Tumores neuroendocrinos de origen pulmonar: reporte de un caso / Neuroendocrine tumors of lung’s origin, a case report

Introduction or case story: Young female patient (24 years-old), without known morbid precedents. She comes for a ten-days period of symptoms characterized by fever of up to 38.5 °C and a dyspnoea grade III. Physical exam showed decreased vesicular murmur on the right pulmonary base with dullness and positive vocal vibrations. Exams: Thorax X-ray: Atelectasis condensation on the right pulmonary base. CT chest scan without contrast: Nodule located in an intermediate bronchus which generates atelectasis in the basal bronchi. Fibro-bronchoscopy (FOB): A tumour-like injury blocking 100% of the right intermediate bronchus’ duct. Biopsy: Pulmonary tissue with haemorrhagic areas, granular tissue with small cellular clusters of lobular disposal and glandular shape with eccentric central nuclei cells, with homogenous chromatin and without atypical mitosis. Immunohistochemistry: Intensely positive cells to synaptophysin and CD56. Diagnosis: Neuroendocrine Typical Carcinoid Tumor. Comments: The patient evolves without progression of dyspnoea, she is waiting for a surgical resolution of tumour at National Institute of Thorax.

Introducción o historia del caso: Mujer joven de 24 años de edad, sin antecedentes mórbidos, acudió por cuadro de 10 días de evolución, de fiebre de hasta 38,5 °C y disnea grado III. Al examen físico destacó a nivel pulmonar: murmullo pulmonar disminuido en base pulmonar derecha, matidez de la misma zona y vibraciones vocales positivas. Exámenes: Radiografía de Tórax: Condensación atelectásica en base pulmonar derecha. TAC de Tórax sin contraste: Imagen nodular a nivel de bronquio intermedio, que genera atelectasia en bronquios basales. Fibrobroncoscopía (FBC): Lesión tumoral que ocluye el 100% del lumen para bronquio intermedio derecho. Biopsia: Tejido pulmonar con áreas de hemorragia, tejido granulatorio y tumor con acúmulos celulares de disposición lobular y glanduliforme, con núcleos centrales excéntricos, cromatina homogénea, sin atipias. Inmunohistoquímica: Células intensamente positivas para sinaptofisina, y CD-56. Diagnóstico: Tumor Neuroendocrino Carcinoide típico Comentarios: Paciente evoluciona sin progresión de su disnea, esperando resolución quirúrgica del tumor en Instituto Nacional del Tórax.

Relación de pesos al nacer con la proc. de la madre en localidades con uso intensivo de agroquimicos / Relationship between low birth weight and the mother’s origin in areas with use of pesticide in the province of Salta

Introducción: numerosas bibliografías relacionandesórdenes reproductivos en población expuesta por razónlaboral o ambiental a agroquímicos. Entre otras, se hanestablecido relaciones con bajo peso al nacer (PN).Objetivo: Analizar comparativamente los pesos al naceren departamentos con uso intensivo de plaguicidas y restode la provincia de Salta.Material y Métodos: Se analizó una serie temporal desde1995 a 2008. Para el año 2010 se analizaron 8588 partosdel Hospital capitalino. Se calcularon medidas descriptivasy pruebas estadísticas con InfoStat v. 2008.Resultados: la procedencia de la madre resultó asociada enforma fuertemente significativa (x2= 63,52; p<0,0001) con losbajos pesos del recién nacido cuando se analizaron todos lospartos del hospital capitalino. El intervalo de confianza parala razón de chances conα=0,05 fue (1,69-2,39), resultandodoble la chance de presentarse bajo PN cuando la madrehabita localidades donde se aplican plaguicidas.Discusión: de la serie de las tasas de recién nacidoscon bajo peso al nacer surge que han sido inferiores enlos departamentos expuestos a plaguicidas que en el restode la provincia, con prevalencias inferiores a 0,08. Puedeinterpretarse como un subregistro de bajos pesos porderivación de los embarazos de riesgo al hospital capitalino.Se debe profundizar el estudio de la carga ambiental de losembarazos de riesgo

Introduction: Literature relates reproductive disorders to population exposed topesticides due to environmental or work reasons. Among others, a relationship to lowbirth weight (LBW) has been established.Objective: To compare and analyze birth weights in areas with intensive use of pesticidesand in the rest of the province.Material and Methods: A temporal series was analyzed between 1995 and 2008. By theyear 2010, 8588 deliveries had been analyzed at the capital hospital. Descriptive measuresand statistical tests were calculated with InfoStat v. 2008.Results: the rate of newborns with low birth weight ranged between 3.5 (1994) and6.5% (1996) in Anta; and between 5.4% (2003) and 7.4% (2007) in Orán. For the restof the province it ranged between 6.4% (1995) and 8.5% (2007). When analyzing theseries, no significant differences in the proportion of low birth weight in exposed areaswere observed when compared to the rest of the province of Salta. However, the mother’sorigin was significantly associated (x2= 63.52; p<0.0001) with low birth rates when alldeliveries were analyzed at the capital hospital. Confidence interval for odds ratio withα=0.05 was (1.69-2.39). There is a double chance of low birth weight when mothers livein areas where pesticides are used.Discussion: from the series of rates of newborns with low birth weight it is seen thatthey have been lower in areas exposed to pesticides than in the rest of the province, withprevalence under 0.08. This can be understood as a sub-record of low weight due toreferral of risk pregnancies to the capital hospital. The study of environmental burden inrisk pregnancies has to continue

Rabdomiólise após exercício físico não intenso / Rhabdomyolysis after non-intense physical exercise

Discutiremos um raro caso clínico de rabdomiólise ocorrido após um exercício físico habitual e não intenso, em paciente masculino de 34 anos e os prováveis fatores desencadeantes envolvidos, bem como suas implicações clínicas. Destacando-se a elevação expressiva e não vista em outros trabalhos como da creatinoquinase, enzimas hepáticas, e as medidas clínicas adotadas para a prevenção de complicações renais sérias e com risco grave para o paciente em análise.

A rare clinical case of rhabdomyolysis occurred after habitual and non-intense physical exercise, in a male, 34 year-old patient, as well as the probable triggered factors involved and their clinical implications will be discussed. Moreover, the expressive increase, which is pioneering compared to other research such as on creatine kinase, hepatic enzymes, as well as clinical measures adopted for serum renal complications and with severe risk to the patient under study will be highlighted.