Técnica modificada de obtención de muestras del mediastino mediante punción transbronquial bajo guía de ecografía endobronquial: resultados de un estudio prospectivo observacional / Modified Technique for Obtaining Mediastinal Samples With Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Results from a Prospective Observational Study

Antecedentes: La aspiración mediante punción transbronquial bajo guía de ecografía transbronquial (EBUS-TBNA) es un método ampliamente aceptado para la obtención de muestras de ganglios linfáticos mediastínicos tanto benignos como malignos. Se presentan los resultados obtenidos con una modificación que simplifica la técnica de obtención de muestras denominada «capilaridad con aguja fina» o EBUS-FNC. Métodos: Estudio prospectivo observacional de 44 pacientes consecutivos a los que se practicó una EBUS en la Clínica de la Universidad de Navarra de Pamplona (España). Todas las muestras se obtuvieron mediante EBUS-FNC en vez de con la EBUS-TBNA convencional. No se aplicó aspiración y en ningún momento se retiró por completo el estilete interno. Resultados: La exploración del mediastino mediante EBUS identificó la presencia de adenopatías o masas mediastínicas en 38 pacientes (86,4%). Se obtuvieron muestras de más de un ganglio linfático en 23 pacientes (52,3%). La EBUS-FNC proporcionó un material adecuado y representativo para realizar la interpretación en todos los pacientes, y el rendimiento diagnóstico fue del 87%. La sensibilidad para la detección del cáncer de pulmón con la EBUS-FNC fue del 84%. Se registraron complicaciones menores tan solo en 2 pacientes (4,5%). Conclusiones: Nuestro estudio sugiere que la EBUS-FNC es una técnica segura y comparable a la EBUS-TBNA en cuanto a su eficacia y obtención de muestras adecuadas(AU)

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely-accepted method for obtaining both benign and malignant mediastinal lymph node samples. We present the results obtained with a modification that simplifies sampling, known as fine-needle capillary sampling or EBUS-FNC. Methods: A prospective observational study with 44 consecutive patients who underwent EBUS at the University of Navarra Clinic in Pamplona, Spain. All samples were obtained by EBUS-FNC instead of by conventional EBUS-TBNA. No suction was used, and the internal stylus was not completely withdrawn at any time. Results: The examination of the mediastinum by means of EBUS identified the presence of lymphadenopathies or mediastinal masses in 38 patients (86.4%). Samples were taken from more than one lymph node in 23 patients (52.3%). EBUS-FNC provided adequate and representative material for interpretation in all patients, and diagnostic performance was 87%. Sensitivity for the detection of lung cancer with EBUS-FNC was 84%. Mild complications were only recorded in two patients (4.5%). Conclusions: Our study suggests that EBUS-FNC is a safe technique, comparable to EBUS-TBNA in efficacy, and is able to obtain adequate samples(AU)

Bilateral bullectomy through uniportal video-assisted thoracoscopic surgery combined with contralateral access to the anterior mediastinum.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP) with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes. RESULTS: All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion. CONCLUSIONS: Bilateral bullectomy through uniportal VATS combined with contralateral access to the anterior mediastinum is technically reliable and provides favorable surgical outcomes for patients with bilateral SP who develop bilateral apical bullae. However, among other requirements, this surgical procedure demands that surgeons be experienced in VATS and that the appropriate thoracoscopic instruments are available.

Bulectomia bilateral por cirurgia torácica vídeo-assistida uniportal combinada com acesso contralateral ao mediastino anterior / Bilateral bullectomy through uniportal video-assisted thoracoscopic surgery combined with contralateral access to the anterior mediastinum

OBJETIVO: A cirurgia torácica vídeo-assistida (CTVA) tem sido uma intervenção de escolha para o tratamento de pneumotórax espontâneo (PS) com bolha pulmonar. Nosso objetivo foi apresentar uma abordagem de CTVA uniportal unilateral para bulectomia bilateral e avaliar sua eficácia terapêutica. MÉTODOS: Entre maio de 2011 e janeiro de 2012, cinco pacientes foram submetidos a bulectomia bilateral por essa abordagem. Todos apresentavam PS bilateral. A TCAR pré-operatória mostrou que todos os pacientes tinham bolhas bilaterais no pulmão apical. As indicações cirúrgicas, os procedimentos de operação e os desfechos foram revisados. RESULTADOS: Todos os pacientes foram submetidos com sucesso a essa abordagem para bulectomia bilateral, sem complicações intraoperatórias. A mediana de tempo para a retirada do dreno torácico foi de 4,2 dias, e a mediana do tempo de hospitalização no pós-operatório foi de 5,2 dias. A mediana de seguimento pós-operatório foi de 11,2 meses. Um paciente teve recidiva de PE do lado esquerdo três semanas após a cirurgia e foi submetido a abrasão pleural. CONCLUSÕES: A bulectomia bilateral utilizando CTVA uniportal combinada com acesso contralateral ao mediastino anterior é tecnicamente confiável e promove desfechos favoráveis para pacientes com PS que desenvolvem bolhas bilaterais no pulmão apical. Entretanto, para a realização desse procedimento cirúrgico, são necessários cirurgiões com experiência em CTVA, instrumentos toracoscópicos longos, entre outras exigências.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP) with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All of the patients presented with bilateral SP. Preoperative HRCT revealed that all of the patients had bilateral apical bullae. We reviewed the surgical indications, surgical procedures, and outcomes. RESULTS: All of the patients were successfully submitted to this approach for bilateral bullectomy, and there were no intraoperative complications. The median time to chest tube removal was 4.2 days, and the median length of the postoperative hospital stay was 5.2 days. The median postoperative follow-up period was 11.2 months. One patient experienced recurrence of left SP three weeks after the surgery and underwent pleural abrasion. CONCLUSIONS: Bilateral bullectomy through uniportal VATS combined with contralateral access to the anterior mediastinum is technically reliable and provides favorable surgical outcomes for patients with bilateral SP who develop bilateral apical bullae. However, among other requirements, this surgical procedure demands that surgeons be experienced in VATS and that the appropriate thoracoscopic instruments are available.

Neumomediastino espontáneo primario / No disponible

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[Experience with the operation of a device for roentgeno-endoscopic examination]. / Opyt ekspluatatsii ustroistva dlia rentgeno-endoskopicheskogo issledovaniia

An appliance for roentgeno-endoscopic investigation permitting rotation of the patient is made in the shape of a crable that turns through 130 degrees and is firmly held in all positions of the X-ray apparatus mounting. The appliance provides good conditions for a multifarious roentgenological control over the manipulations with the bronchoscope, catheters, biopsy instruments and allows it to perform selective bronchography, pneumomediastinography angio- and lymphography. The appliance facilitates the arrest of the intrabronchial hemorrhage after biopsy and does not hamper the performance of reanimation procedures in cases of cardiac arrest. The use of the appliance increases the irradiation (absorbed) dose to which the service staff is exposed at their workplace by no more than 10 per cent.