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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">We describe the early detection of lung cancer during the follow-up of two emphysematous patients undergoing endobronchial treatment with one-way valves &#40;Zephyr TM&#59; Pulmonx Inc&#46;&#44; Redwood&#44; CA&#44; USA&#41; for severe dyspnea&#46; The functional improvement obtained after EBV &#40;endobronchial valve&#41; procedure meant that patients could undergo surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case 1</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 71-year-old male smoker was admitted for giant emphysematous bulla &#40;GEB&#41; that occupied the entire upper left lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; He had had a previous right upper lobectomy for tuberculosis 25 years ago&#46; The patient&#39;s respiratory condition was so poor that bullectomy was contraindicated &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Under moderate sedation&#44; 3 valves were sequentially placed to occlude the left upper lobe communicating with the bulla&#46; One-way flutter EBVs enabled bulla deflation with re-expansion of adjacent compressed lung &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; At 6 months of follow-up&#44; high resolution computed tomography &#40;HRCT&#41; scan revealed a single nodule in the lower right lobe not previously seen &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; This was confirmed as cancer by CT-guided needle biopsy &#40;clinical stage&#58; T1N0M0&#41;&#46; Functional improvement obtained after EBV treatment allowed the performance of a wedge resection via muscle-sparing thoracotomy&#46; Thoracoscopy was avoided due to possible post-operative adhesions stemming from the patient&#39;s previous lobectomy&#46; After resection&#44; respiratory function was similar to post-EBV values&#46; No other treatments were given&#46; After 10 months of follow-up&#44; the patient was alive without recurrence&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 2</span><p id="par0015" class="elsevierStylePara elsevierViewall">A 69-year-old male smoker was admitted for severe dyspnea &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; due to emphysema mostly affecting the upper left lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#46; Two EBVs were sequentially placed in the superior and inferior trunk of the affected lobe&#46; Complete atelectasis of the upper left lobe was achieved with improvement of respiratory function &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#41;&#46; After 12 months of follow-up&#44; an HRCT scan detected a solitary nodular lesion in the upper right lobe &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>F&#41;&#46; Wedge resection was performed via thoracoscopy&#46; Pathological findings revealed a squamous cell carcinoma &#40;pathological stage T1N0M0&#41;&#46; No other treatments were given&#46; After 15 months of follow-up&#44; the patient was alive without recurrence&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Considering the growing number of emphysematous patients treated with EBVs&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> this paper has two important messages for physicians&#58; &#40;i&#41; emphysematous patients who are candidates for EBV treatment should be included in lung cancer screening programs&#59; and &#40;ii&#41; lung function improvement achieved by EBV placement allows some of them to undergo limited surgical resections &#40;open vs thoracoscopic&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The potential development of lung cancer in emphysematous patients treated with EBV is under-evaluated&#46; In the literature&#44; we found only 1 case where a patient developed cancer in the emphysematous lobe treated with valve placement&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The diagnosis was obtained with trans-bronchial biopsy after valve removal&#44; and oncological treatment was limited to chemotherapy alone due to the patient&#39;s altered lung function&#46; In our cases&#44; however&#44; detection of cancer was easier because it developed in the opposite lung&#46; Moreover&#44; surgery was possible due to improved respiratory function achieved after EBV treatment and maintained at the time of the cancer diagnosis&#46; After surgery&#44; in Case 1&#44; respiratory function was similar to post-EBV values&#44; probably due to the effect of lung volume reduction&#44; as part of the surrounding hyper-expanded non-functional lung was removed with the tumor&#46; In Case 2&#44; the slight decline of respiratory function may be attributable to the wedge resection alone&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Obviously&#44; valve placement does not foster the development of cancer associated with the underlying disease&#46; Several mechanisms have been suggested to explain the strong association between emphysema and lung cancer&#46; Smoking is the main risk factor for both lung cancer and emphysema&#44; and induces a chronic inflammatory state in the lung through generation of reactive oxidant species that lead to emphysema and lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Moreover&#44; emphysema and air-flow obstruction are risk factors for lung cancer independently of smoking&#44; as shown by a study from the Mayo Clinic and 2 lung cancer screening programs&#46; In emphysema&#44; mucociliary clearance is impaired&#44; allowing carcinogens to pool in the airway and leading to the development of lung cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Thus&#44; the potentially prolonged survival obtained with EBV treatment may allow a patient to live long enough to develop a malignancy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; lung cancer screening programs may improve early detection of cancer in emphysematous patients undergoing EBV procedure&#44; and cancer therapies&#44; including surgery or non-operative therapy &#40;stereotactic body radiotherapy or chemotherapy&#41; may be offered in accordance with patient&#39;s clinical status&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they did not receive funding for this paper&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of Interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2014-08-28"
    "fechaAceptado" => "2014-09-21"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We describe the early detection of lung cancer during the follow-up of two emphysematous patients undergoing endobronchial treatment with one-way valves for severe dyspnea&#46; In both cases&#44; the lung function improvement achieved after the valves placement allowed their surgical treatment&#46; In additional to standard follow-up for evaluating the progression of emphysema&#44; such patients should be enrolled in a screening program&#46; It may allow the early detection of lung cancer with the possibility for surgery in accordance with respiratory function of patient&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Describimos la detecci&#243;n precoz de c&#225;ncer de pulm&#243;n durante la revisi&#243;n de 2 pacientes enfisematosos con tratamiento endobronquial mediante v&#225;lvulas unidireccionales para la disnea grave&#46; En ambos casos el tratamiento quir&#250;rgico fue posible gracias a la mejora de la actividad pulmonar conseguida tras la colocaci&#243;n de las v&#225;lvulas&#46; Adem&#225;s del seguimiento convencional para evaluar la evoluci&#243;n del enfisema&#44; dichos pacientes deber&#237;an incluirse en un programa de detecci&#243;n sistem&#225;tica&#46; Podr&#237;a conseguirse la detecci&#243;n precoz del c&#225;ncer de pulm&#243;n y&#44; por lo tanto&#44; la posibilidad de operar al paciente en funci&#243;n de su capacidad respiratoria&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fiorelli A&#44; Costanzo S&#44; di Costanzo E&#44; Santini M&#46; Detecci&#243;n precoz de c&#225;ncer de pulm&#243;n durante el seguimiento de pacientes tratados con v&#225;lvulas endobronquiales unidireccionales para el tratamiento del enfisema&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;e13&#8211;e15&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Case</span> 1&#58; A 71-year-old male smoker with giant emphysematous bulla that entirely occupied the left upper lobe &#40;Part A&#41;&#46; After endobronchial valve placement in the left bronchus &#40;thin arrow&#41;&#44; complete atelectasis of bulla was obtained &#40;thick arrow&#41; with re-expansion of adjacent lung parenchyma &#40;Part B&#41;&#46; After 6 months of follow-up&#44; a nodule &#40;&#42;&#41; diagnosed to be a bronchioloalveolar carcinoma was seen in the lower right lobe &#40;Part C&#41;&#46; <span class="elsevierStyleItalic">Case</span> 2&#58; A 69-year-old male smoker with emphysema that mostly affected the left upper lobe &#40;Part D&#41;&#46; After endobronchial valve placement &#40;thin arrow&#41;&#44; complete atelectasis of the treated lobe &#40;thick arrow&#41; was achieved &#40;Part E&#41;&#46; After 12 months of follow-up&#44; a solitary pulmonary nodule &#40;thick arrow&#41; diagnosed to be a squamous cell carcinoma was seen in upper right lobe &#40;Part F&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Data are expressed as liters and &#40;percent of predicted value&#41;&#46; FEV1&#61;<span class="elsevierStyleHsp" style=""></span>forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s&#59; FVC&#61;<span class="elsevierStyleHsp" style=""></span>forced vital capacity&#59; R&#61;<span class="elsevierStyleHsp" style=""></span>residual volume&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Before EBV treatment</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">At time of cancer detection</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">After cancer resection</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Case 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;98 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;1 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8 &#40;215&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;5 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;3 &#40;133&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;2 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2 &#40;125&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;59 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1 &#40;209&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;8 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5 &#40;147&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7 &#40;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;3 &#40;133&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Endobronchial treatment of giant emphysematous bullae with one-way valves&#58; a new approach for surgically unfit patients"
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                          "etal" => false
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                            2 => "G&#46; Vicidomini"
                            3 => "V&#46;G&#46; di Crescenzo"
                            4 => "G&#46; Messina"
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                      "doi" => "10.1016/j.ejcts.2011.03.046"
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                        "tituloSerie" => "Eur J Cardiothorac Surg"
                        "fecha" => "2011"
                        "volumen" => "40"
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                        "paginaFinal" => "1431"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21764325"
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                      "titulo" => "Quantitative assessment of emphysematous parenchima using multidetector-row computed tomography in patients scheduled for endobronchial treatment with one-way valves"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            1 => "M&#46; Petrillo"
                            2 => "G&#46; Vicidomini"
                            3 => "V&#46;G&#46; di Crescenzo"
                            4 => "E&#46; Frongillo"
                            5 => "A&#46; de Felice"
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                  ]
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                    0 => array:2 [
                      "doi" => "10.1093/icvts/ivu107"
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                        "tituloSerie" => "Interact Cardiovasc Thorac Surg"
                        "fecha" => "2014"
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