[Non-invasive ventilation in patients with diaphragmatic paralysis. Case report]

Background Diaphragmatic paralysis (DP) is a rare disease, usually secondary to systemic processes, although idiopathic forms have been described. Aim To describe the use of non-invasive ventilation as a treatment to patients with DP. Material and methods Descriptive study about consecutive cases of DP in a general hospital. Results It has been described 4 patients, all of them with a diminished the maximum mouth pressures and vital capacity in supine position. Three patients presented hypercapnia, and one of them, required intubation with invasive mechanical ventilation. All patients were treated with non-invasive positive pressure (NPPV) mode S/T bilevel, allowing with a reduction in the PCO2, improvement in the symptoms and in the parameters to the nocturnal respiratory polygraphy. Conclusions Use of NPPV in patients with DP could provide a clinical improvement and contributing to recovery of lung functionality that make it recommendable in selected cases.

[Lung eosinophilic syndrome: clinical presentation and cases report]

INTRODUCTION

Pulmonary eosinophilia syndrome is characterized by a group of diseases that present clinical-radiological conditions, pulmonary eosinophilia or peripheral lung parenchyma in its evolution. We described the clinical and radiological presentation.

METHODS

Retrospective descriptive analysis of medical records of 7 patients between 2007 and 2010.

RESULTS

The highest numbers of cases were observed in women, with peripheral eosinophilia with values between 550 and 10,000 cells/mm3. The more frequent signs and symptoms were cough, dyspnea, fever and wheezing. The more prevalent radiological findings were alveolar interstitial and alveolar pattern. At CT scan, the most frequent pattern was ground glass. The main diagnoses made were acute and chronic eosinophilic pneumonia in equal proportions, both with response to steroids.

CONCLUSIONS

The pulmonary eosinophilia syndrome shares common features with clinical and radiological entities most prevalent, particularly community-adquired pneumonia.

[Pulmonary carcinomatous lymphangitis: presentation as acute pneumopathy. Report of two cases]

INTRODUCTION

Carcinomatous lymphangitis of the lung accounts for 6-8% of lung's metastases. There are evidence that it can be a treatable condition with an impact on progression of dyspnea and radiographic lesions, and survival improvement. Two cases are reported, with the aim of increase the clinical suspicion at compatible cases.

METHODS

Case 1: woman 32 years old. Progressive dyspnea and cough two weeks ago, without antibiotic response. Tachypnea, increase of respiratory work, basal crackles. Respiratory failure. Radiography: basal alveolointerstitial opacities. Treatment for severe community-acquired pneumonia is started. She evolves unfavorably, with need of MRA and fatal outcome. Case 2: woman 46 years old. Progressive dyspnea and cough from one week ago. Tachypnea, diffuse crackles. Respiratory failure. Radiography: diffuse nodular-interstitialradiopacity, with radiopacy lesion in right apex. HRCT: nodular thickening of interlobular septum and peribrochovascular interstitial. Treatment for tuberculosis of the lung is started. She evolves unfavorably, with need of MRA and fatal outcome. In both cases a lung biopsy was performed, diagnosing carcinomatous lymphangitis.

DISCUSSION

Two cases are reported, with acute afebrilepneumopathyin young patients, whose manifestations guided to treatment of respiratory infection, and evolved quickly to refractory hypoxemic respiratory failure with need of MRA and fatal outcome.

CONCLUSION

Carcinomatous lymphangitis of the lung should be included as a differential diagnosis of cases of acute lung pathology, especially when there was an unfavorable evolution under antibiotics or have excluded more common etiologies.

[Superior Cava Venous syndrome as presentation of neoplasic disease]

Superior Cava Venous Syndrome (SVCS) encompasses a constellation of signs and symptoms resulting from partial or complete obstruction of blood flow through the superior vena cava (SVC) to the right atrium. Thrombosis can be caused by intrinsic (primary) or extrinsic compression (with or without secondary thrombosis). The causes of SVCS can be grouped according to their etiology in non-neoplastic and neoplastic. The causes malignant correspond to 65-90% of them, thrombosis and nonmalignant conditions are another causes. The presentation may be acute, clinically characterized by dyspnea and a characteristic triad (facial, neck and arms edema, cyanosis and collateral circulation). Early detection improves prognosis and is based on clinical data and imaging studies. We describe 8 cases where the SVCS was the first manifestation of neoplastic diseases. Patients were predominantly of middle-aged, male, without association with consumption of tobacco and lymphoma was most frequent diagnosis.

[Insomnia: prevalence in Cordoba city hospital]

INTRODUCTION

Insomnia is a sleep disorder characterized by a deficient or poor quality sleep, with adverse daytime consequences. Prevalence is 30-50% in adults and can be associated with depression or lead to the development of this condition. Despite the high prevalence rates, is a unrecognized, misdiagnosis and undertreated. There is not much publications about its prevalence in patients with chronic diseases.

OBJECTIVES

to determine prevalence and clinical characteristics of insomnia in outpatients with chronic diseases.

MATERIALS AND METHODS

Prospective observational cross-sectional descriptive study. Insomnia was defined based on ICSD-2criteria. The data collection was performed by a questionnaire.

RESULTS

We surveyed 100 patients who attended the consultation of various clinical specialties, mean age 50 years old, 57% were women. Sixty nine per cent of them met criteria for insomnia. The most prevalent diseases were hypertension: 57%, asthma 20%, diabetes: 18% and hypothyroidism: 17%. Among patients with insomnia, 62% were women, 35% had insomnia without another illness, and the remaining 65% had secondary conditions associated with insomnia (60% depression). 25% of patients consulting for insomnia ever. The prevalence of criteria for depression in outpatients with chronic diseases was 52%, amounting to 63% in patients suffering from insomnia.

DISCUSSION

The prevalence of insomnia in patients with chronic diseases is high (in outpatients with chronic disease: 69%), higher than the average rate described in the general population. It is an undertreated condition.

CONCLUSIONS

The prevalence of insomnia in patients with chronic diseases is high, it is underdiagnosed and undertreated. It is associated with depression in high rate.

[Pulmonary alveolar proteinosis: report of two cases and review of the literature]

Pulmonary alveolar proteinosis is a rare disease characterized by extensive radiological and tomographic pulmonary lesions and a variable clinical picture ranging from pulmonary insufficiency to spontaneous remission. Among its three described forms, the so called Idiopathic or Adult form is responsible for more than 80% of published cases. It's physiopathology depends on an autoimmune process directed against the GM-CSF (Granulocite Macrophage- Colony Stimulating Factor) that induces a functional defect of the macrophage with consequent intraalveolar accumulation of surfactant. Pulmonary and extrapulmonary infections, are common, often with unusual pathogens. Diagnosis can be made from the combination of clinical, radiological and bronchoalveolar lavage data, although sometimes histopathologic material is needed for confirmation. Total pulmonary lavage is currently the treatment of choice. Mortality is usually low and related mostly to infectious complications. We hereby describe our experience with two patients.