Reliability of blood eosinophil count in steady-state bronchiectasis.

RATIONALE: The baseline value of eosinophils in peripheral blood (BEC) has been associated with different degrees of severity, prognosis and response to treatment in patients with bronchiectasis. It is not known, however, if this basal value remains constant over time. OBJECTIVES: The aim of this study was to assess whether the BEC remains stable in the long term in patients with bronchiectasis. METHODS AND MEASUREMENTS: Patients from the RIBRON registry of bronchiectasis diagnosed by computed tomography with at least 2 BEC measurements one year apart were included in the study. Patients with asthma and those taking anti-eosinophilic drugs were excluded. Reliability was assessed using the intra-class correlation coefficient (ICC). A patient with a BEC of at least 300 cells/uL or less than 100 cells/uL was considered eosinophilic or eosinopenic, respectively. Group changes over time were also calculated. MAIN RESULTS: Seven hundred and thirteen patients were finally included, with a mean age of 66.5 (13.2) years (65.8 % women). A total of 2701 BEC measurements were performed, with a median number of measurements per patient of 4 (IQR: 2-5) separated by a median of 12.1 (IQR: 10.5-14.3) months between two consecutive measurements. The ICC was good (>0.75) when calculated between two consecutive measurements (approximately one year apart) but had dropped significantly by the time of the next annual measurements. Similarly, the change from an eosinophilic or eosinopenic patient to a non-eosinophilic or non-eosinopenic patient, respectively, was less than 30 % during the first year with respect to the baseline value but was close to 50 % in later measurements. CONCLUSIONS: Given the significant changes observed in the baseline value of the BEC over time, its monitoring is necessary in patients with bronchiectasis in order to more reliably assess its usefulness.

Pseudomonas aeruginosa and lung function decline in patients with bronchiectasis.

OBJECTIVES: The objective of this study was to analyse lung function decline over time in bronchiectasis, along with the factors associated with it. METHODS: Spirometry was measured every year in this observational, prospective study in 849 patients from the Spanish Bronchiectasis Registry (RIBRON). The main outcome was the decline in the rate of forced expiratory volume during the first second (FEV1). To be included in this study, patients needed a baseline assessment and at least one subsequent assessment. FEV1 decline was analysed using a mixed-effects linear regression model adjusted for clinically significant variables. RESULTS: We recruited 849 bronchiectasis patients with at least two annual lung function measurements (follow-up range 1-4 years). A total of 2262 lung function tests were performed (mean 2.66 per patient, range 2-5). Mean baseline FEV1 was 1.78 L (standard deviation (SD) 0.76; 71.3% predicted). Mean age was 69.1 (SD 15.4) years; 543 (64% women. The adjusted rates of FEV1 decline were -0.98% predicted/year (95% confidence interval (CI) -2.41 to -0.69) and -31.6 (95% CI -44.4 to -18.8) mL. The annual FEV1 decline was faster in those patients with chronic bronchial infection by Pseudomonas aeruginosa (-1.37% (52.1 mL) vs -0.37% (-24.6 mL); p < 0.001), greater age, increased number of severe exacerbations in the previous year and higher baseline FEV1 value. DISCUSSION: In patients with bronchiectasis, the annual rate of FEV1 decline was -31.6 mL/year and it was faster in older patients and those with chronic bronchial infection by P. aeruginosa, increased number of previous severe exacerbations and higher baseline FEV1 value.

Impact of the Xpert(®) MTB/RIF molecular test on the late diagnosis of pulmonary tuberculosis.

We analysed the impact of the Xpert(®) MTB/RIF molecular test on health-care diagnostic delay among tuberculosis patients. Diagnostic delay was 17.2 days (standard deviation 23.2, median 10 days). Of 128 patients recruited into the study, 60 (47%) were smear-negative; of these, 40 (67%) were Xpert-positive and were started on treatment without culture. The sensitivity of smear microscopy was 53% compared with 82% for Xpert. In smear-negative patients, delay in Xpert-positive and -negative patients was respectively 15.5 ± 13.2 and 25.5 ± 12.5 days (P = 0.002). We conclude that Xpert results were significantly associated with shorter health-care diagnostic delay, particularly in smear-negative patients.

Primary pulmonary botryomycosis: a bacterial lung infection mimicking lung cancer.

Primary pulmonary botryomycosis, or bacterial pseudomycosis, is an unusual bacterial infection characterised by the formation of eosinophilic granules that resemble those of Actinomyces species infection. The diagnosis of botryomycosis is based on culture of the granules revealing gram-positive cocci or gram-negative bacilli. The bacterial pathogen most frequently found is Staphylococcus aureus. The pathobiology remains unknown. Pulmonary botryomycosis can resemble actinomycosis, tuberculosis or invasive carcinoma. Definitive treatment requires a combination of both surgical debridement and long-term antimicrobial therapy. We present a case of primary pulmonary botryomycosis in an immunocompetent patient.

Necrotising pneumonia caused by Lactococcus lactis cremoris.

Lactococcus lactis cremoris is a facultative anaerobic, gram-positive coccus whose natural host is bovine livestock. It may form part of the normal human bacterial flora found in the oropharynx, the gastrointestinal tract and the vagina. This bacterium is essential in the food industry, where it is used in milk fermentation to obtain cheese, yoghurt, etc. Exposure to unpasteurised dairy products has thus been recognised as a risk factor for infection by this organism. It is generally considered to be non-pathogenic, although it appears that pathogenicity may be emerging. We present an atypical case of necrotising pneumonia caused by L. lactis cremoris.

Prevalencia del tabaquismo y actitud frente al mismo entre los médicos de Atención Primaria / Prevalence of smoking and attitude towards it among Primary Care Physicians

Fundamento: El tabquismo es la principal causa de enfermedad evitable y el médico juega un papel fundamental en su tratamiento y prevención. Se realizó un estudio para conocer la prevalencia de médicos fumadores en Atención Primaria (AP) y su actitud ante el tabaquismo. Métodos: estudio descriptivo. Se envió una encuesta anónima elaborada para tal fin, a 186 médicos de centros de salud de dos Áreas Sanitarias. Resultados: de 186 encuestas enviadas se obtuvieron 148 respuestas. Edad media, 47,87+/-6,24 años, siendo 58 (39%) varones. El 18,2% (27) eran fumadores y el 43,2% (63), exfumadores. El 80.2% (118) conceden mucha importancia a la función modélica que ejercen ante sus pacientes. El 87,3% (105) de no fumadores frente al 38,4% (11) de fumadores creen que el hecho de que el médico fume influye en su actitud ante el tabaco (p=0,001). El 51% aconsejan siempre a sus pacientes dejar de fumar. El 95,3% (141) consideran que se debería abordar el tabaquismo en AP pero el 37,2% (55) no lo hacen por falta de tiempo. El 71% (20) de los médicos con presión asistencial <35 pacientes/día realizan abordaje al tabaquismo frente al 54% (30) de los que tienen una presión >45 pacientes/día (p=0,357). Conclusiones: la prevalencia de fumadores entre los encuestados es inferior a la población general. Consideran que la función modélica que ejercen es muy importante. La mayoría declaran que el abordaje al tabaquismo debe realizarse en Atención Primaria pero un número importante no lo hace argumentando falta de tiempo (AU)

Background: smoking is the primary cause of avoidable disease and death and the physician plays a fundamental role in its treatment and prevention. A study was made to learn the prevalence of physicians who smoke in Primary Care (PC) and their attitude towards smoking. Methods: descriptive study. An anonymous survey elaborated for this purpose was sent to 186 physiciands in the Health Care Site of two Health Care Areas. Results: a total of 148 answers were obtaine from 186 surveys sent. Mean age 47.87+/-6.24 years, with 58 (39%) men. Of these, 18,2% (27) smoked and 43.2% (63) were ex-smokers and 80.2% (118) considered the model function they have with their patients are very important. A total of 87.3% (105) of non-smokers versus 38.4%(11) of smokers believe that the fact that the physician smokers has an influence on their attitude towards tovaco (p=0.001). Fifty-one percent always recommended that their patients should stop smoking; 95,3% (141) consider that the smoking habit should be dealth with in Primary Care, however, 37,2% (55) do not do so due to lack of time. In regards to dealing with the question of smoking, 71% (20) of those physicians who have a care quota of <35 patients/day do so versus 54% (30) of those who have a quota of >45 patients/day (p=0.357). Conclusions: the prevalence of smokers among those surveyed is less in the general population. We consider that the model function of the physician is very important. Most declare that the approach to smoking should be made in Primary Car, however a significant number do not do so due to lack of time (AU)

[Characteristics of lung cancer in a region in northern Spain]. / Características del carcinoma broncopulmonar en una región del norte de España.

OBJECTIVE: To gather information on the disease characteristics and survival rate of patients diagnosed with bronchogenic carcinoma in the respiratory medicine departments of hospitals in Asturias, Spain. PATIENTS AND METHODS: This was a retrospective observational study carried out using a standardized data collection protocol. All cases of lung cancer diagnosed during 2001 were included provided there was cytologic or histologic confirmation or they fulfilled a series of clinical, radiological, and/or endoscopic criteria consistent with such a diagnosis. RESULTS: Standard incidence rates adjusted to the world population were 22.4, 42.6, and 4.6 per 100,000 population for the whole population, men, and women respectively. The mean (SD) age was 67 (10.9) years, and 92% of the patients were men. Overall, 98% of the men and 44% of the women were smokers. Diagnosis was confirmed by cytologic or histologic findings in 92% of patients, and the majority were non-small cell tumors (81.4%). At the time of diagnosis, 65% of the patients had advanced disease, with distant metastasis in 26.6% of the non-small cell cancers and 52.8% of the small cell cancers. Patients received surgical treatment in 21.3% of cases, chemotherapy alone or combined with radiation therapy in 43.1%, and radiation therapy alone in 9.3%. In 26.2% of patients only palliative care was given. Overall, median survival in weeks was 36.4 (95% confidence interval [CI], 29.4-43.4). Median survival by treatment type was as follows: 69.3 (95% CI, 49-9.5) for surgery; 39.6 (95% CI, 31.2-48) for chemotherapy alone or with radiation therapy; 30 (95% CI, 15.4-44.6) for radiation therapy alone; and 13.3 (95% CI, 5.9-20.6) for patients who received palliative care alone (P< .05). CONCLUSIONS: The findings with respect to age, sex, incidence, histology, extent of tumor, and smoking status of patients with bronchogenic carcinoma in our region does not differ significantly from those reported for other areas of Spain. Current smoking is the primary cause of the high prevalence of this disease. Twenty-six percent of patients received only palliative care. The percentage of patients treated with surgery was low.

Características del carcinoma broncopulmonar en una región del norte de España / Characteristics of lung cancer in a region in Northern Spain

Objetivo: Conocer las características y supervivencia del carcinoma broncogénico (CB) diagnosticado en las unidades de neumología del Principado de Asturias. Pacientes y métodos: Se ha realizado un estudio observacional retrospectivo en el que se ha empleado un protocolo común de recogida de datos. Se incluyeron los CB diagnosticados en el año 2001 con confirmación citohistológica o por concordancia basada en datos clínicos, radiológicos y/o endoscópicos. Resultados: Las tasas de incidencia estándar para toda la población, varones y mujeres, ajustadas a la población mundial fueron de 22,4, 42,6 y 4,6/100.000 habitantes, respectivamente. El 92% era varón; la edad media (± desviación estándar) fue de 67 ± 10,9 años. Tenía hábito tabáquico el 98% de los varones y el 44% de las mujeres. Se alcanzó confirmación citohistológica en el 92% y la mayoría era CB no microcíticos (81,4%). En el momento del diagnóstico el 65% de los pacientes tenía enfermedad avanzada, con metástasis a distancia en el 26,6% de los CB no microcíticos y en el 52,8% de los de células pequeñas. Se trató con cirugía el 21,3% de los casos, con quimioterapia sola o asociada a radioterapia el 43,1%, con radioterapia exclusivamente el 9,3% y recibió tratamiento paliativo el 26,2%. La mediana de supervivencia global, en semanas, fue de 36,4 (intervalo de confianza [IC] del 95%, 29,4-43,4) y para los distintos tratamientos fue la siguiente: para la cirugía, 69,3 (IC del 95%, 49-9,5); para la quimioterapia sola o asociada a radioterapia, 39,6 (IC del 95%, 31,2-48); para la radioterapia sola, 30 (IC del 95%, 15,4-44,6), y para el paliativo, 13,3 (IC del 95%, 5,9-20,6) (p < 0,05). Conclusiones: En nuestra región, las características del CB en cuanto a edad, sexo, incidencia, histología, extensión tumoral y tabaquismo no difieren significativamente de las halladas en otras áreas del ámbito nacional. El tabaquismo activo es la causa fundamental de su alta prevalencia. Se ofreció solamente tratamiento de soporte al 26%. El porcentaje de pacientes quirúrgicos es bajo

Objective: To gather information on the disease characteristics and survival rate of patients diagnosed with bronchogenic carcinoma in the respiratory medicine departments of hospitals in Asturias, Spain. Patients and Methods: This was a retrospective observational study carried out using a standardized data collection protocol. All cases of lung cancer diagnosed during 2001 were included provided there was cytologic or histologic confirmation or they fulfilled a series of clinical, radiological, and/or endoscopic criteria consistent with such a diagnosis. Results: Standard incidence rates adjusted to the world population were 22.4, 42.6, and 4.6 per 100 000 population for the whole population, men, and women respectively. The mean (SD) age was 67 (10.9) years, and 92% of the patients were men. Overall, 98% of the men and 44% of the women were smokers. Diagnosis was confirmed by cytologic or histologic findings in 92% of patients, and the majority were non-small cell tumors (81.4%). At the time of diagnosis, 65% of the patients had advanced disease, with distant metastasis in 26.6% of the non-small cell cancers and 52.8% of the small cell cancers. Patients received surgical treatment in 21.3% of cases, chemotherapy alone or combined with radiation therapy in 43.1%, and radiation therapy alone in 9.3%. In 26.2% of patients only palliative care was given. Overall, median survival in weeks was 36.4 (95% confidence interval [CI], 29.4-43.4). Median survival by treatment type was as follows: 69.3 (95% CI, 49-9.5) for surgery; 39.6 (95% CI, 31.2-48) for chemotherapy alone or with radiation therapy; 30 (95% CI, 15.4-44.6) for radiation therapy alone; and 13.3 (95% CI, 5.9-20.6) for patients who received palliative care alone (P< .05). Conclusions: The findings with respect to age, sex, incidence, histology, extent of tumor, and smoking status of patients with bronchogenic carcinoma in our region does not differ significantly from those reported for other areas of Spain. Current smoking is the primary cause of the high prevalence of this disease. Twenty-six percent of patients received only palliative care. The percentage of patients treated with surgery was low

Derrame pleural neoplásico infectado por Salmonella enteritidis / Malignant pleural efusion infected by Salmonella enteritidis

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[Metastatic pulmonary angiosarcoma]. / Angiosarcoma pulmonar metastásico.

Angiosarcoma involving the lung, usually a result of metastatic disease, is a rare disorder. Primary angiosarcoma of the lung is an extremely rare tumor. The lung is one of the most common sites of metastatic involvement, along with liver and lymph nodes. Hemoptysis is the most frequent presenting symptom even with diffuse pulmonary hemorrhage. Chest radiography may reveal a spectrum of findings ranging form normal to bilateral nodular lesions. Early diagnosis is not common because of the rarity of angiosarcoma in the lung and hence, low index of suspicion. The prognosis is generally poor, with a median survival of 9 months after diagnosis.

Angiosarcoma pulmonar metastásico / Metastatic angiosarcoma of the lung

La afectación pulmonar por angiosarcoma, habitualmente en forma de enfermedad metastásica, es una rara enfermedad. El angiosarcoma pulmonar primario es un tumor extremadamente raro. El pulmón es uno de los lugares más frecuentes de afectación metastásica junto con el hígado y los ganglios linfáticos. La hemoptisis es el síntomas más frecuente, pudiendo presentarse incluso en forma de hemorragia pulmonar difusa.La radiografía de tórax puede ser normal, pero lo más frecuente es la presencia de múltiples imágenes nodulares. No es habitual que se establezca un diagnóstico precoz por el bajo índice de sospecha derivado de la rareza del tumor. El tratamiento sigue siendo desalentador sobre todo en los angiosarcomas metastásicos cuya supervivencia media es de 9 meses tras el diagnóstico (AU)

[Bronchial-associated lymphoid tissue lymphoma]. / Linfoma de tejido linfoide asociado al bronquio (BALT).

Two cases of non-Hodgkin's endobronchial or bronchial-associated lymphoid tissue lymphoma are reported; such cases are either extremely rare or underestimated. We emphasize the need to perform endoscopic examination in patients with lymphoma and clinical findings that suggest bronchial disease.

[Tuberculosis and HIV infection. Evaluation of 132 cases]. / Tuberculosis e infección por VIH. Evaluación de 132 casos.

Tuberculosis is currently one the more frequent opportunistic infections in patients infected by Human Immunodeficiency Virus (HIV) in our setting. Its extrapulmonary localization is considered as diagnostic of the Acquired Immunodeficiency Syndrome (AIDS). We have evaluated the epidemiological, clinical, microbiological, histological and immunological characteristics of 120 patients in the Asturias region who had a tuberculosis diagnosed in any localization, during the period between 1984 and 1991, belonging to a series of 570 patients infected by HIV. Pulmonary types were comparatively analyzed to the extrapulmonary and disseminated ones. Tuberculosis was pulmonary only in 44 occasions (PT), in 36 it was extrapulmonary (EPT) and in 52 disseminated (DT). The more frequent risk factor for the HIV infection was the parenteral consumption of drugs (78.8%). The final diagnosis was microbiologic in 81% of the cases, while bacilloscopia was positive in 62% of the cases. The histologic study showed the presence of granulomas in 86% of the tissues studied and necrosis in 81%. EPT and DT were related with a worse immune situation, bigger mortality rates attributed to tuberculosis and worse survival (p 0.069). Tuberculosis in patients infected by HIV appears mainly in CDVP, being its symptoms the normal ones; but extrapulmonary forms are clearly predominant and within this group those with a ganglionar localization. Normal diagnostic procedures yield a good result. EPT and DT are significantly related to a more severe immunodeficiency in comparison with PT. Survival and prognosis are better in the PT group.

Cytologic and bacteriologic analysis of fluid and pleural biopsy specimens with Cope's needle. Study of 414 patients.

This article describes the results of a dual diagnostic procedure, thoracentesis and pleural biopsy with a Cope's needle, in 414 patients with pleural effusion of unknown origin. A diagnosis of neoplasia or pleural tuberculosis was obtained in 241 subjects (149 with neoplasias and 92 with pleural tuberculosis). In an additional 55 patients, a diagnosis of tuberculosis or neoplasia was obtained using other procedures (15 with tuberculosis and 40 with neoplasias). In 105 subjects, the effusion was neither tuberculosis nor neoplasia. Thirteen patients were excluded from this study due to the impossibility of follow-up. The diagnostic process was repeated in 64 patients. Complications occurred in 46 patients (11%), of which 42 were pneumothorax. The dual diagnostic sensitivity in our series of thoracenteses and pleural biopsies made with a Cope's needle was 86% in tuberculosis and 79% in neoplasia with 100% specificity. The probability of a case being neither tuberculosis nor pleural neoplasia (negative predictive value) when the liquid and the pleural biopsy specimen are nonspecific (each procedure having been applied only once on each patient) is 56%, although a negative result does not exclude these diagnoses. In our opinion, the repetition of the dual procedure is indicated considering the scant morbidity and zero mortality.

[Characteristics of the incidence of bronchogenic carcinoma in extreme age groups]. / Características del carcinoma broncogénico en las edades extremas de su incidencia.

The protocols of 852 patients with bronchogenic carcinoma (BC) were reviewed in order to establish its characteristics in the most extreme age groups in which it appears: group I, patients aged 40 years or younger (18 cases), and group II, patients aged 80 or older (19 cases). No differences were found in the relation men/women, time elapsed from the beginning of symptoms to diagnosis, staging and survival. The differentiating characters included the greater incidence of thoracic pain, microcytic carcinoma, surgery possibilities and therapeutic attitude in group I, and the predominance of squamous cell carcinoma in group II. The continuous and intense exposure to tobacco smoke is common to both groups.