Smoking-related interstitial lung disease.

Exposure to smoke is associated with the development of diseases of the airways and lung parenchyma. Apart from chronic obstructive pulmonary disease (COPD), in some individuals, tobacco smoke can also trigger mechanisms of interstitial damage that result in various pathological changes and pulmonary fibrosis. A causal relation has been established between tobacco smoke and a group of entities that includes respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell histiocytosis (LCH), and acute eosinophilic pneumonia (AEP). Smoking is considered a risk factor for idiopathic pulmonary fibrosis (IPF); however, the role and impact of smoking in the development of this differentiated clinical entity, which has also been called combined pulmonary fibrosis and emphysema (CPFE) as well as nonspecific interstitial pneumonia (NIP), remains to be determined. The definition of smoking-related interstitial fibrosis (SRIF) is relatively recent, with differentiated histological characteristics. The likely interconnection between the mechanisms involved in inflammation and pulmonary fibrosis in all these processes often results in an overlapping of clinical, radiological, and histological features in the same patient that can sometimes lead to radiological patterns of interstitial lung disease that are impossible to classify. For this reason, a combined approach to diagnosis is recommendable. This combined approach should be based on the joint interpretation of the histological and radiological findings while taking the clinical context into consideration. This paper aims to describe the high-resolution computed tomography (HRCT) findings in this group of disease entities in correlation with the clinical manifestations and histological changes underlying the radiological pattern.

Utilidad de la tomografía de emisión de positrones / tomografía computarizada con 18F-colina en el manejo terapéutico de pacientes con recidiva bioquímica de adenocarcinoma de próstata tratados con braquiterapia / Usefulness of 18F-Choline Positron Emission Tomography - Computed Tomography in the therapeutic management of patients with biochemical recurrence of prostate adenocarcinoma treated with brachytherapy

OBJETIVO: El objetivo del trabajo fue valorar la utilidad de la PET/TC con 18F-colina en pacientes con cáncer de próstata tratados con braquiterapia en recidiva bioquímica, así como valorar los cambios en el manejo terapéutico derivados de su resultado. MATERIAL Y MÉTODOS: Estudio retrospectivo en el que se incluyeron 20 pacientes entre 51 y 78 años, con antecedente de adenocarcinoma de próstata que habían sido tratados con braquiterapia, que presentaban recidiva bioquímica (PSA 3,1-12ng/ml) y estudio de extensión (TC y gammagrafía ósea) sin alteraciones. Los hallazgos visualizados en la PET/TC con 18F-colina fueron correlacionados con la histopatología y/o la evolución del PSA tras la terapia. RESULTADOS: En 15 pacientes la PET/TC con 18F-colina detectó únicamente recidiva local. En 4 pacientes recidiva local y linfática y en un1 paciente afectación local y ósea. La recidiva local detectada en la PET se confirmó anatomopatológicamente en el 85% de los casos. En un paciente los hallazgos visualizados en la PET resultaron ser una prostatitis y en otro paciente no se pudo confirmar. De los pacientes con recidiva local y linfática se confirmó histológicamente la recidiva local en 3 de 4. En el 25% de los pacientes la PET/TC con 18F-colina cambió el manejo terapéutico, desestimando la cirugía de rescate inicialmente prevista en 3 casos, en uno radioterapia y en otro la braquiterapia. CONCLUSIÓN: La PET/TC con 18F-colina podría ser una técnica útil en el grupo de pacientes tratados con braquiterapia con recidiva bioquímica, permitiendo localizar la afectación locorregional y a distancia no detectada con imágenes convencionales, determinando así un manejo terapéutico más adecuado

OBJECTIVE: The objective of the study was to evaluate the usefulness of 18F-choline PET/CT in biochemically recurrent prostate cancer patients treated with brachytherapy, as well as to assess the changes in therapeutic management derived from its outcome. MATERIAL AND METHODS: Retrospective study of 20 patients between 51 and 78 years old, with a history of prostate adenocarcinoma that had been treated with brachytherapy and presented biochemical recurrence (PSA 3.1-12 ng/ml) and staging tests (CT and bone scan) without alterations, were included. The findings visualized in the PET/CT scan with 18F-choline were correlated with the histopathology and/or the evolution of the PSA after therapy. RESULTS: 18F-choline PET/CT scan only detected local recurrence in 15 patients. Local and regional recurrences were seen in 4 patients, and 1 patient presented local and bone recurrence. Local recurrence detected in PET was confirmed by anatomopathological studies in 85% of the cases. In one patient, these findings (PET scan) turned out to be prostatitis, and it could not be confirmed in another patient. Of the cases with local and regional recurrence, local recurrence was histologically confirmed in 3 out of 4 patients. 18F-choline PET/CT changed the therapeutic management in 25% of the patients, discarding the initially planned salvage surgery in 3 cases, 1 radiotherapy and 1 brachytherapy. CONCLUSION: 18F-choline PET/CT could be a useful technique in the group of patients with biochemical recurrence after brachytherapy, providing locoregional and distant involvement findings which had not been detected with conventional imaging tests, thus determining a more adequate therapeutic management

Usefulness of 18F-Choline Positron Emission Tomography - Computed Tomography in the therapeutic management of patients with biochemical recurrence of prostate adenocarcinoma treated with brachytherapy. / Utilidad de la tomografía de emisión de positrones / tomografía computarizada con 18F-colina en el manejo terapéutico de pacientes con recidiva bioquímica de adenocarcinoma de próstata tratados con braquiterapia.

OBJECTIVE: The objective of the study was to evaluate the usefulness of 18F-choline PET/CT in biochemically recurrent prostate cancer patients treated with brachytherapy, as well as to assess the changes in therapeutic management derived from its outcome. MATERIAL AND METHODS: Retrospective study of 20 patients between 51 and 78 years old, with a history of prostate adenocarcinoma that had been treated with brachytherapy and presented biochemical recurrence (PSA 3.1-12 ng/ml) and staging tests (CT and bone scan) without alterations, were included. The findings visualized in the PET/CT scan with 18F-choline were correlated with the histopathology and/or the evolution of the PSA after therapy. RESULTS: 18F-choline PET/CT scan only detected local recurrence in 15 patients. Local and regional recurrences were seen in 4 patients, and 1 patient presented local and bone recurrence. Local recurrence detected in PET was confirmed by anatomopathological studies in 85% of the cases. In one patient, these findings (PET scan) turned out to be prostatitis, and it could not be confirmed in another patient. Of the cases with local and regional recurrence, local recurrence was histologically confirmed in 3 out of 4 patients. 18F-choline PET/CT changed the therapeutic management in 25% of the patients, discarding the initially planned salvage surgery in 3 cases, 1 radiotherapy and 1 brachytherapy. CONCLUSION: 18F-choline PET/CT could be a useful technique in the group of patients with biochemical recurrence after brachytherapy, providing locoregional and distant involvement findings which had not been detected with conventional imaging tests, thus determining a more adequate therapeutic management.

Mecanismos patogénicos en la fibrosis pulmonar idiopática. Implicación de los canales de aquoporina 1 (aqp1) / Pathogenic mechanisms in idiopathic pulmonary fibrosis. Involvement of aquoporin 1 (AQP1) channels

La fibrosis pulmonar idiopática (FPI) es una enfermedad pulmonar intersticial difusa (EPID) y progresiva. La FPI resulta de la alteración en la reepitelización tras la lesión de las células epiteliales alveolares. Se produce un aumento en la apoptosis epitelial y en la síntesis de mediadores profibróticos, con la consiguiente proliferación de fibroblastos, transformación a miofibrobastos y el depósito incontrolado de matriz extracelular. La aquoporina 1 (AQP1), es una proteína que facilita el movimiento de agua entre el espacio aéreo pulmonar y el parénquima y se ha demostrado que se regula al alza en animales expuestos a hipoxia. La AQP1 se expresa en células endoteliales, pero no en el epitelio alveolar pulmonar. Más recientemente se ha asociado a la AQP1 en los mecanismos implicados en la proliferación celular. Nuestro objetivo principal ha sido evaluar la participación de las Aquoporinas (AQPs) pulmonares en la patogenia de la FPI. Hemos analizado la expresión de AQP1 en biopsias de pacientes diagnosticados con FPI según los criterios de la ATS/ERS/ALAT de 2011 y en otras patologías pulmonares tales como la neumonitis por hipersensibilidad, sarcoidosis y biopsias de controles sanos. Los resultado de la inmunohistoquímica revelaron una intensa expresión de AQP1 en neumocitos tipo II hiperplásicos solo en las muestras obtenidas de pacientes con FPI. Además hay una inducción de la expresión de AQP1 (mRNA y proteína) tras la estimulación con TGF-ß lo que acompaña a los cambios típicos del proceso de transición epitelio mesenquimal. Por lo tanto, la aparición de AQP1 en las células hiperplásicas tipo II y su regulación podrían estar implicadas en la patogénesis de la FPI

Idiopathic pulmonary fibrosis (IPF) is a diffuse interstitial lung disease (ILD) that is progressive. IPF results from altered re-epithelialization after injury to alveolar epithelial cells. There is an increase in epithelial apoptosis and synthesis of pro-fibrotic mediators, with consequent proliferation of fibroblasts, transformation into myofibroblasts and uncontrolled deposition of extracellular matrix. Aquoporin 1 (AQP1) is a protein that facilitates the movement of water between the pulmonary airspace and the parenchyma and has been shown to be upregulated in animals exposed to hypoxia. AQP1 is expressed in endothelial cells, but not in the pulmonary alveolar epithelium. More recently, AQP1 has been associated in the mechanisms involved in cell proliferation. Our primary objective has been to assess the participation of lung aquoporins (AQPs) in the pathogenesis of IPF. We have analyzed the expression of AQP1 in biopsies of patients diagnosed with IPF according to the ATS/ERS/ALAT 2011 criteria and in other lung diseases such as hypersensitivity pneumonitis, sarcoidosis and biopsies of healthy controls. Immunohistochemistry results revealed an intense expression of AQP1 in Type II pneumocyte hyperplasia only in samples obtained from patients with IPF. Additionally, AQP1 (mRNA and protein) expression is induced after stimulation with TGFß, which accompanies typical changes in the mesenchymalepithelial transition process. Therefore, the appearance of AQP1 in Type II cell hyperplasia and its regulation could be involved in the pathogenesis of IPF

Reconstrucción de la vía aérea principal mediante el uso de prótesis sintéticas integrables / Reconstruction of the main airway through the use of integrable synthetic prosthesis

Uno de los principales problemas que plantea el tratamiento quirúrgico de las lesiones traqueales es la limitación existente en la longitud del segmento que es posible resecar. Actualmente, se puede extirpar con seguridad el 50% de la tráquea como máximo. Lesiones más extensas no se pueden beneficiar de este tratamiento y es necesario utilizar técnicas alternativas, en la mayoría de los casos paliativas. Una posible solución a este problema es la interposición de algún elemento que sustituya el segmento traqueal resecado. Se ha realizado un estudio experimental en animales, sustituyendo segmentos traqueales de distinta longitud por prótesis cilíndricas de politetrafluoroetileno. Posteriormente, se ha realizado un seguimiento y sacrificio de los animales estudiando los cambios histológicos. Los resultados obtenidos muestran la posibilidad técnica de la sustitución de la vía aérea por segmentos de material protésico. En el seguimiento evolutivo de los animales, parece existir una relación directa entre la longitud del implante y la aparición de estenosis traqueal a dicho nivel, tanto en los estudios morfológicos macroscópicos como en los estudios realizados con microscopía óptica. Sin embargo, por el momento, la mortalidad perioperatoria es elevada y, si bien se puede atribuir a la curva de aprendizaje, la traslación de los resultados a una posible práctica clínica no es recomendable

One of the main problems arising from the surgical treatment of tracheal lesions is the existing limitation in the length of segment that can be resected. Currently, a maximum of 50% of the trachea can be safely removed. More extensive lesions cannot benefit from this treatment and alternative techniques must be used, which are palliative in most cases. The interposition of an element which substitutes the segment of resected trachea is a possible solution for this problem. An experimental animal study has been conducted, substituting tracheal segments varying in length with cylindrical polytetrafluoroethylene prostheses. Later, a follow-up was done and the animals were sacrificed to study histological changes. The results show the technical possibility of substituting the airway with segments of prosthetic material. In the monitoring of the animals, there seems to be a direct relationship between the length of the implant and the appearance of tracheal stenosis at the implant site, both in the macroscopic morphological studies and the studies completed with optical microscopy. However, for the time being, perioperative mortality is high and, although it can be attributed to the learning curve, applying the results to possible clinical practice is not recommended

Tratamiento antifibrótico en la fibrosis pulmonar idiopática. Nuestra experiencia en la vida real / Anti-fibrotic treatment in idiopathic pulmonary fibrosis; Our real-life experience

La fibrosis pulmonar idiopática (FPI) es la forma más común de las neumonías intersticiales idiopáticas. Es una neumonía fibrosante, crónica y progresiva, limitada al pulmón, de causa desconocida, con mal pronóstico y, hasta el momento, sin tratamiento curativo. Se caracteriza por un patrón radiológico e histológico de Neumonía Intersticial Usual (NIU).Afecta sobre todo a adultos mayores de 50 años. Su evolución es impredecible en el momento del diagnóstico, condicionando una disminución progresiva de la función pulmonar. Actualmente, existen tratamientos antifibróticos que han demostrado eficacia en frenar la progresión de la enfermedad y, por tanto, mejorando el pronóstico1 . Existe poca información con respecto al uso de estos tratamientos en la vida real, fuera del ámbito de los ensayos clínicos. Presentamos los resultados del seguimiento de 27 pacientes diagnosticados de fibrosis pulmonar idiopática, según los criterios de la ATS/ERS 20112 , 8 de ellos en tratamiento con pirfenidona y 19 en tratamiento con nintedanib. Ambos tratamientos han sido bien tolerados, siendo sus efectos adversos más comunes los síntomas digestivos y la fotosensibilidad, de carácter leve

Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonias, It is a fibrosing, chronic and progressive pneumonia, limited to the lung, cause unknown, with malicious prognosis, without curative treatment in this moment. Is characterized for a radiological and histological pattern of Usual Interstitial Pneumonia (UIP). Especially affects over 50 years old. Its evolution is unpredictable at the time of diagnosis conditioning a progressive decrease in lung function. Currently, there are antifibrotic treatments that have proven effective in Progression of the disease and, therefore, improving the prognosis Regarding the use of these treatments in real life, outside the clinical trials. Objective: We present the results of the follow-up of 27 patients diagnosed with idiopathic pulmonary fibrosis, according to ATS / ERS 2011 criteria, 8 of them being treated with pirfenidone and 19 on treatment with nintedanib. Both treatments have been well tolerated, its adverse events have been digestive symptoms and photosensibility

Mujer fértil con rectorragia periódica / Fertile woman with periodic rectal bleeding

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Expresión de aquaporinas en tejido pulmonar de pacientes con enfermedad pulmonar obstructiva crónica / Aquaporin expression in the lung tissue of copd patients

INTRODUCCIÓN: Estudio de la expresión de aquaporinas (AQP1 y AQP5) en el tejido bronquial y parénquima pulmo-nar de pacientes con enfermedad pulmonar obstructiva cróni-ca (EPOC) y fumadores sin la enfermedad. MÉTODO: Utilizando un diseño caso-control, se seleccionó un grupo de 15 pacientes con EPOC (93,3% varones, con una edad media de 68 años, una media de FEV1 del 72% y 26,7% con corticosteroides inhalados) y 15 fumadores sin la enfermedad, a los cuales se les sometió a cirugía de resección pulmonar por neoplasia pulmonar. Se estudió la expresión de AQP1 y AQP5 en el tejido bronquial y en parénquima pulmo-nar mediante reacción en cadena de la polimerasa en tiempo real.RESULTADOS: No encontramos diferencias en la expresión génica de estas AQPs en ambos territorios pulmonares entre los pacientes con EPOC y los fumadores sin la enfermedad. Sin embargo, en los pacientes EPOC, la expresión de AQP1 era 2,41 veces mayor en el parénquima comparado con los controles, mientras que la AQP5 mostraba un patrón inverso, con 7,75 veces mayor expresión en el tejido bronquial de los sujetos control.CONCLUSIÓN: Los resultados del presente trabajo proporcio-nan evidencia inicial respecto a la expresión de AQP1 y AQP5 en pacientes con EPOC

INTRODUCTION: Study of aquaporin expression (AQP1 and AQP5) in the bronchial tissue and lung parenchyma of pa-tients with chronic obstructive pulmonary disease (COPD) and smokers without the disease. METHOD: Using a case-control design, a group of 15 patients with COPD was selected (93.3% males, with an average age of 68 years, an average FEV1 of 72% and 26.7% with inha-led corticosteroids) and 15 smokers without the disease, who underwent lung resection surgery due to lung neoplasm. The expression of AQP1 and AQP5 in the bronchial tissue and in lung parenchyma was studied using real-time polymerase chain reaction (PCR). RESULTS: No differences were found in the gene expression of these AQPs in either lung territories between the patients with COPD and the smokers without the disease. Nevertheless, in the COPD patients, the expression of AQP1 was 2.41 times greater in the parenchyma compared with the controls, while the AQP5 showed an inverse pattern, with 7.75 times greater expression in the bronchial tissue of the control subject. CONCLUSION: The results of this study provide initial evidence regarding the expression of AQP1 and AQP5 in patient with COPD

Utility of high-resolution computed tomography and BAL in cryptogenic organizing pneumonia.

BACKGROUND: Cryptogenic organizing pneumonia (COP) is a rare disease, and its diagnosis requires histological confirmation. The objective of our study was to describe the findings of the thoracic high-resolution computed tomography (HR-CT) and bronchoalveolar lavage (BAL) in patients with confirmed COP and evaluate the complementary diagnostic use of BAL and thoracic HR-CT. METHODS: Patients recorded in the registry of interstitial pulmonary diseases between 1991 and 2008 were located and the COP patients selected. RESULTS: We identified 21 patients with histological confirmation of COP. The median age was 58.0 ± 15.9 years, and 61.9% of patients were female. The most frequent thoracic HR-CT profile was patchy infiltrate (71.4%), followed by parenchymatous consolidation (42.9%). The most frequent BAL profile was mixed alveolitis (62%) with lymphocyte predominance, a CD4/CD8 index of 0.4 and foamy macrophages. The effectiveness of transbronchial biopsy was 66.6%. The diagnostic utility of Poletti's BAL criteria gives us a specificity of 88.8%, although the sensitivity obtained was low. The specificity of certain HR-CT profiles is 99%. In addition, we observed a complementary use of the HR-CT and the BAL. CONCLUSIONS: The imaging findings and BAL could be useful for patients with appropriate clinical presentation and for those whose transbronchial biopsy is negative or for whom a confirmatory biopsy cannot be performed.

Factores relacionados con la infección por Pneumocystis Jirovecii intersticial difusa (EPID) / Factors related to the infection by Pneumocystis Jirovecii in patients with diffuse interstitial pulmonary disease (DIPD)

Objetivo: Hemos realizado un estudio prospectivo para determinar la prevalencia de colonización de Pn. jiroveccii (PnJ) en muestras de LBA en pacientes con EPID y los factores que pueden condicionar esta situación. Material y métodos: Se incluyen 240 pacientes con EPID con una media de edad de 56 años. Se estudió el gen mtLSU rRNA de PnJ mediante PCR anidada. La PCR resultó positiva en el 32% (78 pacientes).Resultados: Sólo el tabaquismo mostró una asociación significativa con la evidencia de colonización. Hematológicamente, la leucocitosis y eosinofilia son parámetros relacionados con ésta. Radiológicamente, en el TACAR no hay ningún hallazgo distintivo y tampoco hay diferencia entre ambos subgrupos (PCR+ vs PCR-) en la distribución de las patologías más frecuentes en nuestro medio: fibrosis pulmonar idiopática, sarcoidosis, bronquiolitis obliterante con neumonía organizativa y conectivopatías. En el estudio de los parámetros del LBA, tampoco se observan diferencias significativas. En el seguimiento, no se han evidenciado complicaciones infecciosas atribuibles a este patógeno. Conclusiones: PnJ coloniza un tercio de la población con EPID sin que se haya definido con claridad ningún factor determinante. En el seguimiento de estos pacientes no se han evidenciado complicaciones infecciosas significativas. Falta por determinar la posible implicación de PnJ en la aceleración del proceso inflamatorio o deterioro funcional en estos pacientes

OObjective: A prospective study was made to determine the prevalence of colonization with Pn. jiroveccii (PnJ) in bronchoalveolar (BAL) samples of patients with DIPD, and the factors that can condition this situation. Material and methods: 240 patients with DIPD were included in the study, with an average age of 56 years. The mtLSU rRNA gene of PnJ was studied by means of nested PCR. The PCR was positive in 32% (78 patients).Results Only tobacco use showed a significant association with the evidence of colonization. Leucocytosis and eosinophilia are parameters related to this phenomenon also. Radiologically, there were no distinctive findings in high-resolution computed tomography (HRCT) nor difference between both sub-groups (PCR+ versus PCR-) in the distribution of the most frequent pathologies in our area: idiopathic pulmonary fibrosis, sarcoidosis, bronchiolitis obliterans with organizing pneumonia and connective tissue diseases. Also, no significant differences were observed in the study of the BAL parameters. Infectious complications attributable to this pathogen have not been demonstrated in the follow-up. Conclusions: PnJ colonises a third of the population with DIPD without any determining factor having been clearly defined so far. Significant infectious complications have not been demonstrated in the follow up of these patients. The possible implication of PnJ in the acceleration of the inflammatory process or functional deterioration in these patients has not been demonstrated

Factores relacionados con la infección por Pneumocystis jirovecii en pacientes con efermedad pulmonar intersticial difusa (EPID) / Factors related to the infection by pneumocystis jirovecii in patients with intestitial pulmonary disease (DIPD)

Objetivo: Hemos realizado un estudio prospectivo para determinarla prevalencia de colonización de Pn. jiroveccii (PnJ) enmuestras de LBA en pacientes con EPID y los factores que puedencondicionar esta situación.Material y métodos: Se incluyen 240 pacientes con EPID conuna media de edad de 56 años. Se estudió el gen mtLSU rRNA dePnJ mediante PCR anidada. La PCR resultó positiva en el 32%(78 pacientes).Resultados: Sólo el tabaquismo mostró una asociación significativacon la evidencia de colonización. Hematológicamente, la leucocitosisy eosinofilia son parámetros relacionados con ésta. Radiológicamente, en el TACAR no hay ningún hallazgo distintivo ytampoco hay diferencia entre ambos subgrupos (PCR+ vs PCR-)en la distribución de las patologías más frecuentes en nuestromedio: fibrosis pulmonar idiopática, sarcoidosis, bronquiolitisobliterante con neumonía organizativa y conectivopatías. En elestudio de los parámetros del LBA, tampoco se observan diferenciassignificativas. En el seguimiento, no se han evidenciado complicacionesinfecciosas atribuibles a este patógeno.Conclusiones: PnJ coloniza un tercio de la población con EPIDsin que se haya definido con claridad ningún factor determinante.En el seguimiento de estos pacientes no se han evidenciado complicacionesinfecciosas significativas. Falta por determinar la posibleimplicación de PnJ en la aceleración del proceso inflamatorio odeterioro funcional en estos pacientes (AU)

Objective: A prospective study was made to determine the prevalenceof colonization with Pn. jiroveccii (PnJ) in bronchoalveolar (BAL)samples of patients with DIPD, and the factors that can condition this situation.Material and methods: 240 patients with DIPD were included in thestudy, with an average age of 56 years. The mtLSU rRNA gene of PnJ wasstudied by means of nested PCR. The PCR was positive in 32% (78patients).Results Only tobacco use showed a significant association with theevidence of colonization. Leucocytosis and eosinophilia are parametersrelated to this phenomenon also. Radiologically, there were no distinctivefindings in high-resolution computed tomography (HRCT) nor differencebetween both sub-groups (PCR+ versus PCR-) in the distribution of themost frequent pathologies in our area: idiopathic pulmonary fibrosis, sarcoidosis,bronchiolitis obliterans with organizing pneumonia and connectivetissue diseases. Also, no significant differences were observed in thestudy of the BAL parameters. Infectious complications attributable tothis pathogen have not been demonstrated in the follow-up.Conclusions: PnJ colonises a third of the population with DIPDwithout any determining factor having been clearly defined so far. Significantinfectious complications have not been demonstrated in the followupof these patients. The possible implication of PnJ in the acceleration ofthe inflammatory process or functional deterioration in these patients hasnot been demonstrated (AU)

Análisis morfométrico y mineralógico de 14 muestras de talco usado para pleurodesis en distintos países de europayamérica* / Morphometric and mineralogical análisis of 14 samples of talc used for pleurodesis in several european and american countries

FUNDAMENTO DEL ESTUDIO: A pesar de que el talco es elagente más utilizado para pleurodesis, hay controversia respecto asu uso a raíz de la publicación de algunas complicaciones relacionadascon el mismo. Bajo la hipótesis de que diferencias en tamañoy composición pudieran asociarse a distinta incidencia de complicaciones,hemos investigado las características físico-químicas demuestras de talco procedentes de varios países de Europa y América.MÉTODOS: Hemos llevado a cabo un estudio morfométrico ymineralógico de 14 talcos diferentes (9 de Brasil, 3 de Francia, 1de España y 1 de USA). El estudio morfométrico se hizo mediantefotografía de microscopía óptica por dos observadores independientesde nuestro grupo, y mediante microscopía electrónica debarrido, y la composición químico-mineralógica se estudiómediante difracción de rayos X y fluorescencia (Instituto de Cienciade Materiales de Sevilla).RESULTADOS: El diámetro menor de las partículas oscilóentre 3,3 μm (Brasil-4) y 18,5 μm (Brasil-2). El porcentaje de partículasmenores de 10 μm osciló entre 10% (Steritalc® aerosol) y97% (Brasil-4). Respecto a la composición química, encontramostalco como componente mayoritario en ocho muestras (Brasil-2, 6y 7, Francia, España y USA); en el resto el componente mayoritariofue dolomita o flogopita, y en menor porcentaje cuarzo y calcita.CONCLUSIÓN: Observamos gran diversidad en cuanto amorfometría y composición química entre las distintas muestras detalco estudiadas; esto nos lleva a recomendar un estricto análisisdel agente esclerosante, no sólo en relación al tamaño de sus partículassino también en relación a su composición química

AIMS OF THE STUDY: Despite talc being the most commonlysclerosant used for pleurodesis, the ocassional reports ofcomplications occurred after its intrapleural instillation have provokedsome controversy. We hypothezised that differences in particlesize and composition might be associated to incidence of complications,and subsequently investigated the physico-chemicalcharacteristics of talc samples from several European and Americancountries.METHODS: A morphometric and mineralogical study wascarried out on 14 samples of talc obtained from different countries(nine from Brazil, three from France, one from Spain and onefrom the U.S.). Morphometry was performed separately by twoindependent observers through computerized image analysis ofphotographs taken by using optical microscopy under polarizedlight. Scan electron microscopy was used also, and X-rays difractionand fluorescence was used for chemical analysis (Instituto deCiencia de Materiales at Sevilla, Spain).RESULTS: The average minor particle diameter ranged from3,3 μm (Brazilian talc #4) and 18,5 μm (Brazilian talc #2). The percentageof particles smaller than 10 μm ranged between 10% (Steritalc® spray French talc) and 97% (Brazilian talc #4). Regardingchemical composition, we found true talc as the main componentonly in eight samples (Brazilian #2, 6 and 7, plus all French, Spanishand North American samples). Dolomite or flogopite were themain components in the remaining samples, and quartz and calcitewere also found as minoritary components in some cases.Conclusion: We have observed wide differences regardingmorphometry and chemical composition of the talcs studied. Therefore,a strict control of this sclerosant agent is advisable, not onlyregarding the size of particles, but also its chemical composition

[Radiographic staging and bronchoalveolar lavage cell counts in sarcoidosis]. / Estadios radiológicos y lavado broncoalveolar en la sarcoidosis.

OBJECTIVE: Sarcoidosis is a multisystem granulomatous inflammatory disease of unknown etiology that mainly affects the lungs and lymph nodes. Bronchoalveolar lavage (BAL) is known to be useful in diagnosis of the disease but its value as a prognostic marker is unclear. The aim of this study was to assess whether there is a characteristic pattern in BAL cell counts according to radiographic stage and determine whether BAL offers information on disease course. PATIENTS AND METHODS: The study included 34 patients with untreated sarcoidosis. Data were collected on the following variables: age, sex, smoking habit, treatment type, radiographic stage, respiratory function, serological parameters, and BAL cell counts. The patients were classified into 3 groups according to functional and radiographic change at 12-month follow-up. RESULTS: No differences in age, sex, or smoking habit were found according to either radiographic stage or disease course. Although the proportion of lymphocytes in BAL fluid was higher in radiographic stage I than in stages II and III, the differences were not statistically significant. The differences in BAL cell counts between groups based on disease course were not statistically significant. CONCLUSIONS: No differences were found in the characteristics of BAL fluid according to radiographic stage. The differential cell count in BAL fluid does not appear to predict the course of sarcoidosis in the first 12 months.

Estadios radiológicos y lavado broncoalveolar en la sarcoidosis / Radiographic staging and bronchoalveolar lavage cell counts in sarcoidosis

Objetivo: La sarcoidosis es una enfermedad inflamatoria granulomatosa multisistémica de causa desconocida que afecta principalmente al pulmón y a los ganglios linfáticos. La utilidad del lavado broncoalveolar (LBA) en el diagnóstico es conocida, pero su valor como marcador pronóstico es controvertido. El objetivo de nuestro estudio es evaluar si existe un patrón característico en la celularidad del LBA según el estadio radiológico de presentación y determinar si el LBA aporta información sobre la evolución de la enfermedad. Pacientes y métodos: Se incluyó en el estudio a 34 pacientes con sarcoidosis no tratados. Se recogieron las siguientes variables: edad, sexo, hábito tabáquico, tipo de tratamiento, estadio radiológico, exploración funcional respiratoria, parámetros serológicos y análisis celular del LBA. Se clasificó a los pacientes en 3 grupos según la evolución funcional y radiológica a los 12 meses. Resultados: No se encontraron diferencias entre la edad, el sexo y el hábito tabáquico ni entre los estadios radiológicos ni entre los grupos según evolución. En el estadio radiológico I el recuento porcentual de linfocitos del LBA fue mayor que en los estadios II y III, pero las diferencias no fueron estadísticamente significativas. Las diferencias en el LBA por grupos evolutivos no fueron estadísticamente significativas. Conclusiones: Al analizar las características del LBA según estadios radiológicos no se encontraron diferencias. El recuento diferencial de células en el LBA no parece predecir el curso de la sarcoidosis durante los primeros 12 meses

Objective: Sarcoidosis is a multisystem granulomatous inflammatory disease of unknown etiology that mainly affects the lungs and lymph nodes. Bronchoalveolar lavage (BAL) is known to be useful in diagnosis of the disease but its value as a prognostic marker is unclear. The aim of this study was to assess whether there is a characteristic pattern in BAL cell counts according to radiographic stage and determine whether BAL offers information on disease course. Patients and methods: The study included 34 patients with untreated sarcoidosis. Data were collected on the following variables: age, sex, smoking habit, treatment type, radiographic stage, respiratory function, serological parameters, and BAL cell counts. The patients were classified into 3 groups according to functional and radiographic change at 12-month follow-up. Results: No differences in age, sex, or smoking habit were found according to either radiographic stage or disease course. Although the proportion of lymphocytes in BAL fluid was higher in radiographic stage I than in stages II and III, the differences were not statistically significant. The differences in BAL cell counts between groups based on disease course were not statistically significant. Conclusions: No differences were found in the characteristics of BAL fluid according to radiographic stage. The differential cell count in BAL fluid does not appear to predict the course of sarcoidosis in the first 12 months

SLC11A1 promoter gene polymorphisms and fibrosis progression in chronic hepatitis C.

BACKGROUND AND AIMS: The solute carrier family 11 member 1 (SLC11A1) gene (formerly Nramp1) encodes for the protein solute carrier family 11, member 1. It affects susceptibility and clinical outcome of autoimmune and infectious diseases. We investigated the possible role of the functional polymorphism located in the promoter region of SLC11A1 and tumour necrosis factor (TNF) genes in the progression of fibrosis in chronic hepatitis C. METHODS: A total of 242 Caucasian Spanish patients with biopsy proven chronic hepatitis C and 194 healthy control subjects were genotyped for SLC11A1 and TNF promoter polymorphisms. RESULTS: No significant differences in the distribution of frequencies among patient and control groups were observed. The SCL11A1 homozygous 2/2 genotype was rarely detected among patients showing advanced fibrosis (2/82; 2.4%) but was highly represented in those with mild fibrosis (29/160; 18.1%; odds ratio (OR) 8.85 (95% confidence interval (CI) 1.9-55.2, p(c) = 0.002). In patients carrying allele 3 of SLC11A1, the presence of -238 TNF A/G was associated with advanced fibrosis (14/26 (53.8%) v 68/216 (31.4%); OR 2.53 (95% CI 1.03-6.23); p = 0.02). CONCLUSIONS: SLC11A1 gene promoter polymorphism could influence fibrosis progression in chronic hepatitis C in that the homozygous genotype 2/2 exerts a protective effect against cirrhosis development. Also, the combination of TNF -238 A/G and the presence of allele 3 is conducive to progression to pre-cirrhotic or cirrhotic stages of the disease.

Papulosis linfomatoide / Lymphomatoid papulosis

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[Evaluation of clinical diagnostic guidelines for idiopathic pulmonary fibrosis]. / Evaluación de los criterios diagnósticos clínicos de fibrosis pulmonar idiopática.

OBJECTIVES: To analyze the international consensus statement on diagnostic criteria for idiopathic pulmonary fibrosis. METHODS: All patients diagnosed of any interstitial lung disease by means of open lung biopsy since 1980 were included. The patients' clinical records were examined to determine whether they fulfilled the diagnostic criteria, and their biopsies were reviewed to find those with the usual interstitial pneumonia pattern. We calculated sensitivity, specificity, positive and negative predictive values and likelihood ratios for the diagnostic criteria in the consensus statement. Afterwards, we performed the analyses again using only one of the two conditions for fulfilling the function criterion. RESULTS: Of 39 patients enrolled in the study, 17 had idiopathic pulmonary fibrosis. Specificity and positive predictive value were both 100%, but sensitivity was 41.2% and negative predictive value was 68.7%. The likelihood ratio for a negative result was 0.59. In the second analysis, sensitivity was 64.7% and negative predictive value was 78.5%, while specificity and positive predictive value remained unchanged. The likelihood ratio for a negative result was 0.35. CONCLUSIONS: The criteria are sufficiently specific to allow us to diagnose confidently when the criteria are fulfilled. However, a slight change in the function criterion should be considered in order to increase diagnostic yield.

Evaluación de los criterios diagnósticos clínicos de fibrosis pulmonar idiopática / Evaluation of clinical diagnostic guidelines for idiopathic pulmonary fibrosis

OBJETIVOS: Estudiar los criterios diagnósticos de la fibrosis pulmonar idiopática según el último Consenso Internacional. PACIENTES Y MÉTODO: Se incluyó a todos los pacientes diagnosticados de cualquier enfermedad intersticial por medio de biopsia pulmonar abierta desde 1980. Se revisaron sus historias clínicas para averiguar si cumplían los criterios diagnósticos, así como sus biopsias pulmonares en busca del patrón de neumonía intersticial usual. Se calcularon la sensibilidad, la especificidad, los valores predictivos positivo y negativo y los cocientes de probabilidad. Posteriormente, se realizó el mismo análisis requiriendo sólo una de las dos condiciones funcionales para cumplir el criterio funcional. RESULTADOS: Se incluyó a 39 pacientes, 17 de los cuales presentaban una fibrosis pulmonar idiopática. La especificidad y el valor predictivo positivo fue del 100 per cent, mientras que la sensibilidad y el valor predictivo negativo fueron del 41,2 y del 68,7 per cent, respectivamente. El cociente de probabilidad para un resultado negativo fue de 0,59. En el segundo análisis, la sensibilidad y el valor predictivo negativo fueron del 64,7 y del 78,5 per cent, respectivamente, con idéntica especificidad y valor predictivo positivo. El cociente de probabilidad para un resultado negativo fue de 0,35. CONCLUSIONES: Los criterios diagnósticos son lo suficientemente específicos como para estar seguros del diagnóstico cuando se cumplen. Debería considerarse un pequeño cambio en el criterio funcional para aumentar la rentabilidad del diagnóstico (AU)