RESUMEN
El objetivo de este trabajo fue analizar el fenotipo celular en esputo de los pacientes con diagnóstico de EPOC clasificados según el diagrama A-D. Se reclutaron paciente ambos géneros, edad ≥ 60 años, ex fumadores de por lo menos 10 pack/año, con diagnóstico de EPOC en situación estable. Se los clasifico según GOLD 2011 en categorías clínicas A, B, C, D y se les analizó el patrón inflamatorio bronquial por medio de citología de esputo. Se estudiaron 85 pacientes con diagnóstico de EPOC distribuidos en categoría A (19), B (29), C (19) y D (18); la edad de estos últimos fue significativamente mayor que las del resto de los pacientes. El patrón predominante celular en esputo fue Eosinofílico (43), Neutrofílico (17), Mixto (9) y Paucigranulocítico (16). La distribución del patrón celular predominante en relación a cada grupo clínico de EPOC fue estadísticamente significativo p ≤ 0,001. El fenotipo celular Neutrofílico en el grupo A; eosinofílico y mixto en los grupos B y C y en el grupo D, aun presentes los eosinófilos predominó el patrón Neutrofílico. Concluimos que este estudio identificó patrones celulares inflamatorios que caracterizan cada grupo del diagrama A-D de la EPOC lo cual puede contribuir a explicar su carácter heterogéneo, personalizar el tratamiento y especialmente apunta a identificar tempranamente el paciente en riesgo de iniciar y perpetuar la enfermedad.
Asunto(s)
Terapéutica , Clasificación , Enfermedad Pulmonar Obstructiva CrónicaRESUMEN
The purpose of this study was to analyze sputum cellular phenotype in patients with a diagnosis of COPD classified according to the A-D chart. We included patients of both genders, aged ≥ 60 years, who were former smokers of at least 10 packets/year, with a diagnosis of COPD under stable conditions. They were classified according to the 2011 GOLD criteria into clinical categories A, B, C, D and their bronchial inflammatory pattern was analyzed using sputum cytology. Eighty-five patients with a diagnosis of COPD were divided into category A (19), B (29), C (19) and D (18); the age of the latter was significantly higher than the rest of the patients. The predominant cellular pattern in sputum was eosinophilic (43), neutrophilic (17), mixed (9) and paucigranulocytic (16). The distribution of the predominant cellular pattern in connection with each COPD clinical group was statistically significant p ≤ 0.001. The neutrophilic cellular phenotype was predominant in group A; the eosinophilic and mixed phenotypes in groups B and C, and in group D, even though eosinophils were present, the predominant pattern was neutrophilic. We concluded that this study identified inflammatory cellular patterns that distinguish each group in the COPD A-D chart, which can contribute to explain their heterogeneous nature, customize treatment and, most of all, identify patients at risk of disease onset and perpetuation at an early stage.
Asunto(s)
Terapéutica , Clasificación , Enfermedad Pulmonar Obstructiva CrónicaRESUMEN
Wegener's granulomatosis is a systemic necrotizing vasculitis that affects medium size and small vessels. Neurological involvement occurs in 22 percent to 54 percent of patients, mainly in the form of mononeuritis multiplex. Central nervous system involvement is reported in only 2 percent to 8 percent of the cases. We report a 42-year-old male who presented with headache, diplopia, third and sixth cranial nerve palsies and íeft eye amaurosis associated to mass located in the íeft Meckel cavum and diffuse meningeal involvement. A biopsy of the mass disclosed a chronic granulomatous necrotizing inflammation with Langhans giant cells. A chest CAT scan showed three cavitated lung nodules and ANCA antibodies were positive in a titer of 1:80. Treatment with steroid and cyclophosphamide was started and cranial nerve palsies resolved and the number and size of lung nodules decreased. The patient was lost from follow up.