Biomarkers for Predicting Malignant Pleural Mesothelioma in a Mexican Population.

Background: Diagnosis of malignant pleural mesothelioma (MPM) remains a challenge, especially when resources in pathology are limited. The study aimed to evaluate cost-effective tumor markers to predict the probability of MPM in plasma samples in order to accelerate the diagnostic workup of the tissue of potential cases. Methods: We conducted a case-control study stratified by gender, which included 75 incident cases with MPM from three Mexican hospitals and 240 controls frequency-matched by age and year of blood drawing. Plasma samples were obtained to determine mesothelin, calretinin, and thrombomodulin using enzyme-linked immunosorbent assays (ELISAs). We estimated the performance of the markers based on the area under the curve (AUC) and predicted the probability of an MPM diagnosis of a potential case based on the marker concentrations. Results: Mesothelin and calretinin, but not thrombomodulin were significant predictors of a diagnosis of MPM with AUCs of 0.90 (95% CI: 0.85-0.95), 0.88 (95% CI: 0.82-0.94), and 0.51 (95% CI: 0.41-0.61) in males, respectively. For MPM diagnosis in men we estimated a true positive rate of 0.79 and a false positive rate of 0.11 for mesothelin. The corresponding figures for calretinin were 0.81 and 0.18, and for both markers combined 0.84 and 0.11, respectively. Conclusions: We developed prediction models based on plasma concentrations of mesothelin and calretinin to estimate the probability of an MPM diagnosis. Both markers showed a good performance and could be used to accelerate the diagnostic workup of tissue samples in Mexico.

Manejo del empiema con un sistema cerrado de succión y reconstrucción de ventana torácica en un paciente con cirrosis hepática / Management of Pleural Empyema With a Vacuum-Assisted Closure Device and Reconstruction of Open Thoracic Window in a Patient With Liver Cirrhosis

Mujer de 21 años diagnosticada de cirrosis criptogénica desde los 9 años de edad, que presentó empiema izquierdo posneumónico que no remitió con el tratamiento médico convencional y evolucionó con fistulización hacia la piel en el séptimo espacio intercostal a nivel subescapular izquierdo. Se realizó una ventana torácica abierta y al sexto día se envió a su domicilio con colocación de sistema cerrado de succión portátil, con cambios cada 4 días del material hasta la obliteración total de la cavidad (92 días). Se observó por imagen una expansión completa del pulmón y se realizó reconstrucción de la pared torácica con barras de titanio. La alta mortalidad del empiema, en los pacientes con hepatopatías, requiere la implementación y la búsqueda de nuevas terapias adyuvantes, como la utilización del sistema cerrado de succión y la reconstrucción con barras de titanio. Para una adecuada evaluación, se requieren estudios controlados con una serie de casos amplia (AU)

The patient is a 21-year-old female, diagnosed with cryptogenic cirrhosis at the age of 9. She presented with left post-pneumonic empyema that did not remit with conventional medical management and evolved with fistulization to the skin in the 7th intercostal space in the left subscapular region. We performed an open thoracic window procedure, and on the 6th day the patient was sent home with a portable vacuum-assisted closure device, with changes of the material every 4 days until the cavity was completed obliterated (92 days). Imaging tests showed full expansion of the lung, and chest wall reconstruction was performed with titanium rods. The high mortality of empyema in patients with liver disease requires both implementing and searching for new adjuvant therapies, like the use of vacuum-assisted closure systems and reconstruction with titanium rods. Controlled studies with a wide range of cases are needed for proper evaluation (AU)

Management of pleural empyema with a vacuum-assisted closure device and reconstruction of open thoracic window in a patient with liver cirrhosis.

The patient is a 21-year-old female, diagnosed with cryptogenic cirrhosis at the age of 9. She presented with left post-pneumonic empyema that did not remit with conventional medical management and evolved with fistulization to the skin in the 7th intercostal space in the left subscapular region. We performed an open thoracic window procedure, and on the 6th day the patient was sent home with a portable vacuum-assisted closure device, with changes of the material every 4 days until the cavity was completed obliterated (92 days). Imaging tests showed full expansion of the lung, and chest wall reconstruction was performed with titanium rods. The high mortality of empyema in patients with liver disease requires both implementing and searching for new adjuvant therapies, like the use of vacuum-assisted closure systems and reconstruction with titanium rods. Controlled studies with a wide range of cases are needed for proper evaluation.

Lung transplantation with uncontrolled non-heart-beating donor. Review.

The discrepancy between organ availability and the increasing amount of patients on the waiting list has prompted the development of medical strategies to increase the usable organs, including the search for alternative sources of donation, organ optimization and extension of the criteria for donation. The recovery of lungs from non-heart-beating donors (NHBD) is a concept in which death is declared based on cardiopulmonary criteria rather than the currently used definition of "brain death." Obtaining NHBD lungs is currently practiced in many centers. In this review we discuss the current state of lung transplantation from uncontrolled NHBD.

Tracheal dimensions in the Mexican population.

BACKGROUND: There are few studies regarding the measurement of tracheal dimensions. Most are focused on morphology and tracheal development. The aim of this study was to determine the length and tracheal diameter of adults in our population and its correlation with external measurements. METHODS: The study design was prospective, observational and descriptive. We included a nonrandom sampling of deaths of Mexican national citizens who were between 18 and 65 year old. The study period was from June 1 to November 30, 2009, and the study was carried out at the facilities of the Forensic Medical Service of the Federal District, Mexico. Standardized measurements of tracheal diameter and length were correlated with external measurements. RESULTS: We dissected 44 cadavers, 19 (43%) females and 25 (57%) males. In females the average age was 39.2 ± 13.9 years (range: 19-61 years), average height 161.9 ± 7.4 cm (range: 154-179 cm), tracheal length (TL) 8.6 ± 0.5 cm (range: 7.8-9.5 cm) and transverse diameter (TD) 1.7 ± 0.3 cm (range: 1.3-2.0 cm). Average age of males was 36.4 ± 14.4 years (range: 19-65 years), average height 169.8 ± 6.7 cm (range: 156-184 cm), TL 9.1 ± 0.9 cm (range: 8.0-10.7) and TD 1.9 ± 0.2 cm (range: 1.6-2.3 cm). TL was significantly correlated with sternal length (0.82, p <0.0001) and age (0.56, p = 0.0003). According to gender, there was no significant correlation between TL and height. CONCLUSIONS: We found a low average TL and no significant correlation with height. These data should be considered when carrying out direct procedures on the trachea.

[Pioneers of Mexican thoracic surgery]. / Pioneros de la cirugía torácica mexicana.

The development of thoracic surgery as a specialty is linked to the acquisition of knowledge and skills such as the resolution of the open pneumothorax with differential pressure and tracheal intubation, asepsis, antibiotic therapy and intensive care.Our pioneers in thoracic development were general surgeons who ventured into this field during the late nineteenth and early twentieth centuries, culminating in the transition to a full blown specialty during the second half of the 20th century.