[Exogenous lipoid pneumonia and anorexia nervosa: a case report].

Exogenous lipoid pneumonia is a rare entity with non-specific clinical presentation. Early diagnosis is key to prevent pulmonary fibrosis in cases of chronic exogenous lipoid pneumonia . Here, we present the diagnostic process in a 51-year-old female with chronic cough and yellow sputum, no fever nor signs of infection. The computerized axial tomography scan showed alveolar infiltrates in both lungs. We performed a bronchoalveolar lavage and collected a yellowish material, but no clear result were obtained from its analysis. Cryobiopsy of lung tissue was key for the diagnosis of exogenous lipoid pneumonia . This may be related to the chronic anorexia nervosa that the patient suffers, associated with purgative habits. After identifying the cause of the symptoms, the patient is recovering, changing her habits, and has no cough nor sputum.

Neumonía lipoidea exógena y anorexia nerviosa: caso clínico / Exogenous lipoid pneumonia and anorexia nervosa: a case report

La neumonía lipoidea exógena es una entidad infrecuente y con una presentación clínica inespecífica. Su diagnóstico temprano es clave para prevenir la fibrosis pulmonar que produce su cronificación. Presentamos el proceso diagnóstico de una paciente de 51 años, con clínica de tos con expectoración amarillenta, sin síntomas de infección ni fiebre, de larga evolución. En latomografía axial computarizada se observaron infiltrados pulmonares bilaterales de tipo alveolar. Se realizó un lavado broncoalveolar en el que se obtuvo un material amarillento de origen desconocido, que no permitió alcanzar ninguna conclusión clara. La criobiopsia pulmonar fue la prueba clave que llevó al diagnóstico de neumonía lipoidea exógena, en probable relación con la anorexia con hábito purgativo que la paciente sufría de forma crónica. Hallado el origen del problema, la paciente se encuentra actualmente en proceso de recuperación y cambio de hábitos, sin tos ni expectoración.(AU)

Exogenous lipoid pneumonia is a rare entity with non-specific clinical presentation. Early diagnosis is key to prevent pulmonary fibrosis in cases of chronic exogenous lipoid pneumonia . Here, we present the diagnostic process in a 51-year-old female with chronic cough and yellow sputum, no fever nor signs of infection. The computerized axial tomography scan showed alveolar infiltrates in both lungs. We per-formed a bronchoalveolar lavage and collected a yellowish material, but no clear result were obtained from its analysis. Cryobiopsy of lung tissue was key for the diagnosis ofexogenous lipoid pneumonia . This may be related to the chronic anorexia nervosa that the patient suffers, associated with purgative habits. After identifying the cause of the symptoms, the patient is recovering, changing her habits, and has no cough nor sputum.(AU)

Proton pump inhibitor-responsive oesophageal eosinophilia correlates with downregulation of eotaxin-3 and Th2 cytokines overexpression.

BACKGROUND: The molecular basis and effects of proton pump inhibitor (PPI) therapy on PPI-responsive oesophageal eosinophilia (PPI-REE) and eosinophilic oesophagitis (EoE) remain unknown. AIM: To compare symptom-histological and cytokine gene expression in PPI-REE and EoE patients, at baseline and after specific treatment. METHODS: In consecutive adult patients with an EoE phenotype (dysphagia/food impaction, typical endoscopic findings and > 15 eos/HPF), gene expression of eotaxin-3, IL-13, and IL-5 were determined in distal and proximal oesophagus, at baseline and after omeprazole 40 mg b.d. for 8 weeks. PPI-REE was defined by clinicohistological response. PPI nonresponders (EoE) were offered treatment with topical steroids. RESULTS: Fifty three patients were re-evaluated on PPI therapy. 23 patients (43%) had PPI-REE and 30 patients (57%) had EoE. At baseline, eotaxin-3/IL-13/IL-5 gene expression was indistinguishable between EoE and PPI-REE, excepting increased IL-5 expression in proximal oesophagus (12.54 vs. 57, P = 0.029). PPI therapy significantly decreased eotaxin-3/IL-13 in PPI-REE, at both oesophageal sites (P ≤ 0.008), and IL-5 in distal (P = 0.016), but not in proximal oesophagus. Patients with steroid-responsive EoE also showed a significant decrease in eotaxin-3/IL-5 expression at both oesophageal sites. In EoE patients, initial PPI trial significantly decreased distal oesophageal eosinophilia (63.78 to 41.79 eos/HPF, P = 0.025) and led to symptom remission in 16%, but did not influence Th2 markers. CONCLUSIONS: Baseline cytokine gene expression in PPI-REE was nearly indistinguishable from EoE. PPI therapy significantly downregulated oesophageal eotaxin-3/Th2-cytokine gene expression in PPI-REE, similarly to that seen in steroid-responsive EoE. A subset of EoE patients showed clinicohistological improvement on PPI therapy.

Resultados de la biopsia selectiva de ganglio centinela combinada con la localización radioguiada de tumores invasivos no palpables de mama. Técnica de SNOLL / No disponible

Objetivo: La biopsia selectiva del ganglio centinela mediante inyección intralesional de un radiocoloide, combinado con la localización radioguiada de tumores no palpables de mama en el mismo acto quirúrgico se denomina técnica de SNOLL. El objetivo de nuestro estudio es mostrar la factibilidad y sencillez para realizar la técnica en un hospital provincial de 2º nivel dotado con Servicio de Medicina Nuclear, comparando nuestros resultados con las publicaciones de referencia. Métodos: Entre enero 2007 y marzo 2008 se incluyeron 20 pacientes consecutivas diagnosticadas de carcinoma no palpable de mama. Se realizó inyección intratumoral de un nanocoloide- Tc99 de albúmina (0,2 ml, 37MBq) guiada por ecografía o estereotaxia seguida de linfogammagrafía e instilación subareolar de colorante azul patente (2 ml). Tras identificación del ganglio centinela se detectó y extirpó la lesión mamaria mediante uso de sonda detectora de rayos gamma. Se verificaron radiológicamente todos los especímenes extirpados. Resultados: Se obtuvo al menos un ganglio centinela mediante marcaje radiactivo en 19 pacientes (95%). En un paciente el ganglio centinela se detectó únicamente mediante colorante. La localización radioguiada y extirpación de la lesión primaria se consiguió en todos los casos. En dos casos (10%), los márgenes se encontraban afectos (< 2 mm) por enfermedad in situ extensa asociada. 4 pacientes presentaron ganglio centinela positivo. Conclusiones: Las conclusiones de nuestra serie se encuadran en las publicadas hasta la fecha, otorgando a la técnica de SNOLL mejores resultados que la localización con guía metálica y confirmando la factibilidad de la misma en cualquier centro con recurso a Medicina Nuclear(AU)

Introduction: The SNOLL technique results of the combination of radioguided occult lesion localization (ROLL) and sentinel node mapping with a single radiotracer injection in the management of non-palpable breast cancer. The aim of this study was to evaluate the feasibility of this technique in a second-level hospital with a nuclear medicine department and compare our results with the reference publications. Methods: From January 2007 to March 2008, lymphoscintigraphy was performed in 20 consecutive patients with non-palpable breast cancer after the intratumoral injection of albumin nanocolloid-Tc99 (0.2 ml, 37 MBq) guided by stereotaxis or ultrasound. Under general anaesthesia, a subareolar injection of blue dye was performed. After sentinel lymph node biopsy, the gamma-ray detection probe was used for radioguided removal of the breast tumor. All the breast lesions were identified on X-ray control of the surgical specimen. Results: Al least one sentinel node was removed in 19 patients (95%). In one patient, the sentinel node was only detected by blue dye. Radioguided surgery of the breast tumor was successfully achieved in all patients. In two cases (10%), in situ carcinoma was present close to the margins of the surgical specimen (< 2 mm) and further re-excision was therefore performed. Axillary dissection was accomplished in 4 patients with sentinel node metastases. Conclusions: The findings of our study are consistent with those published to date, showing the advantage of SNOLL technique over the wire-guided localization of non-palpable breast cancer and confirming its feasibility in any center with a reference nuclear medicine department(AU)