Tumores pulmonares en pediatría / Pulmonary tumors in pediatrics

In patients under 15 years of age primary lung tumors are infrequent, most thoracic tumors being originated in the mediastinum or the thoracic wall. The great majority of pulmonary masses are non-neoplastic corresponding to inflammatory processes or malformations. Amongst neoplasms metastasis from solid extracraneal tumors are the predominant lesions. Other malignant neoplasms are: bronchial carcinoid, mucoepidermoid carcinoma, pulmonary lymphoma, pleuropulmonary blastoma and metastasis. In the spectrum of benign lesions the following are found: miofibroblastic inflammatory tumor, nodular lymphoid hyperplasia and hamartomas. The diagnosis of primary pulmonary neoplasms is frequently late because of its low incidence, lack of clinical suspicion and the variability of its manifestations. Radiological and tomographical signs are very proteiform and unspecific, representing a great diagnostic challenge.

En pacientes menores de 15 años los tumores pulmonares primarios son infrecuentes, generalmente los tumores torácicos son de origen mediastínico o de la pared torácica. La gran mayoría de las masas pulmonares son de origen no neoplásico, correspondiendo a procesos inflamatorios o malformaciones. Dentro de las neoplasias pulmonares, las metástasis de tumores sólidos extracraneanos son las lesiones predominantes. En el espectro de lesiones benignas se encuentran el tumor miofibroblástico inflamatorio, la hiperplasia nodular linfoidea, los síndromes linfoproliferativos y los hamartomas. Entre las neoplasias malignas se incluyen el tumor carcinoide bronquial, carcinoma mucoepidermoide, linfoma pulmonar, blastoma pleuropulmonar y las metástasis. El diagnóstico de las neoplasias primarias pulmonares frecuentemente es tardío, por su baja incidencia y la falta de sospecha clínica o por su presentación atípica. Los hallazgos radiológicos y tomográficos de los tumores pulmonares son muyproteiformes, según su estirpe y lugar de origen, y no son específicos en la mayoría de los casos, constituyendo habitualmente un gran desafo diagnóstico.

Three-year follow-up study of respiratory and systemic manifestations of chronic obstructive pulmonary disease

Few studies show patient outcomes over time in chronic obstructive pulmonary disease (COPD). In the present study, we monitored forced expiratory volume in the first second (FEV1) and other manifestations of the disease over 3 years in 133 COPD patients (69 percent males, age = 65 ± 9 years, FEV1 = 59 ± 25 percent) evaluated at baseline. During follow-up, 15 patients (11 percent) died and 23 (17 percent) dropped out. Measurements for 95 (72 percent) COPD patients alive after 3 years were analyzed. FEV1, body mass index (BMI), 6-min walking distance (6MWD), Medical Research Council scale (MRC), Saint George’s Respiratory Questionnaire (SGRQ), Charlson Comorbidity index, and BODE index were obtained at baseline and after 3 years. At baseline, 17 patients (18 percent) presented mild, 39 percent moderate, 19 percent severe, and 24 percent very severe COPD. Predicted FEV1 percent and BMI did not change over the period (P > 0.05). FEV1 in liters [1.25 (0.96-1.72) vs 1.26 (0.88-1.60) L; P < 0.001], 6MWD (438 ± 86 vs 412 ± 100 m; P < 0.001), MRC [1 (1-2) vs 2 (1-3); P = 0.002], Charlson index [3 (3-4) vs4 (3-5); P = 0.009], BODE index (2.2 ± 1.8 vs 2.6 ± 2.3; P = 0.008), and total SGRQ (42 ± 19 vs 44 ± 19 percent; P = 0.041) worsened after 3 years compared to baseline measurements. These data show that COPD patients deteriorated during the 3-year follow-up despite the fact that they had only minor modifications in airway obstruction and body composition. They support the need for comprehensive patient assessment to better identify disease progression.

ALT-C, a disintegrin-like Cys-rich protein from Bothrops alternatus, increases skeletal myoblast viability

ALT-C, an ECD motif (glutamic acid, cysteine, aspartic acid) disintegrin from Bothrops alternatus snake venom, induces alfa2beta1 integrin-mediated signaling and neutrophil chemotaxis. In vitro, in human umbilical vein endothelial cells (HUVEC), ALT-C induces cell proliferation, thus showing an interesting potential for tissue regeneration studies. This work aimed to evaluate the influence of ALT-C in myoblast viability and differentiation. Myoblasts were obtained from hind limb muscles of 3 to 4-day old Wistar rats. The cells were incubated with ALT-C at different concentrations and incubation periods were followed by total RNA isolation. cDNA synthesis and real time polymerase chain reaction (PCR) were performed with primers of myoD as well as of both (slow and fast) myosin heavy chain isoforms (MHC). ECD-disintegrin increased myoblast viability in a dose-dependent way, mostly with 50 to 100 nM concentrations, and such effect was more prevalent after 48 hours. No changes in gene expression of both MHC isoforms were observed in ALT-C-treated cells. MyoD expression was not detected, which suggests that myoblasts were in mature stages. Protease activity and cytokine array tested in a medium of 50 nM ALT-C-treated cells after 48 hours were not different from controls. In conclusion, it was shown that myoblats are sensitive to ALT-C indicating an integrin-mediated intracellular signaling that increases cell viability.

Análisis de endoscopías en las vías biliares efectuadas en el Hospital Santo Tomás / An analysis of the endoscopies of the biliary tract performed at the Hospital Santo Tomás

Endoscopic Retrograde Cholangiopancreatography (ERCP) was performed in 146 patients, 93 female and 53 male from 10 to 90 years of age. The patients were referred because it was deemed that it was necessary to perform the procedure to establish or confirm the clinical diagnosis (suspected choledocholithiasis, icterus or abdominal pain of undetermined etiology, pancreatitis or obstruction of prosthesis) and to perform cholangiography and pancreatography, papillotomy, extraction of calculi and placement of biliary prosthesis, as indicated. It was shown that the clinical picture was due to choledocholithiasis in the majority of patients. Stenosis due to inflammatory changes or to tumor were much less frequent. In few patients, there was biliary external fistula, distortion of intrahepatic ducts, cancer of the pancreas or sclerosing cholangitis. Chronic pancreatitis, choledochal granuloma or adenoma, or displacement of a T tube were found occasionally. There were few complications (cholangitis, pancreatitis and hyperamylasemia) and no mortality associated with the procedure

Helicobacter pylori en el Hospital Santo Tomás / Helicobacter pylori at Hospital Santo Tomás

We studied the incidence of infection with Helicobacter pylori in Panamanians with chronic dyspepsia, gastric or duodenal ulcer, gastritis or gastric cancer. The histopathology was positive in 54 (81%) of 66 patients; the urea test was positive in 52 (82.5%) of 63 cases; the impromptu was positive in 51 (79.6) of 64 patients; the endoscopic examination was positive in 64 (82.9%) of 77 examinations

Cuando una ictericia es quirurgica? Valor diagnostico de la colangiografia percutanea transhepatica (CPTH). / When jaundice is surgical? Diagnostic value of the percutaneous transhepatic cholangiography

Se recomienda practicar la colangiografia percutanea transhepatica (CPTH) en aquellos pacientes ictericos que asi lo necesitan para aclarar su diagnostico y planear una terapia correcta. Exhortamos a que este estudio se realice con mas frecuencia, ya que asi disminuiremos la morbilidad y la mortalidad asociadas a una innecesaria cirurgia