Diagnostic approach to subcutaneous nodules in patients with neuroendocrine tumours treated with depot somatostatin analogs: a cross-sectional study.

BACKGROUND: The presence of cutaneous nodules in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NETs) receiving depot somatostatin analogs (SSAs) is a diagnostic challenge as differential diagnosis between injection site reactions and metastases is essential. OBJECTIVE: To characterize the clinical, radiological, cytological and histopathological features of subcutaneous nodules in patients with GEP-NETs treated with SSAs. MATERIALS AND METHODS: Retrospective, cross-sectional study of patients with GEP-NETs treated with SSAs in whom subcutaneous nodules were detected on routine abdominal computed tomography (CT) scans. High resolution and colour Doppler ultrasonography was performed. Those patients with inconclusive radiological studies went through fine-needle aspiration cytology (FNAC) and/or biopsy. RESULTS: Twelve patients (five males, seven females) were included (six midgut carcinoid NETs, six pancreatic NETs). Three patients received intramuscular depot octreotide, seven subcutaneous lanreotide, and two both treatments. CT scan findings were nonspecific. Sonography revealed a hyperechoic pattern in recent injections, and a hypoechoic pattern with a characteristic hyperechoic peripheral rim in long-term injections (more than 3 months after injection). On colour Doppler sonography, nodules showed no signs of intralesional vascularity. Fine-needle aspiration cytology (FNAC) was performed in five patients, revealing a characteristic acellular proteinaceous material. Biopsy in four patients showed different reactional infiltrates around the acellular material. CONCLUSIONS: High resolution and colour Doppler ultrasonography may be very useful for the differential diagnosis of subcutaneous nodules in patients with GEP-NETs treated with SSAs. FNAC and a biopsy are useful tests for confirmation of the diagnosis in patients with inconclusive findings. We propose a management algorithm.

Short-term effects of three slow expiratory airway clearance techniques in patients with bronchiectasis: a randomised crossover trial.

OBJECTIVE: To compare the efficacy of three slow expiratory airway clearance techniques (ACTs). DESIGN: Randomised crossover trial. SETTING: Tertiary hospital. PARTICIPANTS: Thirty-one outpatients with bronchiectasis and chronic sputum expectoration. INTERVENTIONS: Autogenic drainage (AD), slow expiration with glottis opened in lateral posture (ELTGOL), and temporary positive expiratory pressure (TPEP). MAIN OUTCOMES: Sputum expectoration during each session (primary endpoint) and in the 24-hour period after each session. Leicester Cough Questionnaire (LCQ) score and spirometry results were recorded at the beginning and after each week of treatment. Data were summarised as median difference [95% confidence interval (CI)]. RESULTS: Median (interquartile range) daily expectoration at baseline was 21.1 (15.3 to 35.6)g. During physiotherapy sessions, AD and ELTGOL expectorated more sputum than TPEP [AD vs TPEP 3.1g (95% CI 1.5 to 4.8); ELTGOL vs TPEP 3.6g (95% CI 2.8 to 7.1)], while overall expectoration in the 24-hour period after each session was similar for all techniques (P=0.8). Sputum clearance at 24hours post-intervention was lower than baseline assessment for all techniques [AD vs baseline -10.0g (95% CI -15.0 to -6.8); ELTGOL vs baseline -9.2g (95% CI -14.2 to -7.9); TPEP vs baseline -6.0g (95% CI -12.0 to -6.1)]. The LCQ score increased with all techniques (AD 0.5, 95% CI 0.1 to 0.5; ELTGOL 0.9, 95% CI 0.5 to 2.1; TPEP 0.4, 95% CI 0.1 to 1.2), being similar for all ACTs (P=0.6). No changes in lung function were observed. CONCLUSIONS: Slow expiratory ACTs enhance mucus clearance during treatment sessions, and reduce expectoration for the rest of the day in patients with bronchiectasis. CLINICAL TRIAL REGISTRATION NUMBER: NCT01854788.

Acerca de un ensayo clínico aleatorizado de técnicas de aclaramiento mucociliar en niños con bronquiectasias sin fibrosis quística / About at randomized clinical trial on mucociliary clearance techniques in children with non-cystic fibrosis bronchiectasis

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Aggressive transformation of a quiescent primary bone lymphoma simulating Paget's disease.

Primary multifocal osseous lymphoma is a rare and poorly recognized entity. Here, we present an instructive case of a young man who, six years after a local contusion of the left ankle, developed a painful polylobulated large soft tissue mass. This mass turned out to have arisen from the transformation of a centro follicular non-Hodgkin's lymphoma into a diffuse large B-cell lymphoma involving the calcaneus, talus, cuboid and navicular bones. The diagnostic difficulties as well as the implications of this aggressive transformation are highlighted here.

[Frequency with which semiquantitative expressions are used in Mexican medical literature]. / Frecuencia de utilización de expresiones semicuantitativas en la literatura médica mexicana.

OBJECTIVE: To describe the frequency with which semiquantitative expressions are used in Mexican medical journals. STUDY DESIGN: [corrected] Comparative survey. Frame of reference. Four Mexican medical journals considered representative of the medical literature in Mexico were studied (Revista de Investigación Clínica, Archivos de Investigación Médica, Revista Médica del IMSS and the Boletín Médico del Hospital Infantil de México). STUDY UNITS: Ten articles randomly selected and considered as original research material published in 1987 from each journal were used. MEASUREMENTS: Eight terms were identified in each text of the selected articles: almost always, very probably, probable, probably, frequent, possible, improbable and almost never. MAIN RESULTS: One hundred and fifty three expressions were identified, for a global average of 3.8 expressions per article. No statistical significant differences were found between the journals in relation to the frequency with which the expressions were used (P = 0.76). When comparing the chapters of each article, significant statistical differences were found which disappeared when the comparison was rated. In 89% of the cases, the expressions did not have a referral which therefore did not allow for their quantification. Finally, those articles defined as "clinical" had a greater frequency of semiquantitative expressions than those considered as "biomedical" (4.2 vs 1.3 on the average, respectively). CONCLUSIONS: On the average, semiquantitative expressions are used four times per article, 75% of the times without a referral which would allow to quantify them, which could condition for a wide variety of interpretations on behalf of the readers.