[Noninvasive diagnosis of posttraumatic thoracic splenosis]. / Diagnóstico no invasivo de la esplenosis torácica postraumática.

Thoracic splenosis is a rare occurrence that has usually been diagnosed by invasive procedures to allow a pathologic diagnosis to be reached. A firm diagnosis can now be made with the help of new, noninvasive imaging techniques. We report the case of a 34-year-old man with a history of severe thoracic-abdominal injury, including rupture of the spleen and left diaphragm. During computed tomography of the thorax related to a different diagnosis, nonspecific nodules were observed, although the patient was asymptomatic. A suspected diagnosis of thoracic splenosis was confirmed by technetium-99 sulfur colloid scintigraphy.

Diagnóstico no invasivo de la esplenosis torácica postraumática / Noninvasive diagnosis of posttraumatic thoracic splenosis

La esplenosis torácica es una entidad poco frecuente, que habitualmente se diagnostica mediante técnicas invasivas que proporcionan un diagnóstico anatomopatológico. Con el desarrollo de nuevas técnicas de imagen puede realizarse en la actualidad un diagnóstico seguro por métodos no invasivos. Presentamos el caso de un paciente varón de 34 años con antecedente de traumatismo toracoabdominal grave, con rotura esplénica y diafragmática izquierda, al que de forma casual, y encontrándose asintomático, se le hallaron nódulos inespecíficos en una tomografía computarizada torácica. Con la sospecha clínica de esplenosis torácica, se realizó una gammagrafía de coloide de sulfuro marcada con 99mTc metaestable que confirmó el diagnóstico (AU)

Tratamiento quirúrgico de la hiperhidrosis compensadora en el síndrome de Adie / Surgical treatment for compensatory hyperhidrosis in Adie syndrome

La tríada consistente en pupila tónica de Adie, arreflexia osteotendinosa e hipohidrosis segmentaria se conoce como síndrome de Ross. La hipohidrosis puede ir acompañada de un exceso de sudación en el hemicuerpo contralateral. Esta hiperhidrosis es probablemente debida a un mecanismo de compensación. En este artículo presentamos el caso de un paciente con síndrome de Ross cuyo motivo de consulta fue hiperhidrosis socialmente incapacitante en el hemicuerpo izquierdo. El paciente fue intervenido quirúrgicamente, realizándose una simpatectomía del segundo y tercer ganglios torácicos con resultados clínicamente satisfactorios. La simpatectomía torácica es un tratamiento definitivo de la hiperhidrosis, con unos resultados excelentes en la hiperhidrosis primaria y un muy bajo índice de morbilidad (AU)

[Surgical treatment for compensatory hyperhidrosis in Adie syndrome]. / Tratamiento quirúrgico de la hiperhidrosis compensadora en el síndrome de Adie.

Ross syndrome is characterized by a triad of tonic pupil, areflexia and segmental hypohidrosis. Hypohidrosis may be accompanied by contralateral hyperhidrosis, probably due to a compensatory mechanism. We report a case of Ross syndrome with socially disabling left-sided hyperhidrosis. Sympathectomy of the second and third thoracic ganglia was performed with satisfactory results. With excellent results in primary hyperhidrosis and very low morbidity, thoracic sympathectomy is the definitive treatment for hyperhidrosis.

Tratamiento endoscópico de la hiperhidrosis primaria / Endoscopic treatment of primary hyperhidrosis

La hiperhidrosis primaria puede presentar una localización palmar, palmoaxilar, axilar, plantar y cráneofacial. La prevalencia de esta afección se sitúa en torno al 1 por ciento de ciertas poblaciones. Los tratamientos médicos clásicos existentes pueden mejorar algo las formas muy leves pero en los casos medianos y severos solamente el tratamiento quirúrgico es satisfactorio. La aplicación de toxina botulínica es eficaz de forma temporal y puede ser una alternativa válida en ciertos casos. Sería deseable una valoración individualizada de los pacientes afectos de hiperhidrosis por un grupo multidisciplinario (dermatólogo, psicólogo, electrofisiólogo y cirujano torácico) para una indicación más precisa del tratamiento más idóneo en cada caso y momento de su vida (AU)

Actualidad de la simpatectomía torácica por videotoracoscopia / Thoracic sympathectomy by videothoracoscopy: an update

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[Video thoracoscopy and video-assisted thoracic surgery. An analysis of 303 consecutive cases]. / Videotoracoscopia y cirugía torácica videoasistida. Análisis de 303 casos consecutivos.

OBJECTIVES: To present our experience in video thoracoscopy and video-assisted thoracic surgery from November of 1991 until November of 1997. PATIENTS AND METHODS: 303 endoscopic thoracic surgery procedures (210 males and 93 females with a mean age of 42.2 years) with the following indications: 151 spontaneous pneumothorax, 51 pulmonary biopsies, 50 pulmonary nodules, 15 mediastinal tumors, 13 pleuroparietal tumors, 8 pericardial windows and 15 thoracic sympathectomies. RESULTS: Mean postoperative stay was of 5.5 days. The thoracotomy conversion was necessary in 32 cases (10.9%). The morbimortality has been: one parietal recidive of a tumor in the way of one of the trocars and one death of a patient to who was accomplished a pulmonary biopsy by diffuse pneumopathy. CONCLUSIONS: The video thoracoscopy and thoracic surgery are effective and sure technical options for diagnosis and treatment of various thoracic affections.

Videotoracoscopia y cirugía torácica videoasistida.Análisis de 303 casos consecutivos / Videothoracoscopy and videoassisted thoracic surgery

Objetivos: Comunicar nuestra experiencia en videotoracoscopia y cirugía torácica videoasistida desde noviembre de 1991 hasta noviembre de 1997. Pacientes y métodos: Comprende 303 procedimientos de cirugía torácica endoscópica (210 varones, 93 mujeres y edad media de 42,2 años). Las indicaciones fueron: 151 neumotórax espontáneos, 51 biopsias pulmonares, 50 nódulos pulmonares, 15 tumores mediastínicos, 13 tumores pleuroparietales, 8 ventanas pericárdicas y 15 simpatectomías torácicas. Resultados: La estancia media postoperatoria fue de 5,5 días. La conversión a toracotomía fue necesaria en 32 casos (10,9%). La morbimortalidad ha sido: recidiva parietal de tumor en el trayecto de uno de los trócares y fallecimiento por sepsis de un paciente a quien se le realizó una biopsia pulmonar por neumopatía difusa. Conclusiones: La videotoracoscopia y cirugía torácica videoasistida son opciones técnicas seguras y eficaces para el diagnóstico y tratamiento de diversas afecciones torácica (AU)

[Pulmonary biopsy in diffuse interstitial disease: videothoracoscopy versus thoracotomy]. / Biopsia pulmonar en la enfermedad intersticial difusa: videotoracoscopia frente a toracotomía.

The aim of this work was to evaluate and compare the results of lung biopsies performed by videothoracoscopy (VT) and minithoracotomy (MT) in diffuse interstitial disease between 1992 and 1994, during which period 45 lung biopsies were performed on patients (20 women) with a mean age of 56 years. Thirty-one biopsies were performed by VT (group I) and 14 by MT (group II). For all patients we recorded duration of procedure, days to discharge after surgery, total time with a pleural drain in place, and volume of tissue sample. Diagnosis was possible in all cases. Mean duration of surgery was 49.3 minutes for group I and 58.2 minutes for group II. Mean time to discharge was 6.7 days for group I and 10.1 for group II. Mean time of pleural drainage was 3.8 days for group I and 5.9 days for group II. Mean volume of tissue sample was 6.5 cm3 for group I and 5.18 cm3 for group II. One patient died in group I from causes unrelated to surgical technique. In conclusion, lung biopsy with VT is effective and useful for diagnosing diffuse interstitial lung diseases. The sample obtained is in every way comparable to that obtained by thoracotomy. Mean hospital stay and mean time of postoperative drainage decreases significantly (p < 0.05) with VT.

[Rapid surgical exploration of the mediastinum]. / Cirugía de corta estancia en la exploración quirúrgica del mediastino.

This study aimed to evaluate the morbidity-mortality of surgical exploration of the mediastinum in patients with mediastinal masses or adenopathy in the context of a rapid-surgery program that has been operating over the past 8 years (1985-1993). A total of 93 mediastinal explorations have been carried out. Sixty-five involved transcervical mediastinoscopy, 20 were anterior mediastinotomies, 4 were combined procedures and 4 were video-thoracoscopies. We found 34 cases of lymphoma, 28 of metastasis of bronchopulmonary carcinoma and 16 of mediastinal-ganglionic tuberculosis; the 15 remaining cases were classified as miscellaneous. No deaths were directly related to the surgical procedures; morbidity involved 2 wound infections. Surgical exploration of the mediastinum is a safe diagnostic procedure, provided it is carried out by an experienced team, and allows care givers to take better advantage of therapeutic options with no loss of quality.

[Contribution of transcervical mediastinoscopy and anterior mediastinostomy to the diagnosis of mediastinal lymphomas]. / Aportación de la mediastinoscopia transcervical y mediastinotomía anterior al diagnóstico de los linfomas mediastínicos.

UNLABELLED: The aim of this study has been to assess the profitability of mediastinal explorations (transcervical mediastinoscopy and anterior mediastinostomy) in the diagnosis of mediastinal lymphomas within a short-stay surgery programme. Out of 129 mediastinal explorations conducted within a period of six years, 63 were programmed as short-stay surgery, 24 of which were due to mediastinal lymphomas. Fourteen patients were discharged from the hospital within the first twelve hours and ten patients, after 24 hours. RESULTS: There were 11 cases of Hodgkin's lymphomas and 13 non-Hodgkin's lymphomas. No immediate complications were developed by the patients, with just two minor complications which did not delay hospital discharge. CONCLUSIONS: Mediastinal explorations (transcervical mediastinoscospy and anterior mediastinostomy) can be planned as short-stay surgery without any risks if they are conducted by groups with experience in these surgical techniques and provided with an adequate care infrastructure. This allows a more rationale usage of hospital resources without reducing the quality of care.