Albert Marín

Idiopathic azygos vein aneurysm: a rare cause of mediastinal mass

Venous aneurysm of the azygos arch is a very rare cause of mediastinal mass and is usually an incidental finding on chest radiography. Nowadays the diagnosis is made by non-invasive tests such as thoracic CT scanning and/or magnetic resonance imaging. The case is described of an asymptomatic woman in whom a mediastinal mass due to an azygos vein aneurysm was diagnosed by non-invasive procedures, the aetiology of which, in all probability, was idiopathic.

Prevalencia de bronquitis crónica, asma y obstrucción al flujo aéreo en una zona urbano-industrial de Cataluña

Objetivos Determinar la prevalencia de bronquitis cronica, asma y obstruccion al flujo aereo (OFA) en la poblacion general de una zona urbano-industrial de Cataluna (Sabadell y alrededores) y su grado de asociacion con el tabaquismo activo y pasivo. Metodos Estudio transversal sobre una muestra de 642 individuos entre 20-70 anos de edad de ambos sexos obtenida a partir del censo poblacional. Se entrevistaron a 576 individuos (participacion del 90%) mediante el cuestionario estandarizado de la American Thoracic Society, y a 497 individuos (participacion del 77%) se les realizo una espirometria forzada con prueba broncodilatadora. Resultados La prevalencia de bronquitis cronica fue de 11,6% (el 21% en varones; el 2,7% en mujeres) y la de asma previamente diagnosticada por su medico de 3,3% (el 2,1% en varones; el 4,4% en mujeres). La prevalencia de diversos sintomas relacionados con el asma fue mas alta. Asi, el 10,6% de la poblacion (el 11,4% en varones; el 9,8% en mujeres) referian haber presentado crisis de disnea con sibilancias y el 38,2% (el 45,4% en varones; el 31,4% en mujeres) referia sibilancias en el ultimo ano. La prevalencia de OFA (definida como un FEV 1 1 /FVC = 4,6) y sibilancias (OR = 1,8), pero no con alteraciones espirometricas significativas. Conclusiones La prevalencia de sintomas respiratorios y obstruccion al flujo aereo es alta en nuestro medio, sobre todo en varones y en el grupo de mayor edad (60-70 anos). Ademas de los fumadores activos y ex fumadores, tambien los fumadores pasivos tienen mayor riesgo de presentar sintomas respiratorios.

Transcutaneous Measurement of Partial Pressure of Carbon Dioxide and Oxygen Saturation: Validation of the SenTec Monitor

OBJECTIVE To validate a monitor for transcutaneous measurement of oxygen saturation (SpO2) and partial pressure of carbon dioxide (TcPCO2). PATIENTS AND METHODS This observational study included 140 Caucasian nonsmokers without jaundice. Patients underwent forced spirometry, measurement of SpO2 and TcPCO2 with the SenTec monitor, and arterial blood gas analysis (readings with 2 devices) during the stabilization phase of the monitor. In the statistical analysis, values from the 2 devices for measuring arterial blood gases were compared by mean differences for PaCO2 and oxygen saturation (SaO2). The arithmetic mean of the 2 blood gas measurements was calculated and relations between them and the SpO2 and TcPCO2 were assessed by the Pearson correlation coefficient (r) and the intraclass correlation coefficient (ICC) as a measure of agreement. Bland-Altman analysis was used to test data dispersion. RESULTS Ten patients were excluded due to a systematic error in the gas calibrator. The mean (SD) time to stabilization of the monitor before reading was 13.9 (2.4) minutes. The forced expiratory volume in the first second was greater than 80% in 40 patients, between 60% and 79% in 23, between 40% and 59% in 30, and less than 40% in 37. The mean (SD) differences between arterial blood gas measurements were 0.28 (1.0) mm Hg for PaCO2, -0.06% (0.86%) for SaO2, and -0.9 (2.7) mm Hg for PaO2. In the tests for correlation and agreement, r was 0.74 and ICC was 0.73 for SaO2 and SpO2; r was 0.92 and ICC was 0.92 for PaCO2 and TcPCO2. The subgroup analyses did not show any noteworthy differences. The Bland Altman analysis showed no significant dispersion. It was observed that the SenTec monitor underestimated oxygen saturation values by around 1% with respect to SaO2 and overestimated carbon dioxide pressure by 1 mm Hg with respect to PaCO2 values. CONCLUSIONS The stabilization time recommended for the SenTec monitor before taking a reading is 20 minutes. The overestimates and underestimates by the monitor are not clinically relevant. Finally, the values for SpO2 and TcPCO2 measured by the validated monitor are reliable.

Multinuclear Giant Cells in Bronchoalveolar Lavage in Interstitial Lung Diseases

The presence of multinuclear giant cells (MGC) is a pathological feature of interstitial lung diseases produced either by some organic and inorganic dust or by granulomatous disorders. In order to assess the diagnostic significance of the presence of MGC in bronchoalveolar lavage (BAL), the percent of MGC in the BAL of 52 subjects exposed to asbestos (26 with asbestosis) as well as from 79 with several interstitial lung diseases (idiopathic pulmonary fibrosis, pulmonary fibrosis associated with collagen vascular disorders, hypersensitivity pneumonitis and sarcoidosis) was compared with that of a control group of 14 subjects with no evidence of diffuse pulmonary disease. The results of this study suggest that MGC are present in the BAL of subjects with no pulmonary disease, and the quantification of these cells does not aid in the diagnostic evaluation of interstitial lung diseases.

Effectiveness and Efficiency of a Specialized Unit in the Care of Patients With Chronic Obstructive Pulmonary Disease and Respiratory Insufficiency

OBJECTIVE In the absence of a clear health care model for the management of patients with chronic obstructive pulmonary disease and chronic respiratory insufficiency, we evaluated the effectiveness and efficiency of a specialized outpatient unit for these patients managed by the hospital s respiratory medicine department. PATIENTS AND METHODS This was a 1-year prospective study of a group of patients for whom historical control data were available. The mean (SD) descriptive data for the 124 patients (105 men) were as follows: age, 69 (7) years; forced vital capacity, 64.6% (16.1%); forced expiratory volume in the first second (FEV1), 35.6% (12.8%); PaO2, 56.6 (8.3) mm Hg; PaCO2, 49.8 (6.7) mm Hg. Forced spirometry and arterial blood gas analysis were performed at 3-monthly visits. Participants completed a quality-of-life questionnaire (Guyatts Chronic Respiratory Disease Questionnaire) at the beginning and end of the study. The following variables were analyzed: forced spirometry, arterial blood gases, quality of life, number of emergency visits and hospital admissions, mean length of stay in hospital, reduction in the number of inpatient bed-days, mean cost of emergency visits, mean cost of hospital stays for both the Catalan Health Service (CHS) and the hospital, mean total cost per patient for the CHS and the hospital, and aggregate cost for the CHS and the hospital. The results were compared with data for the preceding year taken from the hospital records. RESULTS Significant improvement was found in forced vital capacity and PaO2 (which went from 56.6 [8.2] mm Hg to 59.1 [8.9] mm Hg during the prospective part of the study); FEV1 also tended to improve (875 [282] mL as against 912 [321] mL), but this change was not significant (P= .17). A significant reduction was observed in the following variables: PaCO2; hospital admissions, 1.16 (1.15) in the historical control period compared to 0.67 (1.17) during the prospective study; emergency visits, 2.06 (1.9) as against 1.5 (2.1); mean length of stay in hospital, 14.2 (19) compared to 8.1 (16) days; total number of inpatient bed-days (756 inpatient bed-days were saved in the study period); mean cost of emergency visits and hospital stays for both the hospital (2246 euros [3007 euros] in the historical period as against 1297 euros [2639 euros] with the new management system) and for the CHS; and the aggregate cost both for the hospital (40,011 euros in the historical control period as against 6048 euros with the new model) and the CHS (238,513 euros as against 152,312 euros). The quality-of-life score improved, but the change was not significant. CONCLUSIONS The change in the health care model used to manage these patients led to an improvement in care (effectiveness) as well as a marked reduction in costs (greater efficiency) for both the funding entity (CHS) and for the care provider (the hospital). No change was observed in the quality of life as reported by the patients.

Pulmonary hypoplasia presented in adulthood as a chronic respiratory failure : Report of two cases : Embryology, clinical symptoms and diagnostic procedures

We report 2 cases of pulmonary hypoplasia diagnosed in adulthood presenting clinically as chronic respiratory failure. Both patients met criteria for chronic bronchitis and had shown repeated respiratory infections and increasing dyspnoea. The spirometry showed a severe non-defined ventilatory disturbance and the arterial blood gases showed the presence of marked hypoxaemia. The altered chest X-ray, arterial blood gases and spirometry had been attributed to chronic bronchitis. The CT scan was instrumental in establishing the diagnosis of pulmonary hypoplasia.

Removal of a large endobronchial foreign body with a fiberoptic bronchoscope.

Miquel Ferrer, MD, Servei de Pneumología, Hospital Clínic, Villarroel 170, E-08036 Barcelona (Spain) To the Editor The aspiration of foreign bodies into the tracheo-bronchial tree is frequent in childhood, but it is also not unusual in adults as a labor accident (nails, pins), in mentally retarded patients, in prison population and as suicidal attempts. Although large endobronchial foreign bodies usually require the use of a rigid bronchoscope (RB) [1, 2], we have recently removed a big nail clipper using a fiberoptic bronchoscope (FB). A 26-year-old imprisoned male intravenous drug abuser, came to the emergency room of our hospital because of cough and dyspnea. The physical examination was normal and a chest x-ray film showed a nail clipper behind the right pulmonary hilus which was outside the esophagus and measured 6.5 × 1.7 × 1.8 cm (fig. 1). Fiberoptic bronchoscopy (Olympus BF-10) showed the nail clipper to be located in the right main bronchus. We inserted a grasping forceps (Olympus FG-4L) through the channel of the FB and successfully took out the foreign body together with the FB. During the last 15 years, the FB has been progressively introduced into clinical practice, while the use of the rigid bronchoscope (RB) has decreased for several reasons: worse clinical tolerance, the need of sedation, technical difficulty and worse vision of distal airways. However, the removal of foreign bodies (especially the larger ones located in the proximal airways) remains a first-choice indication of RB [1, 2], since it allows the introduction of larger and stronger forceps, ventilation of the anesthesized patient if required, and is successful in most cases when FB has Fig. 1. a Chest X-ray film. The nail clipper is located behind the right pulmonary hilus. b Esophagogram. The foreign body is outside the esophagus. 232 Ferrer/Ferrer/Marín