Primary pulmonary Hodgkin's lymphoma.

A 21-year-old man presented to hospital with a two-month history of productive cough with no other symptoms. Radiology revealed a cavitating lesion in the left upper lobe for which a variety of diagnoses were considered. A biopsy revealed primary pulmonary Hodgkin's lymphoma. Primary pulmonary Hodgkin's lymphoma is an uncommon initial presentation; lung lesions usually occur later in the course of the disease. Following diagnosis, the patient began chemotherapy and full remission was achieved.

Estudio descriptivo y abstinencia al año en una consulta de tabaquismo / Descriptive study and abstinence at one year of a smoking consultation

Objetivos: Estudio retrospectivo de datos procedentes de revisiónde historias clínicas, obteniendo: características demográficas y de tabaquismo,diferencias en función del género, abstinencia obtenida y predictoresde abstinencia.Pacientes y métodos: Se trata de una consulta individual basada enel tratamiento farmacológico y psicológico mínimo. A los pacientes seles realizó una anamnesis sobre antecedentes y tabaquismo, el test deFagerström, peso y CO en aire espirado. El seguimiento se realizó segúnel esquema propuesto por la SEPAR.Resultados: Sobre datos de 225 historias, la edad media fue de 47 ±10 años, siendo el 57% varones. El 7,4% no presentaba otras enfermedadesaparte del tabaquismo. La media del test de Fagerström, cigarrillos/día,paquetes año y CO fueron de 6,74 ± 2,10, 33,74 ± 15,77, 36,89 ± 20,23 y31,36 ± 15,91 respectivamente. Encontramos diferencias significativas enfunción del sexo en los paquetes-año (p = 0,009), CO (p = 0,004) y test deFagerström (p = 0,003). La abstinencia máxima se alcanzó a las tres semanasy fue del 83%, a los seis meses fue del 37% y al año del 28%.Conclusiones: Concluimos que consultan similar proporción de varonesy mujeres, en edad media, con enfermedades producidas por el tabacoy con alta dependencia a la nicotina; encontramos diferencias porgénero y obtenemos buenos resultados a corto plazo, aunque son menoresa seis meses y un año

Objectives: Retrospective study of data from clinical history review,obtaining: demographic and smoking characteristics, differences basedon gender, abstinence obtained and abstinence predictors.Patients and methods: This is an individual consultation based onminimum drug and psychological treatment. The patients wereadministered an anamnesis on background and smoking, the Fagerströmtest, weight and CO in exhaled air. Follow-up was done according to theSEPAR proposed schedule.Results: Based on data from 225 histories, mean age was 47 ± 10years, 57% being men. Atotal of 7.4% had no other diseases except forsmoking. The mean of the Fagerström test, cigarettes/day, packs per yearand CO were 6.74 ± 2.10, 33.74 ± 15.77, 36.89 ± 20.23 and 31.36 ±15.91 respectively. We found significant differences according to genderin packs-year (p = 0.009), CO (p = 0.004) and Fagerström test (p = 0.003).Maximum abstinence was reached at three weeks and was 83%. It was37% at six months and 28% at one year.Conclusions: We conclude that a similar proportion of consultationfrom men and women who are middle aged, with diseases producedby tobacco and with high dependence to nicotine. We found differencesby gender and obtained good short-term results, although they are lessat six months and one year

Airway responsiveness to acetaldehyde in patients with asthma: relationship to methacholine responsiveness and peak expiratory flow variation.

BACKGROUND: Although airway hyperresponsiveness to inhaled acetaldehyde has been documented in Japanese patients with asthma, the response to this bronchoconstrictor agent has never been studied in Caucasians. OBJECTIVES: The objectives of the study were to determine differences in airway responsiveness to acetaldehyde between asthmatic and healthy subjects, and to examine the relationship between acetaldehyde responsiveness and the variability of peak expiratory flow (PEF). METHODS: The response to methacholine and acetaldehyde challenges was measured in 81 non-smoking adults (61 asthmatics and 20 normal controls). Subjects recorded PEF morning and evening for 14 days. The response to both bronchoconstrictor agents was measured by the PC20 (provocative concentration required to produce a 20% fall in FEV1). PEF variation was expressed as amplitude percentage mean, and as low percentage best (lowest PEF expressed as a percentage of the best PEF recorded). RESULTS: The two types of challenge yielded a similarly high level of sensitivity (100% for methacholine and 92% for acetaldehyde) and specificity (90 and 100%, respectively) to distinguish between asthma and controls. Asthmatic subjects were on average 265-fold less sensitive to acetaldehyde than to methacholine. PC20 acetaldehyde correlated weakly but significantly with both indices of PEF variation (amplitude percentage mean: rho = - 0.36, P = 0. 004; low percentage best: rho = 0.42, P = 0.001). CONCLUSIONS: These results indicate that airway hyperresponsiveness to acetaldehyde is a sensitive and specific indicator for separating asthmatic and normal subjects. Airway responsiveness to methacholine or acetaldehyde and PEF variation are not reflecting the same pathophysiological process in the airways.

[The prevalence of chronic obstructive pulmonary disease and asthma. A cross-sectional study]. / Prevalencia de la enfermedad pulmonar obstructiva crónica y del asma. Estudio transversal.

Four hundred sixty-seven patients between 35 and 65 years of age were studied, all taken from a random sample of the population of Health Area 5 of the Valencian Community. Figures for respiratory symptoms, smoking, previous lung disease, professional activity and lung function were obtained through questionnaires and spirometry. The prevalence of asthma found was 2.78% (C.I. 2.76-2.79); chronic bronchitis was 4.07% (C.I. 2.37-5.77) and airflow limitation was 6.4% (C.I. 4.5-8.3). Smokers represented 33.2% of the sample. A significant association was found between the level of intensity of symptoms and lung function. There were no differences between smokers and non smokers with respect to FEV1%. An association between workplace exposure and spirometry was found only for FEV1/FVC%.

[Hereditary hemorrhagic telangiectasia at an internal medicine service: study of 12 patients]. / La telangiectasia hemorrágica hereditaria en un servicio de medicina interna: estudio de doce enfermos.

Hereditary hemorrhagic telangiectasia (HHT) is a hereditary dominant autosoma clinical entity characterized by repeated hemorrhages (being epistaxis the more frequent) and telangiectasia in skin, mucosa and internal organs. Incidence in Europe is 1,2 per 100,000 pop. We discuss the experience of an Internal Medicine Department (Arnau de Vilanova Hospital), during 10 years, in which 12 patients were diagnosed. With the aim to provide more information about this rare disease. There was no predominant sex and the age of onset was very variable. All patients referred at admission past history of hemorrhages (either the patient him/herself or some relative), or were suffering it at admission. Except one patient, all of them showed telangiectasias in skin and mucosa. In five of them telangiectaias were found in upper gastrointestinal tract, in two there were localized on the tracheobronchial tree and one patient had teleangiectasia in liver. Three patients were diagnosed of pulmonary arteriovenous fistula (PAVF). The clinical, diagnostic and therapeutic aspects of this disease are reviewed.

[Contrast echocardiography in the diagnosis of severe hypoxemia associated with liver cirrhosis]. / Ecocardiografía de contraste en el diagnóstico de la hipoxemia grave asociada a cirrosis hepática.

Severe hypoxemia is an uncommon feature of hepatic cirrhosis. Its major cause are intrapulmonary arteriovenous shunts, both due to direct arteriovenous communications and abnormally dilated pulmonary capillaries. In the present study, a case of cirrhosis associated with severe hypoxemia is reported. Contrast echocardiography showed pulmonary arteriovenous shunts, and low values of mixed venous blood (15% or less were obtained with the method of 100% oxygen breathing). These data suggest that the basic mechanism of hypoxemia, in this case, were capillary dilatations rather than true pulmonary arteriovenous anastomoses. The pathophysiological mechanisms of hypoxemia in cirrhosis are discussed, with emphasis on the present relevance of echocardiography for a full evaluation of these patients, particularly when liver transplantation is contemplated.