ABSTRACT
We report the case of a 29-year-old man with descending necrotizing mediastinitis and subcarinal spread secondary to oropharyngeal infection. The thoracic infection was treated by placement of a transcervical thoracic drain, which was removed 15 days after surgery. The outcome was satisfactory and no further invasive treatment was required. We believe that transcervical thoracic drainage is a useful initial treatment for descending necrotizing mediastinitis with subcarinal spread but no pleural cavity involvement.
Subject(s)
Drainage/methods , Mediastinitis/diagnostic imaging , Mediastinitis/surgery , Adult , Humans , Male , Mediastinitis/microbiology , Necrosis , Tomography, X-Ray ComputedABSTRACT
Presentamos el caso clínico de un varón de 29 años de edad que presentó una mediastinitis necrosante descendente con extensión infracarinal secundaria a un proceso infeccioso orofaríngeo. La infección torácica fue tratada mediante un drenaje torácico vía transcervical, que se retiró al decimoquinto día del postoperatorio. La evolución fue favorable sin necesidad de una reintervención más radical. Consideramos que en la mediastinitis necrosante descendente con extensión infracarinal sin rotura pleural es útil inicialmente el tratamiento con drenaje torácico transcervical
We report the case of a 29-year-old man with descending necrotizing mediastinitis and subcarinal spread secondary to oropharyngeal infection. The thoracic infection was treated by placement of a transcervical thoracic drain, which was removed 15 days after surgery. The outcome was satisfactory and no further invasive treatment was required. We believe that transcervical thoracic drainage is a useful initial treatment for descending necrotizing mediastinitis with subcarinal spread but no pleural cavity involvement
Subject(s)
Male , Humans , Mediastinitis/surgery , Mediastinitis/therapy , Drainage , Peritonsillar AbscessABSTRACT
Sympathectomy of the thoracic chain is an effective surgical procedure for treating axillary and palmar hyperhidrosis. The procedure has been performed with minimal invasion and good results in recent years through the use of videothoracoscopic surgery. This paper describes the technique and our experience with a series of 50 patients between 16 and 48 years old. The earliest approach was unilateral in successive operations. The procedure was later performed bilaterally, at first with the patients in sequential lateral decubitus positions and later in semi-seated position. Complications were 1 case of incomplete Claude-Bernard-Horner syndrome that resolved spontaneously two months after surgery; 1 failure when sympathectomy was performed without location of the chain, obliging rapid re-operation; laminar pneumothorax in 12% of the series; compensatory hyperhidrosis in 26%; 10% with chest pain due to intercostal involvement, resolving with time; and slight bleeding in 8%. Outcome was excellent, with complete disappearance of axillary and palmar perspiration. Patient satisfaction was 9.2/10 one year after surgery. Mean hospital stay was less than 36 h.
Subject(s)
Electrocoagulation , Hyperhidrosis/surgery , Sympathectomy/methods , Thoracic Surgery, Video-Assisted , Adolescent , Adult , Axilla/innervation , Chest Pain/etiology , Contraindications , Female , Hand/innervation , Hemorrhage/etiology , Horner Syndrome/etiology , Humans , Length of Stay , Male , Middle Aged , Patient Satisfaction , Pneumothorax/etiology , Postoperative Complications , Sweat Glands/innervation , Sympathectomy/statistics & numerical data , Thoracic Surgery, Video-Assisted/statistics & numerical data , Treatment OutcomeABSTRACT
La simpatectomía de la cadena torácica constituye un procedimiento quirúrgico efectivo en el tratamiento de las hiperhidrosis axilopalmares. La introducción de la cirugía videotoracoscópica ha permitido realizar en los últimos años este procedimiento quirúrgico de manera poco invasiva y con buenos resultados. En este artículo describimos la técnica y nuestra casuística, con una serie de 50 pacientes, con edades comprendidas entre los 16 y los 48 años. El abordaje al principio fue unilateral en tiempos quirúrgicos sucesivos, para pasar después a efectuarlo bilateral, primero en decúbitos laterales secuenciales y luego en posición semisentada. Las complicaciones de la serie consistieron en un síndrome de Claude Bernard Horner incompleto que cedió espontáneamente a los 2 meses de la intervención; un fallo en la consecución de la simpatectomía por no localización de la cadena, lo que obligó a la reintervención temprana. Un 12 per cent de neumotórax laminares; un 26 per cent de hipersudaciones compensadoras, un 10 per cent de dolor torácico por afección de los intercostales que con el tiempo cedieron y un 8 per cent de hemorragias discretas. En todos los casos se obtuvieron excelentes resultados clínicos, con desaparición completa de la sudación tanto axilar como palmar. El grado de satisfacción de los pacientes fue calificado de 9,2/10 (puntuación obtenida en la consulta postoperatoria al año). La estancia hospitalaria media fue inferior a las 36 h (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Male , Female , Humans , Thoracic Surgery, Video-Assisted , Electrocoagulation , Sweat Glands , Sympathectomy , Patient Satisfaction , Treatment Outcome , Pneumothorax , Postoperative Complications , Axilla , Chest Pain , Horner Syndrome , Hemorrhage , Hyperhidrosis , Length of Stay , HandABSTRACT
We present a case of bilateral hydrothorax after internal jugular vein catheterization. 60 hours after placing the catheter, the patient showed an abrupt picture of jugular ingurgitation, abolished vesicular breath sounds, and displaced cardiac tones. It was necessary to immediately drain one hemithorax to guarantee ventilation of the patient. The present article examines iatrogenicity derived from the placement of central catheters, and special attention is given to the need for post-insertion x-ray control.
Subject(s)
Catheterization, Central Venous/adverse effects , Hydrothorax/etiology , Iatrogenic Disease , Adult , Humans , Hydrothorax/diagnosis , Hydrothorax/therapy , Jugular Veins , Male , Parenteral Nutrition/adverse effects , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Pleural Effusion/therapy , SuctionABSTRACT
We present the case of a young patient with leiomysarcoma of the lung that was at first diagnosed as a hydatid cyst. Pathological tissue analysis was needed for firm diagnosis. This rare tumor, of which fewer than 100 cases have been reported worldwide in the literature, needs to be considered as a differential diagnosis when lung cancer is suspected, given that leiomysarcoma has a better prognosis. Treatment is mainly surgical.
Subject(s)
Leiomyosarcoma/diagnosis , Lung Neoplasms/diagnosis , Adult , Diagnosis, Differential , Humans , Leiomyosarcoma/pathology , Leiomyosarcoma/surgery , Lung/pathology , Lung Neoplasms/pathology , Lung Neoplasms/surgery , Male , Prognosis , Tomography, X-Ray ComputedABSTRACT
The cause of cardiac tamponade is only established in 50% of cases. This problem is most commonly treated by pericardiocentesis alone, pericardiotomy being reserved for cases of recurrence and pericardiectomy for those patients presenting with constrictive pericarditis. A series of 16 patients treated with pericardial fenestration via a thoracoscope is presented. Pericardial and pleural biopsies were performed, together with cytological and biochemical analysis of the pericardial and pleural fluid where present. This procedure established the aetiology of effusion in all cases. In malignant pericardial effusion bleomycin was used for pericardial sclerosis. This resulted in fewer recurrences than in those patients where sclerosis was not attempted (12.5% v 60%).
Subject(s)
Pericardial Effusion/surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Pericardial Effusion/diagnosis , Thoracoscopy , Treatment OutcomeABSTRACT
A case is presented of mediastinal abscess secondary to esophageal perforation after bougie dilation that evolved favorably with antibiotic treatment and without surgical drainage.