Tabaquismo en los estudiantes de alto nivel académico en la Comunidad de Madrid y comparación con estudio previo similar realizado en 2014 / High level of student smokers in Madrid compared with a similar previous study of 2014

El tabaquismo es un problema de salud pública que afecta a los jóvenes, influenciado por el entorno y el nivel cultural. OBJETIVOS: Determinar la prevalencia de tabaquismo en estudiantes de bachillerato de excelencia (BE) con alto nivel académico en la Comunidad Autónoma de Madrid, en el curso 2018-2019. Valorar influencias del ambiente sociocultural en la iniciación del tabaquismo. Comparar con estudios previos realizados en alumnos de BE y la población general. POBLACIÓN Y MÉTODOS: Estudio transversal en alumnos de BE de la Comunidad Autónoma de Madrid. Mediante encuesta anónima se interrogó sobre el consumo de tabaco, alcohol y otras sustancias tóxicas; influencia del entorno, amigos y familiares en el inicio. Comparar con estudios previos. RESULTADOS: Se recogieron 740 jóvenes de 16,57±0,61 años; eran 430 (58,1%) mujeres y fumaban 53 (7,18%). Reconocían la influencia inicial de amigos 39 (78%). Consumían alcohol 349 (47,48%); y otras sustancias 109 (15,27%). Ser fumador se relacionó con consumir alcohol y otras drogas, tener madre, hermanos y amigos fumadores. Respecto a estudios previos, no se modificó la prevalencia de tabaquismo. CONCLUSIONES: La prevalencia del tabaquismo en estudiantes de alto nivel académico del BE de la Comunidad Autónoma de Madrid continúa siendo inferior a la de jóvenes de su edad y no existen variaciones respecto a informes previos. El inicio está relacionado con el tabaquismo de amigos, hermanos y de la madre; con el consumo de alcohol y otras drogas. La educación y los programas preventivos son muy importantes en el inicio y prevención del tabaquismo

Smoking is a public health problem that affects young people, and influenced by the environment and cultural level. OBJECTIVES: To determine smoking prevalence among high-level baccalaureate students in the Autonomous Community of Madrid during the 2018-2019 academic year. To assess the influence of the socio-cultural environment on the onset of youth smoking. To compare the results with previous studies conducted on students of baccalaureate of excellence (BE) and the general population. POPULATION AND METHODS: Cross-sectional study on BE students in the Autonomous Community of Madrid. Using an anonymous questionnaire, they were asked about tobacco, alcohol and drug consumption, as well as the influence of the environment, friends, and family in the beginning. To compare with previous studies. RESULTS: A total of 740 valid questionnaires were collected, of which 430 (58.1%) were female, an overall mean age of 16.57±0.61 years, and 53 (7.18%) were smokers. The majority 39 (78%) of smokers acknowledged their friends' influence at its onset. Alcohol was consumed by 349 (47.48%) and other drugs by 109 (15.27%). Being a smoker was related to alcohol, other drugs, a smoking mother, smoking siblings and smoking friends. CONCLUSIONS: Smoking prevalence among students of BE in Autonomous Community of Madrid continues to be lower than the prevalence of adolescents of their age and there are no variations from previous reports. Starting smoking is related to smoking by friends, siblings, and the mother and with the consumption of alcohol and other substances. Education is very important in the beginning and prevention of smoking, and it is necessary to implement prevention programs at early ages in order to promote their effectiveness, and aimed at young people, parents and teachers

[High level of student smokers in Madrid compared with a similar previous study of 2014]. / Tabaquismo en los estudiantes de alto nivel académico en la Comunidad de Madrid y comparación con estudio previo similar realizado en 2014.

Smoking is a public health problem that affects young people, and influenced by the environment and cultural level. OBJECTIVES: To determine smoking prevalence among high-level baccalaureate students in the Autonomous Community of Madrid during the 2018-2019 academic year. To assess the influence of the socio-cultural environment on the onset of youth smoking. To compare the results with previous studies conducted on students of baccalaureate of excellence (BE) and the general population. POPULATION AND METHODS: Cross-sectional study on BE students in the Autonomous Community of Madrid. Using an anonymous questionnaire, they were asked about tobacco, alcohol and drug consumption, as well as the influence of the environment, friends, and family in the beginning. To compare with previous studies. RESULTS: A total of 740 valid questionnaires were collected, of which 430 (58.1%) were female, an overall mean age of 16.57±0.61 years, and 53 (7.18%) were smokers. The majority 39 (78%) of smokers acknowledged their friends' influence at its onset. Alcohol was consumed by 349 (47.48%) and other drugs by 109 (15.27%). Being a smoker was related to alcohol, other drugs, a smoking mother, smoking siblings and smoking friends. CONCLUSIONS: Smoking prevalence among students of BE in Autonomous Community of Madrid continues to be lower than the prevalence of adolescents of their age and there are no variations from previous reports. Starting smoking is related to smoking by friends, siblings, and the mother and with the consumption of alcohol and other substances. Education is very important in the beginning and prevention of smoking, and it is necessary to implement prevention programs at early ages in order to promote their effectiveness, and aimed at young people, parents and teachers.

Prevalencia del tabaquismo en los estudiantes de bachillerato de la Comarca de Osona (Barcelona) / Smoking Prevalence in High School Students in the Barcelona Region (De Osona District)

El entorno sociocultural influye en el tabaquismo juvenil, y actualmente parece que hay descenso de su prevalencia. Objetivos: Valorar la prevalencia del tabaquismo en estudiantes de bachillerato, la influencia del entorno en su inicio en la Comarca de Osona (Barcelona) (COB) y analizar, si existiera, su disminución. Material y métodos: Estudio transversal en alumnos de bachillerato de COB. Mediante encuesta anónima se interrogó sobre tabaquismo, influencia del entorno y contexto sociocultural en el inicio. Resultados: Participaron 842, se recogieron 714 encuestas y 705 se consideraron válidas. Tenían residencia urbana 303 (93,5%). Fumaban 159 (22,6%) y el 62% eran mujeres; 70 (44%) eran cristianos, 3 (1,9%) musulmanes, 14 (8,8%) de otras religiones y 72 (45,3%) aconfesionales. Consumían alcohol 529 (76,3%) y otras sustancias 308 (46,5%). Padecían alguna enfermedad 40 (6,1%) alumnos y 334 (47,5%) familiares. Había 207 (29,4%) padres fumadores y 152 (22%) madres. Existía tabaquismo familiar en 214 (59%) alumnos y en 582 (82,6%) amigos. Los padres tenían estudios superiores en 212 (30,1%), medios en 331 (48,7%) y primarios en 137 (20,1%); en relación con las madres en 279 (39,6%), en 294(41,7%) y en 116 (16,5%) respectivamente. Ser fumador se relacionaba con consumir alcohol (p = 0,000) y otras sustancias (p = 0,000), ser aconfesional (p = 0,000), no padecer enfermedades (p = 0,043) y con tener madre (p = 0,001), padre (p = 0,005), hermano (p = 0,006), familiares (p = 0,016) o amigos fumadores (p = 0,000). Conclusiones: La prevalencia del tabaquismo en estudiantes de bachillerato en COB es elevada, aunque ha disminuido. Fumar se relacionó con tabaquismo de progenitores, familiares y amigos, ser aconfesional, consumir alcohol y otras sustancias. Se deben implantar programas preventivos dirigidos a estudiantes, progenitores y personal docente

The socio-cultural setting influences youth smoking and its prevalence presumibly has decreased. Objectives: To assess smoking prevalence in high school students, as well as the environmental influence on its onset in the Osona Disrtict of Barcelona (ODB), and to determine whether it has decreased. Material and methods: A cross-sectional study was conducted on high school students in the ODB. In the anonymous questionnaire it was sked asked about smoking and the influence of the social and cultural setting on its onset. Results: A total of 842 students participated, with 714 questionnaires completed, of which 705 were included as valid. A total of 203 (93.5%) students lived in an urban setting. There were 159 smoker students and 62% were women. The smokers were 70 (44%) christians, 3 (1.9%) muslims, 14 (8.%) students with other religions, and 72 (45.3%) non-denominational students. It was detected that 529 (76.3%) of the students consumed alcohol consumers, and 308 (46.5%) consumed other substances. There were 40 (61%) students that suffered a disease, and also 334 students who had ill relatives. There were 207 (29.4%) fathers and 152 (22%) mothers who smoked and 214 (59%) students declared family smoking. Finally 582 (82.6%) had smoker friends. Among fathers, 212 (30.1%), had high level studies, 331 (48.7%) had mid- level studies, and 137 (20.1%) fathers had primary studies. Among mothers, it was 279 (39.6%), 294 (41.7%), and 116 (16.5%). respectively. Being a smoker was associated with alcohol (P = .000) and other substances consumption (P = .000), being non-denominational (P = .000), did not to suffer any disease (P = .043), with having mother (P = .001), father (P = .005), brother or sister (P = .006), and family members (P = .016) who smoked, and smoker friends (P = .000). Conclusions: smoking prevalence in high school students in the ODB is high, but has decreased. Smoking was associated with alcohol and consumption of other substances, being non-denominational, and with friends, parents, and relatives who smoked. It is necessary to establish prevention programs addressed to teenagers, parents and teachers

[Smoking Prevalence in High School Students in the Barcelona Region (De Osona District)]. / Prevalencia del tabaquismo en los estudiantes de bachillerato de la Comarca de Osona (Barcelona).

The socio-cultural setting influences youth smoking and its prevalence presumibly has decreased. OBJECTIVES: To assess smoking prevalence in high school students, as well as the environmental influence on its onset in the Osona Disrtict of Barcelona (ODB), and to determine whether it has decreased. MATERIAL AND METHODS: A cross-sectional study was conducted on high school students in the ODB. In the anonymous questionnaire it was sked asked about smoking and the influence of the social and cultural setting on its onset. RESULTS: A total of 842 students participated, with 714 questionnaires completed, of which 705 were included as valid. A total of 203 (93.5%) students lived in an urban setting. There were 159 smoker students and 62% were women. The smokers were 70 (44%) christians, 3 (1.9%) muslims, 14 (8.%) students with other religions, and 72 (45.3%) non-denominational students. It was detected that 529 (76.3%) of the students consumed alcohol consumers, and 308 (46.5%) consumed other substances. There were 40 (61%) students that suffered a disease, and also 334 students who had ill relatives. There were 207 (29.4%) fathers and 152 (22%) mothers who smoked and 214 (59%) students declared family smoking. Finally 582 (82.6%) had smoker friends. Among fathers, 212 (30.1%), had high level studies, 331 (48.7%) had mid- level studies, and 137 (20.1%) fathers had primary studies. Among mothers, it was 279 (39.6%), 294 (41.7%), and 116 (16.5%). respectively. Being a smoker was associated with alcohol (P=.000) and other substances consumption (P=.000), being non-denominational (P=.000), did not to suffer any disease (P=.043), with having mother (P=.001), father (P=.005), brother or sister (P=.006), and family members (P=.016) who smoked, and smoker friends (P=.000). CONCLUSIONS: smoking prevalence in high school students in the ODB is high, but has decreased. Smoking was associated with alcohol and consumption of other substances, being non-denominational, and with friends, parents, and relatives who smoked. It is necessary to establish prevention programs addressed to teenagers, parents and teachers.

Importancia de la educación en la prevención del tabaquismo. Prevalencia del tabaquismo en escolares de bachillerato con alto nivel académico en la Comunidad de Madrid / No disponible

El tabaquismo suele iniciarse en la adolescencia y está influenciado por el entorno y el nivel cultural de los jóvenes. Objetivos: Valorar la prevalencia del tabaquismo en jóvenes de alto nivel académico y la influencia del entorno en el inicio del tabaquismo. Población y métodos: Estudio transversal en alumnos de Bachillerato de Excelencia, de la Comunidad de Madrid, con alto nivel académico. Mediante encuesta anónima se interrogó sobre el hábito de fumar; influencia del entorno, amigos y familiares en el inicio. Resultados: Se recogieron 322 encuestas válidas, 166 (51,55%) mujeres; edad media, 16,68 ± 2,14 años y en fumadores, 16,67 ± 0,69 años. Fumaban 18 (5,59%) jóvenes: 9 (50%) mujeres y 9 (50%) hombres; comenzaron a los 14,63 ± 1,15 años. Reconocían la influencia de los amigos 11 (64,71%) alumnos. Consumían bebidas alcohólicas 173 (53,73%) y otras sustancias tóxicas 104 (32,2%). Ser fumador se relacionó con: consumir alcohol (p=0,0095), consumir otras sustancias (p<0,0001), tener madre fumadora (p=0,0072), con que el padre tenga estudios primarios (p=0,01) y tener amigo fumador (p=0,001). Conclusiones: La prevalencia del tabaquismo en los estudiantes de bachillerato de alto nivel académico de la Comunidad de Madrid fue baja. El inicio estaba influenciado por el tabaquismo de la madre, de los amigos, con el consumo de alcohol y de otras sustancias tóxicas

The starting on smoking habit usually takes place during the adolescence and in this moment the environment influence and the cultural level have a very important role.Objectives: The aim is to value the smoking habit prevalence in a group of high cultural level students and also the role of the environment influence on the smoking habit beginning. Population and methods: Transversal study of a group of high cultural level students from “Bachillerato de Excelencia” educational program, in the Madrid Region. They answered an anonymous questionnaire about their smoking habit; environment influence, friends and relatives influence on the smoking habit starting. Results: 322 valid questionnaires were included, 166 (51.55%) were women; the average age of the group was 16.68 ± 2.14 years old, the average age of the smoker students was 16.67 ± 0.69 years old. 18 (5.59%) students were smokers: 9 (50%) of them were women and 9 (50%) were men; They started to smoke when they were 14.63 ± 1.15 years old. 11 (64.71%) students of this group recognised the friends influenced on the smoking habit starting. 173 (53.73%) students consumed alcohol and 104 (32.2%) students consumed other toxic substances. Being smoker is related with alcohol consuming (p=0.0095) and is also related with the consumption of toxic substances ( p<0.0001), having a smoker mother (p=0.0072), having a father with elementary studies (p=0.01) and having smoker friend (p=0.001). Conclusions: The smoking habit prevalence among high cultural students in the Madrid Region was low. The smoking beginning was influenced by his smoker friend, smoker mother, smoking habit and with alcohol consumption and other toxic substances consumption

Prevalencia de tabaquismo en escolares de bachillerato con alto nivel académico en un instituto madrileño / No disponible

El tabaquismo suele iniciarse en la adolescencia y en el inicio del hábito tiene importancia la influencia del entorno y el nivel cultural de los jóvenes. El objetivo de este estudio es valorar la prevalencia del tabaquismo en jóvenes de nivel cultural elevado y la influencia del entorno socio-cultural en la iniciación al consumo de tabaco. Población y método: Estudio transversal en alumnos de Bachillerato de Excelencia, de la Comunidad de Madrid, con nivel cultural elevado. Mediante encuesta anónima se interrogó sobre el hábito de fumar; influencia del entorno, amigos y familiares en el inicio. Resultados: Participaron 137 alumnos, respondieron a las encuestas el 88,1%. Mujeres 65 (53,7%) y hombres 56 (46,3%); la edad media general era 16,6 ± 0,52 años, y en los fumadores de 17 ± 0,45 años. Fumaban 11 jóvenes (9,1%): 7 (63,6%) fueron mujeres y 4 (56,4%) hombres; comenzaron a fumar de media a los 13,6 ± 1,8 años. Reconocieron la influencia de los amigos en el inicio del hábito 10 (91%) alumnos. Consumían bebidas alcohólicas 62 (51%) alumnos y otras sustancias tóxicas 47 (38,8%) alumnos. En 36 (29,8%) casos los padres eran fumadores, en 34 (28,1%) lo eran las madres, en 12 (12,4%) fumaban los hermanos y, los amigos en 91 (75,2%) alumnos. La edad media de los fumadores fue superior con p= 0,016. Ser fumador se relacionó con: consumir alcohol (p= 0,036) y tener hermano fumador (p= 0,00). Conclusiones: La prevalencia de tabaquismo en los estudiantes de bachillerato de alto nivel académico de la Comunidad de Madrid fue del 9,1%; inferior a la descrita para jóvenes de su edad. El inicio estaba influenciado por el tabaquismo de hermanos y con el consumo de alcohol

The starting on smoking habit usually takes place during the adolescence and in this moment the environment influence and the cultural level have a very important role. Objectives: The aim is to value the smoking habit prevalence in a group of high cultural level students and also the role of the environment influence on the smoking habit beginning. Population and methods: Transversal study of a group of high cultural level students from "Bachillerato de Excelencia" educational program, in the Madrid Region. They answered an anonymous questionnaire about their smoking habit; environment influence, friends and relatives influence on the smoking habit starting. Results: In this study participated 137 students, answered the questionnaire an 88,1% of them. 65 (53,7%) were women and 56 (46,3%) were men ; the average age of the group was 16,6 ± 0,52 years old, the average age of the smoker students was 17 ± 0,45 years old. 11 (9,1%) students were smokers: 7 (63,6%) of them were women and 4 (56,4%) were men; They started to smoke when they were 13,6 ± 1,8 years old. 10 (91%) students of this group recognised the friends influenced on the smoking habit starting. 62 (51%) students consumed alcohol and 47 (38,8%) students consumed other toxic substances. 36 (29,8%) parents were smokers and 34 (28,1%) mothers were smokers; 12 (12,4%) student brothers were smokers, among the friends 91 (75,2%) were smokers. The average age of the smoker group was higher p=0,016. Being smoker is related with alcohol consuming (p=0,036) and is also related with having and smoker brother (p=0,00). Conclusions: The smoking habit prevalence among high cultural students in the Madrid Region was 9,1%; it is lower than the average prevalence of his age group. The smoking beginning was influenced by his brother,s smoking habit and with alcohol consumption

Mujer con “masa mediastínica” paratraqueal derecha / Woman with right paratracheal “mediastinal mass”

No disponible

[Setting up written informed consent for fiberoptic bronchoscopy in the pneumology units of Spanish hospitals]. / Indice de implantación del consentimiento informado escrito para fibrobroncoscopia en las unidades de neumología de los hospitales españoles.

OBJECTIVES: To assess the implantation and quality of written IC in the pulmonology units of Spanish hospitals. METHOD: A descriptive study was initiated with a nation-wide mail and/or telephone survey of 117 Spanish hospitals to determine whether or not written ICs were signed before fiberoptic bronchoscopy. If the respondents answered affirmatively, a copy of the form was requested for evaluation. Evaluation criteria were a) whether IC was specific for fiberoptic bronchoscopy, and if it was, b) whether it contained information as well as a declaration of consent, and c) whether the information and declaration were adequate, fulfilling minimum requirements. RESULTS: Seventy-three pulmonology units (60%) responded and 49 of them (67.1%) reported that they obtained written ICs while 24 (32.9%) did not. Of the 49 departments that reported asking for written IC, 41 (83%) used forms that were specific for fiberoptic bronchoscopy and 8 (17%) used nonspecific forms. The 41 units with specific IC forms submitted papers containing both information and declaration sections. The information was adequate in 10 cases (24%) and the declaration was appropriate in 17 (41%); only 6 (14%) had both adequate information and an appropriate declaration. CONCLUSIONS: Written ICs are increasingly common and are present in 67% of the pulmonology units that responded to the questionnaire. The low number of forms meeting minimum requirements is remarkable. It would be useful to design an IC form that respects our specific sociocultural context for use nation-wide in Spain.

[Factors related to diagnostic yield and complications of transbronchial biopsy]. / Factores relacionados con la rentabilidad diagnóstica y aparición de complicaciones de la biopsia transbronquial.

To study the diagnostic yield of transbronchial biopsy (TBB) in lung diseases of different ethiology, as well as to examine several factors implicated in diagnostic yield and complications of TBB. Retrospective study of a series of 172 patients (98 women and 74 men) undergoing TBB. Clinical variables, x-ray and CT patterns and technical factors related to TBB were analyzed in relation to diagnostic yield and definitive diagnosis. We recorded the main complications and studied the possible mechanisms implicated in their appearance. The results of TBB were classified as follows: 1) diagnostic TBB (42.8%); 2) nonspecific TBB (21.1%); absence of parenchyma (NP) (9.7%); 4) normal parenchyma (23.4%); 5) incorrect diagnosis (2.9%). Overall yield was 43.6% but rose to 52% when NP and no infiltrative pneumopathies were excluded. The main findings were infections (23.4%), neoplasms (19.4%), sarcoidosis (14.2%), idiopathic pulmonary fibrosis (IPF) (17.7%); and other (23.4%). Significant differences in diagnosis were found for age, sex, time of evolution prior to TBB, and x-ray and CT patterns. Complications and pneumothorax appeared more frequently in IPF, neoplasms and infections, although the differences were non significant. Diagnostic value depended mainly on type of disease and ranged from 60% for sarcoidosis to 24% for IPF (p < 0.05), with no differences related to age, sex, presence of immunosuppression, number of TBB or tolerance to exploration. Yield was higher, however, for patients with no loss of radiographic pulmonary volume (56.3% versus 37.5%) and with absence of a CT reticular pattern (44.7% versus 27.3%). Type of opacites also influenced yield (53.4% for ground glass versus 26.7% for reticular patterns), as did distribution of lesions (8.4% for peripheral patterns versus 48.3% for diffuse patterns and 50% for peribronchio-vascular patterns). The site of TBB was the only factor showing clearly significant differences in yield (100% in mild lobe versus 29.5% in upper lobes). Tolerance was poorer in older patients (63.5 +/- 10 versus 52.2 +/- 17 years) and with greater function abnormalities (%FEV1: 48.2 +/- 16.8 versus 70.2 +/- 17.1). Poor tolerance of exploration was associated with the appearance of complications (16.6% vs 6.3) and pneumothorax (25% versus 6.8%). The diagnostic yield of TBB was mainly influenced by the type of disease studied. The various imaging techniques were fundamental for establishing preliminary diagnoses and degree of evolution of a specific cases. In our series, tolerance of the technique was a reliable predictor of complications and the presence of post-biops pneumothorax.

Thoracic empyema in HIV-infected patients: microbiology, management, and outcome.

OBJECTIVES: To evaluate etiology, bacteriology, stage of disease, treatment, and outcome of HIV-infected patients with thoracic empyema (TE) over a 9-year period at a hospital teaching center. DESIGN: We have retrospectively reviewed the charts of all HIV-infected patients with a hospital discharge diagnosis of empyema between January 1985 and November 1993. PATIENTS: Twenty-three patients were identified (22 male and 1 female). The average patient age was 28.7+/-5.3 years. All the patients were injection-drug users, and 10 (43%) fulfilled criteria for an AIDS diagnosis. In 15 cases (65%), the empyema was the first cause of medical consultation, which then led to an HIV infection diagnosis in 11 of them (48%). MEASUREMENTS: In each case, symptoms, chest studies, culture results, procedure timing, length of hospitalization, and outcome were reviewed. RESULTS: Twenty-one patients (91%) had developed an empyema secondary to community-acquired pneumonia. The cultures of pleural fluid were positive in 19 cases (83%). Anaerobes were isolated from 6 patients and aerobes from 13. A single bacteria was isolated from 10 (52%), and multiple organisms (average 2.66 per case) grew in the remaining 9 positive cultures. The most common organism culture growths were Staphylococcus aureus (23%) and Gram-negative bacilli (36%). Length of hospitalization averaged 25.6 days (+/-15). Intercostal tube drainage was necessary in 18 patients and none required surgery. Patients with AIDS diagnosis needed a longer period of hospitalization, and the presence of bacteremia and bronchopleural fistula was more frequent. However, this did not influence a patient's final outcome. A follow-up was available in 18 cases, with 4 deaths recorded (average survival, 35 months; range, 4 to 84 months). CONCLUSIONS: In our series, TE associated with HIV infection was often the primary cause leading to hospital admission and later HIV diagnosis. IV drug abuse was the predominant factor for HIV infection and was also related to clinical presentation and microbiological findings. The best approach to treatment is--as with other patient groups--a prompt drainage and appropriate antibiotic treatment, since a favorable outcome is expected.

[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.

[Castleman's disease: presentation of a case and review of the literature]. / Enfermedad de Castleman: presentación de un caso y revisión de la literatura.

The traditional Castleman's Disease is characterized by the presence of a single tumor constituted by hyperplasic lymphoid tissue. It is usually asymptomatic and has a good prognosis. More recently, another disease which is histologically undistinguishable has been described. However, it courses with polyadenopathic signs, consumptive syndrome, anemia, hypergammaglobulemia and fever and has been called multicentric Castleman's Disease. A comprehensive review of national and international literature is included.

[Diabetes insipidus and Langerhans-cell histiocytosis without changes in cerebral CAT and NMR]. / Diabetes insípida en histiocitosis de células de Langerhans, sin alteraciones en la TAC y RMN cerebral.

In LCH extended disease CNS involvement in is not infrequent. Diabetes insipidus, due to the affectation of hypothalamus-hypophysis axis, is its most frequent finding. The solitary affectation of hypothalamus-hypophysis axis is exceptional. At times, it's a difficult diagnosis and could precede the diagnosis of LCH several years. Usually, CAT and NMR show morphologic lesions. We report a patient who was diagnosed of idiopathic diabetes insipidus when he was 16 years old. Seven year later, he was diagnosed of LCH after underwent a bone marrow biopsy examination, just when the disease involved the bone and lung. Cerebral CAT and NMR didn't show morphologic lesions. In the presence of morphologic lesions in hypothalamus and/or hypophysis, proved by cerebral CAT and NMR, or a clinical setting of DI, the possibility of LCH must be considered.

[The role of BCG in the prevention of tuberculosis]. / El papel de la BCG en la prevención de la tuberculosis.

Tuberculosis is still a major international public health problem. The role of vaccination with BCG in the prophylaxis of the tuberculosis has been a source of controversy almost since ist introduction in the thirties, because of the disparity of the results regarding efficacy and protection of the several studies that have been done. Currently, everybody seems to agree that in countries with annual infection risk lower than 1%, a massive vaccination campaign with BGC is not profitable. On the other hand, BCG interferes the lecture of the Mantoux intra-dermo-reaction and, thus, it invalidates the most effective test that we have for the diagnosis of the tuberculosis infection. In our country, the battle against tuberculosis is currently focused on the identification and treatment of the tuberculous patient, chemoprophylaxis with contacts of these patients and avoidance of the development of the tuberculosis infection to tuberculosis disease.

[Current status of the antipneumococcal vaccine: a pending issue]. / Situación actual de la vacuna antineumocócica: una asignatura pendiente.

In spite of antibiotic treatment, mortality due to pneumonia caused by Streptococcus pneumoniae is still considerable and it is related to the presence of bacteremia. Prophylaxis with 23-polyvalent anti-pneumococcus vaccine would prevent severe processes in high risk populations. We present in this work the current status of our knowledge about this vaccine, regarding its efficacy in preventing bacteremia, economic cost, and secondary effects, we point out the indications of this vaccine according to IPAC (Immunization Practices Advisory Committee) and those special situations which modify prophylaxis (pregnancy, revaccination and massive immunizations) are discussed.