Características epidemiológicas y análisis de supervivencia en una consulta de cáncer de pulmón / No disponible

Objetivo: Nuestro objetivo principal es conocer la supervivencia de los pacientes diagnosticados de cáncer de pulmón (CP) en una consulta monográfica. Los objetivos secundarios son conocer sus características epidemiológicas y los tiempos de demora hasta el diagnóstico y tratamiento. Pacientes y método: Estudio retrospectivo de las características epidemiológicas y análisis de supervivencia de los pacientes diagnosticados de cáncer de pulmón. Para la comparación de medias se utilizó la U de Mann Whitney. Para el análisis de supervivencia se utilizó la prueba de Kaplan-Meyer. Resultados: Se analizaron 37 pacientes, edad media ± SD: 67 ± 8,4. Treinta y tres eran varones y casi el 92% tenían antecedentes de tabaquismo. Predominio de epidermoides (37,8%). El 69% se diagnosticaron en un estadio avanzado. Se objetivaron diferencias significativas en cuanto al tiempo diagnóstico, siendo mayor en los estadios iniciales. La mediana de supervivencia fue de 12,83 meses (IC 95%: 6,84 a 18,83). El porcentaje de pacientes vivos al final del estudio fue del 24%. Cuando se comparó por grupos, se observó que la mediana era mayor en mujeres, en pacientes sin EPOC, en EPOC graves frente a leves moderados, en los tumores no microcíticos y en los estadios quirúrgicos. Conclusiones: Nuestros datos de supervivencia son algo superiores a lo descrito en la literatura. Llama la atención la mayor supervivencia en pacientes con EPOC grave que en los leves-moderados. Los tiempos diagnósticos y hasta inicio de tratamiento están dentro de lo recomendado por las guías. El predominio de epidermoides puede justificarse por el mayor número de varones y la alta incidencia de tabaquismo

Introduction: The aim of this study is to know the survival rates in our outpatients with lung cancer (LC), the epidemiology and the delay time for diagnosis and treatment. Patients and methods: A retrospective study was performed in patients with LC. Survival was estimated by the Kaplan-Meier method. The U-Mann Whitney test was used to compare variables. Results: 37 patients were studied, with a mean age of 67 ± 8.3. 33 of them were men and 92% were smoker. The most were epidermoids (37.8%). 69% were diagnosed in a advanced stage. Time interval for diagnosis was longer in earlier stage. Mean survival time was 12.83 months (CI 95%: 6.84 to 18.83). Survival rates at the end of the study was 24%. Mean survival was better in women, patients without COPD, in severe COPD, non small cell lung carcinomas and in earliest stages. Conclusions: Our survival rates are a little better than other studies but they remain poor. The delay time for diagnosis and treatment is the recommended for de guides. The higher rates of epidermoids can be explained by a higher number of men and the high rates of smokers. The higher survival rates in severe COPD is not described by other groups

Leishmaniasis endobronquial / No disponible

La afectación del pulmón por leishmaniasis en inmunocompetentes es rara. Presentamos el caso de un paciente de 76 años con antecedentes de EPOC y exposición a polvo inorgánico. Había precisado ingreso por agudización de su EPOC en 3 ocasiones y refería cuadros febriles intermitentes. Se decidió solicitar broncoscopia para toma de muestras microbiológicas, se objetivó una mucosa abollonada que se biopsió descartando malignidad. Realizó tratamiento antibiótico según antibiograma. Ante la persistencia de cuadros febriles de repetición, se realizó broncoscopia en dos ocasiones más, los hallazgos endobronquiales fueron similares. En la última broncoscopia se detectó en la biopsia bronquial la presencia de leishmania, iniciándose tratamiento con anfotericina B con buena respuesta clínica. Existen pocos casos en la literatura que describan afectación endobronquial. Se caracteriza por una importante reacción inflamatoria, lo que justifica la dificultad para detectar el parásito. La recidiva a pesar del tratamiento correcto es frecuente, como en el caso que nos ocupa

Visceral leishmaniasis with endobronchial involvement in an immunocompetent patient is rare. We report a case of a 76 years-old man who presented with intermittent fever and three copd exacerbations. On bronchoscopy there was an inflammatory changes throughout the bronchial tree and lower trachea. The patient was treated with antibiotic without improvement. It was necessary to repeat bronchoscopy two times because of recurrent fever. In the last one, endobronchial biopsies revealed leishmania. Antileishmanian treatmeant with anphotericine B was given with an initial good response. Endobronchial leishmaniasis is an atypical form of leishmaniasis infection. Histopathology showed severe inflammation, making it difficult to diagnose. Recurrences are common despite correct treatment

Impacto del hábito tabáquico al diagnóstico en la supervivencia de pacientes con cáncer de pulmón / Impact of smoking habit on diagnosis of survival of lung cancer patients

Objetivo. Evaluar la influencia del hábito tabáquico en el momento del diagnóstico de cáncer de pulmón sobre la supervivencia a los 5 años. Pacientes y métodos. Se incluyeron pacientes diagnosticados de cáncer de pulmón durante el año 2009 y se analizaron las siguientes variables: edad, sexo, hábito tabáquico (no fumadores, fumadores activos y exfumadores, índice paquetes-año, diagnóstico de EPOC y grado del mismo, motivo de consulta, histología, estadio quirúrgico o no, y supervivencia en meses global y según el hábito tabáquico. Resultados. Se analizaron 37 pacientes, 33 eran hombres. La edad media fue de 67 años (47-85). El 40,5% eran fumadores, 8,1% nunca fumadores, 13,5% exfumadores de menos de 5 años de cesación, 18,9%, entre 5 y 15 años y un 18,9% de más de 15 años. La mediana del índice paquetes-año de fumadores y exfumadores fue 42. El motivo de consulta fue presentar síntomas en 21 pacientes (56,8%) y hallazgo radiológico el resto. La histología fue epidermoide un 37,8%, adenocarcinoma 29,7%, microcítico 16,2%, célula grande 8,1% y otros no microcíticos 8,1%. El tumor fue quirúrgico en 13 casos (35,1%). 17 pacientes tenían EPOC. A los 5 años del diagnóstico, 23 pacientes murieron por causa atribuible al cáncer, 5 murieron por otras causas y 9 continúan vivos. La supervivencia a 5 años fue del 24%. La mediana de supervivencia de los 23 pacientes fallecidos por cáncer fue de 12,83 meses. El análisis de supervivencia respecto al hábito tabáquico no reflejó diferencias estadísticamente significativas entre fumadores activos: mediana de 24,4 meses, y los no fumadores (exfumadores y nunca fumadores): mediana 11,5 meses. Agrupando a los fumadores activos con los fumadores de < 5 años de abandono, tampoco muestra diferencias respecto a los no fumadores y exfumadores > 15 años: medianas 13,9 meses y 11,5 meses, respectivamente, en ambos grupos. Conclusión. No encontramos diferencias significativas en la supervivencia de pacientes con cáncer de pulmón según el hábito tabáquico en el momento del diagnóstico (AU)

Objective. Evaluate the influence of the smoking habit at the time of the diagnosis of lung cancer on 5-year survival rate. Patients and methods. Patients diagnosed of lung cancer during the year 2009 were included and the following variables analyzed: age, gender, smoking habit (non-smokers, active smokers and ex-smokes, package-year index, diagnosis of COPD and its grade, reason for visit, histology, surgical stage or not, and survival in overall months and according to smoking habit. Results. A total of 37 patients were analyzed, 33 of whom were men. Mean age was 67 years (47-85). Smokers accounted for 40.5%, 8.1 had never smoked, 13.5% were ex-smokers with at least 5 years since cessation, 18.9% between 5 and 15 years and 18.9% more than 15 years. Median package-year index of smokers and ex-smokers was 42. Reason for visit was having symptoms in 21 patients (56.8%) and X-ray findings in the rest. Histology was squamous cell in 37.85, adenocarcinoma 29.7%, small cell 16.2%, large cell 8.1% and others non-small cell 8.1%. The tumor was surgical in 13 cases (35.1%) and 17 patients had COPD. At 5 years of the diagnosis, 23 patients had died due to cause attributable to cancer, 5 due to other causes and 9 continued to be alive. Five-year survival was 24%. Median survival of the 23 deceased patients due to cancer was 12.83 months. Survival analysis regarding smoking cessation did not reflect statistically significant differences among active smokers: median of 24.4 months and non-smokers (ex-smokers and non-smokers): median 11.5 months. Grouping active smokers with ex-smokers having < 5 years of cessation, there were also no differences regarding the non-smokers and ex-smokers > 15 years: median 13.9 months and 11.5 months, respectively, in both groups. Conclusion. We found no significant differences in survival of patients with lung cancer according to the smoking habit at the time of diagnosis (AU)

Esperanza ante la futura ley de control y prevención del tabaquismo / Hope in the presence of the future law on control and prevention of smoking

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Estado nutricional de pacientes diagnosticados de cáncer de pulmón en una consulta de alta resolución / Nutritional condition of patients diagnosed of lung cancer in a high-resolution outpatient office

Resumen. Los pacientes diagnosticados de cáncer de pulmón deben recibir tratamiento con quimioterapia, cirugía o ambas. En la literatura está descrito que una desnutrición del paciente puede causar mayor morbi-mortalidad tras el tratamiento. El objetivo de nuestro estudio era conocer el grado de desnutrición que presentan los pacientes que son diagnosticados de cáncer broncogénico en nuestra consulta de alta resolución. El análisis se realizó de forma retrospectiva, se relacionó el IMC y la albúmina con el estadio y la histología del tumor. Se estudiaron 203 casos, la mayoría varones con un predominio de epidermoides, en el momento del diagnóstico un 71 % se encontraban en un estadio avanzado. Se encontraron diferencias significativas en el IMC, si bien casi todos los pacientes estaban dentro de un rango de normopeso. No se encontraron diferencias significativas en cuanto a las cifras de albúmina, aunque los valores extremos más bajos aparecían en los estadios más avanzados. Es posible que intervengan factores adicionales al propio tumor en la pérdida de peso de estos pacientes. Sería importante determinar qué pacientes pueden presentar una mayor desnutrición para intentar corregirla de forma precoz y evitar así las complicaciones tras tratamiento (AU)

Abstract. Patients diagnosed of lung cancer should receive chemotherapy, surgery or both. It has been described in the literature that malnutrition of the patient may cause greater morbidity-mortality after the treatment. Our study has aimed to discover the degree of malnutrition of the patients who are diagnosed of bronchogenic cancer in our high-resolution outpatient office. The analysis was performed retrospectively. BMI and albumin were related with the stage and histology of the tumor. A total of 203 cases were studied. Most were men with predominance of squamous cell carcinoma lung cancer, and 71% were in an advanced stage at the time of diagnosis. Significant differences were found in BMI, although all the patients were within a range of normal weight. No significant differences were found regarding albumin values, although the very lowest values appeared in the more advanced stages. It is possible that factors in addition to the tumor itself participate in the weight loss of the patients. It would be important to determine which patients may have greater malnutrition in order to correct it early and thus avoid complications after the treatment (AU)

Rendimiento de los cuestionarios aplicados en la deshabituación tabáquica / No disponible

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El tabaco: de uso medicinal a primera causa de morbimortalidad / No disponible

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¿Existen diferencias entre fumadores epoc y sanos respecto a las características de sus hábito y dependencia? / No disponible

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Recomendaciones para la organización y funcionamiento de las unidades especializadas en tabaquismo / Guidelines for organizing and operating specialized anti-smoking units

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[Nasal nicotine spray in smoking cessation. Results of a multicenter study]. / Tratamiento del tabaquismo con nebulizador nasal de nicotina. Resultados de un estudio multicéntrico.

We have carried out an open multicenter follow-up study of the efficacy of a smoking cessation therapy that combined psychological support with use of a nicotine nasal spray. Fifty-seven subjects (37 men, 20 women) with a mean age of 40.3 +/- 15.7 yr and smoking 37.4 +/- 4.7 cigarettes per day were enrolled. The mean Fagerström test score was 8.9 +/- 1.1. Patients received minimal psychological support and were prescribed a nicotine nasal spray at the recommended dose of 1 to mg/h for use while awake for a period of three months, with gradual reduction of dose. Subjects were seen on six occasions (on the first day of consultation; 1, 2 and 6 weeks after quitting; 3 and 6 months after quitting). After three months of follow-up, 22 patients (39%) were abstinent; six months after first trying to quit, only 20 of the 57 enrolled had succeeded (35%). Although most subjects (over 90% in the first 15 days, and over 50% at three months) used the treatment, only a small percentage (3%) followed the appropriate doses in the first 15 days and 31% reported doing so at the three-month check-up. The mean score reflecting withdrawal syndrome tripled over baseline level during the first six weeks of follow-up. Over three quarters of the subjects suffered side effects caused by the spray, the most common being nasal irritation, rhinorrhea and tearing. Five patients (87%) lef the study because of intolerance to medication. In conclusion, our study found a rate of success of 35% after six months of follow-up. Use of the prescribed medication was inadequate; withdrawal syndrome was more intense and the prevalence of side effects increased during the early treatment period.

[A pleuropulmonary tuberculosis study in a pneumology service]. / Estudio de la tuberculosis pleuropulmonar en un servicio de Neumología.

We reviewed the records of 125 patients admitted in our Service of Pneumology from January 1985 to December 1992, which were diagnosed of pleural or pulmonary tuberculosis. Several characteristics are described, with the following findings: 1) Higher incidence among men. 2) Relevant incidence among young people. 3) Frequent association with risk factors or concomitant diseases, mainly tobacco and alcohol consumption. 4) Delay in the diagnosis, probably due to the unspecific symptoms observed; fever, cough, constitutional syndrome. 5) The must frequent radiological findings were pleural leakage and cavitated infiltrations affecting the upper lobes. 6) Sputum microbiological exam still has a high diagnostic profitability.

[Kartagener's syndrome with normal ciliary ultrastructure]. / Síndrome de Kartagener con ultraestructura ciliar normal.

We present a case of a man with Kartagener's syndrome (KS) (situs inversus, sinusitis and bronchiectasias) and with clinical signs of respiratory infection. An electronic microscopy study was conducted, showing a normal bronchial cilium. Although, traditionally, KS has been associated to ultrastructural abnormalities of the cilium, some cases similar to ours have been described, suggesting the presence of functional ciliary disorders in absence of ultrastructural defects.

[Mediastinal leiomyosarcoma]. / Leiomiosarcoma mediastínico.

Primary mediastinal leiomyosarcomas are malignant sarcomas with unknown etiology not deriving from the smooth muscle fiber of the esophagus, trachea or main vessels. Very few cases have been reported in the literature and, although they are clinically unspecific, their histology is unique. The case described here is a 66-year-old woman with a leiomyosarcoma localized at the medium and posterior mediastinum, clinically presented as a mediastinal emergency.