This study was designed to investigate the interaction of mild and localized cold exposure and hypoxia on pulmonary hemodynamics in chronic obstructive pulmonary disease (COPD). Nineteen patients with COPD were studied at sea level and seven at an altitude of 2,640 m. For all patients, pulmonary hemodynamic measurements were performed 10 min after insertion of a catheter in a femoral vein and following 10 min of cold exposure. Cold exposure was restricted to the forehead, and subjects breathed air at ambient temperature. Flow and temperature of air (1.5 L.s(-1), 5 degrees C) to the forehead were chosen to cool down the forehead skin to approximately 20 degrees C without discomfort for the subject. For the seven patients studied at high altitude, the same measurements were also performed after 5 min of oxygen supplementation with and without cold exposure. At sea level, an increase in pulmonary vascular resistance (PVR) during cold exposure was inversely related to the initial PaO2. In six severe hypoxic subjects (PaO2 < 50 mm Hg), PVR increased by 24%. At high altitude, PVR was significantly increased by 15%. After O2 supplementation, cold exposure did not induce an increase in PVR. We concluded that mild and localized cold exposure to the forehead only induced an increase in PVR in COPD patients with severe hypoxia. Moreover, in cold exposure responders, O2 supplementation negated the effect of cold exposure on pulmonary hemodynamics.

TIOSPIR patients in Latin America had a higher risk of death or moderate-to-severe exacerbation, but a lower risk of severe exacerbation than those in RoW. Geographical differences may impact outcomes in COPD trials.

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Se presenta el caso de una paciente de 56 años, quien consulta por dolor torácico lateral izquierdo de dos días de evolución y en su radiografía de tórax tomada en preoperatorio de nódulo tiroideo aparece una pequeña banda de atelectasia plana basal izquierda. Por persistencia del dolor en el posoperatorio tardío, se realizan estudios de ultrasonido, gammagrafía ósea, TAC de tórax y RNM de tórax, encontrándose finalmente un elastofibroma dorsi como causa del dolor a partir de los estudios realizados. El elastofibroma dorsi es una entidad relativamente rara, de patogénesis desconocida, que requiere de sospecha clínica para su diagnóstico. Las imágenes pueden comprobar el diagnóstico sin requerir biopsia. La resección es necesaria por crecimiento de la lesión o dolor persistente. Se revisa la literatura pertinente.

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