[Pulmonary haemorrhage and primary antiphospholipid syndrome: case report and review]. / Hemorragia pulmonar y síndrome antifosfolípido primario: aportación de un caso y revisión de la literatura.

The antiphospholipid syndrome is defined by the association of vein and/or arterial thrombotic events and a high level of antiphospholipid antibodies. Pulmonary embolism and pulmonary hypertension are the most usual complications and recently some new cases of alveolar haemorrhage have been described. We present the case of an alveolar haemorrhage in a patient with a primary antiphospholipid syndrome. The first manifestation of this patient was a deep vein thrombosis on his left lower leg . After that he had persistent hemoptoic sputum and his chest x-ray showed alveolar infiltrates. The bronchoscopy ruled out another causes of haemoptysis and the bronchoalveolar lavage confirmed that it was an alveolar haemorrhage (80% of hemosiderophages ). The case is discussed and we do a literature review.

Meaning and diagnostic value of determining the lysozyme level of pleural fluid.

We determined the levels of lysozyme in pleural fluid and serum in 141 patients with the following different causes for their pleural effusions: tuberculosis; neoplasias; transudates; parapneumonic, not complicated; empyemas; and miscellaneous. The lysozyme level of the pleural fluid and the ratio of that level over the serum level of lysozyme (PL/SL ratio) was meaningfully increased in patients with empyema (p less than 0.01). The groups with tuberculous and neoplastic effusions showed significant differences in the PL/SL ratio (p less than 0.01). The existence of a raised PL/SL ratio suggested important local synthesis of lysozyme, and it came up in empyemas and tuberculosis, unlike the other groups. Excluding the patients with empyemas, a PL/SL ratio of 1.2 showed a sensitivity of 100 percent, specificity of 94.9 percent, positive predictive value of 94.7 percent, negative predictive value of 100 percent, and accuracy of 97.3 percent for the diagnosis of tuberculous pleural effusion. All of this suggests that the determination of the lysozyme level can be an easy method of great usefulness in the initial diagnosis of pleural effusions.

Diagnostic value of simultaneous determination of pleural adenosine deaminase and pleural lysozyme/serum lysozyme ratio in pleural effusions.

We have determined simultaneously the ADAp and Lp/Ls ratio in 138 pleural effusions: 61 tuberculous; 42 malignant; 14 transudates; five parapneumonic uncomplicated; six empyematous; and ten cases belonging to a miscellaneous group which included two disseminated lupus erythematosus; two posttraumatic; one pancreatitis; one pleuropericarditis by Mycoplasma; one viral pleuropericarditis; and three pulmonary embolisms. This has allowed us to clear the overlapping for the ADAp activity among tuberculous patients (two cases of lupus and three cases of malignant effusions) in our series. The overlap in the Lp/Ls ratio among tuberculous patients, two malignant, and two parapneumonic uncomplicated cases was also cleared. Fixing the ADAp values at 33 U and the Lp/Ls ratio at 1.2, the tuberculous pleural effusion cases were differentiated from the nontuberculous with a sensibility, positive predictive value, negative predictive value, and safety diagnosis of 100 percent. It has been proven that there is a good correlation between ADAp and Lp/Ls ratio (r = 0.717) and the ADAp and Lp (r = 0.660).

[Pseudotumoral allergic bronchopulmonary aspergillosis]. / Aspergilosis broncopulmonar alérgica seudotumoral.

Allergic bronchopulmonary aspergillosis (ABPA) develops as the result of a hypersensitivity reaction to fungi of the genus Aspergillus. Clinical and radiological presentation can be atypical, requiring a high degree of suspicion on the part of the physician who treats such patients. We report the cases of two patients with APBA in whom the form of presentation--with few asthma symptoms, images showing lobar atelectasia and hilar adenopathy--led to an initial suspicion of lung cancer.

[The epidemiology of COPD and asthma exacerbations in a general hospital]. / Características epidemiológicas de las exacerbaciones por EPOC y asma en un hospital general.

This retrospective study identified the clinical and epidemiological characteristics of patients coming to the emergency room of our hospital with exacerbated asthma or chronic obstructive pulmonary disease (COPD) in 1993 and 1994. We followed a previously established protocol to review the case histories of patients from both years. The 1,592 exacerbations we identified in 1,209 asthmatics accounted for 0.9% of all emergency visits, with a mean of 2.2 1.6 (0-9) visits daily. The 2,106 exacerbations of COPD in 1,208 patients accounted for 1.2% of all emergencies, with a mean 2.9 (1-12) visits per day. The mean age was 51.2 (14-93) years for asthmatics and 70.3 (29-96) years for COPD patients. Of asthmatics, 69.8% were women and 30.1% were men, whereas 91.4% of COPD patients were men. The readmission rate was 3.4% for asthmatics and 4.8% for COPD patients. The hospitalization rate was 26.7% for asthmatics and 49.4% for COPD exacerbation patients. The hospital saw 22.6% of asthma exacerbations between midnight and 8 a.m. and 41.6% of COPD exacerbations during the same time frame. For both diseases, more emergencies occurred in winter. Correlation between asthma and COPD and declared influenza cases in the community were r = 0.63 (p < 0.001) for asthma and r = 0.83 (p < 0.0001) for COPD. Our findings underline the considerable emergency care burden generated by exacerbations of obstructive airway diseases and suggest that community acquired respiratory infections are usually the underlying cause.