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Resumen Antecedentes y objetivos Nos proponemos conocer la magnitud del cancer de pulmon en Avila: sus tasas de incidencia y aspectos epidemiologicos importantes en el ano 2012, comparandolo con los resultados de estudios conocidos realizados con la misma metodologia cada 5 anos, desde hace ya 2 decadas. Pacientes y metodos Inclusion prospectiva de todos los pacientes diagnosticados de cancer de pulmon en la provincia de Avila a lo largo del ano 2012. Resultados Se diagnosticaron 81 enfermos, 70 hombres y 11 mujeres, con edad media de 72,1 anos (extremos: 44-91), superior a la encontrada en estudios anteriores. Dan lugar a unas tasas de incidencia en 2012, brutas y ajustadas a la poblacion mundial estandar, de 80,99 y 31,23 por 100.000, respectivamente, en los hombres, y 12,97 y 5,68 por 100.000 en las mujeres. Estas tasas son menores, en ambos sexos, a las encontradas en Avila en el ano 2002. En 2012 habian sido fumadores el 80,25% (90% de los hombres y 18,18% de las mujeres), aunque al diagnostico lo habian dejado el 68,75%. Realizamos diagnostico clinico-radiologico en 9 (11,1%) y cito-histologico en 72 (88,9%). Tipos histologicos: adenocarcinomas 37,5%; escamosos 33,3%; microciticos 13,8%; indiferenciados no microciticos 11,1%; celulas grandes 2,77% y carcinoides 1,38%. Los tratamientos mas frecuentes fueron quimioterapia (50,6%), sintomatico (23,4%) y cirugia (12,3%). Conclusiones En los ultimos 10 anos disminuye la incidencia del cancer de pulmon en Avila en ambos sexos. En 2012 los pacientes han sido mas ancianos, predominando la histologia adenocarcinoma y el tratamiento con quimioterapia.

Objetivo Durante el esfuerzo fisico la respuesta ventilatoria de los enfermos con enfermedad pulmonar obstructiva cronica (EPOC) grave es mas rapida y superficial que la de los sujetos sanos, y existen indicios de que el entrenamiento fisico podria cambiar el patron ventilatorio de estos pacientes. El proposito del presente estudio fue comprobar los efectos que el entrenamiento fisico de los pacientes con EPOC grave tiene sobre el patron ventilatorio, asi como de-terminar o no el mantenimiento de los posibles cambios pro-ducidos en el tiempo. Material Y Metodo Se realizo un estudio aleatorio y controlado con pacientes con EPOC grave sin reversibilidad bronquial. En estos pacientes se efectuo una intervencion mediante entrenamiento fisico. Los pacientes fueron remitidos al hospital para entrenamiento muscular periferico, todos ellos en situacion clinica estable, sin exacerbacion, y fueron asignados a dos programas diferentes de entrenamiento fisico. Resultados Se estudiaron 35 pacientes varones con EPOC grave, estables (volumen espiratorio forzado en el primer segundo del 41 ± 7%), con una edad media de 64 ± 5 anos, divididos en dos grupos con diferente potencia media estimada de entrenamiento (grupo A: 70 ± 22 W; grupo B: 35 ± 10 W) y trabajo total desarrollado (grupo A: 8.050 ± 2.882 kJ; grupo B: 4.044 ± 1.205 kJ). Solo se objetivaron cambios en el patron ventilatorio durante el ejercicio realizado durante la prueba de esfuerzo en el grupo A, que no se mantuvieron a los 12 meses de finalizado el programa. Conclusiones El entrenamiento intenso produce cambios en el patron ventilatorio de los pacientes con EPOC grave que son inespecificos de la tarea e independientes de la produccion de lactato, y que no se mantienen a largo plazo.

Objective During physical exertion, the ventilatory response of patients with severe chronic obstructive pulmonary disease (COPD) is more rapid and shallow than that of healthy subjects. There is evidence that exercise training can alter breathing pattern in COPD patients. The purpose of the present study was to observe the effects of physical training on patients with severe COPD and to determine whether or not any possible changes were maintained over time. Material and method Patients with severe COPD without bronchial reversibility were enrolled in a randomized controlled trial of a peripheral muscle training program carried out in a hospital setting. All enrolled patients were clinically stable, without exacerbation, and were randomly assigned to a training program of high (group A) or low (group B) intensity. Results Thirty-five men with severe COPD in stable condition (mean [SD] forced expiratory volume in 1 second at 41%[7%]) were enrolled in the study. The mean age was 64(5) years. Group A underwent training at 70(22) W and group B at 35(10) W, such that the estimated total work was 8050(2882) kJ in group A and 4044(1205) kJ in group B. Breathing pattern changes were detected in exercise tests only for group A patients, but the changes were not maintained 12 months after the end of the program. Conclusions Intense training produces changes in the breathing pattern of patients with severe COPD. The changes are not specific to the task performed, not dependent on lactate production, and not maintained over the long term.

Es necesario determinar que pacientes con neumonia adquirida en la comunidad (NAC) presentan mas riesgo de muerte y las caracteristicas que nos permitan tal determinacion. Objetivos Analizar las clases de riesgo de la NAC. Comprobar cual era la comorbilidad asociada y si la edad, el sexo o el lugar de residencia de los pacientes con NAC ingresados incrementan la proporcion de fallecidos. Metodo Estudio retrospectivo con 113 pacientes diagnosticados de NAC e ingresados en una Unidad de Hospitalizacion de Neumologia. Resultados Se estudiaron 113 pacientes (68 hombres y 45 mujeres), de los cuales fallecen 15 (13,3%). La edad media de los fallecidos era de 82,5 anos (desviacion estandar [DE]: 6,63), significativamente mayor que los supervivientes (70,5 anos, DE: 17,3). No existian diferencias significativas de edad o sexo entre los fallecidos y los supervivientes pertenecientes a la clase de mayor riesgo. La mayoria tenian comorbilidad (82 pacientes, 72,6%). Procedian de una residencia asistida 17 de los pacientes ingresados (15%), mas frecuente en los fallecidos (5 pacientes, 33%) que entre los supervivientes (12 pacientes, 12%), diferencia estadisticamente significativa (p Conclusiones No encontramos diferencias de mortalidad entre los pacientes en funcion de la edad o el sexo una vez estratificados por clases de riesgo. Existe una alta proporcion de enfermedades coexistentes, falleciendo en mayor proporcion aquellos que asocian alguna de ellas. En nuestra serie los pacientes procedentes de una residencia asistida presentan una mayor mortalidad.

To determine the extent of lung cancer in Alvila. Its incidence rates and significant epidemiological aspects of the year 2012 were recorded, and the results of each 5-year period (up to 20 years) were compared with those of known studies conducted using the same methodology.A prospective study was conducted on all patients diagnosed with lung cancer in the Province of Avila throughout the year 2012.A total of 81 patients were diagnosed, of whom 70 were males and 11 females, with a mean age of 72.1 years (range: 44-91), and was higher than that found in previous studies. This gave gross, and adjusted to the standard world population, incidence rates in 2012 of 80.99 and 31.23 per 100,000, respectively, in males, and 12.97 and 5.68 per 100,000, respectively in females. These rates are lower in both sexes than those found in Alvila in 2002. In 2012, 80.25% had been smokers (90% of males and 18.18% of the women), although, on diagnosis, 68.75% had quit smoking. A clinical-radiological diagnosis was made in 9 (11.1%), with a histocytological diagnosis in 72 (88.9%). The histological types were: adenocarcinomas in 37.5%; squamous in 33.3%; microcytic in 13.8%; undifferentiated non-small cell in 11.1%; large cell in 2.77%, and carcinoid in 1.38%. The most frequent treatments were chemotherapy (50.6%), symptomatic (23.4%), and surgery (12.3%).The incidence of lung cancer in Avila has decreased in both sexes in the last 10 years. In 2012, the patients have been older, the majority with adenocarcinoma histology, and receiving chemotherapy.

A case of a 30-year-old man is presented. He had a past medical history of asthma and presented with cough, shortness of breath, fever and chest pain. The chest X-ray showed cardiomegaly and a interstitial pattern. The echocardiogram revealed a severe pericardial effusion that required performing a pericardiocentesis. A CT scan showed mediastinal adenopathies and reticulonodular interstitial pattern. A bronchoscopy could not be completed because of non-tolerance. Finally a lung biopsy allowed us to reach a final diagnosis of lung adenocarcinoma. Following, some aspects of lung cancer in young people are commented, especially its incidence, histology, symptoms and a prognosis. A few aspects of the interstitial lung disease are also addressed and the differential diagnosis with lymphangitic carcinomatosis.

Presentamos el caso de un varón de 30 años de edad, con antecedentes de asma bronquial, que presentó un cuadro de tos, disnea, fiebre y dolor torácico. En la radiografía de tórax se observó cardiomegalia y un patrón intersticial bilateral. En el ecocardiograma, se apreció un derrame pericárdico severo, que obligó a la realización de una pericardiocentésis. En una TAC torácica se observaron adenopatías mediastínicas y un patrón intersticial retículo nodular bilateral. No se pudo completar la broncoscopia por mala tolerancia. Finalmente una biopsia pulmonar permitió el diagnóstico de adenocarcinoma de pulmón. Posteriormente se comentan algunos aspectos del cáncer de pulmón en pacientes jóvenes (menores de 40 años), destacando datos sobre su incidencia, anatomía patológica, clínica y pronóstico. Referimos algunos aspectos de la enfermedad intersticial pulmonar y su diagnóstico diferencial con el carcinoma de pulmón con linfangitis carcinomatosa.

The residence and underlying diseases could be increase the severity and risk in the pneumonia in the elderly patient.To analyse demographics qualities and mortality in elderly inpatients with pneumonia, in relation with kind of residence, and to determine the risk classes distribution.Were studied inpatients with 65 years old or more, with pneumonia in a period of 12 months, taking demographics values and underlying diseases, including each patient in a risk class (II to V).One hundred and three patients were studied (78.5 years mean age-SD 7.16), 67 males and 36 females, 80% includes in high risk classes, with 15.5% mortality. 17.5% were home nursing, older (82.7 years mean age-SD 5.72-) (p0.002), predominantly females and in high risk classes, and with lower length of hospital stay.The elderly patients with community-acquired pneumonia was high risk. Home nursing was older, more risk and lower length of hospital stay.

La residencia del paciente y enfermedades subyacentes pueden incrementar la gravedad y el riesgo de la neumonía en el paciente anciano. Objetivos: Analizar las características demográficas y la mortalidad de los pacientes ancianos ingresados con neumonía, según su procedencia y determinar la distribución por clases de riesgo. Método: Se estudiaron los pacientes de al menos 65 años, ingresados con neumonía durante 12 meses, recogiendo datos demográficos, clínicos y de las enfermedades coexistentes, asignando cada paciente a una clase de riesgo (de II a V). Resultados: Se estudiaron 103 pacientes (edad media de 78,5 años-DE 7,16-), 67 hombres y 36 mujeres, el 80% pertenecientes a clases de riesgo alto, con una mortalidad del 15,5%. El 17,5% procedían de una Residencia asistida, con una edad superior al resto (edad media de 82,7 años-DE 5,72-) (p

The Study of Talavera de la Reina analyzes the presence of several cardiovascular risk factors (CVRF) in this city, by means of a cross-sectional study of the population within 1989 and 1990. In this paper, the results on tobacco consumption, as well as the correlation between tobacco consumption and several anthropometric and biochemical parameters, some of which are independent CVRF theirselves, are presented. Seven hundred and two people were evaluated, 332 men and 370 women, with ages between 20 and 79 years, and were randomized according to the current population census. We have carried out a survey to assess smoking habits; physical examination to measure weight and height, systolic and diastolic arterial pressure, blood analysis including total cholesterol, C-HDL, triglycerides and glucose. C-LDL was obtained using the Friedewald-Fredickson formula. Smoking habits among the younger female population is almost equal to male population. Compared by age groups and similar sex, no significant differences were observed related to anthropometric and biochemical parameters between smokers and non-smokers. The lipidic profile of non-smokers against moderate/heavy smokers (smoking 10 or more gr/day) was compared. The presence of an atherogenic profile in 30 to 39-year-old men and in 40 to 49-year-old women was verified, as well as the lower C-HDL levels among younger smokers of both sexes. This provides tobacco with an added value, as it increases the impact of other CVRF in key ages for the pathogenicity of arteriosclerosis.