Prophylactic use of non-invasive mechanical ventilation in lung resection.

OBJECTIVE: To evaluate if the prophylactic application of BiPAP previous to lung resection and 17 hours postoperatively improves respiratory function. In order to do this, we studied the results of arterial blood gases and portable spirometry in the immediate postoperative period and at the first and third postoperative day. Secondary objectives included evaluating whether this same pattern decreases the incidence of postoperative pulmonary complications (PPC) and hospital stay. PATIENTS AND METHODS: This was a prospective, randomized clinical study. Between January 2012 and June 2013, 50 patients who had undergone lung resection with posterolateral thoracotomy were assigned to one of two groups by a random number generator according to whether or not they would receive prophylactic BiPAP pre- and postoperatively. RESULTS: The results of the gasometric and spirometric values were similar in both groups. There were no statistically significant differences (p > 0.05). There was not a decrease in the incidence of PPC in the group that received prophylactic BiPAP. Likewise, postoperative stay was similar in both groups. The BiPAP group was 6.60 ± 4 days and the non BiPAP group was 6.84 ± 3.94 days (p = 0.63). CONCLUSIONS: One drawback of this work was the limited number of hours that BiPAP was employed, and when compared to other studies, the application of low-pressure support. We did not find any significant differences between using prophylactic BiPAP or not, suggesting that such treatment should not be performed indiscriminately. More investigations are needed with a larger number of patients in order to better evaluate the possible benefits of using prophylactic BiPAP in thoracic surgery.

[Lung transplantation in rats: a viable experimental model]. / Trasplante pulmonar en ratas. Un modelo viable de estudio experimental.

OBJECTIVES: To incorporate a new fast, safe, and reversible anesthetic procedure into the experimental model of lung transplantation (LT) using a cuff technique originally described by Mizuta. MATERIAL AND METHOD: Eighty-eight Sprague-Dawley rats were used in the experimental model. Thirty left LTs were performed, using 60 rats. The donor heart-lung block was excised by median sternotomy with dissection of the left lung and cuffs (intravenous catheters cut into 3-mm sections) were put in place. The left lung was implanted in the recipient by lateral thoracotomy using the cuffs for anastomoses. The duration of surgery and postoperative complications were recorded. Also noted were signs of ischemia-reperfusion injury, and acute rejection of the transplanted lung. RESULTS: We discarded lungs excised from 8 animals when developing the experimental model. Transplants could not be completed in 10 rats due to technical problems, despite satisfactory excision. Of the rats who received a transplant, 4 died in the first 24 hours and 26 survived to 48 hours. They were then killed and examined. The state of the anastomoses was good and signs of ischemia-reperfusion injury, as well as acute rejection were observed in the parenchyma of the transplanted lung. CONCLUSIONS: LT with cuffs in rats is a valid, reliable, reproducible, and cheap model for studying ischemia-reperfusion injury and rejection in LT. The surgical technique is complex, requiring experienced surgeons and a long learning process. Modification of the technique to more closely resemble the surgical procedure in humans is possible, thus facilitating interpretation and allowing more reliable extrapolation to humans.

Hemoptisis amenazante y hemotórax simultáneos / Simultaneous threatening hemoptysis and hemothorax

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Feocromocitoma torácico: presentación de un caso / Thoracic pheochromocytoma: report of one case

Un varón de 54 años ingresó en nuestro hospital para estudio de hipertensión arterial, diabetes y una masa torácica posterior. Había presentado en el curso de los dos meses anteriores crisis de cefaleas, palpitaciones y sudación, y tras crisis hipertensiva se detecta masa torácica en la radiografía de tórax y se decide ingreso para completar estudio. Se realizan diversas técnicas de imagen y estudio bioquímico, concluyéndose que la masa es un feocromocitoma torácico. Tras exéresis de la misma se controla la tensión arterial, desaparece la diabetes y un año después de la cirugía permanece asintomático (AU)

Infección por Streptococcus zooepidemicus en un paciente con carcinoma broncogénico. Una rara zoonosis / Infection due to streptococcus zooepidemicus in a patient with bronchogenic carcinoma: a rare zoonosis

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Traumatismo torácico penetrante que afecta a una prótesis mamaria / Penetrating chest wound affecting a breast prosthesis

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Carcinoma tímico asociado a miastenia gravis

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[Transthoracic approach to the spinal column]. / Abordaje transtorácico de la columna vertebral.

Thoracotomy is used to approach and treat anterior spinal lesions arising from various causes. Between 1990 and 1997, we treated 56 patients (40 men and 16 women) between 14 and 67 years old (mean 38.4). All had spinal lesions that were impossible or difficult to reach by a posterior approach. Thirty-one (55.3%) had suffered spinal damage, 8 (14.3%) had spinal deformities, 7 (12.5%) had metastatic tumors, 5 (8.9%) had herniated discs, 4 (7.1%) had Pott's disease and 1 (1.8%) had osteolysis at D6. Thoracotomy was left-sided in 35 cases (62.5%) and right-sided in 19 (33.9%). Video-assisted thoracoscopy was used twice (3.6%). The level of incision was based on the site of the lesion, and the pleural cavity was opened in all cases except one. The posterolateral pleuro-diaphragmatic fold was dissected and the diaphragm opened for retroperitoneal access in 37 cases (66.1%) of thoracolumbar disease. Orthopedic treatment consisted of autologous bone grafts in all cases and placement of a Kaneda splint in 32 cases (57.1%). One patient had to undergo surgery a second time due to inappropriate placement of the vertebral splint. Pneumothorax occurred in one patient after removal of pleural drains. The incision became infected in one patient, and one case of ileal paralysis was observed. Overall, morbidity was 7.1%. We conclude that thoracotomy offers a good alternative approach to spinal lesions. Results are good and morbidity low.