Bullhorn and bullfighting injuries.

PURPOSE: Our purpose was to present our hospital experience with bullhorn injuries. METHODS: A retrospective analysis of patients in our Trauma Registry (1993-2012). RESULTS: Fifteen patients were included. All were hemodynamically stable on presentation, with a mean Glasgow Coma Scale (GCS) score and a Revised Trauma Score (RTS) of 15 and 11.9, respectively. The Injury Severity Score (ISS) and New Injury Severity Score were 13.6 ± 6 and 15.9 ± 9, respectively. Seven had an ISS > 15. Injuries resulted from an isolated blunt trauma (BT) in four, penetrating trauma (PT) in seven, with extensive soft tissue injuries (STI) in three, and a combined BT + PT mechanism in four patients, with extensive STI in all. Three patients had injuries to vessels in the groin, two with prehospital vein ligation. Five patients had abdominal visceral injuries, and another had a sheathed goring, with a traumatic abdominal wall hernia and retroperitoneal hematoma. Four patients had thoracic injuries, and one of them had a traumatic thoracoplasty with a large open thoracic wound, a flail chest, and extensive STI. Two patients had traumatic brain injury, and six had bone fractures. Two-thirds of patients required a surgical procedure under general anesthesia. Morbidity included three surgical site infections, one leg compartment syndrome, and one persistent lymph drainage. There was no mortality, and the mean length of hospital stay was 16 days. CONCLUSIONS: Bullhorn and bullfighting injuries frequently have a multimechanistic origin which goes beyond a pure penetrating trauma. Associated blunt and STI were common in our series, and the overall prognosis of patients admitted to hospital was good.

Neumotórax de repetición / Recurrent pneumothorax

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Lipoma intraóseo en una costilla / Intraosseous lipoma of rib

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[Primary pulmonary lymphoma presenting as a pulmonary mass with cavitation]. / Masa cavitada como forma de presentación de un linfoma pulmonar primario.

Primary pulmonary lymphoma is a rare entity usually formed of B-type cells, usually low-grade and composed of mucosal- or bronchial-associated lymphoid tissue. High-grade primary pulmonary lymphomas usually occur in immunodeficient patients who mostly present with respiratory and nonspecific symptoms. A chest x-ray may show a pulmonary mass or atelectasis and pleural effusion. In such cases, the prognosis is worse than for low-grade pulmonary lymphomas; survival is 8 to 10 years and there is a higher probability of local progression or metastasis. We report the case of an immunocompetent 76-year-old patient who had a pulmonary mass with cavitation secondary to a large B-cell primary pulmonary lymphoma. After the fourth session of chemotherapy the pulmonary mass was reduced in size and an aspergilloma was seen to have developed in the residual cavity. A review of the literature revealed this case to be anecdotal as it is extremely infrequent for a primary pulmonary lymphoma to present in the form of a single mass with cavitation and with few symptoms.

Tratamiento quirúrgico de las metástasis pulmonares: estudio de supervivencia / Surgical treatment of pulmonary metastases: a study of survival

Objetivos: Estudiar los resultados del tratamiento quirúrgico de las metástasis pulmonares realizado en nuestra unidad. Pacientes y métodos: Analizamos retrospectivamente los pacientes intervenidos entre 1986 y 1999. Se incluyeron 44 pacientes a los que se practicó resecciones completas de las metástasis pulmonares, con tumor primario controlado, ausencia de metástasis extrapulmonares y capacidad funcional respiratoria suficiente. Los pacientes fueron distribuidos en grupos pronósticos según criterios del registro internacional de metástasis pulmonares. Resultados: Se practicaron 48 metastasectomías a 44 pacientes, 21 varones y 23 mujeres, con una edad media de 58 años (rango, 31-74). La histología del tumor primario más frecuente fue epitelial, con un 80 por ciento, sarcomas en un 9 por ciento, tumores germinales en un 2,2 por ciento, melanomas en un 2,2 por ciento y otros en un 6,4 por ciento. El intervalo libre de enfermedad medio fue de 37,3 (rango, 0-168), con una mediana de 30 meses. El 66,7 por ciento de los casos presentaron metástasis única y el 33,3 por ciento múltiples (17,9 por ciento bilaterales). La toracotomía posterolateral (66,7 por ciento) fue la vía de acceso más empleada. Se realizaron resecciones atípicas (86,6 por ciento) y lobectomías (11,1 por ciento). La mortalidad perioperatoria fue del 4,4 por ciento. La supervivencia media de la serie fue de 70 meses, del 87 por ciento al año, y del 29 por ciento a los 10 años. Para el grupo I (resecables sin factores de riesgo) (n = 13) fue del 100 por ciento al año y del 75 por ciento a los 10 años. El grupo II (resecables con un factor de riesgo) (n = 16) tuvo un supervivencia al año del 78 por ciento y a los 10 años del 12 por ciento. El grupo III (resecables con dos factores de riesgo) (n = 8) la supervivencia al año fue del 87 por ciento, del 62 por ciento a los 3 años, del 15 por ciento a los 4 años y nula a los 5 años. Log-rank *2 9,8 (2 df), p = 0,0097. Conclusiones: La cirugía de las metástasis pulmonares en pacientes seleccionados constituye un procedimiento terapéutico y diagnóstico con baja mortalidad y buena supervivencia. La clasificación por grupos pronósticos según el número de metástasis, intervalo libre de enfermedad y resecabilidad se correlaciona significativamente con la expectativa de supervivencia de los pacientes, con independencia de la histología del tumor primario. (AU)

Quiste de Gärtner gigante. A propósito de un caso asociado a útero polimiomatoso / Giant Gärtner's duct cyst. Report of a case associated with myomatous uterus

El quiste de Gärtner es un remanente de la porción vaginal de los conductos mesonéfricos. Clínicamente suelen ser asintomáticos. Los quistes retroperitoneales han sido clasificados como traumáticos, infecciosos, degenerativos, neoplásicos y dependientes de su origen. Las presentaciones clínicas dependen de su localización, y en especial los de origen mesotelial, mesonéfricos o paramesonéfricos (AU)

Hematoma de la vaina de los rectos: aportación de cuatro nuevos casos / Hematoma of the rectus sheath: four new cases

El hematoma de la vaina de los rectos es un proceso infrecuente que puede simular una enfermedad intraabdominal. El embarazo y las terapias anticoagulantes han sido señaladas como factores predisponentes y la tos como el principal factor precipitante. Se presentan cuatro casos de pacientes intervenidos quirúrgicamente por hematoma de la vaina de los rectos. Entre ellos, se describe una presentación excepcional de disección del espacio pélvico por el hematoma, ocasionando anuria por compresión vesical. Se discuten los factores etiopatogénicos, los métodos diagnósticos y las opciones terapéuticas (AU)

[Surgical treatment of pulmonary metastasis: survival study]. / Tratamiento quirúrgico de las metástasis pulmonares: estudio de supervivencia.

OBJECTIVE: To study the results of surgical treatment of pulmonary metastases in our department. PATIENTS AND METHODS: We retrospectively studied 44 patients undergoing surgery between 1986 and 1999 for complete resection of pulmonary metastases. Primary tumors had been eradicated, no metastasis to other organs was evident, and functional respiratory capacity was adequate. The patients were assigned to different prognostic groups based on the criteria of the International Registry of Lung Metastases. RESULTS: Forty-eight operations were performed on the 44 patients (21 men and 23 women) whose mean age was 58 years (31-74 years). The most frequent type of primary tumor was epithelial (82%); other types in order of frequency were sarcoma (9%), thyroid gland (4.4%), germ cell (2.2%) and melanoma (2.2%). The mean disease-free interval was 37.7 months (0.168) and the median was 30 months. A single site of metastasis was seen in 66.7% of the cases whereas 33.3% had multiple metastases (17.9% of them bilateral). Posterolateral thoracotomy was the surgical approach in over half the cases (66.7%). We performed wedge resections in 86.6% and lobectomies in 11.1%. Perioperative mortality was 4.4%. Mean survival was 70 months, with 87% alive at one year and 29% at 10 years. For group I (resectable, no risk factors; n = 13) survival was 100% at one year and 75% at 10 years. For group II (resectable, one risk factor; n = 16) the actuarial survival was 78% at one year and 12% at 10 years. For group III (resectable, two risk factors; n = 8), survival was 87% at one year, 62% at three years, 15% at four years and 0% at five years (Log-rank chi 2 9.8 [df = 2)], p = 0.0097). CONCLUSIONS: Surgical resection of pulmonary metastasis is a treatment and diagnostic procedure associated with low mortality and good survival. Prognostic grouping that takes into account number of metastases, disease-free interval and resectability correlates significantly with expected survival regardless of histological typing of the primary tumor.