Lobectomías robóticas y cáncer de pulmón. Experiencia inicial en nuestro centro / Robotic lobectomies and lung cancer. Initial experience in our center

Objetivo: Analizar la seguridad y factibilidad en términos de resultados obtenidos en las primeras lobectomías robóticas realizadas en nuestro centro. Metodología: Estudio prospectivo desde mayo hasta diciembre de 2021 en 13 pacientes (11 hombres y 2 mujeres, edad media 59 años) con carcinoma de pulmón en estadios precoces tributarios de lobectomía robótica.Se utilizó el sistema da Vinci Xi con cuatro puertos y uno asistente. Resultados: Se realizaron 13 lobectomías robóticas. La conversión a cirugía videoasistida fue necesaria en 2 pacientes (15,4%). Se produjeron complicaciones en 3 pacientes (23%). La mediana de tiempo quirúrgico fue180 minutos [IQR 150-210]. La mediana de estancia hospitalaria fue de 4 días [IQR 3 - 6]. La mediana de duración del drenaje pleural fue de 4 días [IQR3 - 6]. La histología predominante fue carcinoma epidermoide en5 pacientes (39%). La media de ganglios linfáticos resecados fue de 15 (IC 95%: 11 - 19) y la de estaciones ganglionares de 5 (IC 95%: 4 - 5). No hubo mortalidad postoperatoria. El estadio postquirúrgico fue IA2 en 4 pacientes (31%), IB en 3 (23%), IIB en 2 (15%), y IIIA en 1 (7%). No se establecen diferencias estadísticamente significativas entre el IMC, el lóbulo resecado y la presencia de complicaciones (p = 0,5; p = 0,2), ni entre el número de ganglios resecados/número de estaciones ganglionares, y el estadio tumoral (p = 0,4; p = 0,9). Conclusiones: La lobectomía robótica con linfadenectomía hiliomediastínica es factible y segura. Es necesaria mayor experiencia y seguimiento a largo plazo para una adecuada evaluación de los resultados postoperatorios, la eficacia oncológica, y la comparación con las vías de abordaje convencionales. (AU)

Objectives: analyze the safety and feasibility in terms of results obtained in the first robotic lobectomies performed in our center. Method: prospective study from May to December 2021 in 13 patients (11 men and 2 women, mean age 59 years) with lung carcinoma in early stages requiring robotic lobectomy. The da Vinci Xi system was used with four ports and one assistant. Results: 13 robotic lobectomies were performed. Conversion to video-assisted surgery was necessary in 2 patients (15.4%). Complications occurred in 3 patients (23%). The median surgical time was 180 minutes [IQR 150-210]. The median hospital stay was 4 days [IQR 3 - 6]. The median duration of pleural drainage was 4 days [IQR3 - 6]. The predominant histology was squamous cell carcinoma in 5 patients (39%). The mean number of lymph nodes resected was 15 (95% CI: 11 - 19) and the number of lymph nodes resected was 5 (95% CI: 4 - 5). There was no postoperative mortality. The postsurgical stage was IA2 in 4 patients (31%), IB in 3 (23%), IIB in 2 (15%), and IIIA in 1 (7%). No statistically significant differences were established between BMI, the resected lobe and the presence of complications (p = 0.5; p = 0.2), nor between the number of resected lymph nodes/number of lymph node stations, and the tumor stage ( p = 0.4; p = 0.9).Conclusions: robotic lobectomy with hiliomediastinal lymphadenectomy is feasible and safe. Greater experience and long-term follow-up are necessary for an adequate evaluation of postoperative results, oncological efficacy, and comparison with conventional approaches. (AU)

Valoración del estado Nutricional en enfermos mentales institucionalizados / Assessing nutritional status in institutionalized mental patients

Introducción y objetivos: la malnutrición continúa siendo un problema no reconocido en los centros psiquiátricos. El objetivo del presente estudio fue conocer la prevalencia de la malnutrición y reconocer la importancia de la dieta en la alimentación de los enfermos mentales. Métodos: se evaluó el estado Nutricional de 65 pacientes mediante medidas antropométricas (peso, talla, índice de masa corporal, pliegue cutáneo tricipital, pliegue cutáneo bicipital, pliegue cutáneo subescapular, pliegue cutáneo suprailíaco, pliegue cutáneo tibial, pliegue cutáneo abdominal, índice cintura-cadera, circunferencia de la cadera y circunferencia de la cintura), analíticas (ferritina, triglicéridos, albúmina, colesterol, glucosa), otras variables (presión arterial), el cuestionario MNA-2009 y el menú de una semana. De cada paciente, además, se registraron datos personales, sexo, hábito tabáquico, edad, tipo de enfermedad, actividad física, visitas familiares y las variables enmarcadas en el cuestionario MNA-2009. Resultados: la muestra estuvo formada por 13 mujeres y 52 hombres, todos ellos enfermos mentales de una institución psiquiátrica. El 43,1 % presentaban sobrepeso y el 21,5 % obesidad, siendo estos índices superiores en las mujeres que en los hombres. Respecto a los valores bioquímicos, se observó que los niveles de triglicéridos y colesterol eran superiores a los valores recomendados. Además, los sujetos presentaron un gran desequilibrio en macronutrientes y micronutrientes en la valoración Nutricional diaria. Conclusión: en este estudio se ha demostrado la gran prevalencia de la malnutrición en los pacientes psiquiátricos, en concreto de la obesidad por el gran exceso que presentan cada uno de los macronutrientes y micronutrientes repartidos en el menú durante el día de los pacientes psiquiátricos (AU)

Introduction and objectives: malnutrition remains an unrecognised problem in psychiatric centers. The aim of the present study was to find out the prevalence of malnutrition and to recognize the importance of diet in the nutrition of the mentally ill. Methods: the nutritional status of 65 patients was assessed by anthropometric measurements (weight, height, body mass index, tricipital skin fold, bicipital skin fold, subscapular skin fold, suprailiac skin fold, tibial skin fold, abdominal skin fold, waist-hip index, hip circumference and waist circumference), blood tests (ferritin, triglycerides, albumin, cholesterol, glucose), other variables (blood pressure), the MNA-2009 questionnaire, and the one-week menu. Personal data, sex, smoking habits, age, type of disease, physical activity, family visits and the variables included in the MNA-2009 questionnaire were also recorded for each patient. Results: the sample consisted of 13 women and 52 men, all of whom were mentally ill patients in a psychiatric institution. A total of 43.1 % were overweight and 21.5 % obese, with more women than men in each category. Regarding biochemical values, it was observed that triglyceride and cholesterol levels were higher than recommended values. In addition, they presented a great imbalance in macronutrients and micronutrients in the daily nutritional assessment. Conclusion: this study has demonstrated the high prevalence of malnutrition in psychiatric patients, in particular obesity, due to the large excess of each of the macronutrients and micronutrients in the daily menu of psychiatric patients (AU)

Recurrent massive pleural effusion as a late complication of radiotherapy in Hodgkin's disease.

We report a very unusual case of a patient with recurrent massive PEs eight years after mediastinal radiotherapy for HD, in which evidence of lymphomatous recurrence could not be demonstrated. The diagnosis of PE as a complication of radiation is presumptive, and other disorders causing PE must be excluded. This condition requires symptomatic treatment and a close follow-up of the patient.

Subglottic inflammatory pseudotumor in a 6-year-old child.

Inflammatory pseudotumors have been given diverse--no fewer than 19--names in the literature. The most frequent localization is in the lung, the gastrointestinal tract, and salivary glands. The case presented here at the subglottic level is exceptional. Although the intraoperative diagnosis is not easy, the prognosis is usually good. Malignant degenerations have not been described. In those cases that cannot be operated on or that extend into the mediastinum, radiotherapy is indicated.

Bronchovascular mucormycosis: an urgent surgical problem.

The case of a 70-year-old male with lymphoblastic leukemia is reviewed, who presented the rare and almost always fatal complication of pulmonary mucormycosis, but who was treated satisfactorily with amphotericin B and surgery. The risk of massive hemoptysis in the course of mucormycosis that invades the lung vessels, makes us believe that surgery is an essential part of the management of this disease. It is suggested that the patient be operated as soon as the diagnosis is obtained, as we did in our case, to avoid other risks in combined management with amphotericin B.

[The treatment of tracheobronchial ruptures: a review of 6 cases]. / Tratamiento de las roturas traqueobronquiales: revisión de 6 casos.

Tracheobronchial ruptures represent a serious pathology difficult to diagnose at the first examination. The authors review 6 cases: four as acute types with pneumomediastinum, pneumothorax and subcutaneous emphysema with a delay in diagnosis of 3.25 days, meanwhile 2 cases were chronic forms with a delay in diagnosis of 124.5 days. Diagnosis should be performed as soon as possible based in the presence of uni or bilateral pneumothorax with pneumomediastinum being confirmed by fiber bronchoscopy. The treatment is based in the resection of the fractured fragments, followed by bronchoplasty always with reabsorbable sutures the most frequent surgical technique, meanwhile in the atelectatic forms it is not possible to perform sometimes and we must practise lung resections.

[Splenic hydatid cyst. A report of 16 cases]. / Quiste hidatídico de bazo. Aportación de dieciséis casos.

The authors' experience with splenic hydatidosis is presented. Sixteen cases, representing 3% of the hydatidosis treated surgically in our center, are reviewed. Pain in the left upper quadrant, splenomegaly and calcifications detected by simple abdominal radiology are the most suggestive indications. The definitive diagnosis is based on abdominal echography and CT scan, which have the greatest sensitivity and specificity. The treatment should be surgical, attempting to preserve as much splenic tissue as possible, although in our experience, it is infrequent that conservative treatment can be used due to massive involvement of the spleen.

Group B streptococcal disease in pregnancy.

Group B Streptococcal (GBS) infection in the pregnant female represents a challenging and often complex scenario which may cause deleterious effects in the neonate. In this paper we present three case reports of GBS infection in neonates with different outcome. A comprehensive review of the history, microbiology, clinical presentation and therapy guidelines is presented. Early diagnosis and institution of therapy are the most important factors which may have an impact on maternal and neonatal outcome.

Reconstrucción de la vía aérea principal mediante el uso de prótesis sintéticas integrables / Reconstruction of the main airway through the use of integrable synthetic prosthesis

Uno de los principales problemas que plantea el tratamiento quirúrgico de las lesiones traqueales es la limitación existente en la longitud del segmento que es posible resecar. Actualmente, se puede extirpar con seguridad el 50% de la tráquea como máximo. Lesiones más extensas no se pueden beneficiar de este tratamiento y es necesario utilizar técnicas alternativas, en la mayoría de los casos paliativas. Una posible solución a este problema es la interposición de algún elemento que sustituya el segmento traqueal resecado. Se ha realizado un estudio experimental en animales, sustituyendo segmentos traqueales de distinta longitud por prótesis cilíndricas de politetrafluoroetileno. Posteriormente, se ha realizado un seguimiento y sacrificio de los animales estudiando los cambios histológicos. Los resultados obtenidos muestran la posibilidad técnica de la sustitución de la vía aérea por segmentos de material protésico. En el seguimiento evolutivo de los animales, parece existir una relación directa entre la longitud del implante y la aparición de estenosis traqueal a dicho nivel, tanto en los estudios morfológicos macroscópicos como en los estudios realizados con microscopía óptica. Sin embargo, por el momento, la mortalidad perioperatoria es elevada y, si bien se puede atribuir a la curva de aprendizaje, la traslación de los resultados a una posible práctica clínica no es recomendable

One of the main problems arising from the surgical treatment of tracheal lesions is the existing limitation in the length of segment that can be resected. Currently, a maximum of 50% of the trachea can be safely removed. More extensive lesions cannot benefit from this treatment and alternative techniques must be used, which are palliative in most cases. The interposition of an element which substitutes the segment of resected trachea is a possible solution for this problem. An experimental animal study has been conducted, substituting tracheal segments varying in length with cylindrical polytetrafluoroethylene prostheses. Later, a follow-up was done and the animals were sacrificed to study histological changes. The results show the technical possibility of substituting the airway with segments of prosthetic material. In the monitoring of the animals, there seems to be a direct relationship between the length of the implant and the appearance of tracheal stenosis at the implant site, both in the macroscopic morphological studies and the studies completed with optical microscopy. However, for the time being, perioperative mortality is high and, although it can be attributed to the learning curve, applying the results to possible clinical practice is not recommended

Biological Control of Agrobacterium tumefaciens, Colonization, and pAgK84 Transfer with Agrobacterium radiobacter K84 and the Tra Mutant Strain K1026.

The efficacies of Agrobacterium radiobacter K84 and K1026 in root colonization, crown gall control, and plasmid transfer were compared. Levels of root colonization by K84 and K1026 of Montclar and Nemaguard peach seedlings were similar during the 21 days of the experiment. Four strains of A. tumefaciens bv. 1 were used for soil inoculations in biological control experiments on GF677 and Adafuel peach x almond rootstocks; two were sensitive and two were resistant to agrocin 84. Both strains K84 and K1026 were very efficient in controlling the sensitive strains, but some tumors appeared with both treatments. In the biocontrol of resistant strains, no galls were observed in K1026-treated plants, but some K84-treated plants had galls. Recovery of agrobacteria from galls in experiments with sensitive and resistant strains showed that all of the isolates from the controls or K1026-treated plants and most of the isolates from K84-treated plants had the same characteristics as the inoculated strains. Nine isolates from the K84-treated plants growing in soil inoculated with one resistant strain were virulent and produced agrocin 84. These isolates had a plasmid that hybridized with a probe prepared with the BamHI C fragment from pAgK84. These results show the efficiency of K1026 in biocontrol of agrocin 84-sensitive and -resistant strains of A. tumefaciens and suggest the use of K1026 as a safer organism than K84 for biological control of crown gall.

Pulmonary hydatidosis in childhood. Review of 21 cases.

Spain is one of the countries with a very high incidence of hydatidosis in the childhood. It represents 16.8% of all cases intervened for thoracic surgery for hydatidosis cysts in our department during the last ten years with a total of 21 children (inferior to 14 years) operated due to hydatidosis. Cough and pain were the symptoms more frequently encountered. The ratio unruptured/ruptured cysts was 3/1, higher than in the adults, with an average of 2.62 cysts per patient. Specific immunoglobulin E and histamine liberation test were the most useful tests in the laboratory. The usual surgical technique was a cystopericystectomy with total extirpation of the parasite of its rests. No recurrence was found in the follow-up of our patients.

Attachment of Agrobacterium tumefaciens B6 and A. radiobacter K84 to Tomato Root Tips.

Agrobacterium tumefaciens B6 and the avirulent Agrobacterium radiobacter strain K84 attached to in vitro-cultured tomato root tips, but the binding of strain B6 to root tips was greater than the binding of strain K84. Strain K84 was not able to block the attachment of A. tumefaciens B6 to in vitro-cultured tomato root tips.

Thoracic surgery in the elderly: review of 100 cases.

One hundred cases surgically intervened due to thoracic pathology between 1977 and 1986 were studied. The ages were equal to or higher than 70 years. Mean age was 73.13 years (70-91). In 70 cases a neoplastic aetiology existed (78.57% of primary bronchial carcinoma), while in the other 30 cases the cause was not neoplastic. In these cases with a high operative risk, a detailed systematic study before surgery is recommended, which should be treated in the most conservative possible way. Although the complication rate was higher than the average in other groups (p less than 0.05), mortality was only 4%, being related, to a greater or lesser extent--, to the surgery (p less than 0.05). In the cases diagnosed as bronchial carcinoma, a 2-year survival was obtained in 66.4%, 3 years in 49.8% and 5 years in 25.7%, concluding that an age equal to, or higher than, 70 years does not represent any contraindication for thoracic surgery.

Group B streptococcal disease in pregnancy

Group B Streptococcal (GBS) infection in the pregnant female represents a challenging and often complex scenario which may cause deleterious effects in the neonate. In this paper we present three case reports of GBS infection in neonates with different outcome. A comprehensive review of the history, microbiology, clinical presentation and therapy guidelines is presented. Early diagnosis and institution of therapy are the most important factors which may have an impact on maternal and neonatal outcome