TB in the elderly: clinical features and outcomes.

BACKGROUND: TB in low-incidence countries is characterised by changes in age distribution towards larger numbers of cases among the elderly.OBJECTIVES: To investigate clinical features and outcomes of TB treatment in older patients and identify predictors of poor outcome.METHODS: Multicentre retrospective study of new TB cases from 53 hospitals included in the registry of the Integrated Tuberculosis Research Programme of the Spanish Society of Pulmonology and Thoracic Surgery (Sociedad Española de Neumología y Cirugía Torácica) between 2006 and 2020.RESULTS: We identified 731 patients aged ≥75 years from a cohort of 7,505 patients with TB. In the elderly, weight loss, disseminated disease and normal X-rays or infiltrates without cavitation were more common. All-cause mortality was 16% (5% of deaths due to TB). The elderly had higher rates of toxicity (6.7%) and hospital admissions (36%). In the multivariate analysis of predictors of TB mortality in ≥75-year-olds, only weight, age and treatment with non-standard regimens remained significant.CONCLUSIONS: TB in older patients needs more attention and remains a challenge because of a lack of specific clinical and radiological features. Standard treatment is effective, although mortality is higher than in young patients. Low weight, non-standard regimens and age are significant predictors of TB mortality.

Prevention and treatment of tuberculosis infection in candidates for biologic therapy: A multidisciplinary consensus statement adapted to the dermatology patient. / Consenso multidisciplinar sobre prevención y tratamiento de la tuberculosis en pacientes candidatos a tratamiento biológico. Adaptación al paciente dermatológico.

Patients with chronic inflammatory diseases being treated with immunosuppressive drugs, and with tumor necrosis factor inhibitors in particular, have an increased risk of infection by Mycobacterium tuberculosis. Screening for latent tuberculosis infection and preventive therapy to reduce the risk of progression to active tuberculosis are mandatory in this group of patients. This updated multidisciplinary consensus document presents the latest expert opinions on the treatment and prevention of tuberculosis in candidates for biologic therapy and establishes recommendations based on current knowledge relating to the use of biologic agents.

FXa inhibition by rivaroxaban modifies mechanisms associated with the pathogenesis of human abdominal aortic aneurysms.

AIMS: To evaluate if rivaroxaban, an oral factor Xa (FXa) inhibitor, could modify the expression in vitro of inflammatory and oxidative stress biomarkers in abdominal aortic aneurysmal (AAA) sites showing intraluminal thrombus. METHODS: AAA sites with intraluminal mural thrombus were obtained from six patients undergoing elective AAA repair. In addition, control abdominal aortic samples were obtained from six organ donors. AAA sites were incubated in the presence and absence of 50 nmol l-1 rivaroxaban. RESULTS: AAA sites showing thrombus demonstrated higher content of FXa than control. Interleukin-6 levels released from AAA [Control: median: 23.45 (interquartile range: 16.17-37.15) vs. AAA: median: 153.07 (interquartile range: 100.80-210.69) pg ml-1  mg tissue-1 , P < 0.05] and the expression levels of nitric oxide synthase 2 were significantly higher in AAA than in control. The protein expression level of NADPH oxidase subunits gp67-and gp91-phox, but did not gp47-phox, were also significantly higher in the AAA sites than in control. Addition of rivaroxaban to AAA sites explants significantly reduced the release of interleukin-6 [median: 51.61 (interquartile range: 30.87-74.03) pg ml-1  mg tissue-1 , P < 0.05 with respect to AAA alone] and the content of nitric oxide synthase 2, gp67 and gp91-phox NADPH subunits. The content of matrix metallopeptidase 9 was significantly higher in the AAA sites as compared to control. Rivaroxaban also reduced matrix metallopeptidase 9 content in AAA sites to similar levels to control. CONCLUSIONS: FXa inhibition by rivaroxaban exerted anti-inflammatory and antioxidative stress properties in human AAA sites, suggesting a role of FXa in these mechanisms associated with the pathogenesis of AAA.

[Results and complications of pertrochanteric hip fractures using an intramedullary nail with a helical blade (proximal femoral nail antirotation) in 200 patients]. / Resultados y complicaciones de la osteosíntesis de fracturas pertrocantéreas de fémur mediante clavo endomedular con espiral cefálica (clavo femoral proximal antirrotación) en 200 pacientes.

OBJECTIVES: Evaluation of the surgical management, outcome and complications in patients with pertrochanteric fractures treated with PFNA nail. MATERIAL AND METHOD: A retrospective study was conducted on 200 patients treated consecutively between April 2010 and February 2012. Radiological assessments were performed before and after the surgery, and during the follow-up (fracture reduction, blade position, consolidation or collapse signs). A clinical evaluation was performed as regards walking capabilities. The results were compared with those of a previous study on 700 patients treated with gamma 3 and TFN nails. RESULTS: The blade position was centre-centre in 64% of patients, and decreased to 53% in the mechanical complications group. Tip-apex distance was less than 25mm in 91.5%. The average hospital stay was 9.17 days, with a mean post-surgery stay of 5.95 days. Complications (7.5%): 2 cut out (1%), one cut through (0.5%), 4 cases of helical blade sliding (2%), one failure in distal locking procedure (0.5%), 2 cases with painful fasciae latae (1%), one union delay (0.5%), 2 cases of non-union with hardware failure (1%), one case of intense bleeding related to distal locking of the nail (0.5%), and one case of avascular necrosis (0.5%). CONCLUSIONS: The PFNA helical blade system seems to reduce the incidence of cut out and cut through in osteoporotic bone. Blade position was one of the main parameters associated with mechanical complications.

[Angina-like chest pain due to gastric anisakiasis]. / Dolor torácico como manifestación inicial de anisakiasis gástrica.

The chest pain is one of the most common reasons for consultation of the patients seen in the emergency services of hospitals. Still being the acute coronary syndrome one of the first causes to confirmed by its important repercussions, we do not have to forget other reasons. We report a case of acute anginalike chest pain due to gastric anisakiasis. The larvae of Anisakis in the gastric mucosa were found and extracted endoscopically. Gastric anisakiasis should be included in the differential diagnosis of acute chest pain.

Airways reactivity, atopy and bronchoalveolar lavage in male smokers with airflow obstruction.

Although cigarette smoking plays a major role in the development of chronic obstructive pulmonary disease, risk factors that might predispose susceptible smokers to develop manifest airflow obstruction are poorly defined. The aim of this study was to investigate whether BAL cell profiles, bronchial hyperresponsiveness, and atopy were different in smokers with and without airway obstruction. Fifty-seven current smokers with (n = 22) and without airflow obstruction (n = 35), defined spirometrically, and 8 nonsmoking subjects (controls) were studied (fiberoptic bronchoscopy and bronchoalveolar lavage (BAL), measurement of IgE concentrations and skin prick testing with common allergen extracts, methacholine bronchoprovocation testing). Mean values of forced expiratory volume in 1 s (FEV1) percent predicted were significantly lower in smokers with obstruction than in those without obstruction (53.1 +/- 16.9 vs. 72.5 +/- 16.6, p < 0.001). Smokers with airflow obstruction showed an improvement in FEV1 < 20% after inhalation of two puffs of 0.250 mg terbutaline. Current smokers as opposed to controls had significantly (p < 0.01) higher values of cells/ml in BAL (78 +/- 72.4 x 10(4) vs. 28.7 +/- 14.5 x 10(4)) and macrophages (90.5 +/- 19.4 vs. 84.3 +/- 9.3%) and lower values of lymphocytes (5.4 +/- 15.4 vs. 13.1 +/- 10.7%). Smokers with obstruction to airflow showed significantly (p < 0.05) higher values of cells/ml in BAL (102 +/- 88 x 10(4)) than smokers without airflow obstruction (63.4 +/- 57.5 x 10(4)) with no differences in differential cell counts. The provocation concentration of methacholine producing a 20% reduction in FEV1 (PC20) was also lower in smokers with obstruction than in smokers without obstruction (2.9 +/- 3.5 vs. 6.4 +/- 7.2 mg/ml, p < 0.05). Differences in atopy were not found. In summary, current smokers with airflow obstruction tended to have more cells recovered by BAL and greater airway responsiveness than smokers without obstruction, although atopy-related parameters were not different for both groups.

[Localized tracheobronchial amyloidosis. The usefulness of computed tomography]. / Amiloidosis traqueobronquial localizada. Utilidad de la tomografía computarizada.

Tracheobronchial amyloidosis is the most common form of localized bronchopulmonary amyloidoses, although its diagnosis is rare in daily practice. We describe two new cases of localized tracheobronchial amyloidosis, one in the form of a single node and one diffuse. We discuss in particular the contribution of computed axial tomography, mainly for diagnosing the diffuse form, in which a finding of a thickened tracheobronchial wall and intraluminal nodes should lead to the suspicion of this entity. The treatment of choice in most cases is resection with an Nd-YAG laser.

Clinical utility of hyaluronic acid values in serum and bronchoalveolar lavage fluid as tumor marker for bronchogenic carcinoma.

Various authors have proposed the use of hyaluronic acid (HA) as a tumor marker. In order to analyze its usefulness as a marker in bronchogenic carcinoma, the most common carcinoma in men, we determined the HA values in serum and bronchoalveolar lavage fluid (BAL). We performed prospective studies on two groups of patients: 81 diagnosed as having bronchial carcinoma and 34 with benign respiratory diseases. HA values were higher in patients with cancer than in those with benign diseases (serum: 79.8 ng/ml vs 63.7 ng/ml; BAL: 927 ng/mg vs 522 ng/mg). Also, the percentage of patients with levels exceeding the established cutoff was greater in the group with cancer than in the group with benign disease (serum: 24.6 vs 17.6; BAL: 25.3 vs 3). Statistically significant differences in these percentages were found in BAL (p<0.01). Patients with extended small cell carcinoma had higher HA values (p =0.04) than those with limited disease, and the percentage of patients with abnormal HA values was larger in the group with extended disease than in the group with limited disease (p = 0.004). The serial determinations of HA values in serum reflected the clinical evolution after treatment in 73% of the small cell carcinomas. Most of the patients with benign diseases whose HA values exceeded the cutoff level suffered from acute infectious dis-eases. Once these cases were excluded, the specificity of HA value determination in the diagnosis of carcinoma was very high (serum 96%, BAL 100%). The determination of HA levels in serum or BAL did not have any prognostic value in this study. We conclude that the HA levels in serum and BAL could be of interest as a tumor marker, especially in patients with small cell carcinoma.

[Pulmonary interstitial disease due to hemochromatosis as a presenting sign of disease]. / Afectación intersticial pulmonar por hemocromatosis como forma de presentación de la enfermedad.

We present a patient with hemochromatosis whose first sign of disease was an accidental finding of interstitial patterns on a chest film and whose transbronchial biopsy showed traces of iron (Fe) in alveolar macrophages and septal matter. We then looked for deposits in other locations, finding Fe ([+]: 6.964 micrograms) in the dry weight of a cylindrical sample of liver tissue. A Medline search on CD-ROM for 1989 through May of 1994 revealed no references to similar cases.

[Spontaneous pneumothorax as the only initial manifestation of bronchogenic carcinoma]. / Neumotórax espontáneo como única manifestación inicial del carcinoma broncogénico.

We present the case of a patient with spontaneous pneumothorax associated to pulmonary epidermoid carcinoma, which was not radiologically visible after pulmonary reexpansion. Neither it was macroscopically detected in the first thoracotomy performed for the treatment of the pneumothorax, being diagnosed after the histological study of the resected blisters. The association between pneumothorax and lung cancer is very rare, especially in the absence of other radiological disorders suggesting neoplasia after the pulmonary reexpansion. In these cases, the diagnosis is extremely difficult and it must be always suspected in patients with spontaneous pneumothorax and risk factors for pulmonary cancer.

[Acute pericarditis as the initial presentation of a primary cardiac angiosarcoma. The anatomicoclinical correlations]. / Pericarditis aguda como presentación inicial de un angiosarcoma primario cardíaco. Correlaciones anatomoclínicas.

We report the clinic and postmortem pathologic examination of a 38-years-old man with a primary angiosarcoma of right atrium and many widespread metastatic. Both his presentation, a clinical course of acute pericarditis self-limited, as the negatives complementary examination, give at case unusual characteristics, for his high malignancy.

[Primary angiosarcoma of the spleen]. / Angiosarcoma primitivo de bazo.

Primary spleen angiosarcoma is a malignant neoplasia based on vascular tissue and it is a rare tumor (65 cases published). The clinical aspects are obscure and the specific diagnosis is made by laparotomy. The prognosis is very poor in any case and survival isn't more than two years, whenever the spleen undergoes spontaneous rupture in which case the survival should be less than six months. The splenectomy before rupture could increase survival. Patients with or without metastatic disease may be treated by chemotherapy but with poor results. Radiotherapy is used for relief the pain produced for bone metastasis.