Effect of an ambulatory diagnostic and treatment programme in patients with sleep apnoea.

The aim of this study to evaluate the efficacy of a home-based programme on clinical response, continuous positive airway pressure (CPAP) compliance and cost in a population of high pre-test probability of suffering obstructive sleep apnoea syndrome (OSAS). Patients were randomised into the following three groups. Group A: home respiratory polygraphy (RP) and home follow-up; group B: hospital polysomnography and hospital follow-up; and group C: home RP and hospital follow-up. Evaluation during 6 months included Epworth Sleepiness Scale (ESS), Functional Outcomes Sleep Questionnaire (FOSQ), and daily activity and symptom questionnaires. Compliance was assessed by memory cards (group A) and using an hourly counter (groups B and C). 66 patients were included (22 per branch), 83% were males, aged mean±sd 52±10 yrs, body mass index 34±7kg·m(-2), apnoea/hypopnoea index 43±20 h(-1), CPAP pressure 8±2 cmH(2)O, with no between-group differences. Clinical response showed an ESS of mean±sd 15±3 to 6±4, a FOSQ of 16±3 to 18±2, symptoms of 43±7 to 25±7, and activity of 37±11 to 25±8. At the end of the study, compliance was: group A 73%, group B 68% and group C 57%. The cost per patient was: group A €590±43, group B €894±11 and group C €644±93 (p<0.001). In conclusion, patients with a high initial probability of having OSAS can be diagnosed and treated in a home setting, with a high level of CPAP compliance and lower cost than using either a hospital-based approach or home RP/hospital follow-up.

[Description of a new procedure for fiberoptic bronchoscopy during noninvasive ventilation through a nasal mask in patients with acute respiratory failure]. / Descripción de un nuevo procedimiento para la realización de fibrobroncoscopia durante ventilación no invasiva mediante mascarilla nasal en pacientes con insuficiencia respiratoria aguda.

A new method is described for performing oral fiberoptic bronchoscopy during noninvasive ventilation through the nose. The technique was successfully applied in 2 patients suffering from acute respiratory failure. The bronchoscope was inserted through a glove finger fitted into a mouth guard. The system works as a valve and does not affect performance of the bronchoscopy procedure or the pressures administered during noninvasive ventilation. We conclude that the procedure has potential advantages over bronchoscopy through the nose and face masks or helmets, particularly for the management of secretions or in special clinical circumstances (hemoptysis or presence of foreign bodies). This method can be used to substitute for or complement other bronchoscopy techniques performed with other interfaces.

Descripción de un nuevo procedimiento para la realización de fibrobroncoscopia durante ventilación no invasiva mediante mascarilla nasal en pacientes con insuficiencia aguda / Description of a new procedure for fiberoptic bronchoscopy during noninvasive ventilation through a nasal mask in patients with acute respiratory failure

Se describe un nuevo método para la realización de fibrobroncoscopia (FB) por vía bucal durante la administración de ventilación no invasiva por vía nasal, que se aplicó con éxito en 2 pacientes afectados de insuficiencia respiratoria aguda. La FB se realizó a través de una pieza de protección bucal a la que se adaptó un dedo de guante por dentro del cual se introdujo el fibrobroncoscopio. El sistema actúa como una válvula y no interfiere con las presiones administradas durante la ventilación no invasiva ni con los procedimientos broncoscópicos. Se concluye que el procedimiento presenta ventajas potenciales frente a la vía nasal por mascarilla facial o helmet, sobre todo en el manejo de secreciones o en circunstancias especiales (hemoptisis o cuerpo extraño), y permite alternar o complementar la FB practicada con otras interfaces

A new method is described for performing oral fiberoptic bronchoscopy during noninvasive ventilation through the nose. The technique was successfully applied in 2 patients suffering from acute respiratory failure. The bronchoscope was inserted through a glove finger fitted into a mouth guard. The system works as a valve and does not affect performance of the bronchoscopy procedure or the pressures administered during noninvasive ventilation. We conclude that the procedure has potential advantages over bronchoscopy through the nose and face masks or helmets, particularly for the management of secretions or in special clinical circumstances (hemoptysis or presence of foreign bodies). This method can be used to substitute for or complement other bronchoscopy techniques performed with other interfaces

[Thoracic actinomycosis: an old disorder with new clinical manifestations]. / Actinomicosis torácica: una vieja entidad con nuevas expresiones clínicas.

Three cases of thoracic actinomycosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empyema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are thoroughly analyzed.

Actinomicosis torácica: una vieja entidad con nuevas expresiones clínicas / Thoracic actinomycosis: an old disorder with new clinical manifestations

Se describen tres casos de actinomicosis torácica, dos asociados a obstrucción bronquial (cuerpo extraño y carcinoma broncogénico) y uno en un paciente con empiema. Se revisan las manifestaciones clínico radiológicas de la misma, los criterios diagnósticos y se exponen de forma pormenorizada todos los casos publicados en la literatura española

Three cases of thoracic actinomicosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empiema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are throughly analyzed

[Two new cases of chronic eosinophilic pneumonia. A revision of the literature]. / Dos nuevos casos de neumonía eosinófila crónica. Revisión de la literatura.

We present two cases of chronic eosinophilic pneumonia in two women of a seventy-seven and sixty-five years old. We revised the clinical and radiologic features, and their pathogenesis. It is necessary to recognize in a precocious time this entity and the utility of the bronchoalveolar lavage fluid in the diagnostic, for to begin a treatment with corticosteroids.

Dos nuevos casos de neumonía eosinófila crónica. Revisión de la literatura / Two new cases of chronic eosinophilic pneumonia. Revision of the literature

Se presentan dos casos de neumonía eosinófila crónica en dos mujeres de 77 y 65 años. Se revisan sus características clínicas y radiológicas, así como su patogenia. Se destaca la necesidad de reconocer precozmente esta entidad así como se resalta la utilidad del lavado broncoalveolar en el diagnóstico con el fin de instaurar un tratamiento adecuado con esteroides (AU)

Derrame pleural como manifestación del síndrome de hiperestimulación ovárica, tras tratamiento de miomas uterinos con triptorelina / Pleural effusion as a manifestation of ovarian hyperstimulation syndrome, after treatment with triptoreline for uterus myomata

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Lesión necrótica en cuero cabelludo tras traumatismo / Necrotic lesion in scalp after injury

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Non-invasive management of an acute chest infection for a patient with ALS.

We describe a man diagnosed with non-bulbar amyotrophic lateral sclerosis (ALS) who uses 24-h non-invasive ventilator at home, and assisted cough through the use of the mechanical insufflation-exsufflation (MAC) device (CoughAssist, J.H. Emerson). This was essential for the removal of bronchial secretions in order to provide successful non-invasive management (and indeed less suffering for the patient) during an acute respiratory tract infection with hypoxemia and failure of manually assisted cough.

Síndrome de Cushing secundario a tumor carcinoide bronquial: uso del octreoscán en el diagnóstico de localización / Cushing's syndrome secondary to bronchial carcinoid tumor: use of octeotride scintigraphy in the localization's diagnosis

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Gonartritis séptica en paciente con fractura de fémur hace 13 años / Septic gonarthritis in a patient with femur fracture 13 years later

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Pulmonary dirofilariasis mimicking lung cancer.

We describe the case of a 30-year-old asymptomatic farmer who underwent a pulmonary segmentectomy due to the casual finding of a pulmonary nodule in preoperative chest radiography. As bronchoscopic samples rule out mycobacterium infection and malignancy, surgery could have been avoided with the use of serological tests and radiographic follow-up based on epidemiology of dirofilariasis in our country.

Vacunaciones en el adulto

En nuestro entorno sanitario, la vacunación del adulto no recibe las mismas prioridades que la infantil. Esta situación se debe en gran parte a una falta de planificación de la vacunación y a una formación inadecuada sobre las indicaciones, beneficios y disponibilidad de la vacunación en el adulto, así como a una sobrevaloración de sus efectos secundarios y contraindicaciones (AU)