[Effect of nebulised iloprost combined with inhaled nitric oxide and oral sildenafil on lung transplant patients. Therapeutic efficacy in pulmonary hypertension during surgery]. / Efecto de iloprost nebulizado combinado con óxido nítrico inhalado y sildenafilo oral en las presiones pulmonares de pacientes sometidos a trasplante pulmonar. Eficacia terapéutica en la hipertensión pulmonar intraoperatoria.

OBJECTIVES: There is a high incidence of pulmonary hypertension during the lung transplant peri-operative period, and could lead to a haemodynamic deterioration that may require the need of extracorporeal circulation. Our aim was to study the haemodynamic effects on the pulmonary and systemic circulation of the combination of inhaled nitric oxide and iloprost and oral sildenafil in patients with severe pulmonary hypertension during lung transplant surgery. PATIENTS AND METHODS: Seventeen patients received 10µg of nebulised iloprost during the peri-operative period of the lung transplant when their mean pulmonary pressure exceeded 50mmHg. AU the patients received 50mg of oral sildenafil 30min before anaesthetic induction, 20ppm of inhaled nitric oxide after tracheal intubation. The haemodynamic and respiratory variables were recorded at baseline (after anaesthetic induction), prior to the administering of iloprost, and at 5 and 30min after it was given. RESULTS: The administering of iloprost significantly reduced the pulmonary arterial pressure and significantly increases the cardiac Índex and the right ventrícular ejection fractíon. There were no signíficant changes occurred in the systemic arterial pressure. CONCLUSIONS: The triple combination significantly reduces the pulmonary pressures in the lung transplant peri-operative and should be considered when there is severe pulmonary hypertension during the surgery or during the immediate post-operative period of lung transplantation.

Prevalence and management of gastrointestinal complications in lung transplant patients: MITOS study group.

INTRODUCTION: No studies have yet been performed to evaluate the prevalence of gastrointestinal (GI) complications in solid organ transplant recipients in Spain. MATERIALS AND METHODS: An observational, cross-sectional study to evaluate the prevalence and management of GI complications in transplanted patients was conducted via a written questionnaire given to doctors at their practice. RESULTS: A total of 58 lung transplant recipients were included. Their mean age was 52.6 +/- 10.8 years; 65% of the patients were men; and the mean time since the transplant was 2.1 +/- 2.3 years. GI complications were seen in 48.6% of the lung transplant patients. Regarding the management, the most frequently used measure was the prescription of gastric protectors (70.5%). In seven patients, the immunosuppressive treatment was also modified (reduced, discontinued temporarily, or discontinued permanently); however, the figure is so low that no conclusions can be drawn from this result. CONCLUSIONS: The prevalence of GI complications in lung transplant was over 50%, and these complications affected patients' daily activities in most cases. In lung transplant recipients, there was a higher prevalence of nausea and abdominal pain and a lower of diarrhea and dyspepsia than what was observed in other type of transplant recipients.

[Hormone expression and opioid receptors in fetal and adult lung]. / Expresión hormonal y de receptores opioides en pulmón fetal y del adulto.

OBJECTIVES: To describe the cellular distribution and level of expression of certain hormones and opioid receptors during fetal development and in the lung of the healthy adult. METHOD: We sampled lung tissue from fetuses at three stages of development (pseudoglandular, canalicular and saccular) (3 samples per stage), from newborn infants (3), from 10-month-old infants (2) and from adults (3) who had died without lung disease. After specific immunohistochemical staining for hormones (calcitonin, parathormone, serotonin and adrenocorticotropic hormone - ACTH) and opioid receptors, we assessed the percentage of positive cells for each cell type in each sample. RESULTS: Serotonin is the first to appear (pseudoglandular stage in isolated neuroendocrine cells) and it disappears later. Calcitonin appears in the canalicular stage in neuroendocrine and lung cells. Expression is at its peak at birth and is less in the adult lung. We found no ACTH or parathormone production. Opioid receptors appear in the canalicular stage and peak at birth. In adult lung, bronchiolar muscle and mesothelial cells, only delta-type opioid receptors are present. CONCLUSIONS: Pulmonary hormone secretion is significant during fetal development and peaks at birth. Calcitonin is the main hormone produced in the fetal lung. Opioid receptors are present during fetal development in various types of cells and peak at birth. An understanding of the expression of active substances could have therapeutic relevance in certain conditions, such as bronchial asthma or respiratory distress syndrome in the child.

Expresión hormonal y de receptores opioides en pulmón fetal y del adulto / Hormone expression and opioid receptors in fetal and adult lung

OBJETIVOS: Describir la distribución celular y el grado de expresión de diversas hormonas y receptores de opioides en el desarrollo embrionario y en el pulmón sano del adulto. MÉTODO: Seleccionamos tejido pulmonar de las tres etapas del desarrollo fetal (seudoglandular, canalicular y sacular, tres muestras por etapa), de recién nacidos (tres), niños de 10 meses (dos) y adultos (tres) fallecidos sin afección pulmonar. Practicamos tinción inmunohistoquímica para hormonas específicas (calcitonina, parathormona, serotonina y hormona adrenocorticotropa [ACTH]) y receptores de opioides tipo delta y mu. Valoramos el porcentaje de células positivas así como el tipo celular reactivo en cada caso. RESULTADOS: La serotonina es la primera en aparecer (estadio seudoglandular en células neuroendocrinas aisladas) para posteriormente desaparecer. La calcitonina aparece en el estadio canalicular en células neuroendocrinas y neumocitos. Su expresión máxima es al nacimiento y disminuye en el pulmón adulto. No hemos encontrado producción de ACTH ni de parathormona. Los receptores de opioides aparecen en la fase canalicular y alcanzan el máximo grado en el nacimiento. En el adulto sólo existen receptores para opioides tipo delta en neumocitos, células musculares bronquiolares y mesoteliales. CONCLUSIONES: La hormonosecreción pulmonar es importante durante el desarrollo fetal y alcanza su máxima expresión en el nacimiento. La principal hormona que produce el pulmón fetal es la calcitonina. Existen receptores opioides durante el desarrollo fetal en diferentes tipos celulares y alcanzan su máxima expresión al nacimiento. El conocimiento de la expresión de sustancias activas podría tener consecuencias terapéuticas en determinados procesos patológicos como el síndrome de distrés respiratorio en el niño o el asma bronquial (AU)

[The characteristics of patients who have died from tuberculosis]. / Características de los pacientes fallecidos por tuberculosis.

OBJECTIVE: To analyze the characteristics of the patients died from tuberculosis (TB) in our hospital. METHOD: We retrospectively reviewed the records of the 46 patients died in-hospital from TB between january, 1992 and june, 1997. MEAN AGE: 55 +/- 19 years (19-85). 35 (76%) males and 11 (24%) females. DIAGNOSIS: pulmonary (63%), disseminated (26%) and extrapulmonary (11%) TB. 87% of the patients had previous comorbidity (35% were seropositive for HIV). The only differences between HIV-infected and non-HIV-infected cases were a greater proportion of normal chest roentgenograms and of toxicity from therapy in seropositive patients. The disease was diagnosed at death in 17% of cases. Chemoprophylaxis had not been used in 5 patients, although they fulfilled criteria for receiving it. Poor compliance with treatment was noted in 6 (13%) patients. CONCLUSIONS: We have found a high prevalence of comorbidity in these patients, which might account for the mortality. Delays in diagnosis, misuse of chemoprophylaxis and poor compliance with therapy might also be implicated in some cases.

[Varicella pneumonia in the previously healthy adult]. / Neumonía varicelosa en el adulto previamente sano.

Varicella (chickenpox) is a contagious, self-limited, usually benign disease common in childhood but uncommon in adulthood. Pneumonia is the most frequent complication of the disease in adults. We retrospectively review 7 cases of varicella pneumonia in previously healthy adults diagnosed in our hospital between 1992 and 1996. All of them were treated with intravenous acyclovir with good therapeutic response save for a patient who developed respiratory insufficiency and died 8 days after his admission. Smoking was the only risk factor detected. Clinical features of our patients are described and the need of an early diagnosis and treatment of varicella pneumonia is emphasized.

Características de los pacientes fallecidos por tuberculosis / Characteristics of patients died from tuberculosis

Objetivo: conocer las características de los pacientes que fallecen por tuberculosis (TB) en nuestro centro. Método: Revisamos retrospectivamente las historias clínicas de los 46 casos de muerte intrahospitalaria debida a TB entre enero de 1992 y junio de 1997. Edad media: 55 ñ 19 años (19-85). 35 (76 %) varones y 11 (24 %) mujeres. Resultados: Tipo de TB: pulmonar (63 %), diseminada (26 %) y extrapulmonar (11 %). El 87 % de los casos presentaban comorbilidad preexistente (el 35 porciento, coinfección por VIH). Las únicas diferencias entre pacientes VIH (+) y (-) fueron un mayor porcentaje de radiografía de tórax normal y de toxicidad medicamentosa en los enfermos seropositivos. En el 17 % de los casos, el diagnóstico se realizó tras el fallecimiento. En 5 pacientes no se había empleado quimioprofilaxis antituberculosa pese a estar indicada, y en 6 (13 %) detectamos un mal cumplimiento terapéutico. Conclusiones: en este tipo de pacientes hay una elevada prevalencia de comorbilidad como posible causa de la mala evolución. La existencia de retrasos en el diagnóstico, un empleo inadecuado de la quimioprofilaxis y un mal cumplimiento terapéutico podrían relacionarse con la mala evolución en algunos casos (AU)

Neumonía varicelosa en el adulto previamente sano / Varicella penumonia in the previously healthy adult

La varicela es una enfermedad contagiosa autolimitada y generalmente benigna propia de la infancia, y poco común en el adulto. La neumonía es la complicación mas frecuente de la enfermedad en el adulto. Revisamos retrospectivamente 7 casos de neumonía varicelosa en adultos previamente sanos diagnosticados en nuestro hospital entre 1992 y 1996. Todos ellos fueron tratados con Aciclovir endovenoso, presentando buena evolución salvo un paciente que desarrolló insuficiencia respiratoria y falleció 8 días tras su ingreso. El tabaco fue el único factor de riesgo detectado. Presentamos las particularidades clínicas de nuestros pacientes y destacamos la necesidad de un diagnóstico y tratamiento precoz de la neumonía por varicela (AU)

[Spontaneous pneumothorax associated with human immunodeficiency virus (HIV) infection]. / Neumotórax espontáneo asociado a la infección por el virus de la inmunodeficiencia humana (VIH).

Spontaneous pneumothorax is a relatively frequent complication of human immunodeficiency virus (HIV) infection. Seven hundred sixty-five HIV-infected inpatients were treated at Marques de Valdecilla University Hospital between 1990 and 1996. Spontaneous pneumothorax developed in 9 patients. Pneumocystis carinii pneumonia was diagnosed in 6 patients (66%), either before or simultaneous to the appearance of pneumothorax. Pneumothorax was related to active or old tuberculosis infection in 3 patients (33%). Prophylactic therapy with nebulized pentamidine was used in 55% of the patients. Successful initial control of pneumothorax was achieved with simple drains in 58% of the episodes, although the recurrence rate was 71%. Pleurodesis with talcum with a chest tube was used successfully in 3 patients, in 2 because of sings of persistent air leakage uncorrected by simple drainage. Pleurodesis initially failed but later controlled pneumothorax the second time it was used. The mortality rate in this series was 66%, with a mean survival time of 55.6 days. We conclude that spontaneous pneumothorax is associated with poor prognosis in HIV infected patients. Prior or concurrent P. carinni pneumonia or tuberculosis were the etiologic factors identified in our patients. A simple pleural drain was associated with a high rate of recurrence, such that pleurodesis seems warranted in all patients.