[Intraoperative diagnosis of a mediastinal paraganglioma: Anesthetic management]. / Diagnóstico intraoperatorio de un paraganglioma mediastínico: manejo anestésico.

A 45-year-old woman with a posterior mediastinal tumor underwent right thoracotomy for resection, developing hypertension and difficult-to-control tachycardia while the tumor was being manipulated. A catecholamine-secreting tumor was suspected, the operation halted, and the patient prepared for surgery at a later time. The tumor was a mediastinal paraganglioma and the final outcome was satisfactory. Risk related to anesthesia is high in such patients, with perioperative mortality ranging from 40 to 85%. Correct diagnosis and appropriate preoperative drug preparation with adrenergic receptor blockers appreciably decreases morbidity and mortality related to surgery. We discuss the effect of labetalol on such tumors and describe our observations.

[Surgery of lung metastasis: results of a hospital survey in the Autonomous Community of Madrid. Working Group on Surgery of Lung Metastasis (GT-CMP)]. / Cirugía en las metástasis pulmonares: resultados de una encuesta hospitalaria en la Comunidad Autónoma de Madrid. Grupo de Trabajo sobre Cirugía en las Metástasis Pulmonares (GT-CMP).

The Task Force on Pulmonary Metastasis Surgery of the Oncology Department of the Madrid Pneumology and Chest Surgery Society designed a questionnaire to determine guidelines for surgery to resect lung metastases in the Autonomous Community of Madrid, an area with over four million inhabitants. The questionnaire was divided into five sections: indications, diagnostic procedures, extension studies, disciplinary foci and surgical techniques. Ten of the hospitals surveyed answered the questionnaire. We found that disagreement is high regarding patient screening, and that there are differences regarding some preoperative procedures and extension studies, as well as in therapeutic approach. Eighty percent of the respondents were not in favor of using video assisted thoracoscopy as a therapeutic technique, and disagreement was greater regarding approaches technique, and disagreement was greater, regarding approaches to bilateral metastases. We infer that between 100 and 120 cases are treated surgically every year. Procedures to join The International Lung Metastases Registry have started.

[Severe hypoglycemia secondary to a fibrous pleural tumor]. / Hipoglucemias severas secundarias a tumor fibroso pleural.

A case with recurrent hypoglycemias following a thoracic tumor is presented. Neurologic symptoms due to hypoglycemia were dominant. Subcutaneous somatostatin was administrated preoperatively and hypoglycemia was controlled following tumor resection. Histology analysis shows a localized fibrous pleural tumor. Origin has been widely questioned but now it is accepted to be mesenchymal and not mesothelial. Lung disease owing to chronic compression of the tumor made necessary a lobectomy. Postoperative atelectasis required reoperation and a pneumonectomy was performed. To date insulin-like factors secreted by the tumor are supposed to be responsible for hypoglycemics discharges.

[Malignant pleural effusions: a description of an alternative method of external drainage with a fine-caliber catheter]. / Derrames pleurales malignos: descripción de un método alternativo de drenaje externo con catéter fino.

We describe the results of treating symptomatic pleural effusion by implanting a Pleurocath-type small-caliber catheter connected to a three-way valve for external evacuation. The method was used in 6 patients with advanced neoplastic disease and dyspnea related to pleural effusion that could not be treated with the usual methods of pleurodesis. Dyspnea disappeared or was significantly relieved in 5 of the 6 patients, such that follow-up could be continued on an outpatient basis for 3. Catheters remained in position for periods of time ranging from 14 days to 10 months. Survival varied from 14 days to 14 months. The only important complication was one case of infection in the area of catheter insertion. We describe the extremely simple technique used and the results that have encouraged us to continue using the method in cases that meet the necessary conditions.

[Necrotizing descendent mediastinitis of oropharyngeal origin]. / Mediastinitis descendente necrosante de origen orofaríngeo.

The spread of oropharyngeal infections to the mediastinum can give rise to descending necrotizing mediastinitis (DNM), which causes a high rate of mortality (around 40%), particularly when diagnosis is late and drainage inadequate. In the first case we report, successful drainage of the mediastinum was achieved at the cervical and sub-xiphisternum levels and by thoracotomy. Given the condition of the second patient, transcervical drainage alone was considered the best option, but this treatment was inadequate. Rapid start of appropriate drainage of the mediastinum is of great importance. Cervical drains, which may be adequate when there is perforation of the cervical esophagus, is insufficient in DNM, which calls for more aggressive, early drainage, such as can be achieved by thoracotomy. Computerized axial tomography of the chest is essential for rapid diagnosis, to plan the most appropriate surgical approach and for follow-up and evaluation of drainage.

[Localized fibrous tumor in the parenchyma. Report of 2 cases, one of them multiple and bilateral]. / Tumor fibroso localizado intraparenquimatoso. A propósito de dos casos, uno de ellos múltiple y bilateral.

Localized fibrous tumor is an uncommon neoplasm that is usually located in the visceral pleura. Histologically these tumors are composed of randomly arranged fascicles or networks of fusiform cells, among which there is a varying amount of collagen. Most authors consider that these cells originate in submesothelial mesenchymal cells. The condition is normally silent, though hypoglycemia, hypertrophic osteoarthropathy or other symptoms sometimes result. The treatment of choice is total resection and imaging techniques are extremely helpful for establishing surgical strategy, even though surgery is often performed before a histopathologic diagnosis is available. We present 2 patients with intrapulmonary fibromas that were histologically identical to localized fibrous pleural tumors. These tumors are rarely found in the parenchyma and multiple bilateral presentation is exceptional, having been described only once in the literature. One of our patients had a single pulmonary node that happened to be noticed on an X-ray. The other had multiple bilateral nodes that required several surgical procedures; the intraparenchymatous location for this type of tumor has not been described to date. We discuss clinical, therapeutic and histopathological aspects of these tumors and review the literature.