The Medtronic 780G advanced hybrid closed-loop system achieves and maintains good glycaemic control in type 1 diabetes adults despite previous treatment.

INTRODUCTION: Improvements in continuous glucose monitoring (CGM) in recent years have changed the treatment of type 1 diabetes (T1D) by permitting the automation of glucose control. The Minimed 780G advanced hybrid closed-loop (ACHL) system adapts basal infusion rates and delivers auto-correction boluses in order to achieve a user-decided glucose target (100, 110 or 120mg/dL). This study set out to evaluate the effectiveness of the Medtronic 780G system in real-life conditions over 6 months. MATERIALS AND METHODS: Prospective study that included T1D subjects previously treated with insulin pump without CGM (pump group) or with sensor-augmented pump with predictive low-glucose suspend (SAP-PLGS group) who started with the Minimed 780G system. Sensor and pump data from baseline, and at 1, 3 and 6 months were downloaded and HbA1c was recorded at baseline and at 6 months. RESULTS: Fifty T1D subjects were included; 25 were previous SAP-PLGS 640G users and 25 used 640G without CGM. 66% were female, 48.6 (40-57) years of age with 20 (12-31.5) years of diabetes duration. Time in range (TIR) improved in the total cohort from baseline to 6 months (69% (57.7-76) vs. 74% (70-82); p=0.01 as did HbA1c (7.6% (7.1-7.8) vs. 7.0% (6.8-7.5); p<0.001), with improvement in times <54, >180 and >250mg/dL. Outcomes at 6 months did not differ between groups, although the SAP-PLGS subjects were prone to hypoglycaemia and the pump group mainly presented suboptimal metabolic control. CONCLUSION: The AHCL Medtronic Minimed 780G system achieves and maintains good glycaemic control over 6 months in real-life conditions in different profiles of T1D subjects.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didn't find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

[Identification and review of health promotion at work programs in Spain.] / Identificación y revisión de los programas de promoción de la salud en el trabajo en España.

OBJECTIVE: Health promotion at work (HPW) is an essential component of social and economic policies. Objectives: 1) To determine which regions in Spain have a HPW program and 2) To review these programs according to health promotion and equity models. METHODS: Regional HPW programs were identified through occupational health committee. Their webs were reviewed, and we interviewed by videoconference the persons in charge of each program. We used a data collection notebook to collect descriptive as well as quality variables, according to health promotion and equity models. RESULTS: 6 regions have a HPW program: Andalucía, Aragón, Cataluña, Comunidad Valenciana, Extremadura and Galicia, developed by health administration or work administration, but only in 1 case by both. 4 programs have regulations and 3 have created a network. The participation of occupational risk prevention services is key, while participation of workers and management teams is variable. Only 2 regions have incorporated information and materials related to COVID-19. Measures to promote equality and work-life balance, but not to promote equity. CONCLUSIONS: HPW in Spain is a reality in 6 regions, with differences between them related to the requisites and what the administration offers to them.

OBJETIVO: La promoción de la salud en el trabajo (PSLT) es un componente esencial de la política social y económica. Los objetivos fueron: 1) Determinar en qué comunidades autónomas (CCAA) existe un programa de PSLT y 2) Revisar dichos programas de acuerdo con los modelos de promoción de la salud y equidad en salud. METODOS: Los programas se han identificado a través de la Ponencia de salud laboral. Se han revisado sus webs y se han entrevistado por videoconferencia las personas responsables de cada programa. Se ha utilizado un cuaderno de recogida de datos para recoger variables descriptivas y de calidad según los marcos de promoción de la salud y equidad. RESULTADOS: 6 CCAA tienen programa de PSLT: Andalucía, Aragón, Cataluña, Comunidad Valenciana, Extremadura y Galicia, desarrollados por la administración sanitaria, por la de trabajo o conjuntamente. 4 CCAA han desarrollado normativa para el programa y 3 han creado una red. La participación de los servicios de prevención de riesgos laborales es clave, mientras que la de las personas trabajadoras y equipos directivos es variable. Sólo 2 CCAA han incorporado información y materiales relacionados con la COVID-19. Se observan medidas para el fomento de la igualdad y conciliación laboral, pero no para fomentar la equidad. CONCLUSIONES: La PSLT en España es una realidad en 6 CCAA, con diferencias entre los programas, tanto en relación con los requisitos, como respecto a lo que les ofrece la administración.

Inflammatory pseudotumor and myofibroblastic inflammatory tumor. Diagnostic criteria and prognostic differences. / Seudotumor inflamatorio y tumor miofibroblástico inflamatorio. Criterios diagnósticos y diferencias pronósticas.

INTRODUCTION: Inflammatory pseudotumor (IPT) and inflammatory myofibroblastic tumor (IMT) are two very rare entities that were formerly included in the same category; however, today they are considered two different diseases due to the neoplastic origin of the IMT. Our objective is to share our experience in the management of these two types of tumors that we must take into account in the differential diagnosis of pulmonary masses or nodules. METHODS: Thirteen patients with a pathological diagnosis of IPT and IMT who underwent surgery between 2008 and 2019 were retrospectively studied. We recorded the pre and postoperative information of each one, as well as the survival analysis. RESULTS: Of the 13 patients, 8 were men and 5 women. The mean age of presentation was 53,5 years. An atypical segmentectomy was performed in 6 patients; a lobectomy was necessary in 6 and a pneumonectomy in 1 case. In all cases a complete resection was achieved. Diagnosis was possible thanks to histology, immunohistochemical (IHQ) and fluorescent in situ hybridization (FISH) techniques determining the expression of IgG4 and the rearrangement of ALK, respectively. After a median follow up of 49 months, we didnt find any loco-regional or distant recurrence in the patients studied. CONCLUSION: IPT and IMT are rare tumors with a very good prognostic. The diagnosis of both entities is based mainly on specific anatomopathological techniques. Surgery has, in most cases, both a diagnostic and therapeutic role.

Prognostic significance of histopathological factors in survival and recurrence of atypical carcinoid tumours.

OBJECTIVES: Atypical carcinoids are neuroendocrine neoplasms of intermediate degree and low frequency. The aim of this study is to analyse their clinical characteristics and the importance of different histopathological factors in their prognosis. METHODS: Multicentre cooperative group EMETNE prospectively reviewed 153 patients operated on between 1998 and 2016 with diagnosis of atypical carcinoids. Clinical variables and histopathological features were assessed. RESULTS: Mean age was 54.36 years, similar for both genders. Concerning pathological study, mean tumour size was 31.7 mm. Rosettes were presented in 17% of the cases and tumoural necrosis in 23.3%. The cell proliferation factor Ki-67 index was 10.7%. The 2- and 5-year overall survival rates were 95.8% and 88.9%, respectively. In the univariate study, statistically significant differences in survival were found for each of the categories of T, N and M factors. Mitotic index and quantification of expression of Ki-67 showed influence in overall survival, although without statistical significance. In the multivariate analysis, factors N, M and mitotic index behaved as independent prognostic factors related to survival. Median disease-free interval in the series was 163.35 months. In cases with loco-regional recurrence, 53% had positive hiliar or mediastinal nodal involvement at the time of the surgery. In the univariate analysis, we observed statistically significant differences in disease-free interval in patients with nodal involvement (P = 0.024) and non-anatomical resections (P = 0.04). Histological characteristics showed no statistically significant differences in disease-free interval. CONCLUSIONS: Lymph node involvement, the development of distant metastasis and mitotic index, more than Ki-67 determination, were shown as independent prognostic factors related to survival of these patients.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia: Report of two cases.

INTRODUCTION: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare disorder characterized by a proliferation of neuroendocrine cells within the lung. It is classically described as a disease with persistent cough, dyspnea and wheezing in non-smoker middle aged females. CT of the chest reveals diffuse air trapping with mosaic pattern. PATIENTS AND METHODS: We present two cases of DIPNECH that were sent to our department to perform a lung biopsy with the diagnostic suspicion of diffuse interstitial disease. Both cases were women with a history of chronic cough and moderate effort dyspnea. RESULTS AND DISCUSSION: The aim of this paper is that physicians take into account this diagnostic entity before treating as an asthmatic a patient with these characteristics, not forgetting that they are prenoplastic lesions.

Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms? / ¿Es la edad un factor predisponente de complicaciones postoperatorias en las resecciones pulmonares por neoplasias pulmonares primarias?

INTRODUCTION: Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. METHODS: A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. RESULTS: The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. CONCLUSION: Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications.

Primary pulmonary synovial sarcoma: a rare neoplasm.

Primary pulmonary synovial sarcoma is an extremely rare tumor with an unknown cause. The diagnosis is established after other primary lung malignancies or metastatic extrathoracic sarcoma have been excluded. We report the case of a 69-year-old man who presented with a well-defined mass in the right upper lobe on a chest X-ray. A video-assisted thoracoscopic surgery (VATS) right upper lobectomy was performed. Immunohistochemically, neoplastic cells were positive for vimentin, CD56 and Bcl-2, and focally positive for CD99, epithelial membrane antigen and cytokeratin 7 and 19. The cytogenetic study revealed a SYT genetic reassortment. So, the final pathological diagnosis was primary pulmonary synovial sarcoma.

Update in the extraction of airway foreign bodies in adults.

Foreign body (FB) aspiration into the airway is lees common in adults than children. Nevertheless its incidence does not decrease through time. We present clinical relevant aspects of airway FBs on the basis of a selective review of pertinent literature retrieved by a search in the PubMed database. The most common aspirated FBs by adults are organics, especially fragments of bones and seeds. Symptoms usually are cough, chocking and dyspnea. Right localization, especially bronchus intermedius and right lower lobe, is more frequent. Chest radiography can be normal in up to 20% of the cases and FBs can be detected in 26% of the patients. FBs can safely remove in the majority of patients under flexible bronchoscopy. Surgical treatment must be reserved for cases in which bronchoscope fails or there are irreversible bronchial or lung complications.

Thoracic liposarcoma: resection and chest wall reconstruction.

Liposarcoma is a malignant neoplasm of mesodermal origin derived from adipose tissue. It most often originates in the extremities and retroperitoneum, and less frequently in the head and neck. Liposarcoma involving the chest wall is extremely rare with few reported cases. Surgery is the mainstay of treatment, and complete resection is the major factor influencing survival. We describe the case of a 65-year-old man diagnosed with a dedifferentiated liposarcoma of the chest wall, who underwent radical resection and chest wall reconstruction with a latissimus dorsi musculocutaneous flap.

Design and development of a nutritional assessment application for smartphones and tablets with Android OS.

BACKGROUND & AIMS: To design and develop a nutritional application for smartphones and tablets with Android operating system for using to in- and outpatients that need a nutritional assessment. To check the validity of the results of such software. METHODS: The application was compiled for version 2.1 of the Android operating system from Google. A cohort of 30 patients was included for evaluating the reliability of the application. The calculations were performed by staff of the Nutrition Unit of the Complexo Hospitalario Universitario de Vigo, manually and through e-Nutrimet software on a smartphone and a tablet. RESULTS: Concordance was absolute between results of different methods obtained using e-Nutrimet on a smartphone and a tablet (Fleiss index κ= 1). The same level of concordance was obtained by comparing handmade and e-Nutrimet made results. CONCLUSIONS: The degree of correlation is good, and it would be extended to all healthcare staff who wants to determine whether a patient has malnutrition, or not. The nutritional assessment software e-Nutrimet does not replace healthcare staff in any case, but could be an important aid in assessing patients who may be in risk of malnutrition, saving time of evaluation.

Introducción y objetivos: Diseñar y desarrollar una aplicación nutricional para smartphones y tablets con Sistema operativo Android® para realizar las valoraciones nutricionales de pacientes ambulatorios y hospitalizados. Verificar y comprobar la validez de los resultados de la aplicación. Métodos: La aplicación se compile para la versión 2.1 del Sistema operativo Android® de Google®. Para evaluar la fiabilidad de la aplicación se incluyeron a 30 pacientes, a los que se le realizó una valoración nutricional. Todos los cálculos fueron efectuados por personal de la Unidad de Nutrición del Complexo Hospitalario Universitario de Vigo, de forma manual y a través del software e-Nutrimet ©, tanto usando un Smartphone como una tablet. Resultados: Se obtuvo una concordancia absoluta entre los resultados de los diferentes métodos obtenidos utilizando la aplicación e-Nutrimet© en smartphones y en tablets (Fleiss index = 1). El mismo nivel de concordancia se obtuvo comparando el método manual como el automatizado mediante el software e-Nutrimet©. Conclusiones: El grado de correlación es muy bueno, permitiendo extender la valoración nutricional usando e-Nutrimet© a todo el personal sanitario que quiera determinar si un paciente presenta malnutrición o no. La aplicación de valoración nutricional e-Nutrimet© no sustituye al personal sanitario en ningún caso, pero podría ser de gran ayuda a la hora de valorar pacientes que pudieran estar en riesgo de malnutrición, ahorrando tiempo en estas valoraciones.

Epithelioid angiosarcoma of the lung with pleural metastases: a rare cause of haemoptysis clinicopathological conference.

Angiosarcomas are a rare type of malignant vascular tumour characterised by proliferation of tumour cells with vascular endothelial features. These tumours are usually very aggressive and overall mortality is very high. Pulmonary angiosarcomas are usually secondary tumours, and only a few primary cases have been reported. We present a case of a 56 year-old male with persistent haemoptysis secondary to lung epithelioid angiosarcoma with pleural metastases.

Extraction of airway foreign bodies in adults: experience from 1987-2008.

To determine the incidence and the clinical, radiographic, and endoscopic characteristics of adult patients in our area diagnosed with tracheobronchial foreign bodies (FBs), we have performed a descriptive retrospective study analysing rigid and flexible bronchoscopies practised at our department between 1987 and 2008 in patients older than 14 years. Of the 9781 bronchoscopies performed, 32 involved cases of bronchoaspiration of FBs. The mean age of the patients was 43.81 years (S.D. 21.43); 65.6% were male and 34.4% were female. Acute or recurrent infection was the most frequent clinical presentation. Chest radiographs provided data for diagnosis in 68% of the cases. The most common FB aspirated were inorganic (pins and plastic devices 21.4%, respectively). In conclusion, we can state that in our area tracheobronchial aspiration of FBs by adults is not common. The clinical symptoms are highly variable and the FBs are usually lodged in the right bronchial tree.

[Solitary pulmonary nodule: primary, metastatic, or both]. / Nódulo pulmonar solitario: ¿primario, metastásico o ambos?

The lung is the most common site for metastasis from colorectal cancer, which is among the most common neoplasms in developed countries. Simultaneous occurrence of pulmonary metastasis of colorectal origin and primary carcinoma has been reported. We describe the case of a 65-year-old man who underwent low anterior resection for colorectal adenocarcinoma in 2007. Follow-up computed tomography revealed a pulmonary nodule that was classified as metastatic. The patient was referred to our thoracic surgery department, where the nodule was resected. The pathology confirmed that the nodule was neoplastic, and histologic and immunohistochemical examination showed the presence of colorectal metastasis and lung adenocarcinoma. Evidence of metastasis was also found in 2 of the lymph nodes analyzed, 1 with features identical to the primary pulmonary adenocarcinoma, and 1 with features identical to the colorectal metastasis.

Systemic air embolism in a patient with ingestion of a foreign body.

Air embolism is defined as the entry of gas into a vascular structure. Frequently it is iatrogenic and can result in serious morbidity and mortality. We describe the case of a 59-year-old woman who presented with mediastinitis as a result of ingestion of a fishbone. Mediastinal debridement was performed which was complicated in the postoperative period by a systemic air embolism, as documented by computed tomography and clinical features.

[Video-assisted thoracic surgery to treat spinal deformities: climbing the learning curve]. / Cirugía torácica videoasistida de las deformidades espinales: afrontando la curva de aprendizaje.

OBJECTIVE: The aim of this study was to analyze the impact of the learning curve on the preliminary results of video-assisted thoracic surgery for spinal deformities in a general hospital setting. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 15 patients who underwent video-assisted thoracic surgery performed by a multidisciplinary team comprising orthopedic and thoracic surgeons. Endoscopic anterior release and fusion were followed by posterior instrumentation in a single procedure. Demographic, orthopedic, morbidity, and mortality statistics were compiled for the 15 patients and compared to results reported for similar series. RESULTS: Endoscopic surgery was indicated for 15 patients: 11 women (73.3%) and 4 men (26.7%). The median age was 15 years (interquartile range [IQR], 14-19 years). Three patients (20%) required conversion to thoracotomy. There were 2 serious (13.3%) and 3 minor complications (20%). They all resolved satisfactorily and there was no perioperative mortality. The median Cobb angle was 71 degrees (IQR, 63.75 degrees -75.25 degrees ) before surgery and 41 degrees (IQR, 30 degrees -50 degrees ) after surgery. Median duration of surgery was 360 minutes (IQR, 300-360 minutes), duration of postoperative recovery unit stay was 1.5 days (IQR, 1-2.75 days), and total hospital stay was 11.5 days (IQR, 8.25-14 days). CONCLUSIONS: Despite the complexity of video-assisted thoracic surgical procedures, we believe they will become the standard approach to treating spinal deformities in the near future. By working together in general hospital settings, orthopedic and thoracic surgeons can help to overcome the steep yet manageable learning curve.

[Influence of delay of surgery on the survival of patients with bronchogenic carcinoma]. / Influencia de la demora quirúrgica en la supervivencia de los pacientes intervenidos por carcinoma broncogénico.

OBJECTIVE: Bronchogenic carcinoma is the main cause of tumor-related deaths among men in Spain. The British Thoracic Society recommends that no longer than 4 weeks should pass from the moment a patient s name is placed on a waiting list until surgery takes place. We analyzed the influence of time until surgery on survival in patients with lung cancer. PATIENTS AND METHODS: We operated on 108 patients diagnosed with bronchogenic carcinoma between January 1, 2001 and December 31, 2002. The time until surgery was defined by the date of application for care in our department until the moment of surgery. RESULTS: The mean time on the waiting list was 56.87 days. No significant differences in mean wait-list times could be found in relation to tumor stage, type of surgery, patient age, or complete resection rate. The median survival in this patient series was 35 months. No significant differences in survival were found in relation to time until surgery in either the univariate or multivariate analysis. Pathologic stage, complete resection of the tumor, and patient age were prognostic factors. CONCLUSIONS: We found no evidence that delaying surgery affects survival in lung cancer patients. However, efforts should be made to reduce surgical wait-list times to bring them into line with the recommendations of scientific societies.