Estudio epidemiológico de incidencia de tuberculosis en la consulta hospitalaria de Neumología del Hospital 12 de Octubre / Epidemiologic study of tuberculosis incidence in hospital consultation of pneumology of the Hospital 12 de Octubre

Objetivo: Conocer las características clínico-epidemiológicas de los pacientes diagnosticados de tuberculosis (TBC) en la consulta externa de Neumología en el Hospital Universitario 12 de Octubre en los tres últimos años.Material y Métodos: Estudio retrospectivo de los casos nuevos de enfermedad TBC de la consulta externa de Neumología en nuestro hospital entre 01/2004 y 12/2006. Los datos se recogieron de la base de datos de codificación diagnóstica de la consulta, la revisión exhaustiva de las historias clínicas y los registros de enfermería. Elaboramos una base de datos enla que se incluyeron todos los datos demográficos, clínicos, relacionados con el diagnóstico y relacionados con el tratamiento.Resultados: Se diagnosticaron 90 casos nuevos, 61,1% varones, de enfermedad TBC. La media de edad fue de 38,6 años con el pico de mayor incidencia entre los 20 y 40 años. Un 38,9% de los casos eran inmigrantes. La edad media al diagnóstico de los inmigrantes fue 31,5 años, significativamente inferior (p = 0,02) a la de los españoles (43,1 años). El 15,6% de casos teníanalgún tipo de inmunosupresión. La forma clínica más frecuente de presentación fue la pulmonar con un 65,6% y el método diagnóstico más frecuente fue el microbiológico. La pauta de tratamiento más utilizada fue de cuatro fármacos, con 2 meses de rifampicina (R), isoniacida (H), pirazinamida (Z) y etambutol (E) y 4 meses con HR, que fue empleada en el 61,1% de los casos. En 13 pacientes se detectó alguna resistencia a fármacos de primera línea siendo la más frecuente a isoniacida (8 casos). Las complicaciones por el tratamiento ocurrieron en el 13,3% y la evolución fue hacia la curación en un91%. El registro de casos nuevos de TBC en nuestra consulta durante los años 2004, 2005 y 2006 refleja un mayor número de casos nuevos respecto a las tasas globales de la CAM y respecto a años anteriores en nuestra propia consulta.Conclusión: Se observa una mayor incidencia de enfermedad tuberculosa en la consulta externa del Hospital 12 de Octubre respecto al último registro. Este aumento de incidencia, dado el elevado porcentaje de población extranjera en los enfermos de TBC de nuestro estudio (38,9%), puede deberse a las mayores tasas de inmigración de la población del área 11 (21,3%) en relación con los datos generales de CAM (13,1%)

Objective: To know the clinical-epidemiological characteristics of patients diagnosed of tuberculosis (TBC) in Pneumology outpatient clinic in the University Hospital 12 de Octubre during the last three years.Material and methods: Retrospective study of new cases of TBC disease in the outpatient pneumology clinic in our hospital between 01/2004 and 12/2006. The data were gathered from the diagnostic coding database of the consultation, thorough review of the clinical histories and registries of the nursing department. We elaborated a database that included demographic, clinical data related with the diagnosis and with the treatment.Results: A total of 90 new cases were diagnosed, 61.1% of whom were men, of TBC disease. Mean age was 38.6 years with a greater peak incidence between 20 and 40 years. A total of 38.9% of the cases were immigrants. Mean age on diagnosis of the immigrants was 31.5 years, significantly lower (p = 0.02) than that of the Spaniards (43.1 years). Some type of immunosuppression was found in 15.6% of the cases. The most frequent clinical presentation form was pulmonary with 65.6% and the most frequent diagnostic method was microbiological. Treatment regime used most was that of four drugs, with 2 months of rifamipicin (R), isoniacid (H), pyrazinamide (Z) and etambutol (E) and 4 months of HR, which was used in 61.1% of the cases. In 13 patients, some resistance to first line drugs was detected, the most frequent being to isoniazide (8 cases). The complications due to the treatment occurred in 13.3% and course was toward cure in 91%. Recording of new cases of TBC in our consultation during the years 2004, 2005 and 2006 reflected a greater number of new cases regarding the overall rates of the Regional Community of Madrid and regarding previous years in our consultation.Conclusion: A greater incidence of tuberculosis disease is observed in the outpatient clinic of the Hospital 12 de Octubre regarding the last record. This increase in incidence, given the elevated percentage of foreign population in TBC patients of our study (38.9%), may be due to the higher rates of immigration of the area 11 population (21.3%) in relationship with the general data of the regional community of Madrid (13.1%)

Infartos pulmonares bilaterales complicados por Staphylococcus warnerii / Bilateral pulmonary infarction complicated by Staphylococcus warnerii

El infarto pulmonar es una complicación que aparece entre un 10-15% de los embolismos pulmonares. Un 5-10% deestos infartos se cavitan secundariamente. El cuadro clínico suele cursar con dolor pleurítico intenso, fiebre y en el 30% de los casos se acompaña de hemoptisis. El diagnóstico diferencial, basado en los hallazgos radiológicos, debe establecerseesencialmente con la tuberculosis pulmonar, el absceso pulmonar y el embolismo séptico. Presentamos el caso deun paciente con infartos pulmonares bilaterales secundariamente complicados por Staphylococcus warnerii

Lung infarction is a frequent complication in about 10-15% of pulmonary embolism. Approximately 5-10% of lunginfarctions are secondarily cavitated. Chest pain and fever are the most frequent symptoms and about 30% of them have haemoptysis. Differential diagnosis based on radiologic findings would be established with pulmonary tuberculosis, lung abscess and septic embolism. We describe the clinical case of a patient with bilateral lung infarction secondarily Staphylococcus warnerii infection

Ventilación no invasiva en pacientes con insuficiencia respiratoria aguda hipercápnica ingresados en una planta de hospitalización / Noninvasive ventilation in patients with acute hypercapnic respiratory failure admitted to a hospitalization

Objetivos: Analizar las características de todos los pacientes a los que se les ha realizado ventilación mecánica no invasiva (VMNI) en el fallo ventilatorio agudo (FVA) en planta de hospitalización convencional y describir el incremento de la frecuencia de la aplicación de esta técnica.Material y Métodos: Estudio descriptivo con recogida prospectiva de los datos de todos los pacientes con FVAa los que se les ha tratado con VMNI por el Servicio de Neumología entre enero de 1995 y diciembre de 2004. Definimos FVA como la existencia de insuficiencia respiratoria aguda con acidosis respiratoria.Resultados: La población a estudio fue de 162 pacientes, con un total de 174 eventos de FVA incluidos en el estudio. La mediana de edad fue 72 años (rango 14-90); 114 (66%) eran varones. Las causas del FVA fueron: EPOC 86 (49%); síndrome de apneas hipopneas durante el sueño (SAHS) o de obesidad hipoventilación 44 (25%); secuelas de tuberculosis 13 (8%); neuromusculares 12 (7%); asociación de EPOC y SAHS 11 (6%); y otros 8 (5%). La mediana de los valores gasométricos previos al tratamiento fueron: pH 7,26 y PaCO2 89. Fallecieron veintiséis (15%) pacientes durante elingreso, siendo la mortalidad mayor en aquellos con pH por debajo de la mediana (p = 0,031). En nuestro hospital el uso de esta técnica terapéutica ha sido progresivamente creciente, principalmente en los últimos tres años, pasando de una media de 5 hasta el año 2001, hasta 74 en el 2004.Conclusiones: La EPOC fue la condición clínica más frecuentemente tratada con VMNI. La mortalidad global fue del 15%, siendo mayor cuando el pH era inferior a 7,26. El uso de VMNI en el FVA ha aumentado considerablemente, sobre todo en los últimos tres años

Objectives: Analyze the characteristics of all the patients who have undergone noninvasive mechanical ventilation (NIMV) in acute ventilatory failure (AVF) in the conventional hospitalization ward and describe the increase of the frequency of the application of this technique.Material and Methods: Descriptive study with prospective collection of data of all patients with AVF who were treated with NIMV by the Pneumology Department between January 1995 and December 2004. We define AVF as the existence of acute respiratory failure with respiratory acidosis.Results: The study population was 162 patients with a total of 174 AVF events included in the study. Mean age was 72 years (range 14-90); 114 (66%) were men. The causes of AVF were: COPD 86 (49%); Sleep Apnea-HypopneaSyndrome (SAHS) or hypoventilation obesity 44 (25%); tuberculosis sequels 13 (8%); neuromuscular 12 (7%); association of COPD and SAHS 11 (6%); and others 8 (5%). The median of the blood gas values prior to treatment were: pH 7.26 and PaCO2 89. Twenty six (15%) of the patients died during admission, mortality being greater in those with pH below the median (p = 0.031). In our hospital, the use of this therapeutic technique has been growing progressively, mainly in the last three years, going from a mean of 5 until the year 2001 to 74 in the year 2004.Conclusions: COPD was the clinical condition most frequently treated with NIMV. Global mortality was 15%, this being greater when the pH was less than 7.26. The use of NIMV in AVF has increased considerably, above all in the last three years

Neumotórax espontáneo, neumomediastino y enfisema subcutáneo en paciente VIH con probable neumonía por Pneumocistis jiroveci / Spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in HIV patient with probable pneumonia due to pneumocistis jiroveci

neumotórax es una complicación frecuente en pacientes con el síndrome de inmunodeficiencia adquirida (VIH), yaque ocurre en más del 2% del total, y este porcentaje se incrementa al 5-10% en aquellos casos con infección activa o pasada por Pneumocistis jiroveci (PJ), anteriormente llamado carinii. La etiología no está aclarada y se ha relacionado con diversos factores tales como la propia infección por PJ o tuberculosis, o bien con el tratamiento inhalado con pentamidina.Puede acompañarse de neumomediastino y enfisema subcutáneo. No hay tratamiento de elección, y éste varíadesde el manejo conservador al tratamiento quirúrgico. Presentamos el caso de un adulto con infección VIH al que se diagnóstico de probable infección por PJ, y que en el curso de la infección presentó neumotórax derecho, neumomediastino y enfisema subcutáneo, que evolucionó favorablemente con tratamiento conservador

Spontaneus pneumothorax is a frequent complication in patients with acquired immune deficiency syndrome (AIDS)that may ocurr in up to 2% of patients and this percentage increases to 5-10% in those patients with current or previous Pneumocystis jiroveci pneumonia (PJP) previously called Pneumocystis carynii. The etiology is unknown but it has been related with infectious diseases like PJP, mycobacterium tuberculosis or aerosolized pentamidine treatment. Sometimesthere could be pneumomediastinum or subcutaneus emphysema. The treatment is not clear and it could ranged between clinical observation to surgical treatment. We present a case report of an adult with AIDS and probably PJP with right pneumothorax, pneumomediastinum and subcutaneus emphysema solved without invasive treatmen (AU)

[Lymphoid interstitial pneumonia resolved through antiretroviral therapy in an adult infected by human immunodeficiency virus]. / Neumonía intersticial linfoidea en un paciente adulto con infección por el VIH, resuelta con tratamiento antirretroviral.

Lymphoid interstitial pneumonia (LIP) is a rare entity characterized by the infiltration of interstitial tissues and alveolar spaces by lymphocytes, plasma cells, and other lymphoreticular structures. The etiology of LIP is unknown, although associations with autoimmune and infectious factors have been described. The incidence of LIP has risen in recent years, mainly in children with acquired immunodeficiency syndrome (AIDS), while remaining less common in the adult population. No agreement has been reached regarding the diagnostic tests necessary for a firm diagnosis although suspicion is usually based on clinical and radiographic findings, with confirmation provided by examination of histological samples. The most common treatment is corticosteroids, either alone or in combination with other immunosuppressant agents although no evidence from controlled trials is available and cases have been reported in which LIP resolved in AIDS patients with antiretroviral therapy alone. We report the case of a human immunodeficiency virus-infected adult who was diagnosed with LIP by open lung biopsy and who responded to antiretroviral drugs with no need for associated corticosteroid therapy.

[Pleural mesothelioma: experience with 62 cases in 9 years]. / Mesotelioma pleural: experiencia durante 9 años y descripción de 62 casos.

OBJECTIVES: To describe the diagnostic approach, clinical and radiological characteristics, and survival of patients with pleural mesothelioma treated in our hospital over a 9-year period. PATIENTS AND METHOD: All patients with a diagnosis of pleural mesothelioma diagnosed in our hospital from January 1992 through December 2000 were studied. RESULTS: Sixty-two patients (49 men) with a mean age of 65 years (range, 45-85) were diagnosed. Probable or known contact with asbestos was established for 41 patients (66%). Ninety-four percent of the patients had chest pain or dyspnea at the onset of clinical assessment. The tumor was situated in the right hemithorax in 33 patients; 59 patients had pleural effusion, and 3 only had pleural thickening. The pleural fluid was bloody in 19% of patients, glucose levels were less than 60 mg/dL in 44%, and the pH of pleural fluid was less than 7.20 in 19%. The diagnosis was established by pleural biopsy for 52%, and by thoracoscopy or thoracotomy for 44%. The median survival was 11 months (95% confidence interval, 8-15); the probability of survival was 0.22 after 2 years, and 0.09 after 5. For the subgroup of patients with epithelial tumors the probability of survival was 0.31 after 2 years and 0.16 after 5 years. In the univariate analysis the predictors of survival were general clinical status (Karnofsky scale), platelet count, serum albumin level, pleural pH, glucose and lactate dehydrogenase levels, and histological type. CONCLUSIONS: The clinical, radiological, and biochemical characteristics of the pleural fluid from patients with pleural mesothelioma and their survival rate were described.

[Mechanical ventilation in a respiratory ward. Evolution from 1994 to 2000]. / Ventilación mecánica en hospitalización neumológica. Evolución en el período 1994-2000.

OBJECTIVE: To investigate the absolute and relative frequency of mechanical ventilation in the management of patients on a respiratory medicine ward between 1994 and 2000. To describe reasons for admission, mean hospital stay and outcomes. SETTING: A tertiary-care university hospital. METHODS: Observational, descriptive study of a case series. RESULTS: During the study period, 257 admissions involved mechanical ventilation of 132 patients. During that time, there was a progressive increase in the total number of ventilated patients as well as in the relative frequency, such that ventilated patients eventually accounted for 6.1% of all admissions for respiratory care in 2000. Nearly 80% of admissions were related to the service's home mechanical ventilation program, either to initiate and adapt ventilation for new patients or to treat exacerbations or diagnose and treat other medical or surgical problems in already-ventilated patients. Patients transferred from the intensive care unit (ICU) because of weaning difficulties (median ventilation, 31 days) had the highest mean stay. Nine of the 132 patients had to be transferred to the ICU and 18 died while hospitalized (7% of admissions and 13.6% of patients). The patients who died were those who were more acutely and severely ill (acute exacerbation in home-ventilated patients, patients with acute respiratory failure treated initially with non-invasive ventilation and patients transferred from the ICU due to weaning difficulties). CONCLUSIONS: Admissions requiring mechanical ventilation have increased and most are related to the home mechanical ventilation program. The mean stay and the mortality rate were related to the reason for admission.

Ventilación mecánica en hospitalización neumológica. Evolución en el período 1994-2000 / Mechanical ventilation in a respiratory ward. Evolution from 1994 to 2000

OBJETIVO: Conocer la frecuencia absoluta y relativa de pacientes que han utilizado la ventilación mecánica como parte de su tratamiento en una sala de hospitalización neumológica en el período 1994-2000, describir las causas que han motivado la indicación y analizar su estancia media y sus resultados. ÁMBITO: Hospital terciario universitario. PACIENTES Y MÉTODOS: Estudio observacional descriptivo de serie de casos. RESULTADOS: En el período de estudio hubo 257 ingresos hospitalarios con ventilación mecánica en 132 pacientes. Durante ese tiempo se produjo un incremento progresivo en el número anual absoluto y relativo de pacientes que, en el año 2000, representó el 6,1 por ciento del total de las hospitalizaciones en la planta de neumología. Casi el 80 por ciento de los ingresos estaban relacionadas con el programa de ventilación mecánica domiciliaria, bien para inicio programado de adaptación a la misma, o estando en tratamiento previo con ella por agudización respiratoria o para el diagnóstico y tratamiento de otros problemas médicos o quirúrgicos. El grupo de mayor estancia media fue el de los pacientes trasladados desde la unidad de cuidados intensivos por ventilación mecánica prolongada (mediana de 31 días). Del total de pacientes (n = 132), nueve fueron trasladados a la unidad de cuidados intensivos y 18 fallecieron (el 7 por ciento del total de las hospitalizaciones y 13,6 por ciento de los pacientes).La mortalidad se concentró en los grupos con pacientes más agudos y graves: pacientes con ventilación mecánica domiciliaria previa y agudización respiratoria, pacientes con ventilación mecánica no invasiva para tratamiento de la insuficiencia respiratoria aguda y pacientes trasladados desde la UCI por ventilación mecánica prolongada y dificultades en la desconexión. CONCLUSIONES: Se ha producido un incremento progresivo del número de pacientes hospitalizados con ventilación mecánica, en la mayor parte de los casos relacionados con el programa de ventilación mecánica domiciliaria. La estancia media y la mortalidad dependieron del motivo de la ventilación mecánica (AU)

[Prospective study of 1,000 consecutive patients with pleural effusion. Etiology of the effusion and characteristics of the patients]. / Estudio prospectivo de 1.000 pacientes consecutivos con derrame pleural. Etiología del derrame y características de los pacientes.

OBJECTIVE: To describe the characteristics of patients with pleural effusion (PE) and the causes of PE in a prospective, consecutive series of patients. SETTING: A tertiary care hospital associated with the Universidad Complutense de Madrid (Spain). PATIENTS: One thousand consecutive patients with PE for whom clinical signs indicated the need for diagnostic thoracocentesis were studied prospectively in our service from December 1991 to July 2000. RESULTS: The most common cause of PE was neoplasm (n = 364 patients). The most common place of origin of the tumor was the lung (n = 125), followed by the pleura (mesothelioma, n = 48). The most common histologic type was adenocarcinoma (n = 128). Tuberculosis was the second most common cause of PE (n = 155). PE was transudate in 118 patients, mainly secondary to heart failure. Among the 42 patients who were positive for human immunodeficiency virus (HIV), the most common cause of PE was tuberculosis. Tuberculosis was also the most likely cause of PE in patients under 40 years of age. CONCLUSIONS: The most common causes of PE were neoplasm and tuberculosis. Tuberculosis was the most common cause in patients under 40 years of age and in those infected by HIV.

Estudio prospectivo de 1.000 pacientes consecutivos con derrame pleural.Etiología del derrame y características de los pacientes / Prospective study of 1,000 consecutive patients with pleural effusion. Etiology of the effusion and characteristics of the patients

OBJETIVO: Describir las características de los pacientes y la etiología del derrame pleural (DP) en una serie prospectiva consecutiva de pacientes con esta afección. ÁMBITO: Hospital terciario, adscrito a la Universidad Complutense de Madrid. PACIENTES: Mil pacientes consecutivos con DP en los que estaba clínicamente indicada la realización de toracocentesis diagnóstica, estudiados de forma prospectiva en nuestro servicio, desde diciembre de 1991 a julio de 2000.RESULTADOS: La primera causa en frecuencia de derrame pleural fue la neoplásica, con 364 pacientes. El origen tumoral más frecuente fue el pulmonar (n = 125), seguido del mesotelioma pleural (n = 48). La estirpe más frecuente fue adenocarcinoma (n = 128). La tuberculosis ha representado la segunda causa de derrame pleural en nuestro medio (n = 155). En 118 pacientes el derrame pleural era trasudado, principalmente secundario a insuficiencia cardíaca. Entre los 42 pacientes con serología positiva para el virus de la inmunodeficiencia humana (VIH), la primera causa de derrame pleural fue la tuberculosis. En pacientes menores de 40 años la tuberculosis fue la causa más probable de derrame pleural. CONCLUSIONES: Las causas más frecuentes de derrame pleural fueron la neoplásica y la tuberculosis. La tuberculosis fue la etiología más frecuente en pacientes menores de 40 años y en aquellos con infección por el VIH (AU)

X-linked agammaglobulinaemia and squamous lung cancer.

A 32yr-old nonsmoking male, diagnosed as having X-linked agamma-globulinemia, presented with fever, cough with purulent sputum, a very intense back pain and a mass of 10 centimetres in lower left lobe. Diagnostic evaluation revealed a squamous cell carcinoma with very aggressive metastases at L3. Malignancies are the second leading cause of death in children and adults with congenital immunodeficiency disorders, mostly non-Hodgkin lymphomas and gastric and colon adenocarcinomas, but this is the first report of lung cancer in a patient with X-linked agammaglobulinemia. Lung cancer incidence has been reported to be higher in patients with other diseases of the lung, however, there is no clear evidence of the role of bronchiectasis in developing lung cancer. It is possible that a longer survival for patients with X-LA recently diagnosed, and an association of chronic bronchial infection, could favour the development of pulmonary neoplasm.

Are pleural fluid parameters related to the development of residual pleural thickening in tuberculosis?

STUDY OBJECTIVE: Identification of predictive factors for the development of residual pleural thickening (RPT). DESIGN: Retrospective study. LOCATION: A 1,500-bed tertiary hospital. PATIENTS: Patients with pleural tuberculosis diagnosed between December 1991 and February 1995 in our Respiratory Disease Service. INTERVENTIONS: The clinical and radiologic characteristics, and measurements of microbiological and biochemical parameters and markers in pleural fluid were studied. RPT was defined in a posteroanterior chest radiograph as a pleural space of >2 mm measured in the lower lateral chest at the level of an imaginary line intersecting the diaphragmatic dome. MEASUREMENTS AND RESULTS: In 56 patients studied, 11 (19.6%) had RPT 10 mm and 24 (42.8%) had RPT >2 mm. The pleural fluid of patients with RPT 10 mm had a significantly lower glucose concentration and pH and higher lysozyme and tumor necrosis factor-alpha levels than the other patients. The pleural fluid of patients with RPT >2 mm showed no significant differences. CONCLUSIONS: The development of RPT 10 mm was related to higher concentrations of lysozyme and tumor necrosis factor-alpha and lower glucose concentration and pH in pleural fluid compared with development of lower measurements of RPT.

[Ambulatory diagnosis of patients requiring a pleural biopsy. Study of 100 consecutive cases]. / Diagnóstico ambulatorio de los pacientes que precisan biopsia pleural. Estudio de 100 casos consecutivos.

Our aim was to describe our experience with outpatients requiring pleural biopsy. The first 100 patients with pleural exudate from whom at least one pleural biopsy specimen was taken on an outpatient basis at our hospital since January 1993. Clinical and radiological signs were recorded for all patients. We also analyzed complications, frequency of use of other diagnostic test and time required for diagnosis. The mean age of the 100 patients (64 men) was 56 years. Outpatient study of these patients was not prevented by the advanced age on the sample (with 35 patients older than 79), the size of the pleural effusions (23 of which were large), or the diagnosis of diseases with poor prognoses (with 43 effusions diagnosed as neoplastic). Complications encountered in taking the biopsy specimens were similar to those reported for other series. The mean time until diagnosis was 7.4 days. Biopsies can often be obtained from patients with pleural effusion on an outpatient basis, even when clinical symptoms vary widely, without increasing the number of complications and within a reasonable period of time.

Interferon-gamma in 388 immunocompromised and immunocompetent patients for diagnosing pleural tuberculosis.

The level of interferon-gamma (IFN-gamma) in pleural fluid has been reported to be increased in pleural tuberculosis. Nevertheless, its diagnostic value has not yet been well-established, and immunocompromised patients have not previously been evaluated. The aim of this study was to determine the value of the IFN-gamma level in pleural fluid for diagnosing tuberculous pleurisy in immunocompetent and immunocompromised patients. Three hundred and eighty eight consecutive patients were studied prospectively (73 with tuberculous pleural effusions, including nine with concurrent human immunodeficiency virus (HIV) infection and one after liver transplantation, and 315 with nontuberculous effusions). IFN-gamma was measured by radioimmunoassay. The sensitivity of the test, using a 3.7 U.mL-1 cut-off point, was 0.99 (95% confidence interval (95% CI) 0.93-1.00) and the specificity was 0.98 (95% CI 0.96-1.00). The sensitivity of the test did not differ in HIV-positive and HIV-negative patients. Patients with lymphoma, vasculitis or vascular connective tissue disease did not have abnormal IFN-gamma values. In conclusion, the level of interferon-gamma in pleural fluid is a very good diagnostic marker of tuberculous pleural effusion, even in immunocompromised patients.

Diagnostic value of CA 72-4, carcinoembryonic antigen, CA 15-3, and CA 19-9 assay in pleural fluid. A study of 207 patients.

BACKGROUND: The differential diagnosis of pleural effusion is a frequent clinical problem. Several tumor markers have been evaluated in pleural fluid, but the value of CA 72-4 assay and of combinations of tumor marker assays has not been firmly established. To find a minimally invasive tool for differentiating between pleural effusions of malignant or benign origin, the authors assessed the diagnostic value of CA 72-4, carcinoembryonic antigen (CEA), CA 15-3, and CA 19-9 assays in pleural fluid individually and in combination. METHODS: The authors prospectively studied 207 patients with pleural effusion (65 malignant, 48 tuberculous, 24 parapneumonic, 26 transudates, 14 miscellaneous, and 30 of unknown nonneoplastic origin). The levels of CA 72-4, CEA, CA 15-3, and CA 19-9 were measured in pleural fluid by radioimmunoassay. RESULTS: CA 72-4 assay in pleural fluid had an acceptable sensitivity and very good specificity for diagnosing malignant pleural effusion. The combination of CA 72-4 plus CEA plus CA 15-3 yielded the best accuracy, 0.90 (95% confidence interval [CI] 0.85-0.94), with a sensitivity of 0.78 (95% CI, 0.67-0.88), specificity of 0.95 (95% CI, 0.90-0.98), positive predictive value of 0.88 (95% CI, 0.77-0.95), and negative predictive value of 0.91 (range, 0.85-0.94). A good clinical strategy may be to begin with a CEA assay (specificity of I) and then, if it is negative, to add CA 15-3 or even CA 72-4 assays to improve sensitivity. The diagnosis of mesothelioma is more likely with a high CA 15-3 level and normal CEA and CA 19-9 levels. CONCLUSIONS: Assays of CEA, CA 72-4, and CA 15-3 in pleural fluid, or the combination of CEA with CA 15-3 and CA 72-4, was useful in differentiating between pleural effusion of malignant and benign origin.

[Recurrent amiodarone lung toxicity after withdrawal of the drug and treatment with corticoids]. / Toxicidad pulmonar recurrente por amiodarona tras retirada del fármaco y tratamiento con corticoides.

We present a case of recidivation in amiodarone-induced pulmonary toxicity 4 months after suspension of the drug, while treatment with corticoids was underway. Possible causes suggested are the persistence of high blood levels of amiodarone and the rapid decrease of corticoid dose.

Determination of tissue polypeptide-specific antigen in pleural fluid and serum from patients with pleural effusion.

As a tool for differentiating malignant and benign pleural effusions, we evaluated the diagnostic value of the assay of tissue polypeptide-specific antigen (TPS) in pleural fluid and serum, and of the pleural fluid TPS/serum TPS ratio in patients with pleural effusion. We studied prospectively 147 consecutive patients who had pleural effusions: 43 malignant pleural effusions and 104 benign pleural effusions. TPS levels were measured by RIA. The sensitivity and specificity of these measurements were: TPS in pleural fluid (cutoff 20,000 U/L): 0.21 and 0.98; TPS in serum (cutoff 300 U/L); 0.31 and 0.96; pleural fluid TPS/serum TPS ratio (cutoff 1200): 0.07 and 0.99. All these values enhanced the sensitivity of cytologic analysis of pleural fluid. However, we conclude that TPS assay in pleural fluid and serum, and the pleural fluid TPS/serum TPS ratio have limited diagnostic value in patients with pleural effusion.