Tejido hepático ectópico intratorácico / Ectopic Intrathoracic Liver Tissue

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Sección traqueal completa por traumatismo cervical cerrado / Complete tracheal resection in closed cervical spine injury

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Estudio comparativo de supervivencias entre la actual y la antigua clasificación del carcinoma broncogénico / Comparative survival study between the old and new bronchogenic carcinoma classification

La nueva clasificación del carcinoma broncogénico ha sido realizada por la Association for the Study of Lung Cancer (IASLC) y publicada por Frank C. Detterbeck et al en la revista Chest (2009). En el Servicio de Cirugía Torácica del Hospital Universitario de Gerona se ha re-estadificado la serie quirúrgica de pacientes intervenidos de carcinoma broncogénico con intención curativa con el objetivo de comparar la supervivencia (supervivencia por T, supervivencia por M y supervivencia por estadios patológicos) entre la antigua y la actual clasificación y además objetivar si estos cambios de supervivencia son estadísticamente significativos. Otro de los objetivos del trabajo es el de establecer la concordancia entre la supervivencia actual de nuestra serie quirúrgica y la publicada por la IASLC. Pacientes y métodos Se introdujeron en una base de datos 855 pacientes intervenidos con intención curativa de carcinoma broncogénico. Fueron estadificados radiológica, clínica y patológicamente según la antigua y la nueva estadificación. Se calculó la supervivencia según la T, la N, la M y los estadios patológicos. Se realizó un estudio estadístico con el programa SPSS, con el que se analizaron los cambios de supervivencia entre ambas clasificaciones. Resultados Se objetivaron cambios de supervivencia no estadísticamente significativos (p=0,58) con la nueva estadificación en el estadio IIA y cambios de supervivencia estadísticamente significativos (p=0,001) en el estadio IIIB. Discusión El estudio confirma que la actual clasificación TNM es útil ya que muestra cambios de supervivencia en 2 estadios patológicos (uno de ellos estadísticamente significativo). Actualmente, los datos de supervivencia de nuestra serie se adecuan mejor a los que aporta la IASLC(AU)

Introduction: A new classification of bronchogenic carcinoma has been made by the International Association for the Study of Lung Cancer (IASLC) and published by Frank C.Detterbeck et al in the journal Chest (2009). The Thoracic Surgery Department of the Gerona(Spain) University Hospital has re-staged a series of patients with bronchogenic carcinoma who had attempted curative surgery, with the aim of comparing the survival (survival for T, survival for M, and survival by disease staging) between the old and new classification, and also to determine whether these changes in survival are statistically significant. Anotherone of the objectives of the study is to see whether there is agreement between the currentsurvival of our surgical series and that published by the IASLC. Patients and methods: Data on 855 patients who had attempted bronchogenic carcinomacurative surgery were entered into a data base. They were radiologically, clinically and histologically staged according to the new and old staging. Survival was calculated according to the T, M, N, and histology stages. A statistical analysis was performed using the SPSS program and the changes in survival between both classifications were analysed. Results: No statistically significant changes were observed in survival (P = .58) with the new classification in stage IIA, but there were statistically significant changes in survival(P = .0001) in stage IIIB. Discussion: The study confirms that the current TNM classification is useful, since it shows changes in survival in 2 histological stages (one of them statistically significant). The survival data of our series now fits better with those provided by the IASLC (AU)

Eficacia y morbimortalidad del tratamiento quirúrgico mediante videotoracoscopia y pleurodesis con talco del neumotórax espontáneo primario / Efficacy, morbidity and morbidity of surgical treatment of a primary spontaneous pneumothorax by videothorascopic talc pleurodesis

Introducción y objetivo Llamamos neumotórax espontáneo primario (NEP) a la presencia de aire en el espacio pleural sin causa o etiología conocida. La característica principal de esta enfermedad es su alta tendencia a la recidiva. Nuestro estudio tiene como objetivos: 1) conocer la eficacia del tratamiento quirúrgico mediante resección pulmonar por videotoracoscopia y pleurodesis con talco, 2) analizar las complicaciones derivadas del uso del talco. Material y métodos Se revisa una serie de 130 casos de NEP tratados mediante videotoracoscopia con o sin resección parenquimatosa y pleurodesis con 3g de talco libre de asbesto (STERITAL®). Hemos recogido datos epidemiológicos, el método diagnóstico, la indicación quirúrgica, la mortalidad, la morbilidad general y la específica de la pleurodesis con talco, el número de recidivas y su tratamiento. Resultados Nuestros pacientes tienen una edad media de 26,4 años, 84,3% son hombres y el 69% tiene hábito tabáquico. La indicación quirúrgica del NEP fue en el 74,4% por recidiva. Registramos una morbilidad del 7% que representan 9 casos, siendo la complicación más frecuente la fuga aérea. No registramos ninguna complicación específica por el uso del talco, tales como empiema, paquipleuritis o síndrome del distrés respiratorio del adulto (SDRA). Se realiza un seguimiento de 10,1 meses de media, constatándose 4 casos de recidiva que representan el 3%.ConclusionesEl tratamiento del NEP mediante videotoracoscopia y pleurodesis con talco tiene una alta eficacia, superior a otras técnicas empleadas para producir pleurodesis, una baja morbilidad general, mortalidad nula, y no registramos ninguna complicación específica debida al talco (AU)

Introduction: A primary spontaneous pneumothorax (PSP) is due to the presence of air in the pleural space and is of unknown cause or a etiology. The main characteristic of this condition is its high tendency to re-occur. This study has two objectives: 1) to determine the efficacy of lung resection surgery using a videothorascope and talc pleurodesis, 2) to analyse the complications originating from the use of talc. Material and methods: A review was carried out on a series of 130 PSP cases treated using videothorascopy, with or without parenchymal resection, and pleurodesis with 3 g of asbestos-free talc (STERITAL1). Epidemiological data were collected, including the diagnostic method, surgical indication, mortality, general morbidity, and the specific morbidity dueto talc pleurodesis, the number of recurrences, and their treatment. Results: The patients had a mean age of 26.4 years, 84.3% were male, and 69% smoked. The surgical indication of the PSP was recurrence in 74.4% of cases. There was morbidity in 7% (9) cases, with the most frequent complication being an air leak. No specific complication, such as empyema, pachypleuritis or adult respiratory distress syndrome (ARDS, on the use of talc was recorded. The mean follow-up was 10.1 months, during which there was recurrence in 4(3%) cases. Conclusions: PSP treatment by videothorascopic talc pleurodesis is highly effective, superior to other techniques use to produce pleurodesis, has a low general morbidity, no mortality, and no specific complications due to the talc (AU)

[Efficacy, morbidity and mortality of surgical treatment of a primary spontaneous pneumothorax by videothorascopic talc pleurodesis]. / Eficacia y morbimortalidad del tratamiento quirúrgico mediante videotoracoscopia y pleurodesis con talco del neumotórax espontáneo primario.

INTRODUCTION: A primary spontaneous pneumothorax (PSP) is due to the presence of air in the pleural space and is of unknown cause or aetiology. The main characteristic of this condition is its high tendency to re-occur. This study has two objectives: 1) to determine the efficacy of lung resection surgery using a videothorascope and talc pleurodesis, 2) to analyse the complications originating from the use of talc. MATERIAL AND METHODS: A review was carried out on a series of 130 PSP cases treated using videothorascopy, with or without parenchymal resection, and pleurodesis with 3g of asbestos-free talc (STERITAL®). Epidemiological data were collected, including the diagnostic method, surgical indication, mortality, general morbidity, and the specific morbidity due to talc pleurodesis, the number of recurrences, and their treatment. RESULTS: The patients had a mean age of 26.4 years, 84.3% were male, and 69% smoked. The surgical indication of the PSP was recurrence in 74.4% of cases. There was morbidity in 7% (9) cases, with the most frequent complication being an air leak. No specific complication, such as empyema, pachypleuritis or adult respiratory distress syndrome (ARDS, on the use of talc was recorded. The mean follow-up was 10.1 months, during which there was recurrence in 4 (3%) cases. CONCLUSIONS: PSP treatment by videothorascopic talc pleurodesis is highly effective, superior to other techniques use to produce pleurodesis, has a low general morbidity, no mortality, and no specific complications due to the talc.

[Comparative survival study between the old and new bronchogenic carcinoma classification]. / Estudio comparativo de supervivencias entre la actual y la antigua clasificación del carcinoma broncogénico.

INTRODUCTION: A new classification of bronchogenic carcinoma has been made by the International Association for the Study of Lung Cancer (IASLC) and published by Frank C. Detterbeck et al in the journal Chest (2009). The Thoracic Surgery Department of the Gerona (Spain) University Hospital has re-staged a series of patients with bronchogenic carcinoma who had attempted curative surgery, with the aim of comparing the survival (survival for T, survival for M, and survival by disease staging) between the old and new classification, and also to determine whether these changes in survival are statistically significant. Another one of the objectives of the study is to see whether there is agreement between the current survival of our surgical series and that published by the IASLC. PATIENTS AND METHODS: Data on 855 patients who had attempted bronchogenic carcinoma curative surgery were entered into a data base. They were radiologically, clinically and histologically staged according to the new and old staging. Survival was calculated according to the T, M, N, and histology stages. A statistical analysis was performed using the SPSS program and the changes in survival between both classifications were analysed. RESULTS: No statistically significant changes were observed in survival (P=.58) with the new classification in stage IIA, but there were statistically significant changes in survival (P=.0001) in stage IIIB. DISCUSSION: The study confirms that the current TNM classification is useful, since it shows changes in survival in 2 histological stages (one of them statistically significant). The survival data of our series now fits better with those provided by the IASLC.

Tratamiento ambulatorio de las fugas aéreas persistentes mediante un sistema de drenaje torácico autónomo (SDTA): resultados preliminares / Ambulatory treatment of persistent air leaks using a portable chest drainage system: Preliminary results

Introducción: La fuga aérea persistente (FAP) es la complicación más frecuente en el postoperatorio de Cirugía Torácica, conllevando un aumento de la estancia hospitalaria y de la morbilidad del paciente. Presentamos un estudio prospectivo realizado en el Hospital Universitario Dr. Josep Trueta de Girona centrado en un sistema de drenaje torácico autónomo (SDTA) conectado a un drenaje pleural que permite tratar ambulatoriamente la fuga aérea. Nuestro objetivo es demostrar que mediante este sistema se permite reducir la estancia hospitalaria sin aumentar la morbilidad postoperatoria, mejorando la calidad de vida del paciente. Material y métodos: En el Servicio de Cirugía Torácica del Hospital de Girona se recogieron 33 pacientes con FAP en el postoperatorio y fueron tratados ambulatoriamente con un SDTA. Se recogieron las complicaciones postoperatorias, la media de días del tratamiento ambulatorio con el SDTA y las estancias hospitalarias ahorradas. Resultados: La estancia media hospitalaria de los 33 pacientes fue de 7,03 días. La media de días que los 33 pacientes fueron tratados ambulatoriamente con el SDTA fue de 9,33 días. Se calculó un ahorro de 308 estancias hospitalarias. El tratamiento ambulatorio de la FAP no aumentó la morbilidad postoperatoria. Conclusiones: Los resultados clínicos y de gestión del SDTA avalan el tratamiento ambulatorio de este problema en pacientes que no tengan otras causas de ingreso hospitalario. El estudio demostró ahorrar un número considerable de estancias hospitalarias, sin aumentar la morbilidad de los pacientes. Todos ellos prefirieron este sistema versus el ingreso hospitalario (AU)

Introduction: Persistent air leaks (PAL) is the most frequent post-operative complication in Thoracic Surgery, leading to a longer hospital stay and an increase in patient morbidity. We present a prospective study conducted in the Dr. Josep Trueta University Hospital in Gerona, involving a portable chest drainage system (PCDS) connected to a pleural drainage which allowed air leaks to be treated ambulatorily. Our aim is to demonstrate that by using this system hospital stay is reduced without increasing post-operative morbidity, and improves the quality of life of the patient. Material and methods: The Thoracic Surgery Department of Gerona Hospital collected the data on 33 patients with PAL in the post-surgical period and who were treated ambulatorily with a PCDS. Post-operative complications were recorded, along with the mean days of ambulatory treatment with the PCDS and the hospital days saved. Results: The mean hospital stay of the 33 patients was 7.03 days. The mean number of days that the 33 patients were treated ambulatorily with the PCDS was 9.33 days. It was calculated that there was a saving of 308 hospital days. The ambulatory treatment of PAL did not increase post-operative morbidity. Conclusions: The clinical results and the management of the PCDS support the treatment of this problem in patients who do not have any other causes to remain in hospital. The study shows a saving in a considerable number of hospital days stay, with no increase in patient morbidity. All the patients preferred this system to hospital admission (AU)

Neumohemotórax catamenial: 189 aportaciones al diagnóstico y tratamiento quirúrgico / Catamenial pneumohemothorax: contributions to diagnosis and surgical treatment

La endometriosis es una entidad infrecuente definida por la presencia de un foco de tejido endometrial fuera de cavidad uterina. El diagnóstico de certeza de la endometriosis torácica se obtiene demostrando histológicamente la presencia de tejido endometrial en la cavidad pleural. La videotoracoscopia es el mejor método diagnóstico y terapéutico, ya que facilita la toma de muestras para obtener la confirmación histológica y permite establecer un procedimiento terapéutico, tratando los focos de tejido endometrial ectópicos. Presentamos 2 casos clínicos de hemo/neumotórax catamenial donde se utilizó la videotoracoscopia para identificar, biopsiar y electrocoagular los focos de tejido endometrial ectópico (AU)

Endometriosis is an infrequent entity defined by the presence of an area of endometrial tissue outside the uterine cavity. Definitive diagnosis of thoracic endometriosis is obtained by histological confirmation of endometrial tissue in the pleural cavity. Videothoracoscopy is the most effective diagnostic and therapeutic procedure as it facilitates sample-taking for histological confirmation and allows a therapeutic procedure to be established, treating the areas of ectopic endometrial tissue. We present two cases of catamenial hemo/ pneumothorax in which videothoracoscopy was used to identify, sample, and electrocauterize ectopic endometrial tissue (AU)

[Influence of thoracentesis and pleural biopsy on biochemical parameters and cytology of pleural fluid]. / Influencia de la toracocentesis y la biopsia pleural en la bioquímica y la citología del líquido pleural.

OBJECTIVE: To assess the influence of thoracentesis and pleural biopsy on biochemical parameters and cytology of pleural fluid from patients with lymphocytic exudate. PATIENTS AND METHODS: A prospective, descriptive study was performed in 72 patients with pleural effusion who had lymphocytic exudate and in whom biopsy was indicated. Biochemical variables and cytology of pleural fluid were analyzed at baseline, 48 hours later (immediately prior to biopsy), and 48 hours after biopsy. RESULTS: The patients had a mean (SD) age of 63 (17) years, 57% were smokers, and 61% were men. Effusion was right-sided in 36% of patients, unilateral in 80%, and massive in 21%. The etiology was benign in 43 cases and neoplastic in 29 (40%). Pleural lactate dehydrogenase (LDH) was found to be increased following biopsy. This effect was significant in the overall population of 72 patients (649 [481] U/L just prior to biopsy and 736 [536] U/L 48 hours after biopsy; mean increase, 86 U/L; 95% confidence interval, 45-128 U/L; P< .001), in patients with pleural tumors (799 [529] U/L prior to biopsy and 957 [571] U/L 48 hours later, P< .001), and in those with LDH concentration greater than 266 U/L. CONCLUSIONS: The results of our study show that a single thoracentesis procedure does not alter biochemical parameters or pleural cytology after 48 hours in lymphocytic exudates. Pleural needle biopsy leads to a significant increase in the concentration of LDH in patients with pleural tumors or higher baseline concentrations of LDH. Thoracentesis, pleural biopsy, or a combination of the two do not lead to significant changes in the number of eosinophils in pleural fluid.

Influencia de la toracocentesis y la biopsia pleural en la bioquímica y la citología del líquido pleural / Influence of thoracentesis and pleural biopsy on biochemical parameters and cytology of pleural fluid

Objetivo: Valorar la influencia de la toracocentesis y la biopsia pleural en la bioquímica y la citología del líquido en los pacientes con un exudado linfocitario. Pacientes y métodos: Se ha realizado un estudio prospectivo y descriptivo de 72 pacientes con derrame pleural que tenían un exudado linfocitario e indicación de biopsia. Se analizaron y compararon la bioquímica y citología del líquido pleural al inicio, a las 48 h de la punción (antes de la biopsia) y a las 48 h de la biopsia pleural. Resultados: Los pacientes tenían una edad media ± desviación estándar de 63 ± 17 años, el 57% eran fumadores y el 61%, varones. El derrame era derecho en un 36%, unilateral en un 80% y masivo en el 21%. La etiología era benigna en 43 casos y neoplásica en 29 (40%). La lactatodeshidrogenasa (LDH) pleural aumentó después de la biopsia en el análisis de todos los pacientes (649 ± 481 U/l antes de ésta y 736 ± 536 U/l a las 48 h; aumentó en promedio 86 U/l; intervalo de confianza del 95%, 45-128 U/l; p < 0,001), en los pacientes con neoplasia pleural (799 ± 529 U/l de LDH antes de la biopsia y 957 ± 571 U/l a las 48 h; p < 0,001) o valores de LDH superiores a 266 U/l. Conclusiones: Nuestro estudio demuestra que una única toracocentesis no modifica los valores de la bioquímica o la citología pleural a las 48 h en los exudados linfocitarios. La biopsia pleural transparietal aumenta de forma significativa los valores de la LDH en los pacientes con neoplasia pleural o valores iniciales de LDH más elevados. La realización de la toracocentesis, la biopsia pleural o ambas técnicas no modifica de forma significativa el número de eosinófilos del líquido pleural

Objective: To assess the influence of thoracentesis and pleural biopsy on biochemical parameters and cytology of pleural fluid from patients with lymphocytic exudate. Patients and methods: A prospective, descriptive study was performed in 72 patients with pleural effusion who had lymphocytic exudate and in whom biopsy was indicated. Biochemical variables and cytology of pleural fluid were analyzed at baseline, 48 hours later (immediately prior to biopsy), and 48 hours after biopsy. Results: The patients had a mean (SD) age of 63 (17) years, 57% were smokers, and 61% were men. Effusion was right-sided in 36% of patients, unilateral in 80%, and massive in 21%. The etiology was benign in 43 cases and neoplastic in 29 (40%). Pleural lactate dehydrogenase (LDH) was found to be increased following biopsy. This effect was significant in the overall population of 72 patients (649 [481] U/L just prior to biopsy and 736 [536] U/L 48 hours after biopsy; mean increase, 86 U/L; 95% confidence interval, 45-128 U/L; P<.001), in patients with pleural tumors (799 [529] U/L prior to biopsy and 957 [571] U/L 48 hours later, P<.001), and in those with LDH concentration greater than 266 U/L. Conclusions: The results of our study show that a single thoracentesis procedure does not alter biochemical parameters or pleural cytology after 48 hours in lymphocytic exudates. Pleural needle biopsy leads to a significant increase in the concentration of LDH in patients with pleural tumors or higher baseline concentrations of LDH. Thoracentesis, pleural biopsy, or a combination of the two do not lead to significant changes in the number of eosinophils in pleural fluid

[Bilateral hemothorax secondary to combined antiplatelet therapy with clopidogrel and acetylsalicylic acid]. / Hemotórax bilateral secundario al tratamiento antiagregante con clopidogrel y ácido acetilsalicílico.

Clopidogrel is a platelet aggregation inhibitor that increases the risk of bleeding complications when combined with acetylsalicylic acid. We report a rare case of a 79-year-old male treated with clopidogrel and acetylsalicylic acid after coronary angioplasty and stenting to treat unstable angina. Two months after initiation of therapy, the patient presented with symptomatic bilateral pleural effusion. Examination of both effusions confirmed the diagnosis of spontaneous bilateral hemothorax due to combined anti-platelet therapy. Serious functional sequelae were still present 18 months after diagnosis despite bilateral pleural drainage and respiratory physiotherapy.

Hemotórax bilateral secundario al tratamiento antiagregante con clopidogrel y ácido acetilsalicílico / Bilateral hemothorax secondary to combined antiplatelet therapy with clopidogrel and acetylsalicylic acid

El clopidogrel es un inhibidor de la agregación plaquetaria que aumenta el riesgo de complicaciones hemorrágicas cuando se combina con el ácido acetilsalicílico. Presentamos un caso excepcional en un varón de 79 años tratado con clopidogrel y ácido acetilsalicílico después de una angioplastia coronaria y la colocación de un stent por una angina inestable. A los 2 meses de tratamiento presentó un derrame pleural bilateral sintomático. El estudio de ambos derrames confirmó el diagnóstico de un hemotórax espontáneo bilateral atribuido a los antiagregantes. El drenaje pleural bilateral y la fisioterapia respiratoria no impidieron la persistencia de importantes secuelas funcionales a los 18 meses del diagnóstico

Clopidogrel is a platelet aggregation inhibitor that increases the risk of bleeding complications when combined with acetylsalicylic acid. We report a rare case of a 79-year-old male treated with clopidogrel and acetylsalicylic acid after coronary angioplasty and stenting to treat unstable angina. Two months after initiation of therapy, the patient presented with symptomatic bilateral pleural effusion. Examination of both effusions confirmed the diagnosis of spontaneous bilateral hemothorax due to combined anti-platelet therapy. Serious functional sequelae were still present 18 months after diagnosis despite bilateral pleural drainage and respiratory physiotherapy