[Stiff person syndrome associated with thymoma]. / Síndrome de la persona rígida asociado a timoma.

Stiff-person syndrome is a rare neurological condition characterized by muscular rigidity of the trunk and extremities and muscle spasms triggered by sensory or emotional stimuli, which progresses towards prostration. It has a pathophysiogenic mechanism with an immunological basis, in which autoantibodies, such as antiGAD65, play a central role. Likewise, the detection of these antibodies corroborates the diagnosis in a patient with a suggestive clinical picture. Four to 6% of cases have underlying neoplasms. Treatment is based on symptomatic, immunomodulatory, and underlying disease management in paraneoplastic cases. We report a case of classic stiff person syndrome associated with thymoma and review the main characteristics of this entity.

El síndrome de persona rígida es un cuadro neurológico infrecuente caracterizado por rigidez muscular de tronco y extremidades y espasmos musculares gatillados por estímulos sensoriales o emocionales, que progresa hacia la postración. Cuenta con un mecanismo fisiopatogénico con base inmunológica, en el cual los autoanticuerpos, como el antiGAD65, cumplen un rol central. Asimismo, la detección de dichos anticuerpos corrobora el diagnóstico ante un paciente con cuadro clínico sugestivo. Un 4 a 6% de los casos tienen neoplasias subyacentes. El tratamiento se basa en el manejo sintomático, inmunomodulador y de la enfermedad de base en los casos paraneoplásicos. Reportamos un caso de síndrome de persona rígida clásico asociado a timoma y describimos las características principales de esta entidad.

Síndrome de la persona rígida asociado a timoma / Stiff person syndrome associated with thymoma

Resumen El síndrome de persona rígida es un cuadro neuro lógico infrecuente caracterizado por rigidez muscular de tronco y extremidades y espasmos musculares ga tillados por estímulos sensoriales o emocionales, que progresa hacia la postración. Cuenta con un mecanismo fisiopatogénico con base inmunológica, en el cual los autoanticuerpos, como el antiGAD65, cumplen un rol central. Asimismo, la detección de dichos anticuerpos corrobora el diagnóstico ante un paciente con cuadro clínico sugestivo. Un 4 a 6% de los casos tienen neoplasias subyacentes. El tratamiento se basa en el manejo sintomático, inmunomodulador y de la enfermedad de base en los casos paraneoplásicos. Reportamos un caso de síndrome de persona rígida clásico asociado a timoma y describimos las características principales de esta entidad.

Abstract Stiff-person syndrome is a rare neurological condi tion characterized by muscular rigidity of the trunk and extremities and muscle spasms triggered by sensory or emotional stimuli, which progresses towards prostra tion. It has a pathophysiogenic mechanism with an immunological basis, in which autoantibodies, such as antiGAD65, play a central role. Likewise, the detec tion of these antibodies corroborates the diagnosis in a patient with a suggestive clinical picture. Four to 6% of cases have underlying neoplasms. Treatment is based on symptomatic, immunomodulatory, and underlying disease management in paraneoplastic cases. We re port a case of classic stiff person syndrome associated with thymoma and review the main characteristics of this entity.

[PEComa of the lung]. / PEComa pulmonar.

Clear cell "sugar" tumor of the lung is a rare benign tumor arising from perivascular epithelioid cells (PECs). They belong to a group of mesenchymal neoplasms called PEComas. Although widely presumed as benign, due to their rich vascular stroma they are usually avid for the different types of contrast agents used in imaging studies, mimicking a malignant lesion. We report the case of a 66-year-old man in whom a solitary pulmonary nodule was discovered during oncological staging for an adenocarcinoma of the prostate who underwent an anatomical pulmonary segmentectomy. The final pathology result was a perivascular epithelioid cell tumor (pulmonary PEComa or clear "sugar" cell tumor).

Los tumores de células claras "de azúcar" (CCTL) son lesiones benignas muy infrecuentes. Forman parte de un grupo de neoplasias mesenquimales denominadas PEComas que se originan de las células epiteloides perivasculares. Por su rico estroma vascular, suelen tener avidez por los distintos tipos de contrastes utilizados en los estudios de diagnóstico por imágenes, simulando lesiones de estirpe maligna. Presentamos el caso de un paciente de 66 años con hallazgo de un nódulo pulmonar durante la estadificación oncológica por adenocarcinoma de próstata al que se le realizó una segmentectomía pulmonar anatómica. El resultado definitivo de anatomía patológica fue tumor de células epiteloides perivasculares (PEComa pulmonar o tumor de células claras "de azúcar").

PEComa pulmonar / PEComa of the lung

Resumen Los tumores de células claras "de azúcar" (CCTL) son lesiones benignas muy infrecuentes. Forman parte de un grupo de neoplasias mesenquimales denominadas PEComas que se originan de las células epiteloides perivasculares. Por su rico estroma vascular, suelen tener avidez por los distintos tipos de contrastes utilizados en los estudios de diagnóstico por imágenes, simulando lesiones de estirpe maligna. Presentamos el caso de un paciente de 66 años con hallazgo de un nódulo pulmonar durante la estadificación oncológica por adenocarcinoma de próstata al que se le realizó una segmentectomía pulmonar anatómica. El resultado definitivo de anatomía patológica fue tumor de células epiteloides perivasculares (PEComa pulmonar o tumor de células claras "de azúcar").

Abstract Clear cell ''sugar'' tumor of the lung is a rare benign tumor arising from perivascular epithelioid cells (PECs). They belong to a group of mesenchymal neoplasms called PEComas. Although widely presumed as benign, due to their rich vascular stroma they are usually avid for the different types of contrast agents used in imaging studies, mimicking a malignant lesion. We report the case of a 66-year-old man in whom a solitary pul monary nodule was discovered during oncological staging for an adenocarcinoma of the prostate who underwent an anatomical pulmonary segmentectomy. The final pathology result was a perivascular epithelioid cell tumor (pulmonary PEComa or clear "sugar" cell tumor).

Resultados del tratamiento quirúrgico en neoplasias epiteliales de timo / Outcomes of surgical treatment for thymic epithelial neoplasms

Resumen Las neoplasias epiteliales del timo (NET) son tumores infrecuentes. El manejo inicial de las mismas se basa en el análisis de la resecabilidad del tumor en los estudios por imágenes, siendo la resección completa el tratamiento estándar para cualquier estadio. El objetivo principal fue evaluar la supervivencia global y la supervivencia libre de enfermedad de los pacientes con diagnóstico de NET sometidos a tratamiento quirúrgico. El objetivo secundario fue comparar la supervivencia global de acuerdo al tipo de resección quirúrgica, el estadio de Masaoka-Koga y subtipo histológico. Estudio observacional descriptivo realizado en el Hospital Británico de Buenos Aires desde 2004 a 2020. Se incluyeron 42 pacientes operados de tumores en mediastino anterior con diagnóstico histopatológico definitivo de NET. Treinta y nueve eran timomas y 3 carcinomas tímicos. La cirugía realizada en todos los pacientes fue una timectomia total. La mediana de seguimiento fue de 63.5 meses (RIQ 32-97.5). La supervivencia global estimada a los cinco y diez años fue del 87% (95% IC, 0.69-0.95) y 78% (95% IC, 0.5-0.92), respectivamente. La supervivencia libre de enfermedad estimada a cinco y diez años fue del 90% (95% IC, 0.74-0.96). Los pacientes a los que se le realizó una resección completa y que tenían estadios tem pranos de Masaoka-Koga presentaron una supervivencia global superior en comparación con las resecciones incompletas y estadios avanzados (p = 0.0097 y p = 0.0028, respectivamente). Al contar con un bajo número de pacientes en el grupo de carcinomas tímicos, no pudimos sacar conclusiones en cuanto a supervivencia entre éstos y los timomas.

Abstract Thymic epithelial tumors are a group of rare neoplasms of the mediastinum. When resectable, complete resection is considered the gold standard for any stage. The primary endpoint was to evaluate overall survival and disease-free survival of patients with thymus epithelial tumors who underwent surgical treatment. The secondary endpoint was to evaluate and compare the overall survival according to: resection type (complete vs. incomplete), Masaoka-Koga stage and tumor histology according to WHO classification. This is a descriptive observational study from January 2004 to December 2020, in which 42 patients with a postoperative histopathological diagnosis of thymic epithelial tumours were included. Thirty-nine were thymomas (92.9%) and 3 were thymic carcinomas (7.1%). In all patients a total thymectomy was performed. The median follow-up was 63.5 months (IQR 32-97.5). The estimated overall survival at five and ten years was 87% (95% CI, 0.69-0.95) and 78% (95% CI, 0.5-0.92), respectively. Estimated disease-free survival at five and ten years was 90% (95% CI, 0.74-0.96). Patients who underwent complete resection and with early Masaoka-Koga stages had superior overall survival compared to incomplete resections and advanced Masaoka-Koga stages (p = 0.0097 and p = 0.0028, respectively). We found no differences in terms of survival between histological subtypes due to a low number of patients in the thymic carcinoma group.

[Outcomes of surgical treatment for thymic epithelial neoplasms]. / Resultados del tratamiento quirúrgico en neoplasias epiteliales de timo.

Thymic epithelial tumors are a group of rare neoplasms of the mediastinum. When resectable, complete resection is considered the gold standard for any stage. The primary endpoint was to evaluate overall survival and disease-free survival of patients with thymus epithelial tumors who underwent surgical treatment. The secondary endpoint was to evaluate and compare the overall survival according to: resection type (complete vs. incomplete), Masaoka-Koga stage and tumor histology according to WHO classification. This is a descriptive observational study from January 2004 to December 2020, in which 42 patients with a postoperative histopathological diagnosis of thymic epithelial tumours were included. Thirty-nine were thymomas (92.9%) and 3 were thymic carcinomas (7.1%). In all patients a total thymectomy was performed. The median follow-up was 63.5 months (IQR 32-97.5). The estimated overall survival at five and ten years was 87% (95% CI, 0.69-0.95) and 78% (95% CI, 0.5-0.92), respectively. Estimated diseasefree survival at five and ten years was 90% (95% CI, 0.74-0.96). Patients who underwent complete resection and with early Masaoka-Koga stages had superior overall survival compared to incomplete resections and advanced Masaoka-Koga stages (p = 0.0097 and p = 0.0028, respectively). We found no differences in terms of survival between histological subtypes due to a low number of patients in the thymic carcinoma group.

Las neoplasias epiteliales del timo (NET) son tumores infrecuentes. El manejo inicial de las mismas se basa en el análisis de la resecabilidad del tumor en los estudios por imágenes, siendo la resección completa el tratamiento estándar para cualquier estadio. El objetivo principal fue evaluar la supervivencia global y la supervivencia libre de enfermedad de los pacientes con diagnóstico de NET sometidos a tratamiento quirúrgico. El objetivo secundario fue comparar la supervivencia global de acuerdo al tipo de resección quirúrgica, el estadio de Masaoka-Koga y subtipo histológico. Estudio observacional descriptivo realizado en el Hospital Británico de Buenos Aires desde 2004 a 2020. Se incluyeron 42 pacientes operados de tumores en mediastino anterior con diagnóstico histopatológico definitivo de NET. Treinta y nueve eran timomas y 3 carcinomas tímicos. La cirugía realizada en todos los pacientes fue una timectomia total. La mediana de seguimiento fue de 63.5 meses (RIQ 32-97.5). La supervivencia global estimada a los cinco y diez años fue del 87% (95% IC, 0.69-0.95) y 78% (95% IC, 0.5-0.92), respectivamente. La supervivencia libre de enfermedad estimada a cinco y diez años fue del 90% (95% IC, 0.74-0.96). Los pacientes a los que se le realizó una resección completa y que tenían estadios tempranos de Masaoka-Koga presentaron una supervivencia global superior en comparación con las resecciones incompletas y estadios avanzados (p = 0.0097 y p = 0.0028, respectivamente). Al contar con un bajo número de pacientes en el grupo de carcinomas tímicos, no pudimos sacar conclusiones en cuanto a supervivencia entre éstos y los timomas.

Incidental pulmonary carcinoid tumorlet associated with lung cancer / Tumorlet carcinoide pulmonar incidental asociado a cáncer de pulmón

Abstract Lung tumorlets are rare neuroendocrine neoplasms of 0.5 cm or less in diameter that extend beyond the basement membrane. Although they are associated with bronchiectasis and fibrosis they tend to be asymptomatic and behave in a benign way, usually being diagnosed as incidental microscopic nests of neuroendocrine cells in lung tissue. We present a case of a pulmonary tumorlet finding after right upper lobectomy for lung cancer.

Resumen. Los tumorlets pulmonares son neoplasias neuroendocrinas poco frecuentes, que se extienden más allá de la membrana basal y miden 0.5 cm o menos de diámetro. Aunque suelen asociarse a bronquiectasias y fibrosis pulmonar, suelen ser asintomáticas comportándose de una manera indolente, siendo usualmente diagnosticadas de forma incidental en el estudio microscópico de una pieza pulmonar. Presentamos el caso de un tumorlet pulmonar incidental luego de una lobectomía superior derecha por cáncer de pulmón.

Incidental pulmonary carcinoid tumorlet associated with lung cancer.

Lung tumorlets are rare neuroendocrine neoplasms of 0.5 cm or less in diameter that extend beyond the basement membrane. Although they are associated with bronchiectasis and fibrosis they tend to be asymptomatic and behave in a benign way, usually being diagnosed as incidental microscopic nests of neuroendocrine cells in lung tissue. We present a case of a pulmonary tumorlet finding after right upper lobectomy for lung cancer.

Los tumorlets pulmonares son neoplasias neuroendocrinas poco frecuentes, que se extienden más allá de la membrana basal y miden 0.5 cm o menos de diámetro. Aunque suelen asociarse a bronquiectasias y fibrosis pulmonar, suelen ser asintomáticas comportándose de una manera indolente, siendo usualmente diagnosticadas de forma incidental en el estudio microscópico de una pieza pulmonar. Presentamos el caso de un tumorlet pulmonar incidental luego de una lobectomía superior derecha por cáncer de pulmón.

Neumotórax catamenial / Catamenial pneumothorax

Resumen El síndrome de endometriosis torácica (TES) es un trastorno poco común caracterizado por la presencia de tejido endometrial ectópico en la cavidad torácica. La manifestación clínica típica es un neumotórax espontáneo, que generalmente se presenta con dolor torácico, disnea y/o tos. El diagnóstico requiere un alto nivel de sospecha clínica junto con una historia ginecológica completa. Los estudios de imáge nes pueden ayudar con el diagnóstico, pero el gold standard es la cirugía toracoscópica videoasistida (VATS). Se ha demostrado que el tratamiento quirúrgico en combinación con al menos 6 meses de tratamiento médico hormonal mejora el pronóstico y reduce la recurrencia de esta entidad. Presentamos el caso de una paciente de 40 años con antecedentes de endometriosis pélvica y múltiples episodios de neumotórax, que consultó en nuestra institución por un nuevo episodio de neumotórax espontáneo. Se realizó una VATS donde se identificaron nódulos en la pleura parietal y orificios diafragmáticos. En el postoperatorio continuó con tratamiento hormonal. A los 6 meses de seguimiento refirió mejoría del dolor y no presentó nuevos episodios de neumotórax.

Abstract. Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical manifestation is a spontaneous pneumothorax, which usually presents with chest pain, dyspnea, and/or cough. The diagnosis requires a high level of clinical suspicion and a complete gynecological history. Imaging studies can help with the diagnosis, although the gold standard is video-assisted thoracoscopic surgery (VATS). Surgical treatment in combination with at least 6 months of hormonal medical treatment has been shown to improve the prognosis and reduce the recurrence of this entity. We present the case of a 40-year-old patient with a history of pelvic endometriosis and multiple episodes of pneumothorax, who consulted at our institution for a new episode of spon taneous pneumothorax. A VATS was performed where nodules in the parietal pleura and diaphragmatic orifices were identified. In the postoperative period, she continued with hormonal treatment. At 6 months of follow-up, she reported improvement in pain and did not present new episodes of pneumothorax.

[Catamenial pneumothorax]. / Neumotórax catamenial.

Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical manifestation is a spontaneous pneumothorax, which usually presents with chest pain, dyspnea, and/or cough. The diagnosis requires a high level of clinical suspicion and a complete gynecological history. Imaging studies can help with the diagnosis, although the gold standard is video-assisted thoracoscopic surgery (VATS). Surgical treatment in combination with at least 6 months of hormonal medical treatment has been shown to improve the prognosis and reduce the recurrence of this entity. We present the case of a 40-year-old patient with a history of pelvic endometriosis and multiple episodes of pneumothorax, who consulted at our institution for a new episode of spontaneous pneumothorax. A VATS was performed where nodules in the parietal pleura and diaphragmatic orifices were identified. In the postoperative period, she continued with hormonal treatment. At 6 months of follow-up, she reported improvement in pain and did not present new episodes of pneumothorax.

El síndrome de endometriosis torácica (TES) es un trastorno poco común caracterizado por la presencia de tejido endometrial ectópico en la cavidad torácica. La manifestación clínica típica es un neumotórax espontáneo, que generalmente se presenta con dolor torácico, disnea y/o tos. El diagnóstico requiere un alto nivel de sospecha clínica junto con una historia ginecológica completa. Los estudios de imágenes pueden ayudar con el diagnóstico, pero el gold standard es la cirugía toracoscópica videoasistida (VATS). Se ha demostrado que el tratamiento quirúrgico en combinación con al menos 6 meses de tratamiento médico hormonal mejora el pronóstico y reduce la recurrencia de esta entidad. Presentamos el caso de una paciente de 40 años con antecedentes de endometriosis pélvica y múltiples episodios de neumotórax, que consultó en nuestra institución por un nuevo episodio de neumotórax espontáneo. Se realizó una VATS donde se identificaron nódulos en la pleura parietal y orificios diafragmáticos. En el postoperatorio continuó con tratamiento hormonal. A los 6 meses de seguimiento refirió mejoría del dolor y no presentó nuevos episodios de neumotórax.

En-bloc resection of soft-tissue sarcoma of anterior chest wall and reconstruction with titanium bars and free anterolateral thigh flap.

Primary soft-tissue sarcomas (STSs) of the chest wall are uncommon. Complete surgical resection remains the mainstay of treatment being sternal resection ocassionally required. We present a 25-year-old man with an anterior chest wall STS. The patient underwent complete oncological resection with reconstruction using titanium bars combined with a free vascularised anterolateral thigh flap. STSs of the chest wall are very rare and they comprise a surgical challenge for both resection and reconstruction.

Utility of PET-CT in non-small cell lung cancer clinical stage IB-IIA according to AJCC 8th edition staging system: an alternative to invasive mediastinal staging?

OBJECTIVE: Mediastinal nodal staging in lung cancer is essential to determine treatment strategy and prognosis. There are controversies as to whether a mediastinal negative result in PET-CT may spare the invasive staging of the mediastinum. The main endpoint is to evaluate the negative predictive value (NPV) of PET-CT in non-small cell lung cancer (NSCLC) clinical stage IB-IIA without clinical nodal involvement. The secondary endpoint is to evaluate the prevalence of mediastinal and hilar nodal affection in this population. METHODS: We performed an observational descriptive study from January 2010 to January 2020, including 76 patients with clinical stage IB-IIA, who underwent pulmonary resection with systematic nodal sampling (pre-determined lymph node stations based on tumour location) for primary NSCLC. Clinically, nodal involvement was defined as any lymph node greater than 1 cm in the short axis on a CT or with metabolic uptake greater than 2.5 SUV on PET-CT. The prevalence of nodal metastases was recorded. RESULTS: Fifty six patients had clinical stage IB and 20 had clinical stage IIA. Mean tumour size was 3.74 ± 0.5 cm. Lobectomy was the resection procedure most frequently performed. Of the 76 patients with clinical N0 by PET-CT who underwent surgical resection, 10 (13.1%) were upstaged to pN1 and none were upstaged to pN2. NPV of PET-CT for overall nodal metastasis was 87% (95% CI: 0.79-0.94). NPV of PET-CT for N2 metastasis was 100%. CONCLUSION: PET-CT might be an alternative to invasive mediastinal staging in patients with NSCLC clinical stage IB-IIA who are surgical candidates. Further prospective multi-institutional studies are necessary to verify the external validity of our study.

Resección de la primera costilla por videotoracoscopía en síndrome de Paget-Schroetter / Resection of the first rib by video thoracoscopy in Paget-Schroetter syndrome

Resumen El síndrome del opérculo torácico se refiere a una serie de signos y síntomas que se producen por la compresión del paquete vásculo-nervioso en la unión costo-clavicular. El síndrome de Paget-Schroetter (SPS) se define como la trombosis primaria, espontánea o de esfuerzo de la vena subclavia. Las vías de abordaje quirúrgicas tradicionales utilizadas para descomprimir el opérculo torácico son la trans axilar y las claviculares (supra e infra). El objetivo del estudio fue describir nuestra experiencia en la resección de la primera costilla por videotoracoscopía (VATS). Este es un estudio descriptivo observacional utilizando una base de datos prospectiva con análisis retrospectivo desde enero de 2017 a marzo de 2020. Se incluyeron 9 pacientes con diagnóstico de SPS en los que se resecó la primera costilla por VATS. En un paciente el procedimiento fue bilateral por presentar trombosis espontánea en ambas venas subclavias. De los 9, 6 eran mujeres. La edad media fue de 30.7 ± 10.7 años. La estadía hospitalaria media fue de 3.1 ± 0.5 días. Uno fue re-operado por hemotórax. No se detectaron recurrencias en el seguimiento a mediano-largo plazo. La resección de la primera costilla por VATS es un procedimiento seguro y factible. La misma, a diferencia de los abordajes tradicionales, puede ser resecada bajo visión directa de todos los elementos del opérculo torácico. Sin embargo, esta técnica requiere un manejo avanzado en cirugía toracoscópica.

Abstract Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to PagetSchroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.

Simpaticotomía bilateral video asistida por hiperhidrosis: análisis de 102 pacientes / Bilateral video-assisted thoracic sympathicotomy for hiperhidrosis: analysis of 102 patients

Resumen La hiperhidrosis es un trastorno caracterizado por la producción excesiva de sudor por las glándulas sudoríparas ecrinas que influye negativamente en las actividades sociales, laborales y fundamentalmente en la calidad de vida. Se divide en primaria o secundaria. La primaria es una enfermedad benigna caracterizada por una excesiva sudoración con mayor frecuencia en palmas, plantas, axilas y cara. Su incidencia es del 1% de la población y su causa es desconocida. La mayoría de los tratamientos médicos no logran un buen control sintomático y frecuentemente son transitorios. La simpaticotomía torácica bilateral videoasistida se ha vuelto el tratamiento de elección en pacientes muy sintomáticos. En el período de 1998 a 2018 se realizaron 174 simpaticotomias bilaterales videoasistidas por hiperhidrosis primaria, de las cuales 102 cumplieron los criterios de inclusión. Se excluyeron a 72 pacientes. El 20.5% fueron hombres y el 79.5% mujeres con una edad media de 29.22 años. En cuanto a la localización fue palmoplantar axilar en un 50.9%, axilar en un 23.5%, palmoplantar en un 10.7%, palmar en un 7.8%, palmoaxilar 6.8% y facial 5.8%. Los pacientes con sudoración palmar presentaron 94.9% de mejoría, axilar 84.51%, plantar 46.25% y facial 84% respectivamente. El post operatorio arrojó una media de internación de 1.1 días. Como efecto no deseado, se presentó sudoración compensatoria en 53 casos y complicaciones postoperatorias en 18 casos. Concluimos que es una técnica segura, que resuelve de manera significativa la sudoración, mejorando la calidad de vida.

Abstract Hyperhidrosis is a disorder consisting of excessive sweating through the different body sweat glands, which produces a negative impact socially and in work-related activities in those that suffer this condition. There are primary and secondary forms. The primary form is a benign condition with excessive sweating mainly in palms, soles of feet, axillae and face. It affects a 1% of the population, and its cause is unknown. Most medical treatments are unsuccessful, and at best, transitory. In patients who are very troubled by the condition, videoassisted bilateral thoracic sympathicotomy has become the elective treatment. In the period ranging from 1998 to 2018, 174 procedures were undertaken for primary hyperhidrosis, of which 102 satisfied the inclusion criteria. 72 patients were excluded. A 20.5% were males, and 79.5% were females, with an average age of 29.22 years at surgery. As to localization of sweating, a 50.9% was palmar-plantar-axillary, 23.5% axillary, 10.7% palmarplantar, 7.8% palmar, 6.8% palmar-axillary, and a 5.8% facial. Those patients with palmar sweating showed a 94.9% improvement, those with axillary sweating a 88.51%, with plantar a 46.25% and those with facial sweating a 84% improvement. The average admission time was 1.1 days. As an undesired effect, compensatory sweating occurred in 53 cases and postoperative complications in 18 cases. We conclude this is a safe technique, that diminishes sweating significantly, improving patient's quality of life.

[Resection of the first rib by video thoracoscopy in Paget-Schroetter syndrome]. / Resección de la primera costilla por videotoracoscopía en síndrome de Paget-Schroetter.

Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to Paget- Schroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.

El síndrome del opérculo torácico se refiere a una serie de signos y síntomas que se producen por la compresión del paquete vásculo-nervioso en la unión costo-clavicular. El síndrome de Paget- Schroetter (SPS) se define como la trombosis primaria, espontánea o de esfuerzo de la vena subclavia. Las vías de abordaje quirúrgicas tradicionales utilizadas para descomprimir el opérculo torácico son la trans axilar y las claviculares (supra e infra). El objetivo del estudio fue describir nuestra experiencia en la resección de la primera costilla por videotoracoscopía (VATS). Este es un estudio descriptivo observacional utilizando una base de datos prospectiva con análisis retrospectivo desde enero de 2017 a marzo de 2020. Se incluyeron 9 pacientes con diagnóstico de SPS en los que se resecó la primera costilla por VATS. En un paciente el procedimiento fue bilateral por presentar trombosis espontánea en ambas venas subclavias. De los 9, 6 eran mujeres. La edad media fue de 30.7 ± 10.7 años. La estadía hospitalaria media fue de 3.1 ± 0.5 días. Uno fue re-operado por hemotórax. No se detectaron recurrencias en el seguimiento a mediano-largo plazo. La resección de la primera costilla por VATS es un procedimiento seguro y factible. La misma, a diferencia de los abordajes tradicionales, puede ser resecada bajo visión directa de todos los elementos del opérculo torácico. Sin embargo, esta técnica requiere un manejo avanzado en cirugía toracoscópica.

[Bilateral video-assisted thoracic sympathicotomy for hiperhidrosis: analysis of 102 patients]. / Simpaticotomía bilateral video asistida por hiperhidrosis: análisis de 102 pacientes.

Hyperhidrosis is a disorder consisting of excessive sweating through the different body sweat glands, which produces a negative impact socially and in work-related activities in those that suffer this condition. There are primary and secondary forms. The primary form is a benign condition with excessive sweating mainly in palms, soles of feet, axillae and face. It affects a 1% of the population, and its cause is unknown. Most medical treatments are unsuccessful, and at best, transitory. In patients who are very troubled by the condition, videoassisted bilateral thoracic sympathicotomy has become the elective treatment. In the period ranging from 1998 to 2018, 174 procedures were undertaken for primary hyperhidrosis, of which 102 satisfied the inclusion criteria. 72 patients were excluded. A 20.5% were males, and 79.5% were females, with an average age of 29.22 years at surgery. As to localization of sweating, a 50.9% was palmar-plantar-axillary, 23.5% axillary, 10.7% palmarplantar, 7.8% palmar, 6.8% palmar-axillary, and a 5.8% facial. Those patients with palmar sweating showed a 94.9% improvement, those with axillary sweating a 88.51%, with plantar a 46.25% and those with facial sweating a 84% improvement. The average admission time was 1.1 days. As an undesired effect, compensatory sweating occurred in 53 cases and postoperative complications in 18 cases. We conclude this is a safe technique, that diminishes sweating significantly, improving patient's quality of life.

La hiperhidrosis es un trastorno caracterizado por la producción excesiva de sudor por las glándulas sudoríparas ecrinas que influye negativamente en las actividades sociales, laborales y fundamentalmente en la calidad de vida. Se divide en primaria o secundaria. La primaria es una enfermedad benigna caracterizada por una excesiva sudoración con mayor frecuencia en palmas, plantas, axilas y cara. Su incidencia es del 1% de la población y su causa es desconocida. La mayoría de los tratamientos médicos no logran un buen control sintomático y frecuentemente son transitorios. La simpaticotomía torácica bilateral videoasistida se ha vuelto el tratamiento de elección en pacientes muy sintomáticos. En el período de 1998 a 2018 se realizaron 174 impaticotomias bilaterales videoasistidas por hiperhidrosis primaria, de las cuales 102 cumplieron los criterios de inclusión. Se excluyeron a 72 pacientes. El 20.5% fueron hombres y el 79.5% mujeres con una edad media de 29.22 años. En cuanto a la localización fue palmoplantar axilar en un 50.9%, axilar en un 23.5%, palmoplantar en un 10.7%, palmar en un 7.8%, palmoaxilar 6.8% y facial 5.8%. Los pacientes con sudoración palmar presentaron 94.9% de mejoría, axilar 84.51%, plantar 46.25% y facial 84% respectivamente. El post operatorio arrojó una media de internación de 1.1 días. Como efecto no deseado, se presentó sudoración compensatoria en 53 casos y complicaciones postoperatorias en 18 casos. Concluimos que es una técnica segura, que resuelve de manera significativa la sudoración, mejorando la calidad de vida.

Outcomes of surgical treatment for isolated adrenal metastasis from non-small cell lung cancer.

OBJECTIVE: Long-term survival of patients who undergo surgical resection of isolated adrenal metastasis instead of nonsurgical treatment has shown higher values than those described for stage IVA. The primary endpoint was to evaluate overall survival (OS) of patients with single adrenal metastasis from non-small cell lung cancer (NSCLC), who underwent surgical treatment. The secondary endpoint was to evaluate and compare the OS and disease-free survival (DFS) according to: pathological lung tumour size, histology, lymph node involvement, type of metastasis at the time of diagnosis and laterality of the metastasis according to the primary lung tumour. METHODS: From August 2007 to March 2020, 13 patients with isolated adrenal gland metastasis were identified. We performed a descriptive observational study including patients with diagnosed single adrenal gland metastasis of resectable primary lung cancer and no history of other malignant disease. Clinical data obtained included patient demographics, metastases characteristics, laterality of the metastasis, time between surgeries, length of follow-up, survival status, pathological lung tumour size, histology and lymph node involvement. The variables analysed were OS and DFS. RESULTS: Median global OS was 31.9 months (interquartile range (IQR), 19.1-51.4). The 2- and 5-year OS estimated was 54% (95% CI: 29.5%-77.4%) and 36% (95% CI: 13.4%-68.1%), respectively. In patients with NSCLC without mediastinal lymph node involvement, we obtain a median OS of 40 months (IQR, 27.4-51.4) and a 2- and 5-year OS estimated of 75% (95% CI: 43.2%-92.2%) and 50% (95% CI: 18.7%-81.2%), respectively. Recurrence was detected in five patients with a median DFS of 11.9 months (IQR, 6-34.2). CONCLUSION: The resection of the adrenal metastasis should be considered if the primary lung cancer is resectable. Presence of mediastinal lymph node involvement should be ruled out through invasive staging of the mediastinum before performing adrenal and lung surgery. Proper selection of patients who would benefit from surgery is essential to obtain better survival results.

Thoracic empyema after gallstone spillage in times of Covid.

INTRODUCTION: Laparoscopic cholecystectomy has become the gold standard for gallbladder disease. Although gallbladder perforation and spilled gallstones during surgery are common complications, thoracic consequences are rare. PRESENTATION OF CASE: We describe a case of a pleural empyema developed in an immunosuppressed patient five months after laparoscopic cholecystectomy, as a result of spilled gallstones. Decortication via video assisted thoracoscopy resulted in retrieval of stone remnants, biliary sludge and diagnosis of a diaphragmatic defect. DISCUSSION: Iatrogenic perforation of the gallbladder is the most common complication after laparoscopic cholecystectomy. Despite this, thoracic consequences derived from spilled gallstones are rare, but they represent significant morbidity. CONCLUSION: Thoracic complications after spilled gallstones are rare. Documentation of iatrogenic perforation of the gallbladder and a high index of suspicious are fundamental to speed diagnosis and treatment.

Laparoscopic treatment of a pericaecal internal hernia.

We present the case of a pericaecal hernia treated successfully with a laparoscopic approach and full recovery after surgery. A 53-year-old female patient with a personal history of depression, osteoporosis and irritable bowel syndrome consulted to the emergency department for abdominal pain and distension in the last 12 h, associated with one episode of vomit and diminished frequency in the passage of stools. The right abdomen was tender to palpation, and blood work revealed no leucocytosis. A computed tomography scan showed small bowel loops distended and displaced to the right parietocolic recess, lateral to the ascending colon. Exploratory laparoscopy was performed confirming the presence of small bowel loops incarcerated in the paracaecal fossa. These ones were reduced with gentle manoeuvres, and the peritoneal folds incised to prevent recurrence. The patient was started on an oral diet 2 days after surgery and discharged home on the 3rd post-operative day.

Two-year disease remission of an unresectable basaloid thymic carcinoma with second line chemotherapy drugs: report of a case.

Thymic carcinomas are extremely infrequent neoplasms (15% of all thymic epithelial tumors). Basaloid carcinoma is a peculiar tumor that represents no more than 2% of those infrequent thymic carcinomas. Surgical excision is the recommended treatment. As it's extremely rare, there is no evidence of the impact of different modalities of treatment. There are no reported cases that did not include surgery as part of their management. We herein present a case of an unresectable thymic basaloid carcinoma treated only with concurrent chemotherapy and radiotherapy that obtained a complete remission and free of disease after 2 years.