Progressive pulmonary fibrosis: an expert group consensus statement.

This expert group consensus statement emphasises the need for standardising the definition of progressive fibrosing interstitial lung diseases (F-ILDs), with an accurate initial diagnosis being of paramount importance in ensuring appropriate initial management. Equally, case-by-case decisions on monitoring and management are essential, given the varying presentations of F-ILDs and the varying rates of progression. The value of diagnostic tests in risk stratification at presentation and, separately, the importance of a logical monitoring strategy, tailored to manage the risk of progression, are also stressed. The term "progressive pulmonary fibrosis" (PPF) exactly describes the entity that clinicians often face in practice. The importance of using antifibrotic therapy early in PPF (once initial management has failed to prevent progression) is increasingly supported by evidence. Artificial intelligence software for high-resolution computed tomography analysis, although an exciting tool for the future, awaits validation. Guidance is provided on pulmonary rehabilitation, oxygen and the use of non-invasive ventilation focused specifically on the needs of ILD patients with progressive disease. PPF should be differentiated from acute deterioration due to drug-induced lung toxicity or other forms of acute exacerbations. Referral criteria for a lung transplant are discussed and applied to patient needs in severe diseases where transplantation is not realistic, either due to access limitations or transplantation contraindications. In conclusion, expert group consensus guidance is provided on the diagnosis, treatment and monitoring of F-ILDs with specific focus on the recognition of PPF and the management of pulmonary fibrosis progressing despite initial management.

Integrating Clinical Probability into the Diagnostic Approach to Idiopathic Pulmonary Fibrosis: An International Working Group Perspective.

Background: When considering the diagnosis of idiopathic pulmonary fibrosis (IPF), experienced clinicians integrate clinical features that help to differentiate IPF from other fibrosing interstitial lung diseases, thus generating a "pre-test" probability of IPF. The aim of this international working group perspective was to summarize these features using a tabulated approach similar to chest HRCT and histopathologic patterns reported in the international guidelines for the diagnosis of IPF, and to help formally incorporate these clinical likelihoods into diagnostic reasoning to facilitate the diagnosis of IPF. Methods: The committee group identified factors that influence the clinical likelihood of a diagnosis of IPF, which was categorized as a pre-test clinical probability of IPF into "high" (70-100%), "intermediate" (30-70%), or "low" (0-30%). After integration of radiological and histopathological features, the post-test probability of diagnosis was categorized into "definite" (90-100%), "high confidence" (70-89%), "low confidence" (51-69%), or "low" (0-50%) probability of IPF. Findings: A conceptual Bayesian framework was created, integrating the clinical likelihood of IPF ("pre-test probability of IPF") with the HRCT pattern, the histopathology pattern when available, and/or the pattern of observed disease behavior, into a "post-test probability of IPF." The diagnostic probability of IPF was expressed using an adapted diagnostic ontology for fibrotic interstitial lung diseases. Interpretation: The present approach will help incorporate the clinical judgment into the diagnosis of IPF, thus facilitating the application of IPF diagnostic guidelines and, ultimately improving diagnostic confidence and reducing the need for invasive diagnostic techniques.

Acute exacerbation of idiopathic pulmonary fibrosis: international survey and call for harmonisation.

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is an often deadly complication of IPF. No focussed international guidelines for the management of AE-IPF exist. The aim of this international survey was to assess the global variability in prevention, diagnostic and treatment strategies for AE-IPF.Pulmonologists with ILD expertise were invited to participate in a survey designed by an international expert panel.509 pulmonologists from 66 countries responded. Significant geographical variability in approaches to manage AE-IPF was found. Common preventive measures included antifibrotic drugs and vaccination. Diagnostic differences were most pronounced regarding use of Krebs von den Lungen-6 and viral testing, while high-resolution computed tomography, brain natriuretic peptide and D-dimer are generally applied. High-dose steroids are widely administered (94%); the use of other immunosuppressant and treatment strategies is highly variable. Very few (4%) responders never use immunosuppression. Antifibrotic treatments are initiated during AE-IPF by 67%. Invasive ventilation or extracorporeal membrane oxygenation are mainly used as a bridge to transplantation. Most physicians educate patients comprehensively on the severity of AE-IPF (82%) and consider palliative care (64%).Approaches to the prevention, diagnosis and treatment of AE-IPF vary worldwide. Global trials and guidelines to improve the prognosis of AE-IPF are needed.

An International Survey of Mediastinal Staging Practices amongst Interventional Bronchoscopists.

INTRODUCTION: In potentially curable non-small-cell lung cancer, different practice guidelines recommend invasive me-diastinal staging in tumors larger than 3 cm, central, or hy-permetabolic N1 lymph nodes. There is no consensus concerning the use of an endosonographic procedure or a mediastinoscopy in the first line in patients with a radiologically normal mediastinum, while in case of a mediastinal involvement, the latest European guidelines recommend the combination of endobronchial ultrasound (EBUS) and endoscopic ultrasound/endoscopic ultrasound with EBUS endoscope (EUS/EUS-B), using a systematic endosonographic procedure. This international survey was conducted to describe current medical practices in endoscopic mediastinal staging amongst interventional bronchoscopists. METHODS: A survey was developed and sent to all members of different interventional pulmonology societies, with the purpose to describe who, when and how an endoscopic mediastinal staging was performed. RESULTS: One hundred and fifty-three bronchoscopists responded to the survey. Most of them practiced in Europe (n = 84, 55%) and North America (n = 52, 34%). In the first line, EBUS alone was the most widely used endoscopic procedure for mediastinal staging. Half of the responders performed a systematic endoscopic staging procedure, including a systematic examination of all accessible nodal stations and a sampling of all lymph nodes >5 mm in the short axis at each station. A higher proportion of bronchoscopists who have completed a dedicated fellowship program performed systematic endoscopic mediastinal staging. Few endoscopists routinely perform combined EBUS/EUS(-B) for mediastinal staging and use the combination only in selected cases. CONCLUSION: There are several areas of divergence between published guidelines and current practices reported by interventional bronchoscopists. EBUS alone is the most widely used endoscopic procedure for mediastinal staging in lung cancer, and a combined endoscopic approach is frequently omitted by the responders. A fellowship program appears to be associated with a higher rate of systematic endoscopic staging procedures.

Management and attitudes about IPF (Idiopathic Pulmonary Fibrosis) among physicians from Latin America.

BACKGROUND: The aim of our study was to assess current practice patterns and attitudes towards diagnosis and management of idiopathic pulmonary fibrosis (IPF) patients in Latin America. METHODS: A Cross-sectional survey was developed and up to 455 physicians were enrolled. We used a rigorous method of validation using the translated version of the AIR Survey. RESULTS: Mean age was 47.5 years (SD 12.6) with 20.4 years (SD 12.3) of practice. In around 30% of physicians were reported access to radiologist, pathologist and multidisciplinary team. Despite almost all physicians reported that (ATS/ERS/JRS/ALAT) guidelines are useful, half of them prescribed corticoids for treatment of disease. Most respondents (69.9%) reported cough as the presenting symptom. Around 80% considered IPF to be an important clinical disorder, and felt that identifying patients at risk for IPF was important or extremely important. However, only 59.7% felt confident in managing patients with IPF, and similar numbers (60.8%) felt confident about their knowledge. Pulmonologist have more confidence and management of IPF that no pulmonologist. CONCLUSION: The results of this survey of Latin American physicians could help to fill gaps regarding awareness, management and treatment of IPF and improve earlier diagnosis of IPF.

[Bilateral pneumothorax complicating cavitary pulmonary metastases in angiosarcoma]. / Neumotórax bilateral como complicación de metástasis pulmonar cavitaria de un angiosarcoma.

Metastatic pulmonary angiosarcomas are a common complication of a rare condition. Generally, they are presented as peripheral solid nodules, infiltrates, and pleural effusions. We report the case of a 65 year-old man with bilateral recurrent pneumothorax secondary to metastatic cavitary lesions from angiosarcoma of the scalp. In this case, videothoracoscopy allowed tumor resection, inspection, and pleurodesis. There weren't complications or tumor recurrence at six months follow up.

Argentine consensus recommendations for lung cancer screening programmes: a RAND/UCLA-modified Delphi study.

BACKGROUND: Lung cancer (LC) screening improves LC survival; the best screening method in terms of improving survival is low-dose CT (LDCT), outpacing chest X-ray and sputum cytology. METHODS: A consensus of experts in Argentina was carried out to review the literature and generate recommendations for LC screening programmes. A mixed-method study was used with three phases: (1) review of the literature; (2) modified Delphi consensus panel; and (3) development of the recommendations. The Evidence to Decision (EtD) framework was used to generate 13 evaluation criteria. Nineteen experts participated in four voting rounds. Consensus among participants was defined using the RAND/UCLA method. RESULTS: A total of 16 recommendations scored ≥7 points with no disagreement on any criteria. Screening for LC should be performed with LDCT annually in the population at high-risk, aged between 55 and 74 years, regardless of sex, without comorbidities with a risk of death higher than the risk of death from LC, smoking ≥30 pack-years or former smokers who quit smoking within 15 years. Screening will be considered positive when finding a solid nodule ≥6 mm in diameter (or ≥113 mm3) on baseline LDCT and 4 mm in diameter if a new nodule is identified on annual screening. A smoking cessation programme should be offered, and cardiovascular risk assessment should be performed. Institutions should have a multidisciplinary committee, have protocols for the management of symptomatic patients not included in the programme and distribute educational material. CONCLUSION: The recommendations provide a basis for minimum requirements from which local institutions can develop their own protocols adapted to their needs and resources.

[Humanitarian ethics and the concept of justice]. / L'ethique humanitaire et la notion de justice.

The bases of humanitarian assistance, beyond a legal norm--which appears to be essential given the inalienable obligations that result for all participating bodies--are influenced by philosophical and political conceptualizations framed in an ethics of justice. Actors in the humanitarian field who adhere to the Rawlsian social contract model their actions based on a philosophy that assistance is a noble and desirable option that remains in the hands of those who offer aid, and who can freely choose to not offer such assistance. Peter Singer and Thomas Pogge propose nuances to the understanding of the duty of assistance. Not assisting would be bad, basically tantamount to killing. Assistance is no longer a caring act deserving of praise, but rather a moral obligation. The financial imperatives of associations, the growing complexity of activities and the development of an important element of communication lead to a professionalization of humanitarian medicine. A modern vision of humanitarian assistance requires an understanding of justice and solidarity and global outreach. We believe that ethics need to be embedded firmly in humanitarian actions that have clear political implications.

[Interstitial lymphoid pneumonia associated with common variable immunodeficiency]. / Neumonía intersticial linfoidea asociada a inmunodeficiencia común variable.

The interstitial lymphoid pneumonia (LIP) is an uncommon disorder, described as non-neoplastic lung lymphoid tissue hyperplasia and classified as an interstitial lung disease. It has been described in association with HIV infection, autoimmune disorders, policlonal hypergammaglobulinemia and less frequently, with hypogammaglobulinemia. We report the case of a 66 year old female patient with a history of diabetes, Sjogren syndrome and hypertension. She was referred to our hospital due to a dry cough and dyspnea (FC II-III). The physical examination showed bilateral dry crackles and splenomegaly. Laboratory studies showed thrombocytopenia (50 000/ mm3) and hypogammaglobulinemia. A computed tomography thoracic scan showed interstitial bilateral basal lung infiltrates with small peribroncovascular nodules. A lung biopsy was made by thoracoscopy and reported LIP. Initial treatment consisted of oral methilprednisone, 40 mg daily, and once a month intravenous gammaglobulin 500 mg/kg, with good clinical and radiological response. A splenectomy was done due to persistent thrombocytopenia associated with hypersplenism, with good response of the platelets counts. No lymphoid clonal or other associated disease was detected.

[Mechanical ventilation. Influence of the age in the outcome]. / Asistencia respiratoria mecánica. Influencia de la edad en la evolución.

There is not consensus about the true influence of age on mortality associated to mechanical ventilation (MV). We performed a prospective study in order to determine if age is an independent factor to predict mortality in patients under MV. Two hundred patients requiring MV at the intensive care unit were included and clinical variables at admission, co-morbidities, complications and outcome at the hospital and after 6 months were registered. Patients were divided in 2 groups: Group 1 (n = 164) under 80 year old and Group 2 (n = 36) 80 year or older. There were no differences in intensive care unit or hospital mortality between the two groups (55.56% vs. 41.46% and 58.33% vs. 42.68%). Six-month survival were significantly lower in patients over 80 year-old (22.22% vs. 48.17%, p = 0.0051). Multivariate analysis showed that only an APACHE II score > 20 (p = 0.0077) or the absence of an autonomous life (p = 0.0028) were independent predictive factors of mortality. Elderly patients under mechanical ventilation do not show a higher mortality because of the advance age in itself. Restriction of mechanical ventilation and invasive care does not seem to be justified based on the advanced age.

Utility of PET-CT in non-small cell lung cancer clinical stage IB-IIA according to AJCC 8th edition staging system: an alternative to invasive mediastinal staging?

OBJECTIVE: Mediastinal nodal staging in lung cancer is essential to determine treatment strategy and prognosis. There are controversies as to whether a mediastinal negative result in PET-CT may spare the invasive staging of the mediastinum. The main endpoint is to evaluate the negative predictive value (NPV) of PET-CT in non-small cell lung cancer (NSCLC) clinical stage IB-IIA without clinical nodal involvement. The secondary endpoint is to evaluate the prevalence of mediastinal and hilar nodal affection in this population. METHODS: We performed an observational descriptive study from January 2010 to January 2020, including 76 patients with clinical stage IB-IIA, who underwent pulmonary resection with systematic nodal sampling (pre-determined lymph node stations based on tumour location) for primary NSCLC. Clinically, nodal involvement was defined as any lymph node greater than 1 cm in the short axis on a CT or with metabolic uptake greater than 2.5 SUV on PET-CT. The prevalence of nodal metastases was recorded. RESULTS: Fifty six patients had clinical stage IB and 20 had clinical stage IIA. Mean tumour size was 3.74 ± 0.5 cm. Lobectomy was the resection procedure most frequently performed. Of the 76 patients with clinical N0 by PET-CT who underwent surgical resection, 10 (13.1%) were upstaged to pN1 and none were upstaged to pN2. NPV of PET-CT for overall nodal metastasis was 87% (95% CI: 0.79-0.94). NPV of PET-CT for N2 metastasis was 100%. CONCLUSION: PET-CT might be an alternative to invasive mediastinal staging in patients with NSCLC clinical stage IB-IIA who are surgical candidates. Further prospective multi-institutional studies are necessary to verify the external validity of our study.

Management of Acute Exacerbation of Idiopathic Pulmonary Fibrosis in Specialised and Non-specialised ILD Centres Around the World.

Background: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a severe complication associated with a high mortality. However, evidence and guidance on management is sparse. The aim of this international survey was to assess differences in prevention, diagnostic and treatment strategies for AE-IPF in specialised and non-specialised ILD centres worldwide. Material and Methods: Pulmonologists working in specialised and non-specialised ILD centres were invited to participate in a survey designed by an international expert panel. Responses were evaluated in respect to the physicians' institutions. Results: Three hundred and two (65%) of the respondents worked in a specialised ILD centre, 134 (29%) in a non-specialised pulmonology centre. Similarities were frequent with regards to diagnostic methods including radiology and screening for infection, treatment with corticosteroids, use of high-flow oxygen and non-invasive ventilation in critical ill patients and palliative strategies. However, differences were significant in terms of the use of KL-6 and pathogen testing in urine, treatments with cyclosporine and recombinant thrombomodulin, extracorporeal membrane oxygenation in critical ill patients as well as antacid medication and anaesthesia measures as preventive methods. Conclusion: Despite the absence of recommendations, approaches to the prevention, diagnosis and treatment of AE-IPF are comparable in specialised and non-specialised ILD centres, yet certain differences in the managements of AE-IPF exist. Clinical trials and guidelines are needed to improve patient care and prognosis in AE-IPF.

Multiplexed methylation profiles of tumor suppressor genes and clinical outcome in lung cancer.

BACKGROUND: Changes in DNA methylation of crucial cancer genes including tumor suppressors can occur early in carcinogenesis, being potentially important early indicators of cancer. The objective of this study was to examine a multiplexed approach to assess the methylation of tumor suppressor genes as tumor stratification and clinical outcome prognostic biomarkers for lung cancer. METHODS: A multicandidate probe panel interrogated DNA for aberrant methylation status in 18 tumor suppressor genes in lung cancer using a methylation-specific multiplex ligation-dependent probe amplification assay (MS-MLPA). Lung cancer cell lines (n = 7), and primary lung tumors (n = 54) were examined using MS-MLPA. RESULTS: Genes frequently methylated in lung cancer cell lines including SCGB3A1, ID4, CCND2 were found among the most commonly methylated in the lung tumors analyzed. HLTF, BNIP3, H2AFX, CACNA1G, TGIF, ID4 and CACNA1A were identified as novel tumor suppressor candidates methylated in lung tumors. The most frequently methylated genes in lung tumors were SCGB3A1 and DLC1 (both 50.0%). Methylation rates for ID4, DCL1, BNIP3, H2AFX, CACNA1G and TIMP3 were significantly different between squamous and adenocarcinomas. Methylation of RUNX3, SCGB3A1, SFRP4, and DLC1 was significantly associated with the extent of the disease when comparing localized versus metastatic tumors. Moreover, methylation of HTLF, SFRP5 and TIMP3 were significantly associated with overall survival. CONCLUSIONS: MS-MLPA can be used for classification of certain types of lung tumors and clinical outcome prediction. This latter is clinically relevant by offering an adjunct strategy for the clinical management of lung cancer patients.

Use of competency-based metrics to determine effectiveness of a postgraduate thoracoscopy course.

BACKGROUND: Despite the paradigm shift from process to competency-based education, no study has explored how competency-based metrics might be used to assess short-term effectiveness of thoracoscopy-related postgraduate medical education. OBJECTIVES: To assess the use of a single-group, pre-/post-test model comprised of multiple-choice questions (MCQ) and psychomotor skill measures to ascertain the effectiveness of a postgraduate thoracoscopy program. METHODS: A 37-item MCQ test of cognitive knowledge was administered to 17 chest physicians before and after a 2-day continued medical education-approved program. Pre- and post-course technical skills were assessed using rigid videothoracoscopy simulation stations. Competency-based metrics (mean relative gain, mean absolute gain, and class-average normalized gain ) were calculated. A >30% was used to determine curricular effectiveness. RESULTS: Mean cognitive knowledge score improved significantly from 20.9 to 28.7 (7.8 ± 1.3 points, p < 0.001), representing a relative gain of 37% and an absolute gain of 21%. Mean technical skill score improved significantly from 5.20 to 7.82 (2.62 ± 0.33 points, p < 0.001), representing a relative gain of 50% and an absolute gain of 33%. Non-parametric testing confirmed t test results (p < 0.001). Class-average normalized gains were 48 and 92%, respectively. CONCLUSION: Competency-based metrics, including class-average normalized gain, can be used to assess course effectiveness and to determine if a program meets predesignated objectives of knowledge acquisition and psychomotor technical skill.

Radiological versus histopathological diagnosis of usual interstitial pneumonia in the clinical practice: does it have any survival difference?

BACKGROUND: Recent studies have shown that quantification of specific histopathologic features found in usual interstitial pneumonia (UIP) are useful in defining a prognosis, suggesting the need of biopsy in all patients. OBJECTIVES: This study examines whether UIP-associated mortality is different in patients diagnosed by high-resolution computed tomography (HRCT) features considered definite of UIP and in patients with no definite radiological diagnosis that required histological confirmation of diagnoses. METHODS: Forty-five patients were included (30 males, mean age 65.3 +/- 10.7 years). Two groups of patients were identified: those with HRCT findings of definite UIP (n = 26) and those whose radiological diagnosis was not definite and required a surgical biopsy to confirm the presence of UIP (n = 19). Forced vital capacity, forced expiratory volume in 1 s and diffusing capacity for carbon monoxide were measured in all patients. All data were obtained from medical records, and the survival status was obtained by telephone or personal interview. All clinical parameters and HRCTs were obtained within 1 month before surgical lung biopsy. RESULTS: Median survival was not different across groups and was similar to that previously reported (35 months). Kaplan-Meier analysis did not show any difference in 5-year survival between both groups. CONCLUSIONS: In a clinical context in which the diagnosis of UIP can be obtained as a dynamic process that includes an integrated clinical, radiological and pathologic approach, a reliable diagnosis of UIP can be obtained based on a typical definite HRCT with no risk of including patients with a more benign disease and a more prolonged survival.

[Initial experience in the attention of patients with COVID-19 in a private third-level hospital in Buenos Aires City]. / Experiencia inicial en la atención de pacientes con COVID-19 en un hospital privado de alta complejidad de la Ciudad de Buenos Aires.

Infection with the SARS coronavirus type 2 (COVID-19) has a variety of presentations, with little data on the evolution of affected patients in Argentina. This is a retrospective and observational study of patients with virological confirmation of coronavirus treated during the months of March to May in a private third-level university hospital in Buenos Aires. O ne hundred and fifty-five adult patients were included, of which 30.3% attended only for a swab; 59.4% were admitted to the hospital and 10.3% were hospitalized at home with daily telephone follow-up. Fifty-four point two percent of participants were women and the median age was 35 years (ICQ 29 to 50). About 59.3% of patients had some risk factor, including age (65 years old or more), underlying chronic disease, were health workers or personnel/residents in a nursing home. The most frequent symptom was fever (75.9%), followed by cough (65.7%), and odyno phagia (48.2%). Globally, 93.5% experienced some symptoms while 17.6% of the participants presented some symptoms but without fever. Chest tomographies were performed to 5 patients. Their chest radiograph was normal or non-diagnostic. Fourteen patients required intensive therapy and 6 of them required mechanical ventilation, 4 of them died. The remaining 2 patients were referred to chronic care centers. No patient with home hospitalization required admission to hospital or died. While this observation is encouraging, it will need to be confirmed with new studies.

La infección por COVID-19 tiene presentaciones variadas, siendo aún escasos los datos de evolución de pacientes afectados en Argentina. Este es un estudio retrospectivo, observacional de pacientes con confirmación virológica de coronavirus atendidos entre marzo y mayo 2020 en un hospital privado universitario de tercer nivel de Buenos Aires. Se incluyeron 155 pacientes adultos de los cuales 47 (30.3%) concurrieron solo para realizarse un hisopado; 92 (59.4%) fueron internados en el hospital y 16 (10.3%) tuvieron internación domiciliaria con seguimiento telefónico diario. El 54.2% fueron mujeres con mediana de edad de 35 años (rango intercuartil [RIC] 29 a 50). El 59.4% (92) tenían algún factor de riesgo, incluyendo edad igual o mayor a 65 años, enfermedad crónica predisponente, eran personal de salud o trabajaban/residían en geriátrico. En los 108 que tuvieron seguimiento, el síntoma más frecuente fue fiebre (75.9%), seguido de tos (65.7%), y odinofagia (48.2%). La odinofagia fue más frecuente en mujeres (p = 0.035) y la disnea en hombres (p = 0.014). El 93.5% de los participantes (101) experimentaron síntomas, mientras que 17.6% (19) presentó algún síntoma, pero encontrándose afebriles. En 5 participantes a los que se les realizó una tomografía se observó que la radiografía había sido normal o no diagnóstica. Catorce pacientes requirieron terapia intensiva y 6 de ellos necesitaron ventilación mecánica, falleciendo cuatro. Los 2 pacientes restantes fueron derivados a centros de cuidados crónicos. Ningún paciente con internación domiciliaria requirió ser hospitalizado ni falleció. Si bien esta observación resulta alentadora, deberá ser confirmado en nuevos estudios.

Lung cancer as a second primary malignancy: increasing prevalence and its influence on survival.

BACKGROUND: The purpose of this study was to review the experience with lung cancer as a second primary malignancy (LCSPM) and to determine whether a history of previous malignancy was an independent prognostic factor in resected non small cell lung cancer (NSCLC). METHODS: We included 414 patients undergoing pulmonary resection with a curative intention between January 1986 and January 2007. The criteria for classifying a lesion as a lung cancer as a second primary malignancy (LCSPM) were a different histological type or a tumor of identical histological type occurring more than 3 years after treatment of the primary tumor, or separated from the initial primary tumor by more than 2 cm of clinically normal epithelium. RESULTS: Thirty-four patients (8.2%) had a history of a previous malignancy. LCSPM were more frequent during the last decade (11.4% vs. 3.91%, P = .0009). Breast, uroepithelial, and lung cancer were the most prevalent initial primary tumors. In 64.7% of patients the time interval between the last malignancy and the current lung cancer was 2 years or shorter. Patients with NSCLC and a previous malignancy did not have a significantly different survival rate than patients with the current NSCLC as the first malignancy (5-year survival 65.3% vs. 58.6%, log-rank P = .416). CONCLUSION: The effectiveness of the surgical resection and the subsequent survival of these patients appear to be well demonstrated, and operative mortality and complications are no higher than for other lung cancer patients.

Patterns of pulmonary function in smoking and nonsmoking patients with progressive systemic sclerosis.

Pulmonary involvement is a prominent feature in systemic sclerosis and a significant cause of morbidity and mortality. A restrictive ventilatory defect is typical and static lung volumes are usually reduced in patients with ILDs. The possibility of obstruction of small airways in progressive systemic sclerosis (SSc) has been suggested by widespread bronchiolectasis and peribronchial fibrosis noted at necropsy. A total of 46 patients with a diagnosis of SSc were retrospectively included in this study. Patients were classified according to their smoking status (never smokers, n = 34 and ex or current smokers, n = 12). Patients were also compared on the basis of the presence or not of an obstructive pattern on spirometry. The purpose of this study was to establish if SSc patients who are smokers have a different pattern of pulmonary function involvement. Our hypothesis was that smoking habit was not the only cause of air trapping and that the existence of small airway involvement secondary to SSc itself cannot be excluded.

[Wegener's granulomatosis and tuberculosis. A bad combination]. / Granulomatosis de Wegener y tuberculosis. Una mala combinación.

Wegener's disease is a vasculitis of small and medium-sized vessels associated with anti-neutrophil cytoplasm antibodies (ANCA). Within their target organs the lungs are involved in 85% of cases. Many entities are part of the differential diagnosis, including pulmonary tuberculosis. We present the case of a 54 years old man, diagnosed as Wegener's disease in 1996 which begins in August 2007 with cough, hemoptysis, progressive dyspnea on effort and serial sputum positive for AFB and then starts TB treatment. Subsequent bronchoalveolar fluids resulted negative for AFB. The patient evolved with impaired renal function, palpable purpura and positive anti-neutrophil cytoplasm antibodies cytoplasmic pattern (c-ANCA), interpreted as Wegener's disease relapse. He started hemodialysis and immunosuppressive therapy and tuberculosis treatment was stopped. One month after discharge was readmitted with a similar picture with serial sputum positive for AFB.