Biliotórax: una entidad rara para un diagnóstico frecuente. Un reporte de caso / Bilothorax: a Rare Entity for a Frequent Diagnosis. A Case Report

Introducción: El biliotórax es una condición infrecuente definida por la presencia de bilis en el espacio pleural. Actualmente, hay alrededor de 70 casos descritos en la litera-tura. Sigue siendo relativamente desconocido, por lo tanto, poco sospechado. Esta entidad suele ser el resultado de una lesión iatrogénica, a menudo secundaria a cirugías o traumatismos del tracto biliar, que conduce a la formación de una fístula pleurobiliar.

Introduction: Bilothorax is a rare condition defined by the presence of bile in the pleural space. Currently, there are around 70 cases described in the literature. It remains relatively unknown and, therefore, little suspected. This entity is usually the result of an iatrogenic injury, often secondary to surgery or trauma to the biliary tract, leading to the formation of a pleurobiliary fistula

Cambios en la tendencia histológica del cáncer pulmonar / Changes in lung cancer's histological trend

El cáncer pulmonar se establece como la segunda causa de muerte en países desarrollados y en algunos en vías de desarrollo. Su diagnóstico es tardío, sus opciones de resección y su curación aun con terapias adyuvantes son limitadas, lo que incide en la pobre sobrevida a 5 años, es por ello que se necesitan mayores esfuerzos para combatir el hábito del tabaco, principal agente etiológico. Material y Métodos: Se trata de un estudio descriptivo transversal en pacientes adultos atendidos de 01 de enero del 2011 al 31 de diciembre del 2021, ingresados al servicio de cirugía del Hospital San Vicente de Guatemala, con diagnósticos de cáncer pulmonar, masa pulmonar, derrame pleural o nódulo pulmonar solitario. Resultados: Se atendieron 202 pacientes con diagnósticos presuntivos de cáncer pulmonar, no encontrando diferencias significativas en relación al sexo. La edad mayormente afectada se estableció entre los 50 y 70 años. Prevalecieron los estadíos IIIA, IIIB y IV basados en los hallazgos clínicos, tomográficos y transoperatorios y solo al 10% se le sometió a una cirugía de resección pulmonar mayor. Los cánceres de células no pequeñas NSCLC fueron reportados en el 68.7% y el adenocarcinoma fue la variedad más frecuente con el 54.95% sobre el 7.29% del epidermoide. La mortalidad a los treinta días se estableció en 2.97%. Conclusión: El adenocarcinoma pulmonar ocupa el primer lugar en la incidencia de los cánceres pulmonares, desplazando así al carcinoma epidermoide popularizado desde la mitad del siglo pasado. Esta tendencia en el cambio histológico está firmemente asociado a las modificaciones en los hábitos del fumar (AU)

Lung cancer is established as the second cause of death in developed countries and in some developing ones. Its diagnosis is late, its resection options and its cure even with adjuvant therapies are limited, which affects the poor survival at 5 years, which is why greater efforts are needed to combat the tobacco habit, the main etiological agent. Material and Methods: This is a cross-sectional descriptive study in adult patients treated from January 1, 2011 to December 31, 2021, admitted to the surgery service of the Hospital San Vicente de Guatemala, with diagnoses of lung cancer, lung mass, effusion pleural or solitary pulmonary nodule. Results: 202 patients with presumptive diagnoses of lung cancer were treated, finding no significant differences in relation to sex and the most affected age was established between 50 and 70 years. Stages IIIA, IIIB, and IV prevailed based on clinical, tomographic, and intraoperative findings, and only 10% underwent major lung resection surgery. NSCLC non-small cell cancers were reported in 68.7% and adenocarcinoma was the most frequent variety with 54.95% over 7.29% of epidermoid. Thirty-day mortality was established at 2.97%. Conclusion: Pulmonary adenocarcinoma occupies the first place in the incidence of lung cancers, thus displacing squamous cell carcinoma popularized since the middle of the last century. This trend in histological change is strongly associated with changes in smoking habits.

Ensayo controlado y aleatorizado del uso de Heberkinasa® en el derrame pleural paraneumónico en niños / Randomized Controlled Trial of the Use of Heberkinase® in Parapneumonic Pleural Effusion in Children

Introducción: El derrame pleural paraneumónico resulta la complicación más frecuente de la neumonía bacteriana, de manejo complejo y muchas veces quirúrgico. No existen publicaciones en Cuba provenientes de ensayos clínicos controlados y aleatorizados ni del uso de la estreptoquinasa recombinante (Heberkinasa®) en el derrame pleural. Objetivo: Evaluar la eficacia y la seguridad de la Heberkinasa® en el tratamiento del derrame pleural paraneumónico complicado complejo y el empiema en niños. Métodos: Ensayo clínico fase III, abierto, aleatorizado (2:1), en grupos paralelos y controlado. Se concluyó la inclusión prevista de 48 niños (1-18 años de edad), que cumplieron los criterios de selección. Los progenitores otorgaron el consentimiento informado. Los pacientes se distribuyeron en dos grupos: I- experimental: terapia estándar y administración intrapleural diaria de 200 000 UI de Heberkinasa® durante 3-5 días y II-control: tratamiento estándar. Las variables principales: necesidad de cirugía y la estadía hospitalaria. Se evaluaron los eventos adversos. Resultados: Ningún paciente del grupo I-experimental requirió cirugía, a diferencia del grupo II-control en el que 37,5 por ciento necesitó cirugía video-toracoscópica, con diferencia altamente significativa. Se redujo la estadía hospitalaria (en cuatro días), las complicaciones intratorácicas y las infecciones asociadas a la asistencia sanitaria en el grupo que recibió Heberkinasa®. No se presentaron eventos adversos graves atribuibles al producto. Conclusiones: La Heberkinasa® en el derrame pleural paraneumónico complicado complejo y empiema resultó eficaz y segura para la evacuación del foco séptico, con reducción de la necesidad de tratamiento quirúrgico, de la estadía hospitalaria y de las complicaciones, sin eventos adversos relacionados con su administración(AU)

Introduction: Paraneumonic pleural effusion is the most frequent complication of bacterial pneumonia, with complex and often surgical management. There are no publications in Cuba from randomized controlled clinical trials or the use of recombinant streptokinase (Heberkinase®) in pleural effusion. Objective: To evaluate the efficacy and safety of Heberkinase® in the treatment of complex complicated parapneumonic pleural effusion and empyema in children. Methods: Phase III, open-label, randomized (2:1), parallel-group, controlled clinical trial. The planned inclusion of 48 children (1-18 years of age), who met the selection criteria, was completed. Parents gave informed consent. The patients were divided into two groups: I-experimental: standard therapy and daily intrapleural administration of 200,000 IU of Heberkinase® for 3-5 days; and II-control: standard treatment. The main variables: need for surgery and hospital stay. Adverse events were evaluated. Results: No patient in group I-experimental required surgery, unlike group II-control in which 37.5 percent required video-assisted thoracoscopic surgery, with a highly significant difference. Hospital stay (to 4 days), intrathoracic complications and infections associated to healthcare in the group that received Heberkinase® was reduced. No serious adverse events attributable to the product occurred. Conclusions: Heberkinase® in complex complicated parapneumonic pleural effusion and empyema was effective and safe for the draining of the septic focus, with reduction of the need for surgical treatment, hospital stay and complications, with no adverse events related to its administration(AU)

Clinical Characteristics and Prognosis of 76 Lung Adenocarcinoma Patients Harboring EGFR Mutations with Pleural Effusion at Initial Diagnosis: A Single-center Retrospective Study / 中国肺癌杂志

BACKGROUND@#Malignant pleural effusion is one of the common clinical manifestations of patients with lung adenocarcinoma. Patients with pleural effusion at the initial diagnosis of lung adenocarcinoma usually indicate poor prognosis. Epidermal growth factor receptor (EGFR) mutations mainly occur in patients with lung adenocarcinoma. Patients with different mutant subtypes have different prognosis. The clinical characteristics and prognostic factors of patients with EGFR mutated lung adenocarcinoma of different molecular subtypes combined with pleural effusion at initial diagnosis are still unclear. This study was designed to explore the clinical characteristics and prognostic factors of these patients in order to provide management recommendations for them.@*METHODS@#A retrospective analysis of the clinical characteristics, treatment, outcomes and progression-free survival (PFS) of first-line treatment in patients with EGFR mutated lung adenocarcinoma combined with pleural effusion at initial diagnosis admitted to Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital from January 2012 to June 2021 was performed. Pearson's chi-square test or Fisher's exact test were performed for comparison between groups. Kaplan-Meier method was performed for survival analysis and Cox proportional risk regression model was performed for multivariate analysis.@*RESULTS@#76 patients met the inclusion criteria in this study. The incidences of EGFR classical mutations 19del, 21L858R and non-classical mutations were 46.0%, 38.2% and 15.8%, respectively among these patients. There was no significant difference between the three mutations in terms of gender, age, presence of dyspnea at presentation, whether other distant metastases were combined, site of pleural effusion, volume of pleural effusion, presence of other combined effusions, tumor-node-metastasis (TNM) stage, presence of other gene mutations, and treatment of pleural effusion (P>0.05). In patients with EGFR classical mutations 19del or 21L858R or non-classical mutations subtype, the proportion of chemotherapy in first-line regimens were 17.1%, 20.7% and 58.3%, respectively (P=0.001); and first-line disease control rates were 94.3%, 75.9% and 50%, respectively (P=0.003); pleural effusion control rates were 94.3%, 79.3% and 66.7%, respectively (P=0.04); PFS were 287 d, 327 d and 55 d, respectively (P=0.001). Univariate analysis showed that EGFR mutation subtype, control of pleural effusion, first-line treatment agents, and first-line treatment efficacy were significantly associated with PFS (P<0.05). Cox multifactorial analysis showed that only EGFR mutation subtype and first-line treatment efficacy were independent prognostic factors for PFS (P<0.05).@*CONCLUSIONS@#PFS was significantly better for classical mutations than for non-classical mutations in patients with EGFR mutated lung adenocarcinoma combined with pleural effusion at initial diagnosis. Improving the efficacy of first-line therapy is the key to improve the prognosis of these patients.

Respiratory mechanics behavior after heart surgery: an experimental study

Changes in ventilatorymechanics and their consequent pulmonary complications are common after surgical procedures, particularly in cardiac surgery (CS), and may be associated with both preoperative history and surgical circumstances. This study aims to compare ventilatory mechanics in the moments before and after cardiac surgery (CS), describing how pulmonary complications occurred. An experimental, uncontrolled study was conducted, of the before-and-after type, and with a descriptive and analytical character. It was carried out in a private hospital in the city of Salvador, Bahia, Brazil, and involved 30 adult patients subjected to CS. In addition to clinical and epidemiological variables, minute volume (VE), respiratory rate (RR), tidal volume (VT), forced vital capacity (FVC), maximum inspiratory pressure (MIP), and peak expiratory flow (PEF) were also recorded. Data were collected in the following moments: preoperative (PRE-OP) period, immediate postoperative (IPO) period, and 1stpostoperative day (1stPOD). The sample was aged 48.1 ± 11.8 years old and had a body mass index of 25.5 ± 4.9 kg m-2; 60% of the patients remained on mechanical ventilation for less than 24 hours (17.5 [8.7-22.9] hours). There was a significant reduction in VT, FVC, MIP and PEF when PRE-OP versus IPO, and PRE-OP versus 1stPOD were compared (p < 0.05). There were no significant changes between IPO and the 1stPOD. The highest incidence of pulmonary complications involved pleural effusion (50% of the patients). This study showed that patients subjected to CS present significant damage to ventilatory parameters after the surgery, especially in the IPO period and on the 1stPOD. It is possible that the extension of this ventilatory impairment has led to the onset of postoperative pulmonary complications.

Transforming growth factor beta1 (TGF-ß1) levels in a rat model of induced pleural empyema

Abstract Purpose: To evaluate the concentration of transforming growth factor beta 1 (TGFB1) levels in a rat pleural effusion obtained by inoculation of intrapleural bacteria or turpentine through thoracentesis. Methods: Thirty-Nine Wistar rats were divided into three groups: Staphylococcus aureus (SA, n = 17); Streptococcus pneumoniae (SP, n = 12); and turpentine (control, n = 10). Pleural fluid was collected through ultrasound-guided thoracentesis 12 h, 24 h, and 36 h after instillation of bacteria or turpentine. Levels of TGFB1 were measured in pleural fluid. Results: At 12 h, mean TGFB1concentrations were 5.3450 pg/mL in the SA group, 5.3449 pg/mL in the SP group, and 5.3450 pg/mL in controls. At 24 h, they were 4.6700 pg/mL in the SA group, 4.6700 pg/mL in the SP group, and 4.6700 pg/mL in controls. At 36 h, they were 4.6699 pg/mL in the SA group and in control. No difference was observed among the groups in mean TGFB1concentration (p = 0.12); however, a significant intragroup reduction in mean TGFB1 was observed between 12 and 24 h (p < 0.01). Conclusion: The transforming growth factor beta 1 concentrations were not useful as a diagnostic tool or an early marker of infected pleural effusion.

Derrame pleural como apresentação de abscesso do psoas por Streptococcus anginosus: relato de caso / Pleural effusion as presentation of psoas abscess due to Streptococcus anginosus: case report

O abscesso do psoas traduz uma situação rara, de etiologia variada e fisiopatologia complexa, mas ainda não clarificada. O objetivo deste estudo foi relatar um caso de apresentação rara de abscesso do psoas sob a forma de derrame pleural. Paciente do sexo masculino, 63 anos, com quadro de dispneia e deterioração do estado geral, associado à febre (38,3ºC). Apresentava perda ponderal de 10kg, taquipneia e semiologia pulmonar compatível com derrame pleural direito. Os dados laboratoriais revelaram leucocitose associada à alteração da função hepática, proteína C-reativa e velocidade de sedimentação elevadas. Radiografia do tórax revelou derrame pleural direito. A tomografia computadorizada confirmou a presença de derrame pleural e de abscesso do psoas homolateral, tendo sido iniciada antibioterapia empírica com piperacilina/tazobactam e metronidazol. Realizou, posteriormente, drenagem guiada por tomografia computadorizada do abscesso do psoas. O exame cultural foi positivo para Streptococcus anginosus no líquido pleural, abscesso do psoas e sangue. Após drenagem de abcesso do psoas, foi mantida a imagem compatível com derrame pleural, tendo sido realizada nova drenagem torácica do derrame pleural. Após vários dias, retirou-se a drenagem torácica. Obteve alta hospitalar sendo referenciado à consulta de medicina. Devido à originalidade do caso, visto não existirem casos descritos com essa forma de apresentação, nem por esse agente etiológico, realizou-se uma revisão da literatura do diagnóstico e tratamento dessa doença.

Psoas abscess represents a rare situation of varied etiology and complex pathophysiology that has not yet been clarified. This study aimed to report an unusual presentation of psoas abscesso in the form of pleural effusion. Male patient, 63 years old, with signs of dyspnea and deterioration of general condition, associated with fever (100,94ºF). He presented with 10-kg weight loss, tachypnea, and pulmonary symptomatology that was consistent with right pleural effusion. Laboratory data showed leukocytosis with alteration of liver function, elevated C-reactive protein, and high erythrocyte sedimentation rate. Chest radiograph revealed right pleural effusion. Computed tomography confirmed the presence of pleural effusion and ipsilateral psoas abscess. Empirical antibiotic therapy with piperacillin/tazobactam and metronidazole was initiated, and computed tomography-guided drainage of the psoas abscess was performed. Culture was positive for Streptococcus anginosus in pleural fluid, psoas abscess and blood. After drainage of the psoas abscess, the image that was consistent with pleural effusion remained, and new chest drainage of pleural effusion has been held. After several days, the chest tube was removed. The patient was discharged and referred to clinical consultation. Because of the originality of the case, since there are no cases describing this presentation nor these etiologic agent, literature review of the diagnosis and treatment of this pathology has been conducted

Clinical Characteristics and Factors Influencing the Occurrence of Acute Eosinophilic Pneumonia in Korean Military Personnel

Acute eosinophilic pneumonia (AEP) is an uncommon inflammatory lung disease, and limited data exist concerning the clinical characteristics and factors that influence its occurrence. We retrospectively reviewed the records of AEP patients treated at Korean military hospitals between January 2007 and December 2013. In total, 333 patients were identified; their median age was 22 years, and all were men. All patients presented with acute respiratory symptoms (cough, sputum, dyspnea, or fever) and had elevated levels of inflammatory markers including median values of 13,185/microL for white blood cell count and 9.51 mg/dL for C-reactive protein. All patients showed diffuse ground glass opacity/consolidation, and most had pleural effusion (n = 265; 80%) or interlobular septal thickening (n = 265; 85%) on chest computed tomography. Most patients had normal body mass index (n = 255; 77%), and only 30 (9%) patients had underlying diseases including rhinitis, asthma, or atopic dermatitis. Most patients had recently changed smoking habits (n = 288; 87%) and were Army personnel (n = 297; 89%).The AEP incidence was higher in the Army group compared to the Navy or Air Force group for every year (P = 0.002). Both the number of patients and patients with high illness severity (oxygen requirement, intensive care unit admission, and pneumonia severity score class > or = III) tended to increase as seasonal temperatures rose. We describe the clinical characteristics of AEP and demonstrate that AEP patients have recently changed smoking habits and work for the Army. There is an increasing tendency in the numbers of patients and those with higher AEP severity with rising seasonal temperatures.

Broncho-Pleural Fistula with Hydropneumothorax at CT: Diagnostic Implications in Mycobacterium avium Complex Lung Disease with Pleural Involvement

OBJECTIVE: To determine the patho-mechanism of pleural effusion or hydropneumothorax in Mycobacterium avium complex (MAC) lung disease through the computed tomographic (CT) findings. MATERIALS AND METHODS: We retrospectively collected data from 5 patients who had pleural fluid samples that were culture-positive for MAC between January 2001 and December 2013. The clinical findings were investigated and the radiological findings on chest CT were reviewed by 2 radiologists. RESULTS: The 5 patients were all male with a median age of 77 and all had underlying comorbid conditions. Pleural fluid analysis revealed a wide range of white blood cell counts (410-100690/microL). The causative microorganisms were determined as Mycobacterium avium and Mycobacterium intracellulare in 1 and 4 patients, respectively. Radiologically, the peripheral portion of the involved lung demonstrated fibro-bullous changes or cavitary lesions causing lung destruction, reflecting the chronic, insidious nature of MAC lung disease. All patients had broncho-pleural fistulas (BPFs) and pneumothorax was accompanied with pleural effusion. CONCLUSION: In patients with underlying MAC lung disease who present with pleural effusion, the presence of BPFs and pleural air on CT imaging are indicative that spread of MAC infection is the cause of the effusion.

Hérnia diafragmática congênita simulando derrame pleural: relato de caso / Congenital diaphragmatic hernia simulating pleural effusion: case report

JUSTIFICATIVA E OBJETIVOS: A hérnia diafragmática congênita de Bochdalek se constitui um defeito na posição póstero-lateral do diafragma, ocorrendo normalmente na infância, sendo causa importante de hipoplasia pulmonar. Em adultos, é uma ocorrência rara, com pouco mais de 100 casos descritos. Os adultos comumente são assintomáticos, podendo apresentar sintomas gastrointestinais e raramente, sintomas respiratórios inespecíficos. O objetivo deste estudo foi relatar uma apresentação tardia de hérnia de Bochdalek em um adulto com sintomatologia respiratória. RELATO DO CASO: Paciente do sexo masculino, 30 anos, com queixa de dispneia de longa data, que teve o seu diagnóstico realizado após apresentar um quadro similar a um derrame pleural. CONCLUSÃO: Devido à raridade das hérnias diafragmáticas congênitas em adultos, é necessário raciocínio clínico, técnico e tático diferenciado por parte do médico clínico, o que pode evitar graves complicações como pneumotórax e necrose intestinal.

BACKGROUND AND OBJECTIVES: Bochdalek congenital diaphragmatic hernia constitutes a defect in the posterolateral position of the diaphragm, usually occurring in childhood and being an important cause of pulmonary hypoplasia. In adults,it is a rare occurrence, with little more than 100 cases reported. Adults are usually asymptomatic but gastrointestinal symptoms and, rarely, nonspecific respiratory symptoms, can occur. This study aimed at reporting a late presentation of Bochdalek herniain adult patient with respiratory symptoms. CASE REPORT: Male patient, 30-year-old with a complaint of long-standing dyspnea, who had the diagnosis made after presenting a clinical picture similar to a pleural effusion. CONCLUSION: Since the occurrence of congenital diaphragmatic hernias in adults is very rare, the clinician needs clinical,technical and tactical reasoning, in order to prevent serious complications such as pneumothorax and intestinal necrosis.

Diagnostic value of NT-PRO BNP in cardiogenic and non cardiogenic pleural effusion

The finding of an exudative effusion usually requires an extensive diagnostic workup, leading to an unnecessary exposure to invasive and expensive diagnostic procedures. Thus a strategy of identifying pleural effusions due to heart failure and possibly avoiding unnecessary diagnostic thoracentesis and/or further diagnostic procedures would be an attractive and potentially beneficial approach [6]. NT-proBNP measured in serum is a sensitive marker of cardiac dysfunction and proven to be a useful tool in the diagnosis of acute and chronic systolic and diastolic left ventricular heart failure [7, 8]. The present study was conducted to assess the diagnostic value of NT-proBNP in the differentiation of cardiogenic and non cardiogenic pleural effusion. Forty patients with pleural effusion were included in this study. Twenty patients with cardiogenic pleural effusions [pleural effusion due to cardiac cause] and 20 patients with non cardiogenic pleural effusions [pleural effusion due to non cardiac cause]. All patients were subjected to full history, clinical examination, investigation to detect the etiology of the pleural effusion and measurement of serum and pleural fluid NT-proBNP. In this study we found that pleural fluid NT-proBNP levels were significantly higher in patients with cardiogenic pleural effusions than that of patients with non cardiogenic pleural effusions [Mean +/- SEM, 5231 +/- 671.1 and 628.8 +/- 120.1 respectively, P value < 0.0001]. Also NT-proBNP levels in the serum of the patients with cardiogenic pleural effusions were significantly higher than that of patients with non cardiogenic pleural effusions [Mean +/- SEM, 4792 +/- 612.7, and 604.0 +/- 120.1 respectively, P value < 0.0001]. There was also a highly significant positive correlation between NT-proBNP levels in serum and pleural fluid Spearman's Coefficient of rank correlation is 0.992 [p < 0.0001]. We found also that at a cut-off value of 1.591 pg/ml, pleural fluid NT-proBNP level had a sensitivity of 95% and a specificity of 90% in the diagnosis of cardiogenic pleural effusion. Also at a cut off value of 1570 pg/ml, serum NT-proBNP level had a sensitivity of 95% and a specificity of 90% in the diagnosis of cardiogenic pleural effusion. It is concluded that serum and pleural fluid NT-proBNP levels are very useful in establishing the diagnosis of cardiogenic pleural effusions

Uso de toracotomía mínima ampliada y lavado de cavidad pleural en el tratamiento del empiema / Using minimal thoracotomy enlarged cavity lavage in treating pleural empyema

El empiema se define como la acumulación patológica de líquido en el espacio pleural y es el resultado de un desequilibrio entre la formación y la reabsorción de líquido a este nivel, causado por neumonías. Evaluar el uso de la toracotomía mínima ampliada y lavado de la cavidad pleural en el tratamiento del empiema, en los pacientes que asistieron al Hospital Universitario de Caracas entre enero de 2007 y Noviembre de 2008. 20 pacientes (12 varones, 8 hembras), con edades comprendidas entre 2 y 9 años fueron tratados por presentar Neumonía complicada con Empiema. La Toracotomía mínima convencional fue realizada en 11 pacientes (5 varones, 6 hembras) y la Toracotomía mínima ampliada y lavado de cavidad pleural fue realizada en 9 pacientes (7 varones, 2 hembras). El tiempo promedio de hospitalización fue de 23,3 días en el grupo control y 23,9 días en el grupo muestra. El tiempo promedio del postoperatorio en el grupo control fue de 7,1 días y 5,9 días en el grupo de casos. Las complicaciones fueron tres en el grupo control, dos requirieron Toracotomía más decorticación, y segmentectomía del lóbulo medio adicional en uno; el grupo muestra no ameritó la realización de procedimiento quirúrgico adicional. El uso de la toracotomía mínima ampliada mas lavado de la cavidad pleural en los pacientes con empiema en etapa temprana; es una opción accesible y útil en aquellos centros en los que no se cuenta con toracoscopio para la realización de la misma, y por ende no requiere realizar decorticaciones o segmentectomias

Empyema is defined as abnormal accumulation of fluid in the pleural space and is the result of an imbalance between formation and resorption of fluid at this level, caused by pneumonia. Our goal is to evaluate the use of extended minimal thoracotomy and pleural lavage in the treatment of empyema in patients attending the Hospital Universitario de Caracas. In total 20 patients (12 males and 8 females), aged between 2 and 9 years were treated for pneumonia complicated with empyema. The conventional minimum Thoracotomy was performed in 11 patients (5 males and 6 females) and the expanded minimum Thoracotomy and pleural cavity lavage was performed in 9 patients (7 males and 2 females). The average length of hospital stay was 23.2 days in the control group and 23. 8 days in the sample group shows no difference from a statistical standpoint. The average time post-procedure hospitalization in the control group was 7 days and 5.8 days in group shows no significant differences. Complications were 3 in the control group, requiring more Thoracotomy and decortication in two cases and middle lobe segmentectomy in another, while in the sample group does not warrant the performance of additional surgical procedure, statistically significant differences exist. We conclude that the use of minimal thoracotomy extended more of the pleural lavage in patients with early-stage empyema, is a useful and accessible option, since it may avoid making decortications or segmentectomy.

BAVT como manifestação inicial de massa cardíaca em paciente de 74 anos / Atrio-ventricular block as inicial manifestation of cardiac mass in a female, 74 years old pacient: a case report

Mulher, 74 anos, internada por quadro, iniciado há cerca de 10 dias, de dispnéia, astenia progressina e tonteira rotatória. ECG:BAVT. O RX de tórax mostrou importante derrame pleural à esquerda. Laboratório: LDH (Lactato desidogenase) elevado. Ecocardiograma transtorácico: Massa aderida à válvula tricúspide em direção ao VD, ovalada com bordos regulares (2,8 x 2,7 cm). Espaço pericárdico adjacente ao VD ocupado, causando restrição diastólica ao VD. Biópsia miocárdica: linfoma difuso de grandes células B - Burkitt like. Linfomas cardíacos primários são raros, mais comuns em adultos, homens e idosos. Os sintomas são tardios. Em cerca de 23 por cento, há aumento de LDH. Cerca de 14 por cento manifestam-se como BAV. Prognóstico reservado.

A Case of Pleural Effusion Associated with Acute Hepatitis A / 대한소화기학회지

Hepatitis A virus (HAV) infection is common in developing countries, including Korea. It can be accompanied by extrahepatic complications such as renal failure, arthritis, and vasculitis. Pleural effusion is a very rare complication of HAV infection, which has been reported usually in children, and has benign clinical courses. Here we report a case of pleural effusion with ascites which occurred in an adult hepatitis A patient. A 26-year-old-woman presented generalized myalgia and fever and was diagnosed as acute hepatitis A. Despite of the improvement of laboratory findings, fever and cough persisted. Pleural effusion newly appeared on the serial chest radiologic images. After the fever settled down, the pleural effusion resolved spontaneously at 13th day of admission.

Derrame pleural / Pleural effusion

El derrame pleural se define como la acumulación anormal de líquido en el espacio pleural que se produce por aumento en la producción o disminución del drenaje, causas comunes en patologías clínicas. Dentro de las causas del incremento de la producción podemos enunciar un aumento de la permeabilidad capilar pleural, disminución de la presión oncótica capilar y aumento de la presión hidrostatica capilar, son menos claras las causas de la disminución del drenaje pero se destacan la alteración de la contractibilidad linfàtica pleural, infiltración de vasos y nódulos linfáticos por enfemedades neoplàsicas y alteraciones a nivel pleural que impidan que el líquido este en contacto con los poros linfáticos. El objetivo de esta revisión es el analisis de las bases fisiológicas de la pleura y la producción del líquido pleural, los aspectos fisiopatológicos del derrame pleural, el enfoque diagnóstico y el manejo médico-quirúrgico del mismo de acuerdo a las diferentes causas que lo producen.

Hérnia lombar adquirida secundária do tipo Grynfeltt: relato de caso / Acquired secondary Grynfeltt's hernia: a case report

A hérnia lombar é um diagnóstico infrequente e difícil. É mais prevalente em pessoas do sexo masculino e de idade avançada. Relatamos o caso de um paciente de 79 anos de idade, do sexo masculino, que realizou drenagem de derrame pleural há 17 anos e que apresentou quadro clínico e tomográfico de hérnia lombar adquirida secundária do tipo Grynfeltt.

Lumbar hernia is a rare condition whose diagnosis is hardly achieved. The prevalence is higher in elderly men. The present case report describes the case of a male, 78-year-old patient who underwent pleural effusion drainage 17 years before presenting with clinical manifestations and tomographic findings compatible with acquired secondary Grynfeltt's hernia.

Derrame pleural complicado en el niño: guía práctica cubana / Complicated pleural leakage: cuban practice guide

Durante el tratamiento actual del niño con derrame pleural paraneumónico complicado se detectan insuficiencias y contradicciones debidas a la diversidad de formas de presentación de dicho trastorno y a la ausencia de consenso con respecto al tratamiento adecuado. Se propone una guía de práctica clínica validada mediante un estudio cuasi experimental desarrollado en la provincia de Holguín, durante 4 años. La guía está compuesta por 4 capítulos e incluye recomendaciones precisas ante cada forma de presentación de la enfermedad.

During present treatment of a child presenting with complicated parapneumonic leakage, it is possible to detect insufficiencies and contraindications due to different ways of presentation of such disorder, and to lack of consensus regarding appropriate treatment. We propose a valid clinical practice by means a quasi-experimental study developed in Holguín province during 4 years. Guide include 4 chapters and precise recommendations in face of each way of presentation of this disease.

Derrame pleural: [revisión] / Pleural effusion: [review]

El derrame pleural se define como la acumulación anormal de líquido en el espacio pleural; no es una enfermedad, es el resultado del desequilibrio entre la formación y la reabsorción del líquido como manifestación de alguna condición que incluso puede amenazar la vida del paciente. Es una entidad a la cual el clínico se ve enfrentado con frecuencia, la mayoría de las veces es secundaria a enfermedad pleural o pulmonar, pero puede también ser causada por enfermedades extrapulmonares, sistémicas o neoplásicas (bien sea primarias o metastásicas)...

Complicated parapneumonic effusion: Etiology and results of lung decortication

Parapneumonic effusion is a common accompaniment of bacterial pneumonia and mostly is resolved with medical management. We studied the etiology and possible underlying causes of complicated parapneumonic effusion and timing of pulmonary decortication. A descriptive study on 34 patients with postpneumonic empyema which required decortication carried out. Post surgical and post traumatic empyema were excluded. Patients' age ranged from 20 to 75 with a mean of 46 years. The most common clinical findings were fever [90%], pleural dull pain [80%], productive cough [73%] and dyspnea [70%]. PPD test was negative in all patients. In 78%, white cell count was normal; in remainder it was more than 10.000. Bacteriological findings were negative and acid fast bacilli were not detected. All patients underwent posterolateral thoracotomy and decortication and completely expansible lung was achieved. Tissue diagnosis after decorticating showed tuberculosis in 8 [24%] patients and necrotic tissue in remainder. Average medical management time and postoperative hospital stay were 38 +/- 2 and 6.7 +/- 2 days, respectively. Morbidity rates were acceptable and there was one late mortality. No recurrence was happened. In parapneumonic effusions not responding to standard treatment, tuberculosis must be considered, especially in addicted persons, positive family history and ESR > 100. In complicated parapneumonic effusion, early thoracotomy and full decortication is recommend because it is diagnostic, allows control of infection, releases the pulmonary entrapment, early discharge from hospital, need not further antibiotic administration and is cost benefit

Factors Influencing Residual Pleural Opacity in Tuberculous Pleural Effusion

Tuberculous pleural effusion (TPE) leads to residual pleural opacity (RPO) in a significant proportion of cases. The aim of this study was to investigate which TPE patients would have RPO following the treatment. This study was performed prospectively for a total of 60 TPE patients, who underwent pleural fluid analysis on the initial visit and chest radiographs and computed tomography (CT) scans before and after the administration of antituberculous medication. At the end of antituberculous medication, the incidence of RPO was 68.3% (41/60) on CT with a range of 2-50 mm. Compared with the non-RPO group, the RPO group had a longer symptom duration and lower pleural fluid glucose level. On initial CT, loculation, extrapleural fat proliferation, increased attenuation of extrapleural fat, and pleura-adjacent atelectasis were more frequent, and parietal pleura was thicker in the RPO group compared with the non-RPO group. By multivariate analysis, extrapleural fat proliferation, loculated effusion, and symptom duration were found to be predictors of RPO in TPE. In conclusion, RPO in TPE may be predicted by the clinico-radiologic parameters related to the chronicity of the effusion, such as symptom duration and extrapleural fat proliferation and loculated effusion on CT.