Usefulness of thoracic ultrasound in the assessment of removal of indwelling pleural catheter in patients with malignant pleural effusion.

INTRODUCTION: There are no defined criteria for deciding to remove a non-functioning indwelling pleural catheter (IPC) when lung re-expansion on chest X-ray is incomplete. Chest computed tomography (chest CT) is usually used. The objective of this work is to validate the usefulness of chest ultrasound performed by a pulmonologist and by a radiologist compared to chest CT. PATIENTS AND METHODS: Prospective, descriptive, multidisciplinary and multicenter study including patients with malignant pleural effusion and non-functioning IPC without lung reexpansion. Decisions made on the basis of chest ultrasound performed by a pulmonologist, and performed by a radiologist, were compared with chest CT as the gold standard. RESULTS: 18 patients were analyzed, all of them underwent ultrasound by a pulmonologist and chest CT and in 11 of them also ultrasound by a radiologist. The ultrasound performed by the pulmonologist presents a sensitivity of 60%, specificity of 100%, PPV 100% and NPV 66% in the decision of the correct removal of the IPC. The concordance of both ultrasounds (pulmonologist and radiologist) was 100%, with a kappa index of 1. The 4 discordant cases were those in which the IPC was not located on the ultrasound. CONCLUSIONS: Thoracic ultrasound performed by an expert pulmonologist is a valid and simple tool to determine spontaneous pleurodesis and remove a non-functioning IPC, which would make it possible to avoid chest CT in those cases in which lung reexpansion is observed with ultrasonography.

[Reabsorption syndrome. Report of a case]. / Síndrome de reabsorción. Presentación de un caso.

OBJECTIVE: To report a case of TURP syndrome and emphasize the importance of early diagnosis. METHODS: A case of reabsorption syndrome in a patient that underwent transurethral resection under spinal anesthesia is presented. RESULTS: Reabsorption syndrome (TURP syndrome) is manifested by neurological and hemodynamic changes resulting from absorption of irrigating fluid used during transurethral resection of the prostate. This complication presented in a patient undergoing elective surgery and with no additional risk factors. CONCLUSIONS: Since it is impossible to prevent this complication of TUR, spinal anesthesia should be utilized whenever possible because it permits early detection before important complications develop.

[Prostatic syndrome and pleural effusion: are they different diseases?]. / Síndrome prostático y derrame pleural: enfermedades diferentes?

OBJECTIVE: To report an uncommon association of prostate and lung cancer. METHODS: The characteristics of both tumors, their association with tumors in other sites and the time of presentation are analyzed. RESULTS: Both tumors were in the advanced stages. Metastatic carcinoma of the prostate was discarded due to the form of presentation. CONCLUSIONS: Although the association of prostate and lung cancer is uncommon, the possibility of synchronous tumors should be considered in patients with urinary and pulmonary symptoms suggestive of neoplasm. It is important to determine if the lesion is a metastasis, since the prognosis depends on the second tumor.

[The advantages of palliative embolization and with preoperative ethanol in hypernephroma]. / Ventajas de la embolización con etanol prequirúrgico y paliativa en hipernefromas.

We report thirty-one embolizations of renal cell carcinomas, using ethanol injected through a balloon-tipped catheter. This technique is performed both as a palliative and as a preoperative treatment. Renal function (urea and creatinine) before and a week after embolization showed no important variations. The CT scan six days after embolization disclosed intratumoral gas formation due to necrosis, without infection. Less time and fewer transfusions were required with this procedure and the morbidity and mortality rates were lower. There were no major complications and the duration of the postembolization syndrome was reduced to 48 hours. A histopathological examination of the tumor and the vascular changes was done, showing the effects of ethanol on the arterial and venous walls.