Malignant pericardial effusion.

OBJECTIVE: To examine the frequency and diagnostic implications of malignant pericardial effusions. STUDY DESIGN: The clinical and histologic records of pericardial effusions diagnosed cytologically as malignant were reviewed. We investigated the relationship between malignancy and type of tumor, interval between diagnosis of the primary tumor and development of the pericardial effusion, and length of survival after the onset of the effusion. RESULTS: There were 375 pericardial effusions among 23,592 effusions studied over 24 years; 65 of them were diagnosed as malignant. The mean age at onset was 53.6 years. In 92% of the cases the primary tumor was epithelial, lung the most frequent in males and breast in females. In 48% of cases the pericardial effusion constituted the first sign of malignancy. CONCLUSION: Diagnosis of a pericardial effusion as malignant carried an ominous prognosis: 86% of patients died within the first year and nearly one-third within the first month. Breast carcinomas were linked with the longest survival and longest interval of latency prior to the onset of the pericardial effusion. There were two effusions associated with lymphoblastic lymphomas; they have had no recurrence 10 and 17 years after the effusion, and the patients can be considered cured.

Extramedullary hematopoietic effusions.

OBJECTIVE: To investigate the frequency and diagnostic implications of extramedullary hematopoietic effusions. STUDY DESIGN: Smears of the effusions diagnosed cytologically as myeloid metaplasia or extramedullary hematopoiesis and their clinical records were reviewed and compared with the histologic diagnoses. RESULTS: There were 7 pleural and 1 peritoneal effusion from 5 patients out of 20,793 pericardial, peritoneal and pleural effusions studied during a period of 21 years. CONCLUSION: When compensatory responses can be ruled out, the diagnosis of extramedullary hematopoietic effusion points toward replacement of the bone marrow by a metastatic process. The first primary to consider in males is lung carcinoma.

[Usefulness of bronchoalveolar lavage in the renal transplant patient with suspected respiratory infection]. / Utilidad del lavado broncoalveolar en el paciente trasplantado renal con sospecha de infección respiratoria.

In this retrospective study we aimed to assess the diagnostic yield of bronchoalveolar lavage (BAL) in kidney transplant patients who were suspected of having severe respiratory infection or in whom empirical antibiotic treatment had failed. All BAL procedures performed on kidney transplanted patients suspected of having respiratory infections between January 1, 1988 and July 31, 1996 were analyzed. BAL was carried out in the standard way and samples were sent for cytologic and bacteriologic study. Thirty-three patients with a mean age of 48.5 years were enrolled. All had been receiving immunosuppressive treatment and the mean time following transplantation was 320 days. Thirty-one had received antibiotic treatment before BAL. BAL was positive for 21 of the 33 patients (64%). Twenty-two pathogens were identified: 6 Pneumocystis carinii, 4 Cytomegalovirus, 3 Mycobacterium tuberculosis, 2 Aspergillus fumigatus, 2 Herpes simplex type I, 1 Streptococcus pneumoniae, 1 Staphylococcus aureus, 1 Streptococcus mitis, 1 Legionella pneumophila, 1 Legionella longbeachae. BAL was negative for 12 patients, of whom 8 were tentatively diagnosed of bacterial infection, 3 of acute pulmonary edema and one of pulmonary infarction. Based on the results, therapy was changed for 20 patients (61%), 19 (58%) because an unsuspected pathogen was identified and 1 because treatment could be simplified. The diagnostic yield of BAL is high (64%) in kidney transplant patients suspected of respiratory infection and is useful for managing such cases, as evidenced by the fact that a high proportion (19/33) of our patients were infected by pathogens not covered by empirical treatment.

Paraganglioma de glomus carotídeo: un caso clínico de presentación inusual / Paraganglioma of carotid glomus: a clinical case of unusual presentation

Se presenta un caso clínico de un paraganglioma benigno, no cromafínico, del glomus carotídeo, en un hombre de 51 años que debutó con dolor torácico y al que posteriormente tras una punción aspiración con aguja fija (PAAF), el estudio citológico fue informado como compatible con oncocitoma de la glándula submaxilar (AU)

Paraganglioma de glomus carotídeo: un caso clínico de presentación inusual / Paraganglioma of carotid glomus: a clinical case of unusual presentation

Se presenta un caso clínico de un paraganglioma benigno, no cromafínico, del glomus carotídeo, en un hombre de 51 años que debutó con dolor torácico y al que posteriormente tras una punción aspiración con aguja fija (PAAF), el estudio citológico fue informado como compatible con oncocitoma de la glándula submaxilar