Selective packing for uncontrollable traumatic thoracic wall bleeding preserving cardiopulmonary function.

BACKGROUND: Uncontrollable chest wall bleeding secondary to thoracic trauma has been a challenging problem faced by surgeons. Thoracic packing has been described as a good alternative although most thoracic surgeons avoid it because of the potential deleterious effects on cardiopulmonary function. METHODS: We describe a selective gauze packing technique of the thoracic wall preserving cardiopulmonary function in 3 patients with uncontrollable bleeding, where gauze packs were placed on bleeding areas holding them in a "sandwich-like" arrangement between the skin and the pleura and tightly fixed with coated wire stitches using internal and external-thoracic Ventrofil® devices. RESULTS: Successful hemostasis and cardio-respiratory stability were achieved in all cases after selective packing. X-ray showed acceptable lung expansion and no heart compression. CONCLUSIONS: This selective packing technique is simple, feasible and highly effective in managing uncontrollable post-traumatic or even post-operative chest wall hemorrhages when the life of patients is in danger.

Uso de barras de pectus en la reconstrucción de defectos complejos de la pared torácica anterior / Use of Pectus Bars in the Reconstruction of Complex Anterior Chest Wall Defects

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Hernia tóraco-abdominal postraumática / Post-traumatic thoracoabdominal hernia

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Primary frontal hyperhidrosis successfully treated with low doses of botulinum toxin A as a useful alternative to surgical treatment.

Frontal hyperhidrosis appears to be a special and rare form of focal hyperhidrosis. These patients may suffer greatly from the condition so an efficient treatment is highly demanded. Surgical treatment may solve this problem permanently, but the possibility of serious complications and low satisfactory results makes it less advisable than in other types of hyperhidrosis where surgery has shown great benefits. We report a case of primary frontal hyperhidrosis in a young man who refused surgery and was treated with low doses of botulinum toxin type A injected into the forehead. The patient noted a high level of satisfaction, with the abolishment of sweating and a long effect that was maintained for up to 10 months without any complications. In conclusion, we consider that low doses of botulinum toxin A is a well tolerated, safe and very effective treatment for primary frontal hyperhidrosis and it should be offered as an alternative to patients who suffer from this disorder.

TEMLA: nueva técnica para el tratamiento de la recidiva del cáncer de tiroides / TEMLA: A new technique for the treatment of recurrent thyroid cancer

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Dermatofibroma y metástasis pulmonares. Tratamiento actual / Dermatofibroma Metastasizing to the Lung: Current Treatment

El dermatofibroma es una lesión cutánea común en la práctica dermatológica. La manifestación típica es una pápula de crecimiento lento, firme y solitaria. Desde el punto de vista histopatológico, se define en ocasiones como una reacción del tejido conectivo dérmico y en otras como una proliferación neoplásica benigna. En 1990 se publicó por primera vez la existencia de metástasis pulmonares de este tumor. Desde entonces se han recogido en todo el mundo 12 casos de similares características. Presentamos el caso de una mujer joven con un dermatofibroma recidivante en el hombro y metástasis pulmonares bilaterales. Analizamos qué características histológicas del tumor podrían hacer sospechar un comportamiento posterior inusualmente agresivo(AU)

Dermatofibromas are very common skin tumors. Their typical presentation is as a slow-growing, firm, solitary papule. They have been described histopathologically as a reaction of the connective tissue of the skin or as a benign neoplasm. Cases of these tumors metastasizing to the lung were first reported in 1990. Since then 12 cases with similar characteristics have been reported worldwide. We present the case of a young woman with a recurrent dermatofibroma on the shoulder that metastasized to both lungs. We discuss the histologic characteristics of this tumor that could raise suspicion of unusually aggressive behavior(AU)

[Dermatofibroma metastasizing to the lung: current treatment]. / Dermatofibroma y metástasis pulmonares. Tratamiento actual.

Dermatofibromas are very common skin tumors. Their typical presentation is as a slow-growing, firm, solitary papule. They have been described histopathologically as a reaction of the connective tissue of the skin or as a benign neoplasm. Cases of these tumors metastasizing to the lung were first reported in 1990. Since then 12 cases with similar characteristics have been reported worldwide. We present the case of a young woman with a recurrent dermatofibroma on the shoulder that metastasized to both lungs. We discuss the histologic characteristics of this tumor that could raise suspicion of unusually aggressive behavior.

[Bilateral Chylothorax after delivery: an infrequent case treated with videothoracoscopic talc pleurodesis]. / Quilotórax bilateral posparto: un caso infrecuente resuelto mediante pleurodesis con talco por videotoracoscopia.

Bilateral chylothorax after delivery is a highly infrequent entity. We present the case of a 28-year-old woman who developed progressive dyspnea due to bilateral milky pleural effusion several months after delivery. The effusion was found to contain chylomicrons in the biochemical analysis. Initial conservative treatment failed twice and the chylothorax was successfully treated through sequential bilateral videothoracoscopy with an interval of 6 days between the two interventions and pleurodesis with spray talc.

Quilotórax bilateral posparto: un caso infrecuente resuelto mediante pleurodesis con talco por videotoracoscopia / Bilateral Chylothorax after delivery: an infrequent case treated with videothoracoscopic talc pleurodesis

El quilotórax bilateral posparto es una entidad muy poco frecuente. Presentamos el caso de una mujer de 28 años que varios meses después de dar a luz presentó disnea progresiva por derrame pleural bilateral de aspecto lechoso y con presencia de quilomicrones en su análisis bioquímico. El tratamiento inicialmente conservador fracasó en 2 ocasiones. El quilotórax fue tratado eficazmente con videotoracoscopia bilateral secuencial con un intervalo de 6 días entre ambas intervenciones y pleurodesis con talco en aerosol (AU)

Bilateral chylothorax after delivery is a highly infrequent entity. We present the case of a 28-year-old woman who developed progressive dyspnea due to bilateral milky pleural effusion several months after delivery. The effusion was found to contain chylomicrons in the biochemical analysis. Initial conservative treatment failed twice and the chylothorax was successfully treated through sequential bilateral videothoracoscopy with an interval of 6 days between the two interventions and pleurodesis with spray talc (AU)