ABSTRACT
Introduction: Mediastinal nodal involvement is essential in lung cancer staging. This can be performed with transbronchial needle aspiration using a flexible bronchoscope. We present the experience of the Instituto Nacional del Tórax. Material and Methods: Retrospective study. The procedure was performed in patients with mediastinal nodes greater than 1 cm on computed tomography of the chest. Results: In 132 bronchoscopies, 136 transbronchial needle aspirations for cytological studies were performed, 98 (72 percent) in subcarinal nodes and 38 (28 percent) in other locations. In 64 (47.1 percent) samples, lung cancer was diagnosed. In 100 (73,5 percent) cases the final diagnosis was lung cancer with mediastinal involvement. In this series transbronchial needle aspiration had a sensitivity of 64 percent for lung cancer diagnosis. There were no complications. Conclusions: Transbronchial needle aspiration cytology is safe and useful for the diagnosis and staging of the mediastinum in lung cancer patients.
Introducción: Identificar el compromiso de los ganglios mediastínicos es fundamental en la etapificación del cáncer pulmonar. Esto puede hacerse con muestras citológicas obtenidas mediante punción aspirativa transbronquial. Presentamos la experiencia del Instituto Nacional del Tórax. Material y Método: Estudio retrospectivo. Se realizó el procedimiento en pacientes con ganglios mediastínicos mayores de 1 cm en la tomografía computada de tórax. Resultados: En 132 fibrobroncoscopías se realizaron 136 citologías por punción aspirativa transbronquial, 98 (72 por ciento) en ganglios subcarinales y 38 (28 por ciento) en otras estaciones. En 64 (47,1 por ciento) muestras, se diagnosticó cáncer pulmonar. En 103 (76 por ciento) casos el diagnóstico final fue cáncer pulmonar. En esta serie la citología por punción aspirativa transbronquial tuvo una sensibilidad de 64 por ciento para diagnóstico de cáncer pulmonar. No se registraron complicaciones. Conclusiones: La citología por punción aspirativa transbronquial es una técnica segura y útil para la etapificación del mediastino en el cáncer pulmonar en nuestra experiencia.
Subject(s)
Humans , Male , Female , Middle Aged , Biopsy, Fine-Needle/methods , Lung Neoplasms/pathology , Bronchoscopy , Mediastinum , Neoplasm Staging , Predictive Value of Tests , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Oral conditions that produce the greatest damage on individuals are cavities and periodontal disease, hence non-expensive and effective solutions are immediately required, particularly for communities with no access to dental services. The antimicrobial and anti-inflammatory potential of the Swedish bitter herbal extract was evaluated, using pure microbial cultures and clinical samples of 29 patients. It was observed that the extract caused significant (p<0.05) in vitro growth inhibition of up to 29%, 17%, 15%, and 50% against Prevotella intermedia, Bacteroides forsythus, Porphyromonas gingivalis and Streptococcus intermedius, respectively. In addition, the extract significantly (p<0.05) inhibited oral flora growth in patient samples showing MICs of < 7.8 μg/ml in 21% of the patients, 15.6μg/ml in 17% of the patients, 31.2 μg/ml in 10% of the patients, 62.5 μg/ml in 17% of the patients, 125 μg/ml in 3% of the patients, and 250 μg/ml in 7% of the patients, and induced a maximum of 75% growth inhibition, as measured by the MTT reduction assay. The extract was also observed to significantly suppress production of the inflammatory marker nitric oxide by LPS-treated murine peritoneal macrophages. The Swedish herbal extract may be considered in the clinics to prevent or treat bacterial oral infections and at the same time reducing inflammation.
ABSTRACT
El estado epiléptico (EE) es una emergencia médica y se asocia a una alta morbimortalidad. En la unidad de cuidadosintensivos (UCI), existen dos grupos de pacientes con EE: pacientes con múltiples episodios de convulsionesque no responden al manejo inicial y aquellos admitidos por otras razones, quienes desarrollan fenómenos ictalessubclínicos en el curso de su estancia en la UCI. El EE no convulsivo (EENC) representa entre el 25-50% delos EE; pero en el paciente crítico esta entidad puede tener una mayor incidencia. Se estima que 10 a 40% de lospacientes con EE evolucionan a un estado epiléptico refractario (EER).El EER se define como la falta de respuesta a un medicamento antiepiléptico de primera línea y a uno o dos medicamentos de segunda línea. Para el manejo del EER, se requiere de múltiples fármacos antiepilépticos (FAE),sedantes en dosis elevadas y a veces del uso de soporte ventilatorio y soporte vasopresor. El manejo del EER estábasado en reportes de casos o experiencia de centros especializados, se recomienda la eliminación de la actividadictal electrográfica con la inducción, por medio de sedación, de un patrón estallido-supresión; siendo una segunda alternativa, un manejo menos agresivo, sin sedación usando altas dosis de antiepilépticos, en una forma escalonada.El propósito de esta revisión es presentar las recomendaciones para el enfoque y manejo del EER en el paciente crítico basadas en la literatura actual y en la experiencia de la UCI del Instituto Neurológico de Antioquia(INDEA).
Status Epilepticus (SE) is a medical emergency, due to significant morbidity and mortality. In the Intensive Care Unit(ICU) there are two groups of patients with SE: patients with multiple episodes of seizures that are non-responsive toinitial management and there are individuals admitted for other reasons who developed non convulsive status epilepticus (NCSE) subclinical ictal episodes in their ICU permanence.It is estimated NCSE represents between 25-50% of the SE, but in the critically-ill patient this entity could have a greater incidence. 10 to 40% of all patients with SE evolve to a refractory status epilepticus (RSE).Refractory status epilepticus (RSE) is defined as the absence of response to a first-line antiepileptic drug (benzodiazepines) and to one or two second-line drugs. Control of RSE demands the use of multiple anticonvulsant drugs (AED), high-dosesedatives, and sometimes vasopressive or mechanical ventilatory support.RSE management is based on case reports and experience from referral centers. It is recommended that the elimination of electrographic ictal activity is conducted through sedation, reaching a pharmacological burst-suppression pattern; a less aggressive alternative is suggested, without sedation, using antiepileptic medication in high-doses, in a step-up approach,guided by the improvement observed through cVEEG monitoring. The purpose of this study is to present recommendations for management of RSE in critically ill patients based on current literature and experience in the ICU of the Neurological Institute of Antioquia (INDEA).
Subject(s)
Humans , Epilepsy , Status Epilepticus , NeurologyABSTRACT
Frankia são microrganismos capazes de fixar N2 quando em simbiose com espécies arbóreas, denominadas plantas actinorrízicas. Este estudo foi conduzido para caracterizar morfologicamente, fisiologicamente e avaliar a nodulação de quatro estirpes referência de Frankia (HFPCcI3, JCT287, KB5 e F59) e 12 estirpes(IPRF) isoladas de nódulos de Casuarina. Todas as estirpes (Referência e IPRF) foram Gram-positivas e 50% foram acid-fast. As estirpes de Frankia alcalinizaram o meio de cultura, exceto IPRF006, IPRF008e IPRF010. As colônias das estirpes F59, IPRF002, IPRF004, IPRF005 e IPRF011, produziram melanina. Entre as estirpes referência, apenas a JCT287 cresceu no meio de cultura com pH 5,5, enquanto no meio com pH 6,0 as duas, JCT287 e KB5, apresentaram crescimento. A análise de regressão mostrou uma relação linear (Y = 67,56+ 3,88X e R2=0,5862, p<0,05) e coeficiente de correlação de Pearson (r=0,766,p<0,05) entre número de esporos e hifas (120 a 480 UFC mL-1) e proteína total (18 a 145 µg mL-1). Foi observado que a estirpe F59 apresentou uma maior proporção de proteína total (50%) do que a JCT287(7,0%) e, que as estirpes IPRF mostraram valores entre 17,5 e 29,3%. Todas as estirpes produziram compostos indólicos com valores variando de 5,9 a 98,8 µM.
Frankia are soil microorganisms that form symbiosis with roots of tree species called actinorhizal plants and are capable of fixing atmospheric N2. This study was carried out to characterize morphologically, physiologically and to assess the nodulation of four Frankia reference strains (HFPCcI3, JCT287, KB5and F59) and 12 (IPRF) isolated from root nodules of Casuarina plants. All strains (Reference and IPRF)were characterized as Gram-positive and 50% as acid-fast. The Frankia strains produced alkali in the culture medium, except the IPRF006, IPRF008 and IPRF010. The colonies of strains F59, IPRF002, IPRF004,IPRF005, and IPRF011 produced melanin. Among reference strains, only JCT287 grew in culture mediawith pH 5.5, while with pH 6.0 both strains JCT287 and KB5 presented growth. The regression analysis showed a linear relationship (Y = 67.56+ 3.88X and R2=0.5862, p<0.05) and Pearsons correlation coefficient(r=0.766, p<0.05) between number of spores and hyphae (120 to 480 UFC mL-1) and total protein (18 to 145µg mL-1). It was observed that the strains F59 had a higher proportion of total protein 50.0% than JCT287with 7.0% and that the IPRF strains showed values between 17.5 and 29.3%. All strains presented ability to produce indolic compounds in growth media with values ranging from 5.9 to 98.8 µM.
Subject(s)
Actinobacteria , Nitrogen Fixation , FrankiaABSTRACT
La cisticercosis es la parasitosis que mas comunmente afecta el sistema nervioso central. En el sistema ocular puede llevar a la perdida visual. El diagnostico actual de la cisticercosis cuenta con la clinica, examenes de laboratorio, estudio radiologicos, e histopatologicos. El diagnostico de la cisticercosis que en el pasado se fundamentaba en la sospecha clinica y en la confirmacion quirurgica se ha revolucionado en los ultimos anos con el advenimiento de nuevas tecnicas serologicas como la prueba inmunoenzimatica (ELISA) e imagenologicas como la tomografia axial computarizada (TAC) y la resonancia magnetica (RH). Un paciente proveniente de zona endemica como Colombia, con presentacion clinica sugestiva, acompanado de deteccion de anticuerpos y una TAC caracteristica son confirmacion casi segura del diagnostico de la cisticercosis
Subject(s)
Humans , Male , Female , Cysticercosis/diagnosis , Colombia , Cysticercosis , Cysticercosis/bloodABSTRACT
En el presente trabajo se evalúa el rendimiento educativo en 53 pacientes que ingresaron a la Unidad de Cuidados Intensivos del Hospital San Juan de Dios con diagnóstico de Infarto Agudo al Miocardio, entre mayo de 1984 y julio de 1985