Ultrasound-Guided Thoracic Paravertebral Block for Pulmonary Radiofrequency Ablation.

Surgical resection is the treatment of choice both for early-stage lung cancer and pulmonary metastatic disease. For patients with lung tumors who are not eligible for surgery, the minimally invasive modality of radiofrequency ablation (RFA) may be curative and, thus, should be considered. However, opinions regarding the optimal anesthetic technique for pulmonary RFA differ. Here the authors report their experience with the use of ultrasound-guided paravertebral block in minimally-sedated patients undergoing pulmonary RFA. This retrospective study was conducted at a single institution. The 17 consecutive patients underwent 19 pulmonary RFA procedures for primary lung tumor or lung metastases. In all patients, RFA was performed according to the protocol of the hospital. Anesthesia in patients receiving RFA for lung tumors consisted of a thoracic paravertebral block (TPVB), performed between T4 and T8, with minimal sedation. This approach allowed intraoperative communication with the patient and apnea pauses as needed. There were no complications after TPVB, which was well-tolerated by all patients. Only two patients required an alfentanil bolus during RFA because of pleuritic pain. No patient required conversion from sedation to general anesthesia. There were no episodes of hemodynamic instability or desaturation (SaO2 ≤95%), and excessive sedation prevented patient collaboration in only one patient. In conclusion, ultrasound-guided single-injection TPVB is a safe and effective anesthetic technique for high-risk patients undergoing RFA for a primary lung tumor or lung metastases.

[Sentinel lymph node in pulmonary carcinoma. Molecular study after radioisotope detection]. / El ganglio centinela en el carcinoma pulmonar. Estudio molecular tras detección con radioisótopo.

INTRODUCTION: Metastatic lymph node affectation is the main prognostic factor in localized lung cancer. Pathological study of the obtained samples even after an adequate lymphadenectomy, present tumoral relapses of 40% of stage I patients after oncological curative surgery. In this paper we have studied micrometastasis in the sentinel lymph node by molecular methods in patients with stage I lung cancer. MATERIAL AND METHODS: The sentinel node was marked by injecting peritumorally performed just after performing the thoracotomy with 2 mCi of nanocoloid of albumin (Nanocol®) marked with 99mTc in 0.3 ml. Guided with a Navigator® gammagraphic sensor, we proceeded to its resection. RNA of the tissue was extracted and the presence of genes CEACAM5, PLUNC and CK7 in mRNA was studied. RESULTS: Twenty nine 29 patients were included. Of the tested genes, CEACAM5 and PLUNC were the ones that showed a high expression in lung tissue. Of the 29 analyzed sentinel lymph nodes, 7 (24%) were positive in the molecular study. A positive sentinel lymph node was found in 4/7 adenocarcinomas and 3/12 squamous-cell tumors. Affected lymph nodes were: station 5 (1/3), station 7 (0/6), station 9 (0/1); station 10 (5/11); station 11 (1/1). CONCLUSIONS: Detection of sentinel node in patients with stage I lung cancer by marking with radioisotope is a feasible technique. The application of molecular techniques shows the tumoral affectation in cases staged as stage I.

[Pulmonary nodular amyloidosis]. / Amiloidosis nodular pulmonar.

Amyloidosis is a systemic disease caused by extracellular accumulation of amyloid in different parts of the body. Pulmonary involvement is infrequent and nodular amyloidosis is extremely rare. We present the case of a 72-year-old man with chronic obstructive pulmonary disease in whom a 3-cm pulmonary nodule was discovered during routine radiological follow-up. After various complementary investigations failed to identify the etiology of the nodule, surgical excision was performed. Subsequent histopathological study revealed the presence of amyloid deposits with characteristic apple-green birefringence when stained with Congo-red under polarized light microscopy.