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Eduardo Garcia-Pachon

Publications and source records attributed to Eduardo Garcia-Pachon.

11 recordsLinked to original sources
PubMed2006

Red cell macrocytosis in COPD patients without respiratory insufficiency: a brief report.

Red cell macrocytosis has been frequently described in hypoxemic patients with chronic obstructive pulmonary disease (COPD). However, macrocytosis is not related to hyoxemia. The objective of this study was to determine the frequency of macrocytosis (defined as mean corpuscular volume (MCV) higher than 94fl) in stable COPD patients without respiratory insufficiency, and to analyze the possible relationship between its presence and clinical and functional parameters. Fifty-eight consecutive patients with COPD, and without other significant comorbid conditions, were included in the study. Macrocytosis was present in 17 of the 58 stable COPD patients (29%). The differences between patients with and without macrocytosis were not statistically significant, except for MCV. In the subgroup of 36 ex-smoker COPD patients, macrocytosis was present in nine patients (25%). In this subgroup, MCV significantly correlated with dyspnea (r=0.36, P=0.03) and forced expiratory volume in 1s (FEV(1)) (r=-0.35, P=0.03). We conclude that macrocytosis is a frequent finding in stable non-hypoxemic COPD patients, and that in ex-smoker patients the degree of macrocytosis is associated with a worse clinical situation in terms of dyspnea and FEV(1).

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PubMed2006

Urinothorax: a new approach.

PURPOSE OF REVIEW: The presence of urine in the pleural space (urinothorax) is a rarely recognized cause of pleural effusion. To date, only 58 cases have been reported. In this article the features of urinothorax are analyzed, and clinical and biochemical characteristics are reviewed in order to propose a classification, founded on pathogenic criteria, that will be useful in achieving the diagnosis. RECENT FINDINGS: Recently reported cases of urinothorax provide a more detailed description of the biochemical characteristics that allow a better understanding of this entity. SUMMARY: Urinothorax can be divided into two categories: (1) obstructive urinothorax, due to bilateral obstructive uropathy; and (2) traumatic urinothorax, due to unilateral traumatic injury of the urinary system, mostly iatrogenic. In patients with urinothorax, the pleural effusion usually has the biochemical characteristics of a transudate, with a pH lower than 7.30 and a pleural fluid/serum creatinine ratio higher than 1. These characteristics are not always present, however, and individually are shared by a significant number of pleural effusions of different etiology.

Creatine↗
PubMed2004

Clinical implications of Hoover's sign in chronic obstructive pulmonary disease.

Background: The objective of the study was to evaluate whether Hoover's sign-the paradoxical inspiratory movement of the lateral rib margin-may have clinical implications in patients with COPD. Methods: The study included two groups of male patients with stable COPD-30 with and 30 without Hoover's sign-who were matched for age and smoking habits. Spirometric values were assessed for both groups. Degree of dyspnea, measured for normal activities with the Medical Research Council (MRC) scale and for climbing two flights of stairs with the Borg scale, and utilization of health resources, including hospitalization, were compared. Results: Patients with Hoover's sign had a higher degree of dyspnea [MRC 2.2 (S.D.: 1.2) and 1.0 (0.8), p<0.0001; Borg 5.6 (2.4) and 3.1 (2.3), p=0.0001] and a higher number of hospitalizations [0.87 (1.0) and 0.27 (0.5), p=0.005] and emergency visits [2.5 (2.3) and 0.9 (2.3), p=0.01] than patient's without it. FEV(1) significantly correlated with dyspnea scales only in patients with Hoover's sign (MRC r=0.48; Borg r=0.49; p<0.05). Conclusions: Our study shows that Hoover's sign in COPD identifies a group of patients with a higher level of dyspnea and a higher use of health care resources, regardless of the degree of functional impairment. Consequently, establishing the presence of Hoover's sign would appear to be valuable in treating patients with COPD.

Journal Article↗
PubMed2004

Can pulse oximetry select patients for screening spirometry?

AIM: To investigate whether the measurement of arterial oxygen saturation (SpO(2)) with pulse oximetry can identify those patients for whom spirometric screening for COPD would be useful, and those patients for whom spirometric assessment would not be useful. METHODS: Two hundred and ten patients, aged over 40, without significant dyspnoea, referred by their primary care physicians to the outpatient pulmonary clinic. The value of SpO(2) was recorded with a finger clip pulse oximeter sensor. Diagnostic values were obtained in order to diagnose COPD (defined as an FEV(1)/FVC ratio <0.70), and in order to detect patients with an FEV(1) <80% of predicted value. RESULTS: With SpO(2) <98%, sensitivity for detecting COPD was 79% and specificity 37%. Similar values were obtained for detecting patients with FEV(1) <80%. When only patients with FEV(1) <50% were considered, using a value of <98% for SpO2, sensitivity was 77%. CONCLUSION: Pulse oximetry is not a useful test for selecting patients for screening spirometry in order to diagnose COPD.

Journal Article↗
PubMed2002

Paradoxical movement of the lateral rib margin (Hoover sign) for detecting obstructive airway disease.

STUDY OBJECTIVE: To evaluate the diagnostic accuracy of Hoover sign for detecting obstructive airway disease (OAD), compared with wheezes, rhonchi, reduced breath sounds, and clinical impression, and to analyze the observer agreement on these signs. DESIGN: Prospective, blind comparison, with a reference standard (spirometry) among a consecutive series of patients. SETTING: Outpatient pulmonary clinic. PATIENTS: One hundred seventy-two patients (117 men [68%] and 55 women [32%]), who were > 40 years of age, had not been known previously by the participating physicians, and met at least one of the following criteria: smokers of > 20 pack-years; patients who had received a diagnosis of or had self-reported COPD (or chronic bronchitis or emphysema); patients who had received inhaler bronchodilator treatment for > 6 months; or patients with any degree of dyspnea. MEASUREMENTS: Patients were examined by a first-year resident in family medicine and by a pulmonologist. Spirometry was performed by a blinded trained technician. OAD was defined as an FEV1/FVC ratio of < 0.70. RESULTS: OAD was present in 64 patients (37%). Observer agreement (kappa statistic) was 0.74 for Hoover sign and was lower for the rest of the signs. Hoover sign had a sensitivity of 58% and a specificity of 86% for detecting OAD, and it had a positive likelihood ratio of 4.16, which was higher than that of the other signs. CONCLUSIONS: Hoover sign, a frequently forgotten sign, is easy to recognize and is useful for detecting OAD.

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PubMedDate not supplied

Urinothorax: case report and review of the literature with emphasis on biochemical diagnosis.

Urinothorax is a rare cause of transudative pleural effusion secondary to obstructive uropathy. We present a case of urinothorax after shock wave lithotripsy and review the literature. A total of 53 cases have been described previously, and in a few of them, the biochemical characteristics of the pleural fluid were detailed. In general, patients with urinothorax have low pH and glucose levels, and their lactate dehydrogenase level can be very high, resulting in misclassification of the effusion as an exudate. The average pleural fluid to serum creatinine ratio reported in 12 cases was 9.15 (range 1.09-19.8).

Exudates and Transudates↗
PubMedDate not supplied

C-reactive protein in lymphocytic pleural effusions: a diagnostic aid in tuberculous pleuritis.

BACKGROUND: C-reactive protein (CRP) pleural fluid levels have been found to be higher in tuberculosis and parapneumonic effusions than in other causes of pleural effusion. OBJECTIVE: The aim of this study was to analyze whether CRP (a simple and inexpensive test) may be a diagnostic aid for tuberculosis in lymphocytic pleural effusions. METHODS: One hundred and forty-four patients with a lymphocytic pleural effusion (more than 50% lymphocytes in the differential white blood cell count) were included. The patients were 93 men (65%) and 51 women (35%), aged 64 +/- 18 years (mean +/- SD). The diagnoses were as follows: tuberculosis, 20; pleural effusion associated with malignancy, 69; transudates, 38; other benign exudates, 17. RESULTS: The CRP pleural fluid level was higher in tuberculous pleuritis (54 +/- 24 mg/l) than in lymphocytic effusions of other origin (21 +/- 16 mg/l; p < 0.001). High CRP levels (>or=50 mg/l) have a high specificity for tuberculosis (95%), and low levels (<30 mg/l) have a high sensitivity (95%) for excluding disease. CONCLUSIONS: CRP pleural fluid level determination is useful in the diagnostic workup of lymphocytic pleural effusions. High CRP levels are very suggestive of tuberculous pleuritis, and low CRP levels make this diagnosis unlikely.

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