Rentabilidad diagnóstica de la broncoscopia en la enfermedad neoplásica en la Unidad de Fibrobroncoscopias del Hospital General Universitario de Albacete / Diagnostic yield of bronchoscopy in neoplastic disease in Bronchofibroscopy Unit of Albacete General University Hospital

Antecedentes: El cáncer de pulmón es la segunda causa de muerte después de las enfermedades cardiovasculares. El carcinoma broncogénico tiene una causa desencadenante fundamental, el tabaco. La fibrobroncoscopia es necesaria para el diagnóstico y la estadificación del cáncer pulmonar, lo que nos ayudará a estimar el pronóstico y decidir la actitud terapéutica a seguir. En este estudio analizamos la rentabilidad de las distintas técnicas de la broncoscopia en el diagnóstico del cáncer de pulmón. Métodos: En 181 pacientes a los que se realizó fibrobroncoscopia y que tuvieron un diagnóstico final de neoplasia, se analizó la comorbilidad previa, el hábito tabáquico, las diversas técnicas broncoscópicas a las que fueron sometidos y el estadio TNM en el que se hallaban en el momento del diagnóstico. También se valoró la rentabilidad de nuestras técnicas en relación con otros estudios de la bibliografía. Resultados: El 86,2% de los pacientes presentaba historia de tabaquismo; el 49,2%, diagnóstico de enfermedad pulmonar obstructiva crónica, y el 18,9%, otra neoplasia previa. La exploración endoscópica mostró lesión endobronquial en el 58% de los pacientes. El broncoaspirado fue positivo en el 53,6% de los procedimientos realizados; la biopsia bronquial, en el 81,9%; la biopsia transbronquial, en el 71,8% (en asociación con radioscopia positiva en el 81% y sin radioscopia, en el 61% de los casos), y la punción transbronquial, positiva en el 64,3% (con patólogo presente la rentabilidad diagnóstica ascendía al 72,7%). Conclusiones: La rentabilidad de las técnicas fibrobroncoscópicas que se utilizan en nuestro medio es similar a la de otros estudios importantes realizados hasta la fecha (AU)

Background: Lung cancer is the second leading cause of mortality after cardiovascular diseases. Bronchogenic carcinoma has a fundamental underlying cause, that is, tobacco. The bronchoscopy is required for lung cancer diagnosis and staging and will help us to estimate prognosis and determine the therapeutic approach to follow. In this study, the yield of the various techniques of bronchoscopy in the diagnosis of lung cancer has been analyzed. Methods: Previous comorbidity, smoking habit, the different bronchoscopic techniques the subject underwent and the patient's TNM stage at the time of diagnosis were analyzed in 181 patients who underwent bronchoscopy and whose final diagnosis was neoplasm. The performance of our techniques in relation to other studies in the literature was also evaluated. Results: A total of 86.2% of patients had a history of smoking, 49.2%, diagnosis of Chronic obstruction pulmonary disease and 18.9% had had another previous malignancy. The endoscopic examination showed endobronchial lesion in 58% of patients. BAS was positive in 53.6% of procedures performed, bronchial biopsy 81.9%, transbronchial biopsy in 71.8% (in association with positive fluoroscopy in 81% and without fluoroscopy in 61% of cases) and positive transbronchial needle aspiration in 64.3% (with pathologist present the diagnostic yield amounted to 72.7%). Conclusions: The yield of bronchoscopic techniques used in our environment is similar to that found in other major studies conducted to date (AU)

Estenosis traqueosubglótica postintubación. Obstrucción aguda de la vía aérea: manejo de la urgencia y tratamiento definitivo / Post-intubation subglottal-tracheal stenosis: Acute airway obstruction: management of the emergency and final treatment

Presentamos el caso de un varón de 46 años que consultó por disnea y estridor 8 meses después de sufrir un infarto agudo de miocardio e intubación orotraqueal. Se sospechó una estenosis traqueal que se agravó repentinamente. La urgencia de la vía aérea se trató con dilataciones progresivas mediante broncoscopio rígido y antiinflamatorios. En un segundo tiempo se realizó la intervención quirúrgica con resección traqueosubglótica de la zona estenótica y reconstrucción laringotraqueal. Comentamos algunos detalles sobre los aspectos técnicos de la intervención (AU)

We present the case of a 46-year-old man who consulted due to dyspnea and stridor 8 months after suffering an acute heart attack requiring orotracheal ventilation. Tracheal stenosis was suspected, with sudden worsened. The airway emergency was treated with rigid bronchoscopy and progressive dilations of the stenosis. At a second time, surgical subglottal-tracheal resection of the stenotic segment and laryngotracheal reconstruction were performed. We also comment on some of the technical details of the operation (AU)

[Bronchoscopic lung biopsy with fluoroscopy to study 164 localized pulmonary lesions]. / Biopsia pulmonar broncoscópica con fluoroscopia en lesiones pulmonares localizadas. Estudio de 164 casos.

OBJECTIVE: To assess the usefulness of bronchoscopic lung biopsy (BLB) in the diagnosis of localized pulmonary lesions. METHODS: A prospective, descriptive study of consecutive patients with a suspected neoplastic nodule, mass, or infiltrate with nonspecific bronchoscopic findings after performing BLB with fluoroscopy. The lesions, clinical and patient characteristics, and outcomes were evaluated. RESULTS: One hundred sixty-four patients with a mean (SD) age of 65 +/- 12 years and a total of 156 masses or nodules and 8 infiltrates (144 neoplasms and 20 nonneoplastic lesions) participated in the study. On average, the lesion was 4.3 +/- 2 cm in diameter and 6 +/- 2 BLBs were performed on each patient, with a rate of serious complications of less than 1%. BLB was diagnostic in 113 cases (69% of the neoplasms and 70% of the nonneoplastic). In cases diagnosed by BLB, the lesions were larger (4.6 +/- 2 cm), more samples were obtained (6 +/- 2 biopsies), nondiagnostic endoscopic alterations were found (30%), and the bronchus sign was present (22%). Moreover, bronchoscopy was better tolerated by those patients. CONCLUSIONS: BLB with fluoroscopy increased the diagnostic yield of bronchoscopy for localized lesions with nonspecific findings, regardless of etiology. Larger neoplasms, the bronchus sign, good tolerance, and more tissue samples increased the number of diagnoses, with few complications.

[Utility of the clinical history, physical examination and radiography in the localization of bleeding in patients with hemoptysis]. / Utilidad de la historia clínica, la exploración física y la radiografía en la localización del sangrado de los pacientes con hemoptisis.

OBJECTIVE: We examined the medical history, physical examination and chest radiography utility to accurately identifying the site of pulmonary bleeding in patients with hemoptysis. METHODS: We prospectively reviewed and compared the suspected site of bleeding obtained with the medical history, physical examination and chest radiography (right or left) in 466 patients with hemoptysis after the confirmation with a bronchoscopy, computed chest tomography (CT) or bronchial arteriography, and separately analysing the more common etiologies and the volume of bleeding. RESULTS: Age 62.6 years (DS 14), 85% males, 80% smokers with a volume of bleeding of 42.5 ml/day (DS 86) and > or = 100 ml/day in 13.5%. Medical history localized the site of bleeding in 1-13% (p < 0.0001), clinical responses in 8-29% (p < 0.0001), physical examination in 13-47.5% (p < 0.0001) and chest radiography in 14.5-88% (p = 0.04), with a more frequent accurately location findings (p < 0.01) that gradually increased as the previous results with the lung carcinomas and decreased with bronchiectasis or chronic bronchitis. When the volume of bleeding was > or = 100 ml/day, clinical responses utility improved (p = 0.04) as when it was < 100 ml/day with the radiography (p = 0.0001). Specificity, sensitivity and predictive values were variable and better with the radiography than with the medical history or physical examination. CONCLUSIONS: We concluded that chest radiography was most useful than the medical history or physical examination to localize the site of bleeding in patients with hemoptysis. Almost all of the findings that suggests the site of bleeding were accurate and they increased with the radiography or decreased with the physical examination and specially with the medical history in patients with bronchiectasis or chronic bronchitis.

Utilidad de la historia clínica, la exploración física y la radiografía en la localización del sangrado de los pacientes con hemoptisis / Medical history, physical examination and chest radiography usefullness to localize the site of blee ding in patients with hemoptysis

Objetivo: Valorar la utilidad de la historia clínica, la exploración física y la radiografía en establecer el origen del sangrado en los pacientes con hemoptisis. Métodos: Estudio prospectivo, descriptivo y comparativo de 466 casos de hemoptisis para valorar la utilidad de la información obtenida de la historia clínica, la exploración física y la radiografía para localizar el origen del sangrado (derecho o izquierdo) previa confirmación con la broncoscopia, la TC torácica o la arteriografía, considerando de forma especial a las etiologías más frecuentes o el volumen de sangrado. Resultados: Edad 62,6 años (DE 14), 85 por ciento varones, 80 por ciento fumadores con un sangrado de 42,5 ml/día (DE 86) y un volumen 100 ml/día en el 13,5 por ciento. La capacidad de localizar el sangrado aumentó progresivamente con la historia clínica (1-13 por ciento, p<0,0001), la clínica (8-29 por ciento, p<0,0001), la exploración física (13-47,5 por ciento, p<0,0001) o la radiografía (14,5-88 por ciento, p=0,04), con unos porcentajes de localización correcta más elevados (p<0,01) y una probabilidad progresivamente mayor de acertar con el mismo orden en la mayoría de grupos, mejorando en las neoplasias y empeorando con las bronquiectasias o bronquitis crónica. En los pacientes con un sangrado 100 ml/día, la clínica fue más útil en la localización (p=0,04) que cuando era <100 ml/día a diferencia de la radiografía (p=0,0001). La sensibilidad, especificidad y valores predictivos fueron muy variables aunque mejores en la radiografía, disminuyendo con la exploración física, la clínica y la historia clínica. Conclusiones: Nuestro estudio demuestra la mayor utilidad de la radiografía y la dificultad de la historia clínica, la clínica o la exploración física en localizar el sangrado de los pacientes con hemoptisis. La presencia de hallazgos sugestivos de una localización estuvo prácticamente siempre relacionada con una elección correcta y su probabilidad de acertar aumentó con la radiografía y disminuyó progresivamente con la exploración física, la clínica y especialmente con la historia clínica en los pacientes con bronquiectasias y bronquitis crónica (AU)

Objective: We examined the medical history, physical examination and chest radiography utility to accurately identifying the site of pulmonary bleeding in patients with hemoptysis. Methods: We prospectively reviewed and compared the suspected site of bleeding obtained with the medical history, physical examination and chest radiography (right or left) in 466 patients with hemoptysis after the confirmation with a bronchoscopy, computed chest tomography (CT) or bronchial arteriography, and separately analysing the more common etiologies and the volume of bleeding. Results: Age 62,6 years (DS 14), 85% males, 80% smokers with a volume of bleeding of 42,5 ml/day (DS 86) and >=100 ml/day in 13,5%. Medical history localized the site of bleeding in 1-13% (p<0,0001), clinical responses in 8-29% (p<0,0001), physical examination in 13-47,5% (p<0,0001) and chest radiography in 14,5-88% (p=0,04), with a more frequent accurately location findings (p<0,01) that gradually increased as the previous results with the lung carcinomas and decreased with bronchiectasis or chronic bronchitis. When the volume of bleeding was >=100 ml/day, clinical responses utility improved (p=0,04) as when it was <100 ml/day with the radiography (p=0,0001). Specificity, sensitivity and predictive values were variable and better with the radiogaphy than with the medical history or physical examination. Conclusions: We concluded that chest radiography was most usefull than the medical history or physical examination to localize the site of bleeding in patients with hemoptysis. Almost all of the findings that suggests the site of bleeding were accurate and they increased with the radiography or decreased with the physical examination and specially with the medical hystory in patients with bronchiectasis or chronic bronchitis (AU)

[Trends in the prevalence of tuberculosis among six-year-olds in Albacete (Spain)]. / Evolución de la prevalencia de la infección tuberculosa en la población escolar de 6 años en Albacete.

OBJECTIVES: To analyze the prevalence and evolution of tuberculous infection among 6-year-olds in Albacete and its relation to socioeconomic status of the family. METHOD: A tuberculin test (2UT RT-23 Tween 80) was given to 6-year-old school children in and around Albacete in 1992 and 1999. We calculated the prevalence of tuberculosis and the relation to family socioeconomic level as assessed by the parents' level of education of the area of residence. RESULTS: The tuberculin test was given to 2,783 children, 1,532 in 1992 (8% bacille-Calmette-Guerin-vaccinated) and 1,251 in 1999. The prevalence of tuberculosis infection among non-vaccinated children was 0.78% in 1992 (3.37% among vaccinated children, p = 0.012) and 0.72% in 1999. No significant differences between the two screenings were found except for the vaccinated and non-vaccinated children. The annual decline was 1.1% and the annual decrease in risk of tuberculosis infection was 0.12%. No significant differences related to level of parental education or area of residence were detected. CONCLUSIONS: The prevalence of tuberculosis infection among 6-year-old school children in Albacete is low, although there is a very slight non-significant downward trend, which may be biased by the inclusion of bacille-Calmette-Guerin-vaccinated children. No differences related to family socioeconomic level were found.

Etiología de la hemoptisis: análisis prospectivo de 752 casos / Etiology of hemoptysis: Prospective analisis of 752 cases

Objetivo. Conocer la etiología de la hemoptisis y su distribución en nuestro medio con relación a otras series actuales o históricas. Métodos. Estudio prospectivo y descriptivo de 752 casos de hemoptisis cuya etiología fue determinada tras la valoración de la historia clínica, radiografía de tórax, pruebas funcionales y baciloscopias de esputo, junto a otras exploraciones como la broncoscopia y la tomografía computarizada (TC) según unos criterios previamente establecidos. Resultados. Edad, 60 años (desviación estándar:15), 79 por ciento varones y 75 por ciento fumadores. Los diagnósticos incluyeron a las neoplasias (28 por ciento), bronquitis crónica (19,8 por ciento), bronquiectasias (14,5 por ciento), neumonía o absceso pulmonar (11,5 por ciento) y formas idiopáticas (8 por ciento) con una miscelánea de causas con porcentajes inferiores como la tuberculosis (1,7 por ciento) y sus secuelas (4 por ciento), las cardiopatías (1,5 por ciento) y el tromboembolismo pulmonar (2,3 por ciento). La broncoscopia fue realizada a 694 casos (92,2 por ciento) y localizó el sangrado o aportó un diagnóstico específico en un 39 por ciento (81 por ciento si sólo consideramos las neoplasias) e inespecífico pero anormal en un 57 por ciento. El volumen del sangrado fue leve en la mayoría y sin relación con las etiologías. Conclusiones. Las causas más frecuentes de hemoptisis en nuestro medio son las neoplasias, la bronquitis crónica y las bronquiectasias. Esta última y la tuberculosis han sufrido un descenso con relación a otras series anteriores utilizadas como referencia que contrasta con el incremento de las dos primeras y una estabilidad de las atribuidas a una cardiopatía, una neumonía o absceso pulmonar y las formas criptogenéticas para cuyo diagnóstico o exclusión la broncoscopia complementada por la TC sigue siendo fundamental (AU)

Un paciente con derrame pleural

El derrame o acumulación de líquido pleural es secundario al desequilibrio producido entre su formación y reabsorción atribuible a una lesión de la misma pleura cuando es un exudado o a distintas patologías extrapleurales que afectan a la fisiología de su tránsito normal en el trasudado. Las etiologías más frecuentes incluyen insuficiencia cardíaca, neoplasia, derrame paraneumónico y tuberculosis, para cuyo diagnóstico es necesario identificar inicialmente su presencia mediante la valoración de la clínica, la exploración física, radiografía de tórax y la toracocentesis, que pueden ser complementadas por el uso de la TC o la ecografía torácicas. Para establecer un diagnóstico etiológico en los exudados, es necesario valorar los hallazgos bioquímicos, microbiológicos o citológicos del líquido pleural acompañados de la biopsia pleural, la toracoscopia o la toracotomía, si los resultados de las exploraciones previas no son definitivos (AU)

[Etiology of hemoptysis: Prospective analysis of 752 cases]. / Etiología de la hemoptisis: análisis prospectivo de 752 casos.

OBJECTIVES: To know the etiology of hemoptysis and its distribution in our area compared with other current and historic series. METHODS: Prospective, descriptive study of 752 cases of hemoptysis. The etiology of these cases was determined by evaluating the clinical record, chest X-ray, functional respiratory tests and sputum smear for acid-fast bacilli, together with other examinations such as bronchoscopy and computerized tomography (CT) according to previously established criteria. RESULTS: The mean age of patients was 60 years (SD: 15 years), 79% were males and 75% smokers. Diagnoses included neoplasms (28%), chronic bronchitis (19.8%), bronchiectasis (14.5%), pneumonia or lung abscess (11.5%), idiopathic forms (8%), and miscellaneous causes with lower percentages such as tuberculosis (1.7%) and its sequelae (4%), cardiac diseases (1.5%) and pulmonary embolism (2.3%). Bronchoscopy was performed in 694 (92.2%) and detected the bleeding site or provided a specific diagnosis in 39% (81% if only neoplasms are considered) and non-specific but abnormal in 57%. The amount of bleeding was small in most cases and kept no relationship with causes. CONCLUSIONS: Neoplasms, chronic bronchitis and bronchiectasis are the most common causes of hemoptisis in our area. Bronchiectasis and tuberculosis have decreased compared with previous series used as reference. In contrast, there has been an increase in the number of neoplasms and chronic bronchitis and a plateau in those attributed to cardiac diseases, pneumonia or lung abscess and cryptogenetic forms. To obtain the origin, bronchoscopy complemented by CT remains essential.

[Obliterating bronchiolitis with organized pneumonia. Experience in a general hospital]. / Bronquiolitis obliterante con neumonía organizada. Experiencia en un hospital general.

Bronchiolitis obliterans with organizing pneumonia (BOOP) is a histopathologic entity that has been described in association with numerous clinical conditions. In the 1980s an idiopathic form was described as a definite clinicopathologic entity differentiated from other infiltrative pulmonary processes. We present 7 patients diagnosed of BOOP over the past 6 years and discuss their clinical and radiologic signs as well as their response to steroid treatment. Our patients' evolution was subacute, cough and fever being the main symptoms. Lung function tests revealed a pattern that was predominantly restrictive. Radiology showed 1 or several alveolar infiltrates in all patients; these were migratory in 3. Bilateral pleural effusion with marked eosinophilia in pleural fluid was observed in 1 patient. In another cavitated nodules were present in chest-X-ray, with no evidence of vasculitis in tissue examination. All patients were treated with steroids (mean 10 months) and a low maintenance dose was required in only 1. The remaining patients experienced full recovery.

[Respiratory muscle involvement in systemic lupus erythematosus: retracted lung syndrome]. / Afección muscular respiratoria en el lupus eritematoso sistémico: síndrome del pulmón retraído.

We describe a case of the Syndrome of Retracted Lung (SRL), a very rare entity which is part of the respiratory pathology that may be seen in the Lupus Erithematosus Systemic (LES). Detailed clinical data are presented and general relevant aspects related to this type of lupidic manifestation are reviewed.