Guía de Práctica Clínica para el diagnóstico temprano y la referencia oportuna del cáncer de pulmón.

OBJETIVO: Proporcionar recomendaciones para la detección temprana de pacientes con alto riesgo de desarrollar cáncer de pulmón (CP) en el primer nivel de atención y su referencia oportuna. Material y métodos. Se realizó una búsqueda detallada de la evidencia científica disponible para responder las preguntas de investigación clínica y se utilizó el Panel Delphi modificado para lograr un consenso entre expertos. RESULTADOS: Se generaron 14 recomendaciones siguiendo los estándares de una GPC. Conclusión. El CP representa un problema de salud pública en México; por ello, esta guía establece recomendaciones que apoyan la toma de decisiones sobre la detección precoz y la referencia de pacientes con sospecha de CP en el primer nivel de atención.

[Third National Ovarian Consensus. 2011. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México "GICOM"]. / Tercer Consenso Nacional de Cáncer de Ovario 2011. Grupo de Investigación en Cáncer de Ovario y Tumores Ginecológicos de México "GICOM".

INTRODUCTION: Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide. Most of cases it is of epithelial origin. At the present time there is not a standardized screening method, which makes difficult the early diagnosis. The 5-year survival is 90% for early stages, however most cases present at advanced stages, which have a 5-year survival of only 5-20%. GICOM collaborative group, under the auspice of different institutions, have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia. MATERIAL AND METHODS: The following recommendations were made by independent professionals in the field of Gynecologic Oncology, questions and statements were based on a comprehensive and systematic review of literature. It took place in the context of a meeting of two days in which a debate was held. These statements are the conclusions reached by agreement of the participant members. RESULTS: No screening method is recommended at the time for the detection of early lesions of ovarian cancer in general population. Staging is surgical, according to FIGO. In regards to the pre-surgery evaluation of the patient, it is recommended to perform chest radiography and CT scan of abdomen and pelvis with IV contrast. According to the histopathology of the tumor, in order to consider it as borderline, the minimum percentage of proliferative component must be 10% of tumor's surface. The recommended standardized treatment includes primary surgery for diagnosis, staging and cytoreduction, followed by adjuvant chemotherapy Surgery must be performed by an Oncologist Gynecologist or an Oncologist Surgeon because inadequate surgery performed by another specialist has been reported in 75% of cases. In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10-30% of all cases, and systematic limphadenectomy, necessary to be able to obtain an adequate surgical staging. Fertility-sparing surgery will be performed in certain cases, the procedure should include a detailed inspection of the contralateral ovary and also negative for malignancy omentum and ovary biopsy. Until now, laparoscopy for diagnostic-staging surgery is not well known as a recommended method. The recommended chemotherapy is based on platin and taxanes for 6 cycles, except in Stage IA, IB and grade 1, which have a good prognosis. In advanced stages, primary cytoreduction is recommended as initial treatment. Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer. Radiotherapy can be used to palliate symptoms. Follow up of the patients every 2-4 months for 2 years, every 3-6 months for 3 years and anually after the 5th year is recommended. Evaluation of quality of life of the patient must be done periodically. CONCLUSIONS: In the present, there is not a standardized screening method. Diagnosis in early stages means a better survival. Standardized treatment includes primary surgery with the objective to perform an optimal cytoreduction followed by chemotherapy Treatment must be individualized according to each patient. Radiotherapy can be indicated to palliate symptoms.

Thoracic radiology of infections emerging after natural disasters.

When natural disasters demolish shelter, destroy sources of clean drinking water, and disrupt the availability of medical care, vast numbers of people are placed at increased risk of disease. The infectious diseases that propagate under these conditions are usually common ones. Occasionally, a natural disaster alters the local environment in ways that markedly increase the prevalence of a disease that is endemic to a geographic region, occurring only as isolated cases under normal conditions. Many of these infections may affect the thorax. In this article, we discuss the radiologic findings of 4 infectious diseases, coccidioidomycosis, leptospirosis, melioidosis, and Chagas disease, which may flourish after natural disasters strike areas where they are endemic.

Bronquio traqueal derecho y persistencia de conducto arterioso diagnosticados por tomografía axial computarizada en un enfermo con síntomas sugestivos de asma / Computerized axial tomography in the diagnosis of a right tracheal bronchus and patent ductus arteriosus in a patient with an asthma-like syndrome

Un varón de 12 años, con sintomatología respiratoria desde los tres meses de vida fue manejado como asmático desde los cinco años, con esteroides y agentes beta dos inhalados, además de inmunoterapia específica durante 18 meses, sin mejoría. La tomografía computada de tórax reveló disminución de calibre de la tráquea con emergencia, por debajo de la misma, de un bronquio traqueal (BT) en la pared lateral derecha de la tráquea, independizando el lóbulo superior derecho del árbol bronquial. Se observó también la persistencia del conducto arterioso (PCA) y una variante anatómica hepática. Estudios de reconstrucción multiplanar, broncoscopía virtual, cateterismo hemodinámico y broncoscopía confirmaron los diagnósticos. No se encontró Tetralogía de Fallot como defecto cardiaco congénito más comúnmente asociado a la variante del BT para lóbulo superior derecho. Posteriormente al cierre programado de PCA, egresó por mejoría clínica.

A 12 year old male had symptoms suggesting asthma since the third month of age; he was managed with inhaled steroids and bronchodilatadors and specific immunotherapy for 18 months, without improvement. Conventional computed tomography (CT) showed tracheai narrowing and a bronchi emerging from the right lateral wall of the trachea, separating the right upper lobe from the tracheobronchial tree. The CT also revealed a patent ductus arteriosus and an anatomic variant of the liver. Helical CT scans, virtual bronchoscopy, cardiac catherization and bronchoscopy confirmed the diagnoses. In this case, Fallot's tetralogy, the commonest cardiac anomaly associated with tracheai bronchi to the right upper lobe, was not found. Symptoms improved after surgical division of the patent ductus arteriosus.

Quiste broncogéiico: reporte de dos casos y revisión de la literatura

El quiste broncogénico es una malformación de la porción ventral del intestino primitivo que ocasiona alteración en el desarrollo del árbol traqueo bronquial. Reportamos dos casos de quistes broncogénicos en niños, ambos con síntomas respiratorios crónicos, uno de localización mediastinal a nivel paratraqueal derecho y, el otro, intraperenquimatoso en lóbulo superior derecho. La radiográfia y tomografía de tórax permitieron evaluar el tipo de lesión, localización y tamaño, así como la compresión de la vía áerea. Ambos pacientes fueron intervenidos quirúrgicamente no se presentaron complicaciones y los síntomas respiratorios desaparecieron. El estudio histopatológico confirmó el diagnóstico.

Bronchogenic cyst arises from abnormal budding of the diverticulum of the foregut that leads to abnormality of the tracheobronquial tree. We report two cases of these cysts in children with respiratory chronic symptom. One was localized in paratraqueal mediastinum and other, intrapulmonary in lower upper right side. The chest radiography and computed tomography allowed evaluation as to the type, site and size of lesion as well as airway compression. Both patients underwent surgery; there were no complications and the respiratory symptoms disappeared. Histologic features confirm the diagnosis.

Utilidad diagnóstica del ultrasonido en la patología torácica / Diagnostic usefulness of ultrasound in thorax pathology

Se demuestra la utilidad diagnóstica del ultrasonido en la patología del tórax, ya que es un método accesible y poco costoso, se puede transportar al lado de la cama del paciente en los casos en que éste se encuentre muy grave para ser trasladado.Es un método que identifica perfectamente la diferencia entre sólido y líquido y puede ser de gran utilidad en las lesiones de pared, tejidos blandos y pleura. Asimismo, muestra utilidad en algunos procedimientos intervencionistas para diagnóstico y tratamiento.

Imágenes tomográficas tridimensionales y sus aplicaciones en la patología de tórax / 3-D tomographic images and their application to thorax pathology

Se realiza una reseña breve de la utilidad que tienen las reconstrucciones en tercera dimensión de la tomografía computada helicoidal en la anatomía y patología del tórax así como su utilidad en algunos procedimientos como la broncoscopia virtual que ayuda en la planeación de la broncoscopia real, y en la angiotomografía, entre otras