[The treatment of tracheobronchial ruptures: a review of 6 cases]. / Tratamiento de las roturas traqueobronquiales: revisión de 6 casos.

Tracheobronchial ruptures represent a serious pathology difficult to diagnose at the first examination. The authors review 6 cases: four as acute types with pneumomediastinum, pneumothorax and subcutaneous emphysema with a delay in diagnosis of 3.25 days, meanwhile 2 cases were chronic forms with a delay in diagnosis of 124.5 days. Diagnosis should be performed as soon as possible based in the presence of uni or bilateral pneumothorax with pneumomediastinum being confirmed by fiber bronchoscopy. The treatment is based in the resection of the fractured fragments, followed by bronchoplasty always with reabsorbable sutures the most frequent surgical technique, meanwhile in the atelectatic forms it is not possible to perform sometimes and we must practise lung resections.

Bronchovascular mucormycosis: an urgent surgical problem.

The case of a 70-year-old male with lymphoblastic leukemia is reviewed, who presented the rare and almost always fatal complication of pulmonary mucormycosis, but who was treated satisfactorily with amphotericin B and surgery. The risk of massive hemoptysis in the course of mucormycosis that invades the lung vessels, makes us believe that surgery is an essential part of the management of this disease. It is suggested that the patient be operated as soon as the diagnosis is obtained, as we did in our case, to avoid other risks in combined management with amphotericin B.

Thoracotomy in patients over 70 years old.

One hundred cases of patients aged 70 yrs or older, who had undergone surgical intervention for a thoracic pathology between 1981 and 1990, were reviewed. The mean age was 73 yrs, and bronchial cancer the most frequent aetiology (55%). A systematic detailed study before surgery is recommended in the these patients, who have the highest operative risk, and whom we should try to treat most conservatively. Although the rate of complications was higher than the normal average, mortality was only 4%, and was related to the greater or lesser aggression of the surgery. In cases of diagnosed bronchial cancer, a survival of 2 yrs was obtained in 66%, 3 yrs in 50%, and 5 yrs in 26%. We conclude that, theoretically, at the age of 70 yrs or older there is no contraindication for surgery, although it does increase the postoperative morbidity.

Prognostic factors in pulmonary metastases from colorectal cancer.

Surgery represents the first-choice treatment to manage pulmonary metastases from colorectal cancer when the primary tumor has been controlled and there is no evidence of metastatic spreading to any other organ. In our experience on 13 patients, we obtained a survival at 5 years of 23%. The average number of metastases resected was 2.9. The increase of carcinoembryonic antigen was the first clinical sign in 10 cases (76.9%, higher or equal to 5 ng/ml) that led to its discovery. The surgical technique most frequently used was wedge resection and/or atypical segmentectomy. Intraoperative mortality was zero and morbidity low (15.3%).

Pulmonary hydatidosis in childhood. Review of 21 cases.

Spain is one of the countries with a very high incidence of hydatidosis in the childhood. It represents 16.8% of all cases intervened for thoracic surgery for hydatidosis cysts in our department during the last ten years with a total of 21 children (inferior to 14 years) operated due to hydatidosis. Cough and pain were the symptoms more frequently encountered. The ratio unruptured/ruptured cysts was 3/1, higher than in the adults, with an average of 2.62 cysts per patient. Specific immunoglobulin E and histamine liberation test were the most useful tests in the laboratory. The usual surgical technique was a cystopericystectomy with total extirpation of the parasite of its rests. No recurrence was found in the follow-up of our patients.

Thoracic surgery in the elderly: review of 100 cases.

One hundred cases surgically intervened due to thoracic pathology between 1977 and 1986 were studied. The ages were equal to or higher than 70 years. Mean age was 73.13 years (70-91). In 70 cases a neoplastic aetiology existed (78.57% of primary bronchial carcinoma), while in the other 30 cases the cause was not neoplastic. In these cases with a high operative risk, a detailed systematic study before surgery is recommended, which should be treated in the most conservative possible way. Although the complication rate was higher than the average in other groups (p less than 0.05), mortality was only 4%, being related, to a greater or lesser extent--, to the surgery (p less than 0.05). In the cases diagnosed as bronchial carcinoma, a 2-year survival was obtained in 66.4%, 3 years in 49.8% and 5 years in 25.7%, concluding that an age equal to, or higher than, 70 years does not represent any contraindication for thoracic surgery.

Bilateral spontaneous pneumothorax associated with metastasis of a malignant fibrohistiocytoma.

The case of a 34-year-old female patient is presented. The patient was admitted because of bilateral pneumothorax caused by the metastasis of a malignant histiocytoma originating in the left gluteus. Bilateral chest-suction was made and the patient received complex chemotherapy. The chest X-ray taken 4 months later showed considerable regression of the lymph node metastases. Neither the time of development of pneumothorax nor its mechanism is known. There are only assumptions about it. Authors have considered their case worthy of publication because the lymph node metastasis of bilateral simultaneous pneumothorax due to histiocytoma has not so far been known in the literature.

Surgical treatment of thoracic hydatidosis. A review of 100 cases.

Hydatid cystic disease continues to hold an important place in chest disease in our country. The authors review their experience from 1977 to 1987 of 100 patients who underwent surgery for pulmonary hydatidosis. Mean age was 36.21 years. Fifty-nine cases were ruptured cysts (RC) and 41 were unruptured cysts (UC). The diagnosis was based on epidemiological, radiological and mainly serological and endoscopic criteria. The indirect haemagglutination test was positive in 100% of RC and 80% of UC, while 70.2% of the patients who underwent fiberoptic bronchoscopy showed pathological changes. The most commonly used surgical procedure in UC was open subtotal cystopericystectomy (89.09%), while wedge resection (41.81%) was the most commonly used technique for the RC. There were no operative deaths and no recurrences were observed for a mean follow-up of 5.4 years. The indications for adjuvant chemotherapy with mebendazole are presented.

Subglottic inflammatory pseudotumor in a 6-year-old child.

Inflammatory pseudotumors have been given diverse--no fewer than 19--names in the literature. The most frequent localization is in the lung, the gastrointestinal tract, and salivary glands. The case presented here at the subglottic level is exceptional. Although the intraoperative diagnosis is not easy, the prognosis is usually good. Malignant degenerations have not been described. In those cases that cannot be operated on or that extend into the mediastinum, radiotherapy is indicated.