Liver and lung hydatid cysts with transdiaphragmatic rupture treated by radical surgery.

Hydatidosis is a parasitic disease caused by Echinococcus granulosus, a tapeworm that is endemic in certain parts of the world. We present a case of hepatopulmonary hydatidosis with diaphragm involvement and close contact with the suprahepatic inferior vena cava treated with radical surgery. We discuss therapeutical surgical options (approach and type of surgery).

[Postoperative analgesia in knee arthroplasty using an anterior sciatic nerve block and a femoral nerve block]. / Analgesia postoperatoria en la artroplastia de rodilla mediante los bloqueos ciático por vía anterior y femoral.

OBJECTIVE: To evaluate the efficacy of a nerve block as an alternative technique for analgesia after knee arthroplasty and to indicate the usefulness and advantages of the anterior approach to the sciatic nerve block. MATERIAL AND METHODS: Between April 2004 and March 2006, we studied a series of consecutive patients undergoing knee arthroplasty in which a subarachnoid block was used as the anesthetic technique and postoperative analgesia was provided by means of a combined peripheral femoral nerve block and an anterior sciatic nerve block. We evaluated the mean length of time free from pain, quality of analgesia, and length of stay in hospital. RESULTS: Seventy-eight patients were included in the study. The mean (SD) length of time free from pain for the group was 42.1 (3.9) hours. Patients reported mild pain after 34.8 (4.1) hours and moderate to severe pain after 42.4 (3.5) hours. By the third day, 62.8% of patients were able to bend the knee to 90 degrees. There were no complications resulting from the technique and the level of patient satisfaction was high. CONCLUSIONS: A combined femoral-sciatic nerve block is effective in knee arthroplasty. It controls postoperative pain and allows for early rehabilitation. The anterior approach to the sciatic nerve is relatively simple to perform without removing the pressure bandaging from the thigh after surgery. This approach also makes it unnecessary to move the patient.

[Single-port video-assisted thoracic surgery in an awake patient]. / Cirugía torácica asistida por vídeo uniportal en paciente despierto.

Video-assisted thoracic surgery is traditionally carried out with general anaesthesia and endotracheal intubation with double lumen tube. However, in the last few years procedures, such as lobectomies, are being performed with loco-regional anaesthesia, with and without sedation, maintaining the patient awake and with spontaneous breathing, in order to avoid the inherent risks of general anaesthesia, double lumen tube intubation and mechanical ventilation. This surgical approach has also shown to be effective in that it allows a good level of analgesia, maintaining a correct oxygenation and providing a better post-operative recovery. Two case reports are presented in which video-assisted thoracic surgery was used, a lung biopsy and a lung resection, both with epidural anaesthesia and maintaining the patient awake and with spontaneous ventilation, as part of a preliminary evaluation of the anaesthetic technique in this type of surgery.

[Thoracoscopic thymectomy with carbon dioxide insufflation in the mediastinum]. / Timectomía toracoscópica con insuflación de dióxido de carbono.

The case is presented of a 71 year-old male, diagnosed with a thymoma. A thoracoscopic thymectomy was performed using the carbon dioxide insufflation technique in the mediastinum. During the procedure, while performing one-lung ventilation, the patient's respiration worsened. The contralateral lung had collapsed, as carbon dioxide was travelling from the mediastinum to the thorax through the opened pleura. Two-lung ventilation was decided upon, which clearly improved oxygenation in the arterial gases and airway pressures. Both pH and pCO2 stabilized. The surgical approach and the carbon dioxide technique were continued because 2-lung ventilation did not affect the surgical procedure. This technique has many serious complications and it should always be performed using 2-lung ventilation.

[Failure in the functioning of an implanted automatic defibrillator due to pneumothorax occurring during its implantation ]. / Fallo en el funcionamiento de un desfibrilador automático implantable durante su colocación ocasionado por un neumotórax.

A 67-year-old man with chronic bronchitis and coronary artery disease was scheduled to receive an implantable cardioverter defibrillator (ICD) after an episode of sustained monomorphic ventricular tachycardia. During implantation through the left subclavian vein, oxygen saturation decreased to slightly below baseline. Nevertheless, the procedure continued, given that the patient experienced neither breathing difficulties nor pain. When the ICD failed to reverse ventricular fibrillation induced to test the device, an external defibrillator was used. At that point, left-sided pneumothorax was observed by x-ray. Air in the pleural cavity caused an increase in the defibrillation threshold. After insertion of a thoracic drain, the ICD implantation procedure was completed successfully.