Calidad de vida relacionada con la salud y tolerancia al esfuerzo en los pacientes trasplantados de pulmón / Health-related quality of life and exercise tolerance in lung transplant recipients

Objetivo: Evaluar y comparar la mejora en la calidad de vida relacionada con la salud y la tolerancia al esfuerzo de los pacientes sometidos a trasplante de pulmón antes y después del procedimiento quirúrgico. Pacientes y métodos: Presentamos un estudio prospectivo, descriptivo y longitudinal de datos apareados. Los criterios de inclusión fueron todos los pacientes supervivientes mayores de 18años sometidos a trasplante pulmonar entre enero de 2015 y marzo de 2017. Se incluyeron 48 pacientes en el estudio, de los cuales 44 cumplimentaron los cuestionarios SF-36, y 36 de ellos realizaron la prueba de 6minutos marcha (P6MM). Resultados: La mejora de calidad de vida relacionada con la salud según el cuestionario SF-36 fue significativa en 8 de sus 10 componentes, destacando en función física, con una media de 50,33 (intervalo de confianza [IC] al 95%: 42,22-58,44) y salud general con media de 44,33 (IC95%: 38,21-50,46). El dolor corporal y el componente sumatorio mental fueron las únicas en no mostrar diferencias significativas. La tolerancia al esfuerzo analizada mediante la P6MM se ha incrementado en 103metros (IC95%: 55,5-150,51). Conclusiones: Tras el trasplante pulmonar, todas las dimensiones del SF-36 han mejorado de manera significativa, excepto el dolor físico y el componente sumatorio mental. La distancia media de la P6MM también se ha visto incrementada tras el trasplante pulmonar de forma significativa

Objectives: To evaluate and compare health-related quality of life and exercise tolerance in lung transplant recipients before and after the surgical procedure. Patients and methods: We conducted a descriptive, observational, longitudinal, prospective and paired data study of all patients older than 18years who survived lung transplantation between January 2015 and March 2017. Forty-eight patients were included in the study, of whom 44 were able to complete the SF-36 questionnaire, and 36 were able to perform the 6-minute walk test. Results: Quality of life improvement according to the SF-36 questionnaire was significant in 8 of its 10 components; physical function had a score of 50.33 (95% confidence interval [CI]: 42.22-58.44) and general health had an average score of 44.33 (95%CI: 38.21-50.46). Body pain and the mental summation component were the only components not showing significant differences. Exercise tolerance analysed by the 6-minute walk test increased by 103metres (95%CI: 55.5-150.51). Conclusions: After lung transplantation, all dimensions of the SF-36 were statistically significantly and clinically improved, except for physical pain and the mental summary component. The mean distance of the 6-minute walk test also increased following lung transplantation

Síndrome de Parsonage-Turner en paciente trasplantado de pulmón. A propósito de un caso / Parsonage-turner syndrome in a lung transplant recipient. Apropos of a case

El síndrome de Parsonage Turner, recibe también otras denominaciones como neuritis atrófica, amiotrofia neurálgica o neuritis braquial. Se caracteriza por un inicio de dolor agudo en la extremidad superior, fundamentalmente a nivel proximal, rara vez afecta a la mano; seguido de debilidad y atrofia (en ocasiones también puede aparecer alteración de la sensibilidad), de causa desconocida y con una fisiopatología compleja donde se han involucrado alteraciones autoinmunes, genéticas, procesos infecciosos e incluso mecánicos. El enfoque del tratamiento ha de ser multidisciplinario con medidas farmacológicas -para control del dolor- y rehabilitadoras. Presentamos el caso de un paciente de 50 años trasplantado pulmonar por fibrosis pulmonar y con infección posterior por citomegalovirus que desarrolló un síndrome de Parsonage Turner con afectación del hombro derecho (AU)

Parsonage-Turner syndrome, also referred to as atrophic neuritis, neuralgic amyotrophy or brachial neuritis, is characterised by abrupt onset of pain in the upper limb, usually unilateral and mainly in the proximal areas of the extremity. It is rare that the hand is affected. The acute pain is followed by weakness and atrophy in affected areas and there can also be alteration of sensitivity. Although various factors are thought to play a role in the development of the disorder, such as autoimmune, genetic, infectious and even mechanical processes, the aetiology of the syndrome is still unclear. The treatment approach must be multidisciplinary, with pharmacological measures for pain control and rehabilitation. We present the case of a 50-year-old male patient, with a lung transplant due to pulmonary fibrosis and cytomegalovirus infection, who developed Parsonage-Turner syndrome with right shoulder involvement (AU)

Recomendaciones SORECAR. Rehabilitación en el trasplante pulmonar / Recommendations of the Spanish Society of Cardiorespiratory Rehabilitation on lung transplantation

Desde que se realizó el primer trasplante pulmonar en 1963, el procedimiento se ha extendido gradualmente. Tras la primera intervención con éxito en 1983, la técnica ha evolucionado y se ha perfeccionado, consiguiéndose un incremento de la supervivencia en los pacientes trasplantados. A este incremento en la supervivencia contribuye indudablemente la correcta evaluación, selección y preparación de candidatos a trasplante pulmonar realizada desde la Medicina Física y Rehabilitación. Actualmente la evaluación y optimización funcional pre y postrasplante aportada desde esta especialidad es clave en el éxito del trasplante pulmonar. Dada la importancia de este hecho, se nombró un grupo de expertos por la Sociedad Española de Rehabilitación Cardio-Respiratoria (SORECAR) para realizar una revisión de la evidencia actual al respecto y redactar un documento consenso de actuación en el trasplante pulmonar (AU)

Since the first lung transplant was carried out in 1963, this procedure has gradually spread. After the first successful lung transplant in 1983, the technique has evolved and has been perfected, leading to an increase in survival among transplant recipients. Factors that have undoubtedly contributed to this increased survival are thorough evaluation, selection and preparation of lung transplant candidates by specialists in physical medicine and rehabilitation. At present, the assessment and functional optimization both pre- and post-transplant provided by this specialty are crucial to lung transplant success. A group of experts was therefore appointed by the Spanish Society of Cardiorespiratory Rehabilitation to review the current evidence on this topic and to produce a consensus document on interventions in lung transplantation (AU)

Recomendaciones sobre rehabilitación en la cirugía de resección pulmonar de la Sociedad Española de Rehabilitación Cardio-Respiratoria (SORECAR) / Recommendations of the Spanish Society of Cardio-Respiratory Rehabilitation (SORECAR) on rehabilitation after lung resection surgery

La cirugía de resección pulmonar es la única opción curativa en las fases tempranas del cáncer de pulmón, pero sigue presentando una alta morbimortalidad perioperatoria. Una correcta estratificación del riesgo quirúrgico y una optimización de la situación general del paciente precirugía son elementos claves para disminuir el riesgo de complicaciones postoperatorias. Por otro lado, la cirugía junto a las posibles terapias adyuvantes impactan de manera negativa en la capacidad funcional y en la calidad de vida de muchos pacientes. Un grupo de expertos fue nombrado por la Sociedad Española de Rehabilitación Cardio-Respiratoria (SORECAR) para que realizaran una revisión de todas las evidencias disponibles sobre la evaluación funcional en la estratificación del riesgo quirúrgico y sobre la rehabilitación pre- y poscirugía de resección pulmonar y para que elaboraran un documento aplicándolas a la práctica clínica. Así se ha diseñado un protocolo de actuación en rehabilitación durante la fase pre- y poscirugía de resección pulmonar, con instrucciones o recomendaciones a modo de resumen. Con esto se pretende potenciar el papel de la rehabilitación en la cirugía de resección pulmonar y consensuar el modo de actuar en este campo (AU)

Lung resection surgery is the only curative option in the early stages of lung cancer but carries a high risk of perioperative morbidity and mortality. Proper surgical risk stratification and pre-surgical optimization of the patient's overall situation are key elements to reduce the risk of postoperative complications. Surgery, together with possible adjuvant therapies, may impact negatively on functional capacity and quality of life in many patients. Consequently, a group of experts was appointed by the Spanish Society of Cardio-Respiratory Rehabilitation (SORECAR) to review all the available evidence on functional assessment in surgical risk stratification and on pre- and postsurgery rehabilitation in order to create a document that applied their findings to clinical practice. As a result, an action plan has been defined for rehabilitation during the pre- and postsurgical stages of lung resection with instructions or recommendations presented as a checklist. The aim of creating this document was to enhance the role of rehabilitation after lung resection surgery and to agree on interventions in this area (AU)

Angiomixoma Agresivo Pélvico / Aggressive Pelvic Angiomyxoma

No disponible

[Are domiciliary care patients receiving adequate thromboprophylaxis?]. / ¿Hacemos profilaxis antitrombótica adecuadamente en los pacientes crónicos domiciliarios?

INTRODUCTION: The study aims to determine the percentage of patients treated at home with an indication of prophylaxis of thromboembolic disease (TED) according to the PRETEMED guidelines and whether they receive such prophylaxis. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted in Segovia Palace Health Centre (Madrid). INCLUSION CRITERIA: to be included in the domiciliary care protocol. EXCLUSION CRITERIA: terminal patient, hospitalised or surgery in the last 3 months. The variables used include, age, sex, duration of domiciliary care, mobility, anticoagulant or antiplatelet treatment and reason, and associated and precipitating factors to calculate the risk of TED according to the PRETEMED guidelines, and if they receive such prophylaxis, by reviewing computerised medical records and meeting with the staff responsible. RESULTS: The study included a total of 187 patients, of whom 81% were women There was a significant differences in mean age by sex (men, 76.91 years, 95% CI; 72.59-81.24, and women, 86.72 years, 95% CI; 72.59-81.24, P<.05). Almost two-thirds (65%) walked in the home. There were 3.7% patients who had an indication for receiving prophylaxis, but did not receive it, although 85.8% of them were on anticoagulants or antiplatelet therapy for other reasons. CONCLUSIONS: Most patients in domiciliary care have a low baseline risk of developing a TED episode in our study. There should be more emphasis placed on the prophylaxis of TED in acute medical episodes in which patients with slightly elevated risk may increase the likelihood of TED. Observational studies should be conducted to study the baseline risk and the subsequent development of TED in the population receiving home care.

[Ingested magnetic button. A rare cause of intestinal rupture]. / Botón magnetizado ingerido. Una causa rara de perforación intestinal.

Indoor wounds in infants probably represent widest range of minor lesions. However, there are casualties as consequence of falls, burns and ingestion of foreign bodies. Intestinal rupture due to ingested magnetic device is a very unusual event. We report the case of a four-month old female patient with this complication is presented. During first laparotomy intestinal rupture and magnetic buttons of cellular telephone as causal agent was found. Three days after operation, she required a second look due to cecum rupture. Primary reparation was performed. In order to demonstrate a pathogenic hypothesis, the bottom was put in a porcine bowel segment surrounding for a metallic jail, resulting in bowel rupture. We concluded that the ingested magnetic devices can produce intestinal rupture.

Tuberculosis trends in Madrid, 1994-2003: impact of immigration and HIV infection.

SETTING: Tuberculosis (TB) cases reported from nine districts of Madrid, where the percentage of immigrant population varied from 1.9% in 1996 to 12.2% in 2003. OBJECTIVE: To describe the trends in TB incidence from 1994 to 2003. DESIGN: Observational study. RESULTS: Between 1994-1995 and 2002-2003, the TB rate decreased from 48.5 (95% CI 45.8-51.1) to 23.3 per 100000 population (95% CI 21.5-25.1) (P < 0.001). The percentage of TB cases co-infected with HIV decreased from 55.9% in 1994 to 14.3% in 2003 (P < 0.001), whereas TB cases in foreigners increased from 2.6% in 1994 to 33.7% in 2003 (P < 0.001). CONCLUSION: Although the TB rates showed a marked decrease in the study period, the increasing impact of immigration contributed to slowing down the trend.

Tratamiento de las bronquiectasias no fibrosis quística en fase estable / Treatment of non-cystc fibrosis bronchiectases in stable phase

Las bronquiectasias no son una entidad nosológica homogénea ya que pueden ser la expresión de varias etiologías y, muy posiblemente, de varios mecanismos patogénicos que se constituyen en un círculo vicioso de alteración del aclaramiento mucociliar, inflamación e infección bacteriana crónica. Las diferentes opciones terapéuticas disponibles pretenden controlar estos aspectos y los objetivos finales son el control de los síntomas, la reducción de la morbilidad y la prevención de la progresión. En la actualidad la evidencia clínica que soporta el tratamiento de esta patología es escasa pero la valoración multidisciplinar de la misma puede hacer cambiar su historia natural (AU)

The bronchiectases are not a homogeneous defined entity since they can be the expression of several aetiologies and, very possibly, of several pathogenic mechanisms that are constituted in a vicious circle of alteration of the mucociliary clearance, inflammation and chronic bacterial infection. The different therapeutic options available try to control these aspects and the final objectives are the control of the symptoms, the prevention of progression and the reduction of morbidity. At present the clinical evidence that supports the treatment of this pathology is scarce, but its multidisciplinary evaluation can change its natural history (AU)

[Traumatic perforation of the small intestine in childhood]. / Perforación traumática del intestino delgado en la infancia.

INTRODUCTION: Traumatic perforation of the small bowel occurs in approximately 1 percent of children with either blunt or penetrating trauma to the abdomen. Difficulty in recognition of initial subtle signs of hollow viscus injury can lead to delay in both diagnosis and operative intervention. MATERIAL AND METHOD: Medical records for patients discharged with traumatic small bowel perforation from the General Surgery Department between 1991 and 1999 were reviewed. RESULTS: Bowel injuries were noted in 41 children. Blunt trauma (battered child syndrome, bike injuries, etc.), was responsible for 37 cases and penetrating wounds in three (firearm wounds and bike pedal accidents). There were 32 boys and a mean age of 6.8 years. The site of perforation was duodenal in four cases, jejunum in 21, and ileum in sixteen. Associated injuries occurred in 11 patients, including stomach, pancreas, liver, spleen, bladder, and ureter. Twenty-nine had simple closure, while seven were resected. Four children died. CONCLUSIONS: These injuries require prompt surgical intervention and are in general curable with excellent prognosis if one is alert to the possibility of their occurrence, if one is familiar with the approaches to prompt and accurate diagnosis, and if associated injuries are not serious.

[Bochdalek hernia with late manifestation. Relevant clinico-surgical features]. / Hernia de Bochdalek de expresión tardía. Aspectos clínico-quirúrgicos relevantes.

INTRODUCTION: Congenital diaphragmatic hernia presents after the first hours of life in 5 to 25% of cases. Presenting symptoms may be quite non-specific, and gastrointestinal rather than respiratory in origin. Bochdalek hernia should be considered when an infant has respiratory distress, vomiting and abdominal pain. MATERIAL AND METHOD: Five-year retrospective study was made of children with congenital posterolateral (Bochdalek) hernia presenting more than 10 days after birth. The records are of 17 patients. The group was divided in two subgroups. The first, was made up of four patients who had digestive emergencies and complications such as colon and gastric perforation. One infant of this group had a left sided defect and inflammatory hepatic-pulmonary fusion. The second group was made up of 13 patients between 2 weeks and four years og age. Main complaints were vomiting, abdominal pain, and respiratory distress. Ten patients were female and 10 had a left-side defect. Herniated viscerae were small bowel, stomach, spleen, and colon. There were six deaths. CONCLUSIONS: Bochdalek hernia in children after the newborn period is a common entity. Frequent digestive and respiratory signs are present. Complications such as colon and gastric perforation are common.

[Interstitial gastric emphysema in children]. / Enfisema gástrico intersticial en niños.

UNLABELLED: Gastric pneumatosis is an unusual clinical finding in infants and children and it appears in the three following similar conditions: pneumatosis cystoides; emphysematous gastritis, and gastric emphysema. MATERIALS METHODS AND RESULTS: The clinical pictures and radiographic appearance of this association are described in four patients in whom the clinical course made suspect interstitial gastric emphysema. Two patients had hypertrophic pyloric stenosis and two, unspecific erosive gastritis. In the first two patients, a Fredet-Ramstedt procedure was performed. All patients survived. Differential diagnostic considerations, the importance of correct radiological diagnosis, and the results of proper therapy are discussed. CONCLUSIONS: Pyloric and duodenal obstruction in infants is the main etiologic factor in gastric emphysema.

Solid substrate fermentation of leached beet pulp withTrichoderma aureoviride.

Optimum production of cellulases on leached beet pulp by native and mutant strains ofTrichoderma aureoviride in column-type, solid-substrate fermenters, at controlled temperature and aeration rate, was with a mutant strain, that produced 11 and 29 filter paper units of activity/g solids on raw and acid pre-treated leached beet pulp, respectively. The former value was 40% higher than in the native strain and 70% higher than in the reference strain. protein enrichment of residual solid was significant in all cases, with values up to 40% of total dry weight. Results are suitable for scale-up to pilot level.

Hemosiderosis pulmonar idiopatica. / Idiopatic pulmonary hemosiderosis

Se presenta el caso clinico de un nino de 13 anos de edad, con manifestaciones clinicas, radiologicas y de laboratorio compatibles con hemosiderosis pulmonar idiopatica (HPI), la cual se corroboro mediante estudio de biopsia pulmonar. El tratamiento fue a base de prednisona, con evolucion satisfactoria y desaparicion de la sintomatologia clinica