Pioderma gangrenoso en herida quirúrgica de lobectomía pulmonar / Pyoderma gangrenosum in a pulmonary lobectomy surgical wound

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Reflexiones sobre la implementación del cribado mediante tomografía computarizada de baja dosis en personas con riesgo elevado de padecer cáncer de pulmón en España / Reflections on the Implementation of Low-Dose Computed Tomography Screening in Individuals at High Risk of Lung Cancer in Spain

El cáncer de pulmón (CP) constituye un problema de salud pública de primer orden. A pesar de los recientes avances en su tratamiento, la prevención primaria y el diagnóstico precoz son las claves para reducir su incidencia y mortalidad. Un ensayo clínico reciente demostró la eficacia del cribado selectivo con tomografía computarizada de baja dosis (TCBD) en la reducción del riesgo de muerte en personas de alto riesgo, tanto por CP como global. Este artículo recoge las reflexiones de un grupo de expertos designados por la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Cirugía Torácica (SECT), la Sociedad Española de Radiología Médica (SERAM) y la Sociedad Española de Oncología Médica (SEOM) sobre el uso de la TCBD para el diagnóstico precoz del CP en personas con riesgo elevado de padecerlo y los pasos necesarios para evaluar su implementación en nuestro país

Lung cancer (LC) is a major public health issue. Despite recent advances in treatment, primary prevention and early diagnosis are key to reducing the incidence and mortality of this disease. A recent clinical trial demonstrated the efficacy of selective screening by low-dose computed tomography (LDCT) in reducing the risk of both lung cancer mortality and all-cause mortality in high-risk individuals. This article contains the reflections of an expert group on the use of LDCT for early diagnosis of LC in high-risk individuals, and how to evaluate its implementation in Spain. The expert group was set up by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM)

Reflections on the Implementation of Low-Dose Computed Tomography Screening in Individuals at High Risk of Lung Cancer in Spain. / Reflexiones sobre la implementación del cribado mediante tomografía computarizada de baja dosis en personas con riesgo elevado de padecer cáncer de pulmón en España.

Lung cancer (LC) is a major public health issue. Despite recent advances in treatment, primary prevention and early diagnosis are key to reducing the incidence and mortality of this disease. A recent clinical trial demonstrated the efficacy of selective screening by low-dose computed tomography (LDCT) in reducing the risk of both lung cancer mortality and all-cause mortality in high-risk individuals. This article contains the reflections of an expert group on the use of LDCT for early diagnosis of LC in high-risk individuals, and how to evaluate its implementation in Spain. The expert group was set up by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM).

Tumor fibroso pleural gigante / Giant pleural fibrous tumour

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Neumotórax itinerante como primera manifestación de metástasis de un cáncer de lengua / Air Travel Pneumothorax as a First Sign of Metastasis of Cancer of the Tongue

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[Pneumonectomy with extracorporeal circulation to treat pulmonary metastasis]. / Neumonectomía por metástasis pulmonar con utilización de circulación extracorpórea.

Surgical resection of pulmonary metastasis is appropriate provided the general principals of oncological surgery are followed. Complete excision of the metastatic tumor is associated with long-term survival and low perioperative mortality. We present 2 cases of single pulmonary metastasis from osteosarcoma with cardiac involvement. In both cases, complete excision required left pneumonectomy by sternotomy with extracorporeal circulation. The outcomes were favorable, no perioperative complications were reported, and the patients remained free of disease at 14 and 17 months after surgery. In conclusion, we believe that the cases presented confirm that extended pneumonectomy with extracorporeal circulation if necessary is a valid approach for complete resection of pulmonary metastasis.

Neumonectomía por metástasis pulmonar con utilización de circulación extracorpórea / Pneumonectomy with extracorporeal circulation to treat pulmonary metastasis

La resección quirúrgica de las metástasis pulmonares es un tratamiento aceptado si se mantienen los principios generales de la cirugía oncológica, y la exéresis completa de las metástasis se asocia a una supervivencia a largo plazo y una mortalidad perioperatoría baja. Presentamos 2 casos de metástasis pulmonar única de osteosarcoma con infiltración cardíaca, que requirió para su exéresis completa neumonectomía izquierda por esternotomía, con utilización de circulación extracorpórea. El resultado fue favorable, sin que hubiera complicaciones perioperatorias y los pacientes permanecen indemnes a los 14 y 17 meses de la intervención quirúrgica. En conclusión, consideramos que en casos seleccionados la neumonectomía ampliada, con utilización de circulación extracorpórea si se precisa, para poder realizar la exéresis completa de metástasis pulmonares es un procedimiento válido

Surgical resection of pulmonary metastasis is appropriate provided the general principals of oncological surgery are followed. Complete excision of the metastatic tumor is associated with long-term survival and low perioperative mortality. We present 2 cases of single pulmonary metastasis from osteosarcoma with cardiac involvement. In both cases, complete excision required left pneumonectomy by sternotomy with extracorporeal circulation. The outcomes were favorable, no perioperative complications were reported, and the patients remained free of disease at 14 and 17 months after surgery. In conclusion, we believe that the cases presented confirm that extended pneumonectomy with extracorporeal circulation if necessary is a valid approach for complete resection of pulmonary metastasis

Cell-free DNA concentration in pleural fluid and serum: quantitative approach and potential prognostic factor in patients with cancer and pleural effusions.

PURPOSE: The presence of pleural effusions in patients with tumors is often indicative of locally advanced or metastatic disease, and detection of malignancy in effusion samples frequently leads to a disease upstaging. Our purpose was to quantify the DNA in pleural effusion and serum in patients presenting pleural effusion in order to assess the potential prognostic impact. PATIENTS AND METHODS: The DNA level was determined by amplifying hRNase P in paired samples of serum and pleural fluid in 70 consecutive patients with cancer showing pleural effusion. A group of 30 patients without cancer was included. The correlation between serum and pleural DNA was calculated. Survival curves according to serum and pleural DNA were analyzed. RESULTS: Median DNA concentrations were greater in patients with neoplasia than in patients without malignancy: 105 ng/mL versus 40 ng/mL (P = 0.001) in serum samples, respectively; 93 ng/mL versus 21 ng/mL (P = 0.001) in pleural fluids, respectively. A positive correlation between serum and pleural levels was confirmed (r = 0.3; P < 0.05). Median survival time for patients with serum DNA < or = 105 ng/mL was 11.03 months in contrast to only 3.63 months for patients with higher values (P = 0.036). Accordingly, median survival time for patients with pleural DNA < or = 93 ng/mL was 12.3 months versus only 4.63 months in case of higher levels (P = 0.027). CONCLUSION: This study shows that there is a strong correlation between higher levels of free DNA in pleural fluid or serum and malignancy. Survival is worse for patients with higher DNA levels in serum and pleural fluid.

Potential diagnostic value of methylation profile in pleural fluid and serum from cancer patients with pleural effusion.

BACKGROUND: The objective of this study was to investigate the diagnostic value of methylation profiles for discrimination between malignant and benign pleural effusions. A secondary objective was to examine the concordance of methylation in samples of serum and pleural fluid. METHODS: The authors used methylation-specific polymerase chain reaction (MSP) analysis to examine the promoter methylation status of 4 genes in patients with pleural effusion: death-associated protein kinase (DAPK), Ras association domain family 1A (RASSF1A), retinoic acid receptor beta (RARbeta), and p16/INK4a. Pleural effusions were collected from 87 patients who had their diagnoses confirmed on cytologic and/or histologic examinations and clinical evolution. Pleural effusions were classified as malignant (n = 53 patients) or benign (n = 34 patients). RESULTS: Methylation was detected in serum from 45.3% of patients with malignant pleural effusions and from 0% of patients with benign pleural effusions, and it was detected in pleural fluid samples from 58.5% of patients with malignant pleural effusions and from 0% of patients with benign pleural effusions (P = .001). The sensitivity of MSP was greater than that of cytologic examination alone (39.1%; P = .001). When MSP was used together with cytologic examination, sensitivity increased to 69.8% (P = .001). CONCLUSIONS: Cell-free methylated DNA in pleural fluid can be detected in patients with neoplastic malignancy in a single extraction by thoracocentesis. Adequate management of the extracted pleural fluid can provide a rapid and reliable diagnosis in patients with pleural effusions who have suspected malignancy. MSP, used together with cytologic examination, may obviate the need for other invasive diagnostic tests.

[Thoracic sympathectomy in primary hyperhidrosis: patient satisfaction]. / Simpatectomía torácica en la hiperhidrosis primaria: grado de satisfacción de los pacientes.

OBJECTIVE: To evaluate satisfaction among patients who underwent thoracic sympathectomy for primary hyperhidrosis and the possible complications after a minimum of 14 months after surgery. MATERIAL AND METHODS: We performed a retrospective study in 108 patients who underwent thoracic sympathectomy and who responded to all the questions asked in a telephone interview. The sample was composed of 21 men and 87 women, with a mean age of 29.73 years. In all patients, surgery was performed with general anesthesia in a single intervention. Special emphasis was placed on the degree of satisfaction (whether patients would recommend this type of surgery) and the possible negative effects or complications experienced by patients or attributed by them to the procedure. RESULTS: Patients were contacted a minimum of 14 months after the intervention. The most frequent complication was compensatory sweating (81.5%). Pain at the site of trocar insertion was reported by 6.5%. There were few immediate and long-term complications. The degree of satisfaction reached 90.7%. CONCLUSION: Video-assisted thoracic sympathectomy is safe and effective. Despite compensatory sweating, overall satisfaction was very high. However, satisfaction gradually decreased in the months after the intervention. Patients with hyperhidrosis with significant or principal axillary involvement could benefit from botulinic toxin administration as the first-line therapy.

Simpatectomía torácica en la hiperhidrosis primaria: grado de satisfacción de los pacientes / Thoracic sympathectomy in primary hyperhidrosis: patient satisfaction

Objetivo. Evaluar el grado de satisfacción de los pacientes a los que se practicó simpatectomía torácica por hiperhidrosis primaria y las posibles complicaciones, transcurridos un mínimo de 14 meses desde el acto quirúrgico. Material y métodos. Estudio retrospectivo sobre 108 pacientes tratados mediante simpatectomía torácica que respondieron a la totalidad de las preguntas realizadas mediante entrevista telefónica. La muestra está compuesta por 21 varones y 87 mujeres, con una edad media de 29,73 años. A todos se les intervino bajo anestesia general, en un solo acto quirúrgico. Se realizó especial hincapié en el grado de satisfacción (aconsejarían o no esta cirugía) y los posibles efectos negativos o complicaciones que los pacientes han sufrido o que ellos atribuyen al procedimiento. Resultados. Pasados un mínimo de 14 meses desde la cirugía se contactó con los pacientes. El sudor compensatorio (81,5%) es la complicación más frecuente. El 6,5% de los pacientes refirieron dolor en las zonas de inserción de los trocares. Las complicaciones inmediatas o a largo plazo fueron escasas. El grado de satisfacción alcanzó el 90,7%. Conclusión. La simpatectomía torácica por vídeo cirugía es un método seguro y efectivo. A pesar de la sudación compensatoria la satisfacción global es muy alta, aunque sufre un descenso paulatino según nos alejamos del momento de la cirugía. Las hiperhidrosis con importante o principal componente axilar podrían beneficiarse de la administración de toxina botulínica, como primera opción terapéutica (AU)

Objective. To evaluate satisfaction among patients who underwent thoracic sympathectomy for primary hyperhidrosis and the possible complications after a minimum of 14 months after surgery. Material and methods. We performed a retrospective study in 108 patients who underwent thoracic sympathectomy and who responded to all the questions asked in a telephone interview. The sample was composed of 21 men and 87 women, with a mean age of 29.73 years. In all patients, surgery was performed with general anesthesia in a single intervention. Special emphasis was placed on the degree of satisfaction (whether patients would recommend this type of surgery) and the possible negative effects or complications experienced by patients or attributed by them to the procedure. Results. Patients were contacted a minimum of 14 months after the intervention. The most frequent complication was compensatory sweating (81.5%). Pain at the site of trocar insertion was reported by 6.5%. There were few immediate and long-term complications. The degree of satisfaction reached 90.7%. Conclusion. Video-assisted thoracic sympathectomy is safe and effective. Despite compensatory sweating, overall satisfaction was very high. However, satisfaction gradually decreased in the months after the intervention. Patients with hyperhidrosis with significant or principal axillary involvement could benefit from botulinic toxin administration as the first-line therapy (AU)