Diagnóstico de una neumonía organizativa criptogenética en pacientes con sospecha de neoplasia pulmonar / Crytogenetic organizing pneumonia diagnosis in patients with suspicion of lung cancer

La neumonía organizativa criptogenética (NOC) es una enfermedadpulmonar poco frecuente de origen desconocido con unaclínica, una radiología y una histología características. Aunque estípica su presentación en forma de patrón alveolar parcheado multifocalbilateral, existen otras múltiples formas inespecíficas quepueden simular otras enfermedades pulmonares. Presentamos dospacientes con una historia clínica y una presentación radiológicamuy sugestiva de neoplasia pulmonar diagnosticados de NOC. Suconfirmación histológica, buena respuesta al tratamiento y ausenciade recidiva obligan a su inclusión en el diagnóstico diferencialde este tipo de lesiones (AU)

Cryptogenic organising pneumonia (COP) is an infrequentpulmonary disease of unknown origin with a characteristic clinicalpicture, radiology and histology. Although its presentation in theform of a bilateral multi-focal patchy alveolar pattern is typical,other multiple non-specific forms exist that can simulate other pulmonarydiseases. We present two patients with a clinical historyand a radiological presentation very suggestive of lung cancerdiagnosed as COP. Their histological confirmation, good responseto the treatment and absence of recurrence makes us recommendtheir inclusion in the differential diagnosis of these types of lesions (AU)

Diagnóstico de una neumonía organizativa criptogenética en pacientes con sospecha de neoplasia pulmonar / Crytogenetic organizing pneumonia diagnosis in patients with suspicion of lung cancer

La neumonía organizativa criptogenética (NOC) es una enfermedad pulmonar poco frecuente de origen desconocido con una clínica, una radiología y una histología características. Aunque es típica su presentación en forma de patrón alveolar parcheado multifocalbilateral, existen otras múltiples formas inespecíficas que pueden simular otras enfermedades pulmonares. Presentamos dos pacientes con una historia clínica y una presentación radiológica muy sugestiva de neoplasia pulmonar diagnosticados de NOC. Su confirmación histológica, buena respuesta al tratamiento y ausencia de recidiva obligan a su inclusión en el diagnóstico diferencial de este tipo de lesiones

Cryptogenic organising pneumonia (COP) is an infrequentpulmonary disease of unknown origin with a characteristic clinical picture, radiology and histology. Although its presentation in theform of a bilateral multi-focal patchy alveolar pattern is typical, other multiple non-specific forms exist that can simulate other pulmonary diseases. We present two patients with a clinical history and a radiological presentation very suggestive of lung cancerdiagnosed as COP. Their histological confirmation, good response to the treatment and absence of recurrence makes us recommend their inclusion in the differential diagnosis of these types of lesions

Valoración de la realización y mejora de la historia clínica respiratoria del residente de neumología con el sistema Self-Audit / Evaluation of the making and improvement of the respiratory clinical history of the pneumology resident with the Self-Audit system

Objetivo: Analizar el contenido de la historia clínica respiratoria realizada por el residente de neumología y la posibilidad de mejora con el sistema de autoevaluación Self-audit.Métodos: Estudio descriptivo y retrospectivo de 17 historias clínicas respiratorias consecutivas realizadas por un residente de neumología en pacientes hospitalizados, al inicio de la rotación por su especialidad (grupo I) y a partir de 28 variablesestablecidas previamente. El análisis de estas variables se realizó con el mismo residente y fueron comparadas conel registro prospectivo de 20 nuevas historias (grupo II).Resultados: Los pacientes de los grupos I y II tenían una edad y sexo similares. En el grupo I, se registraron correctamente una media de15 variables (desviación estándar DE 4 y rango 9-21) y en el grupo II, 28 (DE 1 y rango 26-29) (p <0,0001). En ningún paciente del grupo I se registraron de forma correcta las 28 variables. En el grupo II, se registraron de forma correcta las 28 variables en 10 (50%) y 27 variables en 5 (25%). El sistema de autoevaluación permitió una mejorasignificativa de los registros de tabaquismo, antecedentes laborales, contacto con animales, broncorrea, sibilancias, hemoptisis, enfermedades pleurales, neoplasia pulmonar, historia de asma, atopia, EPOC, bronquiectasias, radiografía o TC previos, pruebas funcionales respiratorias, ingresos previos o en UCI, oxígeno domiciliario, patología del sueño yotras enfermedades respiratorias.Conclusiones: La historia clínica respiratoria realizada por un residente de neumología al llegar a su especialidad es susceptible de mejora. El sistema de autoevalución Self-audit ha sido muy útil para mejorar su realización

Objective: Analyze the contents of the respiratory clinical history made by pneumonology resident on the possibility of improvement with the self-audit self-evaluation system.Methods: Descriptive and retrospective study of 17 consecutive respiratory clinical histories made by the pneumology resident in hospitalized patients when initiating their rotation in the speciality (group 1) and based on 28 previously establishedvariables. The analysis of these variables were performed with the same resident and compared with the prospective registry of 20 new histories (group 2).Results: The age and gender of the group 1 and 2 patients were similar. In group 1, a measurement of 15 variables (standard deviation - SD - 4 and range 9-21) and in group 2, 28 (SD 1 and range 26.29) were correctly recorded (p < 0.0001).The 28 variables were not recorded correctly in any of the patients of group 1. In group II, the 28 variables were correctly recorded in 10 (50%) and 27 variables in 5 (25%). The self-evaluation system allowed for a significant improvement of the recording of smoking, work background, contact with animals, broncorrhea, high pitched wheezes, hemoptysis, pleural diseases, pulmonary neoplasm, background of asthma, atopy, COPD, bronchiectasis, previous X-ray or CT scan, respiratoryfunction tests, previous admissions or in ICU, domiciliary oxygen, sleep disorder and other respiratory diseases.Conclusions: The respiratory clinical history made by the pneumology resident on arriving to the speciality rotation can be improved. The self-audit self-evaluation system has been very useful to improve its performance

[Changes in the acid-base equilibrium of pleural fluid during the first 2 hours after thoracentesis]. / Evolución del equilibrio ácido-base del líquido pleural durante las 2 primeras horas de la toracocentesis.

OBJECTIVE: The aim of this study was to assess changes in the acid-base equilibrium of pleural fluid during the first 2 hours after thoracentesis and to determine whether, as with arterial blood, it is important to keep the fluid on ice. PATIENTS AND METHODS: A prospective, descriptive, comparative study was performed in 53 consecutive patients with pleural effusion. Thoracentesis was performed and pleural fluid was collected in 5 heparinized syringes to determine the pH, PO2, and PCO2 at baseline and at 30, 60, 90, and 120 minutes. In the first 26 patients, pleural fluid was collected in a further 4 syringes that were kept on ice prior to performing the same measurements at 30, 60, 90, and 120 minutes. RESULTS: The patients had a mean (SD) age of 70 (14) years, 66% were smokers, 72% were men, 63% had right-sided pleural effusion, 85% had unilateral effusion, and 15% had massive effusion. In 10 patients the effusion was a transudate, in 35 it was lymphocytic, and in 8 it was neutrophilic. The etiology was benign in 34 cases and neoplastic in 19 cases. The baseline pH was 7.35 (0.1) and baseline values of PO2 and PCO2 were 57.8 (20) mm Hg and 53.7 (15) mm Hg, respectively. No significant changes were observed in the first 2 hours for either pH or PCO2, whereas PO2 did undergo a significant change over this period. The difference between the baseline value and the value obtained at 120 minutes was 0.005 (0.02) for pH, 12.5 (19) mm Hg for PO2, and 0.8 (3) mm Hg for PCO2, with correlation coefficients of 0.97, 0.49, and 0.98, respectively. Comparison of values by simple regression analysis did not reveal a significant difference in the changes in pH, PO2, or PCO2 associated with keeping samples on ice. Multivariate analysis revealed that neoplastic effusion and a higher red blood cell count in pleural fluid had a significant influence on pH changes. CONCLUSIONS: The pH and PCO2 of pleural fluid did not change significantly during the first 2 hours following thoracentesis, whereas PO2 did undergo a significant change. Keeping samples on ice during this period is unnecessary. Only a higher red blood cell count in pleural fluid and neoplastic effusion had a limited effect on changes in the pH of samples from our patients during the first 2 hours following thoracentesis.

Evolución del equilibrio ácido-base del líquido pleural durante las 2 primeras horas de la toracocentesis / Changes in the acid-base equilibrium of pleural fluid during the first 2 hours after thoracentesis

Objetivo: Valorar los cambios en el equilibrio ácido-base del líquido pleural durante las primeras 2 h de la toracocentesis y la importancia de su conservación en hielo como ocurre en la sangre arterial. Pacientes y métodos: Estudio prospectivo, descriptivo y comparativo de 53 pacientes consecutivos con un derrame pleural. Se realizó toracocentesis con extracción del líquido pleural en 5 jeringas heparinizadas para determinar el pH, presión parcial de oxígeno (PO2) y de anhídrido carbónico (PCO2) basales, a los 30, 60, 90 y 120 min. En los primeros 26 pacientes se obtuvieron 4 jeringas que se conservaron en hielo y se realizaron las mismas determinaciones en el tiempo. Resultados: Los pacientes tenían una edad media (± desviación estándar) de 70 ± 14 años, el 66% eran fumadores, el 72% varones, un 63% tenía un derrame derecho, un 85% unilateral y el 15% masivo. En 10 casos era un trasudado, en 35 exudado linfocitario y en 8 neutrofílico. La etiología fue benigna en 34 casos y neoplásica en 19. El valor basal del pH fue de 7,35 ± 0,1, y los de PO2 y PCO2 de 57,8 ± 20 y 53,7 ± 15 mmHg, respectivamente, y no presentaron cambios significativos durante las primeras 2 h, a excepción de la PO2. El pH presentó una diferencia entre su valor basal y a los 120 min de 0,005 ± 0,02, la PO2 de 12,5 ± 19 mmHg y la PCO2 de 0,8 ± 3 mmHg, con unos coeficientes de correlación de 0,97, 0,49 y 0,98, respectivamente. El estudio comparativo y la regresión simple no demostraron una influencia significativa de la conservación en hielo en los cambios de pH, PO2 o PCO2. Una etiología neoplásica y un mayor número de hematíes influyeron de forma significativa en los cambios de pH en el análisis multivariante. Conclusiones: El pH y la PCO2 pleurales no presentaron cambios significativos durante las primeras 2 h de la toracocentesis, a diferencia de la PO2. La conservación en hielo no estaría indicada durante este período. Sólo un número más elevado de hematíes o una etiología neoplásica tuvieron una influencia limitada en los cambios de los valores del pH de nuestros pacientes en las primeras 2 h

Objective: The aim of this study was to assess changes in the acid-base equilibrium of pleural fluid during the first 2 hours after thoracentesis and to determine whether, as with arterial blood, it is important to keep the fluid on ice. Patients and methods: A prospective, descriptive, comparative study was performed in 53 consecutive patients with pleural effusion. Thoracentesis was performed and pleural fluid was collected in 5 heparinized syringes to determine the pH, PO2, and PCO2 at baseline and at 30, 60, 90, and 120 minutes. In the first 26 patients, pleural fluid was collected in a further 4 syringes that were kept on ice prior to performing the same measurements at 30, 60, 90, and 120 minutes. Results: The patients had a mean (SD) age of 70 (14) years, 66% were smokers, 72% were men, 63% had right-sided pleural effusion, 85% had unilateral effusion, and 15% had massive effusion. In 10 patients the effusion was a transudate, in 35 it was lymphocytic, and in 8 it was neutrophilic. The etiology was benign in 34 cases and neoplastic in 19 cases. The baseline pH was 7.35 (0.1) and baseline values of PO2 and PCO2 were 57.8 (20) mm Hg and 53.7 (15) mm Hg, respectively. No significant changes were observed in the first 2 hours for either pH or PCO2, whereas PO2 did undergo a significant change over this period. The difference between the baseline value and the value obtained at 120 minutes was 0.005 (0.02) for pH, 12.5 (19) mm Hg for PO2, and 0.8 (3) mm Hg for PCO2, with correlation coefficients of 0.97, 0.49, and 0.98, respectively. Comparison of values by simple regression analysis did not reveal a significant difference in the changes in pH, PO2, or PCO2 associated with keeping samples on ice. Multivariate analysis revealed that neoplastic effusion and a higher red blood cell count in pleural fluid had a significant influence on pH changes. Conclusions: The pH and PCO2 of pleural fluid did not change significantly during the first 2 hours following thoracentesis, whereas PO2 did undergo a significant change. Keeping samples on ice during this period is unnecessary. Only a higher red blood cell count in pleural fluid and neoplastic effusion had a limited effect on changes in the pH of samples from our patients during the first 2 hours following thoracentesis

[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.

Resolución espontánea de un quiste tímico primario / Spontaneous resolution of a primary thymic cyst

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[Primary pulmonary synovial sarcoma: a report and diagnosis of 2 cases]. / Sarcoma sinovial pulmonar primario. Presentación y diagnóstico de dos casos.

Synovial sarcoma is an extremely rare primary pulmonary tumor whose description is based on a limited number of cases. We report two cases diagnosed by thoracotomy. One patient was initially treated surgically, and a later recurrence was controlled by combined chemotherapy and a second operation after three years of monitoring. In the second case, surgery was imperative to treat massive hemoptysis and was followed by combined chemotherapy after diagnosis of lesions consistent with extrapulmonary metastasis.

Sarcoma sinovial pulmonar primario. Presentación y diagnóstico de dos casos / Primary pulmonary synovial sarcoma: a report and diagnosis of 2 cases

El sarcoma sinovial es un tumor pulmonar primario extremadamente raro y con una descripción basada en un número limitado de casos, de los que presentamos los hallazgos de dos pacientes diagnosticados por una toracotomía. Uno de los casos fue tratado inicialmente con cirugía, seguido de una recidiva más tarde controlada con poliquimioterapia y reintervención tras tres años de seguimiento, mientras que en el otro la cirugía fue necesaria por presentar una hemoptisis masiva y se asoció a un tratamiento con poliquimioterapia tras el diagnóstico de lesiones compatibles con metástasis extrapulmonares (AU)

El asma bronquial en el paciente ambulatorio

El asma es una enfermedad inflamatoria crónica de las vías aéreas que se caracteriza por la presencia de crisis o episodios de obstrucción bronquial variable y reversible de forma espontánea o con tratamiento, aunque puede llegar a ser progresiva, grave e incluso fatal. En las últimas dos décadas ha aumentado de forma ininterrumpida su prevalencia y esto obliga a conocer los principales fundamentos relacionados con su tratamiento fuera de las agudizaciones. Para conseguir un buen control de esta enfermedad es necesario partir de un diagnóstico correcto, conocer su gravedad o intensidad, evitar los factores desencadenantes, realizar un tratamiento correcto, organizar un seguimiento regular a largo plazo y facilitar la educación o participación del paciente en el control de su enfermedad (AU)

[Usefulness of teaching how to manage the pressurized canister and the Turbuhaler system in hospitalized patients]. / Utilidad de la enseñanza del manejo del cartucho presurizado y el sistema Turbuhaler en los pacientes hospitalizados.

OBJECTIVE: [corrected] To assess knowledge of how to use a pressurized canister (PC) or Turbuhaler (TB) systems and to evaluate the usefulness of giving technical instruction to hospitalized patients, analyzing chronic obstructive pulmonary disease (COPD) patients according to degree of obstruction. METHOD: We evaluated the use of the PC by 107 consecutive patients and the TB by 79 patients upon their admission to the respiratory medicine ward, with reference to the guidelines of the Spanish Society of Respiratory Medicine and Thoracic Surgery. We then evaluated the usefulness of instruction PC or TB technique. We recorded age, sex, underlying respiratory disease, the patient's opinion and time in years the patient had been using the inhaler, FEV1, and technique upon admission and after instruction during the hospital stay. RESULTS: Only 19% of the patients used the PC and 32% of the TB patients used their inhaler correctly at first. After instruction, the rates of correct use improved to 42% and 70% for the PC and TB, respectively, over the course of an approximately 4-day hospital stay. Among the PC users, 77% believed they were performing the maneuver correctly. All steps for both inhalers improved, as the number of errors decreased, particularly errors considered most relevant (coordination of the trigger and inspiration from the PC or full expiration and breath holding with both systems). The number of correct techniques at the end of the study was similar for all levels of COPD obstruction, and particularly for those using the TB. CONCLUSIONS: Most patients admitted to our ward were unable to use either inhaler correctly, with incorrect use of the PC being particularly evident. It is possible to improve performance, however, if we take care to teach patients in short instruction sessions. This is true for all COPD patients, regardless of level of obstruction. Our results demonstrate that a program of instruction during a patient's hospital stay is both feasible and important.

[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.

Lesiones pulmonares inducidas por fármacos

El pulmón es uno de los órganos que con mayor frecuencia puede ser afectado por las reacciones adversas o la toxicidad secundaria a la administración de cualquier fármaco. La lista de fármacos que pueden provocar lesiones pulmonares es muy extensa y sigue un rápido aumento proporcional a la contínua aparición de nuevos medicamentos. El conocimiento de los factores predisponentes, los mecanismos fisiopatológicos, las formas de presentación y los procedimientos diagnósticos de este tipo de procesos es de importancia creciente por la posibilidad de producir lesiones graves potencialmente invalidantes o mortales y que, en la mayoría de las ocasiones, pueden tratarse o prevenirse con la supresión del fármaco (AU)

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.

Radiografía de tórax

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