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Objective: The time at which lung transplantation is indicated is determined by clinical and functional criteria that vary according to the particular disease. The aim of our study was to present the criteria according to which patients were placed on waiting lists for lung transplantation in our hospital., Patients and Methods: We analyzed retrospectively the clinical characteristics, lung function, heart function, and 6-minute walk test results of patients who had received a lung transplant in our hospital from January 2002 through September 2005., Results: During the study period 100 lung transplants were performed. The mean age of the patients was 45 years (range, 15-67 years) and 57% were men. The diseases that most often led to a lung transplant were chronic obstructive pulmonary disease (COPD) (35%), pulmonary fibrosis (29%), and bronchiectasis (21%). Lung function values differed by disease: mean (SD) forced expiratory volume in 1 second (FEV1) was 20% (11%) and forced vital capacity (FVC) was 37% (15%) in patients with COPD; FEV1 was 41% (15%) and FVC, 40% (17%) in patients with pulmonary fibrosis; and FEV1 was 23% (7%) and FVC, 37% (10%) in patients with bronchiectasis., Conclusions: The patients who received lung transplants in our hospital were in advanced phases of their disease and met the inclusion criteria accepted by the various medical associations when they were placed on the waiting list.

Objective: New endoscopic techniques have been developed as an alternative to surgical treatment of bronchopleural fistula. The objective of this study was to analyze our experience with endoscopic treatment of such fistulas., Material and Methods: We conducted a retrospective study of patients with bronchopleural fistula diagnosed by fiberoptic bronchoscopy. Patient characteristics, underlying disease, fistula size, and outcome of endoscopic treatment were analyzed. The endoscopic technique consisted of injection of fibrin sealants (Histoacryl and/or Tissucol) through the catheter of the fiberoptic bronchoscope., Results: Between 1997 and 2004, 18 patients were diagnosed with bronchopleural fistula by fiberoptic bronchoscopy. All were men with a mean (SD) age of 62 (12) years. Bronchopleural fistula was diagnosed after neoplastic surgery in 16 patients, in the bronchial suture after lung transplantation in 1 patient, and concurrently with pleural effusion due to hydatidosis in the remaining patient. The size of the fistula ranged from 1 mm to 10 mm (mean 3.6 [2.7] mm). Fibrin sealants were applied in 14 patients, 2 underwent direct surgery after diagnosis, and the bronchopleural fistula closed spontaneously in the remaining 2. The fibrin sealant used was Histoacryl in 12 patients and Tissucol in 2. Pleural drainage was employed simultaneously and antibiotic therapy was administered at the discretion of the surgeon. The 4 patients whose bronchopleural fistula was associated with empyema also underwent pleural lavage. In 12 patients the fistulas closed as a result of the endoscopic technique (85.7%), and no complications were observed. For 85.7%, fewer than 3 applications of fibrin sealant were necessary., Conclusions: The success rate of closure of bronchopleural fistula with fibrin sealants injected under guidance with fiberoptic bronchoscopy is high and there are no complications. This technique can render surgery unnecessary.

Objective: Lung transplantation is a valid therapeutic approach for patients with bronchiectasis. The objective of the present study was to evaluate our experience with bronchiectasis patients and compare the results in patients with cystic fibrosis to results in those with bronchiectasis caused by other processes., Patients and Method: We carried out a retrospective study of bronchiectasis patients treated by lung transplantation in order to analyze demographic, functional and microbiological characteristics before and after transplantation, and survival., Results: From 1991 to 2002 lung transplants were performed on 171 patients, 44 of whom had suppurative lung disease (27 had cystic fibrosis and 17 had bronchiectasis caused by other processes). There were no significant differences in the demographic variables between the 2 groups. At transplantation, lung function variables showed severe bronchial obstruction (mean [SD] forced expiratory volume in 1 second of 808 [342] mL and forced vital capacity of 1,390 [611] mL) and respiratory insufficiency (PaO2 at 52 [10] mm Hg and PaCO2 at 48 [9] mm Hg). Only PaO2 was significantly lower in patients with bronchiectasis from causes other than cystic fibrosis. Airway colonization was present in 91% of the patients; Pseudomonas spp germs were detected in 64% of the cases and were multiresistant in 9%. In the early postoperative period germs were isolated in 59% of the cases, half of which involved the same germ as had been isolated before transplantation. One year after lung transplantation, 34% of the patients continued to have bronchial colonization. Survival at 1 year was 79% and at 5 years, 49%, with no significant difference between the patients with cystic fibrosis and those with other suppurative diseases, nor between the patients with and without Pseudomonas colonization. Only 2 patients had died of bacterial pneumonia at 1 month after transplantation., Conclusions: Although airway colonization in patients with suppurative diseases complicates postoperative management, the results in terms of survival are good.

Constipation has an effect in traumatology and orthopedic surgery as a real and potential problem capable of increasing disease-caused mortality related to the slowness of feces in the intestinal tract; furthermore, constipation contributes manifestly to an alteration in a patient's well-being. In spite of this, there are very few studies in this area of knowledge in nursing and the majority of cases, constipation is considered to be a secondary problem among general treatment plans for trauma patients' linked to a syndrome of disuse due to being bedridden. In this study, the authors have tried to point out the magnitude and the clinical importance constipation has in trauma ward patients as well as create a treatment protocol which has some specific treatments which permit a standardization of nursing care provided to at risk patients. To develop this, the authors have carried out a comparative study following the directions established by the Process of Nursing Treatment as the paradigm for the application of the scientific method in professional practice. The evaluation of the results obtained in this study let the authors conclude that the adoption of this standardized protocol which we present for treatment of constipation suffered by trauma ward patients improves the pattern of bowel movements by patients hospitalized with fractures in their inferior extremities without having backbone complications.

Introduction: In 1977 silica was listed as a group 1 carcinogen (demonstrated in humans) by the International Agency for Research on Cancer. However, conflicting results from various studies have kept debate alive as to its carcinogenic capacity. The interest of this debate lies in the large number of workers exposed to silica., Objective: To analyze the differential characteristics of lung cancer among silica exposed and silica non-exposed individuals, to identify indirectly a possible carcinogenic effect of silica., Methods: For all males with a diagnosis of lung cancer over a period of 22 consecutive months at the National Silicosis Institute (Oviedo, Spain), we recorded work history, age, smoking habits, spirometry, the presence of pneumoconiosis and histology., Results: Comparing the results for silica exposed and non-exposed individuals, we found significant differences for age (63.7 8.8 and 66.7 8.6 y, respectively; p < 0.05), smoking (44.1 22.4 and 48.9 22.3 packs/year; p < 0.05) and a Tiffeneau index under 70% (in 78% of exposed vs. 55% of non-exposed patients; p < 0.05). No significant differences in histology, signs and symptoms or radiographs were observed between the two groups. In the multifactorial analysis in function of age of onset, exposure to silica continued to be an independent predictor., Conclusion: Our results show that the clinical and radiological signs and histology of patients exposed or non-exposed to silica did not differ. However, lung cancer appears earlier among individuals with work-related exposure to silica and lower rates of tobacco smoking, suggesting some carcinogenic effect for silica.

Background: Fungal infections are a frequent cause of morbidity an mortality in transplant recipients. Aspergillus spp. is an ubiquitous fungus capable of producing diverse clinical entities with varying severity., Objective: To study the incidence and severity of Aspergillus spp. infections in lung transplantation, analysing the different clinical presentations and response to antifungal drugs., Methods: A review was made of the clinical histories of all patients undergoing lung transplantation who developed positive Aspergillus spp. cultures in our centre between June 1991 and December 1996., Results: Eleven of 49 transplanted patients (22%) developed Aspergillus spp. infections. Four patients presented invasive aspergillosis forms and 7 tracheobronchitis. In spite of antifungal treatment 3 patients (30%) died of invasive aspergillosis as a direct consequence of the infection. Of the 7 patients with tracheobronchitis, 2 were ulcerative and 1 pseudomembranous, all responded to antifungal treatment. Three patients (10.3%) developed Aspergillus spp. infections despite prophylaxis with itraconazole., Conclusion: Invasive aspergillosis in the immediate posttransplant period was mortal despite treatment. As opposed, aspergillar tracheobronchitis have been overcome using combined treatments of liposomal or lipidic amphotericin, itraconazole and nebulised amphotericin.

Unlabelled: Retrospective analysis of cystic fibrosis patients who underwent pulmonary transplantation at Clínica Puerta de Hierro, Madrid, and at Hospital La Fe, Valencia. Since the beginning of the programme and until March 1998, a total of 63 patients with cystic fibrosis were studied. Among transplanted patients, 18 were males and 16 females, with a mean age of 18.9 years. All patients underwent sequential bilateral pulmonary transplantation. After transplantation, the most common complication was bacterial pneumonia which affected all patients. Six patients had dehiscence or stenosis of the bronchial suture. Other specific complications of this condition by frequency were intestinal obstruction and diabetes mellitus. Six patients developed obliterans bronchiolitis and one of them underwent a repeat transplantation. Three out of the 34 patients died, and the likelihood of survival after one and three years was 94%. Respiratory function tests and PaO2 peaked at sixth post-transplantation month., Conclusion: Pulmonary transplantation is a therapeutic option to be considered for the patient with cystic fibrosis and severe involvement of his/her pulmonary disease.

The objective of this study was to analyze patient survival after lung transplants performed at the Puerta de Hierro clinic in Madrid (Spain) between 1991 and 1996. Survival probability was 65% after one year and 50% after three years. We found no significant differences in survival related to sex or type of transplant. Early survival tended to be higher for the last two years analyzed (71%) than for the first two (55%) (p < 0.00001). The rate was 100% for patients with cystic fibrosis and 0% for pulmonary hypertension and lymphangiomyomatosis. Short- and medium-term lung function results were good in surviving patients who did not develop obliterating bronchiolitis. We conclude that actuarial survival after lung transplant in our program is comparable to that reported in the literature. There are no significant differences related to sex, type of transplant or period. Survival varies greatly, however, depending on disease.

Lung transplantation has become the therapeutic hope of terminal respiratory patients. Infections are among the main causes of morbidity and mortality in these patients. We therefore analyze infections suffered after lung transplants performed at Clínica Puerta de Hierro over a two-year period. The cases of 14 transplanted patients, 6 bilateral and 8 unilateral, were analyzed. Pre-transplant data available for all included analysis of serum antibodies to several viruses, as well as bacterial and fungal cultures, and Ziehl's sputum test. All received prophylactic antibiotic, antifungal and antiviral treatment according to protocol. The bronchial aspirate of the donor, and recipient specimens of bronchial aspirate, bronchoalveolar lavage and biopsies obtained by bronchoscopy after transplantation were cultured. Bronchoscopies were performed according to protocol, based on clinical picture. Other cultures were obtained as needed. We recorded 27 respiratory infections, among which 4 were pneumonia transmitted by the donor, 3 were tuberculosis, 3 were Aspergillus infections, 5 were cytomegalovirus pneumonitis and one, P. carinii pneumonia. Lung infections have a strong impact on outcome of lung transplant patients. Knowledge of the chronological development of infections made appropriate prophylaxis and early detection possible, such that survival during the first two years after transplantation was approximately 70% in our hospital.