[Alveolar lipoproteinosis, an incidental finding during an unrelated pre-surgical study with inadequate response to complete pulmonary washing]. / Proteinosis alveolar, un hallazgo incidental en un estudio preoperatoiro con respuesta insuficiente al lavado pulmonar completo.

The alveolar lipoproteinosis (ALP) is a rare pulmonary disease, characterized by an excess of phospholipids in the distal airway, and the most symptom of which is dyspnea. 35 years old patient in whom we observed incidentally pulmonary infiltrations in a chest X-ray during a unrelated pre-surgical study. We could not make a definitive diagnosis after further investigations carried out in the Division of Respiratory Medicine. We, therefore, sent this patient to the Division of Chest Surgery for a complementary video-thoracoscopy. Biopsy showed presence of ALP. The ALP is a rare disease that originates diagnosis difficulties, and that often needs lung biopsies to confirm its diagnosis. Once treated, its prognosis is excellent. The safest and most effective treatment is a complete pulmonary washing, that, in our patient, was required 7 months after diagnosis as this patient presented clinical deterioration and worsening in the lung function studies. This treatment did not achieve the expected goal. In the subsequent 6 months, we repeated the same treatment and failed again. We then started a treatment with granulocyte-macrophage-colony stimulating factor (GM-CSF) and obtain good response.

Proteinosis Alveolar, un hallazgo incidental en un estudio preoperatorio con respuesta insuficiente al lavado pulmonar completo / Alveolar lipoproteinosis, an incidental finding during an unrelated pre-surgical study with inadequate response to complete pulmonary washing

La lipoproteinosis alveolar (LPA) es una enfermedad pulmonar difusa poco frecuente, acumulándose un exceso de fosfolípidos en la vía aérea distal, cuyo síntoma más frecuente es la disnea. Paciente de 35 años de edad en la que se observan, como hallazgo incidental durante un estudio preoperatorio, infiltrados pulmonares en una radiografía de tórax. Con las exploraciones físicas y complementarias realizadas en el Servicio de Neumología, no se obtiene un diagnóstico definitivo, por lo que la paciente es remitida al Servicio de Cirugía Torácica para realizar videotoracoscopia diagnóstica. El estudio de las biopsias obtenidas demuestra la presencia de LPA. La LPA es una enfermedad poco frecuente que suele plantear dificultades diagnósticas, y en múltiples ocasiones requiere biopsia pulmonar para obtener el diagnóstico definitivo. El pronóstico global de la enfermedad es excelente con tratamiento. La terapia más segura y efectiva es el lavado pulmonar completo (LPC), que en nuestra paciente fue necesario a los 7 meses del diagnóstico por presentar deterioro clínico así como en los estudios de función pulmonar realizados, con pobre respuesta al mismo. En los 6 meses siguientes se realiza nuevo LPC, sin resultados satisfactorios; iniciándose entonces tratamiento con factor estimulante de colonias de granulocito-macrófagos (GM-CSF), con respuesta favorable (AU)

Bronchoesophageal fistulae secondary to tuberculosis.

An elderly patient with a bronchoesophageal fistula secondary to tuberculosis and a 3-month history of cough and dysphagia worsening with deglutition was admitted to hospital. Radiological examination and CT of the thorax revealed mediastinal adenopathy. Bronchoscopy, esophagoscopy and esophagraphy confirmed the presence of a bronchoesophageal fistula. Histological examination of the esophagus and bronchial biopsy specimens revealed nonnecrotic granulomas, and the acid-fast bacilli tested positive for Mycobacterium tuberculosis in respiratory secretions. Antituberculous treatment was started after diagnosis of intrathoracic lymph node tuberculosis with bronchoesophageal fistulization. A month and a half after initiating treatment, paroxistic coughing during deglutition persisted. An esophagoscopy was performed, and the orifice was closed with a fibrin tissue. After 9 months of treatment, the patient was asymptomatic and in good health.

[Tuberculosis in elderly patients. Presentation forms]. / Tuberculosis en pacientes ancianos. Formas de presentación.

OBJECTIVE: To analyse the distribution of the forms of presentation of tuberculosis (TPF) in elderly patients. MATERIAL AND METHODS: The medical records of patients diagnosed with tuberculosis attending the Tuberculosis Prevention and Control Unit of the Santiago Health District were reviewed over of six years period. The classification of TPF was: pulmonary forms (P), disease confined to the lung; extrapulmonary forms (EF), disease outside the lung; mixed forms (MF), the presence of both pulmonary and extrapulmonary tuberculosis; disseminated forms (DF), the presence of two or more extrapulmonary locations; and miliary TB, which was defined by a diffuse pulmonary radiographic pattern or diagnosis was undertaken by necropsy. RESULTS: A total of 278 tuberculosis infected patients were observed, 156 (56.2%) were men and 122 (43.8%) women, their mean age was 75.3 years (range 65-95). The distribution of TPF was: 155 (55.8%) P forms; 66 (23.7%) EF, of which 27 (41.0%) were ganglionary location, 12 (18.2%) bone and joint, 8 (12.0%) intestinal, 6 (9.1%) peritoneal, 5 (7.6%) meningeal, and other locations 8 (12.1%); MF 47 cases (16.9%); miliary TB 7 cases (2.5%) and. DF 3 cases (1.1%). None case was observed of HIV infected patient. CONCLUSIONS: Our findings confirm high incidence of extrapulmonary TB in elderly patients. Our experience shows a modification to the classical presentation of the disease, and thus the need for sensitivity in locating the disease.

Pruebas cutáneas y tuberculosis: aplicación e indicaciones en la profilaxis, con especial incidencia en la coinfección con el VIH

En este artículo queremos hacer especial referencia a la prueba de la tuberculina, que ha sido y es el mejor índice de infección tuberculosa, con las salvedades que expondremos. Por otra parte, la inmunodeficiencia provocada por el virus de la inmunodeficiencia humana nos ha obligado a encontrar medios que nos permitan valorar los resultados de esta prueba, ya que la inmunidad celular alterada es una de las principales causas de falsos negativos en el test de Mantoux. Así, las pruebas de hipersensibilidad retardada (PHR) se han situado como importantísimas ayudas a la hora de dilucidar ciertas negatividades del test de Mantoux, o incluso valores de induración que no alcanzan las cifras habituales.También han aparecido nuevas indicaciones de quimioprofilaxis por lo reseñado con anterioridad y se han reforzado las medidas de prevención clásicas como consecuencia de la aparición de brotes de tuberculosis multirresistente y el aumento de los contagios en la última década. (AU)

Clínica de la tuberculosis

Al hablar de tuberculosis tendemos a pensar en la forma pulmonar de la enfermedad; sin embargo, la tuberculosis puede afectar prácticamente a cualquier órgano de la economía. Si bien la forma pulmonar es aún la más frecuente, otras formas como, por ejemplo, la tuberculosis pleural, ganglionar, abdominal (incluyendo aparato digestivo, peritoneo y ganglios), meníngea, osteoarticular y genitourinaria mantienen, por este orden, una incidencia significativa que obliga al médico a tenerlas en cuenta al realizar la valoración de un enfermo con clínica sugerente (AU)

[Extrapulmonary tuberculosis in our area. Forms of presentation]. / Tuberculosis extrapulmonar en nuestro medio. Formas de presentación.

OBJECTIVE: To analyse the distribution of the extrapulmonary forms of presentation of tuberculosis (EFP) in our health district. MATERIALS AND METHODS: The medical records of patients diagnosed with extrapulmonary tuberculosis attending the Tuberculosis Prevention and Control Unit of the Santiago Health District were reviewed over a three years period. The classification of EFP was: extrapulmonary forms (EF), disease outside the lung; mixed forms (MF), the presence of both pulmonary and extrapulmonary tuberculosis; disseminated forms (DF), the presence of two or more extrapulmonary locations; and miliary TB, which was defined by a diffuse pulmonary radiographic pattern or diagnosis was undertaken by necropsy. RESULTS: A total of 921 tuberculosis infected patients were observed, of which 370 (40.2%) were extrapulmonary forms; of these, 199 were men and 171 women (mean age was 36.9 years, range 19-68). The distribution of EFP was: 307 EF (83%) of which 140 (45.6%) were pleural, 87 (28.3%) ganglionary, 16 (5.2%) intestinal, 14 (4.5%) bone and joint, 11 (3.6%) genitourinary, 11 (3.6%) cutaneous, 10 (3.3%) meningeal, and other locations 18 (5.9); MF 38 cases (10.3%); DF 8 cases (2.1%) and miliary TB 1 cases (4.6%). In HIV infected patients 17 EF (77.3%), which were mainly ganglionary (64.7%); 4 DF (18.2%); and 1 miliary TB (4.5%) cases were observed. CONCLUSIONS: Our findings confirm the high incidence of extrapulmonary TB, similar to the number of pulmonary forms. Our experience shows a significant modification to the classical presentation of the disease, and thus the need for sensitivity in locating the disease.

[Most common cardiovascular diseases and sleep apnea syndrome. A general population study]. / Enfermedades cardiovasculares más frecuentes y síndrome de apnea del sueño. Un estudio en población general.

BACKGROUND: The sleep apnea syndrome (SAS) is a frequent disease associated with significant morbidity. The aim of our study was to investigate diseases associated with the sleep apnea syndrome (SAS) in general population. METHODS: We selected a random sample of 110 people from the electoral census. These people were invited to the clinic where medical history, physical examination and monitoring for sleep-disordered breathing was done. RESULTS: Twenty two subjects were diagnosed of SAS. The prevalence of arterial hypertension in the SAS group was 36.4%, and coronary artery disease 13.6%. CONCLUSIONS: Although the prevalence of this diseases was increased in the SAS group, we do not see significant association with this disease.

Lymphangioleiomyomatosis: the effectiveness of radiotherapy-induced ovarian function annulment. A case report.

Lymphangioleiomyomatosis is an unusual disease characterized by atypical smooth muscle hyperplasia especially of the lymphatic system and affecting females in their child-bearing years. We present a case in which ovarian function was annuled through radiotherapy, instead of resorting to the most commonly used oophorectomy, since the patient's severe respiratory dysfunction made surgery inadvisable. The clinical, radiological and functional characteristics of this entity are discussed, and the therapeutic possibilities are reviewed.

[Pseudotumoral bronchial tuberculosis]. / Tuberculosis bronquial pseudotumoral.

We analyse our own experience of a rare tuberculosis presentation that we call pseudotumoral bronchial tuberculosis. 9 cases were studied, which due to radiological, endoscopic and clinical features, a diagnosis of bronchogenic carcinoma was made. The median age was 63.7 years, 7 were male and 2 were female. The hilar or mediastinic radiological pattern was frequent. The bacterial diagnosis was made through the study of the samples obtained by bronchoscopy, except in 2 cases which were diagnosed through post-bronchoscopy sputum examination. The bronchial biopsy showed the typical necrotic granulomas of tuberculosis in only one case. Supported by the bad evolution of our patients treated without steroids, the possible efficacy of early use of steroid is suggested to avoid the most important sequelae, bronchial stenosis.

[Osteochondroplastic tracheopathy. Diagnostic confirmation. Experience with 8 cases]. / Traqueopatía osteocondroplásica. Confirmación diagnóstica. Experiencia en 8 casos.

We report our experience in 8 patients with osteochondroplastic tracheopathy and consider the importance of its diagnosis y biopsy in order to confirm histology and if possible etiology, because specific treatment could change the course of the disease. Methods such as radiology, CT-scan, respiratory function tests only give diagnostic suspicion, which is a previous step before confirmation by bronchoscopy with biopsy. To date, with the exception of a few cases, the diagnosis is made by necropsy. Thus, this justifies our emphasis in the diagnosis of this rare disease when it is suspected in living patients.