Fibrosis pulmonar idiopática, tenemos alteranativas / No disponible

Presentamos un paciente con diagnóstico de fibrosis pulmonar idiopática (FPI) de grado moderado, en el que se inicia tratamiento con pirfenidona. Ante los efectos secundarios cutáneos recidivantes, a pesar de correctas medidas preventivas de protección solar, se suspende dicho fármaco y se inicia tratamiento alternativo con nintedanib, con efectos gastrointestinales leves que se controlan con tratamiento sintomático. A los 4 meses se observa mejoría clínica y leve mejoría funcional

We present a patient diagnosed with idiopathic pulmonary fibrosis (IPF) of moderate degree, in which treatment is initiated with pirfenidone. Given the recurrent cutaneous side effects, although correct sunscreen preventive measures, the drug is discontinued and alternative treatment begins with nintedanib with mild gastrointestinal effects that are controlled with symptomatic treatment. At 4 months mild clinical improvement and functional improvement is observed

Rentabilidad diagnóstica de la broncoscopia en la enfermedad neoplásica en la Unidad de Fibrobroncoscopias del Hospital General Universitario de Albacete / Diagnostic yield of bronchoscopy in neoplastic disease in Bronchofibroscopy Unit of Albacete General University Hospital

Antecedentes: El cáncer de pulmón es la segunda causa de muerte después de las enfermedades cardiovasculares. El carcinoma broncogénico tiene una causa desencadenante fundamental, el tabaco. La fibrobroncoscopia es necesaria para el diagnóstico y la estadificación del cáncer pulmonar, lo que nos ayudará a estimar el pronóstico y decidir la actitud terapéutica a seguir. En este estudio analizamos la rentabilidad de las distintas técnicas de la broncoscopia en el diagnóstico del cáncer de pulmón. Métodos: En 181 pacientes a los que se realizó fibrobroncoscopia y que tuvieron un diagnóstico final de neoplasia, se analizó la comorbilidad previa, el hábito tabáquico, las diversas técnicas broncoscópicas a las que fueron sometidos y el estadio TNM en el que se hallaban en el momento del diagnóstico. También se valoró la rentabilidad de nuestras técnicas en relación con otros estudios de la bibliografía. Resultados: El 86,2% de los pacientes presentaba historia de tabaquismo; el 49,2%, diagnóstico de enfermedad pulmonar obstructiva crónica, y el 18,9%, otra neoplasia previa. La exploración endoscópica mostró lesión endobronquial en el 58% de los pacientes. El broncoaspirado fue positivo en el 53,6% de los procedimientos realizados; la biopsia bronquial, en el 81,9%; la biopsia transbronquial, en el 71,8% (en asociación con radioscopia positiva en el 81% y sin radioscopia, en el 61% de los casos), y la punción transbronquial, positiva en el 64,3% (con patólogo presente la rentabilidad diagnóstica ascendía al 72,7%). Conclusiones: La rentabilidad de las técnicas fibrobroncoscópicas que se utilizan en nuestro medio es similar a la de otros estudios importantes realizados hasta la fecha (AU)

Background: Lung cancer is the second leading cause of mortality after cardiovascular diseases. Bronchogenic carcinoma has a fundamental underlying cause, that is, tobacco. The bronchoscopy is required for lung cancer diagnosis and staging and will help us to estimate prognosis and determine the therapeutic approach to follow. In this study, the yield of the various techniques of bronchoscopy in the diagnosis of lung cancer has been analyzed. Methods: Previous comorbidity, smoking habit, the different bronchoscopic techniques the subject underwent and the patient's TNM stage at the time of diagnosis were analyzed in 181 patients who underwent bronchoscopy and whose final diagnosis was neoplasm. The performance of our techniques in relation to other studies in the literature was also evaluated. Results: A total of 86.2% of patients had a history of smoking, 49.2%, diagnosis of Chronic obstruction pulmonary disease and 18.9% had had another previous malignancy. The endoscopic examination showed endobronchial lesion in 58% of patients. BAS was positive in 53.6% of procedures performed, bronchial biopsy 81.9%, transbronchial biopsy in 71.8% (in association with positive fluoroscopy in 81% and without fluoroscopy in 61% of cases) and positive transbronchial needle aspiration in 64.3% (with pathologist present the diagnostic yield amounted to 72.7%). Conclusions: The yield of bronchoscopic techniques used in our environment is similar to that found in other major studies conducted to date (AU)

[Usefulness of bronchofiberscopy in the study of pleural effusion]. / Utilidad de la broncofibroscopia en el estudio del derrame pleural.

We revised our own experience in 208 patients with pleural effusion to whom fiberoptic bronchoscopy was made in part of the diagnostic study. In our population the most frequent cause was neoplastic origen, observing that in 97 patients (46%), 60 of them were due to bronchogenic carcinoma. In relation to the presentation symptoms, just when haemoptysis was present bronchoscopy exhibited bigger diagnostic profitability (17 of 29), p < 0.001. There were 106 patients (51%) who had some or several parenchymatic injuries going with the pleural effusion. In this group, in 55 cases, fiberoptic bronchoscopy was useful to the diagnosis; on the contrary when the only radiologic abnormality was pleural effusion, 102 cases, in 96 of them the procedure was not diagnostic, p < 0.001. A close relationship was noticed between diagnostic profitability of bronchoscopy with the existence of pulmonary neoplasm; about the 61 diagnosed patients using bronchoscopy, 53 of them had bronchogenic carcinoma, p < 0.001. We conclude then in our experience bronchoscopy is useful to the diagnosis of pleural effusion if it goes with haemoptysis or parenchymatic lesions in the radioly. Its diagnostic profitability has close relationship with the existence of bronchogenic carcinoma.