Víctor Curull

Adaptation of the Asthma Quality of Life Questionnaire to a second language preserves its critical properties: The Spanish Version

To test the metric proprieties of the Spanish version of the Juniper Asthma Quality of Life Questionnaire (AQLQ), we studied 116 adult asthmatic patients with a wide range of disease severity (53 patients were recruited from the respiratory outpatient department, 38 from a primary health care centre and 25 were patients admitted into hospital due to acute asthma). The patients were assessed twice, at recruitment and after 2 months. The AQLQ showed a high internal consistency (Cronbachs alpha = 0.78 to 0.96) and a high 2-week reproducibility (ICC = 0.82 to 0.92). Expected significant differences in AQLQ scores were observed according to disease severity as measured by symptoms, medication, use of services and recruitment setting. The cross-sectional and longitudinal correlations between AQLQ and the overall St. Georges Respiratory Questionnaire were strong, moderate to strong between AQLQ and dyspnea and weak to moderate between AQLQ and FEV(1). The changes in AQLQ scores were significantly different in patients who either improved or deteriorated from those patients who remained stable (P <.0001 and P <.01, respectively, for the overall AQLQ). We conclude that the Spanish version of the AQLQ is reliable, valid and sensitive to changes.

Lung adenocarcinoma: from molecular basis to genome-guided therapy and immunotherapy

Although adenocarcinoma (ADC) is the most frequent lung cancer, its diagnosis is often late, when the local invasion is important and/or the metastases have already appeared. Therefore, the mortality at 5 years is still very high, ranging from 51% to 99%, depending on the stage. The implementation of different molecular techniques has allowed genomic studies even in relatively small histological samples such as obtained with non-invasive or minimally invasive techniques, facilitating a better phenotyping of lung ADC. Thus, current classification differentiates between preinvasive lesions (atypical adenomatous hyperplasia and in situ ADC), minimally invasive ADC (MIA) and invasive ADC. Field cancerization is a concept that refers to progressive loco-regional changes occurring in tissues exposed to carcinogens, due to the interaction of the latter with a predisposing genetic background and an appropriate tissue microenvironment. Somatic genetic alterations, including mutations but also other changes, are necessary for oncogenesis, being especially frequent in lung ADC. Changes in the epidermal growth factor receptor (EGFR) gene, Kirsten rat sarcoma viral oncogene (KRAS), v-Raf murine sarcoma viral oncogene homolog B (BRAF), gene encoding neurofibromin (NF1), anaplastic lymphoma kinase (ALK) and ROS1 are the main genes that suffer alterations in the tumors of patients with ADC. Molecular profiling of these tumors allows more targeted treatments through two distinct strategies, genome-guided therapy and immunotherapy. The former, targets the aberrant pathways secondary to the genomic alteration, whereas the latter may be based on the administration of antibodies [such as those against cytotoxic T-lymphocyte antigen 4 (CTLA-4) or the programmed cell death ligand 1/protein 1 pathway (PD-L1/PD-1)] or the stimulation of the patients own immune system to produce a specific response. These strategies are obtaining better results in selected ADC patients.

Localized Subcarinal Adenitis following Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure for the diagnosis of mediastinal lymph nodes and masses. Its complications are rare and include hemorrhage, pneumothorax and infections such as mediastinitis. We report the case of a 51-year-old patient who presented with a localized subcarinal adenitis after EBUS-TBNA. Germs colonizing the oropharynx may have been dragged along by the echobronchoscope, inoculating the punctured mediastinal lymph node.

Inflammatory Myofibroblastic Tumor Diagnosed by Transbronchial Needle Aspiration

The inflammatory myofibroblastic tumor (IMT) is a mesenchyal lesion that can arise in multiple locations that have been escribed in the literature, predominantly in the retroperitoneum nd abdomino-pelvic region, including mesentery, omentum, uriary bladder, spleen, liver or even the breast, bladder and larynx. n the WHO classification it is considered a tumor of potential ntermediate malignancy. It appears under different names such s inflammatory pseudotumor, plasma cell granuloma or histioytoma. Currently, this terminology is not recommended by the HO. Pulmonary involvement was first described in 1973.1 It is rare cause of primary lung tumor in adults; however, it is the ost frequent cause of lung tumor in children, which, according o the series of Hartman et al.2 corresponds to as many as 56% of enign lung tumors at this age. The pathogenesis of this lesion is ontroversial, having been formerly considered benign lesions that riginated as an exaggerated local inflammatory response against issue damage. However, the discovery of the presence of anaplasic lymphoma kinase gene (ALK gene) rearrangements in about 50% f these lesions gives them a likely neoplastic origin. The recent evelopment of ALK inhibitors therapies could be an alternative reatment.3 A twenty-seven year-old male presented a pulmonary nodule n the right upper lobe in a chest-X-ray done as a pre-operative xamination due to a spinal disc herniation. He was asymptomatic, he physical examination was unremarkable and the blood analysis s well as arterial blood gas and pulmonary function tests showed o alterations. The chest computed tomography (CT) reported the resence of a solid, homogenous mass of 42 mm in diameter in he right upper lobe. No significant alterations in lung parenchyma r the presence of pathological size adenopathies were observed. bronchoscopy was carried out and found a well-defined hiperascular mass occluding the posterior segmental bronchus of the ight upper lobe. Transbronchial needle aspiration of the lesion was erformed. Cytological study of the smears showed densely cellular extenions constituted by groups of spindle cells, loosely cohesive in ome parts. Cells presented elongated nuclei, with mild cytological typia. Admixed with these cells was a mild infiltrate of lymhoplasmacytic cells (Fig. 1A), along with foamy macrophage and

A foreign body reaction to Surgicel(®) in a lymph node diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration.

Surgicel ® (Ethicon, North Ryde, NSW, Australia) is an absorbable sheet of oxidized cellulose polyanhydroglucuronic acid polymer used as an hemostatic in cardiovascular and thoracic surgery. In some cases, the retained material may cause foreign body granulomatous reactions and simulate tumor recurrence, an abscess, an hematoma, or an infection. We report the case of a 55-year-old patient who was operated of a lung adenocarcinoma. In the thoracic computed tomography scan 1 year after the surgery, a right paratracheal lymph node was detected, so endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed suspecting recurrence of the tumor. The cytology results of the lymph node showed a nonnecrotizing granulomatous reaction secondary to Surgicel ® , used as an hemostatic during the surgery. The objective of presenting this case is to consider foreign body reaction to Surgicel ® in the differential diagnosis of postoperative suspicion of neoplastic recurrence, and on the other hand, to note that EBUS-TBNA enables diagnosis.

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