Revista de Patologia Respiratoria最新文献

The term histiocytosis refers to a heterogeneous group of diseases characterized by the infiltration of Langerhans cells (LC) in different organs. Pulmonary Histiocytosis (PH) is an uncommon disease that typically affects young adults. Its pathogeny is not well known, although a relationship with smoking has been observed. Thus, the first treatment measure should be smoking cessation. We present a case of pulmonary histiocytosis that showed a favorable clinical, functional and radiological course in six months as a consequence of using smoking cessation as the only treatment.

Biological markers are being used in the diagnosis and treatment of disease as prevalent as cardiovascular or cancer. Biomarkers are a useful in clinical practice as a non invasive methods for the accurate diagnosis of the disease, monitor disease and create personalized treatment regimes. Asthma is a heterogeneous disease with different phenotypes. Pulmonary function test are most often used to confirm the diagnosis, but not reflect the pathological processes responsible for different phenotypes that present the disease. Inhaled corticosteroids and beta 2 agonists have been mainstay of asthma therapy for over 30 years, but the heterogeneity of the disease means not all asthmatics respond to the same treatment. Biomarkers are useful tools to identify these specific phenotypes. This review focuses on the utility of biomarkers of inflammation of the airway in the management of asthma patients obtained by noninvasive tecniques including sputum, exhaled breath or serum.

Pulmonary benign metastasising leiomyomatosis is an uncommon disease characterized by the presence of pulmonary leiomyomas, in the absence of malignancy criteria in a patient with previous uterin leiomyomatosis. The disease is very uncommon and should be considered amongst the differential diagnosis of pulmonary benign tumors. Due to the challenge that represents to health care providers specialized in respiratory pathology in the diagnosis and management of these type of patients, we present the case of a patient with hysterectomy for uterin myomatosis in which the diagnosis of pulmonary benign metastasising leiomyomatosis was established and treated successfully.

Introduction: Invasive pneumococcal disease is one of the diseases with higher morbidity and mortality in children. Despite expectations created, we discuss the role of the heptavalent vaccine in the incidence of complicates pneumonia. Our goal is to determine if it has increased in our hospital.

Patients and methods: We studied 9068 patients admitted with the diagnosis of pneumonia in the Hospital Niño Jesús between 1996 and 2010. A retrospective, observational study, analyzing the total or partial introduction of the vaccine.

Results: Sample segregation in 3 groups according to the non introduction and the total or partial introduction of the vaccine. We confirmed an increase in pleural effusion (p< 0.005) in vaccine groups.

Conclusions: After the introduction of heptavalent pneumococcal vaccine it has been found in our sample an increase in complicated pneumonia with pleural effusion.

Lung hernias are rare entities and are primarily related to chest trauma or previous surgery. Spontaneous lung hernias are even more uncommon. We describe three cases of spontaneous intercostal pulmonary hernia, its evaluation and treatment in all its forms, from the conservative management in small hernias without significant clinical impact, to surgical treatment, either with primary closure of the chest wall or using synthetic mesh in larger hernias or in presence of signs of possible complications.

Objective: A large consensus exists within the scientific community with regard to the existence of a high incidence of traffic accidents in people with Sleep Apnea Hypopnea Syndrome (SAHS). However, some aspects of this relationship are still in need of clarification. It has not been possible to show the likely cause of this large rate of accidents, there are possible uncontrolled, confounding factors, and some of the evaluation instruments used have low ecological validity. The goal of the study was to analyze risk behavior during driving in patients with SAS, in a virtual reality setting with simulated traffic.

Material and methods: Evaluation of risk driving behavior was carried out using the Honda Riding Trainer simulator. The participants were 12 patients diagnosed with SAS, treated with continuous positive airway pressure (CPAP), and 12 matched controls. Daytime somnolence, mental fatigue, and levels of activation during the tests, were also evaluated in both groups through the use of questionnaires.

Results: Although patients with SAHS showed higher daytime somnolence, they did not exhibit more risk driving behaviors than the control group. There were no differences in mental fatigue or levels of activation during the simulation.

Conclusion: Unlike the results found in classical studies, when the evaluation is carried out with more ecological tools and the duration of the tests is much shorter, the performance of patients with SAS treated with CPAP does not differ from that of the control group. These findings support the use of CPAP as well as the testing of drivers using virtual simulations in order to obtain a driver's license, especially in high risk populations.

Introduction

The fiberoptic bronchoscopy (FB) is a useful technique in the diagnosis of focal pulmonary nodules and masses. The profitability of the FB and transbronchial biopsy (TB) is variable and depends on different factors such as the operator's experience. The aim of this study was to determine if the diagnostic profitability of these techniques, in the diagnosis of malignant focal pulmonary lesions (FPL), changed with the incorporation of a new medical staff compared with previous data of our center.

Material and methods

A FPL was defined as an intra - parenchymatous pulmonary lesion that is well circumscribed and completely surrounded by healthy lung.

We analyzed all the FBs between 02/2008 and 08/2009 in patients with a FPL with a definitive diagnosis of malignancy. 85 patients were included.

Results

The diagnostic profitability of the TB was 0.55; it was higher when the FPL was > 2 cm (≤ 2 cm vs > 2 cm; 0.38 vs 0.62; p = 0.02) but no difference was found by site (central vs. peripheral; 0.67 vs 0.54; p = 0.16). The previous profitability of TB was 0.76 without differences by size (≤ 2 cm vs > 2 cm; 0.72 vs 0,78; p = 0,48) or site (central vs peripheral; 0.83 vs 0.74; p = 0,39).

Conclusion

We conclude that the operator's experience influences in the diagnostic profitability of the TB, in the malignant FPL.