Current Situation and Prognostic Evolution of Combined Heart-lung Transplantation in a European Union Country.

Background: This study aims to evaluate the entire experience in heart-lung transplantation (HLTx) in a country of the European Union with 47 million inhabitants according to the etiologies that motivated the procedure. Methods: A retrospective study on 1,751 consecutive transplants (HLTx: 78) was performed from 1990 to 2020 in two centers. Overall survival, adjusted for clinical profile and etiological subgroups, was compared. 7 subgroups were considered: 1) Cardiomyopathy with pulmonary hypertension (CM + PH). 2) Eisenmenger syndrome. 3) Congenital heart disease (CHD). 4) Idiopathic pulmonary arterial hypertension (IPAH). 5) Cystic fibrosis. 6) Chronic obstructive pulmonary disease (COPD)/Emphysema. 7) Diffuse interstitial lung disease (ILD). Results: Early mortality was 44% and that of the rest of the follow-up was 31%. There were differences between HTLx and HTx in survival, also comparing groups with a similar clinical profile with propensity score (p= 0.04). Median survival was low in CM + PH (18 days), ILD (29 days) and CHD (114 days), intermediate in Eisenmenger syndrome (600 days), and longer in IPAH, COPD/Emphysema and cystic fibrosis. Conclusion: HLTx has a high mortality. The etiological analysis is of the utmost interest to make the most of the organs and improve survival.

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations.

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.

Demora en la realización de pruebas diagnósticas y estancias innecesarias en el cáncer de pulmón / Delay in the performance of diagnostic tests and unnecessary hospital stays in lung cancer

Fundamentos. Describir en pacientes hospitalizados por sospecha de neoplasia pulmonar la proporción de ingresos y estancias inadecuadas, las causas de inadecuación y los tiempos de demora diagnóstica; analizar la relación entre características del paciente, duración de la estancia y utilización inadecuada de la hospitalización, y valorar la asociación entre solicitud de pruebas diagnósticas, prolongación de la estancia y utilización innecesaria de la hospitalización. Métodos. Cohorte prospectiva de 118 pacientes hospitalizados por sospecha de neoplasia broncopulmonar en un hospital universitario en la que se analizó la duración de la estancia, estancias inadecuadas y demoras en la realización de pruebas diagnósticas. Resultados. La duración media de la estancia fue de 16,3 días, con un 74,2 por ciento de estancias innecesarias e importantes demoras diagnósticas intrahospitalarias, que superaron los 5 días para la realización de una radiografía de tórax, casi 7 para la realización de una tomografía computarizada y 8 para disponer de los resultados de la anatomía patológica. La proporción de estancias inadecuadas se asoció al número y tipo de pruebas solicitadas. Conclusiones. Los resultados de este estudio sugieren amplias posibilidades para mejorar la calidad de la atención a los pacientes con sospecha de neoplasia pulmonar, tanto evitando ingresos innecesarios como acortando las demoras diagnósticas, a la par que se reducen los costes de la atención y se reservan las camas hospitalarias para aquellos casos en que la situación clínica realmente lo requiera (AU)

[Delay in the performance of diagnostic tests and unnecessary hospital stays in lung cancer]. / Demora en la realización de pruebas diagnósticas y estancias innecesarias en el cáncer de pulmón.

OBJECTIVES: To report among hospitalised patients the proportion of admissions and inappropriate stays, causes for inappropriateness and length in diagnosis delay. To analyse the relationship between patient's characteristics, length of stay and inappropriate use of hospitalization; to evaluate the association between requesting diagnostic tests, stay prolongation and unnecessary use of hospitalization. METHODS: Prospective cohort of 118 admitted patients because of bronchopulmonary cancer at a university teaching hospital. Length of stay, inappropriate stays and delays in diagnostic tests were analysed. RESULTS: The mean hospital stay was 16.3 days, with 74.2% of unnecessary stays and relevant intrahospital diagnostic delays, with over five days for obtaining a chest X-ray, almost seven for a computerized tomography, and eight to have pathology results available. The proportion of inappropriate stays was associated with the number and type of requested tests. CONCLUSIONS: The results of this study suggest a number of possibilities to improve care quality to patients with suspect of lung cancer, both avoiding unnecessary admissions and shortening diagnostic delays. Also, care costs are reduced and hospital beds are reserved for those patients whose clinical status warrant hospital admission.

[Adverse effects on the respiratory system in textile printing sprayers]. / Efectos adversos sobre el tracto respiratorio en trabajadores de aerografía textil.

OBJECTIVE: To study the initial respiratory effects and those observed 18 months later after the inhalation of toxic and irritant substances in textile aerography workers. SUBJECTS: Seventeen patients (14 women and 3 men), with a mean age of 21 years (range: 18-38). METHODS: Initially, pulmonary effects were assessed by pathological (transbronchial biopsy and/or video-thoracoscopy) and functional findings [spirometry with lung volumes and study of diffusion capacity of CO (DLCO)]. Eighteen months later a challenge bronchial test with histamine was performed. RESULTS: Forty-one per cent of patients had pathologic lesions with intraalveolar fibrin, 35% had minimal non-specific lesions, 18% bronchiolitis obliterans with organized pneumonia (BOOP) and 6% pulmonary fibrosis and BOOP. Functional respiratory test showed two patients with a slight restrictive pattern, one patient with very severe restriction and six patients with low DLCO. The challenge tests was positive for 59% of patients. CONCLUSION: After the massive inhalation of irritant and/or toxic substances, patients presented different types of pathological response at pulmonary level. In our workers histological repairing lesions--of high or low degree--were found, BOOP being the lesions observed most frequently, and different patterns of functional involvement. Fifty-nine per cent of cases developed non-specific bronchial hyperreactivity consistent with a reactive airways dysfunction syndrome.

[Bronchial provocation test with dermatophagoides in the diagnosis of infantile asthma: sensitivity, specificity and reproducibility]. / Estudio del test de provocación bronquial con dermatofagoides en el diagnóstico del asma infantil: sensibilidad, especificidad y reproductibilidad.

The purpose of this study has been to prove if the lung is the target organ of an allergen against which a biological hypersensitivity, by means of skin test and RAST, has been found; comparing score Foucard diagnostic with inhalatory test result. At the same time, checking test specificity and reproductibility. Fourty children, both sexes aged between 6 and 14 years diagnosed of bronchial asthma divided in two groups were studied. First group included 31 children with hypersensitivity to dermatophagoides and second group was control group including 9 children. The test with dermatophagoides was performed in both groups according to Cockcroft method. The parameters which indicated test positivity were 20% fall in FEV1 for early response and 40% fall in PERF for late response. The results obtained show 83.9% positive tests with 80.6% early responses and 45.2% positive late response. The specificity and reproductibility were of 100%.