Bronchopulmonary dysgenesis

The experience with the diagnosis and treatment of bronchopulmonary dysgenesis is presented. Twenty-eight patients were evaluated: 8 with congenital lobar emphysema; 9 with bronchial cyst; 4 with adenomatoidcystic malformation; 4 with pulmonary sequestration; 2 patients with arteriovenous malformation; and 1 pulmonary agenesia. Two patients died in the postoperative period (7.6 percent of postoperative mortally). Two were not operated on, and the remainder had a satisfactory outcome following sugery. The complications and the follow-up of the patients are analyzed. Embriologic considerations are made and the diagnostic and surgical methods used are evaluated.

Pseudoaneurismas anastomóticos / Anastomotic pseudoaneurysms

Se analizan 81 falsos aneurismas anastomóticos (FAA) en 58 pacientes operados por afecciones vasculares, en el lapso comprendido entre 1966 y 1995. Observamos 60 casos operados originalmente en nuestro hospital y 21 intervenidos en otros servicios. La incidencia de FAA en nuestro hospital fue del 5,46 por ciento. Sobre 502 aneurismas de aorta abdominal, hubo 15 FAA (2,98 por ciento) y sobre 597 aterosclerosis obliterante operados, tuvieron 66 FAA (11,05 por ciento). En la serie global de 81 FAA, 26 por ciento se localizaron a nivel aórtico y, 74 por ciento, a nivel femoral. Se efectuaron estudios bacteriológicos en un 86,4 por ciento de los casos y, sobre el total de cultivados, hubo un 52,9 por ciento de cultivos positivos. El tratamiento quirúrgico realizado en 79 FAA fue el siguiente: reconstrucción anatomótica a nivel aórtico en 55 por ciento (11/20) y, a nivel femoral, en 86,4 por ciento (51/59). Se utilizó técnica extraanatómica en 5 por ciento (8/20) de los FAA aórticos y en 15,3 por ciento (9/59) de los femorales. El índice de amputaciones mayores fue del 24,7 por ciento. De los 79 FAA operados, hubo un 39,2 por ciento de mortalidad postoperatoria. Cuando se comprende la patogénesis de los FAA, los factores involucrados pueden ser considerados en la primera operación previniendo así esta complicación

Tracheobronchoplasties in lung cancer

Seventy-four tracheobronchoplastic procedures were analyzed in a population of 990 pulmonary resections performed for lung cancer between 1954 and 1994. Fifty-four tracheobronchoplasties were performed between 1954 and 1977 without clinical staging. A second group of 20 tracheobronchoplastic procedures were carried out between 1978 and 1994 with prospective staging assessment. These were classified according to stage as follows: stage I, 5; stage II, 4 and stage III, 11. The overall indidence of bronchial fistula was 13.5 percent (10 cases), nine patients in the 1954-1977 group (16.6 percent) and one (5 percent) in the 1978-1994 period. Local recurrence was detected in 8 patients (13.1 percent) out of 61 postoperative survivors in the whole series. However, this figure was markedly reduced (5 percent) in the second group. Overall postoperative mortality was 17.6 percent (13 patients) and was not different in both groups. Five-year actuarial survival curve reached 21.8 percent in the first group and 21.9 percent in the second group. Tracheal and bronchoplastic techniques are useful procedures that can be safely applied to lung cancer surgery. Indications are the following: to extend the limits of resection; to allow resections in limited pulmonary function patients and to perform isolated main stem bronchus or carinal resections.

The utility of percutaneous fine-needle aspiration biopsy in the diagnosis of peripheral pulmonary lesions

A pulmonary lesion usually poses a diagnostic problem requiring a swift solution. Percutaneous fine-needle aspiration biopsy (NAB) technique yields a high percentage of correct diagnosis. However, this procedure is often underestimated and its indication vaguely known. Experience with 185 NAB in 175 patients is reviewed. One hundred and ten procedures were performed in hospitalized patients and 75 in an outpatient setting. Forty-four percent of cases in the whole series have had a previous negative fiberoptic bronchoscopy examination (FOB). Sixty-five percent were peripheral solitary pulmonary nodules, 54 percent of which were less than 2 cm lesions. The majority of NAB were performed under imaging guidance utilizing 20-23 gauge Chiba needles. High resolution fluoroscopic guidance was employed in 86 percent of cases, Computed Tomography (CT) in 11 percent and Ultrasonography in 3 percent. Specific cytologic diagnosis were obtained in 87 percent of the procedures done in hospitalized patients and 86.3 percent in ambulatory cases. In both groups, a 69 percent of neoplastic lesions were obttained. Post-biopsy pneumothorax was detected in 15 percent in each series. Only 3 patients in the whole series required the placement of a chest tube. To date, no needle tract seeding has been observed. A 9.3 percent and 10 percent of false negative results were recorded in both series, respectively. In this report, the complication rate is low and showed no statistical significant differences between the hospitalized and the outpatient groups. The latter resulted in less operative costs. Besides, TC guidance increases about 80 percent the operative expenses without offering a significant diagnostic yield. We conclude that NAB under fluoroscopic guidance in an outpatient basis is a reliable, safe, expeditious and cost effective diagnostic tool in small peripheral pulmonary lesions.