Proteinosis alveolar: revisión de la literatura y presentación de 2 casos / Alveolar proteinosis: review of the literatura y presentacion of 2 case

La proteinosis alveolar (PA), es una enfermedad pulmonar difusa caracterizada por el depósito de material fosfolipídico en los espacios alveolares, con conservación de la arquitectura pulmonar y sin reacción inflamatoria. La etiología es desconocida, sin embargo, actualmente, se han demostrado alteraciones anatómicas y funcionales de los macrófagos alveolares. Las evolución de la enfermedad es crónica y en muchas ocasiones indistinguible de enfermedades intersticiales difusas, en algunos casos el diagnóstico es siguerido por su asociación con enfermedades infecciosas (micosis). El diagnóstico definitivo siempre es histopatológico. No existe un tratamiento curativo, sin embargo, en la catualidad se ha utilizado el lavado pulmonar total, como una alternativa con buenos resultados en la mayoría de los casos. El presente reporte es con motivo de 2 casos estudiados en el Instituto con diferencias en su presentación clínica, radiológica, funcional y evolución final

[A case of pulmonary alveolar proteinosis--evaluation of a Swan-Ganz catheter in bilateral lung lavage].

Lung lavage, known to be effective for alveolar proteinosis, brings about significant hypoxemia immediately after evacuation of lavage fluid. Impeding blood flow of even a distal branch of a pulmonary artery by using a Swan-Ganz catheter (SGC) successfully prevented this hypoxemia. And this SGC procedure could be safely carried out to make lavage of each lung successively in one day.

Fibrobroncoscopia diagnostica y terapeutica / Therapeutic and diagnostic fibroendoscopy

El presente estudio constituye una revision de 80 examenes realizados en el Hospital Clinico Francisco Viedma de Cochabamba en el periodo de mayo de 1990 a julio de 1992. 58 examenes (72//) fueron de tipo diagnostico con biopsia y lavado bronquial 22 (27//) fueron de tipo terapeutico. Se realizaron diagnosticos de 15 casos (26//) de carcinoma laringo traqueo bronquial. Nueve casos (15//) de tuberculosis pulmonar. Nueve de bronquitis cronica. Cuatro (7//) de fibrosis pulmonar. Cinco (8//) de micosis pulmonar. Cuatro de Herpes virus laringeo. Dos casos (3//) de obstruccion supraglotica. Dos de estenosis traqueal. Dos de absceso pulmonar. Y seis (10,8//) de otras patologias. Durante la realizacion del examen no se presento complicacion alguna.

[A case of recurrent pulmonary alveolar proteinosis treated by pulmonary lavage: were the remissions due to the natural course or due to the lavage?].

We report a 39-year-old male with pulmonary alveolar proteinosis. Although no abnormal shadows were seen on regular check-up chest roentgenogram one year previously, diffuse alveolar filling shadows were noted on admission, suggesting fairly acute progression of the disease. He was treated with bronchoalveolar lavage of each segment of both lungs by flexible fiberoptic bronchoscope under local anesthesia. Following this treatment, the shadows on X-ray film and shortness of breath resolved. Oxygen tension of arterial blood, pulmonary function, and serum CEA recovered to almost within normal ranges. The shadows deteriorated twice, but therapeutic lavage performed at the outpatient clinic was effective on each occasion. He thus received 3 series of bronchoalveolar lavage over a period of more than 3 years. We followed the clinical course of this patient for 6 years, and he remained well 3 years after the final treatment.

Bronchoscopy in intensive care.

Fiberoptic bronchoscopy has revolutionized the practice of modern pulmonary medicine. It is estimated that as many as 98% of all bronchoscopies are currently performed using the flexible instrument, and most bronchoscopists have never been trained in the technique of rigid bronchoscopy.