ABSTRACT
No disponible
Subject(s)
Humans , Minimally Invasive Surgical Procedures , Thoracic Surgery, Video-Assisted/methods , Thoracic Diseases/surgery , Thoracic Surgery, Video-AssistedABSTRACT
A 51-year-old woman with carcinoma of the right axillary sweat glands was treated by radical surgery and radiotherapy. Six years later she developed multiple bilateral lung metastases. Nine nodes were resected from both lungs using a clamshell approach (bilateral transsternal, anterolateral thoracotomy). After surgery, the patient received 6 cycles of adjuvant chemotherapy with cisplatin and 5-fluoruracil. Three years after treatment, no intrathoracic recurrences had occurred and the patient was asymptomatic, with good quality of life.
Subject(s)
Adenocarcinoma/secondary , Adenocarcinoma/surgery , Lung Neoplasms/secondary , Lung Neoplasms/surgery , Sweat Gland Neoplasms , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/drug therapy , Antimetabolites, Antineoplastic/therapeutic use , Antineoplastic Agents/therapeutic use , Axilla , Chemotherapy, Adjuvant , Cisplatin/therapeutic use , Combined Modality Therapy , Female , Fluorouracil/therapeutic use , Follow-Up Studies , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/drug therapy , Lymph Node Excision , Middle Aged , Radiography, Thoracic , Thoracotomy , Time Factors , Tomography, X-Ray ComputedABSTRACT
Primary spontaneous pneumothorax in both lungs simultaneously is rare. We report the case of a 22-year-old man with no relevant medical history who came to the emergency room in critical condition after suffering simultaneous massive pneumothorax in both lungs. After a pleural drain was inserted in each hemithorax, elective surgery was prescribed because of the bilaterality and severity of the pneumothorax. Sequential video thoracoscopic surgery was performed in a single session, during which small blebs were identified at both lung vertices. The blebs were resected and pleural abrasion performed. Postoperative recovery was unremarkable. The patient was discharged four days after surgery. Five years later, the patient was asymptomatic, having experienced no recurrences.
Subject(s)
Lung/physiopathology , Pneumothorax/etiology , Adult , Drainage/instrumentation , Humans , Lung/diagnostic imaging , Male , Pneumothorax/diagnostic imaging , Pneumothorax/surgery , Radiography , Thoracoscopy/methodsABSTRACT
Mujer de 51 años con un carcinoma de glándulas sudoríparas (CGS) en la axila derecha tratado mediante cirugía radical y radioterapia, que 6 años después presentó metástasis pulmonares bilaterales múltiples. Se resecaron nueve nódulos en ambos pulmones a través de una toracotomía anterolateral bilateral transesternal (clamshell). La paciente recibió seis ciclos de quimioterapia adyuvante postoperatoria con cisplatino y 5-fluorouracilo. En la actualidad, a los 3 años de seguimiento, no ha habido recidivas intratorácicas, y la paciente se encuentra asintomática y con buena calidad de vida (AU)
Subject(s)
Middle Aged , Female , Humans , Sweat Gland Neoplasms , Tomography, X-Ray Computed , Radiography, Thoracic , Thoracotomy , Time Factors , Chemotherapy, Adjuvant , Antimetabolites, Antineoplastic , Axilla , Antineoplastic Agents , Combined Modality Therapy , Cisplatin , Adenocarcinoma , Lymph Node Excision , Fluorouracil , Follow-Up Studies , Lung NeoplasmsABSTRACT
El neumotórax espontáneo primario bilateral simultáneo es excepcional. Presentamos el caso de un paciente de 22 años, sin antecedentes de interés, que acudió a urgencias en situación crítica tras sufrir un episodio de neumotórax masivo bilateral simultáneo. Tras la inserción de un drenaje pleural en cada hemitórax, se indicó cirugía electiva definitiva, dada la bilateralidad y gravedad del neumotórax. El paciente fue intervenido mediante cirugía videotoracoscópica bilateral secuencial en la misma sesión operatoria, y se identificaron pequeños blebs en ambos vértices pulmonares. Se realizó una resección de los blebs y una abrasión pleural. El postoperatorio cursó sin incidencias y el enfermo fue dado de alta en el cuarto día postoperatorio. Cinco años después, el paciente se encuentra asintomático sin haber sufrido recurrencia del neumotórax (AU)
Subject(s)
Adult , Male , Humans , Thoracoscopy , Pneumothorax , Drainage , LungABSTRACT
BACKGROUND: The aim of this study was to determine independent risk factors for early bronchopleural fistula (BPF) after pneumonectomy and to assess the efficacy of bronchial coverage in preventing this complication. METHODS: We reviewed 242 consecutive patients undergoing pneumonectomy for lung cancer. The bronchial stump was covered with autologous tissue in 178 patients (74%). Perioperative data were recorded to identify risk factors of BPF by univariate and multivariate analyses. RESULTS: Overall morbidity and mortality rates were 59% and 5.4%, respectively. The incidence of BPF was 5.4%. By univariate analysis, patients with chronic obstructive pulmonary disease (COPD; p = 0.017), hyperglycemia (p = 0.003), hypoalbuminemia (p = 0.017), previous steroid therapy (p < 0.001), poor predicted postpneumonectomy forced expiratory volume in 1 second (FEV1; p = 0.012), long bronchial stumps (p < 0.001), and mechanical ventilation (p = 0.015), were related with higher risk of BPF. In the multiple logistic regression model, the independent risk factors of BPF were the bronchial stump coverage and length, side of pneumonectomy, predicted postpneumonectomy FEV1, COPD, and mechanical ventilation. CONCLUSIONS: Bronchial stump coverage is highly recommended in all cases to minimize the risks of BPF. A shorter length of the bronchial stump and early extubation may prevent the development of BPF. Careful attention must be paid to those patients with COPD and poor predicted postpneumonectomy FEV1.
