Histiocitosis X / Histiocytosis X

La histiocitosis X es una enfermedad pulmonar intersticial poco común que afecta a adultos jóvenes y se asocia en un elevado número de casos con antecedente de tabaquismo. Se describen 4 casos de histiocitosis X, revisando las características clínicas, diagnósticas y terapéuticas de la enfermedad (AU)

Histiocytosis X is an uncommon pulmonary interstitial disease that affects young adults and is associated to an elevated number of cases with a background of smoking. Four cases of histiocytosis X are described, reviewing the clinical, diagnostic and therapeutic characteristics of the disease (AU)

[Sleep apnea syndrome in heart failure. Effect of continuous positive airway pressure]. / Síndrome de apnea del sueño en la insuficiencia cardiaca. Efecto de la presión positiva continua en la vía aérea.

INTRODUCTION: Sleep disordered breathing and heart failure are common disorders that are frequently associated in the same patients which may bring on serious consequences. OBJECTIVE: To determine the prevalence of sleep apnea syndrome (SAS) in patients with controlled heart failure and the associated prevalence of arrhythmia. In addition, we to aim to evaluate the effectiveness of continuous positive airway pressure (CPAP) treatment for OSAS on left ventricular ejection fraction (EF). MATERIAL AND METHODS: We prospectively studied 60 patients (50 men, 10 women) with heart failure due to systolic dysfunction (left ventricular EF < 45%). All subjects were classified according the NYHA functional scale and received a specific questionnaire, as well as a home respiratory polygraphy and EKG Holter. A subject was considered to have SAS if their IAH > 15, and, according to standard recommendation, patients with IAH > 30 were treated with CPAP. After 3 months of treatment, the questionnaire, respiratory polygraphy and EKG Holter were repeated. RESULTS: Age was 69.3 +/- 10.4 years and the BMI was 28.5 +/- 4.74 kg/m2. Of the total sample, 55% (33 cases) were habitual snorers. The Epworth scale scores were 7.83 +/- 4.8. The EF was 36.3 +/- 7.4%, and 36 patients were NYHA class II, 23 were class III, and one patient was class IV. A total of 38 patients had SAS (63%): 14 (36%) had central sleep apnea and 24 (64%) had obstructive sleep apnea. EF revealed no significant differences between the SAS and non-SAS groups (36.42 +/- 7.6 vs. 35.81 +/- 6.6%, respectively). The SAS group presented a higher prevalence of bradicardia than the non-SAS group (24 % vs. 9%). After CPAP treatment, there was a significant improvement in EF (9%), in cases of obstructive sleep apnea, but no significant improvement was observed in patients with central sleep apnea. CONCLUSIONS: The prevalence of SAS in patients with heart failure due to systolic dysfunction is very high. CPAP treatment improved the EF in patients with obstructive sleep apnea.

Síndrome de apnea del sueño en la insuficiencia cardiaca. Efecto de la presión positiva continua en la vía aérea / Sleep apnea syndrome in heart failure. Effect of continuous positive airway pressure

Introducción: Los trastornos respiratorios durante el sueño (TRS) y la insuficiencia cardiaca (IC) son patologías muy comunes que con frecuencia se asocian en el mismo paciente con consecuencias que pueden ser graves. Objetivo: Conocer la prevalencia de síndrome de apnea del sueño (SAS) en pacientes con IC estable, arritmias asociadas, así como evaluar el efecto del tratamiento con presión positiva continua (CPAP) del SAS sobre la fracción de eyección de ventrículo izquierdo (FE). Material y métodos: Estudiamos de forma prospectiva a 60 pacientes (50 varones y 10 mujeres) con IC debida a disfunción sistólica (fracción de eyección del ventrículo izquierdo FE < 45%). A todos los pacientes se les realizó un cuestionario específico así como poligrafía respiratoria y un Holter en su domicilio. Se consideró la presencia de SAS cuando el IAH > 15 y aquellos con IAH > 30 fueron tratados con CPAP realizando los mismos estudios anteriores, poligrafía y Holter, a los 3 meses. Resultados: La edad fue de 69,3 ± 10,4 años y el índice de masa corporal (IMC) de 28,5 ± 4,74 kg/m 2. Un 55% (33 casos) eran roncadores habituarles y la puntuación en la escala Epworth era de 7,83 ± 4,8. La FE fue de 36,3 ± 7,4%, estando 36 enfermos en clase funcional II, 23 en clase funcional III y un enfermo en clase funcional IV. Un total de 38 pacientes tenían SAS (63%): 14 (36%) de tipo central y 24 (64%) de tipo obstructivo. La FE no mostró diferencias significativas entre el grupo SAS (36,4 ± 7,6) vs. (35,8 ± 6,6%) en el no-SAS. Los pacientes con SAS presentaron más frecuentemente bradicardia sinusal con respecto a los sujetos sin SAS (24% vs. 9%). Tras tratamiento con CPAP se observa una mejoría significativa de la FE de 9%, en los casos de SAS de predominio obstructivo, no observando cambios en los pacientes con SAS de predominio central. Conclusiones: La prevalencia de síndrome de apnea del sueño en pacientes con insuficiencia cardiaca y disfunción sistólica es muy alta. El tratamiento con CPAP mejora la fracción de eyección de los sujetos con SAS de carácter obstructivo

Introduction: Sleep disordered breathing and heart failure are common disorders that are frequently associated in the same patients which may bring on serious consequences. Objective: To determine the prevalence of sleep apnea syndrome (SAS) in patients with controlled heart failure and the associated prevalence of arrhythmia. In addition, we to aim to evaluate the effectiveness of continuous positive airway pressure (CPAP) treatment for OSAS on left ventricular ejection fraction (EF). Material and methods: We prospectively studied 60 patients (50 men,10 women) with heart failure due to systolic dysfunction (left ventricular EF < 45%). All subjects were classified according the NYHA functional scale and received a specific questionnaire, as well as a home respiratory polygraphy and EKG Holter. A subject was considered to have SAS if their IAH > 15, and, according to standard recommendation, patients with IAH > 30 were treated with CPAP. After 3 months of treatment, the questionnaire, respiratory polygraphy and EKG Holter were repeated. Results: Age was 69.3 ± 10.4 years and the BMI was 28.5 ± 4.74 kg/m2. Of the total sample, 55% (33 cases) were habitual snorers. The Epworth scale scores were 7.83 ± 4.8. The EF was 36.3 ± 7.4%, and 36 patients were NYHA class II, 23 were class III, and one patient was class IV. A total of 38 patients had SAS (63%): 14 (36%) had central sleepapnea and 24 (64%) had obstructive sleep apnea. EF revealed no significant differences between the SAS and non-SAS groups (36.42 ± 7.6 vs.35.81 ± 6.6%, respectively). The SAS group presented a higher prevalence of bradicardia than the non-SAS group (24 % vs. 9%). After CPAP treatment, there was a significant improvement in EF (9%), in cases ofobstructive sleep apnea, but no significant improvement was observed in patients with central sleep apnea. Conclusions: The prevalence of SAS in patients with heart failuredue to systolic dysfunction is very high. CPAP treatment improved the EF in patients with obstructive sleep apnea

Absceso pulmonar por Aeromonas hydrophila / Lung abscess caused by aeromonas hydrophila

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Hidroneumotórax secundario a colocación de sonda nasogástrica / Hydropneumothorax from a nasogastric tube placement

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[Acromegaly and sleep apnea]. / Acromegalia y apnea del sueño.

OBJECTIVE: Acromegaly is often associated with sleep apnea-hypopnea syndrome (SAHS). The purpose of this study was to understand the prevalence of SAHS in patients with acromegaly and define the characteristics of acromegalic patients with and without SAHS. PATIENTS AND METHODS: The study enrolled 17 patients (11 women and 6 men) residing in the province of Ourense, Spain, who were diagnosed with acromegaly. All patients underwent overnight polysomnography in a sleep laboratory. In addition, growth hormone and insulin-like growth factor 1 levels were assessed. Sixteen of the patients underwent cephalometric study. RESULTS: The average age of the patients was 58 years (95% confidence interval [CI], 52-63). The average body mass index was 31 (95% CI, 29-34) and average neck circumference was 41 (95% CI, 39-43). Ten patients (58.8%) had an apnea-hypopnea index (AHI) greater than 10. Nine had obstructive apnea and one had central apnea. Seven (5 with an AHI>10 and 2 with an AHI<10) reported excessive daytime sleepiness with Epworth scores greater than 10 (41.2%). Five patients (29.4%) were diagnosed with SAHS (AHI>10 and Epworth>10). No correlation was found between an AHI greater than 10 and hormonal activity (P=.082). The mean growth hormone level for patients with an AHI greater than 10 was 4.8 (95% CI, 0.5-9) and the mean for those with an AHI less than 10 was 12 (95% CI, 2-27). Fifty percent of the patients were treated with a somatostatin analog and half of those treated exhibited apnea (P=.302). No cephalometric differences related to the presence of apneas were found. CONCLUSIONS: We found a high prevalence of sleep apneas (58.8%) and SAHS (29.4%), and central apneas were rare. We found no correlation between hormone activity level and the presence of SAHS. The incidence of SAHS was the same in somatostatin analog treated and untreated patients. Cephalometric variables did not distinguish between acromegalic patients with and without SAHS.

Empiema pleural y derrame pericárdico por Campylobacter fetus en adulto inmunocompetente / Pleural empyema and pericardial effusion due to Campylobacter fetus

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