Effects of Quercetin in a Rat Model of Hemorrhagic Traumatic Shock and Reperfusion

Background: We hypothesized that treatment with quercetin could result in improved hemodynamics, lung inflammatory parameters and mortality in a rat model of hemorrhagic shock. Methods: Rats were anesthetized (80 mg/kg ketamine plus 8 mg/kg xylazine i.p.). The protocol included laparotomy for 15 min (trauma), hemorrhagic shock (blood withdrawal to reduce the mean arterial pressure to 35 mmHg) for 75 min and resuscitation by re-infusion of all the shed blood plus lactate Ringer for 90 min. Intravenous quercetin (50 mg/kg) or vehicle were administered during resuscitation. Results: There was a trend for increased survival 84.6% (11/13) in the treated group vs. the shock group 68.4% (13/19, p > 0.05 Kaplan–Meier). Quercetin fully prevented the development of lung edema. The activity of aSMase was increased in the shock group compared to the sham group and the quercetin prevented this effect. However, other inflammatory markers such as myeloperoxidase activity, interleukin-6 in plasma or bronchoalveolar fluid were similar in the sham and shock groups. We found no bacterial DNA in plasma in these animals. Conclusions: Quercetin partially prevented the changes in blood pressure and lung injury in shock associated to hemorrhage and reperfusion.

The general public's knowledge of chronic obstructive pulmonary disease and its determinants: current situation and recent changes

BACKGROUND

The objective of this study was to determine the level of knowledge about chronic obstructive pulmonary disease (COPD) and its determinants in the general population of Spain, and to compare it with a similar survey conducted in 2002.

METHODS

We conducted a cross-sectional, observational, epidemiological study in September 2011 by means of a telephone interview with a representative sample of individuals aged 40-80 years living in all 17 regions of Spain.

RESULTS

A total of 6,528 responses were obtained (response rate of 13.1%), 53% of respondents were females with a mean age of 59.8 years. Regarding tobacco use, 19.4% were current smokers while 27.9% reported being former smokers. Only 17.0% spontaneously recognized the term «COPD». Valencia was the region with the highest degree of ignorance regarding COPD (91%), while Aragon had the lowest (73.7%). Nevertheless, COPD is considered a severe disease, following angina pectoris in severity. Upon comparing these results with the previous survey from 2002, we observed significant improvements in the knowledge and understanding of COPD (8.6% vs. 17.0%), with a marked variability between the regions (P<.05). Currently, only 4.7% of the Spanish population knows that there is a National Strategy for COPD, although 86.0% have a favorable or very favorable opinion about the new Anti-tobacco Law.

CONCLUSION

The lack of knowledge about COPD and its determinants in the general population remains high compared to 2002; thus, more and better educational and awareness programs are necessary.

[Positron emission tomography for the study of solitary pulmonary nodules]

Solitary pulmonary nodules are a major clinical challenge for all doctors involved in their study. The aim is always to avoid missing malignant lesions but also to avoid performing unnecessary diagnostic tests. The most recent research suggests that in the near future chest computed tomography will become even more widely used for the early detection of lung cancer. If this occurs, there is likely to be a marked increase in the number of solitary pulmonary nodules detected, making it essential to develop techniques that enable us to manage this problem with an optimal risk-benefit ratio. We review the underlying principles of positron emission tomography and the advances that have been made in its use for the study of solitary pulmonary nodules. In addition, we discuss the possible causes of false positives and negatives in this technique and the strategies aimed at increasing diagnostic yield.

Chronic respiratory symptoms, spirometry and knowledge of COPD among general population

RATIONALE

Infradiagnosis of chronic obstructive pulmonary disease (COPD) may be related to the lack of knowledge about the disease and/or the scarce use of diagnostic procedures. This study analyses the frequency of respiratory symptoms and the knowledge about COPD in the general population, together with the use of spirometry in individuals at risk of COPD.

POPULATION AND METHOD

A telephone survey was carried out in 6758 subjects older than 40 years, stratified by age, habitat (urban or rural) and region, screened by random-digit dialling.

RESULTS

Up to 24% reported having at least one chronic respiratory symptom and 20.9% had a self-reported respiratory diagnosis. A total of 19.2% were active smokers and 40% had never tried to quit. Only 60% of the individuals with chronic symptoms had consulted a physician and, of them, only 45% had undergone spirometry. Spirometry was mentioned more frequently by subjects attended by pulmonologists than by GPs (67.6 vs. 28.6%; P<0.001). The term COPD was identified only by 8.6% of the participants.

CONCLUSIONS

Many individuals with respiratory symptoms do not request medical attention and do not attempt to quit smoking. There is a lack of knowledge about COPD. Physicians should more actively inform about the disease and increase the use of spirometry for early detection.

Treatment With AM3 Restores Defective T-Cell Function in COPD Patients

BACKGROUND

Lymphocyte alterations have been associated with an increased prevalence of acute respiratory infections in COPD patients. AM3 is an oral immunomodulator that normalizes the defective functions of peripheral blood natural killer and phagocytic cells in COPD patients and improves their health-related quality of life.

OBJECTIVES

To characterize putative systemic abnormalities of the T-cell compartment in COPD patients, and to investigate whether AM3 can restore such abnormalities.

DESIGN

The study was a randomized, prospective, double-blind, placebo-controlled trial in a cohort of COPD patients. The results were also compared to those of nonsmoker and ex-smoker healthy control subjects.

SETTING

Outpatient departments of four hospitals.

PATIENTS

Seventy COPD patients were randomized to receive either AM3 or a placebo orally for 90 consecutive days. Populations of 36 healthy nonsmokers and 36 healthy ex-smokers were used as control subjects.

MEASUREMENTS

Peripheral blood mononuclear cell (PBMC) proliferation and production of interleukin (IL)-2, IL-4, IL-12p40, tumor necrosis factor-alpha, and interferon (IFN)-gamma proteins in response to the T-cell polyclonal mitogens were assessed at baseline and at the end of treatment.

RESULTS

The proliferative response was significantly decreased in COPD patients. Decreased production of IFN-gamma was the only defect in the profiles of the cytokine measures, and was selectively observed in COPD patients, but not in nonsmoker and ex-smoker healthy control subjects. Treatment with AM3 significantly restored the PBMC proliferative response to polyclonal mitogens and significantly promoted stimulated IFN-gamma production in these patients. The normalization of these proliferative responses was not related to significant variations in the numbers of peripheral blood monocytes, CD3+, CD4+, CD8+ cells or of any major naïve/memory/activated T-cell subset. The increased IFN-gamma production in the AM3 study arm was associated with an increase in the mean of number of IFN-gamma molecules produced per CD8+ T cells.

CONCLUSIONS

PBMCs of COPD patients showed clear functional T-lymphocyte abnormalities that are rescued by AM3 treatment.

Noninvasive measurement of the maximum relaxation rate of inspiratory muscles in patients with neuromuscular disorders

BACKGROUND

Slowing of inspiratory muscle relaxation has been used as an index for inspiratory muscle fatigue. However, maximum relaxation rate measured from oesophageal pressure traces after maximum sniff (P(oes) MRR) has limited clinical usefulness because it requires an oesophageal balloon catheter system.

OBJECTIVES

It was the aim of this study to establish whether, in neuromuscular patients, maximum relaxation rate assessed from sniff nasal pressure (P(nasal) MRR) reflects oesophageal MRR and the tension-time index of the diaphragm (TT(di)).

METHODS

Twenty patients with neuromuscular disease and 10 healthy subjects were studied. P(oes) and transdiaphragmatic pressure were measured while P(nasal) was recorded with a balloon advanced through the nose into the nasopharynx. Maximum P(oes), transdiaphragmatic pressure and P(nasal) were simultaneously measured while the patients performed maximal sniffs. The MRR (% pressure fall/10 ms) for each sniff, the TT(di) and the tension-time index of respiratory muscles were determined.

RESULTS

Neuromuscular patients showed higher TT(di), lower P(oes) MRR and lower P(nasal) MRR than the control group. In patients with neuromuscular disease, the correlation coefficient of P(nasal) MRR and P(oes) MRR was 0.985 (p < 0.001). Regression analysis showed that P(oes) MRR = -1.101 + 1.113.P(nasal) MRR (r(2) = 0.929, standard error of the estimate = 0.208). Indeed, P(nasal) MRR was negatively correlated with TT(di) (r = -0.914, p < 0.001) and the tension-time index of respiratory muscles (r = -0.732, p < 0.001). In the neuromuscular group, the mean difference between P(nasal) MRR and P(oes) MRR was 0.286 +/- 0.217%/10 ms.

CONCLUSIONS

P(nasal) MRR obtained from a maximal sniff accurately reflects P(oes) MRR and TT(di) in patients with neuromuscular disorders.

[Effect of immunomodulator AM3 on the exacerbations in patients with chronic bronchitis: a systematic review of controlled trials]

OBJECTIVE

Analyze the effect of AM3, an oral immunomodulator, on the exacerbations and on the use of antibiotics in patients with chronic obstructive pulmonary disease (COPD).

DESIGN

Systematic search of controlled clinical trials that used AM3 in some treatment group and that included data on the clinical effects of this drug on patients with COPD. SELECTED VARIABLES: Nine studies were detected in which the clinical effectiveness of AM3 was evaluated in relation to the number of infectious exacerbations, their length, and the length of the antibiotic treatment used.

RESULTS

In comparison with placebo group, the average number of excaerbations suffered by the patients treated with AM3 declined significantly in 0.31 units (p < 0.001; 95% confidence interval: 0.20-0.42), without heterogeneity among the different studies (Q = 6.62; p > 0.43). With regard to the average length of the exacerbations and the average length of the antibiotic treatment used for the exacerbations, both variables declined significantly in the group treated with AM3 (3.10 days, p < 0.001, and 8.07 days, p < 0.001, respectively) but this positive effect could not be confirmed because trials were close to heterogeneity.

CONCLUSIONS

The results of this systematic review show that AM3 has a clinical effect in the prevention of exacerbations of COPD patients because reduces significantly their number. This could be related to a slowing in the progression of the deterioration in the respiratory function with a potential impact on the quality of life of the patients. Furthermore, these data imply a positive therapeutic result and a possible decline in development of bacterial resistances secondary to the frequent and indiscriminate use of antibiotics in these patients.

Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study

BACKGROUND

A study was undertaken to evaluate exacerbations and their impact on the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD).

METHODS

A 2 year follow up study was performed in 336 patients with COPD of mean (SD) age 66 (8.2) years and mean (SD) forced expiratory volume in 1 second (FEV(1)) 33 (8)% predicted. Spirometric tests, questions regarding exacerbations of COPD, and HRQL measurements (St George's Respiratory Questionnaire (SGRQ) and SF-12 Health Survey) were conducted at 6 month intervals.

RESULTS

A total of 1015 exacerbations were recorded, and 103 (30.7%) patients required at least one hospital admission during the study. After adjustment for baseline characteristics and season of assessment, frequent exacerbations had a negative effect on HRQL in patients with moderate COPD (FEV(1) 35-50% predicted); the change in SGRQ total score of moderate patients with > or =3 exacerbations was almost two points per year greater (worse) than those with <3 exacerbations during the follow up (p = 0.042). For patients with severe COPD (FEV(1) <35% predicted) exacerbations had no effect on HRQL. The change in SGRQ total score of patients admitted to hospital was almost 2 points per year greater (worse) than patients not admitted, but this effect failed to show statistical significance in any severity group. There was a significant and independent seasonal effect on HRQL since SGRQ total scores were, on average, 3 points better in measurements performed in spring/summer than in those measured in the winter (p<0.001).

CONCLUSIONS

Frequent exacerbations significantly impair HRQL of patients with moderate COPD. A significant and independent effect of seasonality was also observed.

Pulmonary diffusing capacity in chronic dialysis patients

Patients with end-stage renal disease treated by hemodialysis with bioincompatible membranes are exposed during the dialysis period to acute effects on lung microcirculation, which may result in pulmonary fibrosis and diffusion defects in long-standing dialysis. To investigate the occurrence of these possible chronic pulmonary alterations, we determined lung function in patients with chronic renal failure not undergoing hemodialysis and in patients who had been receiving regular hemodialysis both for short and long periods of time. Forty-three patients divided into three groups were studied: 17 patients before dialysis with a mean (SD) creatinine clearance of 14.1 (6.8) ml/min 11.73 m2, 10 patients receiving regular hemodialysis for a period of less than 12 months (mean 6.4 +/- 3.5 months), and 16 patients receiving regular hemodialysis for more than 5 years (mean 8.3 +/- 3.6 years). First-use bioincompatible cellulosic dialysis membranes were used in all the cases. The following parameters were recorded: forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), total lung capacity (TLC), residual volume (RV), carbon monoxide transfer factor (TLCO), accessible lung volume (VA), carbon monoxide transfer factor/accessible lung volume (KCO- that is, TLCO/VA), and arterial blood gases. Patients receiving regular hemodialysis for more than 5 years showed significantly lower values of TLCO and KCO than patients before dialysis and patients receiving regular hemodialysis for less than 12 months. Seventy-five percent of patients on long-term hemodialysis had markedly reduced TLCO or KCO values (below 80% of the reference value) as compared with 17% of patients before dialysis and 10% of patients dialyzed for less than 12 months (P < 0.001). Differences among groups for the remaining parameters were not observed. In conclusion, patients undergoing long-term regular hemodialysis with a bioincompatible membrane showed a selective reduction in pulmonary diffusing capacity possibly due to chronic pulmonary fibrosis.

Treatment and quality of life in patients with chronic obstructive pulmonary disease

Treatments administered to patients with chronic obstructive pulmonary disease (COPD), especially when used in multiple combinations, are not free of interactions and side effects that can potentially impair health-related quality of life (HRQL). We studied HRQL and its relationship with treatment in a group of 441 patients with stage II or III COPD (age: 66.6 (SD: 8.3) years; FEV1: 32.4% (SD: 8.1%)) using the St George's Respiratory Questionnaire (SGRQ) and the 12-item short form (SF-12) Health Survey. The most prescribed drugs were ipratropium bromide (87.5%), inhaled corticosteroids (69.4%) and short-acting beta-2 agonists (64.9%). Patients with stage III of the disease were receiving more drugs, particularly short-acting beta-2 agonists (p = 0.002) and inhaled corticosteroids (p = 0.031). The use of theophyllines was associated with a worse total SGRQ score (beta = 4.49; p < 0.001), although this negative association decreased with advanced age. A trend towards worse SGRQ scores was observed with the use of high doses of long-acting beta-2 agonists (beta = 3.22; p = 0.072). Patients receiving three drugs or more presented worse total SGRQ scores than patients receiving fewer drugs (beta = 6.1, p < 0.001; and beta = 7.64, p < 0.001, respectively). These findings suggest that the use of multiple drugs in the treatment of patients with COPD is associated with worse total SGRQ scores. The effect of drugs, their dosages and associations with other drugs on HRQL merit further research.

[Analysis of the impact of Archivos de Bronconeumología through the Science Citation Index]

OBJECTIVE

To describe the impact factor of Archivos de Bronconeumología from 1997 until 2000 and to identify the patterns of citation of the journal and topics having the greatest impact.

METHOD

SCISEARCH was used to locate citations of articles published by Archivos de Bronconeumología between 1995 and 1999. The following data were collected for each article: year of publication, authors, journal, country of publication, language, specialty or specialties, institution(s), residence of the first author and topic. The impact factor was calculated as the ratio of citations received in one year by articles published in Archivos de Bronconeumología during the two previous years and the total number of articles published by Archivos de Bronconeumología over the two years under study.

RESULTS

The impact factor of Archivos de Bronconeumología was 0.107 in 1997, 0.089 in 1998, 0.105 in 1999 and 0.119 in 2000. Citations were found in a wide range of source journals, with respiratory system publications having little weight. Citations were made mainly by Spanish authors (75%) and self-citation was restrained (21.1%). Topics related to tuberculosis and respiratory infections (23.6% of the citations received) and chronic obstructive pulmonary disease (12.5%) made the greatest impact.

CONCLUSION

The impact factor of Archivos de Bronconeumología is modest, although higher than those of some other publications included in Journal Citation Reports.

A bibliometric evaluation of European Union research of the respiratory system from 1987-1998

This study analyses the evolution of the bibliometric indicators of productivity and repercussion of European Union (EU) research into the respiratory system during the period from 1987-1998, describing the geographical distribution. Using MedLine, a selection was made of those articles by EU authors published between 1987-1998 in 38 respiratory system journals (classification from the Institute for Scientific Information). The journals, country of origin, number of articles and the relation to socioeconomic data, productivity index, visibility index, expected impact factor (EIF) and relative impact factor (RIF) were all analysed. The number of EU publications in respiratory system journals experienced an exponential increase, going from 606 articles (14.3% of world production) in 1987, to 2,325 (33.2%) in 1998. During this same period, the EIF increased from 1,258 to 2,111. The greatest gross productivities were those of the UK, France, Italy and Germany, although when corrected for number of inhabitants, Sweden, the Netherlands, Belgium and Denmark headed the list. The countries with the greatest mean EIF were the Netherlands, the UK, Spain and Belgium. In conclusion, productivity and repercussions of European Union research of the respiratory system experienced an important increase during this period.

Defective natural killer and phagocytic activities in chronic obstructive pulmonary disease are restored by glycophosphopeptical (inmunoferón)

We have investigated both modifications in natural (innate) immunity caused by chronic obstructive pulmonary disease (COPD) and the effects of a glycophosphopeptical immunomodulator (Inmunoferón) treatment on COPD-associated immunoalterations. In a double-blinded clinical trial, 60 patients with COPD received glycophosphopeptical or placebo during 90 consecutive days at oral doses of 3 g/d. Fifty-six sex- and age-matched healthy control subjects were included as a reference group for immunologic parameters. Peripheral blood natural killer (PBNK) cell cytotoxic activity and phagocytic activity of peripheral monocytes/macrophages (Mo/Ma) and polymorphonuclear (PMN) cells were assessed at baseline and then again at the end of treatments. We found both PBNK activity and phagocytic activity to be significantly decreased in patients with COPD compared with levels in healthy volunteers. The treatment with glycophosphopeptical provoked significant stimulatory effects on PBNK cytotoxic activity. This stimulation was not mediated by an increase in CD3(-)CD56(+) NK cells. Further, glycophosphopeptical significantly increased the percentage of monocytes and PMNs that phagocytize Escherichia coli in vitro, as well as increased phagocytic indices. We conclude that peripheral blood cells of patients with COPD show clear defects in natural immunity that are partially rescued by glycophosphopeptical.

[Evolution of Spanish scientific production in international respiratory system journals from 1987 to 1998]

BACKGROUND

A relevant increase in the clinical relevance of respiratory system area has occurred in the last few years. The aims of this study were: to analyze the evolution of production and impact of Spanish scientific activity in the respiratory system area between 1987 to 1998; and to assess the participation of the different Spanish autonomic communities in this activity.

METHODS

Papers published in 38 international journals of respiratory system during this period of time were selected by the MedLine system, delimiting Spanish production. Geographical and institutional distribution of the production, specialist of authors, main publication journals and type of publication were recorded. Production and impact bibliometric indicators were estimated.

RESULTS

The number of Spanish documents from 1987 to 1998 multiplied by eight, reaching the 1.49% of the total published documents in 1998. However, the growth model of scientific production during this period was lineal. The increase in the scientific production was associated with a increase over time in the expected impact factor. In 1998, expected impact factor was 2. 206. Forty-two percent of the papers were signed by pneumologists. The highest contributor were hospitals. The most productive autonomous communities were Catalonia, Cantabria and Madrid. The communities with the highest expected impact factor were Balears and Catalonia.

CONCLUSIONS

A relevant increase has occurred in the scientific production and impact of Spanish biomedical activity in respiratory system area.

An evaluation of tissue polypeptide antigen (TPA) in the two bronchoalveolar lavage fractions of lung cancer patients

BACKGROUND

It has been proven that cytokeratins (CKs) are useful tumor markers for the follow-up, treatment monitoring and prognosis evaluation of lung cancer and among these, tissue polypeptide antigen (TPA) plays an important role. Nevertheless, only a small number of studies have been reported about their diagnostic capacity. Bronchoalveolar lavage (BAL) can be divided into two fractions: bronchiolar (BF) and alveolar (AF). For the above reasons, our aims were (1) to analyze the diagnostic usefulness of TPA in the BAL of lung cancer patients and (2) to observe if, in lung cancer patients, TPA levels in the two BAL fractions are different. This should mean that the study of tumor markers in the BAL should be carried out in both fractions to increase their diagnostic capacity.

METHODS

We studied 289 BALs divided into two phases. In phase I, TPA was analyzed in the BAL of six groups of subjects (healthy persons, chronic bronchitis, asthma, respiratory infections, diffuse interstitial pulmonary diseases and lung cancer). In phase II, TPA was studied in both BAL fractions of a group of patients with lung cancer.

RESULTS

We observed that TPA levels were significantly higher in the BAL of patients with bronchogenic neoplasias. In these patients, TPA was increased in the BF of the lavage in relation to the AF. In smoker patients with pulmonary carcinomas, TPA was higher in the AF of the BAL than in the lavage of non-smokers. This did not occur in the BF. We found no relation between the TPA concentrations and cancer histology.

CONCLUSIONS

We believe that TPA is a useful tumor marker with diagnostic capacity and this capacity is increased when it is studied in the two BAL fractions. Smoking habit may play a role in the secretion of tumor markers by the tumor cells.

Acute eosinophilic pneumonia associated with antidepressant agents

Acute eosinophilic pneumonia is a severe syndrome characterized by fever, lung infiltrates, blood eosinophilia and respiratory failure. We describe a case of acute eosinophilic pneumonia associated with clomipramine and sertraline. A 40-year-old woman was admitted to the emergency department with 37.9 degrees C and respiratory rate of 35 respirations per minute. Blood analysis showed PaO2 = 57.6 mm Hg and HCO3- = 21.7 mmol/l and 12.2% eosinophils. Chest X-ray showed infiltrates in both lower lobes. She was taking clomipramine 25 mg bid for the last 4 weeks and sertraline 50 mg/day for the last week. Other causes of acute eosinophilic pneumonia such as parasitic and fungal infections or collagen diseases were discarded. Both antidepressant were stopped and the patient became afebrile and asymptomatic. A week later the patient was discharged from hospital. Physicians should be aware of this adverse antidepresant reaction which may result in severe pulmonary symptoms.

[What is the cost of inappropriate admission of pneumonia patients?]

BACKGROUND

The number of patients admitted with community-acquired pneumonia (CAP) varies greatly from one hospital to another. Prognostic models for CAP can help physicians decide which cases to treat on an outpatient basis. Our aims were: a) to validate a model for predicting low-risk CAP, and b) to estimate savings that would have resulted if the low-risk patients identified by the model had been treated at home rather than in hospital.

PATIENTS AND METHODS

All CAP cases diagnosed by the emergency room physicians of a hospital in northwestern Spain (Ferrol) were enrolled prospectively over a period of 19 months. The prediction rule of Fine et al was used to classify all patients. Mortality in each category was compared with the mortality predicted by Fine's system. Patients in the lowest risk categories (I and II) were considered to have been inappropriately admitted unless they were hypoxemic or had significant comorbidity. Costs were figured based on data provided by our accounting department.

RESULTS

Of 192 CAP patients enrolled, 131 were admitted and 61 were treated as outpatients. Ten patients died, none of whom was in classes I or II. The costs of the apparently unnecessary hospital stays of the 34 patients in these classes was 6,979,756 pesetas. The estimated savings that would have derived from treating these patients out-of-hospital was 6,133,292 pesetas (36,862 euros; 322,804 pesetas/month).

CONCLUSIONS

a) The predictive model used has been found useful for identifying patients at very low risk of dying from CAP; b) Using this model can improve CAP admission criteria, and c) Application of the model can lead to savings.

[Estimate of bibliometric indicators of the impact of +Archivos de Bronconeumología]

The main bibliographic impact factors of ARCHIVOS DE BRONCONEUMOLOGIA for the past two years are estimated. Citations of ARCHIVOS DE BRONCONEUMOLOGIA in 1996 and 1997 by Medicina Clínica and all citing journals grouped under the heading "Respiratory System" in the Science Citation Index were counted. The year the citation appeared and the year of publication of the article in ARCHIVOS DE BRONCONEUMOLOGIA were recorded. The total number of articles published by ARCHIVOS DE BRONCONEUMOLOGIA between 1994 and 1996 were also counted. Based on these data we calculated our journal's impact factor for each year studied. Relative impact factor was also figured. In 1996 the exposure factor achieved was 1.602, the half-life of articles was 2.00 years, the impact factor was 0.069 and the relative impact factor was 1.371. In 1997 the exposure index was 1.477, the citation half-life was 3.00 years and the impact factor was 0.030. In conclusion, the international impact of ARCHIVOS DE BRONCONEUMOLOGIA is modest, although our relative impact factor is greater than that of some other internal medicine publications or specialized journals listed in Journal Citation Reports.

[Lymphangioleiomyomatosis and tuberous sclerosis: a casual association or a causative one?]

Lymphangioleiomyomatosis (LAM) is a rare lung disease that mainly affects women of childbearing age. Pulmonary disease that is indistinguishable from LAM appears in 1% of patients with tuberous sclerosis (TS). At present we can not say whether we are looking at an association of two rare diseases or at a single disease with different clinical profiles. To date, open lung biopsy has been required for definitive diagnosis. We report the case of a women with TS and LAM in whom a diagnosis of pulmonary involvement was based on clinical signs and high resolution computerized tomography of the chest.

CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome

AIM

To study if the caliber of the upper airway, measured by CT, allows us to distinguish patients with obstructive sleep apnea syndrome (OSAS) from healthy people.

PATIENTS AND METHODS

Sixteen OSAS patients (with an apnea-hypopnea index > 10) and 39 healthy volunteers were studied. Polysomnography and CT of the upper airways during awake periods were performed in both groups. We used third-generation equipment (Toshiba model TCT 600QT). The area of the nasopharynx, oropharynx, and hypopharynx (in inspiration and expiration), the uvula diameter, and retropharyngeal tissue were evaluated. The simultaneous identification of the variables that differentiate between control and OSAS groups was determined by a multivariate discriminant model.

RESULTS

The retropharyngeal tissue in OSAS men was greater than those of the control men (10.3+/-3.6 mm vs 6.4+/-2.7 mm; p < 0.01). The multivariate analysis was performed on the 29 men (14 OSAS and 15 non-OSAS) who had information compiled in the selected parameters. The retropharyngeal tissue, expiratory hypopharynx, and uvular diameter are used to create a discriminant model (Wilks' lambda=0.556; p < 0.01). Two non-OSAS and five OSAS patients were incorrectly classified by this model as members of the other group (total rate of error, 24.14%). Therefore, the point estimates of specificity and sensitivity are 86.67% and 64.29%, respectively, for this model. The Pearson correlation coefficient between body mass index and retropharyngeal tissue is 0.63 (p < 0.001).

CONCLUSIONS

CT could play an important role in studying the upper airway in patients with OSAS. The determination of the retropharyngeal tissue by CT could be a useful procedure to evaluate OSAS.

[Definitive diagnosis of pulmonary sequestration using magnetic resonance. Description of 3 cases]

Pulmonary sequestration is a congenital malformation in which the pulmonary parenchyma is isolated from the rest of the lung and receives irrigation. Traditionally this malformation has been diagnosed by arteriography, but in recent years the usefulness of magnetic resonance, a technique that can probably substitute for arteriography on many occasions, has been emphasized. We report 3 cases of intralobar pulmonary sequestration diagnosed by magnetic resonance, a procedure that provided adequate presurgical assessment. The magnetic resonance images were later shown to be consistent with anatomical findings.

[Evolution of the bibliometric indicators of production and consumption of Archivos de Bronchopneumología in the last 20 years]

The aim of this study was to evaluate the evolution of bibliometric indicators for authorship and citation of ARCHIVOS DE BRONCONEUMOLOGIA over the past 20 years. At least 16 articles reporting new research or case reports were analyzed for every other year from 1976 to 1996. The following data were collected for each article: type of document, number of authors and their place of work and specialty, time interval between acceptance and publication, and references (including number, types, language, journal name and year of publication). The number of authors per article (collaboration index) averaged around five and has not varied significantly over the 20 years studied. Pulmonologists predominated among the authors, accounting for about 60% of the total, and most contributions came from a few provinces, mainly Barcelona and Madrid. The interval between reception and publication has gradually increased over the 20 years under review, coming to stand around 9.9 +/- 1.6 months in 1996. Most references (over 80%) cite journals and the proportion of references to books has decreased in recent years (from 12.3% in 1976 to 3.5% in 1996). The journal's index of isolation has increased (from 6.2 to 12.1%), as has the index of self-citation (from 0.4 to 6.2%). Although most cited works are in English (over 80%), the proportion of Spanish-language references increased (from 6.2 to 12.1%). In conclusion, maintenance of the number of collaborating authors, the predominance of journals and English-language sources among references are the main traits that characterize the bibliometric indicators for authorship and citation in ARCHIVOS DE BRONCONEUMOLOGIA.

[Bibliometric indicators of production and usage of Archivos de Bronchoneumologia]

We studied the bibliometric indexes referring to production and scientific output published in ARCHIVOS de BRONCONEUMOLOGIA. All issues published between 1993 and 1994 were studied with the exception of monógraphic or supplementary numbers. For each article we recorded article type, number of authors, authors' place of work, specialty, time until acceptance, time until publication, type of references, language of references, journal and year of references. For each year we calculated the productivity index and the cooperation index, or index of signers per work. We also determined the citation period for references, the Price index, and the insularity index. Productivity index was 1.97 in 1993 and 2.05 in 1994. The cooperation index for the two years reached 4.5 +/- 1.9 (1-10). Authors were widely distributed by provinces and by specialties, although "nuclei" of production could be identified. The citation half-life period was 5.67 years for references in 1993 and 5.94 years in 1994, and the Price index surpassed 40%. The insularity index was very low at 7.76%. In conclusion, the bibliometric indicators for production, readership and obsolescence for the two years analyzed indicate that ARCHIVOS de BRONCONEUMOLOGIA occupies an intermediate position in the ranking of Spanish medical journals.

[The diagnosis of sleep apnea syndrome with a portable device. Our experience with 100 cases]

Portable devices might be an alternative method to diagnose patients suspected for obstructive sleep apnea syndrome (OSAS). We have analized one hundred patients consecutively referred to our especialized out-patient clinic for sleep breathing disorders. We have used a previously validated portable device-Polygraphics CNS-which records thoracoabdominal movement, nasobuccal airflow, ECG, oxymetry, body position, and continuous positive airway pressure (CPAP). Sixty patients showed an apnea/hypopnea index (AHI) > 15. Seven patients showed an AHI > 10f plus symptoms suggestive of OSAS. Two patients had an AHI between 5-10 and very high suspicion for OSAS; a subsequent CPAP treatment showed the disappearance of respiratory events and an evident improvement in oxymetric records. Twenty two patients showed an AHI < 5. Nine patients could not be classified and other diagnostic method were deemed necessary.

CONCLUSION

A previously validated cardiorrespiratory portable polygraphic device was useful in most cases for taking diagnostic decisions in OSAS.