Lesión pulmonar de etiología micobacteriana / Pulmonary injury of mycobacterial etiology

Mycobacterium lentiflavum infrecuentemente provoca patogenicidad en el ser humano, aunque se ha descrito como causante de linfadenitis cervical y afectación pulmonar. Generalmente presenta un curso clínico poco agresivo y se asocia un patrón radiológico nódulo-bronquiectásico. En nuestro caso relatamos un paciente con clínica respiratoria inespecífica y presencia de bronquiectasias y lesiones de morfología pseudonodular en la tomografía computarizada (TC) torácica. En la TC torácica de control y tomografía por emisión de positrones (PET) se evidenció aumento de tamaño y del metabolismo de dichas lesiones. Se realiza biopsia para descartar malignidad creciendo en cultivo de la muestra Mycobacterium lentiflavum

Mycobacterium lentiflavum infrequently causes pathogenicity in humans, although it has been identified as causing cervical lymphadenitis and lung involvement. It usually has a poorly aggressive clinical course and a nodule-bronchiectatic radiological pattern is associated. In our case, we report a patient with a nonspecific respiratory clinic and presence of bronchiectasis and pseudonodular morphology lesions in thoracic computed tomography. In the thoracic CT scan of positron emission tomography (PET) there was evidence of an increase in the size and metabolism of these lesions. Biopsy is performed to rule out malignancy, with Mycobacterium lentiflavum growing in sample culture

Sedación con propofol suministrado mediante perfusión controlada por objetivo durante la realización de broncoscopia flexible / Sedation with propofol supplied by perfusion controlled by objective during the realization of flexible bronchoscopy

No disponible

Diagnóstico broncográfico y tratamiento endoscópico con Bioglue® de fuga aérea persistente en paciente con carcinoma escamoso de pulmón / No disponible

Las fistulas broncopleurales suponen un reto terapéutico para el neumólogo, siendo un campo en crecimiento para la neumología intervencionista. El espectro de pacientes que presentan esta patología es amplio y suele estar acompañado de la presencia de comorbilidades que limitan el tipo de abordaje, contraindicando en ocasiones el tratamiento quirúrgico. Presentamos el caso de un paciente diagnosticado de una neoplasia pulmonar en tratamiento activo con inmunoterapia diagnosticado mediante tomografía axial torácica y broncografía selectiva, y tratado de forme exitosa en un segundo tiempo mediante técnicas endoscópicas (AU)

The bronchopleural fistulas represent a therapeutic challenge for the pulmonologist, being a growing field for interventional pneumology. The spectrum of patients with this pathology is broad and is usually accompanied by the presence of comorbidities that limit the type of approach, sometimes contraindicating the surgical treatment. We present the case of a patient diagnosed with pulmonary neoplasia under active treatment with immunotherapy diagnosed by thoracic axial tomography and selective bronchography, and successfully treated in a second time by endoscopic techniques (AU)

Aspiración de un cuerpo extraño insólito: Un riesgo evitable / Aspiration of an unusual foreign body: an avoidable risk

La aspiración de cuerpos extraños (ACE) en el árbol traqueobronquial es un problema común en niños, especialmente en los menores de tres años de edad, que puede causar complicaciones potencialmente mortales. A continuación presentamos un caso clínico de una aspiración de un cuerpo extraño insólito, describimos su curso evolutivo y las implicaciones en términos de salid pública que generó (AU)

Foreign body aspiration (FBA) in the tracheobronchial tree is a common problem in children, especially those under three years old, which can cause life-threatening complications. We present a case of foreign body unusual aspiration and describe its outcome and implications in terms of public health generated (AU)

Actualización en el nódulo pulmonar solitario / No disponible

No disponible

Hamartoma endobronquial. Resección con fibrobroncoscopio / No disponible

No disponible

[Overall long-term survival in lung cancer analyzed in 610 unselected patients]. / Supervivencia global a largo plazo en el cáncer de pulmón. Análisis de una serie de 610 pacientes no seleccionados.

INTRODUCTION AND OBJECTIVES: Many studies of lung cancer survival are carried out in patients selected for certain features that usually influence prognosis favorably. The objective of this study was to assess the overall survival of unselected patients with a diagnosis of lung cancer in our practice. PATIENTS AND METHODS: We studied 610 patients for whom survival information was available, a population comprising 88% of the 694 with lung cancer diagnosed in our hospital from 1991 through 1998. The variables analyzed for their correlation with survival were age, sex, histology, tumor-node-metastasis (TNM) stage, treatment, and time of diagnosis (with patients grouped by 2-year periods). RESULTS: The cases of 596 men and 14 women with a mean age of approximately 67 years were studied. Small cell tumors were found in 141, non-small cell tumors in 447, and other tissue types in 22. Surgical excision was carried out on 118 (19.3%), and treatment was confined to control of symptoms for 6.4% of the patients with small cell tumors and 40.5% of those with non-small cell cancer. Symptomatic treatment alone was more common for patients older than 70 years (52.5%) and less common during the last 2 years of the study period (1997-1998: 19%). Overall 5-year survival was 7.9% (2.8% in small cell cancer and 9.4% in non-small cell cancer). Survival rates were lower in patients over 70 years of age. Significant differences in survival were seen for successive TNM stages, with the exception of IIIA and IIIB. The 1997-1998 period saw better survival rates, at 40.8% after 1 year and 11.2% after 5 years. CONCLUSIONS: The survival rates in lung cancer patients in our hospital practice are low because the rate of surgical resections is low owing to the high percentage of cases found in advanced stages. Our observations are similar to those reported from other European countries.

[Sleepy drivers have a high frequency of traffic accidents related to respiratory effort-related arousals]. / Los conductores somnolientos tienen alta frecuencia de accidentes de tráfico asociados a exceso de RERA.

INTRODUCTION: Respiratory effort-related arousals (RERA) are secondary to subtle obstructions of the upper airway during sleep and can appear in the absence of a predominance of apneas and hypopneas, causing excessive daytime sleepiness. Analyzing the possible consequences of these new respiratory events is of increasing interest. Habitually sleepy drivers are at high risk of having traffic accidents related to sleep disorders (apneas, hypopneas and RERA). OBJECTIVE: The aim of this study was to determine whether excess RERA alone is an independent risk factor among sleepy drivers. METHOD: We studied 40 habitually sleepy drivers and 23 age- and sex-matched controls selected from a sample of 4,002 automobile drivers. We surveyed sleep habits, daytime sleepiness and traffic accidents. Sleep studies of esophageal pressure were performed. RESULTS: The sleepy drivers with apneas (apnea/hypopnea index > 10) had a higher 5-year accident rate (0.33 0.50) than did control drivers (0.004 0.21; p < 0.05). However, a high RERA index, but not sleep apnea, was an independent risk factor among the habitually sleepy drivers. The adjusted odds ratio (OR) for a RERA index > or = 10 was 7.6 (confidence interval [CI], 1.2 to 48); for a RERA index > or = 15, the OR was 17 (CI 1.5 to 91). CONCLUSIONS: The high risk of traffic accidents among sleepy drivers is mainly determined by the presence of RERA rather than the presence of apneas and hypopneas. These findings verify the importance of identifying RERA in routine sleep laboratory studies.

Los conductores somnolientos tienen alta frecuenciade accidentes de tráfico asociados a exceso de RERA / Sleepy drivers have a high frequency of traffic accidents related to respiratory effort-related arousals

INTRODUCCIÓN: Los RERA (respiratory effort-related arousal) son secundarios a sutiles obstrucciones de la vía aérea superior durante el sueño, pueden aparecer sin predominio de apneas e hipopneas y causan somnolencia diurna excesiva. El análisis de las potenciales consecuencias de estos nuevos acontecimientos respiratorios tiene hoy un interés creciente. Los conductores habitualmente somnolientos tienen un riesgo alto de sufrir accidentes de tráfico asociados a trastornos respiratorios durante el sueño (apneas más hipopneas más RERA). OBJETIVO: El objetivo de este trabajo es determinar si exclusivamente el exceso de RERA es un factor independiente de riesgo de accidentes en los conductores somnolientos. MÉTODO: Estudiamos a 40 conductores habitualmente somnolientos y 23 controles (conductores no somnolientos) pareados por edad y sexo, y ambos extraídos de una muestra de 4.002 conductores de vehículos. Se estudiaron datos sobre hábitos de sueño, somnolencia diurna, accidentes de tráfico y se realizaron estudios de sueño con medida de presión esofágica. RESULTADOS: Los conductores somnolientos con apneas de sueño tienen una tasa de accidentes en 5 años mayor que los controles (índice de apneas-hipoapneas [IAH] > 10; 0,33 ñ 0,50 frente a 0,004 ñ 0,21 en los controles; p < 0,05), pero sólo el exceso de RERA y no el de apneas de sueño fue un factor independiente de riesgo de accidentes en conductores somnolientos. La odds ratio (OR) ajustada para un índice de RERA 10 fue de 7,6 (intervalo de confianza [IC] del 95 por ciento, 1,2-48) y para un índice de RERA 15 fue de 17 (IC, 1,5-91).CONCLUSIONES: El alto riesgo de accidentes de tráfico de los conductores somnolientos viene principalmente determinado por la presencia de RERA más que por la presencia de apneas e hipopneas de sueño. Estos datos ratifican la importancia y la necesidad de identificar RERA en la práctica habitual de los laboratorios de sueño (AU)

Punción transbronquial aspirativa / Transbronchial needle aspiration

No disponible

[Diagnostic utility of carcinoembryonic antigen, neuron-specific enolase and squamous cell carcinoma antigen in malignant pleural effusion]. / Utilidad del antígeno carcinoembrionario, enolasa neuroespecífica y antígeno de células escamosas (en líquido pleural y suero) en el diagnóstico del derrame pleural maligno.

We evaluated the diagnostic utility of the carcinoembryonic antigen (CEA), neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC Ag.) in malignant pleural effusion (MPE). CEA, NSE and SCC Ag, blood and pleural levels were quantified by enzyme immunoassay (EIA) in 85 patients with pleural effusions: 35 non malignant pleural effusions, and 50 MPE; 42 with lung carcinoma (LC), and 8 with extrapulmonary carcinoma. The sensitivity and specificity was compared to cytological results of the pleural fluid. The sensitivities of CEA7 NSE and SCC Ag. (in pleural fluid) were 59.5%, 48.7% and 16.7% respectively in patients with LC (specificity higher than 90%). Using a combination with CEA and NSE, the sensitivity reached 80.9% (specificity, 91.4%). The cytology of pleural fluid was positive in 45.2%. The pleural/blood ratios did not improve the diagnostic performance. In patients with extrapulmonary carcinoma, the sensitivity of these tumor markers was lower. The combination of CEA and NSE pleural levels is useful in the diagnostic approach to the patient with pleural effusion. A high level of NSE is suggestive of small cell lung cancer (SCLC).

Nasal intermittent positive pressure ventilation. Analysis of its withdrawal.

Nasal intermittent positive pressure ventilation (NIPPV) applied during sleep has been demonstrated to be useful in the treatment of restrictive thoracic diseases (RTD). The purpose of this study was to evaluate the repercussions of a withdrawal period from NIPPV of 15 days. This would be sufficient time for patients to go on trips without the respirator. It was hypothesized that once daytime improvement was achieved and was stable, it could be maintained for this period of time. Five volunteer patients with severe RTD who had been receiving treatment with nocturnal NIPPV for at least 2 months before and who had improved at least 5 mm Hg in daytime PO2 and PCO2 were included in the study. No significant differences were disclosed clinically or with arterial blood gas levels, spirometry results, lung volumes, airway resistances, or maximal muscle pressures 15 days following the withdrawal. However, in the sleep studies, a severe worsening of gas exchange was observed, mainly during rapid eye movement (REM) sleep, as well as a trend toward a more disturbed sleep pattern and more important alterations in cardiac rhythm. Consequently, withdrawing the treatment with nocturnal NIPPV cannot be recommended, at least for this particular removal period. Moreover, alterations in daytime gas exchange were found to originate in those produced during REM sleep through the blunting of the respiratory center to CO2. The NIPPV obstructs this mechanism, preventing the deterioration of gas exchange during sleep.

[The usefulness of serum neuron-specific enolase in the clinical management of small-cell lung carcinoma]. / Utilidad de la enolasa neuroespecífica sérica en el manejo clínico del carcinoma microcítico de pulmón.

The utility of neuron-specific enolase (NSE) for the diagnosis and management of small cell lung cancer (SCLC) is analyzed. Serum concentrations of NSE were measured in 69 healthy adults, 106 patients with non-neoplastic pneumopathy (NNP), 16 with pulmonary metastasis of extrapulmonary origin (PMEO), 126 with non-small cell lung cancer (NSCLC), and 77 with SCLC. Repeated analyses were carried out for patients in the last group during and after treatment, and survival time was recorded. NSE was high in 77.6% of patients with SCLC [50% in cases with limited disease (LD) and 93.6% in those with extensive disease (ED)]. NSE was high in 10.3% of those with NSCLC, in 11.5% of those with PMEO, and in 2.8% of those with NNP. NSE decreased 100% in SCLC patients achieving full remission after treatment and in 25% of those responding poorly. Later, this marker increased in 81.2% of those experiencing relapse, and in 6.2% of these the increased preceded symptoms. Initial NSE concentrations had prognostic value (p = 0.003) that was independent of disease stage (LD or ED). NSE is of great diagnostic and prognostic value in SCLC, accurately reflecting tumor size. Posttreatment changes closely parallel disease activity.