RESUMEN
Traumatic pulmonary pseudocyst is a very rare consequence of blunt chest trauma characterized by formation of cystic like parenchymal lesions. Generally multiple and bilateral distribution is more rare than a single localization. The computed tomography (CT) scan has an higher diagnostic value compared with conventional chest X-ray. Prognosis of traumatic pseudocysts is generally good with benign clinical course and spontaneous resolution within several months. However initial strictly patient follow-up is necessary to early discover and treat potentially severe complications. Utility of chest magnetic resonance imaging (MRI) to exclude potentially severe infectious complications is described. Any complications required percutaneous drainage or surgical resection.
Asunto(s)
Quistes/etiología , Lesión Pulmonar/complicaciones , Heridas no Penetrantes , Accidentes de Tránsito , Adulto , Quistes/diagnóstico por imagen , Quistes/terapia , Drenaje , Humanos , Lesión Pulmonar/diagnóstico por imagen , Lesión Pulmonar/etiología , Lesión Pulmonar/terapia , Imagen por Resonancia Magnética , Masculino , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Heridas no Penetrantes/complicacionesRESUMEN
The Authors reported the cases of posttraumatic pneumomediastinum came to their observation over the past 8 years. The etiology, pathophysiology, diagnosis, treatment and blunt injures eventually associated are discussed. Conclude that in the absence of associated injuries the treatment and the course of post-traumatic pneumomediastinum are the same that spontaneous pneumomediastinum.
Asunto(s)
Enfisema Mediastínico , Traumatismos Torácicos , Heridas no Penetrantes , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Drenaje/métodos , Femenino , Humanos , Masculino , Enfisema Mediastínico/diagnóstico , Enfisema Mediastínico/etiología , Enfisema Mediastínico/fisiopatología , Enfisema Mediastínico/terapia , Persona de Mediana Edad , Estudios Retrospectivos , Traumatismos Torácicos/complicaciones , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/fisiopatología , Traumatismos Torácicos/terapia , Resultado del Tratamiento , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/fisiopatología , Heridas no Penetrantes/terapiaRESUMEN
BACKGROUND: Isolated sternal fractures occur more and more frequently in traffic road accidents in particular after the introduction of the seat-belt law. This study sets out to assess by laboratory parameters the incidence and consequences of pericardial and myocardial involvement in sternal injury. PATIENTS AND METHODS: Between June 1997 and March 2007, 50 consecutive patients were admitted to our Thoracic Surgical Unit with acute traumatic sternal fractures. X-ray, CT scan, standard 12-lead electrocardiogram (ECG) and echocardiographic evaluation were obtained in all patients. (28 males, 22 females), with displaced and undisplaced fractures. The patients were hospitalised for cardiorespiratory monitoring, pain control and physiotherapy. Oxygen implementation was performed to obtain an arterial saturation above 96%. Supplementary investigations or therapeutic interventions were assessed if clinically indicated. RESULTS: Our data, according to literature, show that sternal trauma must be careful evaluated by monitoring of vital parameters. In our collection we have no mortality with complex comorbidity. The interparametric relation between laboratory values and cardiac involvement was not significant anyway . The prolonged CK-MB peak level in a large number of patients is related with cardiac impairment. CONCLUSIONS: Our results suggest that in traumatic sternal fractures enzymatic activity of CK-MB, echocardiographic investigation and careful monitoring for the first 96 hours are necessary. The cardiac compliance is inadequate in polytrauma patients and can lead to cardiac impairment.
Asunto(s)
Accidentes de Tránsito , Forma MB de la Creatina-Quinasa/sangre , Fracturas Óseas/complicaciones , Fracturas Óseas/enzimología , Lesiones Cardíacas/enzimología , Lesiones Cardíacas/etiología , Esternón/lesiones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aorta Torácica , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Biomarcadores/sangre , Electrocardiografía , Femenino , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico , Fracturas Óseas/cirugía , Lesiones Cardíacas/diagnóstico , Lesiones Cardíacas/cirugía , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Derrame Pericárdico/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The Authors, after extensive introduction on the incidence, etiology, classification, pathophysiology, possible complications, diagnosis and treatment of thoracic trauma, relate their experience on the last eight years, stressing the diagnostic and therapeutic strategy in management of trauma simple and complicated and assessing finally serious social impact of these pathologies and the educational opportunities provided.
Asunto(s)
Traumatismos Torácicos/economía , Traumatismos Torácicos/epidemiología , Cirugía Torácica/educación , Costos y Análisis de Costo , Humanos , Incidencia , Italia , Factores de TiempoRESUMEN
BACKGROUND: The purpose of this study is to assess, through the retrospective analysis of our experience and the literature review, whether the limited pulmonary resection is comparable to lobectomy for treatment of the peripheral stage IA (T1N0M0) non-small cell lung cancers (NSCLC), in terms of oncologic radicality, survival and rate of local, regional and systemic recurrences. Moreover it has been considered the impact of the limited resections in comparison with the lobar resections on the postoperative pulmonary function. PATIENTS AND METHODS: We have analyzed a consecutive series of 36 patients, 28 men and 8 women, of inclusive age among the 61 to 81 years (average 73 years), who underwent surgical resection from January 2000 to December 2003 for T1N0M0 peripheral NSCLC; 11 limited resections and 25 lobectomies have been performed. Comparatively survival and recurrences (follow-up period of 3-5 years) are been analyzed, as well as the pulmonary function tests at 1 year after surgery. RESULTS: The 3-year and 5-year survivals were 88% and 82% in the patient's group underwent to limited resection , 93% and 88% in the patient's group underwent to lobectomy. Postoperative local recurrence was noted in 1 patient (9%) of the first group and in 1 patient (4%) of the second group. One year after surgery was noted a moderate decline in the forced expiratory volume in 1 second (FEV1) and in the diffusing capacity for carbon monoxide (DLCO) in the patients who underwent to lobar resection, whereas in the patient's group submitted to limited resection was observed a substantial maintenance, except for the DLCO, of the preoperative pulmonary function tests. CONCLUSIONS: Our limited experience, according to the actual tendencies of the literature, show that the limited pulmonary resections, in selected patients with peripheral stage IA NSCLC, represents a valid alternative to lobectomy in terms of survival and recurrence's rate, also determining a lower decrement of the postoperative pulmonary function. Therefore the segmentectomy can be considered, in such cases, the gold-standard procedure even if the patient is able to bear a wider resection.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/cirugía , Neumonectomía/métodos , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Estudios Retrospectivos , Sicilia/epidemiología , Análisis de SupervivenciaRESUMEN
Pulmonary metastases resection is a method universally accepted in selected patients. Long-term survival reaches good levels after complete resection of lung metastases independently of primary tumour histology. The Authors emphasizes literature data; they report data of their experience no statistically significant but useful for valuation of results. They discuss of advantages vs disadvantages of the surgical procedures. In conclusion they believe metastasectomy is a safe treatment of pulmonary metastases.
Asunto(s)
Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Adolescente , Adulto , Anciano , Protocolos Clínicos , Terapia Combinada , Interpretación Estadística de Datos , Supervivencia sin Enfermedad , Femenino , Humanos , Pulmón/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Selección de Paciente , Pronóstico , Radiografía Torácica , Ensayos Clínicos Controlados Aleatorios como Asunto , Reoperación , Estudios Retrospectivos , Esternón/cirugía , Análisis de Supervivencia , Cirugía Torácica Asistida por Video , Toracoscopía , Toracotomía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Diseases causing blood accumulation in the pleural space (or haemothorax) are usually very demanding for diagnosis and require a multidisciplinar therapeutical approach in emergency. So, their treatment should always be immediate and should aim to restore the optimal patient's haemodynamic conditions and to find the site of bleeding. Chylothorax, a lymphatic effusion in the pleural space, is also a very important pathology, as it effects the nutritional and immunological state of the patient causing pleural involvement and respiratory insufficiency. Stabilisation of vital parameters with adequate systemic therapies (blood perfusions, fluids and pro-coagulation factors, TPN) preceeds surgery, which can be the placement of a thoracic drain or emergency thorascopy and/or thoracotomy. The Authors report the casistic of the latest three years for diagnosis and treatment of haemothorax and chylothorax stressing the advantages of a minimal invasive approach for evacuation and identification of the origin of bleeding and haemorrhage and/or lymphatic effusion control.
Asunto(s)
Quilotórax/cirugía , Hemotórax/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Quilotórax/diagnóstico , Quilotórax/etiología , Drenaje , Urgencias Médicas , Femenino , Hemotórax/diagnóstico , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Cirugía Torácica Asistida por Video , Toracoscopía , ToracotomíaRESUMEN
Celomic cysts (pericardiopleural or serous cysts) are rare, as they account for about 30% of all the homoplastic disembryogenetic lesions of the mediastinum. There is not usually a characteristic symptomatology associated with this anomaly, which is, however, easily diagnosed by means of the most common radiologic techniques. The TC together with the MRI provides all the necessary data for an appropriate management of the patient. The Authors report on their five year experience of the surgical treatment of celomic cysts, pointing out that surgery must be aimed at preserving pulmonary function as much as possible. They finally maintain that the first surgical approach should be video-thoracoscopic with the aid of a minithoracotomy, if necessary.
Asunto(s)
Quistes/cirugía , Pericardio , Enfermedades Pleurales/cirugía , Adolescente , Adulto , Anciano , Quistes/diagnóstico , Femenino , Cardiopatías/diagnóstico , Cardiopatías/cirugía , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Pleurales/diagnósticoRESUMEN
The therapeutic impact of thymectomy on the clinical course of myasthenia gravis is still very controversial. In fact, while nowadays the surgical approach is widely adopted for thymomas, its role is still debatable in patients suffering from myasthenia gravis. The surgical approach of choice for total thymectomy is represented by median sternotomy. Other surgical methodologies include cervical access and partial sternotomy. All these approaches have shown excellent results in the exeresis of the thymus. More recently video-assisted thoracoscopic thymectomy has been proposed as a less invasive and similarly effective technique for the removal of this organ and the treatment of myasthenia gravis. Aim of the present study is to report Author's experience with thymectomy, emphasizing the data available in the international literature on the surgical mortality, complications and aesthetical results of the different surgical accesses.