Video-Assisted Thoracoscopy For Penetrating Cardiac Box Injury in Stable Patients

Abstract Introduction: In high-volume trauma centers, especially in developing countries, penetrating cardiac box injuries are frequent. Although many aspects of penetrating chest injuries have been well established, video-assisted thoracoscopy is still finding its place in cardiac box trauma and algorithmic approaches are still lacking. The purpose of this manuscript is to provide a streamlined recommendation for penetrating cardiac box injury in stable patients. Methods: Literature review was carried out using PubMed/MEDLINE and Google Scholar databases to identify articles describing the characteristics and concepts of penetrating cardiac box trauma, including the characteristics of tamponade, cardiac ultrasound, indications and techniques of pericardial windows and, especially, the role of video-assisted thoracoscopy in stable patients. Results: Penetrating cardiac box injuries, whether by stab or gunshot wounds, require rapid surgical consultation. Unstable patients require immediate open surgery, however, determining which stable patients should be taken to thoracoscopic surgery is still controversial. Here, the classification of penetrating cardiac box injury used in Colombia is detailed, as well as the algorithmic approach to these types of trauma. Conclusion: Although open surgery is mandatory in unstable patients with penetrating cardiac box injuries, a more conservative and minimally invasive approach may be undertaken in stable patients. As rapid decision-making is critical in the trauma bay, surgeons working in high-volume trauma centers should expose themselves to thoracoscopy and always consider this possibility in the setting of penetrating cardiac box injuries in stable patients, always in the context of an experienced trauma team.

Video-Assisted Thoracoscopy For Penetrating Cardiac Box Injury in Stable Patients.

INTRODUCTION: In high-volume trauma centers, especially in developing countries, penetrating cardiac box injuries are frequent. Although many aspects of penetrating chest injuries have been well established, video-assisted thoracoscopy is still finding its place in cardiac box trauma and algorithmic approaches are still lacking. The purpose of this manuscript is to provide a streamlined recommendation for penetrating cardiac box injury in stable patients. METHODS: Literature review was carried out using PubMed/ MEDLINE and Google Scholar databases to identify articles describing the characteristics and concepts of penetrating cardiac box trauma, including the characteristics of tamponade, cardiac ultrasound, indications and techniques of pericardial windows and, especially, the role of video-assisted thoracoscopy in stable patients. RESULTS: Penetrating cardiac box injuries, whether by stab or gunshot wounds, require rapid surgical consultation. Unstable patients require immediate open surgery, however, determining which stable patients should be taken to thoracoscopic surgery is still controversial. Here, the classification of penetrating cardiac box injury used in Colombia is detailed, as well as the algorithmic approach to these types of trauma. CONCLUSION: Although open surgery is mandatory in unstable patients with penetrating cardiac box injuries, a more conservative and minimally invasive approach may be undertaken in stable patients. As rapid decision-making is critical in the trauma bay, surgeons working in high-volume trauma centers should expose themselves to thoracoscopy and always consider this possibility in the setting of penetrating cardiac box injuries in stable patients, always in the context of an experienced trauma team.

Management of congenital lobar overinflation in an adult.

Congenital lobar overinflation is characterized by disruption of bronchopulmonary development which produces lobar or segmental bronchial abnormalities and overinflation of normal lung tissue. This is a 44-year old man, never smoker, who presents dyspnea every time he arrived in highlands, marked decreased breathing sounds and hyperresonance in the left hemithorax. Imaging studies suggested left upper lobe overinflation. The affected area was resected resulting in symptoms improvement. Accepted treatment is resection, however conservative management has been proposed for asymptomatic patients because cases of spontaneous improvement have been described. We recommend close monitoring and resection if symptoms or overinflation progress.

The Women of Colombian Thoracic and Cardiac Surgery: A Survey-based Assessment.

In Colombia, the number of younger female surgeons is increasing along with a growing interest in thoracic and cardiac surgery. It is our duty to motivate young female surgeons in pursuing a career in chest surgery to answer the already growing deficit of cardio-thoracic surgeons.

Mesotelioma pleural maligno: experiencia del Instituto Nacional de Cancerología (1935-1954)

Introducción: El mesotelioma pleural maligno (MPM) es una neoplasia casi invariablemente fatal, relaciónada la gran mayoría de las veces con la exposición a asbesto. La frecuencia de aparición de MPM es creciente en el mundo entero y, en nuestro país su aumento es alarmante. Sin embargo, hay pocos estudios que describan la experiencia con esta entidad en nuestro medio. Objetivo: Presentar la experiencia del Instituto Nacional de Cancerología de Santafé de Bogotá en MPM. Diseño: estudio observacional descriptivo (serie de casos) Pacientes y Métodos: se revisaron los registros de pacientes con diagnóstico de MPM entre 1935 y 1994. Se escogieron 32 que tuvieron la información requerida. Las variables seleccionadas fueron analizadas estadísticamente por los métods de chi cuadrado, T de student, Kaplan-Meier, Log-Rank-Test y Cox. Resultados: Se diagnósticaron 32 pacientes con Mesotelioma Pleural Maligno. Veintidós (69 por ciento), consultaron en los últimos 6 años; fueron 24 hombres y 8 mujeres (relación 3:1), con edad promedio de 46,5 años (rango 6-76 años). El tiempo promedio de evolución de los síntomas fue de 8 meses (rango 1-72 meses). Se presentó disnea en 22 (69 por ciento) pacientes, dolor torácico en 21 (66 por ciento)y tos en 17 (53 por ciento). Todos presentaron alteraciones radiológicas: 27 derrames pleurales, 24 engrosamientos pleurales y 9 masas. Se definió, si hubo o no exposición a asbesto en 18 pacientes; 14 estuvieron expuestos (78 por ciento). La broncospía y citología del líquido pleural nunca confirmaron el diagnóstico. La biopsia pleural ciega detectó malignidad, pero sólo confirmó el diagnóstico en 2 de 21 pacientes (9,5 por ciento). Las biopsias por toracoscopia o cirugía, siempre permitieron el diagnóstico. Histológicamente fueron 16 epiteliales (51,6 por ciento) 8 mixtos (25.8 por ciento) y 7 sarcomatosos (22,6 por ciento); Veintiocho (90,3 por ciento) fueron difusos. Diez pacientes se consideraron en estado I (34,5 por ciento) y 14 en estado II (48,3 por ciento). Cirugía radical se realizó en 11, con una mortalidad operatoria de 2 (8 por ciento), y una morbilidad de 4 (16 por ciento). Radioterapia se administró a 11 pacientes y quimioterapia a 7. El tiempo libre de enfermedad promedio fue 37,9 meses (rango 1-137), el cual se disminuye a 14,1 meses si excluimos al paciente que duró 137 meses. este tiempo fue influido si la cirugía fue o no...