Síndrome de Doege-Potter: lo que la hipoglucemia escondía / Doege-Potter syndrome: what hypoglycemia hid

No disponible

[Pleurodesis with autologous blood: the results of a series of 17 cases with more than a year of follow-up]. / Pleurodesis con sangre autóloga: resultados de una serie de 17 casos con más de un año de seguimiento.

In an attempt to search for alternatives to the standard techniques of pleurodesis, we performed pleurodesis with autologous blood in 17 patients with spontaneous pneumothorax. The blood volume instilled in every procedure ranged from 50 to 60 ml. In 16 cases (94%) the early closure of the fistula was achieved. The mean follow-up period ranged from 17 and 41 months (mean: 24.2 +/- 6.3). Twelve out of the 17 patients (71%) have not had relapses of pneumothorax after pleurodesis. Tolerance was excellent, with only one complication reported: pleuritis resolved with drainage and antibiotics. Pain was not reported in any case. The were 5 relapses (29%); three were controlled with drainage and two required surgery. The obtention of chest X-rays, CT and/or pleural echography, after pleurodesis, allowed the evaluation of radiologic efficiency with that procedure. In 41% of cases suggestive findings of success were obtained; in the remaining cases no radiologic findings were observed or they were nonspecific. Nevertheless, a poor correlation was observed between radiologic findings and clinical course; therefore, these studies cannot be recommended on a regular basis. The current state of the art is commented and a consideration given to recent reports on this topic, and the advantages and drawbacks are evaluated. We conclude that future studies are necessary to properly place this procedure.

[Pleurodesis with the patient's own blood: the initial results in 14 cases]. / Pleurodesis con sangre del propio paciente: resultados iniciales en 14 casos.

Fourteen adults with spontaneous pneumothorax (SP), 9 of whom had primary SP (PSP) and 5 of whom had secondary forms (SSP), were given intrapleural infusions of self-donated blood for pleurodesis. Instillations of 50 ml were given to all except 1, who required a total volume of 120 ml. The procedure was performed in each patient's bed in all cases. With apical chest tube placement in most cases and the lung expanded, the outer tip of the tube was elevated and the patient's own blood was taken from a superficial forearm vein and instilled. Them, with the tube occluded, the patient's were rotated un bed for a period of 2 hours to distribute the blood evenly throughout the pleural cavity. Tolerance was excellent, with no pain reported by any patient. The only noteworthy complication was 1 case of infectious pleural effusion of unknown etiology which was treated by evacuation and antibiotics. In 13 (92%) patients closure of the fistula was achieved, in under 12 h in 7 (53%), in under 24 h in 3 (23%), in under 48 h in 2 (15%), and in under 72 h in the remaining 2 (15%). In 4 (28.5%) there was recurrence (2 SSP and 2 PSP patients). Over a 10 to 32 month follow-up period (mean 16 months), 10 (71.4%) patients experienced no recurrences or complications. These results allow us to speculate that blood instilled in the pleural cavity may act in 2 ways: in the short term as a blood patch that adheres to and closes the fistula in the visceral pleura, and over the longer term by creating pleural symphysis by adhesions and fibrous tissue. Our limited experience indicates that pleurodesis with self-donated blood is an easy-to-perform, painless, convenient, rapid and inexpensive procedure that is moderately effective in the short and medium term. Its main drawbacks are the lack of consensus on certain technical considerations, such as the optimum amount of blood to be instilled, the number of instillations to perform and, if multiple instillations are carried out, what the interval between them should be. Further study is needed to confirm or discount our results and to determine the place this technique may have in the clinical management of pneumothorax.