[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.

[Survival of lung transplant at the Puerta de Hierro Clinic]. / Análisis de la supervivencia del trasplante pulmonar en la Clínica Puerta de Hierro.

The objective of this study was to analyze patient survival after lung transplants performed at the Puerta de Hierro clinic in Madrid (Spain) between 1991 and 1996. Survival probability was 65% after one year and 50% after three years. We found no significant differences in survival related to sex or type of transplant. Early survival tended to be higher for the last two years analyzed (71%) than for the first two (55%) (p < 0.00001). The rate was 100% for patients with cystic fibrosis and 0% for pulmonary hypertension and lymphangiomyomatosis. Short- and medium-term lung function results were good in surviving patients who did not develop obliterating bronchiolitis. We conclude that actuarial survival after lung transplant in our program is comparable to that reported in the literature. There are no significant differences related to sex, type of transplant or period. Survival varies greatly, however, depending on disease.

An infrequent complication of Swan-Ganz catheters.

The Swan-Ganz catheter complications are infrequent, the most typical one being cardiac arrhythmias. The breaking and embolization of a catheter fragment into the pulmonary vascular system are exceptional and, in any case, benign. We present a patient with severe pulmonary hypertension to the embolization of a Swan-Ganz catheter fragment into the right pulmonary artery which disappeared with the movements of the fragment to the lung periphery.

[Prevention of tuberculosis infection]. / La prevención de la infección tuberculosa.

Tuberculosis (TB) is a disease caused by a mycobacterium, whose incidence has increased in the past years. This increase is related to the adquired immunodeficiency syndrome (AIDS). Due to its high prevalence, Spain is considered a developing country. The tuberculous infection depends on the degree of functionality of the alveolar macrophages that stimulate the lymphocytes and isolate the bacillus. The infection by mycobacterias can be quantified by means of the cutaneous reaction against tuberculin and mantoux, allowing us to select the subjects that must receive prophylaxis. For its correct interpretation, it is currently recommended to avoid BCG vaccination of children, except in countries with high prevalence of TB.