[Lung cancer at a university hospital: epidemiological and histological characteristics of a recent and a historical series]. / Características del cáncer de pulmón en un hospital universitario. Cambios epidemiológicos e histológicos en relación con una serie histórica.

OBJECTIVE: To describe the clinical, histological, and epidemiological characteristics of patients diagnosed with lung cancer in our hospital over a period of 5 years and compare them with those of historical cases treated at the same hospital. PATIENTS AND METHODS: The cases of patients diagnosed with lung cancer from January 1998 through December 2002 were studied retrospectively and compared with data published for the period from 1978 through March 1981. RESULTS: A total of 678 patients (89% men, mean age 67 years) were studied. Fifty-six percent of the men and 38% of the women were smokers (P<.001). The most common histological types were squamous cell carcinoma (33%) and adenocarcinoma (30%): squamous carcinoma in men (36%) and adenocarcinoma in women (56%). Metastasis was present in 42% of the patients with non-small cell lung cancer and in 55% of those with small cell lung cancer. In patients with a history of neoplastic disease, laryngeal tumors were most common in patients with squamous carcinoma whereas bladder tumors were the most frequent in patients with adenocarcinoma. The ratio of men to women was lower in the recent series than in the historical one. The percentage of squamous carcinoma was lower and that of adenocarcinoma higher (P<.001). The percentage of patients diagnosed with regional involvement was greater in the recent series (P<.001). CONCLUSIONS: Squamous cell carcinoma continues to be the most frequent histological type. Male sex and smoking are associated with squamous carcinoma and female sex is associated with adenocarcinoma. Epidemiological and histological patterns have changed, possibly in relation to changes in smoking habits.

Adaptation of the Asthma Quality of Life Questionnaire to a second language preserves its critical properties: the Spanish version.

To test the metric proprieties of the Spanish version of the Juniper Asthma Quality of Life Questionnaire (AQLQ), we studied 116 adult asthmatic patients with a wide range of disease severity (53 patients were recruited from the respiratory outpatient department, 38 from a primary health care centre and 25 were patients admitted into hospital due to acute asthma). The patients were assessed twice, at recruitment and after 2 months. The AQLQ showed a high internal consistency (Cronbach's alpha = 0.78 to 0.96) and a high 2-week reproducibility (ICC = 0.82 to 0.92). Expected significant differences in AQLQ scores were observed according to disease severity as measured by symptoms, medication, use of services and recruitment setting. The cross-sectional and longitudinal correlations between AQLQ and the overall St. George's Respiratory Questionnaire were strong, moderate to strong between AQLQ and dyspnea and weak to moderate between AQLQ and FEV(1). The changes in AQLQ scores were significantly different in patients who either improved or deteriorated from those patients who remained stable (P <.0001 and P <.01, respectively, for the overall AQLQ). We conclude that the Spanish version of the AQLQ is reliable, valid and sensitive to changes.

Diagnostic value of bronchoalveolar lavage in suspected pulmonary tuberculosis.

Of 222 patients suspected of having pulmonary tuberculosis (PT), studied during a one-year period, we performed fiberoptic bronchoscopy together with bronchoalveolar lavage (BAL), bronchial washing and postbronchoscopy sputum smears and Löwenstein cultures in 20 patients. Bronchoalveolar lavage proved to be the most effective method leading to diagnosis in 17 of 20 cases. Diagnosis was obtained in 11 of 20 cases using bronchial washing and postbronchoscopy sputum. The results of this study suggest that bronchoscopy may be required in selected cases for the diagnosis of PT. However, it should be accompanied by BAL, bronchial washings and postbronchoscopy sputum smears. Indications for bronchoscopy as a diagnostic tool for PT may include: (a) patients suspected of having PT with negative smears and in whom treatment must be started due to clinical status; (b) suspicion of associated neoplasia; (c) selected patients with negative Löwenstein cultures; (d) lack of material being obtained by simpler methods.

Time of exposure as a prognostic factor in avian hypersensitivity pneumonitis.

Spirometric values were subsequently evaluated in 22 patients suffering from hypersensitivity pneumonitis caused by avian problems. First spirometric values were abnormal in 18/22 (82%) of patients. A restrictive pattern was observed in 16/22 (72%) of patients and an obstructive pattern in 6/22 (27%). The TLCO was reduced in all cases (12/12). Improvement or normalization of the respiratory function occurred 3.4 +/- 2.4 months after the avian contact had ceased. At the end of the follow-up, parameters were normal in 13/22 (59%) of patients. The restrictive pattern remained unchanged in 7/22 (32%), and the obstructive pattern persisted in 4/22 (18%) of the patients. The TLCO was normal in 6/12 (50%) of patients. Neither age nor treatment with corticosteroids (13 patients) had a significant influence upon the evolution of the lung function. However, total recovery or significant improvement was observed in 12/12 (100%) of patients who had been in contact with birds less than 2 years, in contrast to 6/10 (60%) of patients with more than 2 years of contact (P = 0.002).

[Fiber-optic bronchoscopic biopsy of bronchial smooth muscle. Efficacy of the technique in individuals with normal lung function and patients with COPD]. / Biopsia de músculo liso bronquial mediante fibrobroncoscopia. Eficacia de la técnica en individuos con función pulmonar normal y en pacientes con EPOC.

BACKGROUND AND OBJECTIVES: The epithelium and airway smooth muscles of patients with chronic obstructive pulmonary disease (COPD) or bronchial asthma undergo certain structural changes that are probably related to increased expression of inflammatory molecules and cell growth factors. Studying the relation between disease and changes in bronchial smooth muscle is difficult if investigation is restricted to samples from autopsies or thoracotomies. This study was designed to evaluate the probability of obtaining bronchial smooth muscle by endoscopic bronchial biopsy in patients with COPD and from individuals with normal lung function, the relation of disease to bronchial epithelial histology, and the potential usefulness of studying airway muscle remodeling events. METHODS: Forty-two patients undergoing diagnostic fiberoptic bronchoscopy were enrolled. Bronchial biopsies were taken systematically from the lobar and segmental dividing ridges. The epithelial structure was analyzed by conventional histology. The smooth muscle was identified by immunohistochemistry (anti-desmin antibody assay) and Western-blot analysis (anti-desmin, actin and myosin antibodies). RESULTS: Sixty-nine percent of the biopsies contained bronchial smooth muscle. The probability of obtaining smooth muscle was higher in segmental than in lobar biopsies (72 vs 30%, p < 0.05). This probability was unrelated to the presence of COPD or to signs of epithelial inflammation. The fragments allowed us to use electrophoresis to identify protein structures (myosin, actin, desmin) involved in muscle remodeling processes. CONCLUSIONS: Endoscopic biopsy of the bronchi allows us to obtain bronchial smooth muscle samples in a large percentage of patients, particularly when performed on segmental bronchi. The technique may be useful for future studies examining the processes of airway smooth muscle remodeling.

[Indications, performance and complications of bronchofibroscopy in the aged]. / Indicaciones, rendimiento y complicaciones de la broncofibroscopia en el anciano.

Bronchofibroscopy is a widely used exploration for the diagnosis of several pulmonary processes. However, its use in aged patients, these being considered a high risk group, is still a controversial issue. The aim of this study was to analyze the indications, diagnostic performance and complications of the bronchofibroscopy in the elderly and to determine if there are any differences with respect to the adult population. A retrospective case control study was conducted, taking as cases those patients with 70 or more years of age, and as controls, those patients with less than 70 years. The study period was 1 year, with 54 bronchofibroscopies performed in 49 patients from the study group and 149 in 145 patients from the control group. The indications were similar in both groups, except for the study of opportunistic infections, these being more frequent among the control group. Diagnostic performance and complications did not show any differences between both groups. Indications, performance and complications of bronchofibroscopy in aged patients are similar to those in the adult population. Hence, the age in itself should not be a limiting factor for the indication of this exploration.

[Effects of Sjögren's syndrome on pulmonary function impairment in patients with rheumatoid arthritis]. / Influencia del síndrome de Sjögren en la afectación funcional pulmonar de pacientes con artritis reumatoide.

The influence of Sjögren syndrome (SS) on pulmonary function impairment in rheumatoid arthritis (RA) patients has been few studied. The aim of this study was to analyse the pulmonary function impairment in RA patients, and to establish differences between patients associated or not to SS. Pulmonary function of 57 patients, non smokers and without another pulmonary disease, diagnosed of RA were studied. Fourteen (24.6%) were associated to SS, and 43 (75.4%) to RA without SS. Age and time of evolution of disease were similar. Eight patients with associated SS (57.2%), and in 20 (46.5%) without SS showed pulmonary function disorder. Airflow obstruction and DLCO diminution were the most common types of impairment, respectively. The comparison between the types of impairment and the mean values of FEVI, FVC, FEVI/FVC %, FEF 25-75 and DLCO were not statistical different. This results suggest a poor influence on pulmonary function impairment in RA patients with SS.

[False images of endobronchial tumor in CT-scan]. / Falsas imágenes de tumoración endobronquial por tomografía computarizada.

Bronchoscopic identification of an endobronchial foreign body is an unexpected finding in adults. Modern imaging techniques such as computerised tomography (CT) may identify bronchial obstruction but not the cause. Moreover, images may be suggestive of other pathologies, especially when the previous aspiration cases are unknown. The most common CT findings in this setting are atelectasis, lung hyperlucency, localised bronchiectases and lobar consolidation. CT diagnosis of false endobronchial tumors in patients who have swallowed a foreign body is rarely described in the bibliography. In view of the potential adverse outcome in the case of wrong diagnosis we consider it is of interest to report two cases of endobronchial tumors diagnosed by CT in which flexible bronchoscopy allowed identification and extraction of an endobronchial foreign body.