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OBJECTIVE: The objective of this study has been the description of the cases of carcinoid tumor diagnosed in our Pneumology Service along the last 15 years. METHODS: The study has been conducted retrospectively, including the period between January 1, 1987 and December 31, 2001. The clinical histories of all patients with a diagnosis of carcinoid tumor have been reviewed, collecting the demographic clinical, radiological, bronchoscopic, therapeutic, and evolutionary data. RESULTS. On the whole, 41 cases were diagnosed, 36 typical (88%) and 5 atypical (12%), representing 2% of the total of lung neoplasms. The average age was 50 years, and 66% patients were males, with 61% of smokers and ex-smokers. The most relevant clinical parameter was cough with 68% of cases. Chest X-ray was pathological in 88% and CAT in 100%. Bronchoscopy was done in 40 patients, being the localization of the tumor peripheral in 10% and central in 90%. In 37.5% the classical endoscopic image suggestive of this tumor was observed. The definitive diagnosis was obtained in 26 cases by bronchial biopsy, in 14 cases through thoracotomy, and in 1 case by CAT-guided fine-needle aspiration biopsy. Surgical treatment was carried out in 36 patients (88%). Five year follow-up has been completed in 16 (39%) patients, with 5 recurrences (2 local and 3 systemic). Five patients were lost for follow-up (12%), and in the 20 patients remaining (49%) the evolution is less than 5 years, with no recurrences up to now. There has not been any death. CONCLUSIONS: We conclude that carcinoid tumors are infrequent, most of them central in location, and are diagnosed preferably by bronchoscopy, although the number of cases with suggestive findings is less than 50%. The treatment is surgical except for contraindications, and the percentage of recurrences has been limited.

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Introducción: La posibilidad de emplear técnicas sencillas en su realización y bien toleradas por parte del paciente en el estudio de la función muscular respiratoria posibilitaría su empleo de manera rutinaria y con aplicación clínica. La medición del twitch en boca utilizando la estimulación magnética bien anterior bilateral o posterior cumpliría estos criterios. Sujetos y métodos: Hemos estudiado a 16 sujetos sanos en los que se ha realizado medición de twitch en boca (TwB) utilizando estimulación bilateral anterior (TwBA) y posterior (TwBP). En cada sujeto se han realizado 10 estimulaciones por cada técnica. En 5 casos se repitió el test en 2 días diferentes. Resultados: En sujetos normales, la media del TwBA ha sido de 21,07 ñ 4,4 cmH2O (rango, 13,72-30,11), y la del TwBP de 21,12 ñ 5,9 cmH2O (rango 12,7-35,7), sin diferencias significativas entre ambas. La diferencia de medias ha sido de 2,8 ñ 2,5 cmH2O, con una relación TwBP/PImáx de 0,15 (rango 0,08-0,10) y de 0,14 (rango 0,07-0,15) para la TwBA. La correlación entre ambas técnicas ha sido de 0,8. La TwBA de los sujetos en los que se realizó la técnica en días diferentes presentaba un valor medio de 20 cmH2O (primer día) y de 10,18 (segundo día), sin diferencias significativas. El coeficiente de variación (CoV por ciento) para la TwBA ha sido del 5,9 por ciento y del 7,2 por ciento para la TwBP. Conclusiones: La TwB medida por ambas técnicas es similar en sujetos sanos y presenta coeficientes de variación similares, pudiéndose emplear indistintamente. La variabilidad entre días e intradía de ambas técnicas es baja. (AU)

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BACKGROUND: If techniques for studying respiratory muscle function are easy to use and well tolerates by patients, they can be used routinely. Measuring mouth twitches (TwM) using either bilateral anterior or posterior magnetic stimulation meets both criteria. SUBJECTS AND METHODS: We studied 16 healthy subjects. TwM was measured using bilateral anterior (TwMA) and posterior (TwMP) stimulation. Ten stimuli were applied for each technique for each subject. Five subjects repeated the test was repeated on a different day. RESULTS: The mean TwMA in healthy subjects was 21.07 +/- 4.4 cmH2O (range 13.72-30.11); the mean TwMP was 21.12 +/- 5.9 cmH2O (range 12.7-35.7) (NS). The mean difference was 2.8 +/- 2.5 cmH2O, while the ratio TwMP/PImax was 0.15 (range 0.08-0.10) and TwMA/PImax was 0.14 (range 0.07-0.15). The correlation between the two technique was 0.8. The patients who underwent testing twice had a mean TwMA of 20 cmH2O on the first day and 10.18 cmH2O on the second (NS). The coefficient of variation (CoV%) was 5.9% for TwMA and 7.2% for TwMP. CONCLUSIONS: The two techniques for measuring TwM give similar results and coefficients of variation in healthy subjects; either technique can be used. Variation from one testing day to another is low.

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Liposarcomas are malignant mesenchymal tumors whose primary location in the mediastinum is rare. We report two cases of mediastinal liposarcoma, describing the clinical signs and radiologic features found and the diagnostic procedures performed. The significance of histologic variability as a factor that conditions treatment and prognosis is underlined.

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In this retrospective study we aimed to assess the diagnostic yield of bronchoalveolar lavage (BAL) in kidney transplant patients who were suspected of having severe respiratory infection or in whom empirical antibiotic treatment had failed. All BAL procedures performed on kidney transplanted patients suspected of having respiratory infections between January 1, 1988 and July 31, 1996 were analyzed. BAL was carried out in the standard way and samples were sent for cytologic and bacteriologic study. Thirty-three patients with a mean age of 48.5 years were enrolled. All had been receiving immunosuppressive treatment and the mean time following transplantation was 320 days. Thirty-one had received antibiotic treatment before BAL. BAL was positive for 21 of the 33 patients (64%). Twenty-two pathogens were identified: 6 Pneumocystis carinii, 4 Cytomegalovirus, 3 Mycobacterium tuberculosis, 2 Aspergillus fumigatus, 2 Herpes simplex type I, 1 Streptococcus pneumoniae, 1 Staphylococcus aureus, 1 Streptococcus mitis, 1 Legionella pneumophila, 1 Legionella longbeachae. BAL was negative for 12 patients, of whom 8 were tentatively diagnosed of bacterial infection, 3 of acute pulmonary edema and one of pulmonary infarction. Based on the results, therapy was changed for 20 patients (61%), 19 (58%) because an unsuspected pathogen was identified and 1 because treatment could be simplified. The diagnostic yield of BAL is high (64%) in kidney transplant patients suspected of respiratory infection and is useful for managing such cases, as evidenced by the fact that a high proportion (19/33) of our patients were infected by pathogens not covered by empirical treatment.

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To establish the diagnostic yield of computerized tomography (CT) in pleural effusions with no presumed diagnosis arising from standard clinical examination. A prospective protocol study enrolling all cases of effusion admitted to our hospital between January 1994 through July 1995 without a presumed diagnosis after initial testing that included thoracocentesis. Twenty-two patients were enrolled. All were given a CT scan as well as other complementary examinations considered appropriate and were referred to our outpatient clinic for follow-up. The CT images were read by an expert radiologist and their contribution was classified as "diagnostic", "suggestive" or "nil". A definitive etiologic diagnosis was achieved in 14 cases (8 neoplasms, 4 benign due to asbestos, 1 tuberculosis and 1 pulmonary embolism). The CT contribution was nil in 13 cases (59%), "diagnostic" in 6 (2 mesotheliomas, 1 hypernephroma, 1 lymphoma, 1 adenocarcinoma of the colon and another of the ovary) and "suggestive" in 3 (2 benign due to asbestos and 1 lymphoma). Positive information was obtained in 9 cases (41%). CT gives good yield in the investigation of pleural effusions with no presumed diagnosis and should be made available to this group of patients before other more invasive procedures are resorted to. It is especially useful for detecting neoplastic disease of the upper abdomen, mesothelioma and sings of unsuspected exposure to asbestos.

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