Gestión clínica. Un caso real / No disponible

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Valoración del fenotipo neoangiogénico y linfangiogénico en lesiones preneoplásicas y primarias de cáncer de pulmón / No disponible

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Utility of transfer factor to detect different bronchodilator responses in patients with chronic obstructive pulmonary disease.

Previous studies have described that there are different types of disease in patients with established chronic obstructive pulmonary disease (COPD) with different clinical course and functional responses. The aim of this study was to evaluate if the presence of low transfer factor (LTF) values can predict the effectiveness of bronchodilator therapy, and to assess whether this group has different risk factors that may be related with the responses. Eighty patients with COPD were evaluated on three occasions. Initial assessment included a standard respiratory questionnaire, blood analysis, skin prick test and baseline lung function, all performed on the first visit. Bronchodilator response was evaluated after low (0.2 mg) and high (1 mg) doses of salbutamol, and after 2 weeks of oral prednisone. In patients with normal TLCO/VA % (NTF), a higher proportion of subjects with previous history of atopy was the only statistically significant difference compared to those with LTF (odds ratio 4.33; 95% confidence interval 1.06-25.15). Although the mean response in forced expiratory volume in 1 s (FEV1) to treatment was analogous in both groups, when bronchodilation was expressed as percent of predicted, there was a clear trend to a lower response in patients with LTF (0.2 mg salbutamol: 6.99 +/- 5.64 vs. 8.94 +/- 6. 61, p = 0.15; 1 mg salbutamol: 10.18 +/- 6.37 vs. 13.45 +/- 7.90, p < 0.05; oral prednisone: 5.51 +/- 6.94 vs. 8.74 +/- 10.81, p = 0.06). The percentage of patients who had >12% improvement from that predicted in FEV1 was also lower in this group (42 vs. 72%; p < 0. 05). Moreover, TLCO/VA% was significantly lower in those subjects with a negative bronchodilator trial with salbutamol (68 +/- 25 vs. 81 +/- 26; p < 0.05) and prednisone (69 +/- 26 vs. 90 +/- 22; p < 0. 01). In patients with LTF and NTF, airway responsiveness was only significantly related with basal airflow limitation (LTF, r = 0.44; NTF, r = 0.38). All other interaction terms were not statistically significant. These results indicate that in patiens with similar serverity of COPD, the presence of LTF indicates a decreased probability of a positive bronchodilator response, probably reflecting different pathological lesions. We suggest that transfer factor should be taken into consideration when bronchial response is evaluated in large clinical trials.

[Non-invasive assessment of a snorer with diurnal hypersomnia without features of sleep apnea]. / Valoración no invasiva de un paciente roncador con hipersomnia diurna sin criterios de síndrome de apnea del sueño.

We report a case of increased upper airway resistance diagnosed by impedance plethysmograph. This simple non invasive technique may provide an alternative to polysomnography administered with an esophageal tube, particularly to screen patients before ordering further studies.

[Cholesterol in pleural fluid. Its usefulness in differentiating between exudates and transudates]. / Colesterol en líquido pleural. Utilidad en la diferenciación entre exudados y trasudados.

To analyze the usefulness of cholesterol levels in the differentiation of exudates and transudates. A 3.5-year prospective study of 170 patients with pleural discharge. Clinical microbiological and cyto-histological criteria were used for diagnosis. Exudates were classified by Light's criteria, by cholesterol > or = 45 mg/dl in pleural liquid, by a cholesterol in pleural liquid/cholesterol in serum quotient > or = 0.3 and by a finding of both LDH and cholesterol in pleural fluid. These criteria were compared with the final etiological diagnosis. Only pleural discharges with confirmed etiological diagnoses were analyzed. In the 130 pleural discharges for which certain etiological diagnoses were obtained, 33 were transudates and 97 were exudates. Light's criteria allowed accurate classification of 92 (95%) of the 97 exudates and 30 (91%) of the 33 transudates. The cholesterol in pleural liquid/cholesterol in serum quotient was the most productive and useful parameter (96% sensitivity, 97% specificity), better than pleural fluid cholesterol and the Light's criteria. The association of LDH and pleural fluid cholesterol classified 100% of the exudates, with efficacy similar to that of Light's criteria. The cholesterol in pleural fluid/serum quotient was the most useful biochemical variable. Cholesterol levels were about as useful as Light's criteria. The association of LDH and cholesterol allows us to bypass blood analyses for the diagnosis of exudates.

[Osteochondroplastic tracheopathy. Diagnostic confirmation. Experience with 8 cases]. / Traqueopatía osteocondroplásica. Confirmación diagnóstica. Experiencia en 8 casos.

We report our experience in 8 patients with osteochondroplastic tracheopathy and consider the importance of its diagnosis y biopsy in order to confirm histology and if possible etiology, because specific treatment could change the course of the disease. Methods such as radiology, CT-scan, respiratory function tests only give diagnostic suspicion, which is a previous step before confirmation by bronchoscopy with biopsy. To date, with the exception of a few cases, the diagnosis is made by necropsy. Thus, this justifies our emphasis in the diagnosis of this rare disease when it is suspected in living patients.