Empiema pleural secundario a cálculo biliar. Una complicación infrecuente / Pleural empyema secondary to gallstone. An infrequent complication

Mujer de 84 años que acude a Urgencias por presentar en la semana previa dolor en costado derecho de características pleuríticas asociado a fiebre tras haberse sometido a colecistectomía dos semanas antes. En la radiografía de tórax presenta derrame pleural, confirmándose en la tomografía computarizada de tórax con contraste y objetivándose derrame pleural loculado, así como una imagen compatible con litiasis biliar. Posteriormente se realiza toracocentesis diagnóstica en la que se obtienen resultados compatible con empiema. Se coloca drenaje pleural con instilación de uroquinasa y antibioterapia empírica, presentando buena evolución. Se establece el diagnóstico de empiema pleural secundario a cálculo biliar intraperitoneal (AU)

An 84-year-old woman come to the emergency department for presenting in the previous week pleuritic right flank pain associated with fever after having undergone cholecystectomy 2 weeks earlier. She presents pleural effusion in the chest X-ray, which was confirmed in the chest computered tomography with contrast, showing loculated pleural effusion, as well as an image compatible with biliary lithiasis. Subsequently, diagnostic thoracentesis is performed and the results were compatible with empyema. Pleural drainage is placed with urokinase instillation and empirical antibiotherapy, presenting good evolution. The diagnosis of pleural empyema secondary to intraperitoneal gallstone is established (AU)

Tos e infiltrados pulmonares. Un final inesperado / Pulmonary infiltrates and cough. An unexpected end

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Macitentan in daily clinical practice: A single centre, 1-year experience.

The effectiveness and safety of macitentan, a dual endothelin-receptor antagonist (ERA) approved for the treatment of pulmonary arterial hypertension (PAH), were shown in an extensive clinical trial oriented towards morbidity and mortality events. Our aim was to describe a single centre's experience of the utilization of macitentan in patients with PAH in clinical practice settings. Thirteen patients with different aetiologies and previous PAH treatments were studied. After 12 months of macitentan treatment, 11 patients improved their functional class (FC), all patients improved their 6-minute walk distance (6MWD) test, and 10 patients lowered their NT-proBNP plasma levels. Additionally, cardiac imaging parameters were also improved. No cases resulted in hospitalization, septostomy, transplant or death.

Varón de 49 años con fiebre, malestar general y nódulos pulmonares / 49 Years-old man with fever, malaise and pulmonary nodules

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Manejo de comunicaciones respiratorio-digestivas inusuales de origen neoplásico / No disponible

Las fístulas respiratorio-digestivas secundarias a procesos malignos broncogénicos son complicaciones infrecuentes que generan gran morbimortalidad, ensombreciendo el pronóstico de la neoplasia, más aún cuanto más se demora su diagnóstico. A continuación, describimos 2 casos con inusuales complicaciones de este tipo, el proceso de identificación y su manejo terapéutico. A pesar de la escasa evidencia disponible, se recomienda un abordaje multidisciplinar con un enfoque esencialmente paliativo y mediante técnicas endoscópicas, sobre todo, resolver de forma segura y duradera la disfagia, origen de fatales infecciones respiratorias, que se traducirá en una aceptable calidad de vida y una mayor supervivencia para estos pacientes

Respiratory-digestive fistulas secondary to malignant bronchogenic carcinomas are uncommon complications, which have high morbidity and mortality rates and worsen the prognosis of the neoplasm, particularly if their diagnosis is delayed. In this study we describe 2 cases of this rare complication, together with their identification process and therapeutic management. In spite of the scarce evidence available, a multidisciplinary approach is recommended, mainly with palliative management and through endoscopic techniques in order to achieve a safe and lasting correction of dysphagia, which is the cause of fatal respiratory infections. The treatment will lead to an acceptable quality of life and higher survival rates for these patients

Varón joven con neumonía de lenta resolución. Un hallazgo inesperado / No disponible

La actinomicosis es una enfermedad infecciosa de origen bacteriano. Si bien su evolución es habitualmente favorable con tratamiento antibiótico adecuado, en ocasiones este puede no ser eficaz. Se presenta el caso de un paciente con antecedente de tuberculosis hace 25 años, que acude a consulta para seguimiento tras haber sido ingresado con el diagnóstico de neumonía. Ante la persistencia de alteraciones en la radiografía de tórax se completa el estudio con TC y PET-TC cuyos hallazgos fueron altamente sugerentes de neoplasia. Tras la realización de broncoscopia se confirmó el diagnóstico de actinomicosis

Actinomycosis is an infectious disease with a bacterial origin. Although evolution is usually favorable with adequate antibiotic treatment, sometimes it may not be effective. We present the case of a patient with antecedent of tuberculosis infection 25 years ago, who came to clinic for follow-up after being admitted with the diagnosis of pneumonia. Due to persistence of alterations in chest X-ray, the study was completed by CT and PET-CT, whose findings were highly suggestive of neoplasia. After bronchoscopy, the diagnosis of actinomycosis was confirmed

Disfunción Tiroidea Subclínica / Subclinical thyroid disfunction

El desarrollo de Técnicas más económicas para la determinación de la tirotropina hipofisaria (TSH) y de las hormonas tiroideas (T3 Ft4) ha permitido su utilización en el ámbito de la Atención Primaria, incrementándose de forma notable a este nivel el diagnóstico de difusión tiroidea subclínica (cifras alteradas de TSH con niveles normales de fT) (AU)

Parotid gland tissue is able partially to assume pituitary functions under the influence of hypothalamic factors: in vivo and in vitro studies.

To test whether salivary tissue can secrete pituitary hormones, female Sprague-Dawley rats were hypophysectomized (hypox) and the following were transplanted to the sella turcica: parotid gland (group 3, n=33), adrenal gland (group 4, n=30), muscle (group 5, n=24). Group 2 (n=21) had the sella turcica filled with dentist's cement. In addition a group of rats (group 1, n=22) remained intact as controls. All groups were followed for 8 months. Daily vaginal smears showed normal cyclicity in controls and constant dioestrus in all hypox groups. Blood samples, taken once every 30 days before and after LHRH stimulation, showed significantly lower (P<0.001) plasma LH values in all hypox groups compared with controls. In group 3, a gradual and significant increase (P<0.05) was observed in the LH response to LHRH in parallel with a partial recovery of oestrous smears. No LH modification was observed in the other hypox groups. Plasma prolactin (PRL) levels were also very low in all hypox groups and were unaltered throughout the study. At the end of the experiments, half the animals were killed by decapitation and the hypothalamic-pituitary areas carefully dissected, homogenized and analysed for LH and PRL content. The remaining animals were perfused with 4% paraformaldehyde to obtain fixing of the whole body tissues. Hypothalamic and transplant areas were carefully dissected, frozen, cut and submitted to immunochemical procedures. LH content in the graft of group 3 animals was markedly (P<0.001) lower than in the control pituitary, but significantly higher (P<0.05) than in the other hypox groups. Immunochemistry showed LH and PRL positive cells in the graft of group 3 animals, whereas neither positive cells, nor LH content were observed in the parotid gland in situ. Experiments were completed with in vitro cultures of parotid glands in the presence or absence (controls) of synthetic hypothalamic hormones or rat hypothalamic extracts. After 1.5 weeks of culture, a significantly higher LH concentration (P<0.05) was observed in the wells treated with synthetic hypothalamic hormones (216+/-46 pg/ml vs 41+/-6 pg/ml in controls). When hypothalamic extracts were used, the LH levels increased more markedly (1834+/-190 pg/ml vs 36+/-6 pg/ml in controls) and those values were maintained during 3 weeks of culture. Immunostaining of these cultures showed a positive LH reaction in the epithelial cells found in the hypothalamic extract-treated wells. Both in vivo and in vitro studies confirm the transdifferentiation of parotid gland tissue to pituitary hormone-producing cells under hypothalamic influence.