Mujer de 32 años con disnea progresiva / 32 year old woman with progressive dyspnea

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[Descriptive study of a pneumonia episode due to Legionella]. / Estudio descriptivo de un brote de neumonía por Legionella.

BACKGROUND: Legionella is a gram negative aerobic bacillus. A total of 42 species with 64 serogroups have been described, Legionella pneumophila serogroup 1 being the one that causes the disease most frequently. OBJECTIVE: Describe an outbreak of legionellosis with some characteristics different from those communicated previously. MATERIAL AND METHODS: Descriptive study of the epidemiological and clinical characteristics of the patients affected by an outbreak of pneumonia due to Legionella pneumophila serogroup 1, that occurred in Vigo in September and October, 2000, seen in the Hospital Xeral-Cies. RESULTS: A total of 33 patients, with a mean age of 61 years, were diagnosed. Fifty-nine percent had underlying diseases. The most frequent symptoms were fever, cough, dyspnea, diarrhea and awareness level alterations. Elevation of creatinphosphokinase in 79% and hyponatremia in 12%. The X-ray pattern observed most frequently was unilateral alveolar with predominant involvement of inferior lobes. A total of 77% received treatment with beta lactamics and macrolides, 13% beta lactamics and quinolones and 7% quinolones. Clinical and gasometric improvement were observed at a mean of 5 and 7 days, respectively. X-ray abnormalities improved in 62% in the first week. Eighteen percent had multiorgan failure and four patients died. In the analysis of the variables considered to have poor prognosis, only multiorgan failure demonstrated a significant association with mortality. DISCUSSION: The characteristics of the patients affected by an episode of legionellosis in our health care area were similar to those described in other outbreaks, except for the rapid resolution of the pulmonary infiltrates and low presence of hyponatremia. Multiorgan failure was the only factor associated with poor prognosis.

Estudio descriptivo de un brote de neumonía por Legionella / Descriptive study of a pneumonia episode due to Legionella

Introducción. La Legionella es un bacilo aerobio gramnegativo. Se han descrito 42 especies con 64 serogrupos, siendo Legionella pneumophila serogrupo 1 la que causa enfermedad con mayor frecuencia. Objetivo. Describir un brote de legionelosis con algunas peculiaridades distintas a las comunicadas con anterioridad. Material y método. Estudio descriptivo de las características epidemiológicas y clínicas de los pacientes afectados por un brote de neumonía por Legionella pneumophila serogrupo 1 ocurrido en Vigo durante septiembre y octubre del año 2000 atendidos en el Hospital Xeral-Cíes. Resultados. Se diagnosticaron 33 pacientes, con una edad media de 61 años. El 59% tenía enfermedades subyacentes. Los síntomas más frecuentes fueron fiebre, tos, disnea, diarrea y alteraciones del nivel de conciencia. Se detectó elevación de la creatinfosfoquinasa en el 79% e hiponatremia en el 12%. El patrón radiológico observado con mayor frecuencia fue alveolar unilateral con afectación predominante de lóbulos inferiores. El 77% recibió tratamiento con betalactámicos y macrólidos, el 13% betalactámicos y quinolonas y el 7% quinolonas. Se observó mejoría clínica y gasométrica a los 5 y 7 días de media, respectivamente. En el 62% las alteraciones radiológicas mejoraron en la primera semana. El 18% presentaron fallo multiorgánico y cuatro pacientes fallecieron. En el análisis de las variables consideradas de mal pronóstico, sólo el fracaso multiorgánico demostró una asociación significativa con la mortalidad. Discusión. Las características de los pacientes afectados por un brote de legionelosis en nuestra área sanitaria fueron similares a las descritas en otros brotes, a excepción de la rápida resolución de los infiltrados pulmonares y la baja presencia de hiponatremia. El fracaso multiorgánico fue el único factor que se asoció con mal pronóstico

Background. Legionella is a gram negative aerobic bacillus. A total of 42 species with 64 serogroups have been described, Legionella pneumophila serogroup 1 being the one that causes the disease most frequently. Objective. Describe an outbreak of legionellosis with some characteristics different from those communicated previously. Material and methods. Descriptive study of the epidemiological and clinical characteristics of the patients affected by an outbreak of pneumonia due to Legionella pneumophila serogroup 1, that ocurred in Vigo in September and October, 2000, seen in the Hospital Xeral-Cies. Results. A total of 33 patients, with a mean age of 61 years, were diagnosed. Fifty-nine percent had underlying diseases. The most frequent symptoms were fever, cough, dyspnea, diarrhea and awareness level alterations. Elevation of creatinphosphokuinase in 79% and hyponatremia in 12%. The X-ray pattern observed most frequently was unilateral alveolar with predominant involvement of inferior lobes. A total of 77% received treatment with beta lactamics and macrolides, 13% beta lactamics and quinolones and 7% quinolones. Clinical and gasometric improvement were observed at a mean of 5 and 7 days, respectively. X-ray abnormalities improved in 62% in the first week. Eighteen percent had multiorgan failure and four patients died. In the analysis of the variables considered to have poor prognosis, only multiorgan failure demonstrated a significant association with mortality. Discussion. The characteristics of the patients affected by an episode of legionellosis in our health care area were similar to those described in other outbreaks, except for the rapid resolution of the pulmonary infiltrates and low presence of hyponatremia. Multiorgan failure was the only factor associated with poor prognosis

Hemotórax como forma de presentación de angiosarcoma cardíaco / Cardiac angiosarcoma presenting as hemothorax

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[Clinical usefulness and cost-effectiveness of transbronchial needle aspiration for the diagnosis of mediastinal adenopathy]. / Utilidad clínica y coste-efectividad de la punción-aspiración transbronquial en el diagnóstico de adenopatías mediastínicas.

Transbronchial needle aspiration (TBNA) of mediastinal or hilar enlarged lymph nodes is a useful and safe technique. Nevertheless, its use has not become widespread, and the necessity of a specific training to obtain good results has been reported. In order to evaluate the clinical usefulness and cost-effectiveness of TBNA in inexperienced brochoscopists in this technique, a prospective study was conducted of this technique used in all patients with a chest CT with paratracheobronchial lymph nodes larger than 10 mm who had a fiberbronchoscopy ordered. TBNA was performed in 66 lymph node staging in 59 patients. In 76% of cases adequate specimens were obtaned, and a cytohistologic diagnosis was established in 59%. In 44% of patients, TBNA avoided other more invasive diagnostic procedures. Had TBNA not been performed, cost was estimated to have been at least five times higher. We conclude that TBNA could be a useful cost-effective technique in inexperienced teams.

Utilidad clínica y coste-efectividad de la punción-aspiración transbronquial en el diagnóstico de adenopatías mediastínicas / Clinical usefulness and cost-effectiveness of the transbronchial needle aspiration for the diagnosis of mediastinal lymph node enlargement

La punción-aspiración transbronquial (PATB) de adenopatías mediastínicas o hiliares es una técnica útil y segura. Sin embargo, su uso no se ha generalizado, describiéndose la necesidad de un entrenamiento específico para la obtención de buenos resultados. Con el objetivo de evaluar la utilidad clínica y el coste-efectividad de la PATB en broncoscopistas sin experiencia previa en la misma hemos realizado de forma prospectiva esta técnica a todos los pacientes con una tomografía axial computarizada (TAC) torácica con adenopatías paratraqueobronquiales mayores de 10 mm y a los que se les había solicitado una fibrobroncoscopia. Se realizó la PATB en 66 estaciones ganglionares de 59 pacientes. En el 76 por ciento de los casos se obtuvieron muestras adecuadas, pudiéndose realizar un diagnóstico citohistológico en el 59 por ciento. La PATB evitó en el 44 por ciento de los pacientes la realización de otros procedimientos más cruentos para el diagnóstico. De no haberse realizado la PATB estimamos que el coste hubiera sido como mínimo 5 veces superior. Concluimos que la PATB podría ser una técnica con una buena rentabilidad y coste-efectividad en equipos sin experiencia previa en la misma (AU)

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Pneumothorax in active pulmonary tuberculosis: resurgence of an old complication?

With the recent resurgence of tuberculosis (TB) in western countries, the incidence of complicating secondary pneumothorax has also increased. The work-up and management of this complication differs from that in other types of secondary spontaneous pneumothorax (SSP). Our objective was to assess clinical features and therapeutic modalities of SSP in patients with and without active pulmonary tuberculosis (APTB). All patients diagnosed with SSP seen at the Hospital Xeral of Vigo from January 1990 to June 1995 were candidates for this study. Full clinical, radiological and examinations were performed in all patients. Invasive procedures (thoracic catheter aspiration, thoracoscopy and thoracotomy) and mean hospital stay were compared in patients with and without APTB. Forty-eight patients with SSP were enrolled. Eleven patients (10 males and one female, mean age 30 +/- 11 years) had APTB; and 37 patients (31 males and six females, mean age 49 +/- 20 years) had conditions other than APTB. Chest pain, cough and fever were more frequent in patients with APTB (90% vs 59%; 45% vs 13.5%; 36% vs 5%, respectively). Catheter aspiration was successful in three of 10 (30%) of patients with APTB and in 15/23 (60.86%) of those without APTB. Catheter aspiration time was longer in the former group (25 +/- 22 days vs 13 +/- 11 days, P = 0.17). As initial treatment, thoracoscopy was performed in seven of 37 (18.91%) of those without APTB and in one of 10 (10%) patients with APTB. For patients with unsuccessful catheter aspiration, thoracoscopy was performed in eight of nine (89%) patients without APTB and in none of the patients with APTB. Thoracotomy was performed in only one of nine (11%) without APTB and in four of seven (57%) patients with APTB. Patients with APTB had a longer hospitalization (41 vs 18 days, P < 0.001). We concluded that SSP and APTB was a frequent association in our study. Patients with APTB showed a lesser and slower response to catheter aspiration. Despite severe clinical presentation and demand for more invasive procedures, patients with APTB showed a favourable response.

[Pulmonary inflammatory pseudotumor: report of 2 cases and review of the literature]. / Pseudotumor inflamatorio pulmonar: presentación de dos casos y revisión de la literatura.

Inflammatory pseudotumor (IP) of the lung is a rare pathological entity and its ethiopatology is unknown. It is considered to be a benign lesion with an array of histologic appearances. Although, the pulmonary affection is the most frequent, any other organ can be involved. We report two cases de pulmonary IP, one of them endobronchial, and discuss the clinical and anatomopathological features and review the pertinent literature.

[Adenosine deaminase activity in the pleural effusion. A study of 64 cases]. / Actividad de adenosindesaminasa en líquido pleural. Estudio realizado en 64 casos.

Clinical and analytic data of 64 patients with firm etiologic diagnosis of pleural effusion with adenosine deaminase (ADA) present, were analyzed retrospectively. The patients had entered our hospital over a 40-month period. ADA activity in pleural fluid was analyzed by the Blake and Berman kinetic method. Mean ADA activity of the total sample was 32 U/l (SD:23.9). In patients with tuberculous pleural effusion ADA activity was higher than in the remaining patients (47.7, SD:21.4, versus 15.5 SD: 13.2; p < 0.0001). In the group of patients with tuberculous pleuritis diagnosed by pleural biopsy (22 cases) the presence of necrotizing granulomas was associated with slightly higher ADA activity although the difference was not statistically significant (49.2 SD 10.1 versus 41.3 SD 8.9; p = 0.07). Among only patients with tuberculous pleuritis or neoplasia with lymphocytic exudate, a cut off point greater than 23 U for ADA predicted a diagnosis of tuberculous pleuritis with a sensitivity of 0.96, specificity of 1, positive predictive value of 1, negative predictive value of 0.94, and a confidence limit of 0.97. In conclusion, ADA activity greater than 23 U determined by the kinetic method in pleural fluid with signs of lymphocytic exudate is strongly suggestive of pleural tuberculosis based on our sample of patients with pleural effusion.

[The use of oxygen as therapy in a general hospital]. / Utilización del oxígeno como terapéutica en un hospital general.

A prospective study of the therapeutic use of oxygen in a general hospital was carried out. 120 patients who received oxygen during the first 24 hours of their admission were included. Oxygen was prescribed continually for 113 patients (94%). This was administered with a Venturi mask in 116 patients (97%). Medium FiO2 prescribed initially was of 0.29 (SD = 0.04). Basal arterial blood gas measurement was performed on 101 patients (84%). PaO2 was equal to or lower than 60 mmHg in 69 (68%). Arterial blood gas measurement control was carried out in 51 patients (42.5%). Of the patients with basal PaO2 lower or equal to 60 mmHg, 44 (64%) were submitted to posterior control measurement. 32 of the latter group showed PaO2 higher than 60 mmHg. We observed important deficiencies: increased prescription in patients with PaO2 greater than 60 mmHg; the frequent noncontrol of arterial blood gas measurement; the lack of correction of FiO2 when the initial application of O2 did not increase the PaO2 higher than 60 mmHg.