Hidroneumotórax producido por la migración de un clavo de Kirschner / Hydropneumothorax caused by migration of a Kirschner wire

Las agujas de fijación tienen un amplio uso en el manejo quirúrgico de fracturas y luxaciones. Infrecuentemente se ha descrito la migración intratorácica de las mismas, que generalmente origina complicaciones graves. Presentamos un caso en el que una aguja de Kirschner, utilizada para la fijación de una luxación posterior de hombro, dio lugar a un neumotórax y a un derrame pleural hemático masivo que presenta especial interés por su curso insidioso, relacionado en parte a las características especiales de la paciente (AU)

Pins and wires have a wide use in the management of fractures and dislocations. Migration of these devices within the chest is rare, but can cause serious complications. We report a case of intrathoracic migration of a Kirschner wire used for the treatment of a posterior shoulder dislocation, causing pneumothorax and massive hemothorax, having an insidious course, probably related to the special characteristics of the patient (AU)

[Vascular tumors arising in the chest wall: 25 years' experience]. / Experiencia de 25 años en tumores vasculares de la pared torácica.

Seventy-three interventions for chest wall tumors were performed at our hospital from 1978 through 2003. Six (8.2%) tumors were vascular. Four of them were soft tissue tumors, and two involved bone. The histologic diagnoses were hemangioendothelioma (1), low-grade angiosarcoma (1), and hemangioma (4). The diagnosis was established after surgery in all cases except one that had been previously diagnosed during an attempted resection before the patient came to our hospital. Fine needle aspiration carried out in 4 patients was inconclusive in all cases. Complete tumor resection with a margin greater than 3 cm was performed in each patient. Embolization followed by ligation of the intercostal vessels was performed prior to tumor resection in 1 patient with arteriovenous fistula and diffuse angiomatosis. Chest wall reconstruction after tumor removal was carried out using autologous tissues except in 1 case in which a Marlex mesh (CR Bard Inc., Burlington, USA) and a metallic prosthesis was inserted to prevent deformity in the lower costal arch. All patients have been followed and have survived with no evidence of recurrence after follow up ranging from 2 to 25 years.

Experiencia de 25 años en tumores vasculares de la pared torácica / Vascular tumors arising in the chest wall: 25 years' experience

En el período de 1978 a 2003 realizamos 73 intervenciones en tumores de la pared del tórax, de los cuales 6 eran tumores vasculares, un 8,2%. Cuatro eran tumores de partes blandas y 2 tenían afectación ósea. El diagnóstico histológico fue de 4 hemangiomas, un hemangioendotelioma y un angiosarcoma de bajo grado. En todos el diagnóstico se estableció tras la cirugía, excepto en un caso que había sido diagnosticado previamente en un intento de resección antes de llegara nuestro servicio. A 4 enfermos se les realizó una punción-aspiración con aguja fina, que no fue concluyente en ningún caso. Se practicó resección completa del tumor en todos los pacientes, con un margen superior a 3 cm. En un enfermo con fístula arteriovenosa y angiomatosis difusa se practicó embolización con posterior ligadura quirúrgica de los vasos intercostales antes de la resección tumoral. La reconstrucción parietal del defecto tras la extirpación del tumor se llevó a cabo con tejidos propios, excepto en un caso en que utilizamos placa de Marlex y prótesis metálica para evitar la deformidad de la arcada costal inferior. Hemos realizado seguimiento de todos los enfermos, que en la actualidad están vivos y sin signos de recidiva, entre2 y 25 años tras la cirugía

Seventy-three interventions for chest wall tumors were performed at our hospital from 1978 through 2003. Six(8.2%) tumors were vascular. Four of them were soft tissue tumors, and two involved bone. The histologic diagnoses were hemangio endothelioma (1), low-grade angio sarcoma (1),and hemangioma (4). The diagnosis was established after surgery in all cases except one that had been previously diagnosed during an attempted resection before the patient came to our hospital. Fine needle aspiration carried out in 4 patients was inconclusive in all cases. Complete tumor resection with amargin greater than 3 cm was performed in each patient. Embolization followed by ligation of the intercostal vessels was performed prior to tumor resection in 1 patient with arterio venous fistula and diffuse angiomatosis. Chest wall reconstruction after tumor removal was carried out using autologous tissues except in 1 case in which a Marlex mesh(CR Bard Inc., Burlington, USA) and a metallic prosthesis was inserted to prevent deformity in the lower costal arch. All patients have been followed and have survived with no evidence of recurrence after follow up ranging from 2 to 25 years

[Prognostic factors and outcome of thymectomy in 80 cases of myasthenia gravis]. / Análisis de factores pronósticos y resultados de la timectomía en 80 casos de miastenia gravis.

OBJECTIVES: To analyze the results of thymectomy in our series of patients with myasthenia gravis (MG) and to study the influence of the most common prognostic factors. MATERIAL AND METHODS: Eighty MG patients over a period of 23 years underwent thymectomy consecutively in our hospital. Preoperative assessment included clinical evaluation of muscle weakness, edrophonium testing, electromyography, lung function testing, chest X-rays and CAT scans. Symptoms were assessed by the Osserman scale. The surgical approach was amplified transsternal thymectomy. The prognostic factors studied were sex, age, clinical stage, duration of disease before surgery and histology of the thymus. Clinical outcome was assessed using Millichap and Dodge's criteria. Follow-up was by the chest surgery and neurology departments. RESULTS: Complete remission was observed in 29 cases (36.2%) and significant improvement in 42 (52.5%). Complications developed in 9 patients (11.2%). Most patients were women (53/27) and outcomes for men and women were not statistically different. Mean age was 36 years (range 11-79), with no significant difference in outcome for patients who were older or younger than 60 years of age. Nor were differences evident related to presurgical clinical stage or levels of severity (I + IIa/IIb + III). Differences in outcome were highly significantly related to duration of disease (< 24 / > 24 months) (p = 0.0022), such that outcome was more satisfactory when the pre-surgical course of disease was shorter, provided that no thymoma was present. CONCLUSIONS: Amplified transsternal thymectomy was safe and effective for those patients with MG. When disease had been present for less than two years, the prognosis was better.

Análisis de factores pronósticos y resultados de la timectomía en 80 casos de miastenia gravis / Prognostic factors and outcome of thymectomy in 80 cases of myasthenia gravis

OBJETIVOS: Analizar los resultados de la timectomía en pacientes con miastenia gravis (MG) en nuestra serie y estudiar la influencia de los factores pronósticos más comúnmente investigados. MATERIAL Y MÉTODOS: Durante 23 años 80 pacientes con MG fueron timectomizados consecutivamente en nuestro hospital. El estudio preoperatorio se hizo mediante evaluación clínica de la fatigabilidad muscular, test de edrofonio, electromiografía, pruebas funcionales respiratorias (PFR), radiografía de tórax y TAC. La distribución clínica se hizo según la escala de Osserman. La técnica quirúrgica fue la timectomía trans-esternal ampliada. Los factores pronósticos estudiados son: sexo, edad, estadio clínico, tiempo de evolución prequirúrgico e histología del timo. La respuesta clínica se evaluó según los criterios de Millichap y Dodge. El seguimiento fue realizado por los servicios de cirugía torácica y neurología. RESULTADOS: En 29 casos (36,2 por ciento) se obtuvo la remisión completa y en 42 (52,5 por ciento), una mejoría clínica importante. Hubo complicaciones en 9 casos (11,2 por ciento). Existe un predominio femenino (53/27), sin diferencias significativas en las respuestas respecto a los varones. La edad media es de 36 años (rango, 11-79), sin diferencias significativas entre pacientes mayores o menores de 60 años. No hubo diferencias por el estadio clínico prequirúrgico, ni aun agrupándolos en estadios leves/graves (I + IIa/IIb + III). Comparando las respuestas en los pacientes según el tiempo de evolución (< 24 meses/evolución superior), encontramos diferencias muy significativas (p = 0,0022), favorables a los pacientes con menos tiempo de evolución, cuando no existía un timoma asociado. El estudio no pudo demostrar diferencias significativas en la respuesta según la histología del timo. CONCLUSIONES: La timectomía transesternal ampliada resultó ser un procedimiento seguro, con un alto índice de respuestas clínicas satisfactorias en pacientes con MG. Una evolución inferior a 2 años se reveló como un indicador de buen pronóstico (AU)

[Bronchoplasty in bronchopulmonary tumors. Review of 50 cases]. / Broncoplastias en tumores broncopulmonares. Revisión de cincuenta casos.

Bronchoplasty in oncological surgery is performed to remove a tumor while preserving most of the pulmonary parenchyma. Survival in selected patients is similar to survival after lung removal. We report a series of 50 bronchoplastic procedures performed in 37 patients with bronchopulmonary cancer. Twelve had carcinoid tumors and 1 had single lung metastasis from adenocarcinoma of the colon. Twenty-seven operations were performed on the right side and 23 on the left. The pulmonary parenchyma was not resected in 2 patients. The pulmonary artery was also repaired in 5 patients. Mortality at 30 days was 2% (1 patient) and survival at 5 years was 47% calculated according to the method of Kaplan-Meier. Survival was 37 months in only 1 of the 8 patients with mediastinal adenopathy, for whom complementary radiation therapy was provided. Survival among the patients with carcinoid tumors is 91.6% to date, as all but 1 are alive at present. The single death was due to intestinal diverticulosis. The patient with metastasis is alive 12 years after surgery. Spirometric function tests were performed in 17 patients 1 year after surgery and ventilation perfusion was studied in 13. A slight loss of forced vital capacity and maximum expiratory volume in 1 second, while ventilation perfusion corresponding to the parenchyma preserved was normal. Bronchoplasty is the treatment of choice for endobronchial tumors with low degrees of malignancy. Bronchoplasty is an effective surgical treatment for a select group of carcinomas.