[Langerhans cell histiocytosis]. / Histiocitosis de células de Langerhans.

We describe the case of male diagnosed with histiocytosis of Langerhans cells. Histiocytosis X is an interstitial disease with a real incidence and an unknown prevalence that can be suspected due to epidemiological and radiological data. The diagnosis can be realized using BAL and/or anatomo-pathological study of a biopsy. The principal treatment is to give up the tobacco habit. Evolution can be favourable.

Histiocitosis de células de Langerhans / Langerhans cell histiocytosis

Se describe el caso de un varón con diagnóstico de histiocitosis de células de Langerhans. La histiocitosis X es una enfermedad intersticial con una incidencia real y una prevalencia desconocidas que puede sospecharse por datos epidemiológicos y radiológicos. El diagnóstico puede realizarse mediante BAL y/o estudio anatomo-patológico de biopsia. El principal tratamiento consiste en abandonar el hábito tabáquico. La evolución puede ser variable (AU)

We describe the case of male diagnosed with histiocytosis of Langerhans cells. Histiocytosis X is an interstitial disease with a real incidence and an unknown prevalence that can be suspected due to epidemiological and radiological data. The diagnosis can be realized using BAL and/or anatomo-pathological study of a biopsy. The principal treatment is to give up the tobacco habit. Evolution can be favourable (AU)

[Malign pleural mesothelioma]. / Mesotelioma pleural maligno.

Malign mesothelioma is a pleural neoplasia related to the occupational exposure to asbestos, although other factors can be involved; its incidence is increasing in Western Europe. Pain in the thorax and dyspnoea are its most frequent clinical manifestations. An important role in the evaluation of the disease is played by imaging techniques, of which CAT is the most widely used, although MR and PET are suggested as techniques that can provide additional information in the diagnosis and prognosis of these patients. Survival is short and there is no consensus in the literature that would orientate treatment of these patients. This is due to a lack of data that would confirm an increase of survival with any therapeutic method, although recent efforts have led to the development of new treatments that could change the present pessimistic view of the disease held by doctors and patients.

[Other obstructive diseases: byssinosis, chronic bronchitis and occupational COPD and eosinophilic bronchitis]. / Otras enfermedades obstructivas: bisinosis, bronquitis crónica y EPOC de origen laboral y bronquitis eosinofílica.

Besides occupational asthma and diseases derived from acute inhalation, other obstructive diseases also have an occupational origin. Although at present byssinosis is a rare disease in Spain, we describe its characteristics because of its historical interest amongst occupational respiratory diseases and because it is still relevant in developing countries. Chronic bronchitis can also be related to exposure at work to dust and smoke, and is often referred to as "industrial bronchitis". Historically, the relation of CPOD to occupation has been subject to controversy, but nowadays this relationship is accepted; we describe the present evidence supporting this relationship. Finally, we describe eosinophilic bronchitis without asthma, an entity that was described for the first time in 1989 and that can sometimes have an occupational origin, sharing aetiological agents with occupational asthma.

[Occupational lung cancer]. / Carcinoma de pulmón de origen laboral.

Bronchopulmonary carcinoma is the first cause of death by cancer in males, its principal cause being tobacco consumption. Nonetheless, different studies have attributed a certain, by no means negligible percent of its aetiology to the occupational exposure to agents considered carcinogenic such as asbestos, with which half of the cases of occupational lung cancer are related. Given the low survival rate of this pathology, preventive measures directed at identifying carcinogenic agents and reducing exposure to them are extremely important. Given that the clinical presentation does not differ from tobacco-related carcinoma, a high level of suspicion, based on a meticulous occupational history, is fundamental to its diagnosis. Due to the synergic effect of tobacco, measures aimed at reducing its consumption continue to be extremely important in the exposed population.

[Registry of occupational respiratory diseases in Navarre]. / Registro de enfermedades respiratorias de origen laboral en Navarra.

BACKGROUND: In January 2002 an occupational respiratory diseases record was established in Navarre so that the number and characteristics of the occupational respiratory pathology could be analysed. METHODS: The cases reported by doctors who collaborated in 2002, 2003 and 2004, were entered in a database for subsequently analysis. This database has several variables: gender, age, tobacco habit, hospital department and notifying doctor, diagnosis, job and causal agent. RESULTS: 125 cases were reported. 97 males (77.6%) and 28 females (22.4%). Average age was 55,4 years old. Eighty-eight were non-smokers (70.4%) and 37 were smokers (29.6%). Pneumology reported 84 cases (67.2%) and Allergology 41 (32.8%). The diagnoses were: 50 bronchial asthma (40%), 31 benign pleural disease (24.8%), 8 extrinsic allergic alveolitis (6.4%), 8 mesothelioma (6.4%), 7 bronchopulmonary cancer (5.6%), 5 acute inhalations (4%), 3 amianthinopsy (2.4%), 2 rhinitis (1.6%), 1 RADS (0.8%) and 1 COPD (0.8%). The most reported jobs were: 13 painting and varnishing (10.4%), 12 spinning asbestos yarn (9.6%) and 8 bakery and confectionery (6.4%). The main causal agents were: 49 cases of asbestos (39.2%), 15 isocyanates (12%) and 8 silica (6.4%). CONCLUSIONS: The most frequent pathology was bronchial asthma, followed by benign pleural disease. The most reported job was painting and varnishing and secondly spinning asbestos yarn. Asbestos was the first substance involved and the second was isocyanates. Most of the patients were males and non-smokers. The Pneumology Service of the Virgen del Camino Hospital reported most of the cases. Ratio contrast analysis showed a certain tendency towards a statistical significance in rhinitis, occupational asthma and amianthinopsy.

Mesotelioma pleural maligno / Malign pleural mesothelioma

El mesotelioma maligno es una neoplasia pleuralrelacionada con la exposición laboral a amianto, aunqueotros factores pudieran estar implicados, con unaincidencia en aumento en Europa Occidental. El dolortorácico y la disnea son sus manifestaciones clínicasmás frecuentes. Las técnicas de imagen juegan unpapel importante en la evaluación de la enfermedad,siendo la TAC las más ampliamente utilizada, si bien laRM y el PET se postulan como técnicas que puedenaportar información adicional en el diagnóstico y pronósticode estos pacientes. La supervivencia es corta yno existe un consenso en la literatura que guíe el tratamientode estos pacientes debido a la falta de datosque apoyen un aumento de supervivencia de ningunamodalidad terapéutica, si bien, recientemente losesfuerzos realizados han llevado al desarrollo de nuevostratamientos que podrían cambiar la actual visiónpesimista de la enfermedad por parte de médicos ypacientes

Malign mesothelioma is a pleural neoplasia relatedto the occupational exposure to asbestos, althoughother factors can be involved; its incidence isincreasing in Western Europe. Pain in the thorax anddyspnoea are its most frequent clinical manifestations.An important role in the evaluation of the disease isplayed by imaging techniques, of which CAT is themost widely used, although MR and PET are suggestedas techniques that can provide additional informationin the diagnosis and prognosis of these patients.Survival is short and there is no consensus in theliterature that would orientate treatment of thesepatients. This is due to a lack of data that wouldconfirm an increase of survival with any therapeuticmethod, although recent efforts have led to thedevelopment of new treatments that could change thepresent pessimistic view of the disease held by doctorsand patients

Otras enfermedades obstructivas: bisinosis, bronquitis crónica y EPOC de origen laboral y bronquitis eosinofílica / Other obstructive diseases: byssinosis, chronic bronchitis and occupational COPD and eosinophilic bronchitis

Además del asma ocupacional y las enfermedadesderivadas de la inhalación aguda, otras enfermedadesobstructivas también reconocen un origen laboral.Aunque en la actualidad la bisinosis es una enfermedadrara en España, describimos las características de lamisma por su interés histórico dentro de las enfermedadesrespiratorias de origen laboral y porque todavíasigue vigente en los países en vías de desarrollo. Labronquitis crónica también puede estar relacionadacon la exposición laboral a polvos y humos, con frecuenciadenominada “bronquitis industrial”. La relaciónocupacional de la EPOC ha sido más controvertidaa lo largo de la historia, pero en la actualidad estarelación está aceptada; describimos la evidencia actualque sustenta esta relación. En último lugar, describimosla bronquitis eosinofílica sin asma, entidad descritapor primera vez en 1989 y que en ocasiones tambiénpuede tener un origen laboral, compartiendo agentesetiológicos con el asma ocupacional

Besides occupational asthma and diseases derivedfrom acute inhalation, other obstructive diseases alsohave an occupational origin. Although at presentbyssinosis is a rare disease in Spain, we describe itscharacteristics because of its historical interestamongst occupational respiratory diseases andbecause it is still relevant in developing countries.Chronic bronchitis can also be related to exposure atwork to dust and smoke, and is often referred to as“industrial bronchitis”. Historically, the relation ofCPOD to occupation has been subject to controversy,but nowadays this relationship is accepted; wedescribe the present evidence supporting thisrelationship. Finally, we describe eosinophilicbronchitis without asthma, an entity that wasdescribed for the first time in 1989 and that cansometimes have an occupational origin, sharingaetiological agents with occupational asthma

Carcinoma de pulmón de origen laboral / Occupational lung cancer

El carcinoma broncopulmonar es la primera causade muerte por cáncer en varones, siendo su principalcausa el consumo de tabaco; no obstante, diversosestudios han atribuido un tanto por ciento no despreciablede su etiología a la exposición laboral a agentesconsiderados cancerígenos como el asbesto, con elque tiene relación la mitad de los casos de cáncer pulmonarde origen laboral. Dada la baja supervivencia deesta patología, son de suma importancia las medidasde prevención encaminadas a identificar los agentescancerígenos y a la disminución de su exposición.Puesto que la presentación clínica no difiere del carcinomarelacionado con el tabaco, un alto grado de sospecha,basado en una cuidadosa historia laboral, esfundamental para su diagnóstico. Debido el efectosinérgico del tabaco, medidas destinadas a disminuirsu consumo, continúan siendo de suma importancia enla población expuesta

Bronchopulmonary carcinoma is the first cause ofdeath by cancer in males, its principal cause beingtobacco consumption. Nonetheless, different studieshave attributed a certain, by no means negligiblepercent of its aetiology to the occupational exposure toagents considered carcinogenic such as asbestos, withwhich half of the cases of occupational lung cancer arerelated. Given the low survival rate of this pathology,preventive measures directed at identifyingcarcinogenic agents and reducing exposure to them areextremely important. Given that the clinicalpresentation does not differ from tobacco-relatedcarcinoma, a high level of suspicion, based on ameticulous occupational history, is fundamental to itsdiagnosis. Due to the synergic effect of tobacco,measures aimed at reducing its consumption continueto be extremely important in the exposed population

Registro de enfermedades respiratorias de origen laboral en Navarra / Registry of occupational respiratory diseases in Navarre

Fundamento. Con objeto de analizar la incidenciay características de la patología respiratoria ocupacionalen Navarra, se implantó en enero de 2002 el Registrode Enfermedades Respiratorias de Origen Laboral.Métodos. Los casos notificados por los médicoscolaboradores durante los años 2002, 2003 y 2004, seintrodujeron en una base de datos diseñada para suanálisis posterior, que constaba de distintas variables:sexo, edad, tabaco, servicio y médico declarante, diagnóstico,profesión y agente causal.Resultados. Se notificaron 125 casos. 97 varones(77,6%) y 28 mujeres (22,4%). La media de edad fue 55,4años. Ochenta y ocho pacientes no fumaban (70,4%) y37 eran fumadores (29,6%). Neumología declaró 84casos (67,2%) y Alergología 41 (32,8%). Los diagnósticosfueron: 50 casos de asma bronquial (40%), 31 deenfermedad pleural benigna (24,8%), 8 alveolitis alérgicaextrínseca (6,4%), 8 mesotelioma (6,4%), 7 cáncerbroncopulmonar (5,6%), 5 inhalaciones agudas (4%), 3asbestosis (2,4%), 2 rinitis (1,6%), 1 RADS (0,8%) y 1EPOC (0,8%). Las profesiones más declaradas: 13 pintura/barnizado (10,4%), 12 hilado de ovillos de amianto(9,6%) y 8 panadería/pastelería (6,4%). Como agentescausales principales: 49 casos de asbesto (39,2%),15 isocianatos (12%) y 8 sílice (6,4%).Conclusiones. La patología más frecuente fue elasma bronquial, seguida de la enfermedad pleuralbenigna. La profesión más notificada era pintura/barnizadoy en segundo lugar hilado de ovillos. El asbestofue la primera sustancia implicada seguida de los isocianatos.La mayoría de pacientes eran varones y nofumadores. El Servicio de Neumología del Hospital Virgendel Camino notificó el mayor número de casos. Elanálisis de contraste de proporciones mostró ciertatendencia a la significación en rinitis, asma bronquial yasbestosis

Background. In January 2002 an occupationalrespiratory diseases record was established in Navarreso that the number and characteristics of theoccupational respiratory pathology could be analysed.Methods. The cases reported by doctors whocollaborated in 2002, 2003 and 2004, were entered in adatabase for subsequently analysis. This database hasseveral variables: gender, age, tobacco habit, hospitaldepartment and notifying doctor, diagnosis, job andcausal agent.Results. 125 cases were reported. 97 males (77.6%)and 28 females (22.4%). Average age was 55,4 years old.Eighty-eight were non-smokers (70.4%) and 37 weresmokers (29.6%). Pneumology reported 84 cases(67.2%) and Allergology 41 (32.8%). The diagnoseswere: 50 bronchial asthma (40%), 31 benign pleuraldisease (24.8%), 8 extrinsic allergic alveolitis (6.4%), 8mesothelioma (6.4%), 7 bronchopulmonary cancer(5.6%), 5 acute inhalations (4%), 3 amianthinopsy(2.4%), 2 rhinitis (1.6%), 1 RADS (0.8%) and 1 COPD(0.8%). The most reported jobs were: 13 painting andvarnishing (10.4%), 12 spinning asbestos yarn (9.6%)and 8 bakery and confectionery (6.4%). The maincausal agents were: 49 cases of asbestos (39.2%), 15isocyanates (12%) and 8 silica (6.4%).Conclusions. The most frequent pathology wasbronchial asthma, followed by benign pleural disease.The most reported job was painting and varnishing andsecondly spinning asbestos yarn. Asbestos was thefirst substance involved and the second wasisocyanates. Most of the patients were males and nonsmokers.The Pneumology Service of the Virgen delCamino Hospital reported most of the cases. Ratiocontrast analysis showed a certain tendency towards astatistical significance in rhinitis, occupational asthmaand amianthinopsy

[The characteristics of patients who have died from tuberculosis]. / Características de los pacientes fallecidos por tuberculosis.

OBJECTIVE: To analyze the characteristics of the patients died from tuberculosis (TB) in our hospital. METHOD: We retrospectively reviewed the records of the 46 patients died in-hospital from TB between january, 1992 and june, 1997. MEAN AGE: 55 +/- 19 years (19-85). 35 (76%) males and 11 (24%) females. DIAGNOSIS: pulmonary (63%), disseminated (26%) and extrapulmonary (11%) TB. 87% of the patients had previous comorbidity (35% were seropositive for HIV). The only differences between HIV-infected and non-HIV-infected cases were a greater proportion of normal chest roentgenograms and of toxicity from therapy in seropositive patients. The disease was diagnosed at death in 17% of cases. Chemoprophylaxis had not been used in 5 patients, although they fulfilled criteria for receiving it. Poor compliance with treatment was noted in 6 (13%) patients. CONCLUSIONS: We have found a high prevalence of comorbidity in these patients, which might account for the mortality. Delays in diagnosis, misuse of chemoprophylaxis and poor compliance with therapy might also be implicated in some cases.

Características de los pacientes fallecidos por tuberculosis / Characteristics of patients died from tuberculosis

Objetivo: conocer las características de los pacientes que fallecen por tuberculosis (TB) en nuestro centro. Método: Revisamos retrospectivamente las historias clínicas de los 46 casos de muerte intrahospitalaria debida a TB entre enero de 1992 y junio de 1997. Edad media: 55 ñ 19 años (19-85). 35 (76 %) varones y 11 (24 %) mujeres. Resultados: Tipo de TB: pulmonar (63 %), diseminada (26 %) y extrapulmonar (11 %). El 87 % de los casos presentaban comorbilidad preexistente (el 35 porciento, coinfección por VIH). Las únicas diferencias entre pacientes VIH (+) y (-) fueron un mayor porcentaje de radiografía de tórax normal y de toxicidad medicamentosa en los enfermos seropositivos. En el 17 % de los casos, el diagnóstico se realizó tras el fallecimiento. En 5 pacientes no se había empleado quimioprofilaxis antituberculosa pese a estar indicada, y en 6 (13 %) detectamos un mal cumplimiento terapéutico. Conclusiones: en este tipo de pacientes hay una elevada prevalencia de comorbilidad como posible causa de la mala evolución. La existencia de retrasos en el diagnóstico, un empleo inadecuado de la quimioprofilaxis y un mal cumplimiento terapéutico podrían relacionarse con la mala evolución en algunos casos (AU)

Primary pulmonary hypertension associated with human immunodeficiency virus infection.

Several cardiorespiratory diseases can complicate human immunodeficiency virus infection. Primary pulmonary hypertension is a rare clinical disorder which carries a bad prognosis. More than 90 cases of HIV-associated primary pulmonary hypertension have been reported to date. Although its pathogenesis remains unknown, some evidence suggests a possible role for the virus itself in its development. Genetic susceptibility may also be implicated. The clinical and histopathologic features of this entity do not differ from those of classic primary pulmonary hypertension. The diagnosis requires a high degree of clinical suspicion and a careful evaluation to rule out causes of secondary pulmonary hypertension. In addition to supportive measures, anticoagulation and vasodilators have been used to treat this disorder, although sufficient data regarding long-term results with these therapies are lacking.