ABSTRACT
Introducción La aspiración transbronquial con aguja fina guiada por ultrasonografía endobronquial (EBUS-TBNA) tiene el inconveniente de ofrecer tamaños de muestra pequeños para un diagnóstico preciso. La criobiopsia mediastínica transbronquial (EBUS-TBCB), que permite obtener muestras de mayor tamaño, podría mejorar el rendimiento diagnóstico. Métodos Estudiamos prospectivamente a 50 pacientes con adenopatías mediastínicas a los que se les realizó EBUS-TBNA y EBUS-TBCB en un solo procedimiento. Resultados EBUS-TBCB mejoró el rendimiento diagnóstico en comparación con EBUS-TBNA desde un diagnóstico definitivo de 32 (64%) pacientes a 45 (90%), diferencia 26% (intervalo de confianza [IC] 95%: 14-40%, p < 0,05). EBUS-TBCB fue más sensible tanto para el diagnóstico de enfermedades malignas como inflamatorias. EBUS-TBCB produjo seis complicaciones leves resueltas durante el mismo procedimiento. Conclusiones EBUS-TBCB es una técnica rentable y segura superior a EBUS-TBNA. Futuros estudios pueden confirmar nuestros hallazgos (AU)
Introduction Endobronchial ultrasonography-guided transbronchial fine-needle aspiration (EBUS-TBNA) has the drawback of providing small sample sizes for accurate diagnosis. Transbronchial mediastinal cryobiopsy (EBUS-TBCB), which allows for larger samples, could improve diagnostic yield. Methods We prospectively studied 50 patients with mediastinal lymphadenopathy who underwent EBUS-TBNA and EBUS-TBCB in a single procedure. Results EBUS-TBCB improved the diagnostic performance compared with EBUS-TBNA from a definite diagnosis of 32 (64%) patients to 45 (90%) patients [difference 26% (95% confidence interval: 14%40%, p < 0.05). EBUS-TBCB was more sensitive to both malignant and inflammatory diseases. EBUS-TBCB produced 6 mild complications resolved during the same procedure. Conclusions EBUS-TBCB is a cost-effective and safe technique superior to EBUS-TBNA. Future studies could confirm our findings (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Image-Guided Biopsy/methods , Biopsy, Fine-Needle/methods , Lymphadenopathy/diagnosis , Lymphadenopathy/pathology , Mediastinal Diseases/diagnosis , Mediastinal Diseases/pathology , Prospective Studies , EndosonographyABSTRACT
Objetivo: Describir y analizar la mortalidad de los pacientes que ingresan en nuestra UCRI, tanto durante el ingreso en dicha UCRI, como a lo largo de toda la estancia hospitalaria, y a los 3 y 6 meses del alta hospitalaria. Metodología: Estudio prospectivo de 380 pacientes, no Covid, ingresados en nuestra UCRI, destinada al tratamiento del fallo respiratorio agudo con VMNI, a lo largo de año y medio de actividad. Se recogieron datos demográficos, índice de Charlson modificado (m), tipo de fallo respiratorio, servicio de pertenencia, días de estancia en UCRI y la mortalidad tanto en UCRI como hospitalaria, y a los 3 y 6 meses del alta del hospital. Resultados: El 55% eran varones con una edad media de 71 años y un índice de Charlson (m) de 6,4. La mortalidad en UCRI fue del 16.4% y la intrahospitalaria del 27%, relacionándose ambas con la edad, el índice de Chalson (m), el servicio de pertenencia y el fallo respiratorio hipoxémico. Tras el alta hospitalaria, la supervivencia a los tres meses fue del 83,6% y a los 6 meses del 75,5% relacionándose ambas con la edad y el índice de Charlson (m). Conclusiones: Las UCRIs son útiles en el tratamiento del fallo respiratorio agudo en pacientes con alta carga de comorbilidad, permitiendo a tales pacientes tener una elevada supervivencia a medio plazo tras el alta hospitalaria. (AU)
Objective: describe and analyze the mortality of patients admitted to our IRCU, both during admission to said IRCU, and throughout the entire hospital stay, and 3 and 6 months after hospital discharge. Methodology: prospective study of 380 non-Covid patients admitted to our IRCU, intended for the treatment of acute respiratory failure with NIV, over a year and a half of activity. Demographic data, modified Charlson index (m), type of respiratory failure, service affiliation, days of stay in the IRCU, and mortality both in the IRCU and in hospital, and at 3 and 6 months after hospital discharge were collected. Results: 55% were men with a mean age of 71 years and a Charlson index (m) of 6.4. Mortality in the IRCU was 16.4% and in-hospital mortality was 27%, both being related to age, the Chalson index (m), the service to which they belong, and hypoxemic respiratory failure. After hospital discharge, survival at three months was 83.6% and at 6 months was 75.5%, both related to age and the Charlson index (m). Conclusions: IRCU are useful in the treatment of acute respiratory failure in patients with a high burden of comorbidity, allowing such patients to have a high medium-term survival after hospital discharge. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Respiratory Care Units , Noninvasive Ventilation , Mortality , Prospective Studies , Respiratory Insufficiency , Respiration, ArtificialABSTRACT
INTRODUCTION: Endobronchial ultrasonography-guided transbronchial fine-needle aspiration (EBUS-TBNA) has the drawback of providing small sample sizes for accurate diagnosis. Transbronchial mediastinal cryobiopsy (EBUS-TBCB), which allows for larger samples, could improve diagnostic yield. METHODS: We prospectively studied 50 patients with mediastinal lymphadenopathy who underwent EBUS-TBNA and EBUS-TBCB in a single procedure. RESULTS: EBUS-TBCB improved the diagnostic performance compared with EBUS-TBNA from a definite diagnosis of 32 (64%) patients to 45 (90%) patients [difference 26% (95% confidence interval: 14-40%, p<0.05). EBUS-TBCB was more sensitive to both malignant and inflammatory diseases. EBUS-TBCB produced 6 mild complications resolved during the same procedure. CONCLUSIONS: EBUS-TBCB is a cost-effective and safe technique superior to EBUS-TBNA. Future studies could confirm our findings.
Subject(s)
Lung Neoplasms , Lymphadenopathy , Mediastinal Diseases , Humans , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Mediastinum/diagnostic imaging , Mediastinum/pathology , Mediastinal Diseases/diagnosis , Mediastinal Diseases/pathology , Lymphadenopathy/diagnosis , Lymphadenopathy/pathology , Endosonography , Retrospective Studies , Lung Neoplasms/diagnosis , Lung Neoplasms/pathologyABSTRACT
Las metástasis intramedulares son generalmente raras y se asocian a enfermedad neoplásica avanzada. Dentro de ellas, las más frecuentes son el carcinoma no microcítico de pulmón, el cáncer de mama y el melanoma. Además es poco habitual que se trate de la primera manifestación de la enfermedad. Debido a la sintomatología tan aguda que presentan estas lesiones, es importante realizar el diagnóstico diferencial con la compresión medular. Ambas entidades producen una sintomatología muy similar, siendo la debilidad la manifestación más frecuente. A continuación, presentamos un caso clínico de metástasis intramedular como primera manifestación de una neoplasia pulmonar (AU)
Intramedullary metastases are generally rare and are associated with advanced neoplastic disease. Among them, the most frequent are non-small cell lung carcinoma, breast cancer and melanoma. It is also unusual that it is the first manifestation of the disease. Due to the acute symptoms that these lesions present, it is important to perform a differential diagnosis with spinal cord compression. Both entities produce very similar symptoms, with weakness being the most frequent manifestation. Next, we present a clinical case of intramedullary metastasis as the first manifestation of a lung neoplasm (AU)
Subject(s)
Humans , Female , Aged , Spinal Cord Neoplasms/diagnosis , Spinal Cord Neoplasms/secondary , Carcinoma, Small Cell/diagnosis , Carcinoma, Small Cell/pathology , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Diagnosis, DifferentialABSTRACT
La dermatomiositis amiopática, o sine miositis, se ha asociado a una muy alta prevalencia de anticuerpos anti-MDA5, unos anticuerpos descritos en 2005. Esta entidad a su vez se encuentra fuertemente asociada al desarrollo de enfermedad pulmonar intersticial rápidamente progresiva de mal pronóstico. Presentamos las imágenes radiológicas pulmonares más frecuentemente descritas de esta enfermedad en un caso en el que se descartó la sospecha inicial de neumonia vírica por SARS-2
Amyopathic dermatomyositis, or syne myositis, has been associated with a very high prevalence of anti-MDA5 antibodies, antibodies described in 2005. This entity, in turn, is strongly associated with the development of rapidly progressive interstitial lung disease with a poor prognosis. We present the most frequently described pulmonary radiological images of this disease in a case in which the initial suspicion of SARS-2 viral pneumonia was ruled out
