Staged approach for surgical management of external iliac vein aneurysm associated with traumatic femoral arteriovenous fistula.

Aneurysms of the iliac vein are rare. They can occur in association with arteriovenous fistulae located elsewhere. Here, we present a 30-year-old man who developed a large left external iliac vein aneurysm in association with a chronic traumatic arteriovenous fistula in the left thigh. Less than 25 cases of iliac vein aneurysms have been reported in the last 40 years. The presentation and treatment of this condition has been heterogeneous. We suggest that adequate surgical treatment can be offered in a staged approach: aneurysm resection with reconstruction should be done first, followed by closure of the arteriovenous fistula 6 months later.

Estudio microbiológico y anatomopatológico de bronquiectasias sangrantes en piezas de resección pulmonar / A microbiological and pathological study of bleeding bronchiectasis in pulmonary resection piece

La hemoptisis periódica o recurrente en los pacientes con bronquiectasias sangrantes constituyen un factor de alto riesgo de muerte, asimismo, existe un alto desconocimiento de la comunidad médica acerca de la existencia de otros agentes oportunistas, ajenos a la tuberculosis pulmonar, que pueden producirlas. Objetivos. Describir las características microbiológicas y anatomopatológicas de una serie de pacientes con bronquiectasias sangrantes que fueron negativos a tuberculosis, HIV y neoplasias, en estudios preliminares. Materiales y métodos. Se desarrolló una evaluación microbiológica y anatomopatológica en búsqueda de hongos, tuberculosis, gérmenes comunes y neoplasia pulmonar, sobre 24 piezas operatorias de pacientes con hemoptisis por bronquiectasias sangrantes con antecedente de tuberculosis pulmonar o de contacto con personas que padecían esa enfermedad. Resultados. El hongo Aspergillus fue hallado en 20 de los 24 pacientes estudiados. No se reportó resultados positivos en los exámenes realizados para gérmenes comunes aerobios y tuberculosis. El estudio anatomopatológico, confirmó la presencia de micetoma y Aspergillus. El tejido cicatricial invadido está altamente vascularizado con predisposición a hemorragia y a un acto operatorio de tiempo prolongado. Conclusiones. El hongo Aspergillus es el principal y único agente infeccioso presente en pacientes con bronquiectasia sangrante en esta serie.

The recurrent hemoptysis in patients with bleeding bronchiectasis are a risk factor of death; but also there is high ignorance for the medical community about the existence of other opportunistic agents, and not only tuberculosis, that can produce them. Objectives. To describe the histopathological and microbiological characteristics of a series of bleeding patients with bronchiectasis that were negative for tuberculosis, HIV and cancer in preliminary studies. Material and methods. We developed a pathological and microbiological evaluation in search of fungi, tuberculosis, lung neoplasia and common germs; in 24 surgical patients with hemoptysis of bleeding bronchiectasis with a history of pulmonary tuberculosis or contact with people that suffering this disease. Results. The fungus Aspergillus was found in 20 of the 24 patients studied. No positive results were reported on tests carried out for common aerobic bacteria and tuberculosis. The pathologic examination confirmed the presence of Aspergillus and mycetoma. The cicatricial tissue, that was invaded, is highly vascularized with a predisposition to bleeding and prolonged surgery time. Conclusions. Aspergillus fungus is the single biggest infectious agent present in patients with bleeding bronchiectasis in this series.

Hidatidosis pulmonar en un hospital de Lima, Perú: experiencia en 113 pacientes / Pulmonary hydatidosis in a general hospital from Lima, Peru: experience in 113 patients

Objetivo. Describir las características epidemiológicas, clínicas y quirúrgicas de los pacientes con hidatidosis pulmonar en el Hospital Nacional Dos de Mayo. Materiales y métodos. Estudio descriptivo, retrospectivo y observacional. La población estuvo constituida por todos los casos de hidatidosis pulmonar diagnosticados, operados y controlados en el Programa de Cirugía de Tórax y Cardiovasculardel Hospital Nacional Dos de Mayo entre enero 2003 y diciembre 2005. Se revisó las historias clínicas y el reporte operatorio de 113 casos estudiándose sus características clínicas, epidemiológicas, quirúrgicas, morbimortalidad intraoperatoria y postoperatoria, evolución postoperatoria y seguimiento luego de seis meses de realizado el tratamiento quirúrgico. Resultados. Se captó 113 pacientes, 50,4 por ciento fueron mujeres, 15,9 por ciento procedía de Lima Metropolitana y el síntoma principal fue el dolor torácico. El abordaje quirúrgico fue realizado principalmente mediante toracotomía posterolateral (97,3 por ciento). Las técnicas quirúrgicas empleadas fueron la resección pulmonar (52,2 por ciento), cirugía preservadora (40,7 por ciento) y técnica mixta (7,1 por ciento). La hidatidosis pulmonar con compromiso intratorácico concomitante se observó en el 4,5 por ciento y con compromiso extratorácico en el 25,7 por ciento. En el 80,5 por ciento de casos el quiste se encontraba complicado; se presentaron complicaciones intraoperatorias en el 73,4 por ciento y postoperatorias en el 22,1 por ciento. Conclusiones. Los pacientes son predominantemente adultos jóvenes que se encuentran en condición de migrante o de tránsito en la ciudad de Lima, a menudo con antecedentes epidemiológicos. Son frecuentes las complicaciones intraoperatorias y menos frecuentes las postoperatorias las cuales una vez superadas no tienen repercusión en la mortalidad de los pacientes.

Objective. To describe the surgical, clinical and epidemiological characteristics in patients with pulmonary hydatid in the Hospital Nacional Dos de Mayo. Material and methods. Descriptive, retrospective and observational study. The studied population was patients with thediagnosis of pulmonary hydatid, operated and registered in the Program of Torax and Cardiovascular Surgery of the Hospital Nacional Dos deMayo from January 2003 to December 2005. 113 clinical records and surgical reports were reviewed; clinical, epidemiological and surgicalcharacteristics, intraoperatory and postoperatory morbidity/mortality as well as six-month follow up after the surgical treatment were recorded. Results. 113 patients were enrolled, 50.4 per cent female, 15.9 per cent were from Lima Metropolitana and the main symptom was thoracic pain. The principal surgical approach was the posterolateral toracotomy (97.3 per cent). The surgical techniques used were pulmonary resection (52.2 per cent), preservative surgery (40.7 per cent) and mixed technique (7.1 per cent). Pulmonary hydatidosis with intrapulmonary involvement was presentin 4.5 per cent and extrapulmonary involvement in 25.7 per cent. Complicated cysts were in 80.5 per cent of cases. There were intraoperatives surgical complications in 73.4 per cent and postoperative complications in 22.1 per cent. Conclusions. Patients were young adults, mainly rural immmigrants or people in transit, frequently with risk factors for hydatid. Intra-operatory complications were more frequent and unusual than postoperatory complications, but had no impact on the patientsÆ mortality.

Severe mitral regurgitation and hepatopulmonary hydatid cysts: what should be treated first?

Hydatid cyst can simultaneously affect the liver and lung. Some patients might have additional comorbidities that can make management more challenging. Here, we present a 10-year-old boy with hepatopulmonary hydatid cysts and severe mitral regurgitation, who was successfully managed with a staged surgical approach treating the lung first, followed by the liver and finally, the heart.

Surgical management of Aspergillus colonization associated with lung hydatid disease.

Colonization with Aspergillus sp. usually occurs in previously formed lung cavities. Cystectomy is a widely used surgical technique for hydatid lung disease that can also leave residual cavities and potentially result in aspergilloma. We present two cases of this rare entity and a case with Aspergillus sp. colonization of an existing ruptured hydatid cyst.

Total anomalous pulmonary venous return and Mayer-Rokitansky-Kuster-Hauser syndrome.

We present an adult woman with total anomalous pulmonary venous return (TAPVR) and Mayer-Rokitansky-Kuster-Hauser syndrome that was diagnosed intraoperatively during a planned atrial secundum defect closure. Surgical repair of TAPVR was performed with good outcome.

A large pediculated myxoma of the left ventricle causing outflow obstruction in a young man.

We report a case of a large mobile myxoma of the left ventricle that caused obstruction of the outflow tract. Transthoracic and transesophageal echocardiography defined the extent and location of the mass providing crucial information for surgical treatment, which was successful.

Surgical management of giant superior mesenteric artery aneurysm.

The superior mesenteric artery (SMA) is an uncommon location of aneurysm formation. This entity is potentially lethal and should be treated once a diagnosis is made. When the aneurysm reaches a large size, there is a high risk of rupture and surgical treatment should not be delayed, although it can be technically demanding because there is a significant portion of bowel at risk for ischemia. Here, we describe our approach for the management of a giant SMA aneurysm.

Perforación esofágica y mediastinitis causada por espina de pescado / Esophageal perforation and mediastinitis caused by fishbone

Presentamos 3 casos consecutivos de perforación del esófago por espina de pescado que ocasionó mediastinitis aguda. Todos los pacientes fueron satisfactoriamente manejados con drenaje y debridamiento del mediastino y cavidad pleural. Sin embargo, se realizó exclusión esofágica temporal mediante ligadura externa en un paciente, con recanalización espontánea 2 semanas más tarde. Discutimos el posible rol de esta maniobra quirúrgica en el manejo de perforación esofágica.

We present 3 consecutive cases of fishbone perforation of the esophagus that resulted in acute mediastinitis. All patients were successfully managed with drainage and debridement of the mediastinum and pleural cavity. However, temporary exclusion with external ligation of the esophagus was also performed in one patient, withspontaneous recanalization two weeks later. We discuss the possible role of thissurgical maneuver in the management of esophageal perforation.

[Esophageal perforation and mediastinitis caused by fishbone ingestion: report of 3 cases]. / Perforación esofágica y mediastinitis causada por espina de pescado: reporte de 3 casos.

We present 3 consecutive cases of fishbone perforation of the esophagus that resulted in acute mediastinitis. All patients were successfully managed with drainage and debridement of the mediastinum and pleural cavity. However, temporary exclusion with external ligation of the esophagus was also performed in one patient, with spontaneous recanalization two weeks later. We discuss the possible role of this surgical maneuver in the management of esophageal perforation.