Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada / Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis

Background: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. Aim: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. Material and Methods: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Results: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Conclusions: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

[Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis]. / Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada.

BACKGROUND: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. AIM: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. MATERIAL AND METHODS: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. RESULTS: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. CONCLUSIONS: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

Single site venovenous extracorporeal membrane oxygenation as an alternative to invasive ventilation in post-pneumonectomy fistula with acute respiratory failure.

We report the use of venovenous extracorporeal membrane oxygenation with a single dual lumen cannula in a 42-year-old patient suffering from a post-pneumonectomy fistula and severe respiratory insufficiency, avoiding the classical approach of invasive mechanical ventilation. We discussed the potential advantages of extracorporeal oxygenation as the main support in this particular clinical setting.

Transient diaphragmatic paralysis by continuous para-phrenic infusion of bupivacaine: a novel technique for the management of residual spaces.

Space problems are a common complication after thoracic surgery. Different procedures have been used to manage them. We describe a novel technique using transient diaphragmatic paralysis by continuous para-phrenic infusion of bupivacaine.

[Atypical presentation of a colorectal carcinoma]. / Cáncer colorrectal de presentación atípica.

We report a 67 years old male with a history of pulmonary tuberculosis at the age of 15, that consults for malaise, weight loss and productive cough. Chest X ray examination showed a left pleural effusion. A pleural tap obtained a sterile exudate. A thorax CAT scan showed a proliferating mass in the splenic angle of the colon, with left lung and diaphragmatic invasion. Endoscopic biopsies confirmed the diagnosis of adenocarcinoma. The patient underwent a subtotal colectomy with partial excision of diaphragm and left lung. The pathological report showed a mucosecretory adenocarcinoma, infiltrating the pericolonic adipose tissue without adjacent organ infiltration and a chronic inflammatory process involving colonic serosa, diaphragm pleura, and lung. Adjuvant chemotherapy was indicated and the patient is asymptomatic and without evidences of tumor recurrence after a 24 months follow up.

Analgesia after thoracotomy: epidural fentanyl/bupivacaine compared with intercostal nerve block plus intravenous morphine.

OBJECTIVES: Intercostal nerve blockade plus intravenous (IV) patient-controlled analgesia (PCA) could be an easier and safer alternative to epidural analgesia for postthoracotomy pain, but information about the efficacy of this technique is scarce. The objective of this randomized study was to compare the quality of analgesia and lung function in 2 groups of patients undergoing pulmonary surgery through a posterolateral thoracotomy. METHODS: Two groups were studied: G1 (n = 16) patients received a 5-segment intercostal block plus IV PCA morphine, and G2 (n = 15) patients received a bupivacaine and fentanyl PCA infusion through a thoracic epidural catheter. Resting and dynamic visual analog pain scale (VAS) measurements, forced vital capacity, and forced expiratory volume in 1 second were measured basally, on arrival in the recovery room, then hourly up to 4 hours and then 12, 24 and 48 hours later. Results were analyzed with a 2-way analysis of variance, chi-square, or Fisher exact test. A p value < or =0.05 was considered significant. RESULTS: Resting and dynamic VAS scores were slightly lower in G2 patients, although only resting scores were significant. After the first hour, mean scores were below 4 in both groups. No significant difference was observed between groups in relation to respiratory parameters or side effects. CONCLUSION: The fact that the difference in pain scores is probably not clinically significant shows that an intercostal block with bupivacaine plus IV morphine PCA is a good alternative for postthoracotomy pain management.

[Mechanical ventilation to treat acute respiratory distress syndrome secondary to descending necrotizing mediastinitis. Role of dynamic axial computed tomography of the lung]. / Ventilación diferencial en el manejo del síndrome de distress respiratorio agudo secundario a mediastinitis necrotizante descendente. Rol de la tomografía axial computarizada dinámica de pulmón.

Lung computed tomography (CT) is being used increasingly to assess lung morphology in patients on mechanical ventilation. Lung CT under known levels of airway pressure (dynamic CT) can also assess the response of lung parenchyma to ventilatory therapy. We report a patient with acute respiratory distress syndrome secondary to descending necrotizing mediastinitis, in whom lung dynamic CT oriented ventilatory management. Independent lung ventilation improved gas exchange and helped patient recovery.

Tumores primarios retroperitoneales de origen mesenquimático / Retroperitoneal primary tumors of mesenchimatical origin

Se presentan 30 casos de tumores primarios retroperitoneales de origen mesenquimático, en un período de 11 años, correspondiendo 17 al sexo femenino y 13 al masculino. Los síntomas y signos tuvieron un promedio de 10,8 meses desde su inicio hasta el momento del diagnóstico. Fueron 21 tumores malignos y 9 benignos, siendo los liposarcomas y neurilemomas los más frecuentes respectivamente. Todos fueron intervenidos quirúrgicamente realizándose extirpación completa en 21, parcial en 4 y sólo biopsia en 5. Se analizan las intervenciones agregadas y sus resultados en cuanto a mortalidad intraoperatoria y global. Se presentan los tratamientos coadyudantes como quimioterapia y radioterapia, mostrando los esquemas usados en cada uno de ellos

Esófago de Barret / Barret's esophagus

Se presentan 56 pacientes portadores de esófago de Barret en el período comprendido entre 1978 y 1983. El grupo es analizado desde el punto de vista clínico, endoscópico, radiológico y manométrico. Se cataloga la severidad de la sintomatología de acuerdo con una tabla de puntaje. Fueron intervenidos 41 pacientes, siendo la cirugía antirreflujo la que se le practicó a este grupo de pacientes. En el 75% de ellos, se hizo V.P.G. + calibración cardial + gastropexia posterior y cierre de pilares diafragmáticos. La evolución postoperatoria demuestra importante mejoría manométrica sin regresión del ascenso mucoso. Se hace un comentario de acuerdo con la opinión de otros autores comenzando en la literatura mundial