[Acute non-cardiogenic pulmonary edema secondary to hydrochlorothiazide therapy]. / Edema agudo de pulmón no cardiogénico secundario a hidroclorotiazida.

Several commonly prescribed drugs can cause acute non-cardiogenic pulmonary edema. A cause-effect relationship is usually difficult to establish because symptoms are not specific. We report a case of pulmonary edema induced by a common diuretic, hydrochlorothiazide. This complication can occur after a first dose of the drug or in patients who have been taking it with no side effects. Edema is due to an idiosyncratic reaction rather than an immune response. The clinical course is usually favorable over the first 24 hours with treatment of blood pressure and respiratory support. Given that severity increases with recurrence, we underline the importance of diagnosis in the first episode.

Edema agudo de pulmón no cardiogénico secundario a hidroclorotiazida / Acute non-cardiogenic pulmonary edema secondary to hydrochlorothiazide therapy

Diversos fármacos utilizados con asiduidad pueden producir edema agudo de pulmón no cardiogénico. En la mayoría de los casos es difícil establecer la relación causal por la inespecificidad de los síntomas. Presentamos el caso clínico de un edema pulmonar inducido por un diurético de uso frecuente, la hidroclorotiazida. Esta complicación puede presentarse tras la primera toma del fármaco, o aparecer en pacientes que lo habían tomado previamente sin problemas. Se debe a una reacción idiosincrásica, no inmunitaria. La evolución suele ser favorable en las primeras 14 h con tratamiento de soporte respiratorio y hemodinámico. En caso de recurrencia, aumenta la gravedad, por lo que señalamos la importancia del diagnóstico en el primer episodio (AU)

Asociación entre fibrosis pulmonar y neumomediastino / Association between pulmonary fibrosis and pheumomediastinum

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Tobramycin penetration into epithelial lining fluid of patients with pneumonia.

OBJECTIVE: To study the penetration of tobramycin in lung tissue evaluated as the concentration in epithelial lining fluid and to characterize the time course of the drug in the treatment of patients with pneumonia. METHODS: The subjects were 16 patients with pneumonia and taking tobramycin who had clinical indications for bronchoscopy. Bronchoscopy with bronchoalveolar lavage of the pneumonic area was performed once on each patient 1/2%, 2, 4, or 8 hours after the previous tobramycin dose. Urea was used as an endogenous marker for quantification of epithelial lining fluid obtained at bronchoalveolar lavage. Tobramycin concentrations in serum were measured for all patients at the aforementioned 4 time points. Tobramycin concentration was determined by means of fluorescent polarization immunoassay modified for bronchoalveolar samples. RESULTS: Levels of tobramycin in the fluid of the epithelial lining were 2.33+/-0.5 at 1/2 hour, 1.67+/-0.6 at 2 hours, 1.62+/-1.19 at 4 hours, and 0.77+/-0.38 microg/mL at 8 hours. The ratio of epithelial lining fluid to serum concentration of tobramycin was 0.30+/-0.03 at 1/2 hour, 0.42+/-0.16 at 2 hours, 0.64+/-0.37 at 4 hours, and 1.53+/-0.76 at 8 hours. The ratio at peak serum time was similar to that reported for tobramycin and netilmicin. CONCLUSIONS: High peak serum concentrations of tobramycin are necessary to obtain microbiologically active concentrations at the alveolar level. The fluid of the epithelial lining constitutes a deep compartment for aminoglycosides. The disappearance of tobramycin was slower than at the serum level.

[Almitrine bismesylate treatment in chronic respiratory insufficiency]. / Tratamiento con bismesilato de almitrina en la insuficiencia respiratoria crónica.

This study was designed to evaluate the gasometric and functional respiratory responses in chronic bronchitic patients with chronic respiratory insufficiency (CRI) under ambulatory oxygen therapy (AOT) with almitrine bismesylate (AB). It was a double-blind, placebo-controlled, randomized, prospective study which lasted three months and with a dosage regime of 50-100 mg/day of AB. Fiftyfour patients completed the study (28 in AB and 24 in the placebo (P) groups, respectively). All patients were males, with a mean age or 65 +/- 6.1 years. In the study of pulmonary function only airway resistance (Raw) was changed, with a significant decrease at the third month in the AB group compared with the P group (0.83 +/- 0.31 vs. 1.07 +/- 0.46 kpa/L.S), with a p value of 0.05 (mean +/- SD) and PaO2 which improved from 8.15 +/- 0.88 to 8.81 +/- 2.3 kpa (61.17 +/- 6.6 to 66.10 +/- 10 mmHg), with a p value of 0.05. AB therapy was well tolerated.

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.

[3 nonidiopathic forms of bronchiolitis obliterans organizing pneumonia]. / Tres formas no idiopáticas de bronquiolitis obliterante con neumonía en organización.

Bronchiolitis obliterans organizing pneumonia is the most serious disease of the bronchioli. An idiopathic form of the disease important for differential diagnosis in incipient forms of pulmonary fibrosis has been reported in the literature, along with other forms associated to drug use, infections, and collagen and localized diseases. We describe 3 patients with bronchiolitis obliterans organizing pneumonia, one associated with rheumatoid arthritis and consumption of gold salts, one with HIV infection and one localized form associated with pulmonary hydatidosis.

[Pulmonary involvement in primary Sjogren syndrome]. / Afectación pulmonar en el síndrome de Sjögren primario.

We present 6 cases of patients diagnosed of Primary Sjögren's Syndrome (PSS) according to Fox's criteria (1986). Our goal was to document the pulmonary affection with bronchoalveolar lavage, transbronchial biopsy and respiratory functional assessment. We verified the double affection described for PSS: interstitial and airways. In all the cases, independently of the respiratory radiological or functional findings, we observed a variable lymphocytary alveolitis. We did not find any correlationship between this alveolitis and the histological findings. We conclude that bronchoalveolar lavage and transbronchial biopsy in the PSS are useful for the detection of early pulmonary pathology.

[Elevated negative predictive value of angiotensin converting enzyme in the diagnosis of active sarcoidosis]. / Elevado valor predictivo negativo de la enzima conversora de la angiotensina (ECA) en el diagnóstico de la sarcoidosis en actividad.

OBJECTIVE: To evaluate the usefulness of angiotensin converting enzyme (ACE) in the differential diagnosis of active sarcoidosis in action with other interstitial and granulomatous processes. METHODS: The study involved 30 patients with a histological diagnosis of sarcoidosis, 38 subjects with anatomopathologically and/or microbiologically confirmed pleuropulmonary tuberculosis, and 12 subjects with idiopathic pulmonary fibrosis confirmed by histological studies. Following the technique developed by Rohatgi and Ryan, a radioenzymatic system was used to determine the activity of serum ACE. In patients with sarcoidosis, levels of ACE were measured in active cases as well as those in remission. Our laboratory reference values for those over 20 years of age are 39.84 +/- 9.19 mumol/min/l. RESULTS: Levels of ACE were significantly higher (p < 0.001) in active sarcoidosis (67.71 +/- 17.73 mumol/min/l) than during inactivity (41.18 +/- 16.00 mumol/min/l), tuberculosis (46.99 +/- 13.65 mumol/min/l), or fibrosis (35.87 +/- 11.36 mumol/mol/l). A cut-off point of 59 mumol/min/l shows a significant association with the diagnosis of active sarcoidosis (p < 0.001) and reaches a negative predictive value of 90.90%. CONCLUSION: The usefulness of serum ACE in the differential diagnosis of sarcoidosis should be reconsidered.

[Idiopathic pulmonary fibrosis: new diagnostic and therapeutic perspectives]. / Fibrosis pulmonar idiopática: nuevas perspectivas diagnósticas y terapéuticas.

Idiopathic pulmonary fibrosis (IPF) is a disease of unknown etiology affecting alveolo-interstitial structures. It is clinically characterized by progressive dyspnea and dry cough. In the physical exploration, crakles at the pulmonary bases and acropachies are usually detected. Its diagnosis has been a major clinical problem. Currently, a definitive diagnosis can be established with high resolution computerized axial tomography, bronchoalveolar lavage and open pulmonary biopsy. The next clinical problem is the assessment of activity, since it allows to differentiate subsidiary patients for receiving treatment. The description of new therapeutical alternatives has brought new perspectives in the management of these patients. Corticotherapy associated to immunosuppressors has allowed to reduce side effects and to obtain dramatic improvements. Lung transplantation, currently under study, will be the therapy of the future.

[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.