Pulmonary vascular density: comparison of findings on computed tomography imaging with histology.

BACKGROUND: Exposure to cigarette smoke has been shown to lead to vascular remodelling. Computed tomography (CT) imaging measures of vascular pruning have been associated with pulmonary vascular disease, an important morbidity associated with smoking. In this study we compare CT-based measures of distal vessel loss to histological vascular and parenchymal changes. METHODS: A retrospective review of 80 patients who had undergone lung resection identified patients with imaging appropriate for three-dimensional (3D) vascular reconstruction (n=18) and a second group for two-dimensional (2D) analysis (n=19). Measurements of the volume of the small vessels (3D) and the cross-sectional area of the small vessels (<5 mm2 cross-section) were computed. Histological measures of cross-sectional area of the vasculature and loss of alveoli septa were obtained for all subjects. RESULTS: The 2D cross-sectional area of the vasculature on CT imaging was associated with the histological vascular cross-sectional area (r=0.69; p=0.001). The arterial small vessel volume assessed by CT correlated with the histological vascular cross-sectional area (r=0.50; p=0.04), a relationship that persisted even when adjusted for CT-derived measures of emphysema in a regression model. CONCLUSIONS: Loss of small vessel volume in CT imaging of smokers is associated with histological loss of vascular cross-sectional area. Imaging-based quantification of pulmonary vasculature provides a noninvasive method to study the multiscale effects of smoking on the pulmonary circulation.

Gene expression profile of angiogenic factors in pulmonary arteries in COPD: relationship with vascular remodeling.

Pulmonary vessel remodeling in chronic obstructive pulmonary disease (COPD) involves changes in smooth muscle cell proliferation, which are highly dependent on the coordinated interaction of angiogenic-related growth factors. The purpose of the study was to investigate, in isolated pulmonary arteries (PA) from patients with COPD, the gene expression of 46 genes known to be modulators of the angiogenic process and/or involved in smooth muscle cell proliferation and to relate it to vascular remodeling. PA segments were isolated from 29 patients and classified into tertiles, according to intimal thickness. After RNA extraction, the gene expression was assessed by RT-PCR using TaqMan low-density arrays. The univariate analysis only showed upregulation of angiopoietin-2 (ANGPT-2) in remodeled PA (P < 0.05). The immunohistochemical expression of ANGPT-2 correlated with intimal enlargement (r = 0.42, P < 0.05). However, a combination of 10 factors in a multivariate discriminant analysis model explained up to 96% of the classification of the arteries. A network analysis of 46 genes showed major decentralization. In this network, the metalloproteinase-2 (MMP-2) was shown to be the bridge between intimal enlargement and fibrogenic factors. In COPD patients, plasma levels of ANGPT-2 were higher in current smokers or those with pulmonary hypertension. We conclude that an imbalance in ANGPT-2, combined with related factors such as VEGF, ß-catenin, and MMP-2, may partially explain the structural derangements of the arterial wall. MMP-2 may act as a bridge channeling actions from the main fibrogenic factors.

Tratamiento médico y quirúrgico de la hipertensión pulmonar tromboembólica crónica: experiencia en un único centro / Medical and Surgical Management for Chronic Thromboembolic Pulmonary Hypertension: A Single Center Experience

Introducción: La endarterectomía pulmonar (EP) es el tratamiento de elección para la hipertensión pulmonar tromboembólica crónica (HPTEC). El objetivo del estudio fue analizar nuestra experiencia en el tratamiento médico (TM) y quirúrgico de la HPTEC. Métodos: Se evaluaron 80 pacientes diagnosticados de HPTEC en el periodo enero 2000-julio 2012. En 32 casos se realizó EP, el resto recibió TM. Se analizaron: clase funcional (CF), distancia recorrida en seis minutos (PM6M) y hemodinámica pulmonar. Se analizó la mortalidad según el tratamiento y el periodo. Resultados: Los pacientes del grupo EP eran más jóvenes, mayoritariamente hombres y recorrieron mayor distancia en la PM6M. No hubo diferencias hemodinámicas ni de CF al diagnóstico. Al a˜no del tratamiento, el 100% del grupo EP y el 41% del grupo TM estaban en CF I-II. Al seguimiento, el grupo EP presentó mayor incremento en la PM6M y mayor reducción de la PAPm y la RVP que en el grupo TM (p < 0,05). La supervivencia global del grupo TM a 1 y 5 a˜nos fue del 83% y del 69%, respectivamente. La supervivencia condicionada de los pacientes vivos 100 días post-EP a 1 y 5 a˜nos fue del 95 y del 88%, respectivamente. La mortalidad quirúrgica en los pacientes operados en el período 2000-2006 fue del 31,3%, y en el período 2007-2012, del 6,3%. Conclusiones: La EP proporciona buenos resultados clínicos, hemodinámicos y de supervivencia en los pacientes que superan satisfactoriamente el postoperatorio inmediato. Tras un periodo de aprendizaje, la mortalidad perioperatoria actual en nuestro centro es superponible a los estándares internacionales

Introduction: Pulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH. Methods: We included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underwent PE and 48 received medical treatment (MT). We analyzed functional class (FC), sixminute walking distance (6MWD) and pulmonary hemodynamics. Mortality in both groups and periods were analyzed. Results: Patients who underwent PE were younger, mostly men, and had longer 6MWD. No differences were observed in pulmonary hemodynamics or FC at diagnosis. One year after treatment, all PE patients versus 41% in MT group were at FC I-II. At follow-up, the PE group showed greater increase in 6MWD, and greater reduction in mean pulmonary arterial pressure and pulmonary vascular resistance than the MT group (P < .05). Overall survival in the MT group at 1 and 5 years was 83% and 69%, respectively. Conditional survival in patients alive 100 days post-PE at 1 and 5 years was 95% and 88%, respectively. Surgical mortality in operated patients in the first period (2000-2006) was 31,3%, and 6,3% in the second (2007-2012). Conclusions: PE provides good clinical results, and improves pulmonary hemodynamics in patients who successfully overcome the immediate postoperative period. After a learning period, the current operatory mortality in our center is similar to international standards

Medical and surgical management for chronic thromboembolic pulmonary hypertension: a single center experience.

INTRODUCTION: Pulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH. METHODS: We included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underwent PE and 48 received medical treatment (MT). We analyzed functional class (FC), six-minute walking distance (6MWD) and pulmonary hemodynamics. Mortality in both groups and periods were analyzed. RESULTS: Patients who underwent PE were younger, mostly men, and had longer 6MWD. No differences were observed in pulmonary hemodynamics or FC at diagnosis. One year after treatment, all PE patients versus 41% in MT group were at FCI-II. At follow-up, the PE group showed greater increase in 6MWD, and greater reduction in mean pulmonary arterial pressure and pulmonary vascular resistance than the MT group (P<.05). Overall survival in the MT group at 1 and 5years was 83% and 69%, respectively. Conditional survival in patients alive 100days post-PE at 1 and 5years was 95% and 88%, respectively. Surgical mortality in operated patients in the first period (2000-2006) was 31,3%, and 6,3% in the second (2007-2012). CONCLUSIONS: PE provides good clinical results, and improves pulmonary hemodynamics in patients who successfully overcome the immediate postoperative period. After a learning period, the current operatory mortality in our center is similar to international standards.

[A study on surgical dressings and the uses associated to them]. / Apósitos quirúrgicos factores asociados con su uso.

OBJECTIVE: To identify the variability in the surgical dressing practices and to assess the factors of their use. METHOD: A prospective study on surgical dressings was carried out. Data was collected on some post surgery patients who, once outside the operating room in a general hospital, they were still wearing a surgical dressing. A non-random sample was included. Socio demographic data, pre operative and intra operative data inside the operating room were collected as well as post surgical tests in the surgical inpatient wards. Tests chi2 were carried out for the category variables, tau Student for the continuous ones and the variant analysis. RESULTS: 315 patients were put into groups of 5 according to the surgical proceedings. All dressings were realized with non-woven gauze dressings (more absorbent) and mostly removed every 24 to 48 hours. Two groups showed more exuded dressings. The highest percentage of lesions appeared when dressings were removed between 24 and 48 hours. 50% of the removed ones before the first 24 hours had been over dressed and the chance of having skin lesion was increased 7 times with the reinforcement. Patients showed a medium average of comfort of 6,09 (EVA 0-10) to the dressings. CONCLUSIONS: The use of the traditional dry dressings to cover surgical wounds and the technique to apply a dressing over the existing one are here confirmed. A direct relation is observed between the reapplication of dressings to the same wound and the skin lesions.

Apósitos quirúrgicos. Factores asociados con su uso / A study on surgical dressings and the uses associated to them

Objetivo: identificar la variabilidad en la práctica de los apósitos quirúrgicos y los factores asociados con su uso. Método: se realizó un estudio transversal sobre los apósitos quirúrgicos. Se estudió una población de pacientes quirúrgicos de un hospital general que al salir del quirófano eran portadores de dicho apósito. Se incluyó una muestra no aleatoria. Se recogieron datos sociodemográficos y clínicos preoperatorios e intraoperatorios en el quirófano y postoperatorios en las plantas de hospitalización quirúrgica. Se efectuaron pruebas de alpha2 para las variables categóricas y para las continuas la ? de Student y el análisis de la varianza. Resultados: 315 pacientes se agruparon en cinco grupos, según el procedimiento quirúrgico. Todos los apósitos se realizaron con gasas hidrófilas de algodón, fijados con apósito de tejido sin tejer y la mayoría cambiados entre las 24-48 horas. Dos grupos presentaron más apósitos manchados. El mayor porcentaje de lesiones aparecía cuando se cambiaban entre las 24 y las 48 horas. El 50% de los cambiados antes de las 24 horas había sido reforzado y la probabilidad de que se lesionara la piel se multiplicaba por siete con el refuerzo. Los pacientes manifestaron un confort medio de 6,09 (EVA 0- 10) respecto al apósito. Conclusiones: se constata el uso del apósito tradicional de gasa seca para cubrir las heridas operatorias y la técnica de refuerzo de los apósitos. Se observa una relación directa entre el refuerzo y las lesiones en la piel(AU)

Objective: To identify the variability in the surgical dressing practices and to assess the factors of their use. Method: A prospective study on surgical dressings was carried out. Data was collected on some post surgery patients who, once outside the operating room in a general hospital, they were still wearing a surgical dressing. A non-random sample was included. Socio demographic data, pre operative and intra operative data inside the operating room were collected as well as post surgical tests in the surgical inpatient wards. Tests alpha2 were carried out for the category variables, ? Student for the continuous ones and the variant analysis. Results: 315 patients were put into groups of 5 according to the surgical proceedings. All dressings were realized with non-woven gauze dressings (more absorbent) and mostly removed every 24 to 48 hours. Two groups showed more exuded dressings. The highest percentage of lesions appeared when dressings were removed between 24 and 48 hours. 50% of the removed ones before the first 24 hours had been over dressed and the chance of having skin lesion was increased 7 times with the reinforcement. Patients showed a medium average of comfort of 6,09 (EVA 0-10) to the dressings. Conclusions: The use of the traditional dry dressings to cover surgical wounds and the technique to apply a dressing over the existing one are here confirmed. A direct relation is observed between the reapplication of dressings to the same wound and the skin lesions(AU)