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

Anti-inflammatory effects of high-dose inhaled fluticasone versus oral prednisone in asthma exacerbations.

The objective of the present study was to investigate the kinetics of high doses of inhaled steroid fluticasone in comparison with oral steroid prednisone on plasma protein leakage and bronchial eosinophilia in adults with moderate asthma exacerbations. The study design was a randomised, double-blind, placebo-controlled prospective trial. In total, 45 patients treated at the emergency department for moderate asthma exacerbations were recruited and 39 were assigned to receive fluticasone and placebo of prednisone (19 patients), or prednisone and placebo of fluticasone (20 patients). Medication was administered to all patients via a metered-dose inhaler and spacer (16 puffs; 4,000 microg.day(-1) or placebo) plus one pill (prednisone 30 mg.day(-1) or placebo). Spirometry and induced sputum for differential cell counts, albumin and alpha(2)-macroglobulin levels and blood eosinophils, interleukin-5 and granulocyte-macrophage colony-stimulating factor levels were obtained before treatment and at 2, 6 and 24 h after treatment. Symptoms clearly improved after 24 h in both groups. No differences were seen between groups in peak expiratory flow or forced expiratory flow in one second, which improved progressively but then decayed slightly after 24 h. Eosinophil counts in sputum also improved over time in both groups. The effect was faster with fluticasone than with prednisone, but was partially lost at 24 h. However, plasma proteins in sputum and eosinophil count in blood both decreased until 24 h, with no significant differences between groups. There was no correlation between eosinophil counts and plasmatic protein levels. In conclusion, both treatments improved symptoms, airway obstruction and inflammation, and plasma protein leakage at 24 h. Prednisone reduced blood eosinophil counts, while fluticasone reduced airway eosinophil counts, suggesting that the anti-inflammatory performance of fluticasone is exerted locally.

[Bronchial exudate of serum proteins during asthma attack]. / Exudado bronquial de proteínas séricas en las crisis de asma.

OBJECTIVE: Although altered vascular permeability and edema of the bronchial mucosa are associated with asthma attack, their influence on its severity remains unknown. We address this issue by comparing relative indices for the concentration of albumin (RIAlb) and alpha2-macroglobulin (RIalpha2M) in induced sputum and peripheral blood from patients with exacerbated asthma, patients with stable asthma, and control subjects. PATIENTS AND METHODS: Forty-six volunteers participated in the study: 14 with exacerbated asthma (forced expiratory volume in the first second [FEV1] 74.3% [SD, 20.8%] of reference), 23 with stable asthma (FEV1 93.6% [7.5%]), and 9 controls (FEV1 101.1% [9.9%]). The concentrations of albumin and alpha2-macroglobulin were quantified by immunoturbidimetry and immunonephelometry, respectively. The relative index was then calculated by dividing the concentration in sputum supernatant by the concentration in peripheral blood. RESULTS: The mean RIAlb was 1.2 (1.1) in the control group, 2.9 (3.1) in the stable asthma group, and 6.0 (6.7) in the exacerbated asthma group. The RIalpha2M values were 11.7 (10.9), 11.9 (14.7), and 3.2 (3.8) for the control group and stable and exacerbated asthma groups, respectively. The increases in the RIAlb values between all groups, and the decrease in the RIalpha2M value between the exacerbated asthma and control groups were statistically significant (P<.05). The percentage of neutrophils, but not of eosinophils, in sputum was correlated with the RIAlb (r=0.39; P=.008) but not the RIalpha2M (r=-0.035; P=.82). FEV1 displayed an inverse relationship with the RIAlb (r=-0.43; P=.009) but not with the RIalpha2M (r=-0.206; P=.24). No correlation was found between oxyhemoglobin saturation and either the RIAlb (r=-0.33; P=.19) or the RIalpha2M (r=-0.12; P=.84). CONCLUSIONS: Vascular permeability is altered during asthma exacerbations and appears to be correlated with the presence of neutrophils and the degree of bronchial obstruction.

Exudado bronquial de proteínas séricas en las crisis de asma / Bronchial exudate of serum proteins during asthma attack

Objetivo: La alteración de la permeabilidad vascular y el edema de la mucosa bronquial se asocian con las crisis de asma. Hay pocos datos publicados y además no se conoce su relación con la gravedad de éstas. Así se propuso comparar los índices relativos de albúmina (IRAlb) y de macroglobulina α2 (IRMα2), entre esputo inducido y sangre periférica, de asmáticos agudizados (AA), asmáticos estables (AE) y controles. Pacientes y métodos: Se estudió a 46 voluntarios: 14 del grupo AA (volumen espiratorio forzado en el primer segundo [FEV1]: 74,3 ± 20,8), 23 del AE (FEV1: 93,6 ± 7,5) y 9 controles (FEV1: 101,1 ± 9,9). Se cuantificó la concentración de albúmina (turbidimetría inmunoquímica) y de macroglobulina α2 (nefelometría inmunoquímica) en el sobrenadante del esputo y en sangre venosa periférica y se calcularon los índices relativos. Resultados: La media ± desviación estándar del IRAlb fue de 1,2 ± 1,1 en el grupo control, de 2,9 ± 3,1 en AE y de 6,0 ± 6,7 en AA. El IRMα2 fue 11,7 ± 10,9, 11,9 ± 14,7 y 3,2 ± 3,8, respectivamente. El incremento del IRAlb entre los grupos AA, AE y control, y el descenso del IRMα2 entre AA y control fueron estadísticamente significativos (p < 0,05). Se relacionó el porcentaje de neutrófilos, y no el de eosinófilos, con el IRAlb (r = 0,39; p = 0,008), pero no con el IRMα2 (r = -­0,035; p = 0,82). El FEV1 se relacionó inversamente con el IRAlb (r = ­-0,43; p = 0,009) y no con el IRMα2 (r = -­0,206; p = 0,24), y tampoco se relacionó la saturación de oxihemoglobina con el IRAlb (r = ­0,33; p = 0,19) o el IRMα2 (r = ­-0,12; p = 0,84). Conclusiones: La permeabilidad vascular está alterada en las agudizaciones de asma y parece relacionarse con la presencia de neutrófilos y el grado de obstrucción bronquial

Objective: Although altered vascular permeability and edema of the bronchial mucosa are associated with asthma attack, their influence on its severity remains unknown. We address this issue by comparing relative indices for the concentration of albumin (RIAlb) and α2-macroglobulin (RIα2M) in induced sputum and peripheral blood from patients with exacerbated asthma, patients with stable asthma, and control subjects. Patients and methods: Forty-six volunteers participated in the study: 14 with exacerbated asthma (forced expiratory volume in the first second [FEV1] 74.3% [SD, 20.8%] of reference), 23 with stable asthma (FEV1 93.6% [7.5%]), and 9 controls (FEV1 101.1% [9.9%]). The concentrations of albumin and α2-macroglobulin were quantified by immunoturbidimetry and immunonephelometry, respectively. The relative index was then calculated by dividing the concentration in sputum supernatant by the concentration in peripheral blood. Results: The mean RIAlb was 1.2 (1.1) in the control group, 2.9 (3.1) in the stable asthma group, and 6.0 (6.7) in the exacerbated asthma group. The RIα2M values were 11.7 (10.9), 11.9 (14.7), and 3.2 (3.8) for the control group and stable and exacerbated asthma groups, respectively. The increases in the RIAlb values between all groups, and the decrease in the RIα2M value between the exacerbated asthma and control groups were statistically significant (P<.05). The percentage of neutrophils, but not of eosinophils, in sputum was correlated with the RIAlb (r=0.39; P=.008) but not the RIα2M (r=-­0.035; P=.82). FEV1 displayed an inverse relationship with the RIAlb (r=­-0.43; P=.009) but not with the RIα2M (r=­-0.206; P=.24). No correlation was found between oxyhemoglobin saturation and either the RIAlb (r=­-0.33; P=.19) or the RIα2M (r=­-0.12; P=.84). Conclusions: Vascular permeability is altered during asthma exacerbations and appears to be correlated with the presence of neutrophils and the degree of bronchial obstruction