Prevalence and management of gastrointestinal complications in lung transplant patients: MITOS study group.

INTRODUCTION: No studies have yet been performed to evaluate the prevalence of gastrointestinal (GI) complications in solid organ transplant recipients in Spain. MATERIALS AND METHODS: An observational, cross-sectional study to evaluate the prevalence and management of GI complications in transplanted patients was conducted via a written questionnaire given to doctors at their practice. RESULTS: A total of 58 lung transplant recipients were included. Their mean age was 52.6 +/- 10.8 years; 65% of the patients were men; and the mean time since the transplant was 2.1 +/- 2.3 years. GI complications were seen in 48.6% of the lung transplant patients. Regarding the management, the most frequently used measure was the prescription of gastric protectors (70.5%). In seven patients, the immunosuppressive treatment was also modified (reduced, discontinued temporarily, or discontinued permanently); however, the figure is so low that no conclusions can be drawn from this result. CONCLUSIONS: The prevalence of GI complications in lung transplant was over 50%, and these complications affected patients' daily activities in most cases. In lung transplant recipients, there was a higher prevalence of nausea and abdominal pain and a lower of diarrhea and dyspepsia than what was observed in other type of transplant recipients.

[Ectopic ACTH syndrome (author's transl)]. / Síndrome de ACTH ectópica.

Ectopic ACTH syndrome is a clinicopathologic condition produced by certain tumors which release hormone that is indistinguishable from ACTH. It orginates the chemical and clinical anomalies characteristic of Cushing's syndrome by its action on the adrenal glands. The tumors may be present in any organ, though they are most frequently found in the lungs, thymus, pancreas or gastrointestinal tract. They may be benign or malignant, though usually the latter. Secretion of the hormone is completely autnomous; it is release in a way similar to that of the hypophysis. Not infrequently other hormones besides ACTH are also produced, such as MSH, serotonin, and CRF. Ectopic ACTH is of higher molecular weight than hypophyseal ACTH, which suggest it may be comprised of the latter bounded covalently to a peptide. The clinical course is rapid, so that not all of the symptoms of Cushing's syndrome develop. Moon face, osteoporosis, and obesity are typically lacking; melanodermia and hypokalemic alkalosis ofter appear. Laboratory data include an increase in ACTH and cholesterol concentrations, disappearance of the nictameral rhythm, and an increase in urinary excretion of 17-hydroxycorticoids and 17-ketosteroids. Stimulation and supression tests are abnormal. The prognosis is poor and the only possible treatment is a complete surgical removal of the tumor. Irradiation or chemotherapy could be applied as well as the correction of the adrenal hyperfunction by the administration of drugs or by total bilateral adrenalectomy.

[Pulmonary hypertension secondary to multiple pulmonary thromboembolisms due to thrombosis of the right subclavian vein]. / Hipertensión pulmonar secundaria a tromboembolismos pulmonares múltiples por trombosis de la vena subclavia derecha.

Deep venous thrombosis of the upper limbs is a rare entity which is usually associated to a high number of risk factors, with an incidence of 12.4% approximately, although the development of associated fatal complications is rare. We present the case of a patient without known risk factors who, in the course of a thrombosis at the right subclavian vein, developed very severe pulmonary hypertension secondary to multiple pulmonary embolism.

[Measurement of pulmonary function in laryngectomized patients]. / Medición de la función pulmonar en pacientes laringectomizados.

Comparative study upon clinic, radiological and spirometric parameters in 30 laryngectomees, which were spirometric tested by means of a device either simple, cheap, speed and efficient, designed by the AA. These are the conclusions drown out: 1st. There is a poor correlation clinic-functional in patients with obstructive pathology (which command, in the AA's opinion an exploration of the respiratory function in all laryngectomees). 2nd. On the contrary, there are a good radiological and functional correlation in patients suffering for restrictive disease (here the assessment functional means the quantification of the restrictive process). And 3rd. The laryngectomees show a higher functional affectation and can be expected if related to the age and sex. The explanation is to be found in the intercurrent diseases and also in the infections following the larynx removal.