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The acceptance of transtracheal catheters (TTC) in chronic obstructive pulmonary disease (COPD) patients with severe hypoxaemia was analysed and the adverse events associated with this system of oxygenation described. Once the TTC (Oxycat) was inserted, each patient was monitored on an outpatient basis and information about the associated adverse events was collected. In a group of 70 patients that met the inclusion criteria, only 14 (20%) accepted TTC insertion. The observed adverse events were: haemorrhage through the stoma (3); ejection of the TTC in a cough reflex (2); subcutaneous emphysema (2); mucous plugging (1); and haemoptysis (1). Removal of the TTC was necessary in 29% of the cases, and was associated with the onset of an adverse event in all cases except one. Despite the proven benefits of oxygen therapy performance and the improvement in effort tolerance, transtracheal catheter has a low level of acceptance among patients with extremely disabling diseases. The adverse events observed were frequent, but could have been corrected and in no case worsened our patients' prognosis.

Background: The health professionals have a leading role in the reduction of the smoking prevalence. Spain has one of the big rate of "per capita" tobacco consumption in the world, and the Spanish doctors have the biggest prevalence of smokers among their colleagues from the EEC countries., Methods: The effectiveness of a stop smoking programme in health care professionals was evaluated. This programme combined group therapy, nicotine chewing gum and behavioural assistance through the evaluation of CO contained in expired breath; and it is being applied with good results between the smokers of general population in Spain. A total of 211 voluntary smokers working in Spanish six general hospitals were treated, from those 149 (71%) were physicians and nurses (PS) and 62 (29%) others professionals without sanitary responsibilities (PNA)., Results: At one year follow-up, 64 (30%) were not smoking, and the P.S. had a higher rate of give up than the PNA (p less than 0.05). Specifically the women of P.S. obtained a greater issue than the women of PNA (p less than 0.05). Both, nicotine chewing gum and behavioural assistance were as effective as usual in smoking cessation programme like this, in our country., Conclusions: Although the outcome is lower than the obtained with the same approaches in smokers from general population, the better results of the PS than the PNA imply a good change of attitude of them. Specially the women PS obtained a big success, and this is outstanding in this group with a great prevalence of smokers, increasing in the recent years. The subjects who give up smoking increased their corporal weight less than the observed in smokers of the general population, who also give up with this treatment.

Four cases of acute life-threatening tracheal obstruction due to intrathoracic goiter are reported. Acute respiratory insufficiency caused by an upper airway obstruction in patients with intrathoracic goiter is exceptional. In 3 of 4 cases reported, the histologic study showed multiple foci of recent hemorrhage, the mechanism probably responsible for these episodes.

A prospective study was carried out in 26 patients intubated and mechanically ventilated for severe exacerbation of asthma. The age of onset of asthma and the duration of disease showed wide variations, but most of the patients were women in their fifties with chronic asthma. However, 23% had the more benign intermittent course. Most patients had a prodromal period of several days with progressive deterioration. Eight patients developed sudden attacks, in three of them aspirin-intolerance was responsible, in two patients emotional disturbances could play some role as triggering factors, and in three other patients no obvious reason was found. Identification of factors responsible for the sudden attacks may be relevant to the management of these severe cases. The majority of patients were intubated immediately on arrival or during the first hours after admission. Deaths were related to complications produced by hypoxia, or hospitalization in an intensive care unit. Probably many of these patients would not have died if an appropriate steroid treatment had been given some days before.

The characteristics of 26 pleural effusions associated with non-Hodgkin's Lymphomas (NHL) have been analyzed (13% of the 200 NHL reviewed). Twenty-one of them were exudates and 5 chylous. Cytological examinations were positive in 18/21 of exudate effusions and so were 11 of the 15 pleural biopsies performed. Three of the chylous effusions were associated with chylous ascites, the pleural biopsy being positive in one case. In only 4 cases mediastinal adenopathies were found (3 exudates and one chylous). In half of the cases, the effusion disappeared as a response to chemotherapy. Intrapleural treatment with doxorubicin was performed in 6 patients with exudates, but the pleural effusion disappeared in only one case. The survival was shorter (estimated median survival, 6 months) in those patients in whom the pleural effusion did not disappear under systemic chemotherapy than in those in whom a response was achieved (estimated median survival greater than 40 months; p less than 0.01).

Little is known about the evolution of patients surviving an episode of adult respiratory distress syndrome (ADRS). In the present study the clinical and radiological evolution, and the course of pulmonary function changes were evaluated in nine patients that survived an episode of ADRS. There were six male and three female, with a mean age of 44 +/- 16 (mean +/- SD). The initial PaO2 was 39 +/- 10 with a FiO2 less than 35, and 59 +/- 23 with a FiO2 of 1. Four patients were smokers and one had a history of chronic bronchitis. Pulmonary function studies disclosed a peripheral obstructive ventilatory alteration in one patient, a peripheral and central alteration in four, and non-obstructive changes in three. Follow-up pulmonary functions studies were carried out in six cases and demonstrated a significant increase of DLCO (p less than 0.01). Airway obstruction was present in one case, the same degree of obstruction was maintained in two cases, a reversible bronchospasm appeared in one case, and respiratory fuction returned to normal in two cases. The severity of the ADRS was unrelated to the later evolution. The results suggest that residual functional abnormalities might be related to the administration of high concentrations of O2. No residual clinical or radiological alterations were observed. Because of the multifactorial etiology of ADRS and of the reduced number of patients studied the results are non-homogeneous. However, DLCO appears to be the best parameter to indicate functional recovery. Residual abnormalities are minimal and temporary, and full recovery is to be expected.