[Eosinophils in induced sputum versus nitric oxide in exhaled air: clinical utility in bronchial asthma]. / Eosinofilia en esputo versus óxido nítrico en aire exhalado: aplicación clínica en el asma.

BACKGROUND: Assessment of eosinophils in induced sputum can help to optimize anti-inflammatory therapy in bronchial asthma, but this is a very demanding technique. The aim of the study is to compare nitric oxide in exhaled air (FeNO), an easy to measure inflammatory biomarker, with eosinophils in sputum in terms of relationship with clinical and functional parameters. METHODS: 106 asthmatic patients (50 in anti-inflammatory therapy [AB+] and 56 without it [AB-]) and 15 controls were included. After filling a clinical questionnaire, FeNO measurement, forced spirometry and sputum induction by bronchial challenge with hypertonic saline solution were performed. RESULTS: Adequate measurements of FeNO and eosinophils were obtained in 100% and 81% of the patients, respectively. FENO w were higher for AB- compared to AB+ and controls. The percentage of eosinophils in sputum was higher in asthmatic patients compared to controls but without differences between both asthmatics groups and was well correlated with the slope of the dose-response curve of bronchial challenge. In the AB- group, FeNO and eosinophils were well correlated with asthma control level. CONCLUSION: FENO measurement is readily available and well correlated with clinical and functional markers asthma expression. Anti-inflammatory therapy blunts FeNO levels compromising its utility in the long-term follow-up of asthma patients.

Eosinofilia en esputo versus óxido nítrico en aire exhalado: aplicación clínica en el asma / Eosinophils in induced sputum versus nitric oxide in exhaled air: clinical utility in bronchial asthma

Fundamento. La eosinofilia en esputo inducido permiteoptimizar el tratamiento antiinflamatorio en el asma perosus requerimientos técnicos hacen poco viable su aplicaciónclínica. Evaluamos si el óxido nítrico (FENO), un marcadorinflamatorio de fácil medición, podía suplir a la eosinofiliaen esputo, así como la relación que ambos índicesmostraban con aspectos clínicos y funcionales del asma.Métodos. Se estudiaron 106 asmáticos (50 con tratamientoantiinflamatorio [AB+] y 56 sin él [AB-]) y 15controles. Tras completar un cuestionario clínico, seles realizó medición de FENO, espirometría forzada e inducciónde esputo. Se calculó el valor de pendiente dela curva concentración-respuesta (CCR) obtenida trasla inhalación de salino hipertónico.Resultados. Los resultados de FENO y de eosinofilia enesputo fueron valorables en 100% y 81% de los casosrespectivamente. Los valores de FENO fueron superioresen AB- que en AB+ y en éstos respecto a controles. Laeosinofilia, mayor en asmáticos que en controles aunquesin diferencias entre AB+ y AB-, se correlacionó conla FENO y se comportó de forma paralela a la pendienteCCR. Había correlación entre el nivel de control delasma y los índices inflamatorios (eosinofilia y FENO) enel grupo AB- pero no en el AB+.Conclusión. La obtención de FENO es rápida, sencilla yda resultados inmediatos que se correlacionan con laactividad del asma. Puede desempeñar un papel relevanteen el diagnóstico y manejo terapéutico inicial deasma, aunque se necesitan más estudios para evaluarsu aplicación en la monitorización a largo plazo de laenfermedad, por la influencia tan notable que tiene sobresus niveles el tratamiento antiinflamatorio(AU)

Background. Assessment of eosinophils in inducedsputum can help to optimize anti-inflammatory therapyin bronchial asthma, but this is a very demanding technique.The aim of the study is to compare nitric oxidein exhaled air (FeNO), an easy to measure inflammatorybiomarker, with eosinophils in sputum in terms of relationshipwith clinical and functional parameters.Methods. 106 asthmatic patients (50 in anti-inflammatorytherapy [AB+] and 56 without it [AB-]) and 15 controlswere included. After filling a clinical questionnaire,FeNO measurement, forced spirometry and sputum inductionby bronchial challenge with hypertonic salinesolution were performed.Results. Adequate measurements of FeNO and eosinophilswere obtained in 100% and 81% of the patients,respectively. FENO w were higher for AB- compared toAB+ and controls. The percentage of eosinophils in sputumwas higher in asthmatic patients compared to controlsbut without differences between both asthmaticsgroups and was well correlated with the slope of thedose-response curve of bronchial challenge. In the ABgroup,FeNO and eosinophils were well correlated withasthma control level.Conclusion. FENO measurement is readily available andwell correlated with clinical and functional markersasthma expression. Anti-inflammatory therapy bluntsFeNO levels compromising its utility in the long-termfollow-up of asthma patients(AU)

[Ischemic hepatitis in an 81 year old patient with congenitally corrected transposition of the great arteries]. / Hepatitis isquémica en paciente de 81 años con transposición congénita corregida de grandes vasos.

The congenitally corrected transposition of the great arteries is a rare form of congenital heart disease, with survival beyond the 6th decade of life being rare. Even more unusual is its presentation alone, without any other form of congenital heart disease. Ischemic hepatitis is a rare entity characterized by an elevation of transaminasas and a centrilobular necrosis due to a reduction in hepatic blood flow, generally of reversible evolution. The authors present a case of ischemic hepatitis in an 81-year-old patient with congenitally corrected transposition of the great arteries. The fatal evolution of the episode and the longevity of the patient are both notable. We comment on the clinical and diagnostic aspects of both entities.

Hepatitis isquémica en paciente de 81 años con transposición congénita corregida de grandes vasos / Ischemic hepatitis in an 81 year old patient with congenitally corrected transposition of the great arteries

La transposición corregida de grandes vasos es una malformación congénita cardiaca extraordinariamente inusual, con muy escasa supervivencia por encima de la sexta década. Todavía más rara es su presencia sin otras anomalías cardiacas asociadas.La hepatitis isquémica es una entidad poco frecuente caracterizada por una elevación de transaminasas y necrosis centrolobulillar debida a una reducción del flujo hepático, generalmente de evolución reversible. Se presenta un caso de hepatitis isquémica de curso fulminante en un paciente de 81 años con transposición corregida de grandes vasos. Destacan tanto la tórpida evolución de la hepatitis, como la longevidad del paciente. Comentamos los aspectos clínicos y diagnósticos de ambas entidades

Small bowel intussuspeption is an unusual pathology in the adult. Most commonly, it is secondary to intestinal wall organic disorders. ;;A complete small bowel obstruction is the most frequent clinical presentation, which requires emergency surgery in many cases. The preoperative diagnosis is infrequent. ;;The best treatment is surgical resection

Comparison of allergen-induced changes in bronchial hyperresponsiveness and airway inflammation between mildly allergic asthma patients and allergic rhinitis patients.

Bronchial eosinophilic inflammation and bronchial hyperresponsiveness (BHR) are the main features of allergic asthma (AA), but they have also been demonstrated in allergic rhinitis (AR), suggesting a continuity between both diseases. In spite of not fully reproducing natural allergenic exposure, the allergen bronchial provocation test (A-BPT) has provided important knowledge of the pathophysiology of AA. Our aim was to verify the existence of a behavior of AA and AR airways different from the allergen bronchial challenge-induced airway eosinophilic inflammation and BHR changes. We studied a group of 31 mild and short-evolution AA and 15 AR patients, sensitized to Dermatophagoides pteronyssinus. The A-BPT was performed with a partially biologically standardized D. pteronyssinus extract, and known quantities of Der p 1 were inhaled. Peripheral blood (eosinophils and ECP) and induced sputum (percentage cell counts, ECP, albumin, tryptase, and interleukin [IL]-5) were analyzed, before and 24 h after A-BPT. Methacholine BHR, assessed before and 32 h after the A-BPT, was defined by M-PD20 values and, when possible, by maximal response plateau (MRP). The A-BPT was well tolerated by all the patients. AA presented a lower Der p 1 PD20 and a higher occurrence of late-phase responses (LPR). M-PD20 values decreased in AA, but not in AR, patients. MRP values increased in both groups. Eosinophils numbers and ECP levels increased in blood and sputum from both AA and AR, but only the absolute increment of sputum ECP levels was higher in AA than AR patients (P = 0.025). The A-BPT induced no change in sputum albumin, tryptase, or IL-5 values. We conclude as follows: 1) In spite of presenting a lower degree of bronchial sensitivity to allergen, AR patients responded to allergen inhalation with an eosinophilic inflammation enhancement very similar to that observed among AA. 2) MRP levels increased in both AA and AR patients after allergen challenge; however, M-PD20 values significantly changed only in the AA group, suggesting that the components of the airway response to methacholine were controlled by different mechanisms. 3) It is possible that the differences between AR and AA lie only in the quantitative bronchial response to allergen inhalation.

Aplicación de las oncoproteínas p21RAS, p53, Bcl-2 y del factor de proliferación celular Ki-67(MIB-1) en el diagnóstico y pronóstico de tumores tiroideos / Value of the Expression of p21RAS, P53, Bcl-2 Oncoproteins and Ki-67(MIB-1) Antigen of Cellular Proliferation in the Diagnosis and Prognosis of Thyroid Tumours

Introducción. El tiroides es un buen órgano para estudiar las alteraciones genéticas en el desarrollo y progresión tumoral, siendo de interés estudiar marcadores de proliferación celular y oncogenes. Material y métodos. Se han estudiado 36 adenomas, 58 carcinomas papilares, 32 carcinomas foliculares , 2 carcinomas anaplásicos y 12 carcinomas medulares . Se han estudiado factores clínicos e histológicos relacionados con el pronóstico y mediante inmunohistoquímica se ha estudiado Ki-67(MIB-1), p53, Bcl-2 y p21 RAS. Resultados. Se obtienen diferencias estadísticas en el índice proliferativo Ki-67 (MIB-1) entre adenomas y carcinomas foliculares. La proteína p53 no se expresa en adenomas y lo hace en aquellos carcinomas con mayor desdiferenciación histológica. También se correlaciona con la edad avanzada, el mayor tamaño y progresión tumoral. La expresión de Bcl-2 es alta en tejido tiroideo normal y en adenomas, se conserva en carcinomas y disminuye en relación a la desdiferenciación histológica, perdiéndose totalmente en los carcinomas anaplásicos. En carcinomas medulares su pérdida se correlaciona con la mortalidad. La expresión intensa de la proteína p21 RAS se asocia significativamente en carcinomas papilares con estadios clínicos avanzados. Conclusiones. Las diferencias en la actividad proliferativa entre adenomas y carcinomas foliculares puede ayudar al diagnóstico diferencial. La expresión de p53 y la pérdida de expresión de Bcl-2 se correlacionan con el proceso de desdiferenciación histológica. La sobreexpresión de p21 RAS en carcinomas papilares se relaciona con la progresión tumoral (AU)

Airway inflammation in asthma and perennial allergic rhinitis. Relationship with nonspecific bronchial responsiveness and maximal airway narrowing.

BACKGROUND: Eosinophilic airway inflammation is the hallmark of asthma, but it has also been reported in other conditions such as allergic rhinitis. We have tested whether the analysis of cells and chemicals in sputum can distinguish between patients with mild allergic asthma, those with allergic rhinitis, and healthy controls. The relationship between inflammation markers in sputum and nonspecific bronchial hyperresponsiveness to methacholine (BHR) (PD20 and maximal response plateau [MRP] values) was also evaluated. METHODS: We selected 31 mild asthmatics and 15 rhinitis patients sensitized to house-dust mite. As a control group, we studied 10 healthy subjects. Every subject underwent the methacholine bronchial provocation test (M-BPT) and sputum induction. Blood eosinophils and serum ECP levels were measured. Sputum cell differentials were assessed, and eosinophil cationic protein (ECP), tryptase, albumin, and interleukin (IL)-5 levels were measured in the entire sputum supernatant. RESULTS: Blood eosinophils and serum ECP levels were higher in asthma patients and rhinitis than in healthy controls, but no difference between asthma patients and rhinitis patients was found. Asthmatics had higher eosinophil counts and higher ECP and tryptase levels in sputum than rhinitis patients or control subjects. Sputum albumin levels were higher in asthmatics than in controls. Rhinitis patients exhibited higher sputum eosinophils than healthy controls. An association between sputum eosinophil numbers and MPR values (r= -0.57) was detected, and a trend toward correlation between sputum ECP levels and PD20 values (r= -0.47) was found in the rhinitis group, but not in asthmatics. No correlation between blood eosinophilic inflammation and lung functional indices was found. CONCLUSIONS: Induced sputum is an accurate method to study bronchial inflammation, allowing one to distinguish between rhinitis patients and mildly asthmatic patients. The fact that no relationship was detected between sputum inflammation and BHR suggests that other factors, such as airway remodeling, may be at least partly responsible for BHR in asthma.

Effect of current exposure to Der p 1 on asthma symptoms, airway inflammation, and bronchial hyperresponsiveness in mite-allergic asthmatics.

The existence of a dose-response relationship between indoor allergen exposure and sensitization has been widely described, but the effect of allergen exposure on asthma activity (symptoms, bronchial hyperresponsiveness [BHR], and inflammation) is not clear. Our aim was to determine the existence of an association among current exposure to mite allergens and symptoms, BHR, and airway inflammation assessed in blood and sputum from asthmatic patients sensitized to Dermatophagoides pteronyssinus. We selected 31 mild and recently diagnosed (12-24 months) asthma patients sensitized to D. pteronyssinus. Allergenic exposure (Der p 1, Der 2) was assessed by a commercial assay based on monoclonal antibodies (mAb), carried out on the dust samples collected from patients' beds in a standardized way. Patients completed an asthma symptom questionnaire and underwent skin tests, methacholine bronchial challenge, and sputum induction. Sputum cell profile was analyzed and eosinophil cationic protein (ECP), tryptase, albumin, and interleukin(IL)-5 levels were quantified in sputum supernatant. Total eosinophil numbers and ECP levels were measured in blood samples. Most patients were exposed to Der p 1 levels under 2 microg/g of dust. Der p 1 exposure was higher among the subjects with positive sputum tryptase detection (P = 0.020). Der p 1 levels showed a trend toward correlation with asthma symptoms (P = 0.066, r = 0.36) and correlated with sputum tryptase levels (P = 0.032, r = 0.42). No relationship between BHR, eosinophilic inflammation, and allergenic exposure was found. Our results suggest that asthma symptoms and lung mast-cell activation are at least partially dependent on current allergen exposure. The lack of correlation between mite exposure, eosinophilic inflammation, and BHR supports the role of other factors that enhance the immunologic response initiated by allergen, increasing the activity of asthma.

[Value of the expression of p21RAS, P53, Bcl-2 oncoproteins and Ki-67(MIB-1) antigen of cellular proliferation in the diagnosis and prognosis of thyroi]. / Aplicación de las oncoproteínas p21RAS, p53, Bcl-2 y del factor de proliferación celular Ki-67(MIB-1) en el diagnóstico y pronóstico de tumores tiroid.

INTRODUCTION: The thyroid gland is a good organ for the study of genetic alterations in tumoural development and progress. The study of oncogenes and antigens of cellular proliferation is of interest. MATERIAL AND METHODS: 36 cases of thyroid adenomas, 58 papillary carcinomas, 32 follicular carcinomas, 2 anaplastic carcinomas and 12 medullary carcinomas were selected. Clinical and histological prognostic factors were studied and an immunohistochemical study with Ki-67 (MIB-1), p53, Bcl-2 and p21 RAS antibodies was performed. RESULTS: The proliferative rate Ki-67 (MIB-1) showed statistical differences in adenomas and follicular carcinomas. The p53 protein did not appear in adenomas, but was shown in those carcinomas with bigger histological dedifferentiation. A relationship was also established with greater age, larger size and progression of the tumour. The Bcl-2 protein was high in the normal thyroid, in the adenomas and in the carcinomas, decreasing in correlation with histological dedifferentiation, and totally disappearing in the anaplastic carcinomas. In medullary carcinomas its disappearance was correlated with mortality. The intense expression of the p21 RAS protein in papillary carcinomas is statistically correlated with advanced clinical studies. CONCLUSIONS: The differences in the proliferative rate between adenomas and follicular carcinomas can be of help in differential diagnosis. The p53 manifestation and the loss of the Bcl-2 expression are correlated with the histological redifferentiation process. An intense manifestation of p21 RAS in papillary carcinoma is correlated with tumoural progression.

[The study of the inflammation of the airway in bronchial asthma by cytological and chemical analysis in the fluid phase of samples taken by sputum induction]. / El estudio de la inflamación de la vía aérea en el asma bronquial mediante el análisis citológico y de químicos en la fase fluida de muestras de esputo inducido.

In recent years the study of samples of bronchial biopsies and bronchoalveolar lavage fluid has made it possible to show the existence of significant airway mucosal inflammation, even in cases of mild bronchial asthma. This has led to a renewed interest in the use of sputum to assess airway inflammation non-invasively. Sputum induction has recently been proposed as a non-invasive alternative to bronchoscopy for the collection of airway secretions from asthmatic subjects. Sputum induction yields satisfactory samples of sputum in the great majority of asthmatic subjects, and both differential cell counts and the measurement of molecular markers of inflammation in the sputum fluid phase are feasible. In this paper we review studies where these measurements have been taken from subjects who were asthmatic, affected by other respiratory pathologies or healthy, and we assess their validity. Finally, we consider possible future clinical applications of sputum measurement of airway inflammation in asthma.

Deep intramuscular leiomyoma of the lower limb.

The authors present a case of intramuscular leiomyoma of the lower limb. Its location was the internal gastrocnemius muscle of the right leg. The treatment consisted in ablation of the tumor, which was well delimited and had well-defined edges. The evolution after surgery was entirely satisfactory, with no complications or recurrences in the 24 months following the procedure.

[Cavernous hemangioma of the larynx in the adult. Apropos of a case]. / Hemangioma cavernoso de laringe en el adulto. A propósito de un caso.

We present a case of cavernous hemangioma located in the supraglottic area in an adult, whose clinical debut was airway obstruction. We remark on the singularity of this case, because the great majority are present during the first year of life, located in subglottis. A review of the literature and current modes of treatment of hemangiomas is also presented.