Metástasis pulmonares aisladas de adenocarcinoma ductal de páncreas: una población con supervivencia prolongada / Isolated pulmonary metastases from pancreatic ductal adenocarcinoma: a population with prolonged survival

RESUMEN La incidencia de metástasis pulmonares aisladas en adenocarcinoma ductal de páncreas es aproximadamente del 13%. La resección de estas metástasis es infrecuente; sin embargo, los pacientes que se presentan únicamente con metástasis pulmonares tienen una mejor supervivencia comparadas con otras localizaciones. Presentamos el caso de una paciente a quien se le realizó una lobectomía pulmonar por metástasis de adenocarcinoma ductal de páncreas. Luego de la resección, el período libre de recurrencia y la supervivencia libre de enfermedad específica fueron de 84 y 152 meses, respectivamente. Consideramos que el siguiente paso en el tratamiento de esta subpoblación es poder seleccionar a los pacientes con una biología tumoral favorable y que una estrategia de tratamiento enérgica estaría justificada.

ABSTRACT The incidence of isolated pulmonary metastases in pancreatic ductal adenocarcinoma is about 13%. Resection of these metastases is uncommon; however, patients presenting only with pulmonary metastases have better survival compared to those with metastases on other locations. We report the case of a female patient who underwent lobectomy for metastases from pancreatic ductal adenocarcinoma. After resection, disease-free interval and specific diseases-free survival were 84 and 152 moths, respectively. We consider that the next step in the treatment of this subpopulation of patients is to select those patients with favorable tumor biology who would benefit from a more aggressive approach.

Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: Results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS).

INTRODUCTION: To analyze the predictors of pCR in NSCLC patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. METHODS: All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between 12/20/2016 and 3/20/2018 were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. RESULTS: Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR: 2.814, 95% CI: 1.015-7.806), histology of squamous carcinoma (OR: 3.065, 95% CI: 1.233-7.619) or other than adenocarcinoma (OR: 5.788, 95% CI: 1.878-17.733) and induction therapy that includes radiation therapy (OR: 4.096, 95% CI: 1.785-9.401) and targeted therapies (OR: 7.625, 95% CI: 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). CONCLUSIONS: Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications.

Factores predictores de respuesta completa patológica tras inducción (ypT0N0M0) en cáncer de pulmón no microcítico y resultados a corto plazo: resultados del Grupo Español de Cirugía Torácica Videoasistida (GE-VATS) / Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS)

Introducción Analizar los factores predictores de respuesta patológica completa (RCp) en pacientes con cáncer de pulmón no microcítico (CPNM) sometidos a resección pulmonar anatómica tras terapia de inducción y evaluar los resultados postoperatorios de estos pacientes. Métodos Se incluyeron en el estudio todos los pacientes registrados de forma prospectiva en la base de datos del grupo de trabajo GE-VATS reclutados entre el 20 de diciembre de 2106 y el 20 de marzo de 2018, sometidos a resección pulmonar anatómica por CPNM tras tratamiento de inducción. La población se dividió en dos grupos: pacientes que obtuvieron respuesta completa patológica tras inducción (RCp) y pacientes que no obtuvieron una respuesta patológica completa tras inducción (no-RCp). Se realizó un análisis multivariante mediante una regresión logística binaria para determinar los factores predictores de RCp y se analizaron los resultados postoperatorios de los pacientes. Resultados De los 241 pacientes analizados, 36 pacientes (14,9%) alcanzaron RCp. Los factores predictores de RCp fueron el sexo masculino (OR 2,814, IC 95% 1,015-7,806), la histología de carcinoma escamoso (OR 3,065, IC 95% 1,233-7,619) u otra distinta de adenocarcinoma (ADC) (OR 5788, IC 95% 1,878-17,733), la terapia de inducción que incluye radioterapia (OR 4,096, IC 95% 1,785-9,401) y terapias dirigidas (OR 7,625, IC 95% 2,147-27,077). La ocurrencia de complicaciones respiratorias postoperatorias fue superior en los pacientes que recibieron quimio-radioterapia de inducción (p = 0,032). Conclusiones El sexo masculino, la histología de carcinoma escamoso o diferente de ADC y la terapia de inducción que incluye radioterapia o terapia dirigida son factores predictores positivos para la obtención de RCp. La quimio-radioterapia de inducción se asocia con un mayor riesgo de complicaciones respiratorias postoperatorias (AU)

Introduction To analyze the predictors of pathological complete response (pCR) in not small cells lung carcinoma (NSCLC) patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. Methods All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between December 20th 2016, and March 20th 2018, were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. Results Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR 2.814, 95% CI 1.015-7.806), histology of squamous carcinoma (OR 3.065, 95% CI 1.233-7.619) or other than adenocarcinoma (ADC) (OR 5.788, 95% CI 1.878-17.733) and induction therapy that includes radiation therapy (OR 4.096, 95% CI 1.785-9.401) and targeted therapies (OR 7.625, 95% CI 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). Conclusions Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications (AU)

Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS). / Factores predictores de respuesta completa patológica tras inducción (ypT0N0M0) en cáncer de pulmón no microcítico y resultados a corto plazo: resultados del Grupo Español de Cirugía Torácica Videoasistida (GE-VATS).

INTRODUCTION: To analyze the predictors of pathological complete response (pCR) in not small cells lung carcinoma (NSCLC) patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. METHODS: All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between December 20th 2016, and March 20th 2018, were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. RESULTS: Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR 2.814, 95% CI 1.015-7.806), histology of squamous carcinoma (OR 3.065, 95% CI 1.233-7.619) or other than adenocarcinoma (ADC) (OR 5.788, 95% CI 1.878-17.733) and induction therapy that includes radiation therapy (OR 4.096, 95% CI 1.785-9.401) and targeted therapies (OR 7.625, 95% CI 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). CONCLUSIONS: Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications.

Lobectomía pulmonar: ¿Qué beneficios ofrece la videotoracoscopía? / Pulmonary Lobectomy. What are the Benefits of Video-assisted Thoracoscopy?

Introducción: A pesar del creciente uso de la lobectomía por videotoracoscopía, este abordaje resulta aún controvertido en algunos aspectos. El objetivo del presente trabajo es comparar los resultados quirúrgicos de la lobectomía pulmonar por videotoracoscopía y por toracotomía. Material y métodos: En el Hospital Universitario Fundación Favaloro, entre los años 2008 y 2017, fueron intervenidos quirúrgicamente 153 pacientes (n = 89 masculinos). Resultados: Se realizó lobectomía por videotoracoscopía a 39/89 pacientes. Los pacientes intervenidos por videotoracoscopía y con diagnóstico de cáncer de pulmón, tenían predominantemente tumores en estadío I (25/39 pacientes). La incidencia de complicaciones postoperatorias y mortalidad fueron similares en ambos grupos. En el grupo intervenido por videotoracoscopía la permanencia del drenaje pleural fue significativamente menor (4 versus 3 días, p = 0.004) y, también resultó más breve la estadía hospitalaria (6 versus 4 días de internación, p = 0.03). El número de estaciones ganglionares exploradas durante la cirugía fue mayor en los pacientes operados por toracotomía (4 versus 3.5 estaciones ganglionares, p < 0.001). Conclusión: La lobectomía por videotoracoscopía resultó al menos equivalente a la cirugía por toracotomía en términos de complicaciones postoperatorias. Los principales beneficios del abordaje por videotoracoscopía fueron una menor permanencia del drenaje pleural y menor estadía hospitalaria. Se recomienda tener especial cuidado con el muestreo ganglionar cuando la cirugía se realiza por videotoracoscopía.

Introduction: Despite the widespread adoption of video-assisted thoracoscopic lobectomy, this surgical approach still remains controversial. The objective of this paper is to compare the surgical results of video-assisted thoracoscopic lobectomy to open thoracotomy lobectomy, performed at the Hospital Universitario Fundación Favaloro between 2008 and 2017. Materials and Methods: One-hundred and fifty three patients (n = 89 males) had surgery during the study period; 39/153 had video-assisted thoracoscopic lobectomy. Results: Patients that had video-assisted thoracoscopic lobectomy were more likely to have stage I lung cancer (25/39). Postoperative complications and mortality rates were similar in both groups. Video-assisted thoracoscopic lobectomy patients had a shorter chest tube drainage time (4 vs. 3 days, p = 0.004) and length of hospital stay (6 vs. 4 days of stay, p = 0.03). The median number of lymph node stations sampled at surgery was significantly higher in the patients that had open thoracotomy lobectomy (4 vs. 3.5 lymph node stations, p < 0.001). Conclusion: Video-assisted thoracoscopic lobectomy is at least equivalent to open thoracotomy lobectomy in terms of postoperative complications and mortality. The main benefits of the video-assisted thoracoscopic approach are a shorter chest tube drainage time and length of hospital stay. Special attention should be taken at the time of nodal sampling when the surgery is performed by the video-assisted thoracoscopic approach.

Abdominal Apoplexy after Pulmonary Lobectomy for Lung Cancer / Apoplejía abdominal tras una lobectomía pulmonar por cáncer de pulmón

ABSTRACT Abdominal apoplexy is a rare clinical entity, and its clinical manifestations are diverse. This case report is of a 52-year-old man who developed right upper abdominal pain with unstable haemodynamics 32 hours after right upper pulmonary lobectomy for lung carcinoma. Abdominal computed tomography showed a ruptured right gastric artery aneurysm.

RESUMEN La apoplejía abdominal es una entidad clínica rara, y sus manifestaciones clínicas son diversas. Este es un reporte de caso de un hombre de 52 años que presentó dolor abdominal superior derecho con hemodinámica inestable, 32 horas después de una lobectomía pulmonar superior derecha por carcinoma del pulmón. La tomografía computarizada abdominal mostró una ruptura de aneurisma de la arteria gástrica derecha.

Dieulafoy's disease of the bronchial tree: a case report / Doença de Dieulafoy da árvore brônquica: relato de caso

ABSTRACT CONTEXT: Dieulafoy's disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION: Dieulafoy's disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy's disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.

RESUMO CONTEXTO: A doença de Dieulafoy da árvore brônquica é uma condição muito rara, poucos casos foram descritos na literatura. Pode ser assintomática ou manifestar-se com hemoptise maciça. Esta doença deve ser considerada em fumadores pesados quando eles têm recorrentes hemoptises maciças sem outros achados anormais. O tratamento pode ser tanto embolização arterial como intervenção cirúrgica. RELATO DE CASO: Uma menina de 16 anos foi admitida no Serviço de Urgências devido a hemoptise com uma lesão nos brônquios de origem desconhecida. Havia sofrido hemoptise maciça e insuficiência respiratória uma semana antes da admissão. A broncoscopia de fibra óptica relevou lesão no brônquio do lobo inferior direito, com suspeita de ser lesão de Dieulafoy. Foi realizada uma segmentectomia do lobo inferior direito com excisão da lesão. O resultado da paciente foi excelente. CONCLUSÃO: A doença de Dieulafoy é uma anomalia vascular rara, sendo extremamente rara na árvore brônquica. Na doença de Dieulafoy bronquial, embolização seletiva tem sido sugerida como método para cessação do sangramento; no entanto, a habitual resseção anatômica do pulmão é uma alternativa segura e curativa.

Aspectos táticos e técnicos observados nas ressecções pulmonares anatômicas por videotoracoscopia / Tactical and technical aspects observed in thoracoscopic anatomical pulmonary resections

Introdução: A cirurgia torácica caminha para realização de procedimentos menos invasivos e mórbidos, com objetivo de poupar parênquima pulmonar. Dados da literatura sugerem que a lobectomia por VATS (videoassisted thoracic surgery) apresenta menos complicações que a cirurgia aberta. Objetivo: Analisar os aspectos táticos e técnicos relacionados a diferentes tipos de ressecção pulmonar anatômica, realizadas por videotoracoscopia. Métodos: Estudo de caso de 26 pacientes operados pela equipe de cirurgia de tórax do Hospital Luxemburgo (Instituto Mário Penna), Hospital Mater Dei em Belo Horizonte. Resultados: A taxa de conversão para operação convencional foi de 15,38%, tendo por complicação pós-operatória dois casos de pneumonia nosocomial e nenhum óbito. Conclusão: A VATS tende a se tornar um procedimento cada vez mais comum na condução de afecções do tórax, todavia, devese sempre ter disponível material para toracotomia, já que a conversão é uma opção para solucionar intercorrência. (AU)

Introduction: Thoracic surgery walks to perform less invasive, morbid and goal of saving lung parenchyma procedures. Published data suggest that VATS (video-assisted thoracic surgery) lobectomy for has fewer complications than open surgery. Objectives: To analyze the tactical and technical aspects related to different types of anatomical lung resection performed by thoracoscopy. Methods: A case study in 26 patients operated by the team of thoracic surgery at the Hospital Luxemburgo (Instituto Mário Penna), Hospital Mater Dei and in Belo Horizonte. Results: The conversion rate for conventional surgery was 15.38%, two cases of pneumonia and no deaths due to postoperative complications. Conclusion: VATS tends to become an increasingly common procedure in the management of chest affections, however thoracotomy material must always be available, since conversion is an option to resolve intercurrence. (AU)

[Thoracoscopic lobectomy for the treatment of tracheal bronchus. A pediatric case report]. / Lobectomía toracoscópica para el tratamiento del bronquio traqueal. Reporte de un caso pediátrico.

BACKGROUND: Tracheal bronchus is considered a rare, congenital anomaly, which implies the abnormal origin of a bronchus. When related to repetitive infections the bronchus must be resected, usually via an open procedure. OBJECTIVE: The aim of this paper is to present the case of a patient with tracheal bronchus of the upper right lobe who presented with repetitive pneumonias. Additionally, this text intends to expose the methodology for its diagnosis and surgical resolution through a thoracoscopic lobectomy. CLINICAL CASE: One year old female patient who presented with the disorder at two months of age. The patient presented with constant coughing and persistent fever alongside repetitive pneumonias in the upper right lobe. In order to discard the possibility of gastroesophageal reflux, a bronchoscopy and a panendoscopy of the digestive tube were conducted. The aforesaid procedure demonstrated the existence of a tracheal bronchus located in the right lobe, with functional bronchial segmentation. With these findings and due to the presence of repetitive infections, an apical right lobectomy was performed through a thoracoscopy, with favourable results. CONCLUSIONS: Tracheal bronchus is a rare anomaly that on many occasions is asymptomatic; nonetheless, when related to repetitive infections, a lobectomy must be carried out to avoid further pulmonary damage. This can be done through a thoracoscopy, as was the case with our patient. When treating these patients, it is worth considering they tend to have a different anatomy and to consider the ease at which they can sustain severe inflammation due to repetitive infections.

Secuestro pulmonar intralobar: hallazgo en el intraoperatorio / lntralobar pulmonary sequestration: an intraoperative finding

Reportamos un caso de secuestro pulmonar intralobar ubicado en el lóbulo inferior del pulmón izquierdo en una paciente de sexo femenino de 3 años de edad, diagnosticado en el intraoperatorio. El secuestro pulmonar es una malformación pulmonar congénita muy rara, caracterizada por una masa de tejido pulmonar no funcionante,que recibe irrigación anómala de una arteria sistémica, generalmente, procedente de la aorta descendente; su variedad intralobar usualmente se manifiesta con neumonías recurrentes. El diagnóstico definitivo es hecho al identificar la arteria anómala hacia el pulmón mediante estudios por imágenes (TEM con contraste y ecografía Doppler).No hay estudios de su incidencia a nivel nacional. El presente caso es el primero reportado en la ciudad de Huacho, Perú

The case of a 3 year-old female patient, who was intraoperative diagnosed with intralobar pulmonary sequestration located in the lower lobe of the left lung, is reported. Pulmonary sequestration is a rarecongenital pulmonary malformation characterized by a non-functionalmass of lung tissue, which is irrigatedby an abnormalsystemic artery, general!y originated in the descending aorta;its intralobar variety manifests as recurrent pneumonia. Definitive diagnosis is made after identifying the abnormal artery with imaging techniques (MSCT with contrast and Doppler echocardiography). There is no national incidence study on this condition. The following case is the first pulmonary sequestration case reported in the city of Huacho, Perú

Lobectomía videotoracoscópica en el tratamiento del cáncer de pulmón / Video-thoracoscopic lobectomy in treatment of lung cancer

Introducción: el acceso videotoracoscópico, para la resección del cáncer de pulmón, constituye una alternativa a la cirugía abierta en los estadios I y II de la enfermedad. Objetivo: valorar la aplicación de esta técnica en nuestro medio, y para ello se estudiaron las variables: localización del tumor, tiempo quirúrgico, la conversión a cirugía abierta, sangrado, tipo de resección, tamaño de la incisión, estadía hospitalaria, morbilidad y mortalidad. Métodos: se realizó un estudio descriptivo de los pacientes con carcinoma de pulmón atendidos en el hospital "Hermanos Ameijeiras" en el período comprendido entre octubre de 2009 y marzo de 2010, y entre enero-febrero de 2011, en el que se analizaron 5 pacientes que tenían tumores malignos de 5 cm o menos, de localización periférica, pero sin infiltración de la pared torácica, que no tuvieron enfermedad mediastinal o del hilio pulmonar, y sin cirugía previa del hemitórax afectado. Los resultados se presentaron en por cientos. Resultados: a 4 se les realizó una lobectomía pulmonar y a 1 una bilobectomía media e inferior. El tiempo quirúrgico varió de 210 a 420 min, con mediana de 330. No hubo conversión ni accidente quirúrgico. El tamaño de la incisión varió de 2,5 a 3,8 cm, con una mediana de 3,5. Un paciente con adenocarcinoma bronquioloalveolar y ganglios mediastinales positivos falleció a los 4 meses por enfermedad metastásica. Conclusiones: la resección pulmonar videotoracoscópica, por cáncer de pulmón, es factible y de gran beneficio inmediato para el enfermo en nuestro medio

Introduction: the video-thoracoscopic access to resection of lung cancer is an alternative for the open surgery for a disease in I and II stages. Objective: to value the implementation of this technique in our environment and thus, authors studied the following variables: tumor location, surgical time, open surgery conversion, bleeding, type of resection, incision size, hospital stay, morbility and mortality. Methods: a descriptive study was conducted in patients presenting with lung carcinoma, seen in the "Hermanos Ameijeiras" Clinical Surgical Hospital from October, 2009 to March, 2010 and from January-February, 2011 to analyze the situation of 5 patients with 5 cm or less malignant tumors of peripheral location but without infiltration of the thoracic wall, mediastinal or hilum-pulmonary disease and also without a previous surgery of the involved hemithorax. Results: four patients underwent a pulmonary lobectomy and another one a middle and inferior bi-lobectomy. The surgical time fluctuates between 210 and 420 min, with a mean of 330. There was neither conversion nor surgical accident. The incision size varied from 2.5 to 3.8 cm with a mean of 3.5. A patient with bronchoalveolar adenocarcinoma and positive mediastinal ganglia deceased at 4 months due metastatic disease. Conclusions: the video-thoracoscopic pulmonary resection from pulmonary cancer is feasible and of a immediate benefit for the patient in our environment

Lobectomía videotoracoscópica en el tratamiento del cáncer de pulmón / Video-thoracoscopic lobectomy in treatment of lung cancer

Introducción: el acceso videotoracoscópico, para la resección del cáncer de pulmón, constituye una alternativa a la cirugía abierta en los estadios I y II de la enfermedad. Objetivo: valorar la aplicación de esta técnica en nuestro medio, y para ello se estudiaron las variables: localización del tumor, tiempo quirúrgico, la conversión a cirugía abierta, sangrado, tipo de resección, tamaño de la incisión, estadía hospitalaria, morbilidad y mortalidad. Métodos: se realizó un estudio descriptivo de los pacientes con carcinoma de pulmón atendidos en el hospital "Hermanos Ameijeiras" en el período comprendido entre octubre de 2009 y marzo de 2010, y entre enero-febrero de 2011, en el que se analizaron 5 pacientes que tenían tumores malignos de 5 cm o menos, de localización periférica, pero sin infiltración de la pared torácica, que no tuvieron enfermedad mediastinal o del hilio pulmonar, y sin cirugía previa del hemitórax afectado. Los resultados se presentaron en por cientos. Resultados: a 4 se les realizó una lobectomía pulmonar y a 1 una bilobectomía media e inferior. El tiempo quirúrgico varió de 210 a 420 min, con mediana de 330. No hubo conversión ni accidente quirúrgico. El tamaño de la incisión varió de 2,5 a 3,8 cm, con una mediana de 3,5. Un paciente con adenocarcinoma bronquioloalveolar y ganglios mediastinales positivos falleció a los 4 meses por enfermedad metastásica. Conclusiones: la resección pulmonar videotoracoscópica, por cáncer de pulmón, es factible y de gran beneficio inmediato para el enfermo en nuestro medio(AU)

Introduction: the video-thoracoscopic access to resection of lung cancer is an alternative for the open surgery for a disease in I and II stages. Objective: to value the implementation of this technique in our environment and thus, authors studied the following variables: tumor location, surgical time, open surgery conversion, bleeding, type of resection, incision size, hospital stay, morbility and mortality. Methods: a descriptive study was conducted in patients presenting with lung carcinoma, seen in the "Hermanos Ameijeiras" Clinical Surgical Hospital from October, 2009 to March, 2010 and from January-February, 2011 to analyze the situation of 5 patients with 5 cm or less malignant tumors of peripheral location but without infiltration of the thoracic wall, mediastinal or hilum-pulmonary disease and also without a previous surgery of the involved hemithorax. Results: four patients underwent a pulmonary lobectomy and another one a middle and inferior bi-lobectomy. The surgical time fluctuates between 210 and 420 min, with a mean of 330. There was neither conversion nor surgical accident. The incision size varied from 2.5 to 3.8 cm with a mean of 3.5. A patient with bronchoalveolar adenocarcinoma and positive mediastinal ganglia deceased at 4 months due metastatic disease. Conclusions: the video-thoracoscopic pulmonary resection from pulmonary cancer is feasible and of a immediate benefit for the patient in our environment(AU)

Conducta anestésica en un lactante con enfisema lobar congénito / Behavior of anesthesia in an infant with congenital lobar emphysema

Se presenta el caso clínico de un lactante con enfisema lobar congénito, tratado en el Hospital Infantil Sur de Santiago de Cuba con antecedentes de cuadros respiratorios recurrentes y varias hospitalizaciones previas. Inicialmente ingresó con bronconeumonía y disnea, por lo que se sospechó la presencia de un neumotórax, pero mediante estudios radiológicos se obtuvo el diagnóstico definitivo y se decidió aplicarle tratamiento quirúrgico. En el período intraoperatorio tuvo una complicación cardiovascular (bradicardia extrema), que fue tratada con las medidas adecuadas (oxígeno a 100 %, masaje cardíaco directo y sulfato de atropina), las cuales permitieron una evolución posoperatoria satisfactoria en la Unidad de Cuidados Intensivos Pediátricos.

The case of an infant with congenital lobar emphysema is reported, who was treated in the Southern Children Hospital of Santiago de Cuba with history of recurrent respiratory symptoms and several previous hospitalizations. Initially he was admitted with bronchopneumonia and dyspnea, and the presence of pneumothorax was suspected, but a definitive diagnosis was obtained by radiological studies and surgical treatment was decided. In the intraoperative period he had a cardiovascular complication (extreme bradycardia), which was treated with appropriate measures (100 % oxygen, direct heart massage and atropine sulfate), which allowed a satisfactory postoperative course in the Pediatric Intensive Care Unit.

Conducta anestésica en un lactante con enfisema lobar congénito / Behavior of anesthesia in an infant with congenital lobar emphysema

Se presenta el caso clínico de un lactante con enfisema lobar congénito, tratado en el Hospital Infantil Sur de Santiago de Cuba con antecedentes de cuadros respiratorios recurrentes y varias hospitalizaciones previas. Inicialmente ingresó con bronconeumonía y disnea, por lo que se sospechó la presencia de un neumotórax, pero mediante estudios radiológicos se obtuvo el diagnóstico definitivo y se decidió aplicarle tratamiento quirúrgico. En el período intraoperatorio tuvo una complicación cardiovascular (bradicardia extrema), que fue tratada con las medidas adecuadas (oxígeno a 100 porciento, masaje cardíaco directo y sulfato de atropina), las cuales permitieron una evolución posoperatoria satisfactoria en la Unidad de Cuidados Intensivos Pediátricos(AU)

The case of an infant with congenital lobar emphysema is reported, who was treated in the Southern Children Hospital of Santiago de Cuba with history of recurrent respiratory symptoms and several previous hospitalizations. Initially he was admitted with bronchopneumonia and dyspnea, and the presence of pneumothorax was suspected, but a definitive diagnosis was obtained by radiological studies and surgical treatment was decided. In the intraoperative period he had a cardiovascular complication (extreme bradycardia), which was treated with appropriate measures (100 percent oxygen, direct heart massage and atropine sulfate), which allowed a satisfactory postoperative course in the Pediatric Intensive Care Unit(AU)