Use of oxazolidinones (linezolid or tedizolid) for the treatment of breast infections. A case series from a tertiary referral hospital.

OBJECTIVES: Mastitis is mainly caused by Gram-positive bacteria and usually involves treatment with beta-lactam antibiotics and clindamycin. Oxazolidinones show good results in the treatment of skin and soft tissue infections (SSTIs) due to its pharmacokinetic characteristics. We aimed to describe clinical characteristics and outcomes of patients who received oxazolidinones for the treatment of SSTIs of the mammary tissue. METHODS: Retrospective single-centre study of patients with a diagnosis of breast infection who received treatment with oxazolidinones as initial or salvage therapy between September 2016 and November 2022. Patients were identified through the pharmacy database. The primary outcome was clinical cure. RESULTS: Twenty-nine patients received oxazolidinones: 27 received linezolid and 2 tedizolid. Median age was 41 years (IQR 31.0-56.5) and 28 patients were female. Ten patients (35%) had a history of breast cancer, while three (10%) had an immunosuppressive condition. Microbiological isolation was obtained in 24 individuals (83%). Predominant isolations were methicillin-resistant Staphylococcus aureus (8, 28%) and methicillin-susceptible S. aureus (7, 24%). Twenty-four patients (83%) received oxazolidinones as a salvage therapy, with a median duration of 14 days (IQR 10-17). Clinical cure was achieved in 24 patients (83%), while 4 relapsed after a median of 15 days (IQR 4-34). One was lost to follow-up. Three patients (10%) were taking selective serotonin reuptake inhibitors, and one of them concurrently received linezolid for 4 days with no adverse events recorded. Cytopenia during treatment was observed in 2/12 individuals. Oxazolidinones allowed hospital discharge in 11/13 hospitalized patients. CONCLUSIONS: Oxazolidinones could be considered as an alternative for treating breast infections.

Surgical treatment of lung cancer with synchronous adrenal metastases: Adrenalectomy first. / Tratamiento quirúrgico de metástasis suprarrenal sincrónica de cáncer de pulmón: adrenalectomía primero.

INTRODUCTION: The aim of this study is to present our patients with lung cancer and synchronous adrenal metastases treated with a reversal approach: starting with adrenalectomy and doing the lung resection second. METHODS: A total of 108 laparoscopic adrenalectomies were performed, and we analyze a consecutive serie of 10 patients with isolated adrenal synchronous metastases from the lung, surgically treated in a sequential way. All patients underwent staging mediastinoscopy, and patients with positive lymph nodes were primary treated with chemotherapy. We analyze: postoperative morbidity, length of stay, time between the 2surgeries, suvival free progression and global survival. Survival analysis was performed by the Kaplan-Meier method. RESULTS: Mean age: 56.8 (41-73) years old. Of the total, 8 patients were surgically performed by laparoscopy. Metastases average size: 5.9 (3-10) cm. Days between the 2surgeries were 28 (12-35) days. No morbidity after adrenalectomy. Length of stay was 4.3 (3-5) days. Disease-free survival at 2 years was 60%, the 5-year overall survival was 30%, with a median survival of 41.5 (0-98) months. CONCLUSIONS: Adrenalectomy involves no significant morbidity and can be performed safely without delaying lung surgery, and allows us to operate the primary lung tumor successfully as long as we ensure complete resection of the adrenal gland. A multidisciplinary oncology committee must individualize all cases and consider this therapeutic approach in all patients with resectable primary tumor and resectable adrenal metastases.

Tratamiento quirúrgico de metastasis suprarrenal sincrónica de cáncer de pulmón: adrenalectomía primero / Surgical treatment of lung cancer with synchronous adrenal metastases: adrenalectomy first

INTRODUCCIÓN: El objetivo de este estudio es presentar nuestra serie de pacientes con carcinoma pulmonar y metástasis única suprarrenal sincrónica tratados de manera secuencial inversa: primero adrenalectomía y después resección pulmonar. MÉTODOS: Del total de 108 adrenalectomías laparoscópicas transperitoneales realizadas se analiza de manera retrospectiva una serie consecutiva de 10 pacientes diagnosticados de tumor primario de pulmón con metástasis suprarrenal sincrónica tratados de manera secuencial inversa. A todos se les realizó mediastinoscopia de estadificación; aquellos con metástasis ganglionares recibieron inducción. Las variables analizadas fueron: morbilidad tras adrenalectomía y tras resección pulmonar, estancia hospitalaria, tiempo entre ambas intervenciones, intervalo libre de enfermedad y supervivencia global. La supervivencia se analizó según el método de Kaplan-Meier. RESULTADOS: Edad media: 56,8 años (rango: 41-73). Del total, 8 casos se intervinieron por laparoscopia. Tamaño medio de la metástasis: 5,9cm (rango: 3-10). Tiempo medio entre ambas intervenciones: 28 días (rango: 12-35). No hubo complicaciones tras la adrenalectomía. Estancia media: 4,3 días (rango: 3-5). La supervivencia libre de enfermedad a los 2años fue del 50% y la supervivencia global a los 5 años fue del 30%, con una supervivencia global mediana de 41,5 meses (rango: 0-98). CONCLUSIONES: La adrenalectomía para metástasis de carcinoma pulmonar tiene baja morbilidad, no retrasa la resección del tumor primario y permite realizar la resección pulmonar una vez asegurada la resección completa de la metástasis. Por tanto, a falta de ensayos clínicos, un comité multidisciplinar debe considerar de forma individualizada esta opción terapéutica para todos aquellos pacientes en quienes la estadificación clínica de su carcinoma indique que tanto el tumor primario como la metástasis pueden extirparse de forma completa

INTRODUCTION: The aim of this study is to present our patients with lung cancer and synchronous adrenal metastases treated with a reversal approach: starting with adrenalectomy and doing the lung resection second. METHODS: A total of 108 laparoscopic adrenalectomies were performed, and we analyze a consecutive serie of 10 patients with isolated adrenal synchronous metastases from the lung, surgically treated in a sequential way. All patients underwent staging mediastinoscopy, and patients with positive lymph nodes were primary treated with chemotherapy. We analyze: postoperative morbidity, length of stay, time between the 2surgeries, suvival free progression and global survival. Survival analysis was performed by the Kaplan-Meier method. RESULTS: Mean age: 56.8 (41-73) years old. Of the total, 8 patients were surgically performed by laparoscopy. Metastases average size: 5.9 (3-10) cm. Days between the 2surgeries were 28 (12-35) days. No morbidity after adrenalectomy. Length of stay was 4.3 (3-5) days. Disease-free survival at 2 years was 60%, the 5-year overall survival was 30%, with a median survival of 41.5 (0-98) months. CONCLUSIONS: Adrenalectomy involves no significant morbidity and can be performed safely without delaying lung surgery, and allows us to operate the primary lung tumor successfully as long as we ensure complete resection of the adrenal gland. A multidisciplinary oncology committee must individualize all cases and consider this therapeutic approach in all patients with resectable primary tumor and resectable adrenal metastases

Seccionectomía lateral izquierda por laparoscopia. Presentación de nuestra técnica / Laparoscopic Left Lateral Sectionectomy. Presentation of Our Technique

Introducción En cirugía hepática, la laparoscopia no ha conseguido la difusión obtenida en otras áreas debido a la complejidad de este tipo de cirugía y a la falta de equipos quirúrgicos con experiencia en ambos campos. Material y métodos El objetivo de este trabajo es presentar la técnica utilizada en nuestro centro para realizar la seccionectomía lateral izquierda por laparoscopia (SLI). Entre febrero de 2000 y julio de 2010, 70 pacientes han sido intervenidos por laparoscopia por patología hepática, tanto benigna como maligna. En veintiún casos se realizó una SLI según la técnica descrita. Se describe la técnica quirúrgica, destacando aspectos como la disposición de los trocares, la movilización del hígado o la transección hepática. Se analiza la morbimortalidad relacionada con el procedimiento. Resultados Se ha realizado la SLI en 12 mujeres y 9 hombres con edades comprendidas entre los 35 y los 89 años. El número de lesiones fue de 1,4 (entre 1 y 4), con un tamaño de 3,5cm. El tiempo operatorio fue de 142min (entre 90 y 210). Hubo una conversión a laparotomía. Se registraron complicaciones en 3 pacientes (14%). No hubo reintervenciones y un paciente requirió una transfusión. La estancia media hospitalaria fue de 4,3 días. Conclusiones Las mejoras técnicas y la mayor experiencia en laparoscopia han permitido plantear la realización de este procedimiento con una morbilidad inferior al 15% y una mortalidad nula. La SLI es una técnica segura y efectiva en pacientes seleccionados. La descripción detallada de este procedimiento puede estimular a otros grupos de cirugía hepática a realizar este abordaje (AU)

Introduction Laparoscopy has not been as widely used in hepatic surgery as in other areas due to the complexity of this type of surgery and the lack of surgical teams with experience in both fields. Material and methods The aim of this work is to present the technique used in our centre to perform left lateral sectionectomy (LLS) using laparoscopy. A total of 70 patients have been operated on using laparoscopy due to both benign and malignant liver between February 2000 and July 2010. An LLS was performed on twenty-one cases using the technique described. The surgical technique is described, highlighting aspects such as, the arrangement of the trocars, the mobilisation of the liver or hepatic transection. The morbidity and mortality associated with the procedure are analysed. Results LLS was performed on 12 women and nine men, with ages between 35 and 89 years. The mean number of lesions was 1.4 (between 1 and 4), with a mean size of 3.5cm. The mean surgical time was 142min (between 90 and 210). There was one conversion to laparotomy. Complications were recorded in 3 (14%) patients. There were no repeat surgery, and one patient required a transfusion. The mean hospital stay was 4.3 days. Conclusions The best techniques and the wide experience in laparoscopy have enabled this technique to become established, with a morbidity of less than 15% and zero mortality. LLS is a safe and effective technique in selected patients. The detailed description of this procedure may stimulate other surgery groups to perform this approach (AU)

[Laparoscopic left lateral sectionectomy. Presentation of our technique]. / Seccionectomía lateral izquierda por laparoscopia. Presentación de nuestra técnica.

INTRODUCTION: Laparoscopy has not been as widely used in hepatic surgery as in other areas due to the complexity of this type of surgery and the lack of surgical teams with experience in both fields. MATERIAL AND METHODS: The aim of this work is to present the technique used in our centre to perform left lateral sectionectomy (LLS) using laparoscopy. A total of 70 patients have been operated on using laparoscopy due to both benign and malignant liver between February 2000 and July 2010. An LLS was performed on twenty-one cases using the technique described. The surgical technique is described, highlighting aspects such as, the arrangement of the trocars, the mobilisation of the liver or hepatic transection. The morbidity and mortality associated with the procedure is analysed. RESULTS: LLS was performed on 12 women and nine men, with ages between 35 and 89 years. The mean number of lesions was 1.4 (between 1 and 4), with a mean size of 3.5 cm. The mean surgical time was 142 minutes (between 90 and 210). There was one conversion to laparotomy. Complications were recorded in 3 (14%) patients. There were no repeat surgery, and one patient required a transfusion. The mean hospital stay was 4.3 days. CONCLUSIONS: The best techniques and the wide experience in laparoscopy has enabled this technique to become established, with a morbidity of less than 15% and zero mortality. LLS is a safe and effective technique in selected patients. The detailed description of this procedure may stimulate other surgery groups to perform this approach.