[Physiopathology of respiratory insufficiency of neuromuscular origin]. / Fisiopatología de la insuficiencia respiratoria de origen neuromuscular.

OBJECTIVE: To review the mechanisms involved in the appearance of respiratory failure in patients with neuromuscular disorders. DEVELOPMENT: The development of respiratory failure in patients with weakness of the respiratory muscles secondary to neuromuscular disease is not only due to the disease itself. There are also other mechanisms which contribute in varying degrees. These mechanisms are: 1. Alteration of the mechanical properties of the respiratory apparatus; 2. The appearance of muscle fatigue; 3. Alterations in the control of ventilation; 4. Alterations in gas exchange during the night leading to loss of sensitivity of central and peripheral chemoreceptors. 5. Dysfunction of the upper airway, which favors the appearance of obstructive apnea during sleep. The part played by each of these mechanisms in the development of respiratory failure is different in each individual patient, depending on the type and severity of his particular illness. Ventilatory assistance at night has been shown to be effective in correcting respiratory failure during the day in these patients, probably by acting to a greater or lesser extent on all the different mechanisms involved. CONCLUSIONS: The origin of the respiratory failure seen in patients with neuromuscular diseases is due to many factors. Nocturnal ventilatory assistance is effective since it acts on all the different mechanisms involved.

The clinical value of neuron-specific enolase as a tumor marker in bronchoalveolar lavage.

BACKGROUND: Neuron-specific enolase (NSE) is used in the staging and monitoring of responses to therapy and the detection of recurrences in lung cancer. The diagnostic value of NSE has been under discussion. This may be because NSE usually has been studied in the sera of patients with bronchogenic carcinoma and not in the bronchoalveolar lavage (BAL). METHODS: The NSE levels in the BAL of three groups--control subjects, patients with chronic bronchitis, and patients with tumors--were analyzed. The fluid obtained was centrifuged. The NSE was analyzed in the supernatant of the BAL (NSE, Pharmacia, Columbia, MD). Its concentrations were calculated in relation to milligrams of total protein. RESULTS: A significant difference was noted in the level of NSE in the BAL of the tumor group compared with those of the other two groups. No differences were observed between the other two groups or between healthy smokers and nonsmokers. No correlation was found with the histologic type of pulmonary carcinoma and NSE levels in BAL. The NSE levels were higher in the lavages of patients with primary pulmonary carcinomas than in those with metastases. CONCLUSIONS: Neuron-specific enolase could be of aid in the early diagnosis of solitary pulmonary nodules and lung cancer. More studies would be required to identify a correlation between NSE levels in BAL and those in serum, or between NSE levels in BAL and tumor size and location and disease stage of lung cancer.

[Prevention of tuberculosis infection]. / La prevención de la infección tuberculosa.

Tuberculosis (TB) is a disease caused by a mycobacterium, whose incidence has increased in the past years. This increase is related to the adquired immunodeficiency syndrome (AIDS). Due to its high prevalence, Spain is considered a developing country. The tuberculous infection depends on the degree of functionality of the alveolar macrophages that stimulate the lymphocytes and isolate the bacillus. The infection by mycobacterias can be quantified by means of the cutaneous reaction against tuberculin and mantoux, allowing us to select the subjects that must receive prophylaxis. For its correct interpretation, it is currently recommended to avoid BCG vaccination of children, except in countries with high prevalence of TB.

[Current status of lung transplantation]. / Situación actual del trasplante de pulmón.

Lung transplant has started to develop clinically during the last decade being a valid alternative for a great number of pulmonary diseases. A review of the three types of transplant is presented: single lung, double lung, and heart-lung transplant. We specially point out the indications of those surgical procedures. Furthermore, we expose the attitude towards most of the post-surgery problems: post-surgical follow up, immunosuppression therapy, diagnosis and treatment of graft rejection, main opportunistic infections as well as obliterans bronchiolitis, which is the long term most important complication.

[Clinical study of 20 cases of bronchial carcinoid]. / Estudio clínico de veinte casos de carcinoide bronquial.

We present a retrospective study of twenty patients in whom bronchial carcinoids, and five, peripheric. One case met the criteria of atypical carcinoid. The mean age of presentation was 46.66 +/- 17.07 years (15-76), with predominance of the female gender (3:2). Twenty per cent of patients were asymptomatic and in the remainder, the diagnosis suffered an average delay of 19 months since the appearance of symptoms. Such symptoms were cough (50%), recurrent pneumonias (40%), fever (35%), hemoptysis (35%), thoracal pain (30%), carcinoid syndrome (10%) and consumptive syndrome (5%). The radiology showed lobular or segmentary atelectasis (40%), nodule/mass (30%), lobular or segmentary consolidation (20%), obstructive pneumonitis (5%) and atypical pleural effusion (5%). Direct endoscopic vision offered a sensitivity of 84.6%, while transbronchial biopsy, just 69.2%. Metastasis in mediastinal, suprarenal, thyroid and brain gangliar chains were detected.