Mediastinal paraganglioma irrigated by coronary vessels in a patient with an atypical chest pain.

We present a case of non-functioning anterior mediastinal paraganglioma in a 61-year-old woman. The tumour was accidentally discovered on a coronary angiography performed in an atypical precordial pain and dyspnea. The coronary angiography showed a vascular tumour in the paraaortic localization irrigated from two branches of coronary arteries. Diagnosis was confirmed by a thoracic tomographic scan which revealed an anterior mediastinal tumour. Complete tumour resection was done through a sternotomy with extracorporeal circulation without cardiac arrest. The histological examination of the operative specimen was characteristic of paraganglioma.

[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).

[Cystic lymphangiomas of the mediastinum. Apropos of 2 cases and a review of the literature]. / Lymphangiomes kystiques du médiastin. A propos de 2 cas, revue de la littérature.

Two cases of patients suffering from a cystic lymphangioma of the mediastinum are presented. The literature is reviewed and the surgical and pathological findings are commented.