Lesión quística mediastínica de histología indeterminada / Mediastinal cystic lesion of unknown histology

Los quistes mediastínicos son malformaciones benignas de origen congénito que representan el 20% del total de lesiones primarias del mediastino. Se clasifican según el tipo celular de revestimiento epitelial que contienen. En un 20% de los casos, debido a procesos infecciosos y/o hemorrágicos, se produce una desestructuración del epitelio originario, y es enestos casos cuando los denominamos quistes de histología indeterminada o inespecífica. Aunque existe una amplia variedad, tanto en histología como en localización, cuando presentan clínica lo hacen de forma similar. El dolor torácico es el síntoma más frecuente seguido de la tos, la disnea y la disfagia. Presentamos el caso de un varón de 45 años de edad que consultó por un dolor centrotorácico intenso de aparición brusca. La tomografía axial computarizada (TAC) y la resonanciamagnética (RM) evidenciaron una gran lesión quística que ocupaba el mediastino posterior. La ecoendoscopiaesofágica descartó el origen esofágico de la lesión. Se intervino el paciente mediante toracotomía posterolateral derecha y se realizó la exéresis de la lesión. El curso postoperatorio transcurrió sin complicaciones. El diagnóstico histopatológicoconcluyó que se trataba de una lesión quística de histología indeterminada

Mediastinal cysts are uncommon congenital and benign malformations that represent 20% of all primary mediastinal lesions. They are classified by their specific histologic features. 20% of mediastinal cysts lack specific histologic features, possibly because of haemorrhage or infection, and are termed indeterminate or non-specific cysts. Despite varied location and histology, clinical presentation of mediastinal cysts is similar. Chest pain is the most common symptom followed by cough, dyspnoea and dysphagia. We report the case of a 45-year-old man who sought medical attention for acute chest pain. Computed tomography and magnetic resonance showed a large cystic lesion in the posterior mediastinum. Endoscopic ultrasound excluded a communication of the cyst with the oesophagus. The tumor was resected through a right thoracotomy. No postsurgical complications occurred. The histopathological diagnosis was cystic lesion of nonspecific histology2

Surgical sealant for preventing air leaks after pulmonary resections in patients with lung cancer.

BACKGROUND: Postoperative air leak is a frequent complication after pulmonary resection for lung cancer. It may cause serious complications, such as empyema, or prolong the need for chest tube and hospitalisation. Surgical sealants of different types have been developed to prevent or to reduce postoperative air leaks. A systematic review was therefore undertaken to evaluate the evidence on their effectiveness. OBJECTIVES: To evaluate the effectiveness of surgical sealants in preventing or in reducing postoperative air leaks after pulmonary resection for lung cancer. SEARCH STRATEGY: The electronic databases MEDLINE (1966 to 2004), EMBASE (1974 to 2004), Cancerlit (1993 to 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3/2004) and listed references were searched, and handsearching of conference proceedings was conducted to identify published and unpublished trials. SELECTION CRITERIA: Randomised controlled clinical trials were included in which standard closure techniques plus a sealant were compared with the same intervention with no use of any sealant in patients undergoing elective pulmonary resection provided that a large proportion of the patients included in the studies had undergone pulmonary resection for lung cancer. DATA COLLECTION AND ANALYSIS: Three reviewers independently selected the trials to be included in the review, assessed methodological quality of each trial and extracted data using a standardised form. Because of several limitations, narrative synthesis was used at this stage. MAIN RESULTS: Twelve trials, with 1097 patients in total, were included. In eight trials there was a statistically significant difference between treatment and control patients in reducing postoperative air leaks. However this reduction only proved a significant reduction of hospital stay in one trial. Only in one trial reduction of time of chest drain removal and reduction of percentage of patient with persistent air leak were significantly smaller in the treatment group. AUTHORS' CONCLUSIONS: Although surgical sealants seem to reduce postoperative air leaks, length of hospitalisation is not affected and infectious complications may be increased. Therefore, systematic use of surgical sealants in clinical practice cannot be recommended at the moment. More randomised controlled clinical trials are needed.

Tratamiento quirúrgico de la hiperhidrosis compensadora en el síndrome de Adie / Surgical treatment for compensatory hyperhidrosis in Adie syndrome

La tríada consistente en pupila tónica de Adie, arreflexia osteotendinosa e hipohidrosis segmentaria se conoce como síndrome de Ross. La hipohidrosis puede ir acompañada de un exceso de sudación en el hemicuerpo contralateral. Esta hiperhidrosis es probablemente debida a un mecanismo de compensación. En este artículo presentamos el caso de un paciente con síndrome de Ross cuyo motivo de consulta fue hiperhidrosis socialmente incapacitante en el hemicuerpo izquierdo. El paciente fue intervenido quirúrgicamente, realizándose una simpatectomía del segundo y tercer ganglios torácicos con resultados clínicamente satisfactorios. La simpatectomía torácica es un tratamiento definitivo de la hiperhidrosis, con unos resultados excelentes en la hiperhidrosis primaria y un muy bajo índice de morbilidad (AU)

[Surgical treatment for compensatory hyperhidrosis in Adie syndrome]. / Tratamiento quirúrgico de la hiperhidrosis compensadora en el síndrome de Adie.

Ross syndrome is characterized by a triad of tonic pupil, areflexia and segmental hypohidrosis. Hypohidrosis may be accompanied by contralateral hyperhidrosis, probably due to a compensatory mechanism. We report a case of Ross syndrome with socially disabling left-sided hyperhidrosis. Sympathectomy of the second and third thoracic ganglia was performed with satisfactory results. With excellent results in primary hyperhidrosis and very low morbidity, thoracic sympathectomy is the definitive treatment for hyperhidrosis.