[Bronchial stenosis secondary to severe thoracic contusion. Comment on 2 cases]. / Estenosis bronquial secundaria a contusión torácica grave. Comentario sobre dos casos.

Two cases with complete bronchial stenosis of the mainstem bronchus secondary to thoracic blunt trauma are presented. One patient had hemoneumothorax on the left side, the other one had bilateral hemothorax. Both were initially treated with drainage by thoracostomy tube with partial resolution of the thoracic bloody pleural collection. Later, the two patients developed complete atelectasis of the lung, one on the left side and the other one in the right; this later case was subject to lung decortication. The fiberopticbronchoscopy showed a complete occlusion of the mainstem bronchus in both patients. A bronchoplasty with sleeve resection of the stenotic segment was performed; the lumen of the bronchus was preserved by an end-to-end suture with separate stitchs of Vycryl 0000. Both cases remain without bronchopulmonary pathology after 4 years of follow-up of bronchoplasty. In cases of blunt thoracic trauma, it is important to consider the possibility of bronchial rupture. The importance of bronchoscopic diagnosis and surgical treatment is stressed.

[Surgical treatment of invasive thymoma with superior vena cava syndrome. 3 case reports]. / Tratamiento quirúrgico del timoma invasor con síndrome de vena cava superior. Informe de tres casos.

Three patients with invasive thymoma and superior vena cava syndrome with severe symptoms of cerebral venous hypertension and respiratory obstruction are presented. Two patients showed a type I obstruction and the other had a type II obstruction as defined by Stanford and Doty. In all of them, the tumor was resected and a graft bypass was placed between the left innominate vein and the right appendage. In two patients the grafts were venous and in the other it was a PTFE. All grafts were reinforced with wire rings. The patients improved and the symptoms of the SVCS disappeared, the average time of permeability was 10 months.

[An evaluation of the efficacy of nitrates (transdermal and peroral) in the management of the patient with a myocardial contusion]. / Valoración de la eficacia de los nitratos (transdérmicos y por vía oral) en el manejo del paciente con contusión miocárdica.

Although thoracic trauma is frequently accompanied by myocardial injury; this later is often oversighted at early stages of trauma and misdiagnosed by the time complications are present. Myocardial abnormalities have been attributed to a reduction of cardiac flow. Nitroglycerin and isosorbide dinitrate, both agents with a known vasodilator effect on coronary arteries, might improve myocardial ischemic resulting from traumatic contusion. In order to compare safety and efficacy between two nitrates and placebo on myocardial contusion resulting from thoracic trauma, we carried out a comparative, prospective, single blind study. Subjects were randomly allocated to one of the following 3 groups: a) transdermal nitroglycerin, b) isosorbide dinitrate and c) placebo. Medication was dispensed for five days. Major endpoint were electrocardiographic abnormalities at entry and their final modifications. Other were severity injury score and myocardial enzyme levels. Twelve patients were included in each group. Four measured enzymes were high at entry, but MB fraction in the nitroglycerin group showed the most rapid normalization. Creatine phosphokinase and lactic dehydrogenase significantly correlated with severity injury index, but not MB fraction. Electrocardiographic normalization was mainly observed in the nitroglycerin group. Transdermal nitroglycerin systems demonstrated to be effective on recovering from electrocardiographic abnormalities resulting of myocardial contusion.