Analysis of Intrahospital Mortality in Patients With Lung Transplant Due to Diffuse Parenchymal Lung Disease.

BACKGROUND: Patients with diffuse parenchymal lung disease (DPLD) have the poorest survival rates both before and after lung transplantation (LT). Early mortality among LT patients as a result of DLPD is estimated at 10% to 20%. The aim of the study was to assess intrahospital mortality after LT procedures for DLPD and to identify factors in the recipient, donor, intra- and postoperative periods that might improve early outcomes. METHODS: A retrospective, observational, cohort, single-hospital study was conducted. Data from 67 patients with LT patients owing to DPLD were recorded between October 2008 to June 2017 in Madrid, Spain. RESULTS: Out of 67 LT recipients with DPLD, 51 had idiopathic pulmonary fibrosis (IPF)/usual interstitial pneumonia (UIP), 6 nonspecific interstitial pneumonia (NSIP), and 10 other DPLD. Intrahospital mortality took place in 13.4% of patients, with a median survival time of 34 days (interquartile range [IQR], 27.50-66). In the preoperative period, there were no differences in the recipients' demographic and hemodynamic characteristics, respiratory function, or time spent in the waiting list, except higher doses of systemic steroids in nonsurvivors (prednisone 15 vs 10 mg, P = .046). No differences were reported in the donors' characteristics (age, mechanical ventilation hours, PaO2/FiO2). In the intraoperative and postoperative periods, we found differences statistically significant in longer cold ischemia time and development of primary graft dysfunction (PGD) grade 3 in the nonsurvivor group. CONCLUSIONS: The mortality rate in our series was 13.4%, and the main risk factors for intrahospital mortality were longer cold ischemia time and greater incidence of PGD grade 3.

Liposarcoma mixoide gigante de mediastino / No disponible

Presentamos un caso de una mujer de 70 años con una masa mediastínica gigante. Se le practica toracotomía para resección quirúrgica con resultado anatomopatológico final de una masa tumoral de 23 x 19 x 18 cm, que pesa 2.495 g, con diagnósticos de liposarcoma de tipo mixto que respeta los bordes quirúrgicos. A los 6 meses aparece recidiva tumoral a distancia y la paciente fallece a los 11 meses de la cirugía (AU)

We present a case of a 70-year-old woman with a giant mass of mediastinum. A complete resection of the tumor from the left pleural cavity and posterior mediastinum was made through a posterior–anterior left thoracotomy. The mass weighted 2,495 g and its dimensions were 23 x 19 x 18 cm. The final diagnosis was consistent with a myxoid liposarcoma (MLS), and negative microscopic margins. 6 months after the surgical excision, the patient presented with a distal recurrence and she died after 11 months (AU)

Hernia pulmonar intercostal espontánea secundaria a cuadro de tos / Spontaneous intercostal lung hernia secondary to coughing spell

Las hernias pulmonares son entidades infrecuentes y se relacionan sobre todo con traumatismos torácicos o cirugías previas. Las hernias pulmonares espontáneas son todavía más infrecuentes. Se describen dos casos de hernia pulmonar intercostal espontánea, su evaluación y tratamiento en todas sus modalidades, desde el manejo conservador en hernias de pequeño tamaño sin gran repercusión clínica hasta la corrección quirúrgica, bien con cierre primario de la pared torácica o uso de mallas sintéticas, en hernias de mayor tamaño o que presentaron signos de posible complicación (AU)

Lung hernias are rare entities and are primarily related to chest trauma or previous surgery. Spontaneous lung hernias are even more uncommon. We describe three cases of pontaneous intercostal pulmonary hernia, its evaluation and treatment in all its forms, from the conservative management in small hernias without significant clinical impact, to surgical treatment, either with primary closure of the chest wall or using synthetic mesh in larger hernias or in presence of signs of possible complications (AU)