[Cyclooxygenase-2 polymorphisms and bronchoalveolar lavage cellularity of sarcoidosis]. / El polimorfismo COX2.8473t>C del gen de la ciclooxigenasa-2 está asociado al cociente CD4/CD8 del lavado broncoalveolar en la sarcoidosis.

OBJECTIVES: Recent studies have found cyclooxygenase-2 (COX-2) and its polymorphisms to be associated with sarcoidosis, being it significantly decreased in alveolar macrophages, with no information on the relationship between these polymorphisms and the rest of cells in bronchoalveolar layage (BAL). The present study aimed to investigate the potential association between COX-2 gene polymorphisms and the BAL cell profile including the CD4/CD8 ratio. MATERIAL AND METHODS: This observational cross-sectional study involved six hospitals in Spain. Patients diagnosed with sarcoidosis with a BAL performed were included. The following variables were recorded: age, gender, initial diagnostic methods, serum angiotensin-converting enzyme levels, pulmonary function tests, radiological stage, and the cellularity and CD4/CD8 ratio from BAL. Genotyping of four COX-2 polymorphisms (COX2.5909T>G, COX2.8473T>C, COX2.926G>C, and COX2.3050G>C) was undertaken on DNA extracted from peripheral blood lymphocytes using fluorescent hybridization probes. The relationship between the polymorphisms and the cellularity was done by means of a multiple linear regression, adjusting for gender. RESULTS: A total of 51 sarcoid patients (23 males, mean age: 45 +/- 15 years) were studied. CD4/CD8 ratio was significantly higher among homozygote allele C carriers of the polymorphism COX2.8473T>C (CC 11.2 +/- 5.5 vs. CT+TT 4.4 +/- 3.5; p = 0.022; beta = 7.43; 95% CI 1.38 - 13.48). Although several differences were observed in other cell groups, they did not reach the statistical significance level. CONCLUSIONS: In patients diagnosed with sarcoidosis, there seems to be a relationship between COX2.8473 polymorphism and CD4/CD8 ratio from BAL.

[Arterial blood gases study in patients with stable chronic obstructive pulmonary disease in accordance with spirometric values]. / Gasometría arterial en pacientes con enfermedad pulmonar obstructiva crónica estable según los valores de la espirometría.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the need to assess arterial blood gases in patients with stable chronic obstructive pulmonary disease (COPD) in accordance with spirometric values. PATIENTS AND METHOD: Transverse study in stable COPD patients with spirometry and pulse oximetry assessment. Specific exclusion criteria were: diagnosis of asthma, sleep apnea syndrome or respiratory failure not due to COPD. Diagnostic of respiratory failure was established when pulse oximetry saturation was < or = 92%; we evaluated the best predicted FEV1 cut-off value. RESULTS: 467 patients (age = 64 [8] yr) were evaluated. FEV1 was 44 (14) % predicted. Two patients (1.5%) with FEV1 > 50 % and 29 patients (23.6%) with FEV1 between 41 and 50% had respiratory failure. Sensitivity (0.98) and rate of false-negative (0.98) at a cut-off of 50% predicted value FEV1 was superior to sensitivity (0.75%) and rate of false-negative (0.87) at a cut-off of 40% predicted value FEV1. CONCLUSIONS: In stable COPD patients, the rate of respiratory failure increases when the predicted value FEV1 is below 50%. Therefore, we recommend this spirometric cut-off to evaluate arterial blood gases.

Gasometría arterial en pacientes con enfermedad pulmonar obstructiva crónica estable según los valores de la espirometría / Arterial blood gases study in patients with stable chronic obstructive pulmonary disease in accordance with spirometric values

Fundamento y objetivo: Conocer cuándo debemos realizar gasometría arterial en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable según los valores espirométricos. Pacientes y método: Se ha realizado un estudio transversal en pacientes diagnosticados de EPOC, en fase estable, con espirometría y pulsioximetría. Se excluyó a los pacientes con asma, síndrome de apneas del sueño o insuficiencia respiratoria secundaria a otro proceso. Consideramos insuficiencia respiratoria si la saturación de oxígeno por pulsioximetría era del 92% o menor y analizamos el valor del volumen espiratorio forzado en el primer segundo (FEV1) en porcentaje del teórico que mejor sirve de punto de corte. Resultados: Incluimos a 467 pacientes, con una edad media (desviación estándar) de 64 (8) años y FEV1 medio del 44% (14%). Presentaron insuficiencia respiratoria 2 pacientes (1,5%) con FEV1 mayor del 50% y el 23,6% de los pacientes con FEV1 entre el 41 y el 50%. El punto de corte del FEV1 del 50% presentó una sensibilidad (0,98) y un valor predictivo negativo (0,98) superiores al punto de corte del FEV1 del 40% (sensibilidad de 0,75 y valor predictivo negativo de 0,87). Conclusiones: La proporción de pacientes con EPOC estable con insuficiencia respiratoria aumenta a partir de valores del FEV1 menores del 50%, por lo que aconsejamos realizar gasometría arterial a partir de este punto de corte

Background and objetive: The aim of this study was to evaluate the need to assess arterial blood gases in patients with stable chronic obstructive pulmonary disease (COPD) in accordance with spirometric values. Patients and method: Transverse study in stable COPD patients with spirometry and pulse oximetry assessment. Specific exclusion criteria were: diagnosis of asthma, sleep apnea syndrome or respiratory failure not due to COPD. Diagnostic of respiratory failure was established when pulse oximetry saturation was ¾92%; we evaluated the best predicted FEV1 cut-off value. Results: 467 patients (age = 64 [8] yr) were evaluated. FEV1 was 44 (14) % predicted. Two patients (1.5%) with FEV1 > 50 % and 29 patients (23.6%) with FEV1 between 41 and 50% had respiratory failure. Sensitivity (0.98) and rate of false-negative (0.98) at a cut-off of 50% predicted value FEV1 was superior to sensitivity (0.75%) and rate of false-negative (0.87) at a cut-off of 40% predicted value FEV1. Conclusions: In stable COPD patients, the rate of respiratory failure increases when the predicted value FEV1 is below 50%. Therefore, we recommend this spirometric cut-off to evaluate arterial blood gases

Ventilación no invasiva en el edema pulmonar agudo cardiogénico: ¿debe individualizarse? / Non invasive ventilation in acute cardiogenic lung edema: ¿must it be individualized?

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Tratamiento del empiema y del derrame pleural paraneumónico complicado con fibrinolíticos intrapleurales / Treatment of empyema and complicated parapneumonic effusions with pleural fibrinolytics

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[Non invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis]. / Metaanálisis de la eficacia de la ventilación no invasiva en la exacerbación aguda de la enfermedad pulmonar obstructiva crónica.

BACKGROUND AND OBJECTIVES: The purpose of this study was: 1) To determine the effect of non invasive ventilation (NIV) in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure, and 2) To find out whether there are differences in the results according to the site where ventilation in applied. PATIENTS AND METHOD: Meta-analysis of randomized controlled trials (RCTs) published included studies in MEDLINE, EMBASE, Cochrane Controled Trials Register and Teseo. Study selection included RCTs in COPD patients with acute respiratory failure with PaCO2 > 45 mmHg or pH < 7.35, with underwent NIV versus standard therapy. Mortality, rate of tracheal intubation and length of stay were analized. Individual studies were rated as to their validity and quality by two investigators using the Jadad score. A different meta-analysis was made for intensive-care unit (ICU) RCTs and wards RCTs. RESULTS: Five ICU RCTs and four ward RCTs were included. There was a reduction in hospital mortality (ICU, OR = 0.35; 95% confidence interval [CI], 0.15 to 0.83; n = 166; p = 0.02; ward, OR = 0.39; 95% CI, 0.20 to 0.76; n = 296; p = 0.005) and in the need for intubation (ICU, OR = 0.18; 95% CI, 0.10 to 0.35; n= 219; p < 0,00001; ward, OR = 0.43; IC 95%, 0.24-0.78; n = 270; p = 0.006). Length of stay was lower in the NIV group upon ICU trials (WMD, 3.7 days; 95% CI, 5.46 to 1.93 days). Only one ward RCT showed significant differences in the length of stay. Published data did not allow a meta-analysis for length of stay. CONCLUSIONS: NIV decreases mortality and the need for intubation in COPD patients with acute respiratory failure both in ICU and ward. In ICU non-invasive ventilation decreases the length of stay too.

Metaanálisis de la eficacia de la ventilación no invasiva en la exacerbación aguda de la enfermedad pulmonar obstructiva crónica / Non invasive ventilation for acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis

FUNDAMENTO Y OBJETIVOS: Valorar la eficacia de la ventilación no invasiva (VNI) en la enfermedad pulmonar obstructiva crónica (EPOC) en fracaso respiratorio agudo (FRA) y saber si hay diferencias en los resultados en función del lugar de aplicación. MATERIAL Y MÉTODO: Se realizó un metaanálisis de ensayos controlados aleatorizados (ECA) publicados en Medline, EMBASE, Registro de Ensayos Clínicos Controlados de la Colaboración Cochrane y Teseo hasta junio de 2002. Se efectuó una selección de los ECA en EPOC con FRA y pH sanguíneo 45 mmHg, con VNI frente a tratamiento estándar, y se analizaron mortalidad, tasa de intubación y días de estancia. La validez y calidad de los ECA fueron analizadas por dos investigadores con la escala de Jadad. Realizamos metaanálisis diferentes para los estudios de unidades de cuidados intensivos (UCI) y planta. RESULTADOS: Se incluyeron 5 ECA de UCI y 4 de planta. Se encontró una reducción de la mortalidad (UCI, odds ratio [OR] = 0,35; intervalo de confianza [IC] del 95 por ciento, 0,15-0,82; n = 166; p = 0,02; planta, OR = 0,40; IC del 95 por ciento, 0,21-0,75; n = 330; p = 0,005) y del número de intubaciones (UCI, OR = 0,18; IC del 95 por ciento, 0,10-0,35; n = 219; p < 0,00001; planta, OR = 0,43; IC del 95 por ciento, 0,24-0,78; n = 270; p = 0,006). La estancia media fue menor en UCI (diferencia media ponderada de -3,7 días; IC del 95 por ciento, -5,46 a -1,93; n = 196; p = 0,00004).Sólo un ECA de planta demostró diferencias entre ambos grupos en la estancia media; los datos publicados no permitieron realizar metaanálisis acerca de la estancia. CONCLUSIONES: La VNI reduce la mortalidad y la necesidad de intubación en pacientes con EPOC en FRA cuando se aplica tanto en UCI como en planta. En la UCI la VNI reduce también los días de hospitalización (AU)

Hemotórax espontáneo secundario a fractura de una exostosis costal solitaria / Spontaneous hemothorax secondary to fracture of solitary costal exostosis

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