Adenopatías mediastínicas en síndromes paraneoplásicos / Mediastinal lymphadenopathies in paraneoplastic syndromes

Los síndromes paraneoplásicos son la forma de manifestación de ciertos tumores. La ecografía endobronquial (EBUS) es útil en el estudio de las adenopatías mediastínicas. El objetivo es describir las características de los pacientes con sospecha de síndromes paraneoplásicos y adenopatías mediastínicas. Se realizó un estudio observacional retrospectivo en el que se incluyeron pacientes de la unidad de endoscopia respiratoria de nuestro centro a quienes se realizó EBUS para valorar adenopatías mediastínicas como parte del estudio de cuadros sospechosos de síndrome paraneoplásico entre 2008 y 2021. Se incluyeron 10 pacientes. Los síndromes paraneoplásicos neurológicos fueron los más frecuentes (70%), con síntomas y anticuerpos onconeuronales altamente relacionados con procesos tumorales. La EBUS tuvo una sensibilidad del 83%. La estirpe tumoral más frecuente fue el carcinoma de células pequeñas (40%). Solo uno de los casos con hallazgo de hiperplasia linfoide en la EBUS fue diagnosticado posteriormente de carcinoma mucosecretor. En pacientes con sospecha de síndrome paraneoplásico y adenopatías significativas en las pruebas de imagen se debe valorar su punción mediante EBUS. En nuestra serie, esta técnica tiene una elevada sensibilidad y permite el diagnóstico de procesos tumorales que en muchas ocasiones son la forma manifestación de ciertos tumores (AU)

Paraneoplastic syndromes are the manifestation of certain tumors. Endobronchial ultrasound (EBUS) is useful in the study of mediastinal lymphadenopathies. The objective is to evaluate the effectiveness of the study of mediastinal lymphadenopathies in patients with suspected paraneoplastic syndrome. We conducted a retrospective observational study, including patients from the Respiratory Endoscopy Unit of the Hospital 12 de Octubre who underwent EBUS for the study of mediastinal lymphadenopathies as part of the study of suspected SP between 2008 and 2021. Ten patients were included. Neurological paraneoplastic syndromes were the most frequent (70%), with symptoms and onconeuronal antibodies highly related to tumor processes. EBUS had a sensitivity of 83%. The most frequent tumor type was small cell carcinoma (40%). Only one of the cases with a finding of lymphoid hyperplasia on EBUS was subsequently diagnosed as a mucosecretory carcinoma. Patients with suspected paraneoplastic syndromes and significant lymphadenopathy on imaging tests should be evaluated for EBUS puncture. In our series, this technique has a high sensitivity and allows the diagnosis of tumor processes that often have no other expression (AU)

Cuerpo extraño endobronquial. Cuando la broncoscopia no siempre es la solución / Endobronchial foreign body. When bronchoscopy is not always the answer

La aspiración de cuerpos extraños es una entidad poco común en el adulto. El diagnóstico se basa en la sospecha clínica y la realización de pruebas de imagen, siendo la revisión endoscópica de la vía aérea la que permite el diagnóstico definitivo, así como la extracción del cuerpo extraño. Esto es importante por las posibles complicaciones derivadas de ello, entre las que se incluyen la muerte del paciente. Presentamos el caso de un paciente joven con aspiración de una chincheta que desarrolla una neumonía obstructiva con empiema y que finaliza en cirugía con decorticación pleural.(AU)

Foreign body aspiration is an uncommon entity in adults. Diagnosis is based on clinical suspicion and imaging tests, with endoscopic examination of the airway, allowing definitive diagnosis and removal of the foreign body. This is important because of the potential complications, including death of the patient. We present the case of a young man with aspiration of a drawing pin who developed obstructive pneumonia with empyema and ended up in surgery with pleural decortication.(AU)

RNase L activation in the cytoplasm induces aberrant processing of mRNAs in the nucleus.

The antiviral endoribonuclease, RNase L, is activated by the mammalian innate immune response to destroy host and viral RNA to ultimately reduce viral gene expression. Herein, we show that RNase L and RNase L-mediated mRNA decay are primarily localized to the cytoplasm. Consequently, RNA-binding proteins (RBPs) translocate from the cytoplasm to the nucleus upon RNase L activation due to the presence of intact nuclear RNA. The re-localization of RBPs to the nucleus coincides with global alterations to RNA processing in the nucleus. While affecting many host mRNAs, these alterations are pronounced in mRNAs encoding type I and type III interferons and correlate with their retention in the nucleus and reduction in interferon protein production. Similar RNA processing defects also occur during infection with either dengue virus or SARS-CoV-2 when RNase L is activated. These findings reveal that the distribution of RBPs between the nucleus and cytosol is dictated by the availability of RNA in each compartment. Thus, viral infections that trigger RNase L-mediated cytoplasmic RNA in the cytoplasm also alter RNA processing in the nucleus, resulting in an ingenious multi-step immune block to protein biogenesis.

Lidocaine Infusion for the Treatment of Headache Associated With Subarachnoid Hemorrhage: A Case Report.

Headache after subarachnoid hemorrhage and corresponding craniotomy with aneurysm clipping can be severe and difficult to treat. Currently accepted analgesic therapies are often ineffective at treating the pain without incurring unacceptable side effects. We present an innovative approach wherein intravenous lidocaine infusions were used to successfully treat 2 patients with hyperalgesia refractory to traditional analgesic therapies. Opioid consumption fell to zero for both patients during lidocaine infusions without lidocaine toxicity. Moreover, after discontinuation of lidocaine infusions, both patients reported good pain control using only standard oral medications.

Influence of Cytomegalovirus on the Survival of Cytomegalovirus-Seropositive Lung Transplant.

BACKGROUND: The primary aim of this study was to analyze the survival of patients undergoing lung transplant (LT) with cytomegalovirus (CMV)-positive serologies at the time of transplantation, according to the presence of CMV events and according to the severity of these events. The secondary objective was to assess whether there are differences in the incidence of chronic lung allograft dysfunction (CLAD) according to the presence of these events. METHODS: This was an observational, single-center, retrospective study. The inclusion criterion for the study was having undergone LT at the Hospital Universitario 12 de Octubre from October 2008 to February 2019. Survival was calculated using the Kaplan-Meier method and compared using the log-rank test. The incidence of CLAD was compared using the χ2 test. RESULTS: Inclusion criteria were met by 239 LTs. In terms of survival, no difference was found between patients with and without CMV events (log-rank P = .52), with mean survival of 3223 ± 164 days and 3024 ± 146 days, respectively. Nor did we find a difference when stratifying patients according to no CMV events, infection, syndrome, and disease (log-rank P = .6). There was also no difference in the incidence of CLAD between patients with and without CMV events (P > .178). CONCLUSION: In patients with positive CMV serology, the development of CMV events, including severe disease, does not seem to influence survival. The incidence of CLAD also is not increased by the presence of CMV events.

Antithymocyte Globulin Treatment for Chronic Lung Allograft Dysfunction in Lung Transplant Recipients: Experience From a National Reference Transplant Center.

BACKGROUND: Chronic lung allograft dysfunction (CLAD) is the leading cause of mortality after the first year of transplantation and treatments can have little impact on CLAD progression in some cases. The objective of this study was to evaluate the effectiveness and safety of antithymocyte globulin (ATG) in lung transplant recipients with CLAD. METHODS: We reviewed all patients from our center that had undergone a lung transplant between 2008 and 2019 and selected those with CLAD who were treated with ATG. The closest lung function (forced expiratory volume in the first second) to the ATG administration was recorded, as well as the values 3, 6, and 12 months before and after treatment. We followed and recorded survival during the 12 months after treatment. RESULTS: A total of 13 patients with CLAD received ATG treatment. A favorable positive response to treatment (improvement or stabilization on lung function) was achieved in half of the patients. Most patients (71%) who responded well to ATG were in CLAD stage 1 to 2. The fall slope of forced expiratory volume in the first second is better after treatment. The median survival was 27 months, and we found a trend toward better survival in early CLAD stages 1 to 2. There were also differences in survival between rapid decliners and nonrapid decliners. CONCLUSIONS: ATG treatment could play a role in patient with CLAD who do not respond to conventional therapies. The effect of cytolytic therapy with ATG is clearly better in those patients in early stages, with little effect in those in CLAD stage 3.

Comparison between cotton test and tap test for the assessment of coronal syndesmotic instability: A cadaveric study.

INTRODUCTION: In surgically treated rotational malleolar fractures, residual syndesmotic instability is typically assessed following fixation with the widely used intraoperative Cotton test. However, due to its dynamic nature, there are inconsistencies of the magnitude and direction of the distraction force when attempting to pull the fibula away from the tibia using a bone hook. The novel Tap test advances a cortical tap through a drilled hole in the fibula with a stable, unidirectional distraction force applied to the tibia. The objective of this cadaveric study was to compare the Cotton and Tap tests as diagnostic tools for coronal plane syndesmotic instability. METHODS: Tibiofibular Clear Space (TFCS) of 10 cadaveric specimens was measured for: intact, non-stressed; intact, stressed; injured, non-stressed; and injured, stressed (Tap and Cotton tests). In injured conditions, the syndesmotic ligamentous complex was sectioned using an anterolateral longitudinal approach. Perfect fluoroscopic Mortise images were acquired for all conditions. Two independent and blinded Orthopaedic Foot and Ankle Surgeons measured TFCS 1 cm proximal to the ankle joint line. Intra and interobserver reliabilities were assessed by Intraclass Correlation Coefficient. Syndesmotic TFCS values for all conditions were compared by paired Wilcoxon. Diagnostic performance of the Cotton and Tap tests was assessed using a relative increase of TFCS > 2 mm when comparing intact stressed and injured stressed conditions. P-values <0.05 were considered significant. RESULTS: The intraclass correlation coefficient for intraobserver and interobserver reliability was respectively 0.96 and 0.79. TFCS measurements were similar in intact non-stressed, intact stressed (both Cotton and Tap tests) and injured non-stressed conditions, with mean values and 95% Confidence Intervals of: intact non-stressed, 3.5 mm; intact stressed, 3.6 mm (Cotton test) and 4.0 mm (Tap test); injured non-stressed, 3.8 mm. The Cotton test and Tap test had, respectively, 73.3% and 70% sensitivity, 100% and 90% specificity, 86.7% and 80% diagnostic accuracy. CONCLUSIONS: Our cadaveric study compared the Cotton and Tap tests for detection of coronal plane syndesmotic instability. Both tests demonstrated similar increases in the TFCS measurements in stressed injured conditions when compared to intact non-stressed and stressed conditions, as well as injured non-stressed conditions.

Aspergillus tracheobronchitis: The diagnostic value of endoscopic imaging / Traqueobronquitis aspergilar. El valor diagnóstico de la imagen endoscópica

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Prótesis en T de Montgomery para el tratamiento de la estenosis traqueal: experiencia de una Unidad de Endoscopia Respiratoria y revisión de la literatura / Montgomery T-Tube in the Treatment of Tracheal Stenosis: Experience of a Respiratory Endoscopy Unit and Review of the Literature

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