Modificaciones en el tratamiento de pacientes con bronquiolitis luego de la radiografía de tórax / Treatment modifications in patients with bronchiolitis after chest X-rays

Resumen: Introducción: las pautas nacionales vigentes sobre bronquiolitis recomiendan la realización de radiografía de tórax a todos los pacientes admitidos en áreas de internación. Estudios recientes sugieren que esta conducta tiene bajo rendimiento para diagnosticar complicaciones y determina una mayor prescripción de antibióticos. Objetivos: analizar las características de la radiografía de tórax en pacientes con bronquiolitis que requieren hospitalización y comprobar si se modificó la conducta terapéutica a partir de la realización de la misma. Material y métodos: estudio observacional prospectivo durante el invierno de 2015 en dos centros de asistencia pediátrica. Las radiografías fueron interpretadas por médicos clínicos y un imagenólogo siguiendo un protocolo único en forma independiente. Resultados: se incluyeron 82 pacientes en el estudio. Se observó una escasa coincidencia entre las lecturas radiográficas del médico clínico y el médico imagenólogo. El médico clínico informó neumonía en la radiografía con mayor frecuencia que el imagenólogo (26% vs 6%), Se observó indicación de antibióticos por parte del MC en pacientes con radiografías informadas por el MI como típicas de bronquiolitis. Conclusiones: la radiografía de tórax en lactantes hospitalizados por bronquiolitis fue normal o típica en un 93%. Hubo escasa coincidencia entre el informe del médico clínico y el médico imagenólogo. Se constató una mayor prescripción de antibióticos basado en la interpretación radiográfica realizada por el médico clínico, y no confirmadas por el MI.

Summary: Introduction: current national guidelines recommend routine chest x-rays to patients admitted with bronchiolitis. Recent publications suggest that performing chest x-rays to all admitted infants results in low performance rates in the diagnosis of complications and leads to higher rates of antibiotic prescription. Objectives: to analyze chest x-ray findings in admitted patients with bronchiolitis, and to evaluate whether x-rays findings determine modifications in medical treatment. Compare the interpretation of the x-rays between clinicians and radiologists. Method: observational study conducted in winter 2015, in the pediatric units of two different hospitals. X-rays were independently interpreted by clinicians and by one radiologist, following a single protocol. Results: 82 patients were included in the study. According to the radiologist, 6 % showed complications or non-consistent findings with broncholitis in the chest x-ray (atypical). Clinicians and radiologists interpretation of chest x-rays were barely coincident. Clinicians diagnosed pneumonia more frequently than imagenologists (26% vs 6%), leading to higher antibiotic prescription. Clinicians diagnosed anitbiotics in x-rays informed as typical bronchiolitis by imagenologists. Conclusions: chest x-ray in admitted infants with bronchiolitis were either normal or typical in 93 % of normal or typical findings. Clinicians´ and radiologists´ interpretations differed significantly. Clinicians overdiagnosed pneumonia, and thus antibiotic prescription was higher based on their x-ray interpretation.

Patrón de alteraciones en la radiografía de tórax de niños hospitalizados por infección causada por virus influenza A (H1N1) / Pattern of chest radiographic abnormalities in children hospitalized because of influenza H1N1 virus infection

The first cases of H1N1- type Influenza virus infection in humans were reported in 2009, and since then, it rapidly expanded and became pandemic. At that time, an 88.5 percent increase in emergency consultations was observed in our institution, including adults and children and H1N1- type Influenza virus infection was clinically diagnosed in 10,048patients, 45.6 percent of them with laboratory confirmation. A total of 59 child, 33 girls and 26 boys, aged between 1 month and 15.5 years old, needed hospitalization. The average of hospitalization time was 3.9 days, 9 patients required intensive unit care and 4 of them mechanical ventilation. No fatal cases were registered in this series. Associated infection was confirmed in 15 patients: VRS (5), bacterial (9) and Mycoplasma (1). The most frequent radiological pattern was bilateral interstitial lung involvement (72 percent). A mixed interstitial/alveolar pattern was observed in 78 percent of patients with proven bacterial super infection. The purpose of this review is to describe the radiological pattern observed in children who needed hospitalization due to of H1Nl- type Influenza virus infection, during epidemic last year.

El año 2009 aparecieron los primeros casos de influenza humana causada por virus influenza A H1N1, propagándose como pandemia. En nuestra institución se observó 88,5 por ciento de aumento en consultas de urgencia, adultos y niños; se diagnosticaron 10.048 pacientes como influenza A H1N1 (45,6 por ciento confirmación de laboratorio). La media de edad fue 13 años. Se hospitalizaron 59 niños (edad: 1 mes - 15 años 7 meses), 33 niñas y 26 niños. El tiempo promedio de hospitalización fue de 3,9 días; 9 pacientes requirieron UTIy 4 ventilación mecánica. No hubo mortalidad en esta serie. Se demostró sobreinfección por VRS (5), infección bacteriana (9) y Mycoplasma (1). El patrón radiológico predominante en los niños hospitalizados correspondió a compromiso intersticial (72 por ciento) y el 28 por ciento presentó hiperinsuflación pulmonar. Los niños con infección bacteriana asociada presentaron mayoritariamente (78 por ciento) patrones radiológicos mixtos y de relleno alveolar. El propósito de esta revisión es conocer los patrones radiológicos en los niños que requirieron hospitalización por infección virus influenza A H1N1 en nuestra institución, durante la epidemia del año recién pasado.

Serum ICAM-1 in asthmatic children

The recruitment of leukocytes to inflamed tissues depends on the function of adhesive molecules of the leukocytes and of vascular endothelium. Intercellular adhesion molecules-1 [ICAM-1, CD.54] is a number of the immunoglobulin super-family of adhesion proteins. It is expressed by a number of blood cells and by endothclial, fibroblastic, and epithelial cells. The expression of ICAM-1 is upregulated by a number of cytokines that are released at sites of inflammation. It is probable that ICAM-1 participates in the recruitment of eosmophils to asthmatic airways and contributes to the pathogenesis of asthma. Serum ICAM-1 contains most of the structure of the extracellular portion of membrane-bound ICAM-1 could potentially have physiologic function, perhaps as a modifier of lymphocyte function-associated antigen-1 [LFA-1] dependent leukocyte adhesion. The principle objective of this work is to assess serum soluble intercellular adhesion molecules-1 [slCAM-1] level in asthmatic children during acute asthma exacerbation of their symptoms. We will pay attention to the effect of corticosteroid therapy on serum ICAM-1 level when administered for a short period of time during the acute episode. The study included 30 wheezy children with age from [6 months to 12 year] and 10 normal controls with the same age range. All children and controls undergo good history taking and thorough clinical examination, plain chest X-ray and laboratory investigations including; serum IgE, CBC with differential, serum ICAM-1 determination. Bacterial infection is excluded by clinical examination, leukocytic count, and chest X-ray. Our results showed that serum soluble intercellular adhesion molecules-1 [sICAM-1] level is significantly higher during acute asthma exacerbation in comparison to its level in serum of healthy controls. Also the level of serum soluble adhesion molecules-1 [slCAM-1] is reduced significantly 10 days following the acute episode after a short period of oral corticosteroid therapy

Imaging in 100 patients of thoracic hydatid disease including unusual imaging appearances

To evaluate the chest radiography and CT scan characteristics of pulmonary hydatid disease [PHD]. One hundred patients [59 males and 41 females, age ranged from 9 to 80 years] with surgically proven pulmonary hydatid cysts were studied. We reviewed clinical and imaging findings including PA and LAT chest roentgenograms and conventional CT of the chest. Only 82 patients had CT scan in their files, but all had CXR. The radiological features [localization, diameter, architecture, density and other radiological signs and appearances] were determined. On CXR, 124 cysts were determined. In evaluation of 82 available CT scans, a total of 112 cysts were detected. No cysts was detected on 5 CT scans. No discrete cyst was detected on 10 CXRs: 4 patients. only consolidation; and 6 patients, only hydropneumothorax. The most frequent site of involvement was RLL [29.6%]. Fifteen hydatid cysts appeared as solid masses on CT. Fifty-seven cysts were ruptured cysts and 25 patients with ruptured cysts had hemoptysis [43.9%]. Thirty-eight percent of cysts had thin walls and 62% had thick walls. Sixty-four cysts were round in shape [55.7%]. Single cysts were seen in 63 patients while multiple cysts were seen in 37. Median CT density of the cysts was 24 Hounsfeild Units [HU] [-18 to 84]. There were 16 giant cysts [diameter >/= 10 cm] on CT. Mean maximum and minimum dimensions of cysts were 5 cm and 4 cm on CT and 6.8 cm and 5.7 cm on CXR, respectively. On CT and CXR, "water lily sign" was seen in 18 and 22 patients, 'air-fluid level" in 12 and 17 patients, and "crescent sign" in 11 and 5 of patients, respectively. Inverse crescent sign and calcification were not observed on CXRs, but each was reported on 4 CT scans. On CT' 90% of cysts were smooth, 74 cysts were uniloculated and 9 were multiloculated. Nineteen percent of cysts were infected. Other imaging findings included mediastinal shift, atelectasis, infiltration. pericystic lung reaction, chest wall involvement, and rib destruction. CXR is helpful with diagnosis of intact cysts but fails to define entire morphology of complicated cysts. CT imaging recognizes certain details not visible on radiography. In endemic regions like Iran, atypical imaging presentations of complicated pulmonary hydatid disease, such as solid masses, should be considered in differential diagnosis of pulmonary lesions

Manifestaciones radiográficas de la tuberculosis pulmonar / Radiographic manifestations of pulmonary tuberculosis

La tuberculosis (TBC) es una patología que ha acompañado al hombre desde los comienzos de la historia, y a pesar de que hace más de medio siglo se cuenta con antibióticos eficaces y se puede considerar una enfermedad prevenible, tratable y erradicable, esta meta está lejos de ser alcanzada. En Chile se diagnostican semanalmente entre 40-70 casos, lo que significa que el médico está constantemente enfrentado este cuadro. Por lo general, el diagnóstico se sospecha sobre la base de la sintomatología y antecedentes epidemiológicos, siendo la radiografía de tórax el primer examen de aproximación diagnóstica. Diversos patrones radiológicos, con compromiso parenquimatoso y/o intersticial, son característicos y las manifestaciones son dependientes de la edad del paciente, de su estado inmunológico, de la exposición previa y de sí estamos frente a un cuadro primario o posprimario. Presentamos distintos patrones radiológicos de la TBC pulmonar, en pacientes atendidos durante el primer semestre de este año en el Hospital Clínico de la Universidad de Chile y en el Hospital San Juan de Dios.

Punción biopsia: aspiración percutánea de tórax bajo TC / CT guided needle aspiration biopsy of thoracic lesions

La punción biopsia aspirativa percutánea (PBAP) de tórax (Tx) bajo TC es un procedimiento diagnóstico bien establecido con bajo porcentaje de complicaciones. La literatura existente sobre el tema determina una tasa mayor al 90 por ciento para la certeza citológica e histológica de la lesión. En nuestra experiencia basada en 110 pacientes con PBAP se obtuvo una sensibilidad del 93,7 por ciento. Las complicaciones incluyen el neumotórax (Ntx) y la hemoptisis, siendo significativamente baja su incidencia