Insuficiencia respiratoria aguda inducida por hidroclorotiazida / Acute respiratory failure induced by hydrochlorothiazide

Se describe una paciente con insuficiencia respiratoria aguda recurrente, inducida por la toma repetida de hidroclorotiazida. La patogenia de esta reacción adversa es aún desconocida. Lo más probable es que el mecanismo de producción sea idiosincrásico. El tratamiento es de soporte. Este efecto adverso es raro, pero de grave compromiso vital y producido por un fármaco de uso muy común, de ahí la importancia de que sea reconocido en los Servicios de Urgencias (AU)

To describe a patient with recurrent acute respiratory failure, induced after repeated intake of hydrochlorothiazide. The pathogenesis of this adverse reaction remains unknown. The mechanism of production is, probably idiosyncratic. The treatment of the syndrome involves supportive therapy. The adverse effect is rare, but the potential for life-threatening and because of the high use of this drug it is important to recognize it in the Emergency (AU)

Neumonía varicelosa en el adulto. Diagnóstico y tratamiento en urgencias / Varicela pneumonia in the adult. Diagnosis and treatment in the emergency

La varicela es una enfermedad autolimitada propia de la infancia. Cuando afecta a adultos puede ser un cuadro grave por sus complicaciones, destacando la neumonía por su frecuencia y gravedad. Se presentan dos enfermos de 29 y 34 años con neumonía varicelosa que evolucionaron favorablemente con aciclovir intravenoso. Los adultos con varicela deben recibir un estrecho seguimiento durante la primera semana del rash. Un diagnóstico precoz de la neumonía varicelosa y de la hipoxemia y un tratamiento precoz con aciclovir intravenoso son necesarios para reducir la mortalidad. En adolescentes y adultos sanos con varicela el aciclovir oral es recomendado en las primeras 24 horas del inicio del rash. En pacientes con varicela y alto riesgo para desarrollar neumonía, la quimioprofilaxis con antiviral oral es probablemente beneficioso (AU)

Airways reactivity, atopy and bronchoalveolar lavage in male smokers with airflow obstruction.

Although cigarette smoking plays a major role in the development of chronic obstructive pulmonary disease, risk factors that might predispose susceptible smokers to develop manifest airflow obstruction are poorly defined. The aim of this study was to investigate whether BAL cell profiles, bronchial hyperresponsiveness, and atopy were different in smokers with and without airway obstruction. Fifty-seven current smokers with (n = 22) and without airflow obstruction (n = 35), defined spirometrically, and 8 nonsmoking subjects (controls) were studied (fiberoptic bronchoscopy and bronchoalveolar lavage (BAL), measurement of IgE concentrations and skin prick testing with common allergen extracts, methacholine bronchoprovocation testing). Mean values of forced expiratory volume in 1 s (FEV1) percent predicted were significantly lower in smokers with obstruction than in those without obstruction (53.1 +/- 16.9 vs. 72.5 +/- 16.6, p < 0.001). Smokers with airflow obstruction showed an improvement in FEV1 < 20% after inhalation of two puffs of 0.250 mg terbutaline. Current smokers as opposed to controls had significantly (p < 0.01) higher values of cells/ml in BAL (78 +/- 72.4 x 10(4) vs. 28.7 +/- 14.5 x 10(4)) and macrophages (90.5 +/- 19.4 vs. 84.3 +/- 9.3%) and lower values of lymphocytes (5.4 +/- 15.4 vs. 13.1 +/- 10.7%). Smokers with obstruction to airflow showed significantly (p < 0.05) higher values of cells/ml in BAL (102 +/- 88 x 10(4)) than smokers without airflow obstruction (63.4 +/- 57.5 x 10(4)) with no differences in differential cell counts. The provocation concentration of methacholine producing a 20% reduction in FEV1 (PC20) was also lower in smokers with obstruction than in smokers without obstruction (2.9 +/- 3.5 vs. 6.4 +/- 7.2 mg/ml, p < 0.05). Differences in atopy were not found. In summary, current smokers with airflow obstruction tended to have more cells recovered by BAL and greater airway responsiveness than smokers without obstruction, although atopy-related parameters were not different for both groups.

[Localized tracheobronchial amyloidosis. The usefulness of computed tomography]. / Amiloidosis traqueobronquial localizada. Utilidad de la tomografía computarizada.

Tracheobronchial amyloidosis is the most common form of localized bronchopulmonary amyloidoses, although its diagnosis is rare in daily practice. We describe two new cases of localized tracheobronchial amyloidosis, one in the form of a single node and one diffuse. We discuss in particular the contribution of computed axial tomography, mainly for diagnosing the diffuse form, in which a finding of a thickened tracheobronchial wall and intraluminal nodes should lead to the suspicion of this entity. The treatment of choice in most cases is resection with an Nd-YAG laser.

Clinical utility of hyaluronic acid values in serum and bronchoalveolar lavage fluid as tumor marker for bronchogenic carcinoma.

Various authors have proposed the use of hyaluronic acid (HA) as a tumor marker. In order to analyze its usefulness as a marker in bronchogenic carcinoma, the most common carcinoma in men, we determined the HA values in serum and bronchoalveolar lavage fluid (BAL). We performed prospective studies on two groups of patients: 81 diagnosed as having bronchial carcinoma and 34 with benign respiratory diseases. HA values were higher in patients with cancer than in those with benign diseases (serum: 79.8 ng/ml vs 63.7 ng/ml; BAL: 927 ng/mg vs 522 ng/mg). Also, the percentage of patients with levels exceeding the established cutoff was greater in the group with cancer than in the group with benign disease (serum: 24.6 vs 17.6; BAL: 25.3 vs 3). Statistically significant differences in these percentages were found in BAL (p<0.01). Patients with extended small cell carcinoma had higher HA values (p =0.04) than those with limited disease, and the percentage of patients with abnormal HA values was larger in the group with extended disease than in the group with limited disease (p = 0.004). The serial determinations of HA values in serum reflected the clinical evolution after treatment in 73% of the small cell carcinomas. Most of the patients with benign diseases whose HA values exceeded the cutoff level suffered from acute infectious dis-eases. Once these cases were excluded, the specificity of HA value determination in the diagnosis of carcinoma was very high (serum 96%, BAL 100%). The determination of HA levels in serum or BAL did not have any prognostic value in this study. We conclude that the HA levels in serum and BAL could be of interest as a tumor marker, especially in patients with small cell carcinoma.

[Pulmonary interstitial disease due to hemochromatosis as a presenting sign of disease]. / Afectación intersticial pulmonar por hemocromatosis como forma de presentación de la enfermedad.

We present a patient with hemochromatosis whose first sign of disease was an accidental finding of interstitial patterns on a chest film and whose transbronchial biopsy showed traces of iron (Fe) in alveolar macrophages and septal matter. We then looked for deposits in other locations, finding Fe ([+]: 6.964 micrograms) in the dry weight of a cylindrical sample of liver tissue. A Medline search on CD-ROM for 1989 through May of 1994 revealed no references to similar cases.

[Spontaneous pneumothorax as the only initial manifestation of bronchogenic carcinoma]. / Neumotórax espontáneo como única manifestación inicial del carcinoma broncogénico.

We present the case of a patient with spontaneous pneumothorax associated to pulmonary epidermoid carcinoma, which was not radiologically visible after pulmonary reexpansion. Neither it was macroscopically detected in the first thoracotomy performed for the treatment of the pneumothorax, being diagnosed after the histological study of the resected blisters. The association between pneumothorax and lung cancer is very rare, especially in the absence of other radiological disorders suggesting neoplasia after the pulmonary reexpansion. In these cases, the diagnosis is extremely difficult and it must be always suspected in patients with spontaneous pneumothorax and risk factors for pulmonary cancer.

[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.