[Thymectomy in thymomatous and non-thymomatous myasthenia gravis: analysis of a cohort of 46 patients]. / Timectomía en miastenia grave timomatosa y no timomatosa: análisis de una cohorte de 46 pacientes.

INTRODUCTION: Factors predicting remission after thymectomy for myasthenia gravis are not well known. AIM: To analyze the clinical evolution of the patients after this intervention and discuss about predictors of response. PATIENTS AND METHODS: We retrospectively reviewed all clinical data of thymectomies in myasthenia gravis patients performed at our hospital between 2006 from 2016. Using the MGFA-PIS classification, «complete stable remission¼, «pharmacologic remission¼, «minimal manifestations¼ and «improved¼ were defined as «good clinical outcome¼, and «unchanged¼, «worse¼, «exacerbation¼ or «died¼, as «poor clinical outcome¼. RESULTS: In 46 consecutive thymectomies for myasthenia gravis, women comprised 71.7%. Median age was 37 years and 10.9% had concomitant autoimmune disorders associated. Thymoma (23.96%) was more frequent in older patients (53 ± 20 vs 33 ± 24 years) and men (54.5% vs 18.8%). A year after thymectomy, 28.2% of patients were in poor clinical outcome group and 54.3% had good clinical outcome. On univariate analysis, thymomatous myasthenia was associated with poor clinical outcome a year after surgical intervention. After ten years of follow-up, 9.8% reached complete stable remission, a total of 32 patients (78%) had a favourable outcome and thymoma was not correlated. CONCLUSION: Thymectomy is considered an effective treatment for myasthenia gravis but the benefit is not immediate. The presence of thymoma may determine a worse initial clinical response following thymectomy in patients with myasthenia gravis.

TITLE: Timectomía en miastenia grave timomatosa y no timomatosa: análisis de una cohorte de 46 pacientes.Introducción. En la actualidad, los factores predictores de remisión de la enfermedad en la miastenia grave tras una timectomía no están claramente establecidos. Objetivo. Analizar la evolución clínica de los pacientes tras esta intervención y abordar los posibles determinantes pronósticos. Pacientes y métodos. Se analizaron retrospectivamente los registros de pacientes con miastenia grave timectomizados en nuestro centro entre 2006 y 2016. Se utilizó la escala Miasthenya Gravis Foundation of America-Post Intervention Status agrupando las categorías «remisión completa estable¼, «remisión farmacológica¼, «manifestaciones mínimas¼ y «mejoría¼ como «buen resultado clínico¼, y las categorías «sin cambios¼, «empeoramiento¼, «exacerbación¼ y «muerte¼, como «mal resultado clínico¼. Resultados. Se analizaron 46 timectomías de pacientes con miastenia grave, un 71,7% mujeres. La mediana de edad era de 37 años y el 10,9% asociaba enfermedades autoinmunes. El timoma (23,9%) fue más frecuentes en los varones (54,5% frente a 18,8%) y a mayor edad (53 ± 20 frente a 33 ± 24 años). Un año después de la timectomía, el 28,2% se encontraba en el grupo de mal resultado clínico, y un 54,3%, en el de buen resultado clínico. En el análisis univariante, el timoma se asoció a peor resultado clínico al año de la intervención. Tras diez años de seguimiento, 32 pacientes (78%) alcanzaron un buen resultado clínico, un 9,8% en remisión completa estable, y el timoma no se correlacionó como factor de mal pronóstico. Conclusión. La timectomía se considera un tratamiento efectivo, pero sin beneficio inmediato. La presencia de timoma podría determinar una respuesta clínica inicial peor tras la realización de una timectomía en pacientes con miastenia grave.

[Video-assisted thoracoscopic surgery in 3 cases of adult cystic adenomatoid malformation]. / Tres casos de malformación adenomatoidea quística en el adulto tratados por cirugía videotoracoscópica.

Congenital cystic adenomatoid malformation involving the lung is a rare hamartomatous condition that is usually diagnosed in the neonatal period. The presentation of this malformation in older patients is exceptional and usually manifests in a series of recurrent lung infections affecting a single lobe or segment. The treatment of choice is complete surgical exeresis. This report of 3 cases of late presentation focuses on the surgical approach used and the unusual manifestation of recurrent spontaneous pneumothoraces in 1 patient. The patients were females aged 15, 16, and 25 years with histories of various respiratory diseases (extrinsic asthma, recurrent pneumonias, and pneumothoraces). The patients were referred to us for surgery with suspected diagnoses that were different from the final diagnoses in all cases. All underwent diagnostic video-assisted thoracoscopy to explore the affected hemothorax, and definitive treatment was possible during the procedure for 2 patients (a lobectomy and an atypical segmentectomy) by video-assisted surgery. The third patient underwent lobectomy by lateral thoracotomy after exploratory video-assisted thoracoscopy. Short- and long-term outcomes were excellent for all 3 patients.

[Thoracoscopic sympathectomy for palmar hyperhidrosis. Immediate results and postoperative quality of life]. / Tratamiento de la hiperhidrosis palmar por simpatectomía torácica. Resultados inmediatos y calidad de vida postoperatoria.

OBJECTIVE: Primary palmar hyperhidrosis is a socially and occupationally debilitating disorder characterized by excessive sweating. The purpose of this study was to evaluate the results, complications, and degree of satisfaction among patients who underwent video-assisted bilateral thoracoscopic sympathectomy of the second and third ganglia (T2-T3) to treat primary palmar hyperhidrosis at the Department of General and Thoracic Surgery of the Hospital Universitario Virgen Macarena in Seville, Spain. MATERIAL AND METHOD: A study of 226 thoracoscopic sympathectomies was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample was composed of 113 patients (47 males and 66 females), ranging in age from 14 to 50 years, with primary palmar and axillary hyperhidrosis, in some cases severe. Bilateral video-assisted thoracoscopic T2-T3 sympathectomy was performed under general anesthesia in all cases. Follow up included a questionnaire on pre- and postoperative quality of life and degree of satisfaction. Descriptive statistics on the surgical procedure, quality of life, and postoperative changes were compiled and frequency analyzed. A nonparametric Wilcoxon test for paired variables was performed to contrast significant differences between pre- and postoperative quality of life related to hyperhidrosis and its complications. RESULTS: The therapeutic success rate was 100%. Complications were seen in 14.2% of the cases and included hemothorax in two, hemopneumothorax in three, pleural hemorrhage in two, and minimal apical airspace in nine. Of the 106 patients who were monitored over a period of 6 to 12 months through follow-up interviews and questionnaires, 67% developed compensatory sweating, 95% reported improvement in quality of life, and 4% experienced no change in quality of life, mainly because of the emergence of compensatory sweating. Of the patients interviewed, 97.2% said that they would undergo the operation again. CONCLUSION: Video-assisted thoracoscopic sympathectomy for the treatment of primary palmar hyperhidrosis is effective, with low rates of morbidity and no mortality. Despite the appearance of postoperative changes such as compensatory sweating, patient satisfaction with the procedure is high and their quality of life improves.

[Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules]. / Utilidad de la cirugía videotoracoscópica en el diagnóstico de los nódulos pulmonares solitarios.

OBJECTIVES: Various approaches are used for the diagnosis and treatment of solitary pulmonary nodules (SPN) of unknown origin. New imaging techniques and nuclear medicine have provided more information about SPN, but surgical removal is still the most sensitive and specific way to obtain a correct analysis of the lesion. With video-assisted thoracic surgery (VATS), a histological diagnosis can be obtained without resorting to thoracotomy. In the present study we describe our experience with the diagnosis and treatment of SPN using VATS. MATERIAL AND METHODS: From July 1992 through April 2001, 182 patients were operated on for SPN in our department. DESIGN: Retrospective study. Mean age: 59.2 years (12-78). Sex: 39 women and 143 men. Localization: Visual or instrumental exploration in 102 patients, with palpation in 52 cases and using a hookwire guided by preoperative computed tomography in 25 (with failure in 4 of those cases). Tissue was biopsied during surgery and when the lesion was malignant, oncological excision was performed during the same operation. RESULTS: A firm diagnosis was obtained by VATS for 178 patients (98.3%). For three other patients the surgeon had to take a needle biopsy (Tru-cut) during surgery, and in one case conversion to open surgery was necessary. Histopathology: hamartoma: 11; fibrous nodule: 10; bronchiolitis obliterans: 1; pneumoconiosis: 1; mesenchymal tumor: 3; inflammatory pseudotumor: 14; mucormycosis: 1; tuberculoma:17; lymphoma: 1; carcinoid tumor: 6; metastasis: 22; bronchogenic carcinoma: 95. Mortality was 0.55%, with 1 patient dying from massive pulmonary thromboembolism. Morbidity was 5%, from 9 minor complications. CONCLUSIONS: VATS is an effective approach, with low morbidity and mortality. We consider it to be the technique of choice for the diagnosis of all SPN and for the treatment of some, such as benign nodules and solitary metastases.

[Giant solitary fibrous tumor of the pleura treated by video-assisted surgery: a case report]. / Tumor fibroso solitario gigante de pleura: un caso tratado por cirugía videoasistida.

Solitary fibrous tumors of the pleura are rare, with unpredictable clinical manifestations. By the time of diagnosis, the size and consistency of the tumor usually preclude the use of minimally invasive surgical techniques. We present a case of a 34-year-old male with a solitary fibrous tumor of the visceral pleura masquerading as a mediastinal tumor. The tumor was removed by video-assisted thoracic surgery.

[Video-assisted thoracoscopic thymectomy for the treatment of myasthenia gravis]. / Timectomía videotoracoscópica para el tratamiento de la miastenia gravis.

OBJECTIVE: Traditionally, thymectomy for myasthenia gravis has been performed using either a transcervical approach or a median sternotomy. However, excision of the thymic tissue by video-assisted thoracoscopic surgery is less aggressive and recovery is faster. The aim of this study was to evaluate the usefulness and outcomes of video-assisted thoracoscopic thymectomy. PATIENTS AND METHODS: Over the past 10 years, we have performed 25 video-assisted thoracoscopic thymectomies on patients with myasthenia gravis at our unit. This study included 16 women and 9 men, with a mean age of 48.1 years (range, 14-74 years). Right-side (22 cases) or left-side (3 cases) thoracoscopic surgery was performed, with a mean intervention time of 110 minutes (range, 60-193 minutes). RESULTS: No patient required assisted ventilation for more than 4 hours and the maximum stay in intensive care was less than 24 hours. Complications from surgery included 3 cases of contralateral pneumothorax, 1 pleural effusion, and 2 intraoperative hemorrhages from the thymic vein, all of which were resolved by video-assisted thoracoscopy. Likewise, 3 cases required conversion (due to hemorrhaging in 2 patients and technical difficulties in 1) and 2 required a second thoracoscopic intervention. No deaths occurred and clinical outcome was excellent in 11 cases (medical treatment no longer required), good in 10 (reduced medical treatment), and poor in 4 (no changes). CONCLUSIONS: Video-assisted thoracoscopic thymectomy is effective in the treatment of myasthenia gravis and improves patient recovery. In addition, the excellent surgical view allows the thymectomy to be performed with absolute safety.