[Surgical repair of postpneumonectomy syndrome with vascular compromise]. / Corrección quirúrgica de un síndrome posneumonectomía con compromiso vascular.

Postpneumonectomy syndrome is a rare complication of pneumonectomy that develops as a result of excessive displacement of mediastinal structures into the empty cavity. We report the case of a 72-year-old man who developed dysphagia and progressive weakness, along with signs of hypotension due to low cardiac output, following removal of the left lung for lung cancer. Intubation and transfer to the intensive care unit was necessary. When such causes as pulmonary embolism, pneumonia and COPD exacerbation had been ruled out, postpneumonectomy syndrome was diagnosed. Two tissue expansion prostheses (100 mL and 400 mL) were implanted surgically to keep the mediastinum in position and reverse symptoms immediately. We conclude that postpneumonectomy syndrome after left pneumonectomy is a rare complication that may be more frequent than the literature suggests, given that signs may be masked by a diagnosis of cardiogenic shock that leads to death. Surgical repair is simple, reversing symptoms immediately.

Corrección quirúrgica de un síndrome posneumonectomía con compromiso vascular / Surgical repair of postpneumonectomy syndrome with vascular compromise

El síndrome posneumonectomía es una complicación inusual de la neumonectomía, consecuencia del desplazamiento excesivo de las estructuras mediastínicas hacia el espacio pleural vacío. Presentamos el caso de un varón de 72 años que, tras ser sometido a una neumonectomía izquierda por una neoplasia de pulmón, desarrolló un cuadro de disfagia y fatigabilidad progresiva, junto con un signo de hipotensión arterial por bajo gasto cardíaco, lo que obligó a una intubación e ingreso en la UCI. Descartadas alteraciones como embolismo pulmonar, neumonía, reagudización de una enfermedad pulmonar obstructiva crónica, etc., y tras comprobar el excesivo desplazamiento del mediastino, se diagnosticó de síndrome posneumonectomía. Se intervino quirúrgicamente, introduciéndose dos prótesis de expansión tisular de 1.000 ml y 400 ml, para mantener la recolocación del mediastino, corrigiéndose el cuadro de forma inmediata. Concluimos que el síndrome posneumonectomía tras la neumonectomía izquierda es una complicación inusual, pero que puede ser más alta de lo que se ha publicado, ya que el cuadro puede quedar enmascarado como un shock cardiogénico y conducir a la muerte del paciente, sin llegar a realizarse un diagnóstico etiológico. Además su corrección quirúrgica es sencilla y determina la desaparición inmediata de los síntomas (AU)

[The effect of peroperative transfusion on survival in resected lung carcinomas]. / Influencia de la transfusión perioperatoria en la supervivencia de los carcinomas de pulmón resecados.

This paper analyzes the influence of perioperative transfusion on survival after lung cancer surgery. Between January 1991 and December 1995, we enrolled 405 patients, 196 of whom received transfusions and 209 of whom did not. Follow-up extended to December 1997. Excluded were patients undergoing exploratory thoracotomy (n = 92), those who died during the postoperative period (n = 19) and those lost to follow-up (n = 13). The final number of patients in the study was 281 (136 who received transfusions and 145 who did not). We analyzed age, sex, general clinical status measured on the Eastern Cooperative Oncology Group (ECOG) scale, histological type and TNM staging. Single and multiple variable analyses were performed. At the end of the study 158 patients were alive and 123 had died. Transfusions were used more often in pneumonectomies (p < 0.001) and in patients with an ECOG score of 2 (p < 0.01). Survival at 36 and 60 months, calculated using the Kaplan-Meier method was 52% and 30%, respectively, for those who had received transfusions, and 53% and 49%, respectively, for those who had not. The differences were not statistically significant (p > 0.1). Multivariant analysis failed to demonstrate an influence of transfusion on survival (relative risk of 1.08; 95% confidence interval 0.72-1.61; p > 0.1). We conclude that there is no negative prognostic effect of perioperative transfusion.

[Usefulness of urokinase in multilocular pleural effusion]. / Utilidad de la urocinasa en derrames pleurales multiloculados.

Recognizing the confirmed efficacy of urokinase as a thrombolytic and proteolytic agent, we assess its usefulness in the treatment of multiloculated pleural effusion, empyema and hematoma as a substitute of other more invasive procedures. Treatment with urokinase was applied in 18 consecutive cases. Inclusion criteria were a well-placed thoracic probe that did not drain and a radiological image showing occupation. Patients were excluded if they had bronchial fistulas or hemothorax of less than 7 days duration. Effusion in the included cases had developed after pneumonia, after surgery or after trauma. Treatment lasted 3 to 4 days ant was considered effective or not based on the volume of liquid drained and on radiological evidence of change. The amount of liquid drained was highly variable (mean 1,282 and S.D. 1,224; range 100-3,975). Radiological change was considered completely satisfactory in 10 cases, with 6 patients continuing to show occupation of the costophrenic sinus with no clinical repercussions. Two patients died of causes unrelated to administration of the drug. There were two mild relapses that did not require a second round of treatment with urokinase. Patients were followed for a least 30 days after discharge and no new recurrences were detected. We have found urokinase to be a useful fibrinolytic agent for treating multiloculated effusion. Contraindications are few and therefore urokinase should be considered the first-choice treatment to be applied before other more invasive measures are taken.

[Endoscopic treatment of bronchopleural fistula using fibrin biological adhesive]. / Tratamiento endoscópico de la fístula broncopleural mediante el uso de adhesivos biológicos de fibrina.

Three cases are reported of bronchopleural fistula successfully resolved by using biological adhesives through the intrabronchial way. In the three cases the rigid bronchoscope was used to prepare the field and the passage of the adhesive material. The results obtained allow the consideration of this procedure as useful for small fistulas and as a initial therapeutical approach for other fistulas due to the small morbidity rate associated with this procedure compared with others.

[Thoracic traumatism in a specialized unit. Its epidemiology and morbimortality]. / Traumatismos torácicos en una unidad especializada. Epidemiología y morbimortalidad.

Two hundred forty-eight cases of thoracic trauma arriving at our hospital between 1990 and 1992 are analyzed in this report. Injuries were only thoracic in 29% of the cases. The remaining patients presented associated lesions, mainly in the extremities, followed by head injuries. Single or multiple rib fracture, in 193 (77.8%) patients, was the most frequent thoracic injury, followed by 94 (37.6%) cases of hemothorax and 80 (30.2%) instances of pneumothorax. Pulmonary contusion in 57 (22.9%) cases was a serious consequence with a mortality rate of 35.7%. Eighty six (34.6%) chest tube were placed and 14 (5.6%) thoracotomies were performed. Death occurred in 34 (13.7%) cases and was mainly related to the presence of associated injuries, in 29 (16.7%) patients as opposed to 5 (6.9%) (p < 0.05), and to pulmonary contusion in 20 (35.7%) patients vs. 13 (6.8%) (p < 0.001).