Revista de Patologia Respiratoria最新文献

The tracheopathia osteochondroplastica (TO) is a benign and rare disorder, characterized by the deposit of cartilaginous tissue in the submucosa of the larynx, trachea and occasionally the bronchi. Both the etiology and pathogenesis, as well as the incidence and prevalence, of this disease are unknown. In a large series of 16888 bronchoscopies described, the incidence of TO was 1:1299.

This is usually an incidental finding when a bronchoscopy is performed for another reason as in the cases presented. Endoscopically, a cobblestone mucosa with yellowish-white nodules protruding into the tracheal lumen and main bronchi is observed. Other symptoms have been hemoptysis and treatment-refractory cough.

Despite the low prevalence of this disease, we describe two cases presented in the same hospital, diagnosed by chance when performing a fibrobroncoscopia for the study of a solitary pulmonary nodule.

Introduction

In order to achieve an adequate case management with patients who smoke, we must study the habit and make a correct diagnosis. Respiratory, cardiovascular and psychiatric comorbidities should also be taken into account.

Case report

We present the case of a 53-year old male patient who was an active smoker of 70 packs/year index. He had previously unsuccessfully attempted to quite smoking. Fagerstrom and Glover-Nilsson tests showed low physical (2 points) and psychosocial and behavioral dependence (9 points), respectively, whereas the Richmond test showed a moderate dependence (7 points). After an initial minimum approach, treatment was initiated with varenicline. At week 12 of treatment, he reported work-related insomnia (this had also appeared in the previous attempts to quit the habit, and ceased with habit restoration) that did not respond to lorazepam. He was admitted in Psychiatry and was diagnosed with «adjustment disorder with mixed anxiety and depressed mood». After an 8-month treatment with mirtazapine, the insomnia abated with no smoking relapse.

Comment

In this insomnia should be regarded as a symptom of cigarette withdrawal, a varenicline side effect or a psychiatric symptom. Furthermore, smoking is not only very common among psychiatric patients, and it can mask underlying psychiatric disease in a supposedly non-psychiatric population. We must, therefore, make careful assessments and a correct use of the existing diagnostic tests and drugs currently used for smoking cessation.

Anatomic disorders of upper airway are a risk factor for the development of sleep apnea and hypopnea (SAHS). We present a case of patient with tracheal stenosis and tongue tumoration who development sleep apnea. The patient has satisfactory evolved with non-invasive ventilation.

We present the case of a 46-year-old man who consulted due to dyspnea and stridor 8 months after suffering an acute heart attack requiring orotracheal ventilation. Tracheal stenosis was suspected, with sudden worsened. The airway emergency was treated with rigid bronchoscopy and progressive dilations of the stenosis. At a second time, surgical subglottal-tracheal resection of the stenotic segment and laryngotracheal reconstruction were performed. We also comment on some of the technical details of the operation.

The use of humidifiers in the home is a common practice in patients receiving domiciliary oxygen therapy, probably due to its extensive use in the hospital setting. However, the available evidence and clinical guidelines recommend that the use of a humidifier is not necessary in the hospital or at home when nasal prong oxygen therapy is used with a flow of oxygen of less than 4 l/min. Its generalized use, besides meaning an added cost, may entail health risks (bacterial contamination) and favor O₂ escapes. On the contrary, in patients with artificial airway (tracheostomy) or when higher O₂ flows are used, a humidifier device should be used (simple, thermal or artificial nose).

Introduction

The objectives of this study were to determine the microbiological diagnostic yield of the bronchoalveolar lavage (BAL) and to identify the most frequently isolated microorganisms according to the risk populations.

Material and methods

All the BALs done between January 2008 and December 2009 were studied. The microbiological protocol was carried out for all the BAL samples (bacteria, fungus, mycobacteria, virus and Pneumocystis jiroveci). Social demographic data, priority of the procedure, unit that required the procedure, microbiological results and complications variables were noted. The Chi square statistical test was used, the results being considered as statistically significant when p<0.05.

Results

A total of 244 BALs were done, 46.7% of which were positive (bacteria 15.1%, fungus 16%, mycobacteria 2.5%, virus 5.3% and Pneumocystis jiroveci 7.8%). The population was divided into the following risk subgroups: solid organ transplant, HIV infection or AIDS, diffuse interstitial lung disease with or without immunosuppressant treatment, hematologic diseases, rheumatologic diseases with immunosuppressant treatment, cancer with chemotherapy or radiotherapy. An analysis of BAL microbiological diagnostic yield was done in each group. Those BAL patients with HIV infection or AIDS disease showed a higher frequency of virus, fungus and Pneumocystis jiroveci while the BAL in patients with hematological diseases showed a higher frequency of Pneumocystis jiroveci. No differences were found in the other groups.

Conclusion

Almost half of the BALs carried out showed a final positive microbiological result. The medical background of the patient makes it possible to predict the responsible germ with greater likelihood, especially in HIV positive patients and those with hematological diseases.