Síndrome de Doege-Potter. A propósito de un caso / Doege-Potter syndrome: Presentation of a case

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Artritis reumatoide y nódulos pulmonares: un diagnóstico final inesperado / Rheumatoid arthritis and pulmonary nodules: a unexpected final diagnosis

Se presenta el caso de una mujer de 50 años, fumadora, con artritis reumatoide seropositiva (FR y CCP) de 11 años de evolución en tratamiento con triple terapia, y aparición de nódulos pulmonares con diagnóstico final de histiocitosis de células de Langerhans por biopsia pulmonar. No hemos encontrado casos descritos de la coexistencia de ambas enfermedades. La abstinencia tabáquica llevó a la resolución radiológica sin necesidad de modificar la terapia inmunosupresora (AU)

We report the case of a 50-year-old female smoker with an 11-year history of seropositive rheumatoid arthritis (rheumatoid factor and anti-cyclic citrullinated peptide antibodies) receiving triple therapy. She developed pulmonary nodules diagnosed as Langerhans cell histiocytosis by lung biopsy. We found no reported cases of the coexistence of these two diseases. Smoking abstinence led to radiologic resolution without modifying the immunosuppressive therapy (AU)

Nodulosis reumatoidea pulmonar durante el tratamiento con fármacos anti-TNF / Rheumatoid lung nodulosis during anti-TNF therapy

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Rheumatoid arthritis and pulmonary nodules: An unexpected final diagnosis. / Artritis reumatoide y nódulos pulmonares: un diagnóstico final inesperado.

We report the case of a 50-year-old female smoker with an 11-year history of seropositive rheumatoid arthritis (rheumatoid factor and anti-cyclic citrullinated peptide antibodies) receiving triple therapy. She developed pulmonary nodules diagnosed as Langerhans cell histiocytosis by lung biopsy. We found no reported cases of the coexistence of these two diseases. Smoking abstinence led to radiologic resolution without modifying the immunosuppressive therapy.

Ventilación no invasiva / Non-invasive ventilation

La llegada de la ventilación mecánica no invasiva (VMNI) ha condicionado un cambio radical en el manejode la insuficiencia respiratoria aguda y crónica. A lo largo de los últimos años, hemos asistido al incrementoprogresivo en el número de aplicaciones posibles de la VMNI, tanto en el ámbito hospitalario como extrahospitalario.Su uso se ha universalizado en todos los hospitales y en la actualidad los residentes del sigloXXI reciben una formación específica que no existía hasa hace sólo unos años.Es deber de todos nosotros encabezar el avance asistencial y científico que ha supuesto el desarrollo de laVMNI, liderando los acontecimientos que acompañen al mejor conocimiento de las bases fisiopatológicasde la ventilación, de sus continuas aplicaciones en la práctica clínica diaria y del perfeccionamiento de loselementos necesarios para una correcta aplicación de la técnica.En la presente revisión se pretende efectuar un recorrido global en el procedimiento de la VMNI, desde losconocimientos más teóricos –fisiopatología de la VMNI–, hasta las habilidades más prácticas –reconocimientode las asincronías paciente-ventilador–. En este progreso de lo complejo a lo básico o de lo básico alo complejo, según se mire, intentaremos profundizar en las nociones necesarias para comprender el propiofuncionamiento técnico del ventilador, adentrándonos en los diferentes modos y parámetros, y exponiendolas capacidades que debemos desarrollar para la correcta indicación, uso y monitorización de latécnica, con una última reflexión acerca de otras ayudas respiratorias que podemos ofrecer a pacientes confracaso ventilatorio(AU)

The advent of non-invasive mechanical ventilation (NIMV) has radically changed the management of acuteand chronic respiratory failure. Over the last few years, the number of possible applications of NIMV hasprogressively increased, both in the hospital and extrahospital setting. NIMV is now used in all hospitals andresident physicians currently receive specific training –nonexistent until a few years ago– in this modality.It falls to all of us to push forward the clinical and scientific advances represented by the development ofNIMV, by promoting the events that accompany better knowledge of the physiopathological bases ofventilation and of its continuous applications in daily clinical practice and by perfecting the elementsrequired for the correct application of this technique.The present review aims to provide a broad overview of NIMV, from the most theoretical knowledge (thephysiopathology of NIMV) to the most practical skills (recognition of patient-ventilator asynchrony).Through this progression from the complex to the most basic, or from the basics to the most complex,depending on the perspective taken, we aim to provide deeper knowledge of the concepts required tounderstand the technical functioning of the ventilator, describing its distinct modes and parameters andthe abilities that must be developed for the correct indication, use and monitoring of the technique. Weprovide a final reflection on other forms of respiratory support that can be offered to patients withventilatory failure(AU)

[Non-invasive ventilation]. / Ventilación no invasiva.

The advent of non-invasive mechanical ventilation (NIMV) has radically changed the management of acute and chronic respiratory failure. Over the last few years, the number of possible applications of NIMV has progressively increased, both in the hospital and extrahospital setting. NIMV is now used in all hospitals and resident physicians currently receive specific training -nonexistent until a few years ago- in this modality. It falls to all of us to push forward the clinical and scientific advances represented by the development of NIMV, by promoting the events that accompany better knowledge of the physiopathological bases of ventilation and of its continuous applications in daily clinical practice and by perfecting the elements required for the correct application of this technique. The present review aims to provide a broad overview of NIMV, from the most theoretical knowledge (the physiopathology of NIMV) to the most practical skills (recognition of patient-ventilator asynchrony). Through this progression from the complex to the most basic, or from the basics to the most complex, depending on the perspective taken, we aim to provide deeper knowledge of the concepts required to understand the technical functioning of the ventilator, describing its distinct modes and parameters and the abilities that must be developed for the correct indication, use and monitoring of the technique. We provide a final reflection on other forms of respiratory support that can be offered to patients with ventilatory failure.