RESUMEN La granulomatosis con poliangeítis es una vasculitis sistémica, necrosante y granulomatosa que afecta el tracto respiratorio superior e inferior y los riñones. Se presenta el caso de una paciente blanca, de 59 años de edad, hipertensa y fumadora inveterada, que ingresó por presentar síntomas constitucionales, orinas turbias y hemáticas, así como creatininemia elevada con valor previo normal. Con impresión diagnóstica inicial de infección del tracto urinario se indica antibioticoterapia. Después del tercer día de iniciado el tratamiento, mejoraron los síntomas constitucionales y, de forma progresiva, comenzó con manifestaciones multiorgánicas (renal, respiratoria, cutánea y musculoesquelética) sugestivas de vasculitis sistémica. Como elementos significativos, en exámenes complementarios se detectaron azoados y reactantes de fase aguda aumentados, sedimento urinario activo, imagen nodular en vértice pulmonar derecho y microhemorragias multifocales en ambos campos pulmonares, detectados mediante tomografía computarizada y c-ANCA altamente positivo. Se indicó tratamiento inmunosupresor y citotóxico potente, obteniéndose control inicial de las manifestaciones graves de la enfermedad. Evolutivamente desarrolló complicaciones propias de la entidad y secundarias al tratamiento médico, que la hicieron tributaria de terapia de sustitución renal, falleciendo a los dos años de recibir hemodiálisis iterada. El cuadro clínico, unido a los estudios imagenológicos e inmunológicos (c-ANCA), fueron elementos claves para realizar el diagnóstico.

ABSTRACT Granulomatosis with polyangiitis is a systemic, necrotizing, granulomatous vasculitis that affects the upper and lower respiratory tract and kidneys. The case of a 59-year-old white female patient, who is hypertensive and inveterate smoker, is presented; she was admitted for presenting constitutional symptoms, turbid and bloody urine, as well as elevated creatininemia with a normal previous value. With the initial diagnostic impression of urinary tract infection, antibiotic therapy was indicated. After the third day of starting treatment the constitutional symptoms improved, and progressively began with multiorgan manifestations (renal, respiratory, skin and musculoskeletal) suggestive of systemic vasculitis. As significant elements, complementary examinations detected increased nitrogen and acute phase reactants, active urinary sediment, nodular image in the right lung apex and multifocal microhemorrhages in both lung fields through computed tomography, and highly positive c-ANCA. Potent immunosuppressive and cytotoxic treatment was indicated, obtaining initial control of severe manifestations of the disease. Evolutionarily she developed complications specific to the entity and secondary to medical treatment which made her subject to renal replacement therapy, dying two years after receiving iterated hemodialysis. The clinical characteristics, together with the imaging and immunological studies (c-ANCA) were key elements to make the diagnosis.

Abstract BACKGROUND: The clinical manifestations of ectopic pregnancies are variable and may be related to congenital factors, the age of the patient, previous ectopic pregnancies, among others. OBJECTIVE: To report the case of a cervical ectopic pregnancy that received successful conservative medical treatment. CLINICAL CASE: A 32-year-old patient, nulliparous, who came to the clinic due to vaginal bleeding and pain in the hypogastrium, of three hours of evolution. Physical examination reported: blood pressure 80-40 mmHg, heart rate 100 beats per minute, respiratory rate 22 breaths per minute, Glasgow 15-15; generalized mucocutaneous pallor and cryodiaphoresis. The blood count reported: hemoglobin 7.3 mg/dL; hematocrit of 22.6; leukocytes: 15,000; neutrophils: 90%; platelets: 255,000; blood classification: AB+, positive pregnancy test, and transvaginal ultrasound with a diagnostic impression of a mass in the cervical region, compatible with cervical pregnancy vs uterine myomatosis. With the ultrasound suspicion of ectopic pregnancy, the determination of the beta subunit of human chorionic gonadotropin (β-hCG) was requested, titrating it at 18,273 mUl/mL, which required a transfusion of two units of blood products, due to the hemoglobin concentration , optimizing her figures at 9.6 mg/dL, with stable vital signs and decreased vaginal bleeding. The diagnosis of cervical ectopic pregnancy was established. Treatment with tranexamic acid was started. Hemoglobin was within reference limits. The patient had a satisfactory evolution, with decreased bleeding, so conservative treatment was maintained. CONCLUSION: Conservative treatment is an effective protocol in the follow-up and control of patients with ectopic pregnancy, since it reduces the risk of mortality and hysterectomy, after establishing the timely diagnosis, with anamnesis, ultrasound and β-hCG concentrations for diagnostic suspicion.

Resumen ANTECEDENTES: Las manifestaciones clínicas del embarazo ectópico son variables y pueden relacionarse con factores congénitos, edad de la paciente, embarazos ectópicos previos, entre otros. OBJETIVO: Reportar el caso de una paciente con embarazo ectópico cervical que recibió tratamiento médico conservador. CASO CLÍNICO: Paciente de 32 años, nulípara, que acudió a consulta por sangrado vaginal y dolor en el hipogastrio, de tres horas de evolución. El examen físico reportó: presión arterial de 80-40 mmHg, frecuencia cardiaca de 100 latidos por minuto, frecuencia respiratoria de 22 respiraciones por minuto, Glasgow 15-15; palidez mucocutánea generalizada y criodiaforesis. El hemograma informó: hemoglobina de 7.3 mg/dL; hematocrito de 22.6; leucocitos: 15,000 neutrófilos: 90%; plaquetas: 255,000; hemoclasificación: AB+, prueba de embarazo positiva, y ecografía transvaginal con impresión diagnóstica de masa en la región cervical, compatible con embarazo cervical vs miomatosis uterina. Con la sospecha ecográfica de embarazo ectópico, se solicitó la determinación de la subunidad beta de gonadotropina coriónica humana (β-hCG), titulando en 18.273 mUl/mL, por lo que requirió trasfusión de dos unidades de hemoderivados, debido a la concentración de hemoglobina, optimizando sus cifras en 9.6 mg/dL, con signos vitales estables y disminución del sangrado vaginal. Se estableció el diagnóstico de embarazo ectópico cervical. Se inició tratamiento con ácido tranexámico. La hemoglobina estuvo en los límites de referencia. La paciente tuvo evolución satisfactoria, con disminución del sangrado, por lo que se mantuvo el tratamiento conservador. CONCLUSIÓN: El tratamiento conservador es un protocolo efectivo en el seguimiento y control de pacientes con embarazo ectópico, pues reduce el riesgo de mortalidad e histerectomía, después de establecer el diagnóstico oportuno, con anamnesis, ecografías y concentraciones de β-hCG por sospecha diagnóstica.

RESUMO OBJETIVO Desvelar a assistência prestada aos indivíduos negros internados no período de 1898 a 1930 no Hospício do Juquery, considerados o contexto social e a hegemonia do saber médico da época. MÉTODOS Estudo exploratório-descritivo, qualitativo, análise documental, em prontuários de indivíduos negros(as) internados(as) desde a abertura do Hospício do Juquery em 1898 até 1930. Recorte temporal abarcou direções institucionais específicas e contexto histórico, político, econômico e social vivenciado pela população negra. Realizado no Arquivo do Patrimônio Histórico-cultural do Complexo Hospitalar do Juquery, entre julho e dezembro de 2019. Utilizado instrumento com questões referentes a dados sociodemográficos, data e anamnese de entrada, exame físico e psíquico, hipótese diagnóstica, tratamentos realizados, intercorrências, desfecho e motivo. Análise realizada segundo etapas da análise documental e pautada nos referenciais teóricos psiquiátricos do período. RESULTADOS Foram vistos todos os prontuários do período, cerca de 6.300, dos quais aproximadamente 1.400 eram de negros(as). Desses prontuários, foram incluídos 457, 140 de mulheres e 317 de homens, considerados com informações significativas para objetivos do estudo. Maioria dos participantes teve internações de longa permanência, cuja finalidade não pareceu estar atrelada à possibilidade de cura ou reinserção social, mas à segregação. A partir dos diagnósticos descritos, a impressão é que esses sujeitos compunham nicho com condições imutáveis, permanentes, não passíveis de terapêuticas que possibilitassem retorno à sociedade, exemplificada pela degeneração. Quantidade significativa dos prontuários não traz dados sobre tratamentos, o que reforça a hipótese de que eram mantidos internados não para proposta de cuidado, mas como um depósito da incurabilidade; quando trazem dados observamos empirismo voluntarioso do médico. Metade dos prontuários descreve os desfechos das pessoas internadas e apontam registros muito altos de mortes, seguidos de encaminhamentos para outras instituições de internação a prolongar a vida de confinamento. CONCLUSÕES Internados sofreram com isolamento e assistência focados na política de Estado aliada à ciência, sobretudo psiquiátrica, para legitimar exclusão dos socialmente indesejáveis.

ABSTRACT OBJECTIVE To reveal the assistance provided to black individuals hospitalized at the Juquery Asylum from 1898 to 1930, having considered the social context and the hegemony of medical knowledge of the time. METHODS Exploratory-descriptive, qualitative study, documentary analysis, in medical records of black individuals hospitalized at the Juquery Asylum from 1898 to 1930. The time frame encompassed specific institutional directions as well as the historical, political, economic, and social context experienced by the black population. Held at the archive of the historical and cultural heritage of the Juquery Hospital Complex, between July and December 2019. We used an instrument with questions related to sociodemographic data, date and anamnesis of entry, physical and psychological examination, diagnostic hypothesis, treatments performed, complications, outcome, and motive. The analysis was carried out according to stages of documentary analysis and was based on psychiatric theoretical references of the period. RESULT All medical records of the period were read (approximately 6,300), of which about 1,400 were of black individuals. Of these medical records, 457 were included, 140 of women and 317 of men, which were considered to have significant information for the study’s objectives. Most of the participants had long-term hospitalizations, whose motive did not seem to be linked to the possibility of cure or social reintegration, but rather to segregation. From the diagnoses described, the impression is that these subjects composed a niche with immutable, permanent conditions, not amenable to therapeutics that would allow their return to society, exemplified by degeneration. A significant amount of the medical records do not contain data on treatments, which reinforces the hypothesis that they were kept hospitalized not for the purpose of care, but as a deposit of incurability; when they do bring data, we observe willful empiricism of the physician. Half of the medical records describe the outcomes of hospitalized people and indicate very high records of deaths, followed by referrals to other hospitalization institutions to prolong confinement. CONCLUSIONS Internees suffered from isolation and assistance focused on state policy allied to science, especially psychiatry, to legitimize exclusion of the socially undesirable.

RESUMO OBJETIVO Desvelar a assistência prestada aos indivíduos negros internados no período de 1898 a 1930 no Hospício do Juquery, considerados o contexto social e a hegemonia do saber médico da época. MÉTODOS Estudo exploratório-descritivo, qualitativo, análise documental, em prontuários de indivíduos negros(as) internados(as) desde a abertura do Hospício do Juquery em 1898 até 1930. Recorte temporal abarcou direções institucionais específicas e contexto histórico, político, econômico e social vivenciado pela população negra. Realizado no Arquivo do Patrimônio Histórico-cultural do Complexo Hospitalar do Juquery, entre julho e dezembro de 2019. Utilizado instrumento com questões referentes a dados sociodemográficos, data e anamnese de entrada, exame físico e psíquico, hipótese diagnóstica, tratamentos realizados, intercorrências, desfecho e motivo. Análise realizada segundo etapas da análise documental e pautada nos referenciais teóricos psiquiátricos do período. RESULTADOS Foram vistos todos os prontuários do período, cerca de 6.300, dos quais aproximadamente 1.400 eram de negros(as). Desses prontuários, foram incluídos 457, 140 de mulheres e 317 de homens, considerados com informações significativas para objetivos do estudo. Maioria dos participantes teve internações de longa permanência, cuja finalidade não pareceu estar atrelada à possibilidade de cura ou reinserção social, mas à segregação. A partir dos diagnósticos descritos, a impressão é que esses sujeitos compunham nicho com condições imutáveis, permanentes, não passíveis de terapêuticas que possibilitassem retorno à sociedade, exemplificada pela degeneração. Quantidade significativa dos prontuários não traz dados sobre tratamentos, o que reforça a hipótese de que eram mantidos internados não para proposta de cuidado, mas como um depósito da incurabilidade; quando trazem dados observamos empirismo voluntarioso do médico. Metade dos prontuários descreve os desfechos das pessoas internadas e apontam registros muito altos de mortes, seguidos de encaminhamentos para outras instituições de internação a prolongar a vida de confinamento. CONCLUSÕES Internados sofreram com isolamento e assistência focados na política de Estado aliada à ciência, sobretudo psiquiátrica, para legitimar exclusão dos socialmente indesejáveis.

ABSTRACT OBJECTIVE To reveal the assistance provided to black individuals hospitalized at the Juquery Asylum from 1898 to 1930, having considered the social context and the hegemony of medical knowledge of the time. METHODS Exploratory-descriptive, qualitative study, documentary analysis, in medical records of black individuals hospitalized at the Juquery Asylum from 1898 to 1930. The time frame encompassed specific institutional directions as well as the historical, political, economic, and social context experienced by the black population. Held at the archive of the historical and cultural heritage of the Juquery Hospital Complex, between July and December 2019. We used an instrument with questions related to sociodemographic data, date and anamnesis of entry, physical and psychological examination, diagnostic hypothesis, treatments performed, complications, outcome, and motive. The analysis was carried out according to stages of documentary analysis and was based on psychiatric theoretical references of the period. RESULT All medical records of the period were read (approximately 6,300), of which about 1,400 were of black individuals. Of these medical records, 457 were included, 140 of women and 317 of men, which were considered to have significant information for the study’s objectives. Most of the participants had long-term hospitalizations, whose motive did not seem to be linked to the possibility of cure or social reintegration, but rather to segregation. From the diagnoses described, the impression is that these subjects composed a niche with immutable, permanent conditions, not amenable to therapeutics that would allow their return to society, exemplified by degeneration. A significant amount of the medical records do not contain data on treatments, which reinforces the hypothesis that they were kept hospitalized not for the purpose of care, but as a deposit of incurability; when they do bring data, we observe willful empiricism of the physician. Half of the medical records describe the outcomes of hospitalized people and indicate very high records of deaths, followed by referrals to other hospitalization institutions to prolong confinement. CONCLUSIONS Internees suffered from isolation and assistance focused on state policy allied to science, especially psychiatry, to legitimize exclusion of the socially undesirable.

ABSTRACT Foundation: aging is a biological process that leads to the limitation of the adaptive capacity of the individual and a greater probability of death. Objective: characterize elderly deceased in the General Surgery Service of the Dr. Gustavo Aldereguía Lima Hospital, in Cienfuegos, from January 1, 2016 to December 31, 2018. Methods: case series study of elderly patients who died during the period analyzed. The data was obtained from the medical records, operative reports and minutes of the committee of the deceased. Variables were analyzed: age, sex, associated diseases, surgical risk (American Anesthesia Association classification), diagnostic impression upon admission, operative diagnosis, operation performed, complications, clinical and pathological diagnosis of death. Results: there was a predominance of the female sex, of the age group from 71 to 80 years old, and a personal history of high blood pressure. Grade III of the surgical risk classification prevailed. Intestinal perforation motivated the majority of admissions, followed by mesenteric thrombosis; generalized peritonitis was the main complication. Most of the patients required surgical intervention for their definitive treatment; the state of septic shock was the main direct cause of death (also the main pathological diagnosis) followed by the state of hypovolemic shock due to upper gastrointestinal bleeding. Respiratory complications were the most representative. Conclusions: la edad avanzada, las enfermedades asociadas y el alto riesgo quirúrgico, aumentan la mortalidad por cirugía.

RESUMEN Fundamento: el envejecimiento es un proceso biológico que conduce a la limitación de la capacidad adaptativa del individuo y a una mayor probabilidad de fallecimiento. Objetivo: caracterizar ancianos fallecidos en el Servicio de Cirugía General del Hospital Dr. Gustavo Aldereguía Lima, de Cienfuegos, del primero de enero de 2016 al treinta y uno de diciembre de 2018. Métodos: estudio de serie de casos de pacientes ancianos que fallecieron durante el período analizado. Los datos se obtuvieron de las historias clínicas, informes operatorios y actas del comité de fallecidos. Se analizaron las variables: edad, sexo, enfermedades asociadas, riesgo quirúrgico (clasificación Asociación Americana de Anestesia), impresión diagnóstica al ingreso, diagnóstico operatorio, operación realizada, complicaciones, diagnóstico clínico y anatomopatológico de la defunción. Resultados: existió predominio del sexo femenino, del grupo etáreo de 71 a 80 años y el antecedente personal de hipertensión arterial. El grado III de la clasificación de riesgo quirúrgico prevaleció. La perforación intestinal motivó la mayoría de los ingresos, seguida de la trombosis mesentérica; la peritonitis generalizada fue la principal complicación. La mayoría de los pacientes requirió intervención quirúrgica para su tratamiento definitivo; el estado de choque séptico fue la principal causa directa de muerte (también principal diagnóstico anatomopatológico) seguido del estado de choque hipovolémico por sangramiento digestivo alto. Las complicaciones respiratorias fueron las más representativas. Conclusiones: la edad avanzada, las enfermedades asociadas y el alto riesgo quirúrgico, aumentan la mortalidad por cirugía.

Abstract: OBJECTIVE: To identify the possible association between blood eosinophilia and diagnosis of ovarian cancer. MATERIALS AND METHODS: A retrospective cross-sectional phase 1 study of diagnostic test development was performed. Data were collected on the medical records of patients who consulted at San Vicente Foundation Hospital with a diagnosis of ovarian tumor from 01/01/2011 to 01/01/2016. All patients with a diagnostic impression of ovarian tumor with at least one hemoleukogram at admission were included and those medical records of patients with a history of atopy, who were currently studying with parasitosis or with diagnosis of Hodgkin Lymphoma, colorectal cancer, breast and cervix were excluded. Age, absolute number of eosinophils, histological subtype and stage of the disease were the variables studied. The quantitative variables were evaluated with the Kolmogorov-Smirnov tests and the Mann Whitney and χ2 test was applied to evaluate the qualitative variables. RESULTS: We found 99 files of patients with ovarian cancer: 11.1% with eosinophilia vs 6% in controls (p < 0.197). The histological subtypes of germinal and epithelial cells were the most eosinophilic and stage III was the most associated (n = 19). CONCLUSION: To design a phase I study in order to identify the association between eosinophilia and diagnosis of ovarian cancer epithelial subtype and germ cells is possible.

Resumen: OBJETIVO: Identificar la posible asociación entre la eosinofilia en sangre y el diagnóstico de cáncer de ovario. MATERIALES Y MÉTODOS: Estudio transversal, retrospectivo, fase 1 de desarrollo de una prueba diagnóstica. Los datos se recolectaron de las historias clínicas de pacientes atendidas en el Hospital San Vicente Fundación con diagnóstico de tumor de ovario entre el 1 de enero de 2011 y el 1 de enero de 2016. Se incluyeron todas las pacientes con impresión diagnóstica de tumor de ovario con, al menos, un hemoleucograma al ingreso. Se excluyeron las historias clínicas de pacientes con antecedente de atopia que estuvieran cursando en el momento con parasitosis o tuvieran diagnóstico de linfoma de Hodgkin, cáncer colorrectal, mama y cuello del útero. Variables de estudio: edad, cantidad absoluta de eosinófilos, subtipo histológico y estadio de la enfermedad. Las variables cuantitativas se evaluaron con las pruebas de Kolmogorow-Smirnov y se aplicó la prueba de Mann Whitney y χ2 para evaluar las variables cualitativas. RESULTADOS: Se encontraron 99 expedientes de pacientes con cáncer de ovario: 11.1% con eosinofilia vs 6% en las controles (p < 0.197). Los subtipos histológicos de células germinales y epiteliales fueron los de mayor eosinofilia y el estadio III fue el de mayor asociación (n = 19). CONCLUSIÓN: Se abre la posibilidad de diseñar un estudio fase I con el fin de identificar la asociación entre la eosinofilia y el diagnóstico de cáncer de ovario, subtipo epitelial y células germinales.

Resumo Objetivo: Melhorar a comunicação entre médicos assistentes e radiologistas, definindo quais informações deveriam ser incluídas num relatório radiológico e qual o formato preferido dos solicitantes de um hospital universitário. Materiais e Métodos: Os participantes foram convidados a escolher a opção preferida entre relatórios com diferentes formatos e níveis de detalhamento de três casos hipotéticos e questionados se características comumente encontradas em um laudo radiológico são apropriadas ou não para inclusão. Para atribuição da ordem absoluta de preferência dos diferentes relatórios, o método Kemeny-Young foi utilizado. Resultados: Noventa e nove médicos responderam os questionários (40,4% médicos residentes, 31,3% preceptores dos programas de residência e 28,3% professores da faculdade de medicina). Laudos estruturados com impressão ou comentário foram selecionados nas situações de ultrassonografia normal por 54% dos participantes, ultrassonografia alterada por 59% e tomografia computadorizada por 53%. As informações que deveriam ser incluídas, de acordo com os solicitantes, foram qualidade da imagem (92%), detalhes do cenário clínico (91%), impressão diagnóstica (89%), técnica do exame (72%), informações sobre meio de contraste (68%). Opiniões sobre seguimento e investigação radiológica ou não radiológica se mostraram importantes. Conclusão: Relatórios estruturados com impressão ou comentário de um radiologista são prepostos. Informações como qualidade de exame, meio de contraste utilizado e sugestões de acompanhamento e investigação adicional são valorizadas pelos médicos solicitantes.

Abstract Objective: To improve communication between attending physicians and radiologists by defining which information should be included in radiology reports and which reporting format is preferred by requesting physicians at a university hospital. Materials and Methods: Respondents were asked to choose among reports with different formats and levels of detail, related to three hypothetical cases, and questioned as to which characteristics commonly found in radiology reports are appropriate for inclusion. To assign the absolute order of preference of the different reports, the Kemeny-Young method was used. Results: Ninety-nine physicians completed the questionnaires (40.4% were resident physicians; 31.3% were preceptors of residency programs; and 28.3% were professors of medicine). For ultrasound with normal findings, ultrasound showing alterations, and computed tomography, respectively, 54%, 59%, and 53% of the respondents chose structured reports with an impression or comment. According to the respondents, the characteristics that should be included in the radiology report are the quality of the image, details of the clinical presentation, diagnostic impression, examination technique, and information about contrast administration, selected by 92%, 91%, 89%, 72%, and 68%, respectively. Other characteristics that were considered important were recommendations on follow-up and additional radiological or non-radiological investigation. Conclusion: Requesting physicians apparently prefer structured reports with a radiologist impression or comment. Information such as the quality of the examination, the contrast agent used, and suggestions regarding follow-up and additional investigation are valued.

Bleeding is one of the leading causes of consultation in daily medical practice of the hematologist. Different hemorrhagic manifestations are not always caused by disorders of hemostasis. The proper application of clinical method is essential to correctly orient these patients. Individuals with disorders of hemostasis often have prolonged, recurrent and usually excessive bleeding. In this review we present some considerations to bear in mind when we face this kind of patient where an effective interview with appropriate physical examination may lead to a diagnostic impression that will allow us to direct further studies and use them wisely.

El sangramiento es una de las principales causas de consulta en la práctica médica diaria del hematólogo. Existen diferentes manifestaciones hemorrágicas y no siempre son causadas por trastornos de la hemostasia; por esta razón es imprescindible una aplicación correcta del método clínico para orientar de forma adecuada a estos pacientes. Los individuos con trastornos de la hemostasia suelen presentar hemorragias prolongadas, recurrentes y generalmente excesivas. En esta revisión se exponen algunas consideraciones a tener en cuenta cuando nos enfrentamos a este tipo de casos donde un interrogatorio efectivo con un examen físico preciso puede llevar a una impresión diagnóstica que permitirá dirigir los estudios complementarios y emplearlos de forma racional.

Introducción. En este estudio se evaluó en forma retrospectiva la utilidad de la citología obtenida mediante aspiración con aguja fina, en el diagnóstico de las neoplasias foliculares de la glándula tiroides. Metodología. Se llevó a cabo una revisión retrospectiva de las historias clínicas de los pacientes con impresión diagnóstica de nódulo tiroideo, durante un periodo de 7 años, de 2007 a 2013, durante los cuales se practicó citología mediante aspiración con aguja fina antes del abordaje quirúrgico. El diagnóstico citológico se comparó con el estudio anatomopatológico, con el objetivo de determinar los parámetros de rendimiento. Resultados. La población de estudio fue de 149 pacientes. Para la citología obtenida mediante aspiración con aguja fina, se calcularon los siguientes parámetros de rendimiento en el diagnóstico de neoplasias foliculares: sensibilidad, 54,5 %; especificidad, 92,9 %; valor diagnóstico positivo, 57,1 %; valor diagnóstico negativo, 92,2 %; precisión diagnóstica, 87,2 %; falsos negativos, 6,9 % y falsos positivos, 6,1 %. Conclusión. La citología obtenida mediante aspiración con aguja fina posee una sensibilidad baja en el diagnóstico de las neoplasias foliculares de la glándula tiroides, comportamiento atribuible a la similitud citológica de este grupo de lesiones con los bocios con cambios adenomatosos.

Introduction: This study evaluates retrospectively the performance of cytology obtained by fine needle aspiration in the diagnosis of follicular neoplasms of the thyroid gland. Methods: A review of medical records of patients with diagnostic impression of thyroid nodule over a period of seven years from 2007 to 2013 was completed, in those patients in which a fine needle aspiration cytology prior to a surgical approach was performed. The cytological diagnosis was compared with pathologic study to determine the performance parameters. Results:The study population included 149 patients. The following performance parameters of the fine needle aspiration cytology were determined in the diagnosis of follicular neoplasms: sensitivity, 54.5%; specificity, 92.9%; positive predictive value, 57.1%; negative predictive value, 92.2%; accurately diagnosed, 87.2%; false negatives and false positives 6.9%, 6.1% Conclusion: Fine needle aspiration cytology has a low sensitivity in the diagnosis of follicular neoplasms of the thyroid gland due to the cytologically similarity presented by this group of lesions with goiters with adenomatous changes.

Introducción. La citología obtenida por aspiración con aguja fina (cACAF) es la mejor herramienta diagnóstica para decidir la conducta frente al nódulo tiroideo. La determinación del rendimiento diagnóstico para este procedimiento sustenta este hecho y ayuda a conocer el comportamiento de la enfermedad. Materiales y métodos. Se hizo una revisión retrospectiva de las historias clínicas de los pacientes con impresión diagnóstica de nódulo tiroideo, con citología obtenida por aspiración con aguja fina y manejados quirúrgicamente, en el período de 2007 a 2013. A partir de estos pacientes, se determinaron sensibilidad, especificidad, valor diagnóstico positivo, valor diagnóstico negativo, precisión y concordancia diagnóstica. Resultados. La población de estudio fue de 161 pacientes. Para la citología obtenida por aspiración con aguja fina, se calcularon los siguientes parámetros: sensibilidad, 54,5 %; especificidad, 98 %; falsos positivos, 1,8 %; falsos negativos, 4,5 %; valor diagnóstico positivo, 75 %; valor diagnóstico negativo, 98 %; precisión diagnóstica, 93 %; índice kappa, 0,598 excluyendo los microcarcinomas. Conclusión. La citología obtenida por aspiración con aguja fina es una prueba diagnóstica con gran especificidad para el diagnóstico citológico de las lesiones de la glándula tiroides. Sin embargo, la variabilidad anatómica de las lesiones y el hecho de ser una prueba que depende del operador, disminuyen su sensibilidad, por lo que el estudio histopatológico es el método de referencia en el diagnóstico definitivo de las lesiones de la glándula tiroides.

Background: Fine needle aspiration cytology is the best diagnostic tool to choose the conduct regarding a thyroid nodule. Determination of the diagnostic performance of this procedure supports this fact and helps to recognize the behavior of this pathology in our environment. Methods: A retrospective review of medical records of patients with the diagnostic impression of thyroid nodule in the period of 2007 – 2013 that had fine needle aspiration cytology and were managed surgically was conducted. Sensibility, specificity, positive predictive value, negative predictive value, diagnostic accuracy and concordance were determined in these patients. Results: The study population was conformed by 161 patients. The following parameters were determined: sensibility, 54,5%; specificity, 98%; false positive rate, 1.8%; false negative rate, 4.5%; positive predictive value, 75%; negative predictive value, 98%; diagnostic accuracy, 93%; and Kappa index, 0.598 excluding micro carcinomas. Conclusion: Fine needle aspiration cytology is a diagnostic test with high specificity for the diagnosis of thyroid gland nodular lesions. Nonetheless, the variability of the anatomic lesions and the fact that it is an operator dependent test decreases its sensibility, and therefore the histopathologic diagnosis is the gold standard for the definitive diagnosis of thyroid gland lesions.

Lymphoepithelioma-like gastric carcinoma (LELGC) is a rare neoplasm of the stomach with dense lymphocytic infiltration. More than 80% of LELGCs are positive for the Epstein-Barr virus (EBV). Here, we report a 64-year old Chinese man with swallowing discomfort while eating food. Endoscopy and computed tomography both showed a submucosal lesion at the lesser curvature of the upper gastric body. The first diagnostic impression was a gastrointestinal stromal tumour. Subsequently, the patient received a wedge resection of the stomach. On histopathological examination, the tumour was found to consist of small nests of neoplastic cells within dense lymphocytic infiltration. Additionally, most of the neoplastic cells were positive for cytokeratin and Epstein-Barr virus-encoded RNA (EBER). Subsequently, the diagnosis of LELGC was made. We believe that physicians should be aware of the diagnosis of submucosal gastric lesions, particularly in older male patients.

El carcinoma gástrico de tipo linfoepitelioma (CGLE) es una neoplasia rara del estómago con una infiltración linfocítica densa. Más del 80% de los CGLEs son positivos al virus de Epstein-Barr (EBV). Aquí reportamos el caso de un paciente chino de 64 años, que sentía malestar al efectuar la deglución de alimentos. Tanto la endoscopia como la tomografía computarizada mostraron una lesión submucosa en la curvatura menor de la parte superior del cuerpo gástrico. La primera impresión diagnóstica fue de un tumor del estroma gastrointestinal Posteriormente, al paciente se le hizo una resección en cuña del estómago. En el examen histopatológico, se halló que el tumor consistía de pequeños nidos de células neoplásicas dentro de una infiltración linfocítica densa. Además, la mayoría de las células neoplásicas eran positivas a la citoqueratina y al ARN codificado por el virus de Epstein-Barr (EBER). Posteriormente, se realizó el diagnóstico de CGLE. Creemos que los médicos deben tomar conciencia del diagnóstico de las lesiones submucosas gástricas, especialmente en los pacientes mayores hombres.

Objective Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. Methods This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed Results The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. Conclusion Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.

Objetivos Determinar la prevalencia de la solicitud del perfil lipídico como ayuda diagnóstica de primera línea en pacientes con impresión clínica de vértigo periférico, así como un análisis de la relación costo-beneficio de dicha solicitud. Métodos Estudio de tipo corte transversal retrospectivo. Revisión de 201 historias de pacientes atendidos en la consulta externa tanto de especialistas como de médicos generales de la Clínica Universitaria Teletón y Casa chía, con diagnóstico de vértigo periférico, en el periodo comprendido entre enero de 2005 y julio de 2008. Resultados Las edades de los pacientes oscilaron entre 6 y 87 años, el 36 % de sexo masculino y el 64 % femenino. El perfil lipídico fue solicitado como prueba diagnóstica inicial para el manejo de vértigo a un 76 % de los pacientes. Los perfiles lipídicos hallados fueron normales en el 80 % de los pacientes a quienes se les solicitó. Se presenta el análisis de la relación costo-beneficio de esta prueba. Conclusiones Existe una alta prevalencia de solicitud de perfil lipídico como estudio de primera línea en el abordaje de pacientes con vértigo periférico, aunque no existe evidencia que avale esta solicitud, se requiere retroalimentación al cuerpo médico tanto de atención primaria como especialistas.

Objetivos Determinar la prevalencia de la solicitud del perfil lipídico como ayuda diagnóstica de primera línea en pacientes con impresión clínica de vértigo periférico, así como un análisis de la relación costo-beneficio de dicha solicitud. Métodos Estudio de tipo corte transversal retrospectivo. Revisión de 201 historias de pacientes atendidos en la consulta externa tanto de especialistas como de médicos generales de la Clínica Universitaria Teletón y Casa chía, con diagnóstico de vértigo periférico, en el periodo comprendido entre enero de 2005 y julio de 2008. Resultados Las edades de los pacientes oscilaron entre 6 y 87 años, el 36 % de sexo masculino y el 64 % femenino. El perfil lipídico fue solicitado como prueba diagnóstica inicial para el manejo de vértigo a un 76 % de los pacientes. Los perfiles lipídicos hallados fueron normales en el 80 % de los pacientes a quienes se les solicitó. Se presenta el análisis de la relación costo-beneficio de esta prueba. Conclusiones Existe una alta prevalencia de solicitud de perfil lipídico como estudio de primera línea en el abordaje de pacientes con vértigo periférico, aunque no existe evidencia que avale esta solicitud, se requiere retroalimentación al cuerpo médico tanto de atención primaria como especialistas.

Objective Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. Methods This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed Results The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. Conclusion Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.

The ascaris is the higher nematode to parasitizes the man; it is dioecious helminths (having separate sexes). Its prevalence is due mainly to soil fecal contamination and to survival ability of eggs. The adult Ascaris lumbricoides are located in the small bowel, although some times may be erratic migrations of adult parasites to places like the liver, peritoneum, kidneys, etc. The aim of present paper is to describe the presentation way of intestinal parasitism by Ascaris lumbricoides in a pregnant woman, to update and to inform on the intestinal parasitism, to show the experience in the management of a case of difficult diagnosis and to transmit the knowledges, and to contribute to medical teaching. A bibliographic review on the intestinal parasitism was made, specifically of Ascaris lumbricoides from the existence of a obstetric case carrier of significant cardiovascular manifestations and of a difficult management, thus we made an exhaustive review of medical record of this patient in the two hospitals where she was admitted. A patient with 12 weeks pregnancy to come to consultation due to respiratory and cardiovascular manifestations, the first diagnostic impression was a myocarditis or myocardiopathies. After conclude the pertinent studies she is classified as a Ascaris lumbricoides carrier in right heart and that also it is complicated with a pulmonary thromboembolism. Despite this condition is infrequent nowadays, we must to think about the parasitism like an explanation for some symptomatology of a rare clinical presentation.

El áscaris es el nematodo de mayor tamaño que parasita al hombre; es un helminto dioico (sexos separados). Su prevalencia se debe fundamentalmente a la contaminación fecal del suelo y a la capacidad de supervivencia de los huevos. Los adultos de áscaris lumbricoides se localizan en el intestino delgado, aunque algunas veces puede haber migraciones erráticas de parásitos adultos a lugares como el hígado, peritoneo, riñones, etc. Describir la forma de presentación del parasitismo intestinal por áscaris lumbricoides en una embarazada, actualizar e informar sobre el parasitismo intestinal, mostrar la experiencia en el manejo de un caso de difícil diagnóstico y transmitir conocimientos, contribuir a la docencia médica, son los objetivos de esta presentación. Se realizó una revisión bibliográfica sobre el parasitismo intestinal, específicamente del áscaris lumbricoides partiendo de la existencia de un caso obstétrico portadora de manifestaciones cardiovasculares importantes y de difícil manejo, por lo que se revisó exhaustivamente la historia clínica de dicha paciente en los 2 hospitales en los cuales estuvo ingresada. Paciente portadora de una gestación de 12 sem que acude con manifestaciones respiratorias y cardiovasculares, la primera impresión diagnóstica fue de una miocarditis o miocardiopatías, después de concluir estudios pertinentes se concluye como portadora de áscaris lumbricoides en corazón derecho y además se complica con un tromboembolismo pulmonar. A pesar de ser infrecuente en nuestros días, debemos pensar en el parasitismo como una explicación a ciertas sintomatologías de extraña presentación clínica.

Objetivo: el síndrome de Mayer-Rokitansky-Küster-Hauser (MRKH) es una malformación congénita del útero y la parte superior de la vagina en las mujeres que muestran características sexuales secundarias normales y cariotipo 46 XX. Puede ocurrir aplasia completa del útero en presencia de dos cuernos rudimentarios o hipoplasia uterina simétrica o asimétrica acompañada por aplasia de uno de los dos cuernos. Es poco frecuente la aparición de tumores en los rudimentos uterinos. Este caso se presenta con el objetivo de hacer una revisión de la literatura respecto a la asociación de leiomioma uterino y síndrome de MRKH. Materiales y métodos: se presenta el caso y se realiza búsqueda a través de MEDLINE en la página de PubMed con los términos "leiomyoma" y "Mayer-Rokitansky-Küster-Hauser syndrome". Se obtuvieron 8 referencias, de las cuales 7 se identificaron como pertinentes y se incluyeron en la revisión. Además, se hace una búsqueda manual de publicaciones relacionadas con la patología de base. Conclusión: el hallazgo de un leiomioma en el remanente uterino en el síndrome de MRKH es muy poco frecuente, con apenas unas cuantas publicaciones en la literatura médica. En esta paciente, con la impresión diagnóstica de leiomioma uterino, se prefirió realizar laparotomía dado el tamaño del tumor, donde se reportó la patología de biopsia por congelación y la definitiva como leiomioma

Objective: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital malformation of the uterus and the upper part of the vagina in females having normal secondary sexual characteristics and karyotype 46 XX. Complete uterine apl1asia could happen in the presence of two rudimentary horns or symmetric or asymmetric uterine hypoplasia accompanied by aplasia of one or two horns. The appearance of tumours in uterine rudiments is not often described. This case is presented following a review of the literature regarding an association between uterine leiomyoma and MRKH syndrome. Materials and methods: a case has been presented and a search was made through MEDLINE on the PubMed page using the terms "leiomyoma" and "Mayer-Rokitansky-Küster-Hauser syndrome". 8 references were obtained; 7 of them were identified as being pertinent and included in the review. A manual search was also made of publications related to the base pathology. Conclusion: finding a leiomyoma in an uterine remnant in MRKH syndrome is very rare; there are very few publications about it in the pertinent medical literature. It was preferred to carry out laparotomy given the size of the tumour in this patient who had a diagnostic impression of uterine leiomyoma, the pathology being reported by biopsy freezing and the definitive as leiomyoma.