Localización de nódulos pulmonares mediante arpón guiado por TAC para su resección videotoracoscópica / No disponible

El objetivo de este estudio es la valoración de la técnica de localización de nódulos pulmonares periféricos con arpón guiado con TAC para su posterior resección por cirugía video toracoscópica. Se realizó un estudio retrospectivo con 60 pacientes obteniendo el diagnóstico de certeza en el 100% de los casos, representando los procesos malignos el 71,6% de los nódulos estudiados y el28,4% correspondieron a procesos benignos. La localización de nódulos pulmonares mediante aguja con arpón es un método sencillo y seguro para la localización del nódulo y la obtención de un diagnóstico, previa extirpación video toracoscópica de los mismos, aunque a veces, sean lesiones de difícil abordaje (AU)

The aim of this paper is to study the technique of solitary pulmonary nodule’s localization using CT guided hook wire in the way to make it possible to be resected by VATS. We performed a retrospective study of 60 patients. In all of them a certain diagnosis was obtained. There were 71.6% malignant diseases and 28.4% benign nodules. Localization of solitary pulmonary nodules using hook wire is an easy and safe method to identify this kind of lesion and to get a true diagnosis due VATS resection even in small and central nodules (AU)

Experimental study of sutureless colorectal anastomosis.

BACKGROUND/AIMS: The present research project has been made mainly with the idea of comparing the tensile strength values and histological answers of three types of colon anastomosis: sutured with silk 5/0; polyglycolic acid 5/0; and sutureless anastomosis with human fibrin gum. METHODOLOGY: One hundred and five (105) Wistar breath rats allocated into 3 groups of 35 animals were used to implement this experimental research project: silk, polyglycolic acid and human fibrin gum. Furthermore, each group was subdivided in 5 series respectively to carry out an experimental study on the tensile strength parameter and anatomic-pathological determinations on the 10th, 20th, 30th, 40th and 50th day after the surgical intervention. The following surgical interventions were practiced on them: A cross section of the colon, followed by: group 1: an end-to-end discontinuous suture anastomosis with Silk; group 2: an end-to-end discontinuous suture anastomosis with polyglycolic acid; group 3: sutureless anastomosis with human fibrin gum. On the 10th, 20th, 30th, 40th and 50th days we proceeded to measure the anastomosis' tensile strength value for each series. We used a tensile strength apparatus and waited until the break down of the suture sample took place and wrote down the value, in g/cm, given by the voltmeter at that moment. RESULTS: The results obtained indicate that anastomosis made in group 1 (silk) lasted longer to the tensile strength apparatus; followed by those practiced in group 2 (polyglycolic acid); and finally anastomosis carried out in group 3 (human fibrin gum). However in the anastomotic process carried out with the human fibrin gum the healing started from the 10th day. In the same period of time we carried out the following anatomic-pathological determinations: a) sharp inflammation; b) edema; c) non-specific chronic inflammatory infiltrate; d) granulomatous inflammatory infiltrate to foreign bodies; e) fibrosis. CONCLUSIONS: The results show a better answer for anastomosis made with human fibrin gum than those carried out with the two other suture materials. This conclusion is based on the facts that the human fibrin gum used to carry out sutureless anastomosis during this research project generated a lower sharp inflammation and speediness in its absorption; absence of granular reaction to a foreign body; a minor or non-existent edema at all; as well as a good fibrous healing speediness process. Therefore, all these experimental results lead us to conclude that the human fibrin gum used to carry out sutureless anastomosis may be an alternative to the handmade conventional anastomosis. Moreover they are easy to be implemented.

Nosocomial pneumonia in patients undergoing heart surgery.

OBJECTIVE: To determine the risk factors related to the presence of postsurgical nosocomial pneumonia (NP) in patients who had undergone cardiac surgery. DESIGN: A case-control study. SETTING: Postcardiac surgical intensive care unit at a university center. PATIENTS: A total of 45 patients with NP and 90 control patients collected during a 4-yr period. INTERVENTIONS: Pre-, intra-, and postoperative factors were collected and compared between two groups of patients (cases vs. controls) to determine their influence on the development of NP. The diagnosis of NP was always microbiologically confirmed as pulmonary specimen brush culture of > or =10(3) colony-forming units/mL or positive blood culture/pleural fluid culture by the growth of identical microorganisms isolated at the lung. For each patient diagnosed with NP, we selected control cases at a ratio of 1:2. MEASUREMENTS AND MAIN RESULTS: The incidence of NP was 6.5%. Multivariate analysis found a probable association of the following variables with a greater risk for the development of NP: reintubation (adjusted odds ratio [AOR], 62.5; 95% confidence interval [CI], 8.1-480; p = .01); nasogastric tube (AOR, 19.7; 95% CI, 3.5-109; p = .01), transfusion of > or =4 units of blood derivatives (AOR, 12.8; 95% CI, 2-82; p = .01) and empirical treatment with broad-spectrum antibiotics (AOR, 6.6; 95% CI, 1.2-36.8; p = .02). Culture results showed 13.3% of the NP to be of polymicrobial origin, whereas 77.3% of the microorganisms isolated were Gram-negative bacteria. The mortality (51 vs. 6.7%, p < .01) and the length of stay in the intensive care unit (25+/-14.8 days vs. 5+/-5 days, p < .01) were both greater in patients with NP. CONCLUSIONS: We conclude that the surgical risk factors, except the transfusion of blood derivatives, have little effect on the development of NP. Reintubation, nasogastric tubing, previous therapy with broad-spectrum antibiotics, and blood transfusion are factors most likely associated with NP acquisition.

[Disparity between cytohistopathological results of diagnostic specimens and the resected tumor piece in bronchopulmonary carcinoma]. / Disparidad entre los resultados citohistopatológicos de los especímenes diagnósticos y la pieza tumoral resecada en el carcinoma broncopulmonar.

In 88 patients diagnosed and intervened of lung carcinoma, we evaluate the security of the Diagnostic method--cytology: sputum, brushed bronchial, bronchial aspiration, puncture pulmonary aspiration and histology of the bronchial biopsy--when we correlate them with the histology of the dried up tumour. From the 88 patient, in 11 (12.5%) there was a disparity between some specimen and the piece tumour. If we analyze the specimen: the bronchial biopsy, was different in 3 cases, (4.8%); the brushed and the bronchial biopsy, aspiration in 2, (2.7% and 2.3% respectively); the puncture pulmonary aspiration in 6, (26%) and the cytology of sputum in 2 cases, (2.4%). In 8 patients (9%), the outputs of some specimen were not conclusive, if we remove these we find that: the bronchial biopsy was not conclusive in 2 cases, (3.2%), the brushed bronchial in 5, (6.8%); the bronchial aspiration in 9 (10.2%) and the cytology of sputum in 2 cases, (2.4%). With this data we could infer that sometimes the positive outputs of the specimen have no correlation with the histology of the tumour dried up. This disparity has not been observed in the oat-cells. Therefore when we send the specimens to the pathologist, it would always be advisable for him to inform us if there are any different cells belonging to the principal group of the tumor.

Liver, spleen and kidney cultures in different conditions of splenic preservation.

The appearance of the postsplenectomy syndrome has made investigators focus all attention on the immunitary aspects that could change following a splenic extirpation. Besides this, bacterial clearance has been considered fundamental in this pathology. We present an experimental study comparing liver, spleen and kidney cultures in different conditions of splenic preservation, including autotransplantation, and with sepsis induced by the inoculation of capsulated Escherichia coli. The majority of tissue cultures were positive, showing, in must cases, a statistical correlation between the number of microorganisms in each organ for every animal. This confirms that all three organs act alike, as bacterial filters.

[Anatomopathologic repercussions of segmental liver resection]. / Repercusiones anatomopatológicas de las resecciones hepáticas segmentarias.

We present an experimental study of the anatomopathologic repercussions of segmental liver resection. Sixty rats were used, distributed into 3 groups of 18 animals each one with 6, group I, as follows: 1) anesthesia and laparotomy; 2) 30% liver resection; 3) 50% liver resection, and 4) 80% liver resection. The three resection groups were distributed into three subgroups according to parameters studied at 24 hours, 72 hours and 10 days, respectively. The data studied were: 1. Inflammation: activation of Kupffer cells, state of the lobule and portal spaces. 2. Degeneration: steatosis, necrotic foci, infarction and eosinophilic degeneration. 3. Regeneration: hepatocytic hypertrophy, mitosis, binucleation and trabeculation. The results confirm that the resected liver undergoes regenerative processes that condition the adaptation of the animal after hepatic exeresis.