[Usefulness of induced sputum cytology in the study of central masses in elderly patients]. / Utilidad de la citología de esputo inducido en el estudio de masas centrales en ancianos.

OBJECTIVE: To analyze the diagnostic yield of cytology obtained by means of sputum induction in elderly patients with central masses. METHODS: A total of 23 patients older than 75 years with centrally located pulmonary masses identified by computerized tomography were studied. All patients collected three spontaneously produced sputum specimens and underwent three sputum-induction sessions. Induction was considered satisfactory when the patient expectorated within the following 15 minutes. All sputum specimens were processed by May-Grünwald-Giemsa and Papanicolau staining techniques. The definite diagnostic was considered that obtained by means of bronchial biopsy or chest percutaneous aspirative puncture (PAP). RESULTS: With sputum induction, 19 patients (83%) collected satisfactory specimens and in 14 cases cytology was positive for malignancy (sensitivity 74%) and negative in five. No false-positive cases were recorded and in no patient did complications occur in association with sputum induction. The analysis of agreement between induced sputum and definite diagnosis showed a kappa index of 0.66. CONCLUSIONS: Among elderly patients with central pulmonary masses, the cytology of induced sputum should be considered as the first diagnostic procedure because of its harmlessness, remarkable sensitivity and high histologic correlation.

Noninvasive mechanical ventilation and corrective surgery for treatment of a child with severe kyphoscoliosis.

We report on an 11-year-old boy with severe kyphoscoliosis and respiratory failure. Noninvasive mechanical ventilation by nasal mask and hospitalization resulted in improved pulmonary function, thus facilitating corrective surgery for kyphoscoliosis. Following surgery, the patient remained on mechanical ventilation at home. Clinical and pulmonary function stabilized after discharge, as noted on a 1-month follow-up visit.

Empiema adquirido en la comunidad por Acinetobacter baumannii / Acinetobacter baumannii community-acquired empyema

Presentamos el caso de un paciente de 44 años de edad, sin ningún antecedente de interés y que ingresa por un cuadro de disnea y fiebre y se le detecta un empiema causado por Acinetobacter baumannii adquirido en la comunidad, lo cual no lo hemos encontrado en la bibliografía (AU)

Utilidad de la citología de esputo inducido en el estudio de masas centrales en ancianos / Usefulness of induced sputum cytology in the investigation of central masses in the elderly

Objetivo. Analizar la rentabilidad diagnóstica de la citología obtenida mediante inducción de esputo en pacientes ancianos con masas centrales. Metodología. Se estudiaron 23 pacientes mayores de 75 años con masas pulmonares de localización central identificadas mediante tomografía computarizada. Todos los pacientes recogieron tres muestras de esputo espontáneo y fueron sometidos a tres sesiones de inducción de esputo. Se consideró que la inducción resultó satisfactoria cuando el paciente logró expectorar en los 15 minutos siguientes. Todas las muestras de esputo fueron procesadas mediante las tinciones MayGrünwald-Giemsa y Papanicolau. Se consideró como diagnóstico definitivo el establecido mediante biopsia bronquial o por punción aspirativa percutánea (PAP) torácica. Resultados. Mediante la inducción de esputo 19 pacientes (83 por ciento) consiguieron recoger muestras satisfactorias, resultando su citología positiva para malignidad en 14 casos (sensibilidad: 74 por ciento) y negativa en cinco. No se registraron falsos positivos y en ningún paciente se produjeron complicaciones en relación con la inducción de esputo. El análisis de concordancia entre la citología de esputo inducido y el diagnóstico definitivo mostró un coeficiente kappa de 0,66.Conclusiones. En pacientes ancianos con masas pulmonares centrales debería considerarse como primer procedimiento diagnóstico la citología de esputo inducido por su inocuidad, considerable sensibilidad y elevada correlación histológica (AU)

[Physiopathology of respiratory insufficiency of neuromuscular origin]. / Fisiopatología de la insuficiencia respiratoria de origen neuromuscular.

OBJECTIVE: To review the mechanisms involved in the appearance of respiratory failure in patients with neuromuscular disorders. DEVELOPMENT: The development of respiratory failure in patients with weakness of the respiratory muscles secondary to neuromuscular disease is not only due to the disease itself. There are also other mechanisms which contribute in varying degrees. These mechanisms are: 1. Alteration of the mechanical properties of the respiratory apparatus; 2. The appearance of muscle fatigue; 3. Alterations in the control of ventilation; 4. Alterations in gas exchange during the night leading to loss of sensitivity of central and peripheral chemoreceptors. 5. Dysfunction of the upper airway, which favors the appearance of obstructive apnea during sleep. The part played by each of these mechanisms in the development of respiratory failure is different in each individual patient, depending on the type and severity of his particular illness. Ventilatory assistance at night has been shown to be effective in correcting respiratory failure during the day in these patients, probably by acting to a greater or lesser extent on all the different mechanisms involved. CONCLUSIONS: The origin of the respiratory failure seen in patients with neuromuscular diseases is due to many factors. Nocturnal ventilatory assistance is effective since it acts on all the different mechanisms involved.

Fisiopatología de la insuficiencia respiratoria de origen neuromuscular / The pathophysiology of respiratory failure of neuromuscular origin

Objetivos. Revisar los mecanismos implicados en la aparición de insuficiencia respiratoria en pacientes con enfermedades neuromusculares. Desarrollo. El desarrollo de insuficiencia respiratoria en pacientes con debilidad de los músculos respiratorios secundaria a enfermedad neuromuscular no se debe únicamente a la propia debilidad. Junto a ésta, aparecen otros mecanismos que contribuyen en mayor o menor medida a su aparición. Los mecanismos actualmente implicados son los siguientes: 1. Alteración de las propiedades mecánicas del aparato respiratorio; 2. Aparición de fatiga muscular; 3. Alteraciones del control de la ventilación; 4. Alteraciones del intercambio gaseoso durante la noche que dan lugar a la pérdida de sensibilidad de los quimiorreceptores centrales y periféricos; 5. Disfunción de la vía aérea superior, que favorece la aparición de apneas obstructivas durante el sueño. El papel que desempeña cada uno de estos mecanismos en el desarrollo de insuficiencia respiratoria difiere en cada paciente, en función del tipo y gravedad de su enfermedad en particular. La asistencia ventilatoria nocturna ha demostrado su eficacia a la hora de corregir la insuficiencia respiratoria diurna en estos pacientes, probablemente actuando con mayor o menor intensidad sobre los diferentes mecanismos implicados. Conclusiones. El origen de la insuficiencia respiratoria que presentan los pacientes con enfermedades neuromusculares es multifactorial. La asistencia ventilatoria nocturna es eficaz al actuar sobre los diferentes mecanismos implicados (AU)

[Community-acquired empyema caused by Acinetobacter baumannii]. / Empiema adquirido en la comunidad por Acinetobacter baumannii.

We referred a fourty-four years old male, without interesting personal history and who was accepted in the hospital due to dyspnea and fever and who was diagnosed with empyema by Acinetobacter baumannii acquired in the community; we have found no references about this in the medical literature.

[Evolution of Spanish scientific production in international respiratory system journals from 1987 to 1998]. / Evolución de la producción científica española en revistas internacionales de sistema respiratorio de 1987 a 1998.

BACKGROUND: A relevant increase in the clinical relevance of respiratory system area has occurred in the last few years. The aims of this study were: to analyze the evolution of production and impact of Spanish scientific activity in the respiratory system area between 1987 to 1998; and to assess the participation of the different Spanish autonomic communities in this activity. METHODS: Papers published in 38 international journals of respiratory system during this period of time were selected by the MedLine system, delimiting Spanish production. Geographical and institutional distribution of the production, specialist of authors, main publication journals and type of publication were recorded. Production and impact bibliometric indicators were estimated. RESULTS: The number of Spanish documents from 1987 to 1998 multiplied by eight, reaching the 1.49% of the total published documents in 1998. However, the growth model of scientific production during this period was lineal. The increase in the scientific production was associated with a increase over time in the expected impact factor. In 1998, expected impact factor was 2. 206. Forty-two percent of the papers were signed by pneumologists. The highest contributor were hospitals. The most productive autonomous communities were Catalonia, Cantabria and Madrid. The communities with the highest expected impact factor were Balears and Catalonia. CONCLUSIONS: A relevant increase has occurred in the scientific production and impact of Spanish biomedical activity in respiratory system area.

Síndrome de apnea obstructiva del sueño / The obstructive sleep apnea syndrome

El síndrome de apnea obstructiva del sueño (SAOS) es una enfermedad conocida desde hace pocos años que está siendo objeto de múltiples trabajos. Su alta prevalencia y su asociación a complicaciones que pueden ser resueltas o mejoradas con tratamiento, hace que tenga que ser tenida en cuenta y sospechada por el médico de familia. En este artículo se revisan los aspectos más novedosos sobre etiopatogenia, clínica, complicaciones, criterios y métodos diagnósticos aceptados, así como el tratamiento (AU)

[Free radicals in the bronchoalveolar lavage]. / Radicales libres en el lavado broncoalveolar.

Free radicals are usually reactive species, characterized by the possession of one or more unpaired electrons. This molleculles are involved in the pathogenesis of various respiratory diseases. Free radicals have been evaluated in the bronchoalveolar lavage to understand the importance of its role in lung cancer, adult respiratory distress syndrome, interstitial pulmonary diseases, tobacco induced pulmonary damage, hyperoxia and drug-induced lung toxicity. There are evidences suggesting that these agents play an important role in lung injury. These findings could lead the development of new, and more effective, therapeutic agents in some respiratory diseases.

Radicales libres en el lavado broncoalveolar / Free radicals in the bronchoalveolar lavage

Los radicales libres son moléculas inestables caracterizadas por tener uno o más electrones desapareados en su orbital externo. Estas moléculas están implicadas en la patogenia de numerosas enfermedades respiratorias. Los radicales libres han sido estudiados en el lavado boncoalveolar con el fin de determinar la importancia de su papel en distintos procesos como son el cáncer de pulmón, la toxicidad por fármacos, el síndrome del distrés respiratorio del adulto, las enfermedades pulmonares intersticiales, el daño pulmonar por el tabaco o por la hiperoxia. En la mayoría de los estudios realizados se encuentran evidencias de que estas sustancias están implicadas en la producción de la lesión pulmonar. En neumología, la comprensión de los mecanismos íntimos de actuación de estos agentes podría permitir el desarrollo de nuevos, y más eficaces, tratamientos en un gran número de enfermedades (AU)

[Kartagener's syndrome. Diagnosis in a 75 year-old woman]. / Síndrome de Kartagener. Diagnóstico en una paciente de 75 años.

Kartagener's syndrome is an inherited disease characterized by the clinical triad of bronchiectasis, sinusitis and situs inversus caused by an ultrastructural defect in the cilia that results in impaired mucociliary clearance. It is usually diagnosed during childhood, with a small number of cases discovered in adults and even fewer among patients over 60 years of age. Prompt, appropriate treatment of respiratory infections can minimize irreversible lung damage. We report the case of a woman with bronchiectasis, sinusitis and situs inversus diagnosed of Kartagener's syndrome based on clinical signs at age 75 years.

[The sleep apnea syndrome as a health problem. An estimation of its prevalence and morbimortality]. / El síndrome de apneas durante el sueño como problema sanitario. Valoración de su prevalencia y morbimortalidad.

The sleep apnea syndrome (SAS) is a frequent health problem and has severe consequences. In some reports, their main symptoms like habitual snoring, excessive daytime sleepiness and nocturnal respiratory pauses can affect up to 65, 22.2 and 27.9% of men, respectively, being less frequent in women. The incidence of SAS ranges between 4 and 7% of adult general population. Patients without treatment have an increased mortality (37% to 8 years). Between the complications that made this adverse outcome are cardiovascular problems (arterial hypertension, coronary artery disease, sudden death), cerebral infarctions and other derived from sleepiness like traffic crashes.

El síndrome de apneas durante el sueño como problema sanitario. Valoración de su prevalencia y morbimortalidad / Sleep apnea syndrome like health problem: valuation of ins prevalence and morbimortality

El síndrome de apneas durante el sueño (SAS) es un problema sanitario frecuente y con graves consecuencias. En algunos estudios, sus síntomas principales como el ronquido habitual, la somnolencia diurna excesiva y las pausas respiratorias nocturnas pueden estar presentes hasta en un 65, 22,2 y 27,9 % de hombres, respectivamente, siendo menos frecuentes en mujeres. La incidencia del SAS se sitúa en un 4 a 7 % de la población general adulta. Los pacientes sin tratamiento tienen una mortalidad aumentada (37 % a los ocho años). Entre las complicaciones que ocasionan este pronóstico desfavorable destacan las cardiovasculares (hipertensión arterial, enfermedad arterial coronaria, muerte súbita), los accidentes cerebrovasculares y otras derivadas de la somnolencia como los accidentes de tráfico (AU)

[Angiotensin-converting enzyme in pulmonary thromboembolism as a marker of vascular lesion]. / Enzima conversora de la angiotensina en tromboembolia pulmonar como un marcador de lesión vascular.

UNLABELLED: In pulmonary thromboembolism (PTE) metabolic changes can occur, as in serum levels of angiotensin converting enzyme (ACE); therefore, the measurement of serum levels of this enzyme might be useful for PTE evaluation. The objective of this study was to determine changes in serum ACE in patients with PTE and their possible variations after therapy. MATERIALS AND THERAPY: Thirty-one patients with PTE were studied (15 males and 16 females). The mean age was 56 +/- 16 years (range 19-82 years). The patients were included if they had: a) a suspect diagnosis of PTE; b) confirmed by high probability V/Q gammagraphy, or c) data of intermediate or low probability with positive lower limb phlebography. Patients with associated diseases, under therapy with ACE inhibitors or lost during the six months of therapy were excluded from the study. STUDY DESIGN: Patients were evaluated in the acute phase of PTE and after therapy (six months later). Biochemical, gasometric, spirometric, V/Q gammagraphy and ACE parameters were investigated. All of them were compared with reference values and those obtained in both phases of PTE. STATISTICS: The Student "t" test was used for independent parameters with the Bonferroni correction for multiple contrast and a = 0.05. The Pearson regression analysis was used for correlations. The ROC curve was used to study its usefulness at diagnosis. RESULTS: ACE decreased by a 20.5% in the acute phase (31.69% +/- 10.34 mumol/min/l) and turned to normal values (39.91 +/- 9.75 mumol/min/l) at post-therapy phase. This decrease was related with acute hypoxia and a decrease in the lung vascular bed. The analysis of the ROC curve showed an area of 0.69 and a negative predictive value of 91.67% for ACE values higher than 46 mumol/min/l. CONCLUSIONS: ACE activity is a marker for pulmonary pathology which might be indicative of injury and/or decrease of the lung vascular bed; its measurement can be useful in the clinical follow-up of PTE. A return to normal values should be interpreted as improvement in the perfusion of the lung vascular bed.

[Bibliometric indicators of production and usage of Archivos de Bronchoneumologia]. / Indicadores bibliométricos de producción y consumo de ARCHIVOS DE BRONCONEUMOLOGIA.

We studied the bibliometric indexes referring to production and scientific output published in ARCHIVOS de BRONCONEUMOLOGIA. All issues published between 1993 and 1994 were studied with the exception of monógraphic or supplementary numbers. For each article we recorded article type, number of authors, authors' place of work, specialty, time until acceptance, time until publication, type of references, language of references, journal and year of references. For each year we calculated the productivity index and the cooperation index, or index of signers per work. We also determined the citation period for references, the Price index, and the insularity index. Productivity index was 1.97 in 1993 and 2.05 in 1994. The cooperation index for the two years reached 4.5 +/- 1.9 (1-10). Authors were widely distributed by provinces and by specialties, although "nuclei" of production could be identified. The citation half-life period was 5.67 years for references in 1993 and 5.94 years in 1994, and the Price index surpassed 40%. The insularity index was very low at 7.76%. In conclusion, the bibliometric indicators for production, readership and obsolescence for the two years analyzed indicate that ARCHIVOS de BRONCONEUMOLOGIA occupies an intermediate position in the ranking of Spanish medical journals.