Bacterial proteases and haemostasis dysregulation in the CF lung.

BACKGROUND: Pathogenic bacteria which chronically colonise the cystic fibrosis (CF) lung produce a number of virulence determinants, including distinct proteolytic activities. The potential role bacterial proteases play on haemostatic dysregulation within the CF lung is, however, poorly defined, despite haemoptysis being a common complication in CF. METHODS: The potential impact of known CF pathogens (Pseudomonas aeruginosa and Burkholderia cepacia complex spp.) on haemostasis was examined for their ability to degrade fibrinogen and dysregulate fibrin clot formation and platelet aggregation. RESULTS: Results demonstrate that key CF pathogens growing as a biofilm on mucin exhibit considerable fibrinogenolytic activity, resulting in fibrinogen breakdown, impaired clot formation, and modulation of platelet aggregation. Human neutrophil elastase may also contribute to fibrinogen breakdown and dysregulated clot formation at high concentration. CONCLUSION: Bacterial-derived proteases may play an important role in the dysregulation of airway haemostasis, and potentially contribute to episodes of haemoptysis within the CF lung.

Actualización en el diagnóstico y tratamiento de la tuberculosis pulmonar / Update on the diagnosis and treatment of pulmonary tuberculosis

La tuberculosis (TB) sigue siendo la enfermedad infecciosa humana más importante que existe. El diagnóstico actual de la TB sigue basándose en la presentación clínica, los hallazgos radiográficos y los resultados microbiológicos; todos ellos con problemas de sensibilidad o especificidad. Es por ello que el futuro más inmediato pasa por las técnicas microbiológicas rápidas moleculares, sobre todo el GeneXpert (más sensible que la baciloscopia y con capacidad de detectar resistencia a la rifampicina) y el GenoType. El tratamiento actual de la TB sigue siendo el mismo de 6 meses utilizado desde hace décadas. Los intentos por acortar este tratamiento están fracasando en la actualidad. En los últimos años se han descrito nuevos fármacos que podrían contribuir al tratamiento de la TB en un futuro cercano, y que ya se utilizan en la TB con multifarmacorresistencias (AU)

Tuberculosis (TB) remains the most important human infectious disease. Currently, the TB diagnosis is still based on the clinical presentation, radiographic findings and microbiological results; all of which have sensitivity or specificity issues. For that reason, the immediate future involves rapid molecular microbiological techniques, in particular GeneXpert (which is more sensitive than bacilloscopy and is able to detect rifampicin resistance) and GenoType. The current six-month treatment for TB has remained unchanged for decades. Attempts to shorten this treatment have failed. In recent years, new drugs have been reported that could contribute to TB treatment in the near future, and are already being used in multi-drug-resistance TB (AU)

Síndrome de la cimitarra / Scimitar síndrome

El síndrome de la cimitarra consiste en un retorno venoso pulmonar anómalo. En esta patología la vena pulmonar conecta con la vena cava inferior en lugar de la aurícula izquierda. Presentamos el caso de un hombre de 40 años con el diagnóstico reciente de síndrome de la cimitarra. El paciente estaba asintomático desde el punto de vista cardiológico. Tras el cauteloso estudio de cardiología y varias pruebas complementarias, entre ellas ecografías, resonancia nuclear magnética, TAC y radiología de tórax se le diagnosticó la enfermedad (AU)

Scimitar syndrome consists in an anomalous pulmonary venous return. In this pathology the pulmonary vein connects to the inferior vena cava instead of the left atrium. We present the case of a 40-year-old man with scimitar syndrome. The patient had no cardiological clinical symptoms. After a cautious cardiological study and various complementary tests -among them ecography, magnetic resonance imaging, computed tomography and chest X-ray- the diagnosis was achieved (AU)

Nódulos pulmonares migratorios en paciente con colitis ulcerosa / Migratory Pulmonary Nodules in a Patient With Ulcerative Colitis

No disponible

Carcinoma adenoide quístico traqueal en un paciente con tos crónica / No disponible

El carcinoma adenoide quístico es una neoplasia traqueal primaria poco frecuente cuya histología es la segunda más común después del carcinoma de células escamosas. Los síntomas están usualmente en relación con obstrucción de la vía aérea e incluyen estridor, hemoptisis, disnea y sibilancias. Muchos de estos pacientes son diagnosticados incorrectamente durante meses o años como bronquitis crónica o asma hasta que la lesión se diagnostica. Presentamos un caso de un paciente de 35 años estudiado por tos de seis meses de evolución con carcinoma adenoide quístico traqueal. La exploración física fue normal. La radiografía de tórax mostró una ligera impronta sobre la luz traqueal. La tomografía computarizada y la fibrobroncoscopia con biopsia aportaron el diagnóstico definitivo

Adenoid cystic carcinoma is an infrequent primary tracheal tumor that is second most common tracheal malignancy at histology after squamous cell carcinoma. Symptoms are usually related to airway obstruction including stridor, hemoptysis, shortness of breath and wheezing respiration. Patients may be incorrectly diagnosed and treated for chronic bronchitis or asthma for months or years before the lesion is detected. We present a 35-years-old patient with a 6-month history of cough diagnosed with adenoid cystic carcinoma. General physical examination did not reveal any significant abnormality. Chest radiograph demonstrated a slight narrowing of the tracheal air column. Computed tomography and fibrobronchoscopy with biopsy allowed the final diagnosis

Hemorrhagic pulmonary oxalosis secondary to a noninvasive Aspergillus niger fungus ball.

We report a case of hemorrhagic pulmonary oxalosis secondary to a noninvasive Aspergillus niger fungus ball. A patient with cavitary lung disease and hemoptysis developed progressive lung infiltrates and intractable metabolic acidosis leading to death. At autopsy, aspergillomas were identified in both the right upper and middle lobes surrounded by a large rim of necrotic and hemorrhagic parenchyma. Microscopic examination showed extensive crystal deposition and vascular thrombosis. Fungal growth was limited to the intraluminal mycelia, and no tissue or blood vessel invasion was present. Remote crystal deposits were also localized in the absence of fungal organisms to the contralateral lung and to the tubules of both kidneys. The crystals were birefringent in polarized light and stained with colloidal iron. X-ray powder diffractometry and electron impact ionization mass spectrometry identified the crystals as calcium oxalate monohydrate. Furthermore, non-necrotizing granulomatous lesions were identified in the lungs, liver, and spleen, consistent with sarcoidosis, and may have predisposed this patient to developing pulmonary aspergillomas.

Iron disequilibrium in the rat lung after instilled blood.

STUDY OBJECTIVES: The extravasation of erythrocytes into the human lung occurs in a myriad of pulmonary disorders. Metal that is initially included in hemoglobin has been postulated to precipitate a disequilibrium in iron metabolism, to present an oxidative stress, and to contribute to tissue injury in several lung diseases. The objective of this study is to test the hypothesis that the tracheal instillation of blood in an animal model would have significant effects on iron equilibrium and would be associated with an injury to the lower respiratory tract. DESIGN: Rats were intratracheally instilled with either 1.0 mL saline solution (n = 36) or 1.0 mL blood (n = 36). Biochemical end points and histochemistry were obtained at times between 20 min and 14 days after the exposure to saline solution or blood. RESULTS: Total and nonheme iron concentrations in tracheal lavage fluid increased after the instillation of the blood. The percentage of neutrophils in the lavage fluid was elevated 1 day after the instillation of blood and remained at that level for at least 4 days following exposure, while protein concentrations were significantly increased at 1 day and 2 days only. Erythrocytes in the lung tissue were stained for hemoglobin immediately after exposure, but by 4 days after exposure, there was none. Ferritin was elevated between 1 day and 4 days after exposure, but by 7 days after exposure, the expression of this storage protein had returned to baseline values. CONCLUSIONS: We conclude that intratracheal instillation of whole blood in the rat can induce a neutrophilic lung injury that is associated with a disruption of normal iron metabolism. This disruption of the iron equilibrium is made evident by quantifying iron and staining for hemoglobin and ferritin. All indexes of biological effect had corrected by 7 days after exposure.