Culmenectomía videotoracoscópica uniportal / No disponible

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Manejo del neumotórax / No disponible

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Tratamiento quirúrgico en mediastinitis aguda necrotizante descendente / Surgical treatment in acute descending necrotizing mediastinitis

FUNDAMENTO: Analizar los resultados obtenidos en nuestraexperiencia en el tratamiento quirúrgico de la mediastinitis agudanecrotizante descendente (MAND).MÉTODO: Análisis retrospectivo, descriptivo, transversal yobservacional de los casos consecutivos registrados durante el períodocomprendido entre 1996 y 2003.RESULTADOS: Edad media de los pacientes: 43 años (rango:27-71). Sexo: 7 hombres (87’5%) y 1 mujer (12’5%). Origen: 2abscesos sublinguales (25%), 2 abscesos retrofaríngeos (25%), 1absceso odontógeno (12’5%), 1 flemón laríngeo (12’5%) y 2 sinfoco infeccioso aparente. Seis pacientes (75%) fueron diagnosticadosy tratados en menos de 24 horas y dos (25%) pasadas las primeras24 horas. La TAC de tórax fue la prueba de imagen que confirmóel diagnóstico en todos los casos registrados. En todos loscasos se realizó toracotomía posterolateral estándar, y en ningúncaso fue necesaria la retoracotomía. Excepto en dos pacientes enlos que el cultivo del líquido pleural fue negativo, en el resto de loscasos se cultivó un Estreptococo, siendo el más frecuentemente aisladoel S. Viridans. Dos casos cursaron sin ningún tipo de complicacionesen el postoperatorio. En el resto de casos, las complicacionespostoperatorias más frecuentes, de mayor a menor frecuencia,fueron: neumonía asociada a ventilación mecánica, atelectasia,derrame pleural y shock séptico. La estancia hospitalaria postoperatoriaentre los pacientes que sobrevivieron fue de 32 días. De losocho pacientes, dos (25%) fallecieron en el postoperatorio.CONCLUSIONES: La mortalidad global en nuestro servicioes del 25%, porcentaje que coincide con la literatura revisada.Nuestros datos apuntan hacia la conveniencia de una indicaciónquirúrgica precoz antes de 24 horas después del diagnóstico, condesbridamiento quirúrgico completo del mediastino, que en nuestraserie se ha realizado a través de toracotomía estándar. El abordajevideotoracoscópico puede ser una buena alternativa en manosexperimentadas y siempre que se lleve a cabo precozmente

OBJECTIVE: To analyze the results obtained from our experiencein the surgical treatment of acute descending necrotizingmediastinitis (ADNM).METHOD: Retrospective, descriptive, cross-sectional andobservational analysis of the consecutive cases registered duringthe period covered between 1996 and 2003.RESULTS: Average age of the patients: 43 years (range: 27-71). Sex: 7 men (87.5 %) and 1 woman (12.5 %). Origin: 2 sublingualabscesses (25 %), 2 retropharyngeal abscesses (25 %), 1 odontogenicabscess (12.5 %), 1 laryngeal abscess (12.5 %) and 2without apparent infectious focus. Six patients (75 %) were diagnosedand treated in less than 24 hours and two (25 %) after thefirst 24 hours. (The) Diagnoses were confirmed by thoracic CATscan. In all (the) cases standard posterolateral thoracotomy wasperformed, with none of the cases requiring rethoracotomy. Streptococcuswas cultivated in all but two cases which gave negativeresults with pleural fluid culture. The most frequent isolate bacteriain (the) positive cultures was S. Viridans. Two cases had no postoperativecomplications of any kind. In the rest of the cases, themost frequent postoperative complications, from higher to lowerfrequency, were: pneumonia associated with mechanical ventilation,atelectasis, pleural effusion and septic shock. The postoperativehospitable stay among (the) surviving patients was 32 days.There were two (25 %) postoperative deaths among the eightpatients.CONCLUSIONS: (The) Global mortality in our Service is 25%, which coincides with the reviewed literature. Our data pointtowards the advisability of an early surgical intervention within 24hours of diagnosis, with complete surgical debridement of themediastinum which in our series was achieved through standardthoracotomy. The videothoracoscopic approach can be a goodalternative in experienced hands and with early intervention

[Diffuse thoracic lymphangiomatosis: diagnosis and treatment]. / Linfangiomatosis torácica difusa: diagnóstico y tratamiento.

Histologically, lymphangiomatosis is a rare type of benign neoplasm caused by abnormal development and proliferation of the lymphatic system. Thoracic lymphangiomatosis can present in a localized (lymphangioma) or diffuse form (lymphangiomatosis). In most cases the disease progresses to serious morbidity or even death. The treatment of choice for localized disease is usually surgery or, less frequently, local injection of sclerosing agents (streptococcus antigen OK-432). However, in diffuse forms there is a gelatinous infiltrate without defined limits. In these cases the main treatment option is radiotherapy. We report 2 cases of diffuse thoracic lymphangiomatosis with pulmonary infiltrate. In both cases radiotherapy in appropriate doses successfully eliminated pulmonary infiltrates, pleural effusion, dyspnea, and general discomfort. Surgery was needed to resolve complications of the disease and for diagnosis.

[Bronchiolitis obliterans organizing pneumonia and bronchogenic carcinoma coexisting in different parts of the lungs]. / Coexistencia de bronquiolitis obliterante con neumonía organizada y carcinoma broncogénico en zonas pulmonares distantes.

Bronchiolitis obliterans organizing pneumonia (BOOP) coexisting with nonsmall cell lung cancer in a separate part of the lungs is rare. We report the case of a man diagnosed with BOOP by video-assisted thoracoscopic lung biopsy; the patient also had adenocarcinoma in a different part of the lungs. The BOOP was treated with corticosteroids and the carcinoma was surgically resected. Outcome and clinical course were good after both procedures. The possibility of BOOP associated with bronchogenic carcinoma at a distant part of the lungs, although rare, must be taken into account in the differential diagnosis of radiographic alterations that may present in either of the 2 diseases.

Coexistencia de bronquiolitis obliterante con neumonía organizada y carcinoma broncogénico en zonas pulmonares distantes / Bronchiolitis obliterans organizing pneumonia and bronchogenic carcinoma coexisting in different parts of the lungs

La coexistencia en un paciente de una bronquiolitis obliterante con neumonía organizada (BONO) y un carcinoma pulmonar no microcítico en zonas pulmonares distantes es un hecho muy infrecuente. Presentamos el caso de un paciente con diagnóstico mediante biopsia pulmonar por videotoracoscopia de BONO, que tenía asociado en una zona pulmonar alejada un adenocarcinoma pulmonar. La BONO recibió tratamiento corticoideo y el carcinoma se resecó quirúrgicamente. Ambos procesos presentaron una buena evolución.La posibilidad de que se presenten asociados una BONO y un carcinoma broncogénico en zonas pulmonares distantes, aunque muy infrecuente, deberá tenerse en cuenta en el diagnóstico diferencial de las alteraciones radiológicas que se puedan presentar en cualquiera de estas entidades patológicas (AU)

[Pulmonary sequestration: 2 cases (intralobar and extralobar) in surgically treated adults]. / Secuestro pulmonar: dos casos (intralobar y extralobar) en adultos, intervenidos quirúrgicamente.

We present two cases of pulmonary sequestration, one intralobar and the other extrapulmonary, in young adults. The diagnoses were obtained after surgical resection in both cases. The cases are of interest in that the first (intralobar sequestration) started with massive hemoptysis requiring emergency treatment, and the second (extrapulmonary sequestration) involved an unusual location in the upper mediastinum, requiring surgery by video assisted thoracoscopy.

[Primary tumors of the thoracic wall (1991-1994)]. / Tumores primitivos de pared torácica (1991-1994).

Between 1991 and 1994, 582 operations were performed in our service; 19 (3.26%) were on primitive tumors of the chest wall. We analyze the data for these patients, including age, sex, clinical findings, chest images, diagnoses, therapy and course. Ten tumors were benign and 9 were malignant. The most frequent clinical findings were pain and/or tumor. Diagnosis was achieved before surgery in only 2 cases. Except when there are clear macroscopic and X-ray signs that the tumor is benign, we performed broad exeresis of the chest wall, sometimes also resecting adjacent structures. The defect was repaired directly in 12 cases. The defects were covered by prostheses and/or muscle plasty in the remaining patients. The most frequent tumor was chondrosarcoma (3 cases), followed by 2 cases of osteoblastoma and osteochondroma. Only 1 each of the following tumors were found: plasmocytoma, chondroma, fibrous dysplasia, eosinophilic granuloma, osteosarcoma, Ewing's tumor, epithelioid sarcoma, fibrosarcoma, hemangioma, benign neurilemmoma, desmoid tumor and liposarcoma. Two patients with chondrosarcoma were operated on for recurrences and there was also recurrence in the patient with Ewing's tumor. We conclude that: 1) chest wall tumors are infrequent, 2) radical exeresis is the treatment of choice and prosthesis is often necessary, and 3) chondrosarcoma, with poor outcome in our patients, is the most frequent tumor.

[A superior vena cava syndrome secondary to a pleural fibrous mesothelioma]. / Síndrome de cava superior secundario a mesotelioma fibroso pleural.

Benign fibrous or pleural mesothelioma are rare tumors that seem to originate in the mesenchyma (subpleural fibromas). They are usually discovered by chance and the prognosis for the patient is favorable after surgery. If the tumors are large, extrapulmonary signs may be present (hypertrophic osteoarthropathy, hypoglycemia). We describe a case of unusually large fibrous mesothelioma of the pleura that presented as superior vena cava syndrome, a complication not described in the literature.