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1.
PLoS One ; 16(6): e0252148, 2021.
Article in English | MEDLINE | ID: mdl-34086705

ABSTRACT

OBJECTIVE: One of the main problems of lung transplantation is the shortage of organs as well as reduced survival rates. In the absence of an international standardized model for lung donor-recipient allocation, we set out to develop such a model based on the characteristics of past experiences with lung donors and recipients with the aim of improving the outcomes of the entire transplantation process. METHODS: This was a retrospective analysis of 404 lung transplants carried out at the Reina Sofía University Hospital (Córdoba, Spain) over 23 years. We analyzed various clinical variables obtained via our experience of clinical practice in the donation and transplantation process. These were used to create various classification models, including classical statistical methods and also incorporating newer machine-learning approaches. RESULTS: The proposed model represents a powerful tool for donor-recipient matching, which in this current work, exceeded the capacity of classical statistical methods. The variables that predicted an increase in the probability of survival were: higher pre-transplant and post-transplant functional vital capacity (FVC), lower pre-transplant carbon dioxide (PCO2) pressure, lower donor mechanical ventilation, and shorter ischemia time. The variables that negatively influenced transplant survival were low forced expiratory volume in the first second (FEV1) pre-transplant, lower arterial oxygen pressure (PaO2)/fraction of inspired oxygen (FiO2) ratio, bilobar transplant, elderly recipient and donor, donor-recipient graft disproportion requiring a surgical reduction (Tailor), type of combined transplant, need for cardiopulmonary bypass during the surgery, death of the donor due to head trauma, hospitalization status before surgery, and female and male recipient donor sex. CONCLUSIONS: These results show the difficulty of the problem which required the introduction of other variables into the analysis. The combination of classical statistical methods and machine learning can support decision-making about the compatibility between donors and recipients. This helps to facilitate reliable prediction and to optimize the grafts for transplantation, thereby improving the transplanted patient survival rate.


Subject(s)
Lung Transplantation/methods , Tissue and Organ Procurement/methods , Female , Graft Survival/physiology , Humans , Male , Spain , Survival Rate , Tissue Donors , Transplant Recipients
2.
Rev. esp. patol. torac ; 29(3): 155-166, oct. 2017. ilus, tab, graf
Article in Spanish | IBECS | ID: ibc-167912

ABSTRACT

Objetivos: establecer un modelo murino de fibrosis pulmonar inducida por bleomicina, investigando el posible papel protector del sistema endocannabinoide (SE) frente a la fibrosis. Métodos: se emplearon ratones salvajes (C5BL/6 y Balb/c) así como la cepa TRPV1-/-. Tras una única dosis intratraqueal de bleomicina, se analizó la respuesta fibrótica mediante un análisis histológico, la determinación de la expresión de marcadores del proceso profibrótico, el estudio de la actividad mieloperoxidasa y del contenido en hidroxiprolina del pulmón, así como el análisis de la expresión génica de VIP, PACAP, IL-1β, IL-6, TNF-α e IL-11, y el estado de activación de las rutas MAPKs (fosfo-JNK, fosfo-ERK) de la ruta de NF-κB (p-IκBα), la ruta de β-catenina y del TGFβ (GSK-3B), la activación de SMAD (pSMAD2) y pSTAT3, a nivel proteico. Resultados: la fibrosis pulmonar inducida por bleomicina en los ratones de la cepa TRPV- /- fue más severa que en la cepa salvaje C5BL/6. El contenido en hidroxiprolina y la actividad mieloperoxidasa fue mayor en los ratones TRPV1-/-. Se detectó un incremento significativo en la expresión génica de citoquinas proinflamatorias (TNF-a, IL-1b, IL11 e IL-6), pero no de VIP o PACAP, en la cepa TRPV1-/-. A nivel proteico, la expresión de pIKBα, pSTAT3, pSMAD2 y pJNK, pero no la de pERK, se vio incrementada en los ratones TRPV1-/-. Conclusiones: el modelo murino de fibrosis pulmonar inducida por bleomicina sigue siendo clave para continuar profundizando los conocimientos acerca de la patogénesis de la FPI. La modulación del SE podría tener un papel protector frente a la fibrosis pulmonar


Objectives: to establish a murine model of bleomycin-induced pulmonary fibrosis, analysing the possible protective role of the Endocannabinoid System (ES) against fibrosis. Methods: wild C5BL/6 and Balb/c mice, as well as the genetically modified strain TRPV1- /- were used. After a single dose of intratracheal bleomycin, the fibrotic response was analysed though histologic studies, the assessment of proinflammatory markers, myeloperoxidase activity, hydroxyproline content, genetic expression of VIP, PACAP, IL-1 β, IL-6, TNF-α and IL-11, as well as MAPK route (phospho-JNK, phospho-ERK), NF-κB (p-IκBα), β-cathenin, TGF-β (GSK-3B), SMAD (p-SMAD2) and pSTAT3, at a protein level. Results: pulmonary fibrosis was more severe in TRPV1-/- mice compared to C5BL/6 mice. A significant increase in proinflammatory markers such as TNF-α, IL-1β, IL11 and IL-6, but not VIP or PACAP, was observed. pIKBα, pSTAT3, pSMAD2 and pJNK, but not pERK, were increased at a protein level in TRPV-/- mice. Conclusions: the murine model of bleomycin-induced lung fibrosis remains a keystone to pioneer current investigation in lung fibrosis. Modulation of the ES might have a protective role


Subject(s)
Animals , Mice , Pulmonary Fibrosis/chemically induced , Pulmonary Fibrosis/veterinary , Bleomycin/therapeutic use , Peroxidase/therapeutic use , Endocannabinoids/therapeutic use , Gene Expression , Models, Animal , Laparotomy/methods , Laparotomy/veterinary , Immunohistochemistry/methods , Blotting, Western/methods
3.
Rev. esp. patol. torac ; 28(3): 174-187, mayo 2016. tab, graf
Article in Spanish | IBECS | ID: ibc-152951

ABSTRACT

OBJETIVOS: la resección infralobar (RI) en el carcinoma broncogénico de célula no pequeña (CBCNP) en estadio precoz está ganando popularidad. Sin embargo, la cantidad óptima de parénquima pulmonar a resecar sigue siendo objeto de controversia. Analizamos si la RI difiere de la lobectomía (L) como tratamiento quirúrgico estándar de los pacientes con CBCNP en estadio precoz. MÉTODOS: se analizaron 493 resecciones pulmonares consecutivas realizadas en un periodo de 14 años. 266 pacientes con CBCNP en estadio I fueron sometidos a una lobectomía (L = 178), o a una resección pulmonar atípica/segmentectomía (RI = 88). Se compararon factores demográficos, oncológicos, quirúrgicos y postoperatorios. RESULTADOS: no se observaron diferencias en las características de los pacientes, la mortalidad perioperatoria o la tasa de complicaciones. En los pacientes con CBCNP en estadio I (n = 266) la tasa de recurrencia loco-regional (RI vs L): 14% vs 16% (p = 0,06), metástasis a distancia: 8% vs 9% (p = 0,33), supervivencia (a los 3, 5 años): 78%, 74% vs 74%, 69% (p = 0,37), supervivencia libre de enfermedad (a los 3, 5 años): 82%, 36% vs 80%, 56% (p = 0,93), supervivencia libre de metástasis a distancia (a los 3, 5 años): 90%, 80% vs 86%, 83% (p = 0,73). Complicaciones postquirúrgicas: 30% vs 36% (p = 0,21), mortalidad perioperatoria: 2% vs 5% (p = 0,64). CONCLUSIONES: la resección pulmonar infralobar posee unas tasas aceptables de morbimortalidad y puede ser equivalente a la lobectomía, desde el punto de vista oncológico, en el CBCNP en estadio I


OBJECTIVE: sublobar resection (SLR) for early stage NSCLC is gaining acceptance in the recent years, especially in aging population or with decreased pulmonary function. The optimal extent of surgical resection in stage I NSCLC remains controversial. This study was designed to determine whether SLR differs from lobectomy (L) as the standard of care for the surgical treatment of patients with early stage NSCLC. METHODS: we retrospectively reviewed 493 consecutive lung resections performed over a 5-year period at a single center. A total of 266 patients with NSCLC underwent either lobectomy (L Group: 178 patients), or wedge/segmentectomy (SLR Group: 88 patients) for stage I NSCLC. Demographic, oncological, surgical and postoperative variables were compared between groups. RESULTS: overall, no differences were observed between SLR and L in patient characteristics, 30-day mortality and complications. In stage I patients (n = 266), local recurrence (SLR vs L): 14% vs 16% (p = .06), distant recurrence: 8% vs 9% (p = .33), survival (at 3, 5 years): 78%, 74% vs 74%, 69% (p = .37), local disease-free survival (at 3, 5 years): 82%, 36% vs 80%, 56% (p = .93), distant disease-free survival (at 3, 5 years): 90%, 80% vs 86%, 83% (p = .73). Postoperative complications: 30% vs 36% (p = .21), 30-day mortality: 2% vs 5% (p = .64). CONCLUSION: sublobar resection has acceptable morbidity and mortality rates, and could be oncologically equivalent to lobectomy in stage I NSCLC


Subject(s)
Humans , Carcinoma, Bronchogenic/surgery , Lung Neoplasms/surgery , Carcinoma, Non-Small-Cell Lung/surgery , Pneumonectomy/methods , Neoplasm Staging/methods , Treatment Outcome , Survival Analysis
4.
Transplant Proc ; 47(9): 2656-8, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26680064

ABSTRACT

High early mortality after lung transplantation (LT) for idiopathic pulmonary fibrosis (IPF) is still not well controlled, and some aspects remain debated. The aim of this study was to evaluate our experience to identify factors that might improve the early outcomes. Among the 427 patients transplanted from October 1993 to December 2014, 117 IPF patients underwent LT at our department. There was an increasing age of transplant recipients, and the overall early (1-mo_ mortality was 25/117 (21.4%) with a progressive decrease over the years. Logistic regression analysis for early mortality was performed, and multivariate analysis identified recipient age <55 years (P = .042; odds ratio [OR], 2.98), single-lung transplants (P = .001; OR, 5.226), and previous corticosteroid treatment (P = .05; OR, 5.128) as independent risk factors for development of early mortality. In conclusion, despite the increasing age of transplant recipients, we observed a decrease in mortality to almost one-half compared with our initial results. According to our results, the mortality risk in patients <55 years old is independent from the type of transplant (single or double), being higher with a single transplant. In addition, corticosteroid treatment should be reduced to achieve lower early mortality.


Subject(s)
Forecasting , Idiopathic Pulmonary Fibrosis/surgery , Lung Transplantation/mortality , Risk Assessment/methods , Female , Humans , Idiopathic Pulmonary Fibrosis/mortality , Male , Middle Aged , Odds Ratio , Risk Factors , Spain/epidemiology , Survival Rate/trends
5.
Transplant Proc ; 47(9): 2653-5, 2015 Nov.
Article in English | MEDLINE | ID: mdl-26680063

ABSTRACT

OBJECTIVES: Atrial anastomosis in lung transplantation (LT) can present significant technical difficulties, especially when there is a very posterior left inferior pulmonary vein, in donor-recipient disproportion or excessive separation of the receptor's pulmonary veins owing to atrial dilatation; hence, its implementation requires excessive heart handling and longer ischemia time, which result in increased perioperative complications. This technique, which uses the recipient's superior pulmonary vein, avoids these problems, although it is not applicable in all cases because no pressure gradient at the suture level is required. Therefore, the suture diameter must be equal or greater than the sum of both graft pulmonary veins diameters. METHODS: This retrospective study recorded the age/gender (donor and recipient), preoperative morbidity, type of surgery, perioperative, vascular complications, mortality, and postoperative stay. Descriptive and inferential statistical study was made by SPSS. RESULTS: We performed 82 LTs between January 2009 and June 2012, 18 with the new technique (14 men/4 women; 52 ± 15 years). There were 14 single lung and 4 double lung transplants. The new technique does not increase the ischemic times when compared with the classic technique. No vascular dehiscence, fistulas, or thrombosis were found. There were observed fewer vascular complications (P = .042). Early mortality was presented in 4 cases (22.2%). CONCLUSIONS: This new technique achieves the objectives described (no increases in ischemic time, fewer vascular complications). However, an absolute confirmation requires a study comparing similar technical LT given that the new resource was only used in highly complex procedures.


Subject(s)
Heart Atria/surgery , Lung Transplantation/methods , Postoperative Complications/etiology , Pulmonary Veins/surgery , Adult , Aged , Anastomosis, Surgical/methods , Anastomosis, Surgical/mortality , Female , Humans , Length of Stay , Lung Transplantation/mortality , Male , Middle Aged , Postoperative Complications/mortality , Pulmonary Surgical Procedures/methods , Pulmonary Surgical Procedures/mortality , Retrospective Studies , Tissue Donors
6.
Rev. esp. patol. torac ; 26(4): 253-258, oct.-dic. 2014. ilus, tab
Article in Spanish | IBECS | ID: ibc-132096

ABSTRACT

OBJETIVOS: detectar si existen compuestos en el sudor con potencialidad diagnóstica en el cáncer de pulmón (CP). MÉTODOS: estudio observacional, de cohortes, realizado en un Hospital Universitario. Los sujetos fueron adscritos a grupo con CP, grupo sin CP y sin factor de riesgo (no fumadores) y grupo sin CP y con factor de riesgo (consumo > 20 paquetes/año). Fueron excluidos sujetos > 80 años, existencia de enfermedad grave de órgano, neoplasia extrapulmonar o tratamiento previo con citostáticos. La muestra de sudor se conservó a -80 ºC. Para su análisis se trasvasó cuantitativamente a viales del automuestreador para extracción en fase sólida y retener los componentes de interés. Tras eliminar la matriz de la muestra, los compuestos se eluyeron al instrumento analítico, utilizando la fase móvil cromatográfica. En esta etapa se aplicó el diseño quimiométrico más adecuado en cada caso. RESULTADOS: se incluyeron 96 sujetos. Con las muestras de sudor de cada uno de los 3 subgrupos se formó un pool, que se inyectó 10 veces consecutivas en el cromatógrafo de líquidos acoplado al espectrómetro de masas en tándem (LC-MS/MS). Se observó discriminación entre los tres subgrupos mediante el análisis por componentes principales del perfil de metabolitos detectado por LC-MS/MS y demostró la capacidad para clasificar los pacientes con CP de los individuos control, con y sin factor de riesgo. CONCLUSIÓN: el estudio del sudor abre un campo de investigación novedoso y con importante aplicabilidad clínica, ya que este modelo podría convertirse en una herramienta diagnóstica no invasiva en el CP


AIMS: to detect the presence of sweat compounds with potential diagnostic of lung cancer (LC). METHODS: observational cohort study in a University Hospital. The participants were assigned in a group with LC, a group without LC and without risk factor (non-smoking) and a group without LC and with risk factor (tobacco consumption > 20 package/year). The subjects > 80 years old, severe lung organ disease, extrapulmonary neoplasia or cytostatic pre-treatment were excluded. The sweat sample was stored at -80ºC. For analysis, it was transferred into autosampler vials for solid phased extraction (SPE) in order to keep the interesting compounds. After removing the sample matrix, the compounds were eluted to the analytical instrument using the chromatographic mobile phase. At this stage, the most suitable chemometric design was applied in each case. RESULTS: the population consisted of 96 subjects. A pool establish by the three subgroups sweat samples was injected ten times and row in the liquid chromatograph coupled to mass spectrometer (LC-MS/MS). In was noticed a discrimination between the three subgroups by analyzing the main compounds in metabolite profile, detected by LC-MS/MS. This proved the ability to distinguish patients with LC from control subjects with and without risk factor. CONCLUSIONS: the sweat study open up a novel research field with an important clinical relevance, because this model could become a non invasive diagnostic tool in the LC


Subject(s)
Humans , Metabolomics/methods , Sweat/chemistry , Lung Neoplasms/diagnosis , Biomarkers/analysis , Early Detection of Cancer , Risk Factors , Smoking/adverse effects
7.
Rev. esp. patol. torac ; 25(3): 175-183, jul.-sept. 2013. ilus, tab
Article in Spanish | IBECS | ID: ibc-117711

ABSTRACT

OBJETIVOS: 1. Desarrollar un modelo de bronquiolitis obli-terante en ratas (BO), mediante trasplante heterotópico de tráquea; 2. Eliminar el componente de rechazo alogénico me-diante el reimplante del injerto en un animal isogénico; y 3. Estudiar la respuesta inflamatoria persistente que podría auto-perpetuar la lesión.MÉTODOS: Se utilizaron ratas de las razas Lewis (LW), Wistar (W) y Brown Norway (BN). Se realizaron trasplantes singéni-cos (LW-LW, n=14; W-W, n=6; y BN-BN, n=6) y alogénicos AB (LW-W, n=6; BN-LW, n=6; y W-LW, n=6), alojando el injerto en el tejido celular subcutáneo cervical. Tras 15 días, se explantó el injerto e implantó en una tercera rata singéni-ca o alogénica por otros 15 días, estableciendo un modelo de retrasplante A-B-A y A-B-B. Los injertos se procesaron para realizar estudios histológicos e inmunohistoquímicos. El ori-gen de las células epiteliales se analizó mediante PCR.RESULTADOS: El retrasplante de tráquea, tanto en el diseño A-B-B como A-B-A, dió lugar a la aparición de una rápida respuesta inflamatoria compatible con un proceso de BO, en aquellos animales que habían desarrollado rechazo por tras-plante alogénico previo. En trasplantes ♀-♂-♀, se detectaron células con el cromosoma Y en tráqueas del 2º receptor ♀.CONCLUSIONES: En el modelo de retrasplante de tráquea en ratas, junto a los hallazgos típicos de BO se produce una res-puesta inflamatoria leve-moderada compatible con un recha-zo celular MHC incompatible. Células procedentes del primer receptor se integrarían en la tráquea del segundo trasplante, produciéndose un quimerismo donante receptor, que sería el responsable, en último término, del desarrollo de BO


OBJECTIVES: 1. Develop an obliterative bronchiolitis (OB) model in rats, by means of heterotopic trachea transplant; 2. Eliminate the allogenic rejection component by re-implanting a graft in an isogenic animal; and 3. Study the persistent in-flammatory response that could self-perpetuate the injury. METHODS: The following rat breeds were used: Lewis (LW), Wistar (W) and Brown Norway (BN). Syngenic (LW-LW, n=14; W-W, n=6; and BN-BN, n=6) and allogenic AB (LW-W, n=6; BN-LW, n=6; and W-LW, n=6) transplants were performed, housing the graft in the cervical subcutaneous ce-llular tissue. After 15 days, the graft was removed and implan-ted into a third syngenic or allogenic rat for another 15 days, to establish a re-transplant model A-B-A and A-B-B. The grafts were processed to carry out histological and immunohistoche-mical studies. The origin of the epithelial cells was analyzed using PCR. RESULTS: The tracheal re-transplant, both in the A-B-B and A-B-A design, gave rise to the appearance of a rapid inflam-matory response compatible with OB process, in those ani-mals that rejected the transplant due to previous allogenic transplant. In ♀ -♂ -♀ transplants, cells were detected with the Y chromosome in trachea of the 2nd ♀ receiver. CONCLUSIONS: In the trachea re-transplant model in rats, together with typical OB discoveries, a compatible slight-moderate inflammatory response takes place with an MHC incompatible cellular rejection. Cells from the first receiver became integrated into the trachea of the second transplant, producing a donor-receiver chimerism that would, in the final location, be responsible for the development of OB. Key words: Lung transplant, chronic rejection, obliterative bronchiolitis, chronic dysfunction of the lung graft


Subject(s)
Animals , Rats , Chimerism , Bronchiolitis Obliterans/etiology , Trachea/transplantation , Lung Transplantation , Disease Models, Animal , Reoperation/methods , Graft Rejection/surgery , Graft vs Host Reaction
9.
Rev. esp. patol. torac ; 24(4): 333-335, oct.-dic. 2012. ilus
Article in Spanish | IBECS | ID: ibc-108912

ABSTRACT

Se presenta una paciente de 22 años con tumor desmoide de pared torácica y antecedente de cirugía de reconstrucción mamaria, que se sometió a resección de pared torácica y reconstrucción de esqueleto óseo empleando una malla de titanio como alternativa al metilmetacrilato. La prótesis se cubrió con epiplón mayor y el postoperatorio cursó sin complicaciones. El empleo de mallas de metilmetacrilato maleables proporciona estabilidad a los defectos de pared torácica, son fáciles de implantar y evitan las complicaciones inherentes al empleo de otras prótesis como el metilmetacrilato (AU)


We present a 22-year old patient with a desmoid tumour of chest wall and previous breast reconstructive surgery, who underwent a chest wall resection and reconstruction by using a titanium mesh, as an alternative to the conventional methyl metacrylate mesh. The titanium mesh was covered with omentum and the postoperative course was uneventful. The use of a malleable titanium mesh provides optimal stabilization for chest wall defects, they are easy to use, and avoid the potential complications inherent to the methylmetacrylate and other prosthetic material (AU)


Subject(s)
Humans , Female , Young Adult , Fibromatosis, Aggressive/surgery , Thoracic Neoplasms/surgery , Thoracic Surgical Procedures , Surgical Mesh , Thoracic Wall/surgery , Plastic Surgery Procedures/methods , Titanium
10.
Transplant Proc ; 44(9): 2663-5, 2012 Nov.
Article in English | MEDLINE | ID: mdl-23146487

ABSTRACT

The postoperative period following lung transplantation remains critical because of several complications. Infection, primary graft failure, acute rejection, and surgical complications are risk factors for mortality and morbidity. The recognition and early treatment of these complications is important to optimize outcomes. This article provides an overview of postoperative complications observed in our center during the last year. We were particularly interested in the influence of variables, such as inotrope usage and Acute Physiology and Chronic Health Evaluation (APACHE II) score, a well-known, and validated mortality prediction model for general intensive care unit (ICU) patients only infrequently reported in the transplantation literature. High APACHE II scores were significantly associated with prolonged mechanical ventilation (P = 0.041) and a tracheostomy requirement (P = .035). The factors significantly associated with an early postoperative death were older donor age (P = .005), prolonged donor ICU period (P = .004), need for cardiopulmonary bypass (CB; P = .005), and high inotrope requirements in the ICU (P = .034). CB data were biased because we selected the worst case patients. Donor age and high inotrope requirements in the ICU have been reported previously to be prognostic factors for poor graft function. We believe that control of these variables may improve outcomes.


Subject(s)
Hospitals, University , Intensive Care Units , Lung Transplantation/adverse effects , Postoperative Complications/epidemiology , APACHE , Acute Disease , Adult , Age Factors , Cardiotonic Agents/therapeutic use , Donor Selection , Female , Graft Rejection/epidemiology , Humans , Incidence , Lung Transplantation/mortality , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Postoperative Complications/therapy , Respiration, Artificial , Risk Factors , Spain/epidemiology , Surgical Wound Infection/epidemiology , Time Factors , Tracheostomy , Treatment Outcome
11.
Rev. esp. patol. torac ; 22(2): 109-119, abr.-jun. 2010. ilus, tab
Article in Spanish | IBECS | ID: ibc-97250

ABSTRACT

Objetivo: la escasez de donantes pulmonares válidos es el principal factor que limita el desarrollo de un programa de trasplante pulmonar (TxP). Nuestra experiencia inicial analizando 280 donantes, demostró que solo el 54,7% eran válidos para trasplante. El presente trabajo pretende reexaminar el problema, analizando la evolución de las tasas de validez pulmonar con los años, identificando qué factores son susceptibles de mejorar para incrementar el número de donantes pulmonares, y determinando si el empleo de donantes subóptimos influye en los resultados del TxP a corto y largo plazo. Métodos: se revisaron todos los donantes ofertados a nuestra unidad desde octubre 1993 hasta diciembre 2007. La evaluación del donante pulmonar se dividió en tres fases: fase 1 (análisis de PaO2/FiO2, radiografía de tórax y hallazgos fibrobroncoscópicos); fase 2 (inspeccióny palpación pulmonar en campo operatorio); fase 3 (evaluación pulmonar después de la extracción donante). Se analizaron variables del donante y del receptor y se compararon entre dos periodos: donantes A (entre 1993 y 2001) y donantes B (entre 2002 y 2007). Se realizó un análisis adicional en un subgrupo de donantes con criterios de “subóptimo” (..) (AU)


Objective: The shortage of donors is a major problem limiting lung transplant programmes (LTx). Our early experience analysing 280 donors demonstrated that only 54.7% were (..) (AU)


Subject(s)
Humans , Tissue Donors/supply & distribution , Tissue and Organ Procurement/organization & administration , Lung Transplantation/statistics & numerical data , Tissue and Organ Harvesting/methods
13.
Rehabilitación (Madr., Ed. impr.) ; 44(1): 8-15, ene.-mar. 2010. ilus, tab
Article in Spanish | IBECS | ID: ibc-75473

ABSTRACT

Objetivo Conocer la calidad de vida relacionada con la salud (CVRS) en trasplantados de pulmón y su relación con la disnea y la prueba de 6 min marcha. Material y método Estudio descriptivo. Participantes: pacientes trasplantados de pulmón. Mediciones: variables sociodemográficas, volumen espiratorio forzado en el primer segundo, parámetros funcionales (disnea y prueba de 6min marcha) y test genérico de calidad de vida SF-36. Prueba t de una muestra para comparar las puntuaciones medias en cada dimensión del SF-36 con los valores de referencias de la población española. Correlación de Pearson entre CVRS percibida y parámetros funcionales. Análisis multivariante para identificar variables predictivas de la CVRS. Resultados Participaron 59 personas, 36 hombres y 23 mujeres. La media de edad fue de 43,77 años (DE±15,27) y el tiempo medio postrasplante de 3,7 años (DE±2,18). Las puntuaciones obtenidas en el SF-36 para las dimensiones de función física, dolor, salud mental y vitalidad fueron superiores a las de la población de referencia (p<0,05), no encontrándose diferencias para el resto. Las dimensiones función física, rol físico y función social presentaron correlación con el grado de disnea (p=0,01), así como en el análisis multivariante (R2=0,60). Conclusiones La CVRS declarada por los pacientes trasplantados de pulmón es similar a la de la población de referencia española. El grado de disnea es el parámetro que mejor se relaciona con la calidad de vida (AU)


Objective To know the health-related quality of life (HRQL) to the in lung transplantation recipient and their relationship with the dyspnea and with the 6-min walk test. Material and method Descriptive study. Participants: Lung transplanted patients. Mensurations: socio-demografic data, FEV1, functional parameters (dyspnea and 6-min walk test), and generic test of HRQL SF-36 Health Index. A t-test to compare the mean punctuations in each dimesion the SF-36 with the reference values of the spanish population. Pearson correlation between perceived HRQL and functional parameters. Multivariate analysis to identify predicted variables of the HRQL. Results 59 people, 36 men and 23 women participated. The mean age was 43.77 years (SD±15.27) and the mean time postrasplante of 3.7 years (SD±2.18). The punctuations obtained in the lung transplanted patients for the dimensions physical function, pain, mental health and vitality they went upper to them the population reference values (p value<0.05), not being differences for the rest. The dimensions physical function, role physical and social function presented high correlations with the degree of dyspnea (p value=0.01) as well as in the multivariate analysis (R2=0.60). Conclusions The HRQL declared by the lung transplanted patients it is similar to the reference spanish population. The dyspnea it is the parameter that better is related with the quality of life (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality of Life , Lung Transplantation/rehabilitation , Lung Transplantation/statistics & numerical data , Surveys and Questionnaires , Dyspnea/epidemiology , Dyspnea/rehabilitation , Fujita-Pearson Scale , Multivariate Analysis , Cross-Sectional Studies
14.
Transplant Proc ; 40(9): 3126-7, 2008 Nov.
Article in English | MEDLINE | ID: mdl-19010214

ABSTRACT

OBJECTIVE: To analyze the results of combined lung and liver transplantation. METHODS: We performed two combined lung and liver transplantations for patients with cystic fibrosis with chronic respiratory failure accompanied by advanced liver disease. In each case, all thoracic and abdominal organs were obtained from a single donor by means of standard harvest techniques. In the recipient, a two-stage procedure was adopted with completion of the bilateral lung transplantation before the liver operation. Immunosuppression consisted of three-drug therapy used for isolated lung transplantation. RESULTS: The patients were both boys of 13 and 15 years old. Episodes of acute pulmonary rejection were successfully treated with intravenous steroids. Neither lung disorder was associated with a liver rejection episode. Airway complications that occurred in both cases were managed endoscopically. CONCLUSION: Combined transplantation of lung and liver is a feasible and therapeutically effective procedure for patients with cystic fibrosis complicated by advanced liver disease. Herein we have described our experience in two of the only three cases of combined liver and lung transplantation performed in Spain to date. Patient and graft survivals were comparable to isolated liver or isolated bilateral lung transplantations.


Subject(s)
Cystic Fibrosis/surgery , Liver Diseases/surgery , Liver Transplantation/methods , Lung Transplantation/methods , Adolescent , Cystic Fibrosis/complications , Functional Laterality , Hospitals, University , Humans , Liver Diseases/complications , Male , Spain , Transplantation, Homologous , Treatment Outcome
15.
Neumosur (Sevilla) ; 19(4): 218-221, oct.-dic. 2007. ilus
Article in Es | IBECS | ID: ibc-70704

ABSTRACT

El tumor carcinoide bronquial típico (TCBT) asienta preferentemente en bronquios de grueso calibre produciendo fenómenos de obstrucción distal. Aunque la OMS lo clasifica dentro de las neoplasias malignas broncopulmonares, el TCBT se muestra poco agresivo y su pronóstico a largo plazo es bueno siempre que no exista diseminación linfática ni metástasis sistémicas. La mayoría de los autores son partidarios del tratamiento quirúrgico conservador, evitando la neumonectomía, siempre que este asegure la total resección del TCBT. Presentamos 3 casos de pacientes infantiles diagnosticados de TCBT en el eje bronquial principal con atelectasia de lóbulos inferiores en los que fue posible la resección con reimplante de lóbulos superiores en 2 casos, y un tercero con tumor en bronquio intermediario, resecándose el mismo con reimplante posterior de lóbulos medio e inferior


The typical bronchial carcinoid tumour (TBCT) is usually located in large bronchi, provoking distal obstruction. Although the WHO classifies it within the malignant bronco-pulmonary neoplasias, TBCT does not always present as very aggressive and its long-term prognosis is good, providing there are no lymphatic dissemination or distant metastasis. Most authors favour conservative surgical treatment, avoiding pneumonectomy, provided this assures the total resection of the TBCT. We present three cases of children diagnosed with TBCT in the main bronchi with atelectasis of the inferior lobes in which resection was possible, together with the re-implantation of the superior lobes in 2 cases. In the third case, the tumour in the intermediary bronchus was resected, with subsequent re-implantation of the midle and inferior lobes


Subject(s)
Humans , Male , Female , Child , Adolescent , Bronchial Neoplasms/diagnosis , Bronchial Neoplasms/surgery , Carcinoid Tumor/diagnosis , Carcinoid Tumor/surgery , Treatment Outcome
16.
Arch Bronconeumol ; 42(3): 151-3, 2006 Mar.
Article in Spanish | MEDLINE | ID: mdl-16545256

ABSTRACT

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 , Humans
17.
Arch. bronconeumol. (Ed. impr.) ; 42(3): 151-153, mar. 2006. ilus
Article in Es | IBECS | ID: ibc-046193

ABSTRACT

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/surgery
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