ABSTRACT
RESUMEN Objetivo: Determinar la influencia de las complicaciones postoperatorias sobre los resultados clínicos en pacientes operados por cáncer torácico y gastrointestinal. Métodos: Se realizó un estudio de cohorte prospectivo de 179 pacientes consecutivos que fueron operados de tórax o vías digestivas por cáncer y admitidos en una unidad de cuidados intensivos oncológicos. Se evaluó la incidencia de las complicaciones postoperatorias mediante el Postoperative Morbidity Survey y su influencia sobre la mortalidad y estadía hospitalaria. Resultados: Se presentaron complicaciones postoperatorias en 54 sujetos (30,2%); las más frecuentes fueron las pulmonares (14,5%), el dolor (12,9%), las cardiovasculares (11,7%), las infecciosas (11,2%) y las de la herida quirúrgica (10,1%). En el análisis multivariado de regresión logística las complicaciones pulmonares (OR 18,68; IC95% 5,59 - 62,39; p < 0,0001), cardiovasculares (OR 5,06; IC95% 1,49 - 17,13; p = 0,009), gastrointestinales (OR 26,09; IC95% 6,80 - 100,16; p < 0,0001), infecciosas (OR 20,55; IC95% 5,99 - 70,56; p < 0,0001) y renales (OR 18,27; IC95% 3,88 - 83,35; p < 0,0001) se relacionaron de forma independiente con la mortalidad hospitalaria. La ocurrencia de al menos una complicación incrementó la probabilidad de permanecer hospitalizado (Log Rank test; p = 0,002). Conclusiones: Las complicaciones postoperatorias son trastornos frecuentes y asociados con malos resultados clínicos, por lo que se deben realizar cambios estructurales y de proceso para reducir la morbilidad y mortalidad postoperatorias.
ABSTRACT Objective: This study sought to determine the influence of postoperative complications on the clinical outcomes of patients who underwent thoracic and gastrointestinal cancer surgery. Methods: A prospective cohort study was conducted regarding 179 consecutive patients who received thorax or digestive tract surgery due to cancer and were admitted to an oncological intensive care unit. The Postoperative Morbidity Survey was used to evaluate the incidence of postoperative complications. The influence of postoperative complications on both mortality and length of hospital stay were also assessed. Results: Postoperative complications were found for 54 patients (30.2%); the most common complications were respiratory problems (14.5%), pain (12.9%), cardiovascular problems (11.7%), infectious disease (11.2%), and surgical wounds (10.1%). A multivariate logistic regression found that respiratory complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001), cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009), gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p < 0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p < 0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p < 0.0001) were independently associated with hospital mortality. The occurrence of at least one complication increased the likelihood of remaining hospitalized (log-rank test, p = 0.002). Conclusions: Postoperative complications are frequent disorders that are associated with poor clinical outcomes; thus, structural and procedural changes should be implemented to reduce postoperative morbidity and mortality.
Subject(s)
Humans , Male , Female , Aged , Postoperative Complications/epidemiology , Thoracic Neoplasms/surgery , Gastrointestinal Neoplasms/surgery , Intensive Care Units , Logistic Models , Incidence , Multivariate Analysis , Prospective Studies , Risk Factors , Cohort Studies , Hospital Mortality , Length of Stay , Middle AgedABSTRACT
Na era das cirurgias minimamente invasivas, parece controverso advogar grandes operações. Entretanto, ainda há espaço para grandes intervenções oncológicas. É relatado caso de paciente de 23 anos de idade portador de tumor desmoide em hemitórax direito, com deformidade e erosão de arcos costais, atelectasia parcial do pulmão ipsilateral, compressão e desvio contralateral do mediastino, invasão de nervos do plexo braquial, vasos subclávios e pleura apical direita. Realizada toracectomia, ressecção de tumor em mediastino, amputação do membro superior direito, escapulectomia e reconstrução da parede torácica com tela de márlex e metilmetacrilato e confecção de retalho fasciocutâneo. O paciente encontra-se em seguimento ambulatorial com suas funções diárias quase recuperadas, limitado apenas nas atividades que envolviam o membro desarticulado. Em casos selecionados devem ser consideras grandes intervenções com o objetivo de ressecção R0 (ressecção com margens cirúrgicas livres) e melhora na qualidade de vida, atentando-se sempre para a ressocialização.
In the era of minimally invasive surgery, advocating large operations seems controversial. However, there is still room for major oncologic interventions. This is report of a 23 yearold patient with desmoid tumor in the right hemithorax, deformed and eroded ribs, ipsilateral lung partial atelectasis, contralateral mediastinal compression and shift, invasion ofnerves in the brachial plexus, subclavian vessels and right apical pleura. Thoracectomy was performed with resection of the tumor in the mediastinum, right upper limb amputation, scapulectomy, and chest wall reconstruction with methylmethacrylate and marlex screen, and use of a fasciocutaneous flap. The subject is in follow up as an outpatient andhas almost recovered his daily functions, which are now limited only for activities involving the inarticulate member. Selected cases should be considered for major interventions with aiming at R0 resection (resection with free surgical margins) and improved quality of life, always bearing in mind the need for rehabilitation and socialization.
Subject(s)
Humans , Male , Adult , Fibromatosis, Aggressive/surgery , Thoracic Neoplasms/surgery , Fibromatosis, Aggressive/psychology , Fibromatosis, Aggressive/rehabilitation , Thoracoplasty/psychology , Thoracoplasty/rehabilitationABSTRACT
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.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , History, 21st Century , Polypropylenes , Thoracic Neoplasms , Thoracic Surgery , Thoracoplasty , Thorax , Medical Records , Review , Polymethyl Methacrylate , Plastic Surgery Procedures , Evaluation Study , Thoracic Wall , Polypropylenes/therapeutic use , Polypropylenes/chemistry , Thoracic Neoplasms/surgery , Thoracic Neoplasms/physiopathology , Thoracic Neoplasms/therapy , Thoracic Surgery/methods , Thoracoplasty/methods , Thorax/physiology , Thorax/pathology , Medical Records/standards , Polymethyl Methacrylate/therapeutic use , Polymethyl Methacrylate/chemistry , Plastic Surgery Procedures/methods , Thoracic Wall/surgery , Thoracic Wall/physiopathology , Thoracic Wall/pathologyABSTRACT
Primary chest wall tumours are very rare. Chondrosarcoma is the most common tumour arising from the chest wall. We describe the occurrence of a slow-growing chondrosarcoma arising from the anterior chest wall in a 35-year-old male patient. The tumour was resected successfully and chest wall was reconstucted with prolene mesh and muscle flap. The patient was discharged uneventfully without any respiratory compromise. There was no recurrence after a three-year follow-up. Wide surgical resection with chest wall reconstruction appears to be the preferred treatment option for this rare tumour of the chest wall.
Subject(s)
Adult , Chondrosarcoma/pathology , Chondrosarcoma/physiopathology , Chondrosarcoma/surgery , Humans , Male , Myocutaneous Flap , Plastic Surgery Procedures/methods , Surgical Mesh , Thoracic Neoplasms/pathology , Thoracic Neoplasms/physiopathology , Thoracic Neoplasms/surgery , Thoracic Wall/pathology , Thoracic Wall/surgery , Treatment OutcomeABSTRACT
Neuroblastoma is predominantly a tumor of early childhood, most cases occur in children under 5 years old. It originates in the adrenal gland and paravertebral ganglion cells (neural crest-derived), being the most common an extracranial solid tumor in children. It is characteristic a spontaneous regression, However in some cases it shows progression and dissemination to other organs. Objetive: To show a neuroblastoma in adolescence, with poor response to chemotherapy and radiotherapy, requiring surgery treatment. Clinical case: A 16 y.o. Female patient, previously asymptomatic, who after a body temperature rise up to 39 ° C, was found to have a tumor in the right hemithorax. Biopsy was compatible with neuroblastoma. Surgical removal of a large 20 x 19 cm tumor was achieved, the only complication presented 10 days postop was recurrent pneumothorax. Conclusion: Despite little or no response to standard treatment, surgical resection of this large tumor achieved complete remission for this patient.
El neuroblastoma es predominantemente un tumor de la infancia temprana que en la mayoría de los casos se presenta en menores de 5 años. Se origina en la glándula suprarrenal y células ganglionares paravertebrales (derivadas de la cresta neural), siendo el tumor sólido extracraneal más común en pediatría, presenta regresión espontánea en algunos casos y en otros progresión y diseminación a otros órganos. Objetivo: Analizar el caso de una adolescente portadora de un neuroblastoma resistente a quimioterapia y radioterapia, que requiere tratamiento quirúrgico. Caso clínico: Paciente asintomática, edad 16 años, que a raíz de alza febril se le detecta un tumor en hemitórax derecho. La biopsia fue compatible con un neuroblastoma. Se realizo la extirpación quirúrgica de un gran tumor con diámetro de 20 cm x 19 cm. A los 10 días se complica con neumotórax recidivante. Conclusión: A pesar de la poca o nula respuesta a las armas terapéuticas habituales: quimioterapia y radioterapia, la cirugía logró la resección del tumor torácico con remisión completa.
Subject(s)
Humans , Female , Adolescent , Thoracic Neoplasms/surgery , Neuroblastoma/surgery , Thoracic Neoplasms/diagnosis , Thoracic Neoplasms/drug therapy , Thoracic Neoplasms/radiotherapy , Neuroblastoma/diagnosis , Neuroblastoma/drug therapy , Neuroblastoma/radiotherapy , Treatment OutcomeABSTRACT
PURPOSE: Thoracic dumbbell tumors are relatively rare, usually arising from neurogenic elements. Methods for surgical removal thereof remain controversial. The purpose of this study was to evaluate the surgical results of a single-stage posterior approach with laminectomy and costotransversectomy only for the management of thoracic dumbbell tumors. MATERIALS AND METHODS: Eight cases of thoracic large dumbbell tumor were analyzed retrospectively: seven men and one woman (mean age, 49 years). Pathologic findings included schwannoma in five patients, neurofibroma in two patients (Recklinghausen in one patient), and ganglioneuroma in one patient. All patients underwent single-stage removal of dumbbell tumors by a posterior approach followed by laminectomy and costotransversectomy combined with instrumentation. Clinical and radiologic outcomes were reviewed, thereafter. RESULTS: Operative time ranged from 185 to 420 minutes (mean, 313 minutes), with estimated blood loss ranging from 71 to 1830 mL (mean, 658 mL). Postoperative complications included atelectasis in one case. All patients had tumors successfully removed with no neurological deterioration. Spinal deformities were not observed in any patients at the last follow-up (mean, 52 months), with instrumentation. CONCLUSION: Single-stage surgery with laminectomy and costotransversectomy may be useful for removing thoracic dumbbell tumors without a combined anterior approach.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Laminectomy , Retrospective Studies , Thoracic Neoplasms/surgery , Thoracic Vertebrae/surgeryABSTRACT
The plasmacytomas tumors are caused by a malignant proliferation of plasma cells. Primary tumors of the sternum are uncommon, being this kind of tumors exceptional. We present the case of a 72 years old man with a sternal plasmacytoma, that after 2 years of receiving radiotherapy treatment, had tumor growth, associated with coronary artery disease. In this case, surgical resection of solitary sternal plasmacytoma was performed associated with coronary artery bypass grafting surgery. The chest wall reconstruction was done with a polypropylene mesh. More than 5 years long-term follow up was completed and the patient is asymptomatic and free of malignant proliferation of plasma cells.
Los plasmocitomas son tumores originados por una proliferación neoplásica de células plasmáticas. Los tumores primarios de esternón son infrecuentes, siendo los plasmocitomas solitarios de esternón excepcionales. Presentamos el caso de un hombre de 72 años con un plasmocitoma esternal que después de 2 años post tratamiento con radioterapia presentó aumento de tamaño tumoral asociado a enfermedad coronaria. Se realizó resección quirúrgica del plasmocitoma solitario del esternón asociada a cirugía de revascularización miocárdica con 4 bypass coronarios. La pared torácica fue reconstituida con una malla de polipropileno. A más de 5 años de seguimiento el paciente se encuentra asintomático cardiovascular y libre proliferación maligna de células plasmáticas.
Subject(s)
Humans , Male , Aged , Coronary Artery Disease/complications , Thoracic Neoplasms/surgery , Thoracic Neoplasms/complications , Plasmacytoma/surgery , Plasmacytoma/complications , Sternum , Coronary Artery Disease/surgery , Follow-Up Studies , Myocardial Revascularization , Thoracic Neoplasms/radiotherapy , Plasmacytoma/radiotherapy , Time Factors , Treatment OutcomeSubject(s)
Adult , Female , Humans , Male , Fibromatosis, Aggressive/pathology , Fibromatosis, Aggressive/surgery , Thoracic Neoplasms/pathology , Thoracic Neoplasms/surgery , Thoracic Surgical Procedures/mortality , Thoracic Wall/surgery , Epidemiologic Methods , Recurrence , Thoracic Surgical Procedures/methodsABSTRACT
Los tumores de la pared torácica son neoplasias poco frecuentes, y de difícil tratamiento. Cuatro pacientes con neoplasias de la pared torácica fueron intervenidos en el Hospital Universitario de Maracaibo entre los años 2005 a 2008, con los diagnósticos de: plasmocitoma en dos pacientes y condrosarcoma en dos pacientes. Entre las intervenciones quirúrgicas realizadas destacan: resección de tumor de la pared torácica e interposición de malla en tres pacientes y resección de tumor esternal con interposición de malla y metacrilato en un paciente. La evolución posoperatoria fue satisfactoria en tres pacientes, un paciente en quien se interpuso malla y metacrilato se produjo el desplazamiento de la malla a un año de la intervención. Es importante en los pacientes con tumores de la pared torácica una adecuada planificación preoperatoria de la intervención para disminuir la morbilidad y mortalidad posoperatoria, y lograr mejores resultados quirúrgicos y funcionales.
The chest wall tumors are neoplasm with a low frequency and they are of difficult in the treatment. Four patients with chest wall neoplasm were operated in the Universitary Hospital from Maracaibo between 2005 at 2008 with the diagnoses of plasmacytoma in two patients and chondrosarcoma in two patients. The surgical procedures for us performed were: Chest wall tumor resection and mesh interposition in three patients and sternum tumor resection with interposition of mesh with methyl methacrylate in one patient. The postoperatory evolution was satisfactory in three patients and the patient with the reconstruction using mesh and methyl methacrylate had the displacement of the mesh after of a year of the surgical procedure. It is very important in the patients with chest wall tumors an adequate preoperatory evaluation with the objective of reduces the mortality and morbidity postoperatory and obtains better surgical and functional results.
Subject(s)
Humans , Male , Female , Adult , Surgical Mesh , Manubrium/injuries , Thoracic Neoplasms/surgery , Thoracic Neoplasms/therapy , Tomography/methods , Thoracotomy/methods , Biopsy, Needle/methods , Chondrosarcoma/pathology , Thoracic Wall/surgery , Plasmacytoma/pathologyABSTRACT
Los tumores desmoides originados en la pared torácica son infrecuentes, en nuestro medio y a nivel mundial. Aquellos de dimensiones gigantes son aún más raros, requieren abordajes quirúrgicos adecuados, siendo la única alternativa de tratamiento, razón por la cual presentamos el presente caso.
Desmoid tumors originating in the chest wall are infrequent in our institution as in the rest of the world. Those of huge dimentios are even more unusual and require an adequate surgical approach, the only choice of treatment, reason for presenting this clinical case
Subject(s)
Humans , Male , Adolescent , Fibromatosis, Aggressive/surgery , Thoracic Neoplasms/surgeryABSTRACT
BACKGROUND: We undertook this study to describe the clinical characteristics of primary benign chest wall tumors and to evaluate the results of surgical treatment. METHODS: We included patients with primary benign chest wall tumors who underwent surgical resection at the Instituto Nacional de Cancerología from January 1990 to December 2002. All patients had histological confirmation of benign tumor. Descriptive analysis was carried out. RESULTS: There were 17 patients, nine women (53%), with an average age of 35.1 years (interval 16-66 years). The most frequent tumor was chondroma in seven cases (41%), followed by aponeurotic-muscle fibromatosis in five (30%) and the remaining five patients had other tumor types. All patients were subject to thoracic wall resection, including at least one rib in each patient. In three patients the sternum was resected (17.6%), the clavicle in two (11.7%), thoracic vertebrae in one (5.9%) and associated structures in four patients (23.5%). In eight patients (47%) the thoracic wall was reconstructed with marlex mesh, whereas the remaining patients required no reconstruction. Of the 17 patients, 16 are alive without disease and one presented delayed recurrence with an aponeurotic-muscle fibromatosis requiring a new thoracic wall resection. One patient presented with respiratory complications and died after 42 days due to thoracic wall instability. Average follow-up time was 103 months. CONCLUSIONS: Primary benign chest wall tumors are locally aggressive and must be treated with wide resection of the thoracic wall. In addition, surgical reconstruction with prosthetic materials and/or myocutaneous flaps is done prior to resection, for stability of the thorax when the localization is anterior or lateral.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Thoracic Neoplasms/surgery , Thoracic Wall/surgery , Treatment OutcomeSubject(s)
Humans , Male , Adult , Fibroma/pathology , Thoracic Neoplasms/pathology , Soft Tissue Neoplasms/pathology , Scapula , Fibroma , Fibroma/surgery , Magnetic Resonance Imaging , Thoracic Neoplasms , Thoracic Neoplasms/surgery , Soft Tissue Neoplasms , Soft Tissue Neoplasms/surgery , Surgical Procedures, Operative/methods , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Neoplasms of the chest wall are not uncommon. Majority of the tumours occurring in the chest wall are benign. The tumours may arise from the soft tissues,connective tissues or bone. Metastatic tumours can arise as a result of direct infiltration or haematogenous spread. The management of these tumours is challenging. Resection of the chest wall with or without the excision of ribs, require reconstruction not only for aesthetic reasons but also for providing the stability to the chest wall which is of prime importance in maintaining the respiratory functions. In this article, 46 cases of the primary malignant chest wall tumours seen over a period of 5 years are reviewed.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Thoracic Neoplasms/surgerySubject(s)
Humans , Male , Adult , Cicatrix , Foreign-Body Reaction , Thoracic Neoplasms/surgery , ThoracotomyABSTRACT
Antecedentes: Las resecciones de pared torácica representan la forma terapéutica más eficaz para un número apreciable de pacientes portadores de patología tumoral o no tumoral. Objetivo: Reconstruir desde el punto de vista funcional y estético. Diseño: Retrospectivo, descriptivo. Población: 57 pacientes con patología de la pared torácica, 23 con lesiones benignas (12 tumorales; 11 no tumorales) y 35 con tumores malignos: 16 primarios; 5 metastásicos; 13 recidivas loco-regionales y 1 carcinoma mediastinal con invasión parietal. Entre los tumores primarios predominaron los sarcomas mientras que entre los secundarios los carcinomas. Método: Fueron resecados 55 pacientes: 33 por tumores malignos; 11 por tumores benignos y 11 por lesiones no tumorales (5 úlceras actínicas; 4 osteomielitis; 1 pseudo-tumor inflamatorio; 1 fractura patológica por rarefacción actínica). En 27 oportunidades se emplearon prótesis heterológicas: 24 Marlex-Metilmetacrilato, 2 Marlex exclusivamente y 1 Polipropileno. Dichas prótesis se cubrieron con colgajos miocutáneos, musculares únicamente, epiplón mayor o bien con tejidos vecinos. Resultados: El índice de morbilidad fue 20,3 por ciento, aunque el 82 por ciento consistió en complicaciones banales. Sólo 3 pacientes requirieron algún procedimiento adicional. La supervivencia global actuarial a 5 años de los pacientes con patología maligna fue de 63 por ciento para los sarcomas y 31 por ciento para los carcinomas. De los pacientes operados por recidiva loco-regional de Ca de mama, el 22 por ciento estaban vivos a los 5 años y el 11 por ciento a los 10 años, falleciendo el resto por pregresión de la enfermedad. Analizando los pacientes portadores de metástasis y recidiva loco-regional, la supervivencia media fue de 37,5 meses con una supervivencia a los 5 años de 23 por ciento. Conclusiones: En la patología tumoral de la pared torácica deben evitarse las resecciones económicas dado que exponen a soluciones oncológicas insuficientes. La evaluación de estos enfermos debe ser multidisciplinaria y la actuación de cirujanos reparadores no puede estar ausente
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Dogs , Animals , Thoracic Surgery/methods , Surgical Mesh/trends , Methylmethacrylates/therapeutic use , Thoracic Neoplasms/surgery , Surgical Flaps/standards , Implants, Experimental/standards , Ribs/surgery , Thoracic Neoplasms/complications , Thoracoplasty/standards , Treatment OutcomeABSTRACT
Los sarcomas de la pared torácica corresponden al 5 por ciento de este tipo de neoplasias. La resección y reconstrucción de la pared torácica se ha desarrollado mucho en los últimos años debido a la evolución de las diferentes técnicas de reconstrucción, principalmente de los colgajos miocutáneos. En este artículo presentamos la experiencia obtenida durante 1984 a 1994 en el Instituto Nacional de Cancerología. Se llevaron a cabo 59 resecciones de la pared torácica; la indicación más frecuente la representaron los sarconas óseos en 16 pacientes (27.2 por ciento) y los sarcomas de partes blandas en 15 (25.4 por ciento). La indicación quirúrgica tuvo una finalidad paliativa en 26 casos 844.1 por ciento) y curativa en 33 (54.9 por ciento). A todos los pacientes se les realizó resección ósea. El promedio de costillas resecadas fue de 3.8. Después de la resección, el defecto esquelético y la estabilidad de la pared torácica se reconstruyó en 36 sujetos 861 por ciento); de éstos, se realizó con fascia lata en 17 (47.4 por ciento) y con malla sintética en 18 (50 por ciento). La reconstrucción de partes blandas fue necesaria en 21 casos y se llevó a cabo con colgajos miocutáneos; el más utilizado fue el músculo dorsal ancho en 11 pacientes. El tiempo quirúrgico promedio fue de cuatro horas 15 minutos y el de hospitalización de 8.4 días. La morbilidad fue del 20.3 por ciento y la mortalidad operatoria del 5.0 por ciento
Subject(s)
Humans , Male , Female , Adult , Neoplasm Recurrence, Local , Postoperative Complications/etiology , Sarcoma/complications , Sarcoma/mortality , Sarcoma/surgery , Soft Tissue Neoplasms/surgery , Survivors , Thoracic Neoplasms/surgery , Thoracic Surgery , Tissue TransplantationABSTRACT
Seis pacientes portadores de tumores parietales del tórax resecados, fueron reparados mediante prótesis cubiertas por epiplón mayor traspuesto. El empleo de este tejido fue de elección para casos en que debieron ser ser extirpados músculos contiguos invadidos y por consiguiente hubiera sido necesario colgajos musculares o miocutáneos distantes para una adecuada reconstrucción. En lugar de ellos, hemos elegido el epiplón, el cual además, produjo mejor resultado estético. No hemos observado complicaciones atribuibles al procedimiento
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Surgery, Plastic/methods , Thoracic Surgery/methods , Omentum/surgery , Thoracic Neoplasms/surgery , Surgical Flaps/standards , Surgical Mesh , Omentum/blood supply , Radiotherapy/adverse effects , Thoracic Neoplasms/complicationsABSTRACT
En el período comprendido entre Enero de 1975 y Diciembre de 1994, se trataron un total de 36 pacientes con tumores neurogénicos del mediastino.La edad osciló entre los 15 y 62 años, y la distribución por sexo fue de 22 mujeres y 14 varones.Todos los casos fueron abordados quirurgicamente y dos de ellos fueron operados conjuntamente con el Servicio de Neurocirugía.De los 36 pacientes, 13 fueron sintomáticos (dolor torácico,tos seca y disnea de esfuerzoy los 23 cursaron en forma asintomática.el par radiológico y la tomografía computada lineal hasta 1980 y luego la Tomografía Axial Computada son los requisitos diagnósticos indispensables.Se hallaron 20 neurilemomas (55,5 por ciento) 7 neuroblastomas (19,4 por ciento), 4 neurofibromas (11,1 por ciento),3 Schwanomas malignos (8,3 por ciento) y 2 Tumores de Askin (5,5 por ciento).Creemos que la cirugía y terapéutica absoluta en los tumores neurogénicos del tórax
Subject(s)
Humans , Adult , Thoracic Neoplasms/classification , Thoracic Neoplasms/surgeryABSTRACT
La encefalopatía opsomioclónica infantil o síndrome de Kinsbourne, es una entidad poco frecuente, que asocia clínicamente opsoclonus, polimioclonias y ataxia. Existen casos idiopáticos o vinculados a infecciones virales o a neuroblastoma. Se presenta el caso de una niña de 13 meses, que instala en forma aguda dicha sintomatología. Los estudios etiológicos confirman la presencia de un neuroblastoma torácico. Se realiza la resección tumoral y hormonoterapia, con buena respuesta clínica inicial. Presentamos la revisión bibliográfica, comentando los aspectos más importantes de la enfermedad