Prognostic value of ERCC1, RRM1, BRCA1 and SETDB1 in early stage of non-small cell lung cancer.

INTRODUCTION: Nowadays, 40 % of early-stage NSCLC patients relapse in the 2 years following resection, suggesting a mis-staging in this group of patients who are not receiving adjuvant chemotherapy. Although different biomarkers, such as ERCC1, RRM1 and BRCA1 have been found to present prognostic value in advanced NSCLC patients, in early-stage NSCLC patients its relevance remains unclear. Moreover, SETDB1 has been recently proposed as a bona fide oncogene in lung tumourigenesis and related with metastasis. The aim of the present study was to analyze the prognostic value of ERCC1, RRM1, BRCA1 and SETDB1 expression levels in NSCLC patients at stage I. PATIENTS AND METHODS: ERCC1, RRM1, BRCA1 and SETDB1 expression at mRNA level was analyzed by real-time quantitative RT-PCR in fresh-frozen tumor and normal adjacent lung tissue samples from 64 stage I NSCLC patients. Later, significant association between gene expression levels, clinicopathological characteristics and patient's disease-free survival was assessed. RESULTS: We did not find any statistically significant correlation between gene expression and gender, age, histological type or smoking status. Univariate followed by multivariate Cox analysis showed that higher levels of BRCA1 and SETDB1 expression were significantly associated with shorter disease-free survival in stage I NSCLC patients. CONCLUSION: Our study finds that ERCC1 and RRM1 are not independent prognostic factors of recurrence in stage I NSCLC patients. By contrast, BRCA1 and SETDB1 stand out as the most significant prognostic markers in this group of patients, appearing as promising tools to predict tumor recurrence in early-stage NSCLC patients.

Neumotórax de repetición como presentación de sarcoma sinovial pleuropulmonar / Pleuropulmonary synovial sarcoma presenting as recurrent pneumothorax

Los sarcomas sinoviales son neoplasias de tejidos blandos, afectan a adultos jóvenes y de mediana edad, no existen diferencias con respecto a la distribución por sexo. Se localizan en el 90% de los casos en las extremidades. El sarcoma sinovial pleuropulmonar primario (SSPP) es muy poco frecuente, constituye el 0,1% de los tumores pulmonares. Frecuentemente se manifiesta con tos y/o hemoptisis, el neumotórax es una forma poco común de presentación. Son tumores con mal pronóstico y presentan alto riesgo de recidivas locales. Las mejores supervivencias están relacionadas con el tratamiento quirúrgico, siendo la resección completa tumoral el principal factor pronóstico. El tratamiento de elección es quirúrgico, seguido de quimioterapia, radioterapia o ambas. Presentamos el caso clínico de un sarcoma pleuropulmonar primario que clínicamente se manifestó como neumotórax (AU)

Synovial sarcomas are a soft-tissue neoplasms which affects young and middle-aged people, with no difference in distribution between sexes. They are located in the extremities in the 90% of the cases. Pleuropulmonary primary synovial sarcoma SSPP is very unusual, constitutes 0.1% of pulmonary tumors. In most cases the SSPP present themselves with cough and / or hemoptysis whereas pneumothorax is an uncommon form of presentation. Prognosis is usually poor, they present high risk of local recurrence. The survival rate depends on the surgical treatment, being the complete tumor resection the main predicting factor. Surgery is the treatment of choice followed by chemotherapy, radiotherapy or both. We present a case report of a pleuropulmonary synovial sarcoma which presented with pneumothorax (AU)

Ptosis palpebral asociada a neurofibroma mediastínico posterior. Tratamiento quirúrgico / Ptosis palpebral associated to mediastinal neurofibroma after surgical treatment

Los neurofibromas son tumores neurógenos originados a partir de las células de Schwann y de los fibroblastos de las vainas nerviosas de los nervios periféricos. Entre el 40 y el 60% de los tumores de mediastino posterior son neurofibromas y schawnnomas. El schwanoma es el más frecuente. Su evolución es lenta, ello explica el gran tamaño observado en el momento del diagnóstico en algunos casos, lo que justifica la sintomatología por compresión. Presentamos el caso clínico de un neurofibroma mediastínico posterior que se inició clínicamente con dolor pleurítico y ptosis palpebral (AU)

Neurofibromas are neurogenic tumors originated from Schwann cells and the fibroblasts of the peripheral nerve sheaths. From 40-60% of the posterior mediastinal tumors are neurofibromas and schawnomas. The schwannoma is the most frequent. Its development is slow, which explains the large size observed at the time of diagnosis in some cases. This explains the compression symptoms. We present the clinical case of a posterior mediastinal neurofibroma that began clinically with pleuritic pain and palpebral ptosis (AU)

Clinical-therapeutic management of thoracoscopy in pleural effusion: a groundbreaking technique in the twenty-first century

INTRODUCTION: The aim of this study was to investigate the effectiveness of thoracoscopy in the diagnosis of non-affiliated pleural effusions (PE). MATERIAL AND METHODS: A five-year prospective study including data from 110 patients that were clinically diagnosed as benign (14.5%), malign (34.5%) and non-affiliated (50.9%). PE in patents without oncology disease and negative biopsy or cytology were considered as benign. Malignant diagnosis was established according to a pleural biopsy, compatible cytology and/or clinical features. Remaining cases were considered as non-affiliated. Thoracoscopy was done under local anaesthesia and sedation. RESULTS: Thoracoscopy confirmed previous clinical diagnosis of benignity and malignity. Regarding non-affiliated patients, 30.35% were diagnosed after thoracoscopy as unspecific pleuritis, 17.86% mesothelioma and 1.79% pleural tuberculosis (TBC). The other 48.21% of patients reported as non-affiliated were diagnosed with pleural carcinoma. Statistical analysis did not reveal differences between frequencies analysed. CONCLUSIONS: Our results indicate that thoracoscopy is a cost-effective and reliable technique for obtaining histological diagnosis in PE and also allows a directed pleurodesis if indicated (AU)

Cirugía vídeo-toracoscópica en el manejo diagnóstico-terapéutico de los derrames pericárdicos benignos / Video-assisted thoracoscopic surgery in the diagnostic-therapeutic management of benign pericardial effusions

Introducción. El derrame pericárdico es una entidad clínica que requiere un manejo multidisciplinar. Varios procedimientos han sido descritos para practicar una pericardiectomía parcial suficiente para garantizar el drenado óptimo y que, además, permita la toma de muestras biópsicas. El objetivo del presente trabajo es evaluar la rentabilidad de la pericardiectomía parcial mediante cirugía vídeo-toracoscópica (CVT) en los derrames pericárdicos con sospecha clínica de benignidad, valorando las indicaciones y su valor añadido frente a otras técnicas. Material y métodos. Hemos realizado pericardiectomías a 19 pacientes con sospecha clínica de benignidad por CVT. La indicación fue establecida ante la aparición de síntomas atribuibles al derrame o cuando se precisaba la toma de muestras. La presencia de signos radiológicos y/o ecográficos de pericarditis constrictiva o de inestabilidad clínica, fueron contraindicaciones para la técnica. Resultados. El diagnóstico tras estudio patológico fue de inflamación crónica en 6 casos, tuberculosis (TBC) activa en 2 y una pericarditis de origen urémico en otros 4. Etiología neoplásica no diagnosticada previamente fue establecida en 2 pacientes; en 5 casos se drenaron derrames postquirúrgicos de cirugía cardiaca. Conclusiones. La CVT resulta una técnica adecuada para el manejo diagnóstico-terapéutico de aquellos derrames pericárdicos no diagnosticados y en los postquirúrgicos. Su elevado rendimiento diagnóstico, su baja morbilidad y casi nula existencia de recidivas lo hacen especialmente indicado en casos en que se precise la toma de muestras y la supervivencia previsible sea larga (AU)

Introducción. Introduction. Pericardial effusion is a clinical disease that requires multidisciplinary management. Several procedures have been described to perform a sufficient partial pericardiectomy in order to assure optimum drainage and that would also permit biopsy samples to be obtained. The purpose of this work is to evaluate the profitability of the partial pericardiectomy through video-assisted thoracoscopic surgery (VTS) in pericardial effusions with clinical suspicion of benignancy, evaluating its indications and its added value compared to other techniques Material and methods. We have performed pericardiectomies in 19 patients with clinical suspicions of benignancy using VTS. The indication was established due to the appearance of symptoms that could be attributed to effusion or when it was necessary to obtain samples. The presence of radiological and/or ultrasonographic signs of constrictive pericarditis or clinical instability were contraindications for the technique. Results. The diagnosis after the pathology study was chronic inflammation in 6 cases, active tuberculosis (TBC) in 2 cases and uremic pericarditis in 4 more cases. Previously undiagnosed neoplastic etiology was established in 2 patients; in 5 cases, postsurgical effusions of cardiac surgery were drained. Conclusions. VTS is an adequate technique for the diagnostic-therapeutic management of those undiagnosed pericardial effusions and in post-surgical ones. Its high diagnostic performance, low morbidity and almost null existence of relapses has made it especially indicated in cases where it is necessary to obtain samples and the foreseeable survival is long (AU)

[Thoracic metastasis of breast carcinoma. Current status]. / Metástasis torácicas de carcinoma mamario. Estado actual.

Breast cancer is a common pathology. It is clinically considered as a localized or regionally developing illness at the time of diagnosis, but the appearance of metastases is a frequent complication. Patients are commonly referred with local or regional recurrence of the disease. Invasive metastatic disease found in the chest can be differentiated according to area as follows: pulmonary parenchyma (nodes and/or carcinomatosis lymphangitis), pleural cavity (pleural effusion and/or tumor), pericardial effusion and the thoracic wall. The appearance of pulmonary parenchymal metastases secondary to breast cancer can be further categorized into three types, neoplastic lymphangitis, multiple and single pulmonary nodes. Pleural effusion is the commonest thoracic affection in patients with this pathology. It is accepted that 46% of patients with disseminating breast cancers will develop pleural metastases where the presentation is pericardial effusion, and possible cardiac tamponade. Finally, metastatic disease may be found localized to within the thoracic wall. Breast cancer can produce diverse problems in the thoracic wall, and local recurrence is most frequent at the mastectomy site.

Tratamiento quirúrgico de la variante fibrosarcomatosa de un dermatofibrosarcoma protuberans gigante de pared torácica / Surgical treatment of the fibrosarcomatous variant of giant dermatofibrosarcoma protuberans

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[Video-assisted thoracoscopy for resecting solitary pulmonary nodules]. / Videotoracoscopia en la resección de nódulos pulmonares solitarios.

The objective of this study was to evaluate the usefulness of video assisted thoracoscopy in the resection of solitary pulmonary nodules. Thirty-three patients with solitary pulmonary nodules diagnosed by video assisted thoracoscopy were enrolled prospectively. A preoperative computed tomography scan was obtained for each patient. Harpoons were implanted preoperatively to locate the lesion in patients whose tumors were in the parenchyma. When endoscopic resection proved impossible in five patients, the surgeon resorted to thoracotomy. All were diagnosed after the procedure. One was a case of pulmonary lymphoma, 2 were primary adenocarcinomas of the lung, 2 were oat-cell cancers, 1 was Wegener's disease, 4 were tuberculomas, 3 involved pulmonary infarction and 20 were single pulmonary metastases. Patients who needed thoracotomy required more days of postsurgical drainage (p < 0.05). The size of resected nodules ranged from 0.4 to 6 centimeters. Preoperative positron emission tomographs were available for four patients. No perioperative (< 30 days) mortality occurred and morbidity consisted of one case of prolonged airway leak (> 7 days). Use of video-assisted thoracoscopy reduced perioperative morbidity and hospital stay.

[Surgical resection of recurrent pulmonary metastases]. / Resección quirúrgica de metástasis pulmonares de repetición.

The lung is a common site of metastasis. Resectability seems to be the only prognostic factor acknowledged in the literature. Other variables, such as time until tumoral reproduction, duration of the disease-free period, number of metastases and ganglia involvement are not grounds for ruling out surgery. Between February 1996 and January 1998 we operated on 45 patients with pulmonary metastasis, 16 of whom underwent surgery for the same reason more than once. The total number of chest operations in the study group was 42. Retrospectively, we studied all patients undergoing chest surgery more than once, with histologically confirmed resection of pulmonary metastases. One hundred twenty-five metastases (7.8 metastases/patient) were resected. We recorded 3 cases of persistent air leaks that stopped after aspiration through chest tubes was continued. No postoperative (1 to 30 days) mortality was observed. Repetition of pulmonary metastasis should not by itself be considered a reason for ruling out surgery.

Mediastinal paraganglioma: a case report.

Mediastinal paragangliomas are unusual neoplasms that have been described in the medical literature. The microscopic features of paragangliomas are well established and are essentially similar, regardless of the anatomic site, although some minor differences have been noted according to the location of the tumor. We present a case of nonfunctioning anterior mediastinal paraganglioma in a 33-year-old woman. The mediastinal tumor was accidentally discovered on a thoracic tomographic scan performed for an unrelated minor nasal discomfort. Diagnosis was confirmed by 123I-metaiodobenzylguanidine scintigraphy and mediastinoscopy. Complete resection of the tumor was done through a median sternotomy and the patient received intraoperative radiotherapy.

[Pneumoreduction in the treatment of emphysema: preliminary results]. / Neumorreducción en el tratamiento del enfisema: resultados preliminares.

The results of the first three pulmonary reduction operations performed at our hospital for the palliative treatment of pulmonary emphysema are described. The upper third of the upper right lobe and part of the middle lobe were resected in two patients. An upper right lobectomy was performed on the third. Goretex coated autosutures were used and pleurosis was performed with talcum on the upper third of the hemithorax. Drains with -5 cmH2O suction were inserted. We emphasize the advance stage of disease of the three patients and the good outcomes observed in terms of survival, hospital stay and improvement in lung function and symptoms. We discuss the functional improvement resulting from lung reduction in cancer patients if the resected area is emphysematous.

[Iatrogenic bilateral hydrothorax following the placement of a central catheter]. / Hidrotórax bilateral yatrógeno tras colocación de vía central.

We present a case of bilateral hydrothorax after internal jugular vein catheterization. 60 hours after placing the catheter, the patient showed an abrupt picture of jugular ingurgitation, abolished vesicular breath sounds, and displaced cardiac tones. It was necessary to immediately drain one hemithorax to guarantee ventilation of the patient. The present article examines iatrogenicity derived from the placement of central catheters, and special attention is given to the need for post-insertion x-ray control.