Miocardiopatía de Tako-Tsubo: una manifestación inusual de feocromocitoma / Takotsubo cardiomyopathy: rare manifestation of pheochromocytoma

Takotsubo cardiomyopathy (MTT) is an acute ventricular dysfunction and reversible in absence of coronary disease. It is a rare presentation of pheochromocytoma and paraganglioma (FPGL). It was described for the first time in 1990 by Sato et al, the physiopathology is not clear yet. It is associated with high levels of catecholamines, vasospasm in the micro vascularization, rupture of atheromatous plaque and myiocarditis. The clinical presentation is similar to an acute myocardial infarction because of that the FPGL must be considered in patients without obstructive coronary lesions. We present a case of a 50 years old women with history of Arterial Hypertension, active smoking and Neurofibromatosis, who is admitted to emergency room with an acute myocardial pain.

Utilidad de la pet/tac en la estadificación mediastínica del cáncer pulmonar de células no pequeñas en estadio iii (N2) / Usefulness of ct and pet scans in mediastinal stagingof stage iii (n2) non-small-cell lung cancer

OBJETIVO: Evaluar la validez diagnóstica de la tomografía por emisión de positrones con 18F-fluoro-2-deoxi-D-glucosa y la tomografía computerizada (PET/TAC), como de las maniobras quirúrgicas de estadificación mediastínica (N2) en pacientes con carcinoma broncogénico no microcítico, analizando ambos resultados. MATERIAL Y MÉTODOS: Estudio prospectivo de pacientes con diagnóstico o alta sospecha de carcinoma broncogénico, y posible afectación N2 mediante TAC con contraste y PET/TAC. Se analizaron por pacientes y grupos adenopáticos, confirmándose mediante análisis histopatológico. Se calcularon sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del estudio PET/TAC así como de las maniobras quirúrgicas. RESULTADOS: Se incluyeron 67 pacientes clasificados como N2 mediante TAC con contraste. El PET/TAC clasificó a 63 pacientes como N2. Se encontraron discrepancias en 7 pacientes, 6 como falsos positivos y 1 como falso negativo. Las maniobras invasivas de estadificación analizaron 123 estaciones ganglionares, obteniendo resultado histopatológico en 98 de ellas. La PET/TAC clasificó como positivas 78, 10 falsos positivos y 10 falsos negativos. Para las maniobras invasivas se obtuvieron un total de 97 estaciones ganglionares, 75 positivas, 2 falsos positivos y 5 falsos negativos. CONCLUSIONES: El estudio PET/TAC presenta buena sensibilidad, más una especificidad discreta, en la correcta clasificación de pacientes N2 debido a limitaciones clínico-quirúrgicas. Las técnicas para la comprobación histológica de los hallazgos obtenidos en imagen, presentaron una alta validez diagnóstica. Los resultados delimitan tres subgrupos clínicos de utilidad, en los que cumpliendo unos requisitos radiológicos y clínicos, la cirugía de estadificación puede reservarse, seleccionando los pacientes y evitando la morbimortalidad de la cirugía

OBJECTIVE: To assess the diagnostic validity of FDG-PET, PET-CT, and surgical mediastinal staging (N2) in patients with non-small-cell lung cancer (NSCLC), comparing the outcomes obtained with such diagnostic procedures. MATERIAL AND METHODS: Prospective study of patients with diagnosis of bronchogenic carcinoma and suspected N2 disease by CT and PET-CT. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated and compared among each diagnostic procedure. The analysis was performed both for patients and for lymph node stations. RESULTS: 67 patients with N2 disease by CT were included in disease by CT were included in the analysis. PET-CT identified 63 patients as being N2. Dis-crepancies were observed in 7 patients: 6 false positive, and 1 false negative. Invasive surgical mediastinal staging analyzed 123 lymph node stations, achieving the pathological diagnosis in 98. PET-CT identified positive 78 lymph nodes, 10 false po-sitive and 10 false negative. For invasive procedures, 97 lymph node stations were obtained, 75 positive, 2 false positive, and 5 false negative. CONCLUSIONS: PET-CT has a high sensitivity but only a modest specificity for the correct N2 staging of patients with NSCLC. Diagnostic methods of pathological confirmation of findings observed in imaging procedures, presented a high diagnostic validity. Our results delineate three clinical subgroups of pa-tients in that invasive procedures for mediastinal staging could be reserved, avoiding surgical morbidity and mortality

[Pleura solitary fibrous tumor associated with Doege-Potter Syndrome]. / Solitär fibröser Tumor der Pleura assoziiert mit Doege-Potter-Syndrom.

The Doege-Potter Syndrome is known as a combination of intrathoracic tumor associated to symptomatic hypoglycemia. Solitary Fibrous Tumor is a mesenchymal neoplasm. Initially, it was described in the pleura, however, it starts out in any organ or tissue at the expense of a stromal CD34+ cell. Most of the patients are asymptomatic at the time of diagnosis. Symptoms such as cough, dyspnea, chest pain, and hypoglycemia due to production of IGF-2 have been reported (Doegge- Potter Syndrome). Others described paraneoplastic profiles are hypertrophic osteoarthropathy and in some cases galactorrhea. We report on a case of a 77 year old patient with solitary fibrous tumor in the pleura as well as symptomatic hypoglycemia. The primary treatment is surgical resection, and a longtime monitoring is necessary because recurrences can occur even after a long period of remission.

Estadificación quirúrgica del mediastino y resultados de la terapéutica quirúrgica en el cáncer de pulmón N2 / No disponible

No disponible

Tratamiento quirúrgico de las metástasis pulmonares: estudio de supervivencia / Surgical treatment of pulmonary metastases: a study of survival

Objetivos: Estudiar los resultados del tratamiento quirúrgico de las metástasis pulmonares realizado en nuestra unidad. Pacientes y métodos: Analizamos retrospectivamente los pacientes intervenidos entre 1986 y 1999. Se incluyeron 44 pacientes a los que se practicó resecciones completas de las metástasis pulmonares, con tumor primario controlado, ausencia de metástasis extrapulmonares y capacidad funcional respiratoria suficiente. Los pacientes fueron distribuidos en grupos pronósticos según criterios del registro internacional de metástasis pulmonares. Resultados: Se practicaron 48 metastasectomías a 44 pacientes, 21 varones y 23 mujeres, con una edad media de 58 años (rango, 31-74). La histología del tumor primario más frecuente fue epitelial, con un 80 por ciento, sarcomas en un 9 por ciento, tumores germinales en un 2,2 por ciento, melanomas en un 2,2 por ciento y otros en un 6,4 por ciento. El intervalo libre de enfermedad medio fue de 37,3 (rango, 0-168), con una mediana de 30 meses. El 66,7 por ciento de los casos presentaron metástasis única y el 33,3 por ciento múltiples (17,9 por ciento bilaterales). La toracotomía posterolateral (66,7 por ciento) fue la vía de acceso más empleada. Se realizaron resecciones atípicas (86,6 por ciento) y lobectomías (11,1 por ciento). La mortalidad perioperatoria fue del 4,4 por ciento. La supervivencia media de la serie fue de 70 meses, del 87 por ciento al año, y del 29 por ciento a los 10 años. Para el grupo I (resecables sin factores de riesgo) (n = 13) fue del 100 por ciento al año y del 75 por ciento a los 10 años. El grupo II (resecables con un factor de riesgo) (n = 16) tuvo un supervivencia al año del 78 por ciento y a los 10 años del 12 por ciento. El grupo III (resecables con dos factores de riesgo) (n = 8) la supervivencia al año fue del 87 por ciento, del 62 por ciento a los 3 años, del 15 por ciento a los 4 años y nula a los 5 años. Log-rank *2 9,8 (2 df), p = 0,0097. Conclusiones: La cirugía de las metástasis pulmonares en pacientes seleccionados constituye un procedimiento terapéutico y diagnóstico con baja mortalidad y buena supervivencia. La clasificación por grupos pronósticos según el número de metástasis, intervalo libre de enfermedad y resecabilidad se correlaciona significativamente con la expectativa de supervivencia de los pacientes, con independencia de la histología del tumor primario. (AU)

[Surgical treatment of pulmonary metastasis: survival study]. / Tratamiento quirúrgico de las metástasis pulmonares: estudio de supervivencia.

OBJECTIVE: To study the results of surgical treatment of pulmonary metastases in our department. PATIENTS AND METHODS: We retrospectively studied 44 patients undergoing surgery between 1986 and 1999 for complete resection of pulmonary metastases. Primary tumors had been eradicated, no metastasis to other organs was evident, and functional respiratory capacity was adequate. The patients were assigned to different prognostic groups based on the criteria of the International Registry of Lung Metastases. RESULTS: Forty-eight operations were performed on the 44 patients (21 men and 23 women) whose mean age was 58 years (31-74 years). The most frequent type of primary tumor was epithelial (82%); other types in order of frequency were sarcoma (9%), thyroid gland (4.4%), germ cell (2.2%) and melanoma (2.2%). The mean disease-free interval was 37.7 months (0.168) and the median was 30 months. A single site of metastasis was seen in 66.7% of the cases whereas 33.3% had multiple metastases (17.9% of them bilateral). Posterolateral thoracotomy was the surgical approach in over half the cases (66.7%). We performed wedge resections in 86.6% and lobectomies in 11.1%. Perioperative mortality was 4.4%. Mean survival was 70 months, with 87% alive at one year and 29% at 10 years. For group I (resectable, no risk factors; n = 13) survival was 100% at one year and 75% at 10 years. For group II (resectable, one risk factor; n = 16) the actuarial survival was 78% at one year and 12% at 10 years. For group III (resectable, two risk factors; n = 8), survival was 87% at one year, 62% at three years, 15% at four years and 0% at five years (Log-rank chi 2 9.8 [df = 2)], p = 0.0097). CONCLUSIONS: Surgical resection of pulmonary metastasis is a treatment and diagnostic procedure associated with low mortality and good survival. Prognostic grouping that takes into account number of metastases, disease-free interval and resectability correlates significantly with expected survival regardless of histological typing of the primary tumor.

[Thoracic wounds: review of 90 cases]. / Heridas torácicas: revisión de 90 casos.

Our aim in reviewing all cases of chest wounds (CW) treated in our unit to analyze their causes, clinical characteristics and treatment. We performed a retrospective study of all CW patients admitted and/or treated by us between January 1986 and August 1997, studying causes, history, number and type of wounds, location, the association of chest and non-chest lesions, treatment, complications and length of hospital stay. The 90 CW patients treated in our unit accounted for 10.6% of all CW patients admitted during the study period. Eighty-five (94.4%) were men and five were women (5.6%) and mean age was 33.87 years. Physical attack was the most common cause of CW, accounting for 74 cases (82.2%) and stab wounds (77 cases, 85.6%) were more common than gunshot wounds (13 cases, 14.4%). Sixty-one (67.%) were deep and most were to the left hemithorax (46 cases, 51.1%). Besides damage to skin and soft tissues of the chest wall, lesions most often affected the pleura (59 cases, 65.5%) and parenchyma (27 cases, 30%). Local treatment of the wound was sufficient for 31 patients (34.4%) but 29 (32.3%) also required drainage and 30 (33.3%) required surgery. Complications developed in 8 cases (8.9%) and one patient died while in surgery. Mean duration of hospital stay was 8.64 days. CW in our practice is seen most commonly in young men and is caused by physical aggression, usually involving knives. Most wounds are stabs, usually to the left hemithorax. The prognosis for firearm wounds is poorer. One third of patients require thoracic drains and another third require chest surgery in addition to local treatment of CW and other wounds. The patient's hemodynamic status was the parameter that indicated need for surgical treatment.

[Evolution of resected bronchogenic carcinoma: 5-year survival. Our experience]. / Evolución del carcinoma broncogénico resecado: supervivencia a los 5 años. Nuestra experiencia.

To review the causes of non-small cell bronchogenic carcinoma treated surgically with the intention to cure, in order to determine and analyze the course of disease in our patients, particularly regarding survival after five years, and to compare our outcomes with those reported in the literature. Retrospective study of all patients resected in our unit from September 1984 through December 1990. We also analyze sex, age, and course of disease over a period of 60 months, emphasizing surgically related mortality, TNM stage, type of resection and tissue type. We calculated five year actuarial survival globally and for each variable studied, excluding patients who died as a result of surgery and those who were lost to follow-up. We identified 115 cases (13.62% of all patients under-going surgery during this period). Nine patients (7.82%) died after surgery. Six patients were lost to follow-up and for three patients data were incomplete. Fifty-three patients died within five years of surgery. Forty-four lived at least five years. Overall actuarial survival was 56.05%. Analyzing by TNM stages, 54.9% were stage I, 50% were stage II and 32.09% were stage IIIa. Pneumonectomy was performed on 43.59%, single or double lobectomy on 50.29%, and infralobar resection on 33.33% Histology revealed 54.56% to be epidermoid versus 33.01% for all other tissue types. The outcomes for bronchogenic carcinomas resected in our department are comparable to those in the literature, survival after five postoperative years being similar to the rate reported for other series.

Experimental study of a new porous tracheal prosthesis.

We studied the efficacy of a new tracheal prosthesis made of expanded polytetrafluorethylene reinforced with spiral silicone rings to repair circumferential tracheal defects in rabbits. Results showed an adequate consistency of prosthesis, adequate tolerance without producing tracheal stenoses, and impermeability to air, allowing a correct invasion by granulation tissue. This process was faster than any found in any other porous tracheal implant so far tested. We proved that epithelialization results from capillary invasion through the prosthetic pores and from growth from both tracheal ends. We conclude that this prosthetic material can be useful in repairing tracheal defects and may be the optimal tracheal graft for humans.