[Surgical treatment of hypertrophic myocardiopathy using a video-assisted technique. Apropos of a case]. / Tratamiento quirúrgico de la miocardiopatía hipertrófica mediante técnica vídeo-asistida. A propósito de un caso.

The use of endoscopic technology is gaining more and more popularity within cardiac surgery. We present a case employing endoscopic instruments in the resection of the interventricular septum in a patient with hypertrophic cardiomyopathy unresponsive to medical treatment. Advantages of this technique are discussed.

[Thoracic reconstruction with polytetrafluoroethylene prosthesis]. / Reconstrucción torácica con prótesis de politetrafluoroetileno.

Thoracic wall resections are performed to treat a wide variety of conditions. Reconstruction techniques have varied considerably since the introduction of synthetic prosthesis, the most recent of which are made of polytetrafluoroethylene (PTFE, or Gore-Tex). We describe our department's experience with PTFE prosthesis. PTFE was used in 21 patients treated for various diseases. Thirteen reconstructions were of the thoracic wall, 4 were of the diaphragm and 4 of the pericardium. Three of the 13 thoracic wall reconstructions involved bilateral myoplasty of the pectoralis major, 2 involved omentoplasty and 1 required use of a wide musculocutaneous flap. Complications included pneumonia in 2 cases and 1 seroma with chronic cutaneous fistula that required removal of the prosthesis after 9 months. Two patients died, 1 after 19 days and the other after 9 months, both as a result of causes unrelated to reconstruction. Follow-up of these patients ranged from 3 to 54 months. We recommend the prosthetic use of PTFE for thoracic wall reconstruction, along with plasty or musculocutaneous flaps when necessary.

[Surgical treatment of sternoclavicular osteomyelitis]. / Tratamiento quirúrgico de la osteomielitis esternoclavicular.

Osteomyelitis of the sternocosto-clavicular (SCC) articulation is a rare infection usually caused by Staphylococcus aureus and enterobacteria. It usually occurs in individuals with osteoarticular disease or predisposing factors. Prolonged antibiotic treatment and articular puncture are generally accepted. Authors do not agree on an established protocol. We report three cases of SCC septic arthritis in two previously healthy patients with two foci of infection (one perianal abscess and one dental extraction) and in one adult patient with Still's disease. Pain and intense inflammation was referred to the shoulder, with scarce leukocytosis and fever reaching 38 degrees C. The germs responsible were S. aureus, Bacteroides fragilis and B. oralis. Two of the patients had local, regional abscesses. Long-term antibiotic treatment failed in all cases and surgery for SCC resection and myoplasty of the pectoralis major muscle was required. Recovery was good and shoulder and arm mobility was excellent. We propose medical treatment and articular diagnostic-therapeutic puncture as the first line of therapy for this disease. When evolution is poor or when complications appear, such as abscesses or mediastinitis, we conclude that radical debridement and myoplasty of the pectoralis major muscle are indicated.