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It was hypothesised that monitoring neutrophil and D-dimer (DD) levels into the pleural fluid, after talc instillation, could predict the outcome of pleurodesis. The current authors investigated a total of 168 patients with malignant pleural effusion, who were treated with talc poudrage. According to the outcome the patients were categorised into one of two groups, either successful or failed pleurodesis. In all cases, pleural fluid neutrophils and DDs were determined on serial measurements at 0, 3, 24 and 48 h after the procedure. The time course of these parameters was assessed in both groups and the time point at which they could better predict the outcome was further explored. Neutrophils rose rapidly after talc poudrage in both groups, reaching a plateau at 24 h, although in successful pleurodesis this response was significantly higher. DD dropped markedly at 24 h in the group with the successful outcome, but it did not show significant changes in the other group. A cut-off value of 61% for neutrophils and 61 mg.L-1 for the DD at 24 h yielded the best prognosis for successful pleurodesis. The current authors conclude that serial measurements of neutrophil and d-dimer values into the pleural fluid after talc poudrage could be used as predictors of the outcome of pleurodesis.

Objective: To study the prevalence os smoking in school children in Sevilla and the influence of personal and social environment on smoking patterns., Methods: This study was part of a preventative anti-smoking campaign in schools. Students filled in anonymous questionnaires based on the World Health Organization survey instrument for population attitudes and habits., Results: We surveyed 3385 students between 10 and 19 years of age at 47 schools in Seville and 28 villages in the surrounding province. Current smoking was reported by 19.1% of the students; slightly more girls (19.8%) than boys (18.3%) smoked. Smoking was related to having an older brother or sister who smoked and particularly to having friends who smoked (OR 20.5). The adolescents reported that parents were less permissive than the rest of their environment. Smokers associated tobacco with values such as independence and freedom; they believed that smoking might have an impact on health, although their conviction was less strong than that of non-smokers, regular smokers had high expectations of continuing., Conclusions: We found a high proportion of smokers among students of both sexes. Starting and continuing to smoke during adolescence is considerably influenced by the social environment of peers and is possibly affected by messages of independence and freedom transmitted through tobacco industry advertising.

We aimed to study whether the presence of obstructive sleep apnea syndrome (OSAS) in patients with chronic obstructive pulmonary disease (COPD) led to differences in clinical picture, gas exchange during awake and sleep states and mechanical ventilation, in comparison with patients with COPD alone. We enrolled 48 COPD patients. In 26 (54.1%), OSAS was ruled out (non-OSAS COPD group) by polysomnography, and in 22 (45.8%) associated OSAS was diagnosed (OSAS COPD group). Patients in the OSAS COPD group experienced greater daytime sleepiness and less dyspnea. Body mass index was not significantly difference. The OSAS COPD group had significantly lower daytime PaO2 (66.4 +/- 10.4 mmHg in the OSAS COPD group and 75.5 +/- 11.2 mmHg in the non-OSAS COPD group; p = 0.01); there were no differences in PaCO2.Pimax in the OSAS-COPD group was 70.6 +/- 23.8 cmH2O, a level that was significantly lower than in the non-OSAS COPD group (Pimax 90.5 +/- 26.1 cmH2O; p = 0.04). Patients in the non-OSAS COPD group experienced longer periods of REM sleep. Nighttime saturation parameters were significantly different in the group with OSAS. We conclude that patients with both OSAS and COPD experience greater oximetric changes than those without OSAS, during both sleep and awake states. The deterioration of respiratory muscle pressures in such patients may play an important role in the changes. The groups also present differences in the intensity of some symptoms, such as degree of daytime sleepiness and dyspnea.

Background: The aim of this study was to prospectively evaluate the clinical and gasometric evolution and the side effects of two treatment schedules in the exacerbations of patients with chronic obstructive pulmonary disease (COPD): 500 mg/24 h of azithromycin (AZM) for three days versus 500 mg/12 h of acetyl cefuroxime (ACF) for 10 days., Patients and Methods: Patients were randomized included into each therapeutic schedule. The patients were seen three times (days 1 and 4, and at 15-21 days) to evaluate clinical symptoms scores. Forced spirometry and arterial gasometry were performed the first and the last time the patients were seen. The number of patients requiring admission during follow up and the secondary effects of each antibiotic were quantified., Results: A total de 50 patients were treated with AZM and 51 with ACF. The evolution of the symptoms was similar although with a trend to greater improvement in those treated with AZM. This improvement was significant for the characteristics of expectoration (p < 0.05). Functional and gasometric evolution was similar in the two schedules. Three patients treated with AZM required hospital admission, as did 5 treated with ACF. A greater number of secondary effects were observed in patients treated with ACF (18%) than in those receiving AZM (10%), with gastrointestinal side effects being the most commonly observed., Conclusions: Treatment with short schedule of AZM may have the same activity as longer schedule of ACF, with fewer secondary effects thereby suggesting that AZM may be an effective alternative in the treatment of exacerbations in patients with COPD.

Objectives: To study the prevalence and intensity of smoking among school-age children in Seville by sex, age and type of population, as well as to examine expectations of future smoking., Methods: This study was part of a school anti-smoking campaign. The students completed an anonymous questionnaire based on the one formulated by the World Health Organization on population attitudes and habits., Results: Of 895 school-age subjects surveyed, 879 questionnaires were valid (428 boys and 451 girls). Ages ranged from 12 to 19 years (mean for boys: 15.4 +/- 1.6 years; for girls 14.6 +/- 1.5 years; p < 0.01). As many as 300 girls (67%) and 278 boys (65%) reported having tried a cigarette at some time. Active smoking was reported by 35% (16% occasionally and 19% daily) with no significant differences between boys and girls. The number of smokers increased with age, coming to represent more than half of subjects over 16 years of age, the proportion being even higher for girls aged 14 years and older. Smoking became well established at age 14 or older for most subjects. More rural than urban or large town dwellers reported smoking. The mean number of cigarettes smoked was higher for boys (8.7 +/- 7.4) than for girls (6.4 +/- 6.2) (p < 0.01). We found differences in boys' and girls' future expectations of smoking, as well as differences between habitual and occasional smokers, the latter group being less certain about whether to continue smoking in the future or not.

Pneumomediastinum is an uncommon self-limited clinical entity which usually involves young adults. In asthmatic patients, the manifestation of pneumomediastinum as complication of an asthmatic crisis is considered to be a rare event, and its course is usually favourable with scarce complications. We report here the main clinical and epidemiologic characteristics in four patients with pneumomediastinum secondary to an asthmatic exacerbation, admitted to the Neumology Department in our hospital for a three year period. The clinical course of our patients was favourable, and the picture resolved with conventional medical therapy for the asthmatic crisis.

Pancoast's syndrome arises from neoplasms in 95% of cases but infection is a rare cause. We describe a patient with Pancoast's tumor secondary to tuberculosis. Pain caused by plexopathy and lack of diagnosis by noninvasive means led to the need for open biopsy.

Cystic lymphoepithelial lesion is an infrequent disorder involving the saliva glands mainly the parotid gland; however, its frequency has increased coinciding with the epidemics of HIV-1 infection. Three cases of parotid lymphoepithelial lesion in patients with HIV-1 infection, 2 of whom were hemophiliacs and one an ex-intravenous drug addict, are presented. In all the cases the lesion was a painless slow growth right submandibular mass, with no history of inflammation. Two of the patients had a contralateral tumor of the same characteristics which was not studied. Fine needle aspiration puncture was performed in the three patients although diagnosis was obtained by pathologic study following superficial parotidectomy. Cystic lymphoepithelial lesion is an entity to be taken into account on differential diagnosis of cervical masses in patients with HIV infection. In individuals with severe immunosuppression treatment should be conservative.