Estandarización de requerimientos mínimos para la formación de centro de detección temprana de cáncer de pulmón en América Latina / Standardization of Minimum Requirements for the Formation of an Early Detection Center for Lung Cancer in Latin America

Introducción: El cáncer de pulmón (CP) es una enfermedad con gran impacto a nivel mundial en el número de muertes y en costos en salud. La alta incidencia y mortalidad de esta enfermedad asociada al diagnóstico tardío, y la mejoría del pronóstico ante una detección temprana, determinan que sea una patología pasible de beneficiarse mediante detección temprana. La tomografía de baja dosis de radiación (TCBD) demostró ser un método que se pue- de realizar periódicamente a un grupo de personas con alto riesgo de desarrollar CP y así reducir la mortalidad por esta enfermedad. Sin embargo, este beneficio es tal cuan- do se encuentra desarrollado bajo un programa organizado y con participación multi- disciplinaria especializada en cáncer de pulmón. Métodos: Se plantea determinar lineamientos básicos para el desarrollo de la detección temprana de cáncer de pulmón en América Latina para que pueda ser realizada en forma uniforme, con el menor riesgo y el máximo beneficio esperado. Se analizaron las principales publicaciones referidas a este tema, contemplando la diversidad de atención y acceso de América Latina. Resultado: Se desarrollan requerimientos mínimos para la implementación de un pro- grama. Discusión: El número de programas en la región es escaso y depende más de esfuerzos individuales que de políticas generales de salud. Consideramos que estos lineamien- tos pueden servir de apoyo para el desarrollo de más programas en la región y de for- ma más homogénea.

Introduction: Lung cancer (LC) is a disease with a great impact worldwide in the number of deaths and health costs. The high incidence and mortality of this disease associated with late diagnosis and the improved prognosis with early detection determine that it is a pathology that can benefit from early detection. Low radiation dose tomography (LDCT) demonstrated a method that can be performed periodically to a group of people at high risk of developing CP and thus reduce mortality from this disease. However, this benefit is such when it is developed under an organized program with multidisciplinary participation specialized in lung cancer. Methods: It is proposed to determine basic guidelines for the development of early de- tection of lung cancer in Latin America so that it can be carried out uniformly, with the lowest risk and the maximum expected benefit. The main publications referring to this topic were analyzed, considering the diversity of care and access in Latin America. Result: Minimum requirements are developed for the implementation of a program. Discussion: The number of programs in the region is small and depends more on individual efforts than on general health policies. We consider that these guidelines can serve as support for the development of more programs in the region and in a more ho- mogeneous way.

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)

Perfil epidemiológico de pacientes vítimas de trauma torácico em um hospital de urgência e trauma / Epidemiological profile of patients victims of thoracic trauma in an emergency and trauma hospital

O trauma é responsável por significativos impactos na sociedade. De acordo com dados da Organização Mundial de Saúde (OMS), mais de nove pessoas morrem por minuto, vítimas de trauma. Entre os principais tipos de trauma, o torácico representa na atualidade cerca de 25% dos mortos em politraumatizados, constituindo um problema complexo, tendo em vista os elevados índices de mortalidade e sequelas incapacitantes permanentes. Objetivo: Descrever o perfil epidemiológico dos pacientes atendidos em um hospital de urgências da região centro-oeste, vítimas de trauma torácico. Método: Estudo quantitativo, de caráter transversal e retrospectivo, realizado a partir de coleta de dados efetuada em prontuário eletrônico no período de março a maio de 2022. Resultados: Identificou-se 73 pacientes vítimas de trauma torácico, com maior acometimento de pessoas do sexo masculino, com idade entre 26 e 35 anos. Como causa mais frequente, se destacaram os acidentes motociclísticos, resultando principalmente em lesões do tipo hemopneumotórax. Conclusão: o perfil epidemiológico dos pacientes vítimas de trauma torácico foi representado com maior frequência pelo sexo masculino, com idade entre 26 a 35 anos, causados predominantemente por acidentes motociclísticos, resultando na maioria das vezes em lesões do tipo hemopneumotórax

Trauma is responsible for significant impacts on society. According to data from the World Health Organization (WHO), more than nine people die per minute victims of trauma. Among the main types of trauma, thoracic trauma currently represents about 25% of polytrauma deaths, constituting a complex problem, in view of the high rates of mortality and sequelae permanent disabling. Objective: To describe the epidemiological profile of patients treated at an emergency hospital in the Midwest region, victims of thoracic trauma. Method: Quantitative, cross-sectional and retrospective study carried out from data collection of electronic medical records in the period from March to May of 2022. Results: We identified 73 patients who were victims of chest trauma with higher affecting males aged between 26 and 35 years. As the most frequent cause motorcycle accidents stood out, resulting mainly in lesions of the hemopneumothorax type. Conclusion: the profile epidemiology of patients victims of thoracic trauma was represented with greater frequency by males, aged between 26 and 35 years, caused predominantly by motorcycle accidents, often resulting in hemopneumothorax lesions

Asociación entre sarcopenia medida con el índice del psoas por tomografía abdominal y complicaciones posoperatorias tempranas en pacientes concáncer gástrico / Association between sarcopenia measured with the psoas index by abdominal tomography and early postoperative complications in patients with gastric cancer

Introducción. En Colombia el cáncer gástrico representa un problema de salud pública teniendo en cuenta su alta incidencia y sus elevadas tasas de mortalidad. Cerca del 15 % de los pacientes sufren una pérdida significativa de peso, lo que se asocia con un incremento en la morbilidad y mortalidad. Método. Se realizó un estudio de corte transversal, con el objetivo de determinar la presencia de sarcopenia a través de la medición del índice del psoas por tomografía computarizada y su asociación con morbimortalidad postoperatoria temprana en pacientes con cáncer gástrico. Se incluyeron los pacientes con cáncer gástrico admitidos entre el 1° de enero de 2014 y el 31 de agosto de 2019 en el Hospital Militar Central, en Bogotá, D.C., Colombia. Se hizo un análisis descriptivo, un análisis bivariado y un análisis de regresión logística univariado para determinar la asociación de sarcopenia y complicaciones a 30 días. Todos los análisis fueron realizados en R®. Resultados. Se estudiaron 70 pacientes, encontrando una frecuencia de sarcopenia de 54,3 % (n=38), edad media de 69 años (RIC 54 - 74), mayor proporción de hombres 68,6 % (n=48), siendo menor en el grupo de sarcopenia 55,3 % (n=21), índice de psoas de 0,63 mm (RIC 0,55 - 0,7), mortalidad 2,9 % (n=2) y asociación de sarcopenia con desenlaces a 30 días (OR 1,2; IC95% 0,59 - 2,4). Discusión. Se encontraron resultados similares a los informados en la literatura mundial, con una mortalidad inferior al 3 %. En este estudio, la sarcopenia no se asoció con la aparición de complicaciones a 30 días

Introduction. Gastric cancer represents a public health problem in Colombia considering its high incidence and high mortality rates. About 15% of patients suffer a significant weight loss, which is associated with an increase in morbidity and mortality.Method. A cross-sectional study was carried out in order to determine the presence of sarcopenia by measuring the psoas index by computed tomography and its association with early postoperative morbidity and mortality in patients with gastric cancer. Gastric cancer patients admitted between January 1, 2014 and August 31, 2019 at Hospital Militar Central, in Bogotá, D.C., Colombia were included. Descriptive analysis, bivariate analysis, and univariate logistic regression analysis were performed to determine the association of sarcopenia and complications at 30 days. All analyzes were performed in R®.Results. Seventy patients were studied, finding a frequency of sarcopenia of 54.3% (n=38), mean age of 69 years (IQR 54-74), higher proportion of men 68.6% (n=48), being lower in sarcopenia group 55.3% (n=21), psoas index of 0.63 mm (IQR 0.55 - 0.7), mortality 2.9% (n=2) and no association of sarcopenia with outcomes a 30 days (OR 1.2; 95% CI 0.59 - 2.4). Discussion. Similar results were found to those reported in the world literature, with a mortality of less than 3%. In this study, sarcopenia was not associated with the development of complications at 30 days

Descripción clínica y epidemiológica de pacientes con pancreatitis crónica en un hospital de alta complejidad en Cali, 2011 a 2017 / Clinical and epidemiological description of patients with chronic pancreatitis treated at a quaternary care hospital in Cali, 2011-2017

Resumen Introducción: la pancreatitis crónica (PC) es una inflamación progresiva del páncreas que puede llevar a su destrucción e insuficiencia irreversibles. Es una patología desafiante para el médico, debido a que establecer su diagnóstico puede tomar meses e incluso años, el seguimiento de pacientes suele ser problemático y el conocimiento sobre la clínica y epidemiología en Colombia es incompleto. Este estudio pretende hacer una descripción de pacientes con PC en un centro de referencia en gastroenterología de Cali, Colombia. Metodología: estudio de corte transversal de pacientes adultos con PC confirmada por criterios clínicos y radiológicos entre 2011 y 2017. Resultados: se incluyeron 36 pacientes con PC. La mayoría fueron hombres (72,2%) y la media de edad fue 56 (+ 15,1) años. El dolor abdominal crónico fue la presentación clínica más común (83,3%). Cerca de un cuarto de pacientes presentaba diabetes mellitus (22,2%). Se consideró etiología idiopática en 58,3%, alcohólica en el 11,0% y biliar en el 11,0%. La tomografía axial computarizada (TAC), resonancia magnética (RMN) y colangiopancreatografía por RMN fueron los métodos diagnósticos más usados (60,5%), con los que en su mayoría se visualizó atrofia (53,1%), dilatación de conductos (49,0%) y calcificaciones del páncreas (34,7%). Conclusión: los síntomas inespecíficos de la PC en fases iniciales y su largo curso clínico favorecen al subdiagnóstico de esta patología. Los resultados presentados pueden contribuir a la futura creación de escalas clínicas locales que orienten estudios radiológicos y genéticos tempranos, con el fin de lograr un diagnóstico oportuno y mejorar la calidad de vida de estos pacientes.

Abstract Introduction: Chronic pancreatitis (CP) is a progressive inflammation of the pancreas that can lead to irreversible damage and failure. This condition poses great challenges to physicians since its diagnosis can take months or even years. Patient follow-up is often problematic and knowledge about its clinical presentation and epidemiology in Colombia is scarce. This study aims to describe patients with CP treated at a gastroenterology reference center in Cali, Colombia. Methodology: Cross-sectional study in adult patients with CP confirmed based on clinical and radiological criteria between 2011 and 2017. Results: 36 patients with CP were included. The majority were men (72.2%), and the mean age was 56 (+15.1) years. Chronic abdominal pain was the most common clinical presentation (83.3%). About a quarter of patients had diabetes mellitus (22.2%). Etiology was idiopathic in 58.3%, alcoholic in 11.0%, and biliary in 11.0%. Computed tomography (CT), magnetic resonance imaging (MRI), and MRI cholangiopancreatography were the most commonly used diagnostic methods (60.5%), showing mostly atrophy (53.1%), duct dilation (49.0%), and pancreatic calcifications (34.7%). Conclusion: Nonspecific symptoms of CP in early stages and its long clinical course favor the underdiagnosis of this condition. The results presented may contribute to the future creation of local clinical scales that guide early radiological and genetic studies to achieve a timely diagnosis and improve the quality of life of these patients.

Tumor retroperitoneal en el espectro de enfermedades asociadas a igg4 / Retroperitoneal tumor in the clinical spectrum of igg4 related disease

Presentamos el caso de una mujer de 55 años sin antecedentes, que acude por dolor abdominal, se realiza una tomografía abdominopélvica evidenciando un tumor retroperitoneal de aspecto quístico en la periferia de la aorta abdominal, que afecta el riñón izquierdo. Se le realizó una laparotomía exploratoria, nefrectomía izquierda, tumorectomía retroperitoneal y una resección de un fragmento de la aorta abdominal con reporte histopatológico, corroborado por una prueba inmunohistoquímica de fibrosis retroperitoneal y aortitis por IgG4. El espectro de enfermedades relacionadas con IgG4 es de origen inmunológico con la capacidad de involucrar casi cualquier órgano. La epidemiología no es precisa, aunque se observa mayor predilección por la raza asiática, siendo más común durante la séptima década de vida. El diagnóstico radica en la coexistencia de varios parámetros clínicos, laboratoriales e histopatológicos, sin ser ninguno de estos patognomónicos. El objetivo del presente artículo es exponer el reporte de un caso con manifestación inusual de fibrosis retroperitoneal y dar a conocer que la importancia del diagnóstico radica en la decisión terapéutica, ya que cursa con buena respuesta al tratamiento inmunosupresor.

We present the case of a 55-year-old woman, with noclinical pathological history, who presented with abdominal pain, abdominopelvic tomography showing retroperitoneal tumoral in the periphery of the abdominal aorta, which affects the left kidney producing hydronephrosis. Exploratory laparotomy, left radical nephrectomy, retroperitoneal tumorectomy and resection of a fragment of abdominal aorta were performed, with histopathological report, corroborated by immunohistochemistry of retroperitoneal fibrosis and IgG4 aortitis. The spectrum of diseases related to IgG4, are of immunological origin that can involve almost any organ. The epidemiology is not precise, although a greater predilection for the Asian race is observed, being more common in the seventh decade of life, it should be suspected in patients with unexplained pain in one or more organs.The diagnosis lies in the coexistence of several clinical, laboratorial and histopathological parameters, without being any of these pathognomonic. We present a case with unusual presentation of retroperitoneal fibrosis and the importance of the diagnosis lies in the therapeutic decision, since it responds well to immunosuppressive treatment, without requiring surgical management.

Taponamiento pericárdico asociado a minoxidil: un diagnóstico olvidado / Pericardial tamponade associated with minoxidil: a forgotten diagnosis

Resumen El derrame pericárdico es una acumulación excesiva de líquido en el espacio pericárdico, el cual se ha asociado al empleo crónico de minoxidil desde principios de su uso clínico; este es formulado comúnmente a pacientes con hipertensión arterial de difícil control y con enfermedad renal crónica asociada, por su efecto vasodilatador arterial y poco efecto sobre la circulación venosa. Se expone el caso de un paciente quien presentó clínica sugestiva de derrame pericárdico, el cual fue confirmado por imágenes (rayos X, tomografía y ecocardiografía) y quien además se encontraba en tratamiento de hemodiálisis crónica por enfermedad renal crónica secundaria a síndrome nefrótico. En la literatura existen algunos reportes de casos similares, pero no hay estudios con datos concluyentes que permitan establecer un porcentaje claro de asociación ni la causa de esta enfermedad. Con este reporte de caso se busca aumentar la sospecha diagnóstica de esta asociación para que otros clínicos tengan este posible diagnóstico en mente, una vez se hayan descartado otras etiologías adicionales y puedan suspender a tiempo la medicación a fin de evitar desenlaces catastróficos como el taponamiento pericárdico.

Abstract Pericardial effusion is an excessive accumulation of fluid in the pericardial space and has been associated with the long-term use of minoxidil from the beginning of its clinical use. It is commonly prescribed to patients with difficult to control arterial hypertension and associated chronic kidney disease due to it arterial vasodilator effects and little effect of the venous circulation. A case is presented on a patient who had a clinical picture suggestive of a pericardial effusion, which was confirmed by imaging tests (X-ray, tomography, and cardiac ultrasound). She was also on long-term haemodialysis treatment due to chronic kidney disease secondary to a nephrotic syndrome. There are reports of similar cases in the literature, but there are no studies with conclusive data that may help to establish a clear percentage association or the cause of the disease. This case report seeks to increase the diagnostic suspicion of this association so that other clinicians may have this possible diagnosis in mind, once they have ruled out any other. They can then stop the medication on time in order to prevent catastrophic outcomes like pericardiac tamponade.

Association between Morphodynamic Variables by Transesophageal Echocardiography and CHA2DS2-Vasc Values

In atrial fibrillation (AF), the CHA2DS2-VASc score calculates the risk for stroke. Di Biase classified the left atrial appendage (LAA), using magnetic resonance imaging, into 4 morphological types and correlated it with cerebrovascular events. Transesophageal echocardiography (TEE) also evaluates LAA and is a more widespread technique. Objective: To evaluate, using TEE, the possibility of characterizing LAA and to analyze its morphological aspects using the CHA2DS2VASc score. Methodology: A total of 247 patients were divided into three groups considering the CHA2DS2-VASc score: Group 1: 0 and 1; Group 2: 2 and 3 and, Group 3: ≥ 4 points. TEE produced the echocardiographic data. LAA was classified into thrombogenic and non-thrombogenic morphologies. In the analysis of statistical tests, a significance level of 5% was adopted. Results: The average age was 50 and 16.2% presented AF. In Group 1, we observed normal variables with a lower prevalence of AF (8.7%, p < 0.001). In group 2, spontaneous contrast was detected in 26.7%, (p < 0.001), thrombus in 6.7% (p = 0.079) and flow velocity in LAA < 0.4 m/s in 22.7% (p < 0.001) of the cases. Group 3 presented the highest percentages of AF (31.8%, p < 0.001), stroke/TIA (77.3%, p < 0.001), EF < 55% (18.2%, p = 0.010) and higher prevalence of thrombogenic type LAA (72.7%, p = 0.014). A higher occurrence of stroke/TIA was observed in patients with thrombogenic LAA (25.2%) compared to the non-thrombogenic group (11.2%), (p = 0.005). Conclusions: The thrombogenic morphology of LAA identified in TEE presented a higher risk of stroke regardless of the CHA2DS2VASc score. Patients with higher scores had greater abnormalities in echocardiographic variables

Tamaño del infarto cerebral aterotrombótico del territorio carotídeo según sus factores de riesgo / Size of the atherothrombotic cerebral infarction from carotid territory according to its risk factors

Introducción: La mayoría de los infartos cerebrales aterotrombóticos son debidos a aterosclerosis extracraneal y a los factores de riesgo que lo condicionan. Objetivo: Caracterizar a pacientes con ictus aterotrombótico de territorio anterior según tamaño, sexo y factores de riesgo aterotrombótico. Métodos: Se realizó un estudio transversal a 63 pacientes que acudieron al Hospital Militar Central "Dr. Carlos J. Finlay" con diagnóstico de infarto cerebral aterotrombótico reciente de territorio carotídeo, a los que se les realizó tomografía de cráneo simple, entre los años 2011 y 2013. Resultados: Predominaron los infartos grandes (57,1 por ciento) en hombres (80,6 por ciento) y de forma general también fue el sexo masculino el más afectado (68,3 por ciento). La mayoría de los pacientes que tuvieron tanto infartos medianos (59,3 por ciento) como infartos grandes (58,3 por ciento), refirieron de 3 a 4 factores de riesgo aterotrombótico (58,7 por ciento). Prevaleció la hipertensión arterial (82,5 por ciento), con mayor coincidencia con los infartos medianos (88,9 por ciento), que con los infartos grandes (77,8 por ciento). Conclusiones: El ictus aterotrombótico reciente de territorio de irrigación carotídeo se caracterizó en esta serie, por infartos grandes y mayor afectación de adultos mayores, hipertensos, del sexo masculino. La existencia de 3 a 4 factores de riesgo en cada paciente prevalece tanto en los que presentan infarto cerebral mediano como grande(AU)

Introduction: Most of atherothrombotic cerebral infarctions are due to extracranial atherosclerosis and the risk factors that condition it. Objective: To characterize patients with atherothrombotic stroke of the anterior territory according to size, sex and atherothrombotic risk factors. Method: A cross-sectional study was performed on 63 patients attended at the "Dr. Carlos J. Finlay" hospital with a diagnosis of recent atherothrombotic cerebral infarction of the carotid territory, who underwent simple skull tomography, between 2011 and 2013. Results: Large infarcts predominated (57.1 percent) in men (80.6 percent) and in general, male sex was also the most affected (68.3 percent). Most of patients who had both moderate infarcts (59.3 percent) and large infarcts (58.3 percent), reported 3 to 4 atherothrombotic risk factors (58.7 percent). Prevalence of arterial hypertension (82.5 percent), with greater coincidence with medium infarcts (88.9 percent), than with large infarcts (77.8 percent). Conclusions: The recent atherothrombotic stroke of the carotid irrigation area was characterized in this series, due to large infarcts and greater involvement of elderly, hypertensive males. The existence of 3 to 4 risk factors in each patient prevails both in those with medium cerebral infarction and large ones(AU)

Tratamento endovascular da síndrome de quebra-nozes: relato de caso / Endovascular treatment of Nutcracker syndrome: case report

A dor pélvica crônica é uma doença debilitante, com impacto na qualidade de vida e custos para os serviços de saúde. A síndrome de quebra-nozes é uma importante causa dessa dor, e se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta. Seu tratamento ainda permanece controverso e varia de acordo com a gravidade clínica do paciente. Contudo, a técnica endovascular com implante de stent em veia renal tem obtido excelentes resultados. Relatamos um caso de uma paciente de 59 anos submetida a correção endovascular com stent autoexpansível de nitinol. São apresentados dados clínicos, detalhes do procedimento e resultados do acompanhamento dessa paciente. O sucesso técnico foi obtido e não houve relato de complicações pós-operatórias. Pôde-se observar alívio dos sintomas e melhora nos exames de imagem realizados no acompanhamento de curto prazo

Chronic pelvic pain is a debilitating disease that directly impacts on quality of life and generates costs for health services. Nutcracker Syndrome is an important cause of pelvic pain and consists of a set of signs secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta. Treatment remains controversial and varies depending on the patient's clinical severity. However, endovascular treatment with renal vein stenting has achieved excellent results. We report the case of a 59 year-old female treated by endovascular repair with a self-expanding nitinol stent. Clinical data, details of the procedure, and follow-up results are presented. Technical success was achieved and there patient reported no postoperative complications. Short-term, there was relief from symptoms and follow-up imaging tests showed improvement

Imágenes en Medicina: fibrosis peritoneal / Medical images: retroperitoneal fibrosis

Se reporta el caso de un paciente varón de 36 años con antecedente de litiasis renal que visita al urólogo por lumbalgia crónica y astenia. Se solicita laboratorio que arroja aumento de reactantes de fase aguda y leucocitosis. El diagnóstico por imagen comprende tomografía (TC) de abdomen y pelvis con contraste endovenoso (EV), TC tórax, ecografía testicular con doppler color y Resonancia Magnética de abdomen y pelvis con gadolinio EV. El servicio de diagnóstico por imágenes plantea la posibilidad de fibrosis retroperitoneal como primer diagnóstico diferencial. Se solicita biopsia de la lesiónpara su confirmación, que demuestra tejido fibrótico, confirmando el diagnóstico de fibrosis retroperitoneal, en este caso idiopática

The case of a 36-year-old male patient with a history of renal lithiasis who visits the urologist for chronic low back pain and asthenia is reported. Laboratory is requested to show an increase in acute phase reactants and leukocytosis. The imaging diagnosis includes tomography (CT) of the abdomen and pelvis with intravenous contrast, chest CT, testicular ultrasound with color doppler and Magnetic Resonance of the abdomen and pelvis with gadolinium. The diagnostic imaging service raises the possibility of retroperitoneal fibrosis as the first differential diagnosis. Biopsy of the lesion is requested for confirmation, which demonstrates fibrotic tissue, confirming the diagnosis of idiopathic retroperitoneal fibrosis, in this case

Implante transcateter valvar aórtico (TAVI): onde estamos em 2018 / Transcatheter aortic valve implant (TAVI): where we are in 2018

Por cerca de 15 anos, o Implante Transcateter Valvar Aórtico (TAVI) passou por avanços tecnológicos, adquiriu experiência acumulada e tornou-se alternativa à cirurgia convencional. A principal indicação é a estenose aórtica degenerativa do idoso. Evidências atuais foram ampliadas para aqueles de risco intermediário e se tornaram mais robustas nos pacientes de alto risco e inoperáveis. Em situações específicas, como valva aórtica bicúspide, regurgitação aórtica pura, pacientes de baixo risco e bioprótese cirúrgica degenerada, os resultados ainda não são totalmente previsíveis, mas muito promissores. Os tipos de dispositivos atualmente liberados para uso clinico são divididos em: da geração inicial e os da nova geração, assim como em auto expansível, balão expansível e expansível mecanicamente. O sítio de acesso preferencial na atualidade é a via transfemoral. Outras alternativas de acessos também têm se mostrado viáveis e confiáveis. As principais complicações são vasculares, eventos neurológicos, distúrbios de condução e regurgitação paravalvar. Apesar da baixa incidência, a ruptura aórtica e a oclusão coronária são uma fonte de maior interesse, devido ao seu potencial impacto na morbimortalidade. A realização mais recente do procedimento em pacientes mais jovens faz necessária mais atenção à questões referentes à durabilidade e ao risco de trombose. Embora o TAVI ainda possa ser um procedimento complexo, após atingida experiência, existe a tendência de migração para uma abordagem mais simplificada com segurança. A seleção do paciente deve, idealmente, ser feita por uma equipe multidisciplinar e uma completa avaliação por imagem, em que a angitomografia é imprescindível, mandatória

For around fifteen years, Transcatheter Aortic Valve Implant (TAVI) has undergone technological advances, acquired accumulated experience, and become an alternative to conventional surgery. The main indication is degenerative aortic stenosis in the elderly patient. Current evidence has been extended to those with intermediate risk, and has become more robust in high-risk and inoperable patients. In specific situations, such as bicuspid aortic valve, pure aortic regurgitation, low-risk patients, and degenerated surgical bioprosthesis, the results are not totally predictable, but are very promising. The types of device currently released for clinical use are divided into first generation and new generation devices, and into auto-expandable, balloon-expandable, and mechanically-expandable. The preferential access site is currently the transfermoral route. Other access alternatives have also proven viable and reliable. The main complications are vascular, neurological events, conduction disturbances, and paravalvular regurgitation. Despite their low incidence, aortic rupture and coronary occlusion have attracted greater interest due to their potential impact on morbimortality. The more recent use of the procedure in younger patients raises issues related to durability and the risk of thrombosis. Although TAVI is still a complex procedure, after gaining experience, there is a tendency to move towards a more simplified, safer approach. The patient selection should ideally be carried out by a multidisciplinary team, and a complete imaging assessment that includes angiotomography is absolutely essential

Evolução no tratamento dos aneurismas da aorta torácica / Evolution and treatment of throracic aortic aneurysms

Os autores realizam uma revisão, de característica didática, das aortopatias, focalizando o histórico, o desenvolvimento do tratamento e os aspectos atuais de abordagem, utilizando a alta tecnologia das salas híbridas. Nos últimos anos, graças ao desenvolvimento das técnicas endovasculares, ocorreu uma verdadeira revolução no tratamento, especialmente para as patologias da aorta descendente, em que procedimentos eficientes foram aplicados com acentuada redução da morbimortalidade. A utilização de salas híbridas e tecnologia de moldes 3D, permitindo endoprótese customizadas, constituem-se em avanços significativos a serem utilizados nos próximos anos e que mudarão os paradigmas de uma subespecialidade

The authors performed a didactic review of aortic diseases, focusing on the historical aspects, the development of treatment, and aspects of the current approach using the latest technology of hybrid surgical rooms. In recent years, thanks to the development of endovascular techniques, there has been a real treatment revolution, especially for diseases of the descending aorta, with the application of efficient procedures, resulting in a significant reduction in morbidity and mortality. The use of hybrid technology rooms and computer 3-D reconstruction technology, enabling customized endoprostheses, are significant advances to be used in the coming years, and that will change the paradigms of a sub-specialty.

Plasmocitoma extramedular: una rara causa de masa mediastínica / Extramedullary mediastinal plasmacytoma: report of one case

Solitary extramedullary plasmacytomas represent 3% of plasma cell neoplasms. Their most common locations are the upper gastrointestinal and respiratory tract. We report a 70-year-old male presenting with progressive dyspnea and cough. A chest radiography showed widened mediastinum. Chest computed tomography showed a mediastinal mass. A bronchoscopy showed an extrinsic compression and complete occlusion of the primary bronchus. A self-expandable prosthesis was installed in left bronchus. A population of plasmacytoid cells was evidenced in the mass biopsy. Immunohistochemistry revealed CD20+ and CD138+. These tumor cells stained positively for lambda light chains, but negatively for kappa chains. Therefore an extramedullary plasmacytoma was diagnosed. A multiple myeloma was discarded with a normal blood count, serum calcium and creatinine levels. Serum protein electrophoresis had a monoclonal spike, serum IgG was 1963 mg/dl. Bone marrow aspiration had 1% of plasma cells. Bone x-rays were normal. Computed tomographies of the neck, thorax, abdomen and pelvis ruled out other plasmacytomas. Eight cycles of chemotherapy with thalidomide, melphalan and prednisone were indicated, obtaining complete remission of the tumor. The review of the literature shows that mediastinal extramedullary plasmacytomas are extremely rare. They generally appear in men aged between 50 and 60 years. The treatment of choice is radiotherapy, but given the location in the present case, chemotherapy was considered the best option. Recurrence is approximately 10 to 30% and 10% of patients progress to myeloma, thus requiring close monitoring.

Ileo biliar, reporte de caso clínico / Biliary Ileus, clinical case report

El Íleo biliar es la obstrucción intestinal mecánica secundaria al impacto intraluminal de un lito; considerada como una complicación de la colelitiasis que fistuliza al tubo digestivo, permitiendo la migración del lito, en ocasiones ocurre por paso natural a través de la vía biliar debido a alteraciones del esfínter de Oddi, sobre todo tras la ampliación quirúrgica del mismo.Patología rara que se presenta más en ancianos, la ma-yoría de las series internacionales indican que el promedio de edad en la que se presenta es entre los 60 y 84 años. Afecta principalmente al sexo femenino, con una rela-ción hombre: mujer que va de 1:3 a 1:6, atribuyéndose a la mayor frecuencia de patología biliar en dicho sexo. Esta condición se precede de un cuadro de colecistitis aguda o crónica (75% de los casos). REPORTE DEL CASO Se presenta el caso de un paciente masculino de 83 años, quien acude al servicio de emergencia por pre-sentar dolor más distensión abdominal, nausea y vómito, al examen físico se puede observar un abdomen distendido, con ruidos hidroaéreos abolidos, timpánico a la percusión, doloroso a la palpación profusa. Se le realizan exámenes de laboratorio los cuales indican fórmula leucocitaria incrementada, PCR incrementado mínimamente sobre el límite superior, los exámenes de imagen específicamente la TAC nos indica la existencia de gas en vía biliar y una imagen hiperdensa a nivel de intestino delgado. Cuadro doloroso abdominal se exacerba, persiste distensión abdominal y los ruidos hi-droaereos se mantienen abolidos por lo cual se proyecta una laparotomía exploratoria.

Biliary ileus is the secondary mechanical intestinal obstruction to the intraluminal impact of a litho; it is consi-dered as a complication of cholelithiasis that provokes a fistula in the digestive tract, allowing the migration of the stones. Sometimes occurs by natural passage throu-gh the biliary tract due to alterations of the sphincter of Oddi, especially after the surgical extension of the same.It is a rare pathology that is more common in the elderly, the most international series report an average age be-tween 60 and 84 years.It mainly affects the female sex, with a male relation: female ratio ranging from 1: 3 to 1: 6, attributed to the higher frequency in that sex biliary disease. This condi-tion is preceded by acute or chronic cholecystitis (75% of cases). CASE REPORT It is a case of a man, he is 83-year-old and he goes to emergency service presenting pain and bloating, nausea and vomit, in the physical examination it was observed a distended abdomen with abolished bowel sounds, tympanic to percussion, painful to profuse pal-pation. Laboratory tests are performed and indicate an increased leukocyte count, CRP increased minimally over the upper limit, imaging examinations CT specifi-cally indicates the existence of gas in bile duct and a hyper dense image at the level of the small intestine. The patient still presents pain, for this reason it is projec-ted an exploratory laparotomy.

Tratamento endovascular do aneurisma aortoilíaco: relato do primeiro caso utilizando endoprótese brasileira com ramo ilíaco / Endovascular treatment of aortoiliac aneurysm: first report of a case using a Brazilian device with an iliac branch

Resumo O aneurisma aortoilíaco tem representado desafio terapêutico principalmente em relação ao tratamento endovascular, visto que a embolização das artérias ilíacas internas pode levar a graves complicações. Inúmeras técnicas cirúrgicas convencionais e endovasculares têm sido descritas para a preservação de ao menos um ramo ilíaco interno. Dentre as opções de tratamento totalmente endovascular, podemos citar as endopróteses ramificadas e a técnica de próteses paralelas. Os autores relatam o primeiro caso de tratamento endovascular com preservação de ramo ilíaco interno utilizando endoprótese nacional ramificada.

Abstract Aortoiliac aneurysms are particularly challenging to treat using a totally endovascular approach, because embolization of the internal iliac arteries can cause major complications. Several conventional and endovascular surgical techniques have been described that offer preservation of at least one internal iliac branch and options for completely endovascular treatment include branched stentgrafts and the parallel grafts technique. Here, the authors report the first case of endovascular treatment with preservation of an internal iliac branch using a Brazilian iliac branch device.

Lupus eritematoso sistémico: hallazgos imaginológicos del compromiso torácico / Systemic Lupus Erythematosus: Imaging Findings in Thoracic Involvement

El lupus eritematoso sistémico (LES) es una enfermedad inflamatoria crónica de causa desconocida, que se caracteriza por la afección de múltiples órganos y por la presencia de varias anormalidades inmunológicas, en particular, la producción de anticuerpos antinucleares (ANA). El diagnóstico de LES se basa en los criterios más recientes propuestos en el año 2012 (Systemic Lupus International Collaborating Clinics, SLICC), que reevaluaron los criterios del Colegio Americano de Reumatología descritos desde el año 1982. Las imágenes diagnósticas son una herramienta útil para la evaluación de las manifestaciones de órganos específicos, la progresión de la enfermedad, y la identificación de complicaciones. El compromiso del sistema respiratorio y cardiovascular es frecuente. En esta revisión se describe el espectro de los hallazgos radiológicos de LES en la radiografía de tórax convencional y la escanografía de tórax de alta resolución, modalidades de imagen mediante las cuales se hace el abordaje inicial en el paciente con síntomas respiratorios. Es importante reconocer los hallazgos radiográficos más frecuentes, con el fin de orientar a los médicos en el diagnóstico y seguimiento de esta enfermedad.

Systemic erythematous lupus (SEL) is a chronic inflammatory disease of unknown cause, characterized for affecting multiple organs and for the presence of several immunological abnormalities, in particular the production of antinuclear antibodies (ANAs). SEL diagnosis is based on the most recent criteria proposed on 2012 (Systemic Lupus International Collaborating Clinics, SLICC), which reevaluated the criteria originally described by the American College of Rheumatology in 1982. Diagnostic images are a useful tool for evaluating organ specific manifestations, disease progression, and the identification of complications. Respiratory and cardiovascular system compromise is frequent. In this revision, SEL the spectrum of radiological findings in conventional thorax radiography and high-resolution tomography are described, as these two image modalities are commonly used in patients with respiratory symptoms. It is important to recognize the most frequent radiographic findings with the purpose of guiding physicians in the diagnosis and treatment of the disease.

Cirurgia aberta e endovascular no tratamento de aneurisma de artéria poplítea: experiência de cinco anos do HCRP-FMRP-USP / Open versus endovascular surgery for treatment of popliteal artery aneurysms: 5 years' experience at the HCRP-FMRP-USP

Aneurismas de artéria poplítea (AAPs) correspondem a 70,00% dos aneurismas periféricos. A indicação cirúrgica é para aneurismas com diâmetros maiores que 2,0 cm ou sintomáticos. O tratamento é feito por técnicas cirúrgicas convencionais ou endovasculares. Esta última tem ganho muitos adeptos, mas ainda não há consenso estabelecido sobre sua indicação. Objetivo Apresentar a experiência da Divisão de Cirurgia Vascular e Endovascular do Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo no tratamento dos AAPs. Método Foram revisados casos de reparo convencional e endovascular de AAPs tratados nos últimos cinco anos, avaliando dados demográficos, comorbidades, indicação cirúrgica, complicações pré e pós-operatórias precoces e tardias, tempo de internação e de perviedade em até um ano. Resultados Foram realizadas no período dez cirurgias endovasculares (CE) e 21 cirurgias abertas (CA). O grupo CE teve maior frequência de comorbidades. Houve maior frequência de pacientes sintomáticos no grupo CA (85,00%) do que no grupo CE (40,00%). O Grupo CE apresentou menor número de complicações clínicas e cirúrgicas. A idade entre os grupos e o tempo de internação de cada grupo não apresentaram diferença estatística. A perviedade primária em um ano no Grupo CE foi de 80,00%, enquanto no Grupo CA foi de 75,00%. Conclusão O tratamento endovascular para AAPs apresenta bons resultados, em termos de perviedade com taxas de complicações aceitáveis, em pacientes com risco cirúrgico elevado e anatomia favorável, justificando, assim, a necessidade de mais estudos controlados para modificar a posição da técnica endovascular como uma terapia alternativa para casos selecionados.

Popliteal artery aneurysms (PAAs) account for 70% of peripheral aneurysms. Surgery is indicated for aneurysms that have diameters greater than 2.0 cm or are symptomatic. Repair can be achieved by conventional surgical techniques or using endovascular methods, which are becoming increasingly popular, but for which there is not yet a consensus on indications. Objective To describe the experience of treating PAAs at the vascular and endovascular surgery department of the Hospital das Clínicas de Ribeirão Preto, affiliated to the Universidade de São Paulo (Brazil). Method A review was conducted of cases of conventional and endovascular repair of PAAs over the last 5 years, analyzing demographic data, comorbidities, surgical indications, preoperative and early and late postoperative complications, length of hospital stay and patency, during follow-up of up to 1 year. Results During the period analyzed, ten endovascular surgeries (ES) and 21 open surgeries (OS) were performed. The ES group exhibited a higher frequency of comorbidities. There was a higher frequency of symptomatic patients in the OS group (85%) than in the ES group (40%). The ES group exhibited a lower number of clinical and surgical complications. There were no statistical differences between the groups in terms of age or length of hospital stay. Primary patency at 1 year was 80% in the ES group and 75% in the OS group. Conclusions Endovascular treatment for PAAs offers good results in terms of patency, with acceptable complication rates, in patients with high surgical risk and favorable anatomy. Controlled studies are therefore warranted to validate the endovascular technique and afford it the status of an alternative procedure for use in selected cases.

Endovascular repair of a juxtarenal saccular aneurysm using the Multilayer Flow Modulator: report of the first case performed in a Public Hospital in Brazil / Tratamento de aneurisma de aorta sacular justarrenal com Multilayer Flow Modulator: relato do primeiro caso realizado em Hospital Público no Brasil

Endovascular treatment of abdominal aortic aneurysms (AAA), involving the exits of the renal and visceral arteries still constitutes a considerable challenge. Many different techniques have been developed over the years in attempts to surmount the difficulties presented by these cases. Techniques that have gained prominence include fenestrated or branched stents, methods involving parallel prostheses, such as the chimney, periscope and sandwich techniques, and, more recently, flow modulation with Multilayer stents. We describe a case of a complex juxtarenal saccular AAA with a high surgical risk, both according to cardiological assessment and because the patient had a difficult airway caused by a total laryngectomy for early stage laryngeal neoplasm. In view of the technical simplicity of using Multilayer stents, the presence of chronic obstructive aortoiliac disease, ostial stenosis of the renal artery and a small diameter suprarenal aorta, options involving fenestrated/branched stents and techniques involving parallel prostheses were ruled out, because of the need for multiple accesses. In view of the dilemma it presented, we describe this case as a therapeutic challenge and present the treatment option employed, which has been successful over the short term...

O tratamento endovascular de aneurismas de aorta abdominal (AAA), envolvendo a saída das artérias renais e viscerais, constitui ainda um importante desafio. Diversas técnicas foram desenvolvidas ao longo do tempo para contornar as dificuldades oferecidas por esta situação, destacando-se as endopróteses fenestradas ou ramificadas, as técnicas envolvendo próteses paralelas, como Chaminé, Periscópio e Sanduíche, e, mais recentemente, a utilização da modulação de fluxo por stent multicamadas Multilayer. Apresentamos um caso de AAA sacular complexo justarrenal e com alto risco cirúrgico pela avaliação cardiológica e por apresentar via aérea difícil, em decorrência de laringectomia total por antecedente de neoplasia de laringe. Devido à facilidade técnica do uso do Multilayer, à presença de doença obstrutiva crônica aorto-ilíaca, à estenose ostial renal e ao diâmetro limitado da aorta suprarrenal, descartaram-se as opções envolvendo endopróteses fenestradas/ramificadas ou técnicas envolvendo próteses paralelas, pela necessidade de diversos acessos para a execução. Diante do dilema imposto, apresentamos este caso como desafio terapêutico e com uma opção de tratamento bem sucedida, em curto prazo...

Contribuição da ultrassonografia e da tomografia computadorizada naavaliação do acometimento abdominal na paracoccidioidomicose / The contribution of ultrasonography and computed tomography in the evaluation of abdominal involvement in paracoccidioidomycosis

Introdução: a paracoccidioidomicose (PCM) é doença inflamatória granulomatosa sistêmica, polimórfica, determinada pelo Paracoccidioides brasiliensis, uma das 10 causas de morbimortalidade entre as doenças endêmicas parasitárias no Brasil. Objetivo: identificar pela ultrassonografia (US) e tomografia computadorizada (TC) em relação à PCM: alterações abdominais; intensidade e características das imagens observadas; frequência das alterações em função da sua forma clínica; diferença em relação às outras entidades nosológicas. Pacientes e métodos: este é um estudo retrospectivo, observacional, transversal, realizado em 35 pacientes com PCM atendidos no Hospital das Clínicas (HC) da Universidade Federal de Minas Gerais (UFMG). Foram excluídos pacientes com tuberculose, asma brônquica, doença pulmonar obstrutiva crônica generalizada, contato com sílica ou minas, doenças granulomatosas em algum momento de sua história clínica atual ou pregressa e por intermédio da avaliação sorológica, anatomopatológica e microbiológica. Os dados coletados foram transcritos em SPSS para Windows® e submetidos à análise estatística .Foi aprovado pelo Comitê de Ética (082/00) da UFMG. Resultados e conclusão: a TC e a US evidenciaram acometimento dos órgãos abdominais em todas as formas da PCM, como: linfonodomegalia (40%), hepatomegalia (37%), esplenomegalia (37%) e acometimento adrenal (17%). Observados ainda comprometimento da vesícula biliar e damusculatura retroperitoneal, ascite e derrame pleural. Calcificação linfonodal, acometimento adrenal e ascite constituíram evidência de grande probabilidade de PCM, entretanto, não são capazes de a diferenciar da tuberculose. Nas formas crônicas e sequelares, o comprometimento abdominal é mais frequente do que indicam as manifestações clínicas.

Introduction: paracoccidioidomycosis (PCM) is a polymorphic systemic granulomatous inflammatory disease determined by Paracoccidioides brasiliensis, one of the 10 leading causes of morbidity and mortality among the parasitic diseases endemic in Brazil. Objective: To identify the following aspects of PCM by ultrasound (US) and computed tomography (CT): abdominal changes, intensity and characteristics of the observed images, frequency of changes depending on clinical presentation, differences from other nosological entities. Patients and methods: This was a retrospective, observational, cross-sectional study carried out with 35 patients with PCM treated at the Hospital das Clinicas (HC) at the Universidade Federal de Minas Gerais (UFMG). Patients with tuberculosis, bronchial asthma, generalized chronic obstructive pulmonary disease, or in contact with silica or mines, as well as those with granulomatous diseases at any point in their current or past clinical history and detected through serology, anatomopathology or microbiological exams were excluded. Collected data were transcribed into SPSS for Windows® for statistical analysis. The studywas approved by the UFMG Ethics Committee (082/00). Results and conclusion: CT and U.S. showed involvement of abdominal organs in all forms of PCM, including lymphadenopathy (40%), hepatomegaly (37%), splenomegaly (37%) and adrenal involvement (17%). Gallbladder and retroperitoneal musculature involvement were also observed, along with ascites and pleural effusion. Lymph node calcification, adrenal involvementand ascites constituted evidence of high probability of PCM even though these findings are not enough to differentiate PCM from tuberculosis. Chronic and sequelae forms, abdominal involvement is more frequent than indicated by the clinical manifestations.