ABSTRACT
Introducción: El empiema torácico se define como derrame pleural purulento. La causa más frecuente es el infeccioso paraneumónico, sin embargo, puede presentarse en escenarios posquirúrgicos o postraumáticos. El empiema sigue una evolución progresiva trifásica y el tratamiento debe enfocarse a la causa de la enfermedad, fase evolutiva, y el estado general del paciente. Algunos casos requieren toracotomía con drenaje abierto tipo ventana torácica para solucionar el padecimiento. Materiales y Método: Estudio observacional, retrospectivo y descriptivo basado en una serie de casos. Se analizaron datos de pacientes consecutivos con empiema intervenidos con toracotomía con drenaje abierto tipo ventana torácica y uso de sistema de presión negativa en un Hospital de 3er Nivel del Sureste de México de octubre 2015 a junio 2017. Resultados: Se analizaron seis casos, la mediana de edad fue 46 años (rango intercuartílico 34-47) y 67% eran hombres. El sistema de presión negativa se colocó en el periodo posquirúrgico con una mediana de 6 días (rango intercuartílico 5-7). El tiempo medio de permanencia fue de 61 días (RIC 43-148). Finalmente, el tiempo de estancia hospitalaria fue de 72 días (RIC 49-87). El 67% de los casos evolucionó con cierre de la ventana torácica y adecuada expansión pulmonar. Conclusiones: En pacientes con empiema crónico, la terapia integral que incluya toracotomía con ventana torácica y el uso de sistema de presión negativa es una estrategia aceptable de tratamiento. Se requieren más estudios que ratifiquen los resultados de forma más objetiva.
Background: Thoracic empyema is defined as a purulent pleural effusion. Its most common origin is parapneumonic, nonetheless, post-surgical or post-traumatic empyema can also occur. Empyema has a progressive three-phase evolution and the treatment must focus to the evolutionary phase, cause of the disease and overall state of the patient. Some cases would undergo through thoracotomy with thoracic window open drainage to solve the disease. Material and Methods: This is an observational, retrospective and descriptive study based on all consecutive patients with empyema who underwent thoracotomy with thoracic window open drainage in a 3rd level hospital in the southeast of Mexico between october 2015 and june 2017. Results: We identified 6 cases. Median of age was 46 years (IQR 34-47) and 67% were male. The negative pressure system was placed in the 6th day of surgery (IQR 5-7). Median time of use was 61 days (IQR 43-148). Finally, the length of hospital stay was 72 days (IQR 49-87). 67% of the cases had chest window closure with adequate lung expansion. Conclusions: when we face a clinical scenario with chronic empyema, an integral therapy that includes thoracic window thoracotomy with a negative pressure system is an acceptable treatment strategy. Subsequent studies are required in order to ratify the results
Subject(s)
Pleural Effusion , General Surgery , EmpyemaABSTRACT
Introduction: the thoracic empyema is defined as a purulent pleural effusion. Its most frequent cause is infectious parapneumonic effusion; however, postsurgical or posttraumatic empyema can also occur. The empyema has a progressive three-phase evolution and its treatment shall focus on the cause of the disease, the evolutionary phase and the general condition of the patient. In order to cure this condition, some cases require thoracotomy with open thoracic window drainage. Materials and Method: observational, retrospective and descriptive study based on a series of cases. We analyzed data from consecutive patients with empyema who underwent thoracotomy with open thoracic window drainage and using a negative pressure system in a third-level care hospital in the southeast of Mexico between October 2015 and June 2017. Results: we analyzed 6 cases. Median of age was 46 years (interquartile range 34-47), and 67% were male. The negative pressure system was placed during the postsurgical period, with a median of 6 days (interquartile range 5-7). The mean permanence time was 61 days (IQR 43-148). Finally, the length of hospital stay was 72 days (IQR 49-87). 67% of the cases had thoracic window closure and adequate lung expansion. Conclusions: in patients with chronic empyema, an integral therapy including thoracic window thoracotomy with a negative pressure system is an acceptable treatment strategy. More studies are required in order to ratify the results more objectively.
Subject(s)
Pleural Effusion , General Surgery , EmpyemaABSTRACT
Resumen La pérdida recurrente del embarazo ocurre cuando una mujer tiene 2 ó más pérdidas de embarazos clínicos antes de las 20 semanas de gestación. Existen múltiples factores de riesgo relacionados con este padecimiento, entre ellos, la presencia de Hipertensión Pulmonar (HP) se vincula con elevada mortalidad (30-56% de los casos) y riesgo de abortos entre las semanas 9 y 12 de gestación. No se conoce con precisión la frecuencia de asociación entre las condiciones clínicas referidas. Presentamos el caso de una mujer de 31 años de edad que ingresó al hospital con un aborto en evolución, en el periodo posterior al legrado evidencian Hipoxemia Grave e Insuficiencia Cardiaca Derecha; durante el abordaje diagnóstico se confirma que la causa primaria de la recurrencia de abortos se encuentra asociada con la presencia de Hipertensión Pulmonar Idiopática.
Abstract Recurrent pregnancy loss occurs whenever a woman has 2 or more miscarriages of their clinical pregnancy before 20 weeks of gestation. There are multiple risk factors relates to this condition, among, them, the presence of pulmonary hypertension (PH) is linked with high mortality (30-56% of cases) and risk of miscarriages between 9 weeks and 12 of gestation. The prevalence of both conditions are not well known. Here, we present the case of a 31 year-old women who was admitted to the hospital with an abortion in evolution, immediately after the curettage, the patient exhibit severe hypoxemia in association with Right Heart Failure; the medical approach established that the primary cause of recurrent abortions was an uncontrolled idiopathic pulmonary hypertension.