Enfermedad de Castleman: dos variantes, dos pacientes / Castleman's disease: two variants, two patients

Introducción: La enfermedad de Castleman (EC) es un trastorno linfoproliferativo poco frecuente, localizada más frecuentemente en mediastino y abdomen. Se describen dos casos de EC de localización mediastínica presentados en nuestro servicio. El primer caso una mujer de 33 años con EC variante plasmocelular asociada a enfermedad de Hodgkin, y el segundo caso, una mujer de 32 años con EC tipo hialinovascular. Discusión: De etiología desconocida, clínicamente se distinguen dos formas de EC: a) la multicéntrica, que afecta a más de un órgano, cursa con síntomas generales y puede estar acompañada de otras afecciones como linfoma, y b) la localizada, más frecuente, que cursa de forma asintomática o con síntomas compresivos por efecto de masa. En estos casos presentados, se puede observar la diferencia en la presentación clínica de esta enfermedad en sus dos variedades. Conclusiones: La EC es una rara enfermedad linfoproliferativa cuyo tratamiento es la resección tumoral y su pronóstico es bueno (AU)

Introduction: Castleman's disease (CD) is an uncommon lymphoproliferative disorder most frequently localized in the mediastinum and abdomen. Two cases of CD with mediastinal localization in our service are described. The first case was found in a 33-year old woman with the plasma cell variant of CD associated to Hodgkin's disease and the second case was found in a 32 year old woman with hyalinevascular type CD. Discussion: CD, of unknown etiology, is clinically distinguished with two forms, multicentric that affects more than one organ and occurs with general symptoms and can be accompanied by other involvements such as lymphoma. The second one is the localized one, which is more frequent and evolves asymptomatically or with compressive symptoms due to mass effect. In these cases presented, the difference in the clinical presentation of this condition in its two variants can be seen. Conclusions: CD is an uncommon lymphoproliferative disease whose treatment is tumor resection and whose prognosis is good (AU)

Metástasis endotraqueales de carcinoma colorrectal / No disponible

La existencia de metástasis endotraqueales (ME) de carcinomas de origen no pulmonar es rara. Las manifestaciones clínicas más comunes son hemoptisis, tos y disnea, aunque no es raro encontrarlas como hallazgo casual en el curso de una broncoscopia. Las neoplasias que con mayor frecuencia se asocian a estas lesiones metastásicas son las derivadas de mama, colon y riñón. Su hallazgo supone un estado avanzado de la enfermedad, aunque la supervivencia está en función del tipo de tumor primario, la existencia de lesiones concomitantes y las características del paciente. Por lo tanto el tratamiento debe individualizarse. En el caso de las ME de carcinoma colorrectal (CCR) recomendamos la realización de una broncoscopia preopcratoria pues es posible encontrar lesiones en el árbol traqueobronquial que influyan en el pronóstico y tratamiento de la enfermedad (AU)

Existence of endotracheal metastases (EM) of non-pulmonary origin cancer is rare. The most common clinical manifestations are hemoptysis, cough and dyspnea, although it is not rare to find it as a casual finding during a bronchoscope examination. The neoplasms that are most frequently associated to these lesions are those derived from the breast, colon and kidney. When they are found, it means that there is an advanced stage of the disease, although survival is based on the type of primary tumor, existence of common commitment lesions and the characteristics of the patient. Thus, the treatment should be individualized. In the case of colorectal carcinoma (CRC) EM, we recommend performing a pre-operative bronchoscopy since lesions that influence the prognoses and treatment of the disease may be found in the trachea and bronchial tree (AU)

Endotracheal metastases from colon adenocarcinoma

Endotracheal metastases (ETM) from non-lung cancer are seldom seen. Their main clinical symptoms are cough, haemoptysis and dyspnoea, although occasionally an incidental finding is made during a bronchoscopy. Breast, colon and kidney adenocarcinoma might be associated with ETM, lung cancer being the most frequent cause. Its finding is associated with advanced disease but survival will depend on the primary origin, patient status and comorbidity. Therefore, treatment should be individual for each patient. In our centre we recommend pre-surgery bronchoscopy to exclude metastatic endotracheal lesions in patients with metastatic colon adenocarcinoma disease, as this might affect the final outcome and therefore management of the disease (AU)

No disponible

[Traumatic rupture of the diaphragm]. / Rotura diafragmática traumática.

OBJECTIVE: Traumatic rupture of the diaphragm (TRD) is a rare occurrence, with variable morbidity and mortality. The aim of this study was to analyze cases of TRD in a tertiary hospital and assess prognostic factors associated with mortality. PATIENTS AND METHODS: A retrospective study was performed of patients diagnosed with TRD in Hospital Universitario La Fe, Valencia, Spain, between 1969 and 2006. The following variables were analyzed: sex, age, cause, diagnosis, associated lesions, surgical procedure, side and size of the lesion, visceral herniation, and postoperative morbidity and mortality. RESULTS: The study group comprised 132 patients (105 men, 79.5%) with a mean (SD) age of 39.64 (17.04) years. Traffic accidents were the most common cause of TRD. Rupture involved the left hemidiaphragm in 96 cases (72.7%), and 113 patients (85.6%) had associated lesions, most often affecting the abdomen. Thoracotomy was performed in 83 cases (62.9%) and laparotomy in 41 (31.1%). Visceral herniation was reported in 90 patients (68.3%), most often involving the stomach. The rates of perioperative morbidity and mortality were 62.8% and 20.5%, respectively. Diagnostic delay and the presence of morbidity and serious associated lesions all had a statistically significant impact on mortality (P< .05). In the case of serious associated lesions, the odds ratio was 2.898 (95% confidence interval, 1.018-8.250) and for perioperative morbidity it was 1.488 (95% confidence interval, 1.231-1.798). CONCLUSIONS: TRD is an infrequent occurrence in young men, is generally caused by traffic accidents, and is more common on the left side. Associated lesions are present in most cases and represent the main prognostic factor affecting morbidity and mortality. TRD can be considered a relative surgical emergency when not accompanied by other lesions that in themselves constitute surgical emergencies.

Rotura diafragmática traumática / Traumatic rupture of the diaphragm

Objetivo: La rotura diafragmática traumática (RDT) es una lesión infrecuente, con tasas variables de morbimortalidad. El objetivo del estudio ha sido analizar la experiencia en RDT de un hospital terciario y los factores pronósticos de mortalidad. Pacientes y métodos: Se ha realizado un estudio analítico y retrospectivo de los pacientes diagnosticados de RDT entre 1969 y 2006 en el Hospital La Fe. Se analizaron: sexo, edad, causa, diagnóstico, lesiones asociadas, procedimiento quirúrgico, lado y tamaño, herniación visceral y morbimortalidad postoperatoria. Resultados: Se incluyó en el estudio a 132 pacientes (105 varones; 79,5%) con una edad media ± desviación estándar de 39,64 ± 17,04 años. Los accidentes de tráfico fueron la causa más frecuente de RDT. En 96 casos (72,7%) se afectó el hemidiafragma izquierdo y 113 pacientes (85,6%) asociaron lesiones, de las cuales las abdominales fueron las más frecuentes. Se abordaron por toracotomía 83 casos (62,9%) y por laparotomía 41 (31,1%). En 90 pacientes (68,3%) se evidenció herniación visceral, siendo el estómago la más frecuente. Las tasas de morbilidad y mortalidad perioperatorias fueron del 62,8 y el 20,5%, respectivamente. La presencia de morbilidad y de lesiones asociadas graves, y el retraso diagnóstico tuvieron un impacto significativo en la mortalidad (p < 0,05. Lesiones graves: odds ratio = 2,898; intervalo de confianza del 95%, 1,018-8,250. Morbilidad perioperatoria: odds ratio = 1,488; intervalo de confianza del 95%, 1,231-1,798). Conclusiones: La RDT es una entidad infrecuente que se da en varones jóvenes, generalmente por accidentes de tráfico, y es más frecuente en el lado izquierdo. Las lesiones asociadas están presentes en la mayoría de los casos y son el principal factor pronóstico que condiciona la morbimortalidad. La RDT puede considerarse una urgencia quirúrgica diferida, en ausencia de otras lesiones que constituyan una urgencia quirúrgica en sí mismas

Objective: Traumatic rupture of the diaphragm (TRD) is a rare occurrence, with variable morbidity and mortality. The aim of this study was to analyze cases of TRD in a tertiary hospital and assess prognostic factors associated with mortality. Patients and methods: A retrospective study was performed of patients diagnosed with TRD in Hospital Universitario La Fe, Valencia, Spain, between 1969 and 2006. The following variables were analyzed: sex, age, cause, diagnosis, associated lesions, surgical procedure, side and size of the lesion, visceral herniation, and postoperative morbidity and mortality. Results: The study group comprised 132 patients (105 men, 79.5%) with a mean (SD) age of 39.64 (17.04) years. Traffic accidents were the most common cause of TRD. Rupture involved the left hemidiaphragm in 96 cases (72.7%), and 113 patients (85.6%) had associated lesions, most often affecting the abdomen. Thoracotomy was performed in 83 cases (62.9%) and laparotomy in 41 (31.1%). Visceral herniation was reported in 90 patients (68.3%), most often involving the stomach. The rates of perioperative morbidity and mortality were 62.8% and 20.5%, respectively. Diagnostic delay and the presence of morbidity and serious associated lesions all had a statistically significant impact on mortality (P<.05). In the case of serious associated lesions, the odds ratio was 2.898 (95% confidence interval, 1.018-8.250) and for perioperative morbidity it was 1.488 (95% confidence interval, 1.231-1.798). Conclusions: TRD is an infrequent occurrence in young men, is generally caused by traffic accidents, and is more common on the left side. Associated lesions are present in most cases and represent the main prognostic factor affecting morbidity and mortality. TRD can be considered a relative surgical emergency when not accompanied by other lesions that in themselves constitute surgical emergencies

Tumor de células claras benigno de pulmón. A propósito de un caso / Benign clear cell tumor of the lung

No disponible

No disponible

Carcinoma broncogénico e infección por virus de la inmunodeficiencia humana / Bronchogenic carcinoma and virus infection in human immunodeficiency

Propósito: Mostrar nuestra experiencia en pacientes con carcinoma broncogénico (CB) e infección por el virus de la inmunodeficiencia humana (HIV).- Pacientes y método: Se presentan cuatro pacientes con CB y VIH tratados mediante cirugía. - Resultados: La edad media fue de 43 años y tres pacientes tenían antecedentes tuberculosos. La tasa media de CD4 fue de 211/mm3. Se realizaron tres lobectomías y una neumonectomía. El diagnóstico histológico más frecuente fue el de carcinoma epidermoide. Sólo un enfermo vive en la actualidad tras cinco años de la intervención. - Conclusión: La aparición de un CB en pacientes HIV, población con una alta incidencia de patología pulmonar por infecciones oportunistas, es cada día más frecuente por lo que hay que tener en cuenta la posible asociación de ambos procesos (AU)