The role of specialist nurses in detecting spasticity and related symptoms in multiple sclerosis.

BACKGROUND: Spasticity is a frequent symptom of multiple sclerosis (MS), which may negatively influence daily living activities (ADL). OBJECTIVES: To (1) explore the feasibility to conduct a structured interview by specialist nurses about limitations in ADL; (2) determine the percentage of people with MS (PwMS) with limitations in ADL related to spasticity; (3) to assess the knowledge about spasticity and describe its clinical features. DESIGN: Observational, cross-sectional, multicentre study in 16 MS units of Catalonia (Spain). Participants were recruited from the outpatient facility and day-care hospital between July 2018 and June 2019 and met the following criteria: (1) age 18 or older, (2) diagnosis of MS according to McDonald criteria 2010 and (3) no clinical relapse in previous 30 days. METHODS: Specialist nurses conducted a structured interview divided in two parts: the assessment of (1) limitations in the ADL and (2) the presence of spasticity and associated symptoms. The usefulness of this intervention was requested. This study met the STROBE reporting guidelines checklist for observational studies. RESULTS: Three hundred sixty eight pwMS (244 women) with a mean age of 46 years and a median Expanded Disability Status Scale score of 2.5 (range, 0-8.5) were included. 262 (71%) pwMS had limitations in the ADL, and spasticity was reported as the most limiting symptom in 59 (23%). As a result of the interview, spasticity was observed in 199 (76%) participants; 47 (24%) of them were unaware that they had spasticity and 102 (51%) would not have reported it spontaneously. The level of the interview satisfaction was high (90%). CONCLUSIONS: Spasticity is a complex and limiting symptom in MS. The structured interview conducted by specialist nurses is feasible and has good acceptance. PATIENT CONTRIBUTION: Specialist nurses can be proactive in MS clinical assessment, which may help to detect symptoms with negative impact on quality of life.

Transmogrificación placentaria del pulmón / Placental Transmogrification of the Lung

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[Translated article] Placental Transmogrification of the Lung / Transmogrificación placentaria del pulmón

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Neoadjuvant Chemoradiotherapy Treatment for a Classic Biphasic Pulmonary Blastoma with High PD-L1 Expression.

Pulmonary blastomas are rare malignant tumors, comprising only 0.25-0.5% of all malignant lung neoplasms. The prognosis of pulmonary blastoma is very poor, with an overall five-year survival of 16%. No standard treatment has been defined for unresectable disease. We present the case of a 25-year-old woman with unresectable locally advanced classic biphasic pulmonary blastoma (CBPB) successfully treated with neodjuvant chemoradiotherapy based on two chemotherapy induction cycles of cisplatin plus etoposide, followed by concurrent weekly cisplatin to 50.4 Gy radiotherapy treatment. The patient had a significant reduction in tumor size, allowing for complete resection by pneumonectomy. Molecular study for epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK), proto-oncogene receptor tyrosine kinase (ROS1) and rearranged during transfection (RET) rearrangements, and programmed death ligand 1 (PD-L1) expression was performed in the pre-treatment tumor sample. Our patient presented a high expression (>90% of tumor cells) of PD-L1. To our knowledge, this is the first report of PD-L1 expression in CBPB. This could lead to new treatment options based on new immunotherapy agents blocking the PD-1/PD-L1 pathway for this rare disease with poor prognosis.

Hipoplasia pulmonar en el adulto / Pulmonary hypoplasia in the adult

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[Analysis of the results of a short-stay thoracic surgery program (2001-2005)]. / Análisis de los resultados del programa de corta estancia en cirugía torácica en el período 2001-2005.

INTRODUCTION: A short-stay thoracic surgery program was implemented and a prospective study was initiated to evaluate its results. OBJECTIVE: To analyze the results of the short-stay thoracic surgery program. PATIENTS AND METHOD: The results of 350 procedures (283 lobectomies and 67 pneumonectomies) performed between 2001 and 2005 were analyzed. The variables analyzed were: a) mean length of stay, b) mortality, c) complications, and d) readmission rate. RESULTS: The mean length of postoperative stay was 5.8 +/- 2.8 days for lobectomy and 5.36 +/- 1.8 days for pneumonectomy. Mortality was 3.5% in lobectomy and 3% in pneumonectomy. Complications occurred in 17.3% of lobectomies and 23.8% of pneumonectomies. The readmission rate was 7%. CONCLUSIONS: The results obtained show that, as expected, the short-stay thoracic surgery program reduces the mean length of hospital stay. Moreover, this program is safe, since mortality and morbidity were lower than or similar to the mean and the readmissions rate was similar to the national average. These results have encouraged us to continue the program started in 1998.

Análisis de los resultados del programa de corta estancia en cirugía torácica en el período 2001-2005 / Analysis of the results of a short-stay thoracic surgery program (2001-2005)

Introducción. Tras la puesta en marcha del programa de cirugía de corta estancia iniciamos un estudio prospectivo para evaluarlo. Objetivo. Analizar los resultados asitenciales del programa de cirugía de corta estancia. Pacientes y metodo. Se han analizado los resultados de los 350 procedimientos (283 lobectomías y 67 neumonectomías) realizados entre los años 2001 y 2005 en referencia a: a) estancia media; b) mortalidad; c) complicaciones, y d) tasa readmisiones. Resultados. La estancia media postoperatoria ha sido de 5,8 ± 2,8 días para las lobectomías y de 5,36 ± 1,8 días para las neumonectomías. La mortalidad ha sido del 3,5% en las lobectomías y del 3% en las neumonectomías. La morbilidad ha sido del 17,3% en las lobectomías y del 23,8% en las neumonectomías. El índice de readmisiones ha sido del 7%. Conclusiones. Los resultados asistenciales obtenidos muestran que el programa de cirugía torácica de corta estancia no sólo mejora la estancia media (que ya era esperado), sino que es seguro, ya que las tasas de mortalidad y de morbilidad son menores o similares a la media, con una tasa de readmisiones ajustada a la media nacional. Ello nos estimula a continuar con el programa iniciado en 1998 (AU)

Introduction. A short-stay thoracic surgery program was implemented and a prospective study was initiated to evaluate its results. Objective. To analyze the results of the short-stay thoracic surgery program. Patients and method. The results of 350 procedures (283 lobectomies and 67 pneumonectomies) performed between 2001 and 2005 were analyzed. The variables analyzed were: a) mean length of stay, b) mortality, c) complications, and d) readmission rate. Results. The mean length of postoperative stay was 5.8 ± 2.8 days for lobectomy and 5.36 ± 1.8 days for pneumonectomy. Mortality was 3.5% in lobectomy and 3% in pneumonectomy. Complications occurred in 17.3% of lobectomies and 23.8% of pneumonectomies. The readmission rate was 7%. Conclusions. The results obtained show that, as expected, the short-stay thoracic surgery program reduces the mean length of hospital stay. Moreover, this program is safe, since mortality and morbidity were lower than or similar to the mean and the readmissions rate was similar to the national average. These results have encouraged us to continue the program started in 1998 (AU)

Video-assisted direct closure of bronchial fistula.

Video-assisted thoracoscopic surgery is a well-established method for managing persistent air leak in spontaneous pneumothorax. We describe a case of complicated spontaneous secondary pneumothorax in a patient with bullous emphysema that was treated by video-assisted manual suture of the bronchial fistula at the end of the right upper bronchus.