Desarrollo de un programa de donación pulmonar en asistolia con «preservación en bitermia» y resultados tras un año de experiencia clínica / Development of a Non-Heart-Beating Lung Donor Program With «Bithermia Preservation», and Results After One Year of Clinical Experience

El número de trasplantes pulmonares que se realizan en España continúa en ascenso, con 235 pacientes trasplantados en 2010. Los programas de donantes en asistolia han contribuido a esta progresión. Nuestra Unidad de Trasplante Pulmonar comenzó su actividad en octubre de 2008, y en estos 3 años se han trasplantado con éxito el 97% de los pacientes intervenidos. Para obtener un mayor número de donantes hemos desarrollado un programa de donación pulmonar en asistolia a partir del programa existente en nuestro hospital. Fue necesario la elaboración de una metodología de preservación multiorgánica (pulmonar, hepática y renal) que hemos denominado «preservación en bitermia». Presentamos la experiencia de su aplicación clínica durante el primer año. Hemos trasplantado 3 pacientes utilizando este tipo de donantes en asistolia. Ninguno de los pacientes desarrolló disfunción primaria del injerto, todos fueron dados de alta, realizan vida activa y sin datos de síndrome de bronquiolitis obliterante (AU)

The number of lung transplantations that are performed in Spain continues to grow, with 235 transplant recipients 2010. Non-heart-beating donations have contributed to this upward progression. Our Lung Transplant Unit began its activity in October 2008 and during these last three years 97% of the transplant interventions performed have been successful. In order to increase the number of donations, we have developed a non-heart-beating donor program as part of the existing organs program in our hospital. In doing so, the development of a multi-organic preservation method (lung, liver and kidney), which we call «Bithermia Preservation», was necessary. This paper presents this methodology as well as the first year of clinical application experience. During this time, 3 patients have been transplanted using such non-heart-beating donations. None of them developed primary graft dysfunction; all the patients have been discharged and lead active lives without any evidence of bronchiolitis obliterans syndrome (AU)

Development of a non-heart-beating lung donor program with «Bithermia Preservation¼, and results after one year of clinical experience.

The number of lung transplantations that are performed in Spain continues to grow, with 235 transplant recipients 2010. Non-heart-beating donations have contributed to this upward progression. Our Lung Transplant Unit began its activity in October 2008 and during these last three years 97% of the transplant interventions performed have been successful. In order to increase the number of donations, we have developed a non-heart-beating donor program as part of the existing organs program in our hospital. In doing so, the development of a multi-organic preservation method (lung, liver and kidney), which we call «Bithermia Preservation¼, was necessary. This paper presents this methodology as well as the first year of clinical application experience. During this time, 3 patients have been transplanted using such non-heart-beating donations. None of them developed primary graft dysfunction; all the patients have been discharged and lead active lives without any evidence of bronchiolitis obliterans syndrome.

[Prognostic value study of lung cancer molecular markers]. / Valor pronóstico de los marcadores moleculares en el carcinoma broncogénico.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the prognostic value of molecular markers (proteins) of different paths of lung cancer development in patients with non small cell lung carcinoma (NSCLC) in initial stages. MATERIAL AND METHOD: Observational, cohort study in patients with NSCLC that was initially treated surgically in our hospital between October 1993 and September 1997. Thirty-two proteins were selected. The study consisted of the elaboration of tissue arrays with samples from resected tumour, using a semiquantitative immunohistochemical study. A prognosis analysis was done with the expression of each protein and calculation of the overall 5-year survival rate. The Wilcoxon-Gehan and Log-Rank tests were used for statistical comparisons, with p<.05 being considered to indicate a significant result. RESULTS: One hundred and forty six patients were studied. The overall 5-year survival rate was 37.7%. From 32 proteins studied, three were statistically associated with overall 5-year survival rate. RB protein expression in resected NSCLC was a positive prognostic factor (P=.01). P27 (P=.03) and Ki67 (P=.04) expression in resected NSCLC were negative prognostic factors. There was no protein with prognostic value in epidermoid tumours. CONCLUSIONS: We found three proteins with long-term prognostic value in the long-term in the general population and five adenocarcinoma prognostic proteins in our study of resected non-small cell lung cancer (NSCLC). In the future, genetic-molecular factors should be included along with anatomical (TNM staging) and clinical factors in a multidimensional lung cancer staging.

Valor pronóstico de los marcadores moleculares en el carcinoma broncogénico / Prognostic value study of lung cancer molecular markers

Fundamentos y objetivo: Estudio pronóstico de marcadores moleculares implicados en la carcinogénesis del carcinoma broncogénico (CB), en pacientes con CB no microcítico (CBNM) resecado en estadios iniciales. Material y método: Estudio observacional y de cohorte de pacientes con CBNM en estadios iniciales intervenidos en el Hospital 12 de Octubre de Madrid entre el 1 de octubre de 1993 y el 30 de septiembre de 1997. Se estudiaron 32 proteínas con un análisis inmunohistoquímico semicuantitativo. Se realizó un análisis de la expresión de cada proteína en relación con la supervivencia a 5 años mediante las pruebas de Wilcoxon-Gehan y log rank, aceptando como significativo un valor de p<0,05.ResultadosEl número final de pacientes incluidos fue de 146. La supervivencia a 5 años fue del 37,7%. De las 32 proteínas, hemos encontrado tres con significado pronóstico a 5 años: la expresión de RB, asociada a mejor pronóstico (p=0,01), y la expresión de p27 (p=0,03) y Ki67 (p=0,04), asociadas a peor pronóstico. En el análisis según histología no hay ninguna proteína con valor pronóstico en CB epidermoide, mientras que hay cinco en adenocarcinomas. Conclusiones: En esta serie de CBNM resecado hay 3 marcadores moleculares con valor pronóstico a largo plazo en la población general y cinco en adenocarcinomas. Probablemente, en el futuro los factores moleculares se unan a los de extensión anatómica y clínicos en una clasificación pronóstica multidimensional en CB (AU)

Background and objective: The aim of this study was to determine the prognostic value of molecular markers (proteins) of different paths of lung cancer development in patients with non small cell lung carcinoma (NSCLC) in initial stages. Material and method: Observational, cohort study in patients with NSCLC that was initially treated surgically in our hospital between October 1993 and September 1997. Thirty-two proteins were selected. The study consisted of the elaboration of tissue arrays with samples from resected tumour, using a semiquantitative immunohistochemical study. A prognosis analysis was done with the expression of each protein and calculation of the overall 5-year survival rate. The Wilcoxon-Gehan and Log-Rank tests were used for statistical comparisons, with p<.05 being considered to indicate a significant result. Results: One hundred and forty six patients were studied. The overall 5-year survival rate was 37.7%. From 32 proteins studied, three were statistically associated with overall 5-year survival rate. RB protein expression in resected NSCLC was a positive prognostic factor (P=.01). P27 (P=.03) and Ki67 (P=.04) expression in resected NSCLC were negative prognostic factors. There was no protein with prognostic value in epidermoid tumours. Conclusions: We found three proteins with long-term prognostic value in the long-term in the general population and five adenocarcinoma prognostic proteins in our study of resected non-small cell lung cancer (NSCLC). In the future, genetic-molecular factors should be included along with anatomical (TNM staging) and clinical factors in a multidimensional lung cancer staging (AU)

Analysis of the molecular expression profile of non small cell lung carcinoma associated to chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is an independent risk factor to develop lung cancer but there are no different functional clusters of biomarkers between patients with non-small cell lung cancer (NSCLC) with or without COPD. To analyse protein expression, in order to find out whether samples of resected NSCLC from patients with COPD present a different molecular expression. Observational, cohort, concurrent study with sampling since treatment of disease in patients with NSCLC in initial stages (pIA-pIIB) treated surgically in our hospital between October 1993 and September 1997. The study consisted of the elaboration of tissue arrays with samples from resected tumor, using immunohistochemistry as a study method. Univariate analysis and logistic regression analysis were performed in order to determine molecular markers that showed a differential expression in NSCLC of the patients with COPD. We studied thirty-two proteins in 146 patients. 30% of the patients had COPD. Univariate analysis in patients with COPD showed one molecular marker to be overexpressed and five molecular markers to be underexpressed. Multivariate analysis in patients with COPD identified membranous beta-Catenin as a differential biomarker, which displayed an underexpression, with an Odds Ratio (95% Confidence Interval) of 0.26 (0.07-1.01). A significant lowest expression of membranous beta-catenin was detected in NSCLC of the patients with COPD.

[Bronchioloalveolar carcinoma in Spain: a rare and different form of lung cancer]. / Carcinoma bronquioloalveolar en España. Un cáncer de pulmón infrecuente y diferente.

OBJECTIVE: To describe a series of cases of bronchioloalveolar carcinoma (BAC) treated surgically between 1993 and 1997 in the 19 hospitals that make up the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pulmonology and Thoracic Surgery (GCCB-S). PATIENTS AND METHODS: From a total of 2,944 cases of non-small cell lung cancer (NSCLC), 82 (3%) were BAC. The clinical characteristics and prognosis of patients with BAC were compared with those of the remaining 2,862 patients with NSCLC. RESULTS: The percentage of men was lower for BAC than for other types of NSCLC (64.6% compared with 93.5%; P< .001) and BAC was associated with less comorbidity (50% vs 62%; P< .05), particularly in terms of chronic obstructive pulmonary disease (33% vs 47.2%; P< .05). Other characteristics showing significant differences were the higher frequency of BAC as a chance finding and the lower likelihood of weight loss or reduced performance status at the time of diagnosis. Classification as stage cI was significantly more common in patients with BAC (87% vs 75%; P.001), and this difference between groups was more pronounced for stage pI (68.5% vs 47%; P< .01). Only taking into account patients classified as stage pI with complete resection of NSCLC and following exclusion of operative mortality, patients with BAC presented an overall 5-year survival of 65% (95% confidence interval [CI], 51%-79%), compared with a significantly lower survival of 53% (95% CI, 50%-56%; P< .05) in patients with other forms of NSCLC. CONCLUSIONS: In Spain, among cases of lung cancer treated by surgery, BAC is very rare (3%) and displays clinical characteristics that are different from other forms of NSCLC. Controlling for the most basic prognostic factors (stage pI and complete resection), survival is significantly higher for BAC.

Carcinoma bronquioloalveolar en España. Un cáncer de pulmón infrecuente y diferente / Bronchioloalveolar carcinoma in Spain: a rare and different form of lung cancer

Objetivo: Describir una serie de casos de carcinoma bronquioloalveolar (CBA) tratados quirúrgicamente por los 19 hospitales del Grupo Cooperativo de Carcinoma Broncogénico de la Sociedad Española de Neumología y Cirugía Torácica (GCCB-S) entre 1993 y 1997. Pacientes y métodos: Del total de 2.944 casos de carcinoma broncogénico no microcítico (CBNM), 82 (3%) eran CBA. Se compararon las características clínicas y el pronóstico de los CBA con los de los restantes 2.862 CBNM. Resultados: Los CBA ocurren menos frecuentemente en varones (el 64,6 frente al 93,5%; p = 0,001), tienen menos comorbilidad en general (el 50 frente al 62%; p < 0,05) y enfermedad pulmonar obstructiva crónica en particular (el 33 frente al 47,2%; p < 0,05). Otras características con diferencias significativas son la mayor frecuencia de que el CBA sea un hallazgo casual y la menor probabilidad de que en el momento del diagnóstico exista historia de pérdida de peso o peor estado clínico. Por estadios clínicos, la clasificación Ic es significativamente más frecuente en los CBA (el 87 frente al 75%; p = 0,001), diferencia que se incrementa en la estadificación Ip (el 68,5 frente al 47%; p < 0,01). Considerando la población de CBNM con resección completa en estadio Ip, y una vez excluida la mortalidad operatoria, los CBA presentan una supervivencia global a los 5 años del 65% (intervalo de confianza [IC] del 95%, 51-79%), significativamente superior al resto de CBNM no CBA, en que es del 53% (IC del 95%, 50-56%) (p < 0,05). Conclusiones: En España, entre los casos de cáncer de pulmón operado, el CBA es muy infrecuente (3%) y presenta características clínicas diferentes del resto de los CBNM. Controlando con los factores pronósticos más básicos (estadio Ip y resección completa), la supervivencia del CBA es significativamente superior

Objective: To describe a series of cases of bronchioloalveolar carcinoma (BAC) treated surgically between 1993 and 1997 in the 19 hospitals that make up the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pulmonology and Thoracic Surgery (GCCB-S). Patients and methods: From a total of 2944 cases of non-small cell lung cancer (NSCLC), 82 (3%) were BAC. The clinical characteristics and prognosis of patients with BAC were compared with those of the remaining 2862 patients with NSCLC. Results: The percentage of men was lower for BAC than for other types of NSCLC (64.6% compared with 93.5%; P<.001) and BAC was associated with less comorbidity (50% vs 62%; P<.05), particularly in terms of chronic obstructive pulmonary disease (33% vs 47.2%; P<.05). Other characteristics showing significant differences were the higher frequency of BAC as a chance finding and the lower likelihood of weight loss or reduced performance status at the time of diagnosis. Classification as stage cI was significantly more common in patients with BAC (87% vs 75%; P<.001), and this difference between groups was more pronounced for stage pI (68.5% vs 47%; P<.01). Only taking into account patients classified as stage pI with complete resection of NSCLC and following exclusion of operative mortality, patients with BAC presented an overall 5-year survival of 65% (95% confidence interval [CI], 51%-79%), compared with a significantly lower survival of 53% (95% CI, 50%-56%; P<.05) in patients with other forms of NSCLC. Conclusions: In Spain, among cases of lung cancer treated by surgery, BAC is very rare (3%) and displays clinical characteristics that are different from other forms of NSCLC. Controlling for the most basic prognostic factors (stage pI and complete resection), survival is significantly higher for BAC

Successful conservative management in iatrogenic tracheobronchial injury.

BACKGROUND: The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheobronchial injuries (ITBI). METHODS: Between January 1993 and December 2003, 33 tracheobronchial injuries were treated in our hospital. Eighteen (54.5%) were ITBI and 15 (45.5%) were traumatic noniatrogenic injuries. Of the ITBI patients, sex distribution was 15 (83%) females and 3 (17%) males with a mean age of 57.7 +/- 20.7 years (range, 17 to 88 years). Fifteen (83.3%) of the injuries were caused by orotracheal intubation and 3 (15.7%) by tracheotomy. The average diagnostic delay was 25.7 +/- 22.9 hours. The mean injury size was 2.83 +/- 1.02 cm (range, 1 to 4 cm). Nine (50%) injuries were located in the cervical trachea, 6 (33.3%) in the thoracic trachea, and 3 (16%) involved both trachea and main bronchi. Conservative treatment was chosen for 17 (94.4%) of the 18 cases. We performed surgical repair in only 1 case owing to progressive subcutaneous emphysema and increasing difficulty with mechanical ventilation. RESULTS: No complications arose from the use of conservative treatment. Four patients (22%) died in our hospital, 3 of these of non-ITBI-related causes. Mortality was not related to four variables: sex, diagnostic delay, location, or size of the ITBI. Fourteen of the 18 patients (77.7%) were discharged uneventfully, and the endoscopic and clinical follow-up examinations were satisfactory in all patients. CONCLUSIONS: Conservative treatment for ITBI is effective regardless of production, size, or site of the injuries. Surgical treatment is advisable in specific cases: rapid progression of subcutaneous and mediastinal emphysema, mediastinitis, and difficulty with mechanical ventilation.

Surgical lung cancer. Risk operative analysis.

STUDY OBJECTIVE: To identify those variables that are associated with operative morbidity or mortality in cases of thoracotomy in lung cancer. SETTING: Third level university hospital. PATIENTS: Consecutive patients with thoracotomy due to lung cancer operated on between 1994 and 1997 (n = 115). METHODS: Pre- and postoperative variables potentially associated with operative morbidity or mortality were retrieved prospectively as follows: demographic and clinical characteristics of the patients, cardiopulmonary function characteristics, tumour characteristics, and treatment characteristics. A bivariate analysis of all variables under evaluation was carried out in order to identify those variables associated with operative morbidity and mortality. A multivariable analysis of the selected variables was then conducted using a logistic model. RESULTS: The predicted postoperative product (predicted FEV1 x predicting diffusing capacity of carbon monoxide), the carbon monoxide diffusion coefficient (Kco) and the contralateral pulmonary perfusion are variables that relate to the overall morbidity or mortality (number of events 63, 55%) (-2 log likelihood chi2 = 22.9; R2 = 0.27). For variables associated with postoperative morbidity, the best associative model combines functional variables (diffusion, predicted FEV1), endoscopic variables (obstructed segments to be resected), clinical variables (comorbidity) and an important postoperative variable, the pathological tumoural staging (pN) (number of events 49, 43%) (-2 log likelihood chi2 = 32.9; R2 = 0.36). CONCLUSION: The numerous variables under analysis are poorly associated with morbidity or mortality after thoracotomy in lung cancer. With regard to postoperative morbidity, the best associative models combine information that is known pre- and postoperatively and which is provided by both the patient and the tumour.

Spinal cord compression and epidural abscess extension of pleural empyema.

We report a case of epidural extension of pleural empyema with cord compression and neurologic deficit. Surgical decompression was required and emergency bilateral laminectomy was performed with removal of abscess and granulation tissue. Methicillin-resistant Staphylococcus aureus grew in cultures of pleural and epidural specimens and appropriate intravenous antibiotics were started. In spite of early diagnosis and rapid management the patient suffered severe sequelae.