Empiema pleural recidivante por Staphylococcus aureus tratado con instilaciones de vancomicina a través de un catéter pleural tunelizado / Recidivant pleural empyema from staphylococcus aureus treated with instilations of vancomycin through an indwelling pleural catheter

Los catéteres pleurales tunelizados (indwelling pleural catheter, IPC) tienen su indicación principal en el alivio sintomático de derrames pleurales malignos. No obstante, han sido empleados también en el tratamiento sintomático de derrames pleurales benignos de diferentes etiologías. Presentamos un caso de un empiema pleural recidivante por Staphylococcus aureus en un paciente pluripatológico, que fue tratado con instilaciones intrapleurales de antibióticos a través de un IPC

Indwelling pleural catheter (IPC) is mainly indicated in the treatment of symptomatic and malignant pleural effusions. Nevertheless it have also been used in treatment of benign pleural effusions of different etiologies. We present a case of recidivant pleural empyema from Staphylococcus aureus in a pluripathologic patient, who was treated with intrapleural instilations of antibiotics through an IPC

Utility of transfer factor to detect different bronchodilator responses in patients with chronic obstructive pulmonary disease.

Previous studies have described that there are different types of disease in patients with established chronic obstructive pulmonary disease (COPD) with different clinical course and functional responses. The aim of this study was to evaluate if the presence of low transfer factor (LTF) values can predict the effectiveness of bronchodilator therapy, and to assess whether this group has different risk factors that may be related with the responses. Eighty patients with COPD were evaluated on three occasions. Initial assessment included a standard respiratory questionnaire, blood analysis, skin prick test and baseline lung function, all performed on the first visit. Bronchodilator response was evaluated after low (0.2 mg) and high (1 mg) doses of salbutamol, and after 2 weeks of oral prednisone. In patients with normal TLCO/VA % (NTF), a higher proportion of subjects with previous history of atopy was the only statistically significant difference compared to those with LTF (odds ratio 4.33; 95% confidence interval 1.06-25.15). Although the mean response in forced expiratory volume in 1 s (FEV1) to treatment was analogous in both groups, when bronchodilation was expressed as percent of predicted, there was a clear trend to a lower response in patients with LTF (0.2 mg salbutamol: 6.99 +/- 5.64 vs. 8.94 +/- 6. 61, p = 0.15; 1 mg salbutamol: 10.18 +/- 6.37 vs. 13.45 +/- 7.90, p < 0.05; oral prednisone: 5.51 +/- 6.94 vs. 8.74 +/- 10.81, p = 0.06). The percentage of patients who had >12% improvement from that predicted in FEV1 was also lower in this group (42 vs. 72%; p < 0. 05). Moreover, TLCO/VA% was significantly lower in those subjects with a negative bronchodilator trial with salbutamol (68 +/- 25 vs. 81 +/- 26; p < 0.05) and prednisone (69 +/- 26 vs. 90 +/- 22; p < 0. 01). In patients with LTF and NTF, airway responsiveness was only significantly related with basal airflow limitation (LTF, r = 0.44; NTF, r = 0.38). All other interaction terms were not statistically significant. These results indicate that in patiens with similar serverity of COPD, the presence of LTF indicates a decreased probability of a positive bronchodilator response, probably reflecting different pathological lesions. We suggest that transfer factor should be taken into consideration when bronchial response is evaluated in large clinical trials.

[Non-invasive assessment of a snorer with diurnal hypersomnia without features of sleep apnea]. / Valoración no invasiva de un paciente roncador con hipersomnia diurna sin criterios de síndrome de apnea del sueño.

We report a case of increased upper airway resistance diagnosed by impedance plethysmograph. This simple non invasive technique may provide an alternative to polysomnography administered with an esophageal tube, particularly to screen patients before ordering further studies.

Utility of complete dead space washout by real-time gas analysis in the measurement of transfer factor in patients with chronic airflow limitation.

Chronic obstructive pulmonary disease (COPD) is associated with impaired gas mixing and increased dead space, but little is known about the effect of improving alveolar gas sample by complete correction of dead space in an attempt to significantly improve the final result of transfer factor compared with standard guidelines of the European Respiratory Society (ERS) and American Thoracic Society (ATS). By using a rapid infrared analyzer, TLCO was measured by the single breath method in 152 COPD patients at different stages of severity (FEV1:57% predicted; CI 95%:24-91). Standard washout volume of 0.75 liter was insufficient to clear phases I and II in 36 patients (23.7%). In 19 subjects (12.5%), a washout volume larger than 1 liter was necessary for complete dead space clearance, although in these patients, correction visually adequate to complete clear phases I and II resulted in higher TLCO values. Only in 5 patients (3.3%) did the final result change by more than 5% from the previous value. A vital capacity higher than 3 liters, rather than the degree of airflow limitation was a better predictor for larger washout volume requirements. We conclude that in the measurement of TLCO by the breathholding method, ERS and ATS recommendations for washout volume can be safely used for clinical purposes in a wide range of patients with mild to severe obstruction.