Hallazgos radiológicos en 80 pacientes con compromiso pulmonar por COVID-19. Estudio descriptivo / RADIOLOGICAL FINDINGS FROM 80 PATIENTS WITH COVID-19 PNEUMONIA. A descriptive study

Introducción: El compromiso pulmonar es la complicación más frecuente de la infección por SARS-CoV-2 (COVID-19). Objetivos: Describir la utilidad de la tomografía computarizada (TC) de tórax realizada tempranamente para la detección y evaluación del compromiso pulmonar en la enfermedad COVID-19. Materiales y métodos: Se analizaron de manera retrospectiva ochenta (80) pacientes con diagnóstico confirmado (RT-PCR en hisopados nasofaríngeos con detección de SARS-Cov-2) de neumonía por COVID-19 internados en la Unidad 17, División "B", del Hospital de Referencia en Enfermedades Infecciosas F.J.Muñiz, CABA, a los que se les efectuó TC de tórax en las primeras 24 horas de su ingreso hospitalario. Se analizaron de manera retrospectiva y descriptiva los patrones radiológicos de compromiso pulmonar más frecuentes, su localización y distribución. Resultados: se incluyeron en la evaluación, 80 pacientes internados en el Hospital entre los meses de Junio y Agosto de 2020. Todos (100%) fueron varones con una mediana de edad de 45.5 años (rango 21 a 81 años). El patrón radiológico predominante en la TC fueron las opacidades en vidrio esmerilado (33 [41.3%] de los pacientes); con predominio del compromiso bilateral (71 [93.4%] pacientes), multilobar (71 [93.4%] pacientes) y localización subpleural (periférica) (38 [57.6%] casos). Conclusión: Las opacidades en vidrio esmerilado, bilaterales, difusas y de predominio subpleural en su localización fueron los hallazgos más comunes en la TC de tórax efectuada de forma precoz en pacientes con diagnóstico de neumonía por COVID-19. Las imágenes de consolidación y los patrones mixtos también fueron hallazgos frecuentes en la TC de tórax observados en la mayoría de los pacientes, aún en estadios tempranos de la enfermedad por COVID-19.

Introduction: Pulmonary involvement is the most frequent complication of SARS-CoV-2 infection (COVID-19). Objectives: Describe the utility of early computed tomography (CT) scan of thorax in the management and detection of pulmonary parenchyma compromise. Material and methods: Eighty (80) patients with COVID-19 pneumonia (confirmed by RT-PCR detection of SARS-Cov-2 in nasopharyngeal swabs) who were admitted to the Unit 17th,, "B" Division, Infectious Diseases F. J. Muñiz Reference Hospital, CABA, and who underwent early chest CT scans were retrospectively enrolled. Imaging features, predominant radiological lung patterns, and distribution were retrospectively analyzed. Results: 80 patients admitted to the hospital between June 2020 to August 2020, were retrospectively enrolled. The cohort included 80 (100%) men with a mean age of 45.5 years (range 21 to 81 years). The predominant pattern of abnormality observed was ground-glass opacification (33 [41.3%] patients), bilateral compromise (71 [93.4%] patients), multilobar involvement (71 [93.4%] patients) and subpleural lesions (peripheral) (38 [57.6%] cases). Conclusion: Bilateral, diffuse, ground-glass opacities were the predominance findings on early CT thorax scan of confirmed COVID-19 pneumonia. Consolidation and mixed patterns were also frequent. COVID-19 pneumonia presents with chest CT imaging abnormalities in the majority of patient even in early stages of the disease

Pemphigus vegetans with isolated involvement of the nose and chest: rare variant of pemphigus vulgaris

Abstract: Pemphigus vulgaris is chronic bullous disease that manifests as bullae and erosions of skin and mucosas, with intraepidermal suprabasal cleft formation seen in the histological examination. It has a rare variant called pemphigus vegetans, where vesicles and bullae are replaced by pustular, verrucous and hyperpigmented lesions, mainly in skin folds. The treatment is similar to that for classic pemphigus vulgaris. The authors present an exuberant case of pemphigus vegetans, covering the nose and chest exclusively, without oral or flexural lesions.

Enfermedad de Castleman de localización torácica / Intrathoracic Castleman's disease

Antecedentes: la enfermedad de Castleman es conocida como hiperplasia linfática angiofolicular y se caracteriza por crecimiento masivo del tejido linfático. Histológicamente hay tres categorías: hialino-vascular, tipo células plasmáticas y mixto. Se describen dos variantes clínicas: monocéntrica (localizada) y multicéntrica. Objetivo: presentar nuestra experiencia en el manejo de esta enfermedad haciendo énfasis en su compromiso mediastinal y pulmonar. Material y métodos: revisión de historias clínicas e informes patológicos. Resultados: se identificaron 5 pacientes, 1 mujer y 4 hombres, con edad promedio de 58,5 años. Tres pacientes presentaron la forma localizada y dos la multicéntrica. Los síntomas fueron: dolor torácico en dos casos, astenia en 1 caso y síndrome POEMS (polineuropata, organomegalia, endocrinopata y pico monoclo-nal) en 2 casos. Se realizó toracotomía y resección en 2 casos, lobectomía superior derecha en bloque con la lesión mediastinal en 1 caso, biopsia de masa apical en 1 caso y biopsia ganglionar por mediastinoscopia en 1 caso. Se realizó reoperación por sangrado en 1 caso. Tres pacientes presentaron la forma hialino-vascular y 2 la variante de células plasmáticas. Un paciente resecado se perdió de seguimiento. Los pacientes con síndrome POEMS fallecieron, uno al 8° día por neumonía intrahospitalaria y otro al 6° mes por sepsis. Los enfermos resecados restantes cursan buena evolución. Conclusiones: se recomienda la resección quirúrgica en pacientes con enfermedad de Castleman variedad localizada, la cual es curativa. Los pacientes con la variedad multicéntrica no se benefician con esta terapéu-tica, pero son pasibles de quimioterapia o radioterapia o combinación de ambas.

Background: Castleman's disease, known as angio follicular lymph node hyperplasia, is characterized by the massive growth of lymphoid tissue. Histollogically there are three categories: hyaline-vascular, plasm cell type and mixed type. Two clinical variantis have been described: monocentric (localized) and multicentric. Objective: to describe our experience in the treatment of this disease, focusing on itis mediastinal and pulmonary afecton. Method: review of clinical records and pathological reportis. Resultis: 5 patentis (1 female and 4 male), within an age -range of 58, 5 years were screened. Three patentis were afected by the localized type and two by the multicentric type. The symptoms were: thoracic pain in two of the cases, asthenia in one and POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy and monoclonal changes) in 2 cases. We performed thoracotomy and resecton in two cases, upper right side lobectomy in block with the mediastinal lesion in 1 case, apical mass biopsy in 1 case and lymph node biopsy by mediastinoscopy in one case. We performed reoperaton by bleeding in one case. Three patentis presented the hyaline vascular type and two, the plasma-cell type. We lost track of a resectoned patent. Those patentis with POEMS syndrome died, one of them of intra-hospital pneumonia on the eighth day, and another of sepsis on the sixth month. The remaining resectoned patentis are evolving well. Conclusions: on patentis presenting localized type Castleman's disease, we recommend surgical resecton, which is a curative therapy. Patentis presenting the monocentric type do not beneft from this therapy and are passible of chemotherapy and /or radiotherapy.

Segurança e viabilidade de um novo formato de retalho toracoepigástrico na reconstrução da parede torácica em câncer de mama localmente avançado: um estudo transversal / Safety and viability of a new format of thoracoepigastric flap for reconstruction of the chest wall in locally advanced breast cancer: a cross-sectional study

INTRODUÇÃO: Pacientes submetidas à mastectomia radical, com extensa perda tecidual, necessitam de procedimento cirúrgico de fechamento rápido e simples da lesão, com boa cobertura cutânea e mínima morbidade, para que possam receber precocemente tratamentos complementares. Estudamos a eficácia e a segurança de um novo formato do retalho toracoepigástrico com o posicionamento semissentado (Fowler) da paciente durante a cirurgia. A hipótese é de que o procedimento, além de obter adequado fechamento de grandes lesões, permita garantir a sobrevivência do retalho. MÉTODOS: Foram analisadas todas as pacientes consecutivamente operadas com mastectomias radicais entre 2009 e 2014 submetidas a reconstruções torácicas. Os principais desfechos analisados foram a viabilidade do retalho e a eficácia no fechamento cirúrgico. RESULTADOS: No período do estudo, foram operadas 29 pacientes com tumor localmente avançado (90%) ou recidivado (10%), uma operada bilateralmente (30 retalhos); vinte e três (79%) com estadiamento III e seis (21%), estadiamento IV. A extensão das áreas ressecadas variou de 20 x 15 cm a 13 x 9 cm (média 15,5 x 11,6 cm). Retalho toracoepigástrico foi utilizado com dimensões variando de 25 x 12 cm a 18 x 8 cm (média de 21,3 x 10,4 cm). Houve apenas duas deiscências (7%), que cicatrizaram sem necessidade de intervenção cirúrgica, e um hematoma, drenado cirurgicamente. Uma paciente faleceu no 11º dia pós-operatório. CONCLUSÃO: O retalho toracoepigástrico foi eficaz e seguro, sem necessidade do uso de outros retalhos ou enxertos cutâneos, fechando a área doadora adequadamente em todos os casos. Todas as pacientes, excluindo o óbito, estavam aptas para o tratamento complementar após um mês.

INTRODUCTION: Patients who undergo radical mastectomy with extensive tissue loss require a surgical procedure for rapid and simple closure of the lesion, with good skin coverage and minimal morbidity, to make them eligible for early complementary treatments. We evaluated the efficacy and safety of a new format of thoracoepigastric flap with patients in the Semi-Fowler position during surgery. We hypothesized that this procedure would achieve proper closure of large lesions and ensure the survival of the flap. METHODS: All consecutive patients who underwent radical mastectomy between 2009 and 2014 and had chest wall reconstruction were evaluated. The main outcomes evaluated were the viability of the flap and effectiveness of the surgical closure. RESULTS: During the study period, we operated on 29 patients with locally advanced (90%) or recurrent tumor (10%), and one patient was operated on bilaterally (total of 30 flaps). Of the study sample, 23 patients (79%) were at stage III and 6 (21%), at stage IV. The dimensions of the resected areas varied from 20 x 15 cm to 13 x 9 cm (average 15.5 x 11.6 cm). The dimensions of the thoracoepigastric flaps varied from 25 x 12 to 18 x 8 cm (average 21.3 x 10.4 cm). There were only 2 cases of dehiscence (7%), which resolved without surgical intervention, and one case of hematoma, which was drained surgically. One patient died on the eleventh postoperative day. CONCLUSION: Thoracoepigastric flaps were effective and safe, did not require the use of other flaps or skin grafting, and adequately closed the donor areas in all cases. All patients, except the patient who died, were eligible for complementary treatment one month after surgery.

Evolución clínica, radiológica y auxológica a largo plazo de 8 niños con displasia torácica asfixiante / Clinical, radiological and auxologic long-term evolution of 8 children with asphyxiating thoracic dysplasia

La displasia torácica asfixiante es una enfermedad infrecuente con compromiso multiorgánico y alta letalidad neonatal. Se presenta conbaja estatura, miembros cortos, tórax estrecho. Con la edad, hay mejoría respiratoria, pero aparición de compromiso renal, hepático, pancreático y/o retinal. Objetivo: Describir la evolución a largo plazo de 8 pacientes de un hospital de pediatría. Métodos: Se evaluaron retrospectivamente edad de diagnóstico, sexo, variables antropométricas, complicaciones y radiología. Resultados: Masculino/femenino, 6/2. Edad al momento del diagnóstico mediana: 2,54 años. Evolución: 8/8, compromiso respiratorio; 3/8, renal; 2/8, hepático; 1/8, oftalmológico; 1/8, cardíaco. Mediana de estatura al momento del diagnóstico: -1,76 DE; crecimiento posnatal y proporciones corporales, normales. Radiología: 8/8, tórax estrecho y braquifalangia en manos. 5/8, anomalías acetabulares. Discusión: Es recomendable un seguimiento para monitorear la función renal, hepática y ocular. El pediatra debería sospechar esta entidad ante un recién nacido con tórax estrecho y dificultad respiratoria.

Asphyxiating Thoracic Dysplasia is an uncommon condition with multiple organ afectation and high neonatal mortality. It presents with short stature, short extremities, narrow thorax. With growth, there is respiratory improvement, but emergence of renal, hepatic, pancreatic and/or retinal impairment. Objective: to describe the long-term evolution of 8 patients of a pediatric hospital. Methods: we retrospectively evaluated age at diagnosis, sex, anthropometric variables, complications and radiology. Results: male/female 6/2. Median age at diagnosis: 2.54 years. Evolution: 8/8 respiratory compromise, 3/8 kidney, liver 2/8, 1/8 ophthalmologic, cardiac 1/8. Median height at diagnosis -1.76 DS, normal postnatal growth and body proportions. Radiology: 8/8 narrow chest and brachyphalangia in hands. 5/8 acetabular abnormalities. Discussion: for surveillance it is recommended to monitor renal, liver and eye function. The pediatrician should suspect this entity in a newborn with narrow thorax and respiratory distress.

Ressonância magnética de tórax em portadores de dispositivos cardíacos eletrônicos implantáveis condicionais para ressonância magnética: contraindicação clássica ou exame seguro / Chest magnetic resonance imaging in patients with magnetic resonance imagingconditional pacemakers: classical contraindication or a safe test

Introdução: Este estudo teve por objetivo verificar o impacto do artefato de suscetibilidade magnéticaproduzido pelo gerador de pulsos e pelos cabos-eletrodos dos dispositivos cardíacos eletrônicos implantáveis nasimagens geradas pela ressonância magnética de tórax, avaliando, assim, sua interferência no resultado final doexame, além de analisar as possíveis alterações no funcionamento dos dispositivos, por meio da avaliação e dacomparação dos parâmetros (limiares de estimulação atriais e ventriculares, impedâncias dos cabos-eletrodosatriais e ventriculares, amplitudes das ondas P e R e status da bateria) pré - e pós-ressonância magnética. Método:Foram realizados exames de ressonância magnética de tórax em 20 portadores de dispositivos cardíacos eletrônicosimplantáveis ProMRI®, sendo 11 do sexo masculino e 9 do sexo feminino. As imagens e os artefatos gerados e ofuncionamento pré- e pós-exame dos dispositivos cardíacos eletrônicos implantáveis foram avaliados e comparados.Resultados: A avaliação da imagem gerada mostrou que o artefato de suscetibilidade magnética produzido poresses dispositivos não provocou interferência significativa na imagem, não afetando a avaliação do resultado e,consequentemente, o diagnóstico. As avaliações dos dispositivos pré- e pós-exame de ressonância magnéticademonstraram que não ocorreram danos na interface cabo-eletrodo/miocárdio, alterações na impedância esensibilidade dos cabos-eletrodos, e alterações nas capacidade remanescente das baterias. Conclusão: O examede ressonância magnética de tórax em portadores de dispositivos cardíacos eletrônicos implantáveis ProMRI®pode ser realizado com segurança, sem alterar o funcionamento dos dispositivos e sem prejudicar a imagem daressonância magnética, desde que algumas regras e condições sejam seguidas corretamente.

This study was aimed at assessing the impact of magnetic susceptibility artifactproduced by the pulse generator and the leads of cardiac implantable electronic devices on the images generatedby chest magnetic resonance imaging, and therefore evaluate its impact on the final result of the test, in additionto analyzing possible changes in the operation of these devices, by means of the evaluation and comparisonof parameters (atrial and ventricular pacing thresholds, atrial and ventricular lead impedance, P and Rwave amplitudes and battery status) before and after magnetic resonance imaging. Method: Chest magneticresonance imaging was performed in 20 patients with ProMRITM cardiac implantable electronic device, 11 malesand 9 females. The images and the artifacts and pre and post test operation of cardiac implantable electronic devices were evaluated and compared. Results: The analysis of the generated image showed that the magneticsusceptibility artifact produced by these devices did not cause significant interference in the image and did notaffect the evaluation of the outcome and consequently, the diagnosis. Evaluations of the device before and aftermagnetic resonance imaging showed that there were no damages on the lead/myocardium interface, and nor inthe impedance and sensitivity of the leads and there were no changes in the remaining capacity of the batteries.Conclusion: Chest magnetic resonance imaging in patients with the ProMRITM cardiac implantable electronicdevice can be performed safely with no impact on the operation of the devices and on the image generated bymagnetic resonance imaging, as long as certain rules and conditions are followed.

Utilización de la lista de chequeo como método de valoración de la radiografía de tórax en pacientes con trauma / Usage of the checklist as a method of valuation of chest X ray in patients with Trauma

Introducción: El traumatismo de tórax en el mundo occidental constituye la tercera causa de muerte. El diagnóstico oportuno de las lesiones requiere una adecuada y completa exploración clínica e imagenológica. En el curso ATLS (Advanced Trauma Life Support) se utiliza una sistemática para evaluar la radiología simple de tórax en trauma. Objetivos: identificar el espectro de lesiones posibles por trauma de tórax evaluables mediante radiografía simple; reconocer la importancia de emplear una sistemática para su valoración; investigar si el uso de listas de chequeo es de utilidad para su evaluación. Material y métodos: 52 evaluaciones mediante listas de chequeo a estudiantes de medicina del Internado Anual Rotatorio (IAR) y a residentes de cirugía general, durante la valoración yanálisis de estudios radiográficos de traumatismos torácicos, durante Marzo 2013/ Marzo 2014. Resultados: Se evaluaron 32 alumnos del IAR: utilizaron criterios anatómicos para la identificación de estructuras 23(71.87%); Ninguno utilizó el protocolo del ATLS. 31 (96.88%) mencionaron que les sería de ayuda tener una sistemática para la evaluación de la radiografía de tórax. Se evaluaron 20 residentes de Cirugía General: 11 (55%) utilizaron criterios anatómicos para la identificación de estructuras, 6 (30%) utilizaron la sistemática del ATLS. 20 (100%) mencionaron que les sería de ayuda tener una sistemática ordenada para la evaluación de la radiografía de tórax. Conclusión: La implementación de una sistemática para la correcta valoración de la radiografía simple de tórax y su inclusión en una lista de chequeo para la evaluación de losalumnos, podría ser una de muchas técnicas pedagógicas para evaluación del aprendizaje.

Introduction: Chest trauma is the third cause of death in the western world, after cancer and cardiovascular diseases. Early diagnosis of the lesions presented as a result of chest traumarequires adequate and complete clinical and imaging examination. At the ATLS (Advanced Trauma Life Support) asystematic is used to assess the chest Xray in trauma. Objectives: To identify the spectrum of possible injuries developed in patients with chest trauma by evaluating their radiographies; recognize the importance of using a systematic for its valuation; consider whether the use of checklists is useful for its assessment. Material and methods: 52 evaluations using checklists to students at their final year (Annual Rotating Internship ARI)and to general surgery residents, during their valuation and analysis of chest Xrays studies in trauma, between March 2013 March 2014. Results: 32 students from the ARI were evaluated: 23 (71.87 %) used anatomical criteria for the identification of structures. Noneused the ATLS protocol. 31 (96.88 %) mentioned that it would be helpful to have a systematic for the valuation of chest Xrays. 20 General Surgery residents were evaluated: 11 (55%) used anatomical criteria for the identification of structures. 6 (30 %)used ATLS systematic. 20 (100 %) mentioned that it would be helpful to have a systematic for the valuation of chest Xrays. Conclusion: The implementation of a systematic for the proper valuation of chest Xraysin trauma and its incorporation on achecklist for the students assessment could be one of many pedagogical teaching techniques.

Reconstrução da parede torácica após a ressecção de extensos tumores / Reconstruction of chest wall after resection of large tumors

INTRODUÇÃO: Nos estágios finais da reconstrução torácica, consequente a exéreses tumorais, são necessários procedimentos complexos e implantes. O que requer cuidados multidisciplinares, com a participação dos cirurgiões torácicos, plástico, radiologista e fisioterapeuta. O objetivo foi descrever as opções de reconstrução torácica após ressecção de neoplasia, realizado no Hospital Sarah Brasília. MÉTODO: Estudo retrospectivo de reconstrução torácica em tempo único, após excisão de tumor, fisioterapia respiratória com ventilação não invasiva e exercícios. RESULTADOS: Entre 2007 a 2012 foram operados 10 pacientes, sete homens e três mulheres; idade 10 a 31 anos; oito apresentavam tumores torácicos metastáticos (osteosarcoma, sinoviosarcoma, Fibrosarcoma epitelioide esclerosante e Rabdomiosarcoma) e dois originários da parede torácica (fibromatose e condrosarcoma). Observou-se boa evolução no pós-operatório imediato, com extubação ao final da cirurgia, retirada do dreno torácico entre 5° e 8° PO. As complicações foram: atelectasia (10%), recorrência tumoral (10%), e óbito em 3 (30%) casos . CONCLUSÃO: Foi possível a reconstrução torácica em tempo único utilizando tela de polipropileno, polimetilmetacrilato e retalhos musculares, com recuperação precoce da função pulmonar e baixo índice de complicações imediatas.

INTRODUCTION: Complex procedures and implants are required in the final stages of chest wall reconstruction after tumor excision. This process requires multidisciplinary care with participation from thoracic and plastic surgeons, a radiologist, and a physical therapist. The goal of this study was to describe the options for chest wall reconstruction after neoplasm resection at Hospital Sarah Brasilia. METHOD: A retrospective study of one-time chest wall reconstruction after tumor excision, respiratory physical therapy with noninvasive ventilation, and exercises was conducted. RESULTS: Between 2007 and 2012, 10 patients underwent surgery (seven men, three women; age range: 10-31 years); eight patients had metastatic thoracic tumors (e.g., osteosarcoma, synovial sarcoma, sclerosing epithelioid fibrosarcoma, and rhabdomyosarcoma) and two had tumors originating from the chest wall (fibromatosis and chondrosarcoma). The outcomes were good after the immediate postoperative period, with extubation occurring at the end of surgery and chest tube removal between the fifth and eighth postoperative day. Three cases (30%) involved complications of atelectasis (10%), tumor recurrence (10%), or death. CONCLUSION: One-time chest wall reconstruction using polypropylene mesh, polymethylmethacrylate, and muscle flaps was possible and was associated with early recovery of pulmonary function and a low rate of immediate complications.

Intervencionismo bajo guía ecográfica en patología torácica / Ultrasound-guided intervention in thoracic pathology

Conclusiones: El intervencionismo mediante guía ecográfica se constituye en una herramienta valiosa para el manejo y resolución de la patología torácica. Al realizarse en tiempo real permite disminuir la tasa de complicaciones y conseguir mejores resultados. Se recomienda la realización de dichos procedimientos quirúrgicos mínimanente invasivos a cirujanos torácicos dado que conocen la patología, la indicación de la realización de procedimientos miniinvasivos, sus posibles complicaciones y la capacidad de resolverlas.

Conclusions: Ultrasound-guided interventions are a valuable tool for managing and treating thoracic pathologies. Due to their real-time nature, it is possible to reduce the complications rate and achieve better results. Said minimally-invasive procedures were recommended to thoracic surgeons since they are familiar with the pathology, the indication of minimally-invasive procedures, their possible complications and the ability to solve them.

Análisis de la morfología del raquis torácico y lumbar en mujeres trabajadoras de una cooperativa hortofrutícola / men Analysis of the thoracic and lumbar morphology in woworkers from a fruit and vegetable company

El objetivo del presente estudio fue analizar la disposición angular del raquis torácico y lumbar en bipedestación y sedentación relajada en mujeres trabajadoras de una empresa hortofrutícola. Un total de 50 mujeres (media de edad: 43,62+/-8,43 años) fueron evaluadas mediante un spinal mouse en bipedestación y en sedentación relajada. Los valores angulares medios para el raquis torácico y lumbar fueron de 32,74+/-8,76 y -21,66+/-19,12 en bipedestación y de 36,32+/-10,55 y -1,08+/-18,14, en sedentación. En bipedestación, un elevado porcentaje de casos (86 por ciento y 68,3 por ciento) presentaban una cifosis torácica y lordosis lumbar dentro de los valores de normalidad. En sedentación, el 74 por ciento presentaban hipercifosis torácica y el 20 por ciento una inversión lumbar. En conclusión, aunque en bipedestación la mayoría de las mujeres presentaban una morfología del raquis dentro de los valores de normalidad, en sedentación se observó un elevado porcentaje de casos con hipercifosis torácica y el raquis lumbar en inversión. Debido a las consecuencias negativas que se asocian a dichas desalineaciones raquídeas, es recomendable aplicar programas de mejora de la actitud postural en estas trabajadoras, preferentemente en su contexto laboral.

The aim of this study was to analyze the sagittal spinal morphology of thoracic and lumbar spine in standing and sitting in women workers from a cooperative in the production, handling and marketing business of vegetable and fruit products. A total of 50 women (mean age: 43.62+/-8.43 years old) were evaluated. The spinal mouse system was used to mesasure the sagittal thoracic and lumbar curvatures in standing and relaxed sitting. The values for thoracic and lumbar curvatures were 32.74+/-8.76 and -21.66+/-19.12 in standing and 36.32+/-10.55 and -1.08+/-18.14 in sitting. A high frequency (86.0 percent and 68.3 percent) of normal thoracic kyphosis and lumbar lordosis were found in standing posture. While sitting the 74.0 percent and 20.0 percent presented thoracic hyperkyphosis and lumbar kyphosis. In conclusion, a high percentaje of women workers presented normality values in standing posture, although a high percentage of women were found with thoracic hyperkyphosis and lumbar flexed while sitting relaxed. It is recommended that these women carry out a program to improve their actitudinal postures in their work place.

Experiencia con la construcción quirúrgica de las deformidades de la pared torácica / Surgical experience with reconstruction of chest wall deformities

Analizar las características clínicas, indización para realizar la intervención y los resultados de la cirugía de pacientes con deformidades de la pared torácica. Métodos: Con el fin de obtener la informaci¢ón, se analizaron 32 expedientes clínicos que pudieron ser ubicados y la información incluida en la base de datos del servicio de otros 13 pacientes operados en el servicio de cirugía de tórax del Hospital Rafael Angel Calderón Guardia por Pectus Excavatum o Pectus Carinatum, desde enero de 1998 a enero del 2010. Resultados: Se encontraron 29 pacientes operados por Pectus Excavatum y 16 por Pectus Carinatum, de los cuales 37 fueron varones y 8 mujeres. La edad osciló entre 13 y 24 años con un promedio de 16 años. En 28 pacientes la única indicación para la cirugía fue la afección sicológica causada por la deformidad y en 17 se presentó además algún síntoma como disnea con el ejercicio, dolor torácico o palpitaciones. En 26 de los 29 pacientes operados por Pectus Excavatum se utilizó una barra de metal para manetener el esternón reducido en posición normal mientras se consolidaban retirándola a los seis meses y en los últimos tres las reducción se efectuó con una malla de polipropileno que funcionó igual, pero con la ventaja que no requiere reintervención para retirarla. Los resultados se evaluaron en forma subjetiva de acuerdo a la satisfacción manifestada por el paciente y a la nota del médico; encontrando en un caso de Pectus Excavatum recidiva de la...

Doença de Madelung: relato de caso e revisão da literatura / Madelung's disease: a case report and literature review

Relata-se o caso de um paciente portador da doença de Madelung, definida clinicamente pela presença de múltiplos acúmulos de tecido adiposo não encapsulados, usualmente envolvendo a região cervical e superior do tórax, de distribuição simétrica. O exame de imagem eleito para confirmação do diagnóstico foi tomografia computadorizada, por ser menos dispendiosa e mais acessível, comparando-se à ressonância magnética.

The authors report the case of a patient with Madelung's disease, which is clinically described as the presence of multiple and symmetric non-encapsulated masses of fatty tissue, usually involving the neck and the upper region of the trunk. Computed tomography was selected as the imaging method for diagnosis confirmation, considering its lower cost and higher availability as compared with magnetic resonance imaging.

Populosis atrófica maligna (enfermedad de Degos): a propósito de un caso / Atrophy malignant papulosis (Degos'disease): case report

Presentamos una paciente de sexo femenino, de 53 años de edad, con manifestaciones cutáneas de enfermedad de Degos, sin compromiso sistémico asociado. Se realiza una revisión actualizada de la bibliografía médica mundial, con una descripción clínica, histopatológica, diagnóstica y terapéutica de la enfermedad.

CT guided transthoracic Needle Aspiration biopsy; effect of size of the lesion on the rate of pneumothorax

To analyze the rate of Pneumothorax after CT guided TNAB of lung masses, and correlating it with the size of the lesion. Descriptive study. Department of Radiology Mayo Hospital, Lahore. From June 2002 to April 2003, Seventy patients underwent CT guided FNA of the chest masses. Out of Seventy, 18 patients i.e.; 26% developed Pneumothorax. Lesion less than 1 cm, out of 6 patients 3 developed pneumothorax [50%], lesions 1-2 cm 5 out of 11 developed pneumothorax [45%], lesions with size of 2-3 cm 5 out of 14 patients developed pneumothorax [35%], lesions between 3-4 cm 2 out of 8 developed pneumothorax [25%], lesion sized 4-5 cm 1 out of 15 developed pneumothorax [6%], and lesion with more than 5 cm size 1 out of 16 developed pneumothorax [6%]. The study shows that the rate of Pneumothorax after CT guided TNAB of Lung Masses increases as the size of the lesion decreases

Biópsia do miocárdio em cães: acesso minimamente invasivo por cirurgia torácica videoassistida / Myocardial biopsies in dogs: minimally invasive approach by vídeo-assisted thoracoscopy

Realizou-se uma série de biópsias cardíacas em cães para testar o acesso toracoscópico, utilizando-se oito cães sem raça definida, sob condições de manejo e alimentação adequados. A abordagem à cavidade torácica foi feita por meio de cirurgia torácica videoassistida e o instrumental utilizado para remoção do fragmento de miocárdio foi o convencional em lugar das pinças de videocirurgia. A eficácia do procedimento foi confirmada pelo tempo decorrido entre as incisões, a execução da biópsia e a sutura do tórax, com duração média de 15 minutos. A cirurgia torácica videoassistida para biópsias cardíacas foi considerada segura e adequada, minimizando o desconforto pós-operatório dos pacientes submetidos ao acesso torácico.

In order to evaluate the thoracoscopy access, biopsies were carried out in eight mongrel dogs maintained under appropriate conditions of handling and feeding. The patients were prepared to aseptic and atraumatic surgery approaching the thoracic cavity by means of video-assisted thoracic surgery (VATS). Myocardial biopsies were carried out with conventional surgical instruments as an alternative to the clamps of video surgery. The effectiveness of the procedure was confirmed by mean time (15 minutes) elapsed from thoracic approach and biopsies obtainment to thoracic wall suture. VATS is a secure and appropriate technique to carry out myocardial biopsies that minimize postoperative discomfort in patients submitted to thoracic approach.

Elastofibroma dorsi: an under-diagnosed entity -clinical, imaging and pathological features

To report clinical, radiological and histopathological findings of elastofibroma dorsi.Thepurposeis to increase awareness among radiologists and clinicians of this under-diagnosed and interesting benign lesion. Retrospective review of 624 consecutive thoracic Computed Tomography [CT], 92 ultrasounds and 130 Magnetic Resonance Image [MRI] scans for detection of elastofibroma dorsi along with review of the clinical and histopathological findings. Three radiologists evaluated the imaging features using previously definedcriteria. A histopathologist reviewed the pathological findings. A tertiary level hospital and a specialized orthopedic center. Patients who were subjected to CT, Ultrasound and MRI scans of the thorax Interventions: CT, MRI, Ultrasound scans of the thorax and surgical excision. Detection of elastofibromasand their clinical, radiological and histopathologic findings. Only 50% of patients with elastofibrom a dorsicouldbe detected by all modalities though, on review, all lesions showed characteristic location, morphology, imaging as well as typical clinical and pathological features. Significant contrast enhancement of all lesions on MRI was an unusual finding in our study. An awareness of the radiological findingsand enhancement patterns on CT and MRI can help in the proper diagnosis of elastofibroma dorsi an entity often misdiagnosed in a high percentage of patients

Chest Computed Tomography (CT) Immediately after CT-Guided Transthoracic Needle Aspiration Biopsy as a Predictor of Overt Pneumothorax

BACKGROUND/AIMS: This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. METHODS: Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. RESULTS: Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. CONCLUSIONS: CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax.

Síndrome de Hemitórax opaco / Opacified hemithorax

El síndrome de hemitórax opaco (SHO) se refiere a un grupo de signos y síntomas que se asocian a un hallazgo radiológico en el que se observa una opacidad total o casi total de un hemitórax. En la radiografía de tórax pueden encontrarse ciertas características que ayudan a clasificar la imagen de hemitórax opaco en dos grupos...