Diagnóstico y evolución de los pacientes con derrames pleurales idiopáticos / Diagnosis and outcome of patients with idiopathic pleural effusions

Introducción No se ha determinado la evolución de los pacientes con derrames pleurales idiopáticos con un seguimiento a largo plazo. Métodos Entre octubre de 2013 y junio de 2021 se hizo un seguimiento prospectivo de todos los pacientes con derrame idiopático mediante exploración clínica y estudios de imagen al cabo de 1, 3 y seis meses y cada seis meses durante un mínimo de un año. Resultados Veintinueve pacientes fueron diagnosticados de derrame idiopático y objeto de seguimiento. Durante el seguimiento se detectó un mesotelioma en dos pacientes al cabo de siete y 18 meses; en uno de ellos se observó líquido pleural teñido de sangre y el otro refirió una pérdida de peso de 10%. En ninguno de los pacientes con derrame que cubriera menos de dos tercios del hemitórax y sin síntomas constitucionales ni aparición de líquido teñido de sangre se diagnosticó un mesotelioma. La mayoría de los derrames desaparecieron o mostraron una clara mejoría en los primeros seis meses. Conclusiones Los pacientes sin pérdida de peso y con derrames no hemáticos pequeños pueden beneficiarse de un tratamiento conservador y un seguimiento clínico-radiológico (AU)

Introduction Long-term follow-up course for patients with idiopathic pleural effusions has not been established. Methods From October 2013 to June 2021 all patients with idiopathic effusion were prospectively followed up with clinical examination and imaging at 1,3,6 and every 6 months for a minimum of 1 year. Results Twenty-nine patients were diagnosed with idiopathic effusion and followed up. Mesothelioma was detected during the follow-up in two patients at 7 and 18 months, one of whom had blood-tinged pleural fluid and the other reported a 10% weight loss. Mesothelioma was not diagnosed in any of the patients with effusion covering less than two thirds of the hemithorax, and without constitutional symptoms or a blood-tinged fluid appearance. Most of the effusions resolved or showed a clear improvement in the first six months. Conclusions Patients without weight loss and with small, non-hematic effusions, may benefit from conservative treatment and clinical-radiological follow-up (AU)

Diagnosis and outcome of patients with idiopathic pleural effusions.

INTRODUCTION: Long-term follow-up course for patients with idiopathic pleural effusions has not been established. METHODS: From October 2013 to June 2021 all patients with idiopathic effusion were prospectively followed up with clinical examination and imaging at 1, 3, 6 and every 6 months for a minimum of 1 year. RESULTS: Twenty-nine patients were diagnosed with idiopathic effusion and followed up. Mesothelioma was detected during the follow-up in two patients at 7 and 18 months, one of whom had blood-tinged pleural fluid and the other reported a 10% weight loss. Mesothelioma was not diagnosed in any of the patients with effusion covering less than two thirds of the hemithorax, and without constitutional symptoms or a blood-tinged fluid appearance. Most of the effusions resolved or showed a clear improvement in the first six months. CONCLUSION: Patients without weight loss and with small, non-hematic effusions, may benefit from conservative treatment and clinical-radiological follow-up.

Effect of liraglutide on physical performance in type 2 diabetes: Results of a randomized, double-blind, controlled trial (LIPER2).

AIMS: To assess the effect of the GLP-1 analogue liraglutide on measures of cardiac function and physical performance in patients with type 2 diabetes (T2D). METHODS: In this phase-IV randomized double-blind placebo-controlled parallel-group clinical trial at a tertiary hospital, T2D patients with HbA1c levels of 7-10% with oral agents and/or intermediate-/long-acting insulin were allocated (computer-generated randomization, ratio 1:1) to either liraglutide 1.8 mg/day or a placebo for 6 months. The primary endpoint was maximum oxygen consumption (VO2max) during cycle ergometry, while other procedures included a 6-min walk test, echocardiography, anthropometry and blood tests. Safety endpoints were also monitored, and an intention-to-treat analysis was performed. RESULTS: A total of 24 patients (15 women) aged 52 (11.7) years, with diabetes duration of 8.7 (5.8) years, BMI 34.98 (6.2) kg/m2 and HbA1c 8.2% (0.68%), were randomized to liraglutide 1.8 mg daily or placebo. There were no differences in VO2max [17.98 (4.8) vs. 15.90 (4.96) mL/kg/min; P > 0.10], VE/VCO2 slope [30.18 (4.8) vs. 32 (4.49)], left ventricular ejection fraction or 6-min walk test [530.7 (86) vs. 503.9 (84) m] at 6 months. HbA1c was lower (6.7% vs. 7.7%; P = 0.005), with a trend towards lower maximum systolic blood pressure during ergometry [171.7 (24.4) vs. 192.5 (25.6); P = 0.052] in the liraglutide group at the end of the study. There were no severe adverse events. CONCLUSION: In this trial, liraglutide improved glycaemic control in T2D, but had no significant effects on either physical performance or myocardial function.

Sol-gel hybrid films based on organosilane and montmorillonite for corrosion inhibition of AA2024.

The present work reports the production of films on AA2024-T3 composed of vinyltrimethoxysilane (VTMS)/tetraethylorthosilicate (TEOS) with incorporation of montmorillonite (sodium montmorillonite and montmorillonite modified with quaternary ammonium salt, abbreviated Na and 30B, respectively), generated by the sol-gel process. According to FT-IR analyses the incorporation of montmorillonite does not affect silica network. Electrochemical characterization was performed by electrochemical impedance spectroscopy measurement in 0.05 mol L(-1) NaCl solution. Results indicate that montmorillonite incorporation improves the corrosion protection compared to the non-modified system. Scanning electron microscopy micrographs reveal that high concentrations of montmorillonite provide agglomerations on the metallic surface, which is in detriment of the anticorrosive performance. The VTMS/TEOS/30B films with the lowest concentration (22 mg L(-1)) of embedded clay provide the highest corrosion protection.

Restricted puckering of mineralized RNA-like riboses.

The pseudorotational motions of highly hydroxylated pentafuranose sugars in the free state and tethered to hydroxyapatite have been compared. The conformation pentafuranose ring remains restricted at the North region of the pseudorotational wheel, which is the one typically observed for nucleosides and nucleotides in the double helix A-RNA, when the phosphate-bearing sugar is anchored to the mineral surface. Results indicate that the severe restrictions imposed by the mineral are responsible of the double helix preservation when DNA and RNA are encapsulated in crystalline nanorods.

Sensitive thermal transitions of nanoscale polymer samples using the bimetallic effect: application to ultra-thin polythiophene.

A sensitive nanocalorimetric technology based on microcantilever sensors is presented. The technology, which combines very short response times with very small sample consumption, uses the bimetallic effect to detect thermal transitions. Specifically, abrupt variations in the Young's modulus and the thermal expansion coefficient produced by temperature changes have been employed to detect thermodynamic transitions. The technology has been used to determine the glass transition of poly(3-thiophene methyl acetate), a soluble semiconducting polymer with different nanotechnological applications. The glass transition temperature determined using microcantilevers coated with ultra-thin films of mass = 10(-13) g is 5.2 °C higher than that obtained using a conventional differential scanning calorimeter for bulk powder samples of mass = 5 × 10(-3) g. Atomistic molecular dynamics simulations on models that represent the bulk powder and the ultra-thin films have been carried out to provide understanding and rationalization of this feature. Simulations indicate that the film-air interface plays a crucial role in films with very small thickness, affecting both the organization of the molecular chains and the response of the molecules against the temperature.

Self-assembly of a designed amyloid peptide containing the functional thienylalanine unit.

The self-assembly of a peptide based on a sequence from the amyloid beta peptide but incorporating the non-natural amino acid beta-2-thienylalanine (2-Thi) has been investigated in aqueous and methanol solutions. The peptide AAKLVFF was used as a design motif, replacing the phenylalanine residues (F) with 2-Thi units to yield (2-Thi)(2-Thi)VLKAA. The 2-Thi residues are expected to confer interesting electronic properties due to charge delocalization and pi-stacking. The peptide is shown to form beta-sheet-rich amyloid fibrils with a twisted morphology, in both water and methanol solutions at sufficiently high concentration. The formation of a self-assembling hydrogel is observed at high concentration. Detailed molecular modeling using molecular dynamics methods was performed using NOE constraints provided by 2D-NMR experiments. The conformational and charge properties of 2-Thi were modeled using quantum mechanical methods, and found to be similar to those previously reported for the beta-3-thienylalanine analogue. The molecular dynamics simulations reveal well-defined folded structures (turn-like) in dilute aqueous solution, driven by self-assembly of the hydrophobic aromatic units, with charged lysine groups exposed to water.

Differentiating between malignant and idiopathic pleural effusions: the value of diagnostic procedures.

BACKGROUND: Which diagnostic procedures should be used to differentiate between idiopathic and malignant pleural effusions, is not well established. AIM: To identify which parameters allow differentiation between idiopathic and malignant pleural effusions. DESIGN: Case-note review. METHODS: Over a 12-year period, we treated 1014 consecutive pleural effusion patients, of whom 346 were diagnosed as having an idiopathic or malignant aetiology. We analysed medical history, chest X-ray, pleural fluid analysis (biochemical, microbiological and cytological), chest CT scan and additional examinations that were used according to clinical findings, and compared them with the eventual diagnosis and outcome. RESULTS: Eighty-three patients with idiopathic effusions and 263 with malignant effusions were included. Idiopathic pleural effusion resolved in 47 patients, improved in 20 and persisted in 16. Biochemical pleural fluid analysis did not predict these outcomes. A history of neoplasm, chest X-ray and CT features, as well as additional examinations according to clinical findings, established a diagnosis or suspicion of malignancy in 256 (97.7%) of the 263 patients who received a diagnosis of malignant effusion. Diagnostic thoracoscopy was helpful in seven patients in whom malignant disease was strongly suspected, despite the absence of other pathological findings. DISCUSSION: Non-invasive complementary examinations generally allowed accurate differentiation between malignant and idiopathic effusions. Patients with idiopathic pleural effusions generally had favourable outcomes.

Fentanilo transdérmico en el tratamiento para el dolor neuropático del lesionado medular / Transdermal fentanyl in the treatment of neuropathic pain of spinal cord injured patient

Diseño. Estudio prospectivo, longitudinal y abierto. Objetivos. Valorar la eficacia analgésica del fentanilo transdérmico en dolor neuropático secundario a lesión medular comparándola con otros grupos de pacientes con dolor neuropático. Material y métodos. Se incluyeron pacientes con dolor neuropático afectos de lesión medular, conformándose un grupo control de enfermos amputados y afectos de un accidente cerebrovascular. Fueron registradas las características del dolor: intensidad según escala analógica visual y escala de Latineen, interferencia con el sueño y los efectos secundarios presentados. Se realizaron controles mediante visitas seriadas, monitorizándose los cambios manifestados respecto al dolor tras la administración del fentanilo transdérmico. En el estudio estadístico se emplearon la prueba de x 2 de Pearson y la prueba t, siendo considerados significativos valores de p < 0,05. Resultados. Treinta y dos pacientes fueron incluidos en el estudio, 20 lesionados medulares, 8 amputados y 4 pacientes afectos de un accidente cerebrovascular. La intensidad del dolor neuropático se redujo en ambos grupos, determinándose el descenso global en la escala analógica visual, de 7,54 a 3,8 a los tres meses (p < 0,05) y en la escala de Lattinen de 12,78 a 7,14 (p < 0,05). El descenso en la escala analógica visual fue menos intenso en el grupo de lesionados medulares, de 7,7 a 4,91 (p < 0,05), que en amputados y en pacientes con accidentes cerebrovasculares. Conclusiones. El fentanilo transdérmico es una alternativa terapéutica eficaz para el tratamiento del dolor neuropático secundario a lesión medular, si bien el descenso de intensidad del dolor es menor que en pacientes con dolor neuropático de otro origen

Design. Prospective, longitudinal and open-labeled study. Objectives. Assess analgesic efficacy of transdermal fentanyl in neuropathic pain secondary to spinal cord injury comparing it with other groups of patients with neuropathic pain. Material and methods. Patients with neuropathic pain affected by spinal cord injury were included, the control group being formed by amputee patients and those affected by cerebrovascular accident. The pain characteristics were recorded: intensity according to visual analogue scale and Lattinen scale, interference with sleep and side effects presented. Controls were conducted by seriated visits, monitoring the changes seen regarding pain after administration of transdermal fentanyl. Pearson's x 2 test and the t-test were used in the statistical study, values of p < 0.05 being considered as significant. Results. A total of 32 patients were included in the study, 20 with spinal cord injury, 8 amputees and 4 patients with cerebrovascular accident. Neuropathic pain intensity decreased in both groups, the global decrease on the visual analogue scale being determined from 7.54 to 3.8 at three months (p < 0.05) and on the Lattinen scale from 12.78 to 7.14 (p < 0.05). Decrease on the visual analogue scale was less intense in the spinal cord injured group, from 7.7 to 4.91 (p < 0.05), than in the amputees and in patients with cerebrovascular accidents. Conclusions. Transdermal fentanyl is an effective therapeutic alternative for treatment of neuropathic pain secondary to spinal cord injury although the decrease in pain intensity is less than in patients with neuropathic pain of another origin

Factors influencing length of hospital stay in patients with bacterial pleural effusion.

BACKGROUND: Factors influencing length of hospital stay have been poorly analyzed in parapneumonic pleural effusions (PPE). OBJECTIVES: The aim of this work is to identify the variables that determine increased hospital stay in patients with infectious pleural effusion (PE). PATIENTS AND METHODS: We analyzed 112 patients with PE: empyema, complicated parapneumonic and non-complicated parapneumonic. Epidemiologic, biochemical, therapeutic and radiological variables were analyzed. Correlations with hospital stay were studied using the Student's t test, analysis of variance, Mann-Whitney U-test and linear regression model. RESULTS: Among the 112 patients studied, there were 32 empyema, 50 complicated and 30 non-complicated parapneumonic cases. The median of length stay for all patients was 17 days. Longer hospitalization was required in patients with empyemic PE (p = 0.015), patients with underlying diseases (p = 0.003), those needing pleural drainage (p = 0.005) or decortication (p = 0.043) and those presenting unfavorable radiological outcome after treatment (p = 0.02). Biochemical parameters associated with longer hospital stay were elevated pleural fluid polymorphonuclear elastase (p = 0.001, r = 0.307) and lactate dehydrogenase (p = 0.001, r = 0.312). After linear regression analysis, only underlying disease, pleural drainage and pleural fluid polymorphonuclear elastase values remained in the model, explaining 23.1% of the variability of days of hospitalization. CONCLUSIONS: The patients with PPE and empyema who required longer hospitalization were those with purulent fluid, underlying disease, surgical drainage and/or decortication, with unfavorable radiological outcome and higher pleural fluid levels of lactate dehydrogenase and polymorphonuclear elastase.

Metalloproteinases and tissue inhibitors of metalloproteinases in exudative pleural effusions.

The aim of this study was to assess the expression of several metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in exudative pleural effusions, and their relationship with inflammatory and fibrinolytic mediators in parapneumonic effusions. The study included 51 parapneumonic effusions (30 empyema or complicated parapneumonic, 21 noncomplicated parapneumonic), 28 tuberculous, 30 malignant and 30 transudates. Inflammatory markers (tumour necrosis factor-alpha, interleukin-8, polymorphonuclear elastase), fibrinolytic system variables (tissue plasminogen activator (PA), urokinase PA (u-PA), plasminogen activation inhibitor (PAI)-1, PAI-2), and several MMPs (MMP-1, MMP-2, MMP-8, MMP-9) and TIMPs (TIMP-1, TIMP-2) were determined by ELISA in plasma and pleural fluid. Elevated MMP-2 and TIMP-1 concentrations were observed in all the pleural fluid samples studied. The group of empyema or complicated parapneumonic effusions showed higher MMP-1, MMP-8 and MMP-9 concentrations than the remaining exudates. There was no correlation between MMP and TIMP levels in plasma and pleural fluid in this group of effusions. In parapneumonic effusions, MMP-1, MMP-8 and MMP-9 showed a positive correlation with the inflammatory markers and with u-PA and PAI-1. Moreover, there was a relationship between MMP-8 concentration in pleural fluid and pleural thickening at the end of treatment. In conclusion, elevated metalloproteinase-1, -8 and -9 expression was found in parapneumonic pleural effusions. These metalloproteinases could be implicated in the local inflammatory response existing in this group of effusions.

Stabilization of rasburicase and physico-chemical characterization of the resulting injectable formulation.

Rasburicase (Fasturtec/Elitek) is a new generation of recombinant urate oxidase administred therapeutically by intravenous infusion for the prevention or treatment of hyperuricemia during chemotherapy. To ensure a long storage period, a freeze-dried formulation was developed to guarantee the molecular integrity and enzyme activity. Screening of potential excipients was the first stage of the preformulation study. The selection was based on stability results (rasburicase solution with excipient) obtained with the isoelectric focusing profiles and residual enzyme activity. The different excipients were classified as stabilising, neutral or destabilising. A stability study was then carried out on different freeze-dried formulations containing the usual bulking agents for freeze-drying, excipients with a high glass transition temperature or competitive enzyme inhibitors having a stabilising effect. A mannitol/alanine mixture in phosphate buffer was selected from these preliminary results. Finally, the optimal content of mannitol and alanine in the freeze-dried powder was determined by an experimental design study. The water content and the appearance of the "cake", the osmolality, pH, clarity, and enzyme activity of the reconstituted solution were assessed. The formula with a mannitol/alanine ratio of 0.7 was found to be the best composition. Differential scanning calorimetry and ThermoStimulated Current technique experiments were carried out to study the amorphous phase. A glass transition temperature of about 45-500 degrees C was found. Glassy state is known to preserve stability, which was verified by the real stability data. X-ray diffraction studies have shown that alanine is in a crystallised state and that mannitol remains amorphous. Crystallised excipients participate in forming the structure of the powder and therefore help to prevent any collapse. Amorphous mannitol creates a surrounding medium favourable to the stability of the protein.

Evaluation of the reproductive and developmental toxicity of the D-003, a mixture of long-chain fatty acids, in rats and rabbits.

D-003 is a mixture of long-chain fatty acids isolated and purified from sugar cane wax with cholesterol-lowering properties. D-003 given orally (500 and 1000 mg/kg/day) to female rats for 15 days prior to mating, through mating and gestation to day 21 of lactation and male rats for 4 weeks prior and during mating did not induce toxic effects on reproduction. There were no significant reductions in the number of animals that conceived, in the numbers of pups born to those that did conceive, in the numbers of pups that survived until weaning, and in their body weights at weaning. Drug-treated and control groups' offspring were comparable in growth, physical and behavioral development, spontaneous activity and reproductive performance. Pregnant New Zealand rabbits were given D-003 as oral doses of 500 and 1000 mg/kg/day on days 6 through 18 of gestation without any evidence of embryotoxicity or teratogenicity. The no-observed-effect dose in these two experimental studies was 1000 mg/kg/day. After assessment of the potential of high doses of D-003 to act on developing embryo and reproduction process, no evidence supports the conclusion that D-003 is a reproductive and developmental toxicant/teratogen.

Occupational injuries identified by an emergency department based injury surveillance system in Nicaragua.

OBJECTIVES: To identify and describe the work related injuries in both the formal and informal work sectors captured in an emergency department based injury surveillance system in Managua, Nicaragua. SETTING: Urban emergency department in Managua, Nicaragua serving 200-300 patients per day. METHODS: Secondary analysis from the surveillance system data. All cases indicating an injury while working and seen for treatment at the emergency department between 1 August 2001 and 31 July 2002 were included. There was no exclusion based on place of occurrence (home, work, school), age, or gender. RESULTS: There were 3801 work related injuries identified which accounted for 18.6% of the total 20 425 injures captured by the surveillance system. Twenty seven work related fatalities were recorded, compared with the 1998 International Labor Organization statistic of 25 occupational fatalities for all of Nicaragua. Injuries occurring outside of a formal work location accounted for more than 60% of the work related injuries. Almost half of these occurred at home, while 19% occurred on the street. The leading mechanisms for work related injuries were falls (30%), blunt objects (28%), and stabs/cuts (23%). Falls were by far the most severe mechanism in the study, causing 37% of the work related deaths and more than half of the fractures. CONCLUSIONS: Occupational injuries are grossly underreported in Nicaragua. This study demonstrated that an emergency department can be a data source for work related injuries in developing countries because it captures both the formal and informal workforce injuries. Fall prevention initiatives could significantly reduce the magnitude and severity of occupational injuries in Managua, Nicaragua.

[Repercussion of age on management of neoplastic patients in an Internal Medicine Service]. / Relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un Servicio de Medicina Interna.

AIM: To determine whether age is a factor affecting the management of patients diagnosed with neoplastic disease in an internal medicine service. PATIENTS AND METHODS: Prospective study of 388 patients diagnosed with cancer in the internal medicine service of a large public health teaching hospital. We evaluated clinical characteristics, diagnostic procedures, types and stage of neoplasm, referral after hospital discharge and treatment. A comparative study based on age was performed between patients 65 years older and patients under this age. RESULTS: The 388 cancer patients accounted for 12% of hospital admissions in our service. Among the total, 62% were > or = 65 years old. Constitutional syndrome, the most frequently associated symptom and the main reason for the consultation, was more common in the > or = 65-year-old group. Lung cancer was predominant in men and hematologic neoplasms in women. Patients > or = 65 were referred more frequently to internal medicine physicians, general practitioners and home palliative assistance services (p < 0.05) and they received only palliative treatment in a greater percentage of cases (50% vs. 37%, p = 0.001). CONCLUSIONS: The incidence of neoplasms in our service was high (12%), with a considerable percentage of patients in advanced phases of the disease (83%). Age was not related to diagnostic methods nor was it determinant in the staging, but it did have repercussions on treatment; patients > or = 65 received palliative treatment alone more often than younger patients.

Relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un Servicio de Medicina Interna / Repercussion of age on management of neoplastic patients in an Internal Medicine Service

Objetivo: Valorar la relación de la edad con el manejo de los pacientes diagnosticados de neoplasia en un servicio de Medicina Interna. Pacientes y métodos: Estudio prospectivo de 388 pacientes diagnosticados de cáncer en un Servicio de Medicina Interna. Se evalúan las características clínicas, procedimientos diagnósticos, tipos de neoplasia y estadiaje, derivación al alta y tratamiento. Se realiza un estudio comparativo basado en la edad, pacientes de 65 años o mayores frente a los más jóvenes. Resultados: Los 388 pacientes diagnosticados de cáncer supusieron un 12% de los ingresos en nuestro servicio. El 62% tenían 65 años. El síndrome constitucional fue la sintomatología más frecuente asociada y el principal motivo de consulta, siendo más relevante en los 65 años. El cáncer de pulmón fue el más frecuente en los hombres y las neoplasias hematológicas en las mujeres. Los enfermos 65 años fueron controlados con más frecuencia por Medicina Interna, médico de cabecera y Servicio de Asistencia Paliativa a Domicilio (P<0,05) y recibieron tratamiento únicamente paliativo en un mayor porcentaje de casos (50% vs 37%, p=0,001). Conclusiones: La incidencia de neoplasias en nuestro servicio fue alta (12%), con un alto porcentaje de pacientes en fases avanzadas de la enfermedad (83%). La edad no se relacionó con el manejo diagnóstico ni demostró ser determinante en el estadiaje, pero sí en el tratamiento, puesto que los pacientes 65 años recibieron con mayor frecuencia tratamiento paliativo (AU)

Aim: To determine whether age is a factor affecting the management of patiens diagnosed with neoplastic disease in an internal medicine service. Patients and methods: Prospective study of 388 patients diagnosed with cancer in the internal medicine service of a large public health teaching hospital. We evaluated clinical characteristics, diagnostic procedures, types and stage of neoplasm, referral after hospital discharge and treatment. A comparative study based on age was performed between patients 65 years older and patients under this age. Results: The 388 cancer patiens accounted for 12% of hospital admissions in our service. Among the total, 62% were >= 65 years old. Constitutional syndrome, the most frequently associated symptom and the main reason for the consultation, was more common in the >= 65-year-old group. Lung cancer was predominant in men and hematologic neoplasms in women. Patients >= 65 were referred more frequently to internal medicine physicians, general practitioners and home palliative assistance services (p<0.05) and they received only palliative treatment in a greater percentage of cases (50% vs. 37%, p=0.001). Conclusions: The incidence of neoplasms in our service was high (12%), with a considerable percentage of patients in advanced phases of the disease (83%). Age was not related to diagnostic methods nor was it determinant in the staging, but it did have repercussions on treatment; patients >=65 received palliative treatment alone more often than younger patients (AU)

[Hypernephroma associated motor neuron disease. Presentation of a case]. / Enfermedad de la motoneurona asociada a hipernefroma. Presentación de un caso.

INTRODUCTION: Paraneoplastic motor neuron disease are rare among patients with renal cell carcinoma. OBJECTIVE: Present the clinical and electrophysiological evolution of a patient with a motor neuron disease and hypernephrome. CASE REPORT: A 60 years old woman, affected only by high level pressure since 10 years ago. She noticed sudden palsy of the left leg and 10 months later an abdominal ultrasound showed a renal cell carcinoma, discovered without other symptoms than neurologic. After radical nephrectnomy, the patient was treated with recombinant interferon alpha 2b. The neurologic damage advanced and she has a flaccid weakness and muscle atrophy in the legs and brisk reflexes, also in wasted limbs. There is Babinski, fasciculations, light flaccid dysarthria and laryngospasm. Peripheral nerve conduction studies are within normal limits. The electromyogram show positive sharp waves in both legs and left hand. Recruitment patterns are decreased and there are fasciculations in the tongue, upper and lower limbs. The magnetic resonance of the brain and spinal cord is normal. There are not evidence of metastasis. The question of whether or not this is a paraneoplastic form of motor neuron disease remain unclear. CONCLUSION: This case suggest the need to consider a renal cell carcinoma in the course of a motor neuron disease.

Enfermedad de la motoneurona asociada a hipernefroma. Presentación de un caso / Hypernefroma-associated motor neuron disease. Presentation of a case

Introducción. Las enfermedades de motoneurona como síndromes paraneoplásicos, en especial el daño de motoneurona inferior, se encuentran asociadas a síndromes linfoproliferativos y evolucionan de diversas maneras. Objetivo. Presentar la evolución clínica y electrofisiológica de una paciente en la que se asociaron una enfermedad de motoneurona (EMN) y un hipernefroma. Caso clínico. Mujer de 60 años, con antecedentes de más de una década de hipertensión arterial, que comenzó a presentar paresia brusca e intermitente del miembro inferior izquierdo. Pasados 10 meses del inicio neurológico, se diagnosticó un hipernefroma en un ultrasonido abdominal, sin antecedentes de síntomas y signos renales. Se realizó nefrectomía y se impuso tratamiento con interferón alfa 2b recombinante. De modo progresivo, se instaló una parálisis flácida de ambos miembros inferiores, con hiperreflexia. El daño neurológico se ha extendido a miembros superiores y existen signos ligeros de disfunción bulbar. Predominan los signos de afectación de la motoneurona inferior y también existen manifestaciones de daño de la motoneurona superior. Los estudios de neuroconducción motora y sensitiva fueron normales; la electromiografía mostró abundantes signos de denervación parcial en los músculos afectados; la resonancia magnética nuclear de raquis y cráneo fue normal. Después de 24 meses, no se han detectado metástasis. Conclusiones. El hipernefroma debe descartarse siempre que se sospeche una EMN (AU)

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[Bronchiolitis obliterans organizing pneumonia associated with Legionella pneumophila]. / Bronquiolitis obliterante con neumonía organizativa asociada a Legionella pneumophila.

Bronchitis obliterans organizing pneumonia (BOOP) is an unusual pulmonary condition. The clinical features and the radiologic findings are useful for the diagnosis of BOOP. However it is necessary to confirm its presence by an open or transbronchial pulmonary biopsy specimen. BOOP is usually idiopathic, although it may also occur in association with connective tissue disease, some haematologic disorders and in response to viral infections. The association of Legionella pneumophila infection with BOOP is very rare.