Referral Criteria for Asthma: Consensus Document.

Asthma is one of the most prevalent chronic diseases in Spain. Current treatments ensure that the disease is controlled in most cases. However, disease is often uncontrolled in daily clinical practice, mainly owing to underdiagnosis, loss to follow-up, and poor adherence to therapy. In order to improve this situation, we must coordinate all those health professionals who intervene in patient care. Therefore, the Spanish Society of Allergology and Clinical Immunology (SEAIC), the Spanish Society of Primary Care Physicians (SEMERGEN), the Spanish Society of Family and Community Medicine (semFYC), the Spanish Society of General and Family Physicians (SEMG), and the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) have drawn up a consensus document in which they establish criteria for referral and guidelines for the diagnosis, control, and follow-up of patients with asthma. The document aims to facilitate continuing and improved care in this area.

[Chronic sclerosing mediastinitis: infrequent cause of unilateral diaphragmatic paralysis]. / Mediastinitis esclerosante crónica: una causa infrecuente de parálisis diafragmática unilateral.

Chronic sclerosing mediastinitis (CSM) is a rare disease whose etiology varies and which usually develops through mediastinal compression syndromes, generally due to occlusion of the superior vena cava. We report a case of CSM diagnosed after a chance finding of unilateral diaphragm paralysis, a circumstance not previously reported in the literature. We review the clinical, radiological and histological features of CSM.

[Primary ciliary dyskinesia. A new phenotypic variant]. / Discinesia ciliar primaria. Una nueva variante fenotípica.

Primary ciliary dyskinesia (PCD) is a genetic disorder characterized by the inability of ciliated structures to beat effectively. Clinical course includes recurrent sinus and ear infections, chronic or recurrent bronchitis and infertility in men. Although several phenotypes have been described, lung function deterioration secondary to bronchiectasis becomes severe only rarely. That upper airway tract infections go unnoticed has not been reported. We report a case of PCD characterized by immotile sperm, severe obstructive respiratory disorder that required a sequential double lung transplant with the absence of recurrent sinus and ear infections.

Discinesia ciliar primaria. Una nueva variante fenotípica / Primary ciliary dyskinesia: a new phenotype

La discinesia ciliar primaria (DCP) es un trastorno genético caracterizado por una incapacidad del batido ciliar, que cursa clínicamente con sinusitis y otitis de repetición, bronquitis crónica o recurrente e infertilidad en el varón. Aunque se han descrito diversas variantes fenotípicas, no es frecuente que el deterioro de la función pulmonar, secundario a la presencia de bronquiectasias, llegue a ser muy grave. Tampoco es conocido que las infecciones de las vías respiratorias altas pasen desapercibidas. Presentamos un caso de DCP caracterizado por inmotilidad espermática, grave trastorno ventilatorio obstructivo, que requirió un trasplante bipulmonar secuencial, y ausencia objetiva de sinusitis u otitis recurrentes (AU)

[Community-acquired pneumonia referred for hospital management. Its epidemiology and the diagnostic and therapeutic approaches]. / Neumonía adquirida en la comunidad remitida al medio hospitalario. Epidemiología y actitud diagnóstica y terapéutica.

OBJECTIVES: To determine the epidemiology of community-acquired pneumonia referred to the hospital and to characterize the diagnostic and therapeutic approach adopted by physicians. METHOD: Retrospective epidemiological and descriptive clinical study based on case histories consistent with a diagnosis of community-acquired pneumonia (Fang et al. Medicine, 1990; 69:307-16) of patients referred to hospitals in Soria (Spain) over a period of one year. The patients were grouped by severity and the presence of risk factors for unusual etiology. Initial approaches were compared to those advocated by various sources. RESULTS: Three hundred eight cases of community-acquired pneumonia were diagnosed, and 82% of the patients were admitted. Mean age was 68 +/- 26 years (43% over 80 years of age). Men accounted for 56%. Two hundred seventeen patients (70%) were classified as seriously ill, 203 (66%) had risk factors for unusual etiology, and 166 (54%) were classified in both categories. Mortality among admitted patients was 13%. Etiological diagnoses did not correspond to the guidelines of the Spanish Society of Pneumology and Chest Surgery (SEPAR), with microbial identification achieved in 5%. Empirical treatment followed SEPAR guidelines in 45% of the cases. The Mensa guidelines were followed in 23% and the Sanford guidelines in 20%. CONCLUSIONS: The incidence of community-acquired pneumonia in this population is 3.2 cases per 1,000 inhabitants/year. The population is mainly elderly and comorbidity is common, although mortality is low. We believe common criteria should be adopted for managing community-acquired pneumonia and that empirical treatment should be directed toward germs identified in each setting, based on appropriate etiological investigation.

[An analysis of the care for a tubercular patient. Problem detection]. / Análisis de la atención al paciente tuberculoso. Detección de problemas.

OBJECTIVE: Make a epidemiological and descriptive analysis of the tuberculosis patients care, researching problems which may be the etiology of the increase of illness. DESIGN: Descriptive observing retrospective study. SETTING: Soria County. PATIENTS: 186 cases with positive Mycobacterium tuberculosis culture, since January 1, 1983 until December 31, 1993. RESULTS: The 65.4% of patients were hospitalized to make the diagnostic and/or to begin treatment. We found delayed diagnostics much as 5.5 years. The mean was 120.9 +/- 244.7 days until the diagnostic was performed, 1991 y 1992 were the highest delayed time to diagnostic years of the study. The diagnostic and control of the 99.5% of patients was done at hospital. Only a 64% of patients could be considered as healthy at the onset of his control. CONCLUSIONS: Most of physicians consider the tuberculosis as a hospital illness, so there are delayed diagnostic and therapeutics and worse control of evolution, therapy compliance and contacts study.

[Active pulmonary tuberculosis in young patients: current radiological presentation forms]. / Tuberculosis pulmonar activa en el paciente joven: formas de presentación radiológica actual.

The clinical histories and thorax X-rays of 91 patients aged between 15 and 25 years who were admitted at the Hospital Royo Villanova, Zaragoza from 1983 to 1987 because of active pulmonary tuberculosis, were reviewed in order to study the radiological presentation of pulmonary tuberculosis in young patients and examine if there were any differences with other age groups. We highlight from the results: 1) The male/female ratio was 1.5/1.2) There were no differences in the radiological presentation between this group and older subjects, 3) The radiological localization of the lesions was the classical one, 4) The mean clinical evolution time before diagnosis was made, was of three months, 5) A longer evolution time was related to a greater lesion extension. We highlight that a prompt X-ray contributes to the early diagnosis of pulmonary tuberculosis in young patients avoiding delays in diagnosis and treatment.