Adsorción de un complejo de hierro sobre nanocristales de dióxido de titanio utilizando un residuo piridina / Adsorption of an iron complex on nanocrystals of titanium dioxide using a pyridine residue / Adsorção de um complexo de ferro em nanocristais de dióxido de titânio usando um resíduo de piridina

Resumen Debido a que los fenómenos de adsorción de tinturas sobre óxidos metálicos son de gran importancia en la búsqueda de sistemas de conversión de energía solar, en este trabajo se presenta el comportamiento espectroscópico y electroquímico del complejo [Fe(pytpy2)] (PF6)2 (donde pytpy es 4'-(piridin-4-il)-2,2':6',2"-terpiridina) en solución fluida y anclado sobre una película delgada de nanocristales de dióxido de titanio. La constante de formación del aducto se estimó utilizando el modelo isotérmico de Langmuir y se encontró un valor de 1,03x105 M-1 para dicho complejo. El anclaje del complejo sobre la superficie del óxido metálico semiconductor se debe a la interacción del residuo de piridina con los sitios ácidos de Lewis presentes en la superficie del TiO2. Se observó que las propiedades espectroscópicas y electroquímicas del complejo no se ven modificadas por la adsorción.

Abstract Because the phenomena of adsorption of tinctures on metal oxides are of great importance in the search for solar energy conversion systems, this paper presents the spectroscopic and electrochemical behavior of the complex [Fe(pytpy2)](PF6)2 (where pytpy is 4'-(4-pyridyl)-2,2':6',2''-terpyridine) in a fluid solution and anchored on a thin film of nanocrystals of titanium dioxide. The adduct formation constant was estimated using the Langmuir isothermal model, with a value of 1.03x105 M-1 for the complex. The anchoring of the complex on the surface of the semiconductor metal oxide is due to the interaction of the pyridine residue with the Lewis acid sites presented on the TiO2 surface. Results indicated that the spectroscopic and electrochemical properties of the complex are not modified by the adsorption.

Resumo Os fenômenos de adsorção de tinturas em óxidos metálicos são de grande importância na busca por sistemas de conversão de energia solar, motivo pelo qual neste trabalho o comportamento espectroscópico e eletroquímico do complexo [Fe(pytpy2)] (PF6)2 (onde pytpy é 4'-(piridin-4-il)-2,2':6',2"-terpiridina) em uma solução fluida e ancorada em um filme fino de nanocristais de dióxido de titânio. A constante de formação de aduto foi estimada pelo modelo isotérmico de Langmuir, com valor de 1.03x105 M-1 para o referido complexo. A ancoragem do complexo na superfície do óxido de metal semicondutor é devida à interação do resíduo de piridina com os sítios de ácido de Lewis presentes na superfície do TiO2, observando que as propriedades espectroscópicas e eletroquímicas do complexo não são modificadas pela adsorção.

Chorioamnionitis caused by Listeria monocytogenes: a case report of ultrasound features of fetal infection.

Maternal listeriosis is often associated with mild symptoms for the patient, but fetal infection can lead to severe adverse perinatal outcome. The most described antenatal symptoms are reduced fetal movements and an abnormal fetal heart rate trace. We present a case of fetal listeriosis suspected by ultrasound findings of fetal gastrointestinal compromise, neonatal diagnosis and outcome.

Experiencia inicial de un programa de clipaje del sistema nervioso simpático para el tratamiento de la hiperhidrosis y el rubor facial / Initial experience of a program of clipping the sympathetic nervous system for the treatment of hyperhidrosis and facial flush

Introducción y objetivo Evaluar los resultados de nuestro programa de clipaje del sistema nervioso torácico simpático (SNTS) para el tratamiento del rubor facial y/o hiperhidrosis (HH) y comparar la metodología-resultados de la fase de desarrollo del programa (A: enero 2007-abril 2009) y la fase de consolidación del mismo (B: mayo 2009-marzo 2010).Población y métodos Se ha incluido a 44 pacientes (88 procedimientos) sometidos a clipaje videotoracoscópico del SNTS en régimen de cirugía mayor ambulatoria (CMA). Los datos fueron recogidos prospectivamente y analizados retrospectivamente. Se ha realizado estudio estadístico descriptivo y comparativo entre los 2 grupos. Resultados La morbilidad global fue de 5 casos (11,3%). La tasa de recidiva postquirúrgica de HH fue del 4,54% (2 casos), la incidencia de sudoración compensadora (SC) fue del 65,9% (mínima en 26 de los 29 casos). Al comparar el período B con el A, se aprecia: disminución significativa del tiempo quirúrgico, desaparición de la recidiva de HH, disminución de la morbilidad en un 30%, reducción a la mitad de la incidencia de SC moderada-severa e incremento del grado de satisfacción. En uno de los casos de SC mal tolerada se retiraron los clips consiguiéndose la desaparición de esta. Conclusiones El clipaje del SNTS es una técnica segura en régimen de CMA, con una curva de aprendizaje corta (20 casos) tras la cual se obtienen resultados equiparables o, incluso mejores, que los de la simpaticolisis. Estos resultados, junto a su potencial reversibilidad, la convierten, en nuestra opinión, en la técnica de elección en la cirugía del SNTS (AU)

Introduction and objective: To evaluate the results of our program of clipping the thoracicsympathetic nervous system (TSNS) for the treatment of facial (..) (AU)

[Initial experience of a program of clipping the sympathetic nervous system for the treatment of hyperhidrosis and facial flush]. / Experiencia inicial de un programa de clipaje del sistema nervioso simpático para el tratamiento de la hiperhidrosis y el rubor facial.

INTRODUCTION AND OBJECTIVE: To evaluate the results of our program of clipping the thoracic sympathetic nervous system (TSNS) for the treatment of facial flush and/or hyperhidrosis (HH), and to compare the methodology-results of the program development phase (A: January 2007-April 2009) and its consolidation phase (B: May 2009-March 2010). MATERIAL AND METHODS: The program included a total of 44 patients (88 procedures) subjected to videothoracoscopy and clipping of the TSNS in a one day surgery unit. Data were collected and analysed retrospectively, and a descriptive and comparative statistical analysis was performed between the two periods (A and B). RESULTS: The overall morbidity was 5 cases (11.3%). The post-surgical occurrence rate of HH was 4.54% (2 cases), and the incidence of compensatory sweating was 65.9% (minimal in 26 of the 29 cases). On comparing period B with period A, there was a significant decrease in surgical time, disappearance of recurrence of HH, a decrease of 30% in morbidity, reduction by half in the incidence of moderate to severe compensatory sweating, and an increase in the level of satisfaction. The clamps were removed in one of the poorly tolerated compensatory sweating cases, resulting in its disappearance. CONCLUSIONS: Clipping the TSNS is a safe technique in the one day surgery unit, with a short learning curve (20 cases) after which comparable, or even better, results are obtained than those of sympatholysis. These results, together with their potential reversibility, makes it, in our opinion, the technique of choice in the surgery of the TSNS.

False positive endobronchial ultrasound-guided real-time transbronchial needle aspiration secondary to bronchial carcinoma in situ at the point of puncture: a case report.

Since the development of endobronchial ultrasound-guided real-time needle aspiration (EBUS-rt-TBNA) no false positive (FP) cases have been described. We present the first FP case for EBUS-rt-TBNA secondary to a carcinoma in situ (CIS) in the bronchial point of puncture. A 66-years-old male was referred to our Institution because of a mass in left lower lobe. The bronchoscopy did not show any endobronchial lesion. The cytology of the washing confirmed an unspecified non-small cell lung cancer. An EBUS-rt-TBNA for staging was carried out. No mediastinal nodes over 5 mm length were found but one single left hilar node at station 11 L was sampled. The cytology of the TBNA showed lymphocytes and neoplastic squamous cells. The patient underwent thoracotomy. On the surgical specimen no metastasis on any of the nodes resected were detected but a CIS on the bronchial resection margin was described. A bronchial biopsy confirmed CIS on the bronchial stump. The reported case depicts an unusual situation, we consider EBUS-rt-TBNA an accurate technique if minimal requirements are met.

Randomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery.

OBJECTIVE: Despite the use of thoracic epidural analgesia, a constant severe ache occurs in the ipsilateral shoulder of almost 75% of patients after thoracotomy. The aim of this prospective-randomized study was to investigate the effect of phrenic nerve infiltration (PNI) compared with suprascapular nerve block (SNB) on ipsilateral shoulder pain after thoracic surgery. METHODS: After Local Research Ethics Committee approval, written informed consent was obtained from 90 adult patients undergoing thoracotomy for pulmonary resection. Patients were excluded if they had preexisting shoulder pain, were unable to understand the visual analog scale (VAS) scoring system or due to failure of epidural analgesia. The phrenic group (PNI) received 10 ml of 2% lidocaine infiltrated into the periphrenic fat pad, 1-2 cm close to the diaphragm, just before chest closure. The suprascapular group (SNB) received 10 ml of 0.5% plain bupivacaine injected into the suprascapular fossa once the surgery was finished. A blinded observer to the study group assessed the patient's shoulder and thoracotomy pain, using the VAS score and a five-point observer verbal rating score (OVRS), at 0.5, 1, 2, 3, 4, 5, 6, 12, 48, and 72 h after surgery and at discharge. The time and dose of any administered analgesic medication were recorded. RESULTS: Finally, 74 patients were included (37 per group). Sixteen patients were excluded (unable to understand scoring system, failure of the epidural technique, and lost data). There were no significant differences in age, gender, body mass index, type/duration of operation, and pain scores at rest, between the two groups. Shoulder pain intensity was significantly lower in the PNI group compared with the SNB group (median value of VAS area under the curve for the PNI group: 8.1 (0-70.9)cm vs 114.3 (43.8-193.8)cm for the SNB group; p < 0.001). There were no significant differences between the two groups according to postoperative thoracotomy pain. CONCLUSIONS: Phrenic nerve block with 2% lidocaine should be performed in all patients undergoing a major thoracic surgery procedure. These results strongly support the hypothesis that irritation of the pericardium and/or mediastinal-diaphragmatic pleural surfaces results in pain that is referred to the shoulder via the phrenic nerve.

Preoperative chemotherapy plus surgery versus surgery plus adjuvant chemotherapy versus surgery alone in early-stage non-small-cell lung cancer.

PURPOSE: To address whether preoperative chemotherapy plus surgery or surgery plus adjuvant chemotherapy prolongs disease-free survival compared with surgery alone among patients with resectable non-small-cell lung cancer. PATIENTS AND METHODS: In this phase III trial, 624 patients with stage IA (tumor size > 2 cm), IB, II, or T3N1 were randomly assigned to surgery alone (212 patients), three cycles of preoperative paclitaxel-carboplatin followed by surgery (201 patients), or surgery followed by three cycles of adjuvant paclitaxel-carboplatin (211 patients). The primary end point was disease-free survival. RESULTS: In the preoperative arm, 97% of patients started the planned chemotherapy, and radiologic response rate was 53.3%. In the adjuvant arm, 66.2% started the planned chemotherapy. Ninety-four percent of patients underwent surgery; surgical procedures and postoperative mortality were similar across the three arms. Patients in the preoperative arm had a nonsignificant trend toward longer disease-free survival than those assigned to surgery alone (5-year disease-free survival 38.3% v 34.1%; hazard ratio [HR] for progression or death, 0.92; P = .176). Five-year disease-free survival rates were 36.6% in the adjuvant arm versus 34.1% in the surgery arm (HR 0.96; P = .74). CONCLUSION: In early-stage patients, no statistically significant differences in disease-free survival were found with the addition of preoperative or adjuvant chemotherapy to surgery. In this trial, in which the treatment decision was made before surgery, more patients were able to receive preoperative than adjuvant treatment.

Sensitivity of linear endobronchial ultrasonography and guided transbronchial needle aspiration for the identification of nodal metastasis in lung cancer staging.

The aim of this study is to determine the sensitivity of real-time endobronchial ultrasonography (EBUS)-guided transbronchial needle aspiration (TBNA) in lung cancer staging. Short- and long-axis node diameters were measured during EBUS in patients referred for lung cancer staging and sensitivities for the identification of nodal malignancy at TBNA determined. Three hundred fifteen real-time EBUS-guided TBNA nodal sampling procedures were performed in 161 patients and in 87 of them, N2/N3 metastasis was confirmed (50.9%), eliminating the need for mediastinoscopy. The median (interquartile range [IQR]) short-axis diameters of the sampled mediastinal and lobar nodes were 11 (8-15) and 8 (7-12) mm, respectively. TBNA provided satisfactory samples from 269 nodes (85.4%) and a sensitivity of 100% for the identification of malignant TBNA samples was reached for a short-axis diameter cut-off of 5 mm and a short- to long-axis ratio of 0.5. The probability of malignancy was over 90% for nodes with a short-axis diameter >20 mm and 55% for round nodes (short- to long-axis ratio of 1). In 18 out of 50 patients with a normal mediastinal computed tomography (CT) scan, the technique identified enlarged nodes in the mediastinum (36%), mainly in the subcarinal region and confirmed mediastinal malignancy in 8 (10%). Real-time EBUS-guided TBNA obtains satisfactory node samples in almost 90% of cases and improves the identification of enlarged nodes in patients with a normal mediastinum at CT. If sampling all nodes with a short-axis diameter of > or =5 mm and a short- to long-axis ratio > or =0.5, a sensitivity of 100% for the cytologic identification of malignant nodes can be expected.

Bronchial stump infiltration after lung cancer surgery. Retrospective study of a series of 2994 patients.

The incidence of lung cancer has been increasing in developed countries since the mid-1990s. The main objective of this study is to determine if bronquial stump infiltration can affect survival in patients with lung cancer. For this purpose, we differentiate between carcinoma 'in situ' and invasive carcinoma. We included patients suffering from non-small cell lung cancer who underwent thoracothomy as treatment. The total number of patients was 2994. In this study, 80 patients out of the 2994 had bronchial stump affection. Eight patients were excluded thus a total of 72 patients were included, 52 of them had carcinoma 'in situ' and 20 invasive carcinoma. The global survival was 25 months. Patients with carcinoma 'in situ' had a median survival of 25 months as opposed to 21 months in patients with invasive carcinoma. We only found statistical significance when we compared the histology with the type of bronchial stump infiltration. We did not observe statistical significance in survival between carcinoma 'in situ' and invasive carcinoma bronchial stump infiltration (P=0.094). The only survival predictor variable is histology (adenocarcinoma), P=0.0001.

[Linear endobronchial ultrasound as the initial diagnostic tool in patients with indications of mediastinal disease]. / La ultrasonografía endobronquial lineal como instrumento de diagnóstico inicial en el paciente con ocupación mediastínica.

BACKGROUND AND OBJECTIVE: Linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has proven useful for sampling mediastinal masses and nodes and for staging lung cancer. The aim of this study was to assess the usefulness of this diagnostic tool in patients with indications of mediastinal disease that could not be diagnosed by noninvasive methods or white light bronchoscopy. PATIENTS AND METHODS: All patients undergoing linear EBUS-TBNA for the diagnosis of mediastinal masses and/or adenopathy at our endoscopy unit were included in the study. Diagnoses obtained by linear EBUS-TBNA or any surgical technique performed after a nondiagnostic EBUS-TBNA were considered as final. RESULTS: In the study population of 128 patients with a mean (SD) age of 62.0 (11.2) years, a total of 294 TBNAs were performed on 12 masses and 282 nodes. Satisfactory samples were obtained in 11 cases (91.7%) from masses and in 233 cases (82.6%) from nodes. Linear EBUS-TBNA was diagnostic, obviating the need for mediastinoscopy in 115 patients (diagnostic sensitivity, 89.8%). The technique confirmed the diagnosis in 85 of the 94 patients with cancer (90.4%), in 8 of the 10 patients with tuberculosis (80.0%), and in the 5 patients with sarcoidosis. CONCLUSIONS: Linear EBUS-TBNA is a useful diagnostic tool in patients with mediastinal disease for whom a pathologic diagnosis is not achieved by noninvasive methods or white light bronchoscopy.

Pseudotumor associated with polytetrafluoroethylene sleeves.

We report the case of a patient who was operated on in February 2001. We performed a wedge resection of the upper right lobe. The pathologic examination demonstrated a lung adenocarcinoma (pT2N0M0, R0). We used staple line reinforcement material (ePTFE) during the operation because the patient had an important emphysema. We re-operated in January 2005 because during follow-up we observed a suspicious image that suggested a tumoral relapse. Histopathological study showed extrinsic material compatible with the one used in the original resection.

Long-term survival associated with complete resection after induction chemotherapy in stage IIIA (N2) and IIIB (T4N0-1) non small-cell lung cancer patients: the Spanish Lung Cancer Group Trial 9901.

PURPOSE: To assess the activity of induction chemotherapy followed by surgery in stage IIIA and selected stage IIIB non-small-cell lung cancer patients. PATIENTS AND METHODS: Mediastinoscopy proof of either positive N2 (IIIA) or T4N0-1 (IIIB) disease was required. Induction therapy was three cycles of cisplatin/gemcitabine/docetaxel, followed by surgery. RESULTS: From December 1999 to March 2003, 136 patients were entered onto the study; the clinical response rate in 129 assessable patients was 56%. The overall complete resection rate was 68.9% of patients eligible for surgery (72% of stage IIIA patients and 66% of stage IIIB patients) and 48% of all assessable patients. Eight (12.9%) of 62 completely resected patients had a pathologic complete response. Seven patients (7.8%) died during the postoperative period. The median overall survival time was 15.9 months, 3-year survival rate was 36.8%, and 5-year survival rate was 21.1%, with no significant differences in survival between stage IIIA and stage IIIB patients. Median survival time was 48.5 months for 62 completely resected patients, 12.9 months for 13 incompletely resected patients, and 16.8 months for 15 nonresected patients (P = .005). Three- and 5-year survival rates were 60.1% and 41.4% for completely resected patients, 23.1% and 11.5% for incompletely resected patients, and 31.1% and 0% for nonresected patients, respectively. In the multivariate analysis, complete resection (hazard ratio [HR] = 0.35; P < .0001), clinical response (HR = 0.32; P < .0001), and age younger than 60 years (HR = 0.64; P = .027) were the most powerful prognostic factors. CONCLUSION: Induction chemotherapy followed by surgery is effective in stage IIIA and in selected stage IIIB patients attaining complete resection.

[Selective lobar blockade using an arndt endobronchial blocker in 2 patients with respiratory compromise who underwent lung resection]. / Bloqueo lobular selectivo mediante el bloqueador bronquial de Arndt en 2 pacientes con compromiso respiratorio sometidos a resección pulmonar.

Selective lobar blockade is an alternative to one-lung ventilation in thoracic surgery. We present 2 cases of lung resection with severe respiratory compromise. The first patient had previously undergone a left lower lobectomy and 2 atypical resections in the left and right upper lobes and was scheduled for a right lower lobectomy. The second patient presented chronic obstructive pulmonary disease with forced vital capacity of 1200 mL (26% of predicted value) and forced expiratory volume in 1 second of 820 mL (25% of predicted value) and was scheduled for an atypical resection of the left upper lobe with pleural abrasion. Selective lobar blockade was achieved in both cases using an Arndt endobronchial blocker. Ventilation during the operation was sufficient. Surgery was uneventful in both cases and lobar collapse was satisfactory.

Bloqueo lobular selectivo mediante el bloqueador bronquial de Arndt en 2 pacientes con compromiso respiratorio sometidos a resección pulmonar / Selective lobar blockade using an arndt endobronchial blocker in 2 patients with respiratory compromise who underwent lung resection

En cirugía torácica el bloqueo lobular selectivo representa una alternativa a la ventilación unipulmonar. Se presentan 2 casos de cirugía de resección pulmonar con un compromiso respiratorio grave. El primero, sometido anteriormente a una lobectomía inferior izquierda y 2 resecciones atípicas en lóbulos superiores izquierdo y derecho, se programó para una nueva lobectomía del lóbulo inferior derecho. El segundo paciente, que presentaba una enfermedad pulmonar obstructiva crónica grave con una capacidad vital forzada de 1.200 ml (26%) y volumen espiratorio forzado en el primer segundo de 820 ml (25%), se programó para resección atípica del lóbulo superior izquierdo con abrasión pleural. En ambos casos se consiguieron bloqueos lobulares selectivos con el bloqueador endobronquial de Arndt. La ventilación fue adecuada durante la intervención. La cirugía transcurrió sin incidencias en ambos casos y el colapso lobular fue correcto

Selective lobar blockade is an alternative to one-lung ventilation in thoracic surgery. We present 2 cases of lung resection with severe respiratory compromise. The first patient had previously undergone a left lower lobectomy and 2 atypical resections in the left and right upper lobes and was scheduled for a right lower lobectomy. The second patient presented chronic obstructive pulmonary disease with forced vital capacity of 1200 mL (26% of predicted value) and forced expiratory volume in 1 second of 820 mL (25% of predicted value) and was scheduled for an atypical resection of the left upper lobe with pleural abrasion. Selective lobar blockade was achieved in both cases using an Arndt endobronchial blocker. Ventilation during the operation was sufficient. Surgery was uneventful in both cases and lobar collapse was satisfactory

Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial.

BACKGROUND: Whether adjuvant chemotherapy improves survival of patients with non-small-cell lung cancer (NSCLC) is not known. We aimed to compare the effect of adjuvant vinorelbine plus cisplatin versus observation on survival in patients with completely resected NSCLC. METHODS: 840 patients with stage IB-IIIA NSCLC from 101 centres in 14 countries were randomly assigned to observation (n=433) or to 30 mg/m(2) vinorelbine plus 100 mg/m(2) cisplatin (n=407). Postoperative radiotherapy was not mandatory and was undertaken according to every centre's policy. The primary endpoint was overall survival. Analysis was by intention to treat. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN95053737. FINDINGS: 367 patients in the chemotherapy group and 431 in the control group received their assigned treatment. 301 (36%) patients had stage IB disease, 203 (24%) had stage II disease, and 325 (39%) had stage IIIA disease. Tolerance to chemotherapy mainly included neutropenia in 335 (92%) patients and febrile neutropenia in 34 (9%); seven (2%) toxic deaths were also recorded. Compliance was greater with cisplatin than with vinorelbine (median dose intensity 89% [range 17-108] vs 59% [17-100]). After a median follow-up of 76 months (range 43-116), median survival was 65.7 months (95% CI 47.9-88.5) in the chemotherapy group and 43.7 (35.7-52.3) months in the observation group. Adjusted risk for death was significantly reduced in patients assigned chemotherapy compared with controls (hazard ratio 0.80 [95% CI 0.66-0.96]; p=0.017). Overall survival at 5 years with chemotherapy improved by 8.6%, which was maintained at 7 years (8.4%). INTERPRETATION: Adjuvant vinorelbine plus cisplatin extends survival in patients with completely resected NSCLC, better defining indication of adjuvant chemotherapy.

[Pilot benchmarking study of thoracic surgery in Spain: comparison of cases of lung resection and indicators of quality]. / Experiencia piloto de benchmarking en cirugía torácica: comparación de la casuística e indicadores de calidad en resección pulmonar.

OBJECTIVE: This article describes the methods and conclusions of the first Spanish benchmarking study of thoracic surgery. The proposed aims were to describe cases of lung resection in 9 Spanish hospitals, compare indicators of quality among the 9 participating centers, and identify and propose common areas where lung-resection processes could be improved. METHODS: Information was taken from the minimum basic data set for lobectomy and pneumonectomy processes performed in 2002 and 2003. The chosen outcome indicators were in-hospital mortality, morbidity, length of hospital stay, and emergency readmissions within 30 days of discharge, adjusted according to surgical complexity. Once the results had been analyzed, the participating centers with best outcomes were identified and a variety of proposed improvements were discussed. RESULTS: A total of 1666 procedures (1276 lobectomies and 390 pneumectomies) were studied. We found differences in mean length of stay, mortality, readmission rate, and morbidity that identified centers with lower mortality or shorter hospital stay for comparable or more complex surgical procedures. However, higher morbidity and readmission rates were found in these centers. CONCLUSIONS: Measures were proposed to ensure that relevant diagnostic information is recorded on discharge. It was also proposed to reduce unnecessarily long hospital stays and to standardize the procedures. With such an approach, reliable criteria that improve the quality of lung-resection processes can be established in the future.

Experiencia piloto de benchmarking en cirugía torácica: comparación de la casuística e indicadores de calidad en resección pulmonar / Pilot benchmarking study of thoracic surgery in Spain: comparison of cases of lung resection and indicators of quality

Objetivo: En el presente artículo se describen los métodos y las conclusiones del primer estudio español de benchmarking en cirugía torácica. Los objetivos propuestos fueron: describir la casuística de resección pulmonar desarrollada en 9 hospitales españoles, comparar indicadores de calidad entre los 9 centros participantes e identificar y proponer áreas de mejora comunes para los procesos de resección pulmonar. Métodos: Se utilizó como fuente de información el conjunto mínimo básico de datos de los años 2002 y 2003 de los procesos de lobectomía o neumonectomía. Los indicadores de resultados seleccionados fueron: mortalidad hospitalaria, morbilidad, estancia y readmisiones urgentes en los 30 días siguientes al alta, ajustadas por complejidad de los casos. Una vez presentados los resultados entre los participantes, se identificaron las unidades con mejores resultados y se discutieron diversas propuestas de mejora. Resultados: Se ha estudiado un total de 1.666 procedimientos (1.276 lobectomías y 390 neumonectomías). Se detectaron diferencias en estancia media, mortalidad, tasa de readmisiones y morbilidad, que permitieron identificar unidades, de complejidad equiparable o superior, con baja mortalidad y estancia. Sin embargo, en estas unidades se apreciaron tasas de morbilidad y readmisión más elevadas. Conclusiones: Se propusieron medidas encaminadas a registrar todos los diagnósticos relevantes en los informes de alta, disminuir las estancias inadecuadas y estandarizar los procedimientos que permitirán en el futuro establecer criterios fiables para mejorar la calidad de los procesos de resección pulmonar

Objective: This article describes the methods and conclusions of the first Spanish benchmarking study of thoracic surgery. The proposed aims were to describe cases of lung resection in 9 Spanish hospitals, compare indicators of quality among the 9 participating centers, and identify and propose common areas where lung-resection processes could be improved. Methods: Information was taken from the minimum basic data set for lobectomy and pneumonectomy processes performed in 2002 and 2003. The chosen outcome indicators were in-hospital mortality, morbidity, length of hospital stay, and emergency readmissions within 30 days of discharge, adjusted according to surgical complexity. Once the results had been analyzed, the participating centers with best outcomes were identified and a variety of proposed improvements were discussed. Results: A total of 1666 procedures (1276 lobectomies and 390 pneumectomies) were studied. We found differences in mean length of stay, mortality, readmission rate, and morbidity that identified centers with lower mortality or shorter hospital stay for comparable or more complex surgical procedures. However, higher morbidity and readmission rates were found in these centers. Conclusions: Measures were proposed to ensure that relevant diagnostic information is recorded on discharge. It was also proposed to reduce unnecessarily long hospital stays and to standardize the procedures. With such an approach, reliable criteria that improve the quality of lung-resection processes can be established in the future

Prognostic value of chronic obstructive pulmonary disease in 2994 cases of lung cancer.

OBJECTIVE: Given the frequent association between chronic obstructive pulmonary disease (COPD) and lung cancer (LC), the objective of this paper is to analyse the prognosis of this comorbidity. METHODS: Multicenter prospective study compiling 2994 consecutive cases of surgically treated LC (1993-1997), the population with non-small cell lung cancer and complete resection was selected for the prognostic study of COPD. COPD is defined when the FEV1/FVC is <0.7 (n=1370; 46%). Overall and conditional survivals (survival likelihood when alive at 2, 3 or 5 years after treatment) as well as the degree of severity (FEV1% percentiles) were calculated to establish prognosis. RESULTS: Although the overall survival is similar whether or not COPD is present (Log-rank: 0.34), the conditional survival analysis is different in every stage at 60 months (Log-rank: 0.02) and different in stage pI at 24-36 months (Log-rank: 0.04). In LC (stage pI) with COPD, the presence of a worst pulmonary function (last FEV1% percentile vs first FEV1% percentile) is a bad prognostic factor (Log-rank: 0.002). CONCLUSIONS: The analysis of conditional survival at 24 months shows that COPD can be considered as a prognostic factor and that there is a clear relationship between the severity of the condition (FEV1%) and survival.

Methylation patterns and K-ras mutations in tumor and paired serum of resected non-small-cell lung cancer patients.

Gene methylation and K-ras mutations were examined in tumor and paired serum DNA of 50 resected non-small-cell lung cancer patients. RASSF1A, death associated protein kinase and target of methylation-induced silencing were methylated in 17/50 (34%), 23/50 (45%) and 18/50 (35%) tumors, respectively, and in 17/50 (34%), 20/50 (40%) and 17/50 (34%) sera, respectively. Methylation in tumor and serum were closely correlated (P=0.001), but no correlation was found with survival. Twelve K-ras mutations (cysteine) were found in serum and nine mutations were found in tumor (five cysteine, one alanine, one aspartic, one arginine, and one valine). K-ras mutations in serum correlated significantly with survival (P=0.01).

Estimulación vibroacústica en el trabajo de parto con monitorización externa patológica de la frecuencia cardíaca fetal / Vibratory acoustic stimulation in labor with pathological external monitorization of fetal cardiac frequency

Se efectúa estimulación vibroacústica intraparto a pacientes cuya monitorización externa de la frecuencia fetal resultó patológica. Se correlaciona el resultado de ésta estimulación con Apgar, presencia de meconio y pH de cordón umbilical. Se concluye que en relación al pH, la estimulación vibroacústica tiene una sensibilidad de 83,3%, una especificidad de 81,3%y un valor predictivo positivo de 62,5%. Se recomienda el uso de estimulación vibroacústica en aquellos casos en que la monitorización sea patológica y no se pueda utilizar monitorización interna ni se pueda obtener pH de cuero cabelludo fetal, para asegurar el buen estado fetal