[Video-assisted thoracic surgery to treat spinal deformities: climbing the learning curve]. / Cirugía torácica videoasistida de las deformidades espinales: afrontando la curva de aprendizaje.

OBJECTIVE: The aim of this study was to analyze the impact of the learning curve on the preliminary results of video-assisted thoracic surgery for spinal deformities in a general hospital setting. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 15 patients who underwent video-assisted thoracic surgery performed by a multidisciplinary team comprising orthopedic and thoracic surgeons. Endoscopic anterior release and fusion were followed by posterior instrumentation in a single procedure. Demographic, orthopedic, morbidity, and mortality statistics were compiled for the 15 patients and compared to results reported for similar series. RESULTS: Endoscopic surgery was indicated for 15 patients: 11 women (73.3%) and 4 men (26.7%). The median age was 15 years (interquartile range [IQR], 14-19 years). Three patients (20%) required conversion to thoracotomy. There were 2 serious (13.3%) and 3 minor complications (20%). They all resolved satisfactorily and there was no perioperative mortality. The median Cobb angle was 71 degrees (IQR, 63.75 degrees -75.25 degrees ) before surgery and 41 degrees (IQR, 30 degrees -50 degrees ) after surgery. Median duration of surgery was 360 minutes (IQR, 300-360 minutes), duration of postoperative recovery unit stay was 1.5 days (IQR, 1-2.75 days), and total hospital stay was 11.5 days (IQR, 8.25-14 days). CONCLUSIONS: Despite the complexity of video-assisted thoracic surgical procedures, we believe they will become the standard approach to treating spinal deformities in the near future. By working together in general hospital settings, orthopedic and thoracic surgeons can help to overcome the steep yet manageable learning curve.

[Influence of delay of surgery on the survival of patients with bronchogenic carcinoma]. / Influencia de la demora quirúrgica en la supervivencia de los pacientes intervenidos por carcinoma broncogénico.

OBJECTIVE: Bronchogenic carcinoma is the main cause of tumor-related deaths among men in Spain. The British Thoracic Society recommends that no longer than 4 weeks should pass from the moment a patient s name is placed on a waiting list until surgery takes place. We analyzed the influence of time until surgery on survival in patients with lung cancer. PATIENTS AND METHODS: We operated on 108 patients diagnosed with bronchogenic carcinoma between January 1, 2001 and December 31, 2002. The time until surgery was defined by the date of application for care in our department until the moment of surgery. RESULTS: The mean time on the waiting list was 56.87 days. No significant differences in mean wait-list times could be found in relation to tumor stage, type of surgery, patient age, or complete resection rate. The median survival in this patient series was 35 months. No significant differences in survival were found in relation to time until surgery in either the univariate or multivariate analysis. Pathologic stage, complete resection of the tumor, and patient age were prognostic factors. CONCLUSIONS: We found no evidence that delaying surgery affects survival in lung cancer patients. However, efforts should be made to reduce surgical wait-list times to bring them into line with the recommendations of scientific societies.

Systemic air embolism in a patient with ingestion of a foreign body.

Air embolism is defined as the entry of gas into a vascular structure. Frequently it is iatrogenic and can result in serious morbidity and mortality. We describe the case of a 59-year-old woman who presented with mediastinitis as a result of ingestion of a fishbone. Mediastinal debridement was performed which was complicated in the postoperative period by a systemic air embolism, as documented by computed tomography and clinical features.

[Solitary pulmonary nodule: primary, metastatic, or both]. / Nódulo pulmonar solitario: ¿primario, metastásico o ambos?

The lung is the most common site for metastasis from colorectal cancer, which is among the most common neoplasms in developed countries. Simultaneous occurrence of pulmonary metastasis of colorectal origin and primary carcinoma has been reported. We describe the case of a 65-year-old man who underwent low anterior resection for colorectal adenocarcinoma in 2007. Follow-up computed tomography revealed a pulmonary nodule that was classified as metastatic. The patient was referred to our thoracic surgery department, where the nodule was resected. The pathology confirmed that the nodule was neoplastic, and histologic and immunohistochemical examination showed the presence of colorectal metastasis and lung adenocarcinoma. Evidence of metastasis was also found in 2 of the lymph nodes analyzed, 1 with features identical to the primary pulmonary adenocarcinoma, and 1 with features identical to the colorectal metastasis.

[Hyperparathyroidism, goiter and well-differentiated thyroid carcinoma. A common association with diagnostic implications]. / Hiperparatiroidismo, bocio y carcinoma tiroideo bien diferenciado: una relación frecuente con implicaciones diagnósticas.

OBJECTIVE: To analyze thyroid gland disease incidentally found in patients undergoing surgery for hyperparathyroidism and to compare the frequency of nonmedullary thyroid carcinoma among different hyperparathyroidism varieties. PATIENTS AND METHOD: We retrospectively reviewed 124 clinical records of patients who underwent surgery for hyperparathyroidism by a single surgeon from January 1998 to June 2006. RESULTS: There were 105 women (84.7%) and 19 men (15.3%). The mean age was 59.7 +/- 15.66 years old. Of these, 115 (92.7%) were diagnosed with primary hyperparathyroidism and 9 (7.3%) with renal hyperparathyroidism. In the primary hyperparathyroidism group, 3 patients (2.6%) had received neck irradiation compared with none in the renal hyperparathyroidism group. Thyroid gland surgery was performed simultaneously in 43 patients (34.7%), 40 (34.8%) of them belonging to the first group and three (33.3%) to the second group (p = 1.00). Among the 115 patients operated on for primary hyperparathyroidism, 6 papillary thyroid carcinomas (5.2%) were found and 2 (22.2%) were found among the 9 patients with renal hyperparathyroidism, but this difference was not statistically significant (p = 0.105). CONCLUSIONS: An incidental finding of thyroid disease in patients undergoing surgery for hyperparathyroidism is fairly frequent but no more so than that found in autopsy series. No statistically significant differences were found between primary and renal hyperparathyroidism in the prevalence of papillary thyroid carcinoma. Currently, neck irradiation does not seem to be a clinically significant factor in this issue. The high prevalence of thyroid disease in the general population warrants systematic neck ultrasound before hyperparathyroidism surgery.

[Spontaneous pneumomediastinum mimicking Boerhaave's syndrome]. / Neumomediastino espontáneo que parece un síndrome de Boerhaave.

Spontaneous pneumomediastinum is an uncommon benign disorder that usually occurs in young men. Because of its clinical features and physiopathologic mechanism, other, more serious disorders that could require urgent treatment, such as Boerhaave's syndrome or spontaneous esophageal rupture, must be ruled out. We report the case of a 19-year-old man with no relevant history, who presented mediastinal emphysema after an episode of repeated vomiting in the context of alcohol abuse. Imaging techniques help to assess esophageal involvement.