Central nervous system metastases of a pulmonary epitheloid haemangioendothelioma.

The case of a 55-yr-old male with a right pleural effusion and multiple bilateral nodules is reported. A diagnostic thoracothomy was necessary to obtain a definitive histological diagnosis. During the postoperative course, the subject's neurological condition deteriorated and multiple cerebral mass lesions were discovered. The pathological analysis of both lung and cerebral tumours revealed an atypical endothelial cell proliferation; vascular immunohistochemical markers, such as factor VIII and CD34, were strongly positive. His general condition remained poor and the patient died 18 months after the initial diagnosis. The final diagnosis was pulmonary epitheloid haemangioendothelioma with synchronous central nervous system dissemination, the first time the authors believe that association has been reported. Little is known of the prognosis and treatment of these tumours, due to their rarity. Negative prognostic factors appear to be the presence of symptoms, pleural effusion or multifocal presentations. Treatment should include surgical resection if possible; chemotherapy appears to have little effect. Watchful waiting is an acceptable option, especially in asymptomatic patients.     

Psychiatric care of coronary artery disease in a cardiac rehabilitation unit

The present work describes the psychiatric intervention in the Ramón y Cajal Hospital (Madrid) Cardiac Rehabilitation Program for Coronary Disease patients. The psychopathological concepts in relation to coronary heart disease are reviewed and studied in the foregoing acute and rehabilitation phases. The evaluation and therapeutic intervention methods are related in detail. Finally, results obtained in 90 patients who were treated in the past 3 years are analyzed. We mainly focused on the psychological risk factors and the psychosocial aspects.