[Prognostic features of residual pleural thickening in metapneumonic pleural effusion]. / Factores predictivos del engrosamiento pleural residual en el derrame pleural metaneumónico.

Residual pleural thickening (RPT) develops in some patients after metapneumonic pleural effusion (MPE). Our aim was to identify factors that predict the development of RPT by retrospectively analyzing patients with MPE secondary to bacterial pneumonia in our practice from 1992 through April 1997. Patients were assigned to groups based on the presence or not of RPT (> 10 mm) three months or more after diagnosis of MPE. One hundred twenty-eight patients were included in the analysis. Seventy-nine patients (62%) developed RPT and 49 (38%) did not. Patients with RPT had significantly lower glucose levels and pH and higher LDH levels in pleural fluid. A higher percentage of patients with RPT had loculate pleural effusions and empyema, and they more often required insertion of drains. Logistic regression analysis showed that only glucose < 40 mg/dl (OR: 3.4; CI 95%: 2.3 to 4.5; p < 0.05) and the presence of pus collected from the initial thoracocentesis (OR: 3.6; CI 95%: 2.6 to 4.5; p < 0.01) were significantly associated with increased risk of developing residual pachypleuritis in subjects with MPE.

Malignant pleural effusion: prognostic factors for survival and response to chemical pleurodesis in a series of 120 cases.

Chemical pleurodesis is an effective treatment of malignant pleural effusions, but indications must be individualised to optimise its results. The aim of the present study was to investigate the relationship of various prognostic features with both the response rate to pleurodesis and the probability of patient survival. A non-concurrent cohort study was carried out in which 120 evaluable patients with malignant pleural effusion underwent pleurodesis. Lung (40%), breast (26.6%), and unknown primary site (12.5%) carcinomas were the most frequent neoplasms. Clinical data and pleural fluid parameters were analysed. Median overall survival was 9 months. Pleural fluid glucose (< 60 mg/dl), Karnofsky performance status (< 70), size of the effusion in chest radiographs (massive effusion), pleural fluid pH (< 7.20), presence of concomitant alterations in chest radiographs, and pleural lactic acid dehydrogenase levels (> 600 U/l) showed a significant association with the probability of failure. Patients with these features, along with those having non-chemosensitive tumours (in particular, non-small cell lung cancer), had a significantly worse actuarial survival. This study confirms that some pretreatment clinical data and pleural fluid parameters can predict both the outcome of pleurodesis and the survival of patients with malignant pleural effusion.

Pleurodesis in malignant pleural effusions: a randomized study of tetracycline versus bleomycin.

Malignant pleural effusions are commonly managed with tube thoracostomy drainage followed by chemical pleurodesis. Both tetracycline and bleomycin have been shown to be effective for intrapleural instillation, although neither agent has definitively proved advantages over the other. The aim of the present study was to compare these two agents in terms of response rate and toxicity profile. A prospective, randomized trial was carried out in a single centre. Between May 1993 and January 1996, 62 evaluable patients with proved malignant pleural effusion were allocated to receive either intrapleural tetracycline (1.5 g) or bleomycin (60 mg) after the same drainage procedure. Demographic, clinical and fluid parameter data were comparable in both groups. Response was evaluated at 1, 3 and 6 months after pleurodesis. Mean survival and time to relapse did not differ between the two groups. No statistically significant differences were found in terms of efficacy at each evaluation time. Overall, 16 (52%) and 20 (64%) patients had a recurrence of pleural effusion during follow-up in the tetracycline and bleomycin arms, respectively. Fever was most common in bleomycin-treated patients (p=0.024) while pain was most frequent in the tetracycline arm (nonsignificant). Since no study agent was superior to the other in this trial, we suggest that economic costs, drug availability and medical skill should be considered in the choice of a sclerosing agent.

[The clinical characteristics of pleural tuberculosis in patients with and without human immunodeficiency virus infection]. / Características clínicas de la tuberculosis pleural en el paciente con y sin infección por el virus de la inmunodeficiencia humana.

OBJECTIVE: To determine whether or not there are differences in the characteristics of pleural tuberculosis (PT) related to whether patients are or are not infected by human immunodeficiency virus (HIV). METHODS: We conducted a retrospective study of the medical histories of patients diagnosed of PT in our hospital between 1986 and 1993. RESULTS: We found no significant differences in the proportions of tuberculosis patients with or without HIV infection (8% versus 11%) who were diagnosed of PT. Of the 119 patients diagnosed of PT, 10% were also HIV positive. The HIV patients had more serious forms of PT, and among them there was a higher incidence of pleural discharge, more isolations of Mycobacterium tuberculosis in sputum and pleural fluid (42% and 45% versus 13% and 15%, p < 0.05), and more deaths before end of treatment (17% versus 1%, p < 0.05). The HIV patients had a lower rate of positive results in Mantoux's intradermal reaction test (17% versus 67%, p < 0.01), however, and fewer positive results for pleural biopsy (36% versus 84% positivity for granulomas, p < 0.01). CONCLUSIONS: The frequency of PT was similar for subjects with and without HIV infection in our study. In patients with both HIV and PT pleural fluid and sputum cultures are more useful diagnostic tools than pleural biopsy, and the former tests should therefore be stressed.

Occupational allergy to mites in salty ham, chorizo and cheese.

We present three cases of occupational allergy caused by the manipulation of food: cheese, chorizo (typical Spanish salami) and salty ham. A IgE-mediated sensitization is demonstrated by skin tests, RAST and positive challenge tests to Acarus siro and Blomia kulagini of the cheese rind, Euroglyphus maynei of the "chorizo" and Tyrophagus putrescentiae of the salty ham.

Bronchial fistula to the mediastinum in a heart-lung transplant patient.

We present a case of heart-lung transplantation complicated by bronchial perforation as the cause or consequence of prolonged lung infection. Periodic bronchoscopic and radiological follow-up showed resolution of the condition following adequate antibiotic and physiotherapeutic treatment.

[Preformed crowns in pedodontics. A classic and valid option]. / Las coronas preformadas en odontopediatría: una opción clásica y vigente.

Stainless steel crowns are even now, the best available option to restore deciduous molars with extense decay involving at least one proximal surface. Composites restorations are only an alternative to stainless steel crowns in those cases with vaste occlusal decay with no proximal involvements, even when a pulpal therapy has to be performed. With a standard technique which has remained almost unchanged, the gingival tissues response to crowns and its long term clinical results, are excellents. Preformed or non preformed ones are not two different options to work with, but two choices to consider depending the professional aptitudes and the particular condition of the tooth to be restored. Finally in those cases where the deciduous molar cannot be acceptably restored with a stainless steel crown, no new material has shown to be a reasonably alternative; then, extraction of the tooth has to be considered and adecuate measures will be taken in order to maintain the physiological occlusal development of the child inaltered.