Comment on article "Diagnostic rentability of close pleural biopsy: Tru-cut vs. Cope" / Comentario al artículo "Rentabilidad diagnóstica de la biopsia pleural cerrada: Tru-cut frente a Cope"

In this letter to the editor it is discussed the use of Tru-cut needle in pleural biopsy and its profitability for the diagnosis of mesothelioma; it is exposed as well its usefulness, having the appropriate training, to obtain guiding results in obese people.

En esta carta al editor se discute el uso de la aguja Tru-cut en la biopsia pleural y lo rentable que resulta para el diagnóstico de casos de mesotelioma; también se expone su utilidad, con un adiestramiento adecuado, para obtener resultados diagnósticos orientadores en gente obesa.

Benign recurrent subcutaneous emphysema of the upper limbs in a teenager / Enfisema subcutáneo benigno recurrente de las extremidades superiores en una adolescente

Background: The physiological properties of the interstitial subcutaneous tissue of the limbs could bring the abnormal distribution of air coming from superficial trauma of the skin. We present the case of a young woman who developed subcutaneous emphysema after a superficial trauma and discussed the differential diagnosis and treatment. Clinical case: A teenager woman 13 years old had subcutaneous emphysema in the left arm, following the scratch produced by her cat, of two months of evolution, without signs suggestive of local or systemic infection, it was resolved spontaneously during the period of observation. During this period she also presented subcutaneous emphysema in the right arm as a complication of a peripheral venous access performed for the administration of parenteral solutions, in the same way, it resolved spontaneously within a few days. Conclusion: Benign subcutaneous emphysema is a rare clinical condition which should be considered only after the exclusion of other pathologies that require a more aggressive early medical intervention, such as necrotizing fasciitis, which, if not detected in a timely manner, could endanger life.

Introducción: las propiedades fisiológicas del tejido celular subcutáneo de las extremidades pudieran favorecer la distribución anormal de aire proveniente de traumatismos superficiales de la piel. Presentamos el caso de una joven mujer quien desarrolló enfisema subcutáneo posterior a traumatismos superficiales y discutimos el diagnóstico diferencial y tratamiento. Caso clínico: mujer de 13 años, con signos de enfisema subcutáneo en el brazo izquierdo, posterior al rasguño producido por su gato, de dos meses de evolución, sin signos sugestivos de infección local o sistémica, el cual remitió en forma espontánea durante el periodo de observación. Durante este lapso también presentó enfisema subcutáneo en el brazo derecho, como complicación de un acceso venoso periférico realizado para la administración de soluciones parenterales, igualmente remitió espontáneamente a los pocos días. Conclusión: el enfisema subcutáneo benigno es una condición clínica rara, debe considerarse únicamente después de la exclusión de otras patologías que requieren de una intervención médica temprana más agresiva como en la fascitis necrotizante, la cual de no ser detectada oportunamente pudiera poner en peligro la vida.

Successful Endoscopic Resection of an Endobronchial Lipoma Using a Percutaneous Gastrostomy Snare Device / Resección endoscópica con éxito de un lipoma endobronquial utilizando un dispositivo percutáneo de asa para gastrostomía

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Parálisis diafragmática en granulomatosis eosinofílica con poliangitis / Diaphragmatic paralysis in eosinophilic granulomatosis with polyangiitis

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Fluoroquinolone therapy could influence the clinical signs of pulmonary coccidioidomycosis / La terapia con fluoroquinolonas podría influir en las manifestaciones clínicas de la coccidioidomicosis pulmonar

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Immunoadjuvant Therapy and Noninvasive Ventilation for Acute Respiratory Failure in Lung Tuberculosis: A Case Study.

Acute respiratory failure caused by pulmonary tuberculosis is a rare event but with a high mortality even while receiving mechanical ventilatory support. We report the case of a young man with severe pulmonary tuberculosis refractory to conventional therapy who successfully overcame the critical period of his condition using noninvasive ventilation and immunoadjuvant therapy that included three doses of etanercept 25 mg subcutaneously. We conclude that the use of etanercept along with antituberculosis treatment appears to be safe and effective in patients with pulmonary tuberculosis presenting with acute respiratory failure.

Derrame pleural vasculítico / Vasculitic pleural effusion

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Chronic progressive disseminated histoplasmosis in a Mexican cockfighter.

We present illustrative images from a Mexican 58-year-old man who had the occupation of cockfighting from childhood and presented with chronic progressive disseminated histoplasmosis with primarily cutaneous manifestations.

Acquired Tracheal Diverticulum as an Unexpected Cause of Endotracheal Tube Cuff Leak.

INTRODUCTION: Tracheal diverticulum has been associated with problems during endotracheal intubation but there are no reports concerning air leakage around an endotracheal tube (ETT). CASE REPORT: The case of an elderly woman under mechanical ventilatory support because an exacerbation of chronic obstructive pulmonary disease (COPD) is reported. She presented with an inexplicably air leak around the endotracheal tube not attributed to structural defects. The intra-cuff pressure value was as high as 30 mmHg to prevent an air leakage. Bronchoscopy revealed a tracheal diverticulum at the site ofthe tube cuff that allowed air leakage around it. The problem was overcome by re-intubating the patient with a larger diameter tube and positioning its distal end above the diverticular opening. DISCUSSION: Endotracheal tube air leak is a frequently neglected problem. COPD and other inflammatory conditions are associated with changes in the elastic properties of the airways resulting in tracheomegaly or acquired tracheal diverticulum. Both entities have been linked to problems during intubation or ventilation of patients. However tracheal diverticulum has not been described previously as a cause of air leakage. CONCLUSION: Acquired tracheal diverticulum should be recognized as a cause of air leakage in the intubated patient, especially if associated with a normal or elevated intracuff pressure.

Thoracic empyema due to migrated gallstones.

Hepatobiliary conditions should be considered in the differential diagnosis of right pleural effusion. Here we present the illustrative images of thoracic empyema due to migrated gallstones in a woman who was treated for laparoscopic cholecystectomy one year before. The gallstones were obtained unexpectedly during a thoracentesis with aid of an Abrams needle. This rare complication is discussed under current literature review.