Neumomediastino y neumotórax bilateral en paciente con fibrosis pulmonar idiopática / Pneumomediastinum and Bilateral Pneumothorax in Patients with Idiopathic Pulmonary Fibrosis

Los pacientes con fibrosis pulmonar idiopática (FPI) presentan un mayor riesgo de desarrollar complicaciones pulmonares agudas, incluyendo entre ellas el neumotórax y el neumomediastino. Describimos los hallazgos en la radiografía y el TAC de tórax en un paciente con diagnóstico de FPI. El examen radiológico realizado por dos radiólogos especialistas de tórax reveló hallazgos de aire extra alveolar. La disnea, disfagia, afonía y dolor torácico fueron los síntomas más llamativos que presentó el paciente. En la Rx de tórax se apreció neumotórax bilateral y neumomediastino. El paciente falleció a los 22 días de iniciado el deterioro clínico por insuficiencia respiratoria

Patients with idiopathic pulmonary fibrosis (IPF) have a higher risk of developing acute pulmonary complications, including pneumothorax and spontaneus pneumomediastinum. We describe the findings in the xray and CT scan of the thorax in a patient diagnosed with IPF. The radiography examination by two thoracic specialist radiologists revealed evidenced extravascular air in the thorax. Disnea, disphagia, aphonia, thoracic pain were the most concerning symptom presented in the patient. The thoracic radiology display air in the pleural cavity along bilateral pneumothorax and pneumomediastinum. The patient died 22 days after the start of clinical deterioration due to respiratory failure

Traqueobroncomegalia y bronquiectasias en el síndrome de Mouniere-Kuhn. Colonización por Pseudomonas aeruginosa y antibioterapia inhalada / Tracheobronchomalacia and bronchiectasis in the Mouniere-Kuhn syndrome. Pseudomonas aeruginosa colonization and inhaled antibiotic therapy

El síndrome de Mouniere-Kuhn se caracteriza por bronquiectasias (BQ) congénitas asociadas a traqueobroncomegalia. Es una enfermedad poco prevalente en la población general (1-4,5%), siendo infrecuente el diagnóstico en la edad adulta. Las infecciones respiratorias constituyen una complicación frecuente en su evolución y entre ellas, la infección y colonización por Pseudomona aeruginosa. La terapia antibiótica inhalada con colistina, tobramicina, etc. ha demostrado su eficacia en pacientes con BQ asociadas a fibrosis quística. La instauración de este tratamiento en nuestro caso se asoció con una mejoría en la sintomatología clínica y reducción de las exacerbaciones (AU)

Mounier-Kuhn syndrome is characterized by congenital bronchiectasis (BC) associated to tracheobronchomegaly. It is a disease of little prevalence in the general population (1-4.5%), its diagnosis being uncommon in the adult age. Respiratory infections are a frequent complication in its course and, among them, infection and Pseudomona aeruginosa colonization. Inhaled antibiotic therapy with colistin, tobramycin, etc. has demonstrated its efficacy in patients with cystic fibrosis bronchiectasis. The establishment of this treatment in our case was associated with an improvement in the clinical symptoms and reduction of the deteriorations (AU)

[Review of the post-intubation tracheal stenosis: a case report]. / Revisión de las estenosis traqueales tras intubación: a propósito de un caso.

Postintubation tracheal stenosis is a very important clinical situation. It is estimated to occur in approximately 5% to 20% of intubated or tracheostomized patients. However, 1% also suffers severe respiratory dysfunction. We report the case of a 45-year old patient who required surgery under general anesthesia (first intubation experience) after suffering severe coronary disease. The patient was admitted to the intensive care unit, connected to maintained mechanical ventilation for 9 days when he was weaned and extubated. He then suffered a picture of respiratory failure requiring reintubation (for a second time) and reconnection to the mechanical ventilator. He evolved favorably, and it was possible to wean him again with final extubation on the 12th day. At 28 days, he presented a picture of dyspnea, stridor, tachypnea and a bronchoscope examination show tracheal stenosis in the subglotic region. He was treated with laser and silicone tracheal stent, with good evolution.

Diagnóstico del cáncer de pulmón. ¿Puede hacerse un diagnóstico precoz? / Diagnosis of lung cancer. Can an early diagnosis be made?

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Tabaquismo: de remedio a enfermedad / Tobaccco smoke: from remedy to disease

El tabaquismo es la principal causa evitable de incapacidad y muerte en la mayoría de los países desarrollados. Para muchos gobiernos es un problema de salud pública y por tanto su prevención y consumo exige medidas reguladoras. No siempre se ha tenido una conciencia tan clara, como ahora, del daño físico del tabaquismo sobre el organismo. En este artículo hacemos un repaso de la relación tabaco-sociedad a lo largo de los siglos, desde su introducción en Europa hasta nuestros días (AU)

Tobacco addiction is the main avoidable cause of incapacity and eath in the majority of the developed countries. It is a public health problem for many governments and it´s prevention and consume requires regulation norms so. Not always existed a clear conscience, as now, of the physical damage to the organism done by tobacco. In this article we make a review of the tobacco-society relationship beyond the centuries, from it´s European introduction to our days (AU)

Síndrome del pasajero de clase económica / Economic class syndrome

El grado de confort, seguridad y rapidez conseguido en el transporte por vía aérea, hacen de éste medio un cada vez más popular sistema de transporte, que es utilizado por un gran número de pasajeros. La horquilla de edad en el pasaje se ha ampliado y la accesibilidad a un espectro social cada vez más extenso, ha hecho que el número de pasajeros/año se multiplique. Durante los últimos meses y fundamentalmente producido por la muerte de una pasajera como consecuencia de un tromboembolismo pulmonar (TEP) durante un viaje desde Australia a Europa, se ha discutido sobre el denominado Síndrome del Pasajero de Clase Turista o Económica, en numerosos foros internacionales y se han publicado datos todavía incompletos sobre éste problema. Muchas preguntas todavía no han respondido de acuerdo a una base científica ¿Cuántos casos?, ¿Se asocia al vuelo?, ¿Cómo podemos prevenirlo?.En este trabajo se analiza la incidencia según la bibliografía consultada, así como aspectos epidemiológicos, fisiopatológicos, factores de riesgo, diagnóstico, probabilidad y medidas preventivas que por parte del usuario, compañías y autoridades aeronáuticas se deberían establecer para evitar en la medida de los posible ésta complicación. Finalmente se discute las bases fisiopatológicas en las que se desarrolla la trombosis venosa profunda (TVP) y el tromboembolismo pulmonar, tratando de definir éste síndrome como consecuencia de factores relacionados con el medio aeronáutico y en el contexto eventual de su aparición durante el vuelo o como consecuencia directa de éste (AU)

Comfort, safety and time saving makes air travel more and more popular and widely use by an increased number of people in a range of extended age frame. Recent concerns in the global news have again raised an issue about the association of thromboembolic disease and air travel. Although there are numerous studies in the literature examining venous thromboembolic disease (VTE), variability of population demographics makes difficult a right and prospective assessment in the context of the cabin environment and air travel. Literature review clearly demonstrate that VTE is multicausal in nature, resulting in differing etiologic and predisposing factors across different age groups. Many questions are still to be answered, How many cases?, Direct association to Air Travel?, How to prevent it in the aviation environment?. In this paper we analize the incidence of VTE and some additional epidemiological aspects, risk and predisposing factors, diagnostic, and preventive measures given by the airline, the user, aviation authorities, aeromedical especialist in order to cope this complication. Finally we discuss the physiophatological bases in which VTE is developed and related considerations of this symdrome in the context of the aviation environment (AU)

[Economic class syndrome]. / Síndrome del pasajero de clase económica.

Comfort, safety and time saving makes air travel more and more popular and widely use by an increased number of people in a range of extended age frame. Recent concerns in the global news have again raised an issue about the association of thromboembolic disease and air travel. Although there are numerous studies in the literature examining venous thromboembolic disease (VTE), variability of population demographics makes difficult a right and prospective assessment in the context of the cabin environment and air travel. Literature review clearly demonstrate that VTE is multicausal in nature, resulting in differing etiologic and predisposing factors across different age groups. Many questions are still to be answered, How many cases?, Direct association to Air Travel?, How to prevent it in the aviation environment? In this paper we analyze the incidence of VTE and some additional epidemiological aspects, risk and predisposing factors, diagnostic, and preventive measures given by the airline, the user, aviation authorities, aeromedical especialist in order to cope this complication. Finally we discuss the physiopathological bases in which VTE is developed and related considerations of this syndrome in the context of the aviation environment.

[Bronchiolitis obliterans with idiopathic organizing pneumonia. Usefulness and yield of diagnostic techniques and procedures in a series of 20 patients]. / Bronquiolitis obliterante con neumonía organizativa idiopática. Utilidad y rentabilidad de técnicas y procedimientos diagnósticos en una serie de 20 pacientes.

OBJECTIVE: To assess retrospectively the utility and the profitableness of the diagnostic procedures and techniques in patients with idiopathic BOOP. MATERIAL AND METHODS: We studied epidemiological features, clinical manifestations, respiratory function tests, chest radiology, and other diagnostic procedures and techniques, as well as the evolution and the mortality rates in patients with histological diagnosis of idiopathic BOOP during the period 1992-1999. RESULTS: 20 patients (55% F, 45% M). Age: 64 +/- 15 years old, 50% smokers. The mean period elapsed since the beginning of the symptoms and the time of diagnosis was 51 +/- 30 days. The clinical presentation is of a subacute influenza-like illness, with fever, cough, dyspnea and crackles. The more common abnormalities were. WBC (10,949 +/- 2,6429 mm3, ESR 85 +/- 86 UI/L, LDH 309 +/- 86 UI/L. Arterial blood gas: PaO2 64 +/- 9, PaCO2 35 +/- 3 mmHg. Pulmonary function tests: VCF 81 +/- 25%, FEV1/VCF 78 +/- 17%, TLCO 74 +/- 9%, TLCO sb 77 +/- 4%. Radiological evaluation: bilateral multiple patchy alveolar opacities 75%), solitary focal lesion (15%) and interstitial opacities (10%). The bronchoscopy and BAL 10/20 (50%). Transbronchial biopsy 12/20 wit diagnosis (60%). The video assisted thoracoscopic lung biopsy 1/20 (5%) and open lung biopsy 7/20 (35%). Recurrences 8/20 (40%). Mortality rate 3/20 (15%). CONCLUSIONS: The idiopathic BOOP is a benign entity clinic inespecific, associated to hypoxemia and bilateral alveolar opacities. The transbronchial biopsy is a diagnostic procedure alternative to the open lung biopsy, in a compatible clínico-radiological context. The response to treatment is acceptable although it presents frequent exacerbations, and low mortality rate.

Bronquiolitis obliterante con neumonía organizativa idiopática. Utilidad y rentabilidad de técnicas y procedimientos diagnósticos en una serie de 20 pacientes / Obliterans bronchiolitis with idiopathic origing pneumonia. Utility and profitableness of diagnostic techniques and procedures in 20 patients

Objetivo: Estudio retrospectivo de la utilidad y rentabilidad de las técnicas y procedimientos diagnósticos en pacientes con BONO idiopática. Material y métodos: Pacientes con diagnóstico histológico de BONO idiopática periodo (1992-1999). Realizándose análisis demográficos, manifestaciones clínicas, laboratorio, funcionales, radiológicas, procedimientos y técnicas de diagnóstico, evolución y mortalidad. Resultados: 20 pacientes (55 por ciento) M, (45 por ciento) V. Edad 64 ± 15 años, 50 por ciento fumadores. Intervalo entre inicio clínico y diagnóstico 51 ± 30 días. Un cuadro pseudogripal, junto a fiebre, tos, disnea y estertores crepitantes fueron las manifestaciones más frecuentes. Leucocitosis (10.494 ± 2.642) células/mm3,VSG 85 ± 86 UI/L, LDH 309 ± 86 UI/L. Gasometría arterial: PaO2 64 ± 9, PaCO2 35 ± 3 mm de Hg. Función respiratoria: CVF 81 ± 25 por ciento, VEF1/CVF 78 ± 17 por ciento, DLCO 74 ± 9 por ciento, KCO 77 ± 4 por ciento. Rx: opacidades alveolares múltiples bilaterales (75 por ciento), nodulares solitarias (15 por ciento) e intersticiales (10 por ciento). Fibrobroncoscopia y lavado broncoalveolar 10/20 (50 por ciento). Biopsia transbronquial 12/20, siendo diagnóstica en (60 por ciento). Videotoracoscopia 1/20 (5 por ciento) y biopsia abierta pulmonar 7/20 (35 por ciento). Exacerbaciones 8/20 (40 por ciento), falleciendo 3/20 (15 por ciento) pacientes. Conclusiones: La BONO idiopática es una entidad benigna, clínicamente inespecífica asociada a hipoxemia moderada y opacidades alveolares bilaterales. La biopsia transbronquial constituye una técnica diagnóstica alternativa a la biopsia abierta pulmonar en un contexto clínico-radiológico compatible. La respuesta al tratamiento es buena, presentando frecuentes exacerbaciones y baja mortalidad. (AU)

[Localized tracheobronchial amyloidosis: a case report and review of the literature]. / Amiloidosis traqueobronquial localizada: aportación de un caso y revisión de la literatura.

Tracheobronchial amyloidosis is the most common form of localized bronchopulmonary amyloidoses, although its diagnosis is not very frequent in daily practice. We present a case of localized tracheobronchial amyloidosis presented as hemoptysis. The diagnosis and treatment were performed with rigid bronchoscopy and resection with an Nd-YAG laser.

Amiloidosis traqueobronquial localizada: aportación de un caso y revisión de la literatura / Localized tracheobronchial amyloidosis: report of one case and review of the literature

La amiloidosis traqueobronquial es la variedad más frecuente de amiloidosis broncopulmonar localizada, aunque su diagnóstico es poco frecuente en la práctica clínica. Presentamos un caso de amiloidosis traqueobronquial localizada que debutó con hemoptisis. El diagnóstico y tratamiento se realizó mediante broncoscopia rígida y resección con láser Nd-YAG (AU)

[Study of mast cell, eosinophil and fibroblast activation in bronchoalveolar lavage fluid in patients with lung cancer]. / Estudio de marcadores de activación de mastocitos, eosinófilos y fibroblastos en el lavado broncoalveolar de pacientes con cáncer de pulmón.

To assess the role of some pro-inflammatory cells in inflammatory processes in lung cancer by measuring their respective activation markers in different portions of bronchoalveolar lavage (BAL) fluid. Prospective study in a university hospital. We studied 52 BAL samples, 37 from patients with lung cancer and 15 from a control group, using a radioimmunoassay technique to analyze for tryptase (T), hyaluronic acid (HA) and eosinophil cationic protein (ECP) in separate bronchial and bronchoalveolar samples from BAL fluid. Statistical analysis was performed using the R-SIGMA program. Patients with tumors had significantly higher T and HA levels in BAL fluid than did control patients, in both bronchial and bronchoalveolar portions. Lung cancer patients had higher T and ECP levels in bronchoalveolar portions. Mast cells and fibroblasts, at least, play a part in lung cancer, mainly in the distal portions of the bronchial tree.

[Bilateral pleural effusion and rheumatoid arthritis. Diagnostic value of pleural fluid cytology]. / Derrame pleural bilateral y artritis reumatoide. Valor diagnóstico de la citología en líquido pleural.

We present a 69 years old male patient diagnosed of rheumatoid arthritis (RA) with signs of pleuropulmonar disease. The diagnose of RA was done of 49 years and since then treated with non steroid antiinflammatory drugs and during the acute phases of RA with steroid drugs. The pleural effusions showed an exudate with pseudochilothorax criteria with acid pH acid low glucose concentrations. The cytological study of the effusion demonstrated the presence of characteristic mononuclear cells.

[Diffuse lung hemorrhage and necrotizing glomerulonephritis in a case of Wegener's granulomatosis. Diagnostic and therapeutic approach]. / Hemorragia pulmonar difusa y glomerulonefritis necrotizante en un caso de granulomatosis de Wegener. Actitud diagnóstica y terapéutica.

We present the case of a 59 years old male with Wegener's Granulomatosis with uncommon manifestations such as diffuse pulmonary hemorrhage and acute renal failure due to necrotizing glomerulonephritis. Neutrophil anticytoplasmic antibodies determination was negative. Conventional and high resolution thoracic computed tomography showed cavitated lung nodules with small peripheral vessels. These lesions, that are characteristic of this type of vasculitis, were not appreciated on the routine chest roetgenogram. Definitive diagnosis was made by the histological study of open lung and renal biopsies. Favourable response to corticosteroids, immunosuppressive drugs and hemodialysis was obtained. Diffuse pulmonary hemorrhage is an uncommon manifestation of Wegener's Granulomatosis, and must be considered as a vital emergency that justify the use of aggressive diagnostic and therapeutic methods.

[Pulmonary lymphangiomatosis associated with renal angiomyolipoma. Presentation of a case and review of the literature]. / Linfangiomiomatosis pulmonar asociada con angiomiolipoma renal. Presentación de un caso y revisión de la literatura.

The case concerned is one of lymphangiomyomatosis (LAM) in a woman aged 39, that after a episode of spontaneous pneumothorax was subject to medical research for progressive dyspnea of medium efforts and bloodstained sputum. High resolution CT showed numerous thin-walled cystic airspaces of varying sizes distributed diffusely throughout the lungs. The abdominal CT and ultrasound developed multiple right renal angiomyolipomas. The histopathological study of the sample obtained by open lung biopsy was conclusive of LAM. The main feature of this rare disease, which occurs almost exclusively in women of reproductive age, is the abnormal proliferation of immature smooth muscle at the level of the distal airway, small blood vessels and lung lymphatic system, including sometimes the mediastinal and retroperitoneal lymphatic system. The clinical, functional, radiological and differential diagnostic aspects with entities histopathologically similarities are discussed and the therapeutic possibilities are reviewed.

[Trimethoprim-sulfamethoxazole++ in the treatment of a case of localized Wegener's granulomatosis]. / Trimetoprim-sulfametoxazol en el tratamiento de un caso de granulomatosis de Wegener localizada.

A 50 year old man, affected by a Wegener's granulomatosis limited to lung, is presented. The indirect immunofluorescence test for "Anticytoplasmic Antibodies" (ACPA) was negative and we got the definitive diagnostic by the histological study from thoracotomy and biopsy samples. We started treatment with trimethoprim-sulfamethoxazole and a good evolution with an adequate clinical control, x-ray study and blood test was obtained. Some aspects of the value of the ACPA as diagnostic and activity markers of the disease and also the use of an antimicrobial agent on the treatment of this nosological entity are discussed.

[Percutaneous transluminal valvuloplasty in severe pulmonary stenosis in an aged patient. Presentation of a case]. / Valvuloplastia transluminal percutánea en la estenosis pulmonar severa del paciente anciano. Presentación de un caso.

We report a case of severe pulmonary stenosis in a 74 year old patient who was successfully treated by means of percutaneous transluminal valvuloplasty. This relatively simple technique is extensively used in children. However, its use is considered exceptional in old patients.