Pedro Cabrera Navarro

Textiloma intratorácico interpretado como carcinoma broncogénico. Otro falso positivo de la tomografía por emisión de positrones

Los textilomas, reacciones inflamatorias contra cuerpos extranos de tipo textil, representan una complicacion posquirurgica poco frecuente. La diversidad de sintomas y signos radiologicos con que se manifiestan contribuye a que su diagnostico se confunda con un proceso de tipo neoplasico. Los hallazgos descritos con la tomografia por emision de positrones (PET), tecnica poco habitual en el manejo diagnostico de esta entidad, pueden condicionar falsos positivos neoplasicos. Describimos el caso de un varon de 56 anos, que 23 anos despues de una cirugia de neumotorax presento una masa intratoracica indicativa de neoplasia en la PET, cuyo diagnostico final fue de textiloma.

Prevalencia de enfermedad pulmonar obstructiva crónica en las Islas Canarias

INTRODUCTION The prevalence of chronic obstructive pulmonary disease (COPD) varies significantly among the different geographical areas reported. In Spain, two epidemiological studies have shown a prevalence of 9-10% in the population aged over 40. However, neither of these studies included the Canary Islands, which are of interest due to their climatic conditions and high incidence of smoking. MATERIALS AND METHODS A random group of 1,353 subjects aged between 40 and 70years was selected from a sample population of 596,478 individuals. Participants completed a questionnaire and then performed spirometry with bronchodilator testing if obstruction was observed. COPD was diagnosed when the post-bronchodilator FEV1/FVC ratio was less than 0.70. RESULTS The prevalence of COPD was 7.3% (95%CI: 5.5-9.5) and was higher in males than in females (8.7% vs. 6.3%, P=.134). The incidence of smoking was 29.4% (95%CI: 25.4-33.1) and was also higher in males than in females (35.1% vs 25.4%, P<.001). The prevalence of COPD stratified by severity of obstruction, according to the GOLD criteria, was 16% in groupi, 69.9% in groupii, 10.4% in groupiii and 3.3% in groupiv. 71.6% of the subjects were underdiagnosed and 63.5% undertreated. CONCLUSIONS Despite having one of the highest rates of smoking in Spain, the prevalence of COPD in the Canary Islands is lower than in most of the Spanish regions studied.

Fibrosis quística en la edad adulta: nuevas formas clínicas

La fibrosis quistica ha dejado de ser una enfermedad exclusivamente pediatrica y, cada vez con mayor frecuencia, los medicos de adultos tienen que atender a este tipo de enfermos. Esta situacion deriva de dos condicionantes: mayor supervivencia de los enfermos con fibrosis quistica clasica y aparicion de nuevas formas clinicas. En la poblacion caucasiana, la fibrosis quistica es la enfermedad hereditaria mas frecuente entre las potencialmente mortales. En Espana tiene una frecuencia de uno entre 2.810 recien nacidos

Long-term inhaled nitric oxide plus dipyridamole for pulmonary arterial hypertension.

Inhaled nitric oxide (iNO) has been shown to be a potent and selective vasodilator in pulmonary arterial hypertension (PAH). However, the clinical experience in prolonged treatment is limited. We assess the safety and effectiveness of long-term administration of iNO in severe PAH. Two female patients were admitted to our hospital because of severe dyspnea (World Health Organization functional class IV) and hypoxemia. They were diagnosed with PAH (primary and secondary to congenital heart disease) and treated with iNO for 2 years. The delivery system consisted of an NO tank of 800 ppm, a modified gas-pulsing device, and nasal cannulas. On iNO treatment the patients showed remarkable improvement of symptoms, oxygenation and 6-min walk distance. After 16 months the patients began to experience a progressive rebound of symptoms. A phosphodiesterase type 5 inhibitor (dipyridamole) was added to iNO. This intervention proved useful in improving clinical deterioration and hemodynamics. This is the first study reporting 2-year iNO therapy in 2 patients with primary and secondary pulmonary hypertension. The combination of dipyridamole with iNO augments the pulmonary vasodilatation and may be useful in managing PAH.

Long-term cardiopulmonary function after thoracic sympathectomy: Comparison between the conventional and simplified techniques

OBJECTIVE We sought to compare the long-term effects of conventional and simplified thoracic sympathectomy on cardiopulmonary function. METHODS We performed a prospective and randomized study of 32 patients with diagnoses of primary hyperhidrosis who were candidates for either conventional or simplified thoracic sympathectomy. Patients were randomized according to the type of procedure: conventional thoracic sympathectomy (18 patients) and simplified thoracic sympathectomy (14 patients). Before surgical intervention, forced spirometry, body plethysmography, measurement of the diffusing capacity of the lung for carbon monoxide (DLCO), and exercise tests were carried out in all patients. These evaluations were performed again 1 year after the procedure to assess the long-term effects of sympathectomy. RESULTS Lung function tests revealed a significant decrease in forced expiratory volume in 1 second (FEV(1)) and forced expiratory flow between 25% and 75% of vital capacity (FEF(25%-75%)) in both groups (FEV(1) of -6.3% and FEF(25%-75%) of -9.1% in the conventional thoracic sympathectomy group and FEV(1) of -3.5% and FEF(25%-75%) of -12.3% in the simplified thoracic sympathectomy group). DLCO and heart rate at rest and maximal values after exercise were also significantly reduced in both groups (DLCO of -4.2%, DLCO corrected by alveolar volume of -6.1%, resting heart rate of -11.8 beats/min, and maximal heart rate of -9.5 beats/min in the conventional thoracic sympathectomy group and DLCO of -3.9%, DLCO corrected by alveolar volume of -5.2%, resting heart rate of -10.7 beats/min, and maximal heart rate of -17.6 beats/min in the simplified thoracic sympathectomy group). Airway resistance increased significantly in the group of patients undergoing conventional thoracic sympathectomy (+13%). Despite all these changes, the patients remained asymptomatic. No significant differences were found between the conventional and simplified thoracic sympathectomy groups. CONCLUSIONS Simplified and conventional thoracic sympathectomy resulted in a long-term reduction in FEV(1), FEF(25%-75%), DLCO, and resting and maximal heart rate, as well as a mild but significant increase in airway resistance in the conventional thoracic sympathectomy group, without any clinical consequence to the patient. These changes were unrelated to the level of transection of the thoracic sympathetic chain.

Intrathoracic Gossypiboma Interpreted as Bronchogenic Carcinoma. Another False Positive With Positron Emission Tomography

Gossypibomas from inflammatory reactions to textile foreign bodies are a rare postoperative complication and are easily confused with neoplastic processes because of their diversity of symptoms and radiographic signs. Positron emission tomography (PET) is seldom used to diagnose gossypibomas and PET findings can result in false positives for a diagnosis of neoplastic disease. We describe the case of a 56-year-old man in whom PET findings showed an intrathoracic mass suggesting a tumor. The final diagnosis was gossypiboma, identified 23 years after pneumothorax surgery.