Biliothorax: A Rare Case of Dyspnea.

Biliothorax is the presence of bile in the pleural cavity. This condition is rare, and it usually results as a complication of hepatobiliary procedures. The authors present a case of an 87-year-old female who was admitted to the emergency department with the acute onset of severe dyspnea. A chest X-ray and CT revealed a large right-lung pleural effusion that, after thoracentesis, confirmed the presence of biliothorax. It is important to consider this entity when confronted with an effusion liquid of a dark greenish color, as a delay in diagnosis and management may be life-threatening.

Lack of inflammation or immune response in cyst tissue of patients with symptomatic non-hydrocephalic pineal cysts.

Pineal cysts are frequently encountered as incidental findings in magnetic resonance imaging, usually devoid of symptoms, yet some patients exhibit symptomatic manifestations possibly associated with the cyst, even in the absence of hydrocephalus. The etiology of these symptoms remains contentious. This study aims to investigate the presence of lymphatic endothelial cell (LEC) markers and indications of inflammation or immune response within the pineal cysts of patients experiencing symptomatic non-hydrocephalic presentations. Eight patients who underwent surgical excision of their cysts were included in the study. Immunohistochemistry was utilized to assess the expression of LYVE-1, PDPN, and VEGFR3 as LEC markers, alongside IL-6 and CD3 for indications of inflammation or immune activity. Our analysis revealed an absence of inflammatory markers or immune response. However, a distinct expression of VEGFR3 was observed, likely localized to neurons within the pineal cyst tissue. We propose that these VEGFR3+ neurons within the pineal cyst may contribute to the headache symptoms reported by these patients. Further investigations are warranted to substantiate this hypothesis.

[Human fasciolasis and gastrointestinal compromise: study of 277 patients in the Cayetano Heredia National Hospital (1970-2002)]. / Fasciolosis humana y compromiso gastrointestinal: estudio de 277 pacientes en el Hospital Nacional Cayetano Heredia. 1970-2002.

This is a retrospective and descriptive review of 277 patients suffering fasciolasis. These patients were seen in Hospital Nacional Cayetano Heredia between 1970-2002; 240 (86.6%) developed the chronic phase and 37 (13.3%) the acute form. Group aged 20-29 years were the most affected (24%). The main places infected were the interandean valleys of Lima, Ancash and Junin. The 277 patients the main symptoms were: abdominal pain in 236, nausea/vomiting in 106 and diarrhea in 100. Hepatomegaly in 56, pallor in 44 and fever in 23 were the main physical findings. 47% (80/169) suffered eosinophilia, 46% (38/82) had an increase of alkaline phosphatase and 31% (52/169) anemia.

Addition of amifostine to the CHOP regimen in elderly patients with aggressive non-Hodgkin lymphoma: a phase II trial showing reduction in toxicity without altering long-term survival

We report the 8-year follow-up of 34 patients aged >/= 69 years old with NHL included in a phase IIb open-label randomized parallel groups study to evaluate the effectiveness of amifostine in preventing the toxicity of cyclophosphamide, doxorubicin, vincristine and prednisone [CHOP regime]. Patients were randomized to receive classical CHOP [cyclophosphamide 750 mg/ m[2], doxorubicin 50 mg/m[2], vincristine 1.4 mg/m[2] [maximum 2 mg] on day 1 and prednisone 100 mg/day for 5 days] or CHOP plus amifostine [6 cycles of amifostine 910 mg/m[2] on day 1]. Efficacy [time to progression, TTP; disease-free survival, DFS; overall survival, OS] and toxicity endpoints were evaluated. Thirty-four patients were randomized to A-CHOP [n=18] or CHOP [n=16]. Patients with A-CHOP vs CHOP had significantly lower toxicity; neutropenia grade 4 ocurred in 13/92 [13%] vs 23/85 [27%, P=0.007] cycles, febrile neutropenia in 3/92 A-CHOP [3%] vs 8/85 [10%, P=.056] CHOP cycles, hospitalization for toxicity in 4/92 [4%] A-CHOP vs 11/85 [13%, P=.05] CHOP cycles. Median hospitalization stay for toxicity was 5 days with A-CHOP vs 8 days with CHOP [P=.05]. There were no significant differences at 8 years in TTP [A-CHOP, 48.9% vs CHOP, 36.3%; P=.65], DFS [A-CHOP, 72.9% vs CHOP 55.6%; P=.50] and OS [A-CHOP, 44.3% vs CHOP, 54.4%]. There was no long-term toxicity of clinical interest. The only prognostic factor identified to 8 years was the International Prognostic Index [IPI low/low intermediate risk vs high intermediate/high risk; HR=2.98; CI 95%:1.01-8.77; P=.048]. These results show that amifostine can be added to the standard CHOP treatment schedule with less acute toxicity and without influencing the outcome