Insuficiencia respiratoria en neumonía por varicela zoster durante el embarazo / Respiratory failure in pneumonia by varicella zoster virus during pregnancy

La infección primaria por VZ en el embarazo es raro, con una incidencia de 1-7/10.000. La neumonía por VZ es una complicación aún más infrecuente, responsable de importante morbimortalidad maternofetal, y cuando se asocia a insuficiencia respiratoria (IR) puede llegar a un 40 por ciento. Se presenta y discute el manejo de una paciente con neumonía por VZ en el primer trimestre de embarazo, complicada con IR, que necesitó apoyo de Ventilación mecánica (VM). Evolucionó a un embarazo de término sin complicaciones fetales ni maternas

[The value of xeroradiographic patterns in the diagnosis of breast diseases (author's transl)]. / Il valore diagnostico della semeiotica xeroradiografica nello studio delle affezioni mammarie.

The purpose of this study was to establish the value of xeroradiographic patterns and their applicability in the automatic diagnosis of breast diseases. Such an evaluation is based on the comparison with the histologic examination, irrespective of the overall diagnostic judgement previously formulated. From an analysis of the material examined it was possible to ascertain the distribution frequency, the sensitivity, the specificity, the discriminating capacity, and finally the weight of each radiologic sign considered. There are xeroradiographic signs that are apparent almost exclusively in the malignant pathology and therefore can be considered as positive indices of the malignancy of the alteration. The specificity of the radiologic signs considered is very high, whereas the same cannot be said for the sensitivity. Moreover, a linear discriminating analysis made it possible to identify those semiologic elements which, with a minor probability of error, would attribute the pathologic process to the class verified histologically, for malignant neoplasms as well as benign tumors and dysplastic processes.

Diagnostic accuracy of xeromammography.

The analytical study of the case material has allowed a precise evaluation of the distribution by age groups of the different pathologic processes of the breast, of the localization and dimensions of malignant tumors, as well as the diagnostic accuracy for those cases histologically ascertained and those with a follow-up. The diagnostic accuracy and the consequent reliability of the xeroradiographic method for the diagnosis of breast cancer is distinctly superior to that reported in the literature for traditional mammography, whereas for the differential diagnosis between circumscribed dysplastic manifestations and benign tumors xeromammography is not sufficiently reliable. The authors critically discuss the results and in particular the problem of false positives, which also include diagnostic errors that cannot be avoided in that they directly derive from the pathologic morphology of the disease process (plasma cell mastitis and sclerosing adenosis). As regards the problem of false negatives, they can be reduced within certain limits by resorting to other instrumental investigations. However, there are cases (1% of the malignant neoplasias histologically ascertained) that present a completely negative xeroradiographic finding. There are the limits of the radiologic investigation which cannot in any way be surmounted.