ABSTRACT
Objectives (a) to evaluate and compare the psychological treatment needs of patients with cancer and non-cancer, who are going to undergo scheduled thoracic surgery, and (b) evaluate and compare the diagnostic accuracy of the screening tests of psychological treatment needs for cancer and non-cancer patients. Method The need for psychological treatment was evaluated in a total of 169 patients prior to thoracic surgery, through a clinical interview. The screening tests used were: the physician's judgment (yes/no), the Hospital Anxiety and Depression Scale (HADS) and, the single-item interview to assess depression Do you feel depressed? (DEPQ). Results The number of patients who needed psychological treatment in the total sample was 47 (27.81%), in non-cancer-patients: 22 (30.99%) and in cancer patients: 25 (25.51%). The participants with treatment needs were more often young women with primary education levels, with more fears and concerns regarding their disease. With respect to the screening tests, the HADS-T (cut-off point ≥13) obtained a sensitivity (SE) of 0.75 and Specificity (SP) of 0.81 in the total sample. In patients with cancer, the HADS total score (cut-off point ≥10) obtained an SE=0.84 and SP=0.80, and, in non-cancer patients, the HADS total score (cut-off point ≥13) showed an SE=0.59 and SP=0.84. The DEPQ and the physician's judgment did not achieve adequate levels of precision. Conclusions A high percentage of patients have psychological treatment needs before performing thoracic surgery, which are similar for cancer and non-cancer patients. Preoperative detection of patients who need psychological intervention is feasible with a simple screening test: HADS, which achieves greater precision in cancer patients (AU)
Objetivos Evaluar y comparar: a) las necesidades de tratamiento psicológico de pacientes con cáncer y sin cáncer, que van a someterse a una cirugía torácica programada, y b) la precisión diagnóstica de las pruebas de detección de necesidades psicológicas para pacientes con y sin cáncer. Métodos Se evaluó la necesidad de tratamiento psicológico en un total de 169 pacientes antes de la cirugía torácica, a través de una entrevista clínica. Las pruebas de cribado fueron: el criterio médico (sí/no), la Escala de Ansiedad y Depresión Hospitalaria (HADS) y la entrevista de un solo ítem de depresión «¿Se siente deprimido?» (DEPQ). Resultados El número de pacientes que necesitaron tratamiento psicológico fue en el total 47 (27,81%), en pacientes sin cáncer: 22 (30,99%) y con cáncer: 25 (25,51%). Las participantes con necesidades de tratamiento eran con mayor frecuencia mujeres jóvenes con niveles de educación primaria y más temores con respecto a su enfermedad. Con respecto a las pruebas de detección, el HADS total (corte ≥ 13) obtuvo una sensibilidad (S)=0,75/especificidad (E)=0,81 en la muestra total. En pacientes con cáncer el HADS total (corte ≥ 10): S=0,84/E=0,80 y en pacientes sin cáncer, la HADS total (corte ≥ 13): S=0,59/E=0,84. DEPQ y juicio médico obtuvieron bajos niveles de precisión. Conclusiones Un alto porcentaje de pacientes antes de realizar una cirugía torácica tiene necesidades de tratamiento psicológico, similares para pacientes con y sin cáncer. La HADS total es un buen método de cribado de necesidades psicológicas, especialmente en pacientes con cáncer (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Thoracic Surgical Procedures , Stress, Psychological , Preoperative Care , Surgical Clearance , Anxiety/psychology , Socioeconomic FactorsABSTRACT
El linfangioma quístico mediastínico es un tumor benigno muy poco frecuente. Los pacientes que lo presentan no se diagnostican fácilmente porque están asintomáticos o con síntomas inespecíficos. Los quistes en general se encuentran incidentalmente y el diagnóstico preoperatorio es difícil por su apariencia atípica en los estudios de imagen. Habitualmente se diagnostican durante o después de la operación. Los quistes sintomáticos necesitan tratamiento y la escisión quirúrgica es el tratamiento de elección. Además, el abordaje quirúrgico estándar para la resección aún no ha sido bien establecido. Presentamos un caso de un paciente adulto con un linfangioma quístico mediastínico resecado con éxito por videotoracoscopia. La pieza quirúrgica reveló características de displasia linfática, y se diagnosticó como linfangioma mediastínico. Este caso muestra que la resección por videotoracoscopia es factible cuando se sospecha tumor quístico mediastínico, y que puede ser una alternativa a la toracotomía abierta para tratar el linfangioma quístico mediastínico
Mediastinal cystic lymphangioma is an extremely uncommon benign tumor. The patients with mediastinal cystic lymphangioma are often misdiagnosed because of no specific symptoms. The cysts usually are incidentally found and preoperative diagnosis is difficult due to their atypical appearance on imaging studies. Most cases are diagnosed during or after the operation. Symptomatic cysts need treatment, and surgical excision is the treatment of choice. Moreover, the standard surgical approach for resection has not yet been well established. We report a case of an adult patient with a mediastinal cystic lymphangioma that was successfully resected by video thoracoscopic surgery. The surgical specimen revealed features of lymphatic dysplasia, and was diagnosed it as mediastinal lymphangioma. This case report shows that resection by VTS is feasible when mediastinal cystic tumor is suspected, and that VATS may be an alternative to open thoracotomy to treat mediastinal cystic lymphangiom
Subject(s)
Humans , Female , Middle Aged , Lymphangioma, Cystic/diagnostic imaging , Lymphangioma, Cystic/surgery , Thoracic Neoplasms/diagnostic imaging , Thoracic Neoplasms/surgery , Thoracic Surgery, Video-Assisted , Treatment OutcomeABSTRACT
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Subject(s)
Humans , Female , Aged , Meningioma/diagnosis , Lung Neoplasms/pathology , Solitary Pulmonary Nodule/diagnosis , Diagnosis, DifferentialABSTRACT
AIM: To analyze the pattern of recurrence of esophageal carcinoma after a curative-intention surgical resection. PATIENTS: Ninety-two patients with non-metastatic esophageal carcinoma were included. Ninety percent of patients were male, and the mean age of this series was 61 years. The most frequent histologic subtype was squamous cell carcinoma. Fifty percent of tumors were at or above the tracheal bifurcation. All patients were submitted for transthoracic subtotal esophagectomy plus two-field radical lymphadenectomy, leaving no apparent residual disease. No adjuvant therapy was applied to any patient. RESULTS: Follow-up was complete for 76 out of 80 patients surviving the operation. Thirty-four tumoral recurrences were detected for a disease-free survival af 39% at 9 years after surgery. All recurrences were detected during the first two years after treatment. Tumoral relapse was related to the presence of T3 or T4 tumors, with positive lymph nodes, squamous cell carcinoma subtype and supracarinal location. Nine percent of patients had a distant relapse, 15% had a locorregional relapse and 12% a combination of both. Distant relapse presented significantly earlier. There was no statistical association between type of recurrence and clinico-pathological or surgical features. CONCLUSIONS: After radical surgery for carcinoma of the esophagus, half of the patients relapse in the following two years. Distant metastases happen to appear earlier in the follow-up, but the most frequent recurrence is the locorregional one.
Subject(s)
Carcinoma, Squamous Cell/surgery , Esophageal Neoplasms/surgery , Neoplasm Recurrence, Local , Adult , Aged , Esophagectomy/methods , Female , Follow-Up Studies , Humans , Lymph Node Excision , Male , Middle Aged , Neoplasm Staging , Survival AnalysisABSTRACT
Gunshot wounds, and in particular chest gunshot wounds, are becoming a growing problem in daily practice at many hospitals. Many authors propose a conservative attitude in certain cases. We present a patient with a chest gunshot wound successfully solved under conservative means and videothoracoscopic removal of the bullet.
