[Usefulness of transcutaneous carbon dioxide pressure monitoring to measure blood gases in adults hospitalized for respiratory disease]. / Utilidad de la presión transcutánea del anhídrido carbónico en la valoración gasométrica de adultos hospitalizados con enfermedad respiratoria.

OBJECTIVE: To evaluate the usefulness of transcutaneous carbon dioxide pressure (TcPCO2) monitoring in patients hospitalized for respiratory disease. PATIENTS AND METHODS: We used a SenTec TcPCO2 monitor that also determines transcutaneous oxygen saturation (SpO2) by means of a sensor placed behind the ear lobe at a temperature of 42 degrees C. We compared arterial blood gas measurements--PaCO2 and arterial oxygen saturation (SaO2)--with transcutaneous measurements and analyzed the correlation, regression line, and agreement between the 2 methods. RESULTS: Thirty patients (20 men and 10 women) with various respiratory diseases and a mean (SD) age of 71 (13) years were included in the study. The median TcPCO2 was 43.25 mm Hg and the median PaCO2 was 42.6 mm Hg with no significant differences between the 2 measurements. The correlation was significant (rho=0.979; P< .0001) and the corresponding regression equation was TcPCO2=-2.475+1.058 PaCO2. The mean difference was 0.16 mm Hg (95% confidence interval [CI], --0.74 to 1.06). The lower limit of agreement (mean -1.96 SD) was -4.64 mm Hg, and the upper limit (mean +1.96 SD) was 4.96 mm Hg. For SaO2, the median was 94% and for SpO2, 95%. The difference between the 2 medians was significant (P< .004). The correlation was also significant (rho=0.822; P< .0001) with SpO2=4.427+0.97 SaO2. The mean difference was 1.14% (95% CI, 0.381% to 1.899%). The lower limit of agreement (mean -1.96 SD) was --2.93% and the upper limit (mean +1.96 SD) was 5.21% CONCLUSIONS: Transcutaneous determination of carbon dioxide pressure and oxygen saturation is useful for patients hospitalized for respiratory disease in view of its good correlation and agreement, although SpO2 does tend to overestimate SaO2.

Utilidad de la presión transcutánea del anhídrido carbónico en la valoración gasométrica de adultos hospitalizados con enfermedad respiratoria / Usefulness of transcutaneous carbon dioxide pressure monitoring to measure blood gases in adults hospitalized for respiratory disease

Objetivo: Estudiar la utilidad de la medida de la presión transcutánea de anhídrido carbónico (PtcCO2) en pacientes con enfermedad respiratoria hospitalizados. Pacientes y métodos: Utilizamos el analizador de PtcCO2 SenTec®, que también determina la saturación transcutánea de oxígeno (SpO2), mediante un sensor colocado en el lóbulo de la oreja a una temperatura de 42 °C. Se compararon los valores gasométricos ­--presión arterial de anhídrido carbónico (PaCO2) y saturación arterial de oxígeno (SaO2)--­ con los transcutáneos, analizando la correlación, recta de regresión y la concordancia entre ambos métodos. Resultados: Se incluyó a 30 pacientes (20 varones y 10 mujeres) con diversas enfermedades respiratorias, con una media (± desviación estándar [DE]) de edad de 71 ± 13 años. La mediana de la PtcCO2 era de 43,25 mmHg, y la de la PaCO2 de 42,6 mmHg, sin existir diferencias entre ellas. La correlación era significativa (ρ = 0,979; p < 0,0001), siendo la PtcCO2 = -­2,475 + 1,058 PaCO2. La media de las diferencias fue de 0,16 mmHg (intervalo de confianza del 95%, de ­-0,74 a 1,06); la media de las diferencias menos 1,96 DE fue de ­-4,64 mmHg, y más 1,96 DE, de 4,96 mmHg. En cuanto a la SaO2, la mediana era del 94%, y la de la SpO2 del 95%, con diferencias entre ambas (p < 0,004). La correlación fue significativa (ρ = 0,822; p < 0,0001), con SpO2 = 4,427 + 0,97 SaO2. La media de la concordancia era del 1,14% (intervalo de confianza del 95%, 0,381-1,899%); la media menos 1,96 DE era del ­-2,93%, y más 1,96 DE, del 5,21%. Conclusiones: La determinación transcutánea de anhídrido carbónico y de la SaO2 es de utilidad en pacientes con enfermedad respiratoria hospitalizados, dada su buena correlación y concordancia, aunque la SpO2 tiende a sobrevalorar la SaO2

Objective: To evaluate the usefulness of transcutaneous carbon dioxide pressure (TcPCO2) monitoring in patients hospitalized for respiratory disease. Patients and methods: We used a SenTec TcPCO2 monitor that also determines transcutaneous oxygen saturation (SpO2) by means of a sensor placed behind the ear lobe at a temperature of 42ºC. We compared arterial blood gas measurements--PaCO2 and arterial oxygen saturation (SaO2)--with transcutaneous measurements and analyzed the correlation, regression line, and agreement between the 2 methods. Results: Thirty patients (20 men and 10 women) with various respiratory diseases and a mean (SD) age of 71 (13) years were included in the study. The median TcPCO2 was 43.25 mm Hg and the median PaCO2 was 42.6 mm Hg with no significant differences between the 2 measurements. The correlation was significant (ρ=0.979; P<.0001) and the corresponding regression equation was TcPCO2=­-2.475+1.058 PaCO2. The mean difference was 0.16 mm Hg (95% confidence interval [CI], ­-0.74 to 1.06). The lower limit of agreement (mean ­-1.96 SD) was ­-4.64 mm Hg, and the upper limit (mean +1.96 SD) was 4.96 mm Hg. For SaO2, the median was 94% and for SpO2, 95%. The difference between the 2 medians was significant (P<.004). The correlation was also significant (ρ=0.822; P<.0001) with SpO2=4.427+0.97 SaO2. The mean difference was 1.14% (95% CI, 0.381% to 1.899%). The lower limit of agreement (mean ­1.96 SD) was ­-2.93% and the upper limit (mean +1.96 SD) was 5.21% Conclusions: Transcutaneous determination of carbon dioxide pressure and oxygen saturation is useful for patients hospitalized for respiratory disease in view of its good correlation and agreement, although SpO2 does tend to overestimate SaO2

[Bronchioloalveolar adenoma associated with bronchiolitis obliterans and leishmaniasis with lung involvement in acquired immunodeficiency syndrome]. / Adenoma bronquioloalveolar asociado a bronquiolitis obliterante y leishmaniasis pulmonar en el sida.

Visceral leishmaniasis is not unusual in patients with acquired immunodeficiency syndrome (AIDS), but lung infiltration is uncommon. Leishmaniasis involving the lung often manifests as interstitial pneumonitis. We report a case in which the discovery of amastigotes in the transbronchial biopsy led to a diagnosis of leishmaniasis. However, the findings from x-rays and study of the bronchoalveolar lavage fluid were consistent with bronchiolitis obliterans, possibly caused by the AIDS virus. In addition, the transbronchial biopsy findings were consistent with a diagnosis of bronchioloalveolar adenoma with radiographic evidence of multiple nodules.

Adenoma bronquioloalveolar asociado a bronquiolitis obliterante y leishmaniasis pulmonar en el sida / Bronchioloalveolar adenoma associated with bronchiolitis obliterans and leishmaniasis with lung involvement in acquired immunodeficiency syndrome

La leishmaniasis visceral no es inusual en pacientes con síndrome de inmunodeficiencia adquirida (sida), pero su afectación pulmonar es infrecuente. La leishmaniasis pulmonar a menudo se presenta como neumonitis intersticial. Describimos un caso en el cual el hallazgo de amastigotes en la biopsia transbronquial permitió el diagnóstico de leishmaniasis pulmonar. Sin embargo, los hallazgos radiológicos y del lavado broncoalveolar eran compatibles con una bronquiolitis obliterante que podría deberse al virus del sida. Además, la biopsia transbronquial permitió diagnosticar un adenoma bronquioloalveolar con la presencia radiológica de múltiples nódulos

Visceral leishmaniasis is not unusual in patients with acquired immunodeficiency syndrome (AIDS), but lung infiltration is uncommon. Leishmaniasis involving the lung often manifests as interstitial pneumonitis. We report a case in which the discovery of amastigotes in the transbronchial biopsy led to a diagnosis of leishmaniasis. However, the findings from x-rays and study of the bronchoalveolar lavage fluid were consistent with bronchiolitis obliterans, possibly caused by the AIDS virus. In addition, the transbronchial biopsy findings were consistent with a diagnosis of bronchioloalveolar adenoma with radiographic evidence of multiple nodules

Initial pleural pressure measurement in spontaneous pneumothorax.

To assess whether pleural pressure (PP) measurement is helpful in evaluating the evolution of spontaneous pneumothorax (SP). To measure the inspiratory and expiratory PP at tidal volume in the SP in 85 cases. Ninety-one percent were cured with medical treatment, whereas the remaining 9% required surgery. In the cases medically resolved, the inspiratory pleural pressure (IPP) was -9 +/- 5 mbar, and the expiratory pleural pressure (EPP) was -3 +/- 6 mbar, whereas in the surgical cases, IPP was -7 +/- 2 mbar (p = not significant), and EPP was 1 +/- 3 mbar (p < 0.01). In the SP cases, which resolved in less than 7 days of drainage, IPP was -10 +/- 5 mbar, and EPP was -3 +/- 5 mbar, whereas IPP was -8 +/- 3 mbar (p < 0.01), and EPP was 0 +/- 4 mbar (p < 0.001) in those cases in which SP resolution required more than 7 days. The sensitivity to predict the need for surgery with an EPP > or = 2 mbar was 100%, with a specificity of 49%. The cutoff of the curve was > or = 1 mbar, with a sensitivity of 65% and specificity of 70%. The values of PP at the end of an expiration to tidal volume were negative in the SP cases, which were resolved by medical treatment, whereas they were atmospheric in those cases that required surgery. The static inspiratory and expiratory PP in the SP cases requiring thoracic drainage during < 7 days showed more negative PP than those that resolved in a period longer than 7 days.

[Chronic eosinophilic pneumonia. An analysis of 4 cases]. / Neumonía eosinófila crónica. Análisis de cuatro casos.

Chronic eosinophilic pneumonia (CEP) is characterized by non-specific clinical presentation, interstitial radiological signs, peripheral acini and pulmonary infiltration by eosinophils, accompanied or not by peripheral eosinophilia. Response to treatment with steroids is spectacular. We describe 4 patients with CEP, one diagnosed by response to treatment and the others by bronchoalveolar lavage (BAL). No patient had asthma; 1 also had peripheral eosinophilia. All received long-term treatment with steroids, and there were no relapses. Response to treatment was slow in 2 patients, but obliterans bronchiolitis with or without organizing pneumonia could not be demonstrated. We emphasize the safety and efficiency of BAL for diagnosis of CEP.

[Evaluation of transcutaneous oxygen pressure in adults with respiratory pathology]. / Valoración de la presión transcutánea de oxígeno en adultos con patología respiratoria.

The usefulness of the transcutaneous oxygen tension (tcPO2) in adults is under controversy. In a varied group of respiratory patients, results of the application of this method were compared with those from the arterial blood sampling method. Thirty-eight arterial oxygen tension (PaO2) and tcPO2 simultaneous determinations were made in a group of 22 patients, while in a sitting position; the tcPO2 measurements obtained (68 +/- 12.36 Torr) were significantly lower (p less than 0.05) than the PaO2 values (74 +/- 13.07 Torr). The correlation coefficient was 0.51 (p less than 0.01) with a regression line, tcPO2 = 31.58 + 0.48 PaO2. It is concluded that tcPO2 measurement does not correlate well with PaO2 and that this method cannot be always be safely applied and used in adults with respiratory diseases.

[Pleural tuberculosis: yield of thoracoscopy]. / Tuberculosis pleural: rentabilidad de la toracoscopia.

34 tuberculosis with pleural affectation were diagnosed after examining 292 pleural effusions. 19 cases studied were diagnosed by pleuroscopy. The mean age of patients was 38 years old. The cytology, being mainly limphocytes, cultures and bacyloscopy, were all negative. The cultures of the biopsies was positive in 36.7% of the cases. The pathology report was positive in 88% of them. There was macroscopic suspicion of the disease in 73.6% with good macro-microscopic correlation this being the reason of the early treatment applied. We concluded that pleuroscopy is a good technique to diagnose pleural tuberculosis, reducing the hospital admission time.