[Risk factors for atrial fibrillation after thoracic surgery]. / Factores de riesgo en el desarrollo de fibrilación auricular tras cirugía torácica.

OBJECTIVE: To determine the risk factors for atrial fibrillation after lung resection. PATIENTS AND METHODS: Between January 2002 and December 2003, 149 patients underwent lung resection in our hospital. For all these patients, clinical, surgical, analytical, and oncological data were prospectively collected. The data were subjected to univariate analysis. RESULTS: The mean (SD) age of the 127 men (85.2%) and 22 women (14.8%) who underwent lung resection was 61.8 (12.3) years (range, 17-79 years). Atrial fibrillation was documented in 17 patients (11.4%). Mortality at 30 days was 8.1%. The following risk factors for atrial fibrillation were identified: age 70 years or older (P<.0004), prior heart disease (P<.005), patients undergoing operations for lung cancer (P<.04), and type of resection--right bilobectomy (P<.05) and left pneumonectomy (P<.03). Hypertension, chronic obstructive pulmonary disease, and lung cancer stage were not risk factors. Likewise, systematic lymph node dissection and other forms of lung resection were not risk factors. CONCLUSIONS: After lung resection, atrial fibrillation is a common complication that seems to be associated with old age, history of heart disease, operations for lung cancer, left pneumectomy, and right bilobectomy. The identification of these risk factors may encourage prospective studies that assess the use of antiarrhythmic drugs to prevent atrial fibrillation during chest surgery.

[Effectiveness and complications of video-assisted surgery for primary spontaneous pneumothorax]. / Eficacia y morbilidad del tratamiento con cirugía videoasistida del neumotórax espontáneo primario.

OBJECTIVE: To assess the effectiveness and describe the complications of video-assisted thoracoscopic surgery (VATS) for the treatment of primary spontaneous pneumothorax. PATIENTS AND METHODS: Between May 1997 and September 2003, our department scheduled 147 VATS procedures for spontaneous pneumothorax in 127 patients (102 men [80.5%]). The mean (SD) age for the series was 28.3 (11.6) years. Bullae and blebs were resected by endostapler and vigorous pleural abrasion was carried out. Vanderschueren staging was as follows: stage I, 10 (6.8%); stage II, 22 (15%); stage III, 71 (48.3%); and stage IV, 44 (29.9%). The procedure was indicated for the following reasons: third episode, 56 (38.1%); persistent air leak, 47 (32%); elective, 16 (10.9%); simultaneous bilateral pneumothorax, 28 (19%). VATS was performed on the right side only in 85 patients (57.8%), on the left in 62 (42.2%), and on both sides in 16 (11.6%). RESULTS: A total of 137 of the 147 VATS procedures scheduled (93.2%) were performed, and there were no deaths. The rate of conversion to thoracotomy was 6.8%, and the overall rate of complications was 13.7%. Postoperative complications were due to bleeding in 5 cases (3.6%), air leak (>5 days) in 10 (7.2%), wound infection in 2 (1.4%), residual pneumothorax in 4 (2.9%), need to insert a new pleural drain in 3 (2.1%), and pleural empyema in 1 (0.7%). Two patients took oral analgesics for more than 30 days after the procedure. Pneumothorax recurred during follow-up in 7 patients (5.1%). No significant correlation was found between recurrence of pneumothorax after VATS and Vandeschueren stage, age, bilaterality of the procedure, indication, or days of postoperative drainage (P>.05). CONCLUSIONS: VATS for resection of pleural lesions plus pleural abrasion is an efficacious and simple treatment for primary spontaneous pneumothorax regardless of intraoperative findings.

[Multifocal localized amyloidosis in a pediatric patient]. / Amiloidosis localizada multifocal de la vía aérea superior en una paciente pediátrica.

Amyloidosis of the upper airway is rare in the pediatric age group. We present a primary amyloidosis in the nasopharynx and nasal cavity in a 14-year-old girl. The symptoms were nasal obstruction and mucoid discharge. The diagnostic was revealed by histologycal analysis obtained from local surgical excision.

[Spontaneous hemothorax caused by lung cancer]. / Hemotórax espontáneo por carcinoma broncogénico.

Spontaneous hemothorax is an extremely rare complication of malignant disease. We describe the case of a 26-year-old man with spontaneous hemothorax secondary to large-cell carcinoma of the lung, with liver and bone metastases. The patient died in the fifth week after hospitalization.

[Medical and surgical management of noniatrogenic traumatic tracheobronchial injuries]. / Manejo médico-quirúrgico de las lesiones traqueobronquiales traumáticas no iatrogénicas.

OBJECTIVE: To describe the medical and surgical management of noniatrogenic traumatic tracheobronchial injuries. PATIENTS AND METHOD: From January 1993 to July 2004, 15 cases of traumatic tracheobronchial injury were treated in our department. The diagnosis was established by bronchoscopy and a computed tomography chest scan was performed on all patients. Surgical treatment was selected for patients with unstable vital signs, an open tracheal wound, associated esophageal lesions, progression of subcutaneous or mediastinal emphysema, mediastinitis or suspicious mediastinal secretions on imaging tests, or difficulties with mechanical ventilation due to the traumatic tracheobronchial injury. RESULTS: The mean (SD) age of the patients was 35.5 (18.9) years and 12 (80%) were male. Of the 15 cases, 13 (86.7%) had penetrating trauma and 2 (13.3%) blunt trauma. The most common location of the injury was in the bronchi (9 cases; 60%), followed by the cervical trachea (4 cases; 26.6%), followed by both the thoracic trachea and bronchi (2 cases; 13.4%). The most common initial symptom was subcutaneous emphysema, which presented in 11 (73.3%) patients. Chest (12 cases; 86.7%) and orthopedic injuries (9 cases; 60%) were the most common associated injuries. Surgery was the treatment of choice in 11 (73.3%) cases and conservative medical treatment in 4 (26.7%). An irreversible brain injury caused the death of 1 patient receiving conservative treatment. CONCLUSIONS: Tracheobronchial injuries may be treated conservatively if they meet strict selection criteria. Size and location should not be used as selection criteria for surgical treatment.

Acromegaly and bronchial carcinoid. Effect of removal of the latter.

A patient with a long-standing history of bronchial carcinoid and acromegaly was studied. There was pituitary enlargement with an intrasellar mass (brain computed tomography scan), high basal GH levels, and abnormal GH and other pituitary hormones response to oral glucose and a combined test (LHRH, TRH, insulin). After resection of the bronchial carcinoid, basal GH was normal, GH was normally suppressed during OGTT, pituitary function was within expected normal range, and there was regression of the pituitary tumor together with clinical improvement. These data suggest that the patient's acromegaly was secondary to pituitary stimulation due to the bronchial carcinoid.

Long tracheobronchial and esophageal rupture after blunt chest trauma: injury by airway bursting.

Tracheobronchial rupture can be associated with blunt thoracic trauma. An important factor in the physiopathology of these lesions is reflex closure of the glottis, which can be related to closed chest trauma. We report a case of nonpenetrating thoracic trauma that caused a long membranous tracheal rupture from the subcricoid area to the main carina, extending to both main bronchi. In addition, a complex esophageal rupture occurred due to the great energy liberated by the airway rupture acting as a real tracheal burst. Both lesions were diagnosed by flexible bronchoscopy. The postoperative period was without serious complications.

Successful management of a tracheo-innominate artery fistula following placement of a wire self-expandable tracheal Gianturco stent.

The authors report a case of tracheo-innominate artery fistula secondary to tracheal perforation in an 18-year-old patient who is tetraplegic following cervical trauma. The patient had a very long tracheal stenosis, secondary to tracheostomy, which was managed by laser resection and a Gianturco stent. One of the anterior struts of the stent had eroded the trachea and the posterior wall of the innominate artery. Surgical management consisted of arterial resection, a longitudinal tracheal split incision to withdraw the stent and placement of a Montgomery T-tube. The patient has no respiratory discomfort 7 months after surgery.

Conservative and bronchoplastic resection for bronchial carcinoid tumours.

From January 1974 to December 1987, 45 cases of bronchial carcinoid were surgically managed at our Unit, 44 of which were evaluated. All patients but 2 were submitted to fiberoptic bronchoscopy prior to surgery. A standard resection was performed in 19 cases (13 lobectomies, 4 bilobectomies and 2 pneumonectomies). In 11 cases, pulmonary resection was complemented with a bronchoplastic technique (6 lobectomies, 2 bilobectomies, 2 pneumonectomies, 1 segmentectomy). Four cases were managed by minimal resections (2 segmental, 1 wedge, 1 enucleation) and 8 others by bronchotomy and local resection without the sacrifice of lung tissue. There were two major postoperative complications and no operative mortality. Mean follow-up has been 53 months and no local bronchial recurrence has been observed although 2 patients have developed distant metastases, with 1 death. The absence of local recurrence in a series in which more than 50% of patients were treated with some form of conservative surgery seems to indicate that resection of lung tissue should be avoided whenever possible.

Vibrio carchariae, a pathogen of the abalone Haliotis tuberculata.

Since 1997, mass mortality of the abalone Haliotis tuberculata L. has occurred in the natural environment along the French coast. The outbreak of disease started on the south coast of Brittany near Concarneau in 1997, then spread to the north of Brittany (in 1998) and the west coast of Normandy (Golfe de St. Malo in 1999). Between 60 and 80% of the abalone died. In 1999, mortality also affected a land-based abalone farm in Normandy during the summer. At this farm, a Vibrio sp. was isolated in abundance from abalone that had just died. The disease was experimentally reproduced by inoculation or by introducing the pathogen into the surrounding water. This vibrio, identified by genotypic and phenotypic characters, is related to V carchariae. It is similar to the V carchariae, responsible for mortality in the Japanese abalone Sulculus diversicolor supratexta, but some phenotypic characters differentiate both strains. In 2000, healthy abalone placed in 2 sites on the north and south coasts of Brittany died, and the pathogen V carchariae could be isolated from dead individuals, demonstrating that the pathogen was probably the cause of the abalone disease that has been occurring since 1997 in Brittany.

[Octreotide for conservative management of postoperative chylothorax]. / Tratamiento conservador con octreótido del quilotórax posquirúrgico.

Postoperative chylothorax after lung resection is a major problem leading to morbidity and mortality and requiring reoperation in a large number of cases. The most advisable and least aggressive option is conservative management in progressive stages: a diet rich in medium-chain fatty acids and/or total parenteral nutrition, in addition to chest tube drainage. Including octreotide in this regimen seems to be related to a higher success rate without the need for surgery. We report a case in which the effectiveness and safety of octreotide in the resolution of postoperative chylothorax was excellent.

[Delays in the diagnosis and surgical treatment of bronchogenic carcinoma. Cooperative Group on Bronchogenic Carcinoma of SEPAR (GCCB-S)]. / Demoras en el diagnóstico y en el tratamiento quirúrgico del carcinoma broncogénico. Grupo Cooperativo de Carcinoma Broncogénico de SEPAR (GCCB-S).

The aim of this study was to determine the delay between clinical suspicion and diagnosis of bronchogenic carcinoma, and between diagnosis and performance of therapeutic thoracotomy. The study population included 598 patients undergoing surgery between October 1995 and September 1996 registered in the Bronchogenic Carcinoma Cooperation Group of SEPAR (BCCG-S), and 49 patients from our hospital undergoing surgery during the same period. The mean delay between diagnosis and thoracotomy was 45.15 days (SD 34.7 days) for BCCG-S patients and 53.5 days (SD 22 days) for our hospital patients. In the second group, mean time elapsing between diagnosis suspicion and performance of bronchoscopy was known to be 9.5 days (SD 14.7 days), with the lowest periods recorded for inpatients (3.1 +/- 1.7 days) and for patients who did not require chest x ray guided bronchoscopy (5 +/- 5.8 days). These data are similar to those published for hospitals in other countries. They must be considered long delays and should be shortened.

[Therapy perspectives in subjective tinnitus]. / Perspectivas terapéuticas en los acúfenos subjetivos.

The AA. of this article have achieved a bibliographical perusal about treatment of subjective tinnitus, including even papers based on controlled clinical trials. Pharmacologic agents are settled on vasodilators of cochlear microcirculation (nimodipine, trimetazidine, Ginkgo biloba extract, misoprostol), lidocaine, the anxiolitics (alprazolam, corazepam) and the antidepressants (nortrityline). Comments sonorous amplification. Also are displayed, because of their benefits, the relaxation techniques (biofeeback, hypnotherapy, acupuncture and yoga) and psychological counseling.

[Laryngeal tuberculosis. Report of 4 cases]. / Tuberculosis laríngea. Exposición de 4 casos.

Reporting 4 cases of laryngeal tuberculosis seen between 1992 and 1998 in La Rioja Community. All were men tobacco addicted and alcoholism and since several months presented with dysphonia, odynophagia, dysphagia and lung aspirations. The lesions were localized in epiglottis, vocal fold, back commisure and the subglottic space. Primary complex was pulmonary. All of them were successfully treated with tuberculostsatic drugs, except one who remain with pulmonary aspirations because of a severed epiglottis.

[Nasopharyngeal bacterial flora and secretory otitis in adults]. / Flora bacteriana nasofaríngea y otitis secretora en el adulto.

The AA. have realized a prospective study of the links between the bacterial flora of the nasopharynx and the secretory otitis media in grown-up people. For achieving this purpose nasopharyngeal smears of rhinopharyngeal samples belonging to 85 otitic patients and other 85 healthy adults were cultivated. Statistical analysis showed that the otitis cases presented with 63.6% of microorganisms potentially pathogenic, being the 17.6% the percentage among healthy individuals (p < 0.001). Microorganisms more frequently encountered were: Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus. After the medical treatment those patients recovered showed an increase of saprophyte flora from early 36.4% till 86% (p < 0.001). It could be appreciate a seasonal influence in the debut of this malady specially in winter.

[Granular cell tumor of the tongue. A case report]. / Tumor lingual de células granulares. Aportación de un caso.

Reporting the case of a granular cell tumor (granular cell myoblastoma) developed on the tongue, of a 50-year-old woman presenting with a painless, slightly excrescent and whitish on the tongue's top surface. Diagnose was anatomopahologica was made through. The growth was totally removed even healthy tissue. The case evolved a year later without recurrence.

[Malignant oncocytic papilloma. An infrequent type of sinonasal papilloma]. / Papiloma oncocítico malignizado. Una variante infrecuente de papiloma nasosinusal.

Oncocytic scheneiderian papilloma (OSP), or cylindrical cell papilloma, is the less frequent of the three morphologically distinct papillomas occurring in the nose and paranasal sinuses. We report a case of a patient with an OSP and review on the diagnostic and prognostic implications of this type of tumor.

[Laryngopyocele: apropos a case with onset as acute respiratory insufficiency]. / Laringopiocele: a proposito de un caso que debuto con insuficiencia respiratoria aguda.

Report of an unwonted case of laryngopyocele because of its presentation. The patient came into Hospital suffering from acute laryngeal dyspnea, which made us to carry out an urgent tracheotomy. Afterwards a direct laryngoscopy discovered a large tumor, covered by a mucosa of normal appearance, blocking the laryngeal inlet. The laryngopyocele was confirmed by thyrotomy after the previous direct laryngoscopy awaken the suspicious either a malignant grown or a cancer with a laryngocele association.

[Tonsillar microsurgery by bipolar dissection]. / Microcirugía amigdalar con disección bipolar.

The 66 amygdalectomies done by the AA. under general anesthesia and tracheal intubation are considered in two groups. The first one was composed by 32 patients operated following a dissection and coagulation procedure with the aid of a bipolar forceps and under microscopical magnification. The second group, 34 cases, underwent the classical procedure with ligature of the bleeding vessels. The usage of the bipolar forceps procure lesser loss of blood as compared with the dissection-ligature procedure. On the contrary, the bipolar clip method showed and increased postoperative pain and also the lagging of the swallow function. Both techniques presented with very similar complications (bleeding, edema, loca infection).

[Descriptive epidemiology of hospital interconsultations carried out at the ORL Service for a year in the San Millan-San Pedro Hospital Complex]. / Epidemiología descriptiva de las interconsultas hospitalarias realizadas al Servicio de ORL durante un año en el Complejo Hospitalario San Millán-San Pedro.

UNLABELLED: 391 requests of collaboration to our ENT Department during 1996 have been collected. Twelve variables were analysed: number of request, age, sex, date of emission, type (ordinary, with priority, urgent), time elapsed from emission until valuation of the patient, source, reason's request, pathology, complementary tests, treatment and destination (discharge, re-examination during admission or as an outpatient and admission to ENT-Service). RESULTS: 1,58 request were attended per working day, 80 percent were resolved during the first 48 hours, the Internal Medicine Department was the most frequent source, fever without focus or recalcitrant was the most frequent reason from Paediatric Department. We report the epidemiologic features of the most frequent variables.