ABSTRACT
INTRODUCTION: There are no defined criteria for deciding to remove a non-functioning indwelling pleural catheter (IPC) when lung re-expansion on chest X-ray is incomplete. Chest computed tomography (chest CT) is usually used. The objective of this work is to validate the usefulness of chest ultrasound performed by a pulmonologist and by a radiologist compared to chest CT. PATIENTS AND METHODS: Prospective, descriptive, multidisciplinary and multicenter study including patients with malignant pleural effusion and non-functioning IPC without lung reexpansion. Decisions made on the basis of chest ultrasound performed by a pulmonologist, and performed by a radiologist, were compared with chest CT as the gold standard. RESULTS: 18 patients were analyzed, all of them underwent ultrasound by a pulmonologist and chest CT and in 11 of them also ultrasound by a radiologist. The ultrasound performed by the pulmonologist presents a sensitivity of 60%, specificity of 100%, PPV 100% and NPV 66% in the decision of the correct removal of the IPC. The concordance of both ultrasounds (pulmonologist and radiologist) was 100%, with a kappa index of 1. The 4 discordant cases were those in which the IPC was not located on the ultrasound. CONCLUSIONS: Thoracic ultrasound performed by an expert pulmonologist is a valid and simple tool to determine spontaneous pleurodesis and remove a non-functioning IPC, which would make it possible to avoid chest CT in those cases in which lung reexpansion is observed with ultrasonography.
Subject(s)
Pleural Effusion, Malignant , Humans , Pleural Effusion, Malignant/diagnostic imaging , Pleural Effusion, Malignant/therapy , Pleural Effusion, Malignant/pathology , Prospective Studies , Catheterization , Catheters, Indwelling , UltrasonographyABSTRACT
La acalasia es una de las alteraciones de la motilidad esofágica que más frecuentemente causa disfagia. Es una enfermedad bastante infrecuente con una prevalencia de 0.5-1 por cada 100.000 habitantes en Estados Unidos. La presentación habitual suele ser la disfagia progresiva. Una proporción de estos pacientes con acalasia se pueden presentar incluso inicialmente con síntomas respiratorios que pueden dificultar el diagnóstico. Los síntomas respiratorios más frecuentes son tos, aspiraciones y disnea de esfuerzo aunque pueden presentar cuadros más graves. como neumonías y fallos ventilatorios fulminantes. En cuanto al tratamiento, existen diversas posibilidades, siendo las más utilizadas la miotomía de Heller y las dilataciones endoscópicas. Con la exposición de este caso clínico queremos poner de manifiesto la relación entre acalasia y patología respiratoria de manera que pueda ser más fácilmente detectada por los profesionales sanitarios, consiguiendo así un mejor tratamiento y control de la misma
Achalasia is the leading alteration of esophageal motility that causes dysphagia. It is a rather rare condition with a prevalence of 0.5-1 per 100 000 inhabitants in the United States. Its most common symptom is progressive dysphagia. Some patients with achalasia may even present with respiratory symptoms that make it difficult to reach a diagnosis. The most common respiratory symptoms are cough, aspiration and dyspnea on exertion, although they may also show more severe symptoms such as pneumonia and fulminant respiratory failure. With regard to its treatment, there are different possibilities, and the most common choice is Heller myotomy and endoscopic dilatation. With this clinical case we want to highlight the relation between achalasia and respiratory disease so that it can be easily detected by health professionals, thus achieving a better treatment and control of this condition
Subject(s)
Humans , Male , Aged , Esophageal Achalasia/etiology , Pneumonia/complications , Deglutition Disorders/etiology , Recurrence , Dilatation/methods , Hemoptysis/etiology , Pneumonia, Aspiration/diagnosisABSTRACT
El tabaco es el principal agente causal de la EPOC y la cesación tabáquica la mejor medida preventiva y terapéutica de la enfermedad. Existen guías genéricas para el diagnóstico y tratamiento del tabaquismo e incluso guías específicas para ayudar a dejar de fumar a los pacientes con EPOC. No obstante, un porcentaje elevado de pacientes con EPOC continúan fumando, posiblemente porque tienen mayor dificultad que otros fumadores para dejar de fumar y también porque los clínicos no prestan la atención necesaria a este aspecto dentro de la atención a los pacientes con EPOC que continúan fumando. Documentos como GOLD y guías de práctica clínica como GesEPOC incluyen en distinta medida el abordaje del tabaquismo dentro de la estrategia de atención a la EPOC. El objetivo de este estudio es analizar críticamente los contenidos que ambos documentos dedican al tabaquismo dentro de las estrategias de prevención, diagnóstico y tratamiento de la EPOC, en el convencimiento de que la inclusión de recomendaciones sobre el tabaquismo en este tipo de documentos, resulta mucho más eficaz que las guías específicas de cesación de cara a la implementación en la práctica clínica de la cesación tabáquica (AU)
Tobacco is the main casual agent of COPD and smoking cessation the best preventive measure and disease therapeutics. There are guidelines for the diagnosis and treatment of smoking and even specific guidelines to help patients with COPD quit smoking. However, a high percentage of patients with COPD continue smoking. They may find it more difficult to give up smoking and the fact that clinicians do not pay the necessary attention to this aspect on caring for the patients with COPD who continue smoking should be taken into account too. Documents such as GOLD and clinical practice guidelines such as GesEPOC include, to varying extent, the approach to smoking in the COPD attention strategy. The aim of this study is to critically analyze the contents referring to smoking that both documents present within the strategies for prevention, diagnosis and treatment of COPD. We strongly believe that the inclusion of recommendations on smoking in such documents is much more efficient than the implementation of specific cessation guidelines in this particular clinical practice (AU)
Subject(s)
Humans , Smoking/adverse effects , Smoking Cessation/methods , Pulmonary Disease, Chronic Obstructive/complications , Smoking Prevention , Smoking Prevention , Risk FactorsABSTRACT
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