[Aspergillosis in pulmonary transplantation]. / Aspergilosis en el trasplante pulmonar.

BACKGROUND: Fungal infections are a frequent cause of morbidity an mortality in transplant recipients. Aspergillus spp. is an ubiquitous fungus capable of producing diverse clinical entities with varying severity. OBJECTIVE: To study the incidence and severity of Aspergillus spp. infections in lung transplantation, analysing the different clinical presentations and response to antifungal drugs. METHODS: A review was made of the clinical histories of all patients undergoing lung transplantation who developed positive Aspergillus spp. cultures in our centre between June 1991 and December 1996. RESULTS: Eleven of 49 transplanted patients (22%) developed Aspergillus spp. infections. Four patients presented invasive aspergillosis forms and 7 tracheobronchitis. In spite of antifungal treatment 3 patients (30%) died of invasive aspergillosis as a direct consequence of the infection. Of the 7 patients with tracheobronchitis, 2 were ulcerative and 1 pseudomembranous, all responded to antifungal treatment. Three patients (10.3%) developed Aspergillus spp. infections despite prophylaxis with itraconazole. CONCLUSION: Invasive aspergillosis in the immediate posttransplant period was mortal despite treatment. As opposed, aspergillar tracheobronchitis have been overcome using combined treatments of liposomal or lipidic amphotericin, itraconazole and nebulised amphotericin.

[Chronic obstructive pulmonary disease and lung transplants: results in Spain]. / EPOC y trasplante pulmonar: resultados en España.

OBJECTIVE: To determine the outcome of lung transplantation in patients with chronic obstructive pulmonary disease (COPD) in Spain. METHODS: In all COPD patients transplanted at four Spanish hospitals over a period of seven years, we studied actuarial survival rates retrospectively using the Kaplan Meier test in relation to demographic characteristics, type of transplant, underlying disease, lung function evolution in terms of forced vital capacity (FVC), maximum expiratory flow in 1 second (FEV1) and gasometric evolution (PaO2 and PaCO2). RESULTS: Seventy-four transplants were performed in COPD patients over a five-year period. Mean age was 47 +/- 7 years (26-61) and 77% of the patients were men. A diagnosis of emphysema was made in 58%, alpha-1 antitrypsin deficiency emphysema in 14% and chronic bronchitis in 28%. The likelihood of survival was 75% for the first year, 63% for two years and 41% for the third year. Lung function and blood gases improved significantly by the third month after transplantation: FVC was 1677 +/- 637 ml before transplantation and 2631 +/- 670 ml afterwards; FEV1 was 585 +/- 189 ml before transplantation and 2118 +/- 673 ml afterwards (p < 0.001). Double lung transplants achieved significantly greater improvement in function variables than did single-lung transplants (FVC 2843 +/- 681 ml and FEV1 2543 +/- 620 ml by the third month in DLT patients versus FVC 2402 +/- 587 ml and FEV1 1659 +/- 350 ml for SLT), with no significant differences in blood gases after the two types of transplant. Half the sing-lung transplant patients developed hyperinflation of the native lung and reached maximum lung function values, which tended to be lower than those for patients who did not experience this complication (FEV1 1638 +/- 349 ml versus 1930 +/- 307 ml, p = 0.051). CONCLUSIONS: First-year mortality in patients with COPD undergoing lung transplantation in Spain is similar to that described in the International Transplant Registry. We found no differences between double- and single-lung transplant patients. Functional change is good for both types of transplantation, although this aspect of outcome is significantly better when two lungs are transplanted.

[Lung transplantation in cystic fibrosis. The results of the Clínica Puerta de Hierro (Madrid) and the Hospital La Fe (Valencia)]. / Trasplante pulmonar en la fibrosis quística. Resultados de la Clínica Puerta de Hierro (Madrid) y el Hospital La Fe (Valencia).

UNLABELLED: Retrospective analysis of cystic fibrosis patients who underwent pulmonary transplantation at Clínica Puerta de Hierro, Madrid, and at Hospital La Fe, Valencia. Since the beginning of the programme and until March 1998, a total of 63 patients with cystic fibrosis were studied. Among transplanted patients, 18 were males and 16 females, with a mean age of 18.9 years. All patients underwent sequential bilateral pulmonary transplantation. After transplantation, the most common complication was bacterial pneumonia which affected all patients. Six patients had dehiscence or stenosis of the bronchial suture. Other specific complications of this condition by frequency were intestinal obstruction and diabetes mellitus. Six patients developed obliterans bronchiolitis and one of them underwent a repeat transplantation. Three out of the 34 patients died, and the likelihood of survival after one and three years was 94%. Respiratory function tests and PaO2 peaked at sixth post-transplantation month. CONCLUSION: Pulmonary transplantation is a therapeutic option to be considered for the patient with cystic fibrosis and severe involvement of his/her pulmonary disease.

[Comparative functional study of 25 patients with intrathoracic sarcoidosis (author's transl)]. / Estudio funcional comparativo sobre veinticinco pacientes afectos de sarcoidosis intratorácica.

Pulmonary function in 25 patients with intrathoracic sarcoidosis was studied by three different methods: clinical, as related to the presence or absence of dispnea; response to corticoid treatment, and roentgenologic stage. A total of 60 examination were made on the 25 patients. Each examination included: pulmonary volume (vital capacity and RV/CT coefficient), ventilatory mechanics (elastance, resistance, critical flow, and specific conductance), and gas exchange (DCO/VA and (A-a) O2). The following results were obtained from statistical evaluation of the mean values compared with normal values: 1) patients with dyspnea showed a greater pulmonary elastance and (A-a) O2 than normal; 2) treatment with corticoids only produces an improvement in the diffusion capacity in respect to the total volume (DCO/VT); 3) examinations corresponding to the three different roentgenologic stages varied only in pulmonary volume and only when stage III was compared with stages I and II; 4) the terminal stage of the disease is physiologically similar to the typical pattern of emphysema.

The influence of carboxyhaemoglobin on the oxygen-binding capacity of blood. A comparison of manometric (Van Slyke) and optical (Co-Oximeter) measurements.

Oxygen content measurements determined optically by the Co-Oximeter correlated closely with those obtained using the manometric technique of Van Slyke. In those samples with a high content of carbon monoxide, the agreement between the two methods could be improved, by taking into consideration the concentration of carboxyhaemoglobin (COHb), since this plays no part in oxygen transport. The calculated values of the oxygen-binding capacity varied widely, with mean values less than the theoretical figure of 1.39 ml O2/g Hb. This difference was greater in those samples with a higher content of COHb. When the amount of haemoglobin combined with COHb was taken into consideration the mean corrected values approximated to the theoretical value of 1.39, thus supporting this as the mean value for the oxygen-binding capacity of haemoglobin, although the large individual variability persisted.