Francisco José Vera Sempere

Complicaciones del trasplante de pulmón en la enfermedad pulmonar obstructiva crónica

BACKGROUND AND OBJECTIVE Lung transplantation (LT) in chronic obstructive pulmonary disease (COPD) is a procedure with a high rate of morbimortality. The aim of this paper is to analyze the early and late rates of complications and mortality in COPD patients undergoing LT. PATIENTS AND METHOD Retrospective study of 107 COPD patients transplanted in the Hospital Universitario La Fe, between 1991 and 2008. Preoperative variables were collected as well as all the complications, medical and surgical, occurred in the follow-up, which are expressed as mean or percentage as appropriate. The 30-day mortality and long term survival were established. RESULTS A total of 94 men (87.9%) and 13 women (12.1%) were transplanted with a mean age (SD) of 52.58 (8.05) years with 71% of double-lung LT. BODE score was 7.24 (1.28). The rate of primary graft dysfunction was 39.3%. The most common surgical complications were phrenic paralysis (16.8%), hemothorax (17.8%) and pleural effusion (30.8%). There was a high number of postoperative hospitalization (30%) and medical complications such as hypertension (36%), diabetes mellitus (16.7%) and renal failure (40%), secondary to treatment. Perioperative mortality was 14% and 34.5% after a year, being the most frequent causes infections (34.6%) and chronic rejection (BOS) (17.8%). Five-year survival was 40.9% with bronchiectasis and smoking history being the risk factors. CONCLUSIONS LT is a procedure with a high early mortality rate associated with high medical and surgical complications that affect the outcome.

Expression of cytokeratins in epithelialized periapical lesions

OBJECTIVE This study attempted to clarify whether differential immunocytokeratin expression occurs in cystic and epithelialized noncystic lesions. STUDY DESIGN From January 2003 to June 2004, periapical surgery was carried out on 70 teeth, collecting 70 histologic samples. Serial sections of original histologic slices were prepared for immunostaining. The antibodies used were against cytokeratins CK7, AE1, AE3, AE1-3, and CAM52. The intensity of staining was evaluated as follows: 0 = no cells stained; 1 = weak staining (11%-25%); 2 = moderate staining (26%-75%); and 3 = intense staining (>or=76%). RESULTS Ten epithelized granulomas and 6 cysts were included. Intense staining was seen for AE1 and AE1-3 in the 2 types of lesion; staining with AE3 was moderate for epithelized granulomas and cysts. CK7 demonstrated a light reactivity in the outermost epithelial layer. CAM52 showed weak staining for the epithelized granuloma and moderate for the cyst. CONCLUSIONS Cysts and epithelized granulomas presented the same cytokeratin expression, though with marked differences in distribution and degree of staining of cytokeratins. This immunochemical technique is interesting for the determination of the histologic type and the prognosis, but may not be clinically practicable.

Mortalidad en carcinoma pulmonar no microcítico resecado, con tamaño máximo de 3 cm y sin afectación ganglionar: análisis de riesgos competitivos

BACKGROUND AND OBJECTIVE Survival studies of non-small cell lung cancer (NSCLC) are usually based on the Kaplan-Meier method. However, other factors not covered by this method may modify the observation of the event of interest. There are models of cumulative incidence (CI), that take into account these competing risks, enabling more accurate survival estimates and evaluation of the risk of death from other causes. We aimed to evaluate these models in resected early-stage NSCLC patients. PATIENTS AND METHOD This study included 263 patients with resected NSCLC whose diameter was ≤ 3 cm without node involvement (N0). Demographic, clinical, morphopathological and surgical variables, TNM classification and long-term evolution were analysed. To analyse CI, death by another cause was considered to be competitive event. For the univariate analysis, Grays method was used, while Fine and Grays method was employed for the multivariate analysis. RESULTS Mortality by NSCLC was 19.4% at 5 years and 14.3% by another cause. Both curves crossed at 6.3 years, and probability of death by another cause became greater from this point. In multivariate analysis, cancer mortality was conditioned by visceral pleural invasion (VPI) (P=.001) and vascular invasion (P=.020), with age>50 years (P=.034), smoking (P=.009) and the Charlson index ≥ 2 (P=.000) being by no cancer. CONCLUSIONS By the method of CI, VPI and vascular invasion conditioned cancer death in NSCLC >3 cm, while non-tumor causes of long-term death were determined.