RESUMEN
BACKGROUND: The objective of the present study is to describe the characteristics of interstitial pneumonia with autoimmune features (IPAF) patients, to assess the incidence rate of functional respiratory impairment over time and to evaluate the influence of therapeutic alternatives on the prognosis of these patients. METHODS: A longitudinal observational multicenter study was performed (NEREA registry). It was carried out by a multidisciplinary team in seven Hospitals of Madrid. Patients were included from IPAF diagnosis. MAIN OUTCOME: poor prognosis as functional respiratory impairment (relative decline in FVC % defined as ≥ 5% every 6 months). Covariates: therapy, sociodemographic, clinical, radiological patterns, laboratory and functional tests. STATISTICS: Survival techniques were used to estimate IR per 100 patients-semester with their 95% confidence interval [CI]. The influence of covariates in prognosis were analyzed through cox multivariate regression models (hazard ratio (HR) and [CI]). RESULTS: 79 IPAF were included, with a mean and a maximum follow-up of 3.17 and 12 years respectively. Along the study, 77.2% received treatment (52 glucocorticoids, 25 mycophenolate, 21 azathioprine, 15 rituximab and 11 antifibrotics). IR was 23.9 [19.9-28.8], and 50% of IPAF developed functional respiratory impairment after 16 months from its diagnosis. Multivariate analysis: usual interstitial pneumonia (UIP) had poorer prognosis compared to non-specific interstitial pneumonia (NSIP) (p = 0.001). In NSIP, positive ANA, increased the risk of poor prognosis. In UIP, glucocorticoids (HR: 0.53 [0.34-0.83]), age (HR: 1.04 [1.01-1.07]), and Ro-antibodies (HR: 0.36 [0.19-0.65]) influenced the prognosis. CONCLUSIONS: IPAF have functional impairment during the first years of disease. Factors predicting deterioration differ between radiographic patterns. Our real-life study suggests the potential benefit of particular therapies in IPAF.
Asunto(s)
Enfermedades Autoinmunes , Neumonías Intersticiales Idiopáticas , Fibrosis Pulmonar Idiopática , Enfermedades Pulmonares Intersticiales , Insuficiencia Respiratoria , Humanos , Estudios Retrospectivos , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/epidemiología , Neumonías Intersticiales Idiopáticas/diagnósticoRESUMEN
The aim of this study was to analyze whether FeNO levels in acute exacerbation of COPD (AECOPD) with hospital admission have better diagnostic value than eosinophilia in blood, and to evaluate its usefulness in predicting a better clinical response. An observational prospective study of patients with AECOPD was carried out. FeNO determinations were made on arrival at the emergency room (ER), at discharge and during stability 3-6 months after discharge. Co-morbidities, bronchodilators, inhaled (IGC) and systemic (SGC) glucocorticoids, eosinophils, systemic inflammation markers (procalcitonin, C-reactive protein), eosinophil cationic protein, and total IgE were collected. Fifty consecutive patients (92% men, mean age 75 ± 6 years) were included in this study. Phenotypes were 26% Asthma-COPD Overlap Syndrome (ACOS), 42% chronic bronchitis (CB) and 32% emphysema. ACOS patients showed significantly higher levels of FeNO (73 ppb) and eosinophils (508 cells/mm3) than the rest (CB: 23 ppb, 184 cells/mm3, emphysema: 27 ppb, 159 cells/mm3; p < 0.05). A significant correlation between FeNO levels measured in ER and eosinophils was observed (r = 0.7; p < 0.001), but not at discharge or in stable phase. No significant association was found with parameters of systemic inflammation and mean stay. In conclusion, the determination of FeNO in AECOPD does not offer advantages over the evaluation of eosinophilia. These parameters rise at arrival in ER, descend at discharge, and remain unchanged in the stable phase. Both present similar diagnostic utility and are able to better identify the ACOS phenotype, which helps select a population that could benefit from a glucocorticoids therapy.
Asunto(s)
Asma/inmunología , Eosinofilia/inmunología , Óxido Nítrico/metabolismo , Enfermedad Pulmonar Obstructiva Crónica/inmunología , Anciano , Anciano de 80 o más Años , Asma/complicaciones , Asma/metabolismo , Asma/fisiopatología , Pruebas Respiratorias , Bronquitis Crónica/complicaciones , Bronquitis Crónica/inmunología , Bronquitis Crónica/metabolismo , Bronquitis Crónica/fisiopatología , Proteína C-Reactiva/inmunología , Progresión de la Enfermedad , Proteína Catiónica del Eosinófilo/inmunología , Eosinofilia/complicaciones , Eosinofilia/metabolismo , Eosinófilos , Femenino , Hospitalización , Humanos , Inmunoglobulina E/inmunología , Recuento de Leucocitos , Masculino , Óxido Nítrico/análisis , Polipéptido alfa Relacionado con Calcitonina/inmunología , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/metabolismo , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Enfisema Pulmonar/complicaciones , Enfisema Pulmonar/inmunología , Enfisema Pulmonar/metabolismo , Enfisema Pulmonar/fisiopatologíaRESUMEN
BACKGROUND: Mechanical thrombectomy is a useful technique in patients with high-risk pulmonary embolism. It is indicated as an alternative to systemic fibrinolysis when it is contraindicated or as an adjuvant therapy when it fails. OBJECTIVE: To describe clinical characteristics, evolution and survival of patients with high-risk pulmonary embolism who have undergone mechanical thrombectomy. METHOD: Single-center retrospective descriptive study of consecutive patients who underwent mechanical thrombectomy. Demographic, clinical and survival variables were analyzed. RESULTS: 9 patients were included (56% men, 44% women). All patients had pulmonary artery pressure assessed using a Swan-Ganz catheter before thrombectomy. The median pulmonary artery pressure before the procedure was 46mmHg (51-38mmHg). Systemic fibrinolysis was also performed in 5 cases, in 2 of them in the setting of cardiorespiratory arrest, without hemorrhagic complications. No patient died during hospitalization. Survival one month after the procedure was 100%. CONCLUSIONS: In our series, mechanical thrombectomy is a useful technique as an alternative to systemic fibrinolysis or as an adjuvant therapy to it.
Asunto(s)
Adenocarcinoma del Pulmón , Neoplasias Pulmonares , Síndrome de la Vena Cava Superior , Humanos , Síndrome de la Vena Cava Superior/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiología , Vena Cava Superior/diagnóstico por imagen , Adenocarcinoma del Pulmón/complicaciones , Adenocarcinoma del Pulmón/diagnóstico por imagen , Endosonografía , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagenAsunto(s)
Histiocitosis de Células de Langerhans , Humanos , Histiocitosis de Células de Langerhans/diagnóstico por imagen , Histiocitosis de Células de Langerhans/patología , Histiocitosis de Células de Langerhans/complicaciones , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Tomografía Computarizada por Rayos XRESUMEN
Pneumocystis in humans is caused by a unicellular and eukaryotic organism called P. jirovecii. The overall incidence of P. jirovecii pneumonia (PCP) has decreased with the use of highly active antiretroviral therapy and the use of chemoprophylaxis with trimethroprim sulfametoxazole (TMP/SMX) in cases of immunosuppressed patients. However, approximately 85% of patients with advanced HIV infections continue to experience this disease with inadequate management. Pneumocystis infection can present with spontaneous pneumothorax in 2-6% of cases [8] which can be a potentially fatal complication. We report the case of a 32-year-old man presented with P. jirovecii pneumonia who developed cystic lesions and spontaneous bilateral pneumothorax in spite of TMP/SMX treatment. We consider it an interesting clinical case because few simultaneous bilateral pneumothorax cases have been described directly related to the PCP.
RESUMEN
Bazex syndrome, or paraneoplastic acrokeratosis, is a rare psoriasis-like paraneoplastic skin disease, characterized by erythema and scaling, which is accompanied by hyperkeratotic lesions. The tumors most frequently associated with Bazex syndrome are squamous cell carcinomas of the upper respiratory and digestive tracts, whereas lung cancers, particularly adenocarcinomas, are rarely associated. We present a case in which both pulmonary adenocarcinoma and Bazex syndrome were present.