ABSTRACT
Adult pulmonary Langerhans cell histiocytosis (PLCH) is a rare disorder of unknown etiology that occurs predominantly in young smokers, with an incidence peak at 20-40 years of age. In adults, pulmonary involvement with Langerhans cell histiocytosis usually occurs as a single-organ disease and is characterized by focal Langerhans cell granulomas infiltrating and destroying distal bronchioles. We report a 23-year-old asymptomatic male smoker with a non specific interstitial infiltrate found in preventive chest X ray examination. A high resolution chest CT scan showed multiple cystic structures predominating in the upper lobes, with small centrilobular nodules. A transbronchial biopsy showed a lymphocytic lung infiltrate with Langerhans cells. A surgical biopsy confirmed the diagnosis of pulmonary Langerhans cell histiocytosis. After six months of follow up, the patient is in good conditions.
Subject(s)
Histiocytosis, Langerhans-Cell/diagnosis , Biopsy , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Radiography , Smoking/adverse effects , Young AdultABSTRACT
Introducci¨®n y objetivosLa demanda fisiol¨®gica impuesta por la prueba de marcha de 6 min (PM6M) se ha estudiado escasamente en la enfermedad pulmonar obstructiva cr¨®nica (EPOC) y se desconoce si la gravedad de la enfermedad la afecta. El objetivo del presente estudio fue comparar la PM6M con una prueba de ejercicio cardiopulmonar (PECP) incremental en pacientes categorizados por gravedad y se us¨® como punto de corte un volumen espiratorio forzado en el primer segundo (FEV1) del 50% del valor predicho.Pacientes y m¨¦todoEn 81 pacientes a los que se les realizaron ambos ejercicios se evalu¨® el consumo de ox¨ªgeno (úýO2), la producci¨®n de anh¨ªdrido carb¨®nico (úýCO2), la ventilaci¨®n por minuto, la frecuencia card¨ªaca (FC) y la oximetr¨ªa de pulso con un equipo port¨¢til; adem¨¢s, se cuantific¨® la disnea y la fatigabilidad.ResultadosDurante la PM6M, la velocidad adoptada fue constante y el úýO2 ascendi¨® hasta una meseta a los 3 min, independientemente de la gravedad de la EPOC. Comparado con la PECP, en los pacientes con FEV1 ¡Ý50%, el úýO2 fue mayor, pero la úýCO2, la ventilaci¨®n por minuto, la FC, la disnea, la fatiga de las piernas y la oximetr¨ªa de pulso fueron significativamente inferiores durante la PM6M. En cambio, en aqu¨¦llos con FEV1 <50% la úýCO2, la FC y la disnea fueron similares. La distancia recorrida durante la PM6M en el grupo total se correlacion¨® estrechamente con el úýO2 de la PECP (r=0,78; p=0,0001).Conclusi¨®nLa PM6M posee las caracter¨ªsticas de un ejercicio de carga constante, independientemente del estadio de la EPOC. Impone una alta exigencia metab¨®lica, ventilatoria y cardiovascular, mayor en los pacientes m¨¢s graves, lo que explicar¨ªa la estrecha correlaci¨®n entre distancia recorrida (PM6M) y úýO2 m¨¢ximo (PECP)(AU)
Background and objectivesThe physiological load imposed by the six minute walk test (SMWT) in chronic obstructive pulmonary disease (COPD) patients come from small studies where the influence of disease severity has not been assessed. The aim of the present study was to compare the SMWT with an incremental cardiopulmonary exercise test (CPET) in patients classified by disease severity according to FEV1 (cutoff 50% predicted).Patients and methodsEighty-one COPD patients (53 with FEV1 ¡Ý50%) performed both tests on two consecutive days. Oxygen consumption (úýO2), carbon dioxide production (úýCO2), minute ventilation (úýE), heart rate (HR) and pulse oximetry (SpO2) were measured during SMWT and CPET using portable equipment. Dyspnea and leg fatigue were measured with the Borg scale.ResultsIn both groups, walking speed was constant during the SMWT and úýO2 showed a plateau after the 3rd minute. When comparing SMWT (6th min) and peak CPET, patients with FEV1 ¡Ý50% showed a greater úýO2, but lower values of úýCO2,VE, HR, dyspnea, leg fatigue, and SpO2 during walking. In contrast, in those with FEV1 <50% predicted values were similar. Distance walked during the SMWT strongly correlated with úýO2 at peak CPET (r=0.78; P=0.0001).ConclusionThe SMWT is a constant load exercise in COPD patients, regardless of disease severity. It imposes high metabolic, ventilatory and cardiovascular requirements, which were closer to those of CPET in severe COPD. These findings may explain the close correlation between distance walked and peak CPET úýO2(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/rehabilitation , Pulmonary Disease, Chronic Obstructive/therapy , Gait/physiology , Carbon Dioxide/metabolism , Carbon Dioxide/physiology , Dyspnea/metabolism , Dyspnea/physiopathology , Oximetry/instrumentation , Oximetry/methods , Oximetry , Lactic Acid/metabolism , 28599ABSTRACT
BACKGROUND AND OBJECTIVES: The physiological load imposed by the six minute walk test (SMWT) in chronic obstructive pulmonary disease (COPD) patients come from small studies where the influence of disease severity has not been assessed. The aim of the present study was to compare the SMWT with an incremental cardiopulmonary exercise test (CPET) in patients classified by disease severity according to FEV(1) (cutoff 50% predicted). PATIENTS AND METHODS: Eighty-one COPD patients (53 with FEV(1) > or =50%) performed both tests on two consecutive days. Oxygen consumption (VO(2)), carbon dioxide production (VCO(2)), minute ventilation (V(E)), heart rate (HR) and pulse oximetry (SpO(2)) were measured during SMWT and CPET using portable equipment. Dyspnea and leg fatigue were measured with the Borg scale. RESULTS: In both groups, walking speed was constant during the SMWT and VO(2) showed a plateau after the 3rd minute. When comparing SMWT (6th min) and peak CPET, patients with FEV(1) > or =50% showed a greater VO(2), but lower values of VCO(2),V(E), HR, dyspnea, leg fatigue, and SpO(2) during walking. In contrast, in those with FEV(1) <50% predicted values were similar. Distance walked during the SMWT strongly correlated with VO(2) at peak CPET (r=0.78; P=0.0001). CONCLUSION: The SMWT is a constant load exercise in COPD patients, regardless of disease severity. It imposes high metabolic, ventilatory and cardiovascular requirements, which were closer to those of CPET in severe COPD. These findings may explain the close correlation between distance walked and peak CPET VO(2).
