Impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia.

The aim of this study was to compare the evolution of systemic cytokine levels over time in patients with pneumococal pneumonia treated either with ß-lactam monotherapy or with combination therapy (ß-lactam plus fluoroquinolone). Prospective observational study of hospitalized non-immunocompromised adults with PP. Concentrations of IL-6, IL-8, IL-10, and TNF-α were determined on days 0, 1, 2, 3, 5, and 7. Patients on ß-lactam monotherapy were compared with those receiving combination therapy. Fifty-two patients were enrolled in the study. Concentrations of IL-6, IL-8, and IL-10 decreased rapidly in the first days after admission, in accordance with the mean time to defervescence. High levels of IL-6 were found in patients with the worst outcomes, measured by the need for intensive care unit admission and mortality. No major differences in demographic or clinical characteristics or severity of disease were found between patients treated with ß-lactam monotherapy and those treated with combination therapy. IL-6 levels fell more rapidly in patients with combination therapy in the first 48 h (p = 0.016). Our data suggest that systemic expression of IL-6 production in patients with PP correlates with prognosis. Initial combination antibiotic therapy produces a faster decrease in this cytokine in the first 48 h.

Early mortality in patients with community-acquired pneumonia: causes and risk factors.

The first 48 h of evolution of patients with community-acquired pneumonia (CAP) are critical. The aim of the present study was to determine the frequency, causes and factors associated with early mortality in CAP. Nonimmunocompromised adults hospitalised with CAP were prospectively observed from 1995 to 2005. Early deaths, defined as death due to any cause < or = 48 h after admission, were compared with all patients who survived > 48 h. Furthermore, early deaths were compared with late deaths (patients who died > 48 h) and with survivors. Of 2,457 patients, 57 (2.3%) died < or = 48 h after admission. Overall mortality was 7.7%. The main causes of early mortality were respiratory failure and septic shock/multiorgan failure. Independent factors associated with early deaths were increased age, altered mental status at presentation, multilobar pneumonia, shock at admission, pneumococcal bacteraemia and discordant empiric antibiotic therapy. Currently, early mortality is relatively low and is caused by pneumonia-related factors. It occurs mainly among the elderly and in patients presenting with altered mental status, multilobar pneumonia and septic shock. Pneumococcal bacteraemia and discordant antibiotic therapy, mainly due to lack of coverage against Pseudomonas aeruginosa are also significant risk factors.

Noninvasive positive pressure ventilation prevents postoperative pulmonary complications in chronic ventilators users.

OBJECTIVE: To evaluate the postoperative pulmonary complications and the long-term impact on pulmonary function of different surgical procedures with general anaesthesia in chronic respiratory failure (CRF) patients who were using noninvasive positive pressure ventilation (NPPV). DESIGN: We retrospectively studied 20 stable patients on NPPV for CRF secondary to: kyphoscoliosis (eight), morbid obesity (six), thoracoplasty (four), neuromuscular diseases (two), who underwent surgical procedures with general anaesthesia, between January 1998 and December 2003. MATERIAL AND METHODS: The variables studied were: type of surgery, hours of orotracheal intubation, hours of stay in the postsurgical reanimation unit (PRU), postoperative pulmonary complications and days of hospital stay. These results were compared with those obtained in patients without respiratory pathology and who were submitted to the same type of surgical interventions during the study period. All patients were tested for: arterial blood gases, forced vital capacity (FVC) and forced expiratory volume in 1s (FVE1). These tests were carried out both prior to surgical intervention and 12 months after this intervention, and the use of medical assistance resources the year prior to and the year after the surgical intervention were also analysed. RESULTS: Sixteen patients were using NPPV at home at the time of the intervention and four patients were adapted to NPPV before surgery. The surgical procedures were: gastroplasty: six; mastectomy: five; septoplasty: three; hip prosthesis: two; cholecystectomy: one; Gasserian ganglion thermocoagulation: one; hysterectomy: one; and endoscopic retrograde cholangiopancreatography (ERCP): one. The mean postoperative intubation time was 3.8+/-3.2h, and only one patient remained intubated for more than 12h. The mean stay in the PRU was 19+/-9h (vs 19+/-6h in the general population, p>0.05). The days of hospital stay for the different pathologies were in the majority of cases greater than in the general population. We did not find significant differences on comparing the arterial blood gases, in pulmonary function or in use of assistance resources between the year previous to and the year following the surgical intervention. CONCLUSIONS: In high-risk patients with chronic respiratory failure as a consequence of a restrictive lung pathology, NPPV can play an important role to confront surgical procedure with general anaesthesia with greater security. To obtain these results, it was fundamental to coordinate between the Pulmonary Services and the Anaesthesia Services as well as to follow up jointly in the PRU.

[Analysis of oxidative stress in exhaled breath condensate from patients with severe pulmonary infections]. / Estrés oxidativo en el condensado exhalado de pacientes con infección pulmonar grave.

OBJECTIVE: Oxidative stress is an intrinsic part of the chain of events leading to inflammation of the airways caused by bacterial infection. The aim of this study was to determine whether analysis of exhaled breath condensate from patients with severe lung infections reveals changes in the redox state at the airway surface. PATIENTS AND METHODS: The study included a total of 48 subjects divided into 4 groups: individuals without respiratory disease (n=14), patients with multilobar pneumonia (n=13), patients who had chronic obstructive pulmonary disease with superinfection (n=14), and mechanically ventilated patients with severe pneumonia (n=7). A sample of exhaled breath condensate was obtained within the first 72 hours of hospital admission and the concentrations of nitrite, nitrate, 8-isoprostane, and myeloperoxidase (MPO) were determined. RESULTS: Significant differences in the concentrations of nitrite, 8-isoprostane, and MPO were observed between patients and individuals without respiratory disease but no differences were found between the 3 patient groups. The concentration of MPO was correlated with the concentrations of 8-isoprostane and nitrate, which were normalized to the nitrite concentration. CONCLUSIONS: Analysis of the concentrations of 8-isoprostane and MPO in exhaled breath condensate allows assessment of oxidative stress in the airways of patients with severe lung infections.

Synaptic electrogenesis in eel electroplaques.

Whether evoked by neural or by chemical stimulation, the synaptic membrane of eel electroplaques contributes a depolarizing electrogenesis that is due to an increased conductance for Na and K. The reversal potential (E(S)) is the same for the two modes of synaptic activation. It is inside-positive by about 30-60 mv, or about midway between the emf's of the ionic batteries for Na (E(Na)) and K(E(K)). The total conductance contributed by synaptic activity (G(S)) varied over a fivefold range, but the individual ionic branches, G(SSNa), and G(SSK), change nearly equally so that the ratio G(SSNa):G(SSK) is near unity. G(SSK) increases independently of the presence or absence of Na in the bathing medium, and independently of the presence or absence of the electrically excitable G(K) channels. When activated, the synaptic membrane appears to be slightly permeable to Ca and Mg. When the membrane is depolarized into inside positivity the conductance of the synaptic components decreases and approaches zero for large inside-positive values. Thus, the synaptic components become electrically excitable when the potential across the membrane becomes inside-positive, responding as do the nonsynaptic components, with depolarizing inactivation.

Potassium inactivation and impedance changes during spike electrogenesis in eel electroplaques.

Various degrees of pharmacological K inactivation were induced by Cs or Ba in isolated single electroplaques of the electric eel. The resulting changes in K conductance give rise to very different steady-state current-voltage characteristics. They also induce differences in ion dynamics during spike electrogenesis. The dynamic changes were studied by AC bridge methods, registering the changes in impedance in synchrony with the neurally or directly evoked spikes. While spike electrogenesis was virtually unaffected by addition of Cs or Ba, the patterns of impedance changes were very different. The various patterns are accounted for by the changes in the respective current-voltage characteristics. The data constitute new evidence for regarding the electrically excitable component of the reactive membrane as a heterogeneous electrochemical system with separate and independently reactive channels that in the electroplaques are permselective for Na and K, respectively.

Clindamycin vs penicillin for anaerobic lung infections. High rate of penicillin failures associated with penicillin-resistant Bacteroides melaninogenicus.

Thirty-seven adult patients with anaerobic lung infections (27 lung abscesses and 10 necrotizing pneumonias) were submitted to transthoracic needle-aspiration and/or bronchoscopic specimen brush cultures before therapy and thereafter in all cases considered to be failures. Patients were randomly assigned to receive either clindamycin, 600 mg intravenously every 6 hours, or penicillin G, 2 million U every 4 hours for no less than 8 days, until clinical and radiological improvement became apparent. Treatment was continued orally with clindamycin, 300 mg every 6 hours, or penicillin V, 750 mg every 6 hours, until completing a minimum of 4 weeks. Ten of the 47 anaerobes initially isolated from the lung (nine Bacteroides melaninogenicus and one Bacteroides capillosus) were resistant to penicillin, but none were resistant to clindamycin. Five of the nine patients harboring these penicillin-resistant Bacteroides received penicillin, and all failed to respond to therapy. Overall, eight of the 18 patients in the penicillin group and one of 19 in the clindamycin group failed to respond to therapy. These drugs were equally well tolerated in both groups. The presence of penicillin-resistant Bacteroides is a frequent cause of penicillin failure in patients with anaerobic lung infections. In this setting, clindamycin appears to be the current therapy of choice for initial treatment.

Löfgren's syndrome revisited: a study of 186 patients.

PURPOSE: To evaluate the clinical features, the results of noninvasive tests and biopsies, and the outcome of patients with Löfgren's syndrome. SUBJECTS AND METHODS: Patients diagnosed as having Löfgren's syndrome at a university hospital in Barcelona, Spain, from 1974 to 1996, were prospectively followed. Löfgren's syndrome was defined as the association of erythema nodosum or periarticular ankle inflammation with unilateral or bilateral hilar or right paratracheal lymphadenopathy. RESULTS: Löfgren's syndrome was diagnosed in 186 patients. The mean age was 37 +/- 11 years, and 157 (85%) were women. In 91 patients (49%), symptoms started during the spring (P < 0.0001). Erythema nodosum, periarticular ankle inflammation, or both were present at onset in 173 patients (93%). At the time of diagnosis, 161 patients (87%) had no respiratory symptoms; 151 (81%) had stage I abnormalities on chest radiograph, 29 (16%) stage II, and 6 (3%) stage 0. Five percent of patients had decreased forced vital capacity, and 15% had decreased carbon monoxide diffusing capacity. Extrathoracic involvement was infrequent. Serum angiotensin-converting enzyme levels were increased in 50% of patients. Gallium-67 scans showed hilar uptake in all the studied patients, but it yielded useful additional diagnostic information only in those with normal chest radiographs or with unilateral hilar lymphadenopathy. The diagnosis was proven with biopsy results in 63% of patients. None of the patients without histologic confirmation were subsequently found to have a diagnosis other than sarcoidosis. In the 133 patients who were followed for a mean of almost 5 years, 11 (8%) continued to have active disease, and 8 (6%) had several recurrences between 18 months and 20 years after a complete resolution. A normal serum angiotensin-converting enzyme level at diagnosis was associated with disease resolution without recurrence. CONCLUSION: Löfgren's syndrome is usually a self-limiting form of sarcoidosis. Histologic confirmation is not necessary in typical cases. In a small number of patients, the disease may remain active or recur long after its onset, although usually with mild organ dysfunction.

Impact of a hospital-based home-care program on the management of COPD patients receiving long-term oxygen therapy.

STUDY OBJECTIVES: To analyze the influence of a hospital-based home-care program (HCP) on the management of patients with COPD receiving long-term oxygen therapy. DESIGN AND SETTING: Randomized, controlled study in a 1,000-bed university hospital. INTERVENTION: The HCP applied to patients in the intervention group (HCP group) consisted of a monthly telephone call, home visits every 3 months, and home or hospital visits on a demand basis. Patients in the control group were given conventional medical care. MEASUREMENTS: Pulmonary function data, gas exchange, use of hospital resources (emergency department visits, admissions, and hospital stay) and the cost of medical assistance were investigated in both groups before and after 1 year of study. Quality of life was analyzed using the chronic respiratory questionnaire in the first 40 consecutive patients included in the study. Survival throughout the study was also assessed. RESULTS: One hundred twenty-two patients were enrolled in the study, and 94 patients (46 in the HCP group and 48 in the control group) completed the 1-year follow-up period: 83 patients (88%) were men, and mean (+/- SD) age was 68 +/- 8 years. During the follow-up period, there was a highly significant decrease in the mean number of emergency department visits (0.45 +/- 0.83 vs 1.58 +/- 1.96; p = 0.0001) and also a significant decrease in hospital admissions (0.5 +/- 0.86 vs 1.29 +/- 1.7; p = 0.001) and days of hospital stay (7.43 +/- 15.6 vs 18.2 +/- 24.5; p = 0.01) in the HCP group. Patients in the intervention group required a total of 221 home visits (mean per patient, 4.8 +/- 0.8) and 69 hospital visits (mean per patient, 1.5 +/- 1.07). In spite of the cost of the program, cost analysis showed a total saving of 8.1 million pesetas ($46,823) in the HCP group, mainly due to a decrease in the use of hospital resources. There was no difference in pulmonary function, gas exchange, quality of life, and survival between the two groups. CONCLUSIONS: Hospital-based home care is an effective alternative to hospital admission. It reduces the use of hospital resources and the cost of health care.

Usefulness of betalactam therapy for community-acquired pneumonia in the era of drug-resistant Streptococcus pneumoniae: a randomized study of amoxicillin-clavulanate and ceftriaxone.

Empirical antibiotic therapy of community-acquired pneumonia (CAP) has been complicated by the worldwide emergence of penicillin resistance among Streptococcus pneumoniae. The impact of this resistance on the outcome of patients hospitalized for CAP, empirically treated with betalactams, has not been evaluated in a randomized study. We conducted a prospective, randomized trial to assess the efficacy of amoxicillin-clavulanate (2 g/200 mg/8 hr) and ceftriaxone (1 g/24 hr) in a cohort of patients hospitalized for moderate-to-severe CAP. Three-hundred seventy-eight patients were randomized to receive amoxicillin-clavulanate (184 patients) or ceftriaxone (194 patients). Efficacy was assessed on Day 2, after completion of therapy and at long term follow-up. There were no significant differences in outcomes between treatment groups, both in intention-to-treat and per-protocol analysis. Overall mortality was 10.3% for amoxicillin-clavulanate and 8.8% for ceftriaxone (NS). There were 116 evaluable patients with proven pneumococcal pneumonia. Rates of high-level penicillin resistance (MIC of penicillin > or = 2 microg/mL) were similar in the two groups (8.2 and 10.2%). Clinical efficacy at the end of therapy was 90.6% for amoxicillin-clavulanate and 88.9% for ceftriaxone (95% C.I. of the difference: -9.3 to +12.7%). No differences in outcomes were attributable to differences in penicillin susceptibility of pneumococcal strains. Sequential i.v./oral amoxicillin-clavulanate and parenteral ceftriaxone were equally safe and effective for the empirical treatment of acute bacterial pneumonia, including penicillin and cephalosporin-resistant pneumococcal pneumonia. The use of appropriate betalactams in patients with penumococcal pneumonia and in the overall CAP population, is reliable at the current level of resistance.

Parallel airways inhomogeneity and lung tissue mechanics in transition to constricted state in rabbits.

To investigate whether changes of tissue resistance (Rti) during methacholine (MCh)-induced constriction correspond to an intrinsic mechanism or are an artifact of increased airways inhomogeneity, rabbits were studied after exposure to air (n = 7) or 1.5 parts/million O3 (n = 6). Animals were anesthetized and mechanically ventilated. Tracheal flow and pressure (Ptr) and four alveolar capsule pressures (Pcap) were measured during 3 min after administration of an intrajugular bolus of 0.8 mg/ml MCh. By adjustment of the equation of motion [P(t) = E . V(t) + R . dV(t)/dt + P0] [where P(t), V(t), and dV(t)/dt are pressure, volume, and flow as a function of time, respectively, E is elastance, R is resistance, and P0 is end-expiratory pressure] to Ptr, lung resistance (RL) and dynamic elastance (EL) were determined breath by breath. Rti and airways resistance (Raw) were determined from Pcap in phase with rate of change of pulmonary expansion. Hysteresivity (eta) was calculated. Parallel inhomogeneity was estimated from the coefficients of variation (CV) of every Pcap at end inspiration and end expiration. Increase in CV significantly lagged Rti, RL, and eta. A linear relationship between EL and Raw was observed. Our results suggest that changes in tissue mechanics during the transition to the constricted state are not artifactual.

Long-term mechanical ventilation in amyotrophic lateral sclerosis.

BACKGROUND: Acute respiratory insufficiency (ARI) with alveolar hypoventilation or incapacitating dyspnoea but without peripheral muscle involvement can be an early manifestation of respiratory involvement in amyotrophic lateral sclerosis (ALS). Some of these patients benefit from assisted ventilation. The object of this study was to analyse the results of long-term mechanical ventilation (LTMV) in ten patients with ALS. METHODS: A retrospective analysis of intensive care unit (ICU) or ambulant patients with ALS who underwent LTMV in a conventional hospital ward was performed. Erect and supine spirometry, blood gas analysis and pulse oximetry were performed before the start and during the course of ventilation. RESULTS: Ten patients on LTMV were included. Four from the ICU were ventilated via tracheostomy, and six ambulant patients had non-invasive (nasal) ventilation. In all cases, ventilation was performed in a conventional hospital ward. The ambulant patients improved symptomatically during ventilation, confirmed by measurement of gas exchange and of SaO2 by continuous pulse oximetry. Three of the ten patients survive in long-term care--two with nasal and one with tracheostomy ventilation. CONCLUSIONS: LTMV outside ICU was possible in ten patients, seven of whom returned home. Returning home is very difficult for patients dependent on a ventilator who lack family support.

A way of obtaining isoresource consumption care episodes.

The purpose of this study is to identify groups of care episodes that involve pneumologic and cardiologic problems and that exhibit homogeneous patterns of frequentation and diagnostic test consumption in an ambulatory consulting room. A 1-year prospective study of care content was done, and the episodes were retrospectively analyzed 2 years later. Data were collected in an ambulatory cardiologic and pneumologic consulting room in Spain. Nonlinear principal components analysis was applied before cluster analysis. Five typologies with a homogeneous pattern of resource consumption were obtained: three related to acute episodes of care and two to chronic ones.

[Effectiveness of a mandibular advancement prosthesis in the treatment of obstructive sleep apnea syndrome]. / Eficacia de una prótesis de avance mandibular en el tratamiento del síndrome de apneas obstructivas del sueño.

OBJECTIVE: To assess the efficacy of a mandibular advancement prosthesis for treating obstructive sleep apnea syndrome (OSAS). METHOD: Mandibular advancement appliances were prescribed for 21 patients (20 men) with OSAS diagnosed by polysomnography. Mean age was 51 (8) years, BMI was 30 (4) kg/m2, and the apnea-hypopnea index (AHI) per hour was 48 (17). If the device was well tolerated, regardless of clinical response, polysomnography was repeated between 1 to 3 months after start of treatment. The device was considered effective if the AHI decreased to < 15/h and symptoms related to OSAS disappeared. RESULTS: Seven patients withdrew from treatment after only a few days. The remaining 14 (66%) tolerated treatment well and the second polysomnogram was performed. In six of the 14 (43%), the device proved effective for correcting OSAS. In six more patients, the AHI decreased but failed to become normal. In the remaining two patients, no improvement was observed. Improvement in the AHI was unrelated to severity of OSAS. CONCLUSION: The mandibular advancement prosthesis is effective for some patients with OSAS, including those in whom the AHI is high. Larger studies are needed to allow us to define the type of patients that might benefit.

[Information seeking and decision making in asthmatic patients]. / Búsqueda de información y toma de decisiones en pacientes asmáticos.

Patient cooperation in controlling asthma is a key element for achieving the most efficient therapy possible according to current guidelines. Cooperation requires that the patient be adequately informed about his disease and able to make certain decisions. The aim of this study was to analyze whether patients really desire information about asthma and to what point they are disposed to cooperate actively in managing their disease. Ninety-five adult asthmatics with different levels of severity of disease were studied in stable condition. All responded to the Spanish version of the questionnaire on autonomy in asthma, an instrument with a scoring range of 0 to 100 and 26 items grouped in two subscales: preferences in the search for information (PSI) and preferences in decision making (PDM). The second subscale was based on three scenarios describing stable asthma, slight exacerbation and severe exacerbation. The results obtained indicate that although patients are greatly interested in receiving information (PSI scores of 86.4 +/- 8.7) they express substantially less desire to make decisions (PDM 45 +/- 10.2) (p < 0.01). Attitudes did not change in relation to education, number of exacerbations during the last year, duration of disease or severity as assessed by the patient. Only patient age (with older patients scoring higher on PSI) and presence of severe asthma (according to consensus guidelines) increased the desire for information (but not the preference for decision making). These data indicate the need to implement educational programs about asthma, components of which promote effective desire for self-management.

[The internal consistency and content validity of the Spanish version of the Asthma Autonomy Questionnaire]. / Consistencia interna y validez de contenido de la versión española del Asthma Autonomy Questionnaire.

The Asthma Autonomy Questionnaire (AAQ) was designed to evaluate asthmatics' desire to learn about their disease and to make decisions. The AAQ consists of 26 items distributed in two scales: Preferences in the Search for Information (PSI, 8 items) and Preferences in Decision Making (PDM, 6 general items and 12 related to 3 scenarios depicting asthma in stable phase, during mild exacerbation and during severe exacerbation). The aim of this study was to analyze the internal consistency (Cronbach's-coefficient) and content validity (factorial analysis of principal components) of the AAQ. After translation and back translation, the Spanish version of the AAQ was administered to 115 adult asthmatics of both sexes and differing levels of severity. The alpha coefficients for the two scales and 3 scenarios ranged from 0.42 (PSI) to 0.73 (stable phase scenario); only for the stable-phase scenario were values high or statistically acceptable. Factorial analysis reproduced the content of the scales only approximately, with some items proving to relate to factors that were different from the scale they originally belonged to. These results indicate that, in its current formulation, the AAQ presents important measurement problems and revision is advisable.

[The evaluation of the oxygen-conserving valve during exertion]. / Evaluación de la válvula ahorradora de oxígeno durante el esfuerzo.

BACKGROUND: The oxygen-conserving valve (OCV) permits reduction in oxygen consumption upon the release of oxygen only during inhalation thereby increasing the autonomy of portable sources. METHODS: In order to confirm its efficacy during exercise, 15 patients with chronic limitation of air flow and gasometric criteria of domiciliary oxygen therapy were selected. The patients underwent three walking tests (WT) of 6 minutes during which the continuous form of transcutaneous hemoglobin saturation (SaO2) and the distance covered were registered. The first was carried out breathing synthetic air at a flow of 2 liters per minute; the second with continuous oxygen released by a portable source at 2 liters per minute and the third with the OCV coupled to a portable source at the same flow. RESULTS: SaO2 reached with the continuous oxygen is significantly higher to that of synthetic air while there was no difference between the SaO2 with continuous oxygen and with valve. Improvement in SaO2 upon use the valve was not obtained in only 2 of the 15 patients. A significant increase was observed in the distance covered upon oxygen administration not only in the continuous form but also with OCV with respect to synthetic air. CONCLUSIONS: OCV is as effective as continuous oxygen in the correction of desaturation during exercise, however its indications must be individualized by exercise tests (WT) in each patients in order to ensure its correct functioning.

[The introduction of liquid oxygen as a portable source in continuous home oxygen therapy]. / Introducción del oxígeno líquido como fuente portátil en la oxigenoterapia continua domiciliaria.

The most widespread types of oxygen delivery at home in our area are bottles where the gas is stored under pressure and concentrators. Both devices can only be used at rest. We have assessed a new system for the delivery of liquid oxygen to be used at home, provided with a portable unit which permits that the patients receive oxygen also outside their homes. Seven such devices have been implemented in the Barcelona area, with an excellent acceptance and without technical problems. To verify the clinical indication, exercise tests were carried out both in baseline conditions and receiving oxygen from the portable source. Oxyhemoglobin saturation and the walked distance were continuously measured. In all patients important drops in the saturation of oxyhemoglobin were recorded during walking, which was corrected with oxygen administration. Liquid oxygen with a portable source is a good delivery system for oxygen therapy at home, permitting to receive oxygen throughout the day, particularly during exercise. Although the availability of liquid oxygen is limited, it should be recommended to the patients in whom exercise hypoxemia is shown to be corrected and who desire an active social life.

[Long-term effects of home mechanical ventilation with positive pressure using a nasal mask]. / Efectos a largo plazo de la ventilación mecánica a domicilio con presión positiva mediante máscara nasal.

Home mechanical ventilation (HMV) is an efficient alternative in the treatment of patients with chronic respiratory failure secondary to restrictive mechanical disorders (neuromuscular disease, such as Duchenne's disease, thorax deformities due to kyphoscoliosis or tuberculosis sequelae). The case of a patient with severe kyphoscoliosis in the phase of chronic respiratory failure (PaO2 34 mmHg and PaCO2 61 mmHg, breathing ambient air) is presented in which, following the failure of negative pressure mechanical ventilation ("poncho"), positive pressure ventilation was tested with a silicon made-to-measure nasal mask as the access via. Adaptation to HMV was good with the patient using the ventilation nightly. Following 12 months of treatment the patient is able to carry out everyday activities and arterial gasometry breathing ambient air is PaO2 77 mmHg and PaCO2 43 mmHg.

[Predictive factors of the persistence of sarcoidosis activity 2 years after diagnosis]. / Factores predictivos de persistencia de activad de la sarcoidosis a los 2 años del diagnóstico.

BACKGROUND: The prognosis of sarcoidosis is difficult to predict. In general, sarcoidosis is considered as chronic when it remains active for over 2 years. The aim of this study was to analyze predictive factors in the persistence of sarcoidosis activity 2 years after diagnosis. METHODS: One hundred fifty-five patients diagnosed of having sarcoidosis over a period of 14 years were included in a protocol of prospective study and were followed for at least 2 years. RESULTS: Four variables independently related to the persistence of activity of the disease at 2 years of diagnosis were identified by means of multiple logistic regression analysis: absence of erythema nodosum (relative risk = 23.3), confidence interval 95% = 12.7-44.6), age equal to or greater than 40 years of age (RR = 7.7, IC = 4.3-13.6), presence of splenomegaly (RR = 21.1, IC = 7, 5-59.7) and presence of parenchymatous infiltrates in thorax x-ray (RR = 3.5, IC 2-5.9). CONCLUSIONS: Although the persistence in the activity of sarcoidosis does not always have the same clinical repercussion and does not necessarily imply treatment, these results may permit a greater approximation to the prognosis of the disease and the indication of corticotherapy.