[Transbronchial needle aspiration of diseased mediastinal lymph nodes: predictors of positive findings]. / Factores predictores del resultado de la punción-aspiración transtraqueal de adenopatías mediastínicas neoplásicas.

OBJECTIVE: To assess the factors that may determine the effectiveness of transbronchial needle aspiration through a flexible bronchoscope in the diagnosis of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors. METHODS: Prospective study carried out at 2 hospitals between 1998 and 2004 that included all transbronchial needle aspirations performed on patients who had diseased mediastinal lymph nodes larger than 10 mm and nonlymphoid neoplasms. Univariate and multivariate analysis of the diagnostic results of transbronchial needle aspiration were performed according to the type and location of the primary neoplasm and the lymph node station biopsied, the diameter of the affected node, endoscopic findings, and the results of other bronchoscopic techniques. RESULTS: The study evaluated the transbronchial needle aspiration of 230 lymph node stations in 207 patients. Histologic examination revealed 151 cases (72.9%) of non-small cell lung cancer, 42 cases (20.3%) of small cell lung cancer, and 14 cases (6.8%) of extrapulmonary cancer. The best predictors of obtaining a diagnostic sample were a diameter of the diseased node greater than 20 mm in diameter (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7; P=.01) and a histologic diagnosis of small cell lung cancer (OR, 2.7; 95% CI, 0.9-8.2; P=.07). CONCLUSIONS: The size of the diseased node and the tumor type are the best predictors of obtaining a diagnostic sample with transbronchial needle aspiration of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors.

Factores predictores del resultado de la punción-aspiración transtraqueal de adenopatías mediastínicas neoplásicas / Transbonchial needle aspiration of diseases mediastinal lymph nodes: predictors of positive findings

Objetivo: Analizar los factores que pueden influir en la efectividad de la punción transtraqueal (PTT) a través del broncoscopio flexible en el diagnóstico de adenopatías mediastínicas en pacientes con neoplasias pulmonares o extrapulmonares. Métodos: Estudio prospectivo realizado entre 1998 y 2004 en el que se incluyeron todas las PTT realizadas a pacientes con adenopatías mediastínicas superiores a 10 mm y neoplasias no linfoides de 2 centros hospitalarios. Se realizó un análisis univariado y multivariado entre los resultados diagnósticos de la PTT según el tipo y la localización de la neoplasia primaria y la estación ganglionar analizada, el diámetro de la adenopatía, los hallazgos endoscópicos y los resultados de otras técnicas broncoscópicas. Resultados: Se incluyeron en el estudio 230 PTT de estaciones ganglionares distintas de 207 pacientes. Las estirpes histológicas fueron en 151 casos (72,9%) carcinomas no microcíticos pulmonares, en 42 (20,3%) carcinomas microcíticos y en 14 (6,8%) carcinomas extrapulmonares. Las variables que mejor predijeron la obtención de muestras diagnósticas fueron el diámetro de la adenopatía superior a 20 mm (odds ratio [OR] = 2,4; intervalo de confianza [IC] del 95%, 1,2-4,7; p = 0,01) y que el tipo de neoplasia fuera un carcinoma pulmonar microcítico (OR = 2,7; IC del 95%, 0,9-8,2; p = 0,07). Conclusiones: El tamaño de la adenopatía y el tipo de neoplasia son los factores que mejor predicen la obtención de muestras adecuadas en la PTT de adenopatías mediastínicas en pacientes con neoplasias pulmonares o extrapulmonares

To assess the factors that may determine the effectiveness of transbronchial needle aspiration through a flexible bronchoscope in the diagnosis of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors. Methods: Prospective study carried out at 2 hospitals between 1998 and 2004 that included all transbronchial needle aspirations performed on patients who had diseased mediastinal lymph nodes larger than 10 mm and nonlymphoid neoplasms. Univariate and multivariate analysis of the diagnostic results of transbronchial needle aspiration were performed according to the type and location of the primary neoplasm and the lymph node station biopsied, the diameter of the affected node, endoscopic findings, and the results of other bronchoscopic techniques. Results: The study evaluated the transbronchial needle aspiration of 230 lymph node stations in 207 patients. Histologic examination revealed 151 cases (72.9%) of non-small cell lung cancer, 42 cases (20.3%) of small cell lung cancer, and 14 cases (6.8%) of extrapulmonary cancer. The best predictors of obtaining a diagnostic sample were a diameter of the diseased node greater than 20 mm in diameter (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.2-4.7; P=.01) and a histologic diagnosis of small cell lung cancer (OR, 2.7; 95% CI, 0.9-8.2; P=.07). Conclusions: The size of the diseased node and the tumor type are the best predictors of obtaining a diagnostic sample with transbronchial needle aspiration of diseased mediastinal lymph nodes in patients with lung or extrapulmonary tumors

[Comparison of the effect of desflurane with isoflurane in patients over 65 years of age: multicenter study]. / Comparación de los efectos del desflurano con el isoflurano en los pacientes mayores de 65 años: estudio multicéntrico.

OBJECTIVE: To compare the effects of desflurane (DES) and isoflurane (ISO) in patients over 65 years of age based on recovery, hemodynamic variables, need for additional drugs and postoperative rates of nausea and vomiting. PATIENTS AND METHODS: Ninety-eight patients were anesthetized with DES (n = 51) at an inspired concentration of 3% or ISO (n = 47) at a concentration of 0.5%, both combined with 60% nitrous oxide. Anesthetic concentration was later adjusted to maintain hemodynamic variables within 20% above or below baseline. Analgesia was provided with fentanyl and neuromuscular relaxation with atracurium. After surgery, anesthetic gases were withdrawn. We then recorded variables related to anesthetic recovery, postoperative analgesia and the rates of nausea and vomiting. RESULTS: Mean time (+/- SD) until eye opening was 7.6 +/- 5.5 minutes for patients anesthetized with DES and was significantly less than the 14.4 +/- 8.9 minutes taken by patients anesthetized with ISO (p < 0.01). Patients anesthetized with DES spent 23 minutes less time in the recovery room than did patients anesthetized with ISO (p < 0.05). There were no significant differences in need for fentanyl, atracurium, postoperative analgesia, hemodynamic variables or rates of nausea or vomiting. CONCLUSIONS: Patients over 65 years of age anesthetized with DES recovered in half the time of patients anesthetized with ISO. DES is a safe anesthetic for elderly patients and may offer clinical advantages.