Metástasis tardía de un osteosarcoma / Late metastasis of osteosarcoma

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[Multiple nodular pulmonary AA amyloidosis. A case report]. / Amiloidosis nodular pulmonar múltiple de tipo AA. Presentación de un caso.

Amyloidosis is a uncommon disease which affect respiratory system with well defined patterns. We describe a case of multiple nodular pulmonary amyloidosis in a 81 year old man mimicking other entities: metastatic disease, tuberculosis and other granulomatose diseases. In our patient amyloide substance was type AA, being type AL the most frequent one in nodular pulmonary amyloidosis.

Amiloidosis nodular pulmonar múltiple de tipo AA. Presentación de un caso / Multiple nodular pulmonary AA amyloidosis: a case report

La amiloidosis es una enfermedad poco frecuente, que puede afectar el aparato respiratorio con patrones bien delimitados. Presentamos un caso de amiloidosis nodular pulmonar múltiple en un paciente varón de 81 años, que planteó el diagnóstico diferencial con otras entidades: enfermedad metastásica, tuberculosis, y otras enfermedades granulomatosas. En nuestro paciente la sustancia amiloide era de tipo AA, mientras que en la mayoría de los casos de amiloidosis pulmonar nodular el amiloide es de tipo AL (AU)

[Incorrect use of pressurized aerosols by health personnel]. / Uso incorrecto de los aerosoles presurizados por parte del personal sanitario.

Instruction and training of patients in the use of pressurized aerosols require a well-trained medical personal. This study was designed to analyze the quality of information about pressurize aerosols in medical personal responsible of patient training. Only 20% of the observed trainers made a correct instruction, whereas 63% made more than two mistakes. Primary care nurses had a 100% index of correct training. As indicated in other studies, our result reveals a high index of incorrect training in the use of pressurizes aerosols by medical personnel, and this finding is more frequent ill hospital staff than in primary care personnel.

Diagnostic value of simultaneous determination of pleural adenosine deaminase and pleural lysozyme/serum lysozyme ratio in pleural effusions.

We have determined simultaneously the ADAp and Lp/Ls ratio in 138 pleural effusions: 61 tuberculous; 42 malignant; 14 transudates; five parapneumonic uncomplicated; six empyematous; and ten cases belonging to a miscellaneous group which included two disseminated lupus erythematosus; two posttraumatic; one pancreatitis; one pleuropericarditis by Mycoplasma; one viral pleuropericarditis; and three pulmonary embolisms. This has allowed us to clear the overlapping for the ADAp activity among tuberculous patients (two cases of lupus and three cases of malignant effusions) in our series. The overlap in the Lp/Ls ratio among tuberculous patients, two malignant, and two parapneumonic uncomplicated cases was also cleared. Fixing the ADAp values at 33 U and the Lp/Ls ratio at 1.2, the tuberculous pleural effusion cases were differentiated from the nontuberculous with a sensibility, positive predictive value, negative predictive value, and safety diagnosis of 100 percent. It has been proven that there is a good correlation between ADAp and Lp/Ls ratio (r = 0.717) and the ADAp and Lp (r = 0.660).

Meaning and diagnostic value of determining the lysozyme level of pleural fluid.

We determined the levels of lysozyme in pleural fluid and serum in 141 patients with the following different causes for their pleural effusions: tuberculosis; neoplasias; transudates; parapneumonic, not complicated; empyemas; and miscellaneous. The lysozyme level of the pleural fluid and the ratio of that level over the serum level of lysozyme (PL/SL ratio) was meaningfully increased in patients with empyema (p less than 0.01). The groups with tuberculous and neoplastic effusions showed significant differences in the PL/SL ratio (p less than 0.01). The existence of a raised PL/SL ratio suggested important local synthesis of lysozyme, and it came up in empyemas and tuberculosis, unlike the other groups. Excluding the patients with empyemas, a PL/SL ratio of 1.2 showed a sensitivity of 100 percent, specificity of 94.9 percent, positive predictive value of 94.7 percent, negative predictive value of 100 percent, and accuracy of 97.3 percent for the diagnosis of tuberculous pleural effusion. All of this suggests that the determination of the lysozyme level can be an easy method of great usefulness in the initial diagnosis of pleural effusions.