Patología del diafragma / Diseases of the diaphragm

El diafragma es el principal músculo involucrado en la ventilación y está inervado exclusivamente por los nervios frénicos. Los defectos congénitos de la musculación del diafragma o la lesión de los nervios frénicos causan la patología denominada parálisis-eventración diafragmática. El pronóstico y el tratamiento dependen de si la afectación es uni o bilateral y de la situación clínica previa del paciente. Además, el diafragma sirve de separación anatómica entre la cavidad torácica y abdominal, y está atravesado por el esófago e importantes estructuras vasculares y nerviosas. La dilatación anómala de los orificios naturales del diafragma o la pérdida de continuidad del mismo pueden provocar el paso de estructuras abdominales a la cavidad torácica, lo que conocemos como hernias diafragmáticas. Según su etiología, las hernias se dividen en: congénitas, adquiridas y traumáticas. Las manifestaciones clínicas, el pronóstico y el tratamiento dependen en gran medida del tamaño de la hernia y de la edad de aparición. Como en cualquier músculo, en el diafragma se pueden desarrollar tumores primarios benignos o malignos. Sin embargo, es mucho más frecuente la afectación tumoral del diafragma por tumores que asientan en órganos vecinos. El pronóstico es bueno en los tumores primarios benignos y pésimo en los tumores malignos, tanto primarios como secundarios. En este artículo se revisan las principales características anatómicas y fisiológicas del diafragma, sus vías de abordaje quirúrgico y sus patologías más frecuentes (AU)

The diaphragm is the main muscle involved in ventilation and is supplied exclusively by the phrenic nerves. Congenital defects of the diaphragm muscle or phrenic nerve injury cause diaphragmatic paralysis eventration. Prognosis and treatment depend on whether involvement is unilateral or bilateral and on the patient’s previous clinical status. In addition, the diaphragm is an anatomical barrier between the thoracic and abdominal cavities and is traversed by the esophagus and important vascular and nerve structures. Abnormal dilation of the natural orifices of the diaphragm or loss of its continuity can cause abdominal structures to pass into the chest cavity, an occurrence known as diaphragmatic hernias. According to their etiology, hernias are divided into congenital, acquired and traumatic. Clinical manifestations, prognosis and treatment depend mainly on hernia size and age at diagnosis. Like any muscle, the diaphragm can develop benign or malignant primary tumors. However, diaphragm involvement due to tumors arising in adjacent organs is much more common. The prognosis is good in benign primary tumors and poor in both primary and secondary malignant tumors. This article reviews the main anatomical and physiological characteristics of the diaphragm, routes of surgical access and the most frequent diseases affecting this structure (AU)

[Diseases of the diaphragm]. / Patología del diafragma.

The diaphragm is the main muscle involved in ventilation and is supplied exclusively by the phrenic nerves. Congenital defects of the diaphragm muscle or phrenic nerve injury cause diaphragmatic paralysis-eventration. Prognosis and treatment depend on whether involvement is unilateral or bilateral and on the patient's previous clinical status. In addition, the diaphragm is an anatomical barrier between the thoracic and abdominal cavities and is traversed by the esophagus and important vascular and nerve structures. Abnormal dilation of the natural orifices of the diaphragm or loss of its continuity can cause abdominal structures to pass into the chest cavity, an occurrence known as diaphragmatic hernias. According to their etiology, hernias are divided into congenital, acquired and traumatic. Clinical manifestations, prognosis and treatment depend mainly on hernia size and age at diagnosis. Like any muscle, the diaphragm can develop benign or malignant primary tumors. However, diaphragm involvement due to tumors arising in adjacent organs is much more common. The prognosis is good in benign primary tumors and poor in both primary and secondary malignant tumors. This article reviews the main anatomical and physiological characteristics of the diaphragm, routes of surgical access and the most frequent diseases affecting this structure.

Análisis de supervivencia de la cirugía de resección de metástasis pulmonares de cáncer colorrectal / Survival Analysis of Resection of Lung Metastases from Colorectal Cancer

Introducción: La publicación del Registro Internacional de Metástasis Pulmonares (IRLM, de International Registry of Lung Metastases) en 1997 supuso un punto de inflexión a favor de la cirugía de resección de metástasis pulmonares (MP). Se establecieron grupos pronósticos en función de la resecabilidad, el número de MP y el intervalo libre de enfermedad (ILE). El objetivo de este trabajo ha sido determinar la supervivencia de los pacientes intervenidos con resección de MP de carcinoma colorrectal y evaluar la aplicabilidad de los factores pronósticos establecidos por el IRLM a este grupo concreto de pacientes.Pacientes y métodos: Se ha realizado un trabajo retrospectivo recogiendo los casos de MP de carcinoma colorrectal intervenidos entre el 1 de enero de 2000 y el 30 de noviembre de 2006. Para calcular la supervivencia se empleó el método de Kaplan-Meier con el test de rangos logarítmicos.Resultados: La supervivencia a 1; 3; 5, y 6 años fue del 92, el 75, el 54 y el 43%, respectivamente. Como principal hallazgo, se observó que los pacientes a quienes se realizó resección atípica de las metástasis tuvieron mayor supervivencia que aquellos que necesitaron lobectomía: un 75% de supervivencia a los 3 años frente al 55%, respectivamente. No se encontraron diferencias significativas de supervivencia en cuanto al número de MP resecadas ni en cuanto al ILE.Conclusiones: Los pacientes que requieren lobectomía para la resección de MP de carcinoma colorrectal presentan peor supervivencia que aquellos a los que se realiza resección atípica. El número de metástasis y el ILE pueden ser factores pronósticos cuestionables en el caso de MP de carcinoma colorrectal(AU)

Introduction: The publication of the International Registry of Lung Metastases (IRLM) in 1997 was a turning point in favor of surgical resection of lung metastases. Prognostic groups were defined according to resectability, number of metastases, and disease-free interval. The objective of this study was to determine survival in patients who underwent resection of lung metastases from colorectal carcinoma and to evaluate how applicable the prognostic factors established by the IRLM are in this specific patient group.Patients and Methods: Patients with lung metastases from colorectal carcinoma who underwent resection between January 1, 2000, and November 30, 2006, were retrospectively analyzed. Survival was calculated using the Kaplan-Meier method, with log-rank comparisons between groups.Results: Survivals at 1, 3, 5, and 6 years was 92%, 75%, 54%, and 43%, respectively. The main finding was that 3-year survival was better in patients who underwent atypical resection of the metastasis (75%) than those who required lobectomy (55%). There were no significant differences in survival in terms of number of lung metastases resected or disease-free interval.Conclusions: Survival in patients requiring lobectomy for resection of lung metastases from colorectal carcinoma was worse than in those who underwent atypical resection. The number of metastases and disease-free interval may be questionable prognostic factors in the case of lung metastases from colorectal carcinoma(AU)

[Survival analysis of resection of lung metastases from colorectal cancer]. / Análisis de supervivencia de la cirugía de resección de metástasis pulmonares de cáncer colorrectal.

INTRODUCTION: The publication of the International Registry of Lung Metastases (IRLM) in 1997 was a turning point in favor of surgical resection of lung metastases. Prognostic groups were defined according to resectability, number of metastases, and disease-free interval. The objective of this study was to determine survival in patients who underwent resection of lung metastases from colorectal carcinoma and to evaluate how applicable the prognostic factors established by the IRLM are in this specific patient group. PATIENTS AND METHODS: Patients with lung metastases from colorectal carcinoma who underwent resection between January 1, 2000, and November 30, 2006, were retrospectively analyzed. Survival was calculated using the Kaplan-Meier method, with log-rank comparisons between groups. RESULTS: Survivals at 1, 3, 5, and 6 years was 92%, 75%, 54%, and 43%, respectively. The main finding was that 3-year survival was better in patients who underwent atypical resection of the metastasis (75%) than those who required lobectomy (55%). There were no significant differences in survival in terms of number of lung metastases resected or disease-free interval. CONCLUSIONS: Survival in patients requiring lobectomy for resection of lung metastases from colorectal carcinoma was worse than in those who underwent atypical resection. The number of metastases and disease-free interval may be questionable prognostic factors in the case of lung metastases from colorectal carcinoma.