Revista de Patologia Respiratoria最新文献

Mechanical ventilation is a standard therapy in patients admitted to the ICU in a situation of severe acute respiratory failure. Addition to the disruption of gas exchange, the main indication to start is the presence of signs of respiratory muscle fatigue. For mechanical ventilation is essential to succeed and patient ventilator are synchronized, ie the effort that the patient does the inspiration to start being recognized by the fan and it quickly delivers a gas flow, the flow contributed by the fan will need to adapt to patient flow during the delivery of gas and that the fan recognize the termination of inspiratory activity of the patient, complete the delivery of gas and expiratory valve opens to allow the expiration of the patient. This sequence of events that seem so logical, almost never achieved in clinical practice, still common in ventilated patients see some kind of asynchrony. The presence of mismatch or patient-ventilator asynchrony invariably leads to an increased work of breathing, which will defeat the fundamental objective of ventilatory support which is none other than the decrease of the patient work of breathing.

Synovial sarcomas are a soft-tissue neoplasms which affects young and middle-aged people, with no difference in distribution between sexes. They are located in the extremities in the 90% of the cases.

Pleuropulmonary primary synovial sarcoma SSPP is very unusual, constitutes 0.1% of pulmonary tumors. In most cases the SSPP present themselves with cough and / or hemoptysis whereas pneumothorax is an uncommon form of presentation.

Prognosis is usually poor, they present high risk of local recurrence. The survival rate depends on the surgical treatment, being the complete tumor resection the main predicting factor. Surgery is the treatment of choice followed by chemotherapy, radiotherapy or both.

We present a case report of a pleuropulmonary synovial sarcoma which presented with pneumothorax.

Design

A prospective, longitudinal, consecutive and non randomised study.

Methods

Analysis of the factors related to the decannulation of a group of tracheostomized patients admitted in a pneumological ward coming from the intensive care unit, all of them with prolonged mechanical ventilation.

Results

One hundred patients were studied between January 1994 and December 2001 (72 males, 28 females). Age: 59,26 ± 12,98 years old. 92% were coming from a medical ICU and 8% from a surgical ICU. 59% of patients were smokers. The diagnoses were: ALS (5); Thoracic cage defects (16); COPD (29); Obesity hypoventilation syndrome (11); Postsurgical complications (9); NMD (14); Sleep apnea syndrome (15); Bronchiestasis (1). Time to tracheotomy: 9,8 ± 2,9 days. Time to arrival to pneumological ward: 28,6 ± 36,2 days. Total stay 64,4 ± 44,5 days (ICU stay: 38,4 ± 36,4; ward stay: 25,6 ± 18,8 days). 88% of the patients were decanulated. The 64% of the patients received any kind of domiciliary ventilation support (pressure or volume). One-year survival was 92%. Multivariant analysis shown age, sex and motoneuron disease as factors negatively related to decanulation.

Conclusions

Most patients admitted in our pneumological ward coming from the ICU and receiving ventilatory support by tracheotomy, can be candidates to safe decannulation using non-invasive mechanical ventilation. ALS patients could not be decannulated.

The way in which lung cancer presents itself is related to the location of the tumour and its local and systemic complications. Aggressive forms of presentations have been described in young patients, although fulminating presentation is not usual. We present the case of a patient who in the space of one week went form being asymptomatic to dying from the spread of lung cancer.

This case is exceptional for several reasons: a) the abrupt presentation without previous symptoms or constitutional syndrome; b) the fulminating evolution towards the respiratory failure and death of the patient and c) the unusual initial presentation of the cancer with carcinomatosis lymphangitis.

Backgrounds

The purpose was to analyze the efficacy and safety of Varenicline in smokers who want to try to quit, verifying abstinence and adverse events during the treatment and follow-up phase.

Methods

An analytic, longitudinal and prospective study was performed. A total of 598 smokers who wanted to quit were included. Women accounted for 55% with a mean age of 45.7 years. A clinical history of smoking habit was obtained and associated comorbidity was investigated. Seven visits (baseline, weeks 2 and 4; 8, 12, 24, and week 52) were made. Telephone calls were also made in-between. Verbal manifestation of abstinence was confirmed with measurement of CO in exhaled air (<10 ppm). Treatment was received with Varenicline at standard dose (1 mg/12 h), for 12 weeks.

Results

Mean consumption of cigarettes was 27/day, cooximetry 28 ppm, Fagerström Test mean 6.70. The first cigarette was smoked in less than 30 minutes by 85% of the participants. Abstinence rate was 56% at week 12, 49% at week 24, and 41% at week 52. Most frequent adverse effects were nauseas, headache, insomnia, vomiting, abnormal sleep.

Conclusions

Varenicline has been shown to be an option for 1st line treatment of smoking cessation and can be an alternative to bupropion or nicotine replacement therapy, safe and well tolerated not only in healthy smokers but also in groups of smokers with comorbidity. More studies are needs in the groups of smokers having these characteristics.

We presented a case of patient with bipolar disorder that he was admitted in the respiratory unit of our hospital by empyema produced by Streptococcus constellatus (S. constellatus).

S. constellatus can produce lung infections, specially patients with airway manipulation. The response to treatment with penicillin usually are good.

It was at the beginning of the First World War when the surgical techniques multiplied in the United Kingdom. Drainages, treatment of open wounds and complications such as empyemas were the initiation of new, innovating and resolving techniques in these cases. During these years, many of the British surgeons left the country. We must state that new hospitals, such as the Brompton in London, were created. It was founded by Queen Victoria as a “Hospital for diseases of the chest.” Mention should be made of Dr. Barrett, who was from Adelaida (Australia) and who formed a part of the surgical team of this hospital. In the year 1971, Mac Arthur achieved a two-month survival after a lung transplantation and the influence of R. Abbey Smith during these years is remembered. In more recent years, Dr. Peter Goldstraw occupied the post of chest surgery consultant in Brompton and developed, among other techniques, surgery in bullous emphysema and prospective studies on bronchogenic carcinoma and lymph node staging in lung cancer.