S. García Barajas

OBJECTIVE: Little information is available on postoperative morbidity and mortality after pulmonary metastasectomy. We describe the postoperative morbidity and mortality in a large multicentre series of patients after a first surgical procedure for pulmonary metastases of colorectal carcinoma (CRC) and identify the pre- and intraoperative variables influencing the clinical outcome. METHODS: A prospective, observational and multicentre study was conducted. Data were collected from March 2008 to February 2010. Patients were grouped into Groups A and B according to the presence or absence of postoperative complications. Variables in both groups were compared by univariate and multivariate analyses. P-values of <0.05 were considered statistically significant. RESULTS: A total of 532 patients (64.5% males) from 32 hospitals were included. The mean (SD) ages of both study groups were similar [68 (10) vs 67 (10) years, P = NS). A total of 1050 lung resections were performed (90% segmentectomies or wedge, n = 946 and 10% lobectomies or greater, n = 104). Group A included 83 (15.6%) patients who developed a total of 100 complications. These included persistent air leaks in 18, atelectasis in 13, pneumonia in 13, paralytic ileum in 12, arrhythmia in 9, acute respiratory distress syndrome in 4 and miscellanea in 31. Reoperation was performed in 5 (0.9%) patients due to persistent air leaks in 4 and lung ischaemia in 1. The mortality rate was 0.4% (n = 2). Causes of death were sepsis in 1 patient and ventricular fibrillation in 1. In the multivariate analysis, lobectomy or greater lung resection [odds ration (OR) 1.9, 95% confidence interval (95% CI) 1.04-3.3, P = 0.03], respiratory co-morbidity (OR 2.3, 95% CI 1.1-4.6, P = 0.01) and cardiovascular co-morbidity (OR 2, 95% CI 1-3.8, P = 0.02) were independent risk factors for postoperative morbidity. Video-assisted surgery vs thoracotomy showed a protective effect (OR 0.3, 95% CI 0.1-0.8, P = 0.01). CONCLUSIONS: The first episode of lung surgery for pulmonary metastases of CRC was associated with very low mortality and reoperation rates (<1%). The postoperative morbidity rate was 16%. Independent risk factors of postoperative morbidity were major lung resection and respiratory and/or cardiovascular co-morbidity. Video-assisted surgery showed a protective effect.

FUNDAMENTO: valorar la eficacia de roxitromicina en pacientes asmaticos con titulaciones de IgG frente a Chlamydia pneumoniae ≥ 1:16. METODOS: estudio doble ciego, randomizado y control con placebo en el que han participado 92 asmaticos de entre 183 enfermos con titulaciones de IgG frente a C. pneumoniae ≥ 1:16 (Microinmunofluorescencia Indirecta, MIF, MRL Diagnostic, EE.UU.). 41 asmaticos recibieron 300 mg de roxitromicina via oral al dia durante 21 dias y otros 51 asmaticos placebo durante igual periodo de tiempo. Seguimiento serologico (IgG, IgE) y clinico mediante entrevistas las semanas 0 (primer dia de tratamiento), 4a, 8a y 26a. RESULTADOS: el 61,2% de los asmaticos adultos del Area de Salud de Lucena-Cabra-Montilla presentan titulaciones de IgG frente a C. pneumoniae ≥ 1:16 . El 53,7% de los pacientes tratados con roxitromicina presentaron mejoria clinica y del flujo espiratorio maximo (FEM) (p<0,029) a la 8.a semana postratamiento. Asi mismo, un 54% de los tratados disminuyeron las titulaciones de IgG frente a C. pneumoniae en dos o mas niveles, frente al 14% del grupo placebo (p<0,012). No hay cambios significativos en las titulaciones de IgE. CONCLUSIONES: las titulaciones de IgG frente a C. pneumoniae ≥ 1:16 son frecuentes en asmaticos del Area de Salud de Lucena-Cabra-Montilla. En muchos de estos casos (54%) el tratamiento con roxitromicina aporta una notable mejoria clinica.