Selecting the most suitable microalgae species to treat the effluent from an anaerobic membrane bioreactor.

Conventional treatments for nutrient removal in wastewater are shifting to Anaerobic Membrane Bioreactors, which produce a high-quality effluent with minimum sludge production. The effluent resulting contains high nitrogen and phosphorus load that can be eliminated by microalgae culture. The aim of this study is to evaluate the ammonium and phosphorus removal rate of different microalgae species in the effluent of an anaerobic treatment. For that, 4 different microalgae species have been tested (Chlamydomonas reinhardtii, Scenedesmus obliquus, Chlorella vulgaris and Monoraphidium braunii) in batch monoculture and mixed conditions. Results indicate that all species are able to eliminate both P and N in the medium with high removal rates. However, a slight interspecies competition may boost these removal rates and productivity values ensuring, the success of the process.

Intubación en dos pacientes con vía aérea difícil y estenosis traqueal tras traqueostomía en cirugía torácica / Intubation in two patients with difficult airway management and tracheal stenosis after tracheostomy in thoracic surgery

El aislamiento pulmonar en cirugía torácica es un reto para el anestesiólogo, pero la presencia de estenosis traqueal no conocida complica más esta situación. Describimos dos casos de estenosis traqueal desconocida y el manejo de la vía aérea. La estenosis traqueal aparece frecuentemente tras intubación de larga duración en la zona del neumotaponamiento o en el estoma de la traqueotomía como consecuencia del tejido de granulación que aparece tras la apertura quirúrgica de la tráquea. Son cruciales la historia clínica, la exploración física, los predictores de vía aérea difícil y las imágenes diagnósticas (TAC). Sin embargo, muchas estenosis traqueales pasan desapercibidas y la aparición de síntomas depende del grado de obstrucción. En estos casos, los pacientes presentaron cambios anatómicos debido a la cirugía y traqueotomía previa que ocasionaban estenosis traqueal sin síntomas. Existe escasa literatura sobre intubación en pacientes con traqueotomía previa en cirugía torácica. En el primer caso se utilizó un tubo Univent(R) utilizando un fibrobroncoscopio pero se produjo una hemorragia traqueal aguda. En el segundo caso, tras la intubación con VivaSight SL(R) en paciente despierto, se realizó la inserción de un bloqueador bronquial a través de un tubo endotraqueal guiado por la cámara integrada sin necesidad de control con fibrobroncoscopio

Lung isolation in thoracic surgery is a challenge, this is even more complex in the presence of unknown tracheal stenosis (TS). We report two cases of unknown TS and its airway management. TS appears most frequently after long term intubation close to the endotracheal tube cuff or in the stoma of tracheostomy that appears as a consequence of the granulation tissue after the surgical opening of the trachea. Clinical history, physical examination, difficult intubating predictors and imaging tests (CT scans) are crucial, however most of tracheal stenosis may be unnoticed and symptoms depend on the degree of obstruction. In our cases, the patients presented anatomical changes due to surgery and previous tracheostomy that led to a TS without symptoms. There is scarce literature about the intubation in patients with previous tracheostomy in thoracic surgery. In the first case, a Univent(R) tube was used using a flexible fiberscope but an acute tracheal hemorrhage occurred. In the second case, after intubation with VivaSight SL(R) in an awake patient, the insertion of a bronchial blocker was performed through an endotracheal tube guided by its integrated camera without using flexible fiberscopy

Intubation in two patients with difficult airway management and tracheal stenosis after tracheostomy in thoracic surgery. / Intubación en dos pacientes con vía aérea difícil y estenosis traqueal tras traqueostomía en cirugía torácica.

Lung isolation in thoracic surgery is a challenge, this is even more complex in the presence of unknown tracheal stenosis (TS). We report two cases of unknown TS and its airway management. TS appears most frequently after long term intubation close to the endotracheal tube cuff or in the stoma of tracheostomy that appears as a consequence of the granulation tissue after the surgical opening of the trachea. Clinical history, physical examination, difficult intubating predictors and imaging tests (CT scans) are crucial, however most of tracheal stenosis may be unnoticed and symptoms depend on the degree of obstruction. In our cases, the patients presented anatomical changes due to surgery and previous tracheostomy that led to a TS without symptoms. There is scarce literature about the intubation in patients with previous tracheostomy in thoracic surgery. In the first case, a Univent® tube was used using a flexible fiberscope but an acute tracheal hemorrhage occurred. In the second case, after intubation with VivaSight SL® in an awake patient, the insertion of a bronchial blocker was performed through an endotracheal tube guided by its integrated camera without using flexible fiberscopy.

Comentarios al artículo: «Tratamiento de la rotura traumática del bronquio izquierdo por asta de toro con stent endobronquial. Implicaciones anestésicas» / Comments to the article: «Endobronchial stent for the treatment of atraumatic rupture of the left bronchial dueto a bull horn. Anesthetic implications»

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Trend and seasonality in hospitalizations for pulmonary embolism: a time-series analysis.

BACKGROUND: The existence of seasonal variability in patients with acute pulmonary embolism (PE) has been debated for years, with contradictory results. The aim of this study was to identify the trend and possible existence of a seasonal pattern in hospitalizations for PE in Spain. METHODS: We analyzed the hospital discharge database of the Spanish National Health System from 2001 to 2010. Patients aged > 14 years diagnosed with PE were selected and a time series was constructed considering mean daily admissions for PE by month. The trend and seasonality factor of the series were determined using time-series analysis, and time-series modeling was used for analysis. Exponential smoothing models and the autoregressive integrated moving average test were used to generate a predictive model. RESULTS: From 2001 to 2010, there were 162,032 diagnoses of PE (5.07 per 1000 hospitalizations). In 105,168 cases, PE was the reason for admission. The PE diagnosis rate ranged from 4.14 per 1000 in 2001 to 6.56 per 1000 in 2010; and hospital admissions due to PE ranged from 2.67 to 4.28 per 1000 hospital discharges. Time-series analysis showed a linear increase in the incidence and a significant seasonal pattern with 17% more admissions in February and 12% fewer in June-July with respect to the central tendency (difference from February to June, 29%). CONCLUSIONS: The incidence of hospitalizations for PE showed a linear increase and a seasonal pattern, with the highest number of admissions in winter and the lowest number in summer.

Clinical decisions in patients with diabetes and other cardiovascular risk factors. A statement of the Spanish Society of Internal Medicine / Decisiones clínicas en pacientes con diabetes y otros factores de riesgo cardiovascular. Una declaración de la sociedad española de medicina interna

Although the mortality associated to cardiovascular diseases (CVD) has been reduced in the last decades, CVD remains the main cause of mortality in Spain and they are associated with an important morbidity and a huge economic burden. The increasing prevalence of obesity and diabetes could be slowing down the mortality reduction in Spain. Clinicians have often difficulty making clinical decisions due to the multiple clinical guidelines available. Moreover, in the current context of economic crisis it is critical to promote an efficient use of diagnostic and therapeutic proceedings to ensure the viability of public health care systems. The Spanish Society of Internal Medicine (SEMI) has coordinated a consensus document to answer questions of daily practice with the aim of facilitating physicians’ decision-making in the management of diabetes and cardiovascular risk factors from a cost-efficiency point of view (AU)

Aunque la mortalidad asociada a enfermedades cardiovasculares (ECV) se ha reducido en las últimas décadas, las ECV siguen siendo la causa principal de mortalidad en España y están asociadas a una morbilidad importante y una enorme carga económica. La creciente prevalencia de obesidad y de diabetes podría estar frenando la reducción en la mortalidad en España. Los médicos suelen tener mucha dificultad en la toma de decisiones clínicas debido a las múltiples guías clínicas disponibles. Por otro lado, en el contexto actual de la crisis económica es imprescindible promover un uso eficaz de los procedimientos diagnósticos y terapéuticos para garantizar la viabilidad de los sistemas de salud pública. La Sociedad Española de Medicina Interna (SEMI) ha desarrollado un documento de consenso para responder a las dudas que surgen en la práctica rutinaria con el objetivo de facilitar a los médicos la toma de decisiones en el control de la diabetes y en los factores de riesgo cardiovascular desde el punto de vista de la rentabilidad (AU)

Clinical decisions in patients with diabetes and other cardiovascular risk factors. A statement of the Spanish Society of Internal Medicine.

Although the mortality associated to cardiovascular diseases (CVD) has been reduced in the last decades, CVD remains the main cause of mortality in Spain and they are associated with an important morbidity and a huge economic burden. The increasing prevalence of obesity and diabetes could be slowing down the mortality reduction in Spain. Clinicians have often difficulty making clinical decisions due to the multiple clinical guidelines available. Moreover, in the current context of economic crisis it is critical to promote an efficient use of diagnostic and therapeutic proceedings to ensure the viability of public health care systems. The Spanish Society of Internal Medicine (SEMI) has coordinated a consensus document to answer questions of daily practice with the aim of facilitating physicians' decision-making in the management of diabetes and cardiovascular risk factors from a cost-efficiency point of view.

Atypical carcinoid tumours of the lung: prognostic factors and patterns of recurrence.

BACKGROUND: Atypical carcinoids (AC) of the lung are rare intermediate-grade neuroendocrine neoplasms. Prognostic factors for these tumours are undefined. METHODS: Our cooperative group retrieved data on 127 patients operated between 1980 and 2009 because of an AC. Several clinical and pathological features were studied. RESULTS: In a univariable analysis, T-status (p=0.005), N-status (p=0.021), preoperative M-status (previously treated) (p=0.04), and distant recurrence developed during the outcome (p<0.001) presented statistically significant differences related to survival of these patients. In a multivariable analysis, only distant recurrence was demonstrated to be an independent risk factor for survival (p<0.001; HR: 13.1). During the monitoring, 25.2% of the patients presented some kind of recurrence. When we studied recurrence factors in a univariable manner, sublobar resections presented significant relationship with locoregional recurrence (p<0.001). In the case of distant recurrence, T and N status presented significant differences. Patients with preoperative M1 status presented higher frequencies of locoregional and distant recurrence (p=0.004 and p<0.001, respectively). In a multivariable analysis, sublobar resection was an independent prognostic factor to predict locoregional recurrence (p=0.002; HR: 18.1). CONCLUSIONS: Complete standard surgical resection with radical lymphadenectomy is essential for AC. Sublobar resections are related to locoregional recurrence, so they should be avoided except for carefully selected patients. Nodal status is an important prognostic factor to predict survival and recurrence. Distant recurrence is related to poor outcome.

Glophymed: an index to establish the ecological status for the Water Framework Directive based on phytoplankton in coastal waters.

Phytoplankton and its attributes (biomass, abundance, composition, and frequency and intensity of phytoplankton blooms) are essential to establish the ecological status in the Water Frame Directive. The aim of this study is to develop an index "Glophymed" based on all phytoplankton attributes for coastal water bodies according to the directive requirements. It is also developed an anthropogenic pressure index that takes into account population density, tourism, urbanization, industry, agriculture, fisheries and maritime transport for Comunitat Valenciana (Spain). Both indexes (Glophymed and human pressure index) based on a multisampling dataset collected monthly during several years, show a significant statistical correlation (r2 0.75 α<0.01) for typology IIA and (r2 0.93 α<0.01) for typology III-W. The relation between these indexes provides suitable information about the integrated management plans and protection measures of water resources since the Glophymed index is very sensitive to human pressures.

Bosentan inhibits cigarette smoke-induced endothelin receptor expression in pulmonary arteries.

The endothelin (ET) system contributes to lung vascular tension and remodelling in smokers and chronic obstructive pulmonary disease (COPD) patients. This study examined the effect of cigarette smoke (CS) on ET receptor A (ET(A)) and B (ET(B)) expression in human pulmonary artery smooth muscle cells (HPASMCs) and human small intrapulmonary arteries, as well as their functional consequences. CS extract (CSE) increased ET(A) and ET(B) expression in HPASMCs and small intrapulmonary arteries, which was attenuated by bosentan, the ET(A) antagonist BQ123 and the ET(B) antagonist BQ788, and by blocking ET-1 with a monoclonal antibody against ET-1, suggesting a feed-forward mechanism mediated by ET-1 release. ET receptor (ETR) antagonism attenuated the CSE-induced HPASMC proliferation. Furthermore, CSE exposure increased the acute ET-1-induced small intrapulmonary artery contraction, which was attenuated by bosentan, BQ123 and BQ788. Pulmonary arteries from smokers and COPD patients showed a higher expression of ET(A) and ET(B) than those of nonsmoker patients. These results show a novel mechanism by which ETR blockade attenuates CS-induced ETR overexpression and, subsequently, small intrapulmonary artery tension. These data may be of potential value to explain therapeutic effects of bosentan in some forms of disproportionate pulmonary hypertension in COPD patients.

Phase II clinical trial with gemcitabine and paclitaxel sequential monotherapy as first-line treatment for advanced non-small-cell lung cancer (SLCG 01-04)

BACKGROUND: In advanced-stage (IIIB or IV) non-small-cell lung cancer (NSCLC), combination chemotherapy has demonstrated response rates of 20% and a 1-year survival rate of 30%. We conducted a multicentre, open-label, nonrandomised phase II trial to determine the efficacy and tolerability of sequential monotherapy with gemcitabine followed by paclitaxel in chemotherapy-naïve patients with advanced NSCLC. MATERIALS AND METHODS: Between December 2002 and July 2004, the Spanish Lung Cancer Group (SLCG) conducted a study in which 34 patients with advanced (stage IIIB or IV) NSCLC received 1200 mg/m(2) of i.v. gemcitabine on days 1, 8 and 15 of each 28-day cycle for a total of 3 cycles followed by 100 mg/m(2) of weekly i.v. paclitaxel for a maximum of 8 weeks. If objective response or stable disease was achieved, 70 mg/m(2) of weekly i.v. paclitaxel was maintained until disease progression was evident or toxic effects were intolerable. Lung Cancer Symptom Scale (LCSS) analysis was performed. Baseline levels of serum VEGF, EGFR, telomerase reverse transcriptase (hTERT) and K-ras mutations were analysed. The primary endpoint was the objective response rate. RESULTS: The median age of the 34 patients who were enrolled was 67 years (range 46-77), but later 8 patients were excluded; 78.8% were men, 81.8% had performance status 1 and also 81.8% had metastatic disease at diagnosis. The objective response rate was 28% (95% CI, 14.2-47.8); the median overall survival was 7.2 months (95% CI, 2.1-12.3) and the median time to progression (TTP) was 3.1 months (95% CI, 2.5-5.3). Grade 3 or 4 drug-related haematological toxicities were observed in 6 patients. Patients with lower baseline serum VEGF levels had significantly longer survival. CONCLUSIONS: Sequential therapy with gemcitabine followed by paclitaxel was well tolerated with a low proportion of grade 3 or 4 adverse events, the absence of unexpected toxicity and with an improvement in quality of life. Unfortunately, the response rate did not meet the minimally required rate of 20% and the study was prematurely closed. VEGF was identified as a poor prognostic factor for TTP and survival (AU)

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)

Hypertriglyceridemic waist: an alternative to the metabolic syndrome? Results of the IMAP Study (multidisciplinary intervention in primary care).

AIM: To study the prevalence of hypertriglyceridemic waist (HTGW) in an urban adult Spanish population and its association with type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). METHODS: We undertook a cross-sectional analysis in a random sample of 2270 individuals (18-80 years of age). All participants provided a clinical history and underwent a physical examination. Blood and urine analyses were conducted. HTGW was diagnosed using anthropometric criteria for the European population (waist circumference: for men, ≥ 94 cm; for women, ≥ 80 cm) and fasting plasma triglycerides (TGs) ≥ 1.71 mmol l(-1) (≥ 150 mg per 100 ml). RESULTS: The prevalence of HTGW was 14.5% (men: 18.2%, women: 10.8%) and was significantly greater in men <59 years (P<0.001). HTGW was associated with older individuals, a low educational level and, in men, with a sedentary lifestyle (P<0.001). Subjects with HTGW had higher levels of total cholesterol, low-density lipoprotein-cholesterol (LDL-c) and uric acid, lower levels of high-density lipoprotein-cholesterol, a higher blood pressure, a greater degree of obesity and a higher prevalence of T2DM (20.00 vs 6.4%, P<0.001) (odds ratio (OR) 3.61; 95% confidence interval (95% CI), 2.60-5.01) and CVD (8.5 vs 3.4%, P<0.001) (OR 2.63; 95% CI, 1.66-4.16). The association of HTGW with T2DM and CVD disappeared after adjusting for age. The degree of concordance between HTGW and the metabolic syndrome (MS) was moderate, with both the Adult Treatment Panel III Report (ATP-III) and the International Diabetes Federation criteria (κ=0.51 and κ=0.58, respectively). Subjects with isolated HTGW as compared with those with isolated MS (ATP-III) were younger, had greater levels of total cholesterol, LDL-c and TGs and a lower prevalence of obesity, high blood pressure and dysglycemia. CONCLUSION: HTGW is a phenotype of cardiometabolic risk prevalent in the adult population in our environment. HTGW may be an alternative to MS to detect the population at risk for T2DM and CVD, especially in young individuals who do not fulfill the criteria for MS.

Cigarette smoke exposure up-regulates endothelin receptor B in human pulmonary artery endothelial cells: molecular and functional consequences.

BACKGROUND AND PURPOSE: Pulmonary arteries from smokers and chronic obstructive pulmonary disease patients show abnormal endothelium-dependent vascular reactivity. We studied the effect of cigarette smoke extract (CSE) on endothelin receptor B (ET(B) ) expression in human pulmonary artery endothelial cells (HPAECs) and its role in endothelial dysfunction. EXPERIMENTAL APPROACH: ET(B) receptor expression was measured by real time RT-PCR, Western blot and immunofluorescence. Cell contraction, intracellular Ca(2+) , F/G-actin, RhoA activity, myosin light chain phosphorylation, ET, NO, thromboxane (Tx)A(2) and reactive oxygen species (ROS) were measured by traction microscopy, fluorescence microscopy, phalloidin fluorescence, colorimetric assay, Western blot, elisa and DCFDA fluorescence respectively. KEY RESULTS: Cigarette smoke extract dose-dependently increased ET(B) receptor expression in HPAECs after 24h incubation. CSE-induced ET(B) expression was attenuated by bosentan, the ET(B) receptor antagonist BQ788, the Rho kinase antagonist Y27632 and the antioxidant N-acetylcysteine. A monoclonal antibody to ET-1 prevented CSE-induced ET(B) receptor overexpression. Twenty-four hour exposure to ET-1 dose-dependently increased ET(B) receptor expression, mimicking the effect of CSE. CSE-induced ET(B) receptor overexpression caused greater cell contraction; increased intracellular Ca(2+) ; increased F/G-actin and RhoA activity; increased myosin light chain phosphorylation; augmented TxA(2) and ROS production; and decreased NO after acute ET-1 (10nM). These effects were attenuated by bosentan, BQ788, Y27632 and N-acetylcysteine. CONCLUSIONS AND IMPLICATION: Cigarette smoke extract induced ET(B) receptor overexpression by a feed forward mechanism mediated partly by ET release, promoting HPAEC dysfunction and attenuated by ET(B) receptor blockade, Rho kinase and ROS inhibition. These results provide support for the use of bosentan in CS-related endothelial dysfunction.

[Prevention of osseous defaults in the craneosinostosis surgery using calvarian cranial particulate bone]. / Utilización de hueso craneal particulado de calota para prevención de defectos óseos en la cirugía de las craneosinostosis.

It is considered that up to 20% of the craniosinostosis patients require secondary surgeries. Different techniques have been used in craneofacial surgery for the reconstruction of great osseous defects in pediatric patients for many years. This paper is about a new technique to obtain osseous graft for covering osseous cranial defects, using particulate bone, harvested from the patient calvarian using a hand-driven brace and covered with a fibrin adhesive. This is a very simple technique, which provides a great amount of bone from the patient himself, therefore producing a small morbidity. Since 2007 the authors have been using autologous particulate bone harvested from de patient calvarian for the reconstruction of different size osseous defects found in craneofacial surgery, especially in pediatrics patients. Although alloplastic materials and bone substitutes have been used for cranial reconstruction, the best option is the autogenous bone. In contrast to synthetic materials autologous grafts have a faster osteointegration, due to their osteogenic, osteoinductive and osteconductive properties. Harvesting the bone from the calvarian patient produces a minimal morbidity compared to the extraction of grafts from other donor sites such as rips or hip. The use of autologous particulate bone in craniosinostosis surgery reduces the risk of second interventions due to secondary ossifications defects. On the other hand, the harvest is easy and the supply of bone it is enough in pediatric patients.

Utilización de hueso craneal particulado de calota para prevención de defectosóseos en la cirugía de las craneosinostosis / Prevention of osseous defaults in the craneosinostosis surgery using calvarian cranial particulate bone

considera que hasta un 20% de intervenidos decraneosinostosis requieren cirugías secundarias. Sonvarias las técnicas que se han venido utilizando dentrode la cirugía craneofacial para la reconstrucción degrandes defectos óseos en pacientes pediátricos a lolargo de los años. Presentamos una nueva técnica deobtención de injerto de hueso para el recubrimientode defectos óseos craneales, en la que se utiliza huesoparticulado, obtenido de la calota del paciente medianteun berbiquí y unificado con un adhesivo de fibrina.Está técnica es sencilla y provoca poca morbilidad enel paciente. Además, permite obtener una importantecantidad de hueso.Desde el año 2007 utilizamos el hueso particuladoautólogo obtenido de la calota del paciente para lacorrección de defectos óseos grandes o pequeños que senos presentaban en la cirugía craneofacial practicadasobre todo en pacientes pediátricos.Aunque los materiales aloplásticos y sustitutos dehueso han sido utilizados para la reconstrucción de cráneos,el hueso autógeno es la mejor opción. A diferenciade los materiales sintéticos, los injertos autógenos tienenuna más rápida osteointegración ya que son osteogénicos,osteoinductivos y osteoconductivos, siendo ademásel injerto de la misma naturaleza que el hueso donante.La morbilidad producida al paciente por la obtencióndel hueso de la calota con esta técnica es mínima, encomparación con otras zonas donantes como costilla ocadera.La utilización del hueso particulado autólogodurante la cirugía de las craneosinostosis reduce lanecesidad de segundas intervenciones por defectos deosificación secundarios. Por otro lado, su obtención esfácil y la cantidad de hueso extraído es suficiente paralos pacientes pediátricos (AU)

It is considered that up to 20% of the craniosinostosispatients require secondary surgeries. Differenttechniques have been used in craneofacial surgery forthe reconstruction of great osseous defects in pediatricpatients for many years. This paper is about a newtechnique to obtain osseous graft for covering osseouscranial defects, using particulate bone, harvested fromthe patient calvarian using a hand-driven brace andcovered with a fibrin adhesive. This is a very simpletechnique, which provides a great amount of bone fromthe patient himself, therefore producing a small morbidity.Since 2007 the authors have been using autologousparticulate bone harvested from de patient calvarianfor the reconstruction of different size osseous defectsfound in craneofacial surgery, especially in pediatricspatients.Although alloplastic materials and bone substituteshave been used for cranial reconstruction, the bestoption is the autogenous bone. In contrast to syntheticmaterials autologous grafts have a faster osteointegration,due to their osteogenic, osteoinductive andosteconductive properties. Harvesting the bone fromthe calvarian patient produces a minimal morbiditycompared to the extraction of grafts from other donorsites such as rips or hip.The use of autologous particulate bone in craniosinostosissurgery reduces the risk of second interventionsdue to secondary ossifications defects. On theother hand, the harvest is easy and the supply of bone itis enough in pediatric patients (AU)

Metástasis pulmonares precoces y tardías de fibrohistiocitoma maligno. Tratamiento quirúrgico / Precocious and late lung metastases of malignant fibrohistiocytoma. Surgical treatment

Resumen. El fibrohistiocitoma maligno (FHM) constituye la variante histológica del grupo de los sarcomas de partes blandas más frecuente diagnósticada en el adulto. Es una neoplasia poco común que se localiza, generalmente, en las extremidades inferiores. Son tumores agresivos, con gran tendencia a la recidiva local y a las metástasis sistémicas tardías. El pulmón y el hígado son las localizaciones más frecuentes. Presenta supervivencias cortas. La cirugía radical es el tratamiento de elección. Los pacientes con metástasis pulmonares se benefician de la cirugía. Actualmente la ablación con radiofrecuencia (RFA) de las metástasis pulmonares es una opción terapéutica en pacientes en los que la quirúrgica se desestima. Presentamos un caso clínico de fibrohistiocitoma maligno pleomórfico inguinal con metástasis pulmonares bilaterales precoces y tardías tratado mediante cirugía (AU)

Abstract. The malignant fibrous histyocitoma (FHM) is the most frequent histological variant of the group of the sarcomas of soft parts diagnosed in the adult. It is a slightly common neoplasia that is located generally in the low extremities. They are aggressive tumors, with great trend to the local relapse and to the systemic late metastasis. The lung and the liver are the most frequent locations. They present short survivals. The radical surgery is the treatment of choice. The patients with pulmonary metastasis benefit from the surgery. Nowadays the radiofrecuence ablation (RFA) of the pulmonary metastasis is a therapeutical choice in those patients that surgical is scorned. We present a clinical case of inguinal pleomorfic malignant fibrous histyocitoma whit early bilateral pulmonary metastasis and late ones treated surgically (AU)