Analgesic Efficacy and Safety of Intrathecal Morphine or Intercostal Levobupivacaine in Lung Cancer Patients after Major Lung Resection Surgery by Videothoracoscopy: A Prospective Randomized Controlled Trial.

Background: Lung resection using video-assisted thoracoscopic surgery (VATS) improves surgical accuracy and postoperative recovery. Unfortunately, moderate-to-severe acute postoperative pain is still inherent to the procedure, and a technique of choice has not been established for the appropriate control of pain. In this study, we aimed to compare the efficacy and safety of intrathecal morphine (ITM) with that of intercostal levobupivacaine (ICL). Methods: We conducted a single-center, prospective, randomized, observer-blinded, controlled trial among 181 adult patients undergoing VATS (ISRCTN12771155). Participants were randomized to receive ITM or ICL. Primary outcomes were the intensity of pain, assessed by a numeric rating scale (NRS) over the first 48 h after surgery, and the amount of intravenous morphine used. Secondary outcomes included the incidence of adverse effects, length of hospital stay, mortality, and chronic post-surgical pain at 6 and 12 months after surgery. Results: There are no statistically significant differences between ITM and ICL groups in pain intensity and evolution at rest. In cough-related pain, differences in pain trajectories over time are observed. Upon admission to the PACU, cough-related pain was higher in the ITM group, but the trend reversed after 6 h. There are no significant differences in adverse effects. The rate of chronic pain was low and did not differ significantly between groups. Conclusions: ITM can be considered an adequate and satisfactory regional technique for the control of acute postoperative pain in VATS, compatible with the multimodal rehabilitation and early discharge protocols used in these types of surgeries.

Linfoma testicular primario. A propósito de 2casos nuevos / Primary testicular lymphoma. Two new case reports

El linfoma testicular primario es una entidad muy poco frecuente; sin embargo, su curso clínico es desfavorable, con una elevada tasa de recaídas y baja supervivencia. A propósito de su baja prevalencia, presentamos 2casos con la actualización en el tratamiento y evolución. (AU)

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease. (AU)

[Primary testicular lymphoma. Two new case reports]. / Linfoma testicular primario. A propósito de 2casos nuevos.

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease.

Perioperative outcome of lung cancer surgery in women: results from a Spanish nationwide prospective cohort study.

BACKGROUND: To assess possible differences in the perioperative profile between men and women in lung cancer surgery. METHODS: A prospective cohort multicenter study was design, in which consecutive patients undergoing curative intent surgery for lung cancer in 24 Thoracic Services throughout Spain were included. Clinical features, tumor- and surgery-related data, postoperative complications, and mortality were recorded. RESULTS: There were 2,566 men and 741 women. Women were younger than men [mean (SD) age, 61.8 (10.8) vs. 66.5 (9.1) years, P<0.0001] and showed a more favorable preoperative characteristics, with significantly higher percentages of ECOG grade 0 and lower percentages of active smokers (28.4% vs. 33.9%; pack-years 18.8 vs. 26.9) and comorbidities [chronic obstructive pulmonary disease (COPD), diabetes, hypertension, cardiac disorders]. There were significant differences (P<0.001) in histological types and TNM stages with adenocarcinoma (70.1% vs. 46.4%) and IA stage (41.5% vs. 33.6%) more frequent in women. The use of VATS or thoracotomy was similar. The rate of pneumonectomy was higher in men (10.9%) than in women (5.1%) (P<0.001) but the distributions of other procedures were similar. Postoperative complications (pneumonitis, atelectasis, air leak, hemorrhage, fistula, empyema, wound dehiscence, and need of reintubation) were lower in women. Significant differences (P<0.0001) in the severity of postoperative complications (Clavien-Dindo classification) were also found, with higher percentages of grades I (51.6% vs. 43%) and II (37.5% vs. 33%) and lower percentages of grades III and IV among women. The mean length of hospital stay was 7.8 (7.1) days in men versus 6.3 (5.0) days in women, and the 30-day mortality rate 0.3% in women versus 2.9% in men (P<0.0001). The percentage of readmissions within 30 days after surgery was also higher in men (8.6% vs. 2.8%). CONCLUSIONS: This multicenter nationwide study of lung cancer surgery with curative intent shows that the perioperative profile is better in women than in men.

Determinación de grupo de bajo riesgo para tener nódulos metastásicos no detectados por tomografía axial computarizada en la cirugía de las metástasis pulmonares / Determination of a Low Risk Group for Having Metastatic Nodules Not Detected by Computed Tomography Scan in Lung Metastases Surgery

Introducción: En los últimos años existe un debate en relación con la exactitud diagnóstica de la tomografía axial computarizada (TAC) para identificar metástasis pulmonares y la necesidad de la palpación pulmonar para determinar el número de nódulos metastásicos. El objetivo del estudio fue determinar en qué pacientes era más eficaz la TAC para detectar todas las metástasis. Métodos: Se estudiaron todos los pacientes operados de metástasis pulmonar con intención curativa a través de toracotomía entre 1998 y 2012. Todos los casos fueron revisados preoperatoriamente por 2 radiólogos expertos en pulmón. Para el análisis estadístico se utilizó el programa Systat versión 13. Resultados: Ciento ochenta y tres pacientes (63,6% varones) con una edad media de 61,7 años a los que se les realizaron 217 intervenciones. La TAC acertó en 185 casos (85,3%). Discordancias observadas: 26 pacientes (11,9%) con más metástasis resecadas que las observadas y 6 casos (2,8%) con menos metástasis. Agrupando a los pacientes de origen colorrectal con una o 2 metástasis y metástasis única de cualquier origen, la probabilidad de resecar nódulos extras fue del 9,5%. En el resto la probabilidad fue del 27,8%, observándose diferencias estadísticamente significativas (p = 0,001). La edad media de los pacientes en los que no aparecieron nódulos no observados fue de 62,9 años, frente a 56,5 años de media en los pacientes que se escapaba alguna metástasis (p = 0,001). Conclusiones: Se consideró grupo con baja probabilidad de resecar más metástasis que las observadas a los pacientes mayores de 60 años con una o 2 metástasis de origen colorrectal o una de otro origen (AU)

Introduction: In recent years, there has been debate regarding the diagnostic accuracy of computed tomography (CT) in the identification of lung metastases and the need for lung palpation to determine the number of metastatic nodules. The aim of this study was to determine in which patients the CT scan was more effective in detecting all metastases. Methods: We studied all patients who underwent curative thoracotomy for pulmonary metastasis between 1998 and 2012. All cases were reviewed by two expert pulmonary radiologists before surgery. Statistical analyses were performed using Systat version 13. Results: The study included 183 patients (63.6% male) with a mean age of 61.7 years who underwent 217 interventions. The CT scan was correct in 185 cases (85.3%). Discrepancies observed: 26 patients (11.9%) with more metastases resected than observed and 6 cases (2.8%) with fewer metastases. In patients with one or two metastases of colorectal origin or a single metastasis of any other origin, the probability of finding extra nodules was 9.5%. In the remaining patients, the probability was 27.8%, with statistically significant differences (P=0.001). The mean age of the patients in whom no unobserved nodules were detected was 62.9 years compared to 56.5 years on average in patients who were free from any metastases (P=0.001). Conclusions: Patients older than 60 years, with one or two metastases of colorectal origin or a single metastasis from any other origin were considered to be the group with low probability of having more metastases resected than observed (AU)

Determination of a low risk group for having metastatic nodules not detected by computed tomography scan in lung metastases surgery.

INTRODUCTION: In recent years, there has been debate regarding the diagnostic accuracy of computed tomography (CT) in the identification of lung metastases and the need for lung palpation to determine the number of metastatic nodules. The aim of this study was to determine in which patients the CT scan was more effective in detecting all metastases. METHODS: We studied all patients who underwent curative thoracotomy for pulmonary metastasis between 1998 and 2012. All cases were reviewed by two expert pulmonary radiologists before surgery. Statistical analyses were performed using Systat version 13. RESULTS: The study included 183 patients (63.6% male) with a mean age of 61.7 years who underwent 217 interventions. The CT scan was correct in 185 cases (85.3%). Discrepancies observed: 26 patients (11.9%) with more metastases resected than observed and 6 cases (2.8%) with fewer metastases. In patients with one or two metastases of colorectal origin or a single metastasis of any other origin, the probability of finding extra nodules was 9.5%. In the remaining patients, the probability was 27.8%, with statistically significant differences (P=.001). The mean age of the patients in whom no unobserved nodules were detected was 62.9 years compared to 56.5 years on average in patients who were free from any metastases (P=.001). CONCLUSIONS: Patients older than 60 years, with one or two metastases of colorectal origin or a single metastasis from any other origin were considered to be the group with low probability of having more metastases resected than observed.

La influencia del masaje en el aumentode peso en recién nacidos prematuros / The influence of massage on the weight gain of premature newborns

Objetivo: determinar la influencia del masaje en el aumento de peso derecién nacidos prematuros, con la finalidad de incorporarlo a la prácticaclínica si la evidencia científica lo permite.Material y método: estudio de revisión, partiendo de una pregunta estructuradasegún la estrategia PICO. Se llevó a cabo una búsqueda en basesde datos. Pubmed, Cochrane, Cuiden, Cinahl, Lilacs y Tripdatabase.Se identificaron los MeSH pertinentes, se establecieron límites (cinco añosy ensayos clínicos aleatorios). Fueron seleccionados 19 ensayos clínicospara su lectura crítica y valoración mediante la herramienta CASPe.Resultados: la selección definitiva fue de 10 ensayos clínicos aleatorios.En varios estudios el incremento de peso no fue significativo. Lasintervenciones en los estudios revisados fueron: toques terapéuticos, técnicade Schneider, acupuntura y masajes en meridianos, diferentes modalidadesde masaje combinado con estimulación kinestésica y masajesegún el protocolo de Vimala. Los efectos secundarios derivados de laintervención fueron poco importantes. Únicamente en dos estudios laintervención fue realizada por los padres previa formación.Conclusiones: aunque cabe destacar la rectificación en las investigacionesrevisadas de alguno de los sesgos apuntados en una revisión sistemáticaanterior (consideración de la ingesta energética como variable), los estudioscontinúan presentando debilidades metodológicas (muestras pequeñas,falta de cegamiento, etc.), por lo que no es posible establecer si el masajees un factor causal o un factor colaborador en la ganancia ponderal (AU)

Objective: to determine the influence of massage on the weight gain ofpremature newborns, in order to incorporate this influence into clinicalpractice if the scientific evidence supports it.Material and method: a review study, based on a structured questionaccording to the PICO strategy. A search was conducted in the Pubmed,Cochrane, Cuiden, Cinahl, Lilacs and Tripdatabase databases. ReelvantMeSH were identified and limits were established (five years andrandomized clinical trials). 19 clinical trials were selected for criticalreading and assessment by the CASPe tool.Results: the final selection included 10 randomized clinical trials. Inseveral studies, the weight increase was not significant. The interventionsin the studies reviewed were: therapeutic touch, Schneider's technique,acupuncture and meridian massage, different massage modalities combinedwith kinesthetic stimulation, and massage according to Vimalaprotocol. The side effects deribed from the intervention were not of muchimportance. Only in two studies the intervention was carried out by theparents after training.Conclusions: even though of note is the rectification in the review ofthe investigations of some of the biases found in a previous systematicreview (consideration of energy intake as a variable), studies continueto show methodological weaknesses (small samples, lack of blinding,etc.), and therefore it is not possible to establish whether the massage isa causal factor or a contributing factor to the weight gain (AU)

Percutaneous aspiration versus tube drainage for spontaneous pneumothorax: systematic review and meta-analysis.

Spontaneous pneumothorax is an extremely frequent pathology. Despite this, there is still no clear consensus on managing these patients. Therefore, we perform a systematic review and meta-analysis of the effectiveness of percutaneous aspiration compared with tube drainage for treating idiopathic spontaneous pneumothorax. Controlled, randomised clinical trials were selected, in which the effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission. Relevant articles were identified by searching electronic databases (e.g., Medline, EMBASE, CENTRAL, mRCT and Pascal), as well as the references of the papers found in this manner, with a cut-off date of April 2009. Quality was assessed by two independent evaluators, using the CASPe appraisal tool. Effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission.