Imatinib use in the management of a patient with Doege-Potter syndrome.

Summary: Doege-Potter syndromeis a paraneoplastic syndrome characterized by nonislet cell tumor hypoglycemia due to a solitary fibrous tumor, which produces insulin-like growth factor II. In this report, we present the case of a 67-year-old male with recurrent and refractory hypoglycemia due to DPS successfully treated with imatinib. He initially presented with neuroglycopenic symptoms and dyspnea secondary to a giant tumor in the left hemithorax, which was totally resected. During follow-up, 7 years later, he presented with thoracoabdominal tumor recurrence associated with severe hypoglycemia and underwent subtotal tumor resection, with a subsequent improvement of symptoms. The following year, he had a recurrence of his intra-abdominal tumor, which was unresectable, associated with severe hypoglycemia refractory to dextrose infusion and corticosteroids, thus receiving imatinib with a favorable response. The clinical presentation, diagnostic approach, progression of the disease, and response to treatment with imatinib in the management of a patient with large, recurrent, and unresectable mesenchymal tumors with insulin-like growth factor-2 secretion causing hypoglycemiahighlight the importance of this case report. Learning points: Doege-Potter syndrome (DPS) is a rare cause of tumoral hypoglycemia of non-pancreatic origin. Some malignant or benignant neoplasms have ectopic secretion of insulin-like growth factor-2. Total surgical removal is the principal treatment in patients with DPS. Tyrosine kinase inhibitors management in DPS may contribute to improved tumor control in patients with unresectable tumors and severe hypoglycemia.

Association of outdoor air pollution with the prevalence of asthma in children of Latin America and the Caribbean: A systematic review and meta-analysis.

OBJECTIVE: This study aimed to evaluate the association between asthma prevalence and outdoor air pollution in children in Latin America and the Caribbean. DATA SOURCES: We searched studies in global and regional databases: PubMed, Scopus, LILACS and SciELO. STUDY SELECTION: Articles following a cross-sectional design, studying children from 0 to 18 years old, and comparing the prevalence of asthma in two or more areas of LAC countries with different air pollution levels were included. The exclusion criteria comprised air pollution not related to human activities. RESULTS: Database searches retrieved 384 records, while 20 studies were retained for qualitative and 16 for quantitative analysis, representing 48 442 children. We found a positive association, i.e. a higher prevalence of asthma in children living in a polluted environment, with pooled odds ratio (OR) of 1.34 (95% CI: 1.17-1.54). Heterogeneity between studies was moderate (I2: 68.39%), while the risk of bias was intermediate or high in 14 studies. In all the subgroup and sensitivity analyses, the pooled ORs were significant and higher than those found in the general analysis Conclusions: Our results showed that living in a polluted environment is significantly associated with children having asthma in LAC. Limitations of this study include the low number of studies performed in LAC countries, differences in methodologies and the risk of bias in individual studies.

Effect of outdoor air pollution on asthma exacerbations in children and adults: Systematic review and multilevel meta-analysis.

BACKGROUND: Several observational studies have suggested that outdoor air pollution may induce or aggravate asthma. However, epidemiological results are inconclusive due to the presence of numerous moderators which influence this association. The goal of this study was to assess the relationship between outdoor air pollutants and moderate or severe asthma exacerbations in children and adults through a systematic review and multilevel meta-analysis. MATERIAL AND METHODS: We searched studies published in English on PubMed, Scopus, and Google Scholar between January 2000 and October 2016. Studies following a case-crossover design with records of emergency departments and/or hospital admissions as a surrogate of moderate or severe asthma exacerbations were selected. A multilevel meta-analysis was employed, taking into account the potential clustering effects within studies examining more than one lag. Odds ratios (ORs) and 95% confidence intervals were estimated. A subgroup analysis in children aged 0 to 18 years and a sensitivity analysis based on the quality of the included studies as defined in the Newcastle-Ottawa Scale were performed. Publication bias was evaluated through visual inspection of funnel plots and by a complementary search of grey literature. (Prospero Registration number CRD42015032323). RESULTS: Database searches retrieved 208 records, and finally 22 studies were selected for quantitative analysis. All pollutants except SO2 and PM10 showed a significant association with asthma exacerbations (NO2: 1.024; 95% CI: 1.005,1.043, SO2: 1.039; 95% CI: 0.988,1.094), PM10: 1.024; 95% CI: 0.995,1.053, PM2.5: 1.028; 95% CI: 1.009,1.047, CO: 1.045; 95% CI: 1.005,1.086, O3: 1.032; 95% CI: 1.005,1.060. In children, the association was significant for NO2, SO2 and PM2.5. CONCLUSION: This meta-analysis provides evidence of the association between selected air pollutants and asthma exacerbations for different lags.

Resultados tempranos y alejados del trasplante pulmonar en el enfisema avanzado / Early and Late Results of Lung Transplantation in Advanced Emphysema

Introducción y objetivos: El enfisema constituye la indicación más frecuente de trasplante pulmonar (TP). El propósito del presente trabajo fue evaluar las características demográficas y funcionales de pacientes con enfisema y analizar la supervivencia. Métodos: Estudio observacional analítico de 84 pacientes con enfisema que recibieron TP entre junio 1994 y marzo 2012. Se utilizó el método de Kaplan-Meier para analizar la supervivencia. Resultados: Se realizaron 84 TP en 84 pacientes con enfermedad pulmonar obstructiva crónica (EPOC) por enfisema avanzado, todos fumadores, 11 (13%) padecían déficit de alfa-1 antitripsina (DA1AT); 70 trasplantes unipulmonares (TUP) (83%) y 14 trasplantes bipulmonares (TBP) (17%); 69 en situación electiva (82%) y 15 en emergencia/urgencia (18%). Edad promedio: 54,95 ± 6,10 años, 54 hombres (64%). Volumen espiratorio forzado en el primer segundo (VEF1) 0,60 ± 0,28 L (20 ± 9%); capacidad vital forzada (CVF) 1,78 ± 0,62 L (46 ± 16%); presión arterial pulmonar media (PAPm) 21,08 ± 5,79 mmHg; presión parcial de oxígeno arterial (PaO2) 67,54 ± 12,27 mmHg; presión parcial de dióxido de carbono arterial (PaCO2) 46,40 ± 8,04 mmHg; distancia recorrida en prueba de marcha de 6 minutos (PM6M) 225,59 ± 113,67 m. La mortalidad hospitalaria (MH) fue 16% (13/84). La supervivencia global a 1, 3, 5, 7 y 10 años: 67%, 53%, 40%, 27% y 13%. Supervivencia condicional a 3, 5, 7 y 10 años: 79%, 59%, 41% y 20%. Conclusiones: El TP es una opción terapéutica en enfisema avanzado. Este trabajo muestra características y supervivencia de pacientes con EPOC trasplantados en Hospital Universitario Fundación Favaloro (HUFF).

Introduction and objectives: Emphysema is the most frequent indication of lung transplantation (LT)). The aim of this paper is to evaluate the demographic and functional characteristics of patients with emphysema and to analize survival. Methods: Observational and analytic study of 84 patients with emphysema who were transplanted between june 1994 and march 2012. Kaplan-Meier method was used to analyze survival. Results: 84 (40%) out of 212 transplanted patients had diagnosis of emphysema; 11 (13%) of them with diagnosis of alfa-1 antitrypsin defcit. Seventy of them (83%) were single lung transplantation and 14 (17%) double lung transplantation; 69 in elective situation (82%) and 15 in emergency/urgency situation (18%). Mean age: 54, 95 ± 6, 10 years, 54 male (64%). Baseline characteristics were: forced expiratory volume in first second (FEV1) 0,60 ± 0,28 L (20 ±9%); forced vital capacity (FVC) 1,78 ± 0,62 L (46 ± 16%); mean pulmonary artery pressure (map) 21,08 ± 5,79 mmHg; mean partial artery oxygen pressure (PaO2) 67,54 ± 12,27 mmHg; mean partial carbon dioxide pressure (PaCO2) 46,40 ± 8,04 mmHg, Six minute walk test (6MWT) distance was 225,59± 113,67 m. In-hospital mortality was 16% (13/84). Global survival at 1, 3, 5, 7 y 10 years was 67%, 53%, 40%, 27% y 13% respectively. Conditional survival at 3, 5, 7 y 10 years was 79%, 59%, 41% y 20% respectively. Conclusions: lung transplantation is a therapeutic option in advanced emphysema. This paper shows characteristics and survival of COPD patients who underwent lung transplantation in the University Hospital Foundation Favaloro.

Actinomicosis pulmonar: infección pulmonar inusual / Lung actinomycosis: uncommon pulmonary infection

Paciente masculino de 52 años de edad con antecedentes de diabetes tipo I, tos productiva de tres meses de evolución, disnea de esfuerzo progresiva y aislados episodios de expectoración hemoptoica previos a la consulta. Al examen físico se evidenció matidez percutoria a nivel de campo pulmonar inferior derecho y disminución del murmullo vesicular en región infraaxilar derecha. Las radiografías de tórax de 2 meses previos y la tomografía axial computarizada de tórax revelaron una opacidad heterogénea en el lóbulo medio. Se procedió a realizar una fibrobroncoscopía con lavado broncoalveolar y biopsia transbronquial. El examen anatomopatológico mostró exudado purulento con colonias bacterianas con aspecto de actinomicosis. El paciente inició tratamiento endovenoso con penicilina G.

A 52-year-old male patient with history of type 1 diabetes presented productive cough for a period of three months, progressive exertional dyspnea and isolated episodes of hemoptoic expectoration. Physical examination evidenced percussion dullness in the right lower lung field and a decrease in breath sounds in the right infra-axillary region. Chest X-rays during the two previous months and a chest computerized axial tomography revealed a heterogeneous opacity in the middle lobe. A fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was performed. The anatomopathological examination showed purulent exudates with microbial colonies consistent with actinomycosis. The patient was treated with intravenous penicillin G.

Distribución y tendencia de la trichinellosis humana y porcina en Chile: 1989-1995 / Distribution and tendency of human and swine trichinellosis in Chile: 1989 to 1995

Con información de los años 1989 a 1995, obtenida del Ministerio de Salud de Chile, se describe la prevalencia de la trichinellosis de las poblaciones humana y porcina. La enfermedad en la población porcina se presenta desde la V a la XII Región. En la población humana no se observaron casos en la I, II y X Región. En ambas poblaciones la tendencia es al descenso. No se observó asociación entre las tasas observadas en la población humana con las determinadas en la especie porcina. Tanto entre regiones como entre años