Rib myelolipoma: a case report.

BACKGROUND: Myelolipoma is an uncommon benign tumor composed of mature adipose tissue and hematopoietic elements. These tumors generally affect the adrenal glands, with anomalous presentations being rare and with few cases described in the literature. Most myelolipomas are asymptomatic and discovered incidentally, either through imaging tests or at autopsies. However, depending on the location and size of the lesion, myelolipomas can cause symptoms of mass effect. This article aims to report a very rare presentation of a symptomatic primary myelolipoma affecting the ribs. CASE PRESENTATION: A 21-year-old white female patient presented with a complaint of burning chest pain over 3 months, with gradual worsening in intensity, accompanied by a progressively growing bulge in the right thoracic wall. The patient underwent thoracotomy of the fifth and sixth ribs with complete excision of the lesion with a safety margin. Thoracic wall reconstruction was performed using a polypropylene mesh. The patient had a good postoperative course and was discharged on postoperative day 3. Histopathological examination revealed a histological image consistent with myelolipoma. CONCLUSIONS: This report underscores the importance of considering a myelolipoma diagnosis for tumor masses in the ribs.

Early Outcomes of Minimally Invasive Right Anterior Thoracotomy vs. Median Full Sternotomy in Isolated Aortic Valve Replacement: A Propensity Score Analysis.

INTRODUCTION: This study aimed to compare the early postoperative outcomes of right anterior thoracotomy minimally invasive aortic valve replacement (RAT-MIAVR) surgery with those of median full sternotomy aortic valve replacement (MFS-AVR) approach with the goal of identifying potential benefits or drawbacks of each technique. METHODS: This retrospective, observational, cohort study included 476 patients who underwent RAT-MIAVR or MFS-AVR in our hospital from January 2015 to January 2023. Of these, 107 patients (22.5%) underwent RAT-MIAVR, and 369 patients (77.5%) underwent MFS-AVR. Propensity score matching was used to minimize selection bias, resulting in 95 patients per group for analysis. RESULTS: After propensity matching, two groups were comparable in preoperative characteristics. RAT-MIAVR group showed longer cardiopulmonary bypass time (130.24 ± 31.15 vs. 117.75 ± 36.29 minutes, P=0.012), aortic cross-clamping time (76.44 ± 18.00 vs. 68.49 ± 19.64 minutes, P=0.004), and longer operative time than MFS-AVR group (358.47 ± 67.11 minutes vs. 322.42 ± 63.84 minutes, P=0.000). RAT-MIAVR was associated with decreased hospitalization time after surgery, lower postoperative blood loss and drainage fluid, a reduced incidence of mediastinitis, increased left ventricular ejection fraction, and lower pacemaker use compared to MFS-AVR. However, there was no significant difference in the incidence of major complications and in-hospital mortality between the two groups. CONCLUSION: RAT-MIAVR is a feasible and safe alternative procedure to MFS-AVR, with comparable in-hospital mortality and early follow-up. This minimally invasive approach may be a suitable option for patients requiring isolated aortic valve replacement.

Early Outcomes of Minimally Invasive Right Anterior Thoracotomy vs. Median Full Sternotomy in Isolated Aortic Valve Replacement: A Propensity Score Analysis

ABSTRACT Introduction: This study aimed to compare the early postoperative outcomes of right anterior thoracotomy minimally invasive aortic valve replacement (RAT-MIAVR) surgery with those of median full sternotomy aortic valve replacement (MFS-AVR) approach with the goal of identifying potential benefits or drawbacks of each technique. Methods: This retrospective, observational, cohort study included 476 patients who underwent RAT-MIAVR or MFS-AVR in our hospital from January 2015 to January 2023. Of these, 107 patients (22.5%) underwent RAT-MIAVR, and 369 patients (77.5%) underwent MFS-AVR. Propensity score matching was used to minimize selection bias, resulting in 95 patients per group for analysis. Results: After propensity matching, two groups were comparable in preoperative characteristics. RAT-MIAVR group showed longer cardiopulmonary bypass time (130.24 ± 31.15 vs. 117.75 ± 36.29 minutes, P=0.012), aortic cross-clamping time (76.44 ± 18.00 vs. 68.49 ± 19.64 minutes, P=0.004), and longer operative time than MFS-AVR group (358.47 ± 67.11 minutes vs. 322.42 ± 63.84 minutes, P=0.000). RAT-MIAVR was associated with decreased hospitalization time after surgery, lower postoperative blood loss and drainage fluid, a reduced incidence of mediastinitis, increased left ventricular ejection fraction, and lower pacemaker use compared to MFS-AVR. However, there was no significant difference in the incidence of major complications and in-hospital mortality between the two groups. Conclusion: RAT-MIAVR is a feasible and safe alternative procedure to MFS-AVR, with comparable in-hospital mortality and early follow-up. This minimally invasive approach may be a suitable option for patients requiring isolated aortic valve replacement.

Persistent right aortic arch and aberrant left subclavian artery in a dog / Persistência de arco aórtico direito e artéria subclávia esquerda aberrante em um cão

A 1.5-year-old male German Shepherd dog was referred to a Teaching Veterinary Hospital with a chronic history of regurgitation and a previous presumptive diagnosis of megaesophagus. An esophagogram showed partial esophageal dilation, suggesting one vascular ring anomaly. Computed tomography identified a persistent right aortic arch (PRAA) and an aberrant left subclavian artery (ALSA). The patient underwent thoracotomy, ligamentum arteriosum ligation, and debridement of the periesophageal region. The ligation of the ALSA was not carried out because the esophagus was observed to be released entirely during the surgical intervention. Therefore, intervention on the subclavian artery was not necessary. Clinical follow-up occurred on seven, 14, and 30 postoperative days. The dog improved, showing only sporadic regurgitations. Clinical history and complementary exams were essential to establish a diagnosis. The liberation of the esophageal transit during surgery contributed to the decision not to perform the ALSA ligation.(AU)

Um cão pastor alemão, macho, de 1,5 anos de idade, foi atendido em um Hospital Veterinário Universitário com história crônica de regurgitação e diagnóstico presuntivo prévio de megaesôfago. Um esofagograma mostrou dilatação parcial do esôfago sugerindo uma anomalia de anel vascular. A tomografia computadorizada identificou persistência do arco aórtico direito (PAAD) e artéria subclávia esquerda aberrante (ALSA). O paciente foi submetido à toracotomia, ligadura do ligamento arterioso e desbridamento da região periesofágica. A ligadura da ALSA não foi realizada, pois, durante a intervenção cirúrgica, observou-se que o esôfago estava completamente liberado, não sendo necessária intervenção na artéria subclávia. O acompanhamento clínico ocorreu aos sete, 14 e 30 dias de pós-operatório. O cão evidenciou boa recuperação, apresentando apenas regurgitações esporádicas. A história clínica associada aos exames complementares foi essencial para o diagnóstico. A liberação do trânsito esofágico durante a cirurgia contribuiu para a decisão de não realizar a ligadura da ALSA.(AU)

Comparison between Injury Severity Score (ISS) and New Injury Severity Score (NISS) in predicting mortality of thoracic trauma in a tertiary hospital / Comparação entre o Injury Severity Score (ISS) e o New Injury Severity Score (NISS) na predição da mortalidade de traumas torácicos atendidos em um hospital terciário

ABSTRACT Introduction: measuring the severity of traumatic injuries is crucial for predicting clinical outcomes. Whereas the Injury Severity Score (ISS) has limitations in assigning scores to injuries at the same site, the New Injury Severity Score (NISS) corrects for this problem by taking into account the three most severe injuries regardless of the region of the body. This study seeks to comprehend the clinical and epidemiological profile of trauma patients while comparing the effectiveness of scales for predicting mortality. Methods: a descriptive, observational and retrospective study using records of patients who underwent thoracotomy at the Hospital das Clínicas of the Federal University of Triângulo Mineiro between 2000 and 2019. Demographic data, mechanisms of injury, affected organs, length of stay and mortality were analyzed. Injury severity was assessed using the ISS and NISS, and statistical analyses were conducted using MedCalc and SigmaPlot. Results: 101 patients were assessed, on average 29.6 years old, 86.13% of whom were men. The average duration of hospitalization was 10.9 days and the mortality rate was 28.7%. The ROC curve analysis revealed a sensitivity of 68.97%, specificity of 80.56% and area under the curve of 0.837 for the ISS, and 58.62%, 94.44% and 0.855 for the NISS, respectively. The Youden index was 0.49 for the ISS and 0.53 for the NISS. Conclusion: the study demonstrated comparable efficacy of NISS and ISS in predicting mortality. These findings hold significance in the hospital setting. Professionals must be familiar with these scales to utilize them competently for each patient.

RESUMO Introdução: a medição da gravidade das lesões traumáticas é essencial para prever os desfechos clínicos. Enquanto o Injury Severity Score (ISS) tem limitações ao atribuir pontuações às lesões no mesmo local, o New Injury Severity Score (NISS) corrige esse problema ao considerar as três lesões mais graves independentemente da região corporal. Este estudo visa entender o perfil clínico-epidemiológico dos pacientes traumatizados, comparando a eficácia das escalas para prever mortalidade. Métodos: estudo descritivo, observacional e retrospectivo utilizando registros de pacientes submetidos à toracotomia no Hospital das Clínicas da Universidade Federal do Triângulo Mineiro entre 2000 e 2019. Dados demográficos, mecanismos de lesão, órgãos afetados, tempo de internação e mortalidade foram analisados. A gravidade das lesões foi avaliada usando o ISS e NISS, e as análises estatísticas foram conduzidas no MedCalc e SigmaPlot. Resultados: Foram avaliados 101 pacientes, em média com 29,6 anos, sendo 86,13% homens. A média da internação foi de 10,9 dias e a taxa de mortalidade foi de 28,7%. A análise da curva ROC revelou uma sensibilidade de 68,97%, especificidade de 80,56% e área sob a curva de 0,837 para o ISS, e 58,62%, 94,44% e 0,855 para o NISS, respectivamente. O índice de Youden indicou 0,49 para o ISS e 0,53 para o NISS. Conclusão: o estudo demonstrou semelhante eficácia entre o NISS e o ISS na previsão de mortalidade. Esses resultados geram implicações importantes na aplicação dessas escalas no ambiente hospitalar. É essencial que os profissionais conheçam tais escalas para aplica-las adequadamente no contexto de cada paciente.

Comparative Analysis Between Isolated Posterior and Anteroposterior Approaches for Severe Scoliosis Treatment.

Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications.

Comparative Analysis Between Isolated Posterior and Anteroposterior Approaches for Severe Scoliosis Treatment / Análise comparativa entre as abordagens cirúrgicas por via posterior isolada e por via anteroposterior para tratamento de escoliose severa

Abstract Objective To comparatively analyze isolated posterior and double surgical approaches for the treatment of severe scoliosis. Methods We retrospectively analyzed medical records of 32 patients with scoliosis angular value > 70° submitted to surgical treatment in a tertiary hospital between 2009 and 2019. These patients were divided into two groups: PV group with 17 patients submitted to arthrodesis by isolated posterior route (PV) and APV group with 15 patients approached anteriorly and posteriorly (APV). In the PV group, there were 16 female patients and 1 male, with a mean age of 16.86 years old. In the APV group, there were 10 female patients and 5 males, with a mean age of 17.71 years old. Cobb angles were measured by a single spinal surgeon manually on panoramic radiographs, orthostasis before and after surgery. Weight, pre- and postoperative height, and duration of the procedure were also evaluated. Results In the PV group, preoperative and postoperative Cobb angles, verified in the main curve, were 96.06 ± 8.45° and 52.27 ± 15.18°, with an average correction rate of 0.54 ± 0.16, respectively. In the APV group, these values were 83.12 ± 11.60° for preoperative Cobb angle, and 48.53 ± 10.76° postoperatively, with correction rate of the main curve of 0.58 ± 0.11. Conclusion The two forms of surgical approach for the treatment of severe scoliosis were astowed as to the rate of correction of the deformity. Therefore, isolated posterior access has an advantage over the double approach, based on shorter surgical time, shorter hospital stay, and less risk of complications

Resumo Objetivo Analisar comparativamente as abordagens cirúrgicas por via posterior isolada e dupla abordagem para tratamento da escoliose severa. Métodos Analisou-se retrospectivamente prontuários de 32 pacientes com escoliose de valor angular > 70° submetidos a tratamento cirúrgico em hospital terciário entre 2009 e 2019. Dividiu-se estes pacientes em dois grupos: Grupo VP com 17 pacientes submetidos a artrodese por via posterior isolada (VP) e Grupo VAP com 15 pacientes abordados por via anterior e posterior (VAP). O Grupo VP apresentou 16 pacientes do sexo feminino e 1 do masculino, com idade média de 16,86 anos. No grupo VAP, 10 pacientes do sexo feminino e 5 do masculino, com idade média de 17,71 anos. Os ângulos de Cobb foram mensurados por único cirurgião de coluna, manualmente, em radiografias panorâmicas, em ortostase no pré- e pós-operatório. Foram avaliados também peso, altura pré- e pós-operatória e duração do procedimento. Resultados No Grupo VP, o ângulo de Cobb pré-operatório e pós-operatório, verificados na curva principal, foram respectivamente 96,06° ± 8,45° e 52,27 ± 15,18°, apresentando taxa média de correção de 0,54 ± 0,16. No grupo VAP, esses valores foram de 83,12° ± 11,60° para o ângulo de Cobb pré-operatório, 48,53 ± 10,76, pós-operatório, com a taxa de correção da curva principal de 0,58 ± 0,11. Conclusão As duas formas de abordagem cirúrgica para tratamento de escoliose severa se equiparam quanto à taxa de correção da deformidade. Portanto, o acesso posterior isolado apresenta vantagem em relação a dupla via, baseado no menor tempo cirúrgico, menor tempo de internação e menos risco de complicações

Sistema de presión negativa como tratamiento de la venta torácica: informe de caso / Negative pressure system as a thoracic window treatment: a case report

Introducción: Se presenta un caso clínico de sistema de presión negativa como tratamiento de ventana torácica derecha, realizado en la clínica de heridas. Se describe el tiempo y proceso de cicatrización, desde la llegada del paciente hasta la cicatrización total. Caso: Hombre de 24 años, postoperado de toracotomía, se le colocó terapia de presión negativa inicial a -75mmHg con intensidad media y modalidad continua; se aplicó esponja blanca para proteger el pulmón expuesto y esponja de plata, con tres cambios cada siete días. Posteriormente, se realizaron diez cambios de esponjas cada cuatro días, identificando disminución de las dimensiones de la ventana torácica. En la semana once inició tratamiento con terapia húmeda y fibrina rica en plaquetas, la cual se colocó en el lecho de la herida, aplicándose una vez por semana durante un mes. A partir de la semana quince se realizó curación diaria con aplicación de sulfadiazina de plata. El paciente fue dado de alta en la semana veinte con la herida 100% epitelizada. Conclusiones: El uso de la terapia de presión negativa acelera el proceso de curación, reduce las complicaciones y la carga bacteriana del tejido, debido a que la esponja de plata actúa como barrera antimicrobiana.

Introduction: A clinical case of negative pressure system as a right thoracic window treatment, performed in the wound clinic, is presented. The time and healing process from patient arrival to complete healing is described. Case: A 24-year-old man, postoperative thoracotomy, was placed on negative pressure therapy at -75mmHg with medium intensity and continuous mode; white sponge was applied to protect the exposed lung and silver sponge, with three changes every seven days. Subsequently, ten sponge changes were performed every four days, identifying a decrease in the dimensions of the thoracic window. In week eleven, the patient started treatment with wet therapy and platelet-rich fibrin, which was placed in the wound bed and applied once a week for a month. From week fifteen onwards, daily healing was performed with silver sulfadiazine application. The patient was discharged at week twenty with the wound 100% epithelialized. Conclusions: The use of negative pressure therapy accelerates the healing process, reduces complications and tissue bacterial load, due to the silver sponge acting as an antimicrobial barrier.

[Surgical Revascularization of the Myocardium by Minimally Invasive Access]. / Revascularización quirúrgica del miocardio por acceso mínimamente invasivo.

Median sternotomy is the Gold Standard access for surgical revascularization of the myocardium, but it is not free of complications, especially in patients with multiple comorbidities. Minimally invasive access offers the advantage of avoiding sternotomy, achieving a more accelerated postoperative recovery, with less hospital stay time and a higher level of satisfaction with quality of life. We present the case of a 49-year-old male patient, diabetic, hypertensive, smoker, with multiarterial coronary artery disease, very symptomatic, who underwent surgical revascularization by left mini-thoracotomy.

Onda vermelha: perfil dos pacientes atendidos em um hospital de trauma / Red wave: profile of patients served in a trauma hospital / Onda roja: perfil de pacientes atendidos en un hospital de trauma

Objetivo: Descrever o perfil dos pacientes atendidos pela onda vermelha em 2018 e 2019. Métodos: Trata-se de uma pesquisa quantitativa, de caráter transversal, retrospectiva, descritiva e documental realizada no Hospital de Pronto-Socorro João XXIII, Belo Horizonte, Brasil. O universo deste estudo foram 83 prontuários eletrônicos de pacientes que entraram no protocolo da Onda Vermelha. Foi realizada distribuições de frequência, medidas de tendência central (média e mediana) e de variabilidade (desvio padrão). Resultados: A maioria dos pacientes foi do sexo masculino, com idade entre 1 e 95 anos e média de 33,4 anos. O mecanismo do trauma mais frequente foi contuso, o meio transporte foi ambulância do Serviço de Atendimento Móvel de Urgência, a causa mais frequente dos traumas foi acidente automobilístico seguido de trauma por projétil de arma de fogo. As cirurgias mais frequentes foram laparotomia, toracotomia e craniectomia. Óbito foi o desfecho mais comum. Conclusão: Os pacientes chegam muito graves e o óbito foi o principal desfecho. Sugere-se estudos que possibilitem análise comparativa de dados e padronização do cálculo da probabilidade de sobrevivência. Recomenda-se atualização do protocolo da onda vermelha, incluindo outras cirurgias que já são realizadas e novos critérios de inclusão de pacientes. (AU)

Objective: To describe the profile of patients treated in the "Red Wave", in the period of 2018-2019. Methods: It is a quantitative, cross-sectional, retrospective, descriptive and documentary research. Held at the first-aid post João XXIII Hospital, in Belo Horizonte. The universe of this study was 83 electronic medical records of patients who entered the "Red Wave" protocol. Simple frequency distributions, measures of central tendency (mean and median) and variability (standard deviation) have been performed. Results: Male, aged between 1 and 95 years old, being an average at 33,4 years old. The most frequent trauma mechanism was blunt, the means of transport was an ambulance from the Mobile Emergency Service, the causes of the trauma were an automobile accident, followed by trauma by a firearm projectile. From the performed surgeries, the most frequent ones were laparotomy, thoracotomy and craniectomy. Among the outcome, death was the most common one among patients. Conclusion: Patients arrive very seriously and death was the main outcome. Studies that allow comparative data analysis and standardization of the calculation of survival probability are suggested. It is recommended to update the red wave protocol, including other surgeries that are already performed and new inclusion criteria for patients. (AU)

Objetivo: Describir el perfil de los pacientes atendidos por la onda roja en 2018 y 2019. Métodos: se trata de un estudio cuantitativo, transversal, retrospectivo, descriptivo y documental realizado en el Hospital de Pronto-Socorro João XXIII, Belo Horizonte, Brasil. El universo de este estudio fue de 83 historias clínicas electrónicas de pacientes que ingresaron al protocolo Red Wave. Se realizaron distribuciones de frecuencia, medidas de tendencia central (media y mediana) y variabilidad (desviación estándar). Resultados: La mayoría de los pacientes eran varones, con edades comprendidas entre 1 y 95 años y media de 33,4 años. El mecanismo de traumatismo más frecuente fue contundente, el medio de transporte fue una ambulancia del Servicio Móvil de Emergencias, la causa más frecuente de traumatismo fue un accidente automovilístico seguido del traumatismo por proyectil de arma de fuego. Las cirugías más frecuentes fueron laparotomía, toracotomía y craniectomía. La muerte fue el resultado más común. Conclusión: Los pacientes llegan muy en serio y la muerte fue el resultado principal. Se sugieren estudios que permitan el análisis de datos comparativos y la estandarización del cálculo de la probabilidad de supervivencia. Se recomienda actualizar el protocolo de onda roja, incluyendo otras cirugías que ya se realizan y nuevos criterios de inclusión de pacientes. (AU)

Infraclavicular anterior thoracic approach for access to the upper thoracic vertebrae: case report and description of a new surgical technique.

Patient with spondylodiscitis who presented kyphosis deformity with neurological compromise at the upper thoracic level, who was treated with a new right infraclavicular anterior thoracic approach, as a new alternative surgical technique. 72-year-old male with kyphosis deformity secondary to T2-T3 ASIA "C" spondylodiscitis, treated with C5 to T6 posterior cervicothoracic instrumentation and right infraclavicular transthoracic anterior approach utilizing an expandable cylinder. Within the literature review carried out in the search engines, no similar techniques to the one described in this article were found. Given the complexity of the surgical approach, this new technique is described as a new way for accessing the upper thoracic spine, demonstrating that the right infraclavicular anterior thoracic approach is a new alternative to access the upper thoracic spine from T1 to T4.

Paciente con espondilodiscitis que presentó deformidad cifótica con compromiso neurológico a nivel torácico superior, quien fue tratado con un nuevo abordaje torácico anterior infraclavicular derecho, como nueva técnica quirúrgica alternativa. Varón de 72 años con deformidad en cifosis secundaria a espondilodiscitis T2-T3 ASIA "C", tratado con instrumentación cervicotorácica posterior C5 a T6 y abordaje anterior transtorácico infraclavicular derecho con colocación de cilindro expandible. Dentro de la revisión bibliográfica realizada en los buscadores no se encontraron técnicas similares a la descrita en este artículo. Dada la complejidad del abordaje quirúrgico, esta nueva técnica se describe como una nueva forma de acceder a la columna torácica superior, demostrando que el abordaje torácico anterior infraclavicular derecho es una nueva alternativa para acceder a la columna torácica superior desde T1 a T4.

Post-thoracotomy paraplegia after oxidized cellulose spinal compression

ABSTRACT Post-thoracotomy paraplegia after non-aortic surgery is an extremely uncommon complication. A 56-year-old woman presented with a 1-year history of progressive shortness of breath. Computed tomography revealed a locally advanced posterior mediastinal mass involving the ribs and the left neural foramina. Tumor excision with a left pneumonectomy was performed. Post-resection, bleeding was noted in the vicinity of the T4-T5 vertebral body, and the bleeding point was packed with oxidized cellulose gauze (Surgicel®). Postoperatively, the patient complained of bilateral leg numbness extending up to the T5 level, with bilateral paraplegia. An urgent laminectomy was performed, and we noted that the spinal cord was compressed by two masses of Surgicel® with blood clots measuring 1.5 × 1.5cm at T4 and T5 levels. The paraplegia did not improve despite the removal of the mass, sufficient decompression, and aggressive postoperative physiotherapy. Surgeons operating in fields close to the intervertebral foramen should be aware of the possible threat to the adjacent spinal canal as helpful hemostatic agents can become a preventable threat.

Mesotelioma pleural em mediastino em uma cadela - remoção com esternotomia mediana / Mediastinal mesothelioma in a bitch - removal with median sternotomy

Background: Malignant pleural mesothelioma (MPM) is a neoplasm with low incidence in small animals, and the possible causes are poorly elucidated but may be related to contact with asbestos. In the thoracic cavity, MMP can be localized or generalized to all cavity structures, and its clinical signs depend on this localization. Although some alternative therapies are being discussed, few studies are conclusive, with surgical intervention as the leading therapeutic option. Given this context, this report aimed to describe a case of MMP located in the mediastinum of a bitch treated with radical excision through mediated sternotomy. Case: A 7-year-old bitch of the Shar-pei breed was referred for care due to progressive weight loss and intense dyspnea. During the physical examination, dyspnea and muffled lung sounds were noted. The patient underwent hemodialysis, which showed neutrophilic leukocytosis. An abdominal ultrasound was also performed and revealed mild abdominal effusion, and chest radiography revealed an extensive tumor covering the entire chest cavity. Thoracocentesis was performed, and the material analyzed was a malignant exudate; the patient was referred to median sternotomy for exploratory purposes, and afterward, total macroscopic extirpation of the tumor was performed. A sample was sent for histopathology, and malignant mesothelioma was confirmed. The patient was discharged after 8 days of hospitalization with home treatment and did not return to the hospital. Upon contacting the guardian, we were informed that the animal had died 154 days after the procedure due to unknown causes. Discussion: Malignant pleural mesothelioma affects humans and animals; it is associated with the risk factor of contact with asbestos and the use of flea antiparasitic drugs. In small animals, its incidence is rare, albeit mesotheliomas have been reported in wild and large animals. The clinical signs are related to the location of the neoplasm. When it is located in the thoracic region, dyspnea, muffled lung sounds, cyanosis, and pleural effusion are observed in most cases. Diagnosis is usually late and incidental, although some tests, such as ultrasonography, magnetic resonance imaging, tomography, radiography, and needle biopsy, can help in the diagnosis. Histopathology is the exam of choice for definitive diagnosis, as it helps one observe the proliferation of neoplastic mesothelial cells, atypical mitosis figures, and marked cellular pleomorphism. Many therapeutic options have been discussed, including chemotherapy, immunotherapy, and anti-tumor immunization, although there is little scientific proof of their efficacy in animals. The current treatment of choice is tumor excision by surgical procedure with a palliative objective since the prognosis of the disease is unfavorable. Minimally invasive video surgery has been gaining more and more space in veterinary medicine and has proven successful in numerous cases of thoracic masses. In the present report, we chose to perform median sternotomy for total excision due to the extension of the mass that occupied the thoracic cavity practically in its entirety. Further research should be conducted to help in palliative treatments and increase the survival of patients with mesotheliomas, given that most studies are done in humans and not animals. We conclude that median sternotomy is still the therapeutic option of choice for the palliative treatment of patients with extensive thoracic pleural mesotheliomas.

Doble cuarto arco aórtico persistente en un perro (Canis familiaris): reporte de caso

El doble arco aórtico persistente es una patología caracterizada por anomalías embrionarias en la vascularización, que pueden afectar de manera indirecta a otros sistemas, como el digestivo y el respiratorio. El objetivo de este documento es reportar un caso de doble arco aórtico, persistente en un cachorro Bull terrier, de seis meses de edad. El paciente ingresó a consulta por motivo de regurgitaciones frecuentes y pérdida ponderal. En el estudio radiográfico, se evidenció dilatación esofágica craneal a la base del corazón y en la toracotomía, se confirmó un doble arco aórtico persistente. Se realizó manejo nutricional y posteriormente, corrección quirúrgica de la anomalía vascular. Este es el primer caso de una anomalía de este tipo en Colombia. Se concluye, que un manejo quirúrgico enfocado a liberar el anillo estenosante y a recuperar la función esofágica, son la base terapéutica de este tipo de alteraciones.

Persistent double aortic arch is a pathology characterized by embryonic vascularization anomalies, which can indirectly affect other systems such as the digestive and respiratory systems. The objective of this document is to report a case of persistent double aortic arch in a six-month-old Bull Terrier puppy. The patient was admitted for consultation due to frequent regurgitation and weight loss. The radiographic study revealed cranial esophageal dilation at the base of the heart, and a thoracotomy confirmed a persistent double aortic arch. Nutritional management was performed and subsequently, surgical correction of the vascular anomaly. This is the first case of an anomaly of this type in Colombia. It is concluded that surgical management focused on releasing the stenosing ring and recovering esophageal function are the therapeutic basis for this type of alteration.

Tips and Tricks in Transaortic TAVR

ABSTRACT Transfemoral transcatheter aortic valve replacement (TAVR) is currently the standard catheter-based treatment of severe aortic stenosis patients. Being the transfemoral route not feasible, other access sites could be chosen. Transaortic TAVR via either a J mini-sternotomy or a right anterolateral mini-thoracotomy is a good option for patients having tricky thoracoabdominal aorta. Some tips and tricks may help in getting a fast and safe transaortic procedure.

Tips and Tricks in Transaortic TAVR.

Transfemoral transcatheter aortic valve replacement (TAVR) is currently the standard catheter-based treatment of severe aortic stenosis patients. Being the transfemoral route not feasible, other access sites could be chosen. Transaortic TAVR via either a J mini-sternotomy or a right anterolateral mini-thoracotomy is a good option for patients having tricky thoracoabdominal aorta. Some tips and tricks may help in getting a fast and safe transaortic procedure.

Giant Epicardial Cyst Eroding Left Ventricular Wall Mimicking as Simple Pericardial Cyst.

Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management of epicardial cysts. A 17-year-old normotensive boy presented with chest pain and palpitations, which on evaluation was found to be a mediastinal mass (pericardial cyst). Surgical resection of the cyst via thoracotomy was planned. The cyst was diagnosed as an epicardial cyst intraoperatively. However, due to the epicardial origin of cyst and posterior adhesions, resection was done via midline approach. The base was formed by visceral pericardium and eroding into myocardium of left ventricle, so the resection was concluded with on-pump surgery. In case of erroneous diagnosis or undesirable finding, a safer midline approach with on-pump surgery, as an alternative to minimally invasive approach for complicated epicardial cysts (erosion into ventricle/lying in close proximity to important structures or near to coronary arteries) should be considered.

Giant Epicardial Cyst Eroding Left Ventricular Wall Mimicking as Simple Pericardial Cyst

Abstract Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management of epicardial cysts. A 17-year-old normotensive boy presented with chest pain and palpitations, which on evaluation was found to be a mediastinal mass (pericardial cyst). Surgical resection of the cyst via thoracotomy was planned. The cyst was diagnosed as an epicardial cyst intraoperatively. However, due to the epicardial origin of cyst and posterior adhesions, resection was done via midline approach. The base was formed by visceral pericardium and eroding into myocardium of left ventricle, so the resection was concluded with on-pump surgery. In case of erroneous diagnosis or undesirable finding, a safer midline approach with on-pump surgery, as an alternative to minimally invasive approach for complicated epicardial cysts (erosion into ventricle/lying in close proximity to important structures or near to coronary arteries) should be considered.

In-Hospital Outcomes of Right Minithoracotomy vs. Periareolar Access for Minimally Invasive Video-Assisted Mitral Valve Repair

Abstract Introduction: In minimally invasive mitral valve repair, right minithoracotomy is the most widely performed method, providing a good view of the mitral valve. But regarding other techniques and although it offers limited visualization, the periareolar access is a less traumatic alternative. This study's purpose is to compare in-hospital outcomes in patients who underwent video-assisted minimally invasive mitral valve repair via right minithoracotomy and periareolar access. Methods: This is a retrospective observational study including 37 patients (> 18 years old), without previous right thoracic surgery, who underwent their primary mitral valve repair, with indication for minimally invasive video-assisted approach (via right minithoracotomy or periareolar access), between January 2018 and August 2019. Patients' medical records were consulted to collect demographics data, operative details, and in-hospital outcomes. Results: Twenty-one patients underwent right minithoracotomy, and 16 were operated via periareolar access. The mean patients' age was 62±12 years in the right minithoracotomy group and 61±9 years in the periareolar access group (P=0.2). There are no significant differences in incision length, cardiopulmonary bypass time, aortic cross-clamping time, hematocrit, amount of chest tube drainage, and intensive care unit and in-hospital length of stay. Time to extubation presented significant differences between the right minithoracotomy and the periareolar access group (4.85 hours vs. 5.62 hours, respectively) (P=0.04). Conclusion: In this study, we found similar results in the two applied surgical techniques, except for the time to extubation.

Cirugías por traumatismo torácico: caracterización y variables asociadas a mortalidad / Thoracic trauma surgery: indications, findings and mortality associated variables

Resumen Introducción: El traumatismo torácico (TT) es la causa de aproximadamente un cuarto de las muertes por traumatismos. Los pacientes tratados con cirugía por traumatismo torácico (CTT) presentan un amplio espectro de características y pronósticos. Objetivos: Describir características clínicas, indicaciones, temporalidad, morbilidad, mortalidad y las variables asociadas a mortalidad en pacientes con CTT. Materiales y Método: Estudio observacional de pacientes tratados con CTT, período enero-1981 a diciembre-2019. Revisión de protocolos prospectivos de TT y base de datos. Se realizó regresión logística para variables asociadas a mortalidad. Se utilizó SPSS25® con prueba chi-cuadrado para comparar clasificación, tipo de TT y su distribución temporal, considerando significativo p < 0,05. Resultados: En total 808 casos (18,2%) de 4.448 TT requirieron CTT. Fueron hombres 767 (94,9%) y la edad promedio fue 31,5 ± 13,8 años. El traumatismo fue penetrante y por arma blanca en la mayoría de los casos. Fueron politraumatizados 164 (20,3%). La cirugía fue urgente en 474 (58,7%), precoz en 41 (5,0%) y diferida en 293 (36,3%) casos. La mortalidad global fue de 6,7% y fue significativamente mayor en TT contusos, politraumatizados y en cirugía urgente. La mortalidad fue 9,7% en CTT urgente, 4,9% en precoz y 2,0% en diferida (p < 0,001). Se observaron variables independientes asociadas a mortalidad. Conclusión: En nuestra serie, las CTT se realizaron principalmente en hombres jóvenes con TT penetrantes. Correspondieron a un grupo heterogéneo en cuanto a las indicaciones, hallazgos y lesiones intratorácicas y/o asociadas. Múltiples variables demostraron influir significativamente en la mortalidad de los pacientes tratados con CTT.

Background: Thoracic Trauma (TT) is the cause of approximately a quarter of trauma deaths. The patients who undergo Thoracic Trauma Surgery (TTS) present a wide spectrum of characteristics and prognosis. Aim: To describe clinical characteristics, indications, temporality, morbidity, mortality and mortality associated variables in TTS patients. Materials and Method: Observational study of TT hospitalized patients, period January-1981 to December-2019. A review of operation notes and database was done. A logistic regression for mortality associated variables was made. To compare classification, type of TT and its temporal distribution, SPSS25® with chi-square test was used, considering significant p < 0.05. Results: A total of 808 (18.2%) of 4.448 TT patients required TTS, 767 (94.9%) were men with average age: 31.5 ± 13.8. The trauma was penetrating trauma due to a stab in most cases, 164 (20.3%) were polytraumatized. The surgery was urgent in 474 (58.7%), early in 41 (5.0%) and delayed in 293 (36.3%) cases. The global mortality was 6.7% and was significantly higher in the blunt TT, polytrauma, urgent and early surgery patients. Mortality in urgent TTS was 9.7%, early 4.9% and 2.0% in delayed (p < 0.001). Independent variables associated with mortality were observed. Conclusions: In our series, TTS were performed mainly in young men with penetrating TT. The group was heterogeneous regarding surgical indications, findings and intrathoracic or associated injuries. Multiple variables showed to influence significantly on mortality in patients who underwent TTS.