Ignasi Garcia-Olivé

Evaluation of interferon-gamma release assays in the diagnosis of recent tuberculosis infection in health care workers.

Background Health care workers (HCWs) are a group at risk of latent tuberculosis infection (LTBI). The aims of this study were to determine IFN-γ response by QuantiFERON-TB GOLD In Tube (QFN-G-IT) and T-SPOT.TB in HCWs, comparing the results with tuberculin skin test (TST); and to analyze the capacity of IFN-γ tests to detect recent versus remote LTBI with a prolonged stimulation test (PST). Methodology/Principal Findings A total of 147 HCWs were enrolled; 23 of whom were BCG vaccinated. 95 HCWs (64.6%) had a previous positive TST and were not retested; and 52 HCWs had a previous negative TST or were tested for the first time. When we analysed individuals without previous positive TST, the number of positive results for T-SPOT.TB was 12/52 (23.1%); and for QFN-G-IT, 9/52 (17.3%). The global concordance (κ) between T-SPOT.TB and QFN-G-IT with TST was 0.754 and 0.929 respectively. Of individuals with previous positive TST, T-SPOT.TB and QFN-G-IT were negative in 51.6% (49/95) and 62.1% (59/95) respectively, decreasing the concordance to 0.321 and 0.288, respectively. In non-BCG vaccinated HCWs with previous positive TST a positive IFN-γ test was associated with degree of exposure and diameter of TST. PST was performed in 24 HCW with previous positive TST and negative IFN-γ tests. PST was developed in 3 cell cultures stimulated with medium alone, ESAT-6 and CFP-10, respectively. In the third and sixth day of incubation period, part of the supernatants were replaced with complete medium supplemented with (rIL)-2. On day 9, ELISPOT assay was performed. In 14 samples PST was not valid due to not having enough cells. In 8 cases, the response was negative, and in 2 cases positive, suggesting that these patients were infected with Mycobacterium tuberculosis in some point in the past. Conclusions Both IFN-γ tests showed a similar number of positive results, and concordance between the tests was excellent. None of the tests was affected by prior BCG vaccination. IFN-γ tests are a useful tool for detecting recent infection in HCW population.

Results of Bronchial Artery Embolization for the Treatment of Hemoptysis Caused by Neoplasm

PURPOSE To describe experience with bronchial artery embolization (BAE) in a cohort of patients with cancer. MATERIALS AND METHODS All consecutive patients with cancer and at least one episode of hemoptysis that required BAE during a 14-year period were included in this observational retrospective review. The endpoints of the study were immediate success, recurrence of hemoptysis, mortality resulting from hemoptysis, and all-cause mortality. RESULTS Immediate control of bleeding was achieved in 31 of 40 patients (77.5%). Recurrence requiring BAE occurred in eight patients (20%). Cumulative hemoptysis control rate was 0.90 (95% confidence interval [CI], 0.80-1.0) at 1 month and 0.65 (95% CI, 0.44-0.86) at 6 months. Probability of survival was 0.75 (95% CI, 0.62-0.88) at 1 month, 0.42 (95% CI, 0.27-0.57) at 6 months, 0.36 (95% CI, 0.21-0.51) at 12 months, and 0.08 (95% CI, 0.0-0.18) at 3 years. CONCLUSIONS BAE is an effective and safe technique in the treatment of hemoptysis in patients with cancer. Nevertheless, mortality resulting from hemoptysis and recurrence rate are high among these patients secondary to progression of the underlying disease.

Diagnosis of Acute Pulmonary Embolism by Endobronchial Ultrasound as an Incidental Finding

detected a tumour obstructing the apical segmental bronchus of the left lower lobe. The tumour was biopsied and identified as undifferentiated large cell carcinoma. The patient was referred to the regional hospital for scheduling of endobronchial ultrasound with real-time transbronchial needle aspiration (EBUS-rt-TBNA) for staging. The following week, the patient suffered a brief syncopal episode. He was seen at the emergency department of A 64-year-old male smoker visited his general practitioner complaining of persistent cough. A chest radiograph showed a mass in the left lower lobe. A computed tomography (CT) scan confirmed the finding and also showed mediastinal nodal enlargement. After the CT scan, the patient suffered a rash and dyspnoea, which were assumed to be the result of allergy to the iodinecontaining contrast medium. Fibreoptic bronchoscopy Published online: August 3, 2010

Bronchial stump aspergillosis after lobectomy for lung cancer as an unusual cause of false positive fluorodeoxyglucose positron emission tomography and computed tomography: a case report

IntroductionBronchial stump aspergillosis is a rare entity characterized by cough and hemoptysis.Case presentationWe report the case of a 58-year-old Caucasian woman who developed bronchial stump aspergillosis two years after a left upper lobe resection for lung cancer. Bronchial stump aspergillosis was diagnosed as a result of a focus of increased fluorodeoxyglucose activity in a follow-up positron emission tomography and computed tomography scan. She was treated with oral antifungal therapy and presented with good evolution after three months of treatment.ConclusionBronchial stump aspergillosis is an unusual complication after pulmonary resection. Clinicians should be aware of it when a local recurrence of cancer around the bronchial stump is suspected based on a positive positron emission tomography and computed tomography finding.

Hipertensión pulmonar grave y enfermedad de Takayasu

La enfermedad de Takayasu es una enfermedad inflamatoria que afecta a los grandes vasos, especialmente la aorta y sus ramas. La clinica de la enfermedad depende de la distribucion de las arterias afectadas. A pesar de que la arteria pulmonar se afecta de manera habitual, rara vez es esta la principal manifestacion clinica de la enfermedad. Se describe el caso de una paciente joven con clinica de disnea que presentaba hipertension pulmonar grave secundaria a la afectacion de la arteria pulmonar, que se trato con corticoids (metilprednisolona), inmunodepresores (azatioprina) y la implantacion de un stent en la arteria pulmonar izquierda, tras lo cual presento una notable mejoria tanto hemodinamica como clinica.

Intra- and Interobserver Agreement Among Bronchial Endosonographers for the Description of Intrathoracic Lymph Nodes

Several sonographic features observed by endobronchial ultrasonography have been suggested to be useful to predict malignancy in mediastinal lymph nodes. To evaluate agreement to describe sonographic features, 28 video images were evaluated twice by eight expert bronchoscopists. The observers reviewed each case for the presence of coagulation necrosis sign (CNS), central hilar structure (CHS), heterogeneity, distinct margin, round shape, size >1 cm and malignancy. Intraobserver agreement was almost perfect for size (κ = 0.826), substantial for CNS (κ = 0.721) and shape (κ = 0.615), and moderate for CHS (κ = 0.565), heterogeneity (κ = 0.441) and margin (κ = 0.407). Interobserver agreement was substantial for size (κ = 0.641), moderate for shape (κ = 0.445), and fair for CNS (κ = 0.340) and margin (κ = 0.274). In conclusion, inter- and intraobserver agreement of the endosonographic features for mediastinal or hilar lymph nodes is good for shape or size but not good enough for the other ultrasonographic features.

Severe pulmonary hypertension and Takayasu arteritis

Takayasu arteritis is an inflammatory disease that affects large vessels, especially the aorta and its branches. The clinical features of the disease depend on which arteries are affected. Although pulmonary artery involvement is common, only rarely is this the main clinical manifestation. We describe the case of a young woman with dyspnea who had severe pulmonary hypertension secondary to Takayasu arteritis of the pulmonary artery. She was administered corticosteroid (methylprednisolone) and immunosuppressant (azathioprine) therapy and a stent was implanted in the left pulmonary artery. Both hemodynamic and clinical signs improved.

Association between Air Pollution and Hemoptysis

Background. The relationship between air pollution and exacerbation of respiratory diseases is well established. Nevertheless, its association with hemoptysis has been poorly investigated. This paper describes the relationship of air pollutants with severe hemoptysis. Methods. All consecutive subjects with severe hemoptysis during a 5-year period were included. The relationship between the contamination measurements and the frequency of embolizations was analyzed using Poisson regressions. In these regressions, the dependent variable was the monthly number of embolizations in a given month and the independent variable was either the concentration of an air contaminant during the same month, the concentration of the air contaminant during the previous month, or the difference between the two. Results. A higher total number of embolizations per month were observed over the months with increases in the concentration of NO. The number of embolizations was 2.0 in the 33 months with no increases in the concentration of NO, 2.1 in the 12 months with small increases, 2.2 in the 5 months with moderate increases, 2.5 in the 4 months with large increases, and 4.0 in the 5 months with very large increases. Conclusion. There is association between hemoptysis and increases in the concentration of atmospheric NO in Badalona (Spain).

Estudio de la infección tuberculosa en trabajadores de un hospital general universitario. Factores asociados y evolución en 20 años

OBJECTIVE To estimate the prevalence of tuberculous infection (TI) in the health-care workers of a hospital over the course of a 20-year period and analyze the associated risk factors. SUBJECTS AND METHODS A cross-sectional, descriptive study of the workers of a general hospital from 1988 until 2007, using a tuberculin test (TT) and questionnaire. RESULTS 2,179 workers were studied (mean age 32.4 years (SD 8.4). 24.5% worked in areas at risk for tuberculosis (TB). 8.1% (174) were vaccinated with BCG. The prevalence of positive baseline TT was 25.7% (95% confidence interval: 23.8-27.4%). There was a greater percentage of positive TT in the 1988-1992 period (44.2%) and a smaller percentage (15.8%) in the 2003-2007 period (P<.0001). The prevalence of TI was 1.53 times greater in males and 1.89 in those vaccinated with BCG. When compared with resident physicians, the prevalence of TI was greater in the rest of the professional categories, while increasing 1.03 times per year that age increases and 1.05 times per year of professional activity. CONCLUSIONS The data provide relevant information about the evolution of TI in hospital professionals over the course of a 20-year period. The prevalence decreased during the study period, probably due to a decrease in the incidence of TB in the reference community and to improved prevention measures and nosocomial control.

Cáncer de pulmón en pacientes con combinación de fibrosis pulmonar y enfisema y fibrosis pulmonar idiopática. Estudio descriptivo en una serie española

INTRODUCTION Information on the association of lung cancer (LC) and combined pulmonary fibrosis and emphysema (CPFE) is limited and derived almost exclusively from series in Asian populations. The main objective of the study was to assess the impact of LC on survival in CPFE patients and in patients with idiopathic pulmonary fibrosis (IPF). METHODS A retrospective study was performed with data from patients with CFPE and IPF diagnosed in our hospital over a period of 5 years. RESULTS Sixty-six patients were included, 29 with CPFE and 37 with IPF. Nine had a diagnosis of LC (6 with CPFE and 3 with IPF). Six patients (67%) received palliative treatment even though 3 of them were diagnosed atstage i-ii. Overall mortality did not differ significantly between groups; however, in patients with LC, survival was significantly lower compared to those without LC (P=.044). The most frequent cause of death was respiratory failure secondary to pulmonary fibrosis exacerbation (44%). In a multivariate analysis, the odds ratio of death among patients with LC compared to patients without LC was 6.20 (P=.037, 95% confidence interval: 1.11 to 34.48). CONCLUSIONS Lung cancer reduces survival in both entities. The diagnostic and therapeutic management of LC is hampered by the increased risk of complications after any treatment modality, even after palliative treatment.