Carcinoma sarcomatoide de pulmón / No disponible

El carcinoma sarcomatoide es una neoplasia maligna, poco frecuente,de localización extremadamente rara en pulmón, más frecuenteen varones y en clara relación con el hábito tabáquico.Describimos el caso de un varón de 72 años que presentaba clínicade tos con expectoración hemoptoica, síndrome febril y cuadroconstitucional, en el que se objetivó en la radiografía de tóraxduplicación del tamaño de una lesión quística, ya conocida previamentey con sospecha clínica de quiste hidatídico en lóbulo superiorderecho. Ante la falta de diagnóstico con las pruebas no invasivas,se realizó una toracotomía diagnóstico-terapéutica,estableciéndose el diagnóstico anatomopatológico de carcinomasarcomatoide de pulmón tras la extirpación de la pieza quirúrgica (AU)

Sarcomatoid carcinoma is an infrequent malignant neoplasia,extremely rare in the lung, more frequent in men and with a clearrelationship with the tobacco habit.We describe the case of a 72 year old man who presented a clinicalpicture of cough with haemoptoic expectoration, febrile syndromeand constitutional syndrome, in which chest X-ray examinationshowed a duplication in the size of a previously known cystic lesion,with the clinical suspicion of a hydatid cyst in the right upper lobe.Faced with the lack of a diagnosis with non-invasive tests, a diagnostic-therapeutic thoracotomy was made, establishing the anatomopathologicdiagnosis of sarcomatoid carcinoma of the lung afterthe surgical resection of the lesion (AU)

Evaluación del derrame pleural de origen infeccioso / No disponible

No disponible

Asignatura de libre elección “Abordaje del tabaquismo” en la Facultad de Medicina de Badajoz (Universidad de Extremadura) / Free choice subject “Approach to smoking” in the Medical School of Badajoz (University of Extremadura)

No disponible

Beneficios de la ventilación no invasora en la insuficiencia respiratoria crónica / Benefits of non invasive ventilation in chronic respiratory insufficiency

OBJETIVO: Describir las características clínicas, funcionalesy parámetros ventilatorios de los pacientes con insuficiencia respiratoriacrónica de origen extrapulmonar tratados mediante ventilaciónmecánica no invasora (VMNI) y valorar la eficacia del tratamientoen la mejoría gasométrica y su repercusión en ingresoshospitalarios y retirada de oxigenoterapia.PACIENTES Y MÉTODO: Estudio retrospectivo de lospacientes sometidos a VMNI por insuficiencia respiratoria crónica(IRC) de origen extrapulmonar en el año 2003 analizando la mejoríagasométrica y disminución del número de ingresos hospitalariostras el tratamiento. Los pacientes incluidos al menos cumplíanuno de los siguientes criterios: clínica de hipoventilación o presiónparcial de dióxido de carbono (pCO2) >45 mmHg en vigilia o saturaciónnocturna de O2 <90 % más del 10-20% del tiempo de registroo <88% durante 5 minutos consecutivos o capacidad vital forzada(FVC) <50% del teórico. A los pacientes se les realizóespirometría forzada, estudio poligráfico o polisomnográfico nocturnoy monitorización de la saturación nocturna mediante pulsioximetría.Se utilizaron en todos los casos ventiladores de presiónbinivel (BiPAP).RESULTADOS: Se incluyeron 16 pacientes cuya patologíamas prevalente fue la obesidad en 7 casos. La situación funcionalfue (media ± desv. típica): FVC 48.7% ± 19.4, FEV1 50% ± 19.4 yFEV1/FVC 82% ± 13. Los parámetros ventilatorios empleadosfueron de expiratory positive airway pressure (EPAP) 2.7 cm H2O ±0.8 y de inspiratory positive airway pressure (IPAP) 15 cm H2O ±1.4. Se observaron diferencias estadísticamente significativas en ladisminución de la pCO2 antes y después del tratamiento conVMNI (p=0.006) y en la mejoría de la saturación (p<0.001). Laestancia media hospitalaria del tratamiento fue de 6,25 días, y en 6casos se retiró la oxigenoterapia crónica domiciliaria (OCD). Elgrupo tratado presentó en el año anterior 11 ingresos por IRC reagudizaday ninguno en el año siguiente al tratamiento.CONCLUSIONES: Los pacientes con IRC de origen extrapulmonartratados con VMNI presentaron mejoría gasométrica,con retirada de la OCD en algunos casos y disminución de losingresos hospitalarios

OBJECTIVE: To describe the clinical, functional and ventilatoryparameter characteristics of (the) patients with chronic respiratoryinsufficiency of extra-pulmonary origin treated by means ofnon invasive mechanical ventilation (NIMV), and to evaluate theefficacy of the treatment in gasometric improvement and its repercussionsin terms of hospital admissions and removal of oxygentherapy.PATIENTS AND METHOD: Retrospective study of thepatients submitted to NIMV for chronic respiratory insufficiency(CRI) of extra-pulmonary origin in the year 2003, analyzing (the)gasometric improvement and (the) decrease in the number of hospitableadmissions after the treatment. The included patients fulfilledat least one of the following criteria: symptoms of hypoventilation,partial pressure of carbon dioxide (pCO2)> 45 mmHg whenconscious, nocturnal saturation of O2 <90% for more than 10-20%of the time of measurement, O2 <88 % during 5 consecutive minutesor forced vital capacity (FVC) <50 % of the theoretical. Thesepatients underwent forced spirometry, polygraphy, nocturnalpolysomnography and monitoring (of) the night saturation bymeans of pulse oximetry. Bi-level positive airway pressure (BiPAP)ventilators were used in all the cases.RESULTS: Sixteen patients were included, seven of whomshowed obesity which was the most prevalent pathology. (The)Functional situation was (mean ± standard deviation): FVC 48.7% ± 19.4, FEV1 50 % ± 19.4 and FEV1/FVC 82 % ± 13. The ventilatoryparameters used were expiratory positive airway pressure(EPAP) 2.7 cm H2O ± 0.8 and inspiratory positive airway pressure(IPAP) 15 cm H2O ± 1.4. Statistically significant differences wereobserved in the decrease of pCO2 before and after the treatmentwith NIMV (p=0.006) and in the improvement of saturation (p<0.001). (The) Average hospitable stay for treatment was 6.25 days,and in 6 cases the chronic home oxygen therapy (CHO) was withdrawn.In the year previous to treatment, the treated group presented11 admissions for worsening CRI and none in the year followingthe treatment.CONCLUSIONS: (The) Patients with CRI of extra-pulmonaryorigin treated with NIMV presented improved gasometry,with withdrawal of (the) CHO in some cases and decrease hospitaladmissions

Alopecia aguda asociada a empiema por actinomices / Acute alopecia associated to empyema caused by actinomyces

No disponible

Derrame pleural asociado a macroglobulinemia de Waldenström: a propósito de un caso / Pleural effusion associated with Waldenstrom's macroglobulinemia: a case report

No disponible

No disponible

[Bronchiolitis obliterans in a patient previously working as a printer in a textile factory]. / Bronquiolitis obliterante en un paciente trabajador de estampación en una fábrica textil.

We report the case of a 24-year-old man with a diagnosis of bronchiolitis obliterans, a rare clinical condition; the similarity to Ardystil syndrome was striking. Relevant occupational history included work in a textile air-brushing factory. Also noteworthy were lesions observed by CT scan in the form of cystic formations measuring less than 1 cm, a finding not previously described in the context of bronchiolitis obliterans. The patient improved immediately after starting corticoid treatment although scans failed to improve over several months of follow-up.

Bronquiolitis obliterante en un paciente trabajador de estampación en una fábrica textil / Bronchiolitis obliterans in a textile printing worker

Presentamos el caso de un varón de 24 años de edad diagnosticado de bronquiolitis obliterante, entidad clinicopatológica infrecuente. Llama la atención la similitud con el síndrome de Ardystil. Entre los antecedentes profesionales se encuentra haber trabajado en una empresa de aerografía textil. También son destacables las lesiones radiológicas por tomografía axial computarizada, consistentes en formaciones quísticas de menos de 1 cm, no descritas con anterioridad en relación con la bronquiolitis obliterante. Diagnosticado el paciente, se inicia tratamiento con corticoides, con mejoría clínica inmediata, pero no radiológica, tras varios meses de seguimiento (AU)

[Abbreviated diurnal polysomnographic records in the diagnosis of sleep obstructive apnea syndrome]. / Análisis de los registros polisomnográficos cortos diurnos en el diagnóstico del síndrome de apnea obstructiva del sueño.

OBJECTIVE: To demonstrate the validity of diurnal polysomnography for the diagnosis of obstructive sleep apnea syndrome (OSAS). METHODS: Twenty-five patients with suspect of OSAS were studied with two serial polysomnographic recordings: one during nighttime-nocturnal polysomnography (NPLS) and then a second polysomnographic study during the following morning (DPLS). In both recordings the Sensor Medic Polysomnograph 4250 was used. The certainty OSAS diagnosis was considered when an apnea-hypopnea index (AHI) > or = 10 in the nocturnal recording was obtained. The statistical study was performed with the R-Sigma Horus SA software and sensitivity and specificity values following formulas next indicated. RESULTS: The male/female ratio was 72%/28%. All patients were snorers and 64% had diurnal hypersomnia. Fourteen out of the 25 patients were true positive, five true negative, five false negative and one false positive patients. The specificity and sensitivity of DPLS were 83% and 73%, respectively, with a positive predictive value of 93% and a negative predictive value of 50%. CONCLUSIONS: Abbreviated diurnal polysomnographic recordings, performed with conventional polysomnography, have a good sensitivity and specificity for the diagnosis of OSAS. Given the possibility of false negative results in DPLS, a NPLS should be performed in the patient with presumed OSAS and negative diurnal polysomnographic study.

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.

[Diagnostic and therapeutic thoracoscopy: apropos of 100 cases]. / Toracoscopia diagnóstica y terapéutica: a propósito de 100 casos.

Results and complications of 100 consecutive thoracoscopies performed with local anesthesia, in our department of pneumology are reviewed. The group is constituted by 60 men and 40 women with an average age of 56.1 +/- 16.7 years (13-81). Age difference between tumoral (n = 58) and tuberculous patients (n = 13) was statistically significant (59.6 +/- 12.8 vs 39.3 +/- 18.7; p < 0.001). The most frequent symptom on presentation was dyspnea, an significant association was detected between fever and tuberculosis (p < 0.001). Final diagnosis were: tumor (n = 58), non-specific inflammation (n = 16), tuberculosis (n = 13), pneumothorax (n = 11) and pneumonia (n = 2). In 14 patients some complication of the procedure appeared, all of these had little clinical significance and were resolved with minimal nursing care. To diagnose tumor, macroscopic aspect showed a sensitivity of 96.1%, specificity of 86% and 92% assurance.

A case of hemidiaphragmatic paralysis after an anti-G suit failure.

This paper reports a case of left hemidiaphragmatic paralysis in an instructor pilot and his later recuperation. This incident was provoked by a failure in the anti-G suit, which remained inflated after the aircraft completed the maneuver that had originated the inflation. The spontaneous recuperation of both the respiratory functional test and the neurophysiological pattern are consistent with a Type II Seddon's axonotmesis of the phrenic nerve. Considering the short time of regeneration (6 months), this lesion must have involved the distal portion of the phrenic nerve.