Emergencias oncológicas torácicas del paciente con cáncer de pulmón / Oncologic thoracic emergencies of patients with lung cancer

El paciente con cáncer de pulmón es el paciente oncológico que más frecuentemente acude a urgencias por complicaciones relacionadas con su enfermedad. Se define como emergencia oncológica cualquier evento agudo en un paciente oncológico que se desarrolla de manera directa o indirecta debido al tumor y que pone en riesgo la vida del paciente. Las emergencias oncológicas se dividen en metabólicas, hematológicas y estructurales; en este artículo abordaremos las principales complicaciones estructurales torácicas de los pacientes con cáncer de pulmón, en las que las pruebas de imagen tienen un papel fundamental en su diagnóstico. Las principales emergencias oncológicas torácicas del cáncer de pulmón son: obstrucción de la vía aérea, síndrome de vena cava superior, tromboembolismo pulmonar agudo, taponamiento pericárdico, hemoptisis masiva, compresión medular y derrame pleural. Las emergencias oncológicas son causa importante de morbimortalidad en pacientes con cáncer de pulmón. Los médicos de urgencias juegan un papel fundamental en su detección precoz, por lo que el conocimiento y la correcta identificación de las principales emergencias oncológicas torácicas del paciente con cáncer de pulmón permiten un manejo diagnóstico y terapéutico óptimo

Patients with lung cancer are the type of cancer patient who are most often admitted to emergency departments due to disease-related complications. An oncologic emergency is defined as any acute event in a patient with cancer that develops directly or indirectly from the tumour and that threatens the patient's life. Oncologic emergencies are divided into metabolic, haematologic and structural emergencies. In this article, we address the main structural thoracic complications of patients with lung cancer, in which imaging tests play an essential role in their diagnosis. The main oncologic thoracic emergencies of lung cancer are airway obstruction, superior vena cava syndrome, acute pulmonary thromboembolism, pericardial tamponade, massive haemoptysis, spinal cord compression and pleural effusion. Oncologic emergencies are a significant cause of morbidity and mortality in patients with lung cancer. Emergency department physicians play a fundamental role in the early detection of these emergencies. The knowledge and correct identification of the main oncologic thoracic emergencies of patients with lung cancer therefore enable optimal diagnostic and therapeutic management

Oncologic thoracic emergencies of patients with lung cancer. / Emergencias oncológicas torácicas del paciente con cáncer de pulmón.

Patients with lung cancer are the type of cancer patient who are most often admitted to emergency departments due to disease-related complications. An oncologic emergency is defined as any acute event in a patient with cancer that develops directly or indirectly from the tumour and that threatens the patient's life. Oncologic emergencies are divided into metabolic, haematologic and structural emergencies. In this article, we address the main structural thoracic complications of patients with lung cancer, in which imaging tests play an essential role in their diagnosis. The main oncologic thoracic emergencies of lung cancer are airway obstruction, superior vena cava syndrome, acute pulmonary thromboembolism, pericardial tamponade, massive haemoptysis, spinal cord compression and pleural effusion. Oncologic emergencies are a significant cause of morbidity and mortality in patients with lung cancer. Emergency department physicians play a fundamental role in the early detection of these emergencies. The knowledge and correct identification of the main oncologic thoracic emergencies of patients with lung cancer therefore enable optimal diagnostic and therapeutic management.

Multidetector computed tomographic pulmonary angiography in patients with a high clinical probability of pulmonary embolism.

UNLABELLED: ESSENTIALS: When high probability of pulmonary embolism (PE), sensitivity of computed tomography (CT) is unclear. We investigated the sensitivity of multidetector CT among 134 patients with a high probability of PE. A normal CT alone may not safely exclude PE in patients with a high clinical pretest probability. In patients with no clear alternative diagnosis after CTPA, further testing should be strongly considered. BACKGROUND: Whether patients with a negative multidetector computed tomographic pulmonary angiography (CTPA) result and a high clinical pretest probability of pulmonary embolism (PE) should be further investigated is controversial. METHODS: This was a prospective investigation of the sensitivity of multidetector CTPA among patients with a priori clinical assessment of a high probability of PE according to the Wells criteria. Among patients with a negative CTPA result, the diagnosis of PE required at least one of the following conditions: ventilation/perfusion lung scan showing a high probability of PE in a patient with no history of PE, abnormal findings on venous ultrasonography in a patient without previous deep vein thrombosis at that site, or the occurrence of venous thromboembolism (VTE) in a 3-month follow-up period after anticoagulation was withheld because of a negative multidetector CTPA result. RESULTS: We identified 498 patients with a priori clinical assessment of a high probability of PE and a completed CTPA study. CTPA excluded PE in 134 patients; in these patients, the pooled incidence of VTE was 5.2% (seven of 134 patients; 95% confidence interval [CI] 1.5-9.0). Five patients had VTEs that were confirmed by an additional imaging test despite a negative CTPA result (five of 48 patients; 10.4%; 95% CI 1.8-19.1), and two patients had objectively confirmed VTEs that occurred during clinical follow-up of at least 3 months (two of 86 patients; 2.3%; 95% CI 0-5.5). None of the patients had a fatal PE during follow-up. CONCLUSIONS: A normal multidetector CTPA result alone may not safely exclude PE in patients with a high clinical pretest probability.

Impact of a multidimensional infection control strategy on central line-associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control strategy including a practice bundle to reduce the rates of central line-associated bloodstream infection (CLAB) in patients hospitalized in pediatric intensive care units (PICUs) of hospitals, which are members of the INICC, from nine cities of five developing countries: Colombia, India, Mexico, Philippines, and Turkey. METHODS: CLAB rates were determined by means of a prospective surveillance study conducted on 1,986 patients hospitalized in nine PICUs, over a period of 12,774 bed-days. The study was divided into two phases. During Phase 1 (baseline period), active surveillance was performed without the implementation of the multi-faceted approach. CLAB rates obtained in Phase 1 were compared with CLAB rates obtained in Phase 2 (intervention period), after implementation of the INICC multidimensional infection control program. RESULTS: During Phase 1, 1,029 central line (CL) days were recorded, and during Phase 2, after implementing the CL care bundle and interventions, we recorded 3,861 CL days. The CLAB rate was 10.7 per 1,000 CL days in Phase 1, and in Phase 2, the CLAB rate decreased to 5.2 per 1,000 CL days (relative risk [RR] 0.48, 95% confidence interval [CI] 0.29-0.94, P = 0.02), showing a reduction of 52% in the CLAB rate. CONCLUSIONS: This study shows that the implementation of a multidimensional infection control strategy was associated with a significant reduction in the CLAB rates in the PICUs of developing countries.

[Radiotherapy in vulvar cancer. Experience in the Hospital de Oncología, CMN, SXXI, IMSS]. / Radioterapia en el cáncer de vulva. Experiencia en el Hospital de Oncología, CMN, SXXI, IMSS.

Between 1986 and 1992, 42 patients with carcinoma of the vulva diagnosis, were treated at the Hospital de Oncologia, CMN, SXXI. Mean age was 63 years. There was 1 case stage I, 5 stage II, 25 stage III, 4 stage IV, 2 with recurrent disease and 5 patients could not be classified. Local control was reached in 60% of patients however, 12 patients developed local recurrence after surgery and/or radiation therapy, finally 43% of patients remained disease free after a mean of 19 months of followup. In the subset of advanced disease patients treated with radical or preoperative radiation therapy (27 patients), 41% of them remained without disease. Mean radiation doses for patients treated only with radiation therapy was 6500 cGy. Late vulvar fibrosis and acute desquamative dermatitis, were the morbidity more frequently observed. New directions in the management of vulvar cancer must be developed to improve treatment results, in patients with advanced disease.