ABSTRACT
Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions.
Subject(s)
Adult , Female , Humans , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Infliximab/therapeutic use , Peritoneal Neoplasms/drug therapy , Biopsy , Diagnosis, Differential , Myofibroblasts , Neoplasm Recurrence, Local , Peritoneal Neoplasms/pathology , Tomography, X-Ray ComputedABSTRACT
Cryptococcal infections are classically associated to HIV/AIDS patients without therapy, but its presence among other immunosuppressed patients is less recognized. We report 3 lethal cases in non HIV-patients. Two of them presented with meningitis associated to renal transplant or corticosteroid use and, the third, with a necrotic skin infection in the context of progressive liver cirrhosis. In the former two patients, meningeal infection was suspected late, and in the latter, the diagnosis was established postmortem. Cryptococcal infections in non-HIV immunosupressed patients can affect different sites, are suspected late and have a high case-fatality ratio.
La mayoría de los casos de infecciones criptocócicas se presenta en pacientes con infección por VIH/SIDA con inmunosupresión avanzada. En otro tipo de pacientes inmunosuprimidos es menos conocida, pero ha ido aumentando en frecuencia. Presentamos tres casos de infecciones criptocócicas en pacientes inmunosuprimidos no infectados por VIH, que se manifestaron como meningitis en un receptor de trasplante renal y en un paciente con terapia corticosteroidal y una infección cutánea progresiva necrótica con diseminación secundaria en un paciente con cirrosis hepática avanzada. En todos los casos, la infección fue identificada tardíamente. La infección en el paciente con cirrosis se estableció postmortem. Las infecciones criptocócicas en pacientes sin infección por VIH pueden ocurrir en diferentes sitios, se sospechan tardíamente y tienen alta letalidad.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cryptococcosis/immunology , Cryptococcus neoformans/isolation & purification , Immunocompromised Host , Meningitis, Cryptococcal/immunology , Chile , Dermatomycoses/pathology , Fatal Outcome , Kidney Transplantation/adverse effects , Liver Cirrhosis/complications , Renal Insufficiency/complications , Vasculitis/complicationsABSTRACT
Objective. To identify the coping and adaptation process and its relationship to the spiritual perspective in patients with HIV/AIDS. Methodology. Cross-sectional descriptive study in which 100 patients participated and who were applied instruments like RoyÆs coping and adaptation measurement scale and ReedÆs Spiritual Perspective Scale. The study was conducted in 2009, at a state healthcare institution in Bogotá (Colombia). Results. Five patient subgroups were identified (Recursive and Centered, Physical and Focused, in warning process, in systematic processing, and knowing and relating) who presented different dynamics regarding the greater or lesser use of coping strategies. In most patients a high spiritual perspective was identified upon the experience of the disease. A weak, but significant correlation was found between the coping and adaptation processes and the components of the spiritual perspective. Conclusion. A relationship exists between the spiritual perspective and the coping and adaptation process to the HIV/AIDS disease; the aforementioned must be considered in the therapeutic relationship as a relevant component of caretaking.
Objetivo. Identificar el proceso de afrontamiento y adaptación y su relación con la perspectiva espiritual en el paciente con VIH/SIDA. Metodología. Estudio descriptivo transversal en el que participaron 100 pacientes a quienes se les aplicaron los instrumentos Escala de Medición del Proceso de Afrontamientoy Adaptación de Roy, y la Escala de Perspectiva Espiritual de Reed. El estudio se realizó en 2009, en una institución estatal de salud en Bogotá (Colombia). Resultados. Se identificaron cinco subgrupos de pacientes (recursivo y centrado, físico y enfocado, en proceso de alerta, en procesamiento sistemático y conociendo y relacionando) quienes presentaron diferentes dinámicas en cuanto al mayor o menor uso de las estrategias de afrontamiento. En la mayoría de pacientes se identificó una alta perspectiva espiritual ante la vivencia de la enfermedad. Una débil pero significativa correlación se encontró entre los procesos de afrontamiento y adaptación y los componentes de la perspectiva espiritual. Conclusión. Existe relación entre la perspectiva espiritual y el proceso de afrontamiento y adaptación a la enfermedad del VIH/SIDA. Lo anterior debe ser tenido en cuenta en la relación terapéutica como componente relevante del cuidado.
Objetivo. Identificar o processo de afrontamento e adaptação e sua relação com a perspectiva espiritual no paciente com HIV/AIDS. Metodologia. Estudo descritivo transversal no que participaram 100 pacientes a quem se lhes aplicaram os instrumentos Escala de Medição do Processo de Afrontamento e Adaptação de Roy, e a Escala de Perspectiva Espiritual de Reed. O estudo se realizou em 2009, numa instituição estatal de saúde em Bogotá (Colômbia). Resultados. Identificaram-se cinco subgrupos de pacientes (recursivo e centrado, físico e enfocado, em processo de alerta, em processamento sistemático e conhecendo e relacionando) quem apresentaram diferentes dinâmicas quanto ao maior ou menor uso das estratégias de afrontamento. Na maioria de pacientes se identificou uma alta perspectiva espiritual ante a vivência da doença. Uma débil, mas significativa correlação se encontrou entre os processos de afrontamento e adaptação e os componentes da perspectiva espiritual. Conclusão. Existe relação entre a perspectiva espiritual e o processo de afrontamento e adaptação à doença do HIV/AIDS, o anterior deve ser tido em conta na relação terapêutica, como componente relevante do cuidado.
Subject(s)
Humans , HIV , Adaptation, Psychological , SpiritualityABSTRACT
Se expone una manera sencilla de calcular la concentración de los vapores anestésicos y se da lista de las presiones barométricas de las principales ciudades del país, para cada cual elabore sus propias constantes de evaporación