Cholesterol: a useful parameter for distinguishing between pleural exudates and transudates.

Previously established criteria were used to classify 253 pleural effusions as transudates (65 cases), neoplastic exudates (67 cases), tuberculous exudates (65 cases), or miscellaneous exudate (56 cases). The parameters pleural LDH (PLDH), pleural LDH/serum LDH ratio (P/SLDH), and pleural protein/serum protein ratio (P/SPROT) were compared with pleural cholesterol (PCHOL) and the pleural cholesterol/serum cholesterol ratio (P/SCHOL) with regard to their usefulness for distinguishing between pleural exudates and transudates. The PCHOL values determined were 28.5 +/- 12.8 mg/dl for transudates, 88.1 +/- 30 mg/dl for neoplastic exudates, 96.5 +/- 28 mg/dl for tuberculous exudates, and 88 +/- 35.9 mg/dl for the miscellaneous group; the differences between the transudate group and the others are statistically significant (p less than 0.001). The sensitivity and specificity of P/SPROT for diagnosis of exudates were both 89 percent; the sensitivity of PLDH was 67 percent and its specificity was 95 percent; the sensitivity and specificity of P/SLDH were both 84.6 percent. Using Light's three criteria as a battery, the sensitivity was 94.6 percent and its specificity was 78.4 percent. All the transudates and 17 (9 percent) of the 188 exudates had PCHOL values below 55 mg/dl, so that with this threshold, PCHOL had a sensitivity of 91 percent and a specificity of 100 percent for diagnosis of exudates. With a threshold of 0.3, P/SCHOL had a sensitivity of 92.5 percent and a specificity of 87.6 percent. The number of misclassifications by PCHOL was less than with any other of the parameters, with statistically significant differences with respect to PLDH (p less than 0.001) and P/SLDH (p less than 0.01). We conclude that determination of PCHOL and P/SCHOL is of great value for distinguishing between pleural exudates and transudates, and should be included in routine laboratory analysis of pleural effusions.

Diagnosis of tuberculous pleurisy using the biologic parameters adenosine deaminase, lysozyme, and interferon gamma.

We compared the parameters pleural adenosine deaminase (PADA, determined in 405 patients), the PADA/serum ADA ratio (P/SADA; 276 cases), pleural lysozyme (PLYS, 276 cases), the PLYS/serum LYS ratio (P/SLYS; 276 cases), and pleural interferon gamma (IFN, 145 cases) regarding their ability to differentiate tuberculous pleural effusions from others. The 405 pleural effusions were classified by previously established criteria as tuberculous (91), neoplastic (110), parapneumonic (58), empyemas (10), transudates (88), or miscellaneous (48). The intermean differences between the tuberculous group and each of the others were statistically significant for all five parameters (p < 0.01 for PLYS and P/SLYS with respect to the empyema group; p < 0.001 otherwise), except for PADA and P/SADA with respect to the empyema group. All the tuberculous pleurisy cases had PADA values of 47 U/L or more, as compared to only 5 percent of the other cases (sensitivity, 100 percent; specificity, 95 percent). P/SADA was above 1.5 in 85.7 percent of tuberculous effusions and 11 percent of the others (sensitivity, 85.7 percent; specificity, 89 percent). PLYS, with a diagnostic threshold of 15 g/ml, had a sensitivity of 85.7 percent and a specificity of 61.6 percent; P/SLYS, with a threshold of 1.1, had a sensitivity of 67.3 percent and a specificity of 90.3 percent; and IFN, with a threshold of 140 pg/ml, had a sensitivity of 94.2 percent and a specificity of 91.8 percent. The lowest misclassification rate was achieved by PADA, with statistically significant differences (p < 0.001) with respect to P/SADA, PLYS, and P/SLYS, but not with respect to IFN. The only significant pairwise correlations among these parameters were between P/SLYS and PADA and between P/SLYS and P/SADA. We conclude that PADA and IFN are useful parameters for early diagnosis of tuberculous pleurisy, and that the other parameters considered have no advantages over PADA and IFN for this purpose (though the high specificity of P/SLYS may be noted).

Snoring and myocardial infarction: a 4-year follow-up study.

The association between snoring and myocardial infarction was studied in 1453 people of both sexes aged 20-70 years. The study was carried out in a population of 92,364 residents and the subjects were recruited using the Electoral Census. A questionnaire was sent to all participants, asking about snoring and cardiovascular risk factors. Hospital records were checked for the next 4 years to establish how many of them developed myocardial infarction. At the beginning of the follow-up study 39 patients were diagnosed with ischaemic heart disease. Of the other 1414 participants, 571 (40.4%) were snorers and 843 (59.6%) non-snorers. Twenty-one developed myocardial infarction in the snorer group and four in the non-snorer group. The snorer group presents an adjusted relative risk of myocardial infarction of 3.08 (95% CI 1.01-9.46) with respect to non-snorers. We conclude that snoring seems to be a potential risk factor for myocardial infarction.

[Compliance with inhalation treatment of patients with chronic obstructive pulmonary disease]. / Estudio de cumplimiento del tratamiento por vía inhalatoria en pacientes con enfermedad pulmonar obstructiva crónica.

OBJECTIVES: To evaluate patient compliance with inhaled medication therapy in chronic obstructive pulmonary disease (COPD), to identify determining factors and to propose corrective measures to improve compliance. METHODS: This was an open, observational, cross-sectional, non-comparative, single-measurement, non-random study. The inhalers were the Serevent Accuhaler, the Serevent Inhalador and the Flixotide Inhaler. Compliance was measured in four ways: a) difference in weight at the beginning and end of the study for all devices; b) dose counter reading for the Accuhaler; c) information from patient diaries (by days and by applications); and d) information from patient interviews using the Morinsky-Green Test. Compliance was rated as follows: poor: < 50%, fair 51%-79%, good 80%-119%, or "hypercompliant" > 120%. RESULTS: Seventy-two patients (mean age 65 years) were enrolled. Compliance measured by weight was good in 77.1%, fair in 11.5%, poor in 1.4% and hypercompliant in 10%. Compliance was good for the Accuhaler according to both weight (75%) and counted doses (83.3%). According to patient diaries, compliance was good when assessed by applications (98.8%) and by days (98.3%). According to the Morinksky-Green test, compliance was good for 87.9%. CONCLUSIONS: Compliance was good as assessed by the methods used in this study. Patients who live in families, who enjoy a high socioeconomic level, have simple therapeutic regimens and have a good understanding of their disease and inhaler tend to have good compliance. Careful patient follow-up and good patient-physician communication has improved compliance. However, follow-up studies are needed to check these results.

[Symptoms of sleep apnea syndrome in the general population]. / Sintomatología del síndrome de apnea del sueño en la población general.

The aim of this study was to determine the clinical features of patients with sleep apnea syndrome (SAS) in the general population. One hundred ten individuals were selected randomly from the census and given hospital appointments. Case histories were taken and complete physical examinations were made. Nighttime respiratory polysomnograms were performed. Twenty-two (20%) of the 110 subjects presented SAS. In the SAS group, 59.1% were habitual snorers and 22.7% reported daytime hypersomnolence. The SAS patients has a mean age of 59.6 +/- 8.8 years and 45.4% showed alterations of the pharynx. No differences in spirometric variables were observed. Only age and daytime hypersomnolence predicted SAS in the multivariate analysis. We conclude that the prevalence of snoring, daytime hypersomnolence, pharyngeal alterations are higher in patients with SAS. The patients are also older. Only age and daytime hypersomnolence predicted of SAS.

[Pulmonary diffusion of carbon monoxide in 2 clinical situations: bronchial asthma and diabetes mellitus]. / Estudio de la difusión pulmonar de monóxido de carbono en dos situaciones clínicas: asma bronquial y diabetes mellitus.

OBJECTIVE: The aim of our work has been the study and comparison of diffusion capacity of CO (DLCO) in two different clinical situations: bronchial asthma and diabetes mellitus. METHOD: We have studied 16 control subjects, 38 patients with bronchial asthma and 65 patients with diabetes mellitus. We performed CO pulmonary diffusion tests by single breath method to determine two components: membrane diffusion factor (Dm) and pulmonary capillary blood volume (Vc). RESULTS: We have found a positive correlation of FEV1 with Dm. The bronchial asthma group had a lower FEV1 and FEF25-75% and an increase in DLCO, Dm and Vc, with respect to the control group. The diabetes mellitus group presented a decrease in CVF, FEV1, DLCO and Vc, with respect to the control group. The bronchial asthma group showed a lower ratio of Dm/Vc than the control and diabetes groups. CONCLUSIONS: The bronchial asthma patients have an increase in CO pulmonary diffusion, membrane diffusion factor and pulmonary capillary volume. However, the diabetes mellitus patients present a decrease in CO pulmonary diffusion mainly due to pulmonary capillary volume.

[Non-invasive ventilation in chronic obstructive pulmonary disease patients with acute respiratory hypercapnic failure in a conventional hospital ward]. / Ventilación no invasiva en pacientes con enfermedad pulmonar obstructiva crónica e insuficiencia respiratoria aguda hipercápnica en una sala de hospitalización convencional.

OBJECTIVE: To analyze chronic obstructive lung disease (COPD) subjects in acute hypercapnic failure who were treated with non-invasive mechanical ventilation in a general respiratory ward. METHODS: This was a two-year prospective study of 35 patients with acute exacerbation of COPD and mean FEV1/FVC relation in stable condition of 55.3 +/- 14.8% of predicted that were treated with positive pressure respiration using a facemask in a general respiratory ward. 17 (48.5%) receive long-term oxygen therapy. Analysis was made of blood gases, before and after treatment of non-invasive ventilation, complications, and failure during treatment. RESULTS: A significant improvement in blood gases was observed 24 hours after non-invasive ventilation treatment. The mean hospital stay was of 15.0 +/- 9.1 days and failures were registered in 3 cases (8.5%). Facial scares were the most common complication (13 patients) but it was possible to continue treatment. CONCLUSIONS: Non-invasive ventilation is a viable treatment for patients with chronic obstructive lung disease and acute hypercapnic failure being treated in a general respiratory ward.

[The clinical characteristics of pulmonary tuberculosis in the elderly]. / Características clínicas de la tuberculosis pulmonar en el anciano.

Pulmonary tuberculosis remains as a significant clinical problem in the elderly. To describe age-related differences in disease manifestations, a comparison was made taking in consideration predisposing factors, clinical features, radiographic findings and diagnostic approaches in cases of pulmonary tuberculosis between two groups: equal o higher of 60 years and lower of 60 years. Elderly patients had a higher number of antecedents of previous tuberculosis and underlying diseases than younger patients. At admission, symptoms like fever and hemoptysis were more frequent in the younger group. Radiographic findings revealed that upper lung infiltrates were still common in both groups, and that elderly patients presented less pleural effusions and cavitary lesions than younger patients. Since there were differences in the clinical presentations of pulmonary tuberculosis in the elderly group, a high index of suspicion for the disease should be maintained.

[Sleep apnea syndrome and cardiovascular diseases]. / Síndrome de apnea del sueño y enfermedades cardiovaculares.

The sleep apnea syndrome is a common disease, recognised as a public health problem. Cardiovascular disease is the most frequent cause of morbidity and mortality in these patients, however the underlying mechanisms of this association have not been clearly established. In sleep apnea syndrome different phenomena can be produced which may explain the appearance of cardiovascular problems, such a progressive hypoxia in relationship with the apnea, the increases of intrathoracic pressure cause by the efforts of ventilation system against close upper airway and the modifications of the autonomic nervous system associated with the arousals. In addition, the hypoxia episodes and reoxygenation, which appear in the sleep apnea syndrome, may play a important role in the alteration of the balance between vasoconstriction and vasodilatation substances affecting the vascular homeostasis and conditioning endothelial dysfunction. On the other hand, the increasing of platelets aggregation and the decreased of fibrinolisis in this group of patients may cause vascular diseases.

[Pulmonary diffusion of carbon monoxide in patients with mitral stenosis]. / Estudio de la difusión pulmonar de monóxido de carbono en enfermos con estenosis mitral.

OBJECTIVE: The aim of our work has been the study of CO diffusion capacity in mitral valve stenosis patients. METHOD: We have studied 15 control subjects and 15 patients with mitral valve stenosis. We performed spirometry study and CO pulmonary diffusion tests (DLCO) by single breath method to determine two components: pulmonary capillary blood volume (Vc) and membrane diffusion factor (Dm). In addition, in mitral valve stenosis patients we performed a ecocardiography-doppler study. RESULTS: The mitral valve stenosis group had higher values of DLCO and Vc and a lower ratio of Dm/Vc than the control group. There is a negative correlation between Vc and the mitral valve area (r = -0.63; p = 0.037). We do not find any another correlation between the rest of ecocardiography doppler parameters and lung function test variables that we have measured. We have not found any differences between both groups in Dm. CONCLUSIONS: Mitral valve stenosis patients present a increase of CO pulmonary diffusion capacity and pulmonary capillary blood volume without changes in membrane diffusion factor.

[Respiratory symptoms and lung function in a geriatric population of a Galician rural community: a pilot study]. / Sintomatología respiratoria y función pulmonar en población geriátrica de una comunidad rural gallega: un estudio piloto.

INTRODUCTION: Respiratory diseases are a frequent cause of health demands and have a large impact on morbidity and mortality of the Galician population, especially among the older one. Recent work shows that the diagnosis and treatment of these diseases is not optimal. This increases the utilisation of health care resources. MATERIAL AND METHODS: We studied 28 patients of the municipality of Val del Dubra (Northwest Spain) aged between 65 and 74 years. We performed a spirometric exploration and carried out a questionnaire interview on respiratory symptoms, life style, and occupational and health-related antecedents. RESULTS: Among men, 54% of were or are smokers. None of the women ever smoked. Respiratory symptoms were more frequent among women than among men (80% versus 54%). In the spirometric study, the largest volumes and flux are observed among non-smoking males who do not report dyspnea. DISCUSSION: Respiratory symptoms are frequent in the rural population aged between 65 and 74 years. Tobacco consumption is similar to other Spanish communities, but different from that seen in other countries. Male gender, non-smoking status and absence of respiratory symptoms are associated with higher spirometric figures.

[Most common cardiovascular diseases and sleep apnea syndrome. A general population study]. / Enfermedades cardiovasculares más frecuentes y síndrome de apnea del sueño. Un estudio en población general.

BACKGROUND: The sleep apnea syndrome (SAS) is a frequent disease associated with significant morbidity. The aim of our study was to investigate diseases associated with the sleep apnea syndrome (SAS) in general population. METHODS: We selected a random sample of 110 people from the electoral census. These people were invited to the clinic where medical history, physical examination and monitoring for sleep-disordered breathing was done. RESULTS: Twenty two subjects were diagnosed of SAS. The prevalence of arterial hypertension in the SAS group was 36.4%, and coronary artery disease 13.6%. CONCLUSIONS: Although the prevalence of this diseases was increased in the SAS group, we do not see significant association with this disease.

[Comparative study of the bronchodilator effect of inhaled fenoterol and aerosol salbutamol in patients with chronic bronchial asthma]. / Estudio comparativo del efecto broncodilatador entre fenoterol inhaletas y salbutamol aerosol en pacientes con asma bronquial crónica.

The bronchodilator effects of inhaled fenoterol (FI) and salbutamol aerosol (S) in 15 patients (8 male and 7 female with a median age of 44 +/- 13 years), diagnosed as suffering from asthma, were studied using spirometry (determining FEV1, FEF 25-75% and FVC) and flow volume curves (PEF, MEF 75% and MEF 25%). The mean theroric rate of FEV1, PEF, MEF 75% was defined as the theoric rate of the obstruction of central airways (PCA%) and the mean of FVC, FEF 25-75% and MEF 25% rates defined as the rate of the theoric obstruction of the peripheral airways (PPA%). Basal and 5, 15, 30, 60, 120, 240, 360, 480 minute determinations were done, after the administration of 200 mcg of S in the conventional way on two different days. The statistic study carried out using the "u" test of Mann-Whytney. No statistically significant differences in intensity, onset nor duration of the effect between both drugs were found. We concluded that FI is a drug of great utility in treatment of asthmatic patients and one which allowed, because of the easy inhaling technique, the use of beta 2 adrenergic drugs in a mayor number of patients who would otherwise have to resort to an alternative form of administration.

[Epidemiological study of tuberculosis in the health area of Santiago de Compostella in 1992, 1993 and 1994]. / Estudio epidemiológico de la tuberculosis en el área sanitaria de Santiago de Compostela durante 1992, 1993 y 1994.

An exhaustive search for the clinical records of patients diagnosed with tuberculous disease was done in the hospitals of the area under study, which involves 392,000 population. During the years 1992, 1993 and 1994. There were included: 1) patients who had positive bacilloscopy and/or positive Lowenstein's culture in any specimen: 2) patients younger than 35-years-old who had pleural effusion, significant Mantoux and adenosine deaminase (ADA) over 47 U/I in the pleural effusion. In total 814 patients remained in the study with an average age of 38.39(19.39 DE) in 1992, 39.02 (20.04 DE) in 1993, and 34.1 years-old (19.2 DE) in 1994, with extreme ages of 2 months and 87 years-old. The incidence/100,000 H was: in 1992: 67.86, in 1993: 66.58 and in 1994: 73.2. The contagious forms incidence/100,000 H was: 1.5 in 1992 and 1993; and 1.79 in 1994. The hospital mortality incidence/100,000 H was 2.04 in 1992, 2.30 in 1993 and 2.6 in 1994. We conclude that tuberculosis is endemic in our area with moderately high and stationary incidence.

[Epidemiologic study on tuberculosis in the health area of Santiago de Compostela in 1995, 1996, 1997, and 1998]. / Estudio epidemiológico de la tuberculosis en el Area Sanitaria de Santiago de Compostela durante los años 1995, 1996, 1997 y 1998.

BACKGROUND: We report the epidemiological characteristics of tuberculosis(TB) in the area of Santiago de Compostela (Spain) between 1995 and 1998. METHODS: Inclusion criteria were: 1) microbiological and/or pathological diagnosis of TB in any specimen, and 2) consistent recent medical history of TB with reading > 5 mm to 2 TU PPD tuberculin test 48-72 hours after injection, and adenosine deaminase in pleural effusion > 47 IU/ml. RESULTS: 1,150 patients were included (685 males and 465 females), with mean of age (X) 38.9 years (19.8 SD), range 3 months-88 years. The number of cases was 307 during 1995 and 1996, 302 in 1997 and 213 in 1998. The incidence rate (per 100,000 habitants) was 78.3 in 1995 and 1996, 79.8 in 1997 and 61.9 in 1998. The incidence rate of meningitis was 1.8 in 1995, 1.3 in 1996, 1.05 in 1997 and 0.8 in 1998, with no meningitis in children under 5 years. Cases in association with VIH were 4.2% in 1995, 3.3 in 1996, 5.4 in 1997 and 3.2 in 1998. More of the 50% of cases in both genders were between 15 and 40 years old with another peak over 65 years. The ratio men/woman was 1.8 in 1995 and 1.4 in 1996, 1997 and 1998. CONCLUSIONS: The incidence of tuberculosis has diminished during the last year, but is too early to know the real tendency.

[Tuberculosis in Santiago de Compostela from 1999 to 2002. An epidemiological study]. / Tuberculosis en el área de Santiago de Compostela durante los años 1999, 2000, 2001 y 2002. Un estudio epidemiológico.

OBJECTIVE: The purpose of this study was to determine the epidemiological characteristics of tuberculosis (TB) in the Public Health System District of Santiago de Compostela (population : 386125) from 1999 to 2002. METHODS: Inclusion criteria were: 1). microbiological and/or pathological diagnosis of TB in any specimen, and 2). patient younger 35 years old with recent medical history of TB. Mantoux test positive, and pleural effusion with linfocitosis and adenosine deaminase >47 IU/ml. RESULTS: 946 patients were included (568 men and 378 women), with ages ranging from 2 months to 96 years. The incidence of TB was 60.9/100000 in 1999, 67.6/100000 in 2000, 61.9/100000 in 2001 and 54.6/100000 in 2002. The incidence rate of tuberculous meningitis was 1.03/100000 in 1999 and 2000, 0.77/100000 in 2001 and 0.51/100000 in 2002. The percentage of cases associated with HIV was 3.4% in 1999, 1.9% in 2000, 2.4% in 2001 and 2002. We found an increase in the rate of males over 55 years of age; with incidence per 100000 inhabitants of 122.4 in 1999, 142.8 in 2000, 115 in 2001 and 119 in 2002, whereas in females the incidence was 40.6 in 1999, 60.9 in 2000, 54.1 in 2001 and 39.1 in 2002. CONCLUSIONS: In last four years the incidence of tuberculosis has decreased but remains high in males over 55 years old.