[Strong suspicion of lung toxicity due to riluzole]. / Alta sospecha de toxicidad pulmonar por riluzol.

Riluzole is a drug used in the treatment of amyotrophic lateral sclerosis. To date, reports of lung toxicity have been exceptional. We present the case of a 74-year-old man diagnosed with amyotrophic lateral sclerosis. Following 3, 5 months of treatment with riluzole (Rilutek), the patient began to present a clinical picture consisting of nonproductive cough, progressive dyspnea (even with slight exertion), weakness, and radiologic progression with the appearance of predominantly peripheral bilateral pulmonary infiltrates that did not respond to treatment with amoxicillin-clavulanic acid. Bacterial tests did not reveal the presence of germs, nor did other examinations suggest an alternative diagnosis. The patient did not resume treatment with the drug or undergo complementary procedures aimed at obtaining histologic samples. Nevertheless, the coincidence in time, lack of response to antibiotic treatment, remission of symptoms following withdrawal of the drug without initiating any other treatment except 40 mg/d of methylprednisolone for 6 days, absence of alternative diagnoses, and suggestive clinical and radiologic findings all together point to toxicity due to riluzole.

[Cost and management of asthma exacerbations in Spanish hospitals (COAX study in hospital services)]. / Coste y manejo de una crisis asmática en el ámbito hospitalario de nuestro medio (estudio COAX en servicios hospitalarios).

OBJECTIVE: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. PATIENTS AND METHODS: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). RESULTS: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting beta2 agonists. The mean cost was 1555.70 Euros (95% confidence interval [CI], 1237.60 Euros-1907.00 Euros), of which 93.8% (1460.60 Euros; 95% CI, 1152.50 Euros-1779.40 Euros) was due to direct costs, and 6.2% (95.10 Euros; 95% CI, 35.50 Euros-177.00 Euros) to indirect costs. Cost rose with increasing severity of the exacerbation--292.60 Euros for a mild exacerbation, 1230.50 Euros for a moderate exacerbation, and 3543.10 Euros for a severe exacerbation. CONCLUSIONS: The mean cost was 1555.70 Euros. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting beta2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations.

[Pulse-oximetry monitoring during endoscopy of the upper digestive tract and chronic obstructive lung disease]. / Monitorización con pulsioximetría durante la endoscopia digestiva alta y enfermedad pulmonar obstructiva crónica.

BACKGROUND: During upper digestive endoscopy arterial desaturations occur which may favour cardiopulmonary complications; therefore, monitoring and oxygen administration to risk patients is recommended. The aim of this study was to evaluate desaturations occurring during endoscopy and whether there are differences between patients with or without prior obstructive respiratory pathology. METHODS: A total of 119 consecutive patients undergoing upper digestive endoscopy were studied. The clinical history and simple spirometry were obtained before endoscopy; during endoscopy, a continuous monitoring of oxygen saturation and heart rate with pulse oximetry. RESULTS: Forty-six patients (38.7%) had oxygen saturations lower than 90% (Group I). Patients were significantly older and FEV-1, FVC, FEF 25-75, and FEV-1/FVC significantly lower among patients in Group I than among the 73 patients (61.3%) with no oxygen desaturation (Group II). A Tiffenau index lower than 70% was not a good predictor for oxygen desaturation during endoscopy. CONCLUSIONS: Pulse-oximetry monitoring during upper digestive endoscopy is recommended and particularly in patients with obstructive respiratory conditions and/or advanced age.

[Varicella pneumonia in previously healthy adults]. / Neumonitis varicelosa en el adulto previamente sano.

Two cases of pneumonia associated with chicken pox in previously healthy patients are described. Their known risk factor was heavy smoking. Both were treated successfully with parenteral aciclovir, although one presented a restrictive spirometric pattern with lowered DLCO that became normal 3 months after discharge.

[Acute respiratory insufficiency secondary to Coxiella burnetii pneumonia: a rare complication]. / Insuficiencia respiratoria aguda secundaria a neumonía por Coxiella burnetii: una complicación excepcional.

Acute respiratory failure secondary to Coxiella burnetii infection is an extremely rare but serious complication that usually has a good prognosis after appropriate treatment. We describe a female patient who developed acute respiratory failure secondary to Coxiella burnetii pneumonia requiring mechanical ventilation and antibiotic therapy.