Roberto Chalela

Utilización de glucosa en los músculos de pacientes con enfermedad pulmonar obstructiva crónica

INTRODUCTION Muscle dysfunction is one of the most extensively studied manifestations of COPD. Metabolic changes in muscle are difficult to study in vivo, due to the lack of non-invasive techniques. Our aim was to evaluate metabolic activity simultaneously in various muscle groups in COPD patients. METHODS Thirty-nine COPD patients and 21 controls with normal lung function, due to undergo computed axial and positron emission tomography for staging of localized lung lesions were included. After administration of 18-fluordeoxyglucose, images of 2 respiratory muscles (costal and crural diaphragm, and rectus abdominus) and 2 peripheral muscles (brachial biceps and quadriceps) were obtained, using the standard uptake value as the glucose metabolism index. RESULTS Standard uptake value was higher in both portions of the diaphragm than in the other muscles of all subjects. Moreover, the crural diaphragm and rectus abdominus showed greater activity in COPD patients than in the controls (1.8±0.7 vs 1.4±0.8; and 0.78±0.2 vs 0.58±0.1; respectively, P<.05). A similar trend was observed with the quadriceps. In COPD patients, uptake in the two respiratory muscles and the quadriceps correlated directly with air trapping (r=0.388, 0.427 and 0.361, respectively, P<.05). CONCLUSIONS There is greater glucose uptake and metabolism in the human diaphragm compared to other muscles when the subject is at rest. Increased glucose metabolism in the respiratory muscles (with a similar trend in their quadriceps) of COPD patients is confirmed quantitatively, and is directly related to the mechanical loads confronted.

Immune phenotypes in lung cancer patients with COPD: potential implications for immunotherapy

Lung cancer remains one of the most commonly diagnosed neoplasms, being responsible for the majority of cancer-related deaths worldwide (1,2). Chronic obstructive pulmonary disease (COPD) is also a major cause of morbidity and mortality globally. COPD underlies lung cancer in the majority of the patients.

Tormenta de nieve en el lavado broncoalveolar

A 72-year-old male presented due to a clinical picture of dyspnea with subacute onset and hypoxemia. He was a smoker with no significant clinical history. The chest X-ray showed a diffuse pattern in the right lung and computed tomography of the chest revealed a crazy paving pattern in the right lung and ground-glass opacities in the left lower lobe. Flexible bronchoscopy under conscious sedation was performed. No gross endobronchial signs were observed. Bronchoalveolar lavage (BAL) was performed and transbronchial biopsies were obtained from the right upper lobe. When the BAL fluid was aspirated, it was observed to contain whitish particles, with a snowstorm appearance (see video [appendix]). To our knowledge, this phenomenon in BAL fluid has not been previously described.1,2 Cytological analysis of the BAL sample showed groups of tumor cells with moderately atypical nuclei. The transbronchial biopsy showed alveolar spaces lined with adenocarcinoma cells in a predominantly lepidic pattern. In general, BAL fluid obtained on