Papel de la persona navegadora del paciente en el cáncer de pulmón / The Role of the Navigator Person for a Patient with Lung Cancer

Introducción: la medicina basada en el valor ha logrado mejorar la calidad de atención del paciente y/o la satisfacción de las personas, reduciendo costos y obteniendo mejores resultados. Se apoya sobre tres pilares básicos: la medicina basada en la evidencia, la atención centralizada en el paciente, y la sustentabilidad. Sin embargo, existen pocas publicaciones sobre la estrategia de personas navegadoras para pacientes con cáncer de pulmón, que podrían ser una herramienta clave para brindar apoyo, asegurando que tengan acceso al conocimiento y los recursos necesarios a fin de completar la vía de atención clínica recomendada. Estado del arte: se trata de una intervención en salud cuyo objetivo principal es lograr vencer las barreras relacionadas con la atención (p. ej., logísticas, burocrático-administrativas, de comunicación y financieras) para poder mejorar la calidad y el acceso a la salud en el marco de la atención del cáncer. Estas personas cumplen un papel de guía para pacientes durante el proceso de diagnóstico y tratamiento activo. Su labor consiste en vincular al paciente con los proveedores clínicos, brindar un sistema de apoyo, asegurar un acompañamiento individualizado, garantizar que tengan acceso al conocimiento y a los recursos necesarios para completar el seguimiento y/o tratamiento adecuado. Discusión/Conclusión: indudablemente, es un elemento cada vez más reconocido en los programas de cáncer, centrado en el paciente y de alta calidad. Su implementación será de especial interés en la Unidad de Práctica Integrada para personas con cáncer de pulmón. (AU)

Introduction: Value-based medicine has succeeded in improving the quality of patient care and or patient satisfaction, reducing costs, and obtaining better outcomes. It rests on three fundamental pillars: evidence-based medicine, patient-centered care, and sustainability. However, there are few publications on the people navigator strategy for lung cancer patients, which could be a crucial tool for providing support, ensuring that they have access to the knowledge and resources needed to complete the recommended clinical care pathway. State of the art: It is a health intervention whose main objective is to overcome care-related barriers (e.g., logistical, bureaucratic-administrative, communication, and financial) to improve quality and access to health in the context of cancer care. These individuals play a guiding role for patients during the diagnostic and active treatment process. Their job is to link the patient with clinical providers, provide a support system, ensure individualized accompaniment, and guarantee that they get access to the knowledge and resources necessary to complete the appropriate follow-up and, or treatment. Discussion/Conclusion: Undoubtedly, patient navigators represent an increasingly recognized element of high-quality, patient-centered cancer programs. Its implementation will be of specific interest in the Integrated Practice Unit for people with lung cancer. (AU)

Long-term results in patients with lung resections for colorectal cancer metastases. Experience of a single center in Argentina / [Resultados a largo plazo en pacientes con resecciones pulmonares por metástasis de cáncer colorrectal. Experiencia de un solo centro de Argentina.]

Introduction: Between 5-10% of patients who undergo curative surgery for colorectal cancer (CRC) will present recurrence of their disease on the lungs. Surgical treatment of pulmonary metastases (PM) has gained popularity over the years, different publications report an overall survival rate at 5 years of between 30% and 60%. We present a review of patients with PM resections of CRC treated in a single center in Argentina. Materials and methods: A descriptive, observational, retrospective study was conducted between 2008 and 2018. All patients with pulmonary metastasectomy of colorectal cancer were included. The primary endpoint was to evaluate overall survival and disease-free survival. Possible prognostic factors were evaluated as a secondary endpoint. Results: A total of 99 surgeries were performed in the 68 patients, the resection was multiple in 48.5%, with more than 3 nodules in 13%. Overall and progression-free survival at 5 years was 55% and 27%, respectively. In the statistical analysis we found that the lesions in more than one lobe (p = 0.015) and the resection of more than 3 nodules (p = 0.011) presented a lower overall survival. Conclusions: In this retrospective analysis we evidenced comparable values to the world literature regarding morbidity, mortality, overall survival and progression-free. In our series, patients with disease in more than one lobe or more than three resected lesions had significantly lower overall survival.

Introducción: Entre el 5-10% de los pacientes que se someten a cirugía curativa por cáncer colorrectal (CCR) presentarán en algún momento recurrencia de su enfermedad a nivel pulmonar. El tratamiento quirúrgico de las metástasis pulmonares (MP) fue ganando popularidad a través de los años, diferentes publicaciones informan una tasa de supervivencia global a los 5 años de entre 30% a 60%. Presentamos una revisión de pacientes con resecciones por MP de CCR tratados en un único centro en Argentina. Materiales y métodos: Se realizó un estudio descriptivo, observacional, retrospectivo entre 2008 y 2018. Se incluyeron todos los pacientes con resecciones de MP de CCR.  El objetivo primario fue evaluar la supervivencia global y  supervivencia libre de enfermedad. Como objetivo secundario se evaluaron posibles factores pronósticos. Resultados: Se realizaron un total de 99 cirugías en los 68 pacientes, la resección fue múltiple en un 48,5%, siendo más de 3 nódulos en un 13%. La supervivencia global y libre de progresión a los 5 años fue del 55% y del 27% respectivamente. En el análisis estadístico encontramos que las lesiones en más de un lóbulo (p=0.015) y la resección de más de 3 nódulos (p=0.011) presentaron una menor supervivencia global. Conclusiones: En este análisis retrospectivo evidenciamos valores comparables a la literatura mundial con respecto a morbilidad, mortalidad, supervivencia global y libre de progresión. En nuestra serie los pacientes con enfermedad en más de un lóbulo o más de tres lesiones resecadas presentan significativamente menor supervivencia global.

Is the neutrophil-to-lymphocyte ratio a prognostic factor in non-small cell lung cancer patients who receive adjuvant chemotherapy?

Inflammation plays a key role in malignant tumor progression. Neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and, as such, high isolated pretreatment NLR has been shown in some studies to be associated with worse long-term outcomes. We summarize the data regarding the utility of NLR as a prognosis factor and present results of a single institution study assessing the usefulness of high preoperative NLR as a prognosis factor for patients with successfully resected NSCLC who receive adjuvant cisplatin-based chemotherapy. While largely supportive of the value of NLR as a prognostic factor, the literature is not consistent and suggest a more nuanced association. Our single institution study adds to the exiting literature. We conclude preoperative NLR can be used as a reliable, cost-effective biomarker to estimate prognosis in NSCLC patients who have undergone lung lobectomy with curative intent followed by cisplatin-based adjuvant chemotherapy.

[Emergency pulmonary lobectomy in a patient with severe hemoptisis due to COVID-19]. / Lobectomía pulmonar de urgencia en paciente con cuadro de Hemoptisis grave por COVID-19.

The most common symptoms in patients with SARS-CoV-2 infection are fever, cough, odynophagia, headache, myalgia, and diarrhea. A much smaller percentage have dizziness, rhinorrhea, and hemoptysis as associated symptoms. However, the great magnitude that this second wave acquired, can make this last complication appear more frequently. This report describes the case of a 49-year-old patient with a history of recent COVID-19 infection with requirement of mechanical ventilation due to respiratory failure, who developed during hospitalization in the general ward with parapneumonic pleural effusion and episodes of persistent hemoptysis that required surgical treatment. During surgery, a significant fibro-adhesion process and a congestive lung with focal increased consistency and areas of necrosis were found.

Los síntomas más frecuentes de los pacientes con infección por SARS-CoV-2 suelen ser fiebre, tos, odinofagia, cefalea, mialgias y diarrea. Un porcentaje mucho menor padece mareos, rinorrea y hemoptisis como síntomas asociados. Sin embargo, la gran magnitud que adquirió esta segunda ola, puede hacer que esta última complicación se presente con más frecuencia. Se describe el caso de un paciente de 49 años con antecedente de infección reciente por COVID-19 con requerimiento de ARM por insuficiencia respiratoria que intercurrió, durante la internación en sala general, con derrame pleural de tipo paraneumónico y episodios de hemoptisis persistente que se resolvió de forma quirúrgica. Durante la cirugía se encontró un importante proceso fibro adherencial y un pulmón congestivo con aumento focal de la consistencia y áreas de necrosis.

Estrategias para aumentar la disponibilidad de órganos destinados a trasplante pulmonar. Enfoque desde Argentina / Strategies to increase the availability of organs destined for lung transplantation. Approach from Argentina

Resumen Ante la escasez de donantes pulmonares, el aumento de los pacientes en lista de espera y el aumento de las muertes en lista de espera existen varias estrategias que buscan resolver estos problemas. Las estrategias de promoción son necesarias, continuas y transver sales a todo el proceso. Las de procuración implican mejora continua en la calidad de atención médica, siendo muy costo-efectivas en nuestro contexto. Las de distribución ya se emplean y han generado mejoras en el acceso al trasplante; deben ser constantemente evaluadas. Las de selección involucran mejoras a expensas de mayores costos a veces con consecuencias negativas, por lo que deben ser evaluadas caso a caso. El uso de EVLP es efectivo, aunque pareciera no ser una intervención costo-efectiva en nuestro medio debiendo emplearse otras estrategias previamente. La utilización de donantes a corazón parado es efectiva aunque requiere de una inversión en el sistema logístico que no parece ser viable por el momento en Argentina.

Abstract Given the shortage of lung donors and the increase in patients and deaths on the waiting lists, there are several strategies that could be carried out. Promotion strategies are necessary, continuous and transversal to the entire process. Strategies that attempt to enhance organ procurement involve continuous improvement in the quality of healthcare, which is highly profitable in our context. Interventions on grafts distribution are already in use and have generated improvements in access to lung transplantation. Laxity in the selection criteria generates higher costs, sometimes with negative consequences, so a case-by-case selection must be applied. Ex vivo lung perfusion is effective, although it does not appear to be a cost-effective intervention in our country, other strategies must be implemented previously. The use of non-heart-beating lung donors requires an investment in a logistics system that nowadays does not seem viable in Argentina.

Lobectomía pulmonar de urgencia en paciente con cuadro de hemoptisis grave por COVID-19 / Emergency pulmonary lobectomy in a patient with severe hemoptisis due to COVID-19

Resumen Los síntomas más frecuentes de los pacientes con infección por SARS-CoV-2 suelen ser fiebre, tos, odinofagia, cefalea, mialgias y diarrea. Un porcentaje mucho menor padece mareos, rinorrea y hemoptisis como síntomas asociados. Sin embargo, la gran magnitud que adquirió esta segunda ola, puede hacer que esta última complicación se presente con más frecuencia. Se describe el caso de un paciente de 49 años con antecedente de infección reciente por COVID-19 con requerimiento de ARM por insuficiencia respiratoria que intercurrió, durante la internación en sala general, con derrame pleural de tipo paraneumónico y episodios de hemoptisis persistente que se resolvió de forma quirúrgica. Durante la cirugía se encontró un importante proceso fibro adherencial y un pulmón congestivo con aumento focal de la consistencia y áreas de necrosis.

Abstract The most common symptoms in patients with SARS-CoV-2 infection are fever, cough, odynophagia, headache, myalgia, and diarrhea. A much smaller percentage have dizziness, rhinorrhea, and hemoptysis as associated symptoms. However, the great magnitude that this second wave acquired, can make this last com plication appear more frequently. This report describes the case of a 49-year-old patient with a history of recent COVID-19 infection with requirement of mechanical ventilation due to respiratory failure, who developed during hospitalization in the general ward with parapneumonic pleural effusion and episodes of persistent hemoptysis that required surgical treatment. During surgery, a significant fibro-adhesion process and a congestive lung with focal increased consistency and areas of necrosis were found.

Pneumothorax after percutaneous transthoracic lung biopsy. Non-invasive management in order to avoid unnecessary hospitalizations

BACKGROUND: Image-guided percutaneous transthoracic lung biopsy has become a widely used and less invasive diagnostic method. Pneumothorax is the most frequent complication after lung biopsy. The aim of the present study is to describe the experience with expectant management of asymptomatic small post-biopsy pneumothorax in order to reduce unnecessary hospital admissions. METHODS: A retrospective review was performed analyzing the results of subjects who underwent expectant and conservative treatment after presenting pneumothorax following  percutaneous lung biopsy, in a period of 6 years (January 2013 - December 2019) RESULTS: 160 subjects who underwent diagnostic percutaneous lung biopsy of lung nodules were evaluated. Of these, 46 subjects (29%) presented pneumothorax, of which 36 were small. This group of subjects was managed expectantly, with a therapeutic success of 81% (7 subjects had to undergo percutaneous pleural drainage). CONCLUSIONS: Expectant management in subjects with pneumothorax following percutaneous lung biopsy is a useful tool and should be applied by surgeons in order to avoid hospitalizations and / or unnecessary  and expensive procedures.

INTRODUCCIÓN: La punción biopsia percutánea transtorácica se ha convertido con el devenir del tiempo en un método diagnóstico de uso ubicuo y poco invasivo. Su principal complicación continúa siendo el neumotórax. El presente estudio describe la experiencia de este grupo con el manejo expectante del neumotórax pequeño y asintomático post biopsia, con el fin de reducir ingresos hospitalarios innecesarios. MATERIALES Y MÉTODOS: Se realizó una revisión retrospectiva, analizando los resultados de aquellos pacientes sometidos a tratamiento conservador de neumotórax post punción percutánea transtorácica en un periodo de 6 años ( Enero 2013 a Diciembre 2019). RESULTADOS: Un total de 160 sujetos fueron sometidos a una punción percutánea diagnóstica de pulmón en el lapso de tiempo estudiado. De estos, 46 ( 29%) presentaron neumotórax, siendo 36 de estos neumotórax pequeños. Este grupo fue manejado de forma expectante, con una tasa de éxito terapéutico del 81 % ( 7 sujetos debieron ser sometidos a drenaje pleural percutáneo). CONCLUSIONES: El tratamiento conservador de pacientes con neumotórax secundario a biopsia percutánea transtorácica es seguro, efectivo y útil. Debería ser utilizado por cirujanos como herramienta para evitar internaciones y/o procedimientos innecesarios y costosos.

Complications following transbronchial biopsy: the role of cryobiopsy in the incidence of postoperative pneumothorax / [Complicaciones post biopsia transbronquial: el papel de la criobiopsia en la incidencia de neumotórax postoperatorio]

Introduction: Transbronchial lung cryobiopsy (TBCB) has emerged as a diagnostic alternative to surgical lung biopsy mostly in interstitial lung disease. Despite its less invasive nature and reported higher diagnostic yield, some associated complications have been described, such as pneumothorax. Moreover, a comparison between TBCB and transbronchial forceps biopsy is seldomly made. The aim of the present study is to evaluate the incidence of pneumothorax following TBFB and TBCB and the need for pleural drainage. Methods: Retrospective study of patients who underwent transbronchial forceps biopsy or transbronchial lung cryobiopsy, specifically those who developed postoperative pneumothorax. Results: A total of 181 transbronchial lung biopsies were performed. Sixty three (35%) were TBFB and 118 (65%) were TBCB. Three patients in the TBFB group (5%) presented postoperative pneumothorax, while 16 patients (14%) presented pneumothorax in the TBCB group (p 0,051). The univariate analysis revealed a statistically significant association between the preoperative diagnosis of fibrosis and a higher risk of postoperative pneumothorax following TBCB (p 0.027), while other variables did not yield a statistical significance. Conclusion: Even though more high-volume comparative studies are needed, this paper highlights the relevance of pneumothorax following TBCB. This derives in a strong need for clearly standardized procedure protocols for TBCB and careful evaluation of its complications vs. its definitive diagnostic yields.

Introducción: La criobiopsia pulmonar transbronquial (TBCB) se ha convertido en una alternativa diagnóstica a la biopsia pulmonar quirúrgica, principalmente en la enfermedad pulmonar intersticial. A pesar de su naturaleza menos invasiva y de un mayor rendimiento diagnóstico, se han descrito algunas complicaciones asociadas, como el neumotórax. En pocas oportunidades se ha comparado la TBCB y la biopsia transbronquial con fórceps (TBFB). El objetivo del presente estudio es evaluar la incidencia de neumotórax después de TBFB y TBCB y la necesidad de drenaje pleural. Métodos: Estudio retrospectivo de pacientes que se sometieron a TBCB y TBFB, específicamente aquellos que desarrollaron neumotórax postoperatorio. Resultados: Se realizaron un total de 181 biopsias pulmonares transbronquiales. Sesenta y tres (35%) fueron TBFB y 118 (65%) fueron TBCB. Tres pacientes en el grupo TBFB (5%) presentaron neumotórax postoperatorio, mientras que 16 pacientes (14%) presentaron neumotórax en el grupo TBCB (p 0,051). El análisis univariado reveló una asociación estadísticamente significativa entre el diagnóstico preoperatorio de fibrosis y un mayor riesgo de neumotórax postoperatorio después de TBCB (p 0.027), mientras que otras variables no arrojaron un resultado significativo. Conclusión: Aunque se necesitan más estudios comparativos de alto volumen, este documento destaca la relevancia del neumotórax después de la TBCB. Esto deriva en una fuerte necesidad de protocolos de procedimientos claramente estandarizados para TBCB y una evaluación cuidadosa de sus complicaciones versus su rendimiento diagnóstico

Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis.

Venous thromboembolism (VTE) is an important postoperative complication after major lung cancer resective surgery, such as lobectomy. It is recommended to start chemical thromboprophylaxis within the first 12 h following the procedure. Postoperative bleeding is also a relevant complication in patients with predisposing conditions. However, the criterion for classifying a patient as "high risk of bleeding" is not standardized and is left to the expertise of the attending physician or surgeon. We aim to describe the incidence and risk factors for postoperative VTE and hemorrhage after pulmonary lobectomy; and to assess the impact of the timing of thromboprophylaxis on the incidence of postoperative thrombotic or hemorrhagic events. A retrospective observational study of 358 lobectomies performed in a single center was performed, analyzing the rates of postoperative thrombotic and hemorrhagic events and predisposing factors, including postoperative thromboprophylaxis management. Cumulative incidence of VTE was 3.07% (95% CI 1.54-5.43), and early postoperative bleeding was 10.05% (95% CI 7.14-13.64). Underlying pulmonary disease was associated with VTE (p = 0.001) and open approach was associated with hemorrhagic events (p = 0.01). The use of thromboprophylaxis and timing of its initiation were not associated with a higher incidence of events. VTE and postoperative hemorrhage are relevant complications following pulmonary lobectomy. Compliance with VTE prophylaxis guidelines is essential. Even so, a case-by-case risk evaluation of VTE and bleeding remains preferable and safe in order to decide on the most suitable timing of thromboprophylaxis.

[Lung adenocarcinoma on scar of previous segmentectomy for benign nodule. Case presentation] / Hallazgo de carcinoma sobre cicatriz de segmentectomía pulmonar por patología benigna. Presentación de un caso.

Introduction: Lung cancer is the leading cause of cancer-related mortality worldwide. Although lung cancer is predominantly observed in smokers, non-smoking patients account for 20% of cases worldwide. In this article, we present a case of lung adenocarcinoma that originated from a postoperative scar. We present a 62-year-old male patient who, while being studied for Paget's disease of bone, presented a 1.5 cm pulmonary nodule (SUV 1.6) as an imaging finding in the posterior segment of the left lung. He underwent a upper left lung segmentectomy. Results: During the routine follow-up of his underlying disease, 12 years after the original surgery, a pulmonary nodule was found. The particularity of the sample is based on the macroscopic observation of the tumor piece where the development of the neoplastic mass on the mechanical suture of the previous surgery performed 12 years ago is shown. Conclusion: We describe a rare cancer development mechanism in clinical practice, from chronic postoperative inflammation due to mechanical suturing.

Introducción: El cáncer de pulmón es la principal causa de mortalidad relacionada con el cáncer en todo el mundo. Aunque el cáncer de pulmón se observa predominantemente en fumadores, los pacientes no fumadores representan el 20% de los casos en todo el mundo. Objetivo: En este artículo, debatimos sobre un caso de adenocarcinoma de pulmón que se originó a partir de una cicatriz postoperatoria. Presentamos a un paciente masculino de 62 años que, mientras se estudiaba por diagnóstico de enfermedad ósea de Paget, presentaba un nódulo pulmonar de 1,5 cm (SUV 1.6) como un hallazgo de imagen en el segmento posterior del pulmón izquierdo. Se sometió a una segmentectomía pulmonar superior izquierda. Materiales y métodos: Artículo de tipo caso clínico. Se obtuvieron los datos de manera retrospectiva a partir de la historia clínica del paciente bajo normas del comité de ética. Resultados: Durante el seguimiento de rutina de su enfermedad subyacente, 12 años después de la cirugía original, se encontró un nódulo pulmonar. La particularidad de la muestra se basa en la observación macroscópica de la pieza tumoral donde se muestra el desarrollo de la masa neoplásica en la sutura mecánica de la cirugía previa realizada hace 12 años. Conclusión: Describimos un mecanismo de desarrollo oncológico poco frecuente en la práctica clínica, a partir de la inflamación crónica postoperatoria debido a la sutura mecánica.

Tracheostomy in the intensive care unit: Guidelines during COVID-19 worldwide pandemic.

PURPOSE: COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically ill patients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19 patients, emphasizing the safety of the patient but also the medical team involved. MATERIALS AND METHODS: A multidisciplinary group made up of surgeons with privileges to perform tracheostomies, intensive care physicians, infectious diseases specialists and intensive pulmonologists was created to update previous knowledge on performing a tracheostomy in critically ill adult patients (>18 years) amidst the SARS-CoV-2 pandemic in a high-volume referral center. Published evidence was collected using a systematic search and review of published studies. RESULTS: A guideline comprising indications, surgical technique, ventilator settings, personal protective equipment and timing of tracheostomy in COVID-19 patients was developed. CONCLUSIONS: A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19 patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.

Resultados a largo plazo del manejo expectante del primer episodio de neumotórax espontáneo primario: ¿Es una opción terapéutica segura?

Introducción: El tratamiento expectante de pacientes con neumotórax espontáneo primario (NEP) pequeños y asintomáticos permanece siendo motivo de discusión, en parte debido a la mayor tasa de recurrencia aparente con respecto a los tratados con drenajes pleurales. Objetivo: Presentar la experiencia en el manejo de NEP grado I, comparando los resultados a corto y largo plazo de aquellos tratados con drenajes pleurales de aquellos tratados de manera expectante. Materiales y métodos: Se realizó un estudio retrospectivo sobre una base de datos prospectiva en pacientes con diagnóstico de neumotórax espontáneo grado I clínicamente estables. Resultados: Sobre un total de 69 pacientes, 30 pacientes fueron tratados con drenaje pleural y 39 pacientes realizaron un tratamiento expectante con manejo ambulatorio. No se evidenciaron diferencias poblaciones en cuanto a edad, sex, lado, antecedente de tabaquis­mo, y tamaño de neumotórax. Con respecto a los resultados a corto plazo, no existieron diferencias de resultados de tratamiento con respecto a la falla terapéutica en ambos grupos, existiendo si diferencias significativas con respecto al tiempo de internación en favor del manejo expectante. Con respecto a los resultados a largo plazo, no hubo diferencias significativas con respecto a la recurrencia entre ambos grupos. Conclusión: El manejo expectante de pacientes con neumotórax espontáneo primario pequeños y clínicamente estables con estricto control ambulatorio y pautas de alarmas de los mismos, presenta buenos resultados a corto y largo plazo, debiendo ser considerado como primera opción terapéutica.

Long-Term Results of Expectant Management of First Episode of Primary Spontaneous Pneumothorax: Is it a Safe Therapeutic Option?

Introduction: Expectant treatment in clinically stable patients with small primary spontaneous pneumothorax (PSP) remains in discussion, partly due to the described increased recurrence rate compared to patients treated with pleural drainage. Objective: To present the experience in the management of grade I PSP, comparing long- and short-term results of patients treated with pleural drainage with those treated expectantly. Methods: We present a retrospective study of patients diagnosed with small asymptomatic or mildly symptomatic PSP. Results: 34 out of 69 patients were treated with pleural drainage and 35 underwent expectant treatment with outpatient management. Both groups were comparable regarding sex, side, size of pneumothorax and history of tobacco smoking. As for the short-term results, there weren't any differences between groups in success therapy, but there were significant differences related to hospital stay, where patients treated with pleural drainage presented longer length of stay. Regarding long-term results, there weren't significant differences in terms of recurrence between both groups. Conclusion: The expectant management of clinically stable patients with small primary spontaneous pneumothorax with strict ambulatory control follow-up and those who comply with treatment recommendations and can obtain prompt emergency medical care presents acceptable long- and short-term results and should be the first choice of treatment.

Short- and Long-Term Outcomes After Live-Donor Transplantation with Hyper-Reduced Liver Grafts in Low-Weight Pediatric Recipients.

OBJECTIVE: To evaluate short- and long-term outcomes after live-donor liver transplantation (LT) with hyper-reduced grafts in low-weight pediatric recipients. LT is an established curative therapy for children with end-stage chronic liver disease or acute liver failure. A major problem in pediatric LT has been the lack of size-matched donor organs. The disadvantage of the use of large-for-size grafts is the insufficient tissue oxygenation and graft compression, which result in poor outcomes. The shortage of suitable donors is most notable in children under 10 kg. To overcome such obstacle, in situ hyper-reduced live-donor liver grafts have been introduced. Available articles in the literature are based on small samples and are deficient in long-term follow-up. METHODS: A single-cohort, retrospective analysis was conducted including 59 pediatric patients under 10 kg who underwent hyper-reduced (in situ "a la carte" left lateral segment reduction) live-donor LT (LDLT) between February 1994 and February 2018. RESULTS: The most frequent cause of liver failure was biliary atresia (70%). Median recipient weight was 8 kg. Vascular complications were confirmed in 15% of the sample, while 45% presented biliary complications. Median follow-up time was 40.3 months. Ten-year overall survival rate was 74%. Pediatric end-stage liver disease score > 23 was associated with a higher risk of post-operative complications. CONCLUSION: LDLT can be undertaken in children with body weight < 10 kg achieving good results in high-volume centers by experienced surgeons.

Laparoscopic revisional surgery for an unusual complication of Roux-en-Y gastric bypass.

With the worldwide epidemic of obesity, there has been an increase in the numbers of primary and revisional procedures of bariatric surgery such as the Roux-en-Y gastric bypass (RYGBP). Nevertheless, this type of surgery is not exempt from complications. An excessive length of non-functional Roux limb proximal to the jejunojejunostomy can cause abnormal upper gastrointestinal symptoms after laparoscopic RYGBP. We present the case of a female patient who presented these unspecific abdominal symptoms after laparoscopic RYGBP who underwent laparoscopic resection in order to reduce the length of the dilated blind loop responsible for the symptoms.

Sodium hydroxide as a sclerosing agent in patients with neoplastic pleural effusion non-candidates for VATS: results of a minimally invasive protocol.

Symptomatic neoplastic pleural effusion (SNPE) is a significant cause of morbidity in patients with advanced neoplastic disease. These patients often present a deteriorated general condition which prevents them from undergoing pleurodesis with video-assisted thoracic surgery (VATS). We developed a minimally invasive therapeutic protocol specially designed for this population, achieved by combining chemical pleurodesis with placement of small-bore pleural catheters (PC), which resulted in early hospital discharge, low morbimortality and good therapeutic results. This study reports the safety and efficacy of administration of sodium hydroxide (NaOH) through PC in 60 patients diagnosed with SNPE who were admitted to Hospital Italiano de Buenos Aires between January 2012 and December 2015. Successful pleurodesis was achieved in 96% of procedures. Recurrence occurred in 25% of patients during follow-up, with recurrence occurring earlier than 30 days after pleurodesis in 8% of patients. There were no reports of major morbidity or associated mortality. In total, 44% of patients were discharged within 48 h of pleurodesis. Administration of NaOH through a small-bore PC represents an effective and safe method of pleurodesis in patients who are not candidates for talc pleurodesis by VATS.

Synchronous contralateral adrenal metastasis of colorectal cancer: case report.

The most frequent sites of distant metastasis of colorectal cancer (CRC) are primarily liver and lung, followed by brain and bone metastases. Infrequently, metastases are found in the adrenal glands. They usually have a metachronous and homolateral character. We present a case of contralateral synchronic adrenal metastasis of CRC and its surgical resolution.