[High resolution computerized tomography in pulmonary tuberculosis with negative sputum bacilloscopy]. / Tomografía computarizada de alta resolución en tuberculosis pulmonar con baciloscopia de esputo negativa.

CONTEXT: Pulmonary tuberculosis with negative sputum bacilloscopy involves diagnostic difficulties when there are not available liquid culture media due to the slow growth of Mycobacterium tuberculosis in the traditional culture media, and also due to the need for carrying out invasive examinations. OBJECTIVE: Evaluate the high resolution computerized tomography findings (HRCT) in patients with pulmonary tuberculosis and negative bacilloscopy of sputum. METHOD: Prospectively 28 patients (12 with active tuberculosis and 16 with inactive tuberculosis) were evaluated through HRCT, assessing the following findings: centrolobular nodules, multiple branched linear structures, macronodules, cavitation, consolidation, enlargement of interlobular septums, ground-glass change, bronchiectases, emphysema, broncovascular distortion, fibrotic changes, calcified mediastinal adenopathies, parenchymous calcification, pleural enlargement, and pleural effusion. RESULTS: The findings that were associated significantly to the active disease were: consolidation (67%), macronodules (67%) and centrolobular nodules (67%). The presence of centrolobular nodules and/or consolidation had a sensitivity of 83% and a specificity of 87%. The findings significantly associated to inactive disease were bronchiectases (87%) and broncovascular distortion (62%). CONCLUSION: Our results support the value of HRCT in patients with pulmonary tuberculosis and negative sputum bacilloscopy, since the finding of centrolobular nodules and/or consolidation has good sensitivity and specificity for the diagnosis of active pulmonary disease.

Tomografía computarizada de alta resolución en tuberculosis pulmonar con baciloscopia de esputo negativa / High resolution computerized tomography in pulmonary tuberculosis with negative sputum bacilloscopy

Marco de referencia. La tuberculosis pulmonar con baciloscopia de esputo negativa plantea dificultades diagnósticas cuando no se dispone de medios líquidos de cultivo debido al lento crecimiento del Mycobacterium tuberculosis en los medios tradicionales de cultivo y a la necesidad de utilizar exploraciones invasivas. Objetivo. Evaluar los hallazgos de la tomografía computarizada de alta resolución (HRCT) en pacientes con tuberculosis pulmonar y baciloscopia de esputo negativa. Método. Se estudiaron prospectivamente 28 pacientes (12 con tuberculosis activa y 16 inactiva) mediante HRCT, valorando los siguientes hallazgos: nódulos centrolobulillares, estructuras lineales ramificadas múltiples, macronódulos, cavitación, consolidación, engrosamiento de septos interlobulillares, vidrio esmerilado, bronquiectasias, enfisema, distorsión broncovascular, cambios fibróticos, adenopatías mediastínicas calcificadas, calcificación parenquimatosa, engrosamiento pleural y derrame pleural. Resultados. Los hallazgos que se asociaron significativamente a enfermedad activa fueron: consolidación (67 por ciento), macronódulos (67 por ciento) y nódulos centrolobulillares (67 por ciento). La presencia de nódulos centrolobulillares y/o consolidación tuvo una sensibilidad del 83 por ciento y especificidad del 87 por ciento. Los hallazgos que se asociaron significativamente a enfermedad inactiva fueron bronquiectasias (87 por ciento) y distorsión broncovascular (62 por ciento).Conclusión. Nuestros resultados apoyan el valor de la HRCT en pacientes con tuberculosis pulmonar y baciloscopia de esputo negativa, ya que el hallazgo de nódulos centrolobulillares y/o consolidación tiene una buena sensibilidad y especificidad para diagnosticar enfermedad pulmonar activa. (AU)

[Spontaneous pneumothorax and atmospheric pressure]. / Neumotórax espontáneo y presión atmosférica.

In order to assess factors associated with spontaneous pneumothorax (SP), mainly climatic changes, a prospective study was undertaken of 62 SP episodes among patients admitted to our hospital during a two-year period, from January 1994 to January 1996. Atmospheric pressure (AP) changes were analyzed, with daily recording of the number of unusual changes in AP (increases above 95th percentile and decreases below 5th percentile) and how many of these changes were followed by some episode of spontaneous pneumothorax during the following five days. To measure the degree of this association between the emergence of pneumothorax and exposure to unusual changes I AP, the relative risk (RR) was calculated. A total of 77 unusual AP changes were observed, 17 of which concurred with the emergence of 8 episodes of SP during the following five days, with a RR of 2.7 (1.6-4.4). Although the etiology of SP is unknown and probably of multifactorial origin, these data suggest that unusual changes in AP may play a relevant role in triggering this condition.

Neumotórax espontáneo y presión atmosférica / Spontaneous pneumothorax and atmospheric pressure

Con el fin de valorar los factores asociados al neumotórax espontáneo (NE), fundamentalmente climáticos, se realizó un estudio prospectivo de 62 episodios de NE ingresados en nuestro hospital durante un período de 2 años, desde enero de 1994 a enero de 1996. Para ello se analizaron las variaciones de la presión atmosférica (PA), determinándose diariamente el número de cambios no usuales de la PA (aumentos por encima del percentil 95 y caídas por debajo del percentil 5) y cuántos de estos cambios fueron seguidos de algún episodio de neumotórax en los 5 días siguientes. Para medir la fuerza de asociación entre la aparición del neumotórax y la exposición a cambios no usuales de la PA se calculó el riesgo relativo (RR). Se observaron 77 cambios no usuales de PA y 17 de ellos coincidieron con la aparición de 8 episodios de NE en los 5 días siguientes, obteniéndose un RR de 2,7 (1,6-4,4). Estos datos sugieren que aunque la etiología del NE es desconocida y, probablemente multifactorial, los cambios no usuales de la PA pueden desempeñar un papel importante en el desencadenamiento del mismo (AU)

[Miliary, ganglionar, pancreatic and costal tuberculosis. Clinical presentation and literature review]. / Tuberculosis miliar, ganglionar, pancreática y costal. Presentación clínica y revisión bibliográfica.

A 42-year-old man was admitted to the hospital with fever, abdominal pain and miliary radiological pattern. The amylase and lipase in serum, and the amylase in urine were increased. The tuberculin skin test was negative. The thoracic and abdominal CT scan showed costal affectation, multiple focal hepatic lesions and large necrosing peripancreatic lymphadenopathies. The transbronchial biopsy and the pancreatic punction demonstrated granulomatous necrotic lesions, and M. tuberculosis grew in the bronchial washing culture. The specific treatment normalized the pulmonary, costal and pancreatic lesions.

[Relationship between dyspnea and quality of life with body mass index and pulmonary function in patients with chronic obstructive airways disease and emphysema]. / Relación de la disnea y la calidad de vida con el índice de masa corporal y la función pulmonar en pacientes con enfermedad pulmonar obstructiva crónica tipo enfisema.

BACKGROUND: We aimed to evaluate the differences in pulmonary function, quality of life (CVRS) and dyspnea in patients with chronic obstructive pulmonary disese (COPD) and emphysema according to the body mass index (BMI). Moreover, we analyzed the relation between BMI, pulmonary function, CVRS and dyspnea. PATIENTS AND METHOD: This was a prospective, 12-months study including 20 patients with COPD and emphysema. They were classified in group A (BMI < 21 kg/m(2) group B (BMI >= 21 kg/m(2)). We performed pulmonary function tests and determined the levels of dyspnea and CVRS according to a scale of dyspnea and a CVRS questionnaire. RESULTS: Seven patients had a BMI < 21 kg/m(2) and it was >=21 kg/m(2) in 13 patients. DLCO in group A patients was lower than in group B. After a multiple regression analysis, the FVC accounted for 52% of dyspnea variability. Both PEM and dyspnea were the parameters that better predicted the CVRS. CONCLUSIONS: Patients with COPD and emphysema with a VMI < 21 kg/m(2) have a lower DLCO than patients with a BMI >= 21 kg/m(2). In our patients, dyspnea sensation depended on the FVC. In addition,the CVRS depended on dyspnea sensation and PEM.

Tuberculosis miliar, ganglionar, pancreática y costal. Presentación clínica y revisión bibliográfica / Miliary, ganglionar, pancreatic and costal tuberculosis. clinical presentation and bibliographic review

Se presenta un paciente de 42 años que ingresa en nuestro hospital con fiebre, dolor abdominal y patrón radiológico miliar. Tenía un aumento de amilasemia y amilasuria y de la lipasa sérica. El mantoux era negativo. En el estudio de TAC había engrosamiento costal, lesiones hepáticas focales múltiples y adenopatías necrosadas en zona peripancreática.Las biopsias transbronquiales y la punción pancreática mostraron lesiones granulomatosas necrotizantes, cultivándose M. tuberculosis complex en el broncoaspirado. El tratamiento específico normalizó todas las alteraciones pulmonares, costales y pancreáticas (AU)

[Acute lung injury as initial manifestation of diffuse alveolar hemorrhage]. / Daño pulmonar agudo como manifestación inicial de hemorragia alveolar difusa.

OBJECTIVE: To determine clinical features and outcome in hospitalized patients with acute lung injury secondary to diffuse pulmonary hemorrhage (DPH). PATIENTS AND METHOD: Eight adult patients suffering DPH and acute lung injury were undergone to diagnosis procedure and following. RESULTS: Two cases of idiopathic pulmonary hemosiderosis, two cases of systemic lupus erythematous, two cases of Goodpasture's syndrome, one case of idiopathic rapidly progressive glomerulonephritis and one of periarteritis nodosa were diagnosed. Treatment was methylprednisolone in all cases; besides, three cases required ventilatory support, and one immunosuppressive therapy, plasmapheresis and hemodialysis. One patient died and three of them suffered relapse with satisfactory outcome. CONCLUSION: We remark the presence of acute lung injury as an initial feature of DPH in our experience and the importance of a prompt diagnosis of the underlying disease.

Daño pulmonar agudo como manifestación inicial de hemorragia alveolar difusa / Acute lung injury as an initial feature of diffuse pulmonary hemorrhage

Objetivo: determinar los hallazgos clínicos y la evolución de pacientes hospitalizados por insuficiencia respiratoria aguda secundaria a hemorragia alveolar difusa (HAD). Pacientes y Método: Ocho adultos afectos de HAD y daño pulmonar agudo, sometidos a protocolo diagnóstico y seguimiento evolutivo. Resultados: Se diagnosticaron 2 casos de hemosiderosis pulmonar primaria (HPP), 2 lupus eritematoso sistémico (LES), 2 síndrome de Goodpasture (GP), un caso de glomerulonefritis rápidamente progresiva idiopática (GNRP) y una panarteritis nodosa microscópica (PAN). Todos los pacientes se trataron con metilprednisolona; además 3 de ellos necesitaron ventilación mecánica (VM) y uno inmunosupresores (IS), plasmaféresis (PF) y hemodiálisis (HD). Un paciente falleció y tres, a pesar de recidivar la HAD, evolucionaron favorablemente. Conclusión: Destacamos la presencia de daño pulmonar agudo como síntoma de inicio de HAD y la importancia de un diagnóstico rápido de la enfermedad subyacente (AU)

[A pulmonary cellular immunity study in HIV patients]. / Estudio de la inmunidad celular pulmonar en pacientes VIH.

BACKGROUND: Cellular immunity disorder, showed by a decreased blood level of lymphocytes T CD4, is the main indicator of progression in HIV infection. The diminished level of these lymphocytes and CD4/CD8 ratio in pulmonary samples obtained by bronchoalveolar lavage (BAL) is known, so as the enhanced level of lymphocytes T CD8, while the pulmonary diseases high incidence in these patients could be due to a local immunity disorder or systemic one remains unknown. The aim of this study is to compare systemic immunity disorders, studied in blood samples, with local immunity replay, showed by BAL samples, in patients with HIV infection. METHODS: 74 HIV patients were studied, all of them hospitalized due to acute respiratory disease, and undergone to fiberoptic bronchoscopy for diagnosing. Cellular and lymphocytic populations are compared and measured by flow cytometry in blood and BAL samples. RESULTS: Percentage of total lymphocytes and CD4+ population were decreased in BAL samples, above all in patients with CD4 level minor than 25%. CONCLUSIONS: Cellular immunity disorder of patients with HIV infection is bigger in lung than in blood. It's possible to foresee the lymphocytes T CD4+ pulmonary depletion from their blood levels.

Estudio de la inmunidad celular pulmonar en pacientes VIH / Study of the pulmonary celular immunity in HIV-infected patients

Fundamento: La alteración de la inmunidad celular, manifestada por disminución de los niveles sanguíneos de linfocitos T CD4, es el principal indicador de progresión de la infección por VIH. Se conoce la disminución de estos linfocitos y del cociente CD4/CD8 en muestras pulmonares obtenidas mediante lavado broncoalveolar (LBA), y el aumento de los CD8. Pero se ignora si la alta incidencia de enfermedades del aparato respiratorio se debe a alteraciones inmunitarias locales o sistémicas. El objetivo de este trabajo es comparar estas alteraciones estudiando muestras de sangre periférica y de LBA de estos pacientes. Métodos: Estudiamos 74 pacientes VIH hospitalizados por enfermedad respiratoria aguda y sometidos, con fines diagnósticos, a fibrobroncoscopia y LBA. Se compara las poblaciones linfocitarias analizadas mediante citometría de flujo en sangre y LBA. Resultados: El porcentaje de linfocitos totales y de CD4 fueron menores en LBA, sobre todo en los pacientes que tenían cifras de CD4 sanguíneas inferiores al 25 %. Conclusiones: La alteración de la inmunidad celular de estos pacientes es más manifiesta a nivel local pulmonar. Es posible prever la deplección pulmonar de linfocitos T CD4 a partir de sus valores sanguíneos (AU)

Severe pulmonary hypertension: a feature of Swyer-James syndrome?

Swyer-James syndrome, unilateral hyperlucent lung with air entrapment, generally occurs after severe infections during childhood. It is usually diagnosed by its characteristic chest radiographic image film or computed tomography, in patients who are almost asymptomatic. We report a case of Swyer-James syndrome, diagnosed from the study of severe pulmonary hypertension and with a fatal outcome.

[Can we improve the prevention of tuberculosis? Analysis of the application of chemoprophylaxis]. / Podemos mejorar la prevención de la tuberculosis? Análisis de la aplicación de la quimioprofilaxis.

To analyze the situations that make chemoprophylaxis for tuberculosis difficult. One hundred twenty-eight patients consecutive (106 HIV negative and 22 HIV positive) diagnosed of tuberculosis (TB) were studied. The patients were interviewed and a questionnaire was filled out in order to identify risk groups and determine what steps had been taken to prevent TB. In the HIV negative group, 63 (57.8%) had at least one risk factor. The most common were contact with persons with active TB (31.1%), former TB (15.1%), rapid weight loss or chronic malnutrition (13.2%) and residence in closed institutions (5.6%). Of the 51 (48.1%) for whom evaluation of chemoprophylaxis was indicated, 43 (84.3%) had been examined by a physician within the past five years; only 10 (23.3%) of them, however, had been checked for TB and isoniazide had been prescribed for only 4 (9.3%). In the HIV positive group, 13 (72.2%) of those for whom evaluation of chemoprophylaxis was indicated had been seen by a physician; 12 (97.7%) of them were given tuberculin tests checked for TB and isoniazide was prescribed for 4 (30.7%). None of the patients in either group who were prescribed a full course of prophylaxis actually took the drug enough. Most HIV negative patients for whom evaluation of chemoprophylaxis was indicated had been examined by a physician in the five years before disease was detected; less than a quarter of them were checked for TB, however. This situation is probably a consequence of the structure of health care in Spain as it affects TB control. Nearly all the HIV positive patients were checked for the disease, as they benefited from protocolized health care.

[Bronchioloalveolar carcinoma in a young woman]. / Carcinoma bronquioloalveolar en mujer joven.

Bronchioloalveolar carcinoma is an infrequent malignant lung tumor, specially in patients younger than 50. Diagnosis is difficult and usually late, because its clinical and radiologic features are similar to other lung diseases and because its poor histopathologic differentiation from other primitive o metastatic adenocarcinoma. We report a case of multinodular, diffuse and bilateral bronchioloalveolar carcinoma in a young woman without previous lung disease which suspected diagnosis was by broncho-aspirated cytology and open lung biopsy was necessary for its confirmation.