Diferencias en calidad de vida relacionada con la salud entre pacientes en ventilación mecánica domiciliaria de distinto origen / Differences in health-related quality of life in patients receiving home mechanical ventilation of different origin

OBJETIVOS: Estudiar las diferencias en calidad de vida relacionada con la salud (CVRS) entre pacientes en programa de ventilación mecánica domiciliaria (VMD) por diversas causas empleando un nuevo cuestionario específico (SRI). MÉTODOS: Estudio observacional transversal multicéntrico en el que participaron 5 hospitales. Los pacientes incluidos fueron evaluados en una sola visita, en la que se administró el cuestionario SRI y se recogieron datos sociodemográficos y clínicos. Con estos datos se realizó una comparación entre los distintos grupos diagnósticos. RESULTADOS: Se incluyeron 115 pacientes: 33 toracógenos, 37 síndromes de hipoventilación-obesidad, 18 neuromusculares, 12 secuelas de tuberculosis y 15 enfermedad pulmonar obstructiva crónica. Edad: 62 ± 13 años; hombres: 53 (52,4%). La puntuación global de CVRS estaba disminuida de manera similar para todos los grupos diagnósticos. Sin embargo, aquellas patologías con un componente obstructivo obtuvieron puntuaciones diferentes en diversas escalas del cuestionario, mostrando un perfil distinto. Por otro lado, los pacientes neuromusculares tuvieron una puntuación peor en función física (26 ± 29 vs. 46 ± 25; p = 0,006) y requirieron mayor número de horas al día de ventilación que el resto de categorías diagnósticas (10,8 ± 5 vs. 8,2 ± 2,5 horas; p = 0,046). CONCLUSIONES: Aunque la CVRS está limitada de manera similar globalmente en pacientes con insuficiencia respiratoria crónica en programa de VMD, las diferencias existentes entre los distintos grupos diagnósticos permiten establecer perfiles distintos para pacientes con patología obstructiva, restrictiva o neuromuscular

OBJECTIVES: To study health-related quality of life (HRQL)of patients receiving home mechanical ventilation (HMV) for different causes using a new specific questionnaire (SRI).METHODS: Observational transversal multicentre trial in which 5 hospitals participated. Patients enrolled were scheduled for one only visit, where sociodemographic and clinical data were recorded, and the SRI questionnaire was administered. Comparison of the SRI results between diagnostic groups was performed. RESULTS: One hundred and fifteen patients (33 thoracic cage, 37 obesity hypoventilation syndromes, 18 neuromuscular, 12tuberculosis sequelae, and 15 chronic obstructive pulmonary disease) were included. Global HRQL evaluation was similar for all disease groups. However, patients with an obstructive component in the pulmonary function tests resulted to have a different punctuation in several scales of the questionnaire. Neuromuscular patients had a worse punctuation on PF scale (26 ± 29 vs. 46 ± 25; p = 0.006) and required HMV during more hours of the day than the other diagnostic categories (10.8 ± 5 hours vs.8.2 ± 2.5 hours; p = 0.046).CONCLUSIONS: Although SRI is similarly impaired inpatients receiving HMV, the differences found between the diagnostic groups set different profiles for patients with obstructive, restrictive o neuromuscular diseases (AU)

[Variability among pathologists in the histological diagnosis of diffuse interstitial lung diseases]. / Variabilidad entre patólogos en el diagnóstico histológico de las enfermedades intersticiales difusas del pulmón.

OBJECTIVE: Diffuse interstitial lung diseases (DILD) form a group of diseases which affect the alveolar interstitial space and share very similar clinical, radiological, and functional features, making lung biopsy essential for establishing diagnosis, prognosis, and treatment in many cases. We aimed to see whether there was agreement in histopathological diagnosis among different groups of pathologists in their assessment of these diseases. MATERIAL AND METHODS: Biopsies were studied from 33 patients suffering from noninfectious, nontumorous DILD. The biopsies had been assessed by 2 groups of pathologists: one specializing in this type of disease and another which was not a specialist group. RESULTS: There was disagreement in the histology reports of 10 out of the 33 cases studied (30.3%): 9 cases in the group of 22 cases of idiopathic interstitial pneumonia (40.9%) and 1 in the group of 3 DILD with known or associated causes. No discrepancies were found, however, in the diagnosis of primary DILD or DILD associated with other, less well-defined processes. CONCLUSIONS: We believe that idiopathic interstitial pneumonias are the DILD which pose most problems for pathologists. Therefore, the study of DILD requires specific dedication by pathologists and other professionals and specialists.

Variabilidad entre patólogos en el diagnóstico histológico de las enfermedades intersticiales difusas del pulmón / Variability among pathologists in the histological diagnosis of diffuse interstitial lung diseases

Objetivo: Las enfermedades pulmonares intersticiales difusas (EPID) son un conjunto de enfermedades que afecta al espacio alveolointersticial, con manifestaciones clínicas, radiológicas y funcionales muy similares, por lo que en muchos casos el estudio de la biopsia pulmonar será fundamental para el diagnóstico, pronóstico y tratamiento. Hemos querido ver si hay o no concordancia histopatológica diagnóstica, entre diferentes grupos de patólogos, en la valoración de estas enfermedades. Material y métodos: Se han estudiado las biopsias de 33 pacientes afectados de EPID no infecciosa ni tumoral, las cuales han sido valoradas por 2 grupos de patólogos: uno con especial interés por este tipo de enfermedades, y otro grupo no dedicado especialmente a esta enfermedad. Resultados: Al confrontar posteriormente los resultados, observamos en los informes histológicos una discordancia en el diagnóstico de 10 de los 33 casos estudiados (30,3%), 9 de ellos en el grupo de las 22 neumonías intersticiales idiopáticas (40,9%) y un caso en el grupo de las 3 EPID de causas conocidas o asociadas. Sin embargo, no encontramos ninguna discrepancia en el grupo de EPID primarias o asociadas a otros procesos no bien conocidos. Conclusiones: Creemos que las neumonías intersticiales idiopáticas son el grupo de EPID que más problemas de diagnóstico histológico pueden plantear al patólogo. Por tanto, es fundamental una especial dedicación por parte de estos profesionales y de los distintos especialistas que están relacionados con el estudio de las EPID

Objective: Diffuse interstitial lung diseases (DILD) form a group of diseases which affect the alveolar interstitial space and share very similar clinical, radiological, and functional features, making lung biopsy essential for establishing diagnosis, prognosis, and treatment in many cases. We aimed to see whether there was agreement in histopathological diagnosis among different groups of pathologists in their assessment of these diseases. Material and methods: Biopsies were studied from 33 patients suffering from noninfectious, nontumorous DILD. The biopsies had been assessed by 2 groups of pathologists: one specializing in this type of disease and another which was not a specialist group. Results: There was disagreement in the histology reports of 10 out of the 33 cases studied (30.3%): 9 cases in the group of 22 cases of idiopathic interstitial pneumonia (40.9%) and 1 in the group of 3 DILD with known or associated causes. No discrepancies were found, however, in the diagnosis of primary DILD or DILD associated with other, less well-defined processes. Conclusions: We believe that idiopathic interstitial pneumonias are the DILD which pose most problems for pathologists. Therefore, the study of DILD requires specific dedication by pathologists and other professionals and specialists

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.

BACKGROUND: An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome. METHODS: A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded. RESULTS: Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34 (15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class. CONCLUSIONS: Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.

Absceso de pulmón como manifestación de una neoplasia de esófago / Lung Abscess like manifestation of an esophagus neolasia

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[Disparity between cytohistopathological results of diagnostic specimens and the resected tumor piece in bronchopulmonary carcinoma]. / Disparidad entre los resultados citohistopatológicos de los especímenes diagnósticos y la pieza tumoral resecada en el carcinoma broncopulmonar.

In 88 patients diagnosed and intervened of lung carcinoma, we evaluate the security of the Diagnostic method--cytology: sputum, brushed bronchial, bronchial aspiration, puncture pulmonary aspiration and histology of the bronchial biopsy--when we correlate them with the histology of the dried up tumour. From the 88 patient, in 11 (12.5%) there was a disparity between some specimen and the piece tumour. If we analyze the specimen: the bronchial biopsy, was different in 3 cases, (4.8%); the brushed and the bronchial biopsy, aspiration in 2, (2.7% and 2.3% respectively); the puncture pulmonary aspiration in 6, (26%) and the cytology of sputum in 2 cases, (2.4%). In 8 patients (9%), the outputs of some specimen were not conclusive, if we remove these we find that: the bronchial biopsy was not conclusive in 2 cases, (3.2%), the brushed bronchial in 5, (6.8%); the bronchial aspiration in 9 (10.2%) and the cytology of sputum in 2 cases, (2.4%). With this data we could infer that sometimes the positive outputs of the specimen have no correlation with the histology of the tumour dried up. This disparity has not been observed in the oat-cells. Therefore when we send the specimens to the pathologist, it would always be advisable for him to inform us if there are any different cells belonging to the principal group of the tumor.