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1.
Radiología (Madr., Ed. impr.) ; 57(6): 455-470, nov.-dic. 2015. ilus, tab
Article in Spanish | IBECS | ID: ibc-144985

ABSTRACT

La patología pulmonar en la historia de un paciente con neoplasia hematológica es muy frecuente y variable en función de la enfermedad de base y la terapia recibida. La morbimortalidad asociada es alta, por lo que requiere un tratamiento correcto y precoz. La tomografía computarizada (TC) torácica, junto con el análisis de muestras biológicas, son las herramientas de diagnóstico de primera línea empleadas en estos pacientes, y en determinados casos se requieren métodos invasivos. La interpretación de las imágenes exige el análisis de un contexto clínico en muchas ocasiones complejo. Partiendo del conocimiento que adquiere el radiólogo en su formación sobre el diagnóstico diferencial de los hallazgos pulmonares, el objetivo de este trabajo es explicar los aspectos clínicos y radiológicos claves que permiten orientar correctamente el diagnóstico y asimilar el papel actual de la TC en la estrategia terapéutica de este grupo de enfermos (AU)


Lung disease is very common in patients with hematologic neoplasms and varies in function of the underlying disease and its treatment. Lung involvement is associated with high morbidity and mortality, so it requires early appropriate treatment. Chest computed tomography (CT) and the analysis of biologic specimens are the first line diagnostic tools in these patients, and sometimes invasive methods are necessary. Interpreting the images requires an analysis of the clinical context, which is often complex. Starting from the knowledge about the differential diagnosis of lung findings that radiologists acquire during training, this article aims to explain the key clinical and radiological aspects that make it possible to orient the diagnosis correctly and to understand the current role of CT in the treatment strategy for this group of patients (AU)


Subject(s)
Female , Humans , Male , Hematologic Neoplasms , Tomography, Emission-Computed/instrumentation , Tomography, Emission-Computed/methods , Tomography, Emission-Computed , Multidetector Computed Tomography/instrumentation , Multidetector Computed Tomography/methods , Multidetector Computed Tomography , Thorax , Lung Diseases/complications , Lung Diseases/pathology , Lung Diseases , Multidetector Computed Tomography/standards , Multidetector Computed Tomography/trends , Neutropenia
2.
Radiologia ; 57(6): 455-70, 2015.
Article in English, Spanish | MEDLINE | ID: mdl-26315258

ABSTRACT

Lung disease is very common in patients with hematologic neoplasms and varies in function of the underlying disease and its treatment. Lung involvement is associated with high morbidity and mortality, so it requires early appropriate treatment. Chest computed tomography (CT) and the analysis of biologic specimens are the first line diagnostic tools in these patients, and sometimes invasive methods are necessary. Interpreting the images requires an analysis of the clinical context, which is often complex. Starting from the knowledge about the differential diagnosis of lung findings that radiologists acquire during training, this article aims to explain the key clinical and radiological aspects that make it possible to orient the diagnosis correctly and to understand the current role of CT in the treatment strategy for this group of patients.


Subject(s)
Hematologic Neoplasms/diagnostic imaging , Lung/diagnostic imaging , Tomography, X-Ray Computed , Humans
3.
Med Intensiva ; 32(6): 277-81, 2008.
Article in Spanish | MEDLINE | ID: mdl-18601835

ABSTRACT

BACKGROUND: Arterial oxygen saturation (SaO2) diminishes with altitude. AIM: To know the values of SaO2 in healthy mountaineers during the ascent of a mountain higher than 8,000 metres. METHOD: On occasion of an expedition to Gasher brum II (8,035 m), SaO2 at rest was measured by pulse oxymetry during the approach march, in the base camp (on day one and one month later), in camps II and III, during the assault at 7,500 m and on the summit. RESULTS: During the approach march, the SaO2 in Paiju (3,365 m) was 92.9 +/- 1.4% and in Gore II (4,250 m) 85.0 +/- 4.3%. In the base camp (5,200 m) it was 78.4 +/- 9.5% on the first day and 87.4 +/- 3.0% one month later (p < 0.007). In camp II (6,500 m) it was 72.7 +/- 6.7%. In camp III (7,000 m) it was 68.0 +/- 9.3% (recorded on 21 asymptomatic climbers). At this altitude a SaO2 of 40% was recorded during sleep in an asymptomatic subject, apparently without apnoeic crises. During the assault at 7,500 m, SaO2 was 60.5 +/- 13.5% (measured on 4 climbers). On the summit (8,035 m) the SaO2 of two subjects was 84% and 88%, respectively. CONCLUSION: During expeditions to mountains higher than 8,000 metres, mountaineers have extremely low values of SaO2, similar to those of patients with severe respiratory failure. SaO2 increases progressively with acclimatization. SaO2 on the summit could have been relatively high, probably because of hyperventilation.


Subject(s)
Altitude , Mountaineering , Oxygen/blood , Adult , Age Factors , Female , Humans , Male , Mountaineering/physiology , Oximetry , Sex Factors , Time Factors
4.
Med. intensiva (Madr., Ed. impr.) ; 32(6): 277-281, ago. 2008. tab
Article in Es | IBECS | ID: ibc-66970

ABSTRACT

Fundamento. La saturación arterial de oxígeno (SaO2) disminuye con la altitud.Objetivo. Conocer qué SaO2 presentan los montañeros sanos durante la ascensión a una montaña de más de 8.000 metros.Método. En una expedición al Gasherbrum II (8.035 m) se midió la SaO2 por pulsioximetría durante la marcha de aproximación, en el campamento base (a la llegada y un mes después), en los campamentos II y III, a 7.500 m durante el ataque y en la cumbre.Resultados. En la marcha de aproximación la SaO2 en Paiyu (3.365 m) fue del 92,9 ± 1,4% y en Gore II (4.250 m) del 85,0 ± 4,3%. En el campamento base (5.200 m) a la llegada fue del 78,4 ± 9,5% y un mes después del 87,4 ± 3,0% (p < 0,007). En el campamento II (6.500 m) fue del 72,7 ± 6,7%. En el campamento III (7.000 m) fue del 68,0 ± 9,3% (medida sobre 21 sujetos). A esta altitud se registró una SaO2 del 40% durante el sueño en unsujeto asintomático. A 7.500 m fue del 60,5 ± 13,5% (4 sujetos). En la cumbre (8.035 m) la SaO2 de dos sujetos fue del 84 y 88% respectivamente.Conclusión. Durante las expediciones a montañasde más de 8.000 m los montañeros presentan cifras de SaO2 muy bajas, comparables a las de los pacientes con insuficiencia respiratoria grave. La SaO2 aumenta progresivamente con la aclimatación. Es posible que la SaO2 en la cima del Gasherbrum II fuera relativamente alta, probablemente a consecuencia de la hiperventilación


Background. Arterial oxygen saturation (SaO2) diminishes with altitude.Aim. To know the values of SaO2 in healthy mountaineers during the ascent of a mountain higher than 8,000 metres.Method. On occasion of an expedition to Gasherbrum II (8,035 m), SaO2 at rest was measured by pulse oxymetry during the approach march, in the base camp (on day one and one month later), in camps II and III, during the assault at 7,500 m and on the summit.Results. During the approach march, the SaO2 in Paiju (3,365 m) was 92.9 ± 1.4% and in Gore II (4,250 m) 85.0 ± 4.3%. In the base camp (5,200 m) it was 78.4 ± 9.5% on the first day and 87.4 ± 3.0% one month later (p < 0.007). In camp II (6,500 m) it was 72.7 ± 6.7%. In camp III (7,000 m) it was 68.0 ± 9.3% (recorded on 21 asymptomatic climbers). At this altitude a SaO2 of 40% was recorded during sleep in an asymptomatic subject, apparently without apnoeic crises. During the assault at7,500 m, SaO2 was 60.5 ± 13.5% (measured on 4 climbers). On the summit (8,035 m) the SaO2 of two subjects was 84% and 88%, respectively.Conclusion. During expeditions to mountainshigher than 8,000 metres, mountaineers have extremely low values of SaO2, similar to those of patientswith severe respiratory failure. SaO2 increasesprogressively with acclimatization. SaO2 on the summit could have been relatively high, probably because of hyperventilation


Subject(s)
Humans , Male , Female , Adult , Hypoxia/physiopathology , Altitude Sickness/physiopathology , Oxygen Consumption/physiology , Mountaineering/physiology , Reference Values , Oximetry/methods
5.
Arch Bronconeumol ; 41(10): 547-52, 2005 Oct.
Article in Spanish | MEDLINE | ID: mdl-16266667

ABSTRACT

OBJECTIVE: To ascertain whether climbing a mountain over 3000 meters high produces any alterations in ventilation, whether such alterations are modified by acclimatization, and whether they correlate with changes in arterial oxygen saturation (SaO2) or the development of acute mountain sickness (AMS). SUBJECTS AND METHODS: The following parameters were measured in 8 unacclimatized mountaineers who climbed Aneto (3404 m) and spent 3 days at the summit: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), airway response to inhaled terbutaline, SaO2, and the symptoms of AMS. RESULTS: At the summit, mean (SD) FEV1 declined by 12.3% (5.7%) and mean FVC by 7.6% (6.7%) while the ratio of FEV1 to FVC remained normal. The means for both parameters were higher on the following day. No airway response to bronchodilator treatment was observed. The restriction disappeared entirely on descent. At the peak, SaO2 increased progressively as the climbers became acclimatized. During the ascent, FEV1 correlated with SaO2 (r=0.79). One participant who suffered from AMS had a ratio of FEV1 to FVC less than 70% and the worst SaO2 during the 3 days on the summit. Obstruction preceded the AMS symptoms, did not respond to bronchodilator treatment, and disappeared when the climber descended. CONCLUSIONS: The mountaineers who climbed over 3000 meters presented restriction that correlated with hypoxemia. This restriction did not respond to bronchodilator treatment, improved with acclimatization, and disappeared on descent. One person with AMS presented obstruction that did not respond to terbutaline and disappeared on descent.


Subject(s)
Altitude Sickness/etiology , Altitude , Forced Expiratory Volume , Mountaineering/physiology , Oxygen/blood , Vital Capacity , Adult , Female , Humans , Male , Spirometry
6.
Arch. bronconeumol. (Ed. impr.) ; 41(10): 547-552, oct. 2005. ilus, tab
Article in Es | IBECS | ID: ibc-042763

ABSTRACT

Objetivo: Averiguar si en la ascensión a una montaña de más de 3.000 m se produce alguna alteración ventilatoria, si ésta se modifica por la aclimatación y si se relaciona con los cambios en la saturación arterial de oxígeno (SaO2) o con la aparición de síntomas de mal de montaña agudo (MAM). Sujetos y métodos: En 8 montañeros no aclimatados que ascendieron a la cumbre del Aneto (3.404 m) y permanecieron 3 días en ella medimos: la capacidad vital forzada (FVC), el volumen espiratorio forzado en el primer segundo (FEV1), la respuesta a la inhalación de terbutalina, la SaO2 y los síntomas de MAM. Resultados: Al llegar a la cumbre disminuyeron el FEV1 (12,3 ± 5,7%) y la FVC (7,6 ± 6,7%) con la relación FEV1/FVC% normal. Al día siguiente aumentaron ambos parámetros. No hubo respuesta al tratamiento broncodilatador. La restricción se corrigió totalmente al descender. La SaO2 en la cumbre aumentó progresivamente con la aclimatación. Durante la ascensión el FEV1 se correlacionó con la SaO2 (r = 0,79). Un participante con MAM presentó FEV1/FVC menor del 70% y la peor SaO2 durante la estancia en la cima. Esta obstrucción precedió a los síntomas, no cedió con tratamiento broncodilatador y se corrigió con el descenso. Conclusiones: Los montañeros que ascienden a montañas de más de 3.000 m presentan una restricción que se correlaciona con la hipoxemia, no mejora con el tratamiento broncodilatador, se alivia con la aclimatación y desaparece con el descenso. Un sujeto con MAM sufrió una obstrucción que no respondió a la terbutalina y desapareció con el descenso


Objective: To ascertain whether climbing a mountain over 3000 meters high produces any alterations in ventilation, whether such alterations are modified by acclimatization, and whether they correlate with changes in arterial oxygen saturation (SaO2) or the development of acute mountain sickness (AMS). Subjects and methods: The following parameters were measured in 8 unacclimatized mountaineers who climbed Aneto (3404 m) and spent 3 days at the summit: forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), airway response to inhaled terbutaline, SaO2, and the symptoms of AMS. Results: At the summit, mean (SD) FEV1 declined by 12.3% (5.7%) and mean FVC by 7.6% (6.7%) while the ratio of FEV1 to FVC remained normal. The means for both parameters were higher on the following day. No airway response to bronchodilator treatment was observed. The restriction disappeared entirely on descent. At the peak, SaO2 increased progressively as the climbers became acclimatized. During the ascent, FEV1 correlated with SaO2 (r=0.79). One participant who suffered from AMS had a ratio of FEV1 to FVC less than 70% and the worst SaO2 during the 3 days on the summit. Obstruction preceded the AMS symptoms, did not respond to bronchodilator treatment, and disappeared when the climber descended. Conclusions: The mountaineers who climbed over 3000 meters presented restriction that correlated with hypoxemia. This restriction did not respond to bronchodilator treatment, improved with acclimatization, and disappeared on descent. One person with AMS presented obstruction that did not respond to terbutaline and disappeared on descent


Subject(s)
Male , Female , Adult , Humans , Altitude , Altitude Sickness/etiology , Forced Expiratory Volume , Mountaineering/physiology , Oxygen/blood , Vital Capacity , Spirometry
7.
An Med Interna ; 20(12): 627-9, 2003 Dec.
Article in Spanish | MEDLINE | ID: mdl-14697084

ABSTRACT

A woman, thyroidectomised because of a thyroid papillary carcinoma, interrupted temporarily her levothyroxine intake in order to be subjected to an extension study five weeks later. To minimise her symptoms for the first three weeks, a treatment was prescribed consisting of one 25 micro g-capsule of triiodothyronine every 8 hours. Nine days later she complained of abdominal pain, nausea, vomiting, fever of 40 degrees C and chest discomfort. A serum total triiodothyronine of 575.2 nmol/l was measured by chemoluminiscent immunoassay eleven hours after the intake of the latest capsule (normal level: 1.1-2.9 nmol/l). Along the following ten days the patient suffered from delirium, agitation, tachycardia, hypertension, constipation and later diarrhoea, but neither arrythmias nor axillary temperature over 38 degrees C. Fifty-nine measurements of the serum total triiodothyronine were performed in order to determine the kinetics of elimination of this drug. We estimate that the maximal serum concentration after the intake of the latest capsule could be 794.3 nmol/l, i.e. 397 times higher than the mean normal value. The elimination half-life was 24 hours 40 minutes. The charcoal haemoperfusion had no impact on the velocity of elimination. The concentration of triiodothyronine became normal 200 hours after the intake of the latest capsule, but the clinical manifestations still lasted three days more. The pharmacokinetic data suggest that this intoxication could be due to the intake of capsules containing 5 mg of triiodothyronine, i.e. a dose 200 times higher than that prescribed by her physician.


Subject(s)
Thyrotoxicosis/chemically induced , Triiodothyronine/poisoning , Absorption , Adult , Biological Availability , Carcinoma, Papillary/surgery , Female , Half-Life , Hemoperfusion , Humans , Thyroid Function Tests , Thyroid Neoplasms/surgery , Thyroidectomy , Thyrotoxicosis/diagnosis , Thyrotoxicosis/therapy , Triiodothyronine/blood
8.
Rev. esp. anestesiol. reanim ; 50(10): 521-525, dic. 2003.
Article in Es | IBECS | ID: ibc-28439

ABSTRACT

Una mujer de 69 años, portadora de una prótesis valvular aórtica por insuficiencia aórtica de origen reumático, presentó un taponamiento cardíaco súbito provocado por la rotura de un pseudoaneurisma de aorta ascendente originada en la sutura de aortotomía realizada 10 años atrás. El taponamiento cursó con síncope, ausencia de pulso central acompañado de parada ventilatoria. El episodio fue presenciado permitiendo iniciar con rapidez las maniobras de reanimación cardiopulmonar hasta la recuperación hemodinámica. Tras la reposición de volumen intravascular y la perfusión de catecolaminas se realizó una ecocardiografía transesofágica que demostró el derrame pericárdico y la existencia de flujo entre la aorta y el ventrículo derecho. La actuación quirúrgica, mediante esternotomía exploradora urgente, reparó la cavidad aneurismática y una rara fístula al ventrículo derecho. La evolución cardiovascular fue satisfactoria, si bien las complicaciones respiratorias prolongaron la estancia hospitalaria por la presencia de hipoxemia grave, derrame pleural y neumonía con cultivos positivos para Pseudomona aeruginosa, Acinetobacter spp y Aspergillus flavus en aspirado traqueal y lavado broncoalveolar. Resaltamos que la inmediata aplicación de las maniobras de reanimación evitó la instauración de fracasos orgánicos y permitió una recuperación global satisfactoria tras la cirugía, a pesar de la presencia inicial de factores pronósticos de elevada mortalidad (AU)


Subject(s)
Aged , Female , Humans , Vascular Fistula , Aneurysm, False , Aortic Diseases , Aorta, Thoracic , Cardiac Tamponade , Fistula , Heart Ventricles , Cardiomyopathies
9.
An. med. interna (Madr., 1983) ; 20(12): 627-629, dic. 2003.
Article in Es | IBECS | ID: ibc-28641

ABSTRACT

A una mujer tiroidectomizada por carcinoma papilar de tiroides se le suspendió el tratamiento con L-tiroxina para realizar un estudio de extensión cinco semanas después. Para minimizar sus síntomas durante las tres primeras semanas se le prescribió tratamiento con cápsulas de 25 µg de triyodotironina cada 8 horas. Nueve días después consultó por dolor abdominal, náuseas, vómitos, fiebre de 40 ºC, mareo y molestia torácica. Mediante inmunoanálisis quimioluminiscente se detectó una triyodotironina sérica total de 575,2 nmol/l a las 11 horas de la toma de la última cápsula (valor normal: 1,1-2,9 nmol/l). A lo largo de los diez días siguientes la enferma presentó delirio, agitación, taquicardia, hipertensión arterial, estreñimiento y luego diarrea, pero no arritmias ni temperatura superior a 38 ºC. Se realizaron 59 determinaciones de triyodotironina total para determinar la cinética de eliminación de esta hormona. Se calcula que la máxima concentración sérica tras la ingestión de la última cápsula debió ser de 794,3 nmol/l, es decir, 397 veces superior al promedio de la normalidad. La vida media de eliminación fue de 24 horas y 40 minutos. La hemoperfusión con carbón activado no tuvo impacto alguno sobre la velocidad de eliminación. La concentración de triyodotironina se normalizó a las 200 horas de la toma de la última cápsula, pero las manifestaciones clínicas tardaron tres días más en desaparecer. Los datos farmacocinéticos sugieren que la intoxicación pudo deberse a que durante nueve días la paciente tomara cápsulas con 5 mg de triyodotironina, es decir, una dosis 200 veces mayor que la prescrita por su médico (AU)


Subject(s)
Adult , Female , Humans , Thyrotoxicosis , Triiodothyronine , Thyroidectomy , Biological Availability , Carcinoma, Papillary , Absorption , Half-Life , Hemoperfusion , Thyroid Neoplasms , Thyroid Function Tests
10.
Pediatr Pulmonol ; 35(2): 126-32, 2003 Feb.
Article in English | MEDLINE | ID: mdl-12526074

ABSTRACT

This study was designed to establish reference values of maximal static respiratory pressures in children and adolescents in our community, and compare them with previous studies. Participants were recruited from three schools (randomly chosen from those located in the metropolitan area of the city of Valencia) after appropriate consent. None of the participants had a previous history of pulmonary, cardiac, and/or skeletal abnormalities, and all of them had normal spirometry. Forced spirometry (Spirotrac III, Vitalograph) and maximal inspiratory (P(ImaxRV)) and expiratory (P(EmaxTLC)) pressure values (Sibelmed 163) were obtained by the same investigator, following national guidelines (SEPAR 1990).We studied 392 subjects (185 males, 207 females) whose ages ranged from 8-17 years. The reproducibility of measurements was investigated in a subgroup of 88 participants (randomly selected from the total sample, and stratified for age and gender) by means of the intraclass correlation coefficient (P(EmaxTLC), 0.98; P(ImaxRV), 0.95). P(EmaxTLC) and P(ImaxRV) values were significantly different between males and females (P < 0.0001) and were normally distributed. A stepwise, linear multiple regression model was built in each gender group (male/female) for the prediction of P(ImaxRV) and P(EmaxTLC) values. Independent variables (weight, height, and age) and their potential interactions were forced to enter the model in order to maximize the square of the multiple correlation coefficient of the resultant equation. This model turned out to be applicable (homoscedasticity, independence, and normality requirements) for P(ImaxRV) (in males and females) and for P(EmaxTLC) (in males but not in females). Variables included in the model were age and the product of weight and height. Their predictive power ranged between 0.21-0.51. In conclusion, P(ImaxRV) and P(EmaxTLC) values increase with age from 8 until 17 years. In all age groups, values were higher in males than in females. Weight, height, and age are included in the predictive equations for P(ImaxRV) (in males and females) and P(EmaxTLC) (in males). Their predictive value is similar to that reported by other authors and ranges between 0.21-0.51. This model is not suitable for the prediction of P(EmaxTLC) in females; the observed mean and range should be used instead.


Subject(s)
Forced Expiratory Flow Rates , Inspiratory Capacity , Lung Diseases/diagnosis , Pressure , Spirometry , Adolescent , Age Factors , Child , Female , Humans , Male , Predictive Value of Tests , Random Allocation , Reference Values , Reproducibility of Results , Sex Factors , Total Lung Capacity
11.
Rev Esp Anestesiol Reanim ; 50(10): 521-5, 2003 Dec.
Article in Spanish | MEDLINE | ID: mdl-14737778

ABSTRACT

A 69-year-old woman, with an aortic replacement valve for rheumatic aortic insufficiency suffered a sudden cardiac tamponade caused by a ruptured pseudoaneurysm of the ascending aorta which had its origin in the suture of the aorta performed 10 years earlier. The cardiac tamponade presented as syncope, absent central pulse, and respiratory failure. Hemodynamic variables recovered with early detection and start of cardiopulmonary resuscitation maneuvers. After fluids were replaced and following catecholamine treatment, a transesophageal echocardiogram revealed a pseudoaneurysm and continuous flow between the aorta and the right ventricle. The aneurysm and an unusual right ventricular fistula were repaired surgically through an emergency exploratory sternotomy. Cardiovascular recovery was satisfactory although hospital discharge was delayed because of pulmonary complications leading to severe hypoxia, pleural effusion, and pneumonia, with tracheal aspirate and bronchoalveolar lavage cultures positive for Pseudomonas aeruginosa, Acinetobacter spp, and Aspergillus flavus. We stress that immediate start of cardiopulmonary resuscitation prevented multiorgan failure and allowed for satisfactory recovery from surgery in spite of the presence of risk factors for mortality.


Subject(s)
Aneurysm, False/complications , Aortic Diseases/complications , Cardiac Tamponade/etiology , Cardiomyopathies/complications , Fistula/complications , Vascular Fistula/complications , Aged , Aorta, Thoracic , Female , Heart Ventricles , Humans
12.
Arch Bronconeumol ; 37(6): 292-6, 2001 Jun.
Article in Spanish | MEDLINE | ID: mdl-11412528

ABSTRACT

OBJECTIVE: Cough-inducing agents are used to study the cough reflex in both pharmacological and physiological research. Clinical use of cough challenge testing as a tool in diagnostic algorithms has been limited by the lack of either uniform methodology or reference values for healthy subjects. The objective of this study was to determine the cough threshold for capsaicin in a sample of healthy subjects, while also evaluating the influence of age, sex and smoking. We also assessed the reliability and repeatability of the test. MATERIAL AND METHODS: Ninety-two healthy subjects were enrolled and given a capsaicin challenge test using concentrations from 0.49 to 500mg. The concentrations of capsaicin that triggered two and five coughs, C2 and C5 respectively, were recorded. The test was repeated three days later in a sub-sample of 30 subjects. RESULTS: No subject showed clinical or functional signs of bronchoconstriction. The mean values obtained for the study population were log C2:1.5 +/- 0.69 mM. and log C5: 2.1 +/- 0.4 microM. The geometric means were 31.6 and 134.8 microM for C2 and C5, respectively. No significant differences were found for sex or smoking; however age was significantly related to log C5 (r: -0.27, p < 0.05). Repeatability of the capsaicin test was high, with intra-class correlation coefficients and 95% confidence intervals of 0.75 (0.53-0.87) and 0.88 (0.76-0.97)for C2 and C5, respectively. CONCLUSION: The capsaicin challenge test was safe and easy to administer,gave reproducible results and allowed us to obtain reference values for a healthy population in our community.


Subject(s)
Capsaicin , Cough/physiopathology , Adult , Female , Humans , Male , Reproducibility of Results
13.
Arch. bronconeumol. (Ed. impr.) ; 37(6): 292-296, jun. 2001.
Article in Es | IBECS | ID: ibc-616

ABSTRACT

OBJETIVOS: Es conocido el uso de agentes tusígenos en el estudio del reflejo de la tos, tanto en el campo de la investigación farmacológica como de la fisiología de dicho reflejo. Su aplicación clínica como una herramienta más en los algoritmos diagnósticos se ve limitada por la falta de uniformidad metodológica y de valores de referencia en sujetos sanos. El objetivo del presente estudio ha sido determinar el umbral tusígeno a la capsaicina en una muestra de sujetos sanos, evaluando la influencia de la edad, el sexo y el tabaquismo, así como analizando la fiabilidad y repetibilidad del test. MATERIAL Y MÉTODOS: Se incluyeron en el estudio 92 sujetos sanos a los que se les aplicó el test de provocación con capsaicina, cuyas concentraciones iban desde 0,49 a 500 µM. Se determinaron los valores de C2 y C5, siendo éstas las concentraciones de capsaicina que provocan al menos dos y 5 toses, respectivamente. La prueba se repitió a los 3 días en una submuestra de 30 sujetos. RESULTADOS: Ningún paciente presentó evidencia clínica ni funcional de broncoconstricción. Los valores medios obtenidos en la población de estudio fueron log C2: 1,5 ñ 0,69 µM y log C5: 2,1 ñ 0,4 µM. La media geométrica para ambos valores fue: C2: 31,6 y C5: 134,8 µM. No se hallaron diferencias significativas para el sexo ni el tabaquismo. Sin embargo, la edad guardó una asociación significativa con el log C5. La repetibilidad del test de la capsaicina fue alta, con un coeficiente de correlación intraclase y un intervalo de confianza del 95 por ciento de 0,75 (0,53-0,87) y 0,88 (0,76-0,94) para C2 y C5, respectivamente. CONCLUSIÓN: El test de provocación con capsaicina ha resultado seguro, fácil de aplicar, con unos resultados reproducibles y nos ha permitido obtener unos valores de referencia en una población sana de nuestra área (AU)


Subject(s)
Adult , Male , Female , Humans , Reproducibility of Results , Capsaicin , Cough
14.
Respir Med ; 95(3): 191-5, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11266236

ABSTRACT

Common variable immunodeficiency (CVID) is a heterogeneous immunodeficiency syndrome characterized by hypogammaglobulinemia, recurrent bacterial infections, and various immunologic abnormalities. The clinical presentation is generally that of recurrent pyogenic sinopulmonary infections. Our objectives were to study the prevalence of lung involvement and the response to intravenous immunoglobulin replacement therapy in 19 patients with CVID. Nineteen patients (12 men) with a mean age (SD) of 33.1 (17.1) years had a previous diagnosis of CVID and were treated with intravenous immunoglobulin replacement. All patients underwent complete pulmonary function tests and high-resolution computed tomography (HRCT) examination. Bronchiectasis was diagnosed in 11 (58%) patients and eight (42%) were multi-lobar bronchiectasis. Chronic airflow limitation (CAL) was present in 10 (53%) patients and a restrictive pattern was seen in one case. Eleven patients (58%) presented a decrease in single-breath carbon monoxide diffusing capacity of the lung (DL(CO)). Before intravenous immunoglobulin replacement therapy (INIRT), 84% of patients had suffered from at least one episode of pneumonia. Episodes of lower respiratory tract infection decreased significantly from 0.28 per patient and year before replacement therapy to 0.16 per patient and year after treatment. The mean duration of replacement therapy was 7.5 years. In conclusion lung involvement was frequent in patients with CVID. Long-term administration of intravenous gammaglobulin resulted in a substantial reduction of pneumonic episodes.


Subject(s)
Common Variable Immunodeficiency/complications , Respiratory Tract Diseases/etiology , Adolescent , Adult , Aged , Chi-Square Distribution , Child , Common Variable Immunodeficiency/diagnosis , Common Variable Immunodeficiency/therapy , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Prospective Studies , Respiratory Function Tests , Respiratory Tract Diseases/diagnosis , Respiratory Tract Diseases/therapy , Statistics, Nonparametric , Tomography, X-Ray Computed , Treatment Outcome
16.
Respiration ; 66(1): 52-8, 1999.
Article in English | MEDLINE | ID: mdl-9973691

ABSTRACT

BACKGROUND: Meteorological conditions and a high concentration of air pollutants have been associated with increased respiratory morbidity. However, few studies have examined the association between asthma exacerbation and air pollution. OBJECTIVES: In the present study, the possible relationship of the concentration of black smoke and SO2 in the air, the local weather conditions and emergency room visits for asthma is investigated. METHODS: The weekly total of emergency room admissions for asthmatic adults during a 1-year period was recorded together with daily metereological conditions (average temperature, humidity, rainfall, wind speed and barometric pressure) and average weekly levels of daily pollutant concentrations (black smoke and SO2). The relationship was assessed by stepwise regression linear models and analysis of variance. The analysis took into account season and metereological variables. RESULTS: Both air pollutants correlated significantly with emergency room admissions for asthma (SO2 [r = 0. 32], black smoke [r = 0.35]); however, multiple regression analysis showed that black smoke was the only significant predictor of weekly visits. There were approximately 3.5 admissions a week per SD of change (34.6 microg.m-3). There were no significant correlations between weekly emergency room visits and the weather variables. Analysis of the data stratified by season and weather conditions demonstrated that the association of black smoke with asthma exacerbation was more pronounced in autumn (r = 0.67) or when temperatures were higher than average. CONCLUSION: In our city, a high concentration of certain air pollutants is indeed associated with an increase in the number of hospital emergency room admissions for asthma.


Subject(s)
Air Pollution , Asthma/epidemiology , Weather , Adolescent , Adult , Aged , Aged, 80 and over , Analysis of Variance , Female , Humans , Linear Models , Male , Middle Aged , Retrospective Studies , Smoke , Spain/epidemiology
17.
An Esp Pediatr ; 51(5): 505-11, 1999 Nov.
Article in Spanish | MEDLINE | ID: mdl-10652802

ABSTRACT

OBJECTIVE: Our objectives were to determine the prevalence of alterations in lung function among pediatric cancer survivors with known risk factors and to establish clinical and imaging correlations, as well as to establish follow-up criteria. PATIENTS AND METHODS: Cancer survivors diagnosed at the Pediatric Oncology Unit between 1971 and 1997 who fulfilled at least one of the following criteria were eligible: 1) primary lung or thoracic wall neoplasm; 2) lung metastasis at diagnosis or later, or; 3) irradiation of mediastinum and/or lung fields. Assessment included respiratory symptomatology questionnaire, physical examination, forced spirometry, static lung volumes, maximal static respiratory pressures, single breath CO diffusing capacity, pulse oximetry and imaging studies. RESULTS: Thirty-five (14 females and 21 males) out of 41 survivors were assessed. Mean age at diagnosis, evaluation and follow-up were 9 (1-14), 18 (10-28) and 9 (3-27) years, respectively. The diagnoses included pleuropulmonary blastoma (1), chest wall Ewing's sarcoma (1), Hodgkin's disease (18), nephroblastoma (7), yolk-sac tumor (2), acute leukemia2), non-Hodgkin's lymphoma (1), rhabdomyosarcoma (1), coriocarcinoma of the ovary (1) and osteosarcoma (1). Thirteen patients presented lung metastasis at diagnosis or later. All were administered chemotherapy. Irradiated fields were the mediastinum (dose 20-56 Gy) in 20 cases, the lung (8-30 Gy) in 6 and the spine (24 Gy) in one. Eight underwent thoracotomy. Fourteen percent were dyspneic when walking at the same rate as a person of the same sex and age (grade 2). Twenty percent had a restrictive ventilatory disorder, but none were obstructive. The presence of dyspnea had sensitivity, specificity, positive predictive values and negative predictive value for the diagnosis of restrictive ventilatory disorder of 67%, 96%, 80% and 93%, respectively. Lung irradiation was associated with an increased risk for the development of restrictive disease. Excluding those who received lung irradiation, survivors under 6 years of age at diagnosis obtained lower spirometric values, lung volumes and DLCO values than survivors aged 6 years or older at diagnosis. There were no differences in pulmonary function values between survivors who received mediastinum irradiation and those who did not. The cumulative dose of cyclophosphamide significantly correlated with FVC, FEV1 and FRC. Pulse oximetry values were > or = 95% in all survivors. Maximal static respiratory pressures were within normal limits in all but one survivors whose other pulmonary function results were normal. Thirty-two percent (11 out of 34) had KCO (diffusing capacity adjusted to alveolar volume) values lower than 80% of reference values. Two survivors of nephroblastoma with pulmonary metastasis and who underwent lung irradiation had radiological signs of lung fibrosis. CONCLUSIONS: Pediatric cancer survivors who were administered intensive chemotherapy and/or lung irradiation are eligible for follow-up of lung function. Those diagnosed before 6 years of age and/or with moderate dyspnea are at high risk of having pulmonary restrictive disease. Imaging studies (chest X-ray) have a low sensitivity that prevents their use as a screening method in the follow-up of cancer survivors.


Subject(s)
Lung Neoplasms/mortality , Survivors/statistics & numerical data , Adolescent , Adult , Catchment Area, Health , Child , Child, Preschool , Cross-Sectional Studies , Dyspnea/diagnosis , Female , Humans , Lung Neoplasms/radiotherapy , Male , Predictive Value of Tests , Respiratory Function Tests/methods , Surveys and Questionnaires
18.
An Med Interna ; 10(3): 113-5, 1993 Mar.
Article in Spanish | MEDLINE | ID: mdl-8485279

ABSTRACT

Given that forced spirometry is the main routine exploration in any laboratory of pulmonary functional assessment, we have analyzed the behaviour of O2 arterial saturation (SaO2) during such maneuver in patients with airflow chronic obstruction (AFCO), in order to verify any potential alterations. We have studied three groups of patients: Group A, control, 17 healthy subjects; group B, 18 patients with AFCO and initial saturation higher than 90%; group C, 15 patients with AFCO and saturation equal to or lower than 90%. Total duration of the maneuver was significantly higher in groups B and C compared with the control group (p < 0.001). In groups A and B, we did not observed any significant reductions in SaO2 with respect to the initial value, although we did observed such differences in group C (p < 0.001). None of the patients presented a subjective clinical disorder, although the absence of both complexity and risk suggest the convenience of including the oximetry as an additional parameter when conducting a forced spirometry in patients with AFCO and respiratory failure.


Subject(s)
Oximetry/methods , Spirometry/methods , Adult , Aged , Analysis of Variance , Female , Humans , Lung Diseases, Obstructive/blood , Lung Diseases, Obstructive/diagnosis , Lung Diseases, Obstructive/epidemiology , Male , Middle Aged , Oximetry/instrumentation , Oximetry/statistics & numerical data , Oxygen/blood , Respiratory Insufficiency/blood , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/epidemiology , Spirometry/instrumentation , Spirometry/statistics & numerical data
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