Metástasis endotraqueales de carcinoma colorrectal / No disponible

La existencia de metástasis endotraqueales (ME) de carcinomas de origen no pulmonar es rara. Las manifestaciones clínicas más comunes son hemoptisis, tos y disnea, aunque no es raro encontrarlas como hallazgo casual en el curso de una broncoscopia. Las neoplasias que con mayor frecuencia se asocian a estas lesiones metastásicas son las derivadas de mama, colon y riñón. Su hallazgo supone un estado avanzado de la enfermedad, aunque la supervivencia está en función del tipo de tumor primario, la existencia de lesiones concomitantes y las características del paciente. Por lo tanto el tratamiento debe individualizarse. En el caso de las ME de carcinoma colorrectal (CCR) recomendamos la realización de una broncoscopia preopcratoria pues es posible encontrar lesiones en el árbol traqueobronquial que influyan en el pronóstico y tratamiento de la enfermedad (AU)

Existence of endotracheal metastases (EM) of non-pulmonary origin cancer is rare. The most common clinical manifestations are hemoptysis, cough and dyspnea, although it is not rare to find it as a casual finding during a bronchoscope examination. The neoplasms that are most frequently associated to these lesions are those derived from the breast, colon and kidney. When they are found, it means that there is an advanced stage of the disease, although survival is based on the type of primary tumor, existence of common commitment lesions and the characteristics of the patient. Thus, the treatment should be individualized. In the case of colorectal carcinoma (CRC) EM, we recommend performing a pre-operative bronchoscopy since lesions that influence the prognoses and treatment of the disease may be found in the trachea and bronchial tree (AU)

Endotracheal metastases from colon adenocarcinoma

Endotracheal metastases (ETM) from non-lung cancer are seldom seen. Their main clinical symptoms are cough, haemoptysis and dyspnoea, although occasionally an incidental finding is made during a bronchoscopy. Breast, colon and kidney adenocarcinoma might be associated with ETM, lung cancer being the most frequent cause. Its finding is associated with advanced disease but survival will depend on the primary origin, patient status and comorbidity. Therefore, treatment should be individual for each patient. In our centre we recommend pre-surgery bronchoscopy to exclude metastatic endotracheal lesions in patients with metastatic colon adenocarcinoma disease, as this might affect the final outcome and therefore management of the disease (AU)

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[Localized fibrous tumors of the pleura: clinical and surgical evaluation]. / Tumores fibrosos de localización pleural: valoración clinicoquirúrgica.

Solitary fibrous tumors of the pleura are uncommon and mainly arise in the pleura itself. Such tumors are generally asymptomatic and slow-growing. We report a series of 10 cases (8 men and 2 women with a mean age of 58.6 years) treated over a period of 54 months. The tumors were classified histologically as benign or malignant according to the criteria used by England. The treatment of choice was complete resection of the tumor. Six posterolateral thoracotomies and 4 video-assisted resections were performed. Histology showed a mixture of fibroblast-like cells and collagenous stroma. Sarcomatous degeneration was observed in the excised tumor of 1 patient. The patients were followed for a mean of 23.9 months. We conclude that although fibrous tumors of the pleura are considered benign histologically, complete resection and follow up for all patients are recommended.

Diagnostic utility of eosinophils in the pleural fluid.

This study was conducted to assess the prevalence of eosinophilia in 358 consecutive samples of pleural fluid (all cases corresponded to first thoracentesis), to review the cause of eosinophilic pleural effusions, and to determine whether the presence of eosinophils increases the likelihood of nonmalignant underlying disorders. Eosinophilic pleural effusions were identified in 45 patients (12.6%): malignant underlying conditions were diagnosed in 11 patients (24.4% with eosinophilic effusions) and benign aetiologies were found in 27 patients. Benign aetiologies included uncomplicated paraneumonic effusion in 10 patients, tuberculosis in seven, complicated paraneumonic in five, liver cirrhosis in three, hydronephrosis in one and pulmonary thromboembolism in one. Seven pleural effusions were idiopathic. There was no difference in the prevalence between eosinophilic and noneosinophilic effusions according to the different diagnoses. With parameters of sensitivity, specificity, pretest and post-test probability and positive and negative predictive values for any prevalence figure using the Bayes' theorem and for any value of eosinophils (both in percentage or absolute numbers) in the pleural fluid (receiver operating characteristic curve) an adequate predictor of benign disease was not found. It is concluded that pleural eosinophilia at the initial thoracentesis cannot be considered as a predictor of an underlying benign disorder.

[Adverse effects on the respiratory system in textile printing sprayers]. / Efectos adversos sobre el tracto respiratorio en trabajadores de aerografía textil.

OBJECTIVE: To study the initial respiratory effects and those observed 18 months later after the inhalation of toxic and irritant substances in textile aerography workers. SUBJECTS: Seventeen patients (14 women and 3 men), with a mean age of 21 years (range: 18-38). METHODS: Initially, pulmonary effects were assessed by pathological (transbronchial biopsy and/or video-thoracoscopy) and functional findings [spirometry with lung volumes and study of diffusion capacity of CO (DLCO)]. Eighteen months later a challenge bronchial test with histamine was performed. RESULTS: Forty-one per cent of patients had pathologic lesions with intraalveolar fibrin, 35% had minimal non-specific lesions, 18% bronchiolitis obliterans with organized pneumonia (BOOP) and 6% pulmonary fibrosis and BOOP. Functional respiratory test showed two patients with a slight restrictive pattern, one patient with very severe restriction and six patients with low DLCO. The challenge tests was positive for 59% of patients. CONCLUSION: After the massive inhalation of irritant and/or toxic substances, patients presented different types of pathological response at pulmonary level. In our workers histological repairing lesions--of high or low degree--were found, BOOP being the lesions observed most frequently, and different patterns of functional involvement. Fifty-nine per cent of cases developed non-specific bronchial hyperreactivity consistent with a reactive airways dysfunction syndrome.

[Relationship between peak expiratory flow and clinical exploration and arterial gas analysis in assessing the severity of an asthma attack]. / Relación del flujo espiratorio máximo con la exploración clínica y la gasometría arterial en la valoración de gravedad de la crisis asmática.

Protocols for treating acute asthma presently rely on measurement of peak expiratory flow (PEF) to orient treatment and evaluate progress. Other clinical or functional parameters have also been considered for use in the assessment of severity of attack. In order to investigate the usefulness of these criteria we analyzed their relation to degree of air flow obstruction expressed by PEF in a sample of 48 asthmatics who came to the emergency room for treatment of disease exacerbation, excluding 6 who presented imminent risk of death at the time of admission. Among the clinical parameters analyzed, only presentation of cyanosis or diaphoresis was related to degree of obstruction. The pattern of accessory muscle use or vital signs such as heart, breathing rate or blood pressure were similar in patients with (PEF < 50%) or without (PEF > 50%) severe exacerbation. Among gasometric readings only PaO2 was significantly lower in patients with PEF < 50% and we were able to identify a cutoff point useful as a screen for respiratory insufficiency: when the initial PEF was above 50% of theoretical value, no patient had PaO2 < 60 mmHg. We conclude that: 1) clinical parameters do not always reflect severity of attack established by degree of air flow obstruction, and 2) PEF > 50% at the start of asthmatic exacerbation allows respiratory insufficiency to be ruled out, making performance of gasometric measurement unnecessary.

[Coexistence of bronchogenic carcinoma and active pulmonary tuberculosis]. / Coexistencia de carcinoma broncogénico y tuberculosis pulmonar activa.

We describe 9 patients with coincident active tuberculosis of the lung and bronchogenic carcinoma who were all diagnosed within a 5-year period. All were men, with a mean age of 55 +/- 10 years. The principal symptom was toxic syndrome lasting 1-3 months and the most common X-ray sign was alveolar consolidation. Analysis of tissue samples revealed squamous carcinoma (4 cases), adenocarcinoma (4 cases, one of which was bronchioloalveolar) and non-small cell carcinoma (1 case). Tumoral stage was often advanced: IV (44%) and III (33%). The tuberculosis bacillus was isolated in sputum (100%) and in bronchial aspirate (50%); no in vitro resistance was observed. Three patients were treated with radical surgery and three with radiotherapy. Average survival was 3 months in this series.