Estudio biomecánico de las modificaciones del flujo aéreo traqueal durante los movimientos respiratorios y la tos tras la colocación de una endoprótesis. Posible influencia en la retención de secreciones / Biomechanical study of changes in tracheal airflow during respiratory movements and coughing after placement of an endoprosthesis. Possible influence in secretion retention

Es frecuente que sea precisa la utilización de endoprótesis para el tratamiento de las estenosis traqueales. Aunque solucionan el problema de una forma rápida y segura, su colocación acarrea una serie de efectos secundarios. Los más frecuentes, la retención de secreciones. Utilizando un modelo informático que reproduce el comportamiento biomecánico de la tráquea, se pretende dar explicación a los fenómenos que ocurren tras la implantación de una endoprótesis. Se ha estudiado la variación del flujo aéreo producida tras la intervención durante la respiración normal y la tos. Los resultados obtenidos muestran una disminución de las velocidades de circulación del aire, junto con alteraciones en el patrón de flujo, originadas por la propia morfología de la prótesis, que pueden justificar la dificultad que presentan algunos pacientes para eliminar las secreciones respiratorias, permitiendo que estas se acumulen, sobre todo, en los alrededores de la zona de implantación

Frequently, the use of prosthesis is necessary to deal with a tracheal stenosis. They achieve a rapid and safe resolution of the stenosis, but in some instances, their insertion results in some secondary effects, more often, retained secretions. By using a computer-assisted model that mimics the biome chanical behaviour of the trachea, we aimed at clarifying those phenomena occurring following the prosthesis implantation by assessing the airflow changes during both normal breathing and cough. Our results revealed a decrease in airflow speed and changes in flow patterns secondary to the morphological features of the prosthesis, which might be involved in the inability of these patients to clear secretions, which are retained in the periprosthetic area

Tecnología de simulación tridimensional para la planificación de la implantación de endoprótesis traqueales / Three-dimensional simulation technology for planning tracheal stenting

Objetivo: Se ha realizado un estudio observacional sobre pacientes con estenosis de la vía aérea principal con el objetivo de demostrar la mejorar en los resultados del tratamiento mediante broncoscopia rígida al realizar una planificación preoperatoria (..) (AU)

Objective: An observational study was made of patients with stenosis of the main airway in order to demonstrate the improved results of treatment by rigid bronchoscopy to perform preoperative planning with computer simulation (..) (AU)

Evaluación de la eficacia y el impacto clínico de la PET-FDG en los pacientes con carcinoma broncopulmonar no microcítico candidatos a cirugía / Of FDG-PET on patients with potentially resectable non-small cell lung cancer

Objetivo. Evaluar la eficacia y el impacto clínico de la tomografía por emisión de positrones con 18fluorodeoxiglucosa (PET-FDG) en el diagnóstico del cáncer broncopulmonar no microcítico (CPNM) con estadio limitado en la tomografía axial computarizada (TAC). Material y métodos. Estudio prospectivo de 115 pacientes (104 varones/11 mujeres), con CPNM candidatos a cirugía (TAC: estadio IIIB), incluyendo aquellos con lesiones equívocas en la TAC. Se realizó PET-FDG tras administrar 370-440 MBq de 18F-FDG en normoglucemia, analizando las imágenes cualitativa y semicuantitativamente. Los resultados se confirmaron histopatológicamente. Resultados. La prevalencia de enfermedad linfática mediastínica fue de 46,6 %, no detectándose por TAC en 21, frente a 9 en PET-FDG. La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud fueron 83,3, 73,7,75, 81,8 y 78,3 % para la FDG-PET, frente al 61,1, 68,8, 64,7, 65,6 y 65,2 % en la TAC. No hubo ningún falso negativo (FN) de la PET en los pacientes con enfermedad mediastínica contralateral o supraclavicular (N3), mientras que la TAC tuvo 7. En la afectación metastásica la PET sólo tuvo 1 FN y 4 falsos positivos (FP), mientras que la TAC tuvo 6 FN y 10 FP.Los resultados de la PET modificaron el tratamiento quirúrgico en el 26 % de los pacientes, evitando cirugía del tumor primario en 11, facilitándola en 8, indicando quimioterapia neoadyuvante en 8 y cirugía de segundos tumores sincrónicos en tres. Conclusiones. La PET-FDG tiene mayor eficacia que la TAC en la estadificación inicial del CPNM, por lo que debe incorporarse en el protocolo diagnóstico del CPNM previo a la cirugía

Aims. We have evaluated the efficacy and clinicalimpact of FDG-PET for staging patients with potentially resectable non-small cell lung cancer (NSCL) in CT.Materials and methods. We have prospectively studied115 patients (104 M/11 F and mean age: 59 years old) with diagnosis of potentially resectable NSCL, (resectable criteria: Stage < IIIB in CT), including cases with equivocal lesions in mediastinum or in extrathoracic sites. In all patients we havedone a whole body scan with FDG-PET, after intravenousinjection of 370-440 MBq of 18F-FDG, in normoglucemia conditions. A qualitative and semiquantitative (SUV) analysis of images was carried out. Results. Prevalence of mediastine lymphatic metastasis was 46.6 %, and CT was false negative (FN) in 21 cases and FDG-PET only in 9. Overall sensitivity, specificity, negative predictivevalue, positive predictive value and accuracy were of83.3, 73.7, 75, 81.8 % and 78.3 % in FDG-PET, and 61.1, 68.8, 64.7, 65.6 % and 65.2 % in CT, respectively. All contralateral or supraclavicular lymph metastasis (N3) were detected in FDG-PET, whereas CT had 7 FN cases. In distant metastasis, FDG-PET had 1 FN and 4 FP, whereas CT had 6 cases FN and 10 FP. Clinical Impact of FDG-PET was 26 % of patients, avoiding surgery in 11 cases, allowing in 8, indicating neoadjuvant chemotherapyin 8 and surgery of synchronic incidentaloma in 3 cases.Conclusion. PET-FDG had better efficacy than CT in resectable NSCL, and should be incorporated in diagnosis protocols of NSCL before surgery decision making

[Evaluation of efficacy and clinical impact of FDG-PET on patients with potentially resectable non-small cell lung cancer]. / Evaluación de la eficacia y el impacto clínico de la PET-FDG en los pacientes con carcinoma broncopulmonar no microcítico candidatos a cirugía.

AIMS: We have evaluated the efficacy and clinical impact of FDG-PET for staging patients with potentially resectable non-small cell lung cancer (NSCL) in CT. MATERIALS AND METHODS: We have prospectively studied 115 patients (104 M/11 F and mean age: 59 years old) with diagnosis of potentially resectable NSCL, (resectable criteria: Stage

Obstrucción severa al flujo aéreo como forma de presentación de carcinoma epidermoide traqueal / No disponible

No disponible

[Adenoid cystic carcinoma of respiratory airways: course and treatment]. / Carcinoma adenoide quístico de vías aéreas respiratorias: evolución y tratamiento.

Until recently, adenoid cystic carcinoma (ACC) has been considered to be a borderline disease between benign and malignant because of its low level of malignancy, slow growth and scarce aggressivity. ACC is now a histologically well defined tumor and is currently classified as malignant; it has a prolonged natural history, is infiltrative, and tends to recur locally and give rise to local-regional metastases or, more rarely, remote metastases. Its incidence in the lower airways is low (0.1% of all broncho-pulmonary neoplasms). Eight patients (6 women and 2 men) have undergone surgery for ACC since 1969. The initial clinical picture included long-term evolution and symptoms were usually produced by large caliber obstruction of the airways, mainly affecting the trachea and large bronchi. Three cases involved the trachea resection with end-to-end anastomosis in two cases, right pneumonectomy in two others (one of which also involved tracheal carina resection), and two lobectomies. After thoracotomy, resection of the tumor was deemed impossible in two cases. Postoperative mortality was 12% (1 patient). Complementary radiotherapy was provided in the two non-resectable cases, or when there was invasion of resected edges or regional metastasis involving ganglia. Total survival was 71.4% after two years, 57.1% after five years and 38% after ten years, after excluding postoperative exitus. When the trachea was involved, survival was 33.3% after two and five years and nil after ten years, with the longest survival 108 months. When bronchi were involved, survival was 75% at five and ten years. We conclude that ACC is a rare, locally invasive tumor that tends to local recurrence, but that survival after surgery is prolonged with or without adjuvant radiotherapy.