RESUMEN
Selection criteria for lung donation were based on initial experiences with lung transplantation without further studies to improve them, thereby guaranteeing the best use of donated organs. A definition of an extended criteria donor is therefore required to obtain more lungs to meet the demands of patients awaiting transplantation. Studies have been reviewed for the impact on survival and morbidity of age ranges, oxygen fraction, cause of death, smoking habits, x-ray findings, infection, hepatitis serology and non-heart-beating status, seeking to support physicians to make decisions regarding the use of marginal organs.
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Trasplante de Pulmón , Guías de Práctica Clínica como Asunto , Donantes de Tejidos , HumanosRESUMEN
BACKGROUND: Advanced age has been a relative contraindication to lung transplantation. However, the exact age limit for this procedure has not yet been established. The aim of this work is to present our experience with this particular group. METHODS: This retrospective review included medical charts of patients who underwent lung transplantation at our institution from January 2004 to February 2009: namely, 112 cadaveric lung transplants with 12 patients (10.7%) >65 years old. RESULTS: There were 9 male patients and the overall mean age was 68 years (range 66-72). The indications were pulmonary fibrosis in 8 and emphysema in 4 cases. Four patients had mild coronary artery disease and 4 systemic hypertension. All of the procedures were unilateral and only 2 required extracorporeal circulation. Only 5 patients received blood product transfusions intraoperatively; the mean ischemic time was 222 minutes. Four patients developed primary graft dysfunction, the mean requirement for mechanical ventilation was 30 hours, and the mean intensive care unit stay, 11 days. Postoperative complications were respiratory infections (n = 8), catheter-related infection (n = 1), atrial fibrillation (n = 2). The mean hospital stay was 28 days and the 1-year survival was 75%. CONCLUSION: Lung transplantation is a feasible option for well-selected patients with end-stage pulmonary disease who are >65 years old. Our study reinforces the modern trend for unilateral procedures in this situation.
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Trasplante de Pulmón , Anciano , Estudios de Factibilidad , Femenino , Humanos , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Lymphangioleiomyomatosis (LAM), a rare cystic disease characterized by proliferation of smooth muscle cells in the lung interstitium, almost exclusively affects females in their reproductive years. Lung transplantation has been established as effective therapy for end-stage pulmonary LAM. METHODS: This retrospective study includes lung transplantation patients with LAM at a single institution between 1989 and 2009. RESULTS: During the study period we performed 300 lung transplantations, and in 10 cases the recipients had LAM. All patients were females with a mean age of 43.8 years. The mean time from the diagnosis to lung transplantation was 5 years. Seven patients had experienced previous pneumothoraces, five of whom were treated with pleurodesis. In all patients we performed a single-lung transplantation (left-sided = 9 and right-sided = 1). In three cases, the pleurodesis was on the same side as the transplantation, with great intraoperative bleeding in one subject (left pleurectomy). There was one early death due to infective endocarditis at posttransplant day 19. The median length of mechanical ventilation was 13 hours, while the mean hospital stay was 16.75 days. There was no case of chylothorax. Late complications included one case of native lung pneumothorax, one diaphragmatic hernia, one posttransplant lymphoproliferative disease, one respiratory sepsis, and one mycobacterial infection. The 1- and 3-year survival rates were 90% and 80%, respectively. CONCLUSION: Lung transplantation is a feasible therapeutic option for patients with LAM, despite previous ipsilateral pleurodesis. The left-sided predilection for our procedures may have been responsible for the absence of chylothorax in this series.
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Trasplante de Pulmón , Linfangioleiomiomatosis/cirugía , Adulto , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Peripheral bronchial carcinoids are uncommon. Their presentation as synchronous tumors is rare and limited to anecdotal cases.We report the case of a 62-year-old female with the radiological finding of multiple bilateral nodular lesions. Bilateral sequential thoracotomies were performed and all three nodules were treated by sublobar resections. Pathological examination revealed all specimens to be carcinoid tumors and subsequent investigation confirmed the lung as the primary site. A review of previous cases of multiple carcinoids is presented and the particularities of their management are discussed.
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Neoplasias de los Bronquios/patología , Tumor Carcinoide/patología , Neoplasias Primarias Múltiples , Neoplasias de los Bronquios/diagnóstico por imagen , Neoplasias de los Bronquios/cirugía , Tumor Carcinoide/diagnóstico por imagen , Tumor Carcinoide/cirugía , Femenino , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Toracotomía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Cis -diamminedichloroplatinum(II) (CP), an important antineoplasic drug, shows remarkable toxicity to the kidney. Methods to reduce CP nephrotoxicity include the use of sodium selenite. The aim of the present study was to investigate the interaction between orally administered selenium and CP in the rat. After observing the effects of CP on body growth rate, urinary volume, serum creatinine, serum selenium levels, creatinine clearance, renal malondialdehyde, and glutathione levels, as well as on renal light microscopically visible lesions, the effects of the sodium selenite administration by gavage of 2 mg per kg of body wt. 24 h and 1 h prior to a single CP intraperitoneal injection of 5 mg per kg of body wt. followed by its daily administration for the 7 subsequent days on these parameters, were examined. CP increased renal malondialdehyde, renal glutathione, and serum creatinine and decreased creatinine clearance. Lipid peroxidation is one of the mechanisms by which CP induces renal damage. Selenium treatment decreased the effect of CP on serum creatinine, and renal malondialdehyde levels, but did not affect the other parameters with the exception of kidney necrosis which was also diminished by this treatment.
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Antineoplásicos/toxicidad , Cisplatino/toxicidad , Riñón/efectos de los fármacos , Riñón/patología , Selenio/administración & dosificación , Administración Oral , Animales , Antineoplásicos/antagonistas & inhibidores , Peso Corporal/efectos de los fármacos , Cisplatino/antagonistas & inhibidores , Creatinina/sangre , Glutatión/metabolismo , Intubación Gastrointestinal , Masculino , Malondialdehído/metabolismo , Ratas , Ratas WistarRESUMEN
Cisplatin (c-DDP) is a widely used antineoplastic drug whose main side effect is nephrotoxicity. Selenium, administered intravenously or intraperitoneally, has been shown to provided protection against c-DDP-induced nephrotoxicity in rats. In the present study, the protective effect of orally administered sodium selenite on c-DDP toxicity was further examined. Animals treated with c-DDP alone showed increased urinary volume, decreased creatinine clearance (GFR), and a rise in urinary N-acetyl-(beta-D-glucosaminidase) (NAG) isoenzyme B activity. When sodium selenite was given prior to c-DDP, rats showed less GFR decline, delayed urinary volume increases, and no urinary NAG isoenzyme B activity increment. It is suggested that a single oral dose of sodium selenite given prior to c-DDP administration, although not preventing deterioration of renal function, partially protects rats from early proximal tubular injury.