A rapid calprotectin test for the diagnosis of pleural effusion.

In previous studies, measuring the levels of calprotectin in patients with pleural effusion (PE) was an exceptionally accurate way to predict malignancy. Here, we evaluated a rapid method for the measurement of calprotectin levels as a useful parameter in the diagnosis of malignant pleural effusion (MPE) in order to minimise invasive diagnostic tests. Calprotectin levels were measured with Quantum Blue® sCAL (QB®sCAL) and compared with the gold standard reference ELISA method. Calprotectin levels in patients with benign pleural effusion (BPE) were significantly higher (p < 0.0001) than for MPE patients. We measured the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LRs) for a cut-off value of ≤ 14,150 ng/mL; the diagnostic accuracy was 64%. The odds ratio for PE calprotectin levels was 10.938 (95% CI [4.133 - 28.947]). The diagnostic performance of calprotectin concentration was better for predicting MPE compared to other individual parameters. Comparison of two assays showed a slope of 1.084, an intercept of 329.7, and a Pearson correlation coefficient of 0.798. The Bland-Altman test showed a positive bias for the QB®sCAL method compared to ELISA fCAL®. Clinical concordance between both these methods was 88.5% with a Cohen kappa index of 0.76 (95% CI [0.68 - 0.84]). We concluded that QB®sCAL is a fast, reliable, and non-invasive diagnostic tool for diagnosing MPE and represents an alternative to ELISA that could be implemented in medical emergencies.

e-Consultation Improves Efficacy in Thoracic Surgery Outpatient Clinics. / La discusión de casos por videoconferencia mejora la eficiencia de la consulta externa de cirugía torácica.

OBJECTIVE: The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. METHOD: Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. RESULTS: The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). CONCLUSIONS: The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit.

Diagnosis and Treatment of Hemoptysis. / Diagnóstico y tratamiento de la hemoptisis.

Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located.

[Incidence of bronchopulmonary cancer in Castilla y Leon and Cantabria in the year 2007. A study by the Castilla y Leon and Cantabria Respiratory Diseases Society (SOCALPAR)]. / Incidencia del carcinoma broncopulmonar en Castilla y León y en Cantabria durante el año 2007. Estudio de la Sociedad Castellano-Leonesa y Cántabra de Patología Respiratoria (SOCALPAR).

INTRODUCTION: This study sets out to find out the incidence and other epidemiological characteristics of bronchopulmonary cancer in patients living in Cantabria and Castilla y Leon (Spain) and comparing the current data obtained in the last communities with that obtained 10 years ago in a similar study. PATIENTS AND METHODS: Prospective, multicentre study using information (age, sex, residence, smoking habits and histology) obtained from all patients diagnosed during the year 2007. RESULTS: A total of 1486 patients were included--1295 males (87.1%) and 191 females (12.9%)--, of whom 1145 lived in Castilla y Leon--1010 males (88.2%) and 135 females (11.8%)--, and 341 in Cantabria--285 males (83.6%) and 56 females (16.4%)--. The incidence rates per 100,000 inhabitants adjusted to the world standard population were significantly higher in Cantabria [29.53; (males: 52.9; females: 9.76)] than in Castilla y Leon [21.35; (males: 38.31; females: 5.58)]. A total of 90.24% were smokers (males: 96.12% and women: 49.17%). The main histology types were: squamous, 32, 82%; adenocarcinoma, 28.74%, and small cell carcinomas, 18.33%. In Castilla y Leon, from 1997 to 2007, the numbers went from 920 to 1010 in males and from 95 to 135 in females (a crude rate increase of 10.5% in males and 43% in females), and showed a decrease in squamous tumours and an increase in adenocarcinomas. CONCLUSIONS: The incidence rates of bronchopulmonary cancer in 2007 were significantly higher in Cantabria than those of Castilla y Leon. The 2007 rates in this community were higher than in 1997 in both males and females.