[Progressive primary tuberculosis with endobronchial involvement. Benefits of multislice helical computed tomography]. / Tuberculosis primaria progresiva con afectación endobronquial. Aportación de la TC multicorte.

OBJECTIVES: To assess computed tomography (CT) imaging findings in progressive primary tuberculosis and to determine the use of the multislice images obtained. PATIENTS AND METHODS: We report the case of a 37-day-old infant admitted to hospital because of persistent fever despite antimicrobial therapy. Thoracic X-ray and multislice helical CT (CT Light speed i1.6 GE) were performed with 3-dimensional and virtual endoscopy reconstructions. RESULTS: CT showed mediastinal and hilar necrotic lymph nodes, pulmonary parenchymal involvement with miliary pattern, and multiple cavitated consolidations. Endobronchial involvement was clearly visualized by virtual endoscopy and was confirmed by fiberoptic bronchoscopy. CONCLUSIONS: Virtual endoscopy is a new, less invasive alternative radiological technique to fiberoptic bronchoscopy that may influence the management of patients with tuberculosis with endobronchial involvement.

Tuberculosis primaria progresiva con afectación endobronquial. Aportación de la TC multicorte / Progressive primary tuberculosis with endobronchial involvement. Benefits of multislice helical computed tomography

Objetivos: Describir los hallazgos de la forma progresiva de tuberculosis primaria y determinar la utilidad de las imágenes obtenidas por tomografía computarizada (TC) multicorte. Pacientes y métodos: Presentamos el caso de un lactante de 37 días de vida ingresado por fiebre persistente tras antibioterapia. Fue estudiado con radiografía de tórax y TC helicoidal multicorte (TC Light speed i1.6 GE) con posprocesado de las imágenes, reconstrucciones en tres dimensiones y endoscopia virtual. Resultados: La TC demuestra la presencia de masas adenopáticas mediastínicas e hiliares necrosadas, infiltrados pulmonares con patrón miliar y múltiples condensaciones cavitadas. La endoscopia virtual revela afectación endobronquial confirmada mediante fibrobroncoscopia. Conclusiones: La endoscopia virtual es una nueva técnica radiológica complementaria a la fibrobroncoscopia y menos invasiva que ésta, que puede influir en el tratamiento del paciente con afectación endobronquial por tuberculosis

Objectives: To assess computed tomography (CT) imaging findings in progressive primary tuberculosis and to determine the use of the multislice images obtained. Patients and methods: We report the case of a 37-day-old infant admitted to hospital because of persistent fever despite antimicrobial therapy. Thoracic X-ray and multislice helical CT (CT Light speed i1.6 GE) were performed with 3-dimensional and virtual endoscopy reconstructions. Results: CT showed mediastinal and hilar necrotic lymph nodes, pulmonary parenchymal involvement with miliary pattern, and multiple cavitated consolidations. Endobronchial involvement was clearly visualized by virtual endoscopy and was confirmed by fiberoptic bronchoscopy. Conclusions: Virtual endoscopy is a new, less invasive alternative radiological technique to fiberoptic bronchoscopy that may influence the management of patients with tuberculosis with endobronchial involvement

[Surgical treatment of non-small cell lung cancer with mediastinal node invasion. A retrospective study]. / Resultados del tratamiento quirúrgico y terapia neoadyuvante en el cáncer de pulmón no microcítico con invasión ganglionar mediastínica. Estudio retrospectivo.

OBJECTIVE: To analyze the survival of patients classified as N2M0 (N2 by cytohistology) with non-small cell lung cancer treated by surgical resection of the primary tumor and lymphadenectomy. PATIENTS AND METHODS: Among 1043 consecutive patients with lung cancer who were considered for surgery between 1990 and 2000, 155 were classified N2M0 by histology. Surgical exeresis of the primarily pulmonary tumor and lymphadenectomy were performed in 116 patients of the 130 patients who underwent thoracotomy. Among the 116 N2M0 patients undergoing surgical resection, 23 were diagnosed N2c(C3) by mediastinoscopy and/or mediastinotomy and were given induction chemotherapy (ChT) (mitomycin/ifosfami-de/cisplatin, 3 cycles) and 93 were diagnosed N2pM0 based on samples obtained from mediastinal lymph tissue during thoracotomy. Nineteen of the latter had previously been classified negative during surgical exploration. The patients diagnosed N2p after thoracotomy were given adjuvant ChT, radiotherapy or both. N2p patients who received induction therapy were given radiotherapy. Those found negative after lymphadenectomy and patients with severe disease were given no adjuvant treatment. RESULTS: Mean survival was 18 months for resected patients diagnosed N2 by mediastinoscopy/mediastinotomy and with induction ChT and survival at one, two and five years was 80%, 45% and 30%, respectively. No postoperative mortality was recorded in this group. One patient suffered bronchopleural fistula. Nine patients showed no residual mediastinal node disease after lymphadenectomy. The mean survival of resected patients diagnosed N2p by thoracotomy was 13 months, and one, two and five year survival rates were 56%, 31% and 19%, respectively. Fourteen patients died within 30 days of surgery. Nine patients developed a bronchopleural fistula. The difference in survival of the two groups was not significant. CONCLUSIONS: The prognosis after cytohistologic confirmation of N2 disease can be considered poor. Standard, complete surgery plus induction therapy in screened patients improved survival for those diagnosed N2 by thoracotomy, with no statistically significant differences.

Resultados del tratamiento quirúrgico y terapia neoadyuvante en el cáncer de pulmón no microcítico con invasión ganglionar mediastínica. Estudio retrospectivo / Surgical treatment of non-small cell lung cancer with mediastinal node invasion. A retrospective study

OBJETIVO: Analizar la supervivencia de los pacientes clasificados N2M0 (N2 citohistológico) con cáncer de pulmón no microcítico tratados mediante resección quirúrgica del tumor primario y linfadenectomía. PACIENTES Y MÉTODO: Entre 1.043 pacientes consecutivos con cáncer de pulmón valorados para cirugía desde 1990 al 2000, hallamos 155 clasificados N2M0 por histología y realizamos la exéresis quirúrgica del tumor pulmonar primario y la linfadenectomía en 116 pacientes de los 130 a quienes se había practicado toracotomía. En los 116 pacientes N2M0 con resección quirúrgica, 23 fueron diagnosticados N2c(C3) por mediastinoscopia y/o mediastinotomía y siguieron quimioterapia (QT) de inducción (mitomicina/ifosfamida/cisplatino, 3 ciclos) y otros 93 fueron diagnosticados como N2pM0 con las muestras obtenidas del tejido linfático mediastínico en la toracotomía, 19 de éstos con exploración quirúrgica mediastínica previa negativa. Los pacientes diagnosticados N2p tras la toracotomía recibieron tratamiento adyuvante con QT, radioterapia (RT) o ambas. A los N2p que recibieron terapia de inducción se les administró RT. Los negativizados tras la linfadenectomía y los pacientes graves no recibieron tratamiento adyuvante alguno. RESULTADOS: La mediana de supervivencia de los pacientes resecados diagnosticados N2 por mediastinoscopia/mediastinotomía y con QT de inducción fue de 18 meses, y la supervivencia al año, a los 2 y a los 5 años fue del 80, el 45 y el 30 por ciento, respectivamente. No hubo mortalidad postoperatoria en este grupo. Un paciente presentó una fístula broncopleural. Nueve pacientes no manifestaron enfermedad ganglionar mediastínica residual tras la linfadenectomía. La mediana de supervivencia de los pacientes resecados diagnosticados N2p en la toracotomía fue de 13 meses, y al año, a los 2 y a los 5 años presentaron una supervivencia del 56, el 31 y el 19 por ciento, respectivamente. Fallecieron 14 pacientes en los primeros 30 días del postoperatorio. Nueve pacientes presentaron una fístula broncopleural. La diferencia de supervivencia entre los pacientes de ambos grupos no fue significativa. CONCLUSIONES: La confirmación citohistológica de enfermedad N2 puede considerarse de mal pronóstico. La cirugía estándar completa, con terapia de inducción en pacientes seleccionados, mejoró la supervivencia que presentaron aquellos diagnosticados N2 en la toracotomía, sin diferencias estadísticamente significativas (AU)

[Solitary adrenal metastasis of pulmonary cancer]. / Metástasis única suprarrenal por cáncer de pulmón.

We describe the case of a 46-year-old man with lung cancer and simultaneous solitary adrenal metastases. Adrenalectomy was performed 12 weeks after lung resection through a right subcostal laparotomy. Treatment was complemented with chemotherapy. Twelve months after adrenalectomy the patient was found free of signs of disease and was in satisfactory condition. The advantages of and indications for surgical resection of suprarenal metastasis are discussed in the light of published literature. In some cases, survival may improve with exeresis and chemotherapy.

[Urologic impact of Crohn disease]. / Sobre las repercusiones urológicas de la enfermedad de Crohn (EC).

Presentation of two cases of Crohn's disease seen in our Service in which the urological symptoms were of special relevance. One patient presented clinically with a picture of anaemic gross haematuria. The other one, was a patient already diagnosed with Crohn's disease who developed an enterovesical fistula in spite of receiving medical treatment. Both cases were resolved surgically. The clinical aspects, natural history and treatment of this uncommon form of urinary tract involvement are discussed.