214 consecutive patients with TPE. RESULTS: The pleural fluid was PMNL-rich in 24 (11%) cases at the time of first thoracocentesis. Compared with those whose pleural fluid was predominantly lymphocytic, these patients showed a higher yield of mycobacteria in culture of sputum (50% vs. 25%, P = 0.03) and pleural fluid (50% vs. 10%, P < 0.01) on solid media, as well as higher pleural adenosine deaminase (ADA) levels (80 vs. 62 U/l, P = 0.02) at the expense of both ADA1 and ADA2 isoenzymes. A shift towards pleural lymphocytic predominance was observed in more than half of the PMNL-predominant patients subjected to repeat thoracocentesis. CONCLUSIONS: The finding of a predominantly PMNL exudate should not rule out TPE, particularly when pleural ADA activity is elevated. The collection of sputum and pleural fluid samples for mycobacterial culture should be encouraged in the case of suspected PMNL-rich TPE, as they are frequently positive in this early stage.