F. Villegas Fernández

Síndrome del pasajero de clase económica

: Comfort, safety and time saving makes air travel more and more popular and widely use by an increased number of people in a range of extended age frame. Recent concerns in the global news have again raised an issue about the association of thromboembolic disease and air travel. Although there are numerous studies in the literature examining venous thromboembolic disease (VTE), variability of population demographics makes difficult a right and prospective assessment in the context of the cabin environment and air travel. Literature review clearly demonstrate that VTE is multicausal in nature, resulting in differing etiologic and predisposing factors across different age groups. Many questions are still to be answered, How many cases?, Direct association to Air Travel?, How to prevent it in the aviation environment? In this paper we analyze the incidence of VTE and some additional epidemiological aspects, risk and predisposing factors, diagnostic, and preventive measures given by the airline, the user, aviation authorities, aeromedical especialist in order to cope this complication. Finally we discuss the physiopathological bases in which VTE is developed and related considerations of this syndrome in the context of the aviation environment.

Estudio de marcadores de activación de mastocitos, eosinófílos y fibroblastos en el lavado broncoalveolar de pacientes con cáncer de pulmón

El objetivo de nuestro estudio es valorar la participacion de algunas celulas proinflamatorias en los procesos inflamatorios asociados al cancer de pulmon, mediante la determinacion en el lavado broncoalveolar de sus respectivos marcadores de actividad, y analizar los valores de dichos marcadores en las diferentes fracciones del lavado. Realizamos un estudio prospectivo en un hospital universitario. Se llevaron a cabo 52 lavados broncoalveolares: 37 en pacientes con cancer de pulmon y 15 en individuos de un grupo control. En el liquido recogido se analizaron la triptasa, el acido hialuronico y la proteina cationica de los eosinofilos, mediante radioinmunoanalisis, de forma separada en la fraccion bronquial y en la bronquioloalveolar. Los datos estadisticos se obtuvieron del programa R-SIGMA. En los pacientes tumorales, existen valores significativamente superiores de triptasa y acido hialuronico del lavado broncoalveolar en relacion a los sujetos considerados como controles, tanto en la fraccion bronquial, como en la bronquioloalveolar. Respecto a las fracciones del lavado broncoalveolar, en los pacientes con cancer de pulmon existen valores incrementados en la fraccion bronquioloalveolar, respecto de la bronquial, de triptasa y proteina cationica de los eosinofilos. Concluimos que en el cancer de pulmon existe participacion de, al menos, mastocitos y fibroblastos, siendo esta mayor en las zonas mas distales del arbol bronquial.

Derrame pleural bilateral y artritis reumatoide. Valor diagnóstico de la citología en líquido pleural

Presentamos un caso de manifestacion pleuropulmonar de artritis reumatoide (AR) en forma de derrame pleural bilateral de larga evolucion en un paciente varon asintomatico de 69 anos de edad. Fue diagnosticado de AR a los 49 anos de edad y recibio tratamiento con antiinflamatorios no esteroides y corticoides fundamentalmente durante las exacerbaciones. El examen del liquido pleural demostro un exudado con criterios de seudoquilotorax con pH acido y glucosa muy disminuida. El estudio citologico del liquido pleural demostro la presencia de celulas mononucleares caracteristicas de esta entidad.

PULMONARY LYMPHANGIOMYOMATOSIS AND KIDNEY ANGIOMYOLIPOMAS

L. Callol, Servicio de Aparato Respiratorio, Hospital Universitario del Aire, C/ Arturo Soria 82, E-28027 Madrid (Spain) Dear Sir A woman aged 39, with close antecedents of spontaneous pneumothorax receives medical advice for progressive dyspnea and hemoptysis. X-ray shows bilateral diffuse pattern, and thin-walled aerial cysts of several sizes localized diffusely in both lungs, confirmed with high-resolution CT. Abdominal CT and echography reveal angiomyolipomas in both kidneys and uterine leiomyoma. Brain CT is normal. Transbronchial biopsy and bronchoalveolar lavage are un-specific. Routine blood analysis is normal. Tuberculin skin test, mycobacteria and Lö-wenstein culture of sputum are negative. Basal gasometry shows hypoxemia. Functional respiratory exploration: severe obstruction and small airway disease, total lung capacity 138%, diffusion lung of CO 32%. Cycloergometry suggests high arteriolar pulmonary resistance. Gallium lung scan is normal. Open lung biopsy is conclusive of lymphangiomyomatosis (LAM). With immunohistochemical techniques high cyto-plasmatic positivity for desmine, weak for actin and negative for estrogenic receptors are detected. Treatment with medroxypro-gesterone acetate and tamoxifen was attempted. Total hysterectomy and bilateral salping-oophorectomy was made before the existence of gynecological clinics. The patient is currently undergoing treatment with medroxyprogesterone acetate. The rare association of kidney angiomyolipomas and LAM has been reported. In this case the symptoms are typical, but without chylothorax. The existence of airway obstruction in a woman in fertile age with bilateral reticulonodular chest X-ray pattern makes us think of this sickness. High-resolution CT suggests the diagnosis [1], although it is easily confused with lung emphysema or histiocytosis. The diagnosis is histological, usually with open lung biopsy. It is difficult to distinguish LAM from tuberous sclerosis (TS). Despite the fact that kidney angiomyolipomas are characteristic of TS, their association with LAM has been reported [2,3], as it happens in our case. TS has been excluded on the base of the absence of heritage component and intracranial or cutaneous lesions.

Traqueobroncomegalia y bronquiectasias en el síndrome de Mouniere-Kuhn. Colonización por Pseudomonas aeruginosa y antibioterapia inhalada

Resumen El sindrome de Mouniere-Kuhn se caracteriza por bronquiectasias (BQ) congenitas asociadas a traqueobroncomegalia. Es una enfermedad poco prevalente en la poblacion general (1–4,5%), siendo infrecuente el diagnostico en la edad adulta. Las infecciones respiratorias constituyen una complicacion frecuente en su evolucion y entre ellas, la infeccion y colonizacion por Pseudomona aeruginosa. La terapia antibiotica inhalada con colistina, tobramicina, etc. ha demostrado su eficacia en pacientes con BQ asociadas a fibrosis quistica. La instauracion de este tratamiento en nuestro caso se asocio con una mejoria en la sintomatologia clinica y reduccion de las exacerbaciones.