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1.
Rev. cuba. pediatr ; 93(2): e1268, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280363

ABSTRACT

Introducción: La neumonía adquirida en la comunidad continúa siendo un problema de salud global. Objetivo: Caracterizar desde la óptica clínico-epidemiológica la neumonía adquirida en la comunidad en la edad pediátrica. Métodos: Estudio descriptivo de corte transversal y prospectivo de pacientes entre 1 mes-18 años, no vacunados con antineumocócica, ingresados en el Hospital Pediátrico Centro Habana, enero 2018-julio 2019 con diagnóstico confirmado por radiología de neumonía adquirida en la comunidad. Los pacientes no presentaban enfermedades crónicas, exceptuando el asma. Los padres o tutores dieron su consentimiento. Se evaluaron variables demográficas y clínicas, factores de riesgo, evolución y complicaciones según grupo de edad. Resultados: Se estudiaron 277 enfermos, predominaron los niños entre 1 a 4 años de edad (39,4 por ciento), superioridad del sexo masculino (55,2 por ciento). Los síntomas más frecuentes fueron: fiebre (98,9 por ciento), disnea (99,3 por ciento), tos (98,9 por ciento) y disminución del murmullo vesicular (96,4 por ciento). Como factores de riesgo predominaron la asistencia a círculos infantiles (31,8 por ciento), lactancia materna inadecuada (23,8 por ciento) y el tabaquismo pasivo (16,6 por ciento). Hubo complicaciones en 110 niños (39,7 por ciento) con predominio de derrame pleural, sobre todo en prescolares y asociación significativa entre complicaciones y edad. No hubo fallecimientos. Conclusiones: Es importante la vigilancia de las neumonías y su desarrollo clínico epidemiológico, para la prevención y diagnóstico en esa etapa previa a la introducción de la vacuna antineumoccócica. En población no vacunada contra el neumococo, es estrategia significativa reducir los factores de riesgo modificables como la insuficiente lactancia materna, el tabaquismo pasivo y la malnutrición(AU)


Introduction: Community-acquired pneumonia continues to be a global health problem. Objective: Characterize from the clinical-epidemiological perspective community-acquired pneumonia in the pediatric ages. Methods: Descriptive cross-sectional and prospective study of patients from 1 month to 18 years old not vaccinated with pneumococcal vaccine, admitted in Centro Habana Pediatric Hospital from January 2018 to July 2019 with diagnosis confirmed by radiology of pneumonia acquired in the community. Patients did not have chronic diseases, except for asthma. Parents or guardians consented. Demographic and clinical variables, risk factors, evolution and complications were assessed according to the age group. Results: 277 patients were studied, children from 1 to 4 years old predominated (39.4 percent); there was male superiority (55.2 percent). The most common symptoms were fever (98.9 percent), dyspnea (99.3 percent), cough (98.9 percent) and decreased vesicular murmur (96.4 percent). As risk factors, attendance to nurseries (31.8 percent), inadequate breastfeeding (23.8 percent) and passive smoking (16.6 percent) predominated. There were complications in 110 children (39.7 percent) with prevalence of pleural effusion, especially in pre-schoolers and significant association among complications and age. There were no deaths. Conclusions: Monitoring of pneumonia and its epidemiological clinical development is important for prevention and diagnosis at this stage prior to the introduction of the pneumococcal vaccine. In populations not vaccinated against pneumococcus, it is a significant strategy to reduce modifiable risk factors such as insufficient breastfeeding, passive smoking and malnutrition(AU)


Subject(s)
Humans , Pleural Effusion , Asthma , Tobacco Smoke Pollution , Dyspnea , Malnutrition
2.
Arch. argent. pediatr ; 119(3): e264-e268, Junio 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1248231

ABSTRACT

La linfangiomatosis pulmonar difusa es una enfermedad rara caracterizada por una marcada proliferación y dilatación de los vasos linfáticos en los pulmones, la pleura y el mediastino. Se desconoce la prevalencia, y la etiología no se comprende completamente.Una niña de 22 meses ingresó por poliserositis, con derrame pericárdico y pleural. Requirió pericardiocentesis y avenamiento pleural, y presentó drenaje de quilo (1,5-4 litros/día) sin respuesta al tratamiento médico (ayuno, nutrición parenteral y octreotide). Se realizó biopsia pulmonar. La anatomía patológica mostró hallazgos compatibles con linfangiomatosis difusa pulmonar. Comenzó tratamiento con sirolimus y propanolol, que disminuyeron las pérdidas por el drenaje pleural a la semana. Presentó buena evolución; suspendió aporte de oxígeno y se retiró el drenaje pleural. Se externó al cuarto mes de internación. El diagnóstico temprano de la linfangiomatosis pulmonar difusa es difícil de lograr, pero permite aplicar terapéuticas que evitan la progresión de enfermedad y disminuir la morbimortalida


Diffuse pulmonary lymphangiomatosis is a rare disease characterized by marked proliferation and dilation of lymphatic vessels in the lungs, pleura, and mediastinum. The prevalence is unknown and the etiology is not fully understood.A 22-month-old girl was admitted for polyserositis, with pericardial and pleural effusion. She required pericardiocentesis and pleural drainage, presenting chyle drainage (1.5-4 liters/day) without response to medical treatment (fasting, parenteral nutrition and octreotide). A lung biopsy was performed. The pathological anatomy showed findings compatible with diffuse pulmonary lymphangiomatosis. Treatment with sirolimus and propanolol began, decreasing losses due to pleural drainage one week after treatment. She progressed well, discontinued oxygen supply and pleural drainage was removed, leaving the patient after the fourth month of hospitalization.Early diagnosis of diffuse pulmonary lymphangiomatosis is difficult to achieve, but it allows the application of therapies that prevent disease progression, reducing morbidity and mortality.


Subject(s)
Humans , Female , Infant , Lung Diseases/congenital , Lymphangiectasis/congenital , Pleural Effusion , Propranolol/therapeutic use , Biopsy , Sirolimus/therapeutic use , Lung Diseases/pathology , Lung Diseases/diagnostic imaging , Lymphangiectasis/pathology , Lymphangiectasis/diagnostic imaging
3.
Rev. cuba. pediatr ; 93(2): e1148, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1280374

ABSTRACT

Introducción: El derrame pleural paraneumónico es la enfermedad pleural más frecuente de la infancia, el 40-60 por ciento de los casos se presenta como complicación de neumonía adquirida en la comunidad. Ante la aparición de líquido pleural viscoso, con fibrina o tabiques, la fibrinólisis intrapleural aporta beneficios en la resolución de esta grave afección. Objetivo: Describir la evolución clínica e imagenológica de tres niños graves con derrame pleural paraneumónico complicado complejo y empiema. Presentación de casos: Pacientes ingresados en la Unidad de Terapia Intensiva del Hospital Pediátrico Provincial "Dr. Eduardo Agramonte Piña" con el diagnóstico de neumonía adquirida en la comunidad complicada con derrame pleural paraneumónico complicado complejo, tratados con estreptoquinasa recombinante por vía intrapleural; la primera paciente presentó crecimiento de Pseudomona en el cultivo de líquido pleural, patógeno no habitual en las infecciones respiratorias agudas procedentes de la comunidad. El segundo caso, se recibió complicada con shock séptico y el tercer paciente con ecografía torácica que mostró derrame pleural multitabicado, con grandes bolsones y gruesos tabiques. Los tres casos evolucionaron satisfactoriamente, sin necesidad de tratamiento quirúrgico, ni aparición de reacciones adversas atribuibles al fibrinolítico. Conclusiones: La administración intrapleural de la estreptoquinasa recombinante en niños graves con derrame pleural paraneumónico complicado complejo y empiema, resulta un método eficaz y seguro en la evacuación del foco séptico pleural, lo que favorece el control de la infección, sin aparición de complicaciones. Los casos presentados tuvieron evolución satisfactoria y en ninguno se produjo evento adverso relacionado con la administración de la estreptoquinasa recombinante intrapleural(AU)


Introduction: Parapneumonic pleural effusion is the most common pleural disease in childhood; 40-60 percent of cases occur as a complication of community-acquired pneumonia. Given the onset of viscous pleural fluid, with fibrin or septums, intra-pleural fibrinolysis provides benefits to solve this serious condition. Objective: Describe the clinical and imaging evolution of three seriously ill children with complex complicated parapneumonic pleural effusion and empyema. Case presentation: Patients admitted to the Intensive Therapy Unit of "Dr. Eduardo Agramonte Piña" Provincial Pediatric Hospital with the diagnosis of pneumonia acquired in the community worsen with complex complicated parapneumonic pleural effusion, and treated in the intrapleural way with recombinant streptokinase. The first patient showed growth of Pseudomona in the culture of pleural fluid, a pathogen which is not common in acute respiratory infections from the community. The second case was complicated with septic shock; and the third patient had a chest ultrasound that showed multi-sited pleural effusion, with large bags and thick septums. All three cases evolved satisfactorily, without needing surgical treatment, or having adverse reactions attributable to fibrinolytic ones. Conclusions: Intrapleural administration of recombinant streptokinase in seriously ill children with complex complicated parapneumonic pleural effusion and empyema is an effective and safe method in the evacuation of pleural septic focus, which favors infection control, without complications. The cases presented had satisfactory evolution and none of them occurred adversely related to the administration of intrapleural recombinant streptokinase(AU)


Subject(s)
Humans , Female , Infant , Child, Preschool , Pleural Effusion , Pneumonia , Respiratory Tract Infections , Infection Control , Growth , Drug-Related Side Effects and Adverse Reactions
4.
Rev. cuba. med ; 60(1): e1365,
Article in Spanish | LILACS, CUMED | ID: biblio-1156563

ABSTRACT

Introducción: Se denomina derrame pleural al acúmulo de líquido en el espacio pleural por encima de 5 y 15 mL en un hemitórax. Diferentes etiologías son las responsables de su aparición, pero un grupo estas están dadas por la etiología medicamentosa. El síndrome de hiperestimulación ovárica constituye una complicación secundaria al uso de la terapia con inductores de la ovulación. Es poco conocida en la literatura médica la asociación del tratamiento con inductores de la ovulación en la génesis del derrame pleural. Objetivo: Revisar los aspectos clínico-fisiopatológicos más importantes reportados sobre la pleuresía en el síndrome de hiperestimulación ovárica. Desarrollo: Se realizó una revisión a propósito de un caso clínico de una paciente de 34 años de edad con antecedentes de salud, seguida en consulta de fertilidad, a la cual se le aplicó tratamiento con citrato de clomifeno y desarrolló un síndrome de hiperestimulación ovárica moderado e inmediato, cuya expresión clínica fue un derrame pleural derecho de moderada cuantía. La pleuresía es poco frecuente, depende de la predisposición genética individual de la paciente y la susceptibilidad a los medicamentos; la incidencia varía entre 0,6 y 10 por ciento. Se han descrito diferentes factores de riesgo de presentarlo, aunque cualquier mujer sometida a estos tratamientos lo puede desarrollar. El tratamiento es sintomático restituyendo el volumen intravascular con la administración de cristaloides y/o albúmina. Conclusiones: La asociación del síndrome de hiperestimulación ovárica y la pleuropatía secundaria al tratamiento con citrato de clomifeno no es frecuente(AU)


Introduction: Pleural effusion is called the accumulation of fluid in the pleural space above 5 and 15 mL in a hemithorax. Different etiologies are responsible for its appearance but a group of them are given by drug etiology. Ovarian hyperstimulation syndrome is a secondary complication to the use of ovulation inducer therapy. The association of treatment with ovulation inducers in the genesis of pleural effusion is little known in the medical literature. Objective: To review the most important clinical-pathophysiological aspects reported on pleurisy in ovarian hyperstimulation syndrome. Methods: A review was carried out on the purpose of a clinical case of a 34-year-old patient with a medical history, followed in a fertility consultation. She was treated with clomiphene citrate and she developed an immediate moderate ovarian hyperstimulation syndrome. The clinical expression was a moderate right pleural effusion. Pleurisy is rare. It depends on the individual genetic predisposition of the patient and the susceptibility to drugs; the incidence varies between 0.6 and 10 percent. Different risk factors have been described, although any woman subjected to these treatments can develop it. Treatment is symptomatic, restoring the intravascular volume with the administration of crystalloids and / or albumin. Conclusions: The association of ovarian hyperstimulation syndrome and pleuropathy secondary to treatment with clomiphene citrate is not frequent(AU)


Subject(s)
Humans , Pleural Effusion/diagnosis , Ovarian Hyperstimulation Syndrome
5.
Braz. j. med. biol. res ; 54(2): e10462, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153510

ABSTRACT

Infections caused by uncommon and resistant pathogens in unusual sites have been increasingly reported in medical literature. We describe four cases of rare cytological findings and clinical impact for patients. In the first case, Aspergillus sp and Pneumocystis jirovecii were observed in the bronchoalveolar lavage of a patient with severe systemic lupus. In the second and third cases, we describe the presence of Trichomonas sp and Strongyloides sp larvae in samples of pleural and peritoneal fluid, respectively. The fourth report is about a patient with a wrist subcutaneous nodule whose synovial aspiration and cytology revealed the presence of brown septate hyphae. The early identification of the infectious agent in the cytological examination was essential for the introduction and/or re-adaptation of therapy in the four cases described. Patients in this report were immunocompromised with severe comorbidities, conditions often associated with unfavorable clinical outcomes.


Subject(s)
Humans , Animals , Male , Female , Middle Aged , Communicable Diseases/diagnosis , Cytodiagnosis/methods , Pleural Effusion/parasitology , Aspergillus/isolation & purification , Strongyloides/isolation & purification , Strongyloidiasis/diagnosis , Trichomonas/isolation & purification , Trichomonas Infections/diagnosis , Ascitic Fluid/parasitology , Bronchoalveolar Lavage Fluid/microbiology , Fatal Outcome , Pneumocystis carinii/isolation & purification
6.
Clinics ; 76: e2515, 2021. tab
Article in English | LILACS | ID: biblio-1249577

ABSTRACT

OBJECTIVES: We compared the diagnostic potential of cancer ratio (CR, serum lactate dehydrogenase [LDH]/pleural fluid adenosine deaminase [pfADA]), cancer ratio plus (CR plus, cancer ratio/pleural lymphocyte percentage), and age/pfADA ratio with pfADA in malignant pleural effusion. METHODS: Data from 100 patients with malignant pleural effusion (MPE) and 119 patients with tuberculous pleural effusion (TPE) were retrospectively collected. PfADA, age/pfADA ratio, CR, and CR plus were compared between patients with MPE and those with TPE in two age groups (≤50 and >50 years). The best cut-off value was determined, and the diagnostic performance was evaluated according to the receiver operating characteristic curve. RESULTS: PfADA was statistically significantly lower while age/pfADA ratio, CR, and CR plus were significantly higher in the MPE group than in the TPE group in both age groups (p<0.05). For patients aged ≤50 years, the differential diagnostic value of pfADA for MPE was better than those of age/pfADA ratio, CR, and CR plus. At a cut-off value of 13.0 U/L, the sensitivity, specificity, and accuracy were 88.9%, 100.0%, and 98.9%, respectively. For patients aged >50 years, the diagnostic performance of CR plus was superior to those of pfADA, age/pfADA ratio, and CR. At a cut-off value of 22.6, the sensitivity, specificity, and accuracy of CR plus for the diagnosis of MPE were 86.8%, 84.6%, and 86.2%, respectively. CONCLUSIONS: The best parameter for diagnosing MPE was different for patients aged ≤50 years and >50 years. For patients aged >50 years, CR plus was a good parameter for the differential diagnosis of MPE. For patients aged ≤50 years, pfADA was better.


Subject(s)
Humans , Child, Preschool , Middle Aged , Pleural Effusion/diagnosis , Pleural Effusion, Malignant/diagnosis , Adenosine Deaminase , Retrospective Studies , Sensitivity and Specificity , Diagnosis, Differential
7.
Iatreia ; 33(4): 348-359, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1143087

ABSTRACT

RESUMEN El derrame pleural se define como la acumulación anormal de líquido en el espacio pleural, que se produce por el aumento en la producción o disminución en su drenaje. Es una entidad frecuente en la práctica clínica y obedece a múltiples causas, las cuales varían de acuerdo con la epidemiología local, los antecedentes y el contexto clínico. Es determinante el análisis del líquido pleural, cuando esté indicado, así como otras ayudas diagnósticas teniendo en cuenta la presentación clínica con énfasis en las condiciones comórbidas y las infecciones. De estas últimas, se destaca la tuberculosis y la neumonía, entidades bastante frecuentes en nuestro medio. El tratamiento va dirigido a la causa de base, aunque hasta en el 25 % de los pacientes no se identifica una causa evidente.


SUMMARY Pleural effusion is defined as the abnormal accumulation of fluid in the pleural space that is caused by its increased production or decreased drainage. It is a frequent entity in clinical practice, due to multiple causes, which vary according to local epidemiology, personal history and clinical context. The analysis of pleural fluid will be decisive when indicated, as well as another diagnostic tool taking into account the clinical presentation, emphasizing comorbid conditions and infections, including tuberculosis and pneumonia; quite frequent entities in our environment. The treatment is aimed at the underlying cause, although up to 25% of patients do not identify an obvious cause.


Subject(s)
Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Pleural Effusion
8.
Rev. cuba. pediatr ; 92(3): e1013, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126776

ABSTRACT

La acumulación de fluido purulento o la presencia de bacterias en la tinción de Gram en el líquido pleural se define como empiema, se puede desarrollar entre 2- 12 por ciento de los niños con neumonía, por lo general bacteriana. Evoluciona en tres fases, la exudativa, fibrinopurulenta y organizada. El cuadro clínico está dado por manifestaciones respiratorias con fiebre persistente y malestar general. Los estudios radiológicos son importantes para el diagnóstico y es el ultrasonido pleural la modalidad de imagen preferida pues confirma la presencia y volumen de fluido pleural, así como la existencia de septos o tabiques. El tratamiento se basa en antibioticoterapia y drenaje a través de una pleurostomía; si hay presencia de tabiques, esfacelos o el estudio bioquímico del líquido pleural informa pH /7; glucosa /2,2 mmol/L; LDH/ 1000 UI, se comienza con estreptoquinasa intrapleural. El tratamiento quirúrgico se indica si hay deterioro clínico y radiológico después de concluir el uso de fibrinolíticos, persistencia de sepsis asociada a colección pleural a pesar del drenaje, coraza de fibrina que impide la reexpansión pulmonar y fístula broncopleural con neumotórax. La mortalidad es baja(AU)


The accumulation of purulent fluids or the presence of bacteria in the Gram´s stain in the pleural liquid is defined as empyema. It can develop in the 2 to 12 percent of children with pneumonia, generally the bacterial one. It evolves in three phases: exudative, fibrinopurulent and organized. The clinical picture is a consequence of respiratory manifestations with persistent fever and general discomfort. The radiology studies are important for the diagnosis and the pleural ultrasound is the preferred imaging modality because it confirms the presence and volume of the pleural fluid, as well as the existence of septa. The treatment is based in the use of antibiotic therapy and the drainage through a pleurostomy; if there is presence of septa, slough or the biochemical study of the pleural liquid informs of pH/7, glucose /2.2 mmol/L, LDH / 1000 UI, so it is started the use of intrapleural streptokinase. The surgical treatment is indicated if there is a clinical and radiological worsening after finishing the use of fibrinolytics, persistence of sepsis associated to pleural collection in spite of the drainage, fibrin shell that hampers pulmonar reexpanding; and bronchopleural fistula with pneumothorax(AU)


Subject(s)
Humans , Male , Female , Pleural Effusion , Empyema, Pleural , Practice Guidelines as Topic
9.
Rev. cuba. pediatr ; 92(3): e1092, jul.-set. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126767

ABSTRACT

Introducción: El derrame pleural paraneumónico como complicación de neumonías adquiridas en la comunidad en la población pediátrica constituye un problema de salud mundial y en Cuba. El empleo de fibrinolíticos intrapleurales es una acertada opción terapéutica. Objetivo: Evaluar la eficacia y seguridad de la utilización de la estreptoquinasa recombinante en el tratamiento del derrame pleural paraneumónico complicado complejo en niños. Métodos: Ensayo clínico confirmatorio fase III, monocentro, abierto, aleatorizado y controlado (RPCEC00000292), realizado entre septiembre 2018 - octubre 2019. Se incluyeron niños (1 - 18 años de edad), que cumplieron los criterios de selección, incluida la voluntariedad. Todos recibieron el tratamiento convencional establecido y se distribuyeron en dos grupos: I-experimental (estreptoquinasa recombinante, dosis diaria intrapleural de 200 000 UI, 3-5 días); II-control (terapia convencional). Las variables principales fueron: necesidad de cirugía y la estadía hospitalaria. Se evaluaron también los eventos adversos. Resultados: Se evaluaron 55 niños con la enfermedad referida, de ellos, 34 (61,8 por ciento) se incluyeron en el estudio. Ningún paciente del grupo experimental requirió cirugía, a diferencia del grupo control que lo requirió en 25 por ciento. Se redujo significativamente la estadía hospitalaria en el grupo que recibió estreptoquinasa recombinante. No se presentaron eventos adversos graves atribuibles al tratamiento experimental. Conclusiones: La estreptoquinasa recombinante administrada en el derrame pleural paraneumónico complicado complejo resultó un método eficaz y seguro para la evacuación del foco séptico, con un impacto positivo expresado en la reducción de complicaciones, la necesidad de tratamiento quirúrgico y la estadía hospitalaria, sin la ocurrencia de eventos adversos relacionados con su uso(AU)


in the community by the pediatric population represents a health problem in the world and in Cuba. The use of intrapleural fibrinolytics is a good therapeutic option. Objective: To evaluate the effectiveness and security of the use of recombinant streptokinase in the treatment of complex parapneumonic pleural efussion in children. Methods: Phase III confirmatory clinical trial, monocentric, open, randomized and controlled (RPCEC00000292) - named as DENIS study- carried out from September 2018 to October, 2019. There were included children (from 1 to 18 years old) that met the selection criteria including voluntariness. All of them received the established conventional treatment and were distributed in two groups: I- experimental (recombinant streptokinase, intrapleural daily dose of 200 000 UI, 3 - 5 days); II- control (conventional therapy). The main variables were need of surgery and hospital stay. There were also assessed the adverse events. Results: 55 children with the above mentioned disease were assessed; 34 of them (61.8 percent) were included in the study. Any of the patients of the experimental group required surgery, opposite to the control group that required it in a 25 percent. The hospital stay was significantly reduced in the group that had treatment with recombinant streptokinase. There were not any severe adverse events related to the experimental treatment. Conclusions: When recombinant streptokinase was administered in the complex parapneumonic pleural efussion resulted in an efficient and safe method for the elimination of the septic focus, with a positive impact expressed in the reduction of complications, the need of surgical treatment and the hospital stay without presenting related adverse events while using it(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Pleural Effusion/therapy , Streptokinase/therapeutic use
10.
Rev. argent. cir ; 112(1): 58-62, mar. 2020. tab
Article in English, Spanish | LILACS | ID: biblio-1125783

ABSTRACT

La ascitis quilosa posoperatoria (AQP) se debe a acumulación de líquido rico en triglicéridos en la cavidad peritoneal tras una lesión en la cisterna del quilo o en sus afluentes. Es infrecuente verla después de una hepatectomía. Se presenta el caso de un varón de 44 años con adenocarcinoma a 16 cm del margen anal T3N1, con metástasis que ocupaba casi la totalidad del lóbulo hepático derecho. Luego de quimioterapia se realizó hepatectomía derecha, observándose al cuarto día postoperatorio líquido del drenaje endotorácico de aspecto lechoso, con triglicéridos 223 mg/dL y 77 mg/dL de triglicéridos séricos. Se inició dieta sin grasas, hiperproteica, con ácidos grasos de cadena media y octreótide (100 microgramos subcutáneos cada 8 horas), con resolución del cuadro. En conclusión, la complicación quilosa puede tratarse exitosamente con un abordaje menos agresivo, sin suprimir la ingesta oral, utilizando octreótide subcutáneo, dieta exenta de grasas, suplementada con proteínas y ácidos grasos de cadena media.


Postoperative chylous ascites is an intraperitoneal collection of lymphatic fluid enriched with long-chain triglycerides that results from injury of the cisterna chyli or its main tributaries. This complication is rare after liver resections. Here, we report on the case of a 44 year-old man with a T3N1 rectal adenocarcinoma 16 cm above the anal margin, with metastatic compromise of almost the entire right liver lobe. Following chemotherapy, he underwent right liver resection. On postoperative day four, the thoracic drain evidenced milky fluid containing triglyceride 223 mg/dL with serum triglycerides 77 mg/dL. A fat-free diet was indicated with fat-free protein supplements, medium chain triglycerides and octreotide (100 μg subcutaneously every 8 hours), with complete resolution. In conclusion, postoperative chylous complications may be treated successfully by a less aggressive approach, with oral diet, subcutaneous octreotide, fat-free diet supplemented with proteins and medium chain fatty acids.


Subject(s)
Humans , Male , Adult , Chylous Ascites/complications , Hepatectomy/adverse effects , Pleural Effusion/diagnostic imaging , Postoperative Complications/diagnosis , Rectal Neoplasms/surgery , Radiography, Thoracic/methods , Positron-Emission Tomography/methods
12.
Article in Chinese | WPRIM | ID: wpr-828649

ABSTRACT

Neonatal chylothorax is a common cause of neonatal congenital pleural effusion and is often caused by the accumulation of chylous fluid in the thoracic cavity due to the rupture of the thoracic duct and its branched lymphatic vessels for a variety of reasons. Neonatal chylothorax caused by malignant tumors is extremely rare, and this is the first case of neonatal mediastinal neuroblastoma with chylothorax in China. The boy was found to have pleural effusion in the left thoracic cavity in the uterus, and experienced apnea at birth, as well as dyspnea and cyanosis as the main manifestations after birth. He was diagnosed with left chylothorax based on conventional biochemical analysis of pleural effusion. After the treatment including persistent chest drainage and symptomatic and supportive treatment, the drainage of the left thoracic cavity reached a volume of 90-180 mL per day. Neonatal refractory chylothorax was considered. Chest radiograph on day 13 after birth showed lesions in the upper left lung field, and contrast-enhanced plain CT scan of the chest suggested the possibility of posterior mediastinal neuroblastoma. The autopsy confirmed giant posterior mediastinal neuroblastoma (poorly differentiated), which involved the C7-T6 spinal canal and the nearby erector spinae, with a small amount of tumor tissue in the liver and both adrenal glands. Mediastinal tumor is considered the underlying cause of chylothorax in this case.


Subject(s)
China , Chylothorax , Dyspnea , Female , Humans , Infant, Newborn , Male , Pleural Effusion , Uterus
14.
Fisioter. Mov. (Online) ; 33: e003305, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056188

ABSTRACT

Abstract Introduction: Techniques for lung expansion seem to benefit patients with drained and undrained pleural effusion, but there is a lack of evidence to indicate which technique is best in each situation. Currently, the therapeutic choices of respiratory physiotherapists serving this population are not known. Objective: To know which lung expansion techniques are chosen by chest physiotherapists who assist patients with drained and non-drained pleural effusion. Method: Through the announcement of the Federal Council, 232 physiotherapists who work in hospitals in Brazil were questioned about which techniques they apply to patients with drained and non-drained effusion. Results: Initially, 512 were questioned but 232 (45.3%) answered. The physiotherapists associate more than one technique of lung expansion in both types of patients, besides walking. Deep breathing is the most used technique in patients with drained (92%) and non-drained (77%) pleural effusion. Positive pressure exercises in the airways are chosen by 60% of the physiotherapists to treat patients with drained pleural effusion and by 34% to treat patients with non-drained pleural effusion. Yet the incentive spirometry are used with 66% of patients with drained pleural effusion and 42% with non-drained ones. Conclusion: Deep breathing is the most applied lung expansion technique in the treatment of patients with drained and non-drained pleural effusion by chest physiotherapists. In addition, there is association between greatest degree and time of professional performance and the chosen techniques.


Resumo Introdução: Técnicas para expansão pulmonar parecem beneficiar pacientes com derrame pleural drenado e não drenado, porém há falta de evidências para indicar qual é a melhor técnica em cada situação. Atualmente, as escolhas terapêuticas dos fisioterapeutas respiratórios que atendem essa população não são conhecidas. Objetivo: Conhecer as técnicas de expansão pulmonar escolhidas pelos fisioterapeutas respiratórios que atendem pacientes com derrame pleural drenado e não drenado. Método: Por meio do anúncio do Conselho Federal, 232 fisioterapeutas que trabalham em hospitais no Brasil foram questionados sobre quais técnicas se aplicam a pacientes com derrame drenado e não drenado. Resultados: Inicialmente, 512 foram questionados, mas 232 (45,3%) responderam. Os fisioterapeutas associam mais de uma técnica de expansão pulmonar em ambos os tipos de pacientes, além de deambular. A respiração profunda é a técnica mais utilizada em pacientes com derrame pleural drenado (92%) e não drenado (77%). Exercícios de pressão positiva nas vias aéreas são escolhidos por 60% dos fisioterapeutas para tratar pacientes com derrame pleural drenado e por 34% para pacientes com derrame pleural não drenado. A espirometria de incentivo é utilizada com 66% dos pacientes com derrame pleural drenado e 42% com não drenado. Conclusão: A respiração profunda é a técnica de expansão pulmonar mais aplicada no tratamento de pacientes com derrame pleural drenado e não drenado por fisioterapeutas respiratórios. Além disso, há associação entre maior titulação e tempo de atuação profissional e as técnicas escolhidas.


Resumen Introducción: Técnicas para expansión pulmonar parecen beneficiar a pacientes con derrame pleural drenado y no drenado, pero hay falta de evidencias para indicar cuál es la mejor técnica en cada situación. Actualmente, las opciones terapéuticas de los fisioterapeutas respiratorios que atienden a esa población, no son conocidas. Objetivo: Conocer las técnicas de expansión pulmonar elegidas por los fisioterapeutas respiratorios que atienden pacientes con derrame pleural drenado y no drenado. Método: A través del anuncio del Consejo Federal, 232 fisioterapeutas que trabajan en hospitales en Brasil fueron cuestionados sobre qué técnicas se aplican a pacientes con derrame drenado y no drenado. Resultados: Inicialmente, 512 fueron cuestionados, pero 232 (45,3%) respondieron. Los fisioterapeutas asocian más de una técnica de expansión pulmonar en ambos tipos de pacientes, además de deambular. La respiración profunda es la técnica más utilizada en pacientes con derrame pleural drenado (92%) y no drenado (77%). Los ejercicios de presión positiva en las vías aéreas son elegidos por el 60% de los fisioterapeutas para tratar a pacientes con derrame pleural drenado y por el 34% para pacientes con derrame pleural no drenado. La espirometría de incentivo se utiliza con el 66% de los pacientes con derrame pleural drenado y el 42% con no drenado. Conclusión: La respiración profunda es la técnica de expansión pulmonar más aplicada en el tratamiento de pacientes con derrame pleural drenado y no drenado por fisioterapeutas respiratorios. Además, hay asociación entre mayor titulación y tiempo de actuación profesional y las técnicas elegidas.


Subject(s)
Humans , Pleural Effusion , Respiratory Therapy/methods , Surveys and Questionnaires , Physical Therapy Modalities , Physical Therapists
15.
Einstein (Säo Paulo) ; 18: eRW5741, 2020. graf
Article in English | LILACS | ID: biblio-1133785

ABSTRACT

ABSTRACT The disease caused by the new coronavirus, or COVID-19, has been recently described and became a health issue worldwide. Its diagnosis of certainty is given by polymerase chain reaction. High-resolution computed tomography, however, is useful in the current context of pandemic, especially for the most severe cases, in assessing disease extent, possible differential diagnoses and searching complications. In patients with suspected clinical symptoms and typical imaging findings, in which there is still no laboratory test result, or polymerase chain reaction is not available, the role of this test is still discussed. In addition, it is important to note that part of the patients present false-negative laboratory tests, especially in initial cases, which can delay isolation, favoring the spread of the disease. Thus, knowledge about the COVID-19 and its imaging manifestations is extremely relevant for all physicians involved in the patient care, clinicians or radiologists.


RESUMO A doença causada pelo novo coronavírus, ou COVID-19, foi descrita recentemente e tornou-se uma questão de saúde mundial. Seu diagnóstico de certeza é dado pela reação em cadeia da polimerase. A tomografia computadorizada de alta resolução, entretanto, mostra-se útil no contexto atual de pandemia, especialmente nos casos mais graves, na avaliação da extensão da doença, em possíveis diagnósticos diferenciais e na pesquisa de complicações. Em pacientes com quadro clínico suspeito e achados de imagem típicos, nos quais ainda não há resultado laboratorial ou a reação em cadeia da polimerase não se encontra disponível, ainda se discute o papel desse exame. Importante ressaltar que parte dos pacientes apresenta exames laboratoriais falsos-negativos, notadamente em casos iniciais, o que pode retardar medidas de isolamento, favorecendo a propagação da doença. Dessa forma, o conhecimento da COVID-19 e de suas manifestações nos exames de imagem é de extrema importância para os médicos envolvidos no atendimento, sejam clínicos ou radiologistas.


Subject(s)
Humans , Pneumonia, Viral/diagnostic imaging , Thorax/diagnostic imaging , Tomography, X-Ray Computed , Coronavirus Infections/diagnostic imaging , Lung/diagnostic imaging , Pleural Effusion/diagnostic imaging , Diagnosis, Differential , Pandemics , Lymphadenopathy/diagnostic imaging , Betacoronavirus , SARS-CoV-2 , COVID-19
17.
Article in English | WPRIM | ID: wpr-786140

ABSTRACT

Kawasaki disease (KD) is an acute febrile illness that is characterized by systemic inflammation usually involving medium-sized arteries and multiple organs during the acute febrile phase, leading to associated clinical findings. The diagnosis is based on the principal clinical findings including fever, extremity changes, rash, conjunctivitis, oral changes, and cervical lymphadenopathy. However, KD diagnosis is sometimes overlooked or delayed because other systemic organ manifestations may predominate in acute phase of KD. As a cardiovascular manifestation, an acute pericarditis usually shows a small pericardial effusion, but large pericardial effusion showing clinical signs of cardiac tamponade is very rare. Here, we described a case of incomplete KD presenting with impending cardiac tamponade, and recurrent fever and pleural effusion.


Subject(s)
Arteries , Cardiac Tamponade , Conjunctivitis , Diagnosis , Exanthema , Extremities , Fever , Inflammation , Lymphatic Diseases , Mucocutaneous Lymph Node Syndrome , Pericardial Effusion , Pericarditis , Pleural Effusion
18.
Article in English | WPRIM | ID: wpr-811441

ABSTRACT

Hepatic hydrothorax is a transudative pleural effusion that complicates advanced liver cirrhosis. Patients refractory to medical treatment plus salt restriction and diuretics are considered to have refractory hepatic hydrothorax and may require transjugular intrahepatic portosystemic shunt (TIPS) or liver transplant. Successful antiviral therapy reduces the incidence of some complications of cirrhosis secondary to HCV infection. We report a case of hepatic hydrothorax in a 55-year-old female patient with HCV cirrhosis, which exhibited a spontaneous decrease in pleural effusion after direct antiviral agent (DAA) therapy. In cases of HCV cirrhosis, DAAs are worth administering before treatment by TIPS or liver transplantation.


Subject(s)
Antiviral Agents , Diuretics , Female , Fibrosis , Hepacivirus , Hepatitis C, Chronic , Hepatitis, Chronic , Humans , Hydrothorax , Incidence , Liver , Liver Cirrhosis , Liver Transplantation , Middle Aged , Pleural Effusion , Portasystemic Shunt, Surgical
19.
Medisan ; 23(6)nov.-dic. 2019. graf
Article in Spanish | LILACS-Express | LILACS, CUMED | ID: biblio-1091150

ABSTRACT

Se describe el caso clínico de una paciente de 51 años de edad con antecedente de neoplasia de pulmón derecho, para lo cual recibió tratamiento con quimioterapia. Aproximadamente 3 años después comenzó a presentar dolor tipo cólico en flanco y fosa lumbar izquierdos acompañado de caída del volumen urinario, por lo que fue atendida en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba donde se le diagnosticó cáncer de cuello uterino, etapa IIIB. Se efectuó nefrostomía percutánea izquierda y el nivel del derrame pleural desapareció al transcurrir una semana. La paciente egresó con adecuada diuresis y cifras normales de creatinina; posteriormente se le indicó radioterapia contra el cáncer ginecológico.


The case report of a 51 years patient with a history of neoplasm in the right lung is described, for which she received treatment with chemotherapy. Approximately 3 years later she began to present colic type pain in left flank and lumbar cavity accompanied by fall of the urinary volume, reason why she was assisted in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba where she was diagnosed cervical cancer, stage IIIB. Left percutaneous nephrostomy was made and the level of pleural effusion disappeared within a week. The patient was discharged with appropriate diuresis and normal figures of creatinine; later on radiotherapy was indicated against the gynecological cancer.


Subject(s)
Pleural Effusion , Nephrostomy, Percutaneous , Uterine Cervical Neoplasms , Lung Neoplasms
20.
Rev. am. med. respir ; 19(3): 248-250, set. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1041710

ABSTRACT

La artritis reumatoide (AR) es una enfermedad autoinmune de causa desconocida y de evolución crónica que afecta fundamentalmente a las articulaciones provocando una sinovitis erosiva crónica y simétrica, presenta muchas complicaciones extraarticulares, siendo la patología pleural la complicación más frecuente entre las neumológicas. El síndrome de Contarini1 es una entidad infrecuente que consiste en la existencia concomitante de derrames pleurales bilaterales de diferente etiología. Presentamos el caso de un paciente en el que coincidieron ambas condiciones patológicas


Subject(s)
Pleural Effusion , Arthritis, Rheumatoid
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