Poliadenopatías mediastinales y diagnósticos diferenciales en lupus eritematoso sistémico. Reporte de un caso y revisión de la literatura / Mediastinal polyadenopathies and differential diagnoses in systemic lupus erythematosus. Case report and literature review

Paciente varón de 59 años de edad con diagnóstico de lupus eritematoso sistémico y cuadro de consolidación pulmonar asociada a poliadenopatías mediastinales y derrame pleural, con evolución crónica y tórpida. Se discuten diagnósticos diferenciales e implicancia clínica

A 59-year-old male patient with a diagnosis of systemic lupus erythematosus and pulmonary consolidation associated with mediastinal polyadenopathies and pleural effusion, with chronic and torpid evolution. Differential dignoses and clinical implications are discussed

Protocolos de encaminhamento da Atenção Básica para a Atenção Especializada: cirurgia torácica e pneumologia / Routing protocols of primary care to specialized care: thoracic surgery and pulmonology

Este material tem como objetivo orientar as equipes que atuam na AB, qualificando o processo de referenciamento de usuários para outros serviços especializados. É uma ferramenta, ao mesmo tempo, de gestão e de cuidado, pois tanto guiam as decisões dos profissionais solicitantes quanto se constitui como referência que modula as avaliações apresentadas pelos médicos reguladores.

Lymphadenopathy and fever in a chef during a stay in Europe / Linfadenomegalia e febre em chefe de cozinha durante viagem à Europa

This case illustrates a rare presentation (as lymphadenopathy and fever) of one of the most common zoonotic diseases worldwide-brucellosis-in a 22-year-old Brazilian male (a chef) who had recently returned to Brazil after having lived in and traveled around Europe for one year. The histopathology, clinical history, and response to treatment were all consistent with a diagnosis of brucellosis, which was confirmed by PCR in a urine sample. We also review some aspects of brucellosis, such as the clinical features, diagnosis, and management.

Ilustramos aqui um caso de uma apresentação atípica (na forma de linfadenomegalia e febre) de uma das doenças zoonóticas mais comuns no mundo - brucelose - em um paciente brasileiro de 22 anos (chefe de cozinha) que retornara ao Brasil recentemente após ter morado e viajado na Europa por um ano. A histopatologia, a história clínica e a resposta ao tratamento foram consistentes com o diagnóstico de brucelose, que foi confirmada por PCR em uma amostra de urina. Também revisamos alguns aspectos da brucelose, como manifestações clínicas, diagnóstico e tratamento.

Valor pronóstico del PET/CT en cáncer pulmonar: Estudio de sobrevida y caracterización metabólica tumoral / Prognostic value of PET/CT in lung cancer: Retrospective analysis of 47 patients

Background: PET/CT (Positron emission tomography/computed tomography) is a hybrid image modality widely used in oncology, for staging, therapy evaluation or follow up. Aim: To evaluate the prognostic value ofPET/CT in lung cancer. Material and Methods: Retrospective review of PET/CT records, selecting 51 patients with a lung malignancy, mass or nodule referred for PET/CT between December 2008 and December 2010. All had pathological confirmation of malignancy and had not been treated previously. Age, gender, body mass index, radiological features of lung tumor and metastases, and lung tumor 18F-fluoro-2-deoxy-d-glucose uptake using the SUV (Standardized uptake value) index were recorded. Survival was analyzed usingKaplan-Meier curves and a Cox proportional regression analysis. Results: Pathology confirmed the presence of lung cancer in 47 patients aged 30 to 88 years. Four patients (7.8%) had other type of tumors such as carcinoid or lymphoma. Fifty percent of lung cancer patients died during a mean observation lapse of 18 months (range: 2-34 months). Patients with metastases, local lymph node involvement, a lung tumor size > 3 cm and high tumor uptake (SUVmax > 6) had significantly lower survival. Occurrence of metastases was the only independent prognostic factor in the Cox regression. A lung lesion with a SUVmax ≥ 12 was always associated to hilar/mediastinal lymph node involvement. Conclusions: PET/CT imaging gives important prognostic information in lung cancer patients.

Sarcoidose em cicatrizes prévias / Sarcoidosis on previous scar

A sarcoidose é uma doença sistêmica de etiologia desconhecida, com apresentação clínica variável, onde 30 a 50% dos pacientes são assintomáticos ao diagnóstico. Afeta a pele, pulmões, sistema linfático, fígado e olhos. Outras áreas menos frequentemente afetadas são falanges ósseas, miocárdio, sistema nervoso central, fígado, baço e parótidas. A pele está envolvida em 25 a 35% dos casos, com diferentes formas de apresentação das lesões cutâneas. Relata-se caso de paciente de 26 anos cuja manifestação inicial da sarcoidose foram nódulos cutâneos em cicatrizes prévias e em que na investigação adicional mostrou-se haver acometimento pulmonar e mediastinal.

Sarcoidosis is a systemic disorder of unknown etiology and variable clinical presentation, where 30-50% of patients are asymptomatic at diagnosis. It affects the skin, lungs, lymphatic system, liver, and eyes. Less frequently affected areas are bone phalanxes, myocardium, central nervous system, liver, spleen and parotids. The skin is involved in 25-35% of the cases with different forms of presentation of skin lesions. Here the authors report the case of a 26-year-oldwhose initial manifestation of sarcoidosis were skin nodules on previous scars and which further investigation showed affected lung and mediastinum.

Evaluación de factores predisponentes para el sangrado mediastinal en cirugía de revascularización miocárdica: Papel del ácido acetilsalicílico, otros antiagregantes plaquetarios, y anticoagulantes / Evaluation of Predisposing Factors for Mediastinal Bleeding in Myocardial Revascularization Surgery: Role of Acetylsalicylic Acid, Other Platelet Adhesion Inhibitors, and Anticoagulants

Propósito del trabajo: Determinar los factores predisponentes para sangrados perioperatorios en cirugía de revascularización miocárdica y establecer el papel de ácido acetilsalicílico, otros antiagregantes plaquetarios, y anticoagulantes, en la ocurrencia de estos sangrados. Método: Se realizó un análisis multivariado de 251 pacientes sometidos a cirugía de revascularización miocárdica en el año 2002. Resultados: En la administración prequirúrgica de ácido acetilsalicílico no se encontró diferencia significativa para la ocurrencia de sangrado perioperatorio importante. No existió incremento significativo en la transfusión de unidades de paquetes globulares, plaquetas, crioprecipitados. Los pacientes con administración de heparina no fraccionada y de bajo peso molecular, tuvieron un sangrado transoperatorio significativamente mayor (p < 0.001) que los pacientes sin este fármaco. El empleo del resto de los fármacos estudiados, no incrementó la cantidad de sangrado ni la administración de hemoderivados. Conclusiones: No existe evidencia estadística que justifique suspender la administración de antiagregantes plaquetarios en los pacientes con síndromes coronarios urgentes o electivos, a quienes se les someta a cirugía de revascularización miocárdica. Sin embargo, resultaría conveniente suspender la administración de heparina no fraccionada y de bajo peso molecular, a pacientes sometidos a cirugía de revascularización miocárdica en forma electiva.

Objective: To determine the main factors for perioperative mediastinal bleeding during coronary artery by-pass grafting and to establish the role of acetylsalicylic acid, other inhibitors of platelet adhesion, and anticoagulants in its occurrence. Methods: A multivariate analysis was performed to the data obtained from 251 patients subjected to coronary artery by-pass grafting in the year 2002. Results: There were no significant differences for the occurrence of perioperative bleeding induced by the preoperative administration of acetylsalicylic acid. No significant increment in the need for blood, platelet, or cryoprecipitates transfusion existed. Patients receiving non-fractionated or low molecular weight heparin had a significantly greater (p < 0.001) transoperative bleeding than patients without this drug. Administration of the other studied drugs did not increase either mediastinal bleeding or the need for blood derivatives. Conclusions: No statistical evidence was found to suspend administration of inhibitors of platelet adhesion in patients with coronary syndromes, subjected to coronary artery by-pass grafting. However, data obtained suggest the convenience of suspending administration of low molecular weight or non-fractionated heparin to patients subjected electively to coronary artery by-pass grafting.

Aplasia pura roja : infrecuente manifestación hematológica de mielopatía autoinmune / Pure red aplasia : infrequent hematological manifestation of autoimmune myelopathy

Se presenta una paciente de 65 años de edad, con imagen tomográfica tumoral en lóbulo anterosuperior de pulmón izquierdo, que al resecarse se comprobó que era un nódulo de mediastino de 5 cm de diámetro, sin atipías, pero con infiltración linfoide. A continuación presentó linfocitosis de 10 meses de evolución seguida de anemia hemolítica. Luego de 2 años de remisión clínica se presentó con anemia aguda diagnosticada como Aplasia Pura Roja. Sus patologías revirtieron con corticosteroides. Se hace una actualización acerca de los vínculos entre las enfermedades de la médula ósea y la inmunopatología.