Tracheal Bridge for Reconstruction of the Upper Airway in Double Tracheal Stenosis.

Tracheal reconstruction is a complex surgical procedure that requires a well-trained, multidisciplinary team to achieve optimal results. No reviews or case reports involving the use of a healthy tracheal bridge to achieve reconstruction after extensive tracheal resection (greater than 7 cm) are described. We present a clinical case of a patient with double tracheal stenosis secondary to prolonged intubation and tracheostomy for which a healthy, well-vascularized tracheal bridge was used to achieve a tracheal reconstruction without tension. The key point in performing this type of reconstruction is allowing a tension-free cervical and thoracic anastomosis.

Comparison of the QuantiFERON-TB and tuberculin skin test for detection of latent tuberculosis infection in cancer patients in a developing country.

Cancer patients have an increased risk of reactivation of latent tuberculosis infection. It is unknown which strategy on screening should be used in this population in developing countries. We aimed to determine the concordance between the tuberculin skin test (TST) and QuantiFERON®-TB (QFT) assay in order to diagnose latent tuberculosis infection in cancer patients. We conducted a cross-sectional study of the agreement of diagnostic tests. Prevalence and agreement between tests were calculated. A logistic regression to assess predictors of discordance was performed. The accuracy of the TST to predict QFT results by a receiver operating characteristic (ROC) curve was evaluated. We included 149 adults with cancer without active tuberculosis. Prevalence of latent tuberculosis infection was 21.5% (n=32), defined as positive results on either test. Test agreement was moderate for the diagnosis of latent tuberculosis infection (κ=0.43, 90% CI 0.26-0.6). No predictor was associated with the chance of discordant results. Agreement improved slightly using a cut-off point ≥8 mm (κ=0.5, 90% CI 0.35-0.66). In a moderate-incidence setting, a moderate agreement was found between tests in cancer patients. Modification of the cut-off points of test results achieved marginally better agreement between the TST and QFT.

An asbestos contaminated town in the vicinity of an asbestos-cement facility: The case study of Sibaté, Colombia.

INTRODUCTION: The asbestos industry began operations in Colombia in 1942, with an asbestos-cement facility located in the municipality of Sibaté. In recent years residents from Sibaté have been complaining about what they consider is an unusually large number of people diagnosed with asbestos-related diseases in the town. A study to analyze the situation of Sibaté started in 2015, to verify if the number of asbestos related diseases being diagnosed were higher than expected, and to identify potential asbestos exposure sources in the town. METHODS: A health and socioeconomic survey was implemented door-to-door to identify potential asbestos-related diseases. Several self-reported mesothelioma cases were identified, and for confirmation purposes, copies of the medical record with the histopathology report were obtained. A panel of six physicians analyzed the medical records. Information of validated cases was used to estimate the male and female age-adjusted incidence rate for Sibaté. Based on reports of the existence of potential asbestos-contaminated landfills, topographic maps, a digital elevation model, and current satellite images were crossed using a geographic information system to identify potential landfilled areas, and soils samples were collected in some of these areas. RESULTS: A total of 355 surveys were completed, and 29 self-reported mesothelioma cases were identified. Twenty-five of these cases have been persons who had lived at some moment of their lives in Sibaté. It was possible to obtain copies of the medical diagnosis for 17 cases. Of these, the panel of physicians classified 15 cases as certain pleural mesothelioma, one as probable, and one as not mesothelioma. Based on this information, the estimated age-adjusted incidence rate of mesothelioma in Sibaté was 3.1 × 105 persons-year for males and 1.6 × 105 persons-year for females. These rates are high in comparison to those reported in other cities, regions, and countries of the world. Using geographic information systems, landfilled zones in the urban area of Sibaté were identified, on top of which a school and different sports facilities were built. The analysis of four soil samples collected in landfilled zones, confirmed the existence of an underground layer of friable and non-friable asbestos. CONCLUSION: The collected evidence suggests the presence of a malignant pleural mesothelioma cluster in Sibaté.

Trans-mediastinal herniation of pulmonary bulla with paradoxical pneumothorax.

Trans-mediastinal herniation of a lung bullae is an extremely rare condition. Here we present a case of a 75-year-old patient with a clinical history of chronic obstructive pulmonary disease and emphysema presenting with a right contralateral pneumothorax secondary to a trans-mediastinal herniated lung bullae. Herniation occurred through a mediastinal pleural defect; we call this event a paradoxical pneumothorax. To our knowledge this is the first report in the medical literature. The patient was successfully treated using a VATS approach with a right pleurodesis, a left thoracoscopic trans-mediastinal hernia reduction and bullectomy.

Ultrasound-Guided Percutaneous Dilatational Tracheostomies in 2 Difficult Airways.

Ultrasound has become a rapid, safe, and easy-to-use tool for anesthesiologists. It reduces complications, morbidity, and mortality, especially in patients with anatomic abnormalities in whom a traditional approach may be both difficult and risky. We report 2 cases of symptomatic patients with a difficult airway due to displacement of the trachea by a neck mass. Real-time ultrasound imaging was performed for percutaneous dilatational tracheostomies, identifying important structures, without any complications.

Control de la variabilidad en la programación de pacientes electivos en salas de cirugía / Variability Control in the Scheduling of Elective Patients in Operating Rooms / Controle da variabilidade no agendamento de pacientes eletivos em salas de cirurgia

El Departamento de Cirugía genera una buena parte de los ingresos de un hospital. Este estudio evalúa la variabilidad en la programación de las cirugías y cómo esta atenta contra la eficiencia del servicio. Este estudio implemento un algoritmo para la generación de dos programaciones que luego fueron comparadas con la realizada manualmente en un hospital en Colombia. Las dos programaciones generadas se diferencian entre sí al incluir o no las máximas desviaciones en los tiempos de duración de las cirugías, asumiendo que estas son causadas por factores externas al proceso y pueden ser eliminadas. Los resultados muestran que al emplear un algoritmo automático para programar las cirugías, podrían mejorarse el tiempo de respuesta y la utilización de las salas. Aún más, se pudo concluir que la variabilidad asociada a la programación manual tiene un mayor impacto que la asociada a otros factores en los indicadores de desempeño del servicio.

The Surgery Department generates a sizeable amount of the income of a hospital. This study evaluates the variability in the scheduling of surgeries and how this threatens the efficiency of the service. This study uses an algorithm for the generation of two schedules that were later compared with a manually-generated schedule in a hospital in Colombia. The difference between the generated schedules is the inclusion or lack thereof of the maximum time deviations in surgery times, under the assumption that these are caused by external factors and may be eliminated. Results show that by using an automatic algorithm to schedule the surgeries response time and operating room use can be improved. Moreover, it can be concluded that the variability associated with manual scheduling has a greater impact than the one associated to other factors in the service performance indicators.

O Departamento de Cirurgia gera uma boa parte das rendas de um hospital. Este estudo avalia a variabilidade no agendamento das cirurgias e como ele atenta contra a eficiencia do servico. Este estudo implementou um algoritmo para a geração de dois agendamentos após comparados com aqueles realizados manualmente em um hospital na Colombia. Os dois agendamentos gerados diferenciam-se entre se por incluir ou nao os máximos afastamentos nos tempos de duração da cirurgia, assumindo que estes sao causados por fatores externos ao processo e podem ser eliminados. Os resultados mostram que usando um algoritmo automático para programar cirurgias, poderia se melhorar o tempo de resposta e a utilização das salas. Além disso, pode-se concluir que a variabilidade associada ao agendamento manual tem maior impacto que a associada a outros fatores nos indicadores de desempenho do servico.

Tumor carcinoide broncopulmunar / Bronchopulmonary carcinoid tumor

Los tumores carcinoides son tumores neuroendocrinos raros derivados de células enterocromafines. Han sido reportados en órganos como pulmón, bronquios y en el espacio tractogastrointestinal. La clasificación patológica de la Organización Mundial de la Salud (OMS) de 1999 los divide en tumores carcinoides típicos, tumores carcinoides atípicos y carcinoma de célula pequeña. Los hallazgos radiológicos incluyen masa hiliar o perihiliar, nódulos endobronquiales, hallazgos secundarios a obstrucción bronquial y nódulo solitario. Se presentan, así mismo, los hallazgos patológicos, clínicos, radiológicos y quirúrgicos del tumor carcinoide, y se revisan las características descritas en la literatura.

Hemangioendotelioma epiteloide / Ephitelioid haemangioendotheliom

El hemangioendotelioma epiteloide es una neoplasia poco común que ocurre en mujeres jóvenes, con menos de 50 casos descritos a nivel mundial. Describiremos el caso de un hombre de 54 años con historia de disnea, tos seca y dolor torácico, que consultó por historia de neumonía basal derecha un mes antes y dolor torácico derecho. En la radiografía de tórax se encontraron tractos fibrosos basales derechos y aumento de la arteria pulmonar derecha, diagnosticados inicialmente como tromboembolismo pulmonar no resuelto, evolución posterior con aparición de masa pulmonar que luego de múltiples estudios se diagnosticó como un hemangioendotelioma epiteloide metastásico originado posiblemente en la arteria pulmonar derecha. Describimos las radiografías de tórax, las tomografías, y las teorías actuales sobre el origen celular de esta neoplasia. Discutimos la apariencia citológica, presentación clínica y pronóstico de esta entidad. Este reporte puede contribuir para nueva información y hallazgos de esta poco común presentación de una neoplasia.