Revista de Patologia Respiratoria最新文献

Background

Lung cancer is the second leading cause of mortality after cardiovascular diseases. Bronchogenic carcinoma has a fundamental underlying cause, that is, tobacco. The bronchoscopy is required for lung cancer diagnosis and staging and will help us to estimate prognosis and determine the therapeutic approach to follow. In this study, the yield of the various techniques of bronchoscopy in the diagnosis of lung cancer has been analyzed.

Methods

Previous comorbidity, smoking habit, the different bronchoscopic techniques the subject underwent and the patient's TNM stage at the time of diagnosis were analyzed in 181 patients who underwent bronchoscopy and whose final diagnosis was neoplasm. The performance of our techniques in relation to other studies in the literature was also evaluated.

Results

A total of 86.2% of patients had a history of smoking, 49.2%, diagnosis of Chronic obstruction pulmonary disease and 18.9% had had another previous malignancy. The endoscopic examination showed endobronchial lesion in 58% of patients. BAS was positive in 53.6% of procedures performed, bronchial biopsy 81.9%, transbronchial biopsy in 71.8% (in association with positive fluoroscopy in 81% and without fluoroscopy in 61% of cases) and positive transbronchial needle aspiration in 64.3% (with pathologist present the diagnostic yield amounted to 72.7%).

Conclusions

The yield of bronchoscopic techniques used in our environment is similar to that found in other major studies conducted to date.

Introduction

Castleman's disease (CD) is an uncommon lymphoproliferative disorder most frequently localized in the mediastinum and abdomen.

Two cases of CD with mediastinal localization in our service are described. The first case was found in a 33-year old woman with the plasma cell variant of CD associated to Hodgkin's disease and the second case was found in a 32 year old woman with hyalinevascular type CD.

Discussion

CD, of unknown etiology, is clinically distinguished with two forms, multicentric that affects more than one organ and occurs with general symptoms and can be accompanied by other involvements such as lymphoma. The second one is the localized one, which is more frequent and evolves asymptomatically or with compressive symptoms due to mass effect. In these cases presented, the difference in the clinical presentation of this condition in its two variants can be seen.

Conclusions

CD is an uncommon lymphoproliferative disease whose treatment is tumor resection and whose prognosis is good.

In previous works, we have analyzed the German and British contribution to general Thoracic Surgery and then we developed what had been occurring during the same time in the rest of Europe. We will examine the lack of a Professional Society suitable for the development of Thoracic Surgery, in spite of the existence of surgeons who had begun to develop novel techniques during these years. In the north of Europe, Thoracic Surgery had been initiated with Dr. Jacobeus of Stockholm. In the Netherlands, the first pneumonectomy was performed due to a picture of bronchiectasis in the year 1940. During that time, surgical treatment was performed in approximately 1200 patients suffering tuberculosis conditions with approximately 2% surgical mortality. The contribution in Belgium evolved favorably after the year 1930 and there was a subsequent separation of General and Digestive Surgery from Cardiac, Osteoarticular, Urology and Neurosurgery. In 1970, when extrafascial plombage with fat was begun, Dr. LeBrigand contributed new techniques for treatment of tuberculosis and in thoracic traumas and tracheal-bronchial lesions. Meanwhile, in Marcela, the first practices of bronchographies were conducted and works on experimental lung transplants were begun. The contribution of Iberia and of Italian Surgery were collected in Spain with names such as Dr. González Duarte or Gil Turner and the Italian participation was fundamentally begun between the years 1,900 and 1,976 with the performance of pulmonary and esophageal surgery, standing out, among others, Dr. Erino A Rendina. In Austria, they began with colapsotherapy, performing thoracoplasties, artificial pneumothorax and phrenicectomies. In Turkey and in Greece, the equinococosis was a serious health problem and many techniques were developed for its treatment. Similarly, distal esophageal fundoplications were performed and Antalaya School of Thoracic Surgery was developed. It has been difficult to gather data in regards to the said area of the Eastern Bloc. Until the Berlin Wall fell, the problem was to find reliable sources of information. It was in those countries in which pulmonary surgery was developed and in which esophageal surgical was assimilated. Thus, in the 1930's, the mediastinal approach through the abdomen was proposed and thoracic esophageal-gastric anastomeses were performed by Uglov. Finally, we point out that the School of St. Petersburg is considered as the representative of the surgery of the Russian Federation and in which important periods of development were begun, which have been included in our current bibliographic citations.

Hypersensitivity pneumonitis or extrinsic allergic alveolitis (EAA) originates from a hypersensitivity reaction to inhaled antigens on a lung with individual susceptibility. In the case of bird breeder's lung, they are particles that are generally found on the epithelium, dust that covers the feathers or stools of the birds.

In the physical examination, the inspiratory crackling rales heard on pulmonary auscultations stand out and the findings on the chest X-ray may vary greatly. The CT scan shows us different patterns based on the disease phase in question. Regarding the pulmonary function tests, most of the patients have a restrictive pattern.

Early diagnosis is crucial in the disease course since progression may lead to pulmonary fibrosis or chronic obstructive pulmonary disease.

The most important is to eliminate exposition to the antigens, with which many patients recover.

Intravesical administration of Bacille Calmette-Guérin (BCG) may cause local and systemic infectious complications. Systemic complications are rare but very serious. We report the case of a man with such treatment who began with fever what was initially attributed to a urological sepsis. After, hematogenous dissemination and pneumonitis were suspected, these being diagnosed by gallium-67 scintigraphy. In addition, Mycobacterium bovis was isolated in the urine.

Introduction

Cystic fibrosis (CF) has an increased of the survival due to the multidisciplinary advance. We have proposed to discover if the patients of the Unit of adults of CF know and fulfill their usual treatment, with the aim of seeing what level of knowledge they have their disease and its implications.

Material and methods

We have carried out a simple blind, cross-sectional descriptive study, with ordinal qualitative variable in an adult CF Unit who answered a questionnaire in which they were asked about the treatment of the disease and its administration, toxic habits, knowledge of their disease and concern about their present or future.

Results

The questionnaire was answered by 35 (40%) during the years 2000–2001, with a mean age of 31.43 ± 8.49 years. When asked about their knowledge of the disease, 94.3% (33 patients) considered they were informed about it and 91.4% (32 patients) said the information was adequate. What concerned them the most was the deterioration of their quality of life (14.3%-5 patients), concern about the future (11.4%-4 patients), the limitations in their daily life (8.6%-3 patients) and mortality or having recurrences (2.9%-1 patient). Four patients (11.4%) did not answer this question.

Conclusions

most of the patients who answered the survey knew about their disease, its treatment and were clear about their concerns for the future. However, less than half of all the patients answered, which indicates that more investigations are necessary to find the causes of this problem.

This article presents a decanulation protocol procedure for difficult to wean patients from the intensive care units in whom mechanical ventilation weaning has not been possible, and left this units needing invasive mechanical ventilation and tracheotomy. The appearance of the socalled Intermediate Respiratory Units allow pulmonologists, specialized in critical care medicine to treat these patients as those units deal with upper airway management, artificial invasive and non invasive mechanical ventilation and respiratory endoscopy. Our Pulmonology service include an intermediate respiratory unit and have wide experience in weaning patients from mechanical ventilation and subsequent decanulation. At present, no article in the literature globally explains the management of these patients. We present the protocol we follow in our unit with which we have obtained very favorable results in this type of patient.

Hypothesis

Among the causes of muscle dysfunction in COPD, mention has been made of decreased oxygen delivery during exercise. Saturation levels during the 6 minutes walking test could be associated to muscle mass and function.

Population, material and methods

A group of 75 males patients, 48 (68.6%) males with COPD in different GOLD stages and 28 (74%) with chronic bronchitis (CB) were studied. Tests performed were spirometry, body mass composition analysis, 6 minutes walking test (6MWT), recording of mean hemoglobin saturation and greater or less than 4%, quadriceps voluntary contraction strength test (QMVC). Work performed (Ww) was determined by the Chuang equation and muscle mass by the Janssen Equation.

Results

No statistical differences were found in age, body mass index (BMI), free fat mass index (FFMI), muscle mass index (MMI) and QMVC, 6MWT and Ww between the COPD and CB groups. Desaturation ≥ 4% was more frequent in the COPD group (p < 0.01) and was related with a limitation in the distance walked (p = 0.025). The mean SpO₂ after 6MWT of ≤ 89% differentiates the COPD from the CB population (p = 0.002). We found no relationship between the different levels of SpO₂ after the walk test and muscle mass parameters (MMI, FFMI).

There was a statistical difference between patients with a mean SpO₂ after the walk test ≤ 90% and the distance reached (p = 0.04). When the mean SpO₂ was ≤ 89%, there was a decrease in the WW (p = 0.032). When the mean SpO2 was ≤ 88% we found a decrease in the QMVC (p = 0.05).

Conclusions

After the 6MWT, SpO₂ is more frequent, this having no relationship with the GOLD stage and is only related with the distance reached. Mean SpO₂ after the 6MWT is more sensitive since it is related to performance parameters in the first place, then with muscle strength, and later with quadriceps contraction strength. We found no relationship between the desaturation parameters studied and the muscle mass measurements.