Seudotumor inflamatorio y tumor miofibroblástico inflamatorio. Criterios diagnósticos y diferencias pronósticas / Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences

Introducción El seudotumor inflamatorio (PTI) y el tumor miofibroblástico inflamatorio (TMI) son 2 entidades muy poco frecuentes que se incluían antiguamente en la misma categoría; sin embargo, en la actualidad se consideran 2 enfermedades diferentes debido al origen neoplásico del TMI. Nuestro objetivo es compartir nuestra experiencia en el manejo de estos 2 tipos de lesiones que debemos tener en cuenta en el diagnóstico diferencial de masas o nódulos pulmonares. Métodos Fueron estudiados retrospectivamente 13 pacientes con diagnóstico anatomopatológico de PTI o TMI, intervenidos entre los años 2008 y 2019. Registramos la información pre y postoperatoria de cada uno, así como el análisis de supervivencia. Resultados De los 13 pacientes, 8 eran varones y 5 mujeres. La media de edad de presentación fue de 53,5 años. En 6 pacientes se practicó una segmentectomía atípica, en 6 fue necesario realizar una lobectomía y en un caso una neumonectomía. En todos los casos se consiguió una resección completa. El diagnóstico fue posible gracias a la histología, técnicas de inmunohistoquímica (IHQ) y de hibridación fluorescente in situ (FISH) determinando la expresión de IgG4 y el reordenamiento de ALK, respectivamente. Tras una mediana de seguimiento de 49 meses no se observaron datos de recidiva locorregional ni a distancia en los pacientes estudiados. Conclusión El PTI y el TMI son tumores poco frecuentes con muy buen pronóstico. El diagnóstico de ambas entidades se basa principalmente en técnicas anatomopatológicas específicas. La cirugía tiene, en la mayor parte de las ocasiones, un papel tanto diagnóstico como terapéutico (AU)

Introduction Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. Methods Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. Results Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didńt find any loco-regional or distant recurrence in the patients studied. Conclusion IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role (AU)

Effect of delays on survival in patients with lung cancer

BACKGROUND: The effect on survival of delays in the consultation, diagnostic and treatment processes of lung cancer (LC) is still under debate. The objective of our study was to analyse these time delays and their possible effect on survival. METHODS: A retrospective study has been performed on all patients in our health area diagnosed with LC (confirmed by cytohistology) over 3 years. The delay in specialist consultation (time between start of symptoms and the first consultation with a specialist), hospital delay (time between first consultation and start of treatment) and overall delay (the sum of the previous two delays) were analysed. The influence of each of these delays was calculated using Cox regression, adjusted for other factors. RESULTS: A total of 415 patients were included. Of these, 92.5% were male and 75.4% were in stages III-B or IV. The overall delay gave a mean of 123.6 days, the delay in consulting a specialist 82.1 days and the delay in hospitalisation was 41.4 days. A greater overall delay or greater hospital delay was associated with longer survival. No relationship was observed between the specialist consultation delay and survival. CONCLUSIONS: Globally analysing all the cases and all the stages with LC, it is seen that longer delays are associated with longer survival. This probably reflects the fact that patients with more symptoms are treated more rapidly (AU)

Pneumonitis caused by silicone gel following breast implant rupture.

INTRODUCTION: There have been reports of pneumonitis associated with subcutaneous injection of liquid silicone, and of other pulmonary conditions due to cohesive silicone gel prostheses, but we know of no previous cases of pneumonitis associated with silicone gel. MATERIALS AND METHODS: We report the case of a patient with a cohesive silicone gel mammary prosthesis in whom silicone-induced pneumonitis was diagnosed following radiological observation of pulmonary infiltrates and tests including transbronchial biopsy, which revealed the presence of silicone in alveolar histiocytes and small blood vessels. CONCLUSION: Following removal of the ruptured prosthesis and a course of systemic corticoids, the patient progressed favourably.

Adecuación de las restricciones físicas y farmacológicas en los ancianos institucionalizados: estudio comparativo en Québec y la Suiza Romanda, con implicaciones en nuestro medio / Appropriateness of the use of physical restraints and psychotropic medication in institutionalised older people: comparative study in Quebec and French Switzerland. Applicability to Spain

Objetivo: analizar la variabilidad dentro y entre diferentes países en el empleo de restricciones físicas y fármacos psicotropos en mayores de 65 años institucionalizados en centros de Québec y la Suiza Romanda, y estudiar la aplicabilidad de estos resultados a futuros estudios en nuestro medio. Material y método: se analizan los datos de los individuos institucionalizados en Québec y la zona francófona de Suiza mediante el sistema de información denominado PLAISIR, utilizado en dichos centros para la gestión y el análisis de los recursos financieros. Se obtienen datos de todos los ingresos habidos en 1998 en 179 instituciones de Québec (n = 8.183) y en 250 residencias de Suiza (n = 7.592). Las restricciones físicas se clasifican en fijas y móviles. A través de las Defined Daily Doses se codifica la prescripción diaria y semanal de psicotropos. Se determina la prevalencia de cada uno de los medios físicos y farmacológicos y, posteriormente, se calcula un índice de pertinencia de empleo de cada una de ellas por un método de ajuste indirecto. Mediante el análisis de regresión logística se estiman los valores esperados de uso de las diferentes restricciones en función del estado de salud y la situación funcional de los residentes. Resultados: la proporción de residentes con dependencia de otras personas es elevada en ambas regiones, y alcanza un 80% en las instituciones suizas y un 90% en las canadienses. Se observa una alta variabilidad en el empleo de los diferentes métodos restrictivos, tanto entre países como entre instituciones: los psicotropos se prescriben más en Suiza (78%) que en Québec (67%), mientras que las restricciones físicas se usan más en Québec (76%) que en Suiza (40%). La adecuación de su uso varía de forma importante y no puede atribuirse únicamente a las características de los residentes Conclusiones: la alta variabilidad observada en la adecuación del empleo de diferentes medios restrictivos, físicos y farmacológicos refleja probablemente la ausencia de aplicación de estándares de calidad y/o una legislación insuficiente, tanto en Québec como en Suiza. Estos resultados ilustran un método útil para iniciar la investigación sobre la prevalencia y la adecuación del uso de estos métodos en España

Objective: a) to examine intra- and inter-country variability in the use of physical restraints and psychotropic medication in institutionalised people older than 65 in Quebec and in Romande, Switzerland, and b) to study the applicability of the results to future studies in Spain. Material and method: data were collected through PLAISIR, an information system on persons institutionalised in Quebec and French-speaking Switzerland used for financing and planning, resource allocation and management, utilisation control and quality assurance. Data were obtained from all new admissions to 179 institutions in Quebec (n = 8183) and to 250 institutions in Switzerland (n = 7592) in 1998. Physical restraints were classified into fixed and mobile. Daily and weekly uses of psychotropic medication were coded by defined daily doses. The prevalence of the use of physical restraints and psychotropic medication were estimated and an index of the appropriateness of the use of each was calculated by an indirect adjustment method. A logistic regression model on the use of both types of restriction based on residents’ health and functional status was calculated to estimate expected values of use. Results: the rate of dependency was high in residents of both regions. Approximately 80% of residents in French Switzerland and 90% of those in Quebec were dependent for activities of daily living. Intra- and inter-country variability in the use of restrictions is high: psychotropic medication was more often used in French Switzerland (78%) than in Quebec (67%), while physical restraints were more often used in Quebec (76%) than in French Switzerland (40%). The appropriateness of use varied widely within both regions and cannot be fully explained by the characteristics of the residents. Conclusions: the high variability in the use of physical restraints and psychotropic medication may be a result of the absence of standards of quality and/or legislation both in Quebec and in French Switzerland. This research illustrates a method that could be useful to investigate the prevalence and appropriateness of the use of these restriction methods in Spain