Massive life-threatening hemoptysis from pulmonary hydatid cysts: a 13 - year experience from an endemic area

Echinococcosis is a parasitic disease often seen in sheep and cattle raised in countries with unsanitary conditions. The disease is encountered endemically in northwest of Iran. Life-threatening hemoptysis due to a pulmonary hydatid cyst is a rare condition. This study assessed the prevalence and treatment of this condition. Materials and In a retrospective study, between 1993 and 2005, 520 patients with pulmonary hydatid cysts were operated at the Imam Khomeini Hospital in Tabriz, Iran. Ten [1.9%] cysts exhibited life-threatening hemoptysis [Group II]. The remaining 510 patients with pulmonary hydatid cyst were studied [Group I] and compared with group II. Ten patients were included in group II, with a mean follow - up of 2.5 years. Four [40%] cases were males and six [60%] were females. The age ranged between 8 and 46 [mean 27.90 +/- 13.86] years. The most common symptoms were cough [100%], massive hemoptysis [100%], respiratory distress [100%], and chest pain [90%]. The amount of hemoptysis was between 600 and 1400 ml [mean 840 +/- 249.66] a day. The origin of bleeding in six [60%] was from the cyst in the right lung and in four [40%] from the left lung. Bronchoscopy revealed the site of bleeding in all 10 patients, and the lobe in seven [70%]. Chest x-ray and CT scan showed patchy infiltration in one or both lungs and a ruptured hydatid cyst in eight cases. Lobectomy was the most frequent applied procedure [100%]. Two [20%] cases died due to blood aspiration and respiratory distress syndrome, one in the 3rd and the other in the 4th postoperative day. The postoperative hospital stay ranged between 7 and 25 [mean 11.30 +/- 6.56] days. Two and a half years follow-up of patients was good. There was no recurrence. There were significant differences between the two groups In terms of complications and mortality [X2 =102.39, df=1, p<0.0005] and [X2 = 5.82, df=1, p<0.16]. Massive life-threatening hemoptysis due to pulmonary hydatid cysts must be managed as an urgent clinical entity. It has serious symptoms, serious post-operative complications and a high mortality rate.

Aspergilosis broncopulmonar: consideraciones sobre 122 casos con serología positiva para Aspergillus fumigatus / Bronchopulmonar aspergillosis: 122 cases diagnosed by serological tests for A. fumigatus

Se presenta el análisis de 122 casos de aspergilosis broncopulmonar diagnosticados entre los años 1990 y 1994, en el Departamento de Micología del Instituto Nacional de Higiene y Medicina Tropical de Guayaquil. Todos ellos presentaban anticuerpos frente al antígeno de A. fumigatus demostrables por inmunodifusión por la técnica de Ouchterlony. El estudio micológico en muestras de esputo fue realizado en 60 enfermos. Se señalan los parámetros considerados para el diagnóstico, las lesiones radiológicas observadas y los tratamientos instituídos

Hemoptise/s e síndrome de angústia respiratória do adulto como causas de morte na leptospirose: mudanças de padröes clínicos e anatomopatológicos / Hemoptysis ant the adult respiratory distress syndrome as the causes of death leptospirosis: changes in the clinical and anatomopathological patterns

A leptospirose humana, uma das principais endemias dos centros urbanos no Brasil, vem crescendo de forma dramática nas três últimas décadas, com prevalência após enchentes causadas pelas chuvas de veräo. Säo descritas as recentes modificaçöes de seus padröes clínicos em nossa regiäo, constituídas pelo surgimento de hemoptise/s maciça/s e da síndrome de angústia respiratória do adulto, ou de ambas associadamente. Essas evidentes mudanças situadas nas estruturas respiratórias depontaram como séria ameaça à vida e como mecanismos de morte, passando a representar entre nós, por sua grande freqüência, a principal causa de óbito na leptospirose. A nova face da doença impöe revisäo dos conceitos sobre sua gravidade e especulaçäo sobre a patogenia dessas alteraçöes. A evoluçäo fatal dos seis pacientes descritos, dois deles sem icterícia e sem insuficiência renal, mostra a grandeza do desafio

Leptospirose, uma patologia em metamorfose: revisäo de conceitos / Leptospirosis, a pathology in metamorphosis revisión of concepts

Säo apresentados dois casos de leptospirose com evoluçäo fatal conseqüente a hemorragias pulmonares maciças. O primeiro refere-se a uma paciente jovem que evoluiu sem icterícia ou insuficiência renal e foi a óbito por hemoptises maciças asfixiantes. Os estudos imuno-histológicos de necrópsia confirmaram o diagnóstico de leptospirose. Casos como este, näo eram reconhecidos no passado em nossa regiäo e têm amentado de freqüência, fazendo-nos mudar os conceitos prévios sobre esta patologia. No segundo caso, uma forma clássica da síndrome de Weil na qual a morte foi devida a hemorragia pulmonar severa, o diagnóstico de leptosopirose foi confirmado por sorologia, hemocultivo positivo e estudo necroscópico