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ABSTRACT: We present a case of nephrotic syndrome secondary to a membranous glomerulonephritis (MG), in a nonsmoking female with a solitary pulmonary nodule, which did not show growth during 2 years of followup. A biopsy by videothoracoscopy showed a granulomatous non-neoplastic process with giant multinucleated cells. The appearance of a nephrotic syndrome and its interpretation as paraneoplastic revealed the existence of a primary pulmonary lymphoepithelioma-like carcinoma (LELC), a very rare pulmonary tumor. After resection of tumor there was a complete recovery from the nephrotic syndrome. This case highlights how the investigation of paraneoplastic syndromes can help in the early diagnosis of some malignancies.
Clinical nephrology 09/2009; 72(3):206-10. · 1.17 Impact Factor
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ABSTRACT: A new method is described for performing oral fiberoptic bronchoscopy during noninvasive ventilation through the nose. The technique was successfully applied in 2 patients suffering from acute respiratory failure. The bronchoscope was inserted through a glove finger fitted into a mouth guard. The system works as a valve and does not affect performance of the bronchoscopy procedure or the pressures administered during noninvasive ventilation. We conclude that the procedure has potential advantages over bronchoscopy through the nose and face masks or helmets, particularly for the management of secretions or in special clinical circumstances (hemoptysis or presence of foreign bodies). This method can be used to substitute for or complement other bronchoscopy techniques performed with other interfaces.
Archivos de Bronconeumología 01/2006; 41(12):698-701. · 2.17 Impact Factor
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ABSTRACT: Three cases of thoracic actinomycosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empyema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are thoroughly analyzed.
Anales de medicina interna (Madrid, Spain: 1984) 04/2005; 22(3):124-9.
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ABSTRACT: The Lambert-Eaton myasthenic syndrome is a rare disorder of neuromuscular transmission, usually presenting as a paraneoplastic process associated with a small cell lung cancer. Recently, respiratory muscular impairment has been described in these patients. Acute respiratory failure as a presenting symptom has been reported in few cases. We present a case of acute ventilatory failure as the first manifestation of Lambert-Eaton myasthenic syndrome associated with small cell lung cancer and discuss the main features of this disease, including its treatment. The Lambert-Eaton myasthenic syndrome should be considered in cases of unexplained acute respiratory failure and clinical evidence of neoplasic disease. We thought that electromyographic studies could reveal the real involvement of respiratory muscles, including diaphragm, in this condition.
Anales de medicina interna (Madrid, Spain: 1984) 06/2002; 19(5):243-5.
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ABSTRACT: We describe the case of a 30-year-old asymptomatic farmer who underwent a pulmonary segmentectomy due to the casual finding of a pulmonary nodule in preoperative chest radiography. As bronchoscopic samples rule out mycobacterium infection and malignancy, surgery could have been avoided with the use of serological tests and radiographic follow-up based on epidemiology of dirofilariasis in our country.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 03/2002; 57(1):33-4.
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ABSTRACT: A 52-yr-old man with a residual phase of schizophrenia developed sleep apnoea-hypopnoea syndrome (SAHS). After five days of continuous positive airway pressure (CPAP) treatment, the patient developed an aggressive mood with incoherence, prominent hallucinations and agitation, and attempted to hit his relatives. He was finally admitted to the hospital with an acute psychotic episode. Withdrawal of CPAP, and neuroleptic treatment controlled the episode, and clinical symptoms of SAHS reappeared 10 days later. Schizophrenia associated to sleep apnoea-hypopnoea syndrome has rarely been reported, but, to the authors' knowledge, the induction of a psychotic episode by continuous positive airway pressure treatment in a patient with sleep apnoea-hypopnoea syndrome and coexisting schizophrenia has never been previously reported.
European Respiratory Journal 03/2001; 17(2):313-5. · 5.89 Impact Factor
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Archivos de Bronconeumología 12/2000; 36(10):601-2. · 2.17 Impact Factor
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Archivos de Bronconeumología 06/2000; 36(5):290. · 2.17 Impact Factor
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Respiration 02/2000; 67(6):693-5. · 2.26 Impact Factor
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ABSTRACT: Polysomnography (PSG) is currently the "gold standard" for the diagnosis of the sleep apnoea hypopnoea syndrome (SAHS). Nocturnal oximetry (NO) has been used with contradictory results. A prospective study was performed to determine the accuracy of NO as a diagnostic tool and to evaluate the reduction in the number of PSGs if the diagnosis of SAHS had been established by this method.
Two hundred and seventy five patients with a clinical suspicion of SAHS were admitted to undergo, in the same night, full PSG and NO. Desaturation was defined as a fall in the haemoglobin saturation level (SaO(2)) to lower than 4% from the baseline level and an oxygen desaturation index per hour (ODI) was obtained in each patient with three cut off points: >/= 5 (ODI-5), >/= 10 (ODI-10), and >/= 15 (ODI-15).
SAHS was diagnosed in 216 patients (194 men). After withdrawing patients with abnormal lung function (forced expiratory volume in one second (FEV(1)) lower than 80% predicted), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV) of NO were: ODI-5 (80%, 89%, 97%, 48%); ODI-10 (71%, 93%, 97%, 42%); ODI-15 (63%, 96%, 99%, 38%). The accuracy for each ODI was 0.81, 0.75, and 0.70, respectively. If NO had been considered as a diagnostic tool and PSG had been performed only in patients with a negative NO (false negative and true negative) and those with a positive NO and abnormal pulmonary function tests, 135/275 (ODI-5), 156/275 (ODI-10), and 170/275 (ODI-15) PSGs would have been performed, a reduction of 140, 119, and 105, respectively.
Nocturnal oximetry in patients with suspected SAHS and normal spirometric values permits the institution of therapeutic measures in most patients.
Thorax 12/1999; 54(11):968-71. · 6.84 Impact Factor
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Archivos de Bronconeumología 11/1999; 35(9):464. · 2.17 Impact Factor
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ABSTRACT: A Spanish version of the Epworth Sleepiness Scale (ESS-Sp) was developed by translation, back-translation, formal discussion, and a meeting of researchers with a group of patients with sleep apnea syndrome (SAS). The translated questionnaire was then tested in 345 patients, 275 with SAS at various levels of severity and 70 without SAS. Significant differences existed between the two groups as to age (53 +/- 11 years versus 47 +/- 13, p < 0.001) and BMI (32 +/- 5 versus 29.5 +/- 5, p < 0.001). Patients with SAS had significantly higher scores (14 +/- 5) than did those without SAS (10 +/- 5) (p < 0.001). Reproducibility was tested in 146 patients (113 SAS and 33 non-SAS), with no significant differences found among patients with SAS (14.9 +/- 5 versus 14.2 +/- 5, p = n.s.); significant differences in BMI were found, however, among the 33 non-SAS patients (12 +/- 5 versus 10 +/- 5, p < 0.01). Total scores and individual item scores were related in both groups. Likewise, each item was related to total score in patients with SAS. Sensitivity to post-treatment changes was assessed in 77 SAS patients, with initial scores of 16 +/- 4 seen to decrease to 4 +/- 3 after continuous positive airway pressure. ESS-Sp scores over 10 were recorded for 85% of patients with SAS: 78% of those with mild SAS, 85% of those with moderate disease and 92% of those whose SAS was severe. Significant inter-group differences were found upon applying a test of variance (p < 0.001). Differences continued to be detected when multiple correlations were looked for, with differences increasing with severity. SAS patients with ESS-Sp level one scores (< 10) had lower apnea-hypopnea indices (AHI) (35 +/- 18 versus 42 +/- 20, p < 0.05), lower desaturation levels (21 +/- 21 versus 34 +/- 28, p < 0.01) and higher minimum saturation (80 +/- 10 versus 75 +/- 12, p < 0.05), with no differences in age or BMI. A significant correlation was found between ESS-Sp score and respiratory variables recorded during polysomnography: AHI, r = 0.23 (p < 0.001); percent time in apnea-hypopnea, r = 0.18 (p < 0.01); desaturation index, r = 0.27 (p < 0.01) and minimum saturation (r = -0.14, p < 0.05). We conclude that the Spanish version of the ESS is equivalent to the original, is reproducible in patients with SAS, sensitive to post-treatment changes and seems to discriminate level of severity, showing correlation with polysomnograph variables.
Archivos de Bronconeumología 10/1999; 35(9):422-7. · 2.17 Impact Factor
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ABSTRACT: Corynebacterium pseudodiphtheriticum is a coryneform and diphtheromorphic bacteria rarely found as a cause of pneumonia in immunocompetent hosts. A case of an immunocompetent patient with C. pseudodiphtheriticum pneumonia is presented. This infection responded well to initial empirical treatment with cefotaxime. Very few cases of pneumonia associated with C. pseudodiphtheriticum have been described in the medical literature, this organism mainly being found in immunocompromised hosts. We report a case of pneumonia in an immunocompetent patient in which C. pseudodiphtheriticum was the only micro-organism isolated.
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo 09/1999; 54(4):325-7.
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ABSTRACT: The main aim of the present study was to assess the early diagnostic value of bronchoalveolar lavage (BAL) in radiation-induced lung injury in patients with breast carcinoma. Twenty-six females receiving postoperative radiotherapy for breast cancer were evaluated before and 0, 15, 30, 60, and 180 days after radiotherapy. History, physical examination, chest radiographs, and pulmonary function tests were obtained. BAL, including lymphocyte subsets analysis, was limited to the second evaluation after radiotherapy. A group of 21 healthy females were used as control. Findings after radiotherapy in asymptomatic patients were compared with findings in a group of patients with radiation pneumonitis. Irradiated patients showed a significantly (p<0.01) greater percentage (29.5+/-15.7%) of BAL lymphocytes than controls (6.2+/-3.3%). No statistical differences existed in BAL findings between the irradiated and unirradiated sides of the chest. Percentages of BAL lymphocytes did not differ significantly between patients who developed subsequent pneumonitis (24.5+/-13.5%) and those who did not develop pneumonitis (32.8+/-16.5%). Patients with pneumonitis at the time of BAL had significantly higher (p<0.05) alveolar CD4 subset cells (24.8+/-10.2%) than asymptomatic patients (15.2+/-8.9%). Maximal reductions in total lung capacity (p<0.01), and residual volume (p<0.05) occurred 60 days after irradiation. The early lymphocytic alveolitis induced by unilateral thoracic radiotherapy in most patients with breast cancer is always bilateral and does not predict the subsequent development of radiological evidence of pneumonitis.
European Respiratory Journal 04/1999; 13(4):727-32. · 5.89 Impact Factor
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ABSTRACT: The main aim of the present study was to assess the early diagnostic value of bronchoalveolar lavage (BAL) in radiation-induced lung injury in patients with breast carcinoma.Twenty-six females receiving postoperative radiotherapy for breast cancer were evaluated before and 0, 15, 30, 60, and 180 days after radiotherapy. History, physical examination, chest radiographs, and pulmonary function tests were obtained. BAL, including lymphocyte subsets analysis, was limited to the second evaluation after radiotherapy. A group of 21 healthy females were used as control. Findings after radiotherapy in asymptomatic patients were compared with findings in a group of patients with radiation pneumonitis.Irradiated patients showed a significantly (p<0.01) greater percentage (29.5±15.7%) of BAL lymphocytes than controls (6.2±3.3%). No statistical differences existed in BAL findings between the irradiated and unirradiated sides of the chest. Percentages of BAL lymphocytes did not differ significantly between patients who developed subsequent pneumonitis (24.5±13.5%) and those who did not develop pneumonitis (32.8±16.5%). Patients with pneumonitis at the time of BAL had significantly higher (p<0.05) alveolar CD4 subset cells (24.8±10.2%) than asymptomatic patients (15.2±8.9%). Maximal reductions in total lung capacity (p<0.01), and residual volume (p<0.05) occurred 60 days after irradiation.The early lymphocytic alveolitis induced by unilateral thoracic radiotherapy in most patients with breast cancer is always bilateral and does not predict the subsequent development of radiological evidence of pneumonitis.
European Respiratory Journal 03/1999; 13(4):727 - 732. · 5.89 Impact Factor
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Clinical Infectious Diseases 07/1998; 26(6):1464-5. · 9.15 Impact Factor
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ABSTRACT: A community teaching hospital in Alicante, Spain.
To assess the characteristics of tuberculous pleurisy (TP) in our hospital, and to evaluate the differences between primary and reactivation forms.
Between January 1984 and December 1993, all human immunodeficiency virus (HIV)-negative patients with TP were included in the study. From September 1987 onward, patients were prospectively studied. Charts, radiography, pleural fluid findings and diagnostic methods were evaluated. Two groups were distinguished according to chest radiographs: those patients with upper lobe lesions, calcified adenopathy and old pleural thickening were considered reactivation forms.
Of the 129 patients (mean age, 31 +/- 18 years), 76% had primary TP and 24% reactivation TP. Differences were found in age (28 +/- 17 vs 40 +/- 18 years, P < 0.01), smoking (43% vs 74%, P < 0.01) and alcohol abuse (23% vs 47%, P < 0.05), weight loss (29% vs 50%, P < 0.05), positive sputum smears and cultures (2% vs 16%, 7% vs 28%, P < 0.01), and number of large effusions (46% vs 26%, P < 0.05), but not in tuberculin reactivity, pleural fluid findings, positive pleural cultures, or presence of pleural granuloma.
In our setting, TP predominantly affects young adults. Clinical, immunological, and pleural findings are similar to those of patients with classic symptoms of TP. Older age, smoking and alcohol abuse, smaller effusions and sputum yield are differential characteristics of reactivation forms.
The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 07/1998; 2(6):513-7. · 2.73 Impact Factor
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Archivos de Bronconeumología 06/1998; 34(5):272-3. · 2.17 Impact Factor
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ABSTRACT: To analyze the infrastructure needs for diagnosing sleep apnea syndrome (SAS) in the Community of Valencia, we studied available resources and the diagnostic approaches to SAS in departments of pneumology and neurophysiology in 23 of the 25 public hospitals by means of a telephone interview. Only 52% of pneumology departments and 56% of neurophysiology departments studied SAS at any level. Level I study (conventional polysomnography) was performed by 42% of the pneumology departments and 100% of the neurophysiology departments. The remaining pneumology units used nighttime oximetry (a level IV technique). A special unit and trained personnel were available at 40% of hospitals. Home studies were performed by only 17%. Although 2,000 studies are performed annually, only 1,100 are level I and large interdepartmental differences were detected. The average waiting period was 16 months. Relations between pneumology and neurophysiology units were few and only one hospital took an interdisciplinary approach. The ratio of polysomnographs to inhabitants was 0.52/250,000 and the prevalence of nasal continuous positive airway pressure treatment was 36/100,000, lower than in other communities. We conclude that Valencia is understaffed and under-equipped, and that in some cases resources are under-used. Interdisciplinary approaches are scarcely used by the various specialists involved and the waiting lists for diagnostic tests required for prescribing empirical treatment are long. To attend the approximately 100,000 SAS patients estimated to reside in Valencia, it would be necessary to have 14 polysomnograph devices rather than the 8 available now, as well as to increase staff to meet demand and shorten waiting lists.
Archivos de Bronconeumología 05/1998; 34(4):177-83. · 2.17 Impact Factor
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Chest 08/1996; 110(1):299-300. · 5.25 Impact Factor
