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de-Torres JP, Alcaide AB, Campo A, Zulueta JJ, Bastarrika G, Ezponda A, Mesa M, Murillo D, Rodriguez M, Del Mar Ocón M, Felgueroso C, Pueyo J, Lozano MD, Montuenga LM, Berto J, Perez-Warnisher MT, Di-Frisco IM, Seijo LM. Lung Cancer Screening in People With COPD: The Pamplona-IELCAP Experience. Arch Bronconeumol 2024; 60:95-100. [PMID: 38216404 DOI: 10.1016/j.arbres.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION The Global Initiative for Obstructive Lung Disease (GOLD) recommends lung cancer screening for patients with Chronic Obstructive Pulmonary Disease (COPD), but data is lacking regarding results of screening in this high-risk population. The main goal of the present work is to explore if lung cancer screening with Low Dose Chest Tomography (LDCT) in people with COPD, allows lung cancer (LC) diagnosis in early stages with survival compatible with curative state. METHODS This is a post hoc exploratory analysis. Pamplona International Early Lung Cancer Action Program (P-IELCAP) participants with a GOLD defined obstructive pattern (post bronchodilator FEV1/FVC<0.70) were selected for analysis. The characteristics of those who developed LC and their survival are described. A Cox proportional analysis explored the factors associated with LC diagnosis. RESULTS Eight hundred and sixty-five patients (77% male, 93% in spirometric GOLD stage 1+2) were followed for 102±63 months. LC prevalence was 2.6% at baseline, with an annual LC diagnosis rate of 0.68%. Early-stage tumors predominated (74%) with a median survival (25-75th percentiles) of 139 (76-185) months. Cumulative tobacco exposure, FEV1%, and emphysema were the main predictors of an LC diagnosis. Eight (11%) patients with COPD had a second LC, most of them in early stage (92%), and 6 (8%) had recurrence. Median survival (25-75th percentiles) in these patients was 168 (108-191) months. CONCLUSIONS Lung cancer screening of selected high-risk participants with COPD allowed the LC diagnosis in early stages with survival compatible with curative state.
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Affiliation(s)
- Juan P de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Ana Belén Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Arancha Campo
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Javier J Zulueta
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Division of Pulmonary, Critical Care and Sleep Medicine/Department of Medicine, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Miguel Mesa
- Thoracic Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Diego Murillo
- Thoracic Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - María Rodriguez
- Thoracic Surgery Department, Clínica Universidad de Navarra, Madrid, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - María Del Mar Ocón
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Carmen Felgueroso
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Jesús Pueyo
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - María Dolores Lozano
- Pathology Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Luis M Montuenga
- Solid Tumors Program, Center of Applied Medical Research (CIMA), Cancer Center Clinica Universidad de Navarra (CCUN), University of Navarra and IDISNA, Pamplona, Spain; CIBERONC, Madrid, Spain
| | - Juan Berto
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - María Teresa Perez-Warnisher
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Isberling Madeleine Di-Frisco
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain
| | - Luis M Seijo
- Pulmonary Department, Clínica Universidad de Navarra, Madrid, Spain; Cancer Center Clinica Universidad de Navarra (CCUN), Pamplona, Spain; CIBERES, Madrid, Spain
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2
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de-Torres JP, Casanova C, Marín JM, Cabrera C, Marín M, Ezponda A, Cosio BG, Martínez C, Solanes I, Fuster A, Calle M, Peces-Barba G, Gotera C, Feu-Collado N, Marin A, Alcaide AB, Sangro M, Bastarrika G, Celli BR. Impact of Applying the Global Lung Initiative Criteria for Airway Obstruction in GOLD Defined COPD Cohorts: The BODE and CHAIN Experience. Arch Bronconeumol 2024; 60:10-15. [PMID: 37925245 DOI: 10.1016/j.arbres.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION The Global Lung Function Initiative (GLI) has proposed new criteria for airflow limitation (AL) and recommends using these to interpret spirometry. The objective of this study was to explore the impact of the application of the AL GLI criteria in two well characterized GOLD-defined COPD cohorts. METHODS COPD patients from the BODE (n=360) and the COPD History Assessment In SpaiN (CHAIN) cohorts (n=722) were enrolled and followed. Age, gender, pack-years history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, history of exacerbations and survival were recorded. CT-detected comorbidities were registered in the BODE cohort. The proportion of subjects without AL by GLI criteria was determined in each cohort. The clinical, CT-detected comorbidity, and overall survival of these patients were evaluated. RESULTS In total, 18% of the BODE and 15% of the CHAIN cohort did not meet GLI AL criteria. In the BODE and CHAIN cohorts respectively, these patients had a high clinical burden (BODE≥3: 9% and 20%; mMRC≥2: 16% and 45%; exacerbations in the previous year: 31% and 9%; 6MWD<350m: 15% and 19%, respectively), and a similar prevalence of CT-diagnosed comorbidities compared with those with GLI AL. They also had a higher rate of long-term mortality - 33% and 22% respectively. CONCLUSIONS An important proportion of patients from 2 GOLD-defined COPD cohorts did not meet GLI AL criteria at enrolment, although they had a significant burden of disease. Caution must be taken when applying the GLI AL criteria in clinical practice.
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Affiliation(s)
- Juan P de-Torres
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Ciro Casanova
- Pulmonary Department-Research Unit, Hospital Universitario Nuestra Señora de Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Tenerife, Spain
| | - José M Marín
- Pulmonary Department, Hospital Universitario Miguel Servet, IIS Aragon & CIBERES, University of Zaragoza, Zaragoza, Spain
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | - Marta Marín
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain; Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Ana Ezponda
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Borja G Cosio
- Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Baleares (IdISBa), Palma, Mallorca, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Cristina Martínez
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA-FINBA), Spain
| | - Ingrid Solanes
- Pulmonary Department, Hospital Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Antonia Fuster
- Pulmonary Department, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | - Myriam Calle
- Department of Respiratory Medicine, Hospital Clínico San Carlos, Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Germán Peces-Barba
- Department of Respiratory Medicine, Hospital Universitario Fundación Jiménez Díaz, CIBERES, Madrid, Spain
| | - Carolina Gotera
- Department of Respiratory Medicine, Hospital Universitario Fundación Jiménez Díaz, CIBERES, Madrid, Spain
| | - Nuria Feu-Collado
- Pulmonary Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Alicia Marin
- Pulmonary Department, Hospital Universitario German Trias y Pujol, Barcelona, Spain
| | - Ana Belén Alcaide
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Matilde Sangro
- Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Bartolome R Celli
- Pulmonary Department, Brigham and Women's Hospital, Boston, MA, United States
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3
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Barrio Piqueras M, Ezponda A, Felgueroso C, Urtasun C, Di Frisco IM, Larrache JC, Bastarrika G, Alcaide AB. Acute Eosinophilic Pneumonia Following mRNA COVID-19 Vaccination: A Case Report. Arch Bronconeumol 2021; 58:S0300-2896(21)00379-3. [PMID: 35312492 PMCID: PMC8594056 DOI: 10.1016/j.arbres.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 01/25/2023]
Affiliation(s)
| | - Ana Ezponda
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Carmen Felgueroso
- Department of Pulmonary Medicine, Clínica Universidad de Navarra, Pamplona, Spain
| | - Cesar Urtasun
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - Gorka Bastarrika
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.
| | - Ana Belén Alcaide
- Department of Pulmonary Medicine, Clínica Universidad de Navarra, Pamplona, Spain.
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4
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Recalde-Zamacona B, Tomás-Velázquez A, Campo A, Satrústegui-Alzugaray B, Fernández-Alonso M, Iñigo M, Rodríguez-Mateos M, Di Frisco M, Felgueroso C, Bertó J, Marín-Oto M, Alcaide AB, Zulueta JJ, Seijo L, Landecho MF. Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study. J Intern Med 2021; 289:921-925. [PMID: 33372300 DOI: 10.1111/joim.13237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient's basal clinical conditions. METHODS We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with prolonged viral shedding and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhinosinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89-90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospective trials, this finding might have clinical implications for quarantine duration due to increased risk of pandemic spread.
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Affiliation(s)
- B Recalde-Zamacona
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - A Tomás-Velázquez
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Dermatology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - A Campo
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | | | - M Fernández-Alonso
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Microbiology and Infectious Diseases Division, Clinica, Pamplona, Spain
| | - M Iñigo
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Microbiology and Infectious Diseases Division, Clinica, Pamplona, Spain
| | - M Rodríguez-Mateos
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Microbiology and Infectious Diseases Division, Clinica, Pamplona, Spain
| | - M Di Frisco
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - C Felgueroso
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - J Bertó
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - M Marín-Oto
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - A B Alcaide
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - J J Zulueta
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - L Seijo
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - M F Landecho
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Internal Medicine department, Clinica Universidad de Navarra, Pamplona, Spain
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5
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Landecho MF, Yuste JR, Gándara E, Sunsundegui P, Quiroga J, Alcaide AB, García-Layana A. COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease? J Intern Med 2021; 289:116-120. [PMID: 32729633 DOI: 10.1111/joim.13156] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022]
Abstract
IMPORTANCE COVID-19 is caused by SARS-CoV-2, a betacoronavirus that uses the angiotensin-converting enzyme-related carboxypeptidase (ACE2) receptor to gain entry into cells. ACE2 receptor is widely expressed in multiple organs, including the retina, an extension of the central nervous system. The ACE2 receptor is involved in the diabetic and hypertensive retinopathy. Additionally, coronaviruses cause ocular infections in animals, including retinitis, and optic neuritis. OBJECTIVE To assess whether there is any retinal disease associated with COVID-19. DESIGN We have evaluated 27 asymptomatic subjects, with retinal fundoscopic, optical coherence tomography (OCT) and OCT angiography fourteen days after hospital discharge due to COVID-19 bilateral pneumonia. RESULTS Cotton wool exudates were evident in six out of 27 patients evaluated, a 22%. Cotton wool exudates are a marker vascular disease severity in other medical context, that is diabetes and hypertension, and are associated with increased risk for acute vascular events. Whether antiaggregation therapy may play a role on fundoscopic-selected patients with COVID-19 requires prospective trials.
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Affiliation(s)
- M F Landecho
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - J R Yuste
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Microbiology and Infectious Diseases Division, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - E Gándara
- Ophtalmology Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - P Sunsundegui
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - J Quiroga
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,CIBEREHD
| | - A B Alcaide
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Pulmonary Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - A García-Layana
- Ophtalmology Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
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6
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Recalde-Zamacona B, Ezponda A, Zulueta JJ, Marín-Oto M, Alcaide AB, Campo A, Bertó J. Bronchial Artery Pseudoaneurysm and Mediastinal Hematoma after EBUS-TBNA. Arch Bronconeumol 2020; 57:142-143. [PMID: 32829998 DOI: 10.1016/j.arbres.2020.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Ana Ezponda
- Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Javier J Zulueta
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Marta Marín-Oto
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Ana Belén Alcaide
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Aránzazu Campo
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - Juan Bertó
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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Abstract
Lung cancer screening using computed tomography (CT) is effective in detecting early stage disease. However, concerns regarding adherence have been raised. The current authors conducted a retrospective observational study of 641 asymptomatic smokers enrolled in a lung cancer screening programme between 2000 and 2003. Adherent subjects were compared with nonadherent subjects with regard to lung function, sex, age, motivation for enrollment, smoking status, distance to the referral centre, family history of lung cancer, asbestos exposure, education, the presence and type of nodule(s) seen on initial CT, and exposure to a nursing intervention designed to improve adherence. Overall, early adherence to the study protocol was 65%. Multivariate analysis confirmed the importance of sex, proximity to the referral centre, the presence of noncalcified nodules, and the nursing intervention as factors conditioning adherence to the study protocol. Patients encouraged to participate in the study were more adherent, as were former smokers. Sex interactions were observed in multivariate analysis. The nursing intervention was significant for females, while abnormal lung function improved male adherence. Adherence to lung cancer screening is particularly good among females and subjects living near the referral centre. The present study suggests the need to develop new strategies, especially those targeting males and subjects with low risk perception, in order to improve adherence.
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Affiliation(s)
- U Montes
- Pulmonary Medicine, Clinical University, University of Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain
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8
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Campo A, Frühbeck G, Zulueta JJ, Iriarte J, Seijo LM, Alcaide AB, Galdiz JB, Salvador J. Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients. Eur Respir J 2007; 30:223-31. [PMID: 17459895 DOI: 10.1183/09031936.00115006] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Leptin is a powerful stimulant of ventilation in rodents. In humans, resistance to leptin has been consistently associated with obesity. Raised leptin levels have been reported in subjects with sleep apnoea or obesity-hypoventilation syndrome. The aim of the present study was to assess, by multivariate analysis, the possible association between respiratory centre impairment and levels of serum leptin. In total, 364 obese subjects (body mass index >or=30 kg.m(-2)) underwent the following tests: sleep studies, respiratory function tests, baseline and hypercapnic response (mouth occlusion pressure (P(0.1)), minute ventilation), fasting leptin levels, body composition and anthropometric measures. Subjects with airways obstruction on spirometry were excluded. Out of the 346 subjects undergoing testing, 245 were included in the current analysis. Lung volumes, age, log leptin levels, end-tidal carbon dioxide tension, percentage body fat and minimal nocturnal saturation were predictors for baseline P(0.1). The hypercapnic response test was performed by 186 subjects; log leptin levels were predictors for hypercapnic response in males, but not in females. Hyperleptinaemia is associated with a reduction in respiratory drive and hypercapnic response, irrespective of the amount of body fat. These data suggest the extension of leptin resistance to the respiratory centre.
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Affiliation(s)
- A Campo
- Pulmonary Medicine, Clinica Universitaria de Navarra, Avda. Pío XII, 36, 31008 Pamplona, Spain.
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9
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Seijo L, Campo A, Alcaide AB, Lacunza MM, Armendáriz AC, Zulueta JJ. [Outpatient management of malignant pleural effusion using a tunneled pleural catheter: Preliminary experience]. Arch Bronconeumol 2006; 42:660-2. [PMID: 17178070 DOI: 10.1016/s1579-2129(07)60008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Inpatient management of malignant pleural effusion includes the placement of a conventional thoracostomy tube for drainage and talc slurry pleurodesis and/or a surgical approach consisting of video-assisted thoracoscopic talc insufflation. Both techniques require prolonged hospital stays of up to 1 week. Unfortunately, life expectancy in patients with this disease does not usually exceed 6 months, and so the primary aim of any palliative intervention intended to improve quality of life should be to avoid hospital admissions and to relieve pain as far as possible. Of the few outpatient alternatives to hospital management the most frequently used is repeated thoracentesis. We describe the outpatient management of malignant pleural effusion by placement of a tunneled pleural catheter in a patient with stage IIIB lung adenocarcinoma. In our opinion, the use of this catheter offers a viable alternative to conventional therapy and is better tolerated.
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Affiliation(s)
- Luis Seijo
- Departamento de Neumología, Clínica Universitaria, Universidad de Navarra, Pamplona, Navarra, España.
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10
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Seijo L, Campo A, Belén Alcaide A, del Mar Lacunza M, Carmen Armendáriz A, Zulueta JJ. Manejo ambulatorio del derrame pleural maligno mediante colocación de un catéter de drenaje tunelizado. Experiencia preliminar. Arch Bronconeumol 2006. [DOI: 10.1157/13095975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Bastarrika G, García-Velloso MJ, Lozano MD, Montes U, Torre W, Spiteri N, Campo A, Seijo L, Alcaide AB, Pueyo J, Cano D, Vivas I, Cosín O, Domínguez P, Serra P, Richter JA, Montuenga L, Zulueta JJ. Early lung cancer detection using spiral computed tomography and positron emission tomography. Am J Respir Crit Care Med 2005; 171:1378-83. [PMID: 15790860 DOI: 10.1164/rccm.200411-1479oc] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
RATIONALE Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised. OBJECTIVE To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules. RESULTS A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. CONCLUSION A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions.
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Affiliation(s)
- Gorka Bastarrika
- Department of Radiology, Clínica Universitaria, Avda. Pio XII, 36, 31008 Pamplona, Spain
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