Results in mediastinal lymph node staging of surgical lung cancer: Data from the prospective cohort of the Spanish Video-Assisted Thoracic Surgery Group.

OBJECTIVES: The objective of this study was to assess the diagnostic performance of combined computerised tomography (CT) and positron emission tomography (PET) in mediastinal staging of surgical lung cancer based on data obtained from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS). METHODS: A total of 2782 patients underwent surgery for primary lung carcinoma. We analysed diagnostic success in mediastinal lymph node staging (cN2) using CT and PET. Bivariate and multivariate analyses were performed of the factors involved in this success. The risk of unexpected pN2 disease was analysed for cases in which an invasive testing is recommended: cN1, the tumour centrally located or the tumour diameter >3 cm. RESULTS: The overall success of CT together with PET was 82.9% with a positive predictive value of 0.21 and negative predictive value of 0.93. If the tumour was larger than 3 cm and for each unit increase in mediastinal SUVmax, the probability of success was lower with OR 0.59 (0.44-0.79) and 0.71 (0.66-0.75), respectively. In the video-assisted thoracic surgery (VATS) approach, the probability of success was higher with OR 2.04 (1.52-2.73). The risk of unexpected pN2 increased with the risk factors cN1, the tumour centrally located or the tumour diameter >3 cm: from 4.5% (0 factors) to 18.8% (3 factors) but did not differ significantly as a function of whether invasive testing was performed. CONCLUSIONS: CT and PET together have a high negative predictive value. The overall success of the staging is lower in the case of tumours >3 cm and high mediastinal SUVmax, and it is higher when VATS is performed. The risk of unexpected pN2 is higher if the disease is cN1, the tumour centrally located or the tumour diameter >3 cm but does not vary significantly as a function of whether patients have undergone invasive testing.

Safety and Tolerability of Alveolar Type II Cell Transplantation in Idiopathic Pulmonary Fibrosis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease with limited response to currently available therapies. Alveolar type II (ATII) cells act as progenitor cells in the adult lung, contributing to alveolar repair during pulmonary injury. However, in IPF, ATII cells die and are replaced by fibroblasts and myofibroblasts. In previous preclinical studies, we demonstrated that ATII-cell intratracheal transplantation was able to reduce pulmonary fibrosis. The main objective of this study was to investigate the safety and tolerability of ATII-cell intratracheal transplantation in patients with IPF. METHODS: We enrolled 16 patients with moderate and progressive IPF who underwent ATII-cell intratracheal transplantation through fiberoptic bronchoscopy. We evaluated the safety and tolerability of ATII-cell transplantation by assessing the emergent adverse side effects that appeared within 12 months. Moreover, pulmonary function, respiratory symptoms, and disease extent during 12 months of follow-up were evaluated. RESULTS: No significant adverse events were associated with the ATII-cell intratracheal transplantation. After 12 months of follow-up, there was no deterioration in pulmonary function, respiratory symptoms, or disease extent. CONCLUSIONS: Our results support the hypothesis that ATII-cell intratracheal transplantation is safe and well tolerated in patients with IPF. This study opens the door to designing a clinical trial to elucidate the potential beneficial effects of ATII-cell therapy in IPF.

Video-assisted sympathectomy for essential hyperhidrosis: effects on cardiopulmonary function.

BACKGROUND: Essential hyperhidrosis is characterized by overactivity of the sympathetic fibers passing through the upper-dorsal ganglia (second and third thoracic ganglia [D2-D3]), and the treatment of choice is video-assisted thoracoscopy sympathectomy. Alterations in cardiopulmonary function after treatment have been reported. STUDY OBJECTIVE: To evaluate cardiopulmonary function impairment after sympathectomy in patients with essential hyperhidrosis. DESIGN AND SETTING: Prospective controlled trial at a pulmonary function unit of a university hospital. PATIENTS: Twenty patients (2 men and 18 women) with essential hyperhidrosis. MEASUREMENTS AND RESULTS: Pulmonary function tests, including spirometry and thoracic gas volume, bronchial challenge with methacholine, and maximal exercise, were performed before and 3 months after D2-D3 sympathectomy. Video-assisted sympathectomy was performed using a one-stage bilateral procedure with electrocoagulation of D2-D3 ganglia. Pulmonary function values (spirometrics and volumes) were not statistically different in the two groups. The maximal midexpiratory flow was the only variable that showed significant changes, from 101% (SD, 26%) to 92% (SD, 27%) [p < 0.05]. Ten patients had positive bronchial challenge test results that remained positive 3 months after surgery, and 2 patients whose challenge test results were negative before surgery became positive after sympathectomy. Significant reductions in maximal heart rate (HR) and oxygen and carbon dioxide uptakes were observed during the maximal exercise test. CONCLUSIONS: Video-assisted thoracoscopy is a safe treatment, and the observed modifications in cardiopulmonary function only suggest a minimal small airway alterations in the presence of positive bronchial hyperresponsiveness and mild sympathetic blockade in HR. The clinical importance of these findings is not significant.

Tumor fibroso solitario pleural gigante / Giant solitary fibrous tumor of the pleura

Las neoplasias pleurales primitivas son poco frecuentes. El tumor fibroso solitario pleural (TFSP) es una variedad benigna de tumor pleural primitivo, de clínica habitualmente silente y hallazgo incidental. Sin embargo, en ocasiones puede tener una evolución localmente agresiva e incluso puede poner en peligro la vida del paciente. El tratamiento de elección es la resección quirúrgica. Aportamos un caso de TFSP en una paciente de 78 años de edad sin antecedentes de significación cuya sintomatología inicial fue insuficiencia respiratoria importante, y que como tratamiento precisó una toracotomía posterolateral ampliada para realizar la exéresis completa de un TFSP de 2 kg de peso (AU)

Primitive neoplasms of the pleura are uncommon. Solitary fibrous tumor of the pleura (SFTP) is a benign variety of primitive pleural tumor, which is usually asymptomatic and discovered as an incidental finding. However, these tumors can sometimes be-come locally aggressive and can even be life-threate-ning. The treatment of choice is surgical resection. We report a case of SFTP in a 78-year-old woman with no relevant history, who presented with marked respiratory insufficiency and who required extended posterolateral thoracotomy to achieve complete resection of an SFTP weighing 2 kg (AU)

[Giant solitary fibrous tumor of the pleura]. / Tumor fibroso solitario pleural gigante.

Primitive neoplasms of the pleura are uncommon. Solitary fibrous tumor of the pleura (SFTP) is a benign variety of primitive pleural tumor, which is usually asymptomatic and discovered as an incidental finding. However, these tumors can sometimes become locally aggressive and can even be life-threatening. The treatment of choice is surgical resection. We report a case of SFTP in a 78-year-old woman with no relevant history, who presented with marked respiratory insufficiency and who required extended posterolateral thoracotomy to achieve complete resection of an SFTP weighing 2 kg.

Quiste de duplicación esofágica / Esophageal duplication cyst

Los quistes de duplicación esofágica son alteraciones congénitas del esbozo digestivo. Su incidencia se ha estimado en 1/8.200 nacimientos, con una mayor preponderancia en varones. En adultos suele ser un hallazgo casual. Su tratamiento siempre debe ser quirúrgico, incluso cuando los pacientes están asintomáticos, dada la posibilidad de desarrollar síntomas y complicaciones durante el curso natural de la enfermedad y por el hecho de que el diagnóstico definitivo sólo puede establecerse con la pieza quirúrgica. Presentamos el caso de un paciente varón de 37 años al que se diagnosticó radiológicamente de manera casual de un quiste de duplicación esofágica y que precisó una toracotomía para su exéresis (AU)

Corrección de una hernia diafragmática postraumática por vía torácica / Repair of a post-traumatic diaphragmatic hernia through the thoracic approach

La perforación traumática del diafragma es una lesión que se caracteriza por diagnosticarse de forma tardía y producir una alta tasa de mortalidad. Su incidencia es cada vez mayor, ocurre en el 1-5 por ciento de los accidentes de automóvil y en el 10-15 por ciento de las lesiones penetrantes en el tórax bajo. El porcentaje de lesiones diafragmáticas que no se diagnostica inicialmente oscila entre el 12 y el 60 por ciento. El tratamiento es quirúrgico y debe ser urgente. No existe unanimidad respecto a la vía de abordaje. Suele llevarse a cabo preferentemente por la vía abdominal, dado que permite un mejor control de las posibles lesiones intraabdominales asociadas. Exponemos el caso de un paciente que presentó una herniación del estómago y el bazo a través de una rotura en el hemidiafragma izquierdo. La corrección quirúrgica del cuadro, incluida una esplenectomía, fue llevada a cabo por abordaje torácico (AU)

Tumor carcinoide bronquial. Presentación atípica y tratamiento quirúrgico / Bronchial carcinoid tumor. Atypical presentation and surgical treatment

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Colocación de marcapasos diafragmático por toracotomía mínima para tratamiento de hipo incoercible / Diaphragmatic pacemaker implant by minimal thoracotomy for the treatment of hippuc

Presentamos un caso de hipo incoercible de cuatro años de duración y con clínica de pérdida de peso y fatiga. Refractario al tratamiento médico. Se le implantó un marcapasos diafragmático por vía intratorácica. Este aparato controla los movimientos del diagragma por estimulación eléctrica del nervio frénico. Se consiguió con ello disminuir la intensidad de los episodios de hipo. Este caso constituye la primera experiencia en España de tratamiento de hipo incoercible con marcapasos frénico