Gastric herniation due to rupture of diaphragmatic prosthesis in the postoperative period of pleuropneumonectomy due to mesothelioma: A complication to consider.

Extrapleural pneumonectomy, usually associated with pericardial and diaphragmatic reconstruction with prosthetic material, is one of the surgical techniques used in the treatment of malignant pleural mesothelioma. Herniation of the abdominal viscera towards the thorax through the prosthetic material at the diaphragmatic level is a rare but potentially serious complication of these procedures, which must be diagnosed quickly for urgent repair. We present the case of a patient who presented with gastric herniation in the early postoperative period of a left pneumonectomy due to pleural mesothelioma. The clinical findings were mild, but supported by imaging tests, they confirmed the diagnostic hypothesis and facilitated the solution of the condition. Possible contributing factors are reviewed and the need for early diagnosis and treatment is emphasized to avoid ischemia of herniated abdominal viscera in the thoracic cavity, due to the risk of necrosis and contamination by fecaloid material.

[Perioperative treatment of a man receiving a left-lung transplant combined with coronary revascularization without use of extracorporeal circulation: with a brief review of pathophysiology and the literature]. / Tratamiento perioperatorio de un paciente para trasplante unipulmonar izquierdo combinado con revascularización coronaria sin empleo de circulación extracorpórea. Breve revisión fisiopatológica y de la bibliografía.

Patients with significant coronary artery disease were once traditionally rejected as candidates for lung transplants because of higher risk of morbidity and mortality. We report the case of a man who received a left lung transplant and coronary revascularization without extracorporeal circulation in a combined surgical procedure after being diagnosed with significant coronary disease during the preoperative study for acceptance as a candidate for lung transplantation. We review the history of such combination procedures, which are changing clinicians' attitudes as to appropriate therapeutic approaches to take for complex patients. We also discuss the possible advantages of performing surgery without extracorporeal circulation. To our knowledge, this is the first report of a combined procedure that took place in a Spanish hospital.

[Epidural anesthesia in labor and conversion disorder]. / Analgesia epidural en trabajo de parto y trastorno de conversión.

A 37-year-old woman came to our hospital at the beginning of labor. She reported a history of depression with attempted suicide some years earlier and had also undergone dilation and curettage following an abortion; on admission to our hospital, she was euthymic and not receiving treatment. The patient requested epidural analgesia. Several hours later, she reported dorsal foot numbness and difficulty performing dorsal flexion. After an organic cause had been ruled out, a diagnosis of conversion disorder was considered. The incidence of this psychiatric disorder is high, though it is usually underdiagnosed. Conversion disorder involves at least 1 neurologic symptom suggestive of organic disease. Symptoms are not feigned and cannot be ascribed to a medical disease, the effects of a toxic substance, or culturally normal behavior, yet there is significant clinical, social, and occupational deterioration.