Francisco Rodriguez-panadero | Universidad de Sevilla (original) (raw)
Papers by Francisco Rodriguez-panadero
Archivos De Bronconeumologia, Mar 1, 2016
On-line el 2 de julio de 2015 Palabras clave: Stents Stents liberadores de fármacos Estenosis tra... more On-line el 2 de julio de 2015 Palabras clave: Stents Stents liberadores de fármacos Estenosis traqueal Obstrucción de la vía aérea Experimentación animal r e s u m e n Introducción: El objetivo de este estudio es evaluar la reactividad traqueal tras la implantación de distintos stents metálicos autoexpandibles (SMAE). Material y métodos: Se utilizaron 40 conejos hembra de raza neozelandesa, que se dividieron en 4 grupos. En 3 grupos se implantaron SMAE: de acero (SA), de nitinol (NiTi) o stents liberadores de nitinol (SLF). El cuarto grupo fue el grupo de control (sin stent). Los stents se implantaron por vía percutánea bajo control fluoroscópico. Los animales se evaluaron mediante tomografía axial computarizada (TAC) multicorte y las tráqueas se extirparon para su estudio anatomopatológico (EAP). Los datos de la TAC y el EAP se analizaron estadísticamente y se correlacionaron. Resultados: El grupo que recibió SLF presentaba la mayor longitud de estenosis (20,51 ± 14,08 mm frente a 5,84 ± 12,43 y 6,57 ± 6,54 mm en los grupos NiTi y SA, día 30; p < 0,05) y el mayor índice de formación de granulomas evidenciados mediante TAC (50% de los casos). El grupo al que se implantaron stents NiTi mostró el menor grado de estenosis (2,86 ± 6,91% frente a 11,28 ± 13,98 y 15,54 ± 25,95% en los grupos SLF y SA; p < 0,05). En el estudio AP, el grupo SA presentó reactividad proliferativa intensa en comparación con los otros 2 grupos. En el grupo SLF se observó una respuesta destructiva en el 70% de animales, mientras que el stent NiTi fue el que menos reacción provocó. La TAC resultó ser superior para detectar el engrosamiento (correlación positiva de un 68,9%; p < 0,001) que para la observación de granulomas (n.s.). Conclusiones: El grupo SA desarrolló granulomas y estenosis significativas. El stent NiTi fue el que menos reacción indujo, mientras que el SLN provocó lesiones importantes que podrían estar relacionadas con la dosis de fármaco. Por consiguiente, este tipo de SLF no se recomienda para el tratamiento de la estenosis traqueobronquial.
The American review of respiratory disease, Mar 1, 1989
In order to determine the diagnostic and prognostic significance of low pleural glucose and pH le... more In order to determine the diagnostic and prognostic significance of low pleural glucose and pH levels, we executed a prospective study of these parameters and cytologic yield in 77 cases of malignant pleural effusions diagnosed from 116 consecutive thoracoscopies. The extension of the neoplasms detected by thoracoscopy as well as the results of our attempts to carry out pleurodesis by talc were also studied. Pleural glucose levels were less than 60 mg/dl in 16 cases, and the cytologic yield was positive in 14 of these cases (87%). The glucose value rose above this level in 61 cases, and the cytology was positive in 30 cases (49%; p less than 0.006). A pH less than 7.30 was encountered in 18 cases and there were positive cytologic findings in 14 of these cases (78%). The pH was above 7.30 in 46 cases, and cytologic studies were positive in 22 cases (48%; p less than 0.03). There were ten cases in which both the glucose and pH levels were low, and the cytology was positive in 9 cases (90%), while there were 40 cases in which both the glucose and pH levels were high and cytologic yields of 20 of these cases were positive (50%; p less than 0.03). The extension of the lesions observed during thoracoscopy showed important differences as far as this related to the glucose levels (p less than 0.005), but this relationship as it concerned pH levels was even more significant (p less than 0.0002). The differences were also highly significant (p less than 0.003) when the glucose and pH were jointly considered.(ABSTRACT TRUNCATED AT 250 WORDS)
European Journal of Clinical Investigation, Sep 16, 2019
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
European Journal of Clinical Investigation, Sep 29, 2016
Our findings showed that p53 mRNA expression levels are upregulated in epicardial adipose tissue ... more Our findings showed that p53 mRNA expression levels are upregulated in epicardial adipose tissue (EAT) from patients with heart failure (HF). This upregulation was also found in myocardium [2]. Our group have described its upregulation in EAT by sympathetic system. This article is protected by copyright. All rights reserved.
Chest, Oct 1, 1995
Communications for this section Will be published as space and priorities permit. The comments sh... more Communications for this section Will be published as space and priorities permit. The comments should not exce!!fl 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscrivt.
Springer eBooks, Aug 4, 2013
The fear of complications arising from the procedure is often the main quoted reason for the relu... more The fear of complications arising from the procedure is often the main quoted reason for the reluctance of many pulmonologists to perform thoracoscopy and for a decline of “medical thoracoscopy” in some countries. In addition there is a trend to transfer pleural investigations to the thoracic surgeon in many centres around the world.
Expert Opinion on Medical Diagnostics, Apr 4, 2013
Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural inv... more Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural involvement can be seen without effusion. Imaging, pleural fluid analysis, biomarkers for MPE, needle pleural biopsy and thoracoscopy. To prepare this review, we performed a search using keywords: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;diagnosis&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; + &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;malignant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; + &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;pleural&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; + &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;effusion&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (all fields) in PubMed, and found 4106 articles overall (until 16 January 2013, 881 in the last 5 years). Ultrasound techniques will stay as valuable tools for pleural effusions. Biomarkers in pleural fluid do not currently provide an acceptable yield for MPE. In subjects with past history of asbestos exposure, some serum or plasma markers (soluble mesothelin, fibulin) might help in selecting cases for close follow-up, to detect mesothelioma early. Needle pleural biopsy is justified only if used with image-techniques (ultrasound or CT) guidance, and thoracoscopy is better for both diagnosis and immediate palliative treatment (pleurodesis). Animal models of MPE and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;spheroids&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; are promising for research involving both pathophysiology and therapy. Considering the possibility of direct pleural delivery of nanotechnology-developed compounds-fit to both diagnosis and therapy purposes (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;theranostics&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-MPE and mesothelioma in particular are likely to benefit sooner than later from this exciting perspective.
Epithelial-to-mesenchymal transition EMT is a molecular-cellular process activated during embryon... more Epithelial-to-mesenchymal transition EMT is a molecular-cellular process activated during embryonic development and tissue remodelling, by which epithelial cells lose their polarity and cell contacts, acquire the expression of mesenchymal markers and manifest a migratory phenotype. The progressive loss of E-cadherin is coupled with expression of non-epithelial cadherins, process known as “cadherin switching”. As tumours often mimic embryonic development, it has been postulated that EMT represents a transient event in carcinomas progession. Malignant Mesothelioma MM could represent an EMT in vivo model, because tumor cells can exhibit epithelial, sarcomatous and biphasic differentiation. Forty five patients with MM were investigated by immunohistochemical expression of cadherins E,N,P,11,p120 catenin,SPARC and caveolin in two tissue microarrays. Protein expression was scored from 0 to 3 in tumour and stroma. Data were correlated with histologic patterns, thoracoscopy findings and survival. E-P cadherins expression was observed in 79,3% of epithelial MM without evidence in mesenchymal component of mixed and sarcomatous types. N-11cadherins were detected in 20,6%, 29.4% and 17.6% of these histotypes,respectively.The mesenchymal markers were detected in 100% of sarcomatous and mixed MM and in a many samples of epithelial group. Immunohistochemical data correlated with metastatic status, multi-focal disease and poor survival, showed, in epithelial MM forms, weak or absent E-Pcadherins expression, while N-11cadherins, mesenchymal markers and P120 catenin were observed. Our results suggest that the aggressiveness of MM,could be explained by the acquisition of a mesenchymal phenotype in the context of EMT
PubMed, Feb 1, 2000
The incidence of malignant pleural effusions has been increasing over the last few decades (mainl... more The incidence of malignant pleural effusions has been increasing over the last few decades (mainly due to the absolute increase in several types of cancers, especially those of lung and breast origin) and they account for up to 50% of the exudates in many clinical series. Although pleural malignancies are thought to present most frequently with a pleural effusion, several autopsy series, including the current one, found a pleural effusion present in little more than half of the cases of malignant pleural involvement (55% in this series). Thus, many pleural malignancies without effusion might pass unnoticed in clinical practice, especially in metastatic disease. Primary malignancies of the pleura (mesotheliomas) are associated with asbestos exposure in about two-thirds of cases, and they frequently present with chest pain, sometimes associated with a pleural effusion. Benign pleural plaques can coexist with malignant mesothelioma, and this association should be suspected when long-standing plaques change in shape or size over the years, and especially if chest pain develops in a previously asymptomatic patient. Metastatic pleural involvement is much more frequent than mesotheliomas, and its most frequent mechanism is the vascular spreading of tumour cells from distant organs to the lungs, and on to the visceral and parietal pleura. The visceral pleura was involved in up to 87% of the current metastatic cases, whereas the parietal zone in only 47% of the autopsy series. The diagnostic work-up lies in cytology, whose average yield is approximately 50%, and a biopsy technique (either by blind needle biopsy or thoracoscopy) is recommended when the effusion persists, for > 2 weeks, and the first cytology has been negative. Thoracoscopy has the additional advantage of allowing pleurodesis with talc poudrage if clear tumour lesions are found in the pleura. In cases of malignant effusion which are not sensitive to chemotherapy, pleurodesis is the treatment of choice for palliation of symptoms, and talc is the most effective agent. It can be used either in suspension ("slurry") or in dry aerosolized form ("talc poudrage"), but it seems that this last technique achieves the best effects. However, it requires thoracoscopy for a proper application, and this is its main drawback when that technique is not readily available.
Clinical Biochemistry, Nov 1, 2005
Objectives: To investigate whether pleural levels of the soluble oncoprotein 185 HER-2 (sp185 HER... more Objectives: To investigate whether pleural levels of the soluble oncoprotein 185 HER-2 (sp185 HER-2), individually or in combination with CEA and CA 15-3, were useful for the diagnosis of malignant effusions. Design and methods: Levels of CEA, CA 15-3, and sp185 HER-2 were measured in the pleural fluid from 135 malignant and 103 benign effusions. Thresholds of these tumor markers were chosen for a diagnostic specificity of !99%. Results: Pleural sp185 HER-2 levels greater than 25 ng/mL were observed in 20% of breast and 10% of lung adenocarcinomas, and predicted a malignant effusion with a sensitivity of 7% and a likelihood ratio of 7.6. Combination of CEA and CA 15-3 resulted in 50% sensitivity, while adding sp185 HER-2 to this panel nonsignificantly increased sensitivity by 5% (P = 0.45). Only 1 patient with breast adenocarcinoma among 45 cytology-negative malignant effusions had sp185 HER-2 above the diagnostic cutoff point. Conclusion: Measurement of pleural fluid sp185 HER-2 has poor diagnostic performance in patients with malignant effusions.
Respiration, Sep 27, 2012
after talc) occurred in 8 of 103 patients in the ST and in 1 of 124 in the 'large-particle talc' ... more after talc) occurred in 8 of 103 patients in the ST and in 1 of 124 in the 'large-particle talc' group (p = 0.007). Patients who received ST had significantly higher proinflammatory cytokines in pleural fluid and serum after talc application, and also in supernatants of the in vitro study. Pleural tumor burden correlated positively with proinflammatory cytokines in serum, suggesting that advanced tumor states induce stronger systemic reactions after talc application. Conclusions: ST provokes a strong inflammatory reaction in both pleural space and serum, which is associated with a higher rate of early deaths observed in patients receiving it.
Medicina Clinica, Dec 1, 2008
Archivos De Bronconeumologia, Mar 1, 2009
Enfermedad pulmonar intersticial difusa Sarcoidosis Lavado broncoalveolar RESUMEN Objetivo: en de... more Enfermedad pulmonar intersticial difusa Sarcoidosis Lavado broncoalveolar RESUMEN Objetivo: en determinadas enfermedades pulmonares intersticiales difusas (EPID), el estudio del lavado broncoalveolar (LBA) define patrones típicos de cada enfermedad y tiene valor como apoyo al diagnó stico. El objetivo del estudio ha sido realizar un aná lisis descriptivo del estudio citoló gico y de las subpoblaciones linfocitarias en el LBA efectuado a pacientes con EPID. Pacientes y métodos: estudio prospectivo de 562 pacientes con EPID desde 1991 hasta 2005. Se realizó un estudio de la distribució n celular y de la subpoblaciones linfocitarias en el LBA: CD3, CD4, CD8, CD3 + CD4 À CD8 À y CD56. Resultados: la edad media de los pacientes era de 53,4 añ os y el 53,3% eran mujeres. Se estudiaron las siguientes enfermedades: fibrosis pulmonar idiopá tica (n ¼ 132), sarcoidosis (n ¼ 123), enfermedades del colá geno (n ¼ 133), neumonía organizada criptogené tica (n ¼ 89) y alveolitis alé rgica extrínseca (n ¼ 85). Tanto en los casos de sarcoidosis como en los de alveolitis alé rgica extrínseca fue frecuente la alveolitis linfocitaria aislada. En el resto de enfermedades la alveolitis mixta fue el patró n habitual. El índice CD4/CD8 fue el pará metro má sú til, con un incremento en la sarcoidosis (mediana: 2,3). En el resto de las enfermedades el índice estaba invertido, con una mediana para la fibrosis pulmonar idiopá tica, la alveolitis alé rgica extrínseca, la neumonía organizada criptogené tica y la enfermedad del colá geno de 1,76; 0,45; 0,35, y 0,33, respectivamente. Conclusiones: los pará metros del LBA, junto a los datos clinicorradioló gicos, ayudan a discriminar entre las EPID. Por lo tanto, debe considerarse una té cnica de gran utilidad en el manejo clínico, sobre todo cuando la biopsia pulmonar no resulta diagnó stica o no es posible realizarla.
Respiration, 2008
As opposed to ‘video-assisted thoracoscopic surgery’ which requires general anesthesia, double-lu... more As opposed to ‘video-assisted thoracoscopic surgery’ which requires general anesthesia, double-lumen tracheal intubation and single lung ventilation, medical thoracoscopy (or ‘pleuroscopy’) is frequently performed in the respiratory endoscopy suite using local anesthesia. It can be done by well-trained physicians, either pulmonologists or thoracic surgeons, and its main indication is related to diagnosis and treatment of pleural effusions. Also, pneumothorax can be managed in most cases using medical thoracoscopy. This article focuses in particular on technical aspects of medical thoracoscopy, including the selection and preparation of the patient, the choice of equipment, specific details of the procedure itself, and other technical details aimed at preventing complications.
The European respiratory journal, Apr 1, 1989
Pleural metastatic tumour.f and lffusionr. FreqUl!IICJ and pathogenic mechanisms in a post-mortem... more Pleural metastatic tumour.f and lffusionr. FreqUl!IICJ and pathogenic mechanisms in a post-mortem series.
Archivos De Bronconeumologia, Mar 1, 2016
On-line el 2 de julio de 2015 Palabras clave: Stents Stents liberadores de fármacos Estenosis tra... more On-line el 2 de julio de 2015 Palabras clave: Stents Stents liberadores de fármacos Estenosis traqueal Obstrucción de la vía aérea Experimentación animal r e s u m e n Introducción: El objetivo de este estudio es evaluar la reactividad traqueal tras la implantación de distintos stents metálicos autoexpandibles (SMAE). Material y métodos: Se utilizaron 40 conejos hembra de raza neozelandesa, que se dividieron en 4 grupos. En 3 grupos se implantaron SMAE: de acero (SA), de nitinol (NiTi) o stents liberadores de nitinol (SLF). El cuarto grupo fue el grupo de control (sin stent). Los stents se implantaron por vía percutánea bajo control fluoroscópico. Los animales se evaluaron mediante tomografía axial computarizada (TAC) multicorte y las tráqueas se extirparon para su estudio anatomopatológico (EAP). Los datos de la TAC y el EAP se analizaron estadísticamente y se correlacionaron. Resultados: El grupo que recibió SLF presentaba la mayor longitud de estenosis (20,51 ± 14,08 mm frente a 5,84 ± 12,43 y 6,57 ± 6,54 mm en los grupos NiTi y SA, día 30; p < 0,05) y el mayor índice de formación de granulomas evidenciados mediante TAC (50% de los casos). El grupo al que se implantaron stents NiTi mostró el menor grado de estenosis (2,86 ± 6,91% frente a 11,28 ± 13,98 y 15,54 ± 25,95% en los grupos SLF y SA; p < 0,05). En el estudio AP, el grupo SA presentó reactividad proliferativa intensa en comparación con los otros 2 grupos. En el grupo SLF se observó una respuesta destructiva en el 70% de animales, mientras que el stent NiTi fue el que menos reacción provocó. La TAC resultó ser superior para detectar el engrosamiento (correlación positiva de un 68,9%; p < 0,001) que para la observación de granulomas (n.s.). Conclusiones: El grupo SA desarrolló granulomas y estenosis significativas. El stent NiTi fue el que menos reacción indujo, mientras que el SLN provocó lesiones importantes que podrían estar relacionadas con la dosis de fármaco. Por consiguiente, este tipo de SLF no se recomienda para el tratamiento de la estenosis traqueobronquial.
The American review of respiratory disease, Mar 1, 1989
In order to determine the diagnostic and prognostic significance of low pleural glucose and pH le... more In order to determine the diagnostic and prognostic significance of low pleural glucose and pH levels, we executed a prospective study of these parameters and cytologic yield in 77 cases of malignant pleural effusions diagnosed from 116 consecutive thoracoscopies. The extension of the neoplasms detected by thoracoscopy as well as the results of our attempts to carry out pleurodesis by talc were also studied. Pleural glucose levels were less than 60 mg/dl in 16 cases, and the cytologic yield was positive in 14 of these cases (87%). The glucose value rose above this level in 61 cases, and the cytology was positive in 30 cases (49%; p less than 0.006). A pH less than 7.30 was encountered in 18 cases and there were positive cytologic findings in 14 of these cases (78%). The pH was above 7.30 in 46 cases, and cytologic studies were positive in 22 cases (48%; p less than 0.03). There were ten cases in which both the glucose and pH levels were low, and the cytology was positive in 9 cases (90%), while there were 40 cases in which both the glucose and pH levels were high and cytologic yields of 20 of these cases were positive (50%; p less than 0.03). The extension of the lesions observed during thoracoscopy showed important differences as far as this related to the glucose levels (p less than 0.005), but this relationship as it concerned pH levels was even more significant (p less than 0.0002). The differences were also highly significant (p less than 0.003) when the glucose and pH were jointly considered.(ABSTRACT TRUNCATED AT 250 WORDS)
European Journal of Clinical Investigation, Sep 16, 2019
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
European Journal of Clinical Investigation, Sep 29, 2016
Our findings showed that p53 mRNA expression levels are upregulated in epicardial adipose tissue ... more Our findings showed that p53 mRNA expression levels are upregulated in epicardial adipose tissue (EAT) from patients with heart failure (HF). This upregulation was also found in myocardium [2]. Our group have described its upregulation in EAT by sympathetic system. This article is protected by copyright. All rights reserved.
Chest, Oct 1, 1995
Communications for this section Will be published as space and priorities permit. The comments sh... more Communications for this section Will be published as space and priorities permit. The comments should not exce!!fl 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscrivt.
Springer eBooks, Aug 4, 2013
The fear of complications arising from the procedure is often the main quoted reason for the relu... more The fear of complications arising from the procedure is often the main quoted reason for the reluctance of many pulmonologists to perform thoracoscopy and for a decline of “medical thoracoscopy” in some countries. In addition there is a trend to transfer pleural investigations to the thoracic surgeon in many centres around the world.
Expert Opinion on Medical Diagnostics, Apr 4, 2013
Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural inv... more Malignant pleural effusion (MPE) is a frequent problem faced by clinicians, but tumor pleural involvement can be seen without effusion. Imaging, pleural fluid analysis, biomarkers for MPE, needle pleural biopsy and thoracoscopy. To prepare this review, we performed a search using keywords: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;diagnosis&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; + &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;malignant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; + &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;pleural&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; + &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;effusion&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (all fields) in PubMed, and found 4106 articles overall (until 16 January 2013, 881 in the last 5 years). Ultrasound techniques will stay as valuable tools for pleural effusions. Biomarkers in pleural fluid do not currently provide an acceptable yield for MPE. In subjects with past history of asbestos exposure, some serum or plasma markers (soluble mesothelin, fibulin) might help in selecting cases for close follow-up, to detect mesothelioma early. Needle pleural biopsy is justified only if used with image-techniques (ultrasound or CT) guidance, and thoracoscopy is better for both diagnosis and immediate palliative treatment (pleurodesis). Animal models of MPE and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;spheroids&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; are promising for research involving both pathophysiology and therapy. Considering the possibility of direct pleural delivery of nanotechnology-developed compounds-fit to both diagnosis and therapy purposes (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;theranostics&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-MPE and mesothelioma in particular are likely to benefit sooner than later from this exciting perspective.
Epithelial-to-mesenchymal transition EMT is a molecular-cellular process activated during embryon... more Epithelial-to-mesenchymal transition EMT is a molecular-cellular process activated during embryonic development and tissue remodelling, by which epithelial cells lose their polarity and cell contacts, acquire the expression of mesenchymal markers and manifest a migratory phenotype. The progressive loss of E-cadherin is coupled with expression of non-epithelial cadherins, process known as “cadherin switching”. As tumours often mimic embryonic development, it has been postulated that EMT represents a transient event in carcinomas progession. Malignant Mesothelioma MM could represent an EMT in vivo model, because tumor cells can exhibit epithelial, sarcomatous and biphasic differentiation. Forty five patients with MM were investigated by immunohistochemical expression of cadherins E,N,P,11,p120 catenin,SPARC and caveolin in two tissue microarrays. Protein expression was scored from 0 to 3 in tumour and stroma. Data were correlated with histologic patterns, thoracoscopy findings and survival. E-P cadherins expression was observed in 79,3% of epithelial MM without evidence in mesenchymal component of mixed and sarcomatous types. N-11cadherins were detected in 20,6%, 29.4% and 17.6% of these histotypes,respectively.The mesenchymal markers were detected in 100% of sarcomatous and mixed MM and in a many samples of epithelial group. Immunohistochemical data correlated with metastatic status, multi-focal disease and poor survival, showed, in epithelial MM forms, weak or absent E-Pcadherins expression, while N-11cadherins, mesenchymal markers and P120 catenin were observed. Our results suggest that the aggressiveness of MM,could be explained by the acquisition of a mesenchymal phenotype in the context of EMT
PubMed, Feb 1, 2000
The incidence of malignant pleural effusions has been increasing over the last few decades (mainl... more The incidence of malignant pleural effusions has been increasing over the last few decades (mainly due to the absolute increase in several types of cancers, especially those of lung and breast origin) and they account for up to 50% of the exudates in many clinical series. Although pleural malignancies are thought to present most frequently with a pleural effusion, several autopsy series, including the current one, found a pleural effusion present in little more than half of the cases of malignant pleural involvement (55% in this series). Thus, many pleural malignancies without effusion might pass unnoticed in clinical practice, especially in metastatic disease. Primary malignancies of the pleura (mesotheliomas) are associated with asbestos exposure in about two-thirds of cases, and they frequently present with chest pain, sometimes associated with a pleural effusion. Benign pleural plaques can coexist with malignant mesothelioma, and this association should be suspected when long-standing plaques change in shape or size over the years, and especially if chest pain develops in a previously asymptomatic patient. Metastatic pleural involvement is much more frequent than mesotheliomas, and its most frequent mechanism is the vascular spreading of tumour cells from distant organs to the lungs, and on to the visceral and parietal pleura. The visceral pleura was involved in up to 87% of the current metastatic cases, whereas the parietal zone in only 47% of the autopsy series. The diagnostic work-up lies in cytology, whose average yield is approximately 50%, and a biopsy technique (either by blind needle biopsy or thoracoscopy) is recommended when the effusion persists, for > 2 weeks, and the first cytology has been negative. Thoracoscopy has the additional advantage of allowing pleurodesis with talc poudrage if clear tumour lesions are found in the pleura. In cases of malignant effusion which are not sensitive to chemotherapy, pleurodesis is the treatment of choice for palliation of symptoms, and talc is the most effective agent. It can be used either in suspension ("slurry") or in dry aerosolized form ("talc poudrage"), but it seems that this last technique achieves the best effects. However, it requires thoracoscopy for a proper application, and this is its main drawback when that technique is not readily available.
Clinical Biochemistry, Nov 1, 2005
Objectives: To investigate whether pleural levels of the soluble oncoprotein 185 HER-2 (sp185 HER... more Objectives: To investigate whether pleural levels of the soluble oncoprotein 185 HER-2 (sp185 HER-2), individually or in combination with CEA and CA 15-3, were useful for the diagnosis of malignant effusions. Design and methods: Levels of CEA, CA 15-3, and sp185 HER-2 were measured in the pleural fluid from 135 malignant and 103 benign effusions. Thresholds of these tumor markers were chosen for a diagnostic specificity of !99%. Results: Pleural sp185 HER-2 levels greater than 25 ng/mL were observed in 20% of breast and 10% of lung adenocarcinomas, and predicted a malignant effusion with a sensitivity of 7% and a likelihood ratio of 7.6. Combination of CEA and CA 15-3 resulted in 50% sensitivity, while adding sp185 HER-2 to this panel nonsignificantly increased sensitivity by 5% (P = 0.45). Only 1 patient with breast adenocarcinoma among 45 cytology-negative malignant effusions had sp185 HER-2 above the diagnostic cutoff point. Conclusion: Measurement of pleural fluid sp185 HER-2 has poor diagnostic performance in patients with malignant effusions.
Respiration, Sep 27, 2012
after talc) occurred in 8 of 103 patients in the ST and in 1 of 124 in the 'large-particle talc' ... more after talc) occurred in 8 of 103 patients in the ST and in 1 of 124 in the 'large-particle talc' group (p = 0.007). Patients who received ST had significantly higher proinflammatory cytokines in pleural fluid and serum after talc application, and also in supernatants of the in vitro study. Pleural tumor burden correlated positively with proinflammatory cytokines in serum, suggesting that advanced tumor states induce stronger systemic reactions after talc application. Conclusions: ST provokes a strong inflammatory reaction in both pleural space and serum, which is associated with a higher rate of early deaths observed in patients receiving it.
Medicina Clinica, Dec 1, 2008
Archivos De Bronconeumologia, Mar 1, 2009
Enfermedad pulmonar intersticial difusa Sarcoidosis Lavado broncoalveolar RESUMEN Objetivo: en de... more Enfermedad pulmonar intersticial difusa Sarcoidosis Lavado broncoalveolar RESUMEN Objetivo: en determinadas enfermedades pulmonares intersticiales difusas (EPID), el estudio del lavado broncoalveolar (LBA) define patrones típicos de cada enfermedad y tiene valor como apoyo al diagnó stico. El objetivo del estudio ha sido realizar un aná lisis descriptivo del estudio citoló gico y de las subpoblaciones linfocitarias en el LBA efectuado a pacientes con EPID. Pacientes y métodos: estudio prospectivo de 562 pacientes con EPID desde 1991 hasta 2005. Se realizó un estudio de la distribució n celular y de la subpoblaciones linfocitarias en el LBA: CD3, CD4, CD8, CD3 + CD4 À CD8 À y CD56. Resultados: la edad media de los pacientes era de 53,4 añ os y el 53,3% eran mujeres. Se estudiaron las siguientes enfermedades: fibrosis pulmonar idiopá tica (n ¼ 132), sarcoidosis (n ¼ 123), enfermedades del colá geno (n ¼ 133), neumonía organizada criptogené tica (n ¼ 89) y alveolitis alé rgica extrínseca (n ¼ 85). Tanto en los casos de sarcoidosis como en los de alveolitis alé rgica extrínseca fue frecuente la alveolitis linfocitaria aislada. En el resto de enfermedades la alveolitis mixta fue el patró n habitual. El índice CD4/CD8 fue el pará metro má sú til, con un incremento en la sarcoidosis (mediana: 2,3). En el resto de las enfermedades el índice estaba invertido, con una mediana para la fibrosis pulmonar idiopá tica, la alveolitis alé rgica extrínseca, la neumonía organizada criptogené tica y la enfermedad del colá geno de 1,76; 0,45; 0,35, y 0,33, respectivamente. Conclusiones: los pará metros del LBA, junto a los datos clinicorradioló gicos, ayudan a discriminar entre las EPID. Por lo tanto, debe considerarse una té cnica de gran utilidad en el manejo clínico, sobre todo cuando la biopsia pulmonar no resulta diagnó stica o no es posible realizarla.
Respiration, 2008
As opposed to ‘video-assisted thoracoscopic surgery’ which requires general anesthesia, double-lu... more As opposed to ‘video-assisted thoracoscopic surgery’ which requires general anesthesia, double-lumen tracheal intubation and single lung ventilation, medical thoracoscopy (or ‘pleuroscopy’) is frequently performed in the respiratory endoscopy suite using local anesthesia. It can be done by well-trained physicians, either pulmonologists or thoracic surgeons, and its main indication is related to diagnosis and treatment of pleural effusions. Also, pneumothorax can be managed in most cases using medical thoracoscopy. This article focuses in particular on technical aspects of medical thoracoscopy, including the selection and preparation of the patient, the choice of equipment, specific details of the procedure itself, and other technical details aimed at preventing complications.
The European respiratory journal, Apr 1, 1989
Pleural metastatic tumour.f and lffusionr. FreqUl!IICJ and pathogenic mechanisms in a post-mortem... more Pleural metastatic tumour.f and lffusionr. FreqUl!IICJ and pathogenic mechanisms in a post-mortem series.