Índice predictivo clínico, electrocardiográfico y ecocardiográfico de las recurrencias de la fibrilación auricular paroxística / Clinical, electrocardiographic and echocardiographic predictive index of paroxysmal atrial fibrillation recurrences

Introducción: La fibrilación auricular se ha definido como la taquiarritmia supra-ventricular más frecuente en la práctica clínica. Su prevalencia actual en el mundo desarrollado es de aproximadamente un 1,5-2,0 por ciento de la población general, y la media de edad ha ido en aumento, de tal forma que actualmente se sitúa entre los 75 y 85 años. Con respecto a la prevalencia, las previsiones indican que por lo menos se doblará en los próximos 50 años. Las estadísticas vigentes muestran que esta arritmia está asociada a un riesgo 5 veces mayor de accidente cerebrovascular, una incidencia 3 veces mayor de insuficiencia cardíaca congestiva y mayor mortalidad. En este tópico las recurrencias juegan un importante papel. Objetivo: Diseñar y validar un índice predictivo, con la integración de factores pronósticos, con vistas a evaluar el riesgo de recurrencia de los pacientes con fibrilación auricular paroxística. Método: La construcción de este índice incluyó: la selección de variables y la búsqueda de ponderaciones, en esta etapa se estudiaron 145 pacientes con diagnóstico de fibrilación auricular paroxística. La validación estadística incluyó elementos de validez que fueron satisfactorios. Resultados: Como resultado se obtuvo un índice con dos alternativas, una cualitativa y otra cuantitativa ordinal, con tres niveles de riesgo de recurrencias para la fibrilación atrial paroxística: bajo, moderado y alto. Conclusiones: El índice obtenido, por tanto, se consideró adecuado para aplicar en el contexto de actuación y reducir la recurrencia de la fibrilación auricular paroxística(AU)

Unusual primary pleural leiomyoma.

Primary pleural leiomyoma is extremely rare and has only been described a few times. We present a case of a young woman with right pleuritic pain. A computed tomography confirmed the existence of a solid right pleural tumor which had compressed and displaced the lung, mediastinum and heart. Percutaneous biopsy showed a 'proliferation of smooth muscle cells without evidence of malignancy'. Surgical excision was done and the tumor was not associated to vascular, broncho-pulmonary or mediastinal structures. The definitive diagnosis was primary pleural leiomyoma. Primary pleural leiomyoma should be included in a differential diagnosis of pleural tumors and suspected in asymptomatic patients with radiologically-apparent benign tumors and the presence of smooth muscle fibers in the biopsy. Complete resection and follow-up is advised because it can grow very large and has malignant potential.

Side effects, complications and outcome of thoracoscopic sympathectomy for palmar and axillary hyperhidrosis in 406 patients.

BACKGROUND: Thoracic sympathectomy (TS) is the treatment of choice for severe primary hyperhidrosis. However, complications, side effects and satisfaction have not been well defined. OBJECTIVE: To analyze the complications, side effects, satisfaction degree and quality of life of patients after TS for primary upper limb hyperhidrosis. METHODS: One-year follow-up after 406 consecutive TS for primary upper limb hyperhidrosis. RESULTS: Bilateral TS was completed in all patients. Complications arose in 23 cases (5.6%), with pneumothorax being the most frequent. The success rate after discharge, 6 and 12 months was respectively, 100%, 98.1% and 96.5% for palmo-axillary hyperhidrosis; 100%, 99.3% and 97.8% for isolated palmar hyperhidrosis and 100%, 85.7% and 71.4% for isolated axillary hyperhidrosis. No persistence of hyperhidrosis was observed. Global recurrence was 3.7% (28.5% axillary hyperhidrosis group). Compensatory sweating (CS) appeared in 55% and was not related to the extension of the TS. Being female was a predisposing factor of CS (p<0.004). Excessive dryness appeared at 9% and was associated with extensive TS (P<0.001). Plantar hyperhidrosis improved at 33.6%, worsened at 10% and remained stable during the follow-up. Satisfaction degree decreased with the passage of time and was associated with recurrence. Quality of life was excellent at discharge, 6 and 12 month in 100%, 100% and 97%, respectively. CONCLUSIONS: Pneumothorax is the most frequent complication of TS. CS is the main and undesirable side effect, appears with the passage of time, and is not related to the extension of TS. Being female is the only predictor factor of suffering CS. Plantar hyperhidrosis improves initially, although tends to reappear. Excessive dryness appears in extensive TS and does not improve over time. Postoperative satisfaction degree is high but decreases over time owing to the appearance of recurrence. Effectiveness and the absence of CS determine an excellent quality of life. Six percent of the patients regret the surgery because of severe CS. Informing patients of possible side effects before TS is essential.

Hospital volume: operative morbidity, mortality and survival in thoracotomy for lung cancer. A Spanish multicenter study of 2994 cases.

INTRODUCTION: It has been hypothesized that medical procedures performed in high-volume units carry less risk and achieve a better outcome. OBJECTIVE: To determine the relationship between the number of interventions and the operative morbidity, mortality and long-term survival in the surgery of bronchogenic carcinoma (BC). PATIENTS AND METHOD: Prospective, multicenter Spanish study was conducted in 19 departments of thoracic surgery on 2994 patients operated on consecutively with the aim of curing BC. The thoracic surgery departments have been classified into three groups, according to the number of interventions performed per year: I (1-43 cases/year; centers=7; n=565; 18.9%), II (44-54 cases/year; centers=6; n=1044; 34.9%) and III (55 or more cases/year; centers=6; n=1385; 46.3%). RESULTS: When the three groups were compared, the frequency of complete surgery was found to be 84% for group I, 76% for group II and 83% for group III (p=0.001, for comparisons between groups I/II and II/III). The pathological stages were identical in the three groups. The overall morbidity and the mortality in all patients or above the age of 75 or in pneumonectomies were not different among the groups. When considering all the patients with prognostic information (n=2758), no differences were found regarding the 5-year survival among the groups. When only patients in postoperative stage I-II and complete resection were evaluated, excluding operative mortality (n=1128), 5-year survival was 0.58 for group I, 0.57 for group II and 0.50 for group III (p=0.06 between groups II and III; p=0.08 between groups I and III). CONCLUSIONS: No significant differences that do not favor the hypothesis that there is increased surgical risk and worse survival in centers having a lower volume were found in this Spanish multicenter study.

Spontaneous pneumomediastinum long-term follow-up.

BACKGROUND: Spontaneous pneumomediastinum (SP) is a rare disorder. METHODS: The objective of this study is to examine a series of patients treated during 19 years, analyzing risk, clinical, and diagnostic factors as well as treatment and long-term follow-up. MATERIALS AND METHODS: A descriptive, retrospective study was done from 1984 to 2003 on 32 patients admitted to the hospital with SP. RESULTS: The average age was 21.4+/-6.1 years, 24 (75%) males. 34.4% had developed some strain before arriving at the hospital. Nine of the cases were asthmatic (28.1%) and another nine were smokers (28.1%). The most frequent complaint was thoracic pain, 25 (78.1%). In the physical examination, subcutaneous cervical emphysema was observed in 25 patients (78.1%). A simple X-ray of the thorax was used in the diagnosis of 32 cases. In two patients, radiological signs of pneumothorax were discovered. An esophagogram was done on two patients but there were no significant findings. All of the cases were treated conservatively. The average hospital stay was 3.2+/-1.6 days. No relapses were noted in the follow-ups. CONCLUSION: SP is an entity that evolves correctly without treatment and has no long-term relapses. Once other occasionally associated entities are ruled out, outpatient management can be employed.

Fascitis necrotizante / Necrotizing fascitis

Se realizó una revisión extractada sobre la fascitis necrotizante, infección grave y poco común de partes blandas, que progresa rápidamente y ocasiona necrosis del tejido subcutáneo. Se ha atribuido al estreptococo b hemolítico del grupo A o a sinergismo de gérmenes aerobios y anaerobios. Se planteó que la mortalidad por esta entidad es alta y el mejor modo de mejorar su pronóstico radica en el exhaustivo conocimiento de la misma; así como en el diagnóstico precoz y el tratamiento intensivo médico-quirúrgico. Se brindaron estadísticas provinciales e internacionales acerca de aspectos como incidencia y mortalidad