Bronquiectasias y macrólidos / Bronchiectasis and macrolides

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Nódulos pulmonares múltiples de crecimiento rápido como forma de presentación de un linfoma pulmonar primario de células B grandes

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[Value of transthoracic aspiration puncture in the etiologic diagnosis of nosocomial pneumonia in patients not admitted to the ICU]. / Valor de la punción transtorácica aspirativa en el diagnóstico etiológico de la neumonía nosocomial de los pacientes no ingresados en UCI.

The aim of this study was to determine the etiologic diagnosis of nosocomial pneumonia in hospitalized patients outside the intensive care unit. The study was carried out prospectively at the University Hospital Arnau de Vilanova in Lerida (Spain) from 1 May 1994 through 28 February 1996, during which 103 cases were diagnosed. Transthoracic needle aspiration (TNA) was chosen as the most useful diagnostic procedure, given its high specificity and low rate of complications. Sixty-seven TNA procedures were carried out; 10 (14.9%) were positive. Sputum was cultured for 62 patients and true positives were observed in 6 (9.7%). Pleural liquid was cultured for 35 patients and germs were isolated for 2 (5.7%). Bronchial brushing with a telescoping catheter was performed in 4 patients and brush culture provided 2 additional positives. Blood samples from 51 patients were cultured provided 4 additional diagnoses (7.8%). The most commonly found germs were P. aeruginosa (13.33%), S. aureus (13.3%), C. pneumoniae (10%) and L. pneumophila (10%). Disease was polymicrobial in 33.3%. Complications were observed, in the form of pneumothorax, in 2 cases (3%), one of which required drainage. We conclude that TNA, which is highly specific and has a low rate of complication, is a useful procedure for diagnosing nosocomial pneumonia in patients who are not being mechanically ventilated.

Valor de la punción transtorácica aspirativa en el diagnóstico etiológico de la neumonía nosocomial de los pacientes no ingresados en uci / The value of transthoracic needle aspiration for the etiologic diagnosis of nosocomial pneumonia in non ICU patients

El objetivo de este estudio fue conocer el diagnóstico etiológico de la neumonía nosocomial en pacientes no ingresados en la UCI. Se realizó de forma prospectiva en el Hospital Universitario Arnau de Vilanova de Lleida durante el tiempo comprendido entre el 1 de mayo de 1994 hasta el 28 de febrero de 1996, diagnosticándose 103 casos. Se empleó la punción transtorácica aspirativa por considerarla el método más útil, dada la alta especificidad y la baja complejidad de la técnica. Se practicó punción transtorácica aspirativa en 67 casos, siendo positiva en 10 ocasiones (14,9 por ciento). El cultivo de esputo se recogió en 62, considerándose verdadero positivo en seis (9,7 por ciento), el cultivo de líquido pleural se realizó en 35 ocasiones, y fueron aislados gérmenes en 2 casos (5,7 por ciento), y el cepillado bronquial con catéter telescopado se practicó en 4 pacientes, dando resultado positivo en otros dos. Se tomaron muestras para serología en 51 casos, siendo diagnóstico en cuatro (7,8 por ciento). Los gérmenes más frecuentes fueron Pseudomonas aeruginosa (13,3 por ciento), Staphylococcus aureus (13,3 por ciento), Chlamydia pneumoniae (10 por ciento) y Legionella pneumophila (10 por ciento). Objetivamos etiología polimicrobiana en el 33,3 por ciento de los casos. Sólo se encontraron como complicaciones neumotórax en 2 casos (3 por ciento), de los que uno precisó drenaje. Podemos concluir en que la punción transtorácica aspirativa, técnica de alta especificidad, constituye un procedimiento útil en el diagnóstico de la neumonía nosocomial en pacientes no sometidos a ventilación mecánica, evidenciando además una muy baja tasa de complicaciones. (AU)

[Risk factors of non-ICU nosocomial pneumonia]. / Factores de riesgo de la neumonía nosocomial no UCI.

OBJECTIVE: To know the incidence and risk's factors of nosocomial pneumonia (NN) in patient entered in hospital with age more of 14 years-old. The study was not performed in patients of Unit Care. Also, morbility and mortality are showed and the relation between bacterial agent and inmunologic answer of the patients. By other hand, we reported about specific clinical predictors for NN. MATERIALS AND METHODS: During a period of twenty-two months, 103 cases of NN were diagnosed what supposed 0.34% of the patients entered in this period of time. The study has been carried out in the University Arnau of Vilanova Hospital in Lleida (HUAV), with a capacity of 435 beds. Factors of the patients' risk of NN were valued. Multivariate analysis has been carried out by means of the pattern Cox's regression for proportional risks. RESULTS: About 66.99% of the patients had followed previous antibiotic treatment to the pneumonia episode, but only were significants those that had been treated with amoxicillin-clavulanic acid (28.15%, p = 0.0191). Blocking of the channels of the calcium were administered to 14.56% (p = 0.0030), and treatment with sedative drugs in 27.18% (p = 0.0397). Aerosol therapy was performed in 29 patients (28.15%, p = 0.0030). Nasogastric tube was performed in 19.41% of the patients (p = 0.0132). Creatinine was elevated in 31.42% (p < 0.05). The attributable mortality to the NN was of 33.9%, having a rate of higher mortality that the patients without NN. The agent etiologic was isolated in 23.3% of cases. The NN was polymicrobial in 8 cases with P. aeruginosa and S. aureus as the most frequents. CONCLUSION: In patients with several pathologies and treatments could be changed the immunologic answer and these patients are more predisposed to suffer NN. The mortality is associate to the age and others illness of the patient.

Factores de riesgo de la neumonía nosocomial no UCI / Risk factors in the nosocomial pneumonia non unit care

Objetivos: conocer la incidencia de neumonía nosocomial (NN) en pacientes mayores de 14 años ingresados en el HUAV, con exclusión expresa de los que habían sido diagnosticados en la UCI o habían iniciado la sintomatología en dicha unidad; valorar los factores de riesgo de la NN; estudio de la morbilidad (días de estancia) y mortalidad de la NN; estudiar si existe relación entre morbi-mortalidad y factores propios del huésped y del ambiente; aplicabilidad práctica al paciente de todos los resultados obtenidos. Material y métodos: el estudio se ha realizado en un hospital asistencial de segundo nivel, con una capacidad de 435 camas, durante un período de veintidós meses. Diagnosticándose 103 episodios de NN, en 103 pacientes, lo que supone el 0,34 por ciento de los pacientes ingresados en este período de tiempo. El estudio fue longitudinal prospectivo. Se valoraron los factores de riesgo de los pacientes que habían contraído neumonia nosocomial (NN). El análisis multivariante se ha realizado mediante el modelo de regresión de Cox de riesgos proporcionales. Resultados: un 66,99 por ciento de los pacientes habían seguido tratamiento antibiótico previo al episodio de neumonía, resultando solo significativo los que habían sido tratados con amoxicilina-clavulánico (28,15 por ciento, p=0,0191). Se administraban bloqueadores de los canales del calcio a un 14,56 por ciento (p=0,0030), y seguían tratamiento con sedantes 27,18 por ciento de los pacientes (p=0,0397). Seguían terapia en nebulizador 29 pacientes (28,15 por ciento, p=0,0030). Eran portadores de sonda nasogástrica el 19,41 por ciento de los pacientes (p=0,0132). La creatinina estaba elevada en el 31,42 por ciento (p<0,05). La mortalidad atribuible a la NN fue del 33,9 por ciento, teniendo una tasa de mortalidad más alta que los pacientes sin NN. El agente etiológico fue aislado en 23,3 por ciento de casos. La NN fue polimicrobiana en 8 casos, siendo la P. aeruginosa y el S. aureus los aislados con mayor frecuencia. Conclusión: Los pacientes con mútiples patologías y sometidos a tratamientos que puedan modificar la respuesta inmunológica son los más predispuestos a padecer NN. La mortalidad se asocia a la edad y a la enfermedad de base del enfermo (AU)

[Malignant pleural mesothelioma with an unusual radiologic manifestation]. / Mesotelioma pleural maligno con manifestación radiológica inusual.

The malignant pleural mesothelioma is a rare neoplastic consequence observed in people with previous exposition to asbestos essentially. The malignant mesothelioma like a term, not only reports to primary malignant extended tumors that are derived of pleural mesothelioma but also, pericardial and peritoneal (about 20%). The exposition of asbestos stands for a sequential cellular reaction with oncogenic potential and with a typical majority clinical presentation. We described the case a patient complaint of malignant pleural mesothelioma with unusual radiology presentation with the result that unilateral calcified pleural plaques with pleural thickening and pleural effusion absence. Definitive diagnostic was achieved by thoracotomy.

Mesotelioma pleural maligno con manifestación radiológica inusual / Malignant pleural mesothelioma with inusual radiology manifestation

El mesotelioma pleural maligno es una rara entidad neoplásica observada principalmente, en personas con exposición previa al asbesto. El mesotelioma maligno como término, no solo hace referencia a los tumores malignos primarios difusos que derivan del mesotelioma pleural sino también, del pericardio y peritoneo (sobre el 20 porciento). La exposición al asbesto conlleva una reacción celular secuencial con potencial oncógeno y de presentación clínica mayoritaria típica. Describimos el caso de un paciente afectado de mesotelioma pleural maligno con presentación radiológica inusual, en forma de placas pleurales calcificadas unilaterales con engrosamiento pleural y ausencia total de derrame pleural. El diagnóstico definitivo se realizó por toracotomía (AU)

[Skin metastasis as the lst manifestation of bronchogenic carcinoma]. / Metástasis cutáneas como primera manifestación de carcinoma broncogénico.

Cutaneous metastases as internal neoplasm manifestation are not very frequent. However, the lung cancer in male, is the first cause of cutaneous metastases. The skin metastases may be the first clinical manifestation of cancer in these patients. We report two cases of lung neoplasm in whose first manifestation was metastases of skin. We have reviewed the literature.

[Pulmonary fibrosis as a presentation form of the Jo-1 syndrome]. / Fibrosis pulmonar como forma de presentación del síndrome Jo-1.

Jo-1 syndrome is a disease recently described, included on the list of connective tissue diseases. Its clinical features are myositis and/or pulmonary fibrosis associated to the presence of precipitant antibodies against intracellular enzyme call histidine T-RNA synthetase. This antibody is related to pulmonary fibrosis associated to myositis and some scientist gave predictive value on the onset of pulmonary fibrosis in patients with myositis. However, isolated association of pulmonary fibrosis have been exceptionally described. A patient with severe interstitial pulmonary affliction and positive Jo-1 antibody without myositis is presented. The actual knowledge of the disease and its association is reviewed.

[Gammagraphy with gallium-67 citrate in the diagnosis of pulmonary tuberculosis]. / La gammagrafía con citrato de galio-67 en el diagnóstico de la tuberculosis pulmonar.

The reception of Gallium Citrate 67 (C. de Ga-67) has been studied in 27 patients with active pulmonary TBC shown bacteriologically. The findings of the gammagraphy with C. de Ga-67 have been compared with those of the simple thorax radiology. We have objectified 96% sensitivity in the examination of the tuberculous lesions by isotopic techniques. These have shown, as well, a high performance in the detection of active tuberculous areas at hiliar, mediatinic and extrathoracic level, greater than that of the simple radiography, as well as to evaluate the activity of apparently residual lesions in the thorax radiography. We conclude that the gammagraphy with C. de Ga-67 is a bloodless method which complements radiology in the diagnosis of activity, extension and location of pulmonary tuberculosis.

[Usefulness of total and specific IgE in the diagnosis of respiratory allergy]. / Utilidad de la IgE total y específica en el diagnóstico de la alergia respiratoria.

We studied 500 patients with an average age of 36.25 +/- 14.27 years and did the following tests: Intradermoreaction and prick tests, total IgE by PRIST and specific IgE by RAST. The antigens used for the study were the following: Lolium Perenne, Dermatophagoides pteronyssinus, and house dust. Of de 500 patients studied, 104 had a negative skin test and RAST. They also had a negative history of allergy. The other 396 patients presented a clinical history compatible with the diagnosis of allergy and were positive to skin test and/or RAST. A correlative study between the different techniques utilized in the diagnosis of these patients was undertaken. We observed significant higher levels of total IgE in the allergic than in the non-allergic group (p less than 0.001). The normal levels of total IgE in our environment were equal or inferior to 263.33 UI/ml. In the group of allergic patients, levels higher than 263.33 UI/ml were found in 49.27% of RAST positive patients and 46.35% in skin test positive patients. In the 295 patients studied with intradermoreaction, the correlation coefficients (r) were as follows: Lolium perenne r: 0.90; Dermatophagoides Pteronyssinus r: 0.54; house dust r: 0.14. The correlation coefficients (r) in the 101 patients studied with prick tests were the following; Lolium perenne r: 0.86; Dermatophagoides Pteronyssinus r: 0.82; house dust r: 0.48. As can be observed the prick tests gave overall better results than the intradermoreaction. On comparing the skin and RAST tests qualitatively we observed that in those patients studied by prick tests, 86.79% were pollen-positive in both trials.(ABSTRACT TRUNCATED AT 250 WORDS)

[Study of helper T lymphocytes and suppressor T lymphocytes in respiratory allergy and their modifications in relation to symptomatology]. / Estudio de linfocitos T facilitadores y T supresores en alergia respiratoria y sus modificaciones en relación a la sintomatología.

In has been assumed that in allergic disease there is a primary disorder in the lymphocyte subpopulation with decrease suppressor activity responsible for the pathological increase in IgE. Other authors have found secondary disorder in T lymphocyte subpopulations in relation to the clinical manifestations of the type I hypersensitivity reaction. We have studied the T lymphocyte subpopulations in 152 patients affected with bronchial asthma and/or extrinsic allergic rhinitis (without immunotherapy) in which 72 were male and 80 female with an average age of 26.49 +/- 12.05 years. Monoclonal antibody techniques were used (OKT4 for helpers and OKT8 for suppressors). The results were compared with 30 healthy controls; 60 males and 14 females with an average age of 32.52 +/- 14.23 years. We also studied the T lymphocyte subpopulations in relation to the symptomatology presented by the patients. The results were as follows: Significant decrease in helper and suppressor lymphocytes in allergic patients as compared to controls (p less than 0.001). No significant differences were found between the groups in relation to symptomatology (p greater than 0.05). In our study we found an important and significant decrease in helper T lymphocytes in peripheral blood in patients with respiratory allergy as compared to the control group, such as that found by Hsieh who also observed a deficient OKT4 function. Other authors have also observed a significant decrease in helper T lymphocytes parallel to the symptomatology of the type I hypersensitivity reaction, a finding that we have been unable to confirm in our study since no significant changes were observed between the symptomatic and asymptomatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)