Embolización bronquial en bronquiectasias / Bronchial artery embolization for bronchiectasias

Se presenta nuestra experiencia en el tratamiento de la hemoptisis con embolización bronquial en pacientes con bronquiectasias, desde el 2001 al 2008, en el Hospital Italiano de Buenos Aires. Veinte pacientes fueron tratados con este método: 12 mujeres y 8 hombres con una edad media de 51 años (15-83 años). Las causas de bronquiectasias fueron secundarias a infecciones inespecíficas en el 40%; otro 40% secuelas de tuberculosis y 20% por enfermedad fibroquística. La indicación de embolización fue hemoptisis mayor a 300 ml/24 hs o hemoptisis persistentes durante más de 3 días consecutivos con requerimiento de hospitalización. En el 85% de los casos se efectuó embolización bronquial y en el resto (15%) bronquial y mamaria. Este procedimiento fue bilateral en el 60% de los pacientes, 20% solo en el lado derecho y 20% del lado izquierdo. En 18 pacientes se logró oclusión vascular completa de todos los territorios pulmonares patológicos. Control agudo del sangrado fue obtenido en todos los pacientes (100%) y sólo dos presentaron nuevo sangrado a los 8 y 12 meses respectivamente. Como efecto colateral al tratamiento se observó dolor torácico leve y transitorio en dos pacientes. Concluimos que la embolización de las arterias bronquiales constituye un tratamiento adecuado y seguro para el control agudo de la hemoptisis en pacientes con bronquiectasias.

We present our experience on arterial embolization for the treatment of hemoptysis in patients with bronchiectasis between 2001 and 2008 at the Hospital Italiano in Buenos Aires. Twenty patients were treated with this method: 12 women and 8 men with a median age of 51 years (15-83 years). Bronchiectasis was secondary to bacterial infections in 40% and secondary to tuberculosis infection in 40% of the patients; 20% of the patients had cystic fibrosis. Embolization was prescribed when the hemoptysis was above 300 ml/24 hours or the hemoptysis was persistent for more than 3 consecutive days and the patient’s hospitalization was required. In 85% of the cases embolization was done only in bronchial arteries and in the remaining 15% in bronchial and mammary arteries. The procedure was bilateral in 60% of the patients, only on the right side in 20% and only on the left side in 20%. In 18 patients complete occlusion was achieved. Complete control of the bleeding was obtained in 100% of patients. Only two patients had a new bleeding, 8 and 12 months later respectively. The treatment side effects were slight and transitory thoracic pain in two patients. We concluded that the embolization of the bronchial arteries is a suitable and safe treatment to control hemoptysis in patients with bronchiectasis.

Basal anti-cyclic citrullinated peptide (anti-CCP) antibody levels and a decrease in anti-CCP titres are associated with clinical response to adalimumab in rheumatoid arthritis.

OBJECTIVE: To investigate the effect of adalimumab treatment on anti-cyclic citrullinated peptide antibodies (anti-CCP) in patients with rheumatoid arthritis (RA). METHODS: 70 RA patients who failed treatment with disease modifying antirheumatic drugs (DMARDs) received 40 mg adalimumab subcutaneously every other week during 24 weeks. Serum samples were collected at baseline and at weeks 8, 16 and 24 before the corresponding adalimumab dose. The serum anti-CCP levels were tested by enzyme linked immunosorbent assay. RESULTS: At baseline, 52 of the 70 patients (74.3%) were positive for anti-CCP antibodies. 60 % of the anti CCP positive patients and 44.4% of the anti CCP negative patients were ACR 20 responders at week 24 (p<0.049). The serum levels of anti-CCP antibodies decreased significantly after 24 weeks of adalimumab treatment only in those patients who met ACR 20 response criteria at week 24 (p<0.00044). Differences between baseline anti-CCP titers and those at 8, 16 and 24 weeks were all statistically significant (p<0.014, 0.003 and 0.019 respectively). No statistically significant changes in the anti-CCP levels were observed in patients who did not meet the ACR 20 response criteria. CONCLUSION: Basal anti-CCP antibodies levels correlate with clinical response to adalimumab. A decrease in anti-CCP levels on time was observed in patients showing also clinical improvement, suggesting that serum anti-CCP antibodies determination may be useful in assessing treatment efficacy in RA patients.

Analysis of FcgammaRII gene polymorphisms in Wegener's granulomatosis.

Fcgamma receptors (FcgammaRs) are potent initiators of proinflammatory reactions and tissue injury programs through the oxidative burst, degranulation and the production of a variety of proinflammatory cytokines. Direct experimental evidence indicates that translocation of ANCA target from intracellular granules to the neutrophil membrane and subsequent binding of ANCA enables FcgammaR-mediated neutrophil activation. In the presence of ANCA, these data provide a framework from which to understand the importance of ANCA class, subclass, and titer in Wegener's granulomatosis and other ANCA-positive vasculitides. The well-characterized and functionally important alleles of neutrophil FcgammaR (FcgammaRIIa-H131/R131 and FcgammaRIIIb-NA1/NA2) are possible inheritable genetic elements that may alter disease severity and/or phenotype.

[Hepatitis C virus infection presenting as a polyarthritis: report of 2 cases]. / Poliartritis como manifestación de infección por virus C de la hepatitis: presentación de dos casos clínicos.

Several disease have been associated with hepatitis C virus infections, including rheumatologic, hematologic and neoplastic disorders. We report two women, aged 57 and 39 years old whom the initial presentation of hepatitis C virus infection was an arthritis resembling rheumatoid arthritis. Laboratory work up revealed abnormal liver function tests, stimulating the search for hepatitis C virus infection, having both patients positive ELISA tests. Detection of this agent is extremely important when selecting a therapy for the articular disease, since several drugs used in the treatment of rheumatic disorders are potentially hepatotoxic and immunosuppression is risky in the setting of a viral hepatitis.

[Lyme disease in Chile. Prevalence study in selected groups]. / Enfermedad de Lyme en Chile. Estudio de prevalencia en grupos seleccionados.

BACKGROUND: The prevalence of Lyme disease in Chile is unknown. AIM: To study the existence and epidemiology of Lyme disease in Chile. PATIENTS AND METHODS: One hundred eighteen patients with signs or symptoms suggestive of Lyme disease were studied. Antibodies against Borrelia burgdorferi were measured using ELISA and indirect immunofluorescence screening tests. Positive cases were confirmed with ELISA using a purified antigen and Western Blot analysis. Human biological samples and ticks were cultured in BSK-H medium. RESULTS: Five patients, three with dermatological manifestations and two with facial palsy and other neurological symptoms, had antibodies against Borrelia, measured by ELISA and indirect immunofluorescence. However the presence of IgM antibodies by ELISA using purified antigen, was confirmed in only one case. All sera and cerebrospinal fluids were negative on Western Blot Analysis. No plasma, skin, CSF or thick culture yielded Borrelia CONCLUSIONS: We could not confirm the existence of Lyme disease in Chile. Positive screening with negative confirmatory test suggests false positive non-specific reactivity or that local Borrelia are antigenically different compared to North American strains.

[Tenosynovitis caused by ciprofloxacin. Clinical case]. / Tenosinovitis por ciprofloxacino. Caso clinico.

We report a 67 years old diabetic female that received ciprofloxacin for an acute pyelonephritis. Twelve days after starting this treatment, a hand and forearm tenosynovitis appeared, that subsided after the discontinuation of ciprofloxacin. Literature review disclosed other reports of tenosynovitis associated with the use of this antimicrobial.

[Lupus erythematosus disseminatus and Pneumocystis carinii pneumonia]. / Lupus eritematoso diseminado y neumonia por Pneumocistis carinii.

We report a 49 years old woman with systemic lupus erythematosus and a WHO type IV nephropathy, treated with prednisone 1 mg/kg/day po and cyclophosphamide 1 g/month iv. After two months in this treatment schedule, she presented with an acute pneumonia; broncoalveolar lavage and lung biopsy disclosed the presence of Pneumocystis carinii. She was treated with trimethoprim-sulfamethoxazole 960 mg tid with a favorable response. Opportunistic infections are frequent in lupus erythematosus and Pneumocystis carinii pneumonia has been recently reported in this disease. The changes in immune response and the adverse effects of drugs used in its treatment may explain the increased susceptibility of these patients to infections by Pneumocystis carinii.

[Rapidly progressive kidney failure associated with neutrophil anticytoplasmic autoantibodies. Anatomo-clinical case]. / Insuficiencia renal rápidamente progresiva asociada a anticuerpos anticitoplasmáticos de neutrófilos. Caso anátomo clínico.

We report a 63 year old woman with a rapidly progressive renal failure and fever of unknown origin. Laboratory tests showed anemia, increased ESR and a urine analysis compatible with a glomerular disease. Antineutrophil cytoplasmic autoantibodies were positive with a perinuclear pattern. Kidney biopsy showed an autoimmune crescenteric glomerulonephritis. The patient had a bad evolution, dying after a massive hemoptysis. The necropsy showed a disseminated arteritis without compromise of bronchial vessels. The oligosymptomatic presentation of this patient, bearing in mind the anatomo-pathological findings, is noteworthy and emphasizes the usefulness of serological markers as antineutrophil cytoplasmic autoantibodies in the differential diagnosis.

[Polymorphic reticulosis: a type of lymphoma? Report of 3 cases]. / Reticulosis polimorfa: un tipo de linfoma? A propósito de tres casos.

Three patients seen at the Medicine Department of Del Salvador Hospital between 1986 and 1990 are reported. All had a history of purulent or bloody nasal discharge and recurrent sinusitis, before the appearance of progressive and painful destructive phenomena that affected the rhino faucial region. The diagnosis was made with the histopathological study that disclosed and angiocentric polymorphic infiltrates and perivascular necrosis. The three patients received similar treatment consistent in prednisone 1 mg/kg/day per os, cyclophosphamide 2 mg/kg/day per os and local radiotherapy. The response to therapy was bad and survival was less than three months. It is concluded that although this entity is infrequent, its severity requires and aggressive workup and management by a multidisciplinary team. Notwithstanding the mortality remains to be high.

[Hepatitis by infectious mononucleosis]. / Hepatitis por mononucleosis infecciosa.

Five adult patients presenting with clinical and laboratory manifestations of an acute hepatitis in the course of a hitherto undiagnosed infectious mononucleosis (IM) are reviewed. Chief complaints were intense malaise and prolonged fever (7 to 15 days prior to diagnosis). Serum aminotransferases were moderately raised in all patients; three patients had mild jaundice with a direct-reacting hyperbilirubinemia; 4 patients had an enlarged and tender liver. When making the differential diagnosis of causes of acute hepatitis, blood smear examination was crucial, showing atypical lymphocytes (Downey). The diagnosis of IM was confirmed by the demonstration of high serum titers of antibodies against Epstein-Barr virus, IgM class (4 patients) or heterophil antibodies (1 patient), plus peripheral lymph node enlargement (3 patients), splenomegaly (4 patients) and the time course of the disease. The relevance of blood smear examination as a practical tool in the diagnosis of causes of acute hepatitis is stressed.

[Problems in the diagnosis of thyroid dysfunction of the elderly adult]. / Problemas en el diagnóstico de la disfunción tiroídea del adulto mayor.

Thyroid disfunction in the aged is often misdiagnosed either due to scanty symptoms, masking by other ailments or because function tests can be altered by extrathyroid causes such as chronic diseases, drugs or undernutrition. We surveyed 93 patients from 60 to 104 years old (73 females) living in geriatric homes. Most received at least 2 drugs for control of hypertension, coronary artery disease, diabetes, parkinsonism or psycho-organic deterioration. No clinical evidence of thyroid disfunction was found in 75 patients. T3 was 73.6 +/- 25.5 ng/dl, T4 7.3 +/- 1.8 micrograms/dl, TSH 2.8 +/- 0.9 uU/ml and rT3 32.2 +/- 16.3 ng/dl. Antimicrosomal antibodies were negative in all. Significant differences were found comparing these values with those obtained in 26 normal adults with mean age 39.9 years: T3 was lower and TSH and rT3 were higher in the elderly (p less than 0.0001). T3 decreased and rT3 increased in relation to age and males had significantly lower values of T3, T4 and TSH than females. Some evidence of thyroid disfunction was present in the remaining 18 patients: 9 had multinodular and/or positive antimicrosomal antibodies with euthyroid hormone levels; 6 had elevated T3, T4 and fT4 so hyperthyroidism was suspected; the remaining 3 patients had TSH levels above 20 uU/ml indicating the presence of hypothyroidism of which only one had some clinical manifestation. Thus, thyroid disfunction in the elderly + is not uncommon (3.2% of hyperthyroidism and 2.6% hypothyroidism in this series) in the absence of clinical manifestation. Treatment may improve the quality of life in these patients.