Nivel de conocimiento de la enfermedad de Alzheimer en cuidadores y población general / Level of understanding of Alzheimer disease among caregivers and the general population

Introducción: El conocimiento de la enfermedad de Alzheimer es fundamental para el diagnóstico precoz y para reducir la sobrecarga del cuidador. El objetivo fue evaluar el grado de conocimiento de la enfermedad de Alzheimer mediante la Alzheimer's Disease Knowledge Scale en cuidadores informales y diferentes segmentos de población.Sujetos y métodosSe evaluó el conocimiento a cuidadores en diferente periodo de seguimiento (menor de un año, entre 1-5 y más de 5 años desde el diagnóstico) y sujetos de la población general. La puntuación Alzheimer's Disease Knowledge Scale se agrupó en distintos ítems: impacto vital, factores de riesgo, síntomas, diagnóstico, tratamiento, progresión de la enfermedad y cuidadores.ResultadosTotal de 419 personas; 215 cuidadores, 204 población general. Respecto a la puntuación global de la escala no se encontraron diferencias entre ambos grupos (19,1 vs. 18,8; p=0,9). Destaca un escaso conocimiento de los factores de riesgo de la enfermedad (49,3%) y de los cuidados necesarios (51,2%) mientras que los síntomas (78,6%) y el curso de la enfermedad (77,2%) fueron los aspectos mejor reconocidos. Entre las variables, la edad del cuidador se correlacionó con peor puntuación total de la escala Alzheimer's Disease Knowledge Scale, peor conocimiento sobre el impacto vital, síntomas, cuidados y de la progresión de la enfermedad (p<0,05). La duración de los cuidadores mejoró el conocimiento de los síntomas (p=0,00) y el diagnóstico de la enfermedad (p=0,05).ConclusiónEvaluar el grado de conocimiento de la enfermedad es fundamental para poder elaborar estrategias de educación sanitaria tanto a nivel poblacional como en los cuidadores. (AU)

Introduction: Understanding of Alzheimer disease is fundamental for early diagnosis and to reduce caregiver burden. The objective of this study is to evaluate the degree of understanding of Alzheimer disease among informal caregivers and different segments of the general population through the Alzheimer's Disease Knowledge Scale.Patients and methodsWe assessed the knowledge of caregivers in different follow-up periods (less than one year, between 1 and 5 years, and over 5 years since diagnosis) and individuals from the general population. Alzheimer's Disease Knowledge Scale scores were grouped into different items: life impact, risk factors, symptoms, diagnosis, treatment, disease progression, and caregiving.ResultsA total of 419 people (215 caregivers and 204 individuals from the general population) were included in the study. No significant differences were found between groups for overall Alzheimer's Disease Knowledge Scale score (19.1 vs. 18.8, P = .9). There is a scarce knowledge of disease risk factors (49.3%) or the care needed (51.2%), while symptoms (78.6%) and course of the disease (77.2%) were the best understood aspects. Older caregiver age was correlated with worse Alzheimer's Disease Knowledge Scale scores overall and for life impact, symptoms, treatment, and disease progression (P < .05). Time since diagnosis improved caregivers’ knowledge of Alzheimer disease symptoms (P = .00) and diagnosis (P = .05).ConclusionAssessing the degree of understanding of Alzheimer disease is essential to the development of health education strategies both in the general population and among caregivers. (AU)

Level of understanding of Alzheimer disease among caregivers and the general population.

INTRODUCTION: Understanding of Alzheimer disease (AD) is fundamental for early diagnosis and to reduce caregiver burden. The objective of this study is to evaluate the degree of understanding of AD among informal caregivers and different segments of the general population through the Alzheimer's Disease Knowledge Scale (ADKS). PATIENTS AND METHODS: We assessed the knowledge of caregivers in different follow-up periods (less than one year, between 1 and 5 years, and over 5 years since diagnosis) and individuals from the general population. ADKS scores were grouped into different items: life impact, risk factors, symptoms, diagnosis, treatment, disease progression, and caregiving. RESULTS: A total of 419 people (215 caregivers and 204 individuals from the general population) were included in the study. No significant differences were found between groups for overall ADKS score (19.1 vs 18.8, P = .9). There is a scarce knowledge of disease risk factors (49.3%) or the care needed (51.2%), while symptoms (78.6%) and course of the disease (77.2%) were the best understood aspects. Older caregiver age was correlated with worse ADKS scores overall and for life impact, symptoms, treatment, and disease progression (P < .05). Time since diagnosis improved caregivers' knowledge of AD symptoms (P = .00) and diagnosis (P = .05). CONCLUSION: Assessing the degree of understanding of AD is essential to the development of health education strategies both in the general population and among caregivers.

CO² filtration during pneumoperitoneum inflation and deflation in patients undergoing laparoscopy during the COVID-19 pandemic.

The current Covid-19 pandemic has been the most discussed topic of the year, mostly about protection and ways to avoid dissemination of the virus. In the healthcare system, especially in the operating rooms, the viability of laparoscopic surgery was questioned, mostly because of the transmission through aerosol. This article tries to suggest a way to minimize risks of laparoscopic surgery, during this situation, by using electrostatic filters, a simple, effective and low cost alternative.

CO² filtration during pneumoperitoneum inflation and deflation in patients undergoing laparoscopy during the COVID-19 pandemic / Filtragem do CO² durante a insuflação e esvaziamento do pneumoperitônio em pacientes submetidos a videolaparoscopia durante pandemia de COVID-19

ABSTRACT The current Covid-19 pandemic has been the most discussed topic of the year, mostly about protection and ways to avoid dissemination of the virus. In the healthcare system, especially in the operating rooms, the viability of laparoscopic surgery was questioned, mostly because of the transmission through aerosol. This article tries to suggest a way to minimize risks of laparoscopic surgery, during this situation, by using electrostatic filters, a simple, effective and low cost alternative.

RESUMO A atual pandemia do Covid-19 tem sido o assunto mais discutido do ano de 2020, principalmente no que se refere a proteção e as formas de limitar a disseminação do vírus. No cenário hospitalar, mais especificamente no centro cirúrgico, a viabilidade da cirurgia laparoscópica foi questionada, em relação a transmissibilidade do vírus por aerossol. Este artigo sugere uma forma de minimizar os riscos em cirurgias laparoscópicas durante esse cenário, com o uso de filtros eletrostáticos de ventilação mecânica. Uma alternativa simples, eficaz e de baixo custo.

Effect of chamber characteristics, loading and analysis time on motility and kinetic variables analysed with the CASA-mot system in goat sperm.

Several factors unrelated to the semen samples could be influencing in the sperm motility analysis. The aim of the present research was to study the effect of four chambers with different characteristics, namely; slide-coverslip, Spermtrack, ISAS D4C10, and ISAS D4C20 on the sperm motility. The filling procedure (drop or capillarity) and analysis time (0, 120 and 240s), depth of chamber (10 or 20µm) and field on motility variables were analysed by use of the CASA-mot system in goat sperm. Use of the drop-filling chambers resulted in greater values than capillarity-filling chambers for all sperm motility and kinetic variables, except for LIN (64.5% compared with 56.3% of motility for drop- and capillarity-filling chambers respectively, P<0.05). There were no significant differences in total sperm motility between different chamber depths, however, use of the 20µm-chambers resulted in greater sperm progressive motility rate, VSL and LIN, and less VCL and VAP than chambers with a lesser depth. There was less sperm motility and lesser values for kinetic variables as time that elapsed increased between sample loading and sperm evaluation. For sperm motility, use of droplet-loaded chambers resulted in similar values of MOT in all microscopic fields, but sperm motility assessed in capillarity-loaded chambers was less in the central fields than in the outermost microscopic fields. For goats, it is recommended that sperm motility be analysed using the CASA-mot system with a drop-loaded chamber within 2min after filling the chamber.

Factors affecting milking speed in Murciano-Granadina breed goats.

Milk flow during the first minute of milking was analyzed using data from 1,132 Murciano-Granadina breed goats belonging to 17 herds. During the individual lactations, 2 test days were scheduled for recording several milk flow traits, total milk, milk composition (fat and protein percentages), and somatic cell count. Average lag time from teatcup attachment to arrival of milk at the milk claw (T0) was 4.9 s and at the milk meter (T1) was 15.8 s. Average milk flow after 30 s (MF0.5) was 0.29kg/30 s (0 to 1.1kg/30 s) and milk flow at 60 s or milking speed (MF1) was 0.67kg/min (0.1 to 2.1kg/min). Repeatabilities of T0, T1, MF0.5, and MF1 were 0.45, 0.58, 0.62, and 0.68, respectively. The MF1 showed high phenotypic correlation withT1(-0.63) and MF0.5 (0.90), medium values withT0(-0.42) and total milk (0.22), and very low values (-0.04 to -0.12) with fat, protein, and somatic cell count. We found no differences between flows during the first 3 lactations, with a reduction as the lactation number increased. Months in milk since parturition affected MF1, being highest in the first 3mo (0.67-0.71kg/min) and decreasing until the end of lactation (0.58kg/min). The effect of herd-test day was significant for all traits. Inclusion of all these effects for the analysis of milk flow traits is considered necessary.

Spontaneously Arising Canine Glioma as a Potential Model for Human Glioma.

Human gliomas are malignant brain tumours that carry a poor prognosis and are composed of a heterogeneous population of cells. There is a paucity of animal models available for study of these tumours and most have been created by genetic modification. Spontaneously arising canine gliomas may provide a model for the characterization of the human tumours. The present study shows that canine gliomas form a range of immunohistochemical patterns that are similar to those described for human gliomas. The in-vitro sphere assay was used to analyze the expansion and differentiation potential of glioma cells taken from the periphery and centre of canine tumours. Samples from the subventricular zone (SVZ) and contralateral parenchyma were used as positive and negative controls, respectively. The expansion potential for all of these samples was low and cells from only three cultures were expanded for six passages. These three cultures were derived from high-grade gliomas and the cells had been cryopreserved. Most of the cells obtained from the centre of the tumours formed spheres and were expanded, in contrast to samples taken from the periphery of the tumours. Spheres were also formed and expanded from two areas of apparently unaffected brain parenchyma. The neurogenic SVZ contralateral samples also contained progenitor proliferating cells, since all of them were expanded for three to five passages. Differentiation analysis showed that all cultured spheres were multipotential and able to differentiate towards both neurons and glial cells. Spontaneously arising canine gliomas might therefore constitute an animal model for further characterization of these tumours.

Avaliação oftalmológica de crianças de escolas públicas de Belo Horizonte/MG: um panorama acerca da baixa acuidade visual / Ophthalmologic screening of children of public schools in Belo Horizonte/MG: an overview about the visual impairment in children

Objetivo:Descrever e analisar a prevalência de baixa acuidade visual e suas causas em estudantes do ensino público de Belo Horizonte/MG.Métodos:Estudo transversal de 1452 escolares de 5 a 19 anos, do ensino público de Belo Horizonte/MG, triados e atendidos entre 2011 e 2014.Resultados:Da amostra total, 150 pacientes (10,33%) apresentaram baixa acuidade visual à triagem, recebendo encaminhamento para atendimento oftalmológico. Quarenta (26,66%) foram encaminhados e compareceram à consulta, onde 29 (72,5%) apresentaram indicação de correção visual. O astigmatismo miópico simples e composto foram os diagnósticos mais relacionados à prescrição de óculos.Conclusão:O estudo mostrou que a prevalência de baixa acuidade visual na população estudada foi compatível com demais programas semelhantes. Em contrapartida, a taxa de abstenção foi maior do que o esperado, evidenciando a importância da criação de medidas preventivas e informativas quanto à importância do cuidado com a saúde ocular.

Objective:To describe and analyze the prevalence of visual impairment and its causes in public school students in Belo Horizonte/MG.Methods:Cross-sectional study of 1.452 public school children from 5 to 19 years old, in Belo Horizonte/MG, screened and evaluated between 2011 and 2014.Results:Of the total sample, 150 patients (10,33%) had low visual acuity at the screening, and were referred to an ophthalmologist to further examination. Forty (26%) of the referred patients presented at the ambulatory, where 29 (72,5%) of these showed indication of visual correction. Simple and compound myopic astigmatism were the most frequent diagnoses associated with prescription glasses.Conclusion:The study showed that the prevalence of visual impairment in this population were consistent with other similar programs. By contrast, the abstention rate was much higher than the expectation, showing the importance of preventive and informative actions about the eye health care.

Copper(I) targeting in the Alzheimer's disease context: a first example using the biocompatible PTA ligand.

Copper(I) coordinating ligands in the Alzheimer's disease context have remained unexplored, despite the biological relevance of this redox state of the copper ion. Here, we show that the PTA ligand can remove copper from Aß, prevent reactive oxygen species production and oligomer formation, two deleterious events in the disease's etiology.

Immunohistochemical study of doublecortin and nucleostemin in canine brain.

Finding a marker of neural stem cells remains a medical research priority. It was reported that the proteins doublecortin and nucleostemin were related with stem/progenitor cells in central nervous system. The aim of the present immunohistochemical study was to evaluate the expression of these proteins and their pattern of distribution in canine brain, including age-related changes, and in non-nervous tissues. We found that doublecortin had a more specific expression pattern, related with neurogenesis and neuronal migration, while nucleostemin was expressed in most cells of almost every tissue studied. The immunolabeling of both proteins decreased with age. We may conclude that nucleostemin is not a specific marker of stem/progenitor cells in the dog. Doublecortin, however, is not an exclusive marker of neural stem cells, but also of neuronal precursors.

Alergias alimentarias: problemática en el comedor escolar / Food alergies: problems in the school lunchroom

La alergia a los alimentos constituye un problema de salud emergente. El Programa de Educación Nutricional iniciado en el curso escolar 1995/96 tiene como objetivos conocer la utilización del comedor escolar por alumnos con dietas especiales, obtener información sobre el cumplimiento de la normativa legal existente en nuestra comunidad, formar en el manejo de los niños con alergias alimentarias y contribuir a la coordinación de todos los estamentos implicados para conseguir un medio escolar seguro. Las actuaciones se estructuran en: 1. Encuesta a los centros educativos para recoger datos sobre los niños con dietas especiales. 2. Reuniones de coordinación con directores de los centros, catering y AMPAS para conocer la implantación o no de las dietas y sus dificultades. 3. Formación y elaboración de material informativo para la comunidad educativa sobre esta problemática. La cobertura del programa es de 87,5%. Utilizan el comedor un 34% de los escolares. Un 2,2% son alérgicos a alimentos, el 0,4% son celíacos y un 0,7% presentan dietas especiales. Se distribuye material elaborado sobre las alergias alimentarias y la enfermedad celíaca. Las empresas de restauración han asumido la elaboración de las dietas especiales. el niño alérgico debe participar en todas las actividades incluido el comedor escolar. La coordinación y la formación y distribución de material han ayudado a la total incorporación de los escolares afectados

Food allergic disorders are an emergent health problem. The aims of the Nutritional Educational Program, that carries out from 1995/9, have been created to know the use of the school´s dinning rooms by students with special diets, to be knowledgeable about and to follow applicable laws in our state, training on managing students with food allergies and to cooperate in order to provide a safe school envoronment. Its activities are structured in the following way: 1) Questionnaire to collect information about children with a special diet. 2) Coordination meetings with headmasters, catering´s staff and parents. 3) Training and creation of didactic material towards the educative community about these problems. The coverage of the program reaches the 87.5%. the school´s dinning room is used by the 34% of the students. The 2.2% of the children are food allergic and the 0.4% suffer celiac disease. Another 0.7% need special diets. Coordination meetings have taken place every three month. The didactic materail created about food allergy and celiac disease has been distributed in all school centres. The catering enterprises have assumed special diets. Food allergy children must participate in all school activities including the school dining room. The training, the cooperation and the creation of didactic material have allowed the total incorporation of the affected children

[Health surveillance of workers exposed to asbestos: an example of cooperation between the occupational prevention system and the national health system]. / La Vigilancia de la Salud de los trabajadores expuestos al amianto: ejemplo de colaboracion entre el sistema de prevencion de riesgos laborales y el sistema nacional de salud.

The Ministry of Health and Consumer Affairs and the Autonomous Governments of Spain have designed and agreed by consensus with the sanitary professionals and major employer's organizations and Unions a Integral Health Surveillance Programme of asbestos-exposed workers, in order to assure appropriate, uniform and harmonized action throughout the national territory with relation to these workers. PROGRAM DESCRIPTION: This initiative started from the Occupational Health Working group of the Interterritorial Council, with inputs from the Asbestos Working Group of the National Occupational Safety and Health Commission. It was agreed with occupational medicine and infirmary professionals and was approved by the Health and Labour authorities. The program is organised in seven main activities. CURRENT PROGRAM STATUS: two years after the Programme approval a total of 5778 workers are included in the Registry of asbestos-exposed workers. 208 workers have COPD, 198 benign pleural disease, 8 lung cancer, 10 mesothelioma and 7 workers have other cancers possibly related to asbestos (gastric, larynx and colon cancer). REMARKS: the agreement and participation reached in this Programme allow achieving much higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see during the second year of implementation of the Programme in which the number of attended workers has doubled.

La vigilancia de la salud de los trabajadores expuestos al amianto: ejemplo de colaboración entre el sistema de prevención de riesgos laborales y el sistema nacional de salud / Health surveillance of workers exposed to asbestos: an example of co-operation between the occupational prevention system and the national health system

El Ministerio de Sanidad y Consumo y las Comunidades Autónomashan diseñado y consensuado con los profesionales sanitariosy las organizaciones empresariales y sindicales representativas unPlan Integral de Vigilancia de la Salud de los Trabajadores que hanestado expuestos a Amianto, con el objetivo de garantizar una intervenciónadecuada, uniforme y armonizada de estos trabajadores entodo el territorio nacional. La elaboración del Programa partió delGrupo de Trabajo de Salud Laboral del Consejo Interterritorial, seenriqueció con las aportaciones del Grupo de Trabajo Amianto de laComisión Nacional de Seguridad y Salud en el Trabajo, fue consensuadocon los profesionales de la medicina y enfermería del trabajo,y fue aprobado por las autoridades sanitarias y laborales. El Programaconsta de siete grandes bloques de actividades. Dos años despuésde aprobado el Programa, el estado de implantación en las ComunidadesAutónomas es desigual. Las principales dificultades para supuesta en marcha se encuentran en la elaboración del Registro deexpuestos. Un total de 5.778 trabajadores están incluidos en el Registro.208 trabajadores tienen EPOC, 198 alteraciones pleurales benignas,8 cáncer de pulmón, 10 mesotelioma y 7 presentan otros cáncerescon posible relación con el amianto (gástrico, de laringe y colon). El consenso y la participación alcanzados alrededor de este Programaestán permitiendo lograr coberturas de las políticas de prevenciónde riesgos laborales muy superiores a las que se consiguen conla mera actuación institucional y elaboración de normativa, ya que ensólo los dos primeros años de implantación del Programa se ha duplicadoel número de trabajadores atendidos

The Ministry of Health and Consumer Affairs and the AutonomousGovernments of Spain have designed and agreed by consensuswith the sanitary professionals and major employer's organizationsand Unions a Integral Health Surveillance Programme ofasbestos-exposed workers, in order to assure appropriate, uniformand harmonized action throughout the national territory with relationto these workers. Program description: this initiative startedfrom the Occupational Health Working group of the InterterritorialCouncil, with inputs from the Asbestos Working Group of theNational Occupational Safety and Health Commission. It was agreedwith occupational medicine and infirmary professionals and wasapproved by the Health and Labour authorities. The program isorganised in seven main activities. Current Program status: twoyears after the Programme approval a total of 5,778 workers areincluded in the Registry of asbestos-exposed workers. 208 workershave COPD, 198 benign pleural disease, 8 lung cancer, 10 mesotheliomaand 7 workers have other cancers possibly related toasbestos (gastric, larynx and colon cancer). Remarks: the agreementand participation reached in this Programme allow achievingmuch higher coverage of occupational prevention policies than those obtained with a mere law approval, as we could see duringthe second year of implementation of the Programme in which thenumber of attended workers has doubled

[Use of blood products in patients treated surgically for stage I non-small cell lung cancer]. / Estudio del uso de hemoderivados en el carcinoma broncopulmonar no anaplásico de células pequeñas en estadio I sometido a tratamiento quirúrgico.

OBJECTIVE: Retrospective study on the relation between the use of blood products and survival rates in patients treated surgically for stage I non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: The study included 856 patients who underwent surgical resection from 1969 to 2000 for stage I NSCLC, classified histologically according to the current guidelines of the Spanish Society of Pulmonary and Thoracic Surgery (SEPAR). Patients who died in the postoperative period were excluded from the study. A series of clinicopathological variables were recorded, including the perioperative use or not of blood products. Descriptive, univariate, and multivariate statistical analyses were performed. Follow up concluded in December of 2003. RESULTS: One hundred twenty-five patients (14.6%) underwent a perioperative transfusion. A significant association was found between the use of blood products and tumor size (P<.001), pneumectomy (P<.001), and cell type (P<.05). The respective 2, 5, and 10-year survival rates were 78%, 63%, and 54% for the nontransfusion group, and 73%, 59%, and 46% for the transfusion group. Both survival curves were compared and no significant differences were found (P=.23). Multivariate regression analysis included tumor size, patient age, and histologic cell type (squamous cell carcinoma or not); no relation between transfusion and survival was found. CONCLUSIONS: In our series, we found no difference in survival rates for patients with stage I NSCLC after perioperative blood transfusion.

[Lung transplantation in cystic fibrosis: perioperative mortality]. / Fibrosis quística y trasplante pulmonar. Mortalidad perioperatoria.

OBJECTIVE: To determine the incidence and causes of perioperative mortality following lung transplant for cystic fibrosis. PATIENTS AND METHODS: We analyzed the cases of 57 patients. Fifty-five patients received double lung transplants, 1 received a heart-double lung transplant, and 1 received a combined double lung and liver transplant. Information related to the organ donor, recipient, lung graft, and early postoperative period was gathered. Perioperative mortality was defined as death resulting from anesthesia or surgery regardless of how many days had passed. The Kaplan-Meier method was used to analyze survival. A Cox logistic regression model was used to determine variables affecting mortality. RESULTS: Survival was 83.7% at 1 year after transplantation, 77.3% at 2 years, and 66.9% at 5 years. Five (8.7%) patients died as a result of anesthesia or surgery. A ratio of PaO2 to inspired oxygen fraction (FiO2) less than 200 mm Hg in the early postoperative period was observed in 8 (14%) patients. Primary graft failure occurred in 4 patients, due to pneumonia in 2 and to biventricular dysfunction in 2. Three of those patients died. Two patients with PaO2/FiO2 greater than 200 mm Hg died after surgery, one from septic shock due to Pseudomonas cepacia and the other from massive cerebral infarction. PaO2/FiO2 upon admission to the recovery care unit was the only variable significantly associated with perioperative mortality in the logistic regression model (P=.0034). CONCLUSIONS: The only factor significantly related to perioperative mortality in patients receiving transplants for cystic fibrosis was PaO2/FiO2 upon admission to the recovery unit.

Estudio del uso de hemoderivados en el carcinoma broncopulmonar no anaplásico de células pequeñas en estadio I sometido a tratamiento quirúrgico / Use of blood products in patients treated surgically for stage I non-small cell lung cancer

Objetivo: Estudio retrospectivo sobre la influencia del uso de hemoderivados en la supervivencia del carcinoma broncopulmonar no anaplásico de células pequeñas (CBNACP) en estadio I sometido a tratamiento quirúrgico. Pacientes y métodos: Se incluyó en el estudio a 856 pacientes (1969-2000) diagnosticados de CBNACP, que se resecaron y clasificaron como estadio I patológico según la actual normativa SEPAR, y se excluyó la mortalidad postoperatoria. Se recogieron una serie de variables clinicopatológicas, incluida la utilización o no de hemoderivados en el perioperatorio, y se aplicaron análisis estadísticos descriptivos, univariante y multivariante. El seguimiento finalizó en diciembre de 2003. Resultados: En el perioperatorio se transfundió a 125 pacientes (14,6%). La utilización de hemoderivados se relacionó significativamente con el tamaño tumoral (p < 0,001), la realización de una neumonectomía (p < 0,001) y el tipo histológico (p < 0,05). La supervivencia fue del 78, el 63 y el 54% a los 2, 5 y 10 años, respectivamente, para el grupo de pacientes no transfundidos, y del 73, el 59 y el 46% para el grupo de transfundidos. La comparación de ambas curvas de supervivencia no mostró diferencias significativas (p = 0,23). En el análisis multivariante entraron en regresión el tamaño tumoral, la edad y la variedad histológica epidermoide/no epidermoide. En este análisis no se demostró ninguna relación de la transfusión con la supervivencia. Conclusiones: No se ha encontrado, en nuestra serie, ninguna variación en la supervivencia del CBNACP en estadio I tras el uso de hemoderivados en el perioperatorio inmediato

Objective: Retrospective study on the relation between the use of blood products and survival rates in patients treated surgically for stage I non-small cell lung cancer (NSCLC). Patients and Methods: The study included 856 patients who underwent surgical resection from 1969 to 2000 for stage I NSCLC, classified histologically according to the current guidelines of the Spanish Society of Pulmonary and Thoracic Surgery (SEPAR). Patients who died in the postoperative period were excluded from the study. A series of clinicopathological variables were recorded, including the perioperative use or not of blood products. Descriptive, univariate, and multivariate statistical analyses were performed. Follow up concluded in December of 2003. Results: One hundred twenty-five patients (14.6%) underwent a perioperative transfusion. A significant association was found between the use of blood products and tumor size (P<.001), pneumectomy (P<.001), and cell type (P<.05). The respective 2, 5, and 10-year survival rates were 78%, 63%, and 54% for the nontransfusion group, and 73%, 59%, and 46% for the transfusion group. Both survival curves were compared and no significant differences were found (P=.23). Multivariate regression analysis included tumor size, patient age, and histologic cell type (squamous cell carcinoma or not); no relation between transfusion and survival was found. Conclusions: In our series, we found no difference in survival rates for patients with stage I NSCLC after perioperative blood transfusion

Fibrosis quística y trasplante pulmonar. Mortalidad perioperatoria / Lung transplantation in cystic fibrosis: perioperative mortality

Objetivo: Conocer la incidencia y las causas de mortalidad perioperatoria en el trasplante pulmonar por fibrosis quística. Pacientes y métodos: Se ha analizado a 57 pacientes. Se realizaron 55 trasplantes bipulmonares, uno cardiobipulmonar y uno hepatobipulmonar. Se recogieron una serie de datos del donante, del receptor, del injerto pulmonar y del postoperatorio inmediato. Se definió la mortalidad perioperatoria cuando el fallecimiento aconteció como consecuencia del acto anestésico-quirúrgico, independientemente de los días transcurridos. Para determinar qué variables la condicionaron se utilizó el modelo de regresión logística de Cox. La supervivencia se calculó mediante el método de Kaplan-Meier. Resultados: La supervivencia fue del 83,7% al año del trasplante, del 77,3% a los 2 años y del 66,9% a los 5 años. Cinco pacientes (8,7%) fallecieron en el perioperatorio. En 8 (14%) se objetivó un cociente de presión arterial de oxígeno (PaO2)/fracción inspiratoria de oxígeno (FiO2) inspirado 200 mmHg fallecieron en el perioperatorio, uno por un shock séptico por Pseudomonas cepacia y otro por un infarto cerebral masivo. Mediante el análisis de regresión logística, el cociente PaO2/FiO2 al ingresar en la unidad de reanimación fue la única variable que condicionó significativamente la mortalidad perioperatoria (p = 0,0034). Conclusiones: El cociente PaO2/FiO2 al ingresar en la unidad de reanimación fue la única variable que condicionó significativamente la mortalidad perioperatoria en los pacientes trasplantados por fibrosis quística

Objective: To determine the incidence and causes of perioperative mortality following lung transplant for cystic fibrosis. Patients and Methods: We analyzed the cases of 57 patients. Fifty-five patients received double lung transplants, 1 received a heart-double lung transplant, and 1 received a combined double lung and liver transplant. Information related to the organ donor, recipient, lung graft, and early postoperative period was gathered. Perioperative mortality was defined as death resulting from anesthesia or surgery regardless of how many days had passed. The Kaplan-Meier method was used to analyze survival. A Cox logistic regression model was used to determine variables affecting mortality. Results: Survival was 83.7% at 1 year after transplantation, 77.3% at 2 years, and 66.9% at 5 years. Five (8.7%) patients died as a result of anesthesia or surgery. A ratio of PaO2 to inspired oxygen fraction (FiO2) less than 200 mm Hg in the early postoperative period was observed in 8 (14%) patients. Primary graft failure occurred in 4 patients, due to pneumonia in 2 and to biventricular dysfunction in 2. Three of those patients died. Two patients with PaO2/FiO2 greater than 200 mm Hg died after surgery, one from septic shock due to Pseudomonas cepacia and the other from massive cerebral infarction. PaO2/FiO2 upon admission to the recovery care unit was the only variable significantly associated with perioperative mortality in the logistic regression model (P=.0034). Conclusions: The only factor significantly related to perioperative mortality in patients receiving transplants for cystic fibrosis was PaO2/FiO2 upon admission to the recovery unit

[T2N1M0 non-small cell lung cancer: surgery and prognostic factors]. / Carcinoma broncogénico no anaplásico de células pequeñas T2N1M0. Cirugía y factores pronósticos.

OBJECTIVE: To determine the prognostic factors for the survival in a group of patients operated on for a non-small cell lung cancer classified as T2N1M0. PATIENTS AND METHODS: Two hundred sixteen patients treated exclusively with surgery were studied. Kaplan-Meier survival and Cox multivariable regression analyses were used. RESULTS: The overall survival rate was 39.8% at 5 years and 29.9% at 10 years. Sex, age, presence or absence of symptoms, type of resection, number, and location of affected lymph nodes had no effect on survival. Tumor size (P=.04) and histologic type (P=.03) did significantly affect prognosis. Both variables entered into the Cox multivariable regression model. CONCLUSIONS: Patients operated on for non-small cell lung cancer classified as T2N1M0 have an overall probability of 5-year survival of approximately 40%. However, the prognosis for this group of patients is heterogeneous: in our study it was affected by the histologic type (45.5% for squamous cell and 25% for non-squamous cell cancers) and tumor size (53% for tumors with a diameter of 5 cm).

Carcinoma broncogénico no anaplásico de células pequeñas T2N1M0. Cirugía y factores pronósticos / T2N1M0 non-small cell lung cancer: surgery and prognostic factors

Objetivo: Determinar los factores pronósticos de supervivencia de un grupo de pacientes operados de un carcinoma broncogénico no anaplásico de células pequeñas y clasificados como T2N1M0. Pacientes y métodos: Se estudió a 216 pacientes tratados exclusivamente con cirugía. La supervivencia se analizó con el método de Kaplan-Meier y se utilizó el modelo de Cox para el análisis multivariante. Resultados: La supervivencia global fue del 39,8% a los 5 años y del 29,9% a los 10 años. El sexo, la edad, la presencia o ausencia de síntomas, la amplitud de la exéresis, el número de ganglios afectados y su localización no influyeron en la supervivencia. El tamaño tumoral (p = 0,04) y la estirpe histológica (p = 0,03) sí condicionaron significativamente el pronóstico. Ambas variables entraron en regresión cuando se utilizó el análisis multivariante. Conclusiones: Los pacientes operados de un carcinoma broncogénico no anaplásico de células pequeñas clasificado como T2N1M0 tienen una probabilidad de supervivencia global a los 5 años en torno al 40%. Sin embargo, no es un grupo de pacientes con un pronóstico homogéneo, ya que en nuestro estudio estuvo condicionado por la estirpe histológica (un 45,5% para los epidermoides y un 25% para los no epidermoides) y el tamaño tumoral (un 53% en los tumores con un diámetro ≤ 3 cm, un 45% entre 3,1-5 cm y un 29% en > 5 cm)

Objective: To determine the prognostic factors for the survival in a group of patients operated on for a non-small cell lung cancer classified as T2N1M0. Patients and methods: Two hundred sixteen patients treated exclusively with surgery were studied. Kaplan-Meier survival and Cox multivariable regression analyses were used. Results: The overall survival rate was 39.8% at 5 years and 29.9% at 10 years. Sex, age, presence or absence of symptoms, type of resection, number, and location of affected lymph nodes had no effect on survival. Tumor size (P=.04) and histologic type (P=.03) did significantly affect prognosis. Both variables entered into the Cox multivariable regression model. Conclusions: Patients operated on for non-small cell lung cancer classified as T2N1M0 have an overall probability of 5-year survival of approximately 40%. However, the prognosis for this group of patients is heterogeneous: in our study it was affected by the histologic type (45.5% for squamous cell and 25% for non-squamous cell cancers) and tumor size (53% for tumors with a diameter of ≤3 cm, 45% for tumors between 3.1 and 5 cm, and 29% for a tumor diameter >5 cm)