Mediastinal aortosympathetic paraganglioma: report of two cases.

Thoracic paragangliomas or extra-adrenal pheochromocytomas are uncommon neoplasms that may arise from the extra-adrenal paraganglia. Paragangliomas arising in the anterior mediastinum are most frequent and are related to the base of the heart. Paragangliomas of the posterior mediastinum are most infrequent, and arise from aorticosympathetic paraganglia. We present two cases of posterior mediastinum paraganglioma. Complete tumor resection was done through posterolateral thoracotomy. The diagnosis of aorticosympathectic paraganglioma was established by histologic examination.

Spontaneous pneumomediastinum: 41 cases.

OBJECTIVE: Spontaneous pneumomediastinum is characterized by the presence of interstitial air in the mediastinum without any apparent precipitating factor. The purpose of this study is to review and discuss our experience with this condition. METHODS: A descriptive, retrospective study of 41 cases--34 men (83%) and 7 women (17%)--treated at our hospital for spontaneous pneumomediastinum from January 1990 through June 2006. RESULTS: The mean age of the patients was 21 years (range, 14-35 years). Notably, 22% of patients had a prior history of asthma. No precipitating factor was identified in 51% of cases while onset was associated with physical effort in 12%. Chest pain (85%) and dyspnea (49%) were the most common symptoms. Subcutaneous emphysema, which presented in 71% of patients, was the most common sign. Pneumomediastinum was diagnosed by plain chest radiography in all cases. In certain cases, a computed tomography scan of the chest, contrast-enhanced swallow, or bronchoscopy was performed. All patients were admitted to the hospital with good progress and no instances of morbidity or mortality. Treatment included analgesia, rest, and/or initial oxygen therapy. The mean length of hospital stay was 5 days (range, 1-9 days) with only one case of early recurrence, which was resolved satisfactorily. CONCLUSIONS: Spontaneous pneumomediastinum is a benign process primarily affecting young men. Despite its low incidence, spontaneous pneumomediastinum should be considered in the differential diagnosis of acute chest pain because it requires a high index of suspicion. Patients with spontaneous pneumomediastinum respond well to medical treatment, with no recurrence in the great majority of cases.

An assessment of anxiety in patients with primary hyperhidrosis before and after endoscopic thoracic sympathicolysis.

OBJECTIVE: Endoscopic bilateral thoracic sympathicolysis (EBTS) is an effective and minimally invasive procedure used for patients with primary hyperhidrosis. The purpose of this study was to examine anxiety levels using standardized psychometric tools in hyperhidrosis patients before and after EBTS. METHODS: A total of 106 patients diagnosed with hyperhidrosis who underwent EBTS were asked to fill out a questionnaire before and 12 months after the procedure that elicited the following information: (a) symptoms associated with hyperhidrosis; (b) the patient's level of anxiety; and (c) the extent to which this anxiety was incapacitating in their daily life. All patients also completed State-Trait Anxiety Inventory (STAI) before and 12 months after the EBTS. RESULTS: Palpitations were reported preoperatively by 40% of patients versus 10% postoperatively, trembling of the hands in 24% versus 8%, facial blushing in 55% versus 11%, headache in 29% versus 9%, and non-specific epigastric pain in 19% versus 7%. Patients reported a marked improvement in the level of anxiety from a mean SD of 2.08+/-1.1 preoperatively versus 0.39+/-0.67 postoperatively (p<0.001), and the social impact (debilitating) of primary hyperhidrosis before and after surgery also showed significant improvement (p<0.001). The results of STAI showed significant improvement in the levels of anxiety after surgery compared with the preoperative levels and with established norms (p<0.001). CONCLUSIONS: Patients with primary hyperhidrosis that undergo EBTS presented a decrease in the level of anxiety and associated symptoms.

Tracheal and cricotracheal resection for laryngotracheal stenosis: experience in 54 consecutive cases.

OBJECTIVE: Partial tracheal resection (Küster operation (KO)) and cricotracheal resection (Pearson operation (PO)) are currently the standard operative techniques in the curative treatment of tracheal and cricotracheal stenosis, respectively. This study aims to analyze the outcomes of tracheal and cricotracheal resection when a specific protocol is applied. METHODS: Between 1990 and 2004 we treated 54 patients with laryngotracheal stenosis. The mean age was 44.9 years with a sex ratio of 1:1. All patients were treated according to the random protocol "Lesions of the main airway (MA) protocol," which considers the following stenosis variables: stage of development (S), caliber (C), and length (L). We performed 38 Küster operations, 14 Pearson operations, and 2 combined Pearson-Küster-Rethi operations (ROs). RESULTS: Overall mortality of the series was 1.85%, with a specific morbidity of 27.7%. A total of 96.2% of patients were cured (85.6% of Pearson operation and 100% of Küster operation). We performed 3.7% re-interventions (14.2% of Pearson operation and 0% of Küster operation), and the failure rate was 3.7% (14.4% of Pearson operation and 0% of Küster operation). We had 27.5% who had postoperative complications (28.5% of Pearson operation and 26.3% of Küster operation). The most frequent complications were restenosis (14.2%), granulation tissue (13.1%), edema (10.5%), anastomotic dehiscence (7.1%), and tracheoesophageal fistula (7.1%). In terms of the SCL variables, significant differences were only observed with respect to morbidity between the S4 group and the other cases without tracheoesophageal fistula in the Küster operation group; we found no differences in Pearson operation. CONCLUSIONS: Application of the Main Airway protocol allowed development of a strategy for the surgical treatment of main airway stenosis. This, in turn, enabled a strict selection of cases and meticulous preoperative preparation that, coupled with a highly effective surgical technique, led to excellent outcomes with minimal sequel. The presence of tracheoesophageal fistula could increase the complications.

[Primary hyperhidrosis: prospective study in 338 patients]. / Hiperhidrosis primaria: estudio prospectivo de 338 pacientes.

BACKGROUND AND OBJECTIVE: The objective of this report is to study the clinical aspects of the patients with primary hyperhidrosis (PH) and the social and occupational distressing condition. PATIENTS AND METHOD: From January 1998 to October 2002, 338 patients with PH completed a preoperative questionnaire to register: age, gender, profession, associated diseases, familiar hyperhidrosis history, sweating location, associated dermatological lesions and social embarrassesment. 179 patients were asked about their general symptomatology. RESULTS: In 86% of the patients PH started during infancy, 71.5% were female (mean age 28.8 years). A few patients had others diseases and 42.5% had some associated dermatological lesions. In 47.9% of the patients there is family history of PH. 96.4% reported palmar hyperhidrosis, 80.7% plantar PH and 71.3% reported axillary PH, being less frequent in others regions of the body. The most frequent clinical founding associated is facial blushing in 60.3%, 52.3% heart palpitations, 48% muscle stress, 31.8% reported trembling of the hands and 30,8% headache. In reference to social embarrassesment, we observe that relations between friends and professional environment are the most problematic situation. CONCLUSIONS: PH is a pathologic condition starting in infancy, family history of PH is frequent and most patients have some associated dermatological lesions. Excessive sweating is especially common in palms but no exclusively of this region as it extends to others regions with the same intensity. It can be associated with symptomatology suggestive of hyperexcitability of the sympathetic activity like facial blushing, trembling or headache, symptoms difficult to consider whether they are cause or consequence.

Hiperhidrosis primaria: estudio prospectivo de 338 pacientes / Primary hyperhidrosis: prospective study in 338 patients

FUNDAMENTO Y OBJETIVO: Este trabajo tiene por objetivo estudiar el perfil clínico del paciente con hiperhidrosis primaria (HP) y su repercusión social. PACIENTES Y MÉTODO: La muestra acota un total de 338 pacientes con HP estudiados entre enero de 1998 y octubre de 2002. Todos cumplimentaron una encuesta epidemiológica preoperatoria donde se registraron: edad, sexo, profesión, antecedentes personales y familiares, inicio, localización, clínica cutánea acompañante y repercusión social de la HP. Sobre 179 pacientes se registró sintomatología general acompañante. RESULTADOS: La HP se inicia en la infancia en el 86 por ciento de los casos, el 71,5 por ciento son mujeres y la edad media es de 28,8 años. Son pacientes con escasas enfermedades asociadas y con una clínica local cutánea acompañante en el 42,5 por ciento de los casos. Los familiares con HP alcanzan un 47,9 por ciento de los casos. La localización de la hipersudación es palmar en el 96,4 por ciento de los casos, el 80,7 por ciento plantar, el 71,3 por ciento axilar, siendo menor en otras zonas. La clínica acompañante más frecuente es: enrojecimiento facial (60,3 por ciento), palpitaciones (52,5 por ciento), tensión muscular (48 por ciento), temblor (31,8 por ciento) y cefalea (30,8 por ciento). Las relaciones entre los amigos y el ámbito laboral son las situaciones más problemáticas. CONCLUSIONES: La HP es un trastorno de inicio en la infancia, con historia familiar de HP, con escasas enfermedades asociadas y con repercusión cutánea local. La clínica principal es la hipersudación palmar, aunque no es exclusiva dicha localización. Se suele acompañar de sintomatología indicativa de hiperfunción simpática como enrojecimiento facial, temblor o cefalea, síntomas difíciles de considerar si son causa o consecuencia (AU)