Prognostic value of ERCC1, RRM1, BRCA1 and SETDB1 in early stage of non-small cell lung cancer.

INTRODUCTION: Nowadays, 40 % of early-stage NSCLC patients relapse in the 2 years following resection, suggesting a mis-staging in this group of patients who are not receiving adjuvant chemotherapy. Although different biomarkers, such as ERCC1, RRM1 and BRCA1 have been found to present prognostic value in advanced NSCLC patients, in early-stage NSCLC patients its relevance remains unclear. Moreover, SETDB1 has been recently proposed as a bona fide oncogene in lung tumourigenesis and related with metastasis. The aim of the present study was to analyze the prognostic value of ERCC1, RRM1, BRCA1 and SETDB1 expression levels in NSCLC patients at stage I. PATIENTS AND METHODS: ERCC1, RRM1, BRCA1 and SETDB1 expression at mRNA level was analyzed by real-time quantitative RT-PCR in fresh-frozen tumor and normal adjacent lung tissue samples from 64 stage I NSCLC patients. Later, significant association between gene expression levels, clinicopathological characteristics and patient's disease-free survival was assessed. RESULTS: We did not find any statistically significant correlation between gene expression and gender, age, histological type or smoking status. Univariate followed by multivariate Cox analysis showed that higher levels of BRCA1 and SETDB1 expression were significantly associated with shorter disease-free survival in stage I NSCLC patients. CONCLUSION: Our study finds that ERCC1 and RRM1 are not independent prognostic factors of recurrence in stage I NSCLC patients. By contrast, BRCA1 and SETDB1 stand out as the most significant prognostic markers in this group of patients, appearing as promising tools to predict tumor recurrence in early-stage NSCLC patients.

A new biodegradable polythiourethane as controlled release matrix polymer.

The main aim of this paper is the synthesis and characterization of a new linear functional biodegradable polythiourethane-d,l-1,4-dithiothreitol-hexamethylene diisocyanate [PTU(DTT-HMDI)]. The SeDeM diagram has been obtained to investigate its suitability to be processed through a direct compression process. Furthermore, the ability of this polymer to act as controlled release matrix forming excipient has been studied. Four batches of matrices containing 10-40% of polymer and theophylline anhydrous as model drug have been manufactured. Release studies have been carried out using the paddle method and the polymer percolation threshold has been estimated. The principal parameters of the SeDeM Expert system, such as the parametric profile (mean radius) and the good compression index (IGC=4.59) for the polymer are very close to the values considered as adequate for direct compression even with no addition of flow agents. Furthermore, the results of the drug release studies show a high ability of the polymer to control the drug release. The excipient percolation threshold has been estimated between 20% and 30% w/w of polymer.

Neumotórax de repetición como presentación de sarcoma sinovial pleuropulmonar / Pleuropulmonary synovial sarcoma presenting as recurrent pneumothorax

Los sarcomas sinoviales son neoplasias de tejidos blandos, afectan a adultos jóvenes y de mediana edad, no existen diferencias con respecto a la distribución por sexo. Se localizan en el 90% de los casos en las extremidades. El sarcoma sinovial pleuropulmonar primario (SSPP) es muy poco frecuente, constituye el 0,1% de los tumores pulmonares. Frecuentemente se manifiesta con tos y/o hemoptisis, el neumotórax es una forma poco común de presentación. Son tumores con mal pronóstico y presentan alto riesgo de recidivas locales. Las mejores supervivencias están relacionadas con el tratamiento quirúrgico, siendo la resección completa tumoral el principal factor pronóstico. El tratamiento de elección es quirúrgico, seguido de quimioterapia, radioterapia o ambas. Presentamos el caso clínico de un sarcoma pleuropulmonar primario que clínicamente se manifestó como neumotórax (AU)

Synovial sarcomas are a soft-tissue neoplasms which affects young and middle-aged people, with no difference in distribution between sexes. They are located in the extremities in the 90% of the cases. Pleuropulmonary primary synovial sarcoma SSPP is very unusual, constitutes 0.1% of pulmonary tumors. In most cases the SSPP present themselves with cough and / or hemoptysis whereas pneumothorax is an uncommon form of presentation. Prognosis is usually poor, they present high risk of local recurrence. The survival rate depends on the surgical treatment, being the complete tumor resection the main predicting factor. Surgery is the treatment of choice followed by chemotherapy, radiotherapy or both. We present a case report of a pleuropulmonary synovial sarcoma which presented with pneumothorax (AU)

Ptosis palpebral asociada a neurofibroma mediastínico posterior. Tratamiento quirúrgico / Ptosis palpebral associated to mediastinal neurofibroma after surgical treatment

Los neurofibromas son tumores neurógenos originados a partir de las células de Schwann y de los fibroblastos de las vainas nerviosas de los nervios periféricos. Entre el 40 y el 60% de los tumores de mediastino posterior son neurofibromas y schawnnomas. El schwanoma es el más frecuente. Su evolución es lenta, ello explica el gran tamaño observado en el momento del diagnóstico en algunos casos, lo que justifica la sintomatología por compresión. Presentamos el caso clínico de un neurofibroma mediastínico posterior que se inició clínicamente con dolor pleurítico y ptosis palpebral (AU)

Neurofibromas are neurogenic tumors originated from Schwann cells and the fibroblasts of the peripheral nerve sheaths. From 40-60% of the posterior mediastinal tumors are neurofibromas and schawnomas. The schwannoma is the most frequent. Its development is slow, which explains the large size observed at the time of diagnosis in some cases. This explains the compression symptoms. We present the clinical case of a posterior mediastinal neurofibroma that began clinically with pleuritic pain and palpebral ptosis (AU)

Carbohydrate-based polyesters made from bicyclic acetalized galactaric acid.

The dimethyl ester of 2,3:4,5-di-O-methylene-galactaric acid (Galx) was made to react in the melt with 1,n-alkanediols HO(CH(2))(n)OH containing even numbers of methylenes (n from 6 to 12) to produce linear polycyclic polyesters. Two sets of poly(alkylene 2,3:4,5-di-O-methylene-galactarate) polyesters (PE-nGalx) with weight-average molecular weights in the ∼ 5000-10000 and ∼ 35000-45000 ranges were obtained using TBT and DBTO catalysts, respectively. For comparative purposes a set of poly(alkylene adipate) polyesters (PE-nAd) was also synthesized with molecular weights in the higher range using a similar procedure. The thermal stability of PE-nGalx was greater than that of PE-nAd although it notably decayed as molecular weight decreased. The replacement of Ad by Galx in the polyesters caused increases in T(g) of up to 70 °C, and almost doubled the tensile mechanical parameters. All PE-nGalx were semicrystalline but only those made from 1,12-dodecanediol were able to crystallize from the melt with a crystallization rate that diminished as the molecular weight increased. In general, the galactarate containing polyesters displayed higher solubility and wettability than polyadipates, they hydrolyzed faster and exhibited comparable sensitivity to the action of lipases.

Clinical-therapeutic management of thoracoscopy in pleural effusion: a groundbreaking technique in the twenty-first century

INTRODUCTION: The aim of this study was to investigate the effectiveness of thoracoscopy in the diagnosis of non-affiliated pleural effusions (PE). MATERIAL AND METHODS: A five-year prospective study including data from 110 patients that were clinically diagnosed as benign (14.5%), malign (34.5%) and non-affiliated (50.9%). PE in patents without oncology disease and negative biopsy or cytology were considered as benign. Malignant diagnosis was established according to a pleural biopsy, compatible cytology and/or clinical features. Remaining cases were considered as non-affiliated. Thoracoscopy was done under local anaesthesia and sedation. RESULTS: Thoracoscopy confirmed previous clinical diagnosis of benignity and malignity. Regarding non-affiliated patients, 30.35% were diagnosed after thoracoscopy as unspecific pleuritis, 17.86% mesothelioma and 1.79% pleural tuberculosis (TBC). The other 48.21% of patients reported as non-affiliated were diagnosed with pleural carcinoma. Statistical analysis did not reveal differences between frequencies analysed. CONCLUSIONS: Our results indicate that thoracoscopy is a cost-effective and reliable technique for obtaining histological diagnosis in PE and also allows a directed pleurodesis if indicated (AU)

Synthetic polymers from readily available monosaccharides.

The low degradability of petroleum-based polymers and the massive use of these materials constitute a serious problem because of the environmental pollution that they can cause. Thus, sustained efforts have been extensively devoted to produce new polymers based on natural renewing resources and with higher degradability. Of the different natural sources, carbohydrates stand out as highly convenient raw materials because they are inexpensive, readily available, and provide great stereochemical diversity. New polymers, analogous to the more accredited technical polymers, but based on chiral monomers, have been synthesized from natural and available sugars. This chapter describes the potential of sugar-based monomers as precursors to a wide variety of macromolecular materials.

Cirugía vídeo-toracoscópica en el manejo diagnóstico-terapéutico de los derrames pericárdicos benignos / Video-assisted thoracoscopic surgery in the diagnostic-therapeutic management of benign pericardial effusions

Introducción. El derrame pericárdico es una entidad clínica que requiere un manejo multidisciplinar. Varios procedimientos han sido descritos para practicar una pericardiectomía parcial suficiente para garantizar el drenado óptimo y que, además, permita la toma de muestras biópsicas. El objetivo del presente trabajo es evaluar la rentabilidad de la pericardiectomía parcial mediante cirugía vídeo-toracoscópica (CVT) en los derrames pericárdicos con sospecha clínica de benignidad, valorando las indicaciones y su valor añadido frente a otras técnicas. Material y métodos. Hemos realizado pericardiectomías a 19 pacientes con sospecha clínica de benignidad por CVT. La indicación fue establecida ante la aparición de síntomas atribuibles al derrame o cuando se precisaba la toma de muestras. La presencia de signos radiológicos y/o ecográficos de pericarditis constrictiva o de inestabilidad clínica, fueron contraindicaciones para la técnica. Resultados. El diagnóstico tras estudio patológico fue de inflamación crónica en 6 casos, tuberculosis (TBC) activa en 2 y una pericarditis de origen urémico en otros 4. Etiología neoplásica no diagnosticada previamente fue establecida en 2 pacientes; en 5 casos se drenaron derrames postquirúrgicos de cirugía cardiaca. Conclusiones. La CVT resulta una técnica adecuada para el manejo diagnóstico-terapéutico de aquellos derrames pericárdicos no diagnosticados y en los postquirúrgicos. Su elevado rendimiento diagnóstico, su baja morbilidad y casi nula existencia de recidivas lo hacen especialmente indicado en casos en que se precise la toma de muestras y la supervivencia previsible sea larga (AU)

Introducción. Introduction. Pericardial effusion is a clinical disease that requires multidisciplinary management. Several procedures have been described to perform a sufficient partial pericardiectomy in order to assure optimum drainage and that would also permit biopsy samples to be obtained. The purpose of this work is to evaluate the profitability of the partial pericardiectomy through video-assisted thoracoscopic surgery (VTS) in pericardial effusions with clinical suspicion of benignancy, evaluating its indications and its added value compared to other techniques Material and methods. We have performed pericardiectomies in 19 patients with clinical suspicions of benignancy using VTS. The indication was established due to the appearance of symptoms that could be attributed to effusion or when it was necessary to obtain samples. The presence of radiological and/or ultrasonographic signs of constrictive pericarditis or clinical instability were contraindications for the technique. Results. The diagnosis after the pathology study was chronic inflammation in 6 cases, active tuberculosis (TBC) in 2 cases and uremic pericarditis in 4 more cases. Previously undiagnosed neoplastic etiology was established in 2 patients; in 5 cases, postsurgical effusions of cardiac surgery were drained. Conclusions. VTS is an adequate technique for the diagnostic-therapeutic management of those undiagnosed pericardial effusions and in post-surgical ones. Its high diagnostic performance, low morbidity and almost null existence of relapses has made it especially indicated in cases where it is necessary to obtain samples and the foreseeable survival is long (AU)

[Treating iatrogenic pneumothorax with small-bore chest tube]. / Drenaje de neumotórax iatrogénico con catéter de calibre pequeño.

OBJECTIVE: To evaluate the feasibility of small-bore chest tube placement to treat pneumothorax caused by percutaneous procedures. MATERIAL AND METHODS: Between November 2004 and July 2006 we performed 151 interventional chest procedures (127 biopsies and 24 radiofrequency ablations) in 131 patients (25 women and 106 men; mean age, 63 years, range, 36-83 years). Fine needles (21-25 G) were used in 70 procedures and large core needles (14-20 G) were used in the remaining 81. Pneumothorax occurred in 16 diagnostic procedures (13 of these were treated with small-bore catheter placement) and in two radiofrequency procedures (both cases were treated with small-bore catheter placement). Chest tubes were placed immediately after pneumothorax occurred in all cases because the pneumothorax was greater than 20% or caused symptoms or occurred in patients with emphysema. RESULTS: Chest tubes were successfully placed without incidents in all cases and a Heimlich valve evacuated the air completely. Mean hospital stay was 43 hours (range, 24-72 hours). It was not necessary to place a larger-bore chest tube in any case. CONCLUSION: Small-bore chest tube placement is the treatment of choice for iatrogenic pneumothorax greater than 20% or less than 20% when symptomatic or occurring in patients with emphysema. The procedure is easy, effective, and well tolerated; furthermore, it shortens the hospital stay. The effectiveness of the procedure makes it possible to safely perform percutaneous procedures on patients with emphysema or difficult lesions and to finish an interventional procedure when pneumothorax occurs.

Drenaje de neumotórax iatrogénico con catéter de calibre pequeño / Treating iatrogenic pneumothorax with small-bore chest tube

Objetivo: evaluar la utilidad del drenaje de neumotórax con catéter de calibre pequeño tras la punción de lesiones torácicas. Material y métodos: desde noviembre de 2004 hasta julio de 2006 se realizaron 151 punciones torácicas en 131 pacientes (106 varones y 25 mujeres) con una media de edad de 63 años (36-83 años). Con fines diagnósticos se hicieron 127 punciones y los restantes 24 fueron tratamientos de termocoagulación con radiofrecuencia (RF). Se realizaron 70 punciones con aguja fina (21-25G) y 81 con aguja gruesa (14-20G). En los procedimientos diagnósticos se produjeron 16 neumotórax y se drenaron 13, y en los de RF hubo 2 neumotórax, y se drenaron ambos. El drenaje en todos los casos se realizó inmediatamente después de producirse, porque eran 20 % o presentaban síntomas, o siendo 20 % eran pacientes con enfisema. Resultados: en todos los pacientes pudo colocarse el catéter de drenaje sin incidencias, resolviendo el neumotórax con una válvula de Heimlich. El tiempo máximo de ingreso fue de 72 h, con una media de 43 h. En ningún caso se precisó colocar posteriormente un catéter de mayor calibre. Conclusión: el drenaje de neumotórax con catéter de calibre pequeño tras un procedimiento intervencionista torácico, es la técnica de elección cuando un neumotórax es 20 %, o el paciente está sintomático o tiene enfisema, porque su colocación no es difícil, es resolutivo, bien tolerado y acorta la estancia hospitalaria. Su resolución rápida permite puncionar pacientes con enfisema o lesiones difíciles con mayor seguridad y posibilita finalizar un procedimiento intervencionista si durante su realización se produce el neumotórax (AU)

Objective: to evaluate the feasibility of small-bore chest tube placement to treat pneumothorax caused by percutaneous procedures. Material and methods: between November 2004 and July 2006 we performed 151 interventional chest procedures (127 biopsies and 24 radiofrequency ablations) in 131 patients (25 women and 106 men; mean age, 63 years, range, 36-83 years). Fine needles (21-25 G) were used in 70 procedures and large core needles (14-20G) were used in the remaining 81. Pneumothorax occurred in 16 diagnostic procedures (13 of these were treated with small-bore catheter placement) and in two radiofrequency procedures (both cases were treated with small-bore catheter placement). Chest tubes were placed immediately after pneumothorax occurred in all cases because the pneumothorax was greater than 20 % or caused symptoms or occurred in patients with emphysema. Results: chest tubes were successfully placed without incidents in all cases and a Heimlich valve evacuated the air completely. Mean hospital stay was 43 hours (range, 24-72 hours). It was not necessary to place a larger-bore chest tube in any case. Conclusion: small-bore chest tube placement is the treatment of choice for iatrogenic pneumothorax greater than 20 % or less than 20 % when symptomatic or occurring in patients with emphysema. The procedure is easy, effective, and well tolerated; furthermore, it shortens the hospital stay. The effectiveness of the procedure makes it possible to safely perform percutaneous procedures on patients with emphysema or difficult lesions and to finish an interventional procedure when pneumothorax occurs (AU)

Synthesis and secondary structure of oligo(alpha-isobutyl beta,L-aspartate)s.

The oligo(beta-peptide)s, hexa(alpha-isobutyl beta,L-aspartate) (Hex-AIBLA) and octa(alpha-isobutyl beta,L-aspartate) (Oct-AIBLA), were synthesized in solution by using standard coupling methods. Powder x-ray diffraction showed that the octamer crystallized in the two helical crystal forms known to exist in the homologous poly(beta-peptide), whereas the hexamer seemed to adopt an extended conformation. Both CD and 1H-NMR spectra of Oct-AIBLA in MeOH revealed the presence of a regularly folded conformation in this solvent, presumably the 3(14) helix. The helix-to-coil transition of Oct-AIBLA was observed to take place upon heating in both MeOH and CHCl3, in the second case associated with a not-well-defined aggregation-disaggregation process. The spectroscopic evidence obtained on the presence of folded structures in Hex-AIBLA were much weaker than for the octamer.

[Thoracic metastasis of breast carcinoma. Current status]. / Metástasis torácicas de carcinoma mamario. Estado actual.

Breast cancer is a common pathology. It is clinically considered as a localized or regionally developing illness at the time of diagnosis, but the appearance of metastases is a frequent complication. Patients are commonly referred with local or regional recurrence of the disease. Invasive metastatic disease found in the chest can be differentiated according to area as follows: pulmonary parenchyma (nodes and/or carcinomatosis lymphangitis), pleural cavity (pleural effusion and/or tumor), pericardial effusion and the thoracic wall. The appearance of pulmonary parenchymal metastases secondary to breast cancer can be further categorized into three types, neoplastic lymphangitis, multiple and single pulmonary nodes. Pleural effusion is the commonest thoracic affection in patients with this pathology. It is accepted that 46% of patients with disseminating breast cancers will develop pleural metastases where the presentation is pericardial effusion, and possible cardiac tamponade. Finally, metastatic disease may be found localized to within the thoracic wall. Breast cancer can produce diverse problems in the thoracic wall, and local recurrence is most frequent at the mastectomy site.

Tratamiento quirúrgico de la variante fibrosarcomatosa de un dermatofibrosarcoma protuberans gigante de pared torácica / Surgical treatment of the fibrosarcomatous variant of giant dermatofibrosarcoma protuberans

No disponible

Synthesis of L-arabinitol and xylitol monomers for the preparation of polyamides. Preparation of an L-arabinitol-based polyamide.

Dihydrochlorides of 1,5-diamino-1,5-dideoxy-2,3,4-tri-O-methyl-L-arabinitol (and xylitol) and pentachlorophenyl esters of 2,3,4-tri-O-methyl-L-arabinaric (and xylaric) acids have been prepared as suitable bifunctional monomers for linear polycondensations. A new aregic AABB-type L-arabinitol-based polyamide is also described from the corresponding monomers. It was crystalline with T(m) 250 degrees C, optically active, and soluble in the usual organic solvents, including chloroform, and in water. Its M(w) obtained by GPC was 27,500 with a polydispersity of 1.4.

FDG-PET detection of primary lung cancer in a patient with an isolated cerebral metastasis.

Positron emission tomography (PET) is a new diagnostic technique. It is used to differentiate benign from malignant pulmonary nodules and to detect metastasis and lymph node involvement in primary lung cancer, but little has been published about its possible interest for detection of unknown primary tumors. We report the case of a man who underwent resection of a cerebral tumor. A histological diagnosis of cerebral metastasis from adenocarcinoma with a probable pulmonary origin was made. Preoperative staging (including thoracoabdominal CT-scan and bone scan) did not show any pathologic image, particularly in the thorax. A whole body FDG-PET-scan was then performed. An isolated (1.5 cm of diameter) hypermetabolic focus was discovered in the left upper lobe. Bronchoscopy was normal An upper left lobectomy confirmed the presence of the primary lung adenocarcinoma. In this particular case, FDG-PET proved to be a very useful diagnostic method. New indications are being developed for it.

[Bilateral lung reduction by video-assisted thoracoscopy in a patient with non-bullous pulmonary emphysema and laryngeal neoplasia]. / Neumorreducción bilateral por videotoracoscopia en un paciente con enfisema pulmonar no bulloso y neoplasia laríngea.

Lung reduction has been show to be a promising treatment for the final phases of non-bullous pulmonary emphysema. The role of video-assisted thoracoscopy (VAT) in this disease has not yet been established. We report a case of bilateral non-bullous pulmonary emphysema in which transplantation was ruled out because of laryngeal neoplasm treated three months earlier. Using VAT, we performed bilateral lung reduction in the apical zones with good therapeutic results. We find that in patients reduction by VAT, although not a curative treatment, leads to immediate postoperative improvement in lung function and dyspnea, and does not exclude the possibility of later performing lung transplantation.

Neumorreducción bilateral por videotoracoscopia en paciente con enfisema pulmonar no bulloso y neoplasia laríngea / Bilateral lung reduction by video-assisted thoracoscopy in a patient with non-bullous pulmonary emphysema and laryngeal neoplasia

La neumorreducción pulmonar ha demostrado ser un tratamiento prometedor en las fases finales del enfisema pulmonar no bulloso. El papel de la videotoracoscopia en esta enfermedad todavía está por definir. Presentamos un paciente con un enfisema pulmonar no bulloso bilateral, con una neoplasia laríngea tratada 3 meses antes, y que fue rechazado para trasplante por dicho motivo. Mediante vídeotoracoscopia, se realizó una neumorreducción bilateral en zonas apicales, con buenos resultados terapéuticos. Pensamos que en un seleccionado grupo de pacientes con enfisema no bulloso grave, la reducción de volumen pulmonar bilateral por videotoracoscopia, no siendo un tratamiento curativo, comporta una mejoría postoperatoria instantánea en la función pulmonar y la disnea, no excluyendo la posibilidad de realizar posteriormente un trasplante pulmonar. (AU)

[Video-assisted thoracoscopy for resecting solitary pulmonary nodules]. / Videotoracoscopia en la resección de nódulos pulmonares solitarios.

The objective of this study was to evaluate the usefulness of video assisted thoracoscopy in the resection of solitary pulmonary nodules. Thirty-three patients with solitary pulmonary nodules diagnosed by video assisted thoracoscopy were enrolled prospectively. A preoperative computed tomography scan was obtained for each patient. Harpoons were implanted preoperatively to locate the lesion in patients whose tumors were in the parenchyma. When endoscopic resection proved impossible in five patients, the surgeon resorted to thoracotomy. All were diagnosed after the procedure. One was a case of pulmonary lymphoma, 2 were primary adenocarcinomas of the lung, 2 were oat-cell cancers, 1 was Wegener's disease, 4 were tuberculomas, 3 involved pulmonary infarction and 20 were single pulmonary metastases. Patients who needed thoracotomy required more days of postsurgical drainage (p < 0.05). The size of resected nodules ranged from 0.4 to 6 centimeters. Preoperative positron emission tomographs were available for four patients. No perioperative (< 30 days) mortality occurred and morbidity consisted of one case of prolonged airway leak (> 7 days). Use of video-assisted thoracoscopy reduced perioperative morbidity and hospital stay.

Combined surgical approach for sarcoma lung metastasis with atrial involvement.

A 20-year-old patient, who had been treated for a femur sarcoma with pulmonary metastases 8 years before, arrived at our institution with a new metastatic hilar lung nodule. During the standard lobectomy procedure an unexpected atrial invasion by the tumor was discovered. Intraoperative transesophageal echocardiography (TEE) showed a big pediculated tumor in the atrium. Cardiopulmonary bypass (CPB) was required in order to safely resect the atrial wall with the tumor. The atrial defect was repaired with a pericardial patch. Postoperative course was uneventful. After 14 months, the patient is asymptomatic and free of disease.