[Pulmonary haemorrhage and primary antiphospholipid syndrome: case report and review]. / Hemorragia pulmonar y síndrome antifosfolípido primario: aportación de un caso y revisión de la literatura.

The antiphospholipid syndrome is defined by the association of vein and/or arterial thrombotic events and a high level of antiphospholipid antibodies. Pulmonary embolism and pulmonary hypertension are the most usual complications and recently some new cases of alveolar haemorrhage have been described. We present the case of an alveolar haemorrhage in a patient with a primary antiphospholipid syndrome. The first manifestation of this patient was a deep vein thrombosis on his left lower leg . After that he had persistent hemoptoic sputum and his chest x-ray showed alveolar infiltrates. The bronchoscopy ruled out another causes of haemoptysis and the bronchoalveolar lavage confirmed that it was an alveolar haemorrhage (80% of hemosiderophages ). The case is discussed and we do a literature review.

Hemorragia pulmonar y síndrome antifosfolípido primario: aportación de un caso y revisión de la literatura / Pulmonary haemorrhage and primary antiphospholipid syndrome: case report and review

El síndrome antifosfolípido se caracteriza por la asociación de fenómenos trombóticos venosos y/o arteriales y un título elevado de anticuerpos antifosfolipídicos. Sus manifestaciones pulmonares más frecuentes son el tromboembolismo y la hipertensión pulmonar, pero recientemente también se han descrito algunos casos de hemorragia alveolar. Aportamos un caso de hemorragia alveolar en el seno de un síndrome antifosfolípido primario. La primera manifestación en este paciente fue una trombosis venosa profunda del miembro inferior derecho. Posteriormente presentó esputos hemoptoicos de forma persistente y la radiografía mostró infiltrados alveolares. La broncoscopia descartó otras causas de hemoptisis y el lavado broncoalveolar confirmó que se trataba de una hemorragia alveolar (80% de hemosiderófagos). Se discute el caso y realizamos una revisión de la literatura

The antiphospholipid syndrome is defined by the association of vein and/or arterial thrombotic events and a high level of antiphospholipid antibodies. Pulmonary embolism and pulmonary hypertension are the most usual complications and recently some new cases of alveolar haemorrhage have been described. We present the case of an alveolar haemorrhage in a patient with a primary antiphospholipid syndrome. The first manifestation of this patient was a deep vein thrombosis on his left lower leg . After that he had persistent hemoptoic sputum and his chest x-ray showed alveolar infiltrates. The bronchoscopy ruled out another causes of haemoptysis and the bronchoalveolar lavage confirmed that it was an alveolar haemorrhage (80% of hemosiderophages ). The case is discussed and we do a literature review

Nuevos tratamientos en la fibrosis pulmonar idiomática / New treatments for idiopathic pulmonary fibrosis

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[The epidemiology of COPD and asthma exacerbations in a general hospital]. / Características epidemiológicas de las exacerbaciones por EPOC y asma en un hospital general.

This retrospective study identified the clinical and epidemiological characteristics of patients coming to the emergency room of our hospital with exacerbated asthma or chronic obstructive pulmonary disease (COPD) in 1993 and 1994. We followed a previously established protocol to review the case histories of patients from both years. The 1,592 exacerbations we identified in 1,209 asthmatics accounted for 0.9% of all emergency visits, with a mean of 2.2 1.6 (0-9) visits daily. The 2,106 exacerbations of COPD in 1,208 patients accounted for 1.2% of all emergencies, with a mean 2.9 (1-12) visits per day. The mean age was 51.2 (14-93) years for asthmatics and 70.3 (29-96) years for COPD patients. Of asthmatics, 69.8% were women and 30.1% were men, whereas 91.4% of COPD patients were men. The readmission rate was 3.4% for asthmatics and 4.8% for COPD patients. The hospitalization rate was 26.7% for asthmatics and 49.4% for COPD exacerbation patients. The hospital saw 22.6% of asthma exacerbations between midnight and 8 a.m. and 41.6% of COPD exacerbations during the same time frame. For both diseases, more emergencies occurred in winter. Correlation between asthma and COPD and declared influenza cases in the community were r = 0.63 (p < 0.001) for asthma and r = 0.83 (p < 0.0001) for COPD. Our findings underline the considerable emergency care burden generated by exacerbations of obstructive airway diseases and suggest that community acquired respiratory infections are usually the underlying cause.

Características epidemiológicas de las exacerbaciones por EPOC y asma en un hospital general / The epidemiology of COPD and asthma exacerbations in a general hospital

Realizamos un estudio retrospectivo para conocer las características clínicas y epidemiológicas de los pacientes que acudieron al servicio de urgencias del hospital con exacerbaciones de asma y enfermedad pulmonar obstructiva crónica (EPOC) durante los años 1993 y 1994. El análisis se realizó mediante revisión de las historias clínicas de los pacientes atendidos durante estos 2 años de acuerdo con un protocolo de estudio previamente establecido. Identificamos 1.592 exacerbaciones en 1.209 pacientes asmáticos, lo que representa el 0,9 por ciento del total de urgencias atendidas, y una media ñ desviación estándar de 2,2 ñ 1,6 (límites, 0-9) de exacerbaciones diarias. Las agudizaciones de EPOC fueron 2.106 en 1.208 pacientes, lo que significa el 1,2 por ciento del total de urgencias, y una media diaria de 2,9 (límites, 0-12) casos. La edad media de los pacientes con asma fue de 51,2 (límites, 14-93) años, y la de los que padecían EPOC, de 70,3 (límites, 29-96). Con respecto al sexo, entre los asmáticos el 69,8 por ciento eran mujeres y el 30,1 por ciento, varones, mientras que entre los pacientes con EPOC el 91,4 por ciento eran varones. La tasa de reingresos por asma fue del 3,4 por ciento y para la EPOC, del 4,8 por ciento. Precisaron internamiento hospitalario el 26,7 por ciento de los asmáticos y el 49,4 por ciento de las agudizaciones de EPOC. El 22,6 por ciento de los pacientes con asma y el 41,6 por ciento de los que padecían EPOC acudieron al hospital entre las 0:00 y las 8:00 h. Tanto en el caso del asma como en el de la EPOC, en los meses invernales se registró una mayor afluencia. La correlación observada entre el número de exacerbaciones de asma y EPOC y los casos declarados de gripe en la comunidad para asma fue: r = 0,63 (p < 0,0001) y para EPOC, r = 0,83 (p < 0,0001).Nuestros datos destacan la importante carga asistencial que representan las exacerbaciones por enfermedad obstructiva de la vía aérea como motivo de atención hospitalaria urgente y sugieren que las infecciones respiratorias comunitarias podrían ser la causa subyacente (AU)

[Pseudotumoral allergic bronchopulmonary aspergillosis]. / Aspergilosis broncopulmonar alérgica seudotumoral.

Allergic bronchopulmonary aspergillosis (ABPA) develops as the result of a hypersensitivity reaction to fungi of the genus Aspergillus. Clinical and radiological presentation can be atypical, requiring a high degree of suspicion on the part of the physician who treats such patients. We report the cases of two patients with APBA in whom the form of presentation--with few asthma symptoms, images showing lobar atelectasia and hilar adenopathy--led to an initial suspicion of lung cancer.

Aspergilosis broncopulmonar alérgica seudotumoral / Pseudotumoral allergic bronchopulmonary aspergillosis

La aspergilosis broncopulmonar alérgica (ABPA) se produce por una reacción de hipersensibilidad a hongos, del género Aspergillus. En ocasiones la forma de presentación, tanto clínica como radiológica, es atípica, exigiendo un alto grado de sospecha por parte del clínico que atiende a estos enfermos. Presentamos dos pacientes con ABPA en los que la forma de presentación con asma poco expresivo clínicamente, las imágenes radiológicas de atelectasia lobar y las adenopatías hiliares sugerían, como primera posibilidad, el diagnóstico de una neoplasia pulmonar. (AU)

[Malignant diffuse mesothelioma: contribution of 23 cases]. / Mesotelioma difuso maligno: aportación de 23 casos.

Malignant diffuse mesothelioma is a tumour related to asbestos exposure, more common in males and located primarily in the chest cavity. Its diagnosis requires ruling out other tumours with pleural or peritoneal metastases, a biopsy showing a morphological pattern consistent with mesothelioma and in many cases to perform immunohistochemical markers to rule out an adenocarcinoma. We report here 20 cases of diffuse pleural mesothelioma and three cases of peritoneal mesothelioma in 20 males and three cases of peritoneal mesothelioma in 20 males and three females. Asbestos exposure was observed for 31% of cases. The most common clinical manifestations included headache and dyspnea; interestingly, three cases had hydropneumothorax with poor response to drainage. The diagnostic confirmation was obtained mainly with thoracotomy or laparoscopy biopsies and to rule out an adenocarcinoma immunohistochemical stainings were performed.

[Community acquired pneumonia requiring admission to hospital. Etiology and follow-up of 366 cases]. / Neumonía adquirida en la comunidad que requiere ingreso hospitalario. Aspectos etiológicos y evolutivos entre 366 casos.

UNLABELLED: An eighteen-month prospective study designed to determine the incidence, etiology and prognosis of community acquired pneumonia (CAP) in adults requiring admission to hospital. METHODS: We studied 366 patients admitted to hospital after being diagnosed of CAP at the Emergency Room of a General Hospital. Standard laboratory methods were used for culture from blood and sputum, and serology tests for Legionella pneumophila. Mycoplasma pneumoniae, Chlamydia psittaci and Coxiella burnetti. Patients were evaluated until complete recovery, paying special attention to prognostic factors predictive of death. RESULTS: An etiological diagnosis was established in 99 patients (27.6%). Legionella pneumophila was the most common pathogen accounting for 30 cases (8.2%), followed by Streptococcus pneumoniae with 26 cases. 26 patients died (mortality rate of 7%); factors predictive of death included pre-existing disease, tachypnea and elevated blood urea nitrogen level. CONCLUSIONS: CAP represented 4.4% of admissions. Legionella pneumophila was the most frequently identified pathogen. If tachypnea and/or uremia are noted on admission, there is an increase in the risk of death.

Bronchoscopy findings in invasive pulmonary aspergillosis.

Two patients with invasive aspergillosis had unusual endobronchial appearances at fibreoptic bronchoscopy. Diagnosis was achieved by endobronchial biopsy.