[Spontaneous intercostal pulmonary hernia: a case report]. / Hernia pulmonar intercostal espontánea: aportación de un caso.

In pulmonary hernia or pneumocele the lung protrudes through a defect in the chest wall. In this report of a case of spontaneous intercostal lung hernia, we describe the pathogenesis and classification of such hernias, including signs, symptoms, radiological findings and treatment methods. Our patient presented with severe chest pain at the base of the left hemithorax. A chest film and computed tomography of the region showed an left intercostal hernia. Surgical treatment was successful.

[Usefulness of urokinase in multilocular pleural effusion]. / Utilidad de la urocinasa en derrames pleurales multiloculados.

Recognizing the confirmed efficacy of urokinase as a thrombolytic and proteolytic agent, we assess its usefulness in the treatment of multiloculated pleural effusion, empyema and hematoma as a substitute of other more invasive procedures. Treatment with urokinase was applied in 18 consecutive cases. Inclusion criteria were a well-placed thoracic probe that did not drain and a radiological image showing occupation. Patients were excluded if they had bronchial fistulas or hemothorax of less than 7 days duration. Effusion in the included cases had developed after pneumonia, after surgery or after trauma. Treatment lasted 3 to 4 days ant was considered effective or not based on the volume of liquid drained and on radiological evidence of change. The amount of liquid drained was highly variable (mean 1,282 and S.D. 1,224; range 100-3,975). Radiological change was considered completely satisfactory in 10 cases, with 6 patients continuing to show occupation of the costophrenic sinus with no clinical repercussions. Two patients died of causes unrelated to administration of the drug. There were two mild relapses that did not require a second round of treatment with urokinase. Patients were followed for a least 30 days after discharge and no new recurrences were detected. We have found urokinase to be a useful fibrinolytic agent for treating multiloculated effusion. Contraindications are few and therefore urokinase should be considered the first-choice treatment to be applied before other more invasive measures are taken.

[Thoracic traumatism in a specialized unit. Its epidemiology and morbimortality]. / Traumatismos torácicos en una unidad especializada. Epidemiología y morbimortalidad.

Two hundred forty-eight cases of thoracic trauma arriving at our hospital between 1990 and 1992 are analyzed in this report. Injuries were only thoracic in 29% of the cases. The remaining patients presented associated lesions, mainly in the extremities, followed by head injuries. Single or multiple rib fracture, in 193 (77.8%) patients, was the most frequent thoracic injury, followed by 94 (37.6%) cases of hemothorax and 80 (30.2%) instances of pneumothorax. Pulmonary contusion in 57 (22.9%) cases was a serious consequence with a mortality rate of 35.7%. Eighty six (34.6%) chest tube were placed and 14 (5.6%) thoracotomies were performed. Death occurred in 34 (13.7%) cases and was mainly related to the presence of associated injuries, in 29 (16.7%) patients as opposed to 5 (6.9%) (p < 0.05), and to pulmonary contusion in 20 (35.7%) patients vs. 13 (6.8%) (p < 0.001).

[Idiopathic spontaneous pneumothorax: treatment by small-caliber catheter aspiration compared to drainage through a chest tube]. / Neumotórax espontáneo idiopático: tratamiento basado en la aspiración con catéter fino frente a drenaje torácico.

BACKGROUND: Several options are available for treating patients with a first episode of primary spontaneous pneumothorax (ISP). The aim of this study was to compare the efficacy of two treatment alternatives: puncture-aspiration (PA) using a small caliber catheter, and pleural drainage through a chest tube (DCT). PATIENTS AND METHODS: We compared a current series of 91 patients treated with PA with a retrospective series of 216 patients treated with DCT. PA was performed by emergency room physicians and DCT was performed by chest surgeons. Patients were followed for a period of 24 months. RESULTS: The immediate efficacy of PA was superior to DCT (86.7% versus 76%, p < 0.05). The proportion of recurrences after each treatment was similar (23% and 17%, respectively, NS). Duration of hospital stay was shorter for PA-treated patients (24 h) than for DCT-treated patients (138 h) (p < 0.05). The efficacy of the two procedures 24 months later was similar (63.7% and 62.9%, respectively, NS), and the cost of PA was three times less than that of DCT. CONCLUSIONS: PA is as effective a treatment procedure as DCT. PA is simple enough for emergency room physicians to perform correctly. Inconvenience to the patient, cost to the health care system, and time of hospital stay are all significantly less with PA.

[Endoscopic treatment of bronchopleural fistula using fibrin biological adhesive]. / Tratamiento endoscópico de la fístula broncopleural mediante el uso de adhesivos biológicos de fibrina.

Three cases are reported of bronchopleural fistula successfully resolved by using biological adhesives through the intrabronchial way. In the three cases the rigid bronchoscope was used to prepare the field and the passage of the adhesive material. The results obtained allow the consideration of this procedure as useful for small fistulas and as a initial therapeutical approach for other fistulas due to the small morbidity rate associated with this procedure compared with others.