ABSTRACT
INTRODUCTION: Silicosis is an irreversible and incurable disease. Preventive measures to eliminate exposure are the only effective way to reduce morbidity and mortality. In such situations, having a biomarker for early diagnosis or to predict evolution would be very useful in order to improve control of the disease. The elevation of serum angiotensin-converting enzyme (sACE) in silicosis has been described in previous studies, although its relationship with severity and prognosis is not clear. AIMS: To determine the levels of sACE in a cohort of patients with exposure to silica dust with and without silicosis, and to assess their impact on the prognosis of the aforementioned patients. METHOD: Prospective observational study on patients treated in a silicosis clinic from 2009 to 2018. sACE levels and pulmonary function tests were performed. Radiological progression was assessed in patients who had already had 2 X-rays of the thorax and / or two CT scans with at least a 1-year interval, from the time of inclusion in the study. RESULTS: A total of 413 cases of silicosis were confirmed, as well as 73 with exposure to silica dust but without silicosis. The mean sACE level for healthy subjects was 27.5±7.3U/L, for exposed patients without silicosis it was 49.6±24.2U/L, for simple silicosis it was 57.8±31,3U/L and for complicated silicosis it was 74.5±38.6U/L. Patients with a higher sACE generally progressed radiologically during follow-up (73.3±38.0 vs. 60.4±33.7; p<.001) and so the category of silicosis changed (73,9±38.1 vs. 62.5±34.6; p<.021). CONCLUSIONS: sACE was elevated in patients with silicosis, and the greater its severity, the higher it was, which is associated with disease progression measured radiologically or as a category change of silicosis.
ABSTRACT
La histiocitosis X es una enfermedad pulmonar intersticial poco común que afecta a adultos jóvenes y se asocia en un elevado número de casos con antecedente de tabaquismo. Se describen 4 casos de histiocitosis X, revisando las características clínicas, diagnósticas y terapéuticas de la enfermedad (AU)
Histiocytosis X is an uncommon pulmonary interstitial disease that affects young adults and is associated to an elevated number of cases with a background of smoking. Four cases of histiocytosis X are described, reviewing the clinical, diagnostic and therapeutic characteristics of the disease (AU)
Subject(s)
Humans , Male , Female , Child , Adult , Middle Aged , Histiocytosis, Langerhans-Cell/epidemiology , Lung Diseases, Interstitial/epidemiology , Radiography, Thoracic , Smoking/adverse effects , Tobacco Use Cessation , BronchoscopyABSTRACT
INTRODUCTION: Sleep disordered breathing and heart failure are common disorders that are frequently associated in the same patients which may bring on serious consequences. OBJECTIVE: To determine the prevalence of sleep apnea syndrome (SAS) in patients with controlled heart failure and the associated prevalence of arrhythmia. In addition, we to aim to evaluate the effectiveness of continuous positive airway pressure (CPAP) treatment for OSAS on left ventricular ejection fraction (EF). MATERIAL AND METHODS: We prospectively studied 60 patients (50 men, 10 women) with heart failure due to systolic dysfunction (left ventricular EF < 45%). All subjects were classified according the NYHA functional scale and received a specific questionnaire, as well as a home respiratory polygraphy and EKG Holter. A subject was considered to have SAS if their IAH > 15, and, according to standard recommendation, patients with IAH > 30 were treated with CPAP. After 3 months of treatment, the questionnaire, respiratory polygraphy and EKG Holter were repeated. RESULTS: Age was 69.3 +/- 10.4 years and the BMI was 28.5 +/- 4.74 kg/m2. Of the total sample, 55% (33 cases) were habitual snorers. The Epworth scale scores were 7.83 +/- 4.8. The EF was 36.3 +/- 7.4%, and 36 patients were NYHA class II, 23 were class III, and one patient was class IV. A total of 38 patients had SAS (63%): 14 (36%) had central sleep apnea and 24 (64%) had obstructive sleep apnea. EF revealed no significant differences between the SAS and non-SAS groups (36.42 +/- 7.6 vs. 35.81 +/- 6.6%, respectively). The SAS group presented a higher prevalence of bradicardia than the non-SAS group (24 % vs. 9%). After CPAP treatment, there was a significant improvement in EF (9%), in cases of obstructive sleep apnea, but no significant improvement was observed in patients with central sleep apnea. CONCLUSIONS: The prevalence of SAS in patients with heart failure due to systolic dysfunction is very high. CPAP treatment improved the EF in patients with obstructive sleep apnea.
Subject(s)
Continuous Positive Airway Pressure , Heart Failure/epidemiology , Sleep Apnea, Central/epidemiology , Sleep Apnea, Obstructive/epidemiology , Aged , Aged, 80 and over , Arrhythmias, Cardiac/epidemiology , Comorbidity , Electrocardiography, Ambulatory , Female , Heart Rate , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Sleep Apnea, Central/therapy , Sleep Apnea, Obstructive/therapy , Snoring , Stroke Volume , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Introducción: Los trastornos respiratorios durante el sueño (TRS) y la insuficiencia cardiaca (IC) son patologías muy comunes que con frecuencia se asocian en el mismo paciente con consecuencias que pueden ser graves. Objetivo: Conocer la prevalencia de síndrome de apnea del sueño (SAS) en pacientes con IC estable, arritmias asociadas, así como evaluar el efecto del tratamiento con presión positiva continua (CPAP) del SAS sobre la fracción de eyección de ventrículo izquierdo (FE). Material y métodos: Estudiamos de forma prospectiva a 60 pacientes (50 varones y 10 mujeres) con IC debida a disfunción sistólica (fracción de eyección del ventrículo izquierdo FE < 45%). A todos los pacientes se les realizó un cuestionario específico así como poligrafía respiratoria y un Holter en su domicilio. Se consideró la presencia de SAS cuando el IAH > 15 y aquellos con IAH > 30 fueron tratados con CPAP realizando los mismos estudios anteriores, poligrafía y Holter, a los 3 meses. Resultados: La edad fue de 69,3 ± 10,4 años y el índice de masa corporal (IMC) de 28,5 ± 4,74 kg/m 2. Un 55% (33 casos) eran roncadores habituarles y la puntuación en la escala Epworth era de 7,83 ± 4,8. La FE fue de 36,3 ± 7,4%, estando 36 enfermos en clase funcional II, 23 en clase funcional III y un enfermo en clase funcional IV. Un total de 38 pacientes tenían SAS (63%): 14 (36%) de tipo central y 24 (64%) de tipo obstructivo. La FE no mostró diferencias significativas entre el grupo SAS (36,4 ± 7,6) vs. (35,8 ± 6,6%) en el no-SAS. Los pacientes con SAS presentaron más frecuentemente bradicardia sinusal con respecto a los sujetos sin SAS (24% vs. 9%). Tras tratamiento con CPAP se observa una mejoría significativa de la FE de 9%, en los casos de SAS de predominio obstructivo, no observando cambios en los pacientes con SAS de predominio central. Conclusiones: La prevalencia de síndrome de apnea del sueño en pacientes con insuficiencia cardiaca y disfunción sistólica es muy alta. El tratamiento con CPAP mejora la fracción de eyección de los sujetos con SAS de carácter obstructivo
Introduction: Sleep disordered breathing and heart failure are common disorders that are frequently associated in the same patients which may bring on serious consequences. Objective: To determine the prevalence of sleep apnea syndrome (SAS) in patients with controlled heart failure and the associated prevalence of arrhythmia. In addition, we to aim to evaluate the effectiveness of continuous positive airway pressure (CPAP) treatment for OSAS on left ventricular ejection fraction (EF). Material and methods: We prospectively studied 60 patients (50 men,10 women) with heart failure due to systolic dysfunction (left ventricular EF < 45%). All subjects were classified according the NYHA functional scale and received a specific questionnaire, as well as a home respiratory polygraphy and EKG Holter. A subject was considered to have SAS if their IAH > 15, and, according to standard recommendation, patients with IAH > 30 were treated with CPAP. After 3 months of treatment, the questionnaire, respiratory polygraphy and EKG Holter were repeated. Results: Age was 69.3 ± 10.4 years and the BMI was 28.5 ± 4.74 kg/m2. Of the total sample, 55% (33 cases) were habitual snorers. The Epworth scale scores were 7.83 ± 4.8. The EF was 36.3 ± 7.4%, and 36 patients were NYHA class II, 23 were class III, and one patient was class IV. A total of 38 patients had SAS (63%): 14 (36%) had central sleepapnea and 24 (64%) had obstructive sleep apnea. EF revealed no significant differences between the SAS and non-SAS groups (36.42 ± 7.6 vs.35.81 ± 6.6%, respectively). The SAS group presented a higher prevalence of bradicardia than the non-SAS group (24 % vs. 9%). After CPAP treatment, there was a significant improvement in EF (9%), in cases ofobstructive sleep apnea, but no significant improvement was observed in patients with central sleep apnea. Conclusions: The prevalence of SAS in patients with heart failuredue to systolic dysfunction is very high. CPAP treatment improved the EF in patients with obstructive sleep apnea
Subject(s)
Humans , Male , Female , Middle Aged , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/diagnosis , Heart Failure/complications , Heart Failure/diagnosis , Respiration Disorders/complications , Surveys and Questionnaires , Cardiomyopathy, Dilated/complications , Dyspnea/complications , Sleep Apnea Syndromes/therapy , Sleep Apnea Syndromes/epidemiology , Prospective Studies , Body Mass Index , Cardiomyopathy, Dilated/etiology , Anthropometry/methodsSubject(s)
Hydropneumothorax/etiology , Intubation, Gastrointestinal/adverse effects , Humans , Male , Middle AgedABSTRACT
No disponible
Subject(s)
Lung Abscess/microbiology , Gram-Negative Bacterial Infections/complications , Aeromonas hydrophila/isolation & purification , Anti-Bacterial Agents/therapeutic use , Cefuroxime/therapeutic use , Lung Abscess/drug therapy , Lung Abscess , Tomography, X-Ray Computed , Gram-Negative Bacterial Infections/drug therapyABSTRACT
No disponible
Subject(s)
Male , Middle Aged , Humans , Intubation, Gastrointestinal/adverse effects , Hydropneumothorax/etiology , Hydropneumothorax/therapy , Radiography, ThoracicABSTRACT
OBJECTIVE: Acromegaly is often associated with sleep apnea-hypopnea syndrome (SAHS). The purpose of this study was to understand the prevalence of SAHS in patients with acromegaly and define the characteristics of acromegalic patients with and without SAHS. PATIENTS AND METHODS: The study enrolled 17 patients (11 women and 6 men) residing in the province of Ourense, Spain, who were diagnosed with acromegaly. All patients underwent overnight polysomnography in a sleep laboratory. In addition, growth hormone and insulin-like growth factor 1 levels were assessed. Sixteen of the patients underwent cephalometric study. RESULTS: The average age of the patients was 58 years (95% confidence interval [CI], 52-63). The average body mass index was 31 (95% CI, 29-34) and average neck circumference was 41 (95% CI, 39-43). Ten patients (58.8%) had an apnea-hypopnea index (AHI) greater than 10. Nine had obstructive apnea and one had central apnea. Seven (5 with an AHI>10 and 2 with an AHI<10) reported excessive daytime sleepiness with Epworth scores greater than 10 (41.2%). Five patients (29.4%) were diagnosed with SAHS (AHI>10 and Epworth>10). No correlation was found between an AHI greater than 10 and hormonal activity (P=.082). The mean growth hormone level for patients with an AHI greater than 10 was 4.8 (95% CI, 0.5-9) and the mean for those with an AHI less than 10 was 12 (95% CI, 2-27). Fifty percent of the patients were treated with a somatostatin analog and half of those treated exhibited apnea (P=.302). No cephalometric differences related to the presence of apneas were found. CONCLUSIONS: We found a high prevalence of sleep apneas (58.8%) and SAHS (29.4%), and central apneas were rare. We found no correlation between hormone activity level and the presence of SAHS. The incidence of SAHS was the same in somatostatin analog treated and untreated patients. Cephalometric variables did not distinguish between acromegalic patients with and without SAHS.
Subject(s)
Acromegaly/complications , Sleep Apnea Syndromes/complications , Cephalometry , Female , Humans , Male , Middle Aged , Sleep Apnea Syndromes/epidemiologyABSTRACT
No disponible
Subject(s)
Middle Aged , Adult , Male , Humans , Ribs , Osteosarcoma , Pneumothorax , Testicular Neoplasms , Muscle Neoplasms , Sarcoma, Small Cell , Neoplasms, Germ Cell and Embryonal , Pleural Neoplasms , Bone Neoplasms , Lung NeoplasmsSubject(s)
Cryptogenic Organizing Pneumonia/etiology , Lung/radiation effects , Radiotherapy/adverse effects , Breast Neoplasms/radiotherapy , Cobalt Radioisotopes/therapeutic use , Cryptogenic Organizing Pneumonia/diagnostic imaging , Female , Humans , Middle Aged , Radiography, Thoracic , Radiotherapy Dosage , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Lymphangioma, Cystic , Mediastinal Neoplasms , Radiography, Thoracic , Tomography, X-Ray Computed , Cryptogenic Organizing Pneumonia , Postoperative Period , Radiotherapy , Radiotherapy Dosage , Cobalt Radioisotopes , Magnetic Resonance Imaging , Mediastinum , Lung , Breast NeoplasmsABSTRACT
With the recent resurgence of tuberculosis (TB) in western countries, the incidence of complicating secondary pneumothorax has also increased. The work-up and management of this complication differs from that in other types of secondary spontaneous pneumothorax (SSP). Our objective was to assess clinical features and therapeutic modalities of SSP in patients with and without active pulmonary tuberculosis (APTB). All patients diagnosed with SSP seen at the Hospital Xeral of Vigo from January 1990 to June 1995 were candidates for this study. Full clinical, radiological and examinations were performed in all patients. Invasive procedures (thoracic catheter aspiration, thoracoscopy and thoracotomy) and mean hospital stay were compared in patients with and without APTB. Forty-eight patients with SSP were enrolled. Eleven patients (10 males and one female, mean age 30 +/- 11 years) had APTB; and 37 patients (31 males and six females, mean age 49 +/- 20 years) had conditions other than APTB. Chest pain, cough and fever were more frequent in patients with APTB (90% vs 59%; 45% vs 13.5%; 36% vs 5%, respectively). Catheter aspiration was successful in three of 10 (30%) of patients with APTB and in 15/23 (60.86%) of those without APTB. Catheter aspiration time was longer in the former group (25 +/- 22 days vs 13 +/- 11 days, P = 0.17). As initial treatment, thoracoscopy was performed in seven of 37 (18.91%) of those without APTB and in one of 10 (10%) patients with APTB. For patients with unsuccessful catheter aspiration, thoracoscopy was performed in eight of nine (89%) patients without APTB and in none of the patients with APTB. Thoracotomy was performed in only one of nine (11%) without APTB and in four of seven (57%) patients with APTB. Patients with APTB had a longer hospitalization (41 vs 18 days, P < 0.001). We concluded that SSP and APTB was a frequent association in our study. Patients with APTB showed a lesser and slower response to catheter aspiration. Despite severe clinical presentation and demand for more invasive procedures, patients with APTB showed a favourable response.
Subject(s)
Pneumothorax/etiology , Tuberculosis, Pulmonary/complications , Acute Disease , Adult , Female , Humans , Length of Stay , Male , Middle Aged , Pneumothorax/therapy , Retrospective Studies , Suction , Thoracoscopy , ThoracotomyABSTRACT
Clinical and analytic data of 64 patients with firm etiologic diagnosis of pleural effusion with adenosine deaminase (ADA) present, were analyzed retrospectively. The patients had entered our hospital over a 40-month period. ADA activity in pleural fluid was analyzed by the Blake and Berman kinetic method. Mean ADA activity of the total sample was 32 U/l (SD:23.9). In patients with tuberculous pleural effusion ADA activity was higher than in the remaining patients (47.7, SD:21.4, versus 15.5 SD: 13.2; p < 0.0001). In the group of patients with tuberculous pleuritis diagnosed by pleural biopsy (22 cases) the presence of necrotizing granulomas was associated with slightly higher ADA activity although the difference was not statistically significant (49.2 SD 10.1 versus 41.3 SD 8.9; p = 0.07). Among only patients with tuberculous pleuritis or neoplasia with lymphocytic exudate, a cut off point greater than 23 U for ADA predicted a diagnosis of tuberculous pleuritis with a sensitivity of 0.96, specificity of 1, positive predictive value of 1, negative predictive value of 0.94, and a confidence limit of 0.97. In conclusion, ADA activity greater than 23 U determined by the kinetic method in pleural fluid with signs of lymphocytic exudate is strongly suggestive of pleural tuberculosis based on our sample of patients with pleural effusion.
