Luis Borderías - Academia.edu (original) (raw)
Papers by Luis Borderías
Tubercle and Lung Disease, 1995
Archivos De Bronconeumologia, Sep 1, 2017
Archivos De Bronconeumologia, Nov 1, 2016
Neumonía organizada y tuberculosis pulmonar: coexistencia o enfermedad asociada To the Editor, Or... more Neumonía organizada y tuberculosis pulmonar: coexistencia o enfermedad asociada To the Editor, Organizing pneumonitis (OP) has been defined as secondary (SOP) if it is caused by external aggressions, such as infections, toxic substances, drugs, connective tissue diseases, or other processes, and primary, idiopathic or cryptogenic when no association with any other disease can been determined. 1,2 The relationship between different infection types and the onset of OP is unknown. 2,3 We report the case of a 75-year-old patient, former smoker (25 pack-years) for 30 years, with a history of arterial hypertension, atrial fibrillation and surgery for colonic polyps, receiving treatment with acenocumarol, digoxin and valsartan. He presented with a 2-week history of cough, sputum expectoration, dyspnea on moderate exertion, fever, joint pain and general malaise. Chest radiograph revealed pulmonary infiltrates in the right and left lower lobes, so treatment was started with cefditoren 400 mg/day and azithromycin 500 mg/day for 7 days. The patient developed pleuritic pain in the right hemithorax due to pleural effusion and his clinical symptoms persisted, so he was admitted to hospital. Physical examination showed temperature of 38.1 • C, tachypnea and 93% oxyhemoglobin saturation while breathing ambient air (FiO 2 21%). Pulmonary auscultation revealed rhonchi and crackles in the right lung base. Laboratory tests on admission showed leukocytosis, 13 900 leukocytes/mm 3 (80% neutrophils, 9% lymphocytes, 10% monocytes), 399 000 platelets/mm 3 and ESR 111 mm/h. Of particular note among the biochemistry parameters were: ALP 133 IU/l, gamma-GT 231 IU/l and CRP 140 mg/l. Other liver tests, renal function, ions, lipids, total proteins, albumin, uric acid, thyroid hormones, procalcitonin, ACE, immunoglobulins and complement parameters were within normal limits. Autoimmune assay was negative and no precipitins were detected in plasma for Aspergillus or bird proteins. Arterial blood gases on ambient air showed partial respiratory failure (pO 2 59 mmHg) and intradermal Mantoux reaction was negative. Chest computed tomography showed alveolar infiltrate with poorly defined borders, with the appearance of a polylobulated mass in the anterior segment of the right lower lobe and a solid nodule in the same lobe, measuring 25 mm in diameter, associated
Archivos De Bronconeumologia, Mar 1, 2010
Mutations of the gene that code bone morphogenic protein type 2 receptor (BMPR2) are involved in ... more Mutations of the gene that code bone morphogenic protein type 2 receptor (BMPR2) are involved in the pathogenesis of pulmonary arterial hypertension (PAH), both in its familial (FPAH) and its idiopathic (IPAH) forms. With the aim of increasing the knowledge of these genetic factors in our area, the BMPR2 gene was studied in 17 patients with PAH, 8 with FPAH and 9 with sporadic IPAH. Additionally, a study was made to see whether the presence of BMPR2 mutations was associated with changes in the CO diffusing CO (DL(CO)) with the aim of evaluating the interest in this measurement in the pre-clinical diagnosis. R491Q y R211X mutations were detected in 2 patients with FPAH (prevalence, 25%), and the R332X mutation in one case of IPAH (prevalence, 11%). The familial study of the patient with the R491Q mutation, 14 of the 28 subjects studied had the mutation, and 4 had the diseases (penetration, 36%). A decrease in the DL(CO)/alveolar volume (K(CO)) ratio was observed in asymptomatic family members who expressed the mutation, compared to those who did not express it (88+/-5% and 104+/-9% of the reference value, respectively; P<0.01). We conclude that the frequency of mutations in the BMPR2 gene in the patients studied with FPAH is lower than was previously described. The decrease in the K(CO) observed in asymptomatic carriers of the mutation suggests a certain level of pulmonary vascular changes, therefore its measurement could be useful in the familial study of FPAH.
Medicina Clínica (english Edition), Apr 1, 2016
Bronchial stump aspergillosis. An unusual disease ଝ Aspergilosis del muñón bronquial. Una entidad... more Bronchial stump aspergillosis. An unusual disease ଝ Aspergilosis del muñón bronquial. Una entidad inusual Dear Editor, Aspergillus can cause a wide range of respiratory diseases depending on the fungus-host interaction, where the immune status of the subject plays an important role. 1 In very few cases have we seen an initially saprophytic case of patients after a lung resection, that affects the tissue granulation in the area of the suture and is called bronchial stump aspergillosis. Symptoms consist of coughing with mucous expectoration, sometimes haemoptysis, and dyspnea, 2-5 and the differential diagnosis includes, among others, lung tumours, and other processes caused by Aspergillus. 6-10 We report the case of a 61-year-old woman with no toxic habits and a history of right pneumonectomy after suffering a car accident in 1978. She was referred because of paroxysms of coughing and low mucous expectoration, general malaise, and dyspnoea which she related to her cough lasting approximately 8 weeks. These symptoms did not improve after administration of oral corticosteroids, bronchodilators, oral N-acetylcysteine and antibiotics. On examination there were no abnormalities except decreased a vesicular breath sound in the right chest, and the tests showed an ESR of 60 mmHg in the first hour, a concentration of IgE serum of 756 KU/l, Aspergillus IgE RAST 3.50 KU/l and an undetectable determination of Aspergillus precipitins. The other usual analytical tests, including other immunoglobulins, IgG and immunity subfractions, were normal. Chest radiograph and CT showed the sequelae of pneumonectomy, but there were no images of bronchiectasis, cavities or blisters, mucus plugs or atelectasis. The skin prick test for Aspergillus was negative and the spirometry ruled out bronchial obstruction. Aspergillus fumigatus grew in sputum studies (with CMI voriconazole at 0.5 g/ml) and the sputum cytology showed signs of acute inflammation without eosinophils or neoplastic cells. The fibrobronchoscopy showed a necrotic mass that had a spherical morphology and seemed pearl shaped in the bronchial stump that was aspirated, and the underlying mucosa showed mild inflammation, without evidence of bleeding or other alterations. A histological examination and culture confirmed the presence of Aspergillus. The patient rejected an endoscopic removal of the suture and treatment with antifungals.
Archivos De Bronconeumologia, 2010
A 51-year old woman developed hypersensitivity pneumonitis (HP) after inhaling the excrement of s... more A 51-year old woman developed hypersensitivity pneumonitis (HP) after inhaling the excrement of starlings that populated a park adjacent to her home. The clinical symptoms consisted of a nonproductive cough and grade II dyspnoea and radiological interstitial micronodular involvement. The respiratory function tests showed a restrictive pattern with desaturation on effort and a biopsy using videothorascopy was highly suggestive of HP. After a detailed study of the clinical history the patient mentioned an increase in cough when she crossed a park near her home, where a high population of starlings lived in its trees. Specific antigen extracts were prepared and skin tests were performed, precipitins measured, and bronchial provocation tests specific to this antigen were all positive. This observation identified a species of bird capable of causing the disease and shows a lung disease secondary to the exposure of a not very large but persistent antigen load..
Archivos De Bronconeumologia, Jul 1, 1986
Presentamos 3 casos de neumonia eosinofilica cronica (NEC). Dos con un cuadro clinico radiologico... more Presentamos 3 casos de neumonia eosinofilica cronica (NEC). Dos con un cuadro clinico radiologico tipico de esta entidad, segun las drescripciones clasicas. El otro paciente debuto de una forma bastante infrecuente, apareciendo en el seno de un asma bronquial de 40 anos de evolucion y, durante el tratamiento esteroideo, un cuadro clinico-radiologico que pudiera hacer pensar en un proceso infeccioso y cuya imagen radiologica evoluciono a la cavitacion y derrame pleural; clinicamente desarrollo una insuficiencia respiratoria aguda severa, que respondio adecuadamente al tratamiento esteroideo. Se comentan los hallazgos clinicos, radiologicos y anatomopatologicos, tanto con el microscopio optico como con el microscopio electronico.
Intensive Care Medicine, 1995
Sir: In our hospital, between January 1988 to December 1992, 4 patients out of 3280 pregnant wome... more Sir: In our hospital, between January 1988 to December 1992, 4 patients out of 3280 pregnant women (1.2/1000) developed sepsis complicating pyelonephritis, whose main manifestation was Acute Respiratory Failure (ARF). We are reporting here there unusual cases (Table 1). Acute Respiratory Failure (ARF) during pregnancy appears only very infrequently, i -1 .64/1000 [1], and in most cases it does so in the context of a sepsis. The first cases of ARF associated with pyelonephriits during pregnancy were reported by Cunningham et al. in 1984 [2]. The incidence has been calculated between 2~ by Cunningham et al. [3] and 8.5% by Towers et al. [4]. The gestational age is, generally, after 20 week gestation. The most significant predictive factors associated to ARF reported [4], were elements of treatment such as fluid overload and use of tocolytic agents. However, in our cases, the net fluid balances did not indicate overhydratation. Hemodynamic monitoring in two women showed no evidence of left ventricular failure and tocolytic therapy was not used. In our cases, nreteral obstruction is an important factor (3/4) of severe sepsis and ARE A fact not previously reported in this setting. ARF is caused by an injurious oedema of the alveolus-capillary membrane secondary to the action of the endotoxin released by Gram-negative bacteria [3]. The patients with an initial infection focus present a silent phase between twelve and forty eight hours prior to the onset of the respiratory symptoms, hypoxemia and hypocapnia; in chest radiograph, the usually present diffuse bilateral alveolar infiltrates, and the patients that are monitored by a thermo-dilution catheter present a hyperdynamic pattern, with a low systemic vascular resistance and a high cardiac output, as well as a low pulmonary capillary pressure. Description consistent with adult respiratory distress syndrome. These cases do not allow us to elucidate a possible higher pregnancy sensitivity to endotoxin, as it has been suggested by experiments on animals. In humans, data are limited, because of the relative infrequency of severe sepsis in the pregnant woman. However, the decline in respiratory functional residual capacity, and colloid osmotic pressure, in pregnancy, would amplify effects of capillary injury to endotoxin [5]. In our cases, the most common complications associated to ARF are dissemi-
BMC Pulmonary Medicine, Mar 30, 2009
Background: Differences could exist in the likelihood of asthma attacks in patients treated with ... more Background: Differences could exist in the likelihood of asthma attacks in patients treated with inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and montelukast (MON) (ICS/LABA/ MON) and patients treated with an inhaled corticosteroid (ICS) and montelukast (MON) (ICS/ MON). Methods: This was a post-hoc analysis of a pretest-posttest retrospective cohort study. Patients with mild persistent asthma and allergic rhinitis, who were taking an ICS either alone or in combination with a LABA, started concomitant MON treatment as part of their routine care. Rates of asthma-and allergic rhinitis-related medical resource use in the 12-months after the initial (index) MON prescription were compared in the ICS/MON and ICS/LABA/MON groups. An asthma attack was defined as an asthma-related hospitalization, ER visit, or use of an oral corticosteroid. Results: Of the total of 344 patients, 181 (53%) received ICS/MON and 163 (47%) received ICS/ LABA/MON in the post-index period for means of 10.5 and 11.4 months, respectively, (P < 0.05). Short-acting beta-agonists were used by 74.6% in the ICS/MON and 71.8% in the ICS/LABA/MON groups (P > 0.05). An asthma attack occurred in 4.4% of the ICS/MON group and 6.8% of the ICS/ LABA/MON group (P > 0.05). The adjusted odds of an asthma attack in the post-index period in the ICS/LABA/MON group relative to the ICS/MON group was 1.24, 95% confidence interval 0.35-4.44. Conclusion: In this observational study of combination drug treatment of mild persistent asthma and allergic rhinitis, no difference was observed between LABA/ICS/MON combination therapy and the ICS/MON combination without LABA use, for the rate of asthma attacks over one year.
The European respiratory journal, Aug 4, 2011
Processes of care and adherence to guidelines have been associated with improved survival in comm... more Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia (CAP). In sepsis, bundles of processes of care have also increased survival. We aimed to audit compliance with guideline-recommended processes of care and its impact on outcome in hospitalised CAP patients with sepsis. We prospectively studied 4,137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were adherence to antibiotic prescription guidelines, first dose within 6 h and oxygen assessment. Outcome measures were mortality and length of stay (LOS). Oxygen assessment was measured in 3,745 (90.5%) patients; 3,024 (73.1%) patients received antibiotics according to guidelines and 3,053 (73.8%) received antibiotics within 6 h. In CAP patients with sepsis, the strongest independent factor for survival was antibiotic adherence (OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay. In sepsis, antibiotic adherence is the strongest protective factor of care associated with survival and LOS. In severe sepsis, combined antibiotic adherence and first dose within 6 h may reduce mortality.
Archivos De Bronconeumologia, Oct 1, 2010
Punción transbronquial aspirativa en el estudio de las adenopatías mediastínicas: rentabilidad y ... more Punción transbronquial aspirativa en el estudio de las adenopatías mediastínicas: rentabilidad y coste-beneficio Valores de referencia de función respiratoria en niños y adolescentes (6-18 años) de Galicia Tasa y características de las agudizaciones asmáticas (ASMAB I) Tratamiento de la hipertensión arterial pulmonar postembólica mediante técnicas mínimamente invasivas guiadas por imagen Fiabilidad de la poligrafía respiratoria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en niños Revisión Acetónido de triamcinolona en el tratamiento del asma resistente a los glucocorticoides: riesgos y beneficios Actualización en los mecanismos de disfunción muscular en la EPOC Normativa SEPAR Normativa sobre el diagnóstico y tratamiento del neumotórax espontáneo
American Journal of Respiratory and Critical Care Medicine, 2015
Archivos De Bronconeumologia, Aug 1, 2020
Objective: The objective of the study was to determine the trend of variables related to tubercul... more Objective: The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. Method: Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the y test for lineal trend. Results: A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40−50 and >50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), drug susceptibility testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49.664, numbers of projects initiated annually, presentations at conferences, and theses. Conclusions: PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.
Archivos De Bronconeumologia, May 1, 1990
se han obtenido a través de las compañías suministradoras y creo que son fiables de cara a valora... more se han obtenido a través de las compañías suministradoras y creo que son fiables de cara a valorar de forma global la situación. Existen dos compañías en nuestra región: Carburos Metálicos SA, que suministra a Valladolid, Falencia,
Respiratory Medicine, Oct 1, 1999
This study investigates the effects of moderate-high altitude on lung function and exercise perfo... more This study investigates the effects of moderate-high altitude on lung function and exercise performance in 46 volunteers (19 females, 27 males), with a mean age of 42.45 1.4 years (+_SEM) and varying smoking and exercise habits, who were not previously acclimatized. Measures obtained in the base camp (1140 m) and at altitude (2630 m), in random order, included forced spirometry, maximal voluntary ventilation, maximal inspiratory and expiratory pressures, arterial oxygen saturation and capillary lactate concentration after a standardized exercise test. The smoking history, Fagerstriim test and degree of habitual physical activity were also recorded for each participant. The percentage of smokers was similar in males (19%) and females (21%) (P=n.s.). Mean habitual physical activity index was 8.2kO.2 (range, 5.88-I 1.63). At the base camp, all lung function variables were within the normal range. Lactate concentration after exercise averaged 3.7kO.3 mm 1-l. No significant change was observed at altitude, except for a higher heart rate and a lower arterial oxygen saturation (SaO,) (both at rest and after inspiratory manoeuvres). The smoking history and the degree of physical activity did not influence lung function or exercise performance at altitude. The results of this study show that in middle-aged, healthy, not particularly well-trained individuals, lung function is not significantly altered by moderate-high altitude, despite the absence of any acclimatization period and independent of their smoking history and previous exercise habits.
Archivos De Bronconeumologia, Aug 1, 1990
La mala utilizacion de los inhaladores presurizados de dosis controladas, MDI ( metered-dose inha... more La mala utilizacion de los inhaladores presurizados de dosis controladas, MDI ( metered-dose inhalers ), es un hecho constatado en distintos trabajos. Sin embargo, en Navarra no disponiamos de datos al respecto. Se estudiaron 98 pacientes que utilizaban habitualmente estos inhaladores y acudieron por primera vez a las consultas externas de neumologia, comprobandose que el 60,2% empleaba una tecnica incorrecta; todos se incluyeron en un programa de aprendizaje. Se analizan los resultados obtenidos y se concluye insistiendo en la importancia que tiene la explicacion exhaustiva al enfermo de la tecnica de utilizacion de los inhaladores MDI.
Intensive Care Medicine [ISSN 0342-4642], v. 37 sup. 1, p. S206, Abstract 0804, (Septiembre 2011), 2011
Tubercle and Lung Disease, 1995
Archivos De Bronconeumologia, Sep 1, 2017
Archivos De Bronconeumologia, Nov 1, 2016
Neumonía organizada y tuberculosis pulmonar: coexistencia o enfermedad asociada To the Editor, Or... more Neumonía organizada y tuberculosis pulmonar: coexistencia o enfermedad asociada To the Editor, Organizing pneumonitis (OP) has been defined as secondary (SOP) if it is caused by external aggressions, such as infections, toxic substances, drugs, connective tissue diseases, or other processes, and primary, idiopathic or cryptogenic when no association with any other disease can been determined. 1,2 The relationship between different infection types and the onset of OP is unknown. 2,3 We report the case of a 75-year-old patient, former smoker (25 pack-years) for 30 years, with a history of arterial hypertension, atrial fibrillation and surgery for colonic polyps, receiving treatment with acenocumarol, digoxin and valsartan. He presented with a 2-week history of cough, sputum expectoration, dyspnea on moderate exertion, fever, joint pain and general malaise. Chest radiograph revealed pulmonary infiltrates in the right and left lower lobes, so treatment was started with cefditoren 400 mg/day and azithromycin 500 mg/day for 7 days. The patient developed pleuritic pain in the right hemithorax due to pleural effusion and his clinical symptoms persisted, so he was admitted to hospital. Physical examination showed temperature of 38.1 • C, tachypnea and 93% oxyhemoglobin saturation while breathing ambient air (FiO 2 21%). Pulmonary auscultation revealed rhonchi and crackles in the right lung base. Laboratory tests on admission showed leukocytosis, 13 900 leukocytes/mm 3 (80% neutrophils, 9% lymphocytes, 10% monocytes), 399 000 platelets/mm 3 and ESR 111 mm/h. Of particular note among the biochemistry parameters were: ALP 133 IU/l, gamma-GT 231 IU/l and CRP 140 mg/l. Other liver tests, renal function, ions, lipids, total proteins, albumin, uric acid, thyroid hormones, procalcitonin, ACE, immunoglobulins and complement parameters were within normal limits. Autoimmune assay was negative and no precipitins were detected in plasma for Aspergillus or bird proteins. Arterial blood gases on ambient air showed partial respiratory failure (pO 2 59 mmHg) and intradermal Mantoux reaction was negative. Chest computed tomography showed alveolar infiltrate with poorly defined borders, with the appearance of a polylobulated mass in the anterior segment of the right lower lobe and a solid nodule in the same lobe, measuring 25 mm in diameter, associated
Archivos De Bronconeumologia, Mar 1, 2010
Mutations of the gene that code bone morphogenic protein type 2 receptor (BMPR2) are involved in ... more Mutations of the gene that code bone morphogenic protein type 2 receptor (BMPR2) are involved in the pathogenesis of pulmonary arterial hypertension (PAH), both in its familial (FPAH) and its idiopathic (IPAH) forms. With the aim of increasing the knowledge of these genetic factors in our area, the BMPR2 gene was studied in 17 patients with PAH, 8 with FPAH and 9 with sporadic IPAH. Additionally, a study was made to see whether the presence of BMPR2 mutations was associated with changes in the CO diffusing CO (DL(CO)) with the aim of evaluating the interest in this measurement in the pre-clinical diagnosis. R491Q y R211X mutations were detected in 2 patients with FPAH (prevalence, 25%), and the R332X mutation in one case of IPAH (prevalence, 11%). The familial study of the patient with the R491Q mutation, 14 of the 28 subjects studied had the mutation, and 4 had the diseases (penetration, 36%). A decrease in the DL(CO)/alveolar volume (K(CO)) ratio was observed in asymptomatic family members who expressed the mutation, compared to those who did not express it (88+/-5% and 104+/-9% of the reference value, respectively; P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). We conclude that the frequency of mutations in the BMPR2 gene in the patients studied with FPAH is lower than was previously described. The decrease in the K(CO) observed in asymptomatic carriers of the mutation suggests a certain level of pulmonary vascular changes, therefore its measurement could be useful in the familial study of FPAH.
Medicina Clínica (english Edition), Apr 1, 2016
Bronchial stump aspergillosis. An unusual disease ଝ Aspergilosis del muñón bronquial. Una entidad... more Bronchial stump aspergillosis. An unusual disease ଝ Aspergilosis del muñón bronquial. Una entidad inusual Dear Editor, Aspergillus can cause a wide range of respiratory diseases depending on the fungus-host interaction, where the immune status of the subject plays an important role. 1 In very few cases have we seen an initially saprophytic case of patients after a lung resection, that affects the tissue granulation in the area of the suture and is called bronchial stump aspergillosis. Symptoms consist of coughing with mucous expectoration, sometimes haemoptysis, and dyspnea, 2-5 and the differential diagnosis includes, among others, lung tumours, and other processes caused by Aspergillus. 6-10 We report the case of a 61-year-old woman with no toxic habits and a history of right pneumonectomy after suffering a car accident in 1978. She was referred because of paroxysms of coughing and low mucous expectoration, general malaise, and dyspnoea which she related to her cough lasting approximately 8 weeks. These symptoms did not improve after administration of oral corticosteroids, bronchodilators, oral N-acetylcysteine and antibiotics. On examination there were no abnormalities except decreased a vesicular breath sound in the right chest, and the tests showed an ESR of 60 mmHg in the first hour, a concentration of IgE serum of 756 KU/l, Aspergillus IgE RAST 3.50 KU/l and an undetectable determination of Aspergillus precipitins. The other usual analytical tests, including other immunoglobulins, IgG and immunity subfractions, were normal. Chest radiograph and CT showed the sequelae of pneumonectomy, but there were no images of bronchiectasis, cavities or blisters, mucus plugs or atelectasis. The skin prick test for Aspergillus was negative and the spirometry ruled out bronchial obstruction. Aspergillus fumigatus grew in sputum studies (with CMI voriconazole at 0.5 g/ml) and the sputum cytology showed signs of acute inflammation without eosinophils or neoplastic cells. The fibrobronchoscopy showed a necrotic mass that had a spherical morphology and seemed pearl shaped in the bronchial stump that was aspirated, and the underlying mucosa showed mild inflammation, without evidence of bleeding or other alterations. A histological examination and culture confirmed the presence of Aspergillus. The patient rejected an endoscopic removal of the suture and treatment with antifungals.
Archivos De Bronconeumologia, 2010
A 51-year old woman developed hypersensitivity pneumonitis (HP) after inhaling the excrement of s... more A 51-year old woman developed hypersensitivity pneumonitis (HP) after inhaling the excrement of starlings that populated a park adjacent to her home. The clinical symptoms consisted of a nonproductive cough and grade II dyspnoea and radiological interstitial micronodular involvement. The respiratory function tests showed a restrictive pattern with desaturation on effort and a biopsy using videothorascopy was highly suggestive of HP. After a detailed study of the clinical history the patient mentioned an increase in cough when she crossed a park near her home, where a high population of starlings lived in its trees. Specific antigen extracts were prepared and skin tests were performed, precipitins measured, and bronchial provocation tests specific to this antigen were all positive. This observation identified a species of bird capable of causing the disease and shows a lung disease secondary to the exposure of a not very large but persistent antigen load..
Archivos De Bronconeumologia, Jul 1, 1986
Presentamos 3 casos de neumonia eosinofilica cronica (NEC). Dos con un cuadro clinico radiologico... more Presentamos 3 casos de neumonia eosinofilica cronica (NEC). Dos con un cuadro clinico radiologico tipico de esta entidad, segun las drescripciones clasicas. El otro paciente debuto de una forma bastante infrecuente, apareciendo en el seno de un asma bronquial de 40 anos de evolucion y, durante el tratamiento esteroideo, un cuadro clinico-radiologico que pudiera hacer pensar en un proceso infeccioso y cuya imagen radiologica evoluciono a la cavitacion y derrame pleural; clinicamente desarrollo una insuficiencia respiratoria aguda severa, que respondio adecuadamente al tratamiento esteroideo. Se comentan los hallazgos clinicos, radiologicos y anatomopatologicos, tanto con el microscopio optico como con el microscopio electronico.
Intensive Care Medicine, 1995
Sir: In our hospital, between January 1988 to December 1992, 4 patients out of 3280 pregnant wome... more Sir: In our hospital, between January 1988 to December 1992, 4 patients out of 3280 pregnant women (1.2/1000) developed sepsis complicating pyelonephritis, whose main manifestation was Acute Respiratory Failure (ARF). We are reporting here there unusual cases (Table 1). Acute Respiratory Failure (ARF) during pregnancy appears only very infrequently, i -1 .64/1000 [1], and in most cases it does so in the context of a sepsis. The first cases of ARF associated with pyelonephriits during pregnancy were reported by Cunningham et al. in 1984 [2]. The incidence has been calculated between 2~ by Cunningham et al. [3] and 8.5% by Towers et al. [4]. The gestational age is, generally, after 20 week gestation. The most significant predictive factors associated to ARF reported [4], were elements of treatment such as fluid overload and use of tocolytic agents. However, in our cases, the net fluid balances did not indicate overhydratation. Hemodynamic monitoring in two women showed no evidence of left ventricular failure and tocolytic therapy was not used. In our cases, nreteral obstruction is an important factor (3/4) of severe sepsis and ARE A fact not previously reported in this setting. ARF is caused by an injurious oedema of the alveolus-capillary membrane secondary to the action of the endotoxin released by Gram-negative bacteria [3]. The patients with an initial infection focus present a silent phase between twelve and forty eight hours prior to the onset of the respiratory symptoms, hypoxemia and hypocapnia; in chest radiograph, the usually present diffuse bilateral alveolar infiltrates, and the patients that are monitored by a thermo-dilution catheter present a hyperdynamic pattern, with a low systemic vascular resistance and a high cardiac output, as well as a low pulmonary capillary pressure. Description consistent with adult respiratory distress syndrome. These cases do not allow us to elucidate a possible higher pregnancy sensitivity to endotoxin, as it has been suggested by experiments on animals. In humans, data are limited, because of the relative infrequency of severe sepsis in the pregnant woman. However, the decline in respiratory functional residual capacity, and colloid osmotic pressure, in pregnancy, would amplify effects of capillary injury to endotoxin [5]. In our cases, the most common complications associated to ARF are dissemi-
BMC Pulmonary Medicine, Mar 30, 2009
Background: Differences could exist in the likelihood of asthma attacks in patients treated with ... more Background: Differences could exist in the likelihood of asthma attacks in patients treated with inhaled corticosteroid (ICS), long-acting beta-agonist (LABA), and montelukast (MON) (ICS/LABA/ MON) and patients treated with an inhaled corticosteroid (ICS) and montelukast (MON) (ICS/ MON). Methods: This was a post-hoc analysis of a pretest-posttest retrospective cohort study. Patients with mild persistent asthma and allergic rhinitis, who were taking an ICS either alone or in combination with a LABA, started concomitant MON treatment as part of their routine care. Rates of asthma-and allergic rhinitis-related medical resource use in the 12-months after the initial (index) MON prescription were compared in the ICS/MON and ICS/LABA/MON groups. An asthma attack was defined as an asthma-related hospitalization, ER visit, or use of an oral corticosteroid. Results: Of the total of 344 patients, 181 (53%) received ICS/MON and 163 (47%) received ICS/ LABA/MON in the post-index period for means of 10.5 and 11.4 months, respectively, (P < 0.05). Short-acting beta-agonists were used by 74.6% in the ICS/MON and 71.8% in the ICS/LABA/MON groups (P > 0.05). An asthma attack occurred in 4.4% of the ICS/MON group and 6.8% of the ICS/ LABA/MON group (P > 0.05). The adjusted odds of an asthma attack in the post-index period in the ICS/LABA/MON group relative to the ICS/MON group was 1.24, 95% confidence interval 0.35-4.44. Conclusion: In this observational study of combination drug treatment of mild persistent asthma and allergic rhinitis, no difference was observed between LABA/ICS/MON combination therapy and the ICS/MON combination without LABA use, for the rate of asthma attacks over one year.
The European respiratory journal, Aug 4, 2011
Processes of care and adherence to guidelines have been associated with improved survival in comm... more Processes of care and adherence to guidelines have been associated with improved survival in community-acquired pneumonia (CAP). In sepsis, bundles of processes of care have also increased survival. We aimed to audit compliance with guideline-recommended processes of care and its impact on outcome in hospitalised CAP patients with sepsis. We prospectively studied 4,137 patients hospitalised with CAP in 13 hospitals. The processes of care evaluated were adherence to antibiotic prescription guidelines, first dose within 6 h and oxygen assessment. Outcome measures were mortality and length of stay (LOS). Oxygen assessment was measured in 3,745 (90.5%) patients; 3,024 (73.1%) patients received antibiotics according to guidelines and 3,053 (73.8%) received antibiotics within 6 h. In CAP patients with sepsis, the strongest independent factor for survival was antibiotic adherence (OR 0.4). In severe sepsis, only compliance to antibiotic adherence plus first dose within 6 h was associated with lower mortality (OR 0.60), adjusted for fine prognostic scale and hospital. Antibiotic adherence was related to shorter hospital stay. In sepsis, antibiotic adherence is the strongest protective factor of care associated with survival and LOS. In severe sepsis, combined antibiotic adherence and first dose within 6 h may reduce mortality.
Archivos De Bronconeumologia, Oct 1, 2010
Punción transbronquial aspirativa en el estudio de las adenopatías mediastínicas: rentabilidad y ... more Punción transbronquial aspirativa en el estudio de las adenopatías mediastínicas: rentabilidad y coste-beneficio Valores de referencia de función respiratoria en niños y adolescentes (6-18 años) de Galicia Tasa y características de las agudizaciones asmáticas (ASMAB I) Tratamiento de la hipertensión arterial pulmonar postembólica mediante técnicas mínimamente invasivas guiadas por imagen Fiabilidad de la poligrafía respiratoria para el diagnóstico del síndrome de apneas-hipopneas durante el sueño en niños Revisión Acetónido de triamcinolona en el tratamiento del asma resistente a los glucocorticoides: riesgos y beneficios Actualización en los mecanismos de disfunción muscular en la EPOC Normativa SEPAR Normativa sobre el diagnóstico y tratamiento del neumotórax espontáneo
American Journal of Respiratory and Critical Care Medicine, 2015
Archivos De Bronconeumologia, Aug 1, 2020
Objective: The objective of the study was to determine the trend of variables related to tubercul... more Objective: The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives. Method: Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the y test for lineal trend. Results: A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40−50 and >50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), drug susceptibility testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49.664, numbers of projects initiated annually, presentations at conferences, and theses. Conclusions: PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.
Archivos De Bronconeumologia, May 1, 1990
se han obtenido a través de las compañías suministradoras y creo que son fiables de cara a valora... more se han obtenido a través de las compañías suministradoras y creo que son fiables de cara a valorar de forma global la situación. Existen dos compañías en nuestra región: Carburos Metálicos SA, que suministra a Valladolid, Falencia,
Respiratory Medicine, Oct 1, 1999
This study investigates the effects of moderate-high altitude on lung function and exercise perfo... more This study investigates the effects of moderate-high altitude on lung function and exercise performance in 46 volunteers (19 females, 27 males), with a mean age of 42.45 1.4 years (+_SEM) and varying smoking and exercise habits, who were not previously acclimatized. Measures obtained in the base camp (1140 m) and at altitude (2630 m), in random order, included forced spirometry, maximal voluntary ventilation, maximal inspiratory and expiratory pressures, arterial oxygen saturation and capillary lactate concentration after a standardized exercise test. The smoking history, Fagerstriim test and degree of habitual physical activity were also recorded for each participant. The percentage of smokers was similar in males (19%) and females (21%) (P=n.s.). Mean habitual physical activity index was 8.2kO.2 (range, 5.88-I 1.63). At the base camp, all lung function variables were within the normal range. Lactate concentration after exercise averaged 3.7kO.3 mm 1-l. No significant change was observed at altitude, except for a higher heart rate and a lower arterial oxygen saturation (SaO,) (both at rest and after inspiratory manoeuvres). The smoking history and the degree of physical activity did not influence lung function or exercise performance at altitude. The results of this study show that in middle-aged, healthy, not particularly well-trained individuals, lung function is not significantly altered by moderate-high altitude, despite the absence of any acclimatization period and independent of their smoking history and previous exercise habits.
Archivos De Bronconeumologia, Aug 1, 1990
La mala utilizacion de los inhaladores presurizados de dosis controladas, MDI ( metered-dose inha... more La mala utilizacion de los inhaladores presurizados de dosis controladas, MDI ( metered-dose inhalers ), es un hecho constatado en distintos trabajos. Sin embargo, en Navarra no disponiamos de datos al respecto. Se estudiaron 98 pacientes que utilizaban habitualmente estos inhaladores y acudieron por primera vez a las consultas externas de neumologia, comprobandose que el 60,2% empleaba una tecnica incorrecta; todos se incluyeron en un programa de aprendizaje. Se analizan los resultados obtenidos y se concluye insistiendo en la importancia que tiene la explicacion exhaustiva al enfermo de la tecnica de utilizacion de los inhaladores MDI.
Intensive Care Medicine [ISSN 0342-4642], v. 37 sup. 1, p. S206, Abstract 0804, (Septiembre 2011), 2011