Subject(s)
Humans , Female , Middle Aged , Antihypertensive Agents/therapeutic use , Pulmonary Embolism/surgery , Hypertension, Pulmonary/surgery , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/drug therapy , Endarterectomy , Pulmonary Disease, Chronic Obstructive/therapy , Receptors, EndothelinABSTRACT
La telangiectasia hemorrágica heredofamiliar (THH) o síndrome de Rendu-Osler-Weber es un trastorno sistémico infrecuente asociado con malformaciones vasculares pulmonares (MPAV). Aunque el diagnóstico clínico puede fundamentarse en las manifestaciones cutaneomucosas, de vías aéreas altas o en los múltiples episodios de sangrado, la presencia de un compromiso pulmonar suele cursar inaparente y definir el pronóstico. Se presentan tres pacientes con una THH y con MPAV en los que la medición del shunt con O2 al 100 per cent, la ecocardiografía con contraste y la tomografía helicoidal sustentan el enfoque diagnóstico no invasor. En uno de los pacientes, la arteriografía confirmó la sospecha de MPAV única. Recibió emboloterapia quirúrgica con un coil y se obtuvo definida mejoría clínica y funcional (AU)
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Telangiectasia, Hereditary Hemorrhagic , Pulmonary Artery , Pulmonary Veins , Arteriovenous FistulaABSTRACT
Hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber syndrome, is a rare disorder that is closely linked to the development of pulmonary arteriovenous malformations (PAVM). Diagnosis can be based on clinical signs such as upper respiratory tract changes or recurrent hemorrhagic events. Nevertheless, pulmonary involvement, a prognostic factor, may remain undetected. In the three HTT cases with PAVM we report, the following diagnostic information was obtained non-invasively: shunt fraction measurements (breathing 100% oxygen), echocardiographic contrast studies, and three-dimensional helical computed tomographs. Arteriography demonstrated a single PAVM in one case and the patient underwent successful coil embolization, with clinical and functional improvement.
Subject(s)
Arteriovenous Fistula/complications , Pulmonary Artery/abnormalities , Pulmonary Veins/abnormalities , Telangiectasia, Hereditary Hemorrhagic/complications , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
STUDY OBJECTIVES: To assess oxygen desaturation during activities and to evaluate the short-term effects of supplemental O(2) use in patients with severe COPD who do not qualify for long-term O(2) therapy. DESIGN: A double-blind, randomized, placebo-controlled trial. SETTING: Outpatients from the pulmonary diseases division of a tertiary-care university hospital. PATIENTS: Twenty patients with stable COPD with FEV(1)/FVC ratios of < 50%, FEV(1) levels < 55% of the predicted normal value, and PaO(2) levels of > 60 mm Hg when resting. INTERVENTIONS: Patients were initially evaluated with pulmonary function tests, blood gas analysis, and Doppler echocardiography, and they underwent the following three 6-min walking tests (WTs) in a random sequence: basal WT (BWT); WT while breathing compressed air (CAWT); and WT while breathing O(2) (O(2)WT). MEASUREMENTS AND RESULTS: The distance walked was recorded in meters. Dyspnea was measured by Borg scale measurement before and after the tests, and arterial oxygen saturation measured by pulse oximetry (SpO(2)) was continuously monitored. Results were analyzed by grouping patients in the following manner: desaturators (DSs) (ie, patients with a drop in SpO(2) of at least 5% and < 90% during the WT) vs nondesaturators (NDSs); and O(2) responders (ie, patients with an increase of at least 10% in the distance walked and/or a decrease of at least 3 points in Borg index score) vs nonresponders. During the BWT, 11 of 20 patients (55%) were defined as desaturators. During the O(2)WT, the SpO(2) remained at > 90% in every patient. The distance walked increased by 22% (p < 0.02), and dyspnea decreased 36% (p < 0.01) in DS patients. In NDS patients, O(2) administration reduced dyspnea by 47% (p < 0.001), but the distance walked did not improve. Responses were markedly different from one patient to another. No significant differences were noticed between the results of the BWT and CAWT in any of the groups. Thirteen O(2) responders did not differ from 7 nonresponders either in basal data or in desaturation measure during the BWT, except that all walking responders (five patients) were above the median of basal left ventricle performance. CONCLUSIONS: Most of the studied COPD patients desaturated during the BWT. O(2) administration avoided desaturation and could increase the distance walked and reduce dyspnea, but these effects were not related to walking desaturation in individual cases. Improvements were not a placebo effect. The therapeutic role of O(2) during activities in some patients with severe COPD needs to be individually assessed.
Subject(s)
Lung Diseases, Obstructive/physiopathology , Lung Diseases, Obstructive/therapy , Oxygen/administration & dosage , Physical Exertion , Aged , Double-Blind Method , Dyspnea/prevention & control , Female , Humans , Male , Oxygen/analysis , Oxygen Inhalation Therapy , WalkingABSTRACT
OBJECTIVE: To survey the etiology and epidemiology of community-acquired pneumonia (CAP) in relation to age, comorbidity, and severity and to investigate prognostic factors. DESIGN: Prospective epidemiologic study, single center. SETTING: University hospital at Buenos Aires, Argentina. PATIENTS: Outpatients and inpatients fulfilling clinical criteria of CAP. INTERVENTIONS: Systematic laboratory evaluation for determining the etiology, and clinical evaluation stratifying patients into mild, moderate, and severe CAP (groups 1 to 3), a clinical rule used for hospitalization. RESULTS: During a 12-month period, 343 patients (mean age, 64.4 years; range, 18 to 102 years) were evaluated. We found 167 microorganisms in 144 cases (yield, 42%). Streptococcus pneumoniae, the most common pathogen, was isolated in 35 cases (24%). Mycoplasma pneumoniae, present in 19 (13%), was second in frequency in group 1; Haemophilus influenzae, present in 17 cases (12%), was second in group 2; and Chlamydia pneumoniae, present in 12 cases (8%), was second in group 3. Etiology could not be determined on the basis of clinical presentation; identifying the etiology had no impact on mortality. Some findings were associated with specific causative organisms and outcome. A significantly lower number of nonsurvivors received adequate therapy (50% vs 77%). CONCLUSIONS: Age, comorbidities, alcohol abuse, and smoking were related with distinct etiologies. PaO(2) to fraction of inspired oxygen ratio < 250, aerobic Gram-negative pathogen, chronic renal failure, Glasgow score < 15, malignant neoplasm, and aspirative pneumonia were associated with mortality by multivariate analysis. Local microbiologic data could be of help in tailoring therapeutic guidelines to the microbiologic reality at different settings. The stratification schema and the clinical rule used for hospitalization were useful.
Subject(s)
Community-Acquired Infections/epidemiology , Pneumonia, Bacterial/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Argentina/epidemiology , Chi-Square Distribution , Chlamydophila Infections/classification , Chlamydophila Infections/epidemiology , Chlamydophila pneumoniae , Community-Acquired Infections/classification , Community-Acquired Infections/etiology , Comorbidity , Epidemiologic Studies , Female , Follow-Up Studies , Haemophilus Infections/classification , Haemophilus Infections/epidemiology , Haemophilus influenzae , Hospitalization , Hospitals, Teaching , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Pneumonia, Bacterial/classification , Pneumonia, Bacterial/etiology , Pneumonia, Mycoplasma/classification , Pneumonia, Mycoplasma/epidemiology , Pneumonia, Pneumococcal/classification , Pneumonia, Pneumococcal/epidemiology , Prognosis , Prospective Studies , Severity of Illness Index , Survival RateABSTRACT
In community-acquired pneumonia (CAP) the pathogenic microorganism is unknown at the time of diagnosis. For that reason the antimicrobial therapy is empirical, based in the clinical picture and the presumptive causal microorganisms. Hospitalization is one of the most important decisions in patients with CAP. Clinical criteria appropriate to identifying those patients requiring hospital admission for antimicrobial administration and clinical control must be defined. The stratification of patients according to the presence of risk factors such as age and co-morbidities permit to predict which are the potential pathogenic microorganisms and their adequate therapy. Trovafloxacin covers all the presumed bacterial spectrum, pharmacokinetics, easiness to be administered and to pass to the oral route, advantageous for all the groups under consideration. Patients older than 65 years of age or with co-morbidities and those that need to be hospitalized receive clear benefits from this antibiotic.
Subject(s)
Anti-Infective Agents/therapeutic use , Fluoroquinolones , Naphthyridines/therapeutic use , Pneumonia, Bacterial/drug therapy , Adult , Aged , Child, Preschool , Community-Acquired Infections/drug therapy , Drug Administration Schedule , Hospitalization , Humans , Infant , Middle Aged , Risk Factors , Severity of Illness IndexABSTRACT
In community-acquired pneumonia (CAP) the pathogenic microorganism is unknown at the time of diagnosis. For that reason the antimicrobial therapy is empirical, based in the clinical picture and the presumptive causal microorganisms. Hospitalization is one of the most important decisions in patients with CAP. Clinical criteria appropriate to identifying those patients requiring hospital admission for antimicrobial administration and clinical control must be defined. The stratification of patients according to the presence of risk factors such as age and co-morbidities permit to predict which are the potential pathogenic microorganisms and their adequate therapy. Trovafloxacin covers all the presumed bacterial spectrum, pharmacokinetics, easiness to be administered and to pass to the oral route, advantageous for all the groups under consideration. Patients older than 65 years of age or with co-morbidities and those that need to be hospitalized receive clear benefits from this antibiotic.
ABSTRACT
UNLABELLED: Thirty asthmatic patients were evaluated to assess the association of therapy with inhalatory corticosteroids and an educational program, EDUCASMA. Spirometric evaluation with Flow-Volume loop (MEDICAL GRAPHIC CPF-S), ambulatory FEP (mini WRIGHT meters) was performed. In regard of initial symptoms patients were qualified as moderate or severe. After two weeks of a screening period, they were randomized into 2 groups: a) beclomethasone; b) budesonide; respective doses in according to the initial status. During the study period (8 wks) they visited the medical Staff six or more times. In each visit the patients received clinical evaluation (i.e. clinical scoring), spirometry (i.e. FEV1), and FEP ambulatory revision. FEP x (mean), FEP delta, FEV1, and clinical scores values were matched at the start and at the end of the follow-up period. Non-parametric statistics were applied (Wilcoxon test) and significative changes were defined (p < 0.05). CONCLUSIONS: 1) inhalatory corticosteroids therapy associated with a previous educational program could achieve early improvements of clinical scores; 2) in moderate asthma ambulatory FEP showed objective changes both in beclomethasone and budesonide treatments. It appears to indicate increasing changes very close to the clinical improvement; 3) the short period of our observation and the inflammatory condition of airways in severe asthma, could be explained as probable factors for the minor differences in the FEV1 evaluation; 4) no differences between budesonide and beclomethasone treatment were found.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Asthma/drug therapy , Beclomethasone/administration & dosage , Budesonide/administration & dosage , Health Education , Patient Education as Topic , Administration, Inhalation , Administration, Topical , Adolescent , Adult , Aged , Anti-Inflammatory Agents/therapeutic use , Beclomethasone/therapeutic use , Budesonide/therapeutic use , Female , Follow-Up Studies , Glucocorticoids , Humans , Male , Middle Aged , Severity of Illness Index , SpirometryABSTRACT
Community-acquired pneumonia (CAP) affects approximately 1% of the population annually. Initial antimicrobial therapy is most often empirical. Guidelines designed in other countries for the empirical management of CAP are not recommended for use in Argentina. Studies from other countries were considered together with unpublished local data to define the potential etiologic microorganisms and their antimicrobial susceptibility. Recommended diagnostic tests, groups of patients for different therapies and hospitalization criteria were defined. Severe CAP requiring intensive care was distinguished from the rest because of its distinct spectrum of etiologic agents and its high mortality, requiring a more focused therapy. Age, coexisting conditions and severity of illness were taken into account in the election of therapy.
Subject(s)
Pneumonia/diagnosis , Pneumonia/epidemiology , Pneumonia/therapy , Argentina , Community-Acquired Infections , HumansSubject(s)
Asthma/mortality , Adolescent , Adult , Age Factors , Argentina , Australia , Canada , Child , Child, Preschool , Humans , Infant , Infant, Newborn , New Zealand , United Kingdom , United StatesSubject(s)
Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Asthma/mortality , Age Factors , ArgentinaSubject(s)
Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Asthma/mortality , Age Factors , ArgentinaABSTRACT
Se comunica el caso de una mujer de 44 años con cuadro clínico-histopatológico de una linfangiomiomatosis. Presentaba además lesiones cutáneas y estigmas neurológicos de esclerosis tuberosa. Desarrolló quilotorax recurrente y peoría progresiva que no pudieron ser controladas mediante tratamiento con dieta, broncodilatadores, corticoides y progesterona. La búsqueda de receptores estrogénicos en una biopsia pulmonar a cielo abierto fue positiva. Tal hallazgo representa una evidencia importante para establecer una asociación entre esclerosis tuberosa y linfangiomiomatosis. El tratamiento con tamoxifeno y la pleurodesis con tetraciclina fueron medidas terapéuticas satisfactorias para detener el curso progresivo de la enfermedad y controlar el quilotorax
Subject(s)
Adult , Humans , Female , Lymphangiomyoma/complications , Tuberous Sclerosis/complications , Muscle, Smooth/pathology , Lung/pathology , Chylothorax/therapy , Tamoxifen/therapeutic useABSTRACT
Se comunica el caso de una mujer de 44 años con cuadro clínico-histopatológico de una linfangiomiomatosis. Presentaba además lesiones cutáneas y estigmas neurológicos de esclerosis tuberosa. Desarrolló quilotorax recurrente y peoría progresiva que no pudieron ser controladas mediante tratamiento con dieta, broncodilatadores, corticoides y progesterona. La búsqueda de receptores estrogénicos en una biopsia pulmonar a cielo abierto fue positiva. Tal hallazgo representa una evidencia importante para establecer una asociación entre esclerosis tuberosa y linfangiomiomatosis. El tratamiento con tamoxifeno y la pleurodesis con tetraciclina fueron medidas terapéuticas satisfactorias para detener el curso progresivo de la enfermedad y controlar el quilotorax (AU)
Subject(s)
Adult , Humans , Female , Tuberous Sclerosis/complications , Lymphangiomyoma/complications , Muscle, Smooth/pathology , Lung/pathology , Chylothorax/therapy , Tamoxifen/therapeutic useABSTRACT
Se describen 2 pacientes portadores de hipertensión pulmonar primaria, comprobada por autopsia. Ambas presentaron un colapso hemodinámico, en un caso fatal, después del enclavamiento espontáneo de un catéter de Swan-Ganz en ramas periféricas de arterias pulmonares. En la paciente que falleció pocas horas después de ocurrida la complicación, no se apreciaron alteraciones morfológicas que explicaran el trastorno hemofinámico observado. La migración y enclavamiento espontáneos del catéter parecerían constituir una complicación más frecuente y sus consecuencias particularmente peligrosas (a diferencia de lo que ocurre habitualmente) en estos pacientes, por lo cual sería recomendable retirar el dispositivo en cuestión a una posición bien proximal en el tronco de la arteria pulmonar luego de registrar en forma basal y por única vez la presión capilar pulmonar mediante el inflado del balón, ya que en enfermedades cuya terapéutica es de eficacia discutida es preferible no ahondar el estudio cuando éste importa un riesgo para el enfermo
