Metástasis miocárdica de un carcinoma epidermoide de cérvix en una mujer con trasplante renal / Myocardium metastases from an epidermoid carcinoma of the cervix in a woman with renal transplant

Propósito: La afectación metastásica cardíaca del carcinoma epidermoide de cérvix es muy rara; cuando se presenta suele ser en casos con diseminación generalizada, descubierta en la autopsia. Hay muy pocos casos descritos de metástasis cardíaca secundaria a un carcinoma escamoso de cervix, diagnosticada "in vivo" sin que exista recidiva local o evidencia de enfermedad a distancia y ningún caso descrito en mujer inmunocomprometida. Material y método: Presentamos el caso de una paciente de 54 años portadora de un trasplante renal, sometida a terapia inmunosupresora, que recibió tratamiento exitoso para un cáncer escamoso de cérvix, estadio IIB, a la que se diagnosticó una metástasos cardíaca de gran agresividad. Se describen los hallazgos histopatológicos y revisa la bibliografía existente. Conclusiones: El curso de las enfermedades tumorales en pacientes trasplantados es más agresivo que el esperado en los no transplantados, siendo muy importante intensificar el seguimiento de los supervivientes sometidos a tratamiento inmunosupresor para detectar los tumores malignos tan pronto como sea posible (AU)

[Valve repair in tricuspid endocarditis in the drug addict. Apropos a case]. / Reparación valvular en la endocarditis tricúspide del drogadicto. A propósito de un caso.

Valve replacement, valvulectomy and valve repair are the alternatives for the surgical treatment of intractable tricuspid valve endocarditis. We present the case of a 24-year-old, HIV-positive Caucasian female, intravenous drug addict, with intractable tricuspid valve endocarditis, that was successfully treated with tricuspid valve repair. Advantages and major drawbacks of the different techniques are discussed and the appropriate literature is reviewed.

[Biphasic graft preservation for lung transplantation]. / Preservación bifásica del injerto en el trasplante pulmonar.

The standard, most widely applied way of preserving a lung for transplantation is infusion through the pulmonary artery (PA) of a pulmonaryplegic solution. In this prospective study, we analyzed the initial function of the pulmonary and cardiac graft after biphasic infusion of a solution introduced retrograde through the left auricle and antegrade through the PA. Twenty-six heart and lung grafts (9 unilateral and 17 bilateral) were preserved by cardioplegia and pulmonaryplegia (biphasic) between January 1996 and March 1997. Indicators of graft viability recorded were the ratio of arterial oxygen pressure (PaO2) to inspired fraction (FiO2), mean systemic pressure (MSP), mean pulmonary artery pressure (MPAP) cardiac output, pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). The variables were recorded upon arrival of the grafts in the intensive care unit and in the first 24 h. Morbidity and mortality after heart transplants were recorded throughout a follow-up period of one month. After transplantation, most patients had a oxygenation coefficient (PaO2/FiO2) greater than 252 mmHg in the first 48 h. Hemodynamic parameters were also kept within normal ranges immediately after surgery and 24 h later. Mean ischemic time was 245 min for unilateral transplants, 215 for the first lung in double lung transplants, and 300 min for the second lung. In the early postoperative period, 3 patients suffered lung graft dysfunction, which was treated satisfactorily with nitric oxide (NO). No heart transplant patient suffered primary heart failure or left ventricular dilatation. We conclude that biphasic pulmonary preservation achieves satisfactory initial functional viability of the graft. Heart grafts removed simultaneously functioned successfully in the transplanted patient without additional pharmacological or mechanical support.

[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.