Aportación europea a la especialidad de cirugía torácica general. II parte: contribución británica / European contribution to the general thoracic surgery speciality. Part II: British contribution

Es a principios de la Primera Guerra Mundial cuando se multiplicaron las técnicas quirúrgicas en el Reino Unido. Los drenajes, el tratamiento de las heridas abiertas y las complicaciones como los empiemas eran el inicio de nuevas técnicas, innovadoras y resolutivas en estos casos. En esos años, muchos de los cirujanos britanicos abandonaron el país. Hemos de reseñar que se crearon nuevos hospitales, como el Brompton en Londres. Fue fundado por la Reina Victoria como "hospital para enfermedades del tórax". Hemos de mencionar al Dr. Barret que, procedente de Adelaida (Australia), forma parte del equipo quirúrgico de este hospital. En 1971, MacArthur consiguió una supervivencia de dos meses en un trasplante de pulmón, y se recuerda la influencia de R. Abbey Smith en estos años. Ya en años más recientes, el Dr. Peter Goldstraw ocupó la plaza de especialista en cirugía torácica del Brompton y desarrolló, entre otras técnicas, la cirugía del enfisema bulloso y estudios prospectivos sobre carcinoma broncogénico y estadificación ganglionar en cancer de pulmón (AU)

It was at the beginning of the First World War when the surgical techniques multiplied in the United Kingdom. Drainages, treatment of open wounds and complications such as empyemas were the initiation of new, innovating and resolving techniques in these cases. During these years, many of the British surgeons left the country. We must state that new hospitals, such as the Brompton in London, were created. It was founded by Queen Victoria as a "Hospital for diseases of the chest." Mention should be made of Dr. Barrett, who was from Adelaida (Australia) and who formed a part of the surgical team of this hospital. In the year 1971, Mac Arthur achieved a two-month survival after a lung transplantation and the influence of R. Abbey Smith during these years is remembered. In more recent years, Dr. Peter Goldstraw occupied the post of chest surgery consultant in Brompton and developed, among other techniques, surgery in bullous emphysema and prospective studies on bronchogenic carcinoma and lymph node staging in lung cancer (AU)

Aportación europea a la especialidad de cirugía torácica. Contribución de los países del continente / European contribution to the thoracic surgery speciality. Contribution of the countries of the continent

En anteriores trabajos, hemos analizado la contribución germana y británica a la Cirugía Torácica general y a continuación desarrollaremos lo que fue ocurriendo durante este mismo tiempo en el resto de Europa. Examinaremos la falta de una Sociedad profesional adecuada al desarrollo de la Cirugía Torácica, a pesar de la existencia de cirujanos que comenzaban a desarrollar técnicas novedosas durante estos años. En el norte de Europa la Cirugía Torácica se había iniciado con el Dr. Jacobeus de Estocolmo . En los Países Bajos se llevó a cabo la primera neumonectomía por cuadro de bronquiectasias en el año 1940. Durante este tiempo, se llevaron a cabo tratamientos quirúrgicos de cerca en 1.200 pacientes con procesos tuberculosos con una mortalidad operatoria en torno al 2%. La aportación en Bélgica evolucionó de manera favorable desde el año 1 930 y posteriormente se produjo una separación de la Cirugía General y Digestiva de la Cardiaca, Osteoarticular, Urología y Neurocirugía. Es en 1970 cuando se comienza a desarrollar el plombaje extrafascial con grasa, y el Dr. LeBrigand aporta nuevas tecnicas para el tratamiento tuberculoso, así como en los traumatismos torácicos y lesiones traqueobronquiales. Mientras tanto, en Marsella se llevaron a cabo las primeras prácticas de broncografías y se comienza sobre trabajos de trasplante pulmonar experimental. La contribución Ibérica y la Cirugía Italiana están recogidas en España con nombres como Dr. González Duarte o Gil Turner y la participación italiana se inicia fundamentalmente entre los años 1.900 y 1.976 con la realización de la cirugía pulmonar y esofágica destacando, entre otros, el Dr. Erino A Rendina. En Austria se comenzó con la colapsoterapia llevando a cabo toracoplastias, neumotórax artificiales y frenicectomías. En Turquía y en Grecia la equinocosis era un serio problema de salud y se desarrollaron numerosas técnicas para su tratamiento. De la misma manera, se llevaron a cabo funduplicaciones de esófago distal y se desarrolló la Escuela de Cirugía Torácica en Antalaya (Antalaya School of Thoracic Surgery). En cuanto a los bloques del Este ha sido difícil recopilar datos de dicha área. Hasta que no se produjo la caída del muro de Berlín, el problema fue encontrar fuentes fidedignas de información. Es en estos países donde se produce el desarrollo de la cirugía pulmonar y se va asimilando la cirugía esofágica, así en los años 30 se propone el abordaje mediastínico a través del abdomen y se realizan anastomosis esofagogástricas torácicas por Uglov. Finalmente señalaremos que la escuela de San Petersburgo se considera como la representante de la cirugía en la Federación Rusa y se comienzan importantes periodos de desarrollo, que han llegado hasta nuestras citas bibliográficas actuales (AU)

In previous works, we have analyzed the German and British contribution to general Thoracic Surgery and then we developed what had been occurring during the same time in the rest of Europe. We will examine the lack of a Professional Society suitable for the development of Thoracic Surgery, in spite of the existence of surgeons who had begun to develop novel techniques during these years. In the north of Europe, Thoracic Surgery had been initiated with Dr. Jacobeus of Stockholm. In the Netherlands, the first pneumonectomy was performed due to a picture of bronchiectasis in the year 1940. During that time, surgical treatment was performed in approximately 1200 patients suffering tuberculosis conditions with approximately 2% surgical mortality. The contribution in Belgium evolved favorably after the year 1930 and there was a subsequent separation of General and Digestive Surgery from Cardiac, Osteoarticular, Urology and Neurosurgery. In 1970, when extrafascial plombage with fat was begun, Dr. LeBrigand contributed new techniques for treatment of tuberculosis and in thoracic traumas and tracheal-bronchial lesions. Meanwhile, in Marcela, the first practices of bronchographies were conducted and works on experimental lung transplants were begun. The contribution of Iberia and of Italian Surgery were collected in Spain with names such as Dr. González Duarte or Gil Turner and the Italian participation was fundamentally begun between the years 1,900 and 1,976 with the performance of pulmonary and esophageal surgery, standing out, among others, Dr. Erino A Rendina. In Austria, they began with colapsotherapy, performing thoracoplasties, artificial pneumothorax and phrenicectomies. In Turkey and in Greece, the equinococosis was a serious health problem and many techniques were developed for its treatment. Similarly, distal esophageal fundoplications were performed and Antalaya School of Thoracic Surgery was developed. It has been difficult to gather data in regards to the said area of the Eastern Bloc. Until the Berlin Wall fell, the problem was to find reliable sources of information. It was in those countries in which pulmonary surgery was developed and in which esophageal surgical was assimilated. Thus, in the 1930's, the mediastinal approach through the abdomen was proposed and thoracic esophageal-gastric anastomeses were performed by Uglov. Finally, we point out that the School of St. Petersburg is considered as the representative of the surgery of the Russian Federation and in which important periods of development were begun, which have been included in our current bibliographic citations (AU)

Cirugía torácica videoasistida en el tratamiento del cáncer de pulmón / Video-assisted thoracic surgery in the treatment of lung cancer

Resumen. Pese a las preocupaciones e incertidumbres iniciales respecto a las resecciones pulmonares mayores por cirugía torácica videoasistida, esta técnica ha demostrado ser una opción válida en el tratamiento del carcinoma broncogénico de células no pequeñas en estadios iniciales. Tanto la lobectomía como la linfadenectomía mediastínica por cirugía mínimamente invasiva son técnicamente factibles y seguras. No se aprecia un aumento de las tasas de morbi-mortalidad. Asimismo, la técnica permite mantener los principios oncológicos, logrando buenos resultados reflejados en supervivencias similares o incluso superiores a las alcanzadas por cirugía abierta. Pese a estos resultados, aún está muy poco extendida en la práctica quirúrgica habitual de los servicios de Cirugía Torácica. Por lo tanto, dado que se trata de una técnica factible, segura y con buenos resultados oncológicos, debería comenzar a ser una práctica rutinaria en aquellos centros en que pueda iniciar un programa de lobectomía por cirugía mínimamente invasiva (AU)

Abstract. In spite of the initial concerns and uncertainty regarding major lung resections by video-assisted thoracic surgery, this technique has been demonstrated to be a valid option in the treatment of non-small cell bronchogenic carcinoma in initial stages. Both the lobectomy and the mediastinic lymphadectomy by minimally invasive surgery are technically feasible and safe. No increase in the rates of morbidity-mortality is observed. Furthermore, the technique makes it possible to maintain the oncological principles, achieving good results reflected in similar or even greater survivals than those reached by open surgery. In spite of these results, it is still not very extended in the usual surgical practice of the Thoracic Surgery services. Therefore, given that it is a feasible and safe technique with good oncological results, it should begin to become a route practice in those sites that can initiate a program of lobectomy by minimally invasive surgery (AU)

Aportación europea a la especialidad de Cirugía Torácica. Contribución alemana / European contribution to the thoracic surgery specialty. German contribution

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Diagnóstico y manejo del derrame pleural maligno / Diagnosis and management of the malignant pleural. Efussion

El derrame pleural maligno es una entidad frecuente y debilitante, manifestación de la enfermedad neoplásica avanzada. Su presencia empeora la calidad de vida del paciente e implica una esperanza de vida reducida a unos pocos meses. Previo a iniciar un tratamiento, se debe diagnosticar el derrame pleural como maligno mediante una citología de líquido pleural y/o una histología de pleura positiva para malignidad, lo que a veces requiere emplear varios procedimientos diagnósticos.Una vez diagnosticado, se plantean una serie de consideraciones que el facultativo debe tener en cuenta a la hora de desarrollar una estrategia terapéutica. Factores, como el estado general del paciente y su índice de calidad de vida, parámetrosradiológicos y bioquímicos del derrame y las distintas opciones terapéuticas deben considerarse para conseguirel objetivo principal del tratamiento que es aliviar la sintomatología, así como evitar la reaparición del derrame. La pleurodesis con talco (mediante talco en slurry o talco poudrage) es la técnica más empleada y que ofrece mejores resultados aunque no está exenta de posibles complicaciones

TMalignant pleural effusion is a frequent and weakening entity, manifestation of advanced neoplastic disease. Its presence deteriorates the patient's quality of life and implies a life expectancy that is reduced to a few months. Prior to initiating treatment, the pleural effusion should be diagnosed as malignant by means of a pleural fluid cytology and/or histologyof pleura positive for malignancy. This often requires the use of several diagnostic procedures. Once diagnosed, a series of consideration that the professional should take into account when planning a therapeutic strategy are established.These are factors such as the patient's general condition and quality of life index, radiological and biochemical parameters of the effusion. Furthermore, the different therapeutic options should be considered to achieve the primary objective of the treatment, this being to relieve the symptoms and avoid the reappearance of the effusion. Talc pleurodesis (via slurry or poudrage) is the technique used most and the one that offers the best results, although it is not exemptof possible complications (AU)

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Seudoaneurisma arterial pulmonarsecundario a cateterismo coronario / Pulmonary artery pseudoaneurysm secondary to coronary catheterizarion

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Lipoma mediastínico y síndrome de vena cava superior / Mediastal lipoma and superior vena cava syndrome

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[Surgery of lung metastasis: results of a hospital survey in the Autonomous Community of Madrid. Working Group on Surgery of Lung Metastasis (GT-CMP)]. / Cirugía en las metástasis pulmonares: resultados de una encuesta hospitalaria en la Comunidad Autónoma de Madrid. Grupo de Trabajo sobre Cirugía en las Metástasis Pulmonares (GT-CMP).

The Task Force on Pulmonary Metastasis Surgery of the Oncology Department of the Madrid Pneumology and Chest Surgery Society designed a questionnaire to determine guidelines for surgery to resect lung metastases in the Autonomous Community of Madrid, an area with over four million inhabitants. The questionnaire was divided into five sections: indications, diagnostic procedures, extension studies, disciplinary foci and surgical techniques. Ten of the hospitals surveyed answered the questionnaire. We found that disagreement is high regarding patient screening, and that there are differences regarding some preoperative procedures and extension studies, as well as in therapeutic approach. Eighty percent of the respondents were not in favor of using video assisted thoracoscopy as a therapeutic technique, and disagreement was greater regarding approaches technique, and disagreement was greater, regarding approaches to bilateral metastases. We infer that between 100 and 120 cases are treated surgically every year. Procedures to join The International Lung Metastases Registry have started.

[Spontaneous pneumothorax as the only initial manifestation of bronchogenic carcinoma]. / Neumotórax espontáneo como única manifestación inicial del carcinoma broncogénico.

We present the case of a patient with spontaneous pneumothorax associated to pulmonary epidermoid carcinoma, which was not radiologically visible after pulmonary reexpansion. Neither it was macroscopically detected in the first thoracotomy performed for the treatment of the pneumothorax, being diagnosed after the histological study of the resected blisters. The association between pneumothorax and lung cancer is very rare, especially in the absence of other radiological disorders suggesting neoplasia after the pulmonary reexpansion. In these cases, the diagnosis is extremely difficult and it must be always suspected in patients with spontaneous pneumothorax and risk factors for pulmonary cancer.

Tumours and pseudotumours of the chest wall.

In 78 patients a total of 89 chest wall tumours were considered for surgery between 1960 and 1982. There were 63 neoplasms (12 benign, 51 malignant) and 26 pseudotumours (1 chest wall deformity, 6 inflammatory tumours and 19 hydatid cysts of the chest wall). Radical resection of some kind was possible for 67 tumours and 2 patients underwent palliative resection. Exploratory thoracotomy and biopsy were performed in 9 patients and thoracoscopy and biopsy in 10. One hydatid cyst was managed with mebendazole. There were 11 postoperative complications and three hospital deaths. Chest wall prostheses were used in 13 patients. There was no operative mortality. The mean survival time for the patients with malignant tumour was 12.3 months in pleural mesothelioma and in metastatic pleural tumours, 15.2 months in primary rib tumours and 6.4 months in metastatic rib tumours. There was one death in the benign tumour group and one in the pseudotumour group.