M. Teresa Gómez Hernández

Effect of implementing the European guidelines for functional evaluation before lung resection on cardiorespiratory morbidity and 30-day mortality in lung cancer patients: a case–control study on a matched series of patients

OBJECTIVES We hypothesized that postoperative cardiorespiratory morbidity and/or 30-day death rates decreased after implementing the new European ERS/ESTS guidelines for functional evaluation before lung resection and tested the hypothesis by means of a case-control study. METHODS The analysis included a series of 916 consecutive patients who underwent an anatomical pulmonary resection for non-small-cell lung cancer in our centre. Patients were divided into cases (September 2009-August 2012) and controls (December 2002-August 2009). We reviewed the records from a prospective computerized database; the final dataset included no missing data. The primary studied outcomes were the occurrence of cardiorespiratory morbidity or 30-day death after surgery. The patients were 1:1 propensity score matched according to the following variables age, ppoFEV1% and the need of pneumonectomy. RESULTS After the matching process, 670 cases (335 cases and 335 controls) entered into the study. The rates of pneumonectomy in cases and controls were 5.7 and 13.2%, respectively, (P < 0.0001) in the whole series and 5.7 and 6.9% after matching (P = 0.52). Cardiorespiratory morbidity was 8.1% (27 of 308) in cases and 9.8% (33 of 335) in controls [odds ratio (OR): 0.8; 95% confidence interval (CI): 0.4-1.4]. Thirty-day mortality was 0.90% (3/335) in cases and 1, 2% (4 of 335) in controls (OR: 0.7; 95% CI: 0.1-4.4). CONCLUSIONS Although we have observed a trend towards lower cardiorespiratory morbidity and 30-day mortality after implementing ERS/ESTS guidelines, the benefit of the guidelines remains unclear. Multicentric analysis including a very large number of cases is needed to demonstrate statistically the effectiveness of the guidelines to reduce operative mortality and cardiorespiratory morbidity. Maybe the effect could be easier demonstrated in series with higher operative mortality or morbidity.

Aspiración de cuerpo extraño en relación con la aplicación de broncodilatador inhalado

We read with interest the article by Gómez Hernández et al. published in your journal in May, entitled “Foreign body aspiration during inhaled bronchodilator administration”.1 Last month we encountered in our hospital a patient who had aspirated a coin concealed in the mouthpiece of his salbutamol pressurized inhaler, by the same mechanism described in the above-mentioned article. Our patient was a 67-year-old British man, former smoker with a history of arterial hypertension and COPD, who was on holiday in Spain. He was receiving regular treatment with hypotensive agents and long-acting bronchodilators, and used salbutamol on demand from a pressurized cartridge. On this occasion, he took a puff of salbutamol on demand for dyspnea. The patient reported that he was carrying the inhaler without the mouthpiece cover in his pocket, where he also had loose change. The patient took out the inhaler and took a quick puff without examining the mouthpiece or shaking the device before use, so he failed to notice the coin. He immediately realized that he had aspirated a foreign body and began to cough persistently, so he attended the emergency department. A chest X-ray revealed a coin lodged in the right main bronchus, and the respiratory medicine and thoracic surgery department was alerted. The patient was informed that a foreign body, in the form of a coin, was lodged in the right main bronchus as a result of his hasty inhalation. The decision was made to extract it in the operating room, using rigid bronchoscopy for greater safety due to the size of the foreign body and the danger of it becoming wedged in the trachea. The coin was removed using forceps. No complications occurred and the patient was discharged the next day after being reminded about the correct use of inhalers. As in the previously published case, the patient had been carrying the inhaler without the mouthpiece cover in the same pocket

Timoma y carcinoma tiroideo sincrónicos en paciente con distrofia miotónica de Steinert no conocida

Steinert’s disease or myotonic dystrophy type 1 (MD1) is a multisystemic autosomal-dominant inherited neuromuscular disorder. Some authors have suggested that it is associated with a greater risk of cancer.1–4 We report the case of a patient with undiagnosed MD1 who underwent surgery for 2 synchronous tumors. The patient was a 73-year-old woman, asymptomatic, followed up for multinodular goiter diagnosed of a follicular carcinoma after biopsy. During staging, a mediastinal mass measuring 3.6 cm was revealed (Fig. 1), radiologically consistent with metastasis. The patient had a history of bilateral cataract surgery and basal cell carcinoma. As biopsy of the mediastinal lesion proved impossible, we decided to resect it and to perform a total thyroidectomy. Thus, the patient underwent cervicotomy and partial sternotomy, with successful resection of both lesions. After surgery, extubation was delayed for 48 h, due to ventilatory problems. On day 5 post-surgery, the patient developed respiratory failure due to bronchoaspiration requiring orotracheal intubation, which led to right basal pneumonia. After this was resolved,