RESUMEN
The discovery of an anterior mediastinal mass requires careful management with specific consideration of the pathology. More than 50% of all mediastinal masses seen in adults are in the anterior mediastinum. The most frequent diagnoses are thymoma, lymphoma, teratoma and benign thyroid tumours. 60% of cases are malignant. Often the clinical and radiological findings do not allow a definitive diagnosis and a histological diagnosis is often required to select the optimal treatment modality. The choice of biopsy technique depends on the localization of the lesion, clinical factors, and the availability of special techniques and equipment. Biopsy may be obtained by trans-thoracic puncture under computed tomography or ultrasound guidance, or by a surgical approach (mediastinotomy or thoracoscopy).
Asunto(s)
Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/terapia , Adulto , Biomarcadores de Tumor/análisis , Biopsia con Aguja , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/terapia , Carcinoma/diagnóstico , Carcinoma/terapia , Diagnóstico Diferencial , Granuloma/diagnóstico , Granuloma/terapia , Humanos , Lipoma/diagnóstico , Lipoma/terapia , Linfoma/diagnóstico , Linfoma/terapia , Mediastino/patología , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Neoplasias de Células Germinales y Embrionarias/terapia , Timoma/diagnóstico , Timoma/terapia , Hiperplasia del Timo/diagnóstico , Hiperplasia del Timo/terapia , Neoplasias del Timo/diagnóstico , Neoplasias del Timo/terapia , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/terapiaRESUMEN
Whereas human herpesvirus 6 (HHV-6) reactivation is frequent in solid organ transplant recipients, symptomatic disease is rare. A case of colitis associated with HHV-6B reactivation was observed in a lung transplant recipient. This case report suggests that symptomatic HHV-6 infection may occur in the absence of detectable viremia.
Asunto(s)
Colitis/diagnóstico , Colitis/virología , Herpesvirus Humano 6/fisiología , Trasplante de Pulmón/efectos adversos , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Infecciones por Roseolovirus/diagnóstico , Adulto , Biopsia , Colitis/patología , Colon/patología , Colon/virología , ADN Viral/genética , ADN Viral/aislamiento & purificación , Herpesvirus Humano 6/aislamiento & purificación , Humanos , Mucosa Intestinal/patología , Mucosa Intestinal/virología , Masculino , Reacción en Cadena de la Polimerasa , Infecciones por Roseolovirus/complicaciones , Activación ViralRESUMEN
BACKGROUND: nitric oxide (NO) plays an important role in the regulation of cardiovascular and glucose homeostasis. Mice lacking the gene encoding the neuronal isoform of nitric oxide synthase (nNOS) are insulin-resistant, but the underlying mechanism is unknown. nNOS is expressed in skeletal muscle tissue where it may regulate glucose uptake. Alternatively, nNOS driven NO synthesis may facilitate skeletal muscle perfusion and substrate delivery. Finally, nNOS dependent NO in the central nervous system may facilitate glucose disposal by decreasing sympathetic nerve activity. METHODS: in nNOS null and control mice, we studied whole body glucose uptake and skeletal muscle blood flow during hyperinsulinaemic clamp studies in vivo and glucose uptake in skeletal muscle preparations in vitro. We also examined the effects of alpha-adrenergic blockade (phentolamine) on glucose uptake during the clamp studies. RESULTS: as expected, the glucose infusion rate during clamping was roughly 15 percent lower in nNOS null than in control mice (89 (17) vs 101 (12) [-22 to -2]). Insulin stimulation of muscle blood flow in vivo, and intrinsic muscle glucose uptake in vitro, were comparable in the two groups. Phentolamine, which had no effect in the wild-type mice, normalised the insulin sensitivity in the mice lacking the nNOS gene. CONCLUSIONS: insulin resistance in nNOS null mice was not related to defective insulin stimulation of skeletal muscle perfusion and substrate delivery or insulin signaling in the skeletal muscle cell, but to a sympathetic alpha-adrenergic mechanism.
Asunto(s)
Antagonistas Adrenérgicos alfa/farmacología , Resistencia a la Insulina/fisiología , Óxido Nítrico Sintasa de Tipo I/genética , Óxido Nítrico Sintasa de Tipo I/metabolismo , Animales , Glucemia/efectos de los fármacos , Femenino , Técnica de Clampeo de la Glucosa , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Músculo Esquelético/enzimología , Músculo Esquelético/metabolismo , Fentolamina/metabolismo , Fentolamina/farmacologíaRESUMEN
We report the case of a 58-year-old diabetic man admitted to the hospital in a comatose state due to medicamentous hypoglycemia in a context of hypovolemic acute renal failure. Hypovolemia was due to hemoperitoneum in a alcoholic patient with cirrhotic hepatic failure. CT-scan and arterial angiographies revealed a voluminous isolated hepatic mass with active bleeding suggesting the diagnosis of spontaneous bleeding from a hepatocellular carcinoma. The hemorrhage resolved after selective arterial embolization, but the patient died two weeks later from an infectious cause. The differential diagnosis of a spontaneous hemoperitoneum and possibilities of treatment in the case of ruptured hepatocellular carcinoma are discussed.