Segmentectomía lateral izquierda laparoscópica en donante vivo para trasplante hepático adulto-pediátrico

Introducción: La segmentectomía lateral izquierda es el procedimiento más empleado para la cirugía del donante en trasplante hepático con donante vivo adulto-pediátrico (THDVA-P), y ha demostrado ser seguro y reproducible. Sin embargo, la información aún es escasa respecto al abordaje laparoscópico. Objetivo: El objetivo de este artículo es dar a conocer los resultados posoperatorios de la segmentectomía lateral izquierda laparoscópica (SLI-L) para THDVA-P. Materiales y Método: Realizamos un estudio retrospectivo, observacional, de un solo centro, Hospital del Salvador; con vasta experiencia en trasplante hepático y en resecciones hepáticas laparoscópicas. Se ofreció realizar el procedimiento de SLI-L para la cirugía del donante vivo. Se describe la técnica quirúrgica y los resultados posoperatorios de los donantes. Resultados: Entre abril de 2015 y enero de 2021, 36 pacientes, 25 de ellos hombres, fueron sometidos a SLI-L. El 86% eran madre o padre del receptor, con una mediana de 30 años (19-45). Mediana de tiempo operatorio de 360 min (240-480). Hubo conversión en un caso debido a sangrado venoso de difícil manejo y en dos oportunidades se utilizó técnica mano asistida por la misma causa. Morbilidad Clavien-Dindo III en un paciente debido a fuga biliar precoz, manejada con prótesis vía colangiopancreatografía retrógrada endoscópica exitosamente. La mediana de hospitalización fue de 4 días (3-12) y no hubo mortalidad. Conclusión: La SLI-L ha evolucionado, desde un procedimiento innovador hasta convertirse en el actual procedimiento estándar para THDVA-P. Los buenos resultados en términos de morbimortalidad sugieren que podría ser una técnica segura y reproducible en contextos similares al del centro.

Introduction: Living donor left lateral sectionectomy is a well-established alternative in cadaveric donor pediatric liver transplantation. This procedure has proven to be safe and reproducible. However, laparoscopic approach is still under development and evidence of its feasibility is limited. Aim: The aim of this article is to present the surgical technique and postoperative outcomes of the cases of laparoscopic left lateral sectionectomy performed in this center. Materials and Method: A retrospective, observational, single center study was conducted in Hospital del Salvador. From 04/2015 - 01/2021 laparoscopic left lateral sectionectomy was offered for donor surgery. We present the surgical technique, perioperative care, and early postoperative outcomes in donors. Results: This series includes 36 patients, 25 (69%) of them were males. A total of 31 (86%) donors were mother or father of the recipient. Median age of donors was 30 years (19-45), median operative time was 360 min (240-480). All the patients underwent laparoscopic left lateral sectionectomy. Conversion was necessary in one case due to difficult management of a venous bleeding. Clavien-Dindo Morbidity III, in one patient who required endoscopic retrograde cholangiopancreatography due to an early bile leak. Median hospitalization was 4 days (3-14). There was no mortality. Conclusion: Laparoscopic left lateral sectionectomy has proven to be safe and reproducible. This technique has evolved from an innovative procedure to become the current standard of practice in our center, with excellent results in terms of morbidity and mortality.

Can COVID-19 pandemic worsen previous neurological/psychiatric diseases?

Introduction: The SARS-CoV-2 pandemic has been affecting the world since January 2020. Although its pathogenesis is primarily directed to the respiratory tract, other organs may be affected, including the nervous system. It has also been shown that the social context (confinement, lack of treatment) has affected neurological patients during this period. The aim of the study it was to assess the subjective worsening of neurological/psychiatric diseases in the context of the SARS-Cov-2 pandemic. Methods: Three groups of neurological/psychiatric patients were included: Patients who had symptomatic COVID-19 (n = 89), patients who had asymptomatic COVID-19 (n = 40), and a control group (n = 47), consisting of neurological/psychiatric patients without a history of SARS-Cov-2 infection. Results: 30.7% of the included individuals considered that their basal pathology had worsened during the study period. This feeling was significantly more frequent (P = 0.01) in patients with symptomatic COVID-19 (39.3%) than in patients of the other 2 groups (21.8%). Worsening was not related to the severity of COVID-19. The neurological conditions that significantly worsened after COVID-19, comparing symptomatic COVID-19 with the other 2 groups, were demyelinating and degenerative diseases. Conclusions: These results confirmed the impact of the SARS-Cov-2 pandemic on patients with neurological/psychiatric diseases. Confinement, lack of medical care, and the threat of diagnosis are surely contributing factors. Although the finding of a higher frequency of worsening in symptomatic COVID-19 patients may be related to greater anxiety/depression in this group of patients, we cannot exclude the role of direct affectation of the nervous system by the virus or damage due to neuroinflammation.

Introducción: La pandemia por SARS-CoV-2 afecta al mundo desde enero de 2020. Aunque su patogenia se dirige principalmente a las vías respiratorias, otros órganos pueden verse afectados, incluido el sistema nervioso. También se ha demostrado que el contexto social (confinamiento, falta de tratamiento) ha afectado a los pacientes neurológicos durante este periodo. El objetivo del estudio fue evaluar el empeoramiento subjetivo de enfermedades neurológicas/psiquiátricas en el contexto de la pandemia por SARS-Cov-2. Métodos: Se incluyeron tres grupos de pacientes neurológicos/psiquiátricos: pacientes que tenían COVID-19 sintomático (n = 89), pacientes que tenían COVID-19 asintomático (n = 40) y un grupo control (n = 47), formado por pacientes neurológicos/psiquiátricos sin antecedentes de infección por SARS-Cov-2. Resultados: El 30,7% de los individuos incluidos consideró que su patología basal había empeorado durante el período de estudio. Este sentimiento fue significativamente más frecuente (p = 0,01) en pacientes con COVID-19 sintomático (39,3%) que en pacientes de los otros 2 grupos (21,8%). El empeoramiento no estuvo relacionado con la gravedad de COVID-19. Las condiciones neurológicas que empeoraron significativamente después de la COVID-19, comparando la COVID-19 sintomática con los otros 2 grupos, fueron las enfermedades desmielinizantes y degenerativas. Conclusiones: estos resultados confirmaron el impacto de la pandemia del SARS-Cov-2 en pacientes con enfermedades neurológicas/psiquiátricas. El encierro, la falta de atención médica y la amenaza del diagnóstico son seguramente factores contribuyentes. Aunque el hallazgo de una mayor frecuencia de empeoramiento en pacientes sintomáticos de COVID-19 puede estar relacionado con una mayor ansiedad/depresión en este grupo de pacientes, no podemos excluir el papel de la afectación directa del sistema nervioso por el virus o el daño por neuroinflamación.

Xeno-free approach for the expansion of human adipose derived mesenchymal stem cells for ocular therapies.

To restore corneal transparency and vision loss after an injury on the ocular surface, the use of human stem cells from different origins has been recently proposed. Mesenchymal stem cells (MSCs) seem to be an appropriate adult source of autologous stem cells due to their accessibility, high proliferation rate, and multipotent capacity. In this work, we developed a simple culture system to prepare a graft based on a fibrin membrane seeded with human MSCs. A commercial kit, PRGF Endoret®, was used to prepare both, the growth factors used as culture media supplement and the fibrin membrane grafts. Adipose-derived MSCs (Ad-MSCs) were expanded, characterised by flow cytometry and their multilineage differentiation potential confirmed by inducing adipogenesis, osteogenesis and chondrogenesis. Ad-MSCs seeded on the fibrin membranes were grafted onto athymic mice showing good biocompatibility with no adverse reactions observed during the follow up period. These findings support the assumption that a system in which all the biological components (cells, grow factors and carrier) are autologous, could potentially be used for future ex vivo expansion of Ad-MSCs to treat ocular conditions such as an inflammatory milieu, traumatic scars and loss of the regenerative capacity of the corneal epithelium that compromise the quality of vision.

Rapid acquisition of data dense solid-state CPMG NMR spectral sets using multi-dimensional statistical analysis.

The development of multi-dimensional statistical methods has been demonstrated on variable contact time (VCT) 29Si{1H} cross-polarization magic angle spinning (CP/MAS) data sets collected using Carr-Purcell-Meiboom-Gill (CPMG) type acquisition. These methods utilize the transformation of the collected 2D VCT data set into a 3D data set and use tensor-rank decomposition to extract the spectral components that vary as a function of transverse relaxation time (T2) and CP contact time. The result is a data dense spectral set that can be used to reconstruct CP/MAS spectra at any contact time with a high signal to noise ratio and with an excellent agreement to 29Si{1H} CP/MAS spectra collected using conventional acquisition. These CPMG data can be collected in a fraction of time that would be required to collect a conventional VCT data set. We demonstrate the method on samples of functionalized mesoporous silica materials and show that the method can provide valuable surface specific information about their functional chemistry.

Increased exhaled breath temperature in subjects with uncontrolled asthma.

BACKGROUND: Increased vascularity of the airway mucosa in asthma potentially increases heat loss in the airways. OBJECTIVE: To determine if the inflamed airways of subjects with uncontrolled asthma show increased exhaled breath temperature (EBT). PATIENTS AND METHODS: In 100 patients with persistent asthma and 50 healthy volunteers, we measured lung function by post-bronchodilator forced spirometry, the asthma control test (ACT) and EBT. RESULTS: Patients with asthma, of whom 49 (49%) were female, with a mean (± standard error of the mean) age of 44 (±17) years and a predicted forced expiratory volume in one second of 71% (±16), had a significantly increased EBT, particularly those with uncontrolled asthma (n = 50, ACT ≤ 19, EBT 34.9 ± 0.8°C), compared to patients with controlled asthma (n = 50, ACT ≥ 20, EBT 33.7 ± 0.8°C) and healthy volunteers (n = 50, EBT 33.2 ± 0.2°C, P < 0.001). CONCLUSION: We observed a higher temperature on exhaled breath in subjects with uncontrolled asthma than in subjects with controlled asthma and healthy controls. The increase in exhaled breath temperature may be a proxy for a raised airway inflammatory state in asthma patients.

Alternativas de manejo de colecciones en pancreatitis aguda / Alternatives in the treatment of collections in acute pancreatitis

Acute pancreatitis is a disease that presents heterogeneously with varying severity depending on pancreatic parenchyma and peripancreatic fat. The aim of this publication is to present the nomenclature in use in the different collections that develop in the evolution of acute pancreatitis, and management options of these collections, focusing on the management of infected pancreatic necrosis; emphasizing the benefits, results and limitations of each technique and describing some techniques under development.

La pancreatitis aguda es una enfermedad que se presenta en forma heterogénea con distinta gravedad según el compromiso del parénquima pancreático y de la grasa peripancreática. El objetivo de esta publicación es dar a conocer la nomenclatura en uso en las distintas colecciones que se manifiestan en la evolución de la pancreatitis aguda y las opciones de manejo de estas colecciones, enfocándose en el manejo de la necrosis pancreática infectada; enfatizando las ventajas, resultados y limitaciones de cada técnica, además de describir algunas técnicas en desarrollo.

Migración neuronal, apoptosis y trastorno bipolar / Neuronal migration, apoptosis and bipolar disorder

El trastorno bipolar es considerado, al igual que la mayoría de los trastornos psiquiátricos, una enfermedad del neurodesarrollo. Durante dicho período, existe una marcada tasa de nacimiento y muerte neuronal. En el caso particular de los procesos que determinan la muerte neuronal, es sabido que aquellas neuronas que establecen conexiones sinápticas aberrantes deben ser eliminadas del sistema nervioso central. El trastorno bipolar cursa con un déficit de interneuronas GABAérgicas en la corteza cerebral, acompañado de una sobreexpresión de genes proapoptóticos, así como una alteración en la expresión de moléculas que median la migración de dichas neuronas y su inclusión en sinapsis funcionales durante el estadío fetal. Aquí será revisado el rol de dichas moléculas sobre las vías de muerte neuronal por apoptosis en la procura de establecer hipótesis biológicas de la génesis del trastorno bipolar(AU)

Bipolar disorder, like the majority of psychiatric disorders, is considered a neurodevelopment disease of neurodevelopment. There is an increased rate of neuronal birth and death during this development period. In the particular case of the processes that determine neuronal death, it is known that those neurons that establish connections have to be removed from the central nervous system. There is a deficit of GABAergic interneurons in the cerebral cortex in bipolar disorder, accompanied by overexpression of proapoptic genes. There is also an alteration in the expression of molecules that mediate in the migration of these neurons and their inclusion in functional synapsis during the foetal stage. The role of these molecules in the neuronal death pathways by apoptosis will be reviewed here in an attempt to establish biological hypotheses of the genesis of bipolar disorder(AU)

Identification of a locus for type I punctate palmoplantar keratoderma on chromosome 15q22-q24.

BACKGROUND: The identification of the molecular basis of disorders of keratinisation has significantly advanced our understanding of skin biology, revealing new information on key structures in the skin, such as the intermediate filaments, desmosomes, and gap junctions. Among these disorders, there is an extraordinarily heterogeneous group known as palmoplantar keratodermas (PPK), for which only a few molecular defects have been described. A particular form of PPK, known as punctate PPK, has been described in a few large autosomal dominant pedigrees, but its genetic basis has yet to be identified. AIM: Identification of the gene for punctate PPK. METHODS: Clinical examination and linkage analysis in three families with punctate PPK. RESULTS: A genomewide scan was performed on an extended autosomal dominant pedigree, and linkage to chromosome 15q22-q24 was identified. With the addition of two new families with the same phenotype, we confirmed the mapping of the locus for punctate PPK to a 9.98 cM interval, flanked by markers D15S534 and D15S818 (maximum two point lod score of 4.93 at theta = 0 for marker D15S988). CONCLUSIONS: We report the clinical and genetic findings in three pedigrees with the punctate form of PPK. We have mapped a genetic locus for this phenotype to chromosome 15q22-q24, which indicates the identification of a new gene involved in skin integrity.

Fluticasone propionate attenuates platelet-activating factor-induced gas exchange defects in mild asthma.

Inhaled glucocorticosteroids may reduce airway mucosal oedema in acute asthma. Inhaled platelet-activating factor (PAF) provokes pulmonary gas exchange disturbances, similar to those shown in severe asthma, which may be due to increased airway plasma leakage. This randomized, double-blind, placebo-controlled, crossover study investigated the effects of high doses of inhaled fluticasone propionate (FP) in 12 patients with mild asthma before and after PAF inhalation. Patients were studied before and 12 h after inhaling FP (6 mg) or placebo (P), and then at 5, 15 and 45 min after PAF challenge. Compared with vehicle, FP inhaled before PAF improved forced expiratory volume in one second and respiratory system resistance (Rrs), increased peripheral blood neutrophils and reduced eosinophil counts. After PAF, FP enhanced transient neutropenia at 5 min and facilitated the recovery of oxygen tension in arterial blood (FP: 93+/-4 mmHg; P: 83+/-4 mmHg) at 45 min, without influencing the increases in Rrs. In conclusion, the improvement of platelet-activated factor-induced oxygen tension in arterial blood disturbances after fluticasone proprionate suggests that inhaled glucocorticosteroids may possess vasoconstrictor properties in the pulmonary circulation.

Qué es la odontología basada en la evidencia? / What is evidence-based dentistry?

La gran cantidad de información que surge de las investigaciones científicas, hace que sea muy difícil mantenerse al día con los adelantos que un clínico requiere en su práctica diaria. Este artículo describe un nuevo paradigma para la práctica clínica que permite utilizar la información obtenida a través de un proceso de apreciación crítica en el cuidado de los pacientes, lo que se conoce como odontología basada en la evidencia

Chemical modification and site-directed mutagenesis of human liver arginase: evidence that the imidazole group of histidine-141 is not involved in substrate binding.

Native and wild-type recombinant human liver arginases (EC 3.5.3.1) were photoinactivated by Rose bengal, and protection was afforded by the competitive inhibitor l-lysine. The dissociation constant for the enzyme-protector complex was essentially equal to the corresponding K(i) value. Upon mutation of His141 by phenylalanine, the enzyme activity was reduced to 6-10% of wild-type activity, with no changes in K(m) for arginine or K(i) for l-lysine or l-ornithine. The subunit composition of active enzyme was not altered by mutation, but the mutant H141F was markedly more sensitive to trypsin inactivation and completely insensitive to inactivation by diethyl pyrocarbonate (DEPC) and photoinactivation. Species with histidine groups blocked with DEPC were also insensitive to photoinactivation. We conclude that His141, which is the target for both inactivating procedures, is not involved in substrate binding, but plays a critical, albeit not essential role in the hydrolysis of enzyme-bound substrate.

Evidence that histidine-163 is critical for catalytic activity, but not for substrate binding to Escherichia coli agmatinase.

Agmatinase (agmatine ureohydrolase, EC 3.5.3.11) from Escherichia coli was inactivated by diethyl pyrocarbonate (DEPC) and illumination in the presence of Rose bengal. Protection against photoinactivation was afforded by the product putrescine, and the dissociation constant of the enzyme-protector complex (12 mM) was essentially equal to the K(i) value for this compound acting as a competitive inhibitor of agmatine hydrolysis. Upon mutation of His163 by phenylalanine, the agmatinase activity was reduced to 3-5% of wild-type activity, without any change in K(m) for agmatine or K(i) for putrescine inhibition. The mutant was insensitive to DEPC and dye-sensitized inactivations. We conclude that His163 plays an important role in the catalytic function of agmatinase, but it is not directly involved in substrate binding.

Manganese is essential for catalytic activity of Escherichia coli agmatinase.

Purified Escherichia coli agmatinase (EC 3.5.3.11) expressed the same activity in the absence or presence of added Mn2+ (0-5mM). However, it was strongly inhibited by Co2+, Ni2+, and Zn2+ and almost half inactivated by EDTA. Partial inactivation by EDTA yielded enzyme species containing 0.85 +/- 0.1 Mn2+/subunit, and it was accompanied by a decrease in intensity of fluorescence emission and a red shift from the emission maximum of 340 nm to 346 nm, indicating the movement of tryptophane residues to a more polar environment. The activity and fluorescence properties of fully activated agmatinase were restored by incubation of dialysed species with Mn2+. Manganese-free species, obtained by treatment with EDTA and guanidinium chloride (3 M), were active only in the presence of added Mn2+. Results obtained, which represent the first demonstration of the essentiality of Mn2+ for agmatinase activity, are discussed in connection with a possible binuclear metal center in the enzyme.

Manganese-dependent inhibition of human liver arginase by borate.

Full activation of human liver arginase (EC 3.5.3.1), by incubation with 5 mM Mn2+ for 10 min at 60 degrees C, resulted in increased Vmax and a higher sensitivity of the enzyme to borate inhibition, with no change in the K(m) for arginine. Borate behaved as an S-hyperbolic I-hyperbolic non-competitive inhibitor and had no effect on the interaction of the enzyme with the competitive inhibitors L-ornithine (Ki = 2 +/- 0.5 mM), L-lysine (Ki = 2.5 +/- 0.4 mM), and guanidinium chloride (Ki = 100 +/- 10 mM). The pH dependence of the inhibition was consistent with tetrahedral B(OH)4- being the inhibitor, rather than trigonal B(OH)3. We suggest that arginase activity is associated with a tightly bound Mn2+ whose catalytic action may be stimulated by addition of a more loosely bound Mn2+, to generate a fully activated enzyme form. The Mn2+ dependence and partial character of borate inhibition are explained by assuming that borate binds in close proximity to the loosely bound Mn2+ and interferes with its stimulatory action. Although borate protects against inactivation of the enzyme by diethyl pyrocarbonate (DEPC), the DEPC-sensitive residue is not considered as a ligand for borate binding, since chemically modified species, which retain about 10% of enzymatic activity, were also sensitive to the inhibitor.

Caries clínicas y radiográficas en estudiantes de Odontología, Universidad de Chile: informe 1993-94-95-96 y 1997 / Clinical and radiographic diagnosis decays in dental Students: Universidad of Chile: 1993-94-95-96 - 1997

El objetivo de la presente investigación fue diagnosticar clínica y radiográficamente la presencia de caries dental, en una muestra seleccionada de adultos jóvenes, alumnos que ingresaron a 1er. año a la Facultad de Odontología. Proponer para las lesiones no cavitadas de esmalte, como tratamiento dental operatorio único terapias farmacológicas quimiopreventivas no invasivas, su aplicación durante tres años consecutivos y monitorear su control clínico a cinco años plazo. El control epidemiológico mediante el indice COP-D, realizado durante 5 años consecutivos, demostró que el promedio de caries clínica por alumno fue de 3.15 (2.9), y subió a un x 5.46 (3.7) caries con el examen radiográfico de aleta de mordida. El porcentaje de lesiones de caries no cavitadas (niveles 1 y 2), factibles de remineralizar, constituyeron el 62.4 por ciento, en relación al total de caries diagnosticadas

[Advances and obstacles in the fight against AIDS in Venezuela]. / Avances y tropiezos de la lucha contra el SIDA en Venezuela.

AIDS: It is no secret to the Venezuelan authorities that hundreds of citizens living with HIV/AIDS left the country (mainly to Canada and the United States) in search of treatment to prolong their lives. People who received treatment got better but were forced to stay in the country in order to continue the treatment. People who left in the advanced stages of AIDS returned in coffins. To assist people living with HIV/AIDS (PWAs) in Venezuela, organizations such as Citizen Action Against AIDS and United Against AIDS International have helped to bring thousands of dollars in medication to the country. They also provide emotional support to PWAs.^ieng

Prevalencia de caries y de streptococcus mutans en alumnos de primer año Facultad de Odontología, Universidad de Chile, 1994 / Prevalence of caries and streptococcus mutans in student from the first year at the school of dentistry, Universidad de Chile, 1994

Considerando que cada dia se utilizan más técnicas para evaluar "riesgo de caries", se utilizaron a través de 2 métodos microbiológicos: cuantitativo y semi-cuantitativo el recuento de colonias (UFC) de S. mutans/ml saliva, en 112 adultos jóvenes (68 mujeres y 44 hombres) estudiantes de Odontología, U. de Chile 1994, cuyo promedio de edad era 18.9 años. El porcentaje de estudiantes considerados como de alto riesgo (= a 1 x 10 elevado a 5 a 1 x 10 elevado a 6) correspondió al 31.2 porciento. En cuanto al número de caries diagnosticadas, tanto clínicas como radiográficas, en los grupos clasificados como de mayor o menor riesgo carioso, los resultados no mostraron una relación directa con el promedio de S muutans

Evaluación clínica radiográfica de caries en estudiantes de odontología 1993 / Clinical and radiographic evaluation of caries in odontology students 1993

El análisi epidemiológico realizado, índice COP-D, en estudiantes de 1er año de odontología 1993. Universidad de Chile muestra las diferencias observadas al diagnosticar caries, y compararlas con un estudio radiográfico (técnica de aleta de mordida). Los valores promedios de caries clínica en 97 alumnos corresponden a 2,64 (2,7), de un COP-D 8,66 (3,8). Al examinar a 62 de ellos mediante la técnica de aleta de mordida, los valores por caries ascendieron a un promedio de 6,1 (3,3) de un COP-D 11,05 (3,3), valor que connstituye el 55 por ciento del COP-D total. De acuerdo a la clasificación realizada la presencia de lesiones de caries muy incipientes e incipientes constituyen un valor equivalente al 63,5 por ciento del total de las caries. El promedio de edad del grupo era de 18,7 años, constituida por un 54,6 por ciento de hombres y 45,3 por ciento de mujeres

Interaction of arginase with metal ions: studies of the enzyme from human liver and comparison with other arginases.

As determined by atomic absorption, fully activated human liver arginase contained 1.1 +/- 0.1 Mn2+/subunit. Upon dissociation to inactive subunits (< 0.01 Mn2+/subunit), there was decreased intensity and a red shift in the tryptophan fluorescence emission spectra of the enzyme, and the resulting species were markedly sensitive to thermal and proteolytic inactivation by trypsin. Arginine and lysine specifically protected the subunits from heat inactivation. Subunit activation by Mn2+ followed hyperbolic kinetics (Kd = 0.08 +/- 0.01 microM). In addition to Mn2+, Ni2+ and Co2+ converted inactive subunits into active monomers, and favoured their association to the oligomeric state of the enzyme (M(r) = 120,000 +/- 2000). The replacement of Mn2+ by Ni2+ or Co2+ resulted in significant changes in Vmax without any change in the Km values for the substrates (arginine or canavanine) or the Ki value for lysine inhibition. The results support our previous suggestion (Carvajal et al., 1994) that Mn2+ is not essential for substrate binding to arginase, and substantiates the conclusion that species differences may exist in the interaction of arginase with metal ions.

[Phase II trial with navelbine + cisplatin + etoposide in the treatment of inoperable non-small cell lung carcinoma]. / Estudio en fase II de navelbine + cisplatino + etoposido en el tratamiento del cáncer de pulmón no células pequeñas inoperable.

40 patients with advanced non-small cell lung cancer not previously treated were included in a study at phase II with vinorelbine 20 mg/Sq.m days 1 and 8, etoposide 60 mg/sq.m days 1-3 and cisplatin 75 mg/sq.m day 1 each 28 days for 6 cycles. There were 31 men and 9 women, being the average age of 54 years, with "performance Status" grade 0-2. All of them could be evaluated for toxicity and 31 for responsiveness. 10 patients were in stage IIIb and 21 at stage IV. 42% of objective responses were obtained and an overall survival of 9 months, which justifies further studies.