Vigilancia activa en cáncer de próstata en un grupo de pacientes asistidos en el Centro Docente Asociado de Oncología Médica Rivera: Cooperativa Médica de Rivera (COMERI) / Active surveillance in prostate cancer in a group of patients assisted at the Rivera Associated Teaching Center for Medical Oncology: Rivera Medical Cooperative (COMERI) / Vigilância ativa do câncer de próstata em um grupo de pacientes atendidos no Rivera Associated Teaching Center for Medical Oncology: Rivera Medical Cooperative (COMERI)

Introducción: En Uruguay el cáncer de próstata ocupa el primer lugar en incidencia y el tercer lugar en mortalidad en el hombre. La mayoría de estos cánceres se diagnostican en estadios precoces. Hoy en día, para pacientes con adenocarcinoma de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, la vigilancia activa es una opción adecuada. Objetivos: Describir una población de pacientes con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, en vigilancia activa en COMERI. Material y métodos: Estudio descriptivo, observacional, retrospectivo. Se incluyeron pacientes con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, tratados entre 2010 y 2018 en COMERI. Se recopilaron datos en el sistema de registro clínico electrónico. Resultados: Se incluyeron 33 pacientes, la mediana de edad al diagnóstico fue de 74 años. Todos los pacientes fueron sometidos a controles clínicos y determinación de PSA cada 3 meses. El tacto rectal se realizó en forma anual. El tiempo mediano de vigilancia activa fue de 33 meses. Durante el seguimiento, se observaron pocas variaciones en los valores de PSA. El 21% de los pacientes fue sometido a una nueva biopsia durante el seguimiento activo, y en todos los casos, el Gleason se mantuvo incambiado. Ningún paciente abandonó la modalidad de vigilancia activa. Conclusión: En nuestro entorno, la vigilancia activa se considera una opción terapéutica válida para pacientes altamente seleccionados con cáncer de próstata de muy bajo riesgo, bajo riesgo o riesgo intermedio favorable, y es bien aceptada por ellos.

Introduction: In Uruguay, prostate cancer ranks first in incidence and third in mortality among men. The majority of these cancers are diagnosed at early stages. Nowadays, active surveillance is an appropriate option for patients with adenocarcinoma of very low risk, low risk, or favorable intermediate risk. Objectives: To describe a population of patients with prostate cancer of very low risk, low risk, or favorable intermediate risk under active surveillance at COMERI. Materials and Methods: Descriptive, observational, retrospective study. Patients with prostate cancer of very low risk, low risk, or favorable intermediate risk treated between 2010 and 2018 at COMERI were included. Data were collected from the electronic clinical registry system. Results: Thirty-three patients were included, with a median age at diagnosis of 74 years. All patients underwent clinical monitoring and PSA determination every 3 months. Digital rectal examination was performed annually. The median time of active surveillance was 33 months. During follow-up, there were few variations in PSA values. 21% of patients underwent a repeat biopsy during active surveillance, and in all cases, the Gleason score remained unchanged. No patient discontinued active surveillance. Conclusion: In our setting, active surveillance is considered a valid therapeutic option for highly selected patients with prostate cancer of very low risk, low risk, or favorable intermediate risk, and it is well accepted by them.

Introdução: No Uruguai, o câncer de próstata ocupa o primeiro lugar em incidência e o terceiro lugar em mortalidade entre os homens. A maioria desses cânceres é diagnosticada em estágios precoces. Atualmente, para pacientes com adenocarcinoma de risco muito baixo, baixo risco ou risco intermediário favorável, a vigilância ativa é uma opção adequada. Objetivos: Descrever uma população de pacientes com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável sob vigilância ativa em COMERI. Material e métodos: Estudo descritivo, observacional, retrospectivo. Foram incluídos pacientes com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável, tratados entre 2010 e 2018 em COMERI. Os dados foram coletados no sistema de registro clínico eletrônico. Resultados: Foram incluídos 33 pacientes, com mediana de idade no diagnóstico de 74 anos. Todos os pacientes foram submetidos a controles clínicos e determinação de PSA a cada 3 meses. O toque retal foi realizado anualmente. O tempo médio de vigilância ativa foi de 33 meses. Durante o acompanhamento, houve poucas variações nos valores de PSA. 21% dos pacientes foram submetidos a uma nova biópsia durante a vigilância ativa, e em todos os casos, o Gleason permaneceu inalterado. Nenhum paciente abandonou a modalidade de vigilância ativa. Conclusão: Em nosso ambiente, a vigilância ativa é considerada uma opção terapêutica válida para pacientes altamente selecionados com câncer de próstata de risco muito baixo, baixo risco ou risco intermediário favorável, e é bem aceita por eles.

Neumonía lipoidea exógena crónica y sobreinfección por Mycobacterium tuberculosis / Chronic Exogenous Lipoid Pneumonia and Superinfection by Mycobacterium Tuberculosis

Introducción: la neumonía lipoidea exógena es una enfermedad pulmonar inflamatoria poco común, desencadenada por la inhalación o aspiración de material graso de origen animal, vegetal o mineral. El diagnóstico se establece a través de confirmación histo-patológica, por la presencia de macrófagos cargados de lípidos en muestras respirato-rias, asociado a las características clínicas específicas al momento de su presentación.Requiere de un alto nivel de sospecha y una adecuada anamnesis de los antecedentes exposicionales del paciente debido a que muchos casos son subdiagnosticados y trat-ados como neumonía adquirida en la comunidad, lo que retrasa su diagnóstico y mane-jo, sumado a la ausencia de guías disponibles para su tratamiento.Se han reportado pocos casos de sobreinfección por tuberculosis en pacientes con neu-monía lipoidea exógena crónica. Caso clínico: femenino 33 años, con antecedentes de exposición crónica a sustancias desinfectantes de características aceitosas sin protección de vía aérea, con cuadro de tos y dolor torácico. Conclusión: el diagnóstico temprano, asociado a tratamiento de soporte, general-mente conservador, favorece la mejoría clínica y radiológica, y de esta manera dis-minuye la morbimortalidad. (AU)

Introduction: exogenous lipoid pneumonia is a rare inflammatory lung disease, trigge-red by inhalation or aspiration of fatty material of animal, vegetable or mineral origin. The diagnosis is established through histological confirmation by the presence of lipid-laden macrophages in respiratory samples, associated with the specific clinical charac-teristics at the time of presentation. It requires a high level of suspicion and an adequate anamnesis of the patient's expo-sure history, since many cases are underdiagnosed and treated as community-acquired pneumonia, what delays its diagnosis and management, added to the absence of avai-lable guidelines for its treatment. Few cases of tuberculosis superinfection have been reported in patients with exoge-nous lipoid pneumonia.Clinical case: 33-year-old female, with a history of chronic exposure to oily disinfectant substances without airway protection, with symptoms of cough and chest pain.Conclusion: early diagnosis, associated with supportive treatment, generally conser-vative, favors clinical and radiological improvement, thus reducing morbidity and mor-tality. (AU)

Kidney Disease in Ankylosing Spondylitis: a case series and review of the literature / Doença Renal na Espondilite Anquilosante: uma série de casos e revisão da literatura

Abstract Background Kidney disease is a rare manifestation of ankylosing spondylitis (AS) and its pathological alterations remain poorly described. The aim of this study was to investigate the clinical presentation and pathological alterations on kidney biopsy of AS patients and review and discuss the current literature on the issue. Methods: We retrospectively studied the clinical presentation and kidney pathological alterations of 15 Caucasian AS patients submitted to kidney biopsy between October 1985 and March 2021. Results: Patients were predominantly male (66.7%) with median age at the time of kideney biopsy of 47 years [IQR 34 - 62]. Median serum creatinine at presentation was 1.3 mg/dL [IQR 0.9 - 3] and most patients also had either proteinuria (85.7%) and/or hematuria (42.8%). The most common indication for kidney biopsy was nephrotic syndrome (33.3%), followed by acute or rapidly progressive kidney injury (20%) and chronic kidney disease of unknown etiology (20%). Chronic interstitial nephritis (CIN) (n=3) and AA amyloidosis (n=3) were the most common diagnosis. Others included IgA nephropathy (IgAN) (n=2), focal segmental glomerulosclerosis (n=2), membranous nephropathy (n=1), and immune complex-mediated membranoproliferative glomerulonephritis (IC-MPGN)(n=1). Conclusions: We present one of the largest series of biopsy-proven kidney disease in Caucasian AS patients. We found a lower prevalence of IgAN than previously reported in Asian cohorts. We found a higher prevalence of CIN and a lower prevalence of AA amyloidosis than that described in previous series of Caucasian patients. We also present the first case of AS-associated IC-MPGN.

Resumo Antecedentes: A doença renal é uma manifestação rara de espondilite anquilosante (EA) e as suas alterações patológicas permanecem pouco descritas. O objetivo deste estudo foi investigar a apresentação clínica e alterações patológicas na biópsia renal de doentes com EA bem como rever e discutir a literatura atual sobre o assunto. Métodos: Estudamos retrospectivamente a apresentação clínica e alterações patológicas renais de 15 doentes caucasianos com EA submetidos a biópsia renal entre Outubro de 1985 e Março de 2021. Resultados: Os doentes eram predominantemente homens (66,7%) com idade mediana no momento da biópsia de 47 anos [IIQ 34 - 62]. A creatinina sérica mediana na apresentação foi de 1,3 mg/dL [IIQ 0,9 - 3] e a maioria dos pacientes apresentava também proteinúria (85,7%) e/ou hematúria (42,8%). A indicação mais comum para biópsia renal foi a síndrome nefrótica (33,3%), seguida de lesão renal aguda ou rapidamente progressiva (20%) e doença renal crónica de etiologia desconhecida (20%). A Nefrite intersticial crónica (NIC) (n=3) e a amiloidose AA (n=3) foram os diagnósticos mais comuns. Outros incluíram nefropatia por IgA (NIgA) (n=2), glomeruloesclerose segmentar focal (n=2), nefropatia membranosa (n=1) e glomerulonefrite membranoproliferativa mediada por imunocomplexos (GNMP-IC) (n=1). Conclusões: Apresentamos uma das maiores séries de doenças renais comprovadas por biópsia em doentes caucasianos com EA. Encontramos uma prevalência de NIgA menor do que a relatada anteriormente em coortes asiáticas. Encontramos uma maior prevalência de NIC e uma prevalência menor de amiloidose AA do que a descrita em séries anteriores de pacientes caucasianos. Também apresentamos o primeiro caso de GNMP-IC associada à EA.

Distribution of kidney diseases in Joinville, Santa Catarina: analysis of a kidney biopsy data bank between 2008 and 2019 / Distribuição das nefropatias em Joinville, Santa Catarina: análise de um banco de dados de biópsia renal entre 2008 a 2019

Abstract Introduction: Studies based on kidney biopsies are important for the epidemiological understanding of nephropathies. Objective: To describe the main nephropathies diagnosed through renal biopsies, and compare them with regards to gender, time, healthcare insurance and age. Methods: A population-based retrospective study that reviewed all kidney disease diagnoses obtained by biopsy of a native kidney from pathology services between 2008 and 2019 in Joinville, Brazil. Results: Of 778 biopsies performed, 44.5% were primary nephropathies and 28.5% were secondary. The highest prevalence was focal segmental glomerulosclerosis (FSGS) [18.1%], followed by tubulointerstitial nephropathy (TIN) [15.9%] and IgA nephropathy (IgAN) [9.1%]. There was a growing increase in the prevalence of TIN among elderly and uninsured patients over the period. In the multivariate analysis, among the primary glomerulopathies, males had a higher risk for the occurrence of IgAN [OR=2.02; 95% CI 1.13-3.61; p=0.018], as well as being a protective factor for the occurrence of lupus glomerulonephritis (LGN) [OR=0.20, 95% CI 0.08-0.49; p<0.001]. Advancing age and dependence on a public healthcare decreased the likelihood of having a diagnosis of LGN [OR=0.91, 95% CI 0.88-0.94, p < 0.001 and OR=0.45, CI 95 % 0.21-0.96; p = 0.036, respectively]. Patients without private healthcare insurance were more likely to have TIN [OR=1.77, 95%CI 1.16-2.70; p = 0.008]. Conclusion: Sex, age and type of medical healthcare insurance may be related to the occurrence of some nephropathies. The increased risk of TIN in individuals without a private healthcare plan may be an indication of inequalities in health care.

Resumo Introdução: Estudos com base em biópsias renais são importantes para o entendimento epidemiológico das nefropatias. Objetivo: Descrever as principais nefropatias diagnosticadas por meio de biópsias renais e comparar com relação ao gênero, período, plano de saúde e à idade. Métodos: Estudo retrospectivo de base populacional que revisou todos os diagnósticos de doenças renais obtidos por biópsia de rim nativo de serviços de patologias entre 2008 a 2019, em Joinville, Brasil. Resultados: Do total de 778 biópsias realizadas, 44,5% eram nefropatias primárias e 28,5%, secundárias. A maior prevalência foi de glomeruloesclerose segmentar e focal (GESF) [18,1%], seguida por nefropatia tubulointersticial (NTI) [15,9%] e nefropatia IgA (NIgA) [9,1%]. Houve crescente aumento da prevalência de NTI nos pacientes idosos e sem plano de saúde ao longo do período. Na análise multivariada, entre as glomerulopatias primárias, o sexo masculino apresentou maior risco para ocorrência de NIgA [OR=2,02, IC 95% 1,13-3,61; p=0,018], bem como foi um fator de proteção para ocorrência de glomerulonefrite lúpica (GNL) [OR=0,20, IC 95% 0,08-0,49; p < 0,001]. O avançar da idade e a dependência de plano público de saúde diminuíram a chance para o diagnóstico de GNL [OR=0,91, IC 95% 0,88-0,94, p < 0,001 e OR=0,45, IC 95% 0,21-0,96; p = 0,036, respectivamente]. Pacientes sem plano privado de saúde apresentaram mais chance de NTI [OR=1,77, IC 95%1,16-2,70; p = 0,008]. Conclusão: Sexo, idade e tipo de assistência médica podem estar relacionados à ocorrência de algumas nefropatias. O maior risco de NTI em indivíduos sem plano de saúde privado pode ser um indicativo de desigualdades no cuidado à saúde.

Hallazgos histopatológicos en biopsia renal de pacientes con COVID-19 y compromiso renal / Histopathological findings in renal biopsy of patients with COVID-19 and renal involvement

Introducción. La lesión renal aguda (LRA) en el paciente con COVID-19 ocurre más frecuentemente en presencia de enfermedades crónicas como diabetes, obesidad, hipertensión arterial y enfermedad renal crónica previa, considerándose un fuerte predictor de resultados desfavorables y mortalidad. El propósito de este estudio fue describir las características histopatológicas en biopsias renales de pacientes hospitalizados por COVID-19, que experimentaron algún grado de daño renal durante su hospitalización. Metodología. Se incluyeron 30 pacientes mayores de 18 años, hospitalizados en diferentes centros de atención en Medellín, Colombia, con diagnóstico confirmado de COVID-19, sin antecedente de terapia de reemplazo renal, que durante la infección desarrollaron algún grado de daño renal, y que tuvieran estudio histopatológico de biopsia renal. Se analizaron las características demográficas, formas clínicas de presentación y hallazgos histopatológicos a nivel renal. Resultados. La mayoría de los pacientes eran de sexo masculino (70%). Los antecedentes patológicos más frecuentes fueron la enfermedad renal crónica previa (16,7%), diabetes mellitus (16,7%), trasplante renal (13,3%) y VIH (10%). El 35,7% de los pacientes no tenían ninguna comorbilidad subyacente. La manifestación clínica inicial más frecuente fue la LRA (56,7%). Algunos pacientes tuvieron más de una manifestación clínica inicial. El 100% de los pacientes evaluados tuvieron hallazgos histopatológicos renales, siendo la nefritis tubulointersticial aguda (40%) el más frecuente. Conclusión. Nuestro estudio no descarta una posible asociación del sexo masculino con peores desenlaces en la enfermedad COVID-19. La LRA fue el hallazgo clínico inicial más frecuente. Es posible que los hallazgos histopatológicos del presente estudio puedan ser consecuencia del daño directo a nivel tubulointersticial renal y la mala perfusión renal, dado el estado de choque por la tormenta inflamatoria, el empeoramiento de enfermedades preexistentes, o la superposición clínica con otras entidades. Sin embargo, son necesarios más estudios para dilucidar los mecanismos por los cuales se generan estas lesiones

Acute kidney injury (AKI) in patients with COVID-19 occurs more frequently in the presence of chronic diseases such as diabetes, obesity, hypertension, and previous chronic kidney disease, and is considered a strong predictor of unfavorable outcomes and mortality. The purpose of this study was to describe the histopathological characteristics in kidney biopsies from patients hospitalized for COVID-19, who experienced some degree of kidney damage during their hospitalization. Methodology. We included 30 patients over 18 years of age, hospitalized in different care centers in Medellín, Colombia, with a confirmed diagnosis of COVID-19, without a history of renal replacement therapy, who developed some degree of kidney disease during the infection, and had histopathological study of renal biopsy. Demographic characteristics, clinical manifestations and histopathological findings were analyzed. Results. Most of the patients were male (70%). The most frequent previous pathological findings were chronic kidney disease (16.7%), diabetes mellitus (16.7%), kidney transplant (13.3%) and HIV (10%). 35.7% of the patients did not have any underlying comorbidity. The most frequent initial clinical manifestation was AKI (56.7%). Some patients had more than one initial clinical manifestation. 100% of the patients had renal histopathological findings, with acute tubulointerstitial nephritis (40%) being the most frequent. Conclusion. Our study does not rule out a possible association of the male gender with worse outcomes in COVID-19 disease. AKI was the most common initial clinical finding. It is possible that the histopathological findings of this study may be a consequence of direct damage at the renal tubulointerstitial level and poor renal perfusion due to the inflammatory storm, worsening of pre-existing diseases, or clinical overlap with other entities. However, more studies are needed to elucidate the mechanisms by which these lesions are generated

Hamartomatosis biliar múltiple / Multiple biliary hamartomatosis

Introducción: La hamartomatosis biliar múltiple o también llamada enfermedad de los complejos de von Meyenburg fue descrita por este autor en 1955. Tiene un origen disembriogénico con un curso evolutivo benigno y asintomático, con pruebas funcionales hepáticas normales. Por los estudios de imágenes se puede confirmar el diagnóstico, pero igualmente ante un hígado multinodular pueden diagnosticar una hepatopatía crónica sin precisar su etiología, por lo que es imprescindible el diagnóstico histológico con biopsia hepática translaparoscópica dirigida. No se necesita ningún tratamiento específico y su seguimiento es ecográfico semestral o anual. Objetivo: Presentar el valor de la biopsia hepática dirigida por laparoscopia a las lesiones por hamartomatosis biliar múltiple. Desarrollo: Se presenta un paciente de 53 años con antecedentes de ser un bebedor social con frecuencia semanal. Ingresa por fiebre asociada a una sepsis urinaria, en el que aparece un fortuito hallazgo ecográfico de un hígado multinodular, sin precisar un diagnóstico etiológico por otros estudios de imágenes. Esto motivó a realizarle una laparoscopia con toma de biopsia hepática dirigida a las lesiones observadas. Se confirma el diagnóstico histológico de esta entidad. Conclusiones: Se demostró la importancia y vigencia del valor diagnóstico de la laparoscopia, al igual que la biopsia hepática dirigida para lograr el diagnóstico histológico de certeza en esta entidad(AU)

Introduction: Multiple biliary hamartomatosis or von Meyenburg complex disease was described by this author in 1955. Its origin is dysembryogenic with a benign and asymptomatic evolutionary course, with normal liver function tests. Imaging studies can confirm the diagnosis, but likewise, when it is a multinodular liver, chronic liver disease can be diagnosed without specifying its etiology, which is why it is essential a histological diagnosis with a directed overlaparoscopic liver biopsy. No specific treatment is needed and its follow-up is semi-annual or annual ultrasound. Objective: To present the value of laparoscopically directed liver biopsy for multiple biliary hamartomatosis lesions. Case report: A 53-year-old patient with a history of being a social drinker with a weekly frequency is reported. He was admitted for fever associated with urinary sepsis, in which a fortuitous ultrasound finding of a multinodular liver appeared, without requiring an etiological diagnosis by other imaging studies. This led to a laparoscopy with a liver biopsy aimed at the observed lesions. The histological diagnosis of this entity is confirmed. Conclusions: The importance and validity of the diagnostic value of laparoscopy, as well as directed liver biopsy to achieve a certain histological diagnosis in this entity, was demonstrated(AU)

Hiperqueratosis plantar / Plantar hyperkeratosis

RESUMEN La hiperqueratosis es un trastorno caracterizado por el engrosamiento de la capa externa de la piel, que está compuesta de queratina, una fuerte proteína protectora. Puede ser causada por fricción, conllevando la aparición de callosidades, inflamación crónica, eccema o trastornos genéticos, como la ictiosis ligada al cromosoma X. Se presentó el caso de un paciente de 47 años, que acudió al Servicio de Ortopedia por lesión escamosa a nivel de ambas regiones plantares con dificultad para la marcha. El tratamiento quirúrgico fue el empleado en este paciente para la obtención de la biopsia exerética. La evolución fue favorable en el postoperatorio mediato e inmediato, y el paciente se incorporó de forma rápida a su vida normal. Con este caso se identificaron las características clínicas de la hiperqueratosis plantar, así como el uso de la biopsia exerética como estándar de oro para el diagnóstico positivo en los tumores periféricos. Un diagnóstico adecuado por el médico inicial, la interrelación del Servicio de Ortopedia con la consulta de tumores periféricos, y el tratamiento quirúrgico seleccionado, constituyen factores determinantes en la evolución favorable de los pacientes con este diagnóstico (AU).

ABSTRACT Hyperkeratosis is a disorder characterized by thickening of the outer layer of the skin, which is composed of keratin, a strong protective protein. It can be caused by friction, leading to callosities, chronic inflammation, eczema or genetic disorders such as X chromosome-linked ichthyosis. We presented the case of a patient, aged 47 years, who attended the Orthopedic Service for scaly lesion at the level of both plantar regions with difficulties to walk. Surgical treatment was used in this patient to obtain an exeretic biopsy. The evolution was favorable in both the mediate and immediate postoperative period, and the patient quickly returned to his normal life. This case identified the clinical characteristics of plantar hyperkeratosis and the use of exeretic biopsy as a gold standard for positive diagnosis in the peripheral tumors. An adequate diagnosis by the initial physician, the interrelation of the orthopedic service with the consultation of peripheral tumors, and the chosen surgical treatment are determining factors in the favorable evolution of patients with this diagnosis (AU).

Incidencia de patologías bucomaxilares en un período de aislamiento social preventivo y obligatorio de la pandemia COVID-19 / Incidence of buccomaxillofacial pathologies in a period of preventive and mandatory social isolation due to the COVID-19 pandemic

La urgencia en la práctica odontológica incluye no solo la atención de pacientes con dolor e infección, sino también la atención de pacientes que presentan patologías con presunción diagnóstica de agresividad y/o malignidad. El objetivo de este estudio fue analizar la incidencia de las patologías bucomaxilares biopsiadas en el Servicio de Urgencias y Orientación de Pacientes (SUyOP), y diagnosticadas en el Laboratorio de Patología Quirúrgica de la Cátedra de Anatomía Patológica (LPQ-CAP) de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), en un período del Aislamiento Social Preventivo y Obligatorio de la pandemia COVID-19. Se realizó un estudio observacional, descriptivo y retrospectivo de pacientes que se presentaron para la atención odontológica en el período de tiempo comprendido entre el 20 de marzo al 21 de junio de 2020. Se registraron los pacientes que presentaron lesiones bucales con indicación de biopsia. Del total de pacientes evaluados (4854), 48 presentaron patologías con presunción diagnóstica de agresividad y/o malignidad. Las patologías más frecuentes fueron las neoplasias malignas (21 casos), siendo la entidad prevalente el carcinoma de células escamosas. Para el LPQ-CAP, las muestras biópsicas remitidas por el SUyOP representaron el 44% del total de las muestras recibidas. Si bien la incidencia de patologías bucomaxilares biopsiadas y diagnosticadas fue baja (1%) es de destacar que el diagnóstico histopatológico correspondió, en la mayoría de los casos, a patologías neoplásicas. De allí la importancia de la atención de urgencia a pacientes que presentan lesiones con presunción diagnóstica de malignidad/agresividad (AU)

Glomerulonefritis rápidamente progresiva mediada por inmunocomplejos (tipo II). Revisión de la literatura / Immune complex-mediated rapidly progressive glomerulonephritis (type II). Literature review

La glomerulonefritis rápidamente progresiva mediada por complejos inmunes (GMNRP II) es un síndrome clínico caracterizado por el rápido deterioro de la función renal asociado a hematuria, edemas y oliguria. Histológicamente se manifiesta como una glomerulonefritis crescéntica, con la presencia de depósitos granulares en la inmunofluorescencia. Aunque es una enfermedad rara, es grave y puede evolucionar a una enfermedad renal crónica, por lo cual es fundamental su identificación temprana. A continuación, se presenta una revisión sobre este tipo de glomerulonefritis, con énfasis en su etiología y en las opciones terapéuticas existentes en la actualidad

Rapidly progressive immune complex-mediated glomerulonephritis (RPGNMN II) is a clinical syndrome characterized by severe deterioration of renal function associated with hematuria, edema, and oliguria. It is histologically characterized as a crescentic glomerulonephritis, with the presence of granular deposits on immunofluorescence. Although it is a rare condition, it is a potentially serious disease that may progress to chronic renal disease, therefore its early identification is essential. Here we present a review of this form of glomerulonephritis, with emphasis on its etiology and the currently available therapeutic options

Diagnóstico diferencial en pacientes con granulomas en biopsias de pulmón, pleura y/o ganglios mediastínicos del Instituto Nacional del Tórax / Differential diagnosis in patients with granulomas in the biopsy of the lung, pleura and/or mediastinal nodes

Las enfermedades granulomatosas incluyen una amplia gama de enfermedades. Sin embargo, en la práctica clínica, muchos casos de enfermedad granulomatosa permanecen sin etiología después del examen histológico. Nuestro objetivo fue determinar, a partir de las biopsias de pulmón, pleura y ganglios linfáticos mediastínicos, en los que se informaron granulomas, las características clínicas y los diagnósticos de estos pacientes. Así también la mortalidad a un año de seguimiento. Metodología: Analizamos retrospectivamente biopsias de pulmón, pleura y/o ganglios linfáticos mediastínicos con granulomas de 75 pacientes del Instituto Nacional del Tórax (2012-2016), sus características clínicas y de laboratorio. La información se obtuvo de los registros médicos. Los datos de mortalidad se obtuvieron del registro civil. Resultados: Se determinó una etiología en todos los casos, excepto en 3 (4%). Los diagnósticos más frecuentes fueron tuberculosis (n = 37; 49%) y sarcoidosis (n = 18; 24%). Otras causas fueron silicosis (5,3%), vasculitis (4%) y neumonitis por hipersensibilidad (2,7%). Los pacientes con tuberculosis (TB) tenían parámetros inflamatorios más altos, como velocidad de eritrosedimentación y proteína C reactiva. Además, sólo se encontraron granulomas con necrosis caseosa en pacientes con tuberculosis. En cambio, los pacientes con sarcoidosis tenían lesiones cutáneas y una mayor frecuencia de linfadenopatías. Cuatro (5.3%) pacientes fallecieron a un año de seguimiento: dos debido a neumonía, uno por hipersensibilidad crónica y uno por TB. Conclusión: La tuberculosis y la sarcoidosis fueron las causas más frecuentes de granulomas respiratorios en este estudio retrospectivo. Se logró determinar una etiología en el 96% de los casos, considerando variables clínicas, de laboratorio e histopatológicas para un diagnóstico diferencial correcto.

Granulomatous diseases comprise a wide range of pathologies. However, in clinical practice, many pulmonary granulomas remain without etiology after the histologic examination. Our aim was to determine from the biopsies of the lung, pleura and mediastinal lymph nodes in which granulomas were reported, the clinical characteristics and diagnoses of the patients. Methodology: We analyzed retrospectively biopsies of the lung, pleura and mediastinal lymph nodes with granulomas from 75 patients handled at our institution (2012-2016), as well as their clinical and laboratory data. The information was obtained from medical records. A one-year mortality date was obtained from the civil registry. Main results: A cause was determined in all the cases, except in three of them (4%). The most frequent diagnoses were tuberculosis (n =37; 49%) and sarcoidosis (n =18; 24%). Other causes were silicosis (5.3%), vasculitis (4%) and hypersensitivity pneumonitis (2.7%). Patients with tuberculosis (TB) had higher inflammatory parameters such as erythrocyte sedimentation rate and C-reactive protein. Besides granulomas with caseous necrosis were only found in TB patients. Instead, patients with sarcoidosis had skin lesions and a higher frequency of lymphadenopathy. Four patients (5.3%) died in a one-year of follow-up: two of them because of pneumonia and the other two patients because of chronic hypersensitivity and TB respectively. Conclusion: Tuberculosis and sarcoidosis were the most common causes of respiratory granulomas in this retrospective study. A specific cause was determined in 96% of cases, considering clinical, laboratory and histopathological variables to do a right differential diagnosis.

Caracterización clínica de pacientes con nefropatía lúpica en Santander, la importancia de la biopsia renal / Clinical and epidemiological characterization of patients with lupus nephropathy in Santander, Colombia: the importance of the renal biopsy

Resumen Introducción: el lupus eritematoso sistémico (LES) presenta diferentes manifestaciones clínicas, un de estas es la nefropatia lúpica (NL), que se asocia con progresión a enfermedad renal crónica (ERC) avanzada y mortalidad. Objetivo: determinación de las características clínicas y epidemiológicas de la NL en Santander. Métodos: estudio observacional descriptivo tipo serie de casos en pacientes con NL evaluados por primera vez, entre enero de 2017 a enero 2018, en consulta de nefroprevención. Según criterios de inclusión y exclusión se definieron variables cualitativas y cuantitativas. Se revisaron historias clínicas y el análisis de datos se realizó por medio de SPSS®. Resultados: se estudiaron 14 pacientes (85 % mujeres), la edad promedio de diagnóstico de NL fue de 36 años, con ERC 1 y 2 (72 %) y con proteinuria A3 (85 %). Se obtuvo biopsia renal en 64 %, con resultado concluyente en el 50 %, la clase histopatológica IV de NL fue la más común. La terapia de mantenimiento más frecuente fue corticoide en monoterapia (36 %), seguido de la combinación de corticoide y micofenolato (29 %). Conclusión: la NL predomina en mujeres jóvenes, en estadios tempranos de ERC con altos grados de proteinuria, por lo que se debe realizar una evaluación minuciosa en búsqueda de NL a todos los pacientes con LES, mediante programas de detección y seguimiento nefrológico temprano. El grado histopatológico IV fue el más frecuente, similar a lo reportado en Latinoamérica. Existen dificultades administrativas y técnicas en la toma de biopsias renales, se debe hacer énfasis en la necesidad de su realización, por su primordial importancia para definir el tratamiento.

Abstract Introduction: Systemic Lupus Erythematosus (SLE) has different clinical manifestations, being very relevant lupus nephropathy (NL) because is associated with progression to advanced chronic kidney disease (CKD) and mortality. Objective: Determination of the clinical and epidemiological characteristics of the NL in Santander. Methods: A descriptive observational study of a series of cases in patients with NL diagnosis, evaluated between January 2017 and 2018 for the first time in a nephroprotection consultation. Qualitative and quantitative variables are defined according to the inclusion and exclusion criteria. Electronic medical records were reviewed, and data analysis was performed through SPSS®. Results: 14 patients (85% women) were studied. The average age of diagnosis of NL was 36 years, mostly with stages of CKD 1 and 2 (72%) with proteinuria A3 (85%).Biopsy renal was performed in the 64%, a conclusive result in the 50%, being the histopathological grade IV of NL the most common. The most frequent maintenance therapy was corticosteroid alone (35.7%), followed by the combination of corticosteroid and mycophenolate (28.5%). Conclusion: NL predominates in young women, and presenting in early stages of CKD, with high degrees of proteinuria, so a thorough evaluation should be performed in search of NL in all patients with SLE through early nephrological screening and monitoring programs. The histopathological grade IV found is like that reported in Latin America. There are administrative and technical difficulties in the performance of renal biopsies, emphasis should be placed on the realization of this procedure because it takes a primary role in defining the treatment.

Caracterización clínica e histopatológica de niños con hepatitis autoinmune en un centro de referencia de Bogotá, Colombia / Clinical and histopathological characterization of children with autoimmune hepatitis at a referral center in Bogotá, Colombia

Resumen La hepatitis autoinmune (HAI) es una enfermedad hepática inflamatoria progresiva poco frecuente en niños y adolescentes, la cual es un reto diagnóstico para clínicos y patólogos. Describimos las características clínicas, bioquímicas e histopatológicas de 21 pacientes pediátricos con HAI diagnosticados en los últimos 14 años. Las biopsias hepáticas se reevaluaron para analizar detalladamente los hallazgos histopatológicos. De los 21 casos evaluados, 12 (57,1%) fueron mujeres, la mediana de edad fue 14 años, y 17 (80,9%) tenían HAI tipo 1. Los signos clínicos más frecuentes fueron ictericia (66,7%) y coluria (44,4%); también hubo evidencia de hipertensión portal con várices esofágicas (47,1%) y esplenomegalia (41,2%). El 11,8% de los pacientes tenía antecedentes de otras enfermedades autoinmunes. El 89,5%, 88,9% y 60,0% de los casos tenía elevación de aminotransferasas, hiperbilirrubinemia y bajos niveles de albúmina sérica, respectivamente. Las biopsias reevaluadas mostraron infiltrado linfoplasmocitario portal (94,4%), hepatitis de interfase (77,8%) y formación de rosetas (50,0%). En el 42,9% de las biopsias se hallaron inclusiones hialinas en las células de Kupffer. Cerca del 33,5% de los casos mostró cirrosis en la biopsia inicial. A pesar del tratamiento inmunosupresor, 4 pacientes requirieron trasplante hepático y 2 están en lista de espera. La HAI en niños puede manifestarse con ictericia y coluria, signos de hipertensión portal, aminotransferasas elevadas, hiperbilirrubinemia y anticuerpos circulantes. Las inclusiones hialinas en las células de Kupffer pueden ser un hallazgo útil en el diagnóstico histopatológico de la HAI en niños.

Abstract Autoimmune hepatitis (AIH) is a progressive inflammatory liver disease. It is uncommon in children and adolescents, and is a diagnostic challenge for clinicians and pathologists. We describe the clinical, biochemical and histopathological characteristics of 21 pediatric patients with AIH diagnosed in the last 14 years. Liver biopsies were reassessed to analyze histopathological findings in detail. Of the 21 cases evaluated, 12 (57.1%) were girls and young women, the median age was 14 years old, and 17 (80.9%) had type 1 AIH. The most frequent clinical signs were jaundice (66.7%), choluria (44.4%), evidence of portal hypertension with esophageal varices (47.1%), and splenomegaly (41.2%). Histories of other autoimmune diseases were found in 11.8% of these patients. Elevated levels of aminotransferases were found in 89.5% of the patients, hyperbilirubinemia was found in 88.9%, and 60.0% of the cases had low levels of serum albumin. Reassessed biopsies showed portal lymphoplasmocytic infiltrate (94.4%), interface hepatitis (77.8%) and rosette formation (50.0%). Hyaline inclusions were found in Kupffer cells in 42.9% of the biopsies. About 33.5% of the cases showed cirrhosis at the initial biopsy. Despite immunosuppressive treatment, four patients required liver transplantation and two are on the waiting list. AIH in children can manifest with jaundice, choluria, signs of portal hypertension, elevated aminotransferases, hyperbilirubinemia and circulating antibodies. Hyaline inclusions in Kupffer cells may be a useful finding in the histopathological diagnosis of AIH in children.

Esofagite eosinofílica numa consulta de alergia alimentar: caracterização e comparação entre idade pediátrica e idade adulta / Eosinophilic esophagitis at a food allergy appointment: characterization and comparison between pediatric and adult ages

Introdução: Esofagite eosinofílica (EoE) é uma doença inflamatória crônica do esôfago, mediada imunologicamente e caracterizada por sintomas relacionados com disfunção esofágica e infiltração da mucosa esofágica por eosinófilos (Eo). Os objetivos foram caracterizar os doentes com diagnóstico de EoE e analisar as diferenças entre doentes com diagnóstico em idade pediátrica (Cr, < 18 anos) e adulta (Ad, ≥ 18 anos). Métodos: Estudo observacional retrospetivo dos doentes seguidos no serviço de Imunoalergologia, no período de Fev/2009 a Jul/2017, com diagnóstico de EoE. Foram divididos em dois grupos, Cr e Ad, caracterizados de acordo com dados demográficos, história de atopia, sintomas, sensibilizações alimentares, IgE Total, eosinofilia, achados na endoscopia digestiva alta e biópsias. Avaliou-se a correlação entre sensibilização alimentar, clínica grave (ClinG), ou seja, idas ao serviço de urgência ou internamento por complicações de EoE ou histologia grave (HistG), biópsia com Eo > 50 e/ou microabcessos. Resultados: 74 pacientes (81% sexo masculino, média de idades 27±17 anos), 36 Cr e 38 Ad. Os sintomas mais frequentemente reportados foram, no grupo Cr disfagia (73%) e refluxo gastroesofágico (46%), enquanto no grupo Ad impactação (85%) e disfagia (56%). Foram referidos antecedentes de atopia em 96% das Cr, e 67% dos Ad. Em 77% das Cr e 69% dos Ad havia sensibilização alimentar. Os achados endoscópicos mais frequentes no grupo Cr foram estriação (65%) e placas brancas (50%), enquanto que no grupo Ad foram placas brancas (42%) e anéis esofágicos (35%). HistG (46%) associou-se a ClinG (35%), p = 0,001, nas Cr, mas o mesmo não foi objetivado no grupo Ad [ClinG (22%) e HistG (17%), p = 0,5]. Conclusão: Os nossos resultados estão de acordo com o descrito na literatura, observando-se um predomínio do sexo masculino e uma maior frequência de história de atopia e sensibilização alimentar no grupo Cr. As situações graves de impactação e estenose esofágica foram mais frequentes nos Ad, e objetivou-se uma associação de histologia grave com clínica grave, apenas nas Cr.

Background: Eosinophilic esophagitis (EoE) is an immunologically mediated chronic inflammatory disease of the esophagus characterized by symptoms related to esophageal dysfunction and eosinophilic infiltration in the esophageal mucosa. This study aimed to characterize patients with a diagnosis of EoE and analyze differences between patients with EoE diagnosed at pediatric age (Ch, <18 years) and at adult age (Ad, ≥18 years). Methods: This was a retrospective study of patients with a diagnosis of EoE who were followed in the immunoallergology department from February 2009 to July 2017. Patients were divided into Ch and Ad groups and characterized according to demographic data, history of atopy, symptoms, food sensitization, total IgE, eosinophils (Eo), upper digestive endoscopy (UDE) findings, and biopsy findings. Correlations were assessed between food sensitization, clinical severity (SClin; determined by number of ER visits or hospital admissions for EoE complications), and severe histology (SHist; defined as biopsy with Eo >50 and/or microabscesses). Results: 74 patients (81% male, mean age 27±17 years), 36 Ch and 38 Ad. The most commonly reported symptoms were dysphagia (73%) and gastroesophageal reflux (46%) in the Ch group, and impaction (85%) and dysphagia (56%) in the Ad group. History of atopy was reported in 96% of Ch vs 67% of Ad. Food sensitization was found in 77% of Ch vs 69% of Ad. The most common UDE findings were striation (65%) and white plaques (50%) in the Ch group, and white plaques (42%) and esophageal rings (35%) in the Ad group. SHist (46%) was associated with SClin (35%) in Ch (p=0.001), but not in Ad (SClin [22%] and SHist [17%], p=0.5). Conclusion: Our results are consistent with those reported in the literature, with a male predominance and a higher prevalence of atopy and food sensitization in Ch. Severe impaction and esophageal stenosis were more frequent in Ad, but an association between SHist and SClin was found only in Ch.

Perfil epidemiológico de pacientes com diagnóstico de carcinoma diferenciado de tireoide em seguimento em ambulatório de endocrinologia / Epidemiological profile of patients diagnosed with differentiated thyroid carcinoma followed in an outpatient clinic of endocrinology

Objetivo: Avaliar o perfil epidemiológico de pacientes com diagnóstico de carcinoma diferenciado de tireoide. Métodos: Estudo analítico descritivo, realizado por meio da análise e da coleta de dados de 34 prontuários de pacientes em seguimento em um ambulatório de endocrinologia de um hospital público em São Paulo. Foram incluídos todos os pacientes em acompanhamento no ambulatório com diagnóstico de tumores diferenciados; foram excluídos os menores de 18 anos e/ou com diagnóstico de outras neoplasias de tireoide (que não tumores diferenciados). Resultados: A idade dos pacientes variou de 25 a 84 anos ao diagnóstico, com média de 51 anos, tendo sido representados por 32 mulheres (94,11%) e 2 homens (5,88%). A maioria dos tumores (41,17%) possuía tamanho entre 1 e 2cm. A maior parte dos pacientes tinha baixo risco de recorrência, e todos foram tratados cirurgicamente. Conclusão: O tumor diferenciado mais frequente é o subtipo papilífero. Sua prevalência se dá em mulheres, com média de idade ao diagnóstico de 51 anos. (AU)

Objective: To evaluate the epidemiological profile of patients with differentiated thyroid carcinoma. Methods: Th is i s a d escriptive, analytical study performed through the analysis and collection of data from 34 medical records of patients being followed in an endocrinology clinic of a public hospital in the city of São Paulo. All patients being followed at the outpatients' department with a diagnosis of differentiated thyroid carcinoma were included, and those under 18 and/or with diagnosis of other cancer of the thyroid (other than differentiated tumors) were excluded. Results: the patients' ages ranged from 25 to 84 years at diagnosis, an average of 51 years represented by 32 women (94.11%) and 2 men (5.88%). Most tumors (41.17 %) were between 1 and 2cm. Most patients showed low risk of recurrence, and all were surgically treated. Conclusion: The most frequent differentiated tumor was the papillary one. Its prevalence was on women, with an average age at diagnosis of 51 years. There were only two patients with recurrent disease, and one with metastasis to the lung that died. (AU)

Modelo ambulatorial de atendimento de nódulo de tireoide / Ambulatory care model thyroid nodule

A prevalência de detecção de nódulos na tireoide através da palpação é de aproximadamente 5%. Essa prevalência sobe para 19 a 67% quando utilizada a avaliação ecográfica. A importância da avaliação clínica dessa entidade está na necessidade de diagnosticar o câncer de tireoide que ocorre em 5 a 10% dos casos. O relato descreve o perfil dos atendimentos realizados no ambulatório de nódulos de tireoide do Hospital Municipal Dr. Mário Gatti no período de 01/05/17 a 27/07/18 de pacientes que tiveram diagnóstico ultrassonográfico de nódulo de tireoide e realizaram punção aspirativa por agulha fina, a fim de inferir a respeito da capacidade de resolutividade do ambulatório interdisciplinar (endocrinologia e cirurgia de cabeça e pescoço) no diagnóstico e tratamento do câncer de tireoide. A organização do ambulatório com atendimento integral e por equipe multidisciplinar, possibilita uma melhora na qualidade assistencial além de ser elemento facilitador para o ensino, aprendizado e pesquisa. (AU)

The rate of thyroid node detection by touch is approximately 5%. This rate goes up to a range between 19 and 67% when a sonographic evaluation is used. The importance of the clinical evaluation of those thyroid nodes is within the need of diagnosing the cancer that occurs in 5 to 10% of the cases. This paper describes the profile of consultations performed at the Outpatient Clinic Thyroid Node Unit of the Municipal Hospital Dr. Mário Gatti (HMMG) from 01/05/17 to 07/27/18, of patients who had ultrasonographic diagnostics of thyroid node and underwent fine-needle aspiration, in order to draw conclusions about the capacity of the interdisciplinary clinic (Endocrinology and Head and Neck surgery) to diagnose and treat thyroid cancer effectively. The organization of the outpatient clinic, with comprehensive care and multidisciplinary team, enables an improvement in medical assistance as well as facilitating teaching, learning and research. (AU)

Paget's disease of the breast without associated ductal carinoma: Case report and review of the literature / Enfermedad de paget de la mama, sin carcinoma ductal asociado: reporte de caso y revisión de la literatura

RESUMEN Objetivo: presentar un caso de enfermedad de Paget (EP) de la mama, sin carcinoma ductal asociado, y realizar una revisión de literatura respecto a su diagnóstico y tratamiento. Materiales y métodos: mujer de 59 años, con lesión pruriginosa, eritematosa y ulcerada crónica, en pezón izquierdo, de 2 años de evolución, quien recibió inicialmente manejo dermatológico con corticoides tópicos sin mejoría clínica, que acude finalmente a una institución de atención primaria en Tunja (Colombia) para su diagnóstico, el cual se realizó por biopsia mediante inmunohistoquímica y posterior manejo por cuadrantectomía central con patología posquirúrgica negativa para malignidad, sin recurrencia al año de seguimiento. Se realizó una búsqueda en las bases de datos Medline vía PubMed, SciELO, ProQuest, ScienceDirect y Google Académico con los términos "Paget´s Disease", "Breast Neoplasms", "Mammography" "Ultrasonography Mammary", "Biopsy" y "Mastectomy", rastreando artículos de revisión bibliográfica, editoriales, reportes y series de casos clínicos en inglés y español, sin límite de tiempo. Resultados: se incluyeron 11 publicaciones correspondientes a 5 reportes de caso, 3 series de casos, 1 revisión de la literatura a partir de un caso clínico, y 2 cartas al editor que describieron casos relacionados con enfermedad de Paget del pezón sin carcinoma asociado. El diagnóstico se fundamentó en la sospecha clínica de la enfermedad con la posterior realización de biopsia de la lesión; la inmunohistoquímica fue útil en el diagnóstico diferencial. El tratamiento varió desde mastectomía hasta resección de complejo areola-pezón. La radioterapia también ha sido utilizada. Conclusiones: el diagnóstico de la enfermedad de Paget sin carcinoma ductal asociado se fundamenta en una sospecha clínica temprana y en el estudio histopatológico del complejo areola-pezón. No hay consenso sobre el manejo quirúrgico de esta lesión. Se requieren estudios de seguimiento de este subgrupo de pacientes tratado con radioterapia o cirugía conservadora.

ABSTRACT Objective: To present one case of Paget's disease (PD) of the breast without associated ductal carcinoma, and to conduct a review of the literature on its diagnosis and treatment. Materials and methods: A 59-year-old woman with a two-year history of a chronic erythematous, ulcerated, itchy lesion in the left nipple, initially treated dermatologically with topical steroids with no improvement, finally visits a primary healthcare institution in the city of Tunja, Colombia for diagnosis. A biopsy and histochemical testing were performed to make the diagnosis and the lesion was then treated with central quadrantectomy. The post-operative pathology testing was negative for malignancy, without recurrence at one-year follow-up. A search was conducted in the PubMed, SciELO, ProQuest, ScienceDirect and Google Scholar databases using the terms "Paget´s Disease," "Breast Neoplasms," "Mammography," "Ultrasonography," Mammary," "Biopsy," and "Mastectomy," tracking bibliographic review articles, editorials, reports and clinical case series in English and Spanish, without time limitation. Results: Overall, 11 publications were included consisting of 5 case reports, 3 case series, 1 review of the literature based on a clinical case, and 2 letters to the editor describing cases related to Paget's disease of the nipple with no associated carcinoma. The diagnosis was based on the clinical suspicion of the disease and a biopsy of the lesion. Histochemistry was useful for the differential diagnosis: treatment options ranged from mastectomy to nipple-areolar complex resection. Radiotherapy has also been used. Conclusions: The diagnosis of Paget's disease with no associated ductal carcinoma is based on early clinical suspicion and histopathology of the nipple-areolar complex. There is no consensus regarding surgical management of this lesion. Follow-up studies of this subgroup of patients treated with radiotherapy or conservative surgery are required.

A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features / Modelo preditivo para diferenciação entre nódulos malignos e benignos da tireoide com base na idade, sexo e características ultrassonográficas

Abstract Introduction: A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains. Objective: The purpose of this study was to create a statistical prediction model for thyroid nodules management. Methods: Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case. Results: In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%. Conclusions: The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.

Resumo Introdução: Persiste na literatura uma discussão sobre uma ferramenta padronizada de apoio à decisão para o manejo de nódulos tireoidianos. Objetivo: Criar um modelo de previsão estatística para o manejo de nódulos tireoidianos. Método: Foram selecionados 204 casos de nódulos tireoidianos benignos e 57 malignos para o estudo retrospectivo. As variáveis idade, sexo e características ultrassonográficas foram analisadas com modelos univariados e multivariados. Uma fórmula estatística foi usada para calcular o risco de câncer de cada caso. Resultados: Na análise multivariada, a forma irregular, a ausência de halo, menor idadesubp média, ecotextura homogênea, microcalcificações e conteúdo sólido foram associadas ao câncer. Após a aplicação da fórmula, foram encontrados 20 casos (7,6%) com risco calculado de malignidade ≤ 3,0%, todos benignos. Definiu-se o risco calculado em ≥ 80%, 21 casos (8,0%) foram selecionados e em 85,7% deles o câncer foi confirmado pela histopatologia. A precisão interna da fórmula de previsão foi de 92,5%. Conclusões: A fórmula de previsão alcançou alta precisão e pode ser uma opção para outras ferramentas de apoio à decisão para o manejo de nódulos da tireoide.

Punción percutánea transtorácica con aguja gruesa: complicaciones y factores de riesgo inherentes al paciente / Imaging-guided Chest Biopsies with Thick Needle: Complications and Risk Factors Inherent to the Patient

Objetivo Determinar la incidencia de complicaciones con el uso de una aguja gruesa (semiautomática Trucut 18), para punción pulmonar y realizar un análisis exploratorio de las variables inherentes al paciente que probablemente puedan tener relación con el desarrollo de complicaciones. Materiales y Métodos Estudio retrospectivo de una serie de casos de pacientes sometidos a punción percutánea transtorácica (PPT) con aguja gruesa y guiada por tomografía computada (TC) para el estudio de lesiones pulmonares; se realizó un análisis univariado. Resultados Se realizaron 26 punciones, la tasa de incidencia de complicaciones fue del 38,46% en 1 año; los pacientes presentaron: neumotórax leve (n » 7), neumotórax moderado (n » 3) y hemorragia alveolar difusa (n » 1). El análisis estadístico univariado mostró una diferencia estadísticamente significativa en la edad de los pacientes que presentaron complicaciones v/s los pacientes que no presentaron complicaciones (61,18 þ/- 3,6 versus 75,1 þ/- 2,46 años, p » 0,0107). Conclusión La PPT-TC es un procedimiento con una tasa considerable de complicaciones no severas; en nuestra serie de casos, la edad fue la variable que se asoció con mayor fuerza al probable desarrollo de complicaciones.

Objective Establish the incidence of complications with the use of thick needle (Trucut 18) for pulmonary puncture and perform an exploratory analysis of the inherent variables to the patient that may be related to complication development. Materials and Methods Retrospective study of a case series of patients undergoing transthoracic percutaneous puncture (PPT) with thick needle,guided by computed tomography (CT) for the study of pulmonary lesions; a univariate and multivariate analysis was performed. Results 26 punctures were performed, the incidence rate of complications was 38.46% in 1 year: patients presented: mild pneumothorax (n » 7), moderate pneumothorax (n » 3) and diffuse alveolar hemorrhage (n » 1). The univariate statistical analysis showed a statistically significant difference in the age of the patients who presented complications v/s patients who did not present complications (61.18 þ/- 3.6 versus 75.1 þ/- 2.46 years, p » 0.0107). Conclusion PPT-CT is a procedure with a considerable rate of non-severe complications; in our case series, age was the variable that was most strongly associated with the probable development of complications.

Primary bilateral and symmetric MALT lymphoma of the lacrimal sac mimicking chronic dacryocystitis / Linfoma MALT primário, bilateral e simétrico do saco lacrimal simulando dacriocistite crônica

Abstract We report a case of primary bilateral mucosa associated lymphoid tissue (MALT) lymphoma of the lacrimal sac. MALT lymphoma is a subtype of Non-Hodgkin's Lymphoma of the ocular adnexa. When the primary site of the lymphoma is the lacrimal sac, it mimics chronic dacryocystitis. This may delay diagnosis, with potentially lethal results.

Resumo Descrevemos um caso de um linfoma MALT bilateral, simétrico e primário de saco lacrimal. O linfoma MALT é um subtipo do Linfoma Não-Hodkin dos anexos oculares. Quando o local primário do linfoma é o saco lacrimal, ele pode simular uma dacriocistite crônica. Essa situação pode atrasar o diagnóstico e ter consequências fatais.

Bone biopsy in nephrology practice / Biópsia óssea na prática nefrológica

Abstract Renal osteodystrophy (ROD), a group of metabolic bone diseases secondary to chronic kidney disease (CKD), still represents a great challenge to nephrologists. Its management is tailored by the type of bone lesion - of high or low turnover - that cannot be accurately predicted by serum biomarkers of bone remodeling available in daily clinical practice, mainly parathyroid hormone (PTH) and alkaline phosphatase (AP). In view of this limitation, bone biopsy followed by bone quantitative histomorphometry, the gold-standard method for the diagnosis of ROD, is still considered of paramount importance. Bone biopsy has also been recommended for evaluation of osteoporosis in the CKD setting to help physicians choose the best anti-osteoporotic drug. Importantly, bone biopsy is the sole diagnostic method capable of providing dynamic information on bone metabolism. Trabecular and cortical bones may be analyzed separately by evaluating their structural and dynamic parameters, thickness and porosity, respectively. Deposition of metals, such as aluminum and iron, on bone may also be detected. Despite of these unique characteristics, the interest on bone biopsy has declined over the last years and there are currently few centers around the world specialized on bone histomorphometry. In this review, we will discuss the bone biopsy technique, its indications, and the main information it can provide. The interest on bone biopsy should be renewed and nephrologists should be capacitated to perform it as part of their training during medical residency.

Resumo A osteodistrofia renal (OR), um grupo de doenças ósseas metabólicas secundárias à doença renal crônica (DRC), ainda representa um grande desafio para os nefrologistas. Seu manejo é individualizado de acordo com o tipo de lesão óssea - de alto ou baixo remodelamento - cujo diagnóstico não pode ser prevista com precisão pelos biomarcadores séricos de remodelação óssea disponíveis na prática clínica diária, principalmente o paratormônio (PTH) e a fosfatase alcalina (FA). Em vista dessa limitação, biópsia óssea seguida de histomorfometria óssea quantitativa, método padrão-ouro para o diagnóstico de OR, ainda é considerado um procedimento de grande importância. A biópsia óssea também é recomendada na avaliação da osteoporose em indivíduos com DRC, a fim de auxiliar na escolha do melhor medicamento anti-osteoporótico. É importante observar que a biópsia óssea é o único método diagnóstico capaz de proporcionar informações dinâmicas sobre o metabolismo ósseo. Os ossos trabecular e cortical podem ser analisados separadamente por meio da avaliação de seus parâmetros estruturais e dinâmicos, espessura e porosidade, respectivamente. A deposição óssea de metais como alumínio e ferro também pode ser detectada. Apesar de suas características singulares, o interesse pela biópsia óssea diminuiu nos últimos anos. Poucos centros em todo o mundo são especializados em histomorfometria óssea. A presente revisão discute a técnica de biópsia óssea, suas indicações e as principais informações que ela pode oferecer. O interesse pela biópsia óssea deve ser renovado e os nefrologistas devem ser capacitados a realizá-la durante o período de residência médica.