[Strong suspicion of lung toxicity due to riluzole]. / Alta sospecha de toxicidad pulmonar por riluzol.

Riluzole is a drug used in the treatment of amyotrophic lateral sclerosis. To date, reports of lung toxicity have been exceptional. We present the case of a 74-year-old man diagnosed with amyotrophic lateral sclerosis. Following 3, 5 months of treatment with riluzole (Rilutek), the patient began to present a clinical picture consisting of nonproductive cough, progressive dyspnea (even with slight exertion), weakness, and radiologic progression with the appearance of predominantly peripheral bilateral pulmonary infiltrates that did not respond to treatment with amoxicillin-clavulanic acid. Bacterial tests did not reveal the presence of germs, nor did other examinations suggest an alternative diagnosis. The patient did not resume treatment with the drug or undergo complementary procedures aimed at obtaining histologic samples. Nevertheless, the coincidence in time, lack of response to antibiotic treatment, remission of symptoms following withdrawal of the drug without initiating any other treatment except 40 mg/d of methylprednisolone for 6 days, absence of alternative diagnoses, and suggestive clinical and radiologic findings all together point to toxicity due to riluzole.

Demolition of a hospital building by controlled explosion: the impact on filamentous fungal load in internal and external air.

The demolition of a maternity building at our institution provided us with the opportunity to study the load of filamentous fungi in the air. External (nearby streets) and internal (within the hospital buildings) air was sampled with an automatic volumetric machine (MAS-100 Air Samplair) at least daily during the week before the demolition, at 10, 30, 60, 90,120, 180, 240, 420, 540 and 660 min post-demolition, daily during the week after the demolition and weekly during weeks 2, 3 and 4 after demolition. Samples were duplicated to analyse reproducibility. Three hundred and forty samples were obtained: 115 external air, 69 'non-protected' internal air and 156 protected internal air [high efficiency particulate air (HEPA) filtered air under positive pressure]. A significant increase in the colony count of filamentous fungi occurred after the demolition. Median colony counts of external air on demolition day were significantly higher than from internal air (70.2 cfu/m(3) vs 35.8 cfu/m(3)) (P < 0.001). Mechanical demolition on day +4 also produced a significant difference between external and internal air (74.5 cfu/m(3) vs 41.7 cfu/m(3)). The counts returned to baseline levels on day +11. Most areas with a protected air supply yielded no colonies before demolition day and remained negative on demolition day. The reproducibility of the count method was good (intra-assay variance: 2.4 cfu/m(3)). No episodes of invasive filamentous mycosis were detected during the three months following the demolition. Demolition work was associated with a significant increase in the fungal colony counts of hospital external and non-protected internal air. Effective protective measures may be taken to avoid the emergence of clinical infections.

[Acute respiratory insufficiency secondary to Coxiella burnetii pneumonia: a rare complication]. / Insuficiencia respiratoria aguda secundaria a neumonía por Coxiella burnetii: una complicación excepcional.

Acute respiratory failure secondary to Coxiella burnetii infection is an extremely rare but serious complication that usually has a good prognosis after appropriate treatment. We describe a female patient who developed acute respiratory failure secondary to Coxiella burnetii pneumonia requiring mechanical ventilation and antibiotic therapy.

[Varicella pneumonia in previously healthy adults]. / Neumonitis varicelosa en el adulto previamente sano.

Two cases of pneumonia associated with chicken pox in previously healthy patients are described. Their known risk factor was heavy smoking. Both were treated successfully with parenteral aciclovir, although one presented a restrictive spirometric pattern with lowered DLCO that became normal 3 months after discharge.

[Tracheobronchopathia osteochondroplastica . Apropos a case]. / Traqueobroncopatía osteocondroplástica. A propósito de un caso.

We present one case of osteochondroplastic tracheobronchopathy in a patient with right laterocervical tumoration as a manifestation of a normofunctional nodular goiter detected in a thyroid morphofunctional study, and tracheal stenosis secondary both to the goiter and the tracheobronchial process. The coincidence of these two processes, probably fortuitous, has never been described before.

[Clinical and neurochemical aspects of diaphragmatic myoclonus]. / Aspectos clínicos y terapéuticos de las mioclonías diafragmáticas.

The case of a 35-year-old woman with diaphragmatic myoclonus of four year duration is presented. The myoclonus deteriorated with anxiety, menstruation and orthostatism. It was frequently accompanied by urinary retention or incontinence. Several pharmacologic agents were shown to be ineffective until the myoclonus was suppressed with a combination of gabapentin and tiagabine. In this article, the respiratory center is proposed as the original focus of the myoclonus, a deficit of gamma-aminobutyric acid (GABA) in brainstem structures as its neurochemical substrate, and GABAergic enhancement as an effective therapeutic measure. The clinical manifestations, etiology, ancillary studies and treatment of diaphragmatic myoclonus are reviewed. Experimental evidence on the anatomical localization, physiology and neurochemistry of the respiratory center is examined. The authors try to relate some of the patient's clinical findings to the experimental data found in the medical literature. The action mechanisms of gabapentin and tiagabine are examined and these drugs are proposed as effective means of enhancing GABAergic neurotransmission and treating diseases with increased inspiratory drive.

[Pulse-oximetry monitoring during endoscopy of the upper digestive tract and chronic obstructive lung disease]. / Monitorización con pulsioximetría durante la endoscopia digestiva alta y enfermedad pulmonar obstructiva crónica.

BACKGROUND: During upper digestive endoscopy arterial desaturations occur which may favour cardiopulmonary complications; therefore, monitoring and oxygen administration to risk patients is recommended. The aim of this study was to evaluate desaturations occurring during endoscopy and whether there are differences between patients with or without prior obstructive respiratory pathology. METHODS: A total of 119 consecutive patients undergoing upper digestive endoscopy were studied. The clinical history and simple spirometry were obtained before endoscopy; during endoscopy, a continuous monitoring of oxygen saturation and heart rate with pulse oximetry. RESULTS: Forty-six patients (38.7%) had oxygen saturations lower than 90% (Group I). Patients were significantly older and FEV-1, FVC, FEF 25-75, and FEV-1/FVC significantly lower among patients in Group I than among the 73 patients (61.3%) with no oxygen desaturation (Group II). A Tiffenau index lower than 70% was not a good predictor for oxygen desaturation during endoscopy. CONCLUSIONS: Pulse-oximetry monitoring during upper digestive endoscopy is recommended and particularly in patients with obstructive respiratory conditions and/or advanced age.

[Active pulmonary tuberculosis in young patients: current radiological presentation forms]. / Tuberculosis pulmonar activa en el paciente joven: formas de presentación radiológica actual.

The clinical histories and thorax X-rays of 91 patients aged between 15 and 25 years who were admitted at the Hospital Royo Villanova, Zaragoza from 1983 to 1987 because of active pulmonary tuberculosis, were reviewed in order to study the radiological presentation of pulmonary tuberculosis in young patients and examine if there were any differences with other age groups. We highlight from the results: 1) The male/female ratio was 1.5/1.2) There were no differences in the radiological presentation between this group and older subjects, 3) The radiological localization of the lesions was the classical one, 4) The mean clinical evolution time before diagnosis was made, was of three months, 5) A longer evolution time was related to a greater lesion extension. We highlight that a prompt X-ray contributes to the early diagnosis of pulmonary tuberculosis in young patients avoiding delays in diagnosis and treatment.

Alta sospecha de toxicidad pulmonary por riluzol / Strong suspicion of luna toxicity due to riluzole

El riluzol es un fármaco utilizado en el tratamiento de la esclerosis lateral amiotrófica. Hasta la fecha, las referencias de toxicidad pulmonar han sido excepcionales. Presentamos el caso de un varón de 74 años, diagnosticado de esclerosis lateral amiotrófica, que tras 3 meses y medio de tratamiento con riluzol (Rilutek®) inició un cuadro clínico consistente en tos no productiva, disnea progresiva hasta hacerse de pequeños esfuerzos, astenia sin fiebre y con progresión radiológica con aparición de infiltrados pulmonares bilaterales de predominio periférico que no respondieron al tratamiento con amoxicilina-ácido clavulánico. Los estudios bacteriológicos realizados no demostraron gérmenes y otras exploraciones tampoco apuntaron un diagnóstico alternativo. El paciente no accedió a la realización de pruebas complementarias destinadas a la obtención de muestras histológicas ni a la reintroducción del fármaco. No obstante, la coincidencia en el tiempo, la falta de respuesta al tratamiento antibiótico, la resolución del cuadro tras la retirada del fármaco sin instaurar otro tratamiento salvo 40 mg/día de metilprednisolona durante 6 días, la ausencia de diagnósticos alternativos y hallazgos clínicos y radiológicos indicativos apuntan a la toxicidad por el riluzol

Riluzole is a drug used in the treatment of amyotrophic lateral sclerosis. To date, reports of lung toxicity have been exceptional. We present the case of a 74-year-old man diagnosed with amyotrophic lateral sclerosis. Following 3,5 months of treatment with riluzole (Rilutek®), the patient began to present a clinical picture consisting of nonproductive cough, progressive dyspnea (even with slight exertion), weakness, and radiologic progression with the appearance of predominantly peripheral bilateral pulmonary infiltrates that did not respond to treatment with amoxicillin-clavulanic acid. Bacterial tests did not reveal the presence of germs, nor did other examinations suggest an alternative diagnosis. The patient did not resume treatment with the drug or undergo complementary procedures aimed at obtaining histologic samples. Nevertheless, the coincidence in time, lack of response to antibiotic treatment, remission of symptoms following withdrawal of the drug without initiating any other treatment except 40 mg/d of methylprednisolone for 6 days, absence of alternative diagnoses, and suggestive clinical and radiologic findings all together point to toxicity due to riluzole