Linfoma primario difuso de células B grandes que debuta como masa paravertebral izquierda con infiltración medular / No disponible

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Impact of the Xpert(®) MTB/RIF molecular test on the late diagnosis of pulmonary tuberculosis.

We analysed the impact of the Xpert(®) MTB/RIF molecular test on health-care diagnostic delay among tuberculosis patients. Diagnostic delay was 17.2 days (standard deviation 23.2, median 10 days). Of 128 patients recruited into the study, 60 (47%) were smear-negative; of these, 40 (67%) were Xpert-positive and were started on treatment without culture. The sensitivity of smear microscopy was 53% compared with 82% for Xpert. In smear-negative patients, delay in Xpert-positive and -negative patients was respectively 15.5 ± 13.2 and 25.5 ± 12.5 days (P = 0.002). We conclude that Xpert results were significantly associated with shorter health-care diagnostic delay, particularly in smear-negative patients.

Primary pulmonary botryomycosis: a bacterial lung infection mimicking lung cancer.

Primary pulmonary botryomycosis, or bacterial pseudomycosis, is an unusual bacterial infection characterised by the formation of eosinophilic granules that resemble those of Actinomyces species infection. The diagnosis of botryomycosis is based on culture of the granules revealing gram-positive cocci or gram-negative bacilli. The bacterial pathogen most frequently found is Staphylococcus aureus. The pathobiology remains unknown. Pulmonary botryomycosis can resemble actinomycosis, tuberculosis or invasive carcinoma. Definitive treatment requires a combination of both surgical debridement and long-term antimicrobial therapy. We present a case of primary pulmonary botryomycosis in an immunocompetent patient.

Necrotising pneumonia caused by Lactococcus lactis cremoris.

Lactococcus lactis cremoris is a facultative anaerobic, gram-positive coccus whose natural host is bovine livestock. It may form part of the normal human bacterial flora found in the oropharynx, the gastrointestinal tract and the vagina. This bacterium is essential in the food industry, where it is used in milk fermentation to obtain cheese, yoghurt, etc. Exposure to unpasteurised dairy products has thus been recognised as a risk factor for infection by this organism. It is generally considered to be non-pathogenic, although it appears that pathogenicity may be emerging. We present an atypical case of necrotising pneumonia caused by L. lactis cremoris.

Conocimientos actuales de la etiopatogenia del asma / Current knowledge on the etiopathogeny of asthma

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Corticoides inhalados: ¿a quién y cuándo? / No disponible

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Pruebas de ejercicio cardiopulmonar / Cardiopulmonary stress testing

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[Dysphonia produced by corticoid inhalation: truth or myth?]. / Disfonía producida por corticoides en inhalación: verdad o mito?

One of the undesirable side-effects usually related to the administration of inhaled corticoids is the development of dysphonia. This association has been attributed to the effect of the corticoid on vocal muscles. We present 5 asthma patients who all developed dysphonia at some time. All were examined by video laryngostroboscope. Abundant mucus on the vocal cords was observed in 4 patients, and small vocal nodules as well as mucus was seen in 2. We believe that dysphonia is transitory in these patients and is related to the presence of mucus that prevents correct closure of the glottis. Corticoids are not only not contraindicated in such cases, but their continued use would also benefit the condition of dysphonia as asthmatic inflammation improves.

[Comparison of the rapidity of action of dry-powder inhaler vs pressurized aerosol terbutaline]. / Comparación de la rapidez de acción de terbutalino en inhalador de polvo seco con el aerosol presurizado.

The speed of bronchodilatation with terbutaline administered through the Turbuhaler system and the same drug administered through a pressurized liquid aerosol device was compared in 9 patients with reversible air flow obstruction. On 2 consecutive days, terbutaline 0.5 mg in aerosol or dry-powder form (Turbuhaler) was administered after baseline spirometric measurements were taken. Spirometry was repeated at 15, 45 and 90 s and at 3, 5, 10, 15, 30, 60 and 120 min after administration of the drug. Both forms of presentation produced approximately 50% of their maximum effect within the first 45 s; 80% of the patients in the dry-powder group reached the mean of maximum FEV1 increase at 10 min, while 83% in the pressurized-aerosol-device group did so. The maximum increase was reached at 52 (54) min with the Turbuhaler and at 69 (50) min for the aerosol. The difference in speed of effect for the two pharmaceutical forms were not statistically significant. The administration of terbutaline in powder form (Turbuhaler) was as fast and effective in achieving bronchodilatation as was the aerosol form.