PubMed Health⌕ Search

Biomedical subjects

N Novoa

Publications and source records attributed to N Novoa.

12 recordsLinked to original sources
PubMed2006

[Sleeve lobectomy compared to pneumonectomy for the treatment of N0-N1 non-small cell lung cancer].

OBJECTIVE: To compare survival, morbidity, and mortality rates for a series of patients who underwent either bronchoplastic sleeve lobectomy or pneumonectomy to treat non-small cell lung cancer (NSCLC). PATIENTS AND METHOD: We reviewed the clinical records for patients who underwent sleeve lobectomy or pneumonectomy for NSCLC from January 1994 through December 2003. RESULTS: From January 1994 through December 2003, 35 sleeve lobectomies and 220 pneumonectomies were performed at our department on patients with NSCLC. The perioperative mortality rate was 2.8% for the lobectomy group and 9.1% for the pneumonectomy group. The mean survival time for the pneumonectomy group was 45 months (95% confidence interval [CI], 37-53), with a 5-year survival rate of 32% (SE, 5.1%). The mean survival time for the sleeve lobectomy group was 72 months (95% CI, 56-87) (P< or =.0041), with a 5-year survival rate of 56% (SE, 9.6%). If we stratify the groups according to node involvement, patients classified as N0-N1 had a mean survival time of 52 months (95% CI, 43-61), with a 5-year survival rate of 39% (SE, 6.2%) for the pneumonectomy group. The mean survival time for patients undergoing sleeve lobectomy was 75 months (95% CI, 59-92) (P< or =.018), with a 5-year survival rate of 60% (SE, 10.4%). Survival for patients with N2 disease was similar to that of patients with N0-N1 disease. CONCLUSION: For patients with N0-N1 non-small cell lung cancer, sleeve lobectomy offers better survival than pneumonectomy.

Adult↗
PubMed2005

[Agreement between type of lung resection planned and resection subsequently performed on lung cancer patients].

OBJECTIVE: To assess agreement between planned lung resections and the type subsequently performed on a series of patients, to assess whether tumor location (central or peripheral) affected the degree of discrepancy, and, in the case of unscheduled pneumonectomies, to examine why the planned resection had to be extended. METHOD: Prospective, observational clinical study of 199 patients scheduled for lung cancer surgery. Tumors were preoperatively classified as central or peripheral, and the type of operation planned--lobectomy (or bilobectomy) or pneumonectomy--was compared with the operation finally performed. Rates of agreement and Wilks' lambda statistic were calculated. RESULTS: Twenty unscheduled pneumonectomies were performed. Agreement between planned and performed operations was found in 86.9% of cases (76.9% in central tumors and 95.4% in peripheral tumors). Wilks' lambda statistic was 0.38 (0.42 for central tumors and 0.17 for peripheral tumors). Seven unscheduled pneumonectomies were performed due to hilar node involvement. CONCLUSIONS: The resections performed differed from the resections initially planned in 13% of the bronchial carcinoma operations, in most cases because the planned lobectomy had to be converted to pneumonectomy, a situation which occurred more often with central tumors and was more often due to direct invasion of anatomic structures rather than hilar spread.

Adult↗
PubMed2003

[A model to predict death after lung cancer resection: applicability to individual cases].

OBJECTIVE: To evaluate the reliability of a logistic regression model to predict individual risk of death related to lung cancer resection. METHOD: A study of 515 consecutive patients undergoing anatomical pulmonary resection (lobectomy or pulmonectomy) for lung cancer between January 1994 and December 2001. Dependent variable: death in or out of hospital within 30 days of surgery. Continuous independent variables: age, body mass index, and percent of predicted postoperative FEV1. Binary independent variables: ischemic heart disease, diabetes mellitus, preoperative arrhythmia, induction chemotherapy, type of resection (lobectomy or pneumonectomy), chest wall resection, tumor extension (localized or extended tumor) and perioperative blood transfusion. All data were gathered prospectively. A univariate analysis was performed using contingency tables for binary variables and analysis of variance for continuous ones; stepwise logistic regression analysis was then performed and the likelihood of death for each individual was calculated. A receiver operating characteristic (ROC) curve was constructed with the data, using surgical death as the state variable. RESULTS: The following variables were found to be independently related to death in the univariate analysis: age (p < 0.001, odds ratio 1.11); tumor extension (p = 0.002; OR 3.47) and perioperative transfusion (p = 0.004; OR 3.87). The area under the ROC curve was 0.77, attributable to high specificity given that none of the complications could have been predicted. CONCLUSION: Although some variables are related to surgical death, the described model is not able to give a prediction. Therefore, the model is of little use for application in making decisions about individual cases.

Adult↗
PubMed2003

[A descriptive analysis of a series of patients diagnosed with acute mediastinitis].

Acute mediastinitis is one of the most aggressive chest diseases. The mortality rate ranges between 14% and 42%. We present a retrospective analysis of a series of 26 cases (20 men and 6 women) treated between January 1994 and March 2002 and review the literature. Mediastinitis originated in the esophagus in 17 patients (8 postoperative, 4 due to iatrogenic perforation, 4 due to noniatrogenic perforation, and 1 due to a foreign body) and in the oropharynx in 6 patients; mediastinitis was secondary to median sternotomy in 3. Twenty-five patients were treated surgically. In addition to radical debridement and drainage, which were carried out on all the patients, 10 also underwent esophagectomy or resection of the esophago-gastric reconstruction, 5 received primary sutures of the esophagus, 1 received reconstructive surgery with a pectoral muscle flap, and 1 underwent sternectomy plus intrathoracic omental transposition. Four patients died within 30 days of surgery (15.4%). The mortality rate in our practice is similar to that described in the literature. The results argue for early, aggressive treatment.

Acute Disease↗
PubMed2001

Utility of standardized exercise oximetry to predict cardiopulmonary morbidity after lung resection.

OBJECTIVES: To evaluate if desaturation, measured by finger oximetry on standardized exercise, accurately predicts cardiopulmonary morbidity after pulmonary resection. METHODS: A prospective observational clinical study was carried out on 81 consecutive lung carcinoma patients scheduled for pulmonary resection from February 1998 to March 1999. Finger oximetry was monitored during an incremental to exhaustion cycle exercise test. The presence or absence of desaturation (cut-off value 90%) during exercise was recorded. Other independent analyzed variables were: age of the patient (over 75th percentile), body-mass index (BMI) (over 75th percentile), presence of major cardiovascular co-morbidity, and calculated postoperative FEV1% (under 25th percentile) according to the number of resected segments (ppoFEV1%). Postoperative cardiopulmonary morbidity was the evaluated dependent outcome. Fisher's exact test and risk calculation on contingency tables were used for statistical analysis. RESULTS: A lobectomy was performed in 62 cases, a pneumonectomy was performed in 16 cases, and a segmentectomy was performed in three cases. The mean age of the patients was 63.6 years (SD 10.3, range 34-79 years, 75th percentile 72 years), the mean BMI was 25.9 (SD 4.9, range 16.9-38.1, 75th percentile 29.3), and the mean ppoFEV1% was 64.1 (SD 2016.1, range 29.5-98.6, 25th percentile 50.5). In 14 patients exercise desaturation was registered. Postoperative cardiopulmonary morbidity was presented in 32 cases (five deaths). No correlation was found between postoperative morbidity and any of the following variables: age of the patient, BMI, and co-morbidity. On univariate analysis only low ppoFEV1% (P<0.001) was associated with the outcome, so no multivariate analysis has been carried out. CONCLUSIONS: We have shown that desaturation during standardized exercise in this series adds no relevant information to predict postoperative cardiorespiratory morbidity after lung resection.

Adenocarcinoma↗
PubMed2001

Morbidity after surgery for non-small cell lung carcinoma is not related to neoadjuvant chemotherapy.

OBJECTIVES: To compare postoperative morbidity and mortality rates in two groups of operated non-small cell lung carcinoma patients (NSCLC) with or without induction chemotherapy. METHODS: This is a case-control study on 42 cases and 42 controls. Cases (Group A) underwent induction chemotherapy. Chemotherapy indications and regimens were variable. Control cases (Group B) were randomly selected among 494 NSCLC comparable patients operated on in the same period of time. The selection criteria for operation were the same in both groups. Dependent outcomes were operative death and complications. Independent selected variables were: age, co-morbidity, predicted postoperative FEV1% (1 s forced expiratory volume in percentage), type of surgery and clinical and pathological staging. All postoperative events and independent variables were prospectively registered. Chi-square and risk calculations on contingence tables and one-way ANOVA have been tested. RESULTS: Both series are comparable in demographics, preoperative variables and type of surgery. No mortality has been registered. In Group A, the overall morbidity was 26.2% (11 out of 42 cases), and in Group B, this was 42.9% (18 out of 42 cases; P=0.084). Morbidity was not related to the type of surgery (pneumonectomy vs. other; P=0.205 in Group A and P=0.08 in Group B). Pathological staging did not influence the postoperative outcome, either in Group A (P=0.72; odds ratio, 1.515; 95% confidence interval (CI), 0.375-6.122) or Group B (P=0.299; odds ratio, 0.4; 95% CI, 0.089-1.797). CONCLUSIONS: Induction chemotherapy in NSCLC has no influence on postoperative morbidity.

Adult↗
PubMed2000

Influence of age and predicted forced expiratory volume in 1 s on prognosis following complete resection for non-small cell lung carcinoma.

OBJECTIVE: To evaluate age of the patient at the time of surgery and estimated postoperative forced expiratory volume in 1 s (FEV1%) as predictors of long-term survival following complete resection of non-small cell lung carcinoma (NSCLC). METHODS: Retrospective, observational study. Records of patients operated on for NSCLC between January 1994 and December 1997 were reviewed. One hundred and ninety three patients who underwent complete pathological resection and survived surgery were included for study. Patients were divided in groups depending on age at the time of surgery and predicted postoperative FEV1% calculated according to the number of resected segments. Values of the 75th percentile of age (70.29 years) and 50th percentile of predicted FEV1% (52.9) were the cut-points selected for group division. To increase the power of the analysis pathological staging was also converted in a binary variable and resumed to localized (stage I) or extended (stage II-IIIB). Univariate analysis of the effect of each variable on survival was assessed by Kaplan-Meier method and log-rank test. Relationship between variables was investigated using 2x2 tables and Fisher's exact test. Unrelated variables (extension, age and low estimated postoperative FEV1%) entered in a Cox-regression model to predict long-term survival following resection. RESULTS: Pathological stage (P<0.0001), age (P=0.01) and low estimated postoperative FEV1% (P=0.0007) showed independent value to predict the outcome. CONCLUSION: Advanced age and low predicted postoperative FEV1% play an adverse effect on survival of completely resected NSCLC.

Adult↗
PubMed1999

Ruptured hemidiaphragm after bilateral lung transplantation.

A case of right hemidiaphragm rupture and abdominal herniation into the thorax occurring during the immediate post-operative course of double-lung transplantation is reported. This complication has not been reported previously. We examine the possible aetiology and suggest that the direct cause could be an increase in intra-abdominal pressure during chest physiotherapy.

Abdomen↗
PubMed1995

[The usefulness of 99mTc-tetrofosmin in the diagnosis of pulmonary tumors. A preliminary assessment].

We conducted a preliminary study of captation of the new radiopharmaceutical 99mTc-tetrofosmin in cases of primary carcinoma of the lung, analyzing the results of 5 cases studied before surgery with single photon emission tomography (SPECT) of the lung. The results obtained by imaging were compared with those from surgery. Tumor size ranged between 3.5 and 9 cm. In all cases the images showed that captation of the radiotracer by the neoplasm was satisfactory, leaving the area of the tumor clearly distinguishable from normal adjacent lung tissue and giving no signs of interference caused by absorption of 99mTc-tetrofosmin by contiguous structures (heart or liver). Based on these preliminary results we assert that SPECT of the lung using 99mTc-tetrofosmin may be useful in the clinical diagnosis of malignant lung tumors, although further research must determine to what extent the technique can be relied upon.

Adenocarcinoma↗
PubMedDate not supplied

[How long should a patient stay in the hospital after lung resection?].

OBJECTIVE: To describe the hospital stay of patients undergoing lobectomy or pneumonectomy in comparison with reference data from the Spanish National Health Service. MATERIAL AND METHOD: Prospective study of all consecutive lobectomy or pneumonectomy cases from January 1998 through December 2000. Data collected prospectively were as follows: date of birth, main diagnosis, dates of admission and discharge, surgical procedure, complications and postoperative exitus. Data collected retrospectively included all information related to readmission over the 30 days following discharge. Reference data were obtained from the web page of the Spanish Ministry of Health and Consumer Affairs. RESULTS: Mean hospital stay for the 279 patients studied was 8.3 days (8.4 for 214 lobectomy patients and 7.7 for 65 pneumonectomy patients). For either of the procedures the 50 percentile was 7 days. The rate of readmission was 8.6%. The 83 patients with postoperative complications required a mean stay of 11.9 days (p < 0.001). The reference data for 1998 were 17.5 days for a lobectomy (n = 1,443) and 19.8 days (n = 693) for pneumonectomy. CONCLUSION: The mean hospital stay of reference is far longer than that which we consider adequate for pulmonary resection.

Adolescent↗