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Biomedical subjects

M Solèr

Publications and source records attributed to M Solèr.

At least 19 recordsLinked to original sources
PubMed1999

[Etiology, diagnosis and therapy of COPD].

COPD is a disorder characterized by chronic exspiratory airflow limitation in patients with chronic bronchitis and/or emphysema. The obstruction is generally progressive, but may be partially reversible and may be accompanied by airway hyperreactivity. In this review we discuss the epidemiology, Pathophysiology, clinical features, diagnostic approaches and therapeutic management in patients with COPD. Cigarette smoking is the main risk factor for the development and progression of COPD; environmental or occupational exposure to dust or fumes and genetic factors are further contributing factors. Therefore, smoking cessation is the most important therapeutic approach. Better knowledge of neutrophilic inflammation led to the development of new drugs for the treatment of COPD. The new long-acting inhaled beta 2-agonists fundamentally improved antiobstructive therapy. They are useful to control night-time or early morning symptoms. The role of steroids and theophylline is still unclear. Their value and efficient use are discussed.

Administration, Inhalation↗
PubMed1999

Prospective evaluation of an algorithm for the functional assessment of lung resection candidates.

Patients with impaired pulmonary function are at increased risk for the development of postoperative complications. Recently exercise testing and predicted postoperative (ppo) function have gained increasing importance in the evaluation of lung resection candidates. We prospectively evaluated an algorithm for the preoperative functional evaluation that was developed at our institution. This algorithm incorporated the cardiac history including an electrocardiogram (ECG), and the three parameters FEV1, diffusing capacity of the lungs for carbon monoxide (DLCO), and maximal oxygen uptake (VO2max), as well as their respective ppo values (FEV1-ppo, DLCO-ppo, and VO2max-ppo) calculated based on radionuclide perfusion scans. A consecutive group of 137 patients (mean age 62 yr; range 23 to 81; 102 males, 35 females) with clinically resectable lesions underwent assessment according to our algorithm. Five patients were deemed functionally inoperable, 132 passed the algorithm and underwent pulmonary resections with standard thoracotomy: 9 segmental or wedge resections, 85 lobectomies (inclusive 3 bilobectomies), and 38 pneumonectomies. All patients were extubated within 24 h. The mean stay in the ICU was 1.4 (+/- 1.8) d, and the mean hospital stay was 14.6 (+/- 5) d. Postoperative complications (within 30 d) occurred in 15 patients (11%), of whom two died (overall mortality rate 1.5%). In comparison to our previous series this meant a 50% reduction in complications whereas the percentage of inoperable patients remained unchanged (4% now, 5% before). We conclude that adherence to our algorithm resulted in a very low complication rate (morbidity and mortality), and excluded more rigorous patient selection as a bias for the improved results.

Aged↗
PubMed1998

[Pleural effusion: what next?].

This article gives an overview of the aetiology, diagnostic evaluation and treatment of pleural effusions. A systematic approach including radiological and sonographic examinations and pleural fluid analysis is proposed with a view to selecting the most appropriate therapy. Common forms of exudative pleural effusions are explained in detail. For complicated parapneumonic effusions, new therapeutic options such as the use of fibrinolytics or thoracoscopic debridement are discussed. Talc slurry and thoracoscopic talc poudrage provide effective methods for pleurodesis in case of malignant effusions.

Diagnosis, Differential↗
PubMed1997

Treatment of early parapneumonic empyema by "medical" thoracoscopy.

We report on a consecutive series of 16 patients with complicated parapneumonic effusion or empyema, in whom, after a failed attempt at tube drainage, thoracoscopy under local anesthesia ("medical" thoracoscopy) was performed for debridement and placement of a chest tube. This approach led to immediate clinical improvement in all patients and to definitive cure in 12 of 16. In 4 patients open surgical debridement was necessary after a few days in an elective procedure. In a subgroup of thoracoscopically treated patients, lung function tests were performed at least 6 months after the procedure and did not demonstrate significant restrictive changes. We conclude that thoracoscopy under local anesthesia is a valuable addition to the treatment options in patients with multiloculated, complicated parapneumonic effusion or empyema not responsive to simple tube thoracotomy. The procedure is less taxing for the patient and less expensive than video-assisted thoracoscopic surgery under general anesthesia or open decortication.

Adult↗
PubMed1997

[New aspects in the treatment of bronchial asthma and chronic obstructive lung diseases].

The expansion of our knowledge regarding the pathogenesis of asthma has now made clear that it is an inflammatory disease. Although the treatment of bronchospasm associated with asthma is essential, it is important to consider the inflammatory aspect of the disease. The first therapeutic approach is to control environmental hazards (allergen, air pollution, tobacco smoke). It should always be remembered that patient education is of critical importance. Patients with only occasional asthma symptoms (2-4 times a week) should receive inhaled short-acting beta-2 agonists as needed. Treatment with inhaled corticosteroids is instituted in all asthmatics except the mildest cases. Long-acting beta-2 agonists are an additional therapy for patients with unsatisfactory symptom control despite an optimal dose of inhaled steroids, particularly when there are nocturnal symptoms. Chronic obstructive pulmonary disease is defined as a disease state characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema. Although the airflow obstruction is generally progressive, comprehensive therapeutic management benefits all patients including those with severe disease: stopping smoking, vaccination against influenza and pneumococcus, pharmacologic therapy. The judicious use of bronchodilators increases airflow and reduces dyspnea. Ipratropium and beta-2 agonists are equally efficacious and may work synergistically. The use of corticosteroids is controversial. Thus a closely monitored steroid trial of therapy should be considered in patients who have continuing symptoms or severe airflow limitation despite maximal therapy with other agents. Broad spectrum antibiotics are beneficial in severe exacerbations.

Asthma↗
PubMed1997

Insufficient control of asthma: increase the dose of inhaled steroids or add long-acting beta 2-agonists?

Internationally accepted treatment guidelines for bronchial asthma have established the early introduction of inhaled corticosteroids as a disease-modifying treatment, in addition to bronchodilator treatment as needed. In a small group of patients this approach does not lead to sufficient control of asthma. It is a matter of debate whether in this situation the dose of inhaled steroids should be increased or the bronchodilator treatment intensified by the introduction of long-acting beta 2-agonists. Advantages and limitations of both treatment strategies are discussed in the light of recent data. Guidelines for the use of long-acting beta 2-agonists are proposed.

Adrenal Cortex Hormones↗
PubMed1997

DNA aneuploidy, S-phase fraction, nuclear p53 positivity, and survival in non-small-cell lung carcinoma.

Inactivation of the p53 gene plays a key role in tumour biology, probably through a disturbed cell cycle control and an increased genetic instability in p53-inactivated tumours. To learn more about the relationship between p53 alterations, proliferation and genetic instability (DNA aneuploidy) in lung cancer patients, specimens of 220 surgically resected lung carcinomas with clinical follow-up information were examined by immunohistochemistry (p53; CM1) and flow cytometry. Nuclear p53 positivity--found in 49.5% of the tumours--was associated with both high S-phase fraction (SPF) and DNA ploidy aberrations. SPF was higher in p53-positive tumours (15.9 +/- 10.2) than in p53-negative tumours (10.3 +/- 8.7; P = 0.03). The rate of p53 positivity was higher in 101 DNA-aneuploid and DNA-multiploid tumours (55%) than in 27 diploid and peridiploid carcinomas (33%; P = 0.0512). These results are consistent with an in vivo role of p53 inactivation for increased proliferative activity and development of genomic instability in lung cancer. There was no association between SPF and prognosis. Although prognosis was worse in DNA-aneuploid and multiploid tumours than in diploid, peridiploid and tetraploid carcinomas (P = 0.029), DNA ploidy was not an independent predictor of poor prognosis in multivariate analysis. These data show that DNA-flow cytometry has little prognostic value for patients with resected non-small-cell lung carcinoma.

Aneuploidy↗
PubMed1997

Dyspnea after pneumonectomy: the result of an atrial septal defect.

We report the case of severe hypoxemia attributable to right-to-left shunting through an atrial septal defect after right-sided pneumonectomy that developed in a 70-year-old man. Normal right atrial and pulmonary artery pressures were measured. Right-to-left shunting through a patent foramen ovale is known as a rare complication after pneumonectomy. Our patient, however, demonstrated a true atrial septal defect (septum secundum defect) upon open operative repair of the interatrial connection.

Aged↗
PubMed1997

MMP and TIMP expression pattern in pleural effusions of different origins.

The matrix metalloproteinases (MMP) are proteolytic enzymes that are essentially involved in the turnover of the extracellular matrix (ECM). Their activity is counterbalanced by specific antagonists, the tissue inhibitors of metalloproteinases (TIMP). In this study, we sought to analyze the expression of MMP and TIMP isoforms in pleural effusions from 88 patients. We compared MMP and TIMP isoform expression in transudates (n = 21) and exudates (n = 67), the latter divided into exudates of paraneoplastic (n = 46) or parainfectious (n = 21) origin. Zymographic and Western blot analyses revealed constant expression of interstitial collagenase (MMP-1), gelatinase-A (MMP-2), and TIMP-1 in all 88 samples. In contrast, analyses of gelatinase-B (MMP-9) demonstrated a specific expression pattern, with high expression in exudates and lack of expression in transudates. Neutrophil collagenase (MMP-8) was detected in trace amounts, and correlated with the number of neutrophils in the effusion. Low levels of TIMP-2 were detected only in exudates and not in transudates. Quantitative analysis of the expression ratio of gelatinase-B to gelatinase-A revealed statistically significant differences between effusions of different origin. The ratio was highest in exudates of paraneoplastic origin and lowest in transudates. Our data thus suggest that interstitial collagenase, gelatinase-A, and TIMP-1 play a role in homeostasis of the pleural space in vivo as constitutively expressed proteins, whereas gelatinase-B and TIMP-2 expression are induced in specific disease states. These observations contribute to the understanding of the pathophysiology of pleural effusions, and may help to characterize and possibly distinguish effusions of different origin.

Adult↗
PubMed1996

Nuclear p53 overexpression is an independent prognostic parameter in node-negative non-small cell lung carcinoma.

The prognosis of operated patients with non-small cell lung cancer (NSCLC) is poor despite thorough pre-operative staging. An improved preselection is needed of patients likely to profit from surgery. This study was undertaken to evaluate the prognostic significance of nuclear p53 overexpression in a cohort of 247 surgically treated patients with NSCLC. It showed that the prevalence of immunohistochemically detectable p53 overexpression varied between different tumour types. p53 overexpression was equally frequent in large cell carcinoma (53 per cent) and in squamous cell carcinoma (54 per cent), but significantly less frequent in adenocarcinoma (34 per cent; P = 0.009). p53 overexpression was particularly rare in bronchioloalveolar carcinoma (positivity in 1 of 17 cases). These variations may reflect aetiological differences between the histological subtypes. p53 overexpression was also associated with high tumour grade (P = 0.0157) and the presence of lymph node metastasis (P = 0.0259), but not with advanced tumour stage. Survival analysis showed no difference in clinical outcome between p53-positive and p53-negative tumours within 101 node-positive tumours. In contrast, survival time was significantly better in p53-negative tumours than in p53-positive tumours within the group of 113 node-negative tumours (P = 0.032). Stepwise regression analysis showed that p53 overexpression is an independent prognostic factor in node-negative NSCLC.

Biomarkers, Tumor↗
PubMed1996

Pulmonary function and exercise capacity after lung resection.

The influence of pulmonary resection on functional capacity can be assessed in different ways. The aim of this study was to compare the effect of lobectomy and pneumonectomy on pulmonary function tests (PFT), exercise capacity and perception of symptoms. Sixty eight patients underwent functional assessment with PFT and exercise testing before (Preop), and 3 and 6 months after lung resection. In 50 (36 males and 14 females; mean age 61 yrs) a lobectomy was performed and in 18 (13 males and 5 females; mean age 59 yrs) a pneumonectomy was performed. Three months after lobectomy, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), transfer factor of the lungs for carbon monoxide (TL,CO) and maximal oxygen uptake (V'O2,max) were significantly lower than Preop values, increasing significantly from 3 to 6 months after resection. Three months after pneumonectomy, all parameters were significantly lower than Preop values and significantly lower than postlobectomy values and did not recover from 3 to 6 months after resection. At 6 months after resection significant deficits persisted in comparison with Preop: for FVC 7% and 36%, FEV1 9% and 34%, TLC 10% and 33% for lobectomy and pneumonectomy, respectively; and V'O2,max 20% after pneumonectomy only. Exercise was limited by leg muscle fatigue in 53% of all patients at Preop. This was not altered by lobectomy, but there was a switch to dyspnoea as the limiting factor after pneumonectomy (61% of patients at 3 months and 50% at 6 months after resection). Furthermore, pneumonectomy compared to lobectomy led to a significantly smaller breathing reserve (mean +/- SD) (28 +/- 13 vs 37 +/- 16% at 3 months; and 24 +/- 11% vs 33 +/- 12% at 6 months post resection) and lower arterial oxygen tension at peak exercise 10.1 +/- 1.5 vs 11.5 +/- 1.6 kPa (76 +/- 11 vs 86 +/- 12 mmHg) at 3 months; 10.1 +/- 1.3 vs 11.3 +/- 1.6 kPa (76 +/- 10 vs 85 +/- 12 mmHg) at 6 months postresection. We conclude that measurements of conventional pulmonary function tests alone overestimate the decrease in functional capacity after lung resection. Exercise capacity after lobectomy is unchanged, whereas pneumonectomy leads to a 20% decrease, probably due to the reduced area of gas exchange.

Adult↗
PubMed1996

[Lung scintigraphy and ergospirometry in prediction of postoperative course in lung resection candidates with increased risk of postoperative complications].

Patients with impaired pulmonary function are at increased risk for the development of postoperative complications. We therefore analyzed the value of preoperative lung scanning and exercise testing for the prediction of postoperative complications and of the short- as well as long-term performance in lung resection candidates at increased risk for complications. Twenty-five (mean age 63 y; 17 m) out of 84 consecutive lung resection candidates were considered at increased risk for postoperative complications due to impaired pulmonary function (FEV1 < 2L or diffusion for carbon monoxide (DLCO) < 50% predicted, or FEV1 and DLCO < or = 80% predicted combined with New York Heart Association dyspnea index > or = 2). Candidates underwent radionuclide perfusion scans and exercise testing to predict postoperative ( = ppo) values for FEV1, DLCO and maximal O2-uptake (VO2max). They all underwent thoracotomy for neoplastic lesions; 7 had pneumonectomies, 18 lobectomies. Six had postoperative complications (within 30 days), of whom three died. Three and 6 months postoperatively, pulmonary function tests and VO2max were repeated. In the 22 survivors, the observed values were then compared with the predicted values. At 3 months, there were excellent correlations (absolute/predicted values): for FEV1r = 0.78 and 0.81; for DLCOr = 0.77 and 0.74; and for VO2max r = 0.71 and 0.83. The means of FEV1 and VO2max did not differ from the predicted values, whereas the predicted DLCO was lower than the observed value (ml/min/mmHg: 15.1 vs 17.9; percent predicted: 59.6 vs 70.9) (p < 0.05). At 6 months, correlations remained very good for FEV1 (r = 0.81 and 0.84) and for DLCO (r = 0.76 and 0.74), but had decreased for VO2max to 0.56 and 0.65, respectively. All means were higher than predicted (p < 0.05) owing to recovery in the lobectomy group. Patients with postoperative complications (group B) had a lower preoperative VO2max in percent predicted (62.8 +/- 7.5% vs 84.6 +/- 19.7%) (p < 0.01) and also a lower VO2max-ppo (10.6 +/- 3.6 vs 14.8 +/- 3.5 ml/kg/min and 44.3 +/- 13.5 vs 68.0 +/- 20.7 percent predicted) (p < 0.05) than patients without complication (group A). AVO2max-ppo < 10/ml/kg/min was associated with a 100% mortality. Although FEV1-ppo and DLco-ppo were lower in group B the difference did not reach significance. We conclude that radionuclide-based calculations of postoperative VO2max are predictive of perioperative morbidity and mortality: a VO2max-ppo of < 10 ml/kg/min may indicate inoperability. Further, short-term postoperative performance is accurately predicted by FEV1-ppo and VO2max-ppo, but long-term function is underestimated after lobectomy.

Adult↗