Biomedical subjects
A Xaubet
Publications and source records attributed to A Xaubet.
[Etiology of chylothorax of non-traumatic origin].
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Correlation of bronchoalveolar lavage and clinical and functional findings in asbestosis.
Respiratory clinical, radiographic, and functional findings were assessed and correlated with bronchoalveolar lavage (BAL) cellular changes in 52 asbestos workers (27 with and 25 without asbestosis) and in 15 control subjects without asbestos exposure. Subjects with asbestosis had a moderate neutrophilic alveolitis (7.8 +/- 5%) compared with the other groups (p less than 0.001) that was correlated with the presence of crackles (p = 0.03) and PaO2 (p less than 0.05) and AaPO2 at rest (p less than 0.05) values. Asbestos bodies (AB) in BAL were quantitated in 34 of the 52 asbestos workers (21 with and 13 without asbestosis) and in the control group. They were present in 83% of asbestos workers but they were absent in the latter. No significant differences were observed in the number of AB between those asbestos workers with and without lung disease. We conclude that crackles on auscultation and PaO2 and AaPO2 values may well be good indicators of the staging of neutrophilic alveolitis in asbestosis. In contrast, the amount of AB in BAL is not a reliable marker of asbestos lung fibrosis.
Endobronchial involvement in non-Hodgkin's lymphoma.
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[Eosinophils in the broncho-alveolar lavage of diffuse interstitial lung diseases].
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[Spontaneous pneumomediastinum associated with anorexia nervosa].
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Spontaneous pneumothorax in cryptogenic fibrosing alveolitis.
The prevalence of spontaneous pneumothorax was studied in 82 patients with cryptogenic fibrosing alveolitis. In 46 patients the disease affected only the lung ('lone' fibrosing alveolitis); in the remaining 36 patients the interstitial lung disease was associated with several systemic diseases ('associated' fibrosing alveolitis). 3 patients with the 'lone' form had a spontaneous pneumothorax. This figure represents a prevalence of 3.6%. We did not observe this complication in any patient with the associated form. Suction drainage was ineffective in the 3 patients. One of them died as a consequence of pleural infection. In the other 2 subjects thoracotomy, resection of blebs and pleurectomy were required.
Characteristics and prognostic value of pleural effusions in non-Hodgkin's lymphomas.
The characteristics of 26 pleural effusions associated with non-Hodgkin's Lymphomas (NHL) have been analyzed (13% of the 200 NHL reviewed). Twenty-one of them were exudates and 5 chylous. Cytological examinations were positive in 18/21 of exudate effusions and so were 11 of the 15 pleural biopsies performed. Three of the chylous effusions were associated with chylous ascites, the pleural biopsy being positive in one case. In only 4 cases mediastinal adenopathies were found (3 exudates and one chylous). In half of the cases, the effusion disappeared as a response to chemotherapy. Intrapleural treatment with doxorubicin was performed in 6 patients with exudates, but the pleural effusion disappeared in only one case. The survival was shorter (estimated median survival, 6 months) in those patients in whom the pleural effusion did not disappear under systemic chemotherapy than in those in whom a response was achieved (estimated median survival greater than 40 months; p less than 0.01).
[Use of fibrobronchoscopy in the therapeutic evaluation of small-cell pulmonary carcinoma].
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[Familial diffuse interstitial pulmonary fibrosis].
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Mechanical ventilation in severe exacerbation of asthma. Study of 26 cases with six deaths.
A prospective study was carried out in 26 patients intubated and mechanically ventilated for severe exacerbation of asthma. The age of onset of asthma and the duration of disease showed wide variations, but most of the patients were women in their fifties with chronic asthma. However, 23% had the more benign intermittent course. Most patients had a prodromal period of several days with progressive deterioration. Eight patients developed sudden attacks, in three of them aspirin-intolerance was responsible, in two patients emotional disturbances could play some role as triggering factors, and in three other patients no obvious reason was found. Identification of factors responsible for the sudden attacks may be relevant to the management of these severe cases. The majority of patients were intubated immediately on arrival or during the first hours after admission. Deaths were related to complications produced by hypoxia, or hospitalization in an intensive care unit. Probably many of these patients would not have died if an appropriate steroid treatment had been given some days before.
[Clinical, radiological, and respiratory fuction evolution of the adult respiratory distress syndrome (author's transl)].
Little is known about the evolution of patients surviving an episode of adult respiratory distress syndrome (ADRS). In the present study the clinical and radiological evolution, and the course of pulmonary function changes were evaluated in nine patients that survived an episode of ADRS. There were six male and three female, with a mean age of 44 +/- 16 (mean +/- SD). The initial PaO2 was 39 +/- 10 with a FiO2 less than 35, and 59 +/- 23 with a FiO2 of 1. Four patients were smokers and one had a history of chronic bronchitis. Pulmonary function studies disclosed a peripheral obstructive ventilatory alteration in one patient, a peripheral and central alteration in four, and non-obstructive changes in three. Follow-up pulmonary functions studies were carried out in six cases and demonstrated a significant increase of DLCO (p less than 0.01). Airway obstruction was present in one case, the same degree of obstruction was maintained in two cases, a reversible bronchospasm appeared in one case, and respiratory fuction returned to normal in two cases. The severity of the ADRS was unrelated to the later evolution. The results suggest that residual functional abnormalities might be related to the administration of high concentrations of O2. No residual clinical or radiological alterations were observed. Because of the multifactorial etiology of ADRS and of the reduced number of patients studied the results are non-homogeneous. However, DLCO appears to be the best parameter to indicate functional recovery. Residual abnormalities are minimal and temporary, and full recovery is to be expected.
[Treatment of the syndrome of inappropriate antidiuretic hormone secretion with demethylchlortetracycline (author's transl)].
A patient with a syndrome of inappropriate antidiuretic hormone secretion secondary to an undifferentiated bronchogenic carcinoma with distant metastases was treated with demethylchlortetracycline. Up until recently, treatment of this syndrome was based on water restriction and when the plasma sodium concentration became extremely low, hypertonic saline solution administration. Recently it has been demonstrated that the antibiotic demethylchlortetracycline inhibits the action of the antidiuretic hormone on the renal tubules. The drug has been used successfully in five patients with the syndrome of inappropriate antidiuretic hormone secretion. The administration of 900 mg of demethylchlortetracycline per day for 7 days in our patient produced an increase of free water clearance, diuresis, plasma sodium concentration, and plasma osmolarity. Urinary excretion of sodium and urinary osmolarity declined. Furthermore, the neurological symptoms attributed to hyponatremia improved markedly. The patient lost 6 kg during treatment, probably because of negative water balance induced by demethylchlortetracycline. Even though the administration of demethylchlortetracycline did not produce significant decreases in the glomerular filtration rate or renal blood flow in our patient, it is advisable to control the renal function in individuals treated with this drug since it may on occasion determine renal insufficiency.
Imported histoplasmosis in Spain.
Histoplasma capsulatum is a dimorphic fungus endemic in the American continent but not in Europe, where cases are usually imported. Its favorite habitat is in warm humid soils. Guano from birds and bats enhance the sporulation of the mycelial phase.1 Man acquires H. capsulatum through inhalation of spores. Most people infected by this fungi remain asymptomatic, but around 10-50% can start an illness ranging from acute pulmonary histoplasmosis to chronic histoplasmosis. In both, there is close clinical resemblance to pulmonary tuberculosis. Immunodepressed patients undergo a more severe form of the disease, usually presenting in the acute disseminated form. We present seven immunocompetent patients with histoplasmosis acquired after traveling to several American countries.