Luis Valdés Cuadrado

Normativa sobre el diagnóstico y tratamiento del derrame pleural. Actualización

Although during the last few years there have been several important changes in the diagnostic or therapeutic methods, pleural effusion is still one of the diseases that the respiratory specialist have to evaluate frequently. The aim of this paper is to update the knowledge about pleural effusions, rather than to review the causes of pleural diseases exhaustively. These recommendations have a longer extension for the subjects with a direct clinical usefulness, but a slight update of other pleural diseases has been also included. Among the main scientific advantages are included the thoracic ultrasonography, the intrapleural fibrinolytics, the pleurodesis agents, or the new pleural drainages techniques.

Platelet count: association with prognosis in lung cancer

Lung cancer (LC) is now the leading cause of cancer mortality in the world, therefore it would be useful to identify prognostic factors to determine patient outcome. The objective of this study is to evaluate the usefulness of platelet counts at the time of diagnosis as a prognostic factor. A retrospective study of patients with histological diagnostic evidence of LC was carried in our catchment area over a 3-year period. Survival adjusted for other factors was assessed according to the platelet count at the time of diagnosis. Patients with platelet levels within the reference range (RR) (135000–381000/µl) were divided into two groups, between 135000–258000/µl and 258000–381000/µl. A third group was made up of patients with platelet counts over 381000/µl. Adjusted survival was analysed using Cox regression models. Patients with high platelets have a 37% worse survival than those with a platelet level within the RR, but lower than 258000/µl. When tumour stage is included in the covariates, platelet levels are no longer an independent survival factor. In conclusion, platelet levels at the time of diagnosis could be a useful prognostic factor in LC.

Lung Function Reference Values in Children and Adolescents Aged 6 to 18 Years in Galicia

OBJECTIVE It is well known that lung function reference values differ between populations, hence the apparent importance of establishing such values. The aim of this study was to develop prediction equations for spirometry for healthy children and adolescents in Galicia, Spain. POPULATION AND METHODS We studied children and adolescents aged 6 to 18 years from randomly selected schools in 14 municipalities in Galicia. Spirometric values were measured following the protocols established by the American Thoracic Society in 1987, with real-time monitoring of flow-volume curves. The prediction equations were derived using multivariate linear regression. RESULTS We developed equations to predict the main spirometry parameters for this age group according to sex, height, and weight. Mean spirometry values in relation to height were higher for boys than for girls, except in the 140-160 cm range, where they were higher for girls. Equations published in other studies in similar populations gave different predictions, ranging from an underestimation of forced midexpiratory flow rate (FEF(25%-75%)) by 16% in comparison to ours to an overestimation of peak expiratory flow (PEF) rate by 15% for an average boy. For a girl, the corresponding differences ranged from an underestimation of FEF(25%-75%) by 17% to an overestimation of PEF by 19%. CONCLUSIONS These results support the importance of using population-specific prediction equations to establish lung function reference values.

Valores de referencia de función respiratoria en niños y adolescentes (6-18 años) de Galicia

Objetivo Son conocidas las diferencias entre distintas poblaciones en cuanto a los valores de referencia de la funcion respiratoria, por lo cual parece importante establecerlos. El objetivo del estudio ha sido establecer las ecuaciones de prediccion de parametros espirometricos en ninos y adolescentes sanos de Galicia. Poblacion y metodos Hemos estudiado a ninos y adolescentes sanos de 6 a 18 anos de edad, de colegios seleccionados aleatoriamente en 14 municipios de Galicia. Las maniobras espirometricas se realizaron de acuerdo con los protocolos de la American Thoracic Society de 1987, con evaluacion continua de los espirogramas. Se obtuvieron las ecuaciones de prediccion mediante regresion lineal multivariante. Resultados Con este estudio se obtuvieron las ecuaciones de prediccion de los principales parametros espirometricos en este grupo de edad, en funcion de la edad, el sexo, la talla y el peso. Los valores medios de los parametros espirometricos, en funcion de la estatura, son superiores en la poblacion masculina comparada con la femenina, excepto en el rango entre 140 y 160 cm de altura, donde las mujeres superan a los varones. Para un varon medio de nuestra poblacion, los parametros de funcion pulmonar obtenidos con las ecuaciones de prediccion referidas por otros autores en poblaciones similares difieren de los nuestros, desde una infraestimacion de un 16% para el flujo mesoespiratorio forzado hasta una sobreestimacion de un 15% para el pico de flujo espiratorio; para una mujer, las discrepancias van desde la infraestimacion del flujo mesoespiratorio forzado del 17% hasta la sobreestimacion del pico de flujo espiratorio de un 19%. Conclusiones Estos resultados refuerzan la importancia de utilizar ecuaciones de prediccion especificas para cada poblacion.

Asthma and risk of lung cancer

Asthma is a very common chronic disease that occurs in all age groups. Its high prevalence has significant health costs, which are even higher in the most severe disease forms. Lung cancer has the highest incidence of all cancers in the developed world and is an important cause of mortality. Patients with lung cancer are a big economic burden on health services, both in direct and indirect costs. Different authors suggest that atopic constitution, including different manifestations of allergy and asthma, are possible risk factors for lung cancer, above all in never-smokers. Given the high asthma prevalence and lung cancer incidence and mortality in developed countries, this association would have important public health implications. Uncertainties about the association and the underlying physiopathological mechanisms, however, seem to require further studies.

Efecto del valor de la hemoglobina en la supervivencia del cáncer de pulmón

Fundamento y objetivo La anemia es un hallazgo frecuente en pacientes con cancer de pulmon (CP). Los valores de hemoglobina en el momento del diagnostico del CP podrian permitirnos una mas precisa clasificacion pronostica inicial de estos pacientes. El objetivo de nuestro estudio ha sido analizar el valor de la hemoglobina en el momento del diagnostico como factor pronostico en pacientes con CP. Pacientes y metodo Se ha realizado un estudio retrospectivo de todos los pacientes diagnosticados de CP (con confirmacion citohistologica) durante 3 anos en nuestra area sanitaria. Se evaluo la supervivencia en funcion de la hemoglobina en el momento del diagnostico, ajustada por otros factores. Segun el valor de hemoglobina, los pacientes se clasificaron en 2 grupos: uno con hemoglobina baja ( Resultados Se incluyo finalmente a 421 pacientes, de los que el 52,3% presentaron anemia al diagnostico. La edad media fue de 65,8 anos y el 92,7% fueron varones. Presentar una hemoglobina inferior al percentil 25 supone una posibilidad de supervivencia un 41% inferior. Conclusiones La hemoglobina baja se asocia con disminucion de la supervivencia. La evaluacion de este parametro podria permitir una mayor precision en el pronostico del CP y una major adecuacion de las indicaciones terapeuticas.