Preoperative detection and evaluation of the need for psychological intervention in cancer and non-cancer patients referred to thoracic surgery / Detección y evaluación de la necesidad de atención psicológica preoperatoria en pacientes oncológicos y no oncológicos derivados a cirugía torácica

Objectives (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. Method The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression “Do you feel depressed?” (DEPQ). Results The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. Conclusions A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients (AU)

Objetivos Evaluar y comparar: a) las necesidades de tratamiento psicológico de pacientes con cáncer y sin cáncer, que van a someterse a una cirugía torácica programada, y b) la precisión diagnóstica de las pruebas de detección de necesidades psicológicas para pacientes con y sin cáncer. Métodos Se evaluó la necesidad de tratamiento psicológico en un total de 169 pacientes antes de la cirugía torácica, a través de una entrevista clínica. Las pruebas de cribado fueron: el criterio médico (sí/no), la Escala de Ansiedad y Depresión Hospitalaria (HADS) y la entrevista de un solo ítem de depresión «¿Se siente deprimido?» (DEPQ). Resultados El número de pacientes que necesitaron tratamiento psicológico fue en el total 47 (27,81%), en pacientes sin cáncer: 22 (30,99%) y con cáncer: 25 (25,51%). Las participantes con necesidades de tratamiento eran con mayor frecuencia mujeres jóvenes con niveles de educación primaria y más temores con respecto a su enfermedad. Con respecto a las pruebas de detección, el HADS total (corte ≥ 13) obtuvo una sensibilidad (S)=0,75/especificidad (E)=0,81 en la muestra total. En pacientes con cáncer el HADS total (corte ≥ 10): S=0,84/E=0,80 y en pacientes sin cáncer, la HADS total (corte ≥ 13): S=0,59/E=0,84. DEPQ y juicio médico obtuvieron bajos niveles de precisión. Conclusiones Un alto porcentaje de pacientes antes de realizar una cirugía torácica tiene necesidades de tratamiento psicológico, similares para pacientes con y sin cáncer. La HADS total es un buen método de cribado de necesidades psicológicas, especialmente en pacientes con cáncer (AU)

Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer.

Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.

Linfangioma quístico intratorácico. Resección videotoracoscópica / Thoracic cystic lymphangioma. Thoracoscopic surgery

El linfangioma quístico mediastínico es un tumor benigno muy poco frecuente. Los pacientes que lo presentan no se diagnostican fácilmente porque están asintomáticos o con síntomas inespecíficos. Los quistes en general se encuentran incidentalmente y el diagnóstico preoperatorio es difícil por su apariencia atípica en los estudios de imagen. Habitualmente se diagnostican durante o después de la operación. Los quistes sintomáticos necesitan tratamiento y la escisión quirúrgica es el tratamiento de elección. Además, el abordaje quirúrgico estándar para la resección aún no ha sido bien establecido. Presentamos un caso de un paciente adulto con un linfangioma quístico mediastínico resecado con éxito por videotoracoscopia. La pieza quirúrgica reveló características de displasia linfática, y se diagnosticó como linfangioma mediastínico. Este caso muestra que la resección por videotoracoscopia es factible cuando se sospecha tumor quístico mediastínico, y que puede ser una alternativa a la toracotomía abierta para tratar el linfangioma quístico mediastínico

Mediastinal cystic lymphangioma is an extremely uncommon benign tumor. The patients with mediastinal cystic lymphangioma are often misdiagnosed because of no specific symptoms. The cysts usually are incidentally found and preoperative diagnosis is difficult due to their atypical appearance on imaging studies. Most cases are diagnosed during or after the operation. Symptomatic cysts need treatment, and surgical excision is the treatment of choice. Moreover, the standard surgical approach for resection has not yet been well established. We report a case of an adult patient with a mediastinal cystic lymphangioma that was successfully resected by video thoracoscopic surgery. The surgical specimen revealed features of lymphatic dysplasia, and was diagnosed it as mediastinal lymphangioma. This case report shows that resection by VTS is feasible when mediastinal cystic tumor is suspected, and that VATS may be an alternative to open thoracotomy to treat mediastinal cystic lymphangiom

Adjuvant chemotherapy for early-stage non-small-cell lung cancer. Single-centre experience and literature review

BACKGROUND: In recent years platinum-based chemotherapy has become the standard of care for patients with good performance status after complete resection in stages IB-IIIA non-small-cell lung cancer (NSCLC), although the benefit is mainly in stages II and IIIA. PATIENTS AND METHODS: In a retrospective trial we evaluate the clinical efficacy and toxicity profile of a platinum- and taxanes-based adjuvant chemotherapy in completely resected IB-IIIA NSCLC. The primary end point was relapse- free survival (RFS); principal secondary end points were overall survival (OS) and safety of the regimen. Potential predictive factors of efficacy and clinical patterns of relapse were also analysed. RESULTS: From January 2003 to December 2006, 41 patients met the inclusion criteria and were evaluable. Median age at diagnosis was 68.1 years (CI 95% 54-72; range 45-78). Most patients were males (87.7%) and had an Eastern Cooperative Oncology Group performance status score (PS) of 0-1 (87.8%), and 53.6% had adenocarcinomas. Pathological stages were as follow: 48.7% stage IB, 24.3% stage II and 26.8% stage IIIA. 75.6% of patients underwent a lobectomy and mediastinal lymphadenectomy and were treated with a combination of carboplatin AUC6 and paclitaxel 200 mg/m2 (85.36%) for 3 or 4 cycles. With a median follow-up of 18.2 months (range 5.1-46.5), 26 patients (63%) were free of disease and 32 of them were alive (78%). Median RFS was 12.1 months (CI 95% 9.8-14.9) and median OS had not been reached at the time of analysis. Patients with PS< or =1 at diagnosis had a higher RFS [p=0.051 (CI 95% 0.90-0.96)]. Toxicity was generally mild and haematologic events were the most frequent. Non-haematologic toxic effects of chemotherapy were asthenia/ anorexia (12.2%), nausea/vomiting (12.2%) and peripheral neuropathy (17%), but severe toxic effects (grade 3 or greater) were uncommon (<10%). We did not observe treatment-related deaths. CONCLUSIONS: Platinum-taxane-based adjuvant chemotherapy in IB-IIIA NSCLC following complete resection is feasible, well tolerated and can be delivered in most patients in the adjuvant setting. Ongoing molecular studies may have value in determining which patients will benefit from adjuvant chemotherapy (AU)

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Injury patterns from major urban terrorist bombings in trains: the Madrid experience.

BACKGROUND: Terrorist urban mass casualty incidents (MCI) in the last 3 years have targeted commuter trains at rush hour, producing large numbers of casualties. Civilian care providers are usually not familiar with the types of blast injuries sustained by victims of these MCI. METHODS: We focus on the injury patterns sustained by casualties of the Madrid, 11 March 2004, terrorist bombings, at the seven hospitals that received most victims. Data were gathered of casualties who had injuries other than superficial bruises, transient hearing loss from barotrauma without eardrum perforation, and/or emotional shock. The degree of severity in critical patients was assessed with the ISS. RESULTS: The bombings resulted in 177 immediate fatalities, 9 early deaths, and 5 late deaths. Most survivors had noncritical injuries, but 72 (14%) of 512 casualties assessed had an Injury Severity Score (ISS) >15. The critical mortality rate was of 19.5%. The most frequently injured body regions were the head-neck and face. Almost 50% of casualties had ear-drum perforation, and 60% of them were bilateral. There were 43 documented cases of blast lung injury, with a survival rate of 88.3%. Maxillofacial and open long-bone fractures were most prevalent. Gustillo's grade III of severity predominated in tibia-fibular and humeral fractures. Upper thoracic fractures (D1-6 segment) represented 65% of all vertebral fractures and were associated with severe blast to the torso. Severe burns were uncommon. Eye injuries were frequent, although most were of a mild-to-moderate severity. Abdominal visceral lesions were present in 25 (5%) patients. A multidisciplinary approach was necessary in most operated patients, and orthopedic trauma procedures accounted for 50% of the caseload in the first 24 h. CONCLUSIONS: Ninety-three percent of the fatalities of the Madrid trains terrorist bombings were immediate, and most survivors had noncritical injuries. Closed doors increased the immediate fatality rate in the trains. Severely wounded casualties presented specific patterns of injuries, some of them life-threatening and unusual in other types of trauma mechanisms. Ear-lobe amputations and upper thoracic spine fractures were markers of critical injuries.

Recurrence pattern of esophageal cancer after esophagectomy with two-field lymphadenectomy.

AIM: To analyze the pattern of recurrence of esophageal carcinoma after a curative-intention surgical resection. PATIENTS: Ninety-two patients with non-metastatic esophageal carcinoma were included. Ninety percent of patients were male, and the mean age of this series was 61 years. The most frequent histologic subtype was squamous cell carcinoma. Fifty percent of tumors were at or above the tracheal bifurcation. All patients were submitted for transthoracic subtotal esophagectomy plus two-field radical lymphadenectomy, leaving no apparent residual disease. No adjuvant therapy was applied to any patient. RESULTS: Follow-up was complete for 76 out of 80 patients surviving the operation. Thirty-four tumoral recurrences were detected for a disease-free survival af 39% at 9 years after surgery. All recurrences were detected during the first two years after treatment. Tumoral relapse was related to the presence of T3 or T4 tumors, with positive lymph nodes, squamous cell carcinoma subtype and supracarinal location. Nine percent of patients had a distant relapse, 15% had a locorregional relapse and 12% a combination of both. Distant relapse presented significantly earlier. There was no statistical association between type of recurrence and clinico-pathological or surgical features. CONCLUSIONS: After radical surgery for carcinoma of the esophagus, half of the patients relapse in the following two years. Distant metastases happen to appear earlier in the follow-up, but the most frequent recurrence is the locorregional one.