ABSTRACT
La linfangiomatosis pulmonar difusa es una enfermedad rara caracterizada por una marcada proliferación y dilatación de los vasos linfáticos en los pulmones, la pleura y el mediastino. Se desconoce la prevalencia, y la etiología no se comprende completamente.Una niña de 22 meses ingresó por poliserositis, con derrame pericárdico y pleural. Requirió pericardiocentesis y avenamiento pleural, y presentó drenaje de quilo (1,5-4 litros/día) sin respuesta al tratamiento médico (ayuno, nutrición parenteral y octreotide). Se realizó biopsia pulmonar. La anatomía patológica mostró hallazgos compatibles con linfangiomatosis difusa pulmonar. Comenzó tratamiento con sirolimus y propanolol, que disminuyeron las pérdidas por el drenaje pleural a la semana. Presentó buena evolución; suspendió aporte de oxígeno y se retiró el drenaje pleural. Se externó al cuarto mes de internación. El diagnóstico temprano de la linfangiomatosis pulmonar difusa es difícil de lograr, pero permite aplicar terapéuticas que evitan la progresión de enfermedad y disminuir la morbimortalida
Diffuse pulmonary lymphangiomatosis is a rare disease characterized by marked proliferation and dilation of lymphatic vessels in the lungs, pleura, and mediastinum. The prevalence is unknown and the etiology is not fully understood.A 22-month-old girl was admitted for polyserositis, with pericardial and pleural effusion. She required pericardiocentesis and pleural drainage, presenting chyle drainage (1.5-4 liters/day) without response to medical treatment (fasting, parenteral nutrition and octreotide). A lung biopsy was performed. The pathological anatomy showed findings compatible with diffuse pulmonary lymphangiomatosis. Treatment with sirolimus and propanolol began, decreasing losses due to pleural drainage one week after treatment. She progressed well, discontinued oxygen supply and pleural drainage was removed, leaving the patient after the fourth month of hospitalization.Early diagnosis of diffuse pulmonary lymphangiomatosis is difficult to achieve, but it allows the application of therapies that prevent disease progression, reducing morbidity and mortality.
Subject(s)
Humans , Female , Infant , Lung Diseases/congenital , Lymphangiectasis/congenital , Pleural Effusion , Propranolol/therapeutic use , Biopsy , Sirolimus/therapeutic use , Lung Diseases/pathology , Lung Diseases/diagnostic imaging , Lymphangiectasis/pathology , Lymphangiectasis/diagnostic imagingABSTRACT
Diffuse pulmonary lymphangiomatosis is a rare disease characterized by marked proliferation and dilation of lymphatic vessels in the lungs, pleura, and mediastinum. The prevalence is unknown and the etiology is not fully understood. A 22-month-old girl was admitted for polyserositis, with pericardial and pleural effusion. She required pericardiocentesis and pleural drainage, presenting chyle drainage (1.5-4 liters/ day) without response to medical treatment (fasting, parenteral nutrition and octreotide). A lung biopsy was performed. The pathological anatomy showed findings compatible with diffuse pulmonary lymphangiomatosis. Treatment with sirolimus and propanolol began, decreasing losses due to pleural drainage one week after treatment. She progressed well, discontinued oxygen supply and pleural drainage was removed, leaving the patient after the fourth month of hospitalization. Early diagnosis of diffuse pulmonary lymphangiomatosis is difficult to achieve, but it allows the application of therapies that prevent disease progression, reducing morbidity and mortality.
La linfangiomatosis pulmonar difusa es una enfermedad rara caracterizada por una marcada proliferación y dilatación de los vasos linfáticos en los pulmones, la pleura y el mediastino. Se desconoce la prevalencia, y la etiología no se comprende completamente. Una niña de 22 meses ingresó por poliserositis, con derrame pericárdico y pleural. Requirió pericardiocentesis y avenamiento pleural, y presentó drenaje de quilo (1,5- 4 litros/día) sin respuesta al tratamiento médico (ayuno, nutrición parenteral y octreotide). Se realizó biopsia pulmonar. La anatomía patológica mostró hallazgos compatibles con linfangiomatosis difusa pulmonar. Comenzó tratamiento con sirolimus y propanolol, que disminuyeron las pérdidas por el drenaje pleural a la semana. Presentó buena evolución; suspendió aporte de oxígeno y se retiró el drenaje pleural. Se externó al cuarto mes de internación. El diagnóstico temprano de la linfangiomatosis pulmonar difusa es difícil de lograr, pero permite aplicar terapéuticas que evitan la progresión de enfermedad y disminuir la morbimortalidad.
Subject(s)
Lung Diseases , Lymphangiectasis , Child , Female , Humans , Infant , Mediastinum , Pleura , ThoraxABSTRACT
Desde la eliminación de la circulación del virus polio salvaje, disminuyeron los casos de parálisis fláccida aguda. Sin embargo, continúan ocurriendo casos asociados a otros enterovirus no polio y virus neurotropos. Se presenta el caso de una paciente de 9 años con diagnóstico de meningitis y mielitis con compromiso motor en los miembros inferiores y vejiga neurogénica asociado a enterovirus, con resolución completa del cuadro neurológico posterior a la administración de gammaglobulina hiperinmune.
Since the wild poliovirus no longer circulates, the number of cases of acute flaccid paralysis decreased. However, cases related to non-polio enteroviruses and neurotrope viruses continue to occur. We present a nine-year-old patient with meningitis and myelitis with motor involvement in the lower limbs and neurogenic bladder associated with enterovirus, with complete resolution of the neurological symptoms following the administration of hyperimmune gammaglobulin.
Subject(s)
Humans , Female , Child , gamma-Globulins/therapeutic use , Enterovirus , Myelitis/diagnostic imaging , ParalysisABSTRACT
Since the wild poliovirus no longer circulates, the number of cases of acute flaccid paralysis decreased. However, cases related to non-polio enteroviruses and neurotrope viruses continue to occur. We present a nine-year-old patient with meningitis and myelitis with motor involvement in the lower limbs and neurogenic bladder associated with enterovirus, with complete resolution of the neurological symptoms following the administration of hyperimmune gammaglobulin.
Desde la eliminación de la circulación del virus polio salvaje, disminuyeron los casos de parálisis fláccida aguda. Sin embargo, continúan ocurriendo casos asociados a otros enterovirus no polio y virus neurotropos. Se presenta el caso de una paciente de 9 años con diagnóstico de meningitis y mielitis con compromiso motor en los miembros inferiores y vejiga neurogénica asociado a enterovirus, con resolución completa del cuadro neurológico posterior a la administración de gammaglobulina hiperinmune.
Subject(s)
Enterovirus Infections/diagnosis , Meningitis, Viral/virology , Myelitis/virology , Paralysis/virology , Child , Enterovirus Infections/drug therapy , Enterovirus Infections/pathology , Female , Humans , Meningitis, Viral/drug therapy , Myelitis/drug therapy , Paralysis/drug therapy , Urinary Bladder, Neurogenic/drug therapy , Urinary Bladder, Neurogenic/virology , gamma-Globulins/administration & dosageABSTRACT
OBJECTIVE: To discover the prevalence of 4 preventable and treatable diseases among newly arriving refugees. DESIGN: Retrospective cohort study. SETTING: An immigrant-friendly family medicine centre in Ottawa, Ont, that offers newly arriving refugees a clinical preventive program following a specially designed protocol. PARTICIPANTS: A total of 112 adult government-assisted refugees seen during 2004 and 2005 within 6 months of arrival. MAIN OUTCOME MEASURES: Demographic information and prevalence of HIV infection, latent tuberculosis (TB), chronic hepatitis B surface antigen-positive status, and intestinal parasites. RESULTS: Descriptive analysis revealed that 71% of the adults were younger than 35 years and 83% of them had come from sub-Saharan Africa. Disease prevalence rates were 6.3% for HIV (95% confidence interval [CI] 1.8 to 10.8), 49.5% for latent TB (95% CI 39.5 to 49.8), 5.4% for chronic hepatitis B surface antigen-positive status (95% CI 1.2 to 9.5), and 13.6% for intestinal parasites (95% CI 7.2 to 20.0). Most refugees (83%) successfully completed the preventive care program. Performing chi(2) analysis revealed a statistically significant higher risk of latent TB among the men (P < .032). Most of the women had never had a Papanicolaou test. CONCLUSION: Refugees are a vulnerable population with unique, but often preventable or treatable, health issues. This study demonstrated substantial differences in the prevalence of HIV, TB, chronic hepatitis B, and intestinal parasites between government-assisted refugees and Canadian residents. These health disparities and the emerging field of health settlement are new challenges for family physicians and other primary health care providers.
