Mortalidad en el síndrome de obesidad-hipoventilación y factores de riesgo pronóstico / Mortality in obesity-hypoventilation syndrome and prognostic risk factors

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Características de los pacientes con hipertensión pulmonar tromboembólica crónica atendidos en una consulta específica de hipertensión pulmonar / No disponible

La hipertensión pulmonar tromboembólica crónica (HPTEC) es una complicación a largo plazo de la embolia pulmonar sintomática, con una incidencia acumulada del 1-5% en los 2 años siguientes al episodio. Además, alrededor del 40% de los casos tiene su origen en un tromboembolismo venoso asintomático. En estos casos se recomienda la administración de anticoagulación oral a largo plazo. No obstante, hay que tener en cuenta que el único tratamiento curativo es la tromboendarterectomía. Para los pacientes no candidatos a cirugía, con malos resultados tras la misma, o como puente antes de la intervención, está indicado el tratamiento médico. El fármaco más estudiado en esta enfermedad es el bosentán, que ha demostrado que mejora significativamente la resistencia vascular pulmonar y el índice cardíaco. En este artículo se analizan los diferentes tipos de tratamiento disponibles en la actualidad, mediante el análisis de seis casos de HPTEC atendidos en una consulta específica durante un periodo de 2 años (AU)

Chronic thromboembolic pulmonary hypertension (CTEPH) is a long-term complication of symptomatic pulmonary embolism, with an incidence of 1-5% in the two years following the episode. In addition, about 40% of cases stems from asymptomatic venous thromboembolism. In these cases we recommend the administration of long-term oral anticoagulation. However, we must bear in mind that the only curative treatment is thromboendarterectomy. For patients who are not candidates for surgery, with poor results after the same, or as a bridge before surgery, medical treatment is indicated. The most studied drug in this disease is the bosentan, which has shown to significantly improve pulmonary vascular resistance and cardiac index. This article discusses the different types of treatment available today, through the analysis of six cases of CTEPH treated in a separate consultation for a period of two years (AU)

Enfermedad pulmonar venooclusiva en una mujer jardinera / No disponible

La enfermedad pulmonar venooclusiva (EPVO) es una forma infrecuente de hipertensión arterial pulmonar, con un pronóstico sombrío. El diagnóstico suele ser tardío y el único tratamiento curativo en la actualidad es el trasplante pulmonar. Presentamos el caso de una mujer jardinera de 51 años, cuyo diagnóstico se obtuvo por biopsia pulmonar abierta realizada previamente a su fallecimiento. Si bien existen casos reportados de enfermedad pulmonar venooclusiva hepática secundaria a agentes tóxicos presentes en la naturaleza, como el alcaloide pirrolizidina, hasta el momento no se han relacionado con la enfermedad a nivel pulmonar (AU)

Pulmonary veno-occlusive disease (PVOD) is a subgroup of pulmonary arterial hypertension with a poor prognosis. The diagnosis is usually delay and treatment options other lung transplation are unfortunately limited. We report the case of gardener 51 year old woman diagnosed with PVOD by open lung biopsy before her death. There are any cases report of hepatic veno-occlusive disease due to nature, like “pyrrolizidine alkaloid” exposure, but this is not proven to PVOD (AU)

Necesidad de normativas específicas para el manejo del tabaquismo en fumadores con enfermedades pulmonares intersticiales / Need for specific guidelines for the treatment of smoking habit in smokers with interstitial lung disease

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Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias / Unsuspected pulmonary thromboembolism in the Emergency Department

Antecedentes y objetivos. El tromboembolismo pulmonar (TEP) es una enfermedad que en ocasiones, se diagnostica con un elevado retraso, lo que puede provocar una mayor morbimortalidad. Hemos definido el perfil clínico de los pacientes con TEP no sospechado en el Servicio de Urgencias, y los factores que influyen en el retraso para establecer el diagnóstico de TEP. Pacientes y métodos. Se analizaron retrospectivamente 148 pacientes ingresados con diagnóstico de TEP confirmado mediante TAC (n=133) o gammagrafía de ventilación/perfusión de alta probabilidad (n=15). Fueron divididos en dos grupos: los que no tenían sospecha diagnóstica de la enfermedad en el Servicio de Urgencias (TEP no sospechado) y aquellos en los que sí se sospechó este proceso (TEP sospechado). Se estudiaron las características clínicas, los factores de riesgo, los signos y los síntomas a su llegada a Urgencias; las pruebas complementarias realizadas, los días de ingreso hospitalario y la mortalidad. Resultados. De los 148 enfermos con TEP, el diagnóstico no se sospechó en el Servicio de Urgencias en 63 pacientes (42,6%). La disnea y el dolor torácico fueron las manifestaciones clínicas más comunes y se identificaron con mayor frecuencia entre los enfermos con TEP sospechado, que entre los pacientes con TEP no sospechado, con diferencias significativas (OR=0,4 [0,2-0,9] para la disnea y OR=0,3 [0,2-0,7], para el dolor torácico). Sin embargo, la presencia asociada de trombopenia (OR=3,4 [1,1-10,2], p<0,05), un electrocardiograma (ECG) normal (OR=3,4 [1,1-10,2], p<0,05), y la localización del TEP en pulmón derecho (OR=4,7 [2-11,3], p<0,001), fueron factores asociados a la no sospecha de la enfermedad. Los días de ingreso y de duración de los síntomas, así como la mortalidad, no fueron estadísticamente diferentes entre ambos grupos. Conclusiones. La proporción de enfermos con TEP confirmado pero no sospechado en el Servicio de Urgencias fue elevada (cerca del 40%). La presencia de disnea y dolor torácico se asociaron a la sospecha de TEP. Por el contrario, la presencia de trombopenia, un ECG normal, y la localización del TEP en el pulmón derecho se asociaron a la no sospecha de TEP en urgencias(AU)

Background and objectives. Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. Patients and methods. A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. Results. The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. Conclusions. According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department(AU)

[Unsuspected pulmonary thromboembolism in the Emergency Department]. / Tromboembolismo pulmonar no sospechado en el Servicio de Urgencias.

BACKGROUND AND OBJECTIVES: Pulmonary embolism (PE) is a disease that sometimes has a significant delay in diagnosis. This situation may lead to an increase in morbidity and mortality in patients who have it. The aim of our study has been to define the clinical profile of patients with unsuspected PE in the emergency department and the factors that influence the delayed diagnosis. PATIENTS AND METHODS: A total of 148 patients admitted with diagnosis of PE confirmed by CT (n=133) or by high-probability ventilation-perfusion scintigraphy scan (n=15) were retrospectively analyzed. They were divided into two groups: those with unsuspected disease in the emergency department (USPE) and those who it was suspected (SPE). Baseline characteristics of the patients, risk factors, signs and symptoms in the emergency department, complementary test, days of hospitalization and mortality were studied. RESULTS: The USPE was found in 63/148 patients (42.6%) in the emergency department. Dyspnea and chest pain were the most frequent clinical manifestations of this disease, this being more commonly identified in the SPE group than in the USPE group, with significant differences (OR=0.4 [0.2-0.9] for dyspnea and OR=0.3 [0.2-0.7] for chest pain). However, However, the presence of thrombocytopenia (OR=3.4 [1.1-10.2], P<.05), normal electrocardiogram (EC) (OR=3.4 [1.1-10.2], P<.05), and localization of PE in right lung (OR=4.7 [2-11.3], P<.001) were risk factors for not suspect it. Days of hospitalization, days of symptoms and mortality were not statistically different between groups. CONCLUSIONS: According to the results, the proportion of unsuspected PE in the emergency department was high (close to 40%). The presence of dyspnea and chest pain was associated to suspicion of SPE. On the contrary, the presence of thrombocytopenia, normal EC and right localization of PE were associated to the non-suspicion of SPE in the emergency department.