Effectiveness of different treatments in obesity hypoventilation syndrome.

Obesity hypoventilation syndrome (OHS) is an undesirable consequence of obesity, defined as daytime hypoventilation, sleep disorder breathing and obesity; during the past few years the prevalence of extreme obesity has markedly increased worldwide consequently increasing the prevalence of OHS. Patients with OHS have a lower quality of life and a higher risk of unfavourable cardiometabolic consequences. Early diagnosis and effective treatment can lead to significant improvement in patient outcomes; therefore, such data has noticeably raised interest in the management and treatment of this sleep disorder. This paper will discuss the findings on the main current treatment modalities OHS will be discussed.

Relationship between O2 saturation in the 6-minute walking test with muscle mass and contraction strength of the quadriceps in men with COPD / Relación de la saturación de O2 en la prueba de los seis minutos marcha con la masa muscular y la fuerza de contracción del cuádriceps en hombres con EPOC

Hypothesis: Among the causes of muscle dysfunction in COPD, mention has been made of decreased oxygen delivery during exercise. Saturation levels during the 6 minutes walking test could be associated to muscle mass and function. Population, material and methods: A group of 75 males patients, 48 (68.6%) males with COPD in different GOLD stages and 28 (74%) with chronic bronchitis (CB) were studied. Tests performed were spirometry, body mass composition analysis, 6 minutes walking test (6MWT), recording of mean hemoglobin saturation and greater or less than 4%, quadriceps voluntary contraction strength test (QMVC). Work performed (Ww) was determined by the Chuang equation and muscle mass by the Janssen Equation. Results: No statistical differences were found in age, body mass index (BMI), free fat mass index (FFMI), muscle mass index (MMI) and QMVC, 6MWT and Ww between the COPD and CB groups. Desaturation ≥ 4% was more frequent in the COPD group (p < 0.01) and was related with a limitation in the distance walked (p = 0.025). The mean SpO2 after 6MWT of ≤ 89% differentiates the COPD from the CB population (p = 0.002). We found no relationship between the different levels of SpO2 after the walk test and muscle mass parameters (MMI, FFMI). There was a statistical difference between patients with a mean SpO2 after the walk test ≤ 90% and the distance reached (p = 0.04). When the mean SpO2 was ≤ 89%, there was a decrease in the WW (p = 0.032). When the mean SpO2 was ≤ 88% we found a decrease in the QMVC (p = 0.05). Conclusions: After the 6MWT, SpO2 is more frequent, this having no relationship with the GOLD stage and is only related with the distance reached. Mean SpO2 after the 6MWT is more sensitive since it is related to performance parameters in the first place, then with muscle strength, and later with quadriceps contraction strength. We found no relationship between the desaturation parameters studied and the muscle mass measurements (AU)

Hipótesis: Entre las causas de la disfunción muscular en la EPOC se menciona el déficit en el aporte de oxígeno durante el ejercicio. Por ello, la saturación observada tras la prueba de la marcha de seis minutos (P6m) debe tener relación con la masa y la función muscular. Población, material y métodos: Se estudian 48 pacientes varones con EPOC, en distintos estadios GOLD, y 28 con bronquitis crónica (BC). Se les realizó una espirometría, análisis de composición corporal, P6m, registro de la saturación de la hemoglobina media y mayor o menor del 4% y análisis de la fuerza de contracción del cuádriceps (FCC). Se determina el trabajo realizado por la fórmula de Chuang y la masa muscular por la ecuación de Janssen. Resultados: No hubo diferencias significativas en la edad, índice de masa corporal (IMC), índice de masa libre de grasa (IMLG), índice de masa muscular (IMM) y FCC, P6m y trabajo realizado (Ww) entre los grupos. La desaturación ≥ 4% es más frecuente en el grupo EPOC (p < 0,01) con independencia del estadio y se relaciona con una reducción de la distancia recorrida (p = 0,025). La SpO2 media tras la marcha ≤ 89% diferencia a la población con EPOC de la población con BC (p = 0,002). No se encuentra relación entre los distintos niveles de SpO2 media tras la marcha y los parámetros de masa muscular (IMM, IMLG). Sí existen diferencias significativas entre la SpO2 media tras la marcha ≤ 90% y la distancia recorrida (p = 0,04). Cuando la SpO2 media es ≤ 89% se reduce el Ww (p = 0,032) y cuando la SpO2 media es ≤ 88% se aprecia una disminución en la FCC (p = 0,05). Conclusiones: Tras la P6m la SpO2 es más frecuente en la EPOC sin correspondencia con el estadio GOLD y sólo se relaciona con la distancia alcanzada. La SpO2 media tras el P6m es más sensible, ya que se relaciona en primer lugar con el rendimiento después con el Ww y con posterioridad la FCC. No encontramos relación entre los parámetros de desaturación estudiados y las medidas de masa muscular (AU)

Hidatidosis como causa de hipertensión arterial pulmonar / Hydatic disease as a cause of pulmonary arterial hypertension

La hidatidosis es la zoonosis más frecuente en nuestro medio y afecta principalmente al hígado (60%) y a los pulmones (10-30%). La clínica depende fundamentalmente del tamaño, la localización o las complicaciones como la ruptura al pulmón de los quistes hidatídicos. Su diagnóstico se fundamenta en los estudios de imagen y la serología. El tratamiento de elección es la cirugía. Presentamos un caso clínico de hidatidosis con afectación de las arterias pulmonares principales, pulmonar bilateral y hepática. La presencia de quistes hidatídicos en las arterias pulmonares es una complicación de la hidatidosis hepática o cardíaca, su tratamiento de elección es la endarterectomía, en caso contrario conllevaría al desarrollo de hipertensión pulmonar y mal pronóstico (AU)

Hydatidosis is the most important zoonosis in our environment that affects primarily the liver (60%) and the lungs (10-30%). The clinical effects depend on the localization, the size or the complications associated with the cysts. The diagnosis is based on image studies and on serology. The choice treatment is surgery. We hereby present a clinical case of hydatidosis with affectation of principal pulmonary arteries, both lungs and the liver. Hydatic cysts in the pulmonary artery correspond to a complication of hepatic or cardiac hydatidosis. In that case the choice treatment is endarterectomy, otherwise leading to develop chronic pulmonary hypertension and bad prognosis (AU)

Actualización en el nódulo pulmonar solitario / No disponible

No disponible

Evaluación de los valores de la Proteína C Reactiva y su relación con la tensión arterial en una población fumadora y no fumadora / Evaluation of C-Reactive Protein values and their relationship with blood pressure in a smoking and

Introducción: La PCR es un reactante de fase aguda sintetizado en el hígado que se asocia con una disminución de la relajacióndel endotelio vascular, con la incidencia de hipertensión arterial y parece ser predictor de riesgo cardiovascular.Objetivo: Determinar la relación de los valores de proteína C reactiva (PCR) y las cifras de tensión arterial (TA), y observar si están influidos por el hábito tabáquico. Observar si el tabaco ocasiona una respuesta inflamatoria evaluable mediante PCR en suero en la población en estudio, y si ésta se relaciona con las cifras de TA.Material y método: Se evaluaron 228 pilotos aéreos, todos hombres, se recogió la historia de tabquismo, se determinó en suero al PCR y se practicaron tomas de TA. Se analizaron los datos según fueran fumadores (97) o no (131). Se calculó la correlación entre PCR y las cifras de TA sistólica y diastólica mediante la Rho de Sperman y R de Pearson. Seconsideraron diferencias significativas para una p < 0,05.Resultados: Las edades medias fueron de 46,97 años (fumadores) y 46,80 años (no fumadores). Los niveles de PCR fueron 2,55 (± 1,86) mg/l en fumadores y de 1,55 (± 1,14) mg/l en no fumadores (p < 0,001). La cifra de tensión arterial sistólica 124,93 (± 12,71) mm Hg en fumadores y 127,06 (± 13,64) mmHg en no fumadores y de diastólica 76,89 (± 8,30) mmHg en fumadores y 77,52 (± 8,92) mmHg en no fumadores. Se ha encontrado una leve correlación positiva entre la PCR y la TA diastólica sólo en fumadores activos (r = 0,21, p < 0,03).Conclusión: Encontramos una correlación significativa entre los valores de PCR y TA diastólica sólo en fumadores, lo que sugiere una posible influencia del tabaquismo sobre la elevación de la TA mediado por un mecanismo inflamatorio

Introduction: C-reactive protein (CRP) is a synthesized acute phase reactant in the liver associated with a decrease of vascular endothelial and relaxation, with the incidence of arterial hypertension and seems to be a predictor of cardiovascularrisk.Objective: Determine the relationship of the C-reactive protein values and blood pressure (BP) values and observe if they are influenced by the smoking habit. Observe if tobacco causes an evaluable inflammatory response by CRP in serum in the study population, and if it is related with the BP values.Material and methods: A total of 228 airline pilots, all men, were evaluated. Their history of smoking was collected and CRP was measured in serum. Blood pressure was obtained. Data were analyzed according to whether they were smokers (97) or not (131). Correlation was calculated between CRP and systolic and diastolic BP values using Sperman Rho and Pearson's R. Significant differences were considered for a p < 0.05.Results: Mean ages were 46.97 years (smokers) and 46.80 years (non-smokers). CRP levels were 2.55 (± 1.86) mg/l in smokers and 1.55 (± 1.14) mg/l in non-smokers (p < 0.001). Systolic blood pressure value was 124.93 (± 12.71) mm Hg in smokers and 127.06 (± 13.64) mmHg in non-smokers and diastolic 76.89 (± 8.30) mmHg in smokers and 77.52 (± 8.92) mmHg in non-smokers. A mild positive correlation was found between CRP and diastolic BP only in active smokers (r =0.21, p < 0.03). Conclusion: We found a significant correlation between the CRP values and diastolic BP only in smokers. This suggestsa possible influence of smoking on the elevation of BP mediated by an inflammatory mechanismlll_lo (AU)

Síndrome de la cimitarra / Scimitar syndrome

No disponible

How to express tumor markers in bronchoalveolar lavage.

INTRODUCTION: Bronchoalveolar lavage (BAL) is a fundamental technique in the diagnosis of different respiratory diseases including lung cancer. Tumor marker values can be determined in the BAL fluid, but controversy still exists about how to express the results. OBJECTIVE: The aim of this study was to determine the best method of expressing tumor markers in BAL, either referring to total proteins or volume of fluid recovered. PATIENTS AND METHODS: A prospective, randomized, non-blind study was carried out. Seventy-six patients (72 men and 4 women) diagnosed with lung cancer and 17 subjects without respiratory disease were included. BAL was performed in all patients and the fluid retrieved was divided into two fractions: a bronchiolar fraction (F0) and an alveolar fraction (F1). Five tumor markers: cytokeratin fragment 19 (CYFRA 21-1), squamous cell carcinoma antigen (SCC), tissue polypeptide antigen (TPA), tissue polypeptide-specific antigen (TPS) and neuron-specific enolase (NSE) as well as total protein were measured in both fractions. The concentrations were expressed in relation to the volume of BAL fluid recovered (ng or mU/mL) and in milligrams of total protein of lavage fluid (ng or mU/mg TP). The SPSS 11.01 software was used for statistical analysis. Mann-Whitney U test and ROC curves were developed when significant differences were found. RESULTS: We found significant differences in the CYFRA 21-1 values in the two BAL fractions and in both ways of expressing its concentration; in SCC in F1 expressed in ng/mg TP; in TPA in F0 expressed in mU/mg TP; in TPS in both fractions expressed in mU/mg TP, and in NSE in both fractions in ng/mg TP. The markers that best differentiated tumors from controls (ROC curves) were CYFRA 21-1 in F0 and NSE in both fractions in ng/mg TP. CONCLUSIONS: Our study demonstrates that the concentrations of tumor markers in BAL expressed in relation to total protein were more effective than if expressed in mL of BAL fluid collected.

Marcadores tumorales en el cáncer de pulmón / Tumor markers in lung cancer

No disponible

[Free radicals in the bronchoalveolar lavage]. / Radicales libres en el lavado broncoalveolar.

Free radicals are usually reactive species, characterized by the possession of one or more unpaired electrons. This molleculles are involved in the pathogenesis of various respiratory diseases. Free radicals have been evaluated in the bronchoalveolar lavage to understand the importance of its role in lung cancer, adult respiratory distress syndrome, interstitial pulmonary diseases, tobacco induced pulmonary damage, hyperoxia and drug-induced lung toxicity. There are evidences suggesting that these agents play an important role in lung injury. These findings could lead the development of new, and more effective, therapeutic agents in some respiratory diseases.

Radicales libres en el lavado broncoalveolar / Free radicals in the bronchoalveolar lavage

Los radicales libres son moléculas inestables caracterizadas por tener uno o más electrones desapareados en su orbital externo. Estas moléculas están implicadas en la patogenia de numerosas enfermedades respiratorias. Los radicales libres han sido estudiados en el lavado boncoalveolar con el fin de determinar la importancia de su papel en distintos procesos como son el cáncer de pulmón, la toxicidad por fármacos, el síndrome del distrés respiratorio del adulto, las enfermedades pulmonares intersticiales, el daño pulmonar por el tabaco o por la hiperoxia. En la mayoría de los estudios realizados se encuentran evidencias de que estas sustancias están implicadas en la producción de la lesión pulmonar. En neumología, la comprensión de los mecanismos íntimos de actuación de estos agentes podría permitir el desarrollo de nuevos, y más eficaces, tratamientos en un gran número de enfermedades (AU)

[Kartagener's syndrome. Diagnosis in a 75 year-old woman]. / Síndrome de Kartagener. Diagnóstico en una paciente de 75 años.

Kartagener's syndrome is an inherited disease characterized by the clinical triad of bronchiectasis, sinusitis and situs inversus caused by an ultrastructural defect in the cilia that results in impaired mucociliary clearance. It is usually diagnosed during childhood, with a small number of cases discovered in adults and even fewer among patients over 60 years of age. Prompt, appropriate treatment of respiratory infections can minimize irreversible lung damage. We report the case of a woman with bronchiectasis, sinusitis and situs inversus diagnosed of Kartagener's syndrome based on clinical signs at age 75 years.