Recibido el 29 de noviembre de 2010; aceptado el 13 de diciembre de 2010 Disponible en Internet el 15 de diciembre de 2011 PALABRAS CLAVE Derrame pleural maligno; Drenaje tunelado; Tratamiento ambulatorioResumen El derrame pleural maligno es una patología frecuente en los pacientes con cáncer, y por tanto en los servicios de cuidados paliativos. Esta complicación se asocia tanto a los tumores pulmonares primarios como a los metastásicos, y suele plantear problemas relevantes a la hora de tomar decisiones terapéuticas.Presentamos un caso clínico de un enfermo diagnosticado de carcinoma epidermoide de pulmón y derrame pleural secundario, en quien se realizó tratamiento domiciliario por expreso deseo del paciente. Tras valorar las distintas opciones, se decidió la colocación de un tubo tunelado permanente para drenaje pleural, cuyo manejo domiciliario resultó sencillo y eficaz. El paciente mantuvo el dispositivo funcionante hasta su fallecimiento, con buen control de los síntomas.El derrame pleural maligno requiere un manejo individualizado y una adecuada gestión de las diversas modalidades terapéuticas disponibles. En determinados casos, el empleo de un tubo tunelado permanente puede aportar claros beneficios terapéuticos y mejorar la calidad de vida de los enfermos.Abstract Malignant pleural effusion (MPE) is a frequent disorder in patients with cancer and thus often seen in Palliative Care Units. MPE is associated with both primary lung cancer and metastatic tumours and will be a significant complication in making decisions about patients.We report a case of a patient with squamous cell lung cancer associated with a newly diagnosed malignant pleural effusion. At the express wish of the patient on regular at-home-treatment and assessing the therapeutic options for treatment, it was decided to place permanent tunnelled pleural drainage catheter, which was easily performed by the palliative care team at home. The patient had a functionally operating pleural drainage with good control of symptoms until his death at home. * Autor para correspondencia. Correo electrónico: mcano40@hotmail.com (M. Cano Hoz).
Correspondence to Miguel F Carrascosa, mcarrascosa@hlrd.scsalud.es
SummaryThe authors report a case of severe pulmonary arterial hypertension (PAH) in a 75-year-old woman who had received a diagnosis of neurofibromatosis type 1 (NF1) 23 years before. She presented with progressive dyspnoea and recurrent syncope. Even though the patient initially improved after starting supportive and specific treatment for PAH, she then deteriorated and died from respiratory failure 11 months after the diagnosis of PAH. Prompt recognition of such an unusual association between PAH and NF1 and appropriate therapeutic intervention could ameliorate quality of life and prolong survival in this patient population.
BACKGROUND
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