RESUMEN
BACKGROUND: (18)FDG-PET plays a significant role in diagnosing malignancy of lung lesions but remains an expensive test available at a limited number of sites in Italy. OBJECTIVE: We prospectively compare the diagnostic accuracy of (99m)Tc-MIBI- SPECT and (18)FDG-PET in patients with indeterminate lung lesions to demonstrate that (99m)Tc-MIBI-SPECT may be considered as a valid alternative when (18)FDG-PET is not available. METHODS: 52 patients with indeterminate lung lesion were examined by (18)FDG-PET and (99m)Tc-MIBI-SPECT before surgery. The scintigraphic findings were analyzed visually and semiquantitatively and then correlated to the definitive diagnosis. RESULTS: 38 were malignant lesions while 14 were benign. At visual analysis, the sensitivities of (18)FDG-PET and (99m)Tc-MIBI-SPECT were 92 and 84%, respectively (McNemar test p = 0.4), whereas the specificities were 78.6 and of 93% (p = 1.0), respectively. At semiquantitative analysis, (18)FDG-PET showed a sensitivity and specificity of 92 and 71.4%, respectively, while (99m)Tc-MIBI-SPECT produced a sensitivity and specificity of 86 and 100%, respectively (p = 0.194). For lymph node staging, (18)FDG-PET and (99m)Tc-MIBI-SPECT have a sensitivity and specificity of 88 and 92 of 77 and 100%, respectively. CONCLUSION: (99m)Tc-MIBI-SPECT is similar to (18)FDG-PET in the detection of lung malignancies and represents an alternative when PET is not available. Yet, the combination of both techniques may improve patient selection for surgery.
Asunto(s)
Carcinoma/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Neoplasias Pulmonares/diagnóstico por imagen , Radiofármacos , Tecnecio Tc 99m Sestamibi , Adulto , Anciano , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Estudios ProspectivosRESUMEN
OBJECTIVE: Our goal is to determine whether infiltration with a short-acting local anaesthetic such as lidocaine before the surgical incision has a pre-emptive effect on postoperative pain intensity and on incidence of paraesthesia in patients undergoing standard thoracoscopic sympathectomy for palmar hyperhidrosis. MATERIAL AND METHODS: This prospective study includes a consecutive series of 18 patients undergoing bilateral standard thoracoscopic sympathectomy for palmar hyperhidrosis during January 2005-December 2007. Each patient enrolled in the study was randomised to receive pre-incisional lidocaine with epinephrine infiltration of the wounds on the one side, and normal saline solution on the other. The identical surgery was performed on each side to allow patients to act as their own controls. Then, the side which received local analgesia was compared with the control side with regard to pain control and paraesthesia after 4, 24 and 168 h postoperatively. The patients and investigators were both blinded concerning the side randomised to receive pre-emptive local analgesia (PLA). RESULTS: We found that patients reported significantly less pain on the side treated with pre-emptive local anaesthesia in contrast to the control side 4 and 24h after surgery (p=0.001 and p=0.004, respectively). However, that difference decreased with time and was no longer significant 168 h following surgery (p=0.156). Regarding the paraesthesia, the incidence was higher in the control side than the PLA side at 4, 24 and 168 h postoperatively, but the difference was not statistically significant. A total of 17 of 18 (94%) patients noted a change in palmar hyperhidrosis status after surgery. CONCLUSION: Our study shows that the pre-injection of local anaesthetic before standard thoracoscopic sympathectomy suppresses the local pain mediators, hence resulting in significantly less pain in the first postoperative 24 h but not thereafter. The clinical impact of the procedure is the possibility of early discharge to home and early return to work with potential economical benefits. However, because of the small number of patients, further studies are needed to corroborate our results.
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Anestésicos Locales/administración & dosificación , Hiperhidrosis/cirugía , Lidocaína/administración & dosificación , Dolor Postoperatorio/prevención & control , Simpatectomía/efectos adversos , Adulto , Anestesia Local/métodos , Método Doble Ciego , Femenino , Mano/cirugía , Humanos , Masculino , Dimensión del Dolor/métodos , Parestesia/etiología , Parestesia/prevención & control , Medicación Preanestésica/métodos , Estudios Prospectivos , Simpatectomía/métodos , Cirugía Torácica Asistida por Video/efectos adversos , Cirugía Torácica Asistida por Video/métodos , Adulto JovenRESUMEN
We report a surgical a case of pyothorax-associated lymphoma of T-cell origin arising from the chest wall and developing on pleural sequelae of therapeutic pneumothorax for pulmonary tuberculosis. The tumor was removed with resection of the fifth to eighth ribs. The chest wall defect repaired with a Marlex (Phillips Sumika Polypropylene Co, Houston, TX) prothesis. The histologic, immunohistochemical, and genotypic features were conclusive for a diagnosis of T-cell non-Hodgkin lymphoma. The patient received postoperative chemotherapy and is doing well after 15 months.
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Empiema Tuberculoso/complicaciones , Linfoma de Células T/etiología , Neoplasias Torácicas/etiología , Pared Torácica , Anciano , Enfermedad Crónica , Humanos , Inmunohistoquímica , Linfoma de Células T/diagnóstico , Linfoma de Células T/metabolismo , Linfoma de Células T/patología , Linfoma de Células T/cirugía , Masculino , Derrame Pleural/diagnóstico por imagen , Neumotórax Artificial , Prótesis e Implantes , Radiografía , Neoplasias Torácicas/diagnóstico , Neoplasias Torácicas/metabolismo , Neoplasias Torácicas/patología , Neoplasias Torácicas/cirugía , Pared Torácica/diagnóstico por imagen , Pared Torácica/patología , Pared Torácica/cirugía , Tuberculosis Pulmonar/cirugíaRESUMEN
Iatrogenic pulmonary hernia is a rare condition. Repair is performed due to persistent symptoms and it is usually carried out by open surgery. We report a case of a 59-year-old woman who developed a lung hernia after small anterior thoracotomy that was performed for mitral valve surgery. The herniated lung is reduced with success by video thoracoscopic surgery and the chest wall defect is repaired by a polypropylene mesh fitted to the thoracic wall. At six-month follow-up, she was asymptomatic and without recurrence of hernia. Our experience suggests that video thoracoscopic surgery is a feasible surgical technique even for lung hernia secondary to mini-thoracotomy. However, before performing video thoracoscopic surgery, several factors preclusive to using this strategy must be considered, including the extensiveness of pleural adhesions due to the time interval between the previous operation and lung hernia, the site and the size of the hernia, and the insufficient experience in video thoracoscopic surgery.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Herniorrafia , Enfermedad Iatrogénica , Enfermedades Pulmonares/cirugía , Válvula Mitral/cirugía , Cirugía Torácica Asistida por Video , Toracotomía/efectos adversos , Femenino , Hernia/etiología , Hernia/patología , Humanos , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/patología , Persona de Mediana Edad , Mallas Quirúrgicas , Cirugía Torácica Asistida por Video/instrumentación , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: Our goal was to determine the role of technetium-99m hexakis-2-methoxyisobutyl isonitrile ((99m)Tc-MIBI) in the detection of neoplastic lung lesions. MATERIALS AND METHODS: We prospectively studied 79 consecutive patients with indeterminate lung lesion between January 2006 and September 2007. All patients were submitted to (99m)Tc-MIBI single-photon emission chest tomography (SPECT) before invasive diagnostic procedure. Qualitative analysis was performed to evaluate SPECT images in order to localize abnormal activity in the radiologically demonstrated lesion. In addition, semiquantitative analysis was made by calculating tumor/contralateral normal lung ratio (T/N). Finally, the scintigraphic findings were correlated to the histopathological diagnosis obtained by invasive procedure or confirmation of instrumental exams. RESULTS: Sixty patients had a malignant lesion: 44 squamous cell carcinoma, 7 adenocarcinomas, 4 large cell carcinoma, 1 small cell lung cancer, and 4 metastases. The mean size+/-standard deviation of malignant nodules was 3.9+/-1.61 cm (range 1.5-5.5 cm). Nineteen patients had a benign disease. The mean size+/-standard deviation of benign nodules was 3.3+/-1.71 cm (range 2-6 cm). (99m)Tc-MIBI SPECT delineated focal lesions with an increase in tracer accumulation in 55/60 malignant lesions; in 5/60 malignant lesions was negative. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 91%, 73%, 91%, and 73%, respectively. In patients with neoplastic lesion, the mean T/N ratio value+/-standard deviation was 1.72+/-0.35 whereas in patients with benign lesions was 1.14+/-0.25. Semiquantitative analysis showed that for a T/N value >1.23, the value of sensitivity, specificity, PPV, and PNV were 91%, 84%, 94%, and 76%, respectively (ROC curve). Metastatic mediastinal lymph nodes were found in 3/57 patients. (99m)Tc-MIBI SPECT showed a specificity and PPV of 100% in the detection of mediastinal lymph nodes with sensitivity, and PNV of 66% and 97%, respectively. Age, sex, histological type, and size of lesion did not affect the SPECT results. CONCLUSION: Our experiences seem to confirm that (99m)Tc-MIBI SPECT is a reliable diagnostic tool in the finding of lung cancer particularly cases in which radiological evaluation is indeterminate.
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Neoplasias Pulmonares/diagnóstico por imagen , Radiofármacos , Tecnecio Tc 99m Sestamibi , Adulto , Anciano , Anciano de 80 o más Años , Métodos Epidemiológicos , Femenino , Humanos , Neoplasias Pulmonares/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada por Rayos XAsunto(s)
Adenocarcinoma/patología , Fístula Bronquial/diagnóstico , Neoplasias Pulmonares/patología , Invasividad Neoplásica/patología , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirugía , Biopsia con Aguja , Fístula Bronquial/cirugía , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/cirugía , Persona de Mediana Edad , Estadificación de Neoplasias , Neumotórax/diagnóstico , Neumotórax/etiología , Medición de Riesgo , Cirugía Torácica Asistida por Video/métodos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Various techniques have been proposed to reduce intraoperative blood loss in surgery. We report our experience with the use of LigaSure, a new electrothermal bipolar tissue sealing system, in lung surgery. This system has been already applied with good results in other surgical fields. However, the experience reported in the literature with the use of this technique in lung surgery is limited. Our clinical series with LigaSure (160 procedures in a 4-year period) is the largest reported to date. Technical aspects, clinical results and an overview of the literature are presented. We believe that LigaSure is an easy and safe technique, suitable for lung surgery. It could be a valid alternative or complement to staplers for several procedures, also in the thoracoscopic setting. Furthermore, it seems to allow functional lung tissue preservation and reduction of surgical supplies costs.
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Lipoma/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos , Cavidad Torácica , Diagnóstico Diferencial , Humanos , Lipoma/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Cirugía Torácica Asistida por Video , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos XRESUMEN
Aim of this research is the evaluation of an oncotropic drug in diagnostics of substernal goiter. We used the SESTA-MIBI in 26 patients with cervico-mediastinal goiter and evaluated the pre and intra operating data with the histopathological specimen. The radiodrug has noticed profit in the differential from neoplastic and colloidal tissue, even if in a few cases it has also demostrated affinity for the benign adenomas. When the fine aspirated needle biopsy has turned out inadwisable or not setting, the MIBI methodical has been of special help. The extent of the use of this radiodrug also to parathyroid and cardiac pathology has made the economical costs cheaper and promoted the routine use of the methodology.
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Bocio Subesternal/diagnóstico por imagen , Radiofármacos , Tecnecio Tc 99m Sestamibi , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Bocio Subesternal/diagnóstico , Bocio Subesternal/patología , Bocio Subesternal/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Radiografía Torácica , Glándula Tiroides/patología , Neoplasias de la Tiroides/diagnóstico , Factores de Tiempo , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: We evaluated the validity of an electrothermal bipolar tissue sealing system (LigaSure, Valleylab Inc., USA) in lung surgery. METHODS: Our study was divided into two phases. EXPERIMENTAL: We performed sutures of pulmonary vessels and bronchi and lung wedge resections by LigaSure in 28 lungs of adult pigs; subsequently, we quantitated the sealing capacity of the system detecting the burst pressure for each anatomical structure. Clinical: LigaSure was used in 36 patients undergoing lung surgery. We performed 23 thoracotomic procedures in 16 patients (19 wedge resections, 2 segmentectomies, and 2 fissure separations), and 20 thoracoscopic procedures (13 wedge resections, 5 bullectomies, and 2 adherence dissections). EXPERIMENTAL: Bronchi and vessels were divided into seven groups (diameter: 1-7 mm); 10 burst pressure measurements for each group were performed. A total of 84 wedge resections were performed; lung specimens were divided into seven groups (weight: 0.2-1.4 g). The percentage of bronchial sutures resistant to the pneumatic critical pressure (60 mmHg) was 100% in the 1-mm and 2-mm groups. No bronchi with 6-mm or 7-mm diameter reached the critical pressure. All pulmonary vessel sutures were resistant to the critical hydrostatic pressure (150 mmHg). The average burst pressure of wedge resection margins was higher than the critical pressure, and the percentage of suture margins resistant to the critical pressure decreased from 95% (0.2-g group) to 68% (1.4-g group). Histology confirmed the sealing of vessels, with a mean depth of thermal injury limited to 1.1mm. Clinical: In all patients, hemostasis obtained by LigaSure was effective, with minimal perioperative bleeding. The mean operating time was 77.2 min (range: 60-97) for thoracotomies and 60.3 min (range: 46-80) for thoracoscopies. The mean drainage duration was 3.1 days (range: 1-8). Two patients had prolonged air leaks (>7 days). The mean postoperative stay was 7.3 days (range: 5-13) for thoracotomies and 4.6 days (range: 1-6) for thoracoscopies. CONCLUSIONS: Use of LigaSure in lung surgery appears feasible and easy. It provides satisfactory hemostasis and air-leak prevention; results are comparable to those of stapling devices, but this system seems to have a better benefit/cost ratio. Larger series are needed to confirm these data.