[Solitary pulmonary nodule due to Mycobacterium fortuitum]. / Nódulo pulmonar solitario por M. fortuitum.

We report the case of an asthmatic man in whom a solitary pulmonary nodule was discovered after an episode of self-limited hemoptysis. Infection was suspected after initial response to empirical antibiotic therapy, and the pathogen was later identified to be a rare mycobacterium. The pulmonary nodule resolved without surgery after oral quinolone therapy. Mycobacterium fortuitum should be added to the list of possible causes of solitary pulmonary nodule in Spain.

Nódulo pulmonar solitario por M. fortuitum / Solitary pulmonary nodule due to Mycobacterium fortuitum

Comunicamos el caso de un paciente asmático en el que se descubrió un nódulo pulmonar solitario tras presentar un episodio de hemoptisis autolimitada. La naturaleza infecciosa del proceso se sospechó tras la respuesta inicial a un tratamiento antimicrobiano empírico y su agente causal, una micobacteria infrecuente, se identificó con posterioridad tras recibir los resultados de los cultivos de esputo. El tratamiento con una quinolona por vía oral condujo a la resolución del nódulo pulmonar sin requerir cirugía. Mycobacterium fortuitum debe añadirse a las posibles causas de nódulo pulmonar solitario también en nuestro país. (AU)

[The solitary pulmonary nodule. An analysis of the experience over 6 years in a medical service]. / Nódulo pulmonar solitario. Análisis de la experiencia durante 6 años en un servicio médico.

We conducted a retrospective analysis of the epidemiological, etiological, clinical and radiological characteristics, and mainly of those related to the diagnosis and treatment, of all the patients with radiological criteria of solitary pulmonary nodule (SPN) studied in our environment during a period of six years (1984-1989). The incidence of SPN was 3.1% (123/3953). Among the 117 cases of filiated etiology, 83 (71%) were malignant and 34 (29%), benign thoracotomy was used as diagnostic method in 11 (32%) benign cases and in 8 (9.6%) malignant cases. Due to several causes, only 31 out of the 75 (41.3%) malignant nodules diagnosed prior to the thoracotomy underwent resection surgery. According to the selection criteria applied in our medium, a high number of the SPN were malignant; in most of these cases, the diagnosis was established without the need of thoracotomy and in less that half of them, curative surgery was attempted.

[The functional sequelae of Mycoplasma pneumoniae pneumonia]. / Secuelas funcionales de la neumonía por Mycoplasma pneumoniae.

To check the possible existence of long-term pulmonary functional sequelae in patients with pneumonia due to Mycoplasma pneumoniae, 17 patients who showed evident spirometric disorders during the recovery from the acute phase of a pneumonia due to Mycoplasma pneumoniae were studied. In the acute phase of the disease, 7 patients showed a ventilatory restriction, 6 of them had an obstructive pattern while in four patients a mixed pattern was observed. After a latency period, which mean length was 39 months, it was seen that there was a return to normal values of the spirometric conventional parameters initially altered in all cases. However 5 patients (33%) who did not smoke, showed a significant decrease on the maximum flows at low volume. These results suggest that in a high percentage of adult patients, as has been previously described in children, pneumonia due to M. pneumoniae could leave as a sequelae the persistent affectation of small airway.

[Value of the determination of CA 15-3 in the diagnosis of malignant pleural effusion]. / Valor de la determinación del CA 15-3 en el diagnóstico de los derrames pleurales malignos.

In 160 consecutive patients with pleural shedding, antigen CA 15-3 values in pleural fluid were determined, in a prospective way using monoclonal antibodies (115D8 and DF3). In 49 patients with malignant pleural shedding, the mean value of CA 15-3 (47.6 U/ml) was significantly higher (p less than 0.01) to the values in the 111 benign ones (12.9 U/ml). Its sensibility for malignity, with a trough level of 27 U/ml, was of 37% with an specificity of 96%. When a specificity of 100% was required its sensibility (18%) was significantly lower to the carcinoembryonic antigen (CEA) (33%), measured simultaneously with comparative purposes. The simultaneous determination of both markers raised sensibility to 39%, without reaching statistical signification. In the ten patients whose pleural sheddings was secondary to breast carcinoma, both minimum (15 U/ml) as medium (110 U/ml) values, as well as CA 15-3 sensibility (80%), were higher to the ones found in the rest of patients with shedding of malignant origin, but without a clear superiority over the values obtained with CEA. Based on these results, we conclude that the usefulness of the determination, as a tumoral marker, in pleural fluid, of CA 15-3 is lower than CEA and that its simultaneous determination seems not justified. We think that its specific usefulness in pleural sheddings secondaries to breast carcinomas deserves a study with a bigger sample.

[Diagnostic cost-effectiveness of bronchofiberoscopy in pleural effusions]. / Rentabilidad diagnóstica de la broncofibroscopia en los derrames pleurales.

With the aim of testing the cost-effectiveness of diagnostic fiberbronchoscopy in pleural effusions, the results obtained in a study of 46 patients in whom pleural effusion was the only indication for this diagnostic technique was analyzed. Patients were divided into two groups based on whether they presented pleural effusion of unkown ethiology (group A) or non-localized primary metastatic effusion (group B). Two out of 28 patients in group A, and 5 out of 18 in group B were diagnosed by means of fiberbronchoscopy. It is concluded that given the good tolerance and low morbidity of this exam, the diagnostic cost-effectiveness justifies its performance in such situations. Possible modifications in the indications that could influence its utility are discussed.

[Yield of bronchofibroscopy in patients with hemoptysis and normal thorax radiography]. / Rentabilidad de la broncofibroscopia en pacientes con hemoptisis y radiografía de tórax normal.

The clinical histories of all the patients with hemoptysis who underwent bronchofibroscopy (FB) during a period of 5 years (1981-1986) are revised. 25.6% (108 out of 702) of the endoscopic explorations were performed in patients without radiographic pleuropulmonary abnormalities with a definite pathology. In these patients, an early FB results in one of the diagnostic methods with greatest sensibility to diagnose subglottic bleeding. Its efficacy decreases when it is performed more than 24 hours after the bleeding apparently ceased. As a whole, the side of the bleeding was determined in 50% of cases with the localization of the segment involved in 53 occasions (29.4%). In 8 (4.4%) patients, hemoptysis was secondary to bronchial neoplasia and in 6 of them FB contributed with the diagnostic material. In 5 cases hemoptysis lasted for more than seven days. Seven patients suffering bronchial carcinoma were males over 40 years old and smokers of more than 40 years/packet. There was a 77 year old female, with a carcinoid tumor who was a non smoker. In other 3 patients (2 suffering endobronchial angiomas and one case of tracheal bronchus ) the cause of bleeding could be determined with FB. We conclude that in patients presenting hemoptysis and normal chest x ray, FB is a useful procedure to localize the origin of bleeding and in a significant percentage of cases permits the etiological diagnosis.

[Short-term prognosis in cryptogenetic hemoptysis]. / Pronóstico a corto plazo de las hemoptisis criptogenéticas.

149 patients suffering from hemoptysis of unknown origin who presented a normal chest X-ray were followed up, in order to evaluate their prognosis, during a mean period of 12.6 months after the initial study which included fiberoptic bronchoscopy. During this time, 24 patients (16.1%) presented new episodes of hemoptysis without radiological modifications; a second fiberoptic bronchoscopy carried out in 13 of these patients did not contribute with any new diagnostic data. One patient was diagnosed of pulmonary thromboembolism after persistent hemoptysis and two others of bronchial carcinoma 4 and 30 months after the initial fiberoptic bronchoscopy when the chest X-ray had already suffered significant changes. These data confirm that short term prognosis of cryptogenetic hemoptysis is generally favourable when the fiberoptic bronchoscopy is negative. The fact that a high percentage of these patients (37%, 55/149) had previously suffered pulmonary tuberculosis and/or inflammatory-scar type localized endobronchiolar lesions suggests that sequelae of these diseases, not observed in the X-ray, could play an etiological role in the bleeding.

[Usefulness of the determination of lipids parameters in pleural effusions]. / Utilidad de la determinación de parámetros grasos en los derrames pleurales.

In 160 patients with pleural effusion, consecutively studied in our section, cholesterol and triglyceride concentrations and lipidogram were prospectively measured in the pleural fluid and the blood to rule out the possible occurrence of chylothorax. For the diagnosis of chylothorax the presence of chylomicrons in the pleural fluid was required. The macroscopic appearance of the fluid was a poor indicator of the presence of chylothorax, as in three of the seven patients in which the latter was discovered the characteristically reported milky appearance of the pleural fluid was not found. The mean value of triglycerides in the chylous effusions (162.3 +/- 34.8 mg/dl) was significantly higher (p less than 0.001) than in nonchylous effusions (45.8 +/- 26.3 mg/dl). All patients with chylothorax had triglyceride values higher than 110 mg/dl; using this figure as the cut-off value, 7.5% of the patients with pleural effusion were selected as those in whom, irrespectively of the macroscopic appearance of their effusions, the performance of lipidogram would be indicated to rule out chylothorax.