Evaluación postural y análisis del equilibrio en principiantes de esquí nórdico / Postural evaluation and balance analysis in nordic skiing beginners

Se trata de un estudio de diseño transversal con evaluación del control postural antes-después de un curso de iniciación al esquí nórdico (5 jornadas, 6h/día), a un grupo experimental de 25 sujetos, participantes de la formación, y un grupo control de 8 sujetos. Se pretende evaluar el efecto de un entrenamiento inicial de esquí nórdico sobre el control postural en jóvenes deportistas. La estabilidad corporal se evaluó por medio de un test estabilométrico, calculando el área de desviación del centro de presiones por medio de una plataforma de fuerzas con sensores electrónicos. No se aprecian diferencias significativas en el grado de mejora del equilibrio entre el grupo experimental y el grupo control. Nuevos estudios con una mayor exigencia en la formación en esquí nórdico y un mayor número de sujetos en el grupo control son requeridos (AU)

Cross-sectional study with evaluation of postural control before and after a course of initiation to Nordic skiing (5 days, 6 hours per day). The sample consisted of an experimental group of 25 subjects participated in the training and a control group of 8 subjects. It is intended to evaluate the effect of initial training of Nordic skiing on postural control in young athletes. The physical stability was evaluated by a stabilometric test, calculating the deviation of the area of the center of pressures by the use of a force platform with electronic sensors. No significant differences were observed in the degree of improvement of the balance between the experimental group and the control group. New studies with a greater emphasis on training in Nordic skiing and a greater number of subjects in the control group are required (AU)

Linfangioleiomiomatosis: a propósito de un caso de lenta progresión / No disponible

La linfangioleiomiomatosis (LAM) es una enfermedad multisistémica que afecta predominantemente a mujeres en edad fértil. Se caracteriza por la proliferación anormal de células musculares lisas (células LAM) tanto a nivel pulmonar como extrapulmonar. Las manifestaciones pulmonares son la expresión clínica de la infiltración de las células LAM en los diferentes niveles pulmonares: disnea progresiva, tos seca, neumotórax, hemoptisis y quilorórax. Hay pocos estudios que determinen el pronóstico a largo plazo de esta enfermedad, estableciéndolo en un rango de supervivencia a los 10 años de entre el 10 y el 90% de los casos. Presentamos el caso de una paciente de 46 años diagnosticada de LAM desde hace más de 15 años, con buen estado funcional hasta la actualidad y manifestaciones limitadas exclusivamente al aparato respiratorio (AU)

The lynphangioleiomyomatosis (LAM) is a multisystemic disease that mainly affects to women during fertile age. The disease is characterized by an abnormal proliferation of smooth-muscle cells (LAM cells), that infiltrate the pulmonary and extrapulmonary tissues. The respiratory manifestations represent the consequence of this infiltration into several levels of the respiratory system: progressive dyspnoea, dry cough, pneumothorax, hemoptysis, and chylothorax. There are few studies about long term prognosis of LAM, and the range of survival at 10 years varies from 10 to 90%. We present the case of a 46-year old woman who was diagnosed of LAM more than 15 years before, with an acceptable functional status and clinical manifestations only in the respiratory system (AU)

Tratamiento y evolución de los empiemas diagnosticados en un estudio multicéntrico de la Comunidad de Madrid / Treatment and course of empyema diagnosed in a multicenter study of the Community of Madrid

Objetivo. Analizar las terapias utilizadas y la evolución de los empiemas incluidos en un estudio del Grupo de Pleura de Neumomadrid. Material y métodos. Estudio prospectivo y multicéntrico realizado entre 2004 y 2006, sobre los empiemas procedentes de neumología o cirugía torácica de siete hospitales de la Comunidad de Madrid. Se realizó un análisis descriptivo de los datos relacionados con el tratamiento y la evolución. Resultados. Los antibióticos iniciales más utilizados fueron levofloxacino y amoxicilina-clavulánico. Tras la toracocentesis se modificó el tratamiento en el 47% de los casos. La cobertura inicial para anaerobios se instauró en 41 pacientes (50%). El drenaje inicial se realizó mediante tubo endotorácico (89%), cirugía (9%) y toracocentesis evacuadora (2%). Se emplearon fibrinolíticos en un 51% de los casos con una eficacia del 88%. Se especificó la dosis empleada en 41 pacientes: 100.000 UI/día (39%), 200.000 UI/día (23%) y 300.000 UI/día (37%). Globalmente, requirieron cirugía 23 pacientes con evolución favorable del 91,3%. La necesidad de cirugía y la evolución de los pacientes con y sin cobertura inicial para anaerobios fue similar. La evolución final fue a la curación (84%), cronicidad (5%) o éxitus (11%) sin encontrarse diferencias entre los pacientes sometidos o no a cirugía. Conclusiones. No existió un criterio unificado para la antibioterapia y la dosis de fibrinolíticos. Los fibrinolíticos se emplearon en la mitad de los drenajes con una alta eficacia. No se observó una peor evolución en los empiemas que no recibieron cobertura para anaerobios y tampoco en aquellos que precisaron cirugía (AU)

Objective. To analyze the treatments used and course of the empyema patients enrolled in a study of the Neumomadrid Pleura Work Group. Material and methods. A prospective and multicenter study conducted between 2004 and 2006, on the empyemas from the Pneumology or Thoracic Surgery of 7 hospitals of the Community of Madrid. A descriptive analysis was made of the data related with the treatment and course. Results. The initial antibiotics used most were levofloxacin and amoxicillin and clavulanic acid. After the thoracocentesis, treatment was modified in 47% of the cases. Initial coverage for anaerobic bacteria was established in 41 patients (50%). Initial drainage was performed by endothoracic tube (89%), surgery (9%) and thoracocentesis for evacuation (2%). Fibrinolytics were used in 51% of the cases with 88% efficacy. The dose used in 41 patients was specified: 100,000 IU/day (39%), 200,000 IU/day (23%) and 300,000 IU/day (37%). Globally, 23 patients required surgery, 91.3% of whom had a favorable evaluation. The need for surgery and the course of the patients with and without initial coverage for anaerobic bacteria was similar. Final evolution was cure (84%), chronicity (5%) or exitus (11%), there being no differences found between the patients undergoing surgery or not. Conclusions. There was no unified criterion for the antibiotic treatment and dose of fibrinolytics. Fibrinolytics were used in half of the drainages with high efficacy. Worse evolution of the empyemas was not observed in those who did not receive coverage for anaerobic bacteria or in those who required surgery (AU)

Estudio multicéntrico de los empiemas en la Comunidad de Madrid / Multicenter study of empyemas in the community of Madrid

Resumen. El aumento de los microorganismos resistentes a los antibióticos, de las infecciones por anaerobios y nosocomiales, así como de los pacientes inmunodeprimidos, hacen del empiema un problema clínico frecuente con una mortalidad y morbilidad significativas. En este estudio multicéntrico y prospectivo, el Grupo de Trabajo de Pleura de Neumomadrid ha realizado un análisis descriptivo de los datos epidemiológicos, etiológicos, características del líquido pleural (LP), microbiología y evolución en función de estos hallazgos, de los empiemas de nuestro medio. Durante dos años se identificaron 82 empiemas procedentes de Servicios de Neumología o Cirugía Torácica de siete hospitales de la Comunidad de Madrid. En un tercio de nuestros pacientes se pudo identificar algún factor predisponente, destacando la diabetes, el virus de la inmunodeficiencia humana y el carcinoma broncogénico. La neumonía fue la etiología más frecuente. Las características bioquímicas del LP no mostraron diferencias significativas entre los pacientes con cultivo del LP positivo y negativo. En más de la mitad de los cultivos del LP se aisló algún germen, con predominio del género Streptococcus y de los cultivos unimicrobianos. Tras la toracocentesis diagnóstica, se modificó el tratamiento en casi la mitad de los casos. Un tercio de los pacientes requirieron cirugía, identificándose entre ellos un mayor número de mujeres, antecedentes de cirugía previa, causas extrapulmonares y gérmenes Gram positivos. Los pacientes cuyo empiema se desarrolló a raíz de procedimientos quirúrgicos recientes presentaron peor evolución (AU)

Abstract. The increase of antibiotic resistant microorganisms, of infections due to anaerobes and nosocomial infections and of immunodepressed patients is making empyema a frequent clinical problem having significant mortality and morbidity. In this multicenter and prospective study, the Neumomadrid Pleura Work Group has made a descriptive analysis of the epidemiological and etiological data that are characteristics of pleural fluid (PF), microbiology and evolution based on these findings, of the empyemas of our setting. During two years, 82 empyemas coming from the Pneumology or Thoracic Surgery Services of 7 hospitals of the Community of Madrid were identified. It was possible to identify some predisposing factors in one third of our patients, diabetes, human immunodeficiency and bronchogenic carcinoma standing out. Pneumonia was the most frequent etiology. The biochemistry characteristics of PF did not show any significant differences between the patients with positive and negative PF culture. In over half of the PF cultures, some germ was isolated, with predominance of the Streptococcus genus and of unimicrobial cultures. After the thoracocentesis diagnosis, treatment was modified in almost half of the cases. One third of the patients required surgery, identifying among them a greater number of women, background of previous surgery, extrapulmonary causes and Gram positive germs. The patients whose empyema developed due to recent surgical procedures had a worse evolution (AU)

Lymphangioleiomyomatosis: a study of 72 patients from the Spanish registry.

BACKGROUND: Pulmonary lymphangioleiomyomatosis (LAM) is a rare lung disease that almost exclusively affects young women of childbearing age. The true incidence and prevalence of LAM are unknown. This study was conducted to evaluate the characteristics of lymphangioleiomyomatosis in Spain. METHODS: Over a 2-year period, a questionnaire designed for this study was collected. This questionnaire included sociodemograhic, clinical, radiological and functional data. Information about the study and this questionnaire were both sent by e-mail to all the participants of the interstitial disease registry of 2004. RESULTS: Seventy-two patients, all of whom were women, were included in the registry, with a mean age of 44.56 +/- 11.1 yr. Sixty-three patients (87.5%) presented the sporadic LAM and 9 (12.5%) presented LAM associated with tuberous sclerosis (LAM-TS). LAM diagnosis was confirmed with an open lung biopsy in 57 patients (79.2%) and was performed with thoracic HRCT compatible with LAM diagnosis in the other 15 cases. The most frequent symptom was dyspnoea (90%) followed by cough (44.4%). Almost 40% of patients presented renal angiomyolipomas in the study and the most frequent spirometric pattern was obstructive in more than half of the patients. Most patients with LAM-TS (88.8%) had renal angiomyolipomas compared with 31.7% in the sporadic LAM group. CONCLUSION: The characteristics of the Spanish population affected with LAM are similar to those of other countries. Most patients were symptomatic, had a history of previous pneumothorax and presented abnormal radiological findings and pulmonary function tests.

Diagnóstico y tratamiento de las enfermedades pulmonares intersticiales difusas / Diagnosis and treatment of diffuse interstitial lung diseases

No disponible

[Prospective study of 1,000 consecutive patients with pleural effusion. Etiology of the effusion and characteristics of the patients]. / Estudio prospectivo de 1.000 pacientes consecutivos con derrame pleural. Etiología del derrame y características de los pacientes.

OBJECTIVE: To describe the characteristics of patients with pleural effusion (PE) and the causes of PE in a prospective, consecutive series of patients. SETTING: A tertiary care hospital associated with the Universidad Complutense de Madrid (Spain). PATIENTS: One thousand consecutive patients with PE for whom clinical signs indicated the need for diagnostic thoracocentesis were studied prospectively in our service from December 1991 to July 2000. RESULTS: The most common cause of PE was neoplasm (n = 364 patients). The most common place of origin of the tumor was the lung (n = 125), followed by the pleura (mesothelioma, n = 48). The most common histologic type was adenocarcinoma (n = 128). Tuberculosis was the second most common cause of PE (n = 155). PE was transudate in 118 patients, mainly secondary to heart failure. Among the 42 patients who were positive for human immunodeficiency virus (HIV), the most common cause of PE was tuberculosis. Tuberculosis was also the most likely cause of PE in patients under 40 years of age. CONCLUSIONS: The most common causes of PE were neoplasm and tuberculosis. Tuberculosis was the most common cause in patients under 40 years of age and in those infected by HIV.

Estudio prospectivo de 1.000 pacientes consecutivos con derrame pleural.Etiología del derrame y características de los pacientes / Prospective study of 1,000 consecutive patients with pleural effusion. Etiology of the effusion and characteristics of the patients

OBJETIVO: Describir las características de los pacientes y la etiología del derrame pleural (DP) en una serie prospectiva consecutiva de pacientes con esta afección. ÁMBITO: Hospital terciario, adscrito a la Universidad Complutense de Madrid. PACIENTES: Mil pacientes consecutivos con DP en los que estaba clínicamente indicada la realización de toracocentesis diagnóstica, estudiados de forma prospectiva en nuestro servicio, desde diciembre de 1991 a julio de 2000.RESULTADOS: La primera causa en frecuencia de derrame pleural fue la neoplásica, con 364 pacientes. El origen tumoral más frecuente fue el pulmonar (n = 125), seguido del mesotelioma pleural (n = 48). La estirpe más frecuente fue adenocarcinoma (n = 128). La tuberculosis ha representado la segunda causa de derrame pleural en nuestro medio (n = 155). En 118 pacientes el derrame pleural era trasudado, principalmente secundario a insuficiencia cardíaca. Entre los 42 pacientes con serología positiva para el virus de la inmunodeficiencia humana (VIH), la primera causa de derrame pleural fue la tuberculosis. En pacientes menores de 40 años la tuberculosis fue la causa más probable de derrame pleural. CONCLUSIONES: Las causas más frecuentes de derrame pleural fueron la neoplásica y la tuberculosis. La tuberculosis fue la etiología más frecuente en pacientes menores de 40 años y en aquellos con infección por el VIH (AU)

Combined use of novel epithelial (MOC-31) and mesothelial (HBME-1) immunohistochemical markers for optimal first line diagnostic distinction between mesothelioma and metastatic carcinoma in pleura.

AIMS: To determine the value of immunohistochemistry in differentiation of malignant pleural mesothelioma from carcinoma in a pleural biopsy we optimized a double panel of MOC-31 and HBME-1 and compared the results with others from the literature. METHODS AND RESULTS: A multi-antibody panel was applied to biopsy samples from 44 cases of malignant pleural mesothelioma and 23 cases of carcinoma metastatic to the pleura. We used monoclonal antibodies against keratins, epithelial membrane antigen (EMA), epithelial antigen Ber-EP4, carcinoembryonic antigen (CEA), tumour-associated glycoprotein (B72.3), LeuM1, vimentin, desmin, epithelial related antigen (MOC-31) and mesothelial cell (HBME-1). Positivity for MOC-31 and Ber-EP4 was found to have the highest nosologic sensitivity (94.1% and 84.6%, respectively) and specificity (86.3% both antibodies) for carcinoma. Positive staining for HBME-1 and vimentin had the highest sensitivity (90.9% and 100%, respectively) and specificity (91.3% and 60%, respectively) for mesothelioma. A two-marker antibody panel with HBME-1 and MOC-31 was the most efficient for the distinction between carcinoma and malignant pleural mesothelioma. CONCLUSION: A combination of MOC-31 (an anti- epithelial marker) and HBME-1 (an anti-mesothelial marker) has a diagnostic efficiency of 76.1% for the distinction between carcinoma and mesothelioma in pleura.

X-linked agammaglobulinaemia and squamous lung cancer.

A 32yr-old nonsmoking male, diagnosed as having X-linked agamma-globulinemia, presented with fever, cough with purulent sputum, a very intense back pain and a mass of 10 centimetres in lower left lobe. Diagnostic evaluation revealed a squamous cell carcinoma with very aggressive metastases at L3. Malignancies are the second leading cause of death in children and adults with congenital immunodeficiency disorders, mostly non-Hodgkin lymphomas and gastric and colon adenocarcinomas, but this is the first report of lung cancer in a patient with X-linked agammaglobulinemia. Lung cancer incidence has been reported to be higher in patients with other diseases of the lung, however, there is no clear evidence of the role of bronchiectasis in developing lung cancer. It is possible that a longer survival for patients with X-LA recently diagnosed, and an association of chronic bronchial infection, could favour the development of pulmonary neoplasm.

Measurement of pleural pressure during therapeutic thoracentesis.

The aim of therapeutic thoracentesis (TT) is to aspirate as much pleural fluid as possible. Monitoring pleural pressure (PlP) during TT has been proposed to avoid the adverse effects due to an unintended sharp drop in PlP. The objectives of this study are to ascertain the diagnostic value of the PlP measurement, to find a predictive variable of the amount of fluid that can be removed, to obtain insight into the characteristics of the PlP curve and pleural elastance (PE) during TT, and to describe the complications of TT. Sixty-one unselected patients were studied. Only the four patients with suspected trapped lung had an initial PlP lower than -4 cm H(2)O and a PE higher than 33 cm H(2)O/L. There was a weak correlation (r = 0.52) between PE during the first 0.5 L aspirated and the total amount of fluid aspirated. Partial PE values were 10, 7.5, and 14 cm H(2)O/L at the early, intermediate, and late phases of TT. No complications were found except for nine pneumothoraces. In conclusion, the technique was clinically helpful because large amounts of pleural fluid could be aspirated with few and mild complications, and because it allows clinicians to support the preliminary diagnosis of trapped lung. None of the studied variables was found to predict the suitability of aspirating more than 1.5 L. Rather than being monotonically descendent, the PlP curve shows a three-part line with the deepest slopes at the first and last phases of the thoracentesis.

Are pleural fluid parameters related to the development of residual pleural thickening in tuberculosis?

STUDY OBJECTIVE: Identification of predictive factors for the development of residual pleural thickening (RPT). DESIGN: Retrospective study. LOCATION: A 1,500-bed tertiary hospital. PATIENTS: Patients with pleural tuberculosis diagnosed between December 1991 and February 1995 in our Respiratory Disease Service. INTERVENTIONS: The clinical and radiologic characteristics, and measurements of microbiological and biochemical parameters and markers in pleural fluid were studied. RPT was defined in a posteroanterior chest radiograph as a pleural space of >2 mm measured in the lower lateral chest at the level of an imaginary line intersecting the diaphragmatic dome. MEASUREMENTS AND RESULTS: In 56 patients studied, 11 (19.6%) had RPT 10 mm and 24 (42.8%) had RPT >2 mm. The pleural fluid of patients with RPT 10 mm had a significantly lower glucose concentration and pH and higher lysozyme and tumor necrosis factor-alpha levels than the other patients. The pleural fluid of patients with RPT >2 mm showed no significant differences. CONCLUSIONS: The development of RPT 10 mm was related to higher concentrations of lysozyme and tumor necrosis factor-alpha and lower glucose concentration and pH in pleural fluid compared with development of lower measurements of RPT.