Spatiotemporal architecture of immune cells and cancer-associated fibroblasts in high-grade serous ovarian carcinoma

High-grade serous ovarian carcinoma (HGSOC), the deadliest form of ovarian cancer, is typically diagnosed after it has metastasized and often relapses after standard-of-care platinum-based chemotherapy, likely due to advanced tumor stage, heterogeneity, and immune evasion and tumor-promoting signaling from the tumor microenvironment. To understand how spatial heterogeneity contributes to HGSOC progression and early relapse, we profiled an HGSOC tissue microarray of patient-matched longitudinal samples from 42 patients. We found spatial patterns associated with early relapse, including changes in T cell localization, malformed tertiary lymphoid structure (TLS)-like aggregates, and increased podoplanin-positive cancer-associated fibroblasts (CAFs). Using spatial features to compartmentalize the tissue, we found that plasma cells distribute in two different compartments associated with TLS-like aggregates and CAFs, and these distinct microenvironments may account for the conflicting reports about the role of plasma cells in HGSOC prognosis.

Fallopian tube single cell analysis reveals myeloid cell alterations in high-grade serous ovarian cancer

Most high-grade serous ovarian cancers (HGSCs) likely initiate from fallopian tube (FT) epithelia. While epithelial subtypes have been characterized using single-cell RNA-sequencing (scRNA-Seq), heterogeneity of other compartments and their involvement in tumor progression are poorly defined. Integrated analysis of human FT scRNA-Seq and HGSC-related tissues, including tumors, revealed greater immune and stromal transcriptional diversity than previously reported. We identified abundant monocytes in FTs across two independent cohorts. The ratio of macrophages to monocytes is similar between benign FTs, ovaries, and adjacent normal tissues but significantly greater in tumors. FT-defined monocyte and macrophage signatures, cell-cell communication, and gene set enrichment analyses identified monocyte- and macrophage-specific interactions and functional pathways in paired tumors and adjacent normal tissues. Further reanalysis of HGSC scRNA-Seq identified monocyte and macrophage subsets associated with neoadjuvant chemotherapy. Taken together, our work provides data that an altered FT myeloid cell composition could inform the discovery of early detection markers for HGSC.

INHBA(+) cancer-associated fibroblasts generate an immunosuppressive tumor microenvironment in ovarian cancer

Effective targeting of cancer-associated fibroblasts (CAFs) is hindered by the lack of specific biomarkers and a poor understanding of the mechanisms by which different populations of CAFs contribute to cancer progression. While the role of TGFβ in CAFs is well-studied, less attention has been focused on a structurally and functionally similar protein, Activin A (encoded by INHBA). Here, we identified INHBA(+) CAFs as key players in tumor promotion and immunosuppression. Spatiotemporal analyses of patient-matched primary, metastatic, and recurrent ovarian carcinomas revealed that aggressive metastatic tumors enriched in INHBA(+) CAFs were also enriched in regulatory T cells (Tregs). In ovarian cancer mouse models, intraperitoneal injection of the Activin A neutralizing antibody attenuated tumor progression and infiltration with pro-tumorigenic subsets of myofibroblasts and macrophages. Downregulation of INHBA in human ovarian CAFs inhibited pro-tumorigenic CAF functions. Co-culture of human ovarian CAFs and T cells revealed the dependence of Treg differentiation on direct contact with INHBA(+) CAFs. Mechanistically, INHBA/recombinant Activin A in CAFs induced the autocrine expression of PD-L1 through SMAD2-dependent signaling, which promoted Treg differentiation. Collectively, our study identified an INHBA(+) subset of immunomodulatory pro-tumoral CAFs as a potential therapeutic target in advanced ovarian cancers which typically show a poor response to immunotherapy.

Rewiring of master transcription factor cistromes during high-grade serous ovarian cancer development

The transcription factors MECOM, PAX8, SOX17 and WT1 are candidate master regulators of high-grade serous 'ovarian' cancer (HGSC), yet their cooperative role in the hypothesized tissue of origin, the fallopian tube secretory epithelium (FTSEC) is unknown. We generated 26 epigenome (CUT&TAG, CUT&RUN, ATAC-seq and HiC) data sets and 24 profiles of RNA-seq transcription factor knock-down followed by RNA sequencing in FTSEC and HGSC models to define binding sites and gene sets regulated by these factors in cis and trans. This revealed that MECOM, PAX8, SOX17 and WT1 are lineage-enriched, super-enhancer associated master regulators whose cooperative DNA-binding patterns and target genes are re-wired during tumor development. All four TFs were indispensable for HGSC clonogenicity and survival but only depletion of PAX8 and WT1 impaired FTSEC cell survival. These four TFs were pharmacologically inhibited by transcriptional inhibitors only in HGSCs but not in FTSECs. Collectively, our data highlights that tumor-specific epigenetic remodeling is tightly related to MECOM, PAX8, SOX17 and WT1 activity and these transcription factors are targetable in a tumor-specific manner through transcriptional inhibitors.

Single-cell transcriptomic analysis of endometriosis

Endometriosis is a common condition in women that causes chronic pain and infertility and is associated with an elevated risk of ovarian cancer. We profiled transcriptomes of >370,000 individual cells from endometriomas (n = 8), endometriosis (n = 28), eutopic endometrium (n = 10), unaffected ovary (n = 4) and endometriosis-free peritoneum (n = 4), generating a cellular atlas of endometrial-type epithelial cells, stromal cells and microenvironmental cell populations across tissue sites. Cellular and molecular signatures of endometrial-type epithelium and stroma differed across tissue types, suggesting a role for cellular restructuring and transcriptional reprogramming in the disease. Epithelium, stroma and proximal mesothelial cells of endometriomas showed dysregulation of pro-inflammatory pathways and upregulation of complement proteins. Somatic ARID1A mutation in epithelial cells was associated with upregulation of pro-angiogenic and pro-lymphangiogenic factors and remodeling of the endothelial cell compartment, with enrichment of lymphatic endothelial cells. Finally, signatures of ciliated epithelial cells were enriched in ovarian cancers, reinforcing epidemiologic associations between these two diseases.

Single-cell myeloid diversity in human fallopian tube and its implications for early high grade serous ovarian cancer

The 5-year survival rate of high grade serous ovarian cancer (HGSOC) has remained below 40% for decades. This rises significantly to 90% when detected early. Increasing evidence suggests that HGSOC tumors originate in the fallopian tube (FT). However, little is known about FT’s immune cell heterogeneity and how it contributes to HGSOC development. Here we show a single-cell transcriptome analysis of non-malignant FT samples, revealing high monocyte diversity that is lost in HGSOC. FT monocyte subsets display distinct inflammatory gene signatures such as IL1A, CCL3/4 and others. Trajectory inference showed potential monocyte maturation steps that started with early cytokine/chemokine secreting monocytes that gain MHCII expression and develop into macrophages or dendritic cells. We found the macrophage-to-monocyte ratio is remarkably elevated in tumors compared to adjacent normal ovary and non-cancerous FT tissues in ours and publicly available scRNA-Seq. Intriguingly, analysis of FT of patients with BRCA1/2 germline mutations revealed half of these high-risk individuals are more like those found in HGSOC tumors than in normal FT. They also showed distinct T cell phenotypes in their FTs. Our data suggested that myeloid diversity, and their interactions with T cells in the FT, might contribute to early HGSOC development. Understanding tissue-of-origins immune microenvironment has a potential contribution to early cancer detection. We anticipate this work provides evidence of how myeloid cell plasticity induces tumorigenesis and can shape different tumor microenvironments.

Supported by startup grants from UW-Madison School of Medicine and Public Health and UW-Madison Cellular and Molecular Pathology Graduate Training Program travel awards

Integrated single-cell transcriptome analysis reveals heterogeneity of esophageal squamous cell carcinoma microenvironment

The tumor microenvironment is a highly complex ecosystem of diverse cell types, which shape cancer biology and impact the responsiveness to therapy. Here, we analyze the microenvironment of esophageal squamous cell carcinoma (ESCC) using single-cell transcriptome sequencing in 62,161 cells from blood, adjacent nonmalignant and matched tumor samples from 11 ESCC patients. We uncover heterogeneity in most cell types of the ESCC stroma, particularly in the fibroblast and immune cell compartments. We identify a tumor-specific subset of CST1⁺ myofibroblasts with prognostic values and potential biological significance. CST1⁺ myofibroblasts are also highly tumor-specific in other cancer types. Additionally, a subset of antigen-presenting fibroblasts is revealed and validated. Analyses of myeloid and T lymphoid lineages highlight the immunosuppressive nature of the ESCC microenvironment, and identify cancer-specific expression of immune checkpoint inhibitors. This work establishes a rich resource of stromal cell types of the ESCC microenvironment for further understanding of ESCC biology.

Single-cell transcriptomics identifies gene expression networks driving differentiation and tumorigenesis in the human fallopian tube

The human fallopian tube harbors the cell of origin for the majority of high-grade serous "ovarian" cancers (HGSCs), but its cellular composition, particularly the epithelial component, is poorly characterized. We perform single-cell transcriptomic profiling of around 53,000 individual cells from 12 primary fallopian specimens to map their major cell types. We identify 10 epithelial subpopulations with diverse transcriptional programs. Based on transcriptional signatures, we reconstruct a trajectory whereby secretory cells differentiate into ciliated cells via a RUNX3^high intermediate. Computational deconvolution of advanced HGSCs identifies the "early secretory" population as a likely precursor state for the majority of HGSCs. Its signature comprises both epithelial and mesenchymal features and is enriched in mesenchymal-type HGSCs (p = 6.7 × 10^-27), a group known to have particularly poor prognoses. This cellular and molecular compendium of the human fallopian tube in cancer-free women is expected to advance our understanding of the earliest stages of fallopian epithelial neoplasia.

Are Epithelial Ovarian Cancers of the Mesenchymal Subtype Actually Intraperitoneal Metastases to the Ovary?

Primary ovarian high-grade serous carcinoma (HGSC) has been classified into 4 molecular subtypes: Immunoreactive, Proliferative, Differentiated, and Mesenchymal (Mes), of which the Mes subtype (Mes-HGSC) is associated with the worst clinical outcomes. We propose that Mes-HGSC comprise clusters of cancer and associated stromal cells that detached from tumors in the upper abdomen/omentum and disseminated in the peritoneal cavity, including to the ovary. Using comparative analyses of multiple transcriptomic data sets, we provide the following evidence that the phenotype of Mes-HGSC matches the phenotype of tumors in the upper abdomen/omentum: (1) irrespective of the primary ovarian HGSC molecular subtype, matched upper abdominal/omental metastases were typically of the Mes subtype, (2) the Mes subtype was present at the ovarian site only in patients with concurrent upper abdominal/omental metastases and not in those with HGSC confined to the ovary, and (3) ovarian Mes-HGSC had an expression profile characteristic of stromal cells in the upper abdominal/omental metastases. We suggest that ovarian Mes-HGSC signifies advanced intraperitoneal tumor dissemination to the ovary rather than a subtype of primary ovarian HGSC. This is consistent with the presence of upper abdominal/omental disease, suboptimal debulking, and worst survival previously reported in patients with ovarian Mes-HGSC compared to other molecular subtypes.

A Paradoxical Correlation of Cancer-Associated Fibroblasts With Survival Outcomes in B-Cell Lymphomas and Carcinomas

The tumor microenvironment is increasingly recognized as an active participant in tumor progression. A recent pan-cancer genomic profile analysis has revealed that gene signatures representing components of the tumor microenvironment are robust predictors of survival. A stromal gene signature representing fibroblasts and extracellular matrix components has been associated with good survival in diffuse large B-cell lymphoma (DLBCL). Paradoxically, a closely related gene signature has been shown to correlate with poor survival in carcinomas, including breast, ovarian, pancreatic, and colorectal cancer. To date, there has been no explanation for this paradoxical inverse correlation with survival outcomes in DLBCL and carcinomas. Using public gene data sets, we confirm that the DLBCL stromal gene signature is associated with good survival in DLBCL and several other B-cell lymphomas while it is associated with poor survival in ovarian cancer and several other solid tumors. We show that the DLBCL stromal gene signature is enriched in lymphoid fibroblasts in normal lymph nodes and in cancer-associated fibroblasts (CAFs) in ovarian cancer. Based on these findings, we propose several possible mechanisms by which CAFs may contribute to opposite survival outcomes in B-cell lymphomas and carcinomas.

TLR and CLR agonists induce anti-tumor B cell responses against peritoneal carcinomatosis

Peritoneal carcinomatosis is a condition where primary tumors metastasize into the peritoneal cavity and induce malignant ascites. The median survival of patients is poor, averaging about twenty weeks post diagnosis. Due to the high mortality rate associated with this disease and the lack of curative treatments available, it is imperative that more effective treatments be developed for peritoneal carcinomatosis. The immune system plays an important role in tumor elimination, and one strategy currently being explored to treat malignancies involves leukocyte activation through pattern recognition receptors (PRRs), including Toll-Like Receptors (TLRs) and C-type Lectin Receptors (CLRs). Our data shows that mice treated with a TLR and CLR agonist are afforded significant protection when challenged with an aggressive ascites-forming mammary tumor cell line (TA3-Ha). However, when mice lack B cells, the protection is lost. Administration of the combined treatment results in a significant increase in proliferating, antibody-producing B cells within the visceral adipose tissue (VAT). Consistent with this, the treatment induces a significant increase in IgM and complement (C′) bound to tumor cells, both of which were determined to be critical players in the anti-tumor effects. In summary, our data demonstrates pathogen associated molecular patterns can induce rapid natural IgM production that elicits anti-tumor protection via C′ activation.

Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients

Objectives

To assess the prevalence of the main causes of morbi-mortality in the antiphospholipid syndrome (APS) during a 10-year-follow-up period and to compare the frequency of early manifestations with those that appeared later.

Methods

In 1999, we started an observational study of 1000 APS patients from 13 European countries. All had medical histories documented when entered into the study and were followed prospectively during the ensuing 10 years.

Results

53.1% of the patients had primary APS, 36.2% had APS associated with systemic lupus erythematosus and 10.7% APS associated with other diseases. Thrombotic events appeared in 166 (16.6%) patients during the first 5-year period and in 115 (14.4%) during the second 5-year period. The most common events were strokes, transient ischaemic attacks, deep vein thromboses and pulmonary embolism. 127 (15.5%) women became pregnant (188 pregnancies) and 72.9% of pregnancies succeeded in having one or more live births. The most common obstetric complication was early pregnancy loss (16.5% of the pregnancies). Intrauterine growth restriction (26.3% of the total live births) and prematurity (48.2%) were the most frequent fetal morbidities. 93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of catastrophic APS occurred and 5 (55.6%) of them died. The survival probability at 10 years was 90.7%.

Conclusions

Patients with APS still develop significant morbidity and mortality despite current treatment. It is imperative to increase the efforts in determining optimal prognostic markers and therapeutic measures to prevent these complications.

Haematophagous bat bites in Ecuadorian Amazon: characterisation and implications for sylvatic rabies prevention

OBJECTIVE

To characterise the risk factors of haematophagous bat bites and to provide information to contribute to the prevention of rabies in Ecuador.

DESIGN

Cross-sectional study based on interviews with 3518 individuals, from which two sets of variables were generated: characteristics of haematophagous bat attacks in the previous year among humans and risk factors for being bitten.

METHODS

Data were analysed using multivariate logistic regression models, taking history of bat bites in the previous year as the response variable.

RESULTS

In the previous year 723 (20.6%, 95%CI 19.3-21.9) of the participants declared having received haematophagous bat bites and 50.4% in the previous month, giving an incidence rate of 10.4% (95%CI 9.6-11.6) per month. Sleeping on the floor or in a hammock (adjusted odds ratio [aOR] 1.58, 95%CI 1.21-2.06), not using a protective bed net (aOR 1.25, 95%CI 1.03-1.50) and living in a dwelling with permanent openings in the structure (aOR 1.49, 95%CI 1.12-1.95) were associated with a higher probability of bat bites. Those most affected were the group aged ≤12 years (age 13-19 years, aOR 0.39, 95%CI 0.32-0.48; age ≥20 years, aOR 0.67, 95%CI 0.50-0.90).

CONCLUSION

Primary prevention based on pre-exposure vaccination would be justifiable given the high dispersion of the population and the high incidence of bat bites. As a secondary protective measure, communities should work towards increasing the use of protective measures and putting barriers in permanent openings in their dwellings.

Understanding Gas-Induced Structural Deformation of ZIF-8

ZIF-8 is a zeolitic imidazolate framework with very good thermal and chemical stability that opens up many applications that are not feasible by other metal-organic frameowrks (MOFs) and zeolites. Several works report the adsorption properties of ZIF-8 for strategic gases. However, despite the vast experimental corpus of data reported, there seems yet to be a dearth in the understanding of the gas adsorption properties. In this work we provide insights at a molecular level on the mechanisms governing the ZIF-8 structural deformation during molecular adsorption. We demonstrate that the ZIF-8 structural deformation during the adsorption of different molecules at cryogenic temperature goes beyond the gas-induced rotation of the imidazolate linkers. We combine experimental and simulation studies to demonstrate that this deformation is governed by the polarizability and molecular size and shape of the gases, and that the stepped adsorption behavior is defined by the packing arrangement of the guest inside the host.

First detection and genotyping of human-associated microsporidia in pigeons from urban parks

Microsporidia are ubiquitous opportunistic parasites in nature infecting all animal phyla, and the zoonotic potential of this parasitosis is under discussion. Fecal samples from 124 pigeons from seven parks of Murcia (Spain) were analyzed. Thirty-six of them (29.0%) showed structures compatible with microsporidia spores by staining methods. The DNA isolated from 26 fecal samples (20.9%) of microsporidia-positive pigeons was amplified with specific primers for the four most frequent human microsporidia. Twelve pigeons were positive for only Enterocytozoon bieneusi (9.7%), 5 for Encephalitozoon intestinalis (4%), and one for Encephalitozoon hellem (0.8%). Coinfections were detected in eight additional pigeons: E. bieneusi and E. hellem were detected in six animals (4.8%); E. bieneusi was associated with E. intestinalis in one case (0.8%); and E. hellem and E. intestinalis coexisted in one pigeon. No positive samples for Encephalitozoon cuniculi were detected. The internally transcribed spacer genotype could be completed for one E. hellem-positive pigeon; the result was identical to the genotype A1 previously characterized in an E. hellem Spanish strain of human origin. To our knowledge, this is the first time that human-related microsporidia have been identified in urban park pigeons. Moreover, we can conclude that there is no barrier to microsporidia transmission between park pigeons and humans for E. intestinalis and E. hellem. This study is of environmental and sanitary interest, because children and elderly people constitute the main visitors of parks and they are populations at risk for microsporidiosis. It should also contribute to the better design of appropriate prophylactic measures for populations at risk for opportunistic infections.

[Trends in the prevalence of tuberculosis among six-year-olds in Albacete (Spain)]

OBJECTIVES

To analyze the prevalence and evolution of tuberculous infection among 6-year-olds in Albacete and its relation to socioeconomic status of the family.

METHOD

A tuberculin test (2UT RT-23 Tween 80) was given to 6-year-old school children in and around Albacete in 1992 and 1999. We calculated the prevalence of tuberculosis and the relation to family socioeconomic level as assessed by the parents' level of education of the area of residence.

RESULTS

The tuberculin test was given to 2,783 children, 1,532 in 1992 (8% bacille-Calmette-Guerin-vaccinated) and 1,251 in 1999. The prevalence of tuberculosis infection among non-vaccinated children was 0.78% in 1992 (3.37% among vaccinated children, p = 0.012) and 0.72% in 1999. No significant differences between the two screenings were found except for the vaccinated and non-vaccinated children. The annual decline was 1.1% and the annual decrease in risk of tuberculosis infection was 0.12%. No significant differences related to level of parental education or area of residence were detected.

CONCLUSIONS

The prevalence of tuberculosis infection among 6-year-old school children in Albacete is low, although there is a very slight non-significant downward trend, which may be biased by the inclusion of bacille-Calmette-Guerin-vaccinated children. No differences related to family socioeconomic level were found.

[Usefulness of computerized tomography and bronchoscopy in patients with hemoptysis. Analysis of 482 cases]

OBJECTIVE

We have examined the computed chest tomography (CT) and bronchoscopy utility in diagnosis and accurately identifying the sites of pulmonary bleeding in patients with hemoptysis.

METHODS

We prospectively reviewed the etiology and the site of bleeding of 482 patients with hemoptysis who had undergone bronchoscopy and CT when we suspected a carcinoma, bronchiectasis or the type of bleeding. We analyzed the age, sex, history of tobacco, bleeding, chest radiography, chest computed tomography and bronchoscopy.

RESULTS

62 years (DS 13.6), 84.4% males, 80% smokers and a volume of bleeding of 42.5 ml/day (DS 89) for 15 days (DS 25). Lung cancer was identified in 43%, bronchiectasis in 20%, chronic obstructive lung disease in 14%, pneumonia 8% and an unknown etiology in only 3%. Bronchoscopy located the site of bleeding in 77% and CT in 83%. When we examine only the lung carcinomas, the chest radiography was normal in 11% and the bronchoscopy was diagnostic in 87%, including 6 cases with a normal CT. Simultaneously chest CT or radiography and bronchoscopy detected all the lung cancers. When the chest radiography was inespecific (32%), CT was diagnostic in 43% and bronchoscopy in 14% (p < 0.001) or localized the site of bleeding in 52% with the CT or 23% with the bronchoscopy (< 0.001).

CONCLUSIONS

We concluded that bronchoscopy and CT were useful and complementary in etiologic diagnosis and to localize the site of bleeding in patients with hemoptysis. The bronchoscopy was preferable in patients with a lung cancer and the CT when we studied all the etiologies or the patients without a lung cancer, especially when the radiography was normal. When we simultaneously used a CT or a radiography and the bronchoscopy, all the lung cancers were detected.

Thermodynamic Properties of Isomeric Butanols with 2-Bromobutane

Excess volumes and excess enthalpies for mixtures of isomeric butanols with 2-bromobutane were determined at the temperatures of 298.15 K and 313.15 K. Excess volumes are positive over the whole composition range except for the mixture 1-butanol with 2-bromobutane at 298.15 K in which

[Usefulness of carcinoembryonic antigen and other markers in patients with hemoptysis]

OBJECTIVE

We have examined the carcinoembryonic antigen (CEA) and other tumor markers (immunoglobulins, CA 19.9, LDH, alpha-fetoprotein and alpha-1-antitrypsin) with the purpose of recognize their utility in patients with hemoptysis and patients older than 45 years with a positive smoking history and hemoptysis.

METHODS

We measured, analyzed and compared these markers in 336 patients with a known etiology of hemoptysis divided in group I (malignant etiology) with 101 cases (30.1%) and II (nonmalignant) with 235 cases (69.9%) (p < 0.001).

RESULTS AND CONCLUSIONS

The values of CEA, LDH and CA 19.9 were increased in group I, without differences when we compared immunoglobulins (G, A and M), alpha-fetoprotein and alpha-1-antitrypsin in both groups. CEA and LDH were increased significantly according to the disease extent in nonsmall cell lung carcinoma. Smokers had an increased CEA only in group II. Plasma values of CEA higher than 5 ng/mL meant that the likelihood of bronchial carcinoma was high. Our markers proved to be more specific and with a high positive or negative predictive values than sensitives. These results would suggest that they are not of great help for early diagnosis of lung cancer, however an increase of CEA, LDH and CA 19.9 plasma concentrations could suggest with high probability a bronchial carcinoma, improving their diagnostic sensibility when we used them in combination.

[Tracheobronchomegaly: an exceptional predisposing factor for pulmonary aspergillomas and massive hemoptysis]

Mounier-Kuhn syndrome--or tracheobronchomegaly--is a rare congenital disorder characterized by significant dilation of the trachea and main bronchi. It is accompanied by ineffective cough and is often complicated by recurrent lung infections and bronchiectasis. Clinical presentation varies widely, ranging from forms with scarce involvement of functional capacity to others that progress to respiratory failure that can prove fatal. We report an exceptional case of massive hemoptysis secondary to the presence of pulmonary aspergillomas and bilateral bronchiectasis in which bronchial arteriography with embolization and surgical resection were insufficient for resolving the complications.

[Impact of gender and influence of tobacco on the etiology of patients with hemoptysis]

OBJECTIVE

To evaluate the importance of the sex and the influence of tobacco on the etiology of patients with hemoptysis.

METHODS

We analyzed and compared the etiology of 394 consecutive patients with hemoptysis, divided in two groups: I (males) and II (females), and stratified in relation to tobacco.

RESULTS

305 males (77.4%) and 89 females (p < 0.0001). Lung cancer was more frequent in both groups (26.9%), especially squamous cell carcinoma, but nonmalignant etiologies were more common when we considered all globally (73.1%), including chronic obstructive lung disease (COPD) (14.9%) or bronchiectasis (20.4%) as the more frequent diseases, and 14.2% of unknown etiology (5.2% if we excluded bronchitis or lung infections). Lung tuberculosis was decreased (1.5%) in relation to a increased frequency of its sequelaes or residual lesions (10%). The initial increased frequency of lung cancers or COPD in males and bronchiectasis or heart diseases in females disappeared after the stratification and elimination of the tobacco effect.

CONCLUSIONS

Hemoptysis was more frequent in males and nonmalignant etiologies were more common in both groups, with similar rates as in previous literature and a low number of cases with a unknown etiology associated to a protocolized study and the increased use of diagnostic procedures. In our study, the etiology of patients with hemoptysis was sex independent, to show that the susceptibility to tobacco illness was similar in both sexes.

Massive haemoptysis complicating exogenous lipid pneumonia

Exogenous lipid pneumonia is an uncommon condition resulting from the aspiration or inhalation of fat or oil material. The prognosis in this entity is usually good and complications are rare. We report an unusual case of chronic lipid pneumonia complicated with massive haemoptysis who responded to steroid therapy after arterial embolization.

[Comparative study of acute and chronic forms of pleural tuberculosis]

To analyze whether a characteristic pattern distinguishes acute forms (symptoms starting no more than one week earlier) and subacute or chronic forms (symptoms lasting more than one week) of pleural tuberculosis (PT) in our practice. Retrospective analysis of 102 cases of PT diagnosed between 1986 and 1992, comparing the findings of case histories, imaging, pleural biochemistry and cytology, microbiology of sputum, pleural biopsy and fluid, anatomy and pathology studies of the biopsy specimens, course of disease, response to treatment and sequelae after one year and a half. Thirty-two patients (31.4%) had acute PT and 70 (68.6%) had chronic forms. LDH levels and the percentage of pleural nuclear polymorphism were higher in acute cases, while the concurrence of systemic involvement and lymphocytic predominance was more often seen in chronic cases. Other data analyzed were similar in both groups. No specific clinical or X-ray profiles or differences in course of disease and response to treatment distinguishes between acute and chronic forms of PT after 7 days. Only LDH levels and cytology results differentiated acute forms and, occasionally, such cases were indistinguishable from pneumonia-like effusion.

[Analysis of 90 cases of pleural tuberculosis in relation to adenosine deaminase levels]

BACKGROUND

To analyze the adenosine deaminase (ADA) pleural levels and the possibility of a typical pattern of tuberculous pleuritis (TP) in relation to these values.

PATIENTS AND METHODS

We analyzed 90 consecutive cases of TP dividend into two groups on the basis of the pleural ADA measurements: group 1 (less than 43 U/I) and group 2 (equal or higher than 43 U/I). We compared: age, sex, tuberculous risk factors, clinic onset and duration, PPD, chest roentgenogram, biochemical (LDH, glucose and proteins) and cytological examination of the pleural fluid, microbiologic studies on sputum, pleural fluid and biopsies, histologic findings of the biopsies, evolution and sequelae after the treatment.

RESULTS

36 patients in the group 1 (40%) and 54 in the group 2 (60%) (p = 0.01). All the parameters were similar in both groups excluding LDH pleural levels, that were higher in group 2. In 20 cases of the group 1, we obtained a second analysis of pleural ADA and we observed in 11 cases (55%) an ADA value above 43 U/I.

CONCLUSIONS

We confirmed that ADA pleural level is increased in the majority of our patients with a low initial sensibility of 60%, that can increase with a second determination (72%). ADA activity below 43 U/I cannot exclude the tuberculous aetiology of an effusion and can persist negative in other analyses. The results suggest a response of different chronology without any relation to initial ADA pleural level.

[Factors associated with pleural thickening in pleural tuberculosis. Review of 99 cases]

OBJECTIVE

To analyze which factors were related to the development of pleural thickening in pleural tuberculosis (PT).

METHODS

We reported 99 patients diagnosed as having PT separated into two different groups according to the presence of radiographic pleural thickening after completing the treatment: normal chest roentgenogram (group 1) or pleural thickening (group 2). We compared: clinical history, chest radiography, pleural fluid analysis, microbiological studies and effects of the treatment.

RESULTS

35 cases in group 1 (35.35%) and 64 in group 2 (64.45%). All the compared results did not differ between the two groups, excluding a higher incidence of febrile cases, increased white cell count and decreased relative percentage of pleural lymphocytes in group 1, and increased number of cases with hemoptysis, positive sputum cultures in patients with parenchymal infiltrates, relative percentage of pleural lymphocytes and decreased white cell count in group 2.

CONCLUSIONS

We reported an elevated incidence of residual pleural thickening, but it is unlikely that all the cases could have any clinical significance. We didn't confirm a characteristic pattern. Our findings suggested that a different reaction related or not to the hypersensitivity, rather than the inflammatory response to infection was the responsible for the fibrosis.

[Pleural tuberculosis: analysis of 105 cases]

BACKGROUND

We present the results of a retrospective study with patients diagnosed of tuberculous pleuritis (TP) to offer a view and a perspective of this entity in our area.

METHODS

We reviewed 105 cases of TP according to age, tuberculous risk factors, clinical onset, tuberculin test, chest roentgenogram, pleural fluid analysis (ADA, LDH, glucose and proteins) and pleural biopsy, and the evolution or sequels of the pleural effusion after a specific treatment.

RESULTS

TP was a disease of younger patients (62% less than 30 years old) with tuberculous risk factors (34.3%), positive tuberculin test (81%) and an acute or subacute onset (88.5%). The pleural effusion was unilateral (98.1%), small-sized (61%), with pulmonary infiltrates in the 22.4%. All of the effusions were exudates with the exception of a transudative case. The levels of LDH, glucose and ADA were increased and the white cell counts below 6000/mm2, predominantly mononuclear. ADA was below 40 U/L in the 17% of cases. Pleural biopsy established the diagnosis in the 92.2% and the diagnosis was obtained in the 98.6% when we associated the analysis of ADA, pleural fluid and pleural biopsy. Specific treatment was accompanied with a good response.

CONCLUSIONS

Our findings supported that TP maintained the predilection for younger patients with tuberculous risk factors. The clinical onset, radiographies, pleural fluid analysis and the utility of all diagnostic examinations were similar to other previous studies with the exception of few atypical cases. We confirmed a good prognosis with a correct treatment.

[Paroxysmal melanoptysis secondary to the cavitation of pulmonary pneumoconiosis conglomerate]

Progressive massive fibrosis (PMF) secondary to pneumoconiosis involves the formation of fibrotic masses that eventually cause death from multiple complications. We present a rare but potentially serious complication in a patient with coal pneumoconiosis with PMF, in whom the appearance of paroxysmal melanoptysis was attributed to the cavitation of one of the pneumoconiotic masses. We emphasize the need for differential diagnosis to exclude other more common causes, as well as the use of bronchoscopy for diagnosis and confirmation. Strict control is needed to prevent possible respiratory failure when melanoptysis is massive.

[Diaphragm paralysis as a complication of internal jugular vein puncture]

Rare complications of using the internal jugular vein for vascular access are related to puncture of neighboring organs or other structures. We report the atypical case of a 55-years-old woman with unilateral diaphragm paralysis attributed to accidental damage of the phrenic nerve during an attempt to canalize the internal jugular vein. Other more common causes were ruled out. The severe restrictive ventilatory changes produced had only minor clinical and gasometric repercussions, as previous function was normal and no acute or chronic respiratory disease was present. When ventilation is already compromised, however, this event could seriously worsen the patient's condition.

Nosocomial and community-acquired Legionella pneumonia: clinical comparative analysis

Previous reports have suggested that nosocomial and community Legionella pneumonia cases are similar. However, community and hospital characteristics, such as aquatic environment, antibiotic pressure (usage) and populations, are quite different, leading to the suspicion that Legionella infection may differ in the two settings. Univariate and multivariate analyses were performed to compare demographic data, risk factors, clinical, radiological and outcome data between 125 nosocomial and 33 community-acquired cases of Legionella pneumophila infection. Patients in the nosocomially acquired Legionella pneumonia (NALP) group were older than those in the community-acquired Legionella pneumonia (CALP) group. Univariate analysis showed that smoking habit, cough, thoracic pain, and extrapulmonary manifestations were more prevalent in the CALP group, whilst chronic lung disease and cancer were more prevalent in the NALP group. Moreover, patients in the NALP group were more likely to have received oxygen and corticosteroid therapy and also to have altered creatinine values than patients in the CALP group, whilst more patients in the latter group had altered alanine amino-transferase values. However, multivariate analysis failed to confirm most of these differences. Smoking habit and blood creatinine levels were the only variables remaining significant. In conclusion, demographic, clinical, laboratory, radiological and outcome data in nosocomial and community-acquired Legionella pneumonia are quite similar.

Idiopathic bronchiolitis obliterans organizing pneumonia with multiple cavitary lung nodules

Bronchiolitis obliterans organizing pneumonia (BOOP) is a pulmonary disorder with a wide spectrum of radiological features. We report the case of a 58 year old woman, in whom the radiological appearance was multiple cavitary nodules in both lungs, that responded with a complete resolution after corticosteroid therapy. This finding justifies the inclusion of BOOP in the differential diagnosis of multiple cavitary nodules.

[The prevalence of tuberculous infection in the 6- to 7-year-old schoolchild population in Albacete]

To analyze the prevalence of tuberculosis infection, tuberculin tests were given to 3,292 elementary school children in the first and second grades in the environs of Albacete (Spain) in 1992. There were 1,532 children aged 6 (122 vaccinated with BCG) and 1,760 children aged 7 (162 vaccinated); 51 children tested positive (20 who had been vaccinated and 31 who had not been). The prevalence of infection was 0.78% at 6 years of age and 1.25 at 7 years of age in non vaccinated children, a rate similar to that found by earlier national surveys. One case of active pulmonary tuberculosis was identified. Inclusion of the 8.6% who had been vaccinated caused significant distortion of the initial prevalences. The annual rate of infection, estimated based on an annual decline of 4%, was 0.143 %. Differences in tuberculosis infection by family socioeconomic level, as indicted by level of parental studies or place of residence, were not statistically significant, although we did observe a slightly greater rate among children living in poorer areas and with parents with only elementary school education. Our results confirm a downward trend in the prevalence of tuberculosis infection in the population studied, as well as the importance of carrying out this type of survey to provide a reference for active control and for taking an active stand.

[Pneumonitis secondary to the inhalation of isocyanates. An analysis of 2 cases]

We present two patients with diffuse interstitial lung disease attributed to two different forms of presentation of pneumonitis due to inhalation of isocyanates. The first case was acute and accidental and the second was due to longer workplace exposure. In both cases, clinical, radiological and lung function findings as well as results of bronchoalveolar lavage were similar to those of hypersensitivity pneumonitis triggered by organic agents.

Massive haemoptysis complicating prosthetic patch pulmonary embolism after atrial septal defect repair

A case is presented of a 43 year old woman with massive haemotypsis secondary to non-thrombotic pulmonary embolism complicating atrial septal defect repair with a prosthetic patch. Non-thrombotic embolus must be considered in the differential diagnosis of massive haemoptysis.