ABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Hemangioendothelioma/diagnosis , Hemangioendothelioma/surgery , Mediastinal Neoplasms/diagnosis , Mediastinal Neoplasms/surgeryABSTRACT
No disponible
Subject(s)
Male , Aged , Humans , Thymoma/diagnosis , Thymus Neoplasms/diagnosis , Chest Pain/etiology , Tomography, X-Ray Computed , Mediastinal Neoplasms/diagnosisABSTRACT
No disponible
Subject(s)
Humans , Thoracic Surgical Procedures/adverse effects , Postoperative Complications/epidemiology , Risk AssessmentABSTRACT
OBJECTIVES: To incorporate a new fast, safe, and reversible anesthetic procedure into the experimental model of lung transplantation (LT) using a cuff technique originally described by Mizuta. MATERIAL AND METHOD: Eighty-eight Sprague-Dawley rats were used in the experimental model. Thirty left LTs were performed, using 60 rats. The donor heart-lung block was excised by median sternotomy with dissection of the left lung and cuffs (intravenous catheters cut into 3-mm sections) were put in place. The left lung was implanted in the recipient by lateral thoracotomy using the cuffs for anastomoses. The duration of surgery and postoperative complications were recorded. Also noted were signs of ischemia-reperfusion injury, and acute rejection of the transplanted lung. RESULTS: We discarded lungs excised from 8 animals when developing the experimental model. Transplants could not be completed in 10 rats due to technical problems, despite satisfactory excision. Of the rats who received a transplant, 4 died in the first 24 hours and 26 survived to 48 hours. They were then killed and examined. The state of the anastomoses was good and signs of ischemia-reperfusion injury, as well as acute rejection were observed in the parenchyma of the transplanted lung. CONCLUSIONS: LT with cuffs in rats is a valid, reliable, reproducible, and cheap model for studying ischemia-reperfusion injury and rejection in LT. The surgical technique is complex, requiring experienced surgeons and a long learning process. Modification of the technique to more closely resemble the surgical procedure in humans is possible, thus facilitating interpretation and allowing more reliable extrapolation to humans.
Subject(s)
Lung Transplantation/methods , Animal Experimentation , Animals , Male , Models, Animal , Rats , Rats, Sprague-DawleyABSTRACT
OBJETIVOS: Desarrollar el modelo experimental de trasplante pulmonar (TP) con cuffs (técnica de manguito), inicialmente descrito por Mizuta, como medio de estudio del TP en nuestro medio incorporando un nuevo protocolo anestésico rápido, seguro y reversible. MATERIAL Y MÉTODO: Se han utilizado ratas Sprague-Dawley (n = 88) para el desarrollo del modelo experimental y se han logrado realizar 30 TP izquierdos (n = 60). En el animal donante se han efectuado una esternotomía media y extracción del bloque cardiopulmonar con disección del pulmón izquierdo y colocación de los cuffs (catéteres de venopunción cortados en cilindros de 3 mm). En el receptor, a través de una toracotomía lateral, se ha llevado a cabo el implante del pulmón izquierdo mediante las anastomosis con cuffs. Se han valorado el tiempo quirúrgico y las complicaciones postoperatorias, así como la presencia de signos de lesión de isquemia-reperfusión y rechazo agudo en el pulmón trasplantado. RESULTADOS: Durante el desarrollo del modelo experimental rechazamos a 8 animales en la extracción. Tras completarla satisfactoriamente, no se pudo realizar el implante en 10 ratas por problemas técnicos. De los animales trasplantados, 4 fallecieron en las primeras 24 h y 26 ratas sobrevivieron hasta las 48 h, momento en que fueron sacrificadas. Hallamos un buen estado de las anastomosis y signos de lesión de isquemia-reperfusión y rechazo agudo en el parénquima pulmonar del pulmón trasplantado. CONCLUSIONES: El TP con cuffs en ratas es un modelo válido, fiable, reproducible y económico para el estudio del TP y de los fenómenos de isquemia-reperfusión y rechazo. La técnica quirúrgica es compleja, tiene una larga curva de aprendizaje y requiere personal con experiencia quirúrgica. Además, es subsidiaria de modificaciones que hagan que se asemeje más a la técnica quirúrgica utilizada en clínica humana para interpretar mejor y poder extrapolar los resultados al humano con más fiabilidad (AU)
Subject(s)
Rats , Animals , Male , Rats, Sprague-Dawley , Models, Animal , Lung Transplantation , Animal ExperimentationABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Bronchial Arteries , Aneurysm, Ruptured , Hemoptysis , HemothoraxABSTRACT
BACKGROUND: This paper reports the findings of a prospective multicenter study whose main objective was to determine the indications for video-assisted thoracoscopic surgery (VATS), as well as the techniques used, results and complications. METHODS: Seventeen chest surgery units provided data on 1,573 procedures performed over a period of two years (July 1996 to July 1998). RESULTS: Spontaneous pneumothorax (45.4%), lung biopsy (18.4%), pulmonary nodes (13.3%) and thoracic sympathectomy (5.3%) accounted for over 80% of the indications for VATS. An assistive mini-thoracotomy was required in 5.6%. A change to standard thoracotomy was needed in 167 cases (10.6%). Complications were observed in 10.8%, persistent air leakage being the most important. Spontaneous pneumo-thorax recurred in 17 cases (2.4%). Ten patients (0.6%) died. CONCLUSIONS: Technological developments have led to new applications for VATS as well as improved outcome for the most common, well established indications. It is advisable to continue to perform prospective, randomized, controlled trials to validate techniques for which little experience has accumulated.
Subject(s)
Thoracic Surgery, Video-Assisted , Adult , Aged , Biopsy , Humans , Lung/pathology , Middle Aged , Pneumothorax/surgery , Postoperative Complications , Prospective Studies , Solitary Pulmonary Nodule/surgery , Spain , Sympathectomy , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/methodsSubject(s)
Carcinoma, Bronchogenic , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Pneumothorax/complications , Adult , Carcinoma, Bronchogenic/complications , Carcinoma, Bronchogenic/diagnosis , Carcinoma, Bronchogenic/surgery , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/surgery , Humans , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Lung Neoplasms/surgery , Lymph Node Excision , Pneumonectomy , Smoking/adverse effectsABSTRACT
INTRODUCCIÓN: Se presenta un estudio prospectivo multicéntrico cuyo principal objetivo es conocer los datos sobre indicaciones, técnicas, resultados y complicaciones de pacientes sometidos a cirugía videotoracoscópica (CTV).MÉTODOS: Han participado en el estudio 17 servicios de cirugía torácica, que en un período de 2 años (julio de 1996 a julio de 1998) han recogido 1.573 procedimientos. RESULTADOS: Más del 80 por ciento de las indicaciones estuvieron constituidas por neumotórax espontáneo (45,4 por ciento), biopsia pulmonar (18,4 por ciento), nódulos pulmonares (13,3 por ciento) y simpatectomía torácica (5,3 por ciento). En el 5,6 por ciento de los casos se requirió una minitoracotomía de asistencia. En 167 casos (10,6 por ciento) fue precisa la conversión a toracotomía estándar. Hubo algún tipo de complicación en el 10,8 por ciento destacando las fugas aéreas persistentes. Hubo recidiva de los neumotórax espontáneos en 17 casos (2,4 por ciento). Fallecieron 10 pacientes (0,6 por ciento).CONCLUSIONES: La evolución tecnológica ha hecho aparecer nuevas indicaciones de la CTV y ha mejorado los resultados de las indicaciones más corrientes y bien establecidas. Es aconsejable seguir realizando trabajos controlados, prospectivos y aleatorizados para validar las técnicas en las que dispone de una menor experiencia. (AU)
Subject(s)
Middle Aged , Adult , Aged , Humans , Thoracic Surgery, Video-Assisted , Spain , Sympathectomy , Postoperative Complications , Pneumothorax , Prospective Studies , Biopsy , Solitary Pulmonary Nodule , LungABSTRACT
BACKGROUND: Extended cervical mediastinoscopy (ECM) is a technique in the staging of bronchogenic carcinoma described first by Ginsberg in 1984. To update our experience we have prospectively evaluated our results on 106 patients who underwent the technique from 1985 to 1998. METHODS: The ECM technique is performed once the operability of the patient has been evaluated, according to the computed tomography findings. The intervention is carried out at the same time as a standard cervical mediastinoscopy through the same incision following the same technique as previously published. The ECM is considered positive when metastatic nodes or tumor involvement directly in the paraaortic or subaortic regions is detected and confirmed histologically. Negative cases of ECM and positive cases of standard cervical mediastinoscopy are excluded from this study. A false-negative ECM is defined as the presence of infiltrated adenopathies at the paraortic level detected on postoperative histologic study. RESULTS: We had performed ECM in 106 patients, and a total of 13 were subsequently excluded for the reasons stated above. Of the remaining cases, 26 were positive, 61 negative and 6 had false-negative results with no false-positive results. Sensitivity was 81.2%, specificity 100%, accuracy 93.3%, positive predictive value 100%, and negative predictive value 91%. There were no complications with the technique. CONCLUSIONS: We conclude that ECM is a useful technique for staging bronchogenic carcinoma that allows samples to be taken from paraortic and subaortic regions with minimally invasive techniques.
Subject(s)
Carcinoma, Bronchogenic/pathology , Lung Neoplasms/pathology , Mediastinoscopy/methods , Neoplasm Staging/methods , Adenocarcinoma/pathology , Adult , Aged , Carcinoma, Large Cell/pathology , Carcinoma, Small Cell/pathology , Carcinoma, Squamous Cell/pathology , False Negative Reactions , False Positive Reactions , Humans , Middle Aged , Prospective Studies , Sensitivity and SpecificityABSTRACT
No disponible
Subject(s)
Middle Aged , Adult , Male , Female , Humans , Wounds, Penetrating , Breast Implants , Laryngectomy , Empyema, Pleural , Pneumonia, Bacterial , Gram-Positive Bacterial Infections , BreastSubject(s)
Myasthenia Gravis/etiology , Thymoma/complications , Thymus Neoplasms/complications , Adult , Humans , MaleABSTRACT
No disponible
Subject(s)
Adult , Male , Humans , Thymoma , Myasthenia Gravis , Thymus NeoplasmsABSTRACT
Seven cases of solitary fibrous tumours of the pleura are here reported, formerly named benign fibrous mesotheliomas. Histologically, these tumours are formed by fusiform cells with a minimal cellular pleomorphism and absence of mitosis. These tumours cause scarce symptoms which are usually diagnosed as a casual finding when a chest X-ray is performed on account of other cause. Treatment should be surgical, with removal of all tumoral mass, thus avoiding its growth and the possibility of the reported degeneration towards malignancy.
