ABSTRACT
Graft-versus-host disease is a major complication for bone marrow transplant recipients and is often a cause of late mortality. It can affect any tissue, and involvement of the lungs--target organs of particular importance--can lead to chronic respiratory failure due to bronchiolitis obliterans. We report the case of a lung transplant in a woman who developed bronchiolitis obliterans after receiving a marrow transplant to treat bone marrow aplasia. Three years later, clinical course was satisfactory, with full functional recovery.
Subject(s)
Bone Marrow Transplantation/adverse effects , Bronchiolitis Obliterans/etiology , Bronchiolitis Obliterans/surgery , Lung Transplantation , Child , Female , HumansABSTRACT
La enfermedad del injerto contra el huésped es una complicación importante de los pacientes sometidos a trasplante de médula ósea, en quienes es causa de una elevada mortalidad tardía. Puede afectar a cualquier tejido y, cuando afecta a los pulmones, que son órganos diana de particular relevancia, acarrea insuficiencia respiratoria crónica secundaria al desarrollo de bronquiolitis obliterante. Presentamos el caso de una paciente con trasplante pulmonar por bronquiolitis obliterante tras haber recibido un trasplante de médula ósea por aplasia medular. La evolución tras el trasplante pulmonar, a los 3 años de seguimiento, es favorable, con recuperación clínica y funcional completa
Graft-versus-host disease is a major complication for bone marrow transplant recipients and is often a cause of late mortality. It can affect any tissue, and involvement of the lungs --target organs of particular importance-- can lead to chronic respiratory failure due to bronchiolitis obliterans. We report the case of a lung transplant in a woman who developed bronchiolitis obliterans after receiving a marrow transplant to treat bone marrow aplasia. Three years later, clinical course was satisfactory, with full functional recovery
Subject(s)
Female , Child , Humans , Lung Transplantation , Bronchiolitis Obliterans/etiology , Bone Marrow Transplantation/adverse effects , Transplantation, Homologous , Anemia, Aplastic/surgeryABSTRACT
No disponbile
Subject(s)
Humans , Thoracic Surgery, Video-Assisted/methods , Endoscopy/methods , Respiratory Tract Diseases/diagnosis , Thoracentesis/methods , Image-Guided Biopsy/methods , Drainage/methodsABSTRACT
No disponible
Subject(s)
Humans , Minimally Invasive Surgical Procedures , Thoracic Surgery, Video-Assisted/methods , Thoracic Diseases/surgery , Thoracic Surgery, Video-AssistedABSTRACT
AIMS: Combinations of surgery and chemotherapy have a favourable impact on survival in the treatment of disseminated neoplastic disease isolated to the lung. Sample and technical factors have made the reproduction of the published results difficult. METHODS: In this study we report experience over 10 years. RESULTS: From 1989 to 1999 40 patients underwent metastasectomy. Thirty received chemotherapy. The median survival is 51 months, similar to other published series. CONCLUSION: Survival benefit can be observed in small series of such cases.
Subject(s)
Lung Neoplasms/secondary , Lung Neoplasms/surgery , Adolescent , Adult , Aged , Female , Humans , Lung Neoplasms/mortality , Male , Middle Aged , Survival RateABSTRACT
UNLABELLED: Pneumonectomy continues to be associated with high rates of morbidity and mortality. OBJECTIVE: The aim of this study was to determine the mortality and morbidity rates after pneumonectomy and to analyze perioperative risk factors related to mortality. PATIENTS AND METHODS: The cases of 266 patients undergoing pneumonectomy between January 1986 and December 1997 were reviewed retrospectively: 241 patients with lung cancer, 4 with pulmonary metastasis, 9 with bronchiectasis and 12 with other benign diseases; 13% received neoadjuvant therapy. The bronchial stump was stapled in 92%, sutured in 8%, and covered with autologous tissue in 73%. Intrapericardial pneumonectomy was performed in 32%, pneumonectomy extended to the chest wall or diaphragm in 9%, and completion pneumonectomy was performed in 3%. We collected general demographic data, medical histories, pulmonary function data and surgical technique. Deaths and postoperative complications within the first 30 days after pneumonectomy were also known. RESULTS: Two hundred sixty-six pneumonectomies were performed [right 102 (38%); left 164 (62%)] in 249 men (93%) and 17 women (7%) who were 58 +/- 11 years of age (20 to 79 years). The rate of early postoperative death (30 days) was 5.6%. Mortality rates were higher among patients over 70 years of age (p = 0.045), diabetics (p = 0.038), patients undergoing neoadjuvant therapy (p = 0.031), those with FEV1 under 1,800 ml (p = 0.013), cases of right-sided pneumonectomy (p = 0.001), cases of extended pneumonectomy (p = 0.037) or those without coverage of the bronchial stump (p = 0.005). Mortality was also higher when complications appeared involving the bronchial stump (p < 0.01), heart (p < 0.001), respiration (p < 0.001) or digestion (p = 0.002). Overall morbidity was 40%. Surgical complications developed in 23%: postpneumonectomy empyema (10%), bronchopleural fistula (7%) (with no significant difference related to stapling or suturing), hemothorax (3%) and wound complications (3%). Twelve patients (4.5%) underwent second operations. Cardiac morbidity was 20% (atrial fibrillation in 12%), respiratory morbidity was 8% and other complications appeared in 19% of cases. CONCLUSION: In our experience, mortality after pneumonectomy is 5.6% with an overall complication rate of 40%, mainly due to surgical and cardiac complications. Coverage of the bronchial stump with autologous tissue reduces the risk of postoperative death due to fistula and/or empyema after pneumonectomy.
Subject(s)
Lung Diseases/surgery , Pneumonectomy/adverse effects , Postoperative Complications/epidemiology , Adult , Aged , Female , Humans , Lung Diseases/complications , Male , Middle Aged , Retrospective Studies , Risk FactorsABSTRACT
Objetivo: Determinar la tasa de mortalidad y morbilidad tras neumonectomía y analizar factores de riesgo perioperatorios relacionados con la mortalidad. Pacientes y métodos: Se han revisado retrospectivamente 266 pacientes sometidos a neumonectomía entre enero de 1986 y diciembre de 1997: 241 casos por carcinoma broncogénico, metástasis pulmonares en 4, bronquiectasias en 9 casos y otra afección benigna en 12 pacientes; el 13 por ciento de los casos recibieron terapia neoadyuvante. El muñón bronquial se suturó mecánicamente en el 92 por ciento y manualmente en el 8 por ciento, y se realizó cobertura del mismo con tejido autólogo en el 73 por ciento de los casos. La neumonectomía fue intrapericárdica en el 32 por ciento, extendida a pared torácica o diafragma en el 9 por ciento y se completó neumonectomía tras resección menor previa en el 3 por ciento de los casos. Se recogieron datos demográficos generales, antecedentes patológicos, datos de función respiratoria y técnica quirúrgica. También se obtuvieron datos de mortalidad y complicaciones postoperatorias en los primeros 30 días tras la neumonectomía. Resultados: Se han realizado 266 neumonectomías, 102 derechas (38 por ciento) y 164 izquierdas (62 por ciento), en 249 varones (93 por ciento) y 17 mujeres (7 por ciento), con una media de 58 ñ 11 años (rango, 20-79 años). La mortalidad postoperatoria temprana (30 días) fue del 5,6 por ciento. La mortalidad fue superior en pacientes mayores de 70 años (p = 0,045), diabéticos (p = 0,038), sometidos a terapia neoadyuvante (p = 0,031), con FEV1 menor de 1.800 ml (p = 0,013), en las neumonectomías derechas (p = 0,001), extendidas (p = 0,037) o sin cobertura del muñón bronquial (p = 0,005). Asimismo, la mortalidad fue mayor cuando aparecieron complicaciones del muñón bronquial (p < 0,01), complicaciones cardíacas (p < 0,001), respiratorias (p < 0,001) y digestivas (p = 0,002). La morbilidad global fue del 40 por ciento. Aparecieron complicaciones quirúrgicas en un 23 por ciento de los casos: empiema posneumonectomía (10 por ciento), fístula broncopleural (7 por ciento) (sin diferencias entre sutura manual y mecánica), hemotórax (3 por ciento) y complicaciones de la toracotomía (3 por ciento). Doce pacientes se reoperaron (4,5 por ciento). La morbilidad cardíaca fue del 20 por ciento (fibrilación auricular en el 12 por ciento), la morbilidad respiratoria fue del 8 por ciento y otras complicaciones aparecieron en el 19 por ciento de los casos. Conclusión: En nuestra experiencia, la mortalidad tras neumonectomía es del 5,6 por ciento, con una morbilidad global del 40 por ciento, principalmente debida a complicaciones quirúrgicas y cardíacas. La cobertura del muñón bronquial con tejido autólogo reduce el riesgo de muerte postoperatoria por fístula y/o empiema posneumonectomía. (AU)
Subject(s)
Middle Aged , Adult , Aged , Male , Female , Humans , Risk Factors , Postoperative Complications , Pneumonectomy , Retrospective Studies , Lung DiseasesABSTRACT
Very few cases of lung transplantation have been described for patients with Kartagener's syndrome. We report the first case to be published in Spain. A 15-year-old girl with complete Kartagener's syndrome underwent sequential transplantation of both lungs. Due to the unusual distribution of the organs in this syndrome, the bronchial stumps of donor and recipient had to be distributed differently. With the initial technical difficulties overcome, the patient now leads a normal life two years after transplantation.
