Volumetric evaluations of the maxillary sinus before and post regenerative surgery

OBJECTIVE

The purpose of this study was to investigate possible differences in the filling of the various recesses of the maxillary sinus after the procedure of sinus floor elevation in relation with the initial volume of the same and if the sinus volume can influence long-term graft dimensions, by using cone beam computed tomography (CBCT) as diagnostic analysis device.

PATIENTS AND METHODS

This study included 32 sinuses corresponding to 16 patients referred for bilateral maxillary sinus augmentation procedures needing to increase the volume of the surgical site with the porcine cortical bone for dental implant placement in the posterior maxilla. The sinuses were analyzed by preoperative and postoperative (15 days and 6 months after sinus surgery) cone beam computed tomography.

RESULTS

No statistically significant relations were observed between initial sinus dimensions and the entity of the contraction of the graft between T1 (15 days after surgery) and T2 (180 days after surgery). The behavior was the same either for the large sinus (> 15.65 cm3) and for the small one (< 15.65 cm3). Instead, about the filling of the various sinus recesses, a linear regression model was used to explain the difference between the mean preoperative and postoperative surgical spaces; in most of the samples, the filling of the anterior recess was ~15% of the total volume of the graft, i.e., the minor one among the main recesses.

CONCLUSIONS

Our findings suggest that: (1) in the procedure of sinus floor augmentation by a lateral approach with deproteinized porcine bone there are no relations between the initial dimensions of the sinus and the long-term dimensional changes of the graft, and (2) that, among the main recesses of the sinus, the anterior one is generally the less filled.

Indirect potable water reuse to face drought events in Barcelona city. Setting a monitoring procedure to protect aquatic ecosystems and to ensure a safe drinking water supply

The climate change and increasing anthropogenic pressures are expected to limit the availability of water resources. Hence, active measures must be planned in vulnerable regions to ensure a sustainable water supply and minimize environmental impacts. A pilot test was carried out in the Llobregat River (NE Spain) aiming to provide a useful procedure to cope with severe droughts through indirect water reuse. Reclaimed water was used to restore the minimum flow of the lower Llobregat River, ensuring a suitable water supply downstream for Barcelona. A monitoring was performed to assess chemical and microbiological threats throughout the water treatment train, the river and the final drinking water, including 376 micropollutants and common microbiological indicators. The effects of water disinfection were studied by chlorinating reclaimed water prior to its discharge into the river. Data showed that 10 micropollutants (bromodichloromethane, dibromochloromethane, chloroform, EDDP, diclofenac, iopamidol, ioprimid, lamotrigine, ofloxacin and valsartan) posed a potential risk to aquatic life, whereas one solvent (1,4-dioxane) could affect human health. The chlorination of reclaimed water mitigated the occurrence of pharmaceuticals but, conversely, the concentration of halogenated disinfection by-products increased. From a microbiological perspective, the microbial load decreased along wastewater treatments and, later, along drinking water treatment, ultimately reaching undetectable values in final potable water. Non-chlorinated reclaimed water showed a lower log reduction of E. coli and coliphages than chlorinated water. However, the effect of disinfection vanished once reclaimed water was discharged into the river, as the basal concentration of microorganisms in the Llobregat River was comparable to that of non-chlorinated reclaimed water. Overall, our study indicates that indirect water reuse can be a valid alternative source of drinking water in densely populated areas such as Barcelona (Catalonia - NE Spain). A suitable monitoring procedure is presented to assess the related risks to human health and the aquatic ecosystem.

Printing via Laser-Induced Forward Transfer and the Future of Digital Manufacturing

In the last decades, digital manufacturing has constituted the headline of what is starting to be known as the 'fourth industrial revolution', where the fabrication processes comprise a hybrid of technologies that blur the lines between fundamental sciences, engineering, and even medicine as never seen before. One of the reasons why this mixture is inevitable has to do with the fact that we live in an era that incorporates technology in every single aspect of our daily lives. In the industry, this has translated into fabrication versatility, as follows: design changes on a final product are just one click away, fabrication chains have evolved towards continuous roll-to roll processes, and, most importantly, the overall costs and fabrication speeds are matching and overcoming most of the traditional fabrication methods. Laser-induced forward transfer (LIFT) stands out as a versatile set of fabrication techniques, being the closest approach to an all-in-one additive manufacturing method compatible with virtually any material. In this technique, laser radiation is used to propel the material of interest and deposit it at user-defined locations with high spatial resolution. By selecting the proper laser parameters and considering the interaction of the laser light with the material, it is possible to transfer this technique from robust inorganic materials to fragile biological samples. In this work, we first present a brief introduction on the current developments of the LIFT technique by surveying recent scientific review publications. Then, we provide a general research overview by making an account of the publication and citation numbers of scientific papers on the LIFT technique considering the last three decades. At the same time, we highlight the geographical distribution and main research institutions that contribute to this scientific output. Finally, we present the patent status and commercial forecasts to outline future trends for LIFT in different scientific fields.

Criteria for progressive fibrotic hypersensitivity pneumonitis in a Portuguese patient cohort

Background

Hypersensitivity pneumonitis (HP) is a syndrome caused by sensitisation to inhaled antigens that leads to an abnormal immune response in the airways and lung parenchyma. Some patients previously diagnosed with certain types of fibrotic interstitial lung diseases (f-ILDs), including fibrotic HP (f-HP), are susceptible to develop a progressive fibrosing phenotype (PF-ILD), despite initial state-of-the-art management.

Objectives

To characterise a cohort of patients with a multidisciplinary diagnosis (MTD) of chronic f-HP, who were followed up in an ILD outpatient clinic of a hospital in Portugal, and to assess the prevalence of PF-ILD criteria in these patients.

Methods

Data were collected from all patients with a definite or provisional diagnosis of f-HP after a multidisciplinary team discussion. Patients were followed up between December 2014 and July 2019. Data included clinical characteristics, high-resolution chest tomography (HRCT) disease patterns, lung function tests, bronchoalveolar lavage and further immunological work-up, biopsy reports (conventional transbronchial lung biopsy, transbronchial lung cryobiopsy or surgical video-assisted thoracoscopic lung biopsy), all ILD multidisciplinary team records and diagnostic confidence levels. Patients were assessed according to PF-ILD criteria as defined in the INBUILD trial.

Results

We identified 83 patients with an MTD of HP, who had been followed up for at least 12 months. Of these, 63 (75.9%) were diagnosed with f-HP. Of the 63 f-HP patients, 33.3% (n=21) fulfilled the predefined criteria for PF-HP: 66.7% had a relative decline of ≥10% forced vital capacity (FVC); 5% a relative decline of 5 - 9% FVC, with worsening symptoms or increased fibrosis on HRCT; and 23.8% had worsening respiratory symptoms with radiological progression.

Conclusion

This single-centre cohort study demonstrated that a third of f-HP patients presented with PF-ILD, as determined by progression during initial standard-of-care treatment. A usual interstitial pneumonia (UIP)/UIP-like pattern was present in >70% of patients with f-HP, and two-thirds of these patients had an FVC decline of ≥10%. PF-HP patients were also more exacerbation prone. According to recent trial data, this segment of patients can be considered possible candidates for antifibrotic treatment, with a reasonable prospect of effectiveness. Further efforts should focus on refining knowledge of longitudinal behaviour of large multicentric cohorts of f-HP patients, establishing a consensual and uniform definition of progression for use in clinical practice, as well as developing prognostic prediction tools to better (and early) inform the disease course.

P5 ACCESSORY PATHWAYS HIGH–DENSITY MAPPING IN WOLFF–PARKINSON–WHITE SYNDROME

Wolff–Parkinson–White syndrome is a common condition characterized by atrioventricular accessory pathways (AP), which can be asymptomatic or can be responsible for atrioventricular reentrant tachycardia or rapid conduction of atrial fibrillation to the ventricles: for this reason, patients are referred for catheter ablation procedures. Although success rates of ablation are &gt;95%, late recurrences can occur in 2–21% of cases mainly depending on the anatomical position. Current approaches remain suboptimal, and when failures occur, they may be due to technical difficulties such as poor contact or catheter stability, inability to access the target site as well as mapping errors resulting in inaccurate location of the AP itself. High–density mapping represents an alternative approach to mapping arrhythmias since the collection of a high density of points allows pathway conduction to be mapped more efficiently. The use of a new software called open–window mapping proved to be reliable in the localization of AP and therefore in the determination of the effective ablation site. A 41–year–old male patient was referred to our Centre following the ECG finding of manifest ventricular preexcitation and short–lasting paroxysmal palpitations. In the Electrophysiology Lab, the diagnostic catheters were inserted with the “fluoroless” technique using the EnSite Precision™ mapping system (Abbott): the ECG and the endocavitary electrograms were indicative of a right Parahissian accessory pathway. The mapping was performed with a multipolar catheter (Advisor™ HD Grid). Once the location of the pathway had been estimated, the roving acquisition interval (RAI) was set according to the expected position of atrial and ventricular electrogram. The RAI window was centered at this point and was opened in both directions (open window mapping) to fully include signals leading up to and traveling away from the AP. It accurately showed the location of the pathway just few millimeters from the Hissian potential. The baseline electrophysiological study revealed an effective antegrade refractory period (PREAP) of 320 msec. In isoproterenol, antegrade PREAP was reduced to 300 msec and inducibility of arrhythmias was not observed. Therefore, in consideration of the poor conductive properties and the non–inducibility of arrhythmias, as well as the anatomical site near the conduction system, it was decided not to proceed with the ablation due to the significant risk of atrio–ventricular block.

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Endobronchial ultrasound guided transbronchial cryobiopsy versus forceps biopsy in peripheral lung lesions

INTRODUCTION

Radial probe endobronchial ultrasound (RP-EBUS) is a modern technique for diagnosis of peripheral lung lesions. It is assumed that the addition of transbronchial cryobiopsy (TBCB) could increase the diagnostic value for RP-EBUS.

OBJECTIVES

The main objectives were to evaluate the efficacy and safety of RP-EBUS-guided TBCB for diagnosis of peripheral lung lesions and comparing it with RP-EBUS-guided transbronchial forceps biopsy.

METHODS

Sixty patients with peripheral lung diseases were divided into two groups. Group I included 45 patients who were eligible for TBCB and they subjected to forceps transbronchial biopsy (forceps TBB) and TBCB guided by RP-EBUS. Fifteen patients who were not eligible for TBCB were included in group II and they were subjected to forceps TBB and/or cytology retrieval procedures guided by RP-EBUS.

RESULTS

In group I, forceps TBB had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of; 67.5%, 100%, 100%, 18.8%, and 69.8%, respectively, while TBCB had sensitivity, specificity, PPV, NPV, and accuracy of 75%, 100%, 100%, 23.1%, and 76.7%, respectively. The sensitivity in group II was 80% and the overall results including both groups were sensitivity, specificity, PPV, NPV, and accuracy of 85.2%, 100%, 100%, 42.8%, and 86.7%, respectively. Regarding the complications, only one patient (1.7%) had significant bleeding. One patient (1.7%) had pneumothorax and another patient (1.7%) suffered from hypoxemia.

CONCLUSIONS

RP-EBUS-guided TBCB is a safe and effective technique for diagnosis of peripheral lung lesions. TBCB has achieved higher diagnostic values and better quality of samples.

Is it necessary to sample the contralateral nodal stations by EBUS-TBNA in patients with lung cancer and clinical N0 / N1 on PET-CT?

OBJECTIVES

Systematic mediastinal staging (sampling all visible nodes measuring ≥ 5 mm from N3 station to N1, regardless of PET/CT (positron emission tomography/computed tomography) by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a decisive step in patients with non-small cell lung cancer (NSCLC). We analyzed the prevalence of N3 disease and the utility of systematic staging in the subgroup of patients who underwent EBUS-TBNA staging without showing mediastinal lesions on the PET/CT (N0/N1).

MATERIAL AND METHODS

We conducted a retrospective analysis of a prospectively collected database that included 174 patients with a final diagnosis of NSCLC, with N0/N1 disease on PET/CT who underwent a systematic EBUS-TBNA staging.

RESULTS

174 consecutive patients were included. Systematic EBUS-TBNA detected N2 mediastinal involvement in 21 (12 %) cases, and no cases of N3 disease were detected (neither hilar nor mediastinal). Of the remaining 153 patients N0/N1 EBUS-TBNA, 122 underwent lung resection that revealed 4 cases of N2 disease while 117 were confirmed to be N0/N1. Thirty-three patients with N0/1 disease after EBUS-TBNA did not undergo surgery and were excluded for the NPV calculation. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and overall accuracy of systematic EBUS was 84 %, 100 %, 96.7 %, 100 % and 97 % respectively.

CONCLUSION

Systematic EBUS-TBNA is a very accurate method for lymph node staging in patients with NSCLC without mediastinal involvement on PET/CT. Pending more studies, the absence of contralateral hilar nodal involvement in our series, questions the need for a contralateral hilar sampling in this subgroup of patients.

Anesthetic management of the diaphragmatic pacemaker placement surgery. Our experience in the Institut Guttmann

BACKGROUND

The diaphragm pacemaker (DP) has proven its utility in replacing mechanical ventilation in patients with chronic spinal cord injury (SCI) and amyotrophic lateral sclerosis (ALS). The DP improves patient quality of life and reduces morbidity and mortality and their associated health care costs. The anesthetic management of these patients and the particularities of the surgical procedure are challenging. The aim of our study is to analyze anesthetic management and intraoperative complications in patients undergoing DP placement in our hospital.

METHODS

We performed a chart review of patients treated between December 2007 and July 2017, recording the patients' preoperative status, anesthetic management and intraoperative complications.

RESULTS

The study included 16 patients (5 pediatric) undergoing DP implantation for chronic SCI (63%), ALS (25%) and other neurologic conditions (12%). Abdominal laparoscopy was performed under general anesthesia, with intravenous (87%) or inhalational (13%) induction and maintenance using total intravenous (50%) or balanced (50%) anesthesia. Rocuronium was administered in one case to permit airway management. Complications included: hypotension (50%), difficulties in mechanical ventilation during laparoscopy (31%), pneumothorax (12.5%) and autonomic dysreflexia (6%).

CONCLUSIONS

DP placement under general anesthesia is a safe intervention in both adult and pediatric patients. Complications derived from both the underlying disease and the surgical technique may appear, and must be rapidly identified and treated to obtain a satisfactory surgical outcome.

Remotely sensed indicators and open-access biodiversity data to assess bird diversity patterns in Mediterranean rural landscapes

Biodiversity monitoring at simultaneously fine spatial resolutions and large spatial extents is needed but limited by operational trade-offs and costs. Open-access data may be cost-effective to address those limitations. We test the use of open-access satellite imagery (NDVI texture variables) and biodiversity data, assembled from GBIF, to investigate the relative importance of variables of habitat extent and structure as indicators of bird community richness and dissimilarity in the Alentejo region (Portugal). Results show that, at the landscape scale, forest bird richness is better indicated by the availability of tree cover in the overall landscape than by the extent or structure of the forest habitats. Open-land birds also respond to landscape structure, namely to the spectral homogeneity and size of open-land patches and to the presence of perennial vegetation amid herbaceous habitats. Moreover, structure variables were more important than climate variables or geographic distance to explain community dissimilarity patterns at the regional scale. Overall, summer imagery, when perennial vegetation is more discernible, is particularly suited to inform indicators of forest and open-land bird community richness and dissimilarity, while spring imagery appears to be also useful to inform indicators of open-land bird richness.

Urban Growth, Land-use Efficiency and Local Socioeconomic Context: A Comparative Analysis of 417 Metropolitan Regions in Europe

The present study presents a multidimensional analysis of land-use efficiency in terms of per-capita built-up area over 417 metropolitan regions from 27 European countries. The study period encompasses two urban phases including economic expansion (2000-2007) and crisis (2008-2015). Multiple geographical gradients were identified as relevant predictors of land-use efficiency across Europe. The socioeconomic variables most associated with high land-use efficiency were per-capita disposable income (in Western, Atlantic and Central Europe) and income growth during 2000-2007 (in Eastern Europe), indicating that wealthier cities are characterized by higher land-use efficiency. Land-use efficiency increased in contexts with diversified urban landscapes.

Do spatial patterns of urbanization and land consumption reflect different socioeconomic contexts in Europe?

Land-use changes and urban sprawl have transformed European cities, with a direct impact on both metropolitan structures and socioeconomic functions. However, these processes tend to be relatively different across countries, being influenced by place-specific factors associated to socioeconomic, historical, political and cultural factors that influence decisions on the use of land. Considering 155 metropolitan areas in 6 European macro-regions, the present study investigates spatial patterns of land consumption profiling cities according to a large set of territorial variables, with the final objective to identify relevant socioeconomic dimensions characteristic of recent processes of urban growth. Investigating the socioeconomic background underlying land-use changes in metropolitan regions allows identification of place-specific factors improving the design of effective strategies containing land consumption in different European urban typologies. An exhaustive analysis of land-use changes at regional and local spatial scales contributes to find alternative policies for land-use efficiency and long-term environmental sustainability.

Feasibility of a Cell Kinetic-Based Adjuvant Chemotherapy Trial in Axillary Node-Negative Breast Cancer

Aims and background

Accumulated information on biologic prognostic indicators and predictors of response to different types of treatment in patients with different tumor characteristics has made it possible to design clinical protocols on biologic bases. Among cell proliferation indices, the thymidine labelling index (TLI) has proved to be an independent and consistent prognostic indicator over time. Moreover, experimental and retrospective analyses of clinical studies have revealed a direct relation between TLI and response to chemotherapy. On the basis of the results, a prospective clinical protocol on axillary node-negative breast cancer was activated in Italy in 1989.

Methods

Patients with low TLI tumors were treated with local-regional therapy alone, whereas patients with high TLI tumors were randomized to receive local-regional therapy followed or not by adjuvant chemotherapy consisting of 6 cycles of CMF.

Results and Conclusions

The present paper reports on the feasibility of a prospective clinical protocol based on a subgroup of patients with specific pathologic (node negative) and biologic (rapidly proliferating) breast cancers. However, patient eligibility was only 11%.

Systematic Compared With Targeted Staging With Endobronchial Ultrasound in Patients With Lung Cancer

BACKGROUND

To evaluate the accuracy of systematic mediastinal staging by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) (sampling of all visible nodes measuring ≥5 mm from stations N3 to N1 regardless of their positron emission tomography/computed tomography [PET/CT] features) and compare this staging approach with targeted EBUS-TBNA staging (sampling only 18F-fluorodeoxyglucose [FDG]-avid nodes) in patients with N2 non-small cell lung cancer on PET/CT.

METHODS

Retrospective study of 107 patients who underwent systematic EBUS-TBNA mediastinal staging. The results were compared with those of a hypothetical scenario where only FDG-avid nodes on PET/CT would be sampled.

RESULTS

Systematic EBUS-TBNA sampling demonstrated N3 disease in 3 patients, N2 disease in 60 (42 single-station or N2a, 18 multiple-station or N2b) and N0/N1 disease in 44. Of these 44, 7 underwent mediastinoscopy, which did not show mediastinal disease; 6 of the 7 proceeded to lung resection, which also showed no mediastinal disease. Thirty-four N0/N1 patients after EBUS-TBNA underwent lung resection directly: N0/N1 was found in 30 and N2 in 4 (1 N2b with a PET/CT showing N2a disease, 3 N2a). Sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy of systematic EBUS-TBNA were 94%, 100%, 90%, 100% and 96%, respectively. Compared with targeted EBUS-TBNA, systematic EBUS-TBNA sampling provided additional important clinical information in 14 cases (13%): 3 N3 cases would have passed unnoticed, and 11 N2b cases would have been staged as N2a.

CONCLUSIONS

In clinical practice, systematic sampling of the mediastinum by EBUS-TBNA, regardless of PET/CT features, is to be recommended over targeted sampling.

Identification of oestrogen, progesterone receptor and human epidermal growth factor receptor 2 expression in mediastinal metastases of breast cancer obtained by endobronchial ultrasound-guided transbronchial needle aspiration

BACKGROUND

In breast cancer patients, the expression statuses of oestrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) are crucial in the choice of treatment. Receptor expression in metastatic lesions can differ from the primary tumour. The aim of our study was to analyse the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to obtain samples allowing the identification of ER, PR and HER2 expression in patients with mediastinal metastases of breast cancer.

PATIENTS AND METHODS

The clinical files of all patients with a final diagnosis of breast cancer mediastinal metastases diagnosed by EBUS-TBNA in our institution were retrospectively analysed. The ability of EBUS-TBNA to obtain samples that allowed hormone receptor and HER2 expression analysis was calculated.

RESULTS

Twenty-four patients were included. ER, PR and HER2 assessments could be performed in 22, 20 and 22 patients, respectively. In 20 of the 24 patients it was possible to investigate all three types of receptor expression. In the remaining four cases, where ER, PR or HER2 expression tests could not be performed, it was due to a lack of tissue. In cases with adequate results for EBUS-TBNA and the primary tumour agreement was greater for ER (16/19) and HER2 (12/14) than PR (8/17). Based on receptor status, there was a change in the choice of treatment for five patients.

CONCLUSION

In patients with breast cancer mediastinal metastases, ER, PR and HER2 expression can be assessed in samples obtained by EBUS-TBNA whenever a sufficient tissue sample is collected.

Low-Cost Fabrication of Printed Electronics Devices through Continuous Wave Laser-Induced Forward Transfer

Laser-induced forward transfer (LIFT) is a direct-writing technique that allows printing inks from a liquid film in a similar way to inkjet printing but with fewer limitations concerning ink viscosity and loading particle size. In this work, we prove that liquid inks can be printed through LIFT by using continuous wave (CW) instead of pulsed lasers, which allows a substantial reduction in the cost of the printing system. Through the fabrication of a functional circuit on both rigid and flexible substrates (plastic and paper), we provide a proof-of-concept that demonstrates the versatility of the technique for printed electronics applications.

Transbronchial and transesophageal fine-needle aspiration using a single ultrasound bronchoscope in the diagnosis of locoregional recurrence of surgically-treated lung cancer

Background

The present study sought to evaluate the usefulness of EBUS-TBNA in the diagnosis of locoregional recurrence of lung cancer in a cohort of lung cancer patients who were previously treated surgically, and describe our initial experience of EUS-B-FNA in this clinical scenario.

Methods

We retrospectively studied the clinical records of all patients with a previous surgically-treated lung cancer who were referred to our bronchoscopy unit after suspicion of locoregional recurrence. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were evaluated.

Results

Seventy-three patients were included. EBUS-TBNA confirmed malignancy in 40 patients: 34 confirmed to have locoregional recurrence, six had metachronous tumours. Of the 33 patients with non-malignant EBUS-TBNA; 2 had specific non-malignant diseases, 26 underwent radiological follow up and 5 patients underwent surgery. Of the 26 patients who had radiological follow up; 18 remained stable, three presented thoracic radiological progression and 5 presented extrathoracic progression. Of the 5 patients who underwent surgery; 3 had metachronous tumours, one confirmed to be a true negative and one presented nodal invasion. Seven patients underwent EUS-B-FNA, four of them confirmed to have recurrence. The sensitivity, specificity, NPV, PPV and overall accuracy of EBUS-TBNA for the diagnosis of locoregional recurrence were 80.9, 100, 69.2, 100 and 86.6% respectively.

Conclusions

EBUS-TBNA is an accurate procedure for the diagnosis of locoregional recurrence of surgically-treated lung cancer. EUS-B-FNA combined with EBUS-TBNA broads the diagnostic yield of EBUS-TBNA alone.

Lung Cancer in Patients With Combined Pulmonary Fibrosis and Emphysema and Idiopathic Pulmonary Fibrosis. A Descriptive Study in a Spanish Series

INTRODUCTION

Information on the association of lung cancer (LC) and combined pulmonary fibrosis and emphysema (CPFE) is limited and derived almost exclusively from series in Asian populations. The main objective of the study was to assess the impact of LC on survival in CPFE patients and in patients with idiopathic pulmonary fibrosis (IPF).

METHODS

A retrospective study was performed with data from patients with CFPE and IPF diagnosed in our hospital over a period of 5 years.

RESULTS

Sixty-six patients were included, 29 with CPFE and 37 with IPF. Nine had a diagnosis of LC (6 with CPFE and 3 with IPF). Six patients (67%) received palliative treatment even though 3 of them were diagnosed atstage i-ii. Overall mortality did not differ significantly between groups; however, in patients with LC, survival was significantly lower compared to those without LC (P=.044). The most frequent cause of death was respiratory failure secondary to pulmonary fibrosis exacerbation (44%). In a multivariate analysis, the odds ratio of death among patients with LC compared to patients without LC was 6.20 (P=.037, 95% confidence interval: 1.11 to 34.48).

CONCLUSIONS

Lung cancer reduces survival in both entities. The diagnostic and therapeutic management of LC is hampered by the increased risk of complications after any treatment modality, even after palliative treatment.