ABSTRACT
Objetivo: determinar si la metabolómica aplicada a una muestra de sudor permite diferenciar la concentración relativa de ciertos metabolitos en pacientes con cáncer de pulmón en estadio inicial (I - II) respecto a estadios avanzados (III - IV). Pacientes y métodos: fueron incluidos 21 pacientes diagnosticados de cáncer escamoso de pulmón en un hospital universitario. Para la inducción del sudor se utilizaron discos de Pilogel(R) y la recolección mediante dispositivo Macroduct(R) conservando la muestra a -80 ºC. Para el análisis metabolómico se utilizó un cromatógrafo de líquidos acoplado a un espectrómetro de masas de alta resolución (LC - QTOF) provisto de fuente de ionización por electroespray. Los datos se procesaron con el software MassHunter Workstation y se realizó análisis de cambio (FC, Fold Change Analysis) para detectar las diferencias de concentración relativa de metabolitos entre los diferentes estadios tumorales. Resultados: se estudiaron 21 muestras de sudor pertenecientes a 9 pacientes en estadio I - II y 12 en estadio III - IV. En una lista preferente de 16 compuestos que incluyeron diversos aminoácidos, azúcares, ácidos carboxílicos y ácidos grasos, no se observaron cambios significativos según la extensión tumoral. El análisis de cambio mostró que una trihexosa (FC: -2,175) fue el compuesto con diferencias significativas de concentración relativa en las muestras de sudor según los dos estadios tumoral comparados. Conclusión: en muestras de sudor de pacientes con carcinoma escamoso de pulmón la huella metabolómica se mantiene relativamente estable con escasas diferencias en la concentración relativa de metabolitos, únicamente se observó un cambio significativo en una trihexosa en estadios de cáncer de pulmón inicial y avanzado
Objective: To determine whether applying metabolomics to a sweat sample allows different metabolite concentrations to be differentiated in patients with early-stage lung cancer (stages I-II) compared to advanced stages (III-IV). Patients and methods: 21 patients diagnosed with squamouscell lung cancer in a university hospital were included. Pilogel(R) discs were used to induce sweat, which was collected using the Macroduct(R) system, storing the samples at -80 ºC. For the metabolomic analysis, a liquid chromatograph was used, attached to a high-resolution mass spectrometer (LC - QTOF) supplied with electrospray ionization. The data was processed using the MassHunter Workstation software and a fold change analysis (FC) was done to detect differences in metabolite concentrations between different tumor stages. Results: 21 sweat samples from 9 stage I-II patients and 12 stage III-IV patients were studied. In a list of 16 compounds that included several amino acids, sugars, carboxylic acids and fatty acids, no significant changes were observed according to tumor extension. The change analysis showed that a trihexose (FC: -2.175) was the compound with significant concentration differences in sweat samples according to the two tumor stages compared. Conclusion: In sweat samples from patients with squamouscell lung cancer, metabolomic markers remain relatively stable with slight differences in metabolite concentrations, only observing a significant change in a trihexose between early and advanced stages of lung cancer
Subject(s)
Humans , Male , Middle Aged , Aged , Biomarkers, Tumor/analysis , Sweat/chemistry , Neoplasms, Squamous Cell/diagnosis , Sweat/metabolism , Lung Neoplasms/diagnosis , Neoplasm Staging/classification , Mass Spectrometry/methods , Metabolomics/methodsABSTRACT
Graft-versus-host disease is a major complication for bone marrow transplant recipients and is often a cause of late mortality. It can affect any tissue, and involvement of the lungs--target organs of particular importance--can lead to chronic respiratory failure due to bronchiolitis obliterans. We report the case of a lung transplant in a woman who developed bronchiolitis obliterans after receiving a marrow transplant to treat bone marrow aplasia. Three years later, clinical course was satisfactory, with full functional recovery.
Subject(s)
Bone Marrow Transplantation/adverse effects , Bronchiolitis Obliterans/etiology , Bronchiolitis Obliterans/surgery , Lung Transplantation , Child , Female , HumansABSTRACT
La enfermedad del injerto contra el huésped es una complicación importante de los pacientes sometidos a trasplante de médula ósea, en quienes es causa de una elevada mortalidad tardía. Puede afectar a cualquier tejido y, cuando afecta a los pulmones, que son órganos diana de particular relevancia, acarrea insuficiencia respiratoria crónica secundaria al desarrollo de bronquiolitis obliterante. Presentamos el caso de una paciente con trasplante pulmonar por bronquiolitis obliterante tras haber recibido un trasplante de médula ósea por aplasia medular. La evolución tras el trasplante pulmonar, a los 3 años de seguimiento, es favorable, con recuperación clínica y funcional completa
Graft-versus-host disease is a major complication for bone marrow transplant recipients and is often a cause of late mortality. It can affect any tissue, and involvement of the lungs --target organs of particular importance-- can lead to chronic respiratory failure due to bronchiolitis obliterans. We report the case of a lung transplant in a woman who developed bronchiolitis obliterans after receiving a marrow transplant to treat bone marrow aplasia. Three years later, clinical course was satisfactory, with full functional recovery
Subject(s)
Female , Child , Humans , Lung Transplantation , Bronchiolitis Obliterans/etiology , Bone Marrow Transplantation/adverse effects , Transplantation, Homologous , Anemia, Aplastic/surgeryABSTRACT
No disponible
Subject(s)
Humans , Lung Transplantation/statistics & numerical data , Lung Diseases/surgery , Patient SelectionABSTRACT
OBJECTIVES: To analyse the prevalence of malnutrition in candidates for lung transplantation and to establish if there are any differences in the prevalence of malnutrition among the different groups of patients regarding their illness. METHODS: We reviewed the nutritional evaluation of 163 consecutive transplant candidates referred to our hospital (1996-2001). The nutritional assessment included: clinical history, anthropometric measurements, bioelectrical impedance analysis, and biochemical measurements. The nutritional status diagnosis was determined following RWS Chang protocol. RESULTS: 163 patients (108 male/55 female; 42.9 +/- 14.7 yr.) agrupped into four main lung diseases groups: obstructive (chronic obstructive pulmonary disease): 60 (36.8%); interstitial (idiopathic pulmonary fibrosis): 45 (27.6%); septic (cystic fibrosis and bronchiectasis): 47 (28.8%); and vascular (primary pulmonary hypertension and miscellaneous etiology): 11 (6.7%). The prevalence of malnutrition is 60.9% (IC 95%; 53.4-68.4) and the most prevalent type is moderate caloric malnutrition (23.3%). Percentage of triceps skinfold thickness was lower in the septic group (65.1 +/- 43.0) than in the obstructive (94.8 +/- 53.9; p < 0.05) or in the interstitial one (130.3 +/- 61.5; p < 0.0001). Interstitial group had also the higher weight, BMI and percentage of ideal weight. Percentage of arm muscle circumference was only different between interstitial and septic groups (105.5 +/- 18.3 vs 95.9 +/- 11.1; p < 0.01). Resting energy expenditure was lower in septic patients. This group had lower levels of prealbumin than obstructive (17.6 +/- 4.7 vs 24.4 +/- 4.8 mg/dl; p < 0.0001) or interstitial groups (17.6 +/- 4.7 vs 27.3 +/- 7.7 mg/dl; p < 0.0001). CONCLUSIONS: Malnutrition in patients awaiting lung transplantation is highly prevalent, specially in septic and vascular lung diseases. Anthropometric measurements are a good and easy option to explore this problem. Nutritional rehabilitation of these patients could improve their postoperative course.
Subject(s)
Lung Diseases/complications , Lung Transplantation , Nutrition Disorders/epidemiology , Adolescent , Adult , Anthropometry , Body Composition , Diagnosis-Related Groups , Energy Metabolism , Female , Humans , Male , Middle Aged , Nutrition Assessment , Nutrition Disorders/complications , Nutrition Disorders/diagnosis , Obesity/complications , Prevalence , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Fibrosis/complications , Retrospective Studies , Sepsis/complications , Spain/epidemiology , Vascular Diseases/complicationsABSTRACT
Objetivos: Determinar la prevalencia de desnutrición en candidatos a trasplante pulmonar y establecer los grupos de patología pulmonar con mayor frecuencia de desnutrición. Metodología: Estudio de la evaluación nutricional de 163 candidatos a trasplante pulmonar remitidos a nuestro hospital entre 1996-2001. La evaluación incluyó: historia clínica, antropometría, impedanciometría y medidas bioquímicas. El diagnóstico nutricional se estableció según RWS Chang. Resultados: 163 enfermos (108 hombre/55 mujeres; 42,9+/- 14,7 años) clasificados según los siguientes grupos de enfermedad pulmonar: obstructivo (enfermedad pulmonar obstructiva crónica): 60 (36,8 por ciento); intersticial (fibrosis pulmonar idiopática): 45 (27,6 por ciento); séptico (fibrosis quística y bronquiectasias): 47 (28,8 por ciento) y vascular (hipertensión pulmonar primaria y miscelánea): 11 (6,7 por ciento). La prevalencia de desnutrición es del 60,9 por ciento (IC 95 por ciento: 53,4-68,4) siendo la más frecuente la calórica moderada (23,3 por ciento). El porcentaje de pliegue triccipital es menor en el grupo séptico ( 65,1+/- 43,0) que en el obstructivo ( 94,8 +/- 53,9; p<0,05) o en el intersticial (130,3+/- 61,5; p<0,0001). El grupo intersticial tiene mayores peso, IMC y porcentaje de peso ideal. El porcentaje de circunferencia muscular del brazo sólo resultó diferente entre los grupos intersticial y séptico (105,5 +/- 18,3 frente a 95,9 +/- 11,1; p<0,01). El gasto energético basal es menor en los enfermos sépticos. Este grupo tiene niveles de prealbúmina menores que el obstructivo (17,6 +/- 4,7 frente a 24,4 +/- 4,8 mg/dl; p<0,0001) o el intersticial (17,6 +/- 4,7 frente a 27,3 +/- 7,7 mg/dl; p<0,0001). Conclusiones: La desnutrición en candidatos a trasplante pulmonar es altamente prevalente, especialmente en enfermedades sépticas o vasculares. Las antropometría es una técnica adecuada para detectar precozmente este problema. La mejoría del estado nutricional de estos enfermos puede favorecer su evolución postrasplante (AU)
Objectives: To analyse the prevalence of malnutrition in candidates for lung transplantation and to establish if there are any differences in the prevalence of malnutrition among the different groups of patients regarding their illness. Methods: We reviewed the nutritional evaluation of 163 consecutive transplant candidates referred to our hospital (1996-2001). The nutritional assessment included: clinical history, anthropometric measurements, bioelectrical impedance analysis, and biochemical measurements. The nutritional status diagnosis was determined following RWS Chang protocol. Results: 163 patients (108 male/55 female; 42,9 ± 14,7 yr.) agrupped into four main lung diseases groups: obstructive (chronic obstructive pulmonary disease): 60 (36,8%); interstitial (idiopathic pulmonary fibrosis): 45 (27,6%); septic (cystic fibrosis and bronchiectasis): 47 (28,8%); and vascular (primary pulmonary hypertension and miscellaneous etiology): 11 (6,7%). The prevalence of malnutrition is 60,9% (IC 95%; 53,4-68,4) and the most prevalent type is moderate caloric malnutrition (23,3%). Percentaje of triceps skinfold trickness was lower in the septic group (65,1 ± 43,0) than in the obstructive (94,8 ± 53,9; p < 0,05) or in the interstitial one (130,3 ± 61,5; p < 0,0001). Interstitial group had also the higher weight, BMI and percentaje of ideal weight. Percentaje of arm muscle circumference was only different between interstitial and septic groups (105,5 ± 18,3 vs 95,9 ± 11,1; p < 0,01). Resting energy expenditure was lower in septic patients. This group had lower levels of prealbumin than obstructive (17,6 ± 4,7 vs 24,4 ± 4,8 mg/dl; p < 0,0001) or interstitial groups (17,6 ± 4,7 vs 27,3 ± 7,7 mg/dl; p < 0,0001). Conclusions: Malnutrition in patients awaiting lung transplantation is highly prevalent, specially in septic and vascular lung diseases. Anthropometric measurements are a good and easy option to explore this problem. Nutritional rehabilitation of these patients could improve their postoperative course (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Male , Female , Humans , Lung Transplantation , Spain , Vascular Diseases , Nutrition Assessment , Prevalence , Sepsis , Nutrition Disorders , Obesity , Pulmonary Fibrosis , Retrospective Studies , Pulmonary Disease, Chronic Obstructive , Anthropometry , Body Composition , Diagnosis-Related Groups , Energy Metabolism , Lung DiseasesABSTRACT
Very few cases of lung transplantation have been described for patients with Kartagener's syndrome. We report the first case to be published in Spain. A 15-year-old girl with complete Kartagener's syndrome underwent sequential transplantation of both lungs. Due to the unusual distribution of the organs in this syndrome, the bronchial stumps of donor and recipient had to be distributed differently. With the initial technical difficulties overcome, the patient now leads a normal life two years after transplantation.
Subject(s)
Kartagener Syndrome/surgery , Lung Transplantation , Adolescent , Female , Follow-Up Studies , Humans , Immunosuppression Therapy/methods , Kartagener Syndrome/diagnostic imaging , Lung/diagnostic imaging , Lung Transplantation/methods , Tomography, X-Ray ComputedABSTRACT
Se han descrito muy pocos casos de trasplante pulmonar en pacientes con un síndrome de Kartagener. Describimos el primer caso que se publica en España. Una mujer de 15 años con un síndrome de Kartagener completo fue sometida a un trasplante bipulmonar secuencial. Debido a la disposición especular de los órganos en esta entidad clínica, se hizo necesario recurrir a modificaciones en la distribución habitual de los muñones bronquiales, tanto del donante como del receptor. Superadas las dificultades técnicas iniciales, la paciente realiza actualmente vida normal a los dos años postrasplante. (AU)
Subject(s)
Adolescent , Female , Humans , Lung Transplantation , Tomography, X-Ray Computed , Kartagener Syndrome , Immunosuppression Therapy , Lung , Follow-Up StudiesABSTRACT
OBJECTIVE: The aim of this study was to analyze the postoperative progress and medical management in the Pediatric Intensive Care Unit (PICU) of patients that underwent bilateral lung transplant. PATIENTS AND METHODS: From April 1997 to June 1998, 10 pediatric lung transplants were performed at the Hospital Reina Sofía (Córdoba, Spain). There were 4 males and 6 females (mean age 11.5 years, range 5 to 15 years). Indications for transplantation were cystic fibrosis (n = 9) and one pulmonary fibrosis secondary to viral infection. Before the transplant, two patients required mechanical ventilation for acute respiratory decompensation and one patient was ventilator-dependent. Immunosuppression consisted of corticosteroids, azathioprine and cyclosporine or tacrolimus. Post-transplantation management included early extubation, when possible, optimal fluid balance to prevent lung edema, low aggressive mechanical ventilation and adequate treatment of complications, such as rejection and infection. RESULTS: There were no peri-operative mortalities. The mean stay in the PICU was 28 days (median: 17 days) and the mean time on mechanical ventilation was 19 days (median: 5.5 days). The most frequent complications were rejection (n = 8), hyperglycemia (n = 6), renal failure (n = 4), arterial hypertension (n = 4) and respiratory infections (n = 3). There were no airway complications. CONCLUSIONS: Even if the post-operative period in pediatric lung transplant patients is difficult, the results have been good with an important improvement in the quality of life of these patients has been achieved.
