RESUMEN
Cancer of the esophagus is an aggressive cancer with high mortality. Because of the esophagus's lack of serosa and its peculiar lymphatic drainage, esophageal cancer is diagnosed in advanced stages. The eighth edition of the TNM (2017) aims to standardize care for esophageal cancer throughout the world; it includes not only patients treated with esophagectomy alone, but also those receiving neoadjuvant chemotherapy and/or radiotherapy. One new development in the eighth edition is that it establishes separate classifications for different time periods, with pathologic stage groups for prior to treatment (cTNM), after esophagectomy (pTNM), and after neoadjuvant therapy (ypTNM). The combined use of endoscopic ultrasound, CT, PET-CT, and MRI provides the greatest accuracy in determining the clinical stage, and these techniques are essential for planning treatment and for evaluating the response to neoadjuvant treatment. Esophagectomy continues to be the main treatment; it is also the elective gastrointestinal surgery that has the highest mortality, and it carries the risk of multiple complications, including anastomotic leaks, pulmonary complications, technical complications, and functional complications.
Asunto(s)
Neoplasias Esofágicas , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias Esofágicas/terapia , Unión Esofagogástrica/patología , Humanos , Estadificación de Neoplasias , PronósticoRESUMEN
La bronconeumonitis por virus herpes simple (VHS) es una entidad clínica descrita en pacientes críticos, asociada clásicamente a estados de inmunosupresión. Estudios recientes han demostrado una elevada frecuencia de detección del virus en muestras del tracto respiratorio inferior (obtenidas por lavado broncoalveolar [BAL]) de pacientes críticos inmunocompetentes ventilados mecánicamente, lo que indicaría su papel como sustrato patogénico independiente. Presentamos el caso de una paciente que ingresa tras intervención quirúrgica de neoplasia de recto, con sospecha de broncoaspiración durante la inducción anestésica. Presenta evolución clínica marcada por fiebre persistente pese a tratamiento antibiótico de amplio espectro, ausencia de crecimiento bacteriano en los cultivos obtenidos, sin claros infiltrados radiológicos y ventilación mecánica prolongada con reiterados fracasos en el destete, y que precisa traqueostomía percutánea. Se realiza broncoscopia con BAL y se detecta VHS (a nivel microbiológico e histológico), por lo que se inicia tratamiento con aciclovir con mejoría clínica y retirada del soporte ventilatorio (AU)
Herpes simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation (AU)
Asunto(s)
Humanos , Femenino , Anciano , Bronconeumonía/etiología , Herpes Simple/etiología , Neumonía Viral/etiología , Complicaciones Posoperatorias/etiología , Insuficiencia Respiratoria/etiología , Enfermedad Aguda , Antivirales/uso terapéutico , Líquido del Lavado Bronquioalveolar/virología , Bronconeumonía/diagnóstico , Bronconeumonía/tratamiento farmacológico , Diagnóstico Diferencial , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Huésped Inmunocomprometido , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/virología , Insuficiencia Respiratoria/terapiaRESUMEN
Herpes simplex virus bronchopneumonitis is a clinical entity described in critically ill patients and classically associated to immunosuppression. Recent reports have shown a higher frequency of virus detection from samples obtained by bronchoalveolar lavage of immunocompetent critically ill patients undergoing mechanical ventilation. This fact suggests its role as an independent pathogenic substrate. We report the case of a female patient who was admitted after an elective surgery of rectal tumor with suspected bronchoaspiration during anesthetic induction. The patient presented persistent fever despite broad spectrum antibiotic treatment. All cultures were negative for bacterial growth. The chest X-ray did not show opacifities. Prolonged mechanical ventilation with repeated failures to wean made it mandatory to perform percutaneous tracheostomy. A fibrobronchoscopy with bronchoalveolar lavage, performed previously, showed positive result for herpes simplex virus (PCR and specific nuclear inclusions in cells). Thus, treatment was initiated with acyclovir, with clinical improvement and weaning from mechanical ventilation.
Asunto(s)
Bronconeumonía/etiología , Herpes Simple/etiología , Neumonía Viral/etiología , Complicaciones Posoperatorias/etiología , Insuficiencia Respiratoria/etiología , Enfermedad Aguda , Aciclovir/uso terapéutico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Anciano , Antimetabolitos Antineoplásicos/efectos adversos , Antimetabolitos Antineoplásicos/uso terapéutico , Antivirales/uso terapéutico , Líquido del Lavado Bronquioalveolar/virología , Bronconeumonía/diagnóstico , Bronconeumonía/tratamiento farmacológico , Terapia Combinada , Diagnóstico Diferencial , Femenino , Fluorouracilo/efectos adversos , Fluorouracilo/uso terapéutico , Herpes Simple/diagnóstico , Herpes Simple/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Neumonía por Aspiración/diagnóstico , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/virología , Radioterapia Adyuvante , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Respiración Artificial , Insuficiencia Respiratoria/terapiaRESUMEN
Objetivos: Exponer los resultados de la implantación de un cribado ecográfico "semiuniversal" para el diagnóstico precoz de la displasia de desarrollo de la cadera (DDC) que incluye a todas las niñas y a los varones con factor de riesgo. Material y método: De los 16.943 recién nacidos en nuestro hospital en 4 años, se estudiaron por ecografía 8.596 (7.892 niñas y 744 varones). El cribado se realizó a las 5 semanas de vida e incluyó seguimiento de las caderas con inmadurez fisiológica. Resultados: Se detectaron 76 niños con DDC resultando una incidencia del 4,4 por mil. La edad media de detección fue de 1,4 meses y la duración media de los tratamientos 3 meses. Se consiguieron bajos índices de displasias tardías (0,2 por mil) y de cirugía (0,3 por mil). Todos los niños curaron sin secuelas. Conclusión: Consideramos al cribado semiuniversal una opción válida al cribado universal, con resultados similares y menor coste
Objective: The purpose of this article is to describe the findings of our semiuniversal ultrasound screening for the early diagnosis of developmental dysplasia of the hip (DDH) including all newborn females and males with risk factors. Materials and methods: 8596 newborn (7852 females and 744 males) underwent sonography from a total of 16943 newborn in our hospital over a four year period. The screening ultrasound was performed when the infant was five weeks old and included follow-up of the hips with physiological immaturity. Results: 76 infants with hip dysplasia were detected with a resulting incidence of 4.4 per thousand. Mean age at diagnosis was of 1.4months and the mean length of treatment was of 3 months. With this strategy low rates of late dysplasias (0.2 per thousand) and surgical treatment (0.3 per thousand) were achieved All infants recovered without secuelae. Conclusion: We consider the semiuniversal screening to represent a valid alternative to the universal screening, with similar results and reduced costs
Asunto(s)
Masculino , Femenino , Recién Nacido , Humanos , Luxación Congénita de la Cadera , Luxación Congénita de la Cadera/terapia , Tamizaje Neonatal/métodos , Resultado del Tratamiento , Estudios de Seguimiento , Factores de Riesgo , EspañaRESUMEN
Ante una lesión mamaria no palpable que precise una biopsia diagnóstica debe valorarse el método de guiado idóneo para acceder a la misma. En la actualidad se emplean tres métodos: la estereotaxia (fundamentalmente en casos de microcalcificaciones), la ecografía (sobre todo en los nódulos) y la resonancia magnética (para lesiones no visibles mediante los anteriores sistemas). El siguiente paso es elegir la técnica de biopsia más adecuada. La técnica más clásica y fiable es la biopsia quirúrgica con marcaje previo con un arpón metálico, pero tiene los inconvenientes de ser una técnica agresiva para el diagnóstico de la patología benigna, además de presentar un alto coste. Como alternativas se han desarrollado múltiples sistemas de punción. La punción con aguja fina es de fácil realización técnica y puede dar buenos resultados en los nódulos mamarios, pero la existencia de resultados falsos positivos y negativos han limitado progresivamente su utilización. Como alternativa, los sistemas de biopsia con aguja gruesa han permitido la obtención de múltiples cilindros con gran fiabilidad diagnóstica, sobre todo en el caso de los nódulos mamarios. Sin embargo, su empleo en las microcalcificaciones continúa mostrando resultados falsos negativos. El advenimiento de los sistemas de biopsia asistida por vacío ha permitido la obtención de cilindros de mayor calidad, mejorando claramente los resultados de los sistemas anteriores, sobre todo en los casos de microcalcificaciones. Por último, los sistemas de biopsia escisional percutánea mediante cánulas de hasta 22 mm de diámetro consiguen la extracción completa de lesiones de tamaño inferior al de la cánula, con una fiabilidad similar al de la biopsia quirúrgica (AU)
Asunto(s)
Femenino , Humanos , Biopsia/métodos , Enfermedades de la Mama/diagnóstico , Enfermedades de la Mama/patología , Técnicas EstereotáxicasRESUMEN
Facing a non-palpable mammary lesion requiring a diagnostic biopsy, consideration must be given to the most suitable guiding method for obtaining the latter. Three methods are employed at present: stereotaxy (basically in cases of microcalcifications), echography (above all in the nodules), and magnetic resonance (for lesions not made visible through the previous systems). The next step is to select the most suitable biopsy technique. The most classical and reliable technique is the surgical biopsy with prior marking using a metallic harpoon, but, besides its high cost, it has the drawback of being an aggressive technique for the diagnosis of a benign pathology. Numerous systems of puncture have been developed as alternatives. Puncture with a fine needle is technically simple to carry out and can provide good results in the mammary nodules, but the existence of positive and negative false results has progressively limited its use. As an alternative, the systems of biopsy with a broad needle have made it possible to obtain multiple cylinders with a high diagnostic reliability, above all in the case of mammary nodules. However, their use in microcalcifications continues to show negative false results. The arrival of systems of vacuum-assisted biopsy has made it possible to obtain cylinders of greater quality, above all in cases of microcalcifications. Finally, the systems of percutaneous resection biopsy by means of cannulas with a diameter of 22 mm make it possible to completely extract lesions of a size below that of the cannula, with a reliability similar to that of the surgical biopsy.
Asunto(s)
Biopsia/métodos , Neoplasias de la Mama/patología , Biopsia/instrumentación , Diseño de Equipo , HumanosRESUMEN
In this second chapter on Acute Drugs Poisoning we deal with two groups of substances of great transcendence from the point of view of their use and morbidity/mortality. Within the group of analgesic-anti-inflammatory drugs we consider paracetamol and the salicylates, which are easily available to the population. With respect to the anticonvulsants, although they are barely involved in the ensemble of acute drug poisonings, their effects can be serious. We concentrate on four drugs: valproic acid, phenobarbitol, carbamacepine, and phenytoin. Finally, a section is dedicated to isoniazid, a drug that, with the renewed incidence of tuberculosis, is of toxicological interest.
Asunto(s)
Analgésicos/envenenamiento , Anticonvulsivantes/envenenamiento , Intoxicación/etiología , Intoxicación/terapia , Enfermedad Aguda , Humanos , Intoxicación/diagnósticoRESUMEN
OBJECTIVE: To find out the quality of extended treatments as recorded on the long-treatment medical record cards of the users of Chantrea Health Centre (Pamplona). DESIGN: This was a descriptive crossover study. SITE. An urban Primary Care centre. PATIENTS OR OTHERS PARTICIPANTS: The record cards filled in by registered nurses and physicians during one week in May 1990 were chosen. No prior notice was given to the rest of the team. Overall, 370 record cards were studied. MAIN MEASUREMENTS AND RESULTS: The average of drugs per person is 2.93 + 1.81, with significant differences for those over 65 years old (p less than 0.01). Regarding the quality indicators used: 78% of the medicines are included in the Primary Care Guide; 79.5% of those studied only took one drug; drugs were administered orally in 83% of cases; occasional concomitant medication was detected on 22.7% of the record cards and potential interactions existed on 35% of the cards. CONCLUSIONS: A therapeutic level, which was acceptable in terms of the indicators used, was supposed. For the Primary Care team to reflect jointly on prescriptions was thought to be important. The question was posed of a training programme for all doctors working in the area.