Primary pulmonary lymphoma: a case serie

Los linfomas primarios de pulmón (LPP) son infrecuentes. Sus manifestaciones clínicas y las imágenes son inespecíficas. El retraso diagnóstico puede ser considerable. Objetivo: Analizar los LPP durante el período 2003-2013 en nuestra institución. Sobre 1892 linfomas, 4 fueron LPP (0,21%): 1) linfoma no Hodgkin (n = 2); 2) linfoma Hodgkin (n= 1); 3) linfoma intravascular pulmonar (n = 1). Las manifestaciones clínicas y radiológicas fueron inespecíficas (masa pulmonar y derrame pleural, consolidación con broncograma aéreo y cavitación o bien ausencia de lesiones). Los métodos diagnósticos fueron: 1) punción guiada bajo TAC; 2) videotoracoscopía (VATS) y 3) VATS orientada por PET (tomografia por emisión de positrones) y 4) toracotomía. El tiempo entre la consulta inicial hasta el diagnóstico fue de 45 a 90 días. Este reporte confirma la baja incidencia de LPP, y sus manifestaciones clínicas y radiologías poco específicas. Esto puede contribuir a las demoras en el diagnóstico. El PETpuede mejorar el rendimiento diagnóstico, en especial en ausencia de compromiso pulmonar radiológico evidente.Primary Pulmonary Lymphomas (LPP) are infrequent and their clinical manifestations and images are usually nonspecific. Diagnostic delay may be important. The objective of this study was to analyze the LLP in our institution. Between 2003 and 2013, over 1,892 lymphomas were analyzed in our institution. Only 4 of them (0.21% incidence) were detected as LPP: Non Hodgkin's Lymphoma (n = 2), Hodgkin's Lymphoma (n = 1), and Intravascular Pulmonary Lymphoma (n = 1). Clinical manifestations of the 4 cases presented were unspecific: 1) pulmonary mass and pleural effusion; 2) consolidation with air bronchogram and cavitations; 3) normal images and 4) pulmonary mass. Given these clinical settings, 4 diagnostic methods were used: 1) Computed Tomography-Guided Puncture, 2) Video-Assisted Thoracoscopic Surgery (VATS); 3) VATS guided by positron emission tomography (PET) and 4) thoracotomy. Hence, diagnosis was successfully made between 45 to 90 days from the initial consultation. This report confirms the low incidence of LPP, and its unspecific clinical and radiographic manifestations that may cause delay in diagnosis. PET can contribute to improve diagnostic performance, especially in patients without apparent lung involvement.Fil: Villarroel Saavedra, Julio César. Hospital Italiano; ArgentinaFil: Romanczuk, Máximo. Hospital Italiano; ArgentinaFil: Wainstein, Esteban Javier. Hospital Italiano; ArgentinaFil: Las Heras, Marcos. Hospital Italiano; ArgentinaFil: de Vito, Eduardo. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Svetliza, Graciela. Hospital Italiano; ArgentinaFil: Precerutti, Juan A.. Hospital Italiano; Argentin

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts

Broncodilatadores agonistas b2 de acción larga durante las exacerbaciones de la EPOC

La exacerbación aguda de la EPOC (EA-EPOC) constituye una causa frecuente de consulta en el ámbito de atención primaria y en los hospitales. Aproximadamente el 40% de los pacientes que acuden a un servicio de urgencias hospitalario debido a una exacerbación precisan ingreso al hospitalFil: Maritano Furcada, Juaquín. Hospital Italiano; ArgentinaFil: Svetliza, Graciela. Hospital Italiano; ArgentinaFil: de Vito, Eduardo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Precerutti, Juan A.. Hospital Italiano; Argentin