Neumotórax y síndrome de Marfan / Marfan syndrome and pneumothorax

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Pseudoaneurysm of the right hepatic artery following cholangiocarcinoma resection. A case report and review of the literature.

Pseudoaneurysms of the hepatic artery are infrequent, but potentially fatal. Apart from the performance of percutaneous techniques, such lesions are fundamentally produced as a result of surgery. The causal surgical techniques may sometimes be quite complex, though in other cases they are very common (e.g. laparoscopic cholecystectomy). Knowledge of such aneurysms is therefore of great interest for general surgeons, with a view to prompt diagnosis and adequate management of potential digestive and/or peritoneal bleeding--this being the typical form of presentation of hepatic artery aneurysms. We present the case of a 70-year-old woman with a pseudoaneurysm of the right hepatic artery that manifested as massive upper digestive bleeding and abdominal pain 13 days after en bloc resection of the gallbladder and choledochus with regional lymphadenectomy due to cholangiocarcinoma. Management comprised emergency surgery with ligation of the right branch of the hepatic artery and reconstruction of the biliary anastomosis according to the Hasegawa technique.

[Usefulness of computed tomography in determining risk of recurrence after a first episode of primary spontaneous pneumothorax: therapeutic implications]. / Utilidad de la tomografía computarizada para determinar el riesgo de recidiva tras un primer episodio de neumotórax espontáneo primario. Implicaciones terapéuticas.

OBJECTIVE: The main cause of primary spontaneous pneumothorax is the rupture of subpleural blebs or bullae. The presence of bullae may also lead to an increased risk of recurrence. The best way to detect them is by means of computed tomography (CT). Our objective in the present study was to determine whether bullae detected by CT represent an increased risk of recurrence after a first episode of primary spontaneous pneumothorax. We also evaluated therapeutic implications. PATIENTS AND METHODS: We carried out a prospective study that included 55 patients (41 men and 14 women) with primary spontaneous pneumothorax. For all patients, the therapeutic recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) were followed. After resolution of the episode, a chest CT was performed and the presence, location, number, and size of bullae were evaluated. Subsequently, the number of recurrences in each group was evaluated. RESULTS: The mean follow-up period was 30.7 months (95% confidence interval, 24-37 months). Twenty-six patients presented bullae, and 6 of these experienced recurrence. Of the 29 patients without bullae, 7 experienced recurrence. No association was found between the presence or absence of bullae and recurrence (P=.92). Bullae in the right lung led to more frequent recurrence of pneumothorax (P=.03). The number and size of the bullae had no significant influence on recurrence (P=.51). CONCLUSIONS: The present study could not demonstrate that the presence, size, or number of bullae on CT scans has any influence on recurrence rate. We cannot recommend surgery after a first episode of primary spontaneous pneumothorax based on the presence of bullae on the CT scan.

Utilidad de la tomografía computarizada para determinar el riesgo de recidiva tras un primer episodio de neumotórax espontáneo primario. Implicaciones terapéuticas / Usefulness of computed tomography in determining risk of recurrence after a first episode of primary spontaneous pneumothorax: therapeutic implications

Objetivo: La causa fundamental del neumotórax espontáneo primario es la rotura de bullas o blebs subpleurales. Estas bullas podrían también condicionar un mayor riesgo de recidiva. La mejor forma de detectarlas es mediante tomografía axial computarizada (TAC). Nos planteamos aquí si las bullas en la TAC suponen un riesgo mayor de recidivas tras un primer episodio de neumotórax espontáneo primario. Asimismo, se valoran las implicaciones terapéuticas. Pacientes y métodos: Se trata de un estudio prospectivo en el que se incluyó a 55 pacientes (41 varones y 14 mujeres) con neumotórax espontáneo primario. En todos ellos se siguieron las recomendaciones terapéuticas de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Tras la resolución del episodio se efectuó una TAC de tórax y se valoraron la presencia, la localización, el número y el tamaño de bullas. Posteriormente, se evaluó el número de recidivas en cada grupo. Resultados: El tiempo medio de seguimiento fue de 30,7 meses (intervalo de confianza del 95%, 24-37 meses). Presentaron bullas 26 pacientes, de los que en 6 hubo recidiva. De los 29 pacientes sin bullas, 7 presentaron recidiva. No se encontraron diferencias entre la presencia o ausencia de bullas y la recidiva (p = 0,92). Las bullas derechas recidivaron con mayor frecuencia (p = 0,03). El número y el tamaño de las bullas no tuvieron influencia significativa (p = 0,51). Conclusiones: El estudio no ha podido demostrar que la presencia de bullas en la TAC, su tamaño o su número influyan en el índice de recidivas. No se puede recomendar la cirugía tras un primer episodio de neumotórax espontáneo primario por presentar bullas en la TAC

Objective: The main cause of primary spontaneous pneumothorax is the rupture of subpleural blebs or bullae. The presence of bullae may also lead to an increased risk of recurrence. The best way to detect them is by means of computed tomography (CT). Our objective in the present study was to determine whether bullae detected by CT represent an increased risk of recurrence after a first episode of primary spontaneous pneumothorax. We also evaluated therapeutic implications. Patients and methods: We carried out a prospective study that included 55 patients (41 men and 14 women) with primary spontaneous pneumothorax. For all patients, the therapeutic recommendations of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) were followed. After resolution of the episode, a chest CT was performed and the presence, location, number, and size of bullae were evaluated. Subsequently, the number of recurrences in each group was evaluated. Results: The mean follow-up period was 30.7 months (95% confidence interval, 24-37 months). Twenty-six patients presented bullae, and 6 of these experienced recurrence. Of the 29 patients without bullae, 7 experienced recurrence. No association was found between the presence or absence of bullae and recurrence (P=.92). Bullae in the right lung led to more frequent recurrence of pneumothorax (P=.03). The number and size of the bullae had no significant influence on recurrence (P=.51). Conclusions: The present study could not demonstrate that the presence, size, or number of bullae on CT scans has any influence on recurrence rate. We cannot recommend surgery after a first episode of primary spontaneous pneumothorax based on the presence of bullae on the CT scan

Cáncer gástrico: valoración probabilística ante un estadio ganglionar negativo y sus consecuencias / Gastric cancer: probability assessment after lymph node-negative staging and its consequences

Objetivo. Aproximación al cálculo de la probabilidad de error tras un estadio ganglionar negativo en el cáncer gástrico. Pacientes y método. A partir de los datos retrospectivos de 75 resecciones gástricas por cáncer, se calculan dichas probabilidades de forma general, según el estadio T de la clasificación TNM, 6.a edición, y según el tipo de linfadenectomía realizada. Se utiliza una modificación de un procedimiento basado en el teorema de Bayes. Resultados. De forma general, se precisan al menos 11 ganglios negativos para asegurar un verdadero pN0. Para los tumores T1 se precisan, al menos, 2 ganglios, 11 para los T2, y 14 para los T3. Una linfadenectomía D2 requiere más ganglios que una D1, pero sus estadios pN0 son casi siempre seguros, mientras que en las linfadenectomías D1 se produjo un 24% de estadificaciones inseguras. Conclusiones. Se ha descrito un modelo matemático sencillo y reproducible que puede ayudar al cirujano a conocer la calidad de las estadificaciones ganglionares negativas en un importante grupo de pacientes con cáncer gástrico (AU)

Objective. To provide an approach to calculating the probability of error after lymph node-negative staging in gastric cancer. Patients and method. Retrospective data of 75 gastric resections for cancer were used to calculate the probability of error in general, according to T staging of the TNM classification (6th edition) and according to the type of lymphadenectomy performed. A modification of a procedure based on Bayes' theorem was used. Results. For all tumors, at least 11 negative lymph nodes were required to ensure a true pN0. Two lymph nodes were required for T1 tumors, 11 for T2 tumors, and 14 for T3 tumors. A greater number of lymph nodes were required for a D2 lymphadenectomy than for a D1 lymphadenectomy. However, in D2 lymphadenectomy, pN0 stages were almost always reliable, while in D1 lymphadenectomy 24% of stagings were unreliable. Conclusions. The present study describes a simple and reproducible mathematical model that could help surgeons to determine the accuracy of lymph node-negative stages in a substantial group of patients with gastric cancer (AU)

[Gastric cancer: probability assessment after lymph node-negative staging and its consequences]. / Cáncer gástrico: valoración probabilística ante un estadio ganglionar negativo y sus consecuencias.

OBJECTIVE: To provide an approach to calculating the probability of error after lymph node-negative staging in gastric cancer. PATIENTS AND METHOD: Retrospective data of 75 gastric resections for cancer were used to calculate the probability of error in general, according to T staging of the TNM classification (6th edition) and according to the type of lymphadenectomy performed. A modification of a procedure based on Bayes' theorem was used. RESULTS: For all tumors, at least 11 negative lymph nodes were required to ensure a true pN0. Two lymph nodes were required for T1 tumors, 11 for T2 tumors, and 14 for T3 tumors. A greater number of lymph nodes were required for a D2 lymphadenectomy than for a D1 lymphadenectomy. However, in D2 lymphadenectomy, pN0 stages were almost always reliable, while in D1 lymphadenectomy 24% of stagings were unreliable. CONCLUSIONS: The present study describes a simple and reproducible mathematical model that could help surgeons to determine the accuracy of lymph node-negative stages in a substantial group of patients with gastric cancer.

Esofagoyeyunostomía en el mediastino. Recursos técnicos por vía transhiatal / Esophagojejunal anastomosis in the mediastinum. Technical resources uding the transhiatal approach

La realización de una gastrectomía total con resección extendida del esófago precisa la reconstrucción de la continuidad digestiva mediante una anastomosis esofagoyeyunal más o menos alta en el mediastino, en muchas ocasiones a través de la denominada vía transhiatal. Su confección siempre resulta dificultosa, incluso cuando se utilizan aparatos de sutura mecánica. Para paliar esta dificultad se han diseñado diversas modificaciones tácticas de la clásica esofagoyeyunostomía en "Y" de Roux. Generalmente, estas técnicas de recurso se publican de forma aislada y dispersa en el tiempo, por lo que no es fácil tener una idea de conjunto de sus ventajas, inconvenientes o indicaciones. La presente revisión trata de sistematizar en alguna medida el abanico más importante de recursos técnicos disponibles para este tipo de anastomosis complejas. Tras su descripción resumida se comentan sus características según la opinión de sus creadores y la experiencia personal de los autores de esta revisión (AU)