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Introduction: Immune cell functional assay (ImmuKnow®) is a non-invasive method that measures the state of cellular immunity in immunosuppressed patients. We studied the prognostic value of the assay for predicting non-cytomegalovirus (CMV) infections in lung transplant recipients., Methods: A multicenter prospective observational study of 92 patients followed up from 6 to 12 months after transplantation was performed. Immune cell functional assay was carried out at 6, 8, 10, and 12 months., Results: Twenty-three patients (25%) developed 29 non-CMV infections between 6 and 12 months post-transplant. At 6 months, the immune response was moderate (ATP 225-525ng/mL) in 14 (15.2%) patients and low (ATP<225ng/mL) in 78 (84.8%); no patients had a strong response (ATP≥525ng/mL). Only 1 of 14 (7.1%) patients with a moderate response developed non-CMV infection in the following 6 months compared with 22 of 78 (28.2%) patients with low response, indicating sensitivity of 95.7%, specificity of 18.8%, positive predictive value (PPV) of 28.2%, and negative predictive value (NPV) of 92.9% (AUC 0.64; p=0.043). Similar acute rejection rates were recorded in patients with mean ATP≥225 vs. <225ng/mL during the study period (7.1% vs. 9.1%, p=0.81)., Conclusion: Although ImmuKnow® does not seem useful to predict non-CMV infection, it could identify patients with a very low risk and help us define a target for an optimal immunosuppression., (Copyright © 2021 SEPAR. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Long-term survival of lung transplantation (LT) patients is mainly limited by the development of chronic lung allograft dysfunction (CLAD). Lung retransplantation (LR) is an alternative for a selected population. The aim of this study was to review the LR experience in our center., Patients and Methods: We conducted a retrospective study of patients undergoing LR between August 1990 and July 2017., Results: Fourteen LR out of a total of 998 (1.4%) LT were performed. Twelve patients (85.7%) underwent LR due to CLAD: 10 (71.4%) because of bronchiolitis obliterans syndrome and 2 (14.3%) due to restrictive allograft syndrome. LR was performed in 2 patients within 30 days of the first LT. In those who underwent LR due to CLAD, mean time between the first LT and LR was 48 months, and mean duration of invasive mechanical ventilation was 32 days. The increase in FEV 1 after LR was 24±18%. The best spirometry values were observed after 7.3 months. Mean survival of the cohort was 43.8 months. In patients with bronchiolitis obliterans syndrome, mean survival was 63.4 months, while in those with restrictive allograft syndrome, it was 19.5 months. Only 1 of the 2 early LR patients survived., Conclusion: LR is a therapeutic option in selected patients with CLAD, with acceptable survival. Indication for LR early after LT shows poor outcomes., (Copyright © 2018 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: COPD and emphysema due to alpha-1 antitrypsin deficiency (AATD) are the first and fourth indications for lung transplantation worldwide, respectively. Despite this, there is little information regarding the health status of these patients at the time of transplantation., Methods: Patients who received a lung transplant in the Hospital Vall d'Hebron between July 1993 and August 2013 were identified and data from the evaluation prior to the transplant were collected., Results: A total of 217 patients who received a lung transplant for COPD and 19 in whom the indication was AATD were included. These patients were severely impaired at the time of the evaluation for lung transplantation, although the trend in recent years has been to evaluate patients at earlier stages of the disease. Baseline characteristics were similar in both groups except that patients with AATD were younger [43 (7.7) vs. 53.6 (6.1) years old, P<.001], with less exposure to tobacco [23.9 (15) vs. 50 (29) packs-year, P<002] and lower PCO2 [41.7 (7.6) vs. 47.9 (9.7) mmHg, P<.004]., Conclusions: The number of patients receiving a lung transplant for COPD has progressively increased and the tendency is to perform the evaluation in earlier stages of the disease. Patients receiving transplants for COPD and AATD had similar characteristics at the time of the evaluation, although AATD patients were younger and had less exposure to tobacco and lower PCO2., (Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.)

Treatment of pulmonary arterial hypertension has achieved significant progress over the past 20 years. Currently, 3 groups of drugs have proven useful for the treatment of this disease: endothelin receptor antagonist, phosphodiesterase inhibitors and prostacyclin and its analogues. It is recommended to initiate treatment with one of these drugs, the choice depending on the initial severity of patient disease and the preferences of the treating physician. When the patient does not have a satisfactory response, new drugs acting at a different pathway are most commonly added. At this time, considering referral for lung transplantation could be an alternative. Most experts recommend grouping maximum experience in what is known as expert centers. Treatment has led to better survival in these patients, but there is still a long way to cure this life-threatening disease., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Pathogenic bronchopulmonary colonizations and the exacerbations produced are among the most important causes of reduced pulmonary function in patients with bronchiectasis. The most frequent pathogens in these patients are Haemophilus influenzae and Pseudomonas aeruginosa. Lesions are produced by the local inflammatory process and the vicious circle developed by antigen stimulation, the release of inflammatory mediators, the presence of neutrophils, the increase of bacterial inoculum and the release of bacterial exoproducts. P. aeruginosa has been demonstrated to affect the patients with bronchiectasis and poorest quality of life and to colonize those with the poorest pulmonary function and the highest number of antimicrobial treatments. In bronchiectasis, as in chronic obstructive pulmonary disease (COPD) or cystic fibrosis, P. aeruginosa is able to colonize the respiratory mucosa chronically. Due to the ecological niche occupied by P. aeruginosa and the multitude of cycles with antimicrobial agents to which these patients are subjected, the development of antimicrobial resistance is highly likely, encouraged by the high proportion of hypermutation variants in existence. Likewise, P. aeruginosa naturally grows in the form of biofilms on the mucosal surface, greatly contributing to its persistence. Antimicrobial treatment in patients with bronchiectasis and P. aeruginosa colonization should be based on antimicrobial agents, alone or in combination, that do not lose activity when acting on biofilms., (Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.)

Background: Laparoscopic approach is widely used in our country. This technique has dramatically improved the outcome after surgery, reducing pain, morbidity, hospital stay, and promoting early patient mobilization., Objective: This study presents 10 years experience and the first 100 adrenalectomies using laparoscopy performed between 1996 and 2007 in Hospital La Fe, Valencia, Spain., Methods: A descriptive and prospective study was designed, 100 consecutive cases were included. Sixty-seven variables were analysed; these variables were influenced by factors depending on patient susceptibility, surgical technique, surgeon, as well as in-surgery and post-surgery complications., Results: None of the patients in our series died. In the follow-up, only minor complications were reported: nosocomial pneumonia (1 patient), small eventration (2 patients), haematomas (2 patients), and infection at surgery site (2 patients). None of the complications required surgery., Conclusions: We conclude that adrenalectomy by the laparoscopic approach could be the gold standard technique in a variety of patients with adrenal tumours. However, these should be performed within a specialised endocrinology surgery unit., (Copyright 2008 AEC. Published by Elsevier Espana. All rights reserved.)

Introduction: Listeria monocytogenes is an unusual pathogenic agent in the general population, but is an important cause of bacteriemia and meningoencephalitis among newborns, pregnant women, the elderly population, and immunosuppressed patients. In rare cases, it has been described in joint prosthesis infections., Methods: A case description of prosthetic joint infection caused by Listeria in a 74-year-old man is presented. A systematic review of the literature (MEDLINE up to November 2007) was performed, and the reported cases are summarized., Results: Sixteen cases of prosthetic joint infection by L. monocytogenes have been reported, mainly in patients of advanced age (mean, 67.4 years; mode, 70 years) and immunosuppressed patients. Most cases were late infections., Conclusion: L. monocytogenes should be kept in mind as a pathogen involved in joint prosthesis infection, particularly among the elderly and immunosuppressed populations. Based on the literature review, parenteral ampicillin for at least 6 weeks is the treatment of choice. If possible, prosthesis removal should also be performed.

Background: Pulmonary hypertension is a serious disease that, in its terminal phase, requires lung transplantation., Patients and Methods: A retrospective study was undertaken of 15 patients with pulmonary hypertension who underwent lung transplantation between 1994 and 2004. Clinical data recorded before the procedure and during follow-up were reviewed., Results: Pulmonary hypertension was reported as idiopathic in 8 patients (53%) and related to consumption of toxic oil in 2. The remaining causes were documented as chronic peripheral pulmonary embolism, histiocytosis X, venoocclusive disease, scleroderma, and simple corrected congenital heart defect in 1 patient each. The mean values of the hemodynamic variables were 100, 50, and 67 mm Hg for systolic, diastolic, and mean pulmonary artery pressure, respectively; 2.63 L/min for cardiac output; and 20.9 Wood units for total pulmonary resistance. The mean time between diagnosis of pulmonary hypertension and lung transplantation was 5.9 years (range, 0.4-20 y). Seven patients were in functional class III and 8 in functional class IV. The mean 6-minute walk distance was 204 m (range, 0-360 m). Four patients (26%) died during the during the perioperative period and 9 (60%), 7 (46%), and 6 (40%) were still alive at 1, 3, and 5 years, respectively., Conclusions: Double-lung transplantation is a therapeutic option that, in certain cases, has similar outcomes to those achieved with the most aggressive medical treatment for pulmonary hypertension.

Two cases are reported of spontaneous ascitic fluid Candida albicans peritonitis in two patients with liver cirrhosis secondary to HBV. In non of the two cases was there evidence of findings associated with secondary peritonitis, where ascitic fluid Candida infection has usually been reported.

Background: A one year prospective study was carried out to assess the etiology of community-acquired pneumonia (CAP), and also to know the incidence, characteristics and evolution of infection by Chlamydia pneumoniae; and the effectiveness of DNA probes in CAP due to Mycoplasma pneumoniae and Legionella., Methods: One hundred and ten patients with a diagnosis of CAP in the emergency department were studied. Serologic studies were performed, and also tests commonly used for the diagnosis of respiratory tract pathogens in respiratory samples, including serology and culture of Chlamydia pneumoniae and DNA probes for Mycoplasma pneumoniae and Legionella., Results: In 72 cases (71.3%) some pathogen was found and in 5 cases more than one microorganism was involved. The etiology was bacterial in 31% of the cases, with S. pneumoniae being the most frequent (19 cases). Forty percent of the cases were "atypical" pneumonias with 33 cases of M. pneumoniae and 5 by Chlamydia pneumoniae. Diagnostic data of viral pneumonia were found in 2 cases. DNA probes were not useful for the diagnosis of pneumonia by Legionella pneumophila and had low effectiveness (31.8%) in Mycoplasma pneumoniae CAP., Conclusions: a) M. pneumoniae was the most frequent pathogen (33%). b) DNA probes for M. pneumoniae had low sensitivity in sputum (31.8%) and none in pharyngeal exudate. c) Acute infection by C. pneumoniae was diagnosed in 5 cases. Previous data of infection were recorded in 60.4% of the patients. d) Bacterial pneumonia (31%) was underestimated due to a low rate of bacteremic cases (7.9%) and the low number of positive cultures with definitive diagnostic value. e) The evolution was good except in two cases (death due to staphylococcal pneumonia with alcohol withdrawal syndrome and multiorganic failure by disseminated chicken-pox).

We show a case of right neck abscess, in which the Eikenella corrodens, acted as pathogen together which other microorganism. We call attention to this germ that has a slow growing in culture and generally intervene in infections in which it is assumed the presence of anaerobic germs (intrathoracic abscess, neck abscess, etc.) and the are habitually treated with clindamycin, antibiotic which Eikenella corrodens is systematically resistant (to this antibiotic).

The recovery rate of Moraxella catarrhalis in a selective culture medium with acetazolamide and in a conventional blood-agar medium was compared from 1291 samples from the respiratory tract and conjunctivae of children and adults with respiratory and ocular symptomatology. M. catarrhalis was recovered in 215 samples on the acetazolamide medium, and only. 18 cases in the blood agar medium (p < 0.001). The highest recovery of M. catarrhalis was in samples with an accompanying flora, either pathogenic or commensal, such as pharyngeal and nasal exudates. The prevalence of M. catarrhalis in adults and children was 2% and 28%, respectively. We therefore, recommend the use of the acetazolamide medium for the recovery of M. catarrhalis in samples where M. catarrhalis is expected to be present with an accompanying flora.

During a 2 years period the serological markers of viral infections were evaluated in the semen of 24 donors who were involved in assisted reproduction techniques. The presence of cytomegalovirus, hepatitis B virus and human immunodeficiency virus were investigated. The results were as expected, no data of viral infection at the time of donation being found because the study population was a highly selected one. Taking into account all the known microorganisms that can be transmitted through semen, a protocol for the prevention of infections in the mother and in the prospective newborn is suggested.